Healthcare Workers and COVID-19-Related Moral Injury: An Interpersonally-Focused Approach Informed by PTSD

The COVID-19 pandemic has resulted in a still-unfolding series of novel, potentially traumatic moral and ethical challenges that place many healthcare workers at risk of developing moral injury. Moral injury is a type of psychological response that may arise when one transgresses or witnesses another transgress deeply held moral values, or when one feels that an individual or institution that has a duty to provide care has failed to do so. Despite knowledge of this widespread exposure, to date, empirical data are scarce as to how to prevent and, where necessary, treat COVID-19-related moral injury in healthcare workers. Given the relation between moral injury and post-traumatic stress disorder (PTSD), we point here to social and interpersonal factors as critical moderators of PTSD symptomology and consider how this knowledge may translate to interventions for COVID-19-related moral injury. Specifically, we first review alterations in social cognitive functioning observed among individuals with PTSD that may give rise to interpersonal difficulties. Drawing on Nietlisbach and Maercker\u27s 2009 work on interpersonal factors relevant to survivors of trauma with PTSD, we then review the role of perceived social support, social acknowledgment and social exclusion in relation to potential areas of targeted intervention for COVID-19-related moral injury in healthcare workers. Finally, building on existing literature (e.g., Phoenix Australia—Centre for Posttraumatic Mental Health and the Canadian Centre of Excellence—PTSD, 2020) we conclude with individual and organizational considerations to bolster against the development of moral injury in healthcare workers during the pandemic

An evaluation of the natural radioactivity in Andaman beach sand samples of Thailand after the 2004 tsunami.

Following the 2004 'Boxing day' tsunami, a determination has been made of the activity concentrations of (226)Ra, (232)Th and (40)K in beach sand samples which have been collected from various locations along the Andaman coast of the Thai peninsula. Use has been made of a HPGe detector-based, low-background gamma-ray counting system. The natural radioactivity levels of (226)Ra, (232)Th and (40)K measured from these samples was found to lie in the range 1.6-52.5, 0.3-73.9 and 2.8-1111.9Bq/kg respectively for the west coast and 3.5-83.1, 4.5-42.0, and 9.6-1376 Bq/kg respectively for the east coast. The radioactivity concentrations of (226)Ra, (232)Th and (40)K along the Andaman coast are comparable to that of the east coast, which was not exposed to the tsunami. The corresponding annual effective dose varies from 1.6-105.9 μSv/y with a mean value of 59.1 ± 0.3 μSv/y, significantly lower than the worldwide average as reported by United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) (2000)

An evaluation of the natural radioactivity in Andaman beach sand samples of Thailand after the 2004 tsunami.

Following the 2004 'Boxing day' tsunami, a determination has been made of the activity concentrations of (226)Ra, (232)Th and (40)K in beach sand samples which have been collected from various locations along the Andaman coast of the Thai peninsula. Use has been made of a HPGe detector-based, low-background gamma-ray counting system. The natural radioactivity levels of (226)Ra, (232)Th and (40)K measured from these samples was found to lie in the range 1.6-52.5, 0.3-73.9 and 2.8-1111.9Bq/kg respectively for the west coast and 3.5-83.1, 4.5-42.0, and 9.6-1376 Bq/kg respectively for the east coast. The radioactivity concentrations of (226)Ra, (232)Th and (40)K along the Andaman coast are comparable to that of the east coast, which was not exposed to the tsunami. The corresponding annual effective dose varies from 1.6-105.9 μSv/y with a mean value of 59.1 ± 0.3 μSv/y, significantly lower than the worldwide average as reported by United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) (2000)

Effect of the grain size of the soil on the measured activity and variation in activity in surface and subsurface soil samples

Correlation between grain size and activity concentrations of soils and concentrations of various radionuclides in surface and subsurface soils has been measured for samples taken in the State of Qatar by gamma-spectroscopy using a high purity germanium detector. From the obtained gamma-ray spectra, the activity concentrations of the 238U (226Ra) and 232Th (228Ac) natural decay series, the long-lived naturally occurring radionuclide 40K and the fission product radionuclide 137Cs have been determined. Gamma dose rate, radium equivalent, radiation hazard index and annual effective dose rates have also been estimated from these data. In order to observe the effect of grain size on the radioactivity of soil, three grain sizes were used i.e., smaller than 0.5 mm; smaller than 1 mm and greater than 0.5 mm; and smaller than 2 mm and greater than 1 mm. The weighted activity concentrations of the 238U series nuclides in 0.5-2 mm grain size of sample numbers was found to vary from 2.5±0.2 to 28.5±0.5 Bq/kg, whereas, the weighted activity concentration of 40 K varied from 21±4 to 188±10 Bq/kg. The weighted activity concentrations of 238U series and 40 K have been found to be higher in the finest grain size. However, for the 232Th series, the activity concentrations in the 1-2 mm grain size of one sample were found to be higher than in the 0.5-1 mm grain size. In the study of surface and subsurface soil samples, the activity concentration levels of 238 U series have been found to range from 15.9±0.3 to 24.1±0.9 Bq/kg, in the surface soil samples (0-5 cm) and 14.5±0.3 to 23.6±0.5 Bq/kg in the subsurface soil samples (5-25 cm). The activity concen- trations of 232Th series have been found to lie in the range 5.7±0.2 to 13.7±0.5 Bq/kg, in the surface soil samples (0-5 cm) and 4.1±0.2 to 15.6±0.3 Bq/kg in the subsurface soil samples (5-25 cm). The activity concentrations of 40K were in the range 150±8 to 290±17 Bq/kg, in the surface soil samples (0-5 cm) and 129±7 to 299±14 Bq/kg, in the subsurface soil samples (5-25 cm). The activity concentrations of 238U series, 232Th series and 40K in the surface and deep soil samples are approximately same. The 137Cs activity concentration levels in surface soil samples in four sites were found to be higher than those observed for the soil samples that been collected at a depth of 5-25 cm. They ranged from 1.65±0.22 to 19.0±0.9 Bq/kg, in the surface soil samples (0-5 cm) and 0.5±0.2 to 15.4±0.7 Bq/kg, in the subsurface soil samples (5-25 cm)