Wellness and coping of physicians who worked in ICUs during the pandemic: A multicenter cross-sectional North American survey

OBJECTIVES: Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic. DESIGN: Cross-sectional survey using four validated instruments. SETTING: Sixty-two sites in Canada and the United States. SUBJECTS: Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures. CONCLUSIONS: Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness

Neutrino Oscillations and Moments of Electron Spectra

We show that the effects of neutrino oscillations on 8B solar neutrinos are described well by the first two moments (the average and the variance) of the energy distribution of scattered or recoil electrons. For the SuperKamiokande and the Sudbury Neutrino Observatory experiments, the differences between the moments calculated with oscillations and the standard, no-oscillation moments are greater than 3 standard deviations for a significant fraction of the neutrino mass-mixing (Delta m^2, sin^2 2 theta) parameter space.Comment: 16 pages, Latex, text+figures. To be published in Physical Review C, January 199

Scale-Free model for governing universe dynamics

We investigate the effects of scale-free model on cosmology, providing, in this way, a statistical background in the framework of general relativity. In order to discuss properties and time evolution of some relevant universe dynamical parameters (cosmographic parameters), such as $H(t)$ (Hubble parameter), $q(t)$ (deceleration parameter), $j(t)$ (jerk parameter) and $s(t)$ (snap parameter), which are well re-defined in the framework of scale-free model, we analyze a comparison between WMAP data. Hence the basic purpose of the work is to consider this statistical interpretation of mass distribution of universe, in order to have a mass density $\rho$ dynamics, not inferred from Friedmann equations, via scale factor $a(t)$. This model, indeed, has been used also to explain a possible origin and a viable explanation of cosmological constant, which assumes a statistical interpretation without the presence of extended theories of gravity; hence the problem of dark energy could be revisited in the context of a classical probability distribution of mass, which is, in particular, for the scale-free model, $P(k)\sim k^{-\gamma}$, with $2<\gamma<3$. The $\Lambda$CDM model becomes, with these considerations, a consequence of the particular statistics together with the use of general relativity.Comment: 7 pages, 4 figure

A Link between Meiotic Prophase Progression and Crossover Control

During meiosis, most organisms ensure that homologous chromosomes undergo at least one exchange of DNA, or crossover, to link chromosomes together and accomplish proper segregation. How each chromosome receives a minimum of one crossover is unknown. During early meiosis in Caenorhabditis elegans and many other species, chromosomes adopt a polarized organization within the nucleus, which normally disappears upon completion of homolog synapsis. Mutations that impair synapsis even between a single pair of chromosomes in C. elegans delay this nuclear reorganization. We quantified this delay by developing a classification scheme for discrete stages of meiosis. Immunofluorescence localization of RAD-51 protein revealed that delayed meiotic cells also contained persistent recombination intermediates. Through genetic analysis, we found that this cytological delay in meiotic progression requires double-strand breaks and the function of the crossover-promoting heteroduplex HIM-14 (Msh4) and MSH-5. Failure of X chromosome synapsis also resulted in impaired crossover control on autosomes, which may result from greater numbers and persistence of recombination intermediates in the delayed nuclei. We conclude that maturation of recombination events on chromosomes promotes meiotic progression, and is coupled to the regulation of crossover number and placement. Our results have broad implications for the interpretation of meiotic mutants, as we have shown that asynapsis of a single chromosome pair can exert global effects on meiotic progression and recombination frequency

Disease prevention not decolonization – a model for fecal microbiota transplantation in patients colonized with multidrug-resistant organisms

Fecal microbiota transplantation (FMT) yields variable intestinal decolonization results for multidrug-resistant organisms (MDROs). This study showed significant reductions in antibiotic duration, bacteremia and length of stay in 20 patients colonized/ infected with MDRO receiving FMT (compared to pre-FMT history, and a matched group not receiving FMT), despite modest decolonization rates

Biophilic architecture: a review of the rationale and outcomes

Contemporary cities have high stress levels, mental health issues, high crime levels and ill health, while the built environment shows increasing problems with urban heat island effects and air and water pollution. Emerging from these concerns is a new set of design principles and practices where nature needs to play a bigger part called “biophilic architecture”. This design approach asserts that humans have an innate connection with nature that can assist to make buildings and cities more effective human abodes. This paper examines the evidence for this innate human psychological and physiological link to nature and then assesses the emerging research supporting the multiple social, environmental and economic benefits of biophilic architecture

Fecal microbiota transplant mitigates adverse outcomes in patients colonized with multidrug-resistant organisms undergoing allogeneic hematopoietic cell transplantation

The gut microbiome can be adversely affected by chemotherapy and antibiotics prior to hematopoietic cell transplantation (HCT). This affects graft success and increases susceptibility to multidrug-resistant organism (MDRO) colonization and infection. We performed an initial retrospective analysis of our use of fecal microbiota transplantation (FMT) from healthy donors as therapy for MDRO-colonized patients with hematological malignancy. FMT was performed on eight MDRO-colonized patients pre-HCT (FMT-MDRO group), and outcomes compared with 11 MDRO colonized HCT patients from the same period. At 12 months, survival was significantly higher in the FMT-MDRO group (70% versus 36% p = 0.044). Post-HCT, fewer FMT-MDRO patients required intensive care (0% versus 46%, P = 0.045) or experienced fever (0.29 versus 0.11 days, P = 0.027). Intestinal MDRO decolonization occurred in 25% of FMT-MDRO patients versus 11% non-FMT MDRO patients. Despite the significant difference and statistically comparable patient/transplant characteristics, as the sample size was small, a matched-pair analysis to non-MDRO colonized control cohorts (2:1 matching) was performed. At 12 months, the MDRO group who did not have an FMT had significantly lower survival (36.4% versus 61.9% respectively, p=0.012), and higher non relapse mortality (NRM; 60.2% versus 16.7% respectively, p=0.009) than their paired non-colonized cohort. There was no difference in survival (70% versus 43.4%, p=0.14) or NRM (12.5% versus 31.2% respectively, p=0.24) between the FMT-MDRO group and their paired cohort. Negative outcomes, including mortality associated with MDRO colonization, may be ameliorated by pre-HCT FMT, despite lack of intestinal decolonization. Further work is needed to explore the observed benefit

Integrated predictive modelling of JET H-mode plasma with type-I ELMs

It is well known that edge plasma parameters influence performance in many different ways (profile stiffness is probably one of the best known examples). In ELMy H-mode a thin region with improved transport characteristics (Edge Transport Barrier) c

Coexistence of the spin-density-wave and superconductivity in the (Ba,K)Fe2As2

The relation between the spin-density-wave (SDW) and superconducting order is a central topic in current research on the FeAs-based high Tc superconductors. Conflicting results exist in the LaFeAs(O,F)-class of materials, for which whether the SDW and superconductivity are mutually exclusive or they can coexist has not been settled. Here we show that for the (Ba,K)Fe2As2 system, the SDW and superconductivity can coexist in an extended range of compositions. The availability of single crystalline samples and high value of the energy gaps would make the materials a model system to investigate the high Tc ferropnictide superconductivity.Comment: 4 pages, 5 figure