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

AI is a viable alternative to high throughput screening: a 318-target study

: High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery

Correction: Evolving Trends in the Management of Acute Appendicitis During COVID-19 Waves: The ACIE Appy II Study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system. Results A total of 3288 patients were included in the analysis, of whom 301 (9 center dot 2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0 center dot 001). There were no significant differences in rates of readmission between these groups (6 center dot 6 versus 8 center dot 0 per cent; P = 0 center dot 499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0 center dot 90, 95 per cent c.i. 0 center dot 55 to 1 center dot 46; P = 0 center dot 659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34 center dot 7 versus 39 center dot 5 per cent; major 3 center dot 3 versus 3 center dot 4 per cent; P = 0 center dot 110). Conclusion Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Measurement of charged pion, kaon, and proton production in proton-proton collisions at root s=13 TeV

Transverse momentum spectra of charged pions, kaons, and protons are measured in proton-proton collisions at √s = 13 TeV with the CMS detector at the LHC. The particles, identified via their energy loss in the silicon tracker, are measured in the transverse momentum range of pT ∼ 0.1-1.7 GeV/c and rapidities /y/ < 1. The pT spectra and integrated yields are compared to previous results at smaller √s and to predictions of Monte Carlo event generators. The average pT increases with particle mass and charged particle multiplicity of the event. Comparisons with previous CMS results at √s = 0.9, 2.76, and 7 TeV show that the average pT and the ratios of hadron yields feature very similar dependences on the particle multiplicity in the event, independently of the center-of-mass energy of the pp collision

Search for a light charged Higgs boson decaying to c-sbar in pp collisions at sqrt(s) = 8 TeV

see paper for full list of authorsInternational audienceA search for a light charged Higgs boson, originating from the decay of a top quark and subsequently decaying into a charm quark and a strange antiquark, is presented. The data used in the analysis correspond to an integrated luminosity of 19.7 inverse-femtobarns recorded in proton-proton collisions at sqrt(s) = 8 TeV by the CMS experiment at the LHC. The search is performed in the process t tbar to W+/- b H-/+ bbar, where the W boson decays to a lepton (electron or muon) and a neutrino. The decays lead to a final state comprising an isolated lepton, at least four jets and large missing transverse energy. No significant deviation is observed in the data with respect to the standard model predictions, and model-independent upper limits are set on the branching fraction BF( t to H+ b ), ranging from 1.2 to 6.5% for a charged Higgs boson with mass between 90 and 160 GeV, under the assumption that BF( H+ to c sbar ) = 100%

Observation of nuclear modifications in W± boson production in pPb collisions at sNN=8.16TeV

The production of W± bosons is studied in proton-lead (pPb) collisions at a nucleon-nucleon centre-of-mass energy of sNN=8.16TeV. Measurements are performed in the W±→μ±νμ channel using a data sample corresponding to an integrated luminosity of 173.4±6.1nb−1, collected by the CMS Collaboration at the LHC. The number of positively and negatively charged W bosons is determined separately in the muon pseudorapidity region in the laboratory frame |ηlabμ|25GeV/c. The W± boson differential cross sections, muon charge asymmetry, and the ratios of W± boson yields for the proton-going over the Pb-going beam directions are reported as a function of the muon pseudorapidity in the nucleon-nucleon centre-of-mass frame. The measurements are compared to the predictions from theoretical calculations based on parton distribution functions (PDFs) at next-to-leading-order. The results favour PDF calculations that include nuclear modifications and provide constraints on the nuclear PDF global fits

Measurement of ttˉ\hbox {t}{\bar{\hbox {t}}} normalised multi-differential cross sections in pp{\text {p}}{\text {p}} collisions at s=13 TeV\sqrt{s}=13\,{\text {TeV}} , and simultaneous determination of the strong coupling strength, top quark pole mass, and parton distribution functions

Normalised multi-differential cross sections for top quark pair ($$\hbox {t}{\bar{\hbox {t}}}$$) production are measured in proton-proton collisions at a centre-of-mass energy of 13$$\,{\text {TeV}}$$ using events containing two oppositely charged leptons. The analysed data were recorded with the CMS detector in 2016 and correspond to an integrated luminosity of $$35.9{\,{\text {fb}}^{-1}}$$. The double-differential $$\hbox {t}{\bar{\hbox {t}}}$$ cross section is measured as a function of the kinematic properties of the top quark and of the $$\hbox {t}{\bar{\hbox {t}}}$$ system at parton level in the full phase space. A triple-differential measurement is performed as a function of the invariant mass and rapidity of the $$\hbox {t}{\bar{\hbox {t}}}$$ system and the multiplicity of additional jets at particle level. The data are compared to predictions of Monte Carlo event generators that complement next-to-leading-order (NLO) quantum chromodynamics (QCD) calculations with parton showers. Together with a fixed-order NLO QCD calculation, the triple-differential measurement is used to extract values of the strong coupling strength $$\alpha _{S}$$ and the top quark pole mass ($$m_{{\text {t}}}^{{\text {pole}}}$$) using several sets of parton distribution functions (PDFs). The measurement of $$m_{{\text {t}}}^{{\text {pole}}}$$ exploits the sensitivity of the $$\hbox {t}{\bar{\hbox {t}}}$$ invariant mass distribution to $$m_{{\text {t}}}^{{\text {pole}}}$$ near the production threshold. Furthermore, a simultaneous fit of the PDFs, $$\alpha _{S}$$, and $$m_{{\text {t}}}^{{\text {pole}}}$$ is performed at NLO, demonstrating that the new data have significant impact on the gluon PDF, and at the same time allow an accurate determination of $$\alpha _{S}$$ and $$m_{{\text {t}}}^{{\text {pole}}}$$. The values $$\alpha _{S}(m_{{\text {Z}}}) = 0.1135{}^{+0.0021}_{-0.0017}$$ and $$m_{{\text {t}}}^{{\text {pole}}} = 170.5 \pm 0.8 \,{\text {GeV}}$$ are extracted, which account for experimental and theoretical uncertainties, the latter being estimated from NLO scale variations. Possible effects from Coulomb and soft-gluon resummation near the $$\hbox {t}{\bar{\hbox {t}}}$$ production threshold are neglected in these parameter extractions. A rough estimate of these effects indicates an expected correction of $$m_{{\text {t}}}^{{\text {pole}}}$$ of the order of $$+1 \,{\text {GeV}}$$, which can be regarded as additional theoretical uncertainty in the current $$m_{{\text {t}}}^{{\text {pole}}}$$ extraction

Search for single production of vector-like quarks decaying to a top quark and a W boson in proton–proton collisions at s=13TeV

A search is presented for the single production of vector-like quarks in proton-proton collisions at s = 13 TeV . The data, corresponding to an integrated luminosity of 35.9 fb - 1 , were recorded with the CMS experiment at the LHC. The analysis focuses on the vector-like quark decay into a top quark and a W boson, with one muon or electron in the final state. The mass of the vector-like quark candidate is reconstructed from hadronic jets, the lepton, and the missing transverse momentum. Methods for the identification of b quarks and of highly Lorentz boosted hadronically decaying top quarks and W bosons are exploited in this search. No significant deviation from the standard model background expectation is observed. Exclusion limits at 95% confidence level are set on the product of the production cross section and branching fraction as a function of the vector-like quark mass, which range from 0.3 to 0.03 pb for vector-like quark masses of 700 to 2000 GeV . Mass exclusion limits up to 1660 GeV are obtained, depending on the vector-like quark type, coupling, and decay width. These represent the most stringent exclusion limits for the single production of vector-like quarks in this channel