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

Tailoring Properties of Polypropylene through Crystallization in the Presence of Polymeric Nucleating Agents.

In this communication, we present a strategy for the addition of polymeric nucleating agents for the crystallization of isotactic polypropylene (iPP) that guarantees a perfect fine dispersion of nucleating particles within the entire mass of the polymer, with consequent their high efficiency even at very low concentrations. The Ziegler-Natta catalyst particles are coated by a thin skin of poly(trimethylallylsilane) (PTMAS) or poly(vinylcyclohexane) (PVCH) that will act as nucleating agents, by prepolymerization of the corresponding monomers. PVCH shows higher nucleation efficiency than PTMAS with greater increase of crystallization temperature by standard cooling from the melt. Both polymeric nucleating agents affect the crystal morphology greatly reducing the size of shperulites. This in turn affects the mechanical properties improving ductility and flexibility. The presence of the nucleating agent accelerates the crystallization of iPP and affords crystallization of the α form even upon fast crystallization by quenching the melt, condition that generally produces crystallization of the mesomorphic form of iPP. Crystals of α form so obtained show a nodular morphology and absence of spherulitic superstructure. This novel iPP material is characterized by outstanding and unexpected properties of high mechanical strength and modulus and contemporarily high ductility, flexibility and good transparency due to the nodular morphology of α form

Resource utilization and cost of treatment with anidulafungin or fluconazole for candidaemia and other forms of invasive candidiasis: focus on critically ill patients

Candidaemia and other forms of invasive candidiasis (C/IC) are serious and costly events for hospitalized patients, particularly those in the ICU. Both fluconazole and the echinocandins are recommended as first-line therapy for C/IC. Resource use and cost considerations are important in selecting appropriate treatment but little information is available on the economic implications of using echinocandins in this setting. To compare resource utilization and treatment costs (in $US) associated with the echinocandin anidulafungin (200 mg intravenously on day 1, then 100 mg intravenously daily) versus those of fluconazole (800 mg intravenously on day 1, then 400 mg intravenously daily) as first-line treatment for C/IC. Available charts from patients enrolled in a recent clinical trial comparing anidulafungin and fluconazole for C/IC were reviewed. Patients who were in the ICU at study entry were identified, and the following data, collected during the 13-week study period, were compared between treatment groups: global response at end of study treatment, number of days patients survived after hospital discharge ('hospital-free' days), hospital resource use, and C/IC-related costs (year 2008 values) to a US hospital payer. These comparisons were also conducted for all non-ICU hospitalized patients, and for survivors in both study populations. Sensitivity analyses explored the cost impact of variability in the hospitalization costs between ICUs and non-ICU wards and of reduced duration intravenous therapy. Statistical comparisons between the two treatment groups were conducted for clinical outcomes, resource use and cost measures, using regression models. All statistical comparisons were adjusted for baseline co-variates (Acute Physiology and Chronic Health Evaluation [APACHE] II score, absolute neutrophil count and catheter removal status). For ICU patients with C/IC (n = 63), global response was significantly higher for anidulafungin than fluconazole (68.6$US2680 (p = 0.73). For hospitalized patients who survived (anidulafungin 81.9%, fluconazole 69.7%), anidulafungin treatment was associated with an incremental cost of $US231 (p = 0.98). Anidulafungin as first-line treatment of C/IC appears to be of particular benefit to ICU patients, improving clinical outcomes and possibly decreasing costs, driven by reduced ICU and hospital stay, when compared with fluconazole. Anidulafungin also yielded significantly improved treatment outcomes in the general inpatient population, with total costs similar to fluconazole

Crystallization and mechanical properties of metallocene made 1-butene-pentene and 1-butene-hexene isotactic copolymers

