Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

A hybrid reptile search algorithm and Levenberg–Marquardt algorithm based Haar wavelets to solve regular and singular boundary value problems

Various engineering applications lead to the appearance of partial differential equations resulting in boundary value problems (BVPs). Orthogonal collocation method based Haar wavelets has gained significant attention in solving these problems. The Haar wavelets have several properties like vanishing moment, compact effect, and orthogonality. These properties prioritize being used as base functions for solving BVPs. However, the approximation leads to a relatively high number of unknown coefficients, which needs an efficient and reliable nonlinear solver to reach their values. The Levenberg–Marquardt algorithm (LM) is one of the most efficient nonlinear solvers. However, it may diverge in case of too far initial guesses, especially in many unknowns. The reptile search algorithm (RSA) is a recent reliable, nature-inspired optimization technique that has a noticeable capability in dealing with high-dimensional issues. Therefore, this paper proposes a hybrid optimization algorithm that integrates the RSA and LM algorithms using Haar wavelets as bases, named RSA–LM–Haar algorithm, to solve regular and singular natures of the BVPs more efficiently. To evaluate the performance of the proposed RSA–LM–Haar algorithm, it is tested on twelve case studies of BVPs including the singular and regular problems. The results are compared with those based on the LM alone, named LM–Haar algorithm. Finally, the applicability of the proposed algorithm is verified using two practical chemical applications to prove its ability to solve real-time applications effectively. All the results affirmed the capability of the proposed algorithm in solving both regular and singular BVPs. All results and comparisons illustrated that the proposed hybridization algorithm provides remarkable performance.Web of Science6041823179

(Dis)connectivities in wartime: The therapeutic geographies of Iraqi healthcare–seeking in Lebanon

The proliferation of conflicts across borders of Middle Eastern States has transformed the landscapes of health and healthcare across the region. In the case of Iraq, state healthcare has collapsed under the strain of protracted conflicts. Meanwhile, Lebanon’s post-war healthcare system is booming, and becoming more privatised. In this paper, we build on an ethnographic study on the movements and experiences of Iraqi patients in Lebanon to show how one of the consequences of war is the rise of alternative forms of healthcare–seeking practices and survival strategies – a therapeutic geography that is embedded in regional economies and geopolitical relations and reconfigurations. We argue for the need to reimagine the disconnectivity and connectivity of healthcare systems under war and conflict as grounded in the empirical realities and experiences of mobility in the Middle East

The effect of sodium citrate as a complex agent on the corrosion properties of the electroless Ni-P coating

Electroless Ni-P coatings have a wide range of industrial applications due to their surface properties especially for their corrosion resistance. The research presented investigates the influence of sodium citrate concentration, as a complexing agent, on the surface and corrosion properties of the Ni-P coating layer. The deposition rate (DR) at different sodium citrate concentrations was calculated. The results show that the maximum deposition rate of about 15 µm h-1 was obtained at the lowest sodium citrate concentration of 0.05 M. Surface profiles were used to show the effect of citrate concentration on the final coated surfaces and the average surface roughness (Ra) of the coated samples was calculated. The results show that the citrate concentration has an adverse effect on the deposition rate (DR) and the surface roughness (Ra). Electrochemical testing in aerated artificial seawater was used to monitor the corrosion properties of the coated and uncoated samples. The Ni-P coated samples, when compared to the uncoated steel sample, show a nobler Ecorr and lower corrosion current density (icorr) with an inhibition efficiency range from 86 to 94%. The corrosion properties of coated samples were greatly affected by the citrate concentration in the plating bath. It was found that the increase of citrate concentration results in an increase of coating P content and decrease the porosity involved in coating, which consequently maximizes the corrosion protectability of the coating

Screening for thyroid disease among children and adolescents with type 1 diabetes mellitus

Altered thyroid hormones have been described in patients with diabetes especially those with poor glycemic control. The aim of this work was to evaluate; the presence of serum anti-thyroid peroxidase (serum anti-TPO) autoantibodies and the prevalence of autoimmune thyroid disease in children with type 1 diabetes mellitus. Patients and methods: Fifty diabetic children coming for regular follow-up in the diabetes clinic of El-Shatby University Children’s Hospital were enrolled in the study and 20 healthy children matching in age and sex were taken as control. History taking, clinical examination, measurement of HbA1c, serum anti-TPO autoantibodies and serum TSH levels were carried out. Serum T4 and T3 were measured in samples with abnormal serum TSH level. Results: Serum anti-TPO was positive in 12% of cases, and was negative in 100% of controls. Serum TSH level was abnormal in 50.0% of positive serum anti-TPO cases, in cases where serum anti-TPO was negative, 97.7% had normal serum TSH level, this difference was statistically significant P = 0.004. Good metabolic control was found in 42% of all diabetic children, 19% of them had positive serum anti-TPO, fair control was seen in 36%, only 5% of them were positive for serum anti-TPO, 22% had poor control and 9.1% were positive for serum anti-TPO, these differences had no statistical significance P = 0.550. Conclusion: Although serum TSH screening is more sensitive for detecting thyroid abnormalities in children and adolescents with type1 diabetes, the presence of positive serum anti-TPO antibodies may be an earlier marker for thyroid disease, therefore, patients with positive antibodies should be monitored for serum TSH elevation at yearly intervals

Spectrophotometric detenilination of Co(II), Cu(II) and Pd(II) using benzoylformazans

718-720The complexes formed between 1-(o-arsonophenyl)5-phenyl-3-benzoylformazan and Co(II), CU(Il) and Pd(II) and the complex formed between 1,5-diphenyl-3-benzoylformazan and Cu(ll) have been studied spectrophotometrically. The optimum conditions for the formation of the complexes have been investigated and stoichiometry and stability constant of the formed complexes determined. Methods for the spectrophotometric determination of these metal ions and spectrophotometric titration using EDTA and CDTA as titrants are reported. The effect of diverse ions on the estimations is investigated. The study has been extended to the determination of CU(Il) in brass and Cu-Ni and Devarda's alloys

Spectrophotometric detenilination of Co(II), Cu(II) and Pd(II) using benzoylformazans

718-720The complexes formed between 1-(o-arsonophenyl)5-phenyl-3-benzoylformazan and Co(II), CU(Il) and Pd(II) and the complex formed between 1,5-diphenyl-3-benzoylformazan and Cu(ll) have been studied spectrophotometrically. The optimum conditions for the formation of the complexes have been investigated and stoichiometry and stability constant of the formed complexes determined. Methods for the spectrophotometric determination of these metal ions and spectrophotometric titration using EDTA and CDTA as titrants are reported. The effect of diverse ions on the estimations is investigated. The study has been extended to the determination of CU(Il) in brass and Cu-Ni and Devarda's alloys