Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Dynamics of the North Balearic Front during an autumn tramontane and mistral storm: air–sea coupling processes and stratification budget diagnostic

International audienceThe North Balearic Front forms the southern branch of the cyclonic gyre in the northwestern Mediterranean Sea. Its dynamics exhibit significant seasonal variability. During autumn, the front spreads northward during the calm wind periods and rapidly moves back southward when it is exposed to strong northerly wind events such as the tramontane and mistral. These strong winds considerably enhance the air-sea exchanges. To investigate the role of airsea exchanges in the dynamics of the North Balearic front, we used observations and a high-resolution air-sea coupled modelling system. We focused on a strong-wind event observed in late October 2012, which was well-documented during the Hydrological Cycle Mediterranean Experiment. The coupled model was able to correctly reproduce the 4 • C sea surface temperature drop recorded in the frontal zone together with the observed southwestward displacement of the front. The comparison between the weak wind period preceding the event and the strong-wind event itself highlighted the impact of the wind regime on the air-sea coupling. During the low-wind period the coupling is thermal and dynamical whereas during the strong-wind period the coupling is mainly thermal. The effect of air-sea exchanges on the stratification variations in the frontal zone was investigated with a stratification budget diagnosis. The stratification variations are controlled by diabatic air-sea buoyancy flux, adiabatic Ekman buoyancy flux, and advective processes. During the strong-wind period, the Ekman buoyancy flux was found to be 3 times greater than the air-sea buoyancy flux and thus played a major role in the de-stratification of the frontal zone. The role of Ekman pumping and inertial wave in the advective processes is also discussed

HyMeX-SOP2: The field campaign dedicated to dense water formation in the northwestern Mediterranean

International audienceThe HYdrological cycle in the Mediterranean Experiment (HyMeX) Special Observing Period 2 (SOP2, January 27–March 15, 2013) was dedicated to the study of dense water formation in the Gulf of Lion in the northwestern Mediterranean. This paper outlines the deep convection of winter 2012–2013 and the meteorological conditions that produced it. Alternating phases of mixing and restratification are related to periods of high and low heat losses, respectively. High-resolution, realistic, three-dimensional models are essential for assessing the intricacy of buoyancy fluxes, horizontal advection, and convective processes. At the submesoscale, vertical velocities resulting from symmetric instabilities of the density front bounding the convection zone are crucial for ventilating the deep ocean. Finally, concomitant atmospheric and oceanic data extracted from the comprehensive SOP2 data set highlight the rapid, coupled evolution of oceanic and atmospheric boundary layer characteristics during a strong wind event

Overview of the Meso-NH model version 5.4 and its applications

International audienc