The structure and the mechanical properties of metallocene-made butene-pentene (iPBC5) and butene-hexene (iPBC6) isotactic copolymers are studied. The effect of the presence of pentene and hexene units on the crystallization behavior and the mechanical properties of isotactic polybutene (iPB) is analyzed. All iPBC5 copolymers crystallize from the melt in form II of iPB, which transforms into form I by aging at room temperature. On the contrary, in iPBC6 copolymers the presence of hexene units stabilizes the form II and, for hexene concentrations higher than 11 mol%, prevents the transformation of form II into form I at room temperature. Both iPBC5 and iPBC6 copolymers show mechanical behavior of highly flexible and ductile materials with enhanced ductility compared to iPB, with values of stress at yielding and of Young's modulus that decrease with increasing comonomer content. In all the iPBC5 copolymers, form II crystallized from the melt transforms into form I by stretching, whereas in iPBC6 copolymers form II is stabilized and the transformation of form II into form I by stretching is completely inhibited at high hexene concentrations

Crystallization and mechanical properties of metallocene made 1-butene-pentene and 1-butene-hexene isotactic copolymers

The structure and the mechanical properties of metallocene-made butene-pentene (iPBC5) and butene-hexene (iPBC6) isotactic copolymers are studied. The effect of the presence of pentene and hexene units on the crystallization behavior and the mechanical properties of isotactic polybutene (iPB) is analyzed. All iPBC5 copolymers crystallize from the melt in form II of iPB, which transforms into form I by aging at room temperature. On the contrary, in iPBC6 copolymers the presence of hexene units stabilizes the form II and, for hexene concentrations higher than 11 mol%, prevents the transformation of form II into form I at room temperature. Both iPBC5 and iPBC6 copolymers show mechanical behavior of highly flexible and ductile materials with enhanced ductility compared to iPB, with values of stress at yielding and of Young's modulus that decrease with increasing comonomer content. In all the iPBC5 copolymers, form II crystallized from the melt transforms into form I by stretching, whereas in iPBC6 copolymers form II is stabilized and the transformation of form II into form I by stretching is completely inhibited at high hexene concentrations

Treatment patterns among patients with moderate-to-severe ulcerative colitis in the United States and Europe.

OBJECTIVE:The aim of the present study is to examine how moderate-to-severe ulcerative colitis (UC) is currently managed in real-world clinical practice across the United States (US) and European Union Five (EU5; France, Germany, Italy, Spain, and the United Kingdom). METHODS:Data from the 2017 Adelphi Inflammatory Bowel-Disease Specific Programme (IBD-DSP) were used. The IBD-DSP is a database of patient chart information abstracted by selected gastroenterologists across the US and EU5. Eligible gastroenterologists who agreed to participate were asked to complete patient record forms for the next seven consecutive eligible adult patients with UC. Only charts from patients with moderate-to-severe UC were included in the analysis (defined as those with documented administration of either an immunosuppressant [IM] or a biologic). Treatment patterns were reported descriptively. RESULTS:411 and 1191 patient charts were included in the US and EU5 (mean ages 44.2 and 39.6 years; 53.0% and 43.5% female), respectively. For those with complete treatment history, 40.7% and 52.9% used either an IM or biologic as their first treatment (with or without steroids). Usage of these therapies increased in subsequent lines. The percentage of patients treated with combination therapy (i.e., biologic therapy with a concomitant IM) in first line generally varied between 10-20% (e.g., US: adalimumab (ADA), 10.8%; infliximab (IFX), 18.2%; EU5: ADA, 12.5%; IFX, 19.9%), though increased in later lines in the EU5. Among patients currently using a biologic therapy, between 10-40% of patients used a higher than indicated dose or greater than indicated dosing frequency during maintenance (e.g., US: IFX, 37.1%; ADA, 13.4%; EU5: IFX, 39.1%; ADA, 36.1%). In both the US and EU5, the primary reason for switching therapy was efficacy-related. CONCLUSIONS:In this analysis, many patients with moderate-to-severe UC use an IM or biologic as their first therapy after diagnosis. Combination therapy and dose escalation are also common, and underscore the challenges with managing this patient population