Morally distressing experiences, moral injury, and burnout in florida healthcare providers during the covid-19 pandemic

Because healthcare providers may be experiencing moral injury (MI), we inquired about their healthcare morally distressing experiences (HMDEs), MI perpetrated by self (Self MI) or others (Others MI), and burnout during the COVID-19 pandemic. Participants were 265 healthcare providers in North Central Florida (81.9% female, Mage = 37.62) recruited via flyers and emailed brochures that completed online surveys monthly for four months. Logistic regression analyses investigated whether MI was associated with specific HMDEs, risk factors (demographic characteristics, prior mental/medical health adversity, COVID-19 protection concern, health worry, and work impact), protective factors (personal resilience and leadership support), and psychiatric symptomatology (depression, anxiety, and PTSD). Linear regression analyses explored how Self/Others MI, psychiatric symptomatology, and the risk/protective factors related to burnout. We found consistently high rates of MI and burnout, and that both Self and Others MI were associated with specific HMDEs, COVID-19 work impact, COVID-19 protection concern, and leadership support. Others MI was also related to prior adversity, nurse role, COVID-19 health worry, and COVID-19 diagnosis. Predictors of burnout included Self MI, depression symptoms, COVID-19 work impact, and leadership support. Hospital administrators/supervisors should recognize the importance of supporting the HCPs they supervise, particularly those at greatest risk of MI and burnout

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

A comparison between environmental sustainability rating systems LEED and ITACA for residential buildings

The paper presents a comparison between two different rating systems to evaluate buildings sustainability: LEED (USA) and ITACA (Italy), thanks to the application of both methods to two residential buildings located in Italy. The LEED green building rating system encourages an integrated design approach, with a points scheme that allots credits for building design features deemed to improve sustainability, which includes reductions in energy use, improvements in indoor environment quality, protection of the construction site, reduction in water consumption and use of sustainable materials. ITACA procedure, the environmental quality rating system adopted in Italy, consists of the compilation of a group of worksheets, one for each different performance indicator, at the aim of describing the building environmental quality, including the maintenance of indoor comfort during the entire life cycle. The chosen buildings are located in central Italy; they are both energy efficient and designed according to the principles of bioclimatic architecture, even if they are characterized by different features. Five common areas (site, water, energy, materials, indoor environmental quality) were identified in order to compare the two methods and to normalize their score; this original approach can be transferred also to the comparison of other building environmental assessment tools. The comparison allows to prove the main features of both schemes. Even though the two procedures give different importance to the various areas, the analysis show a proportionality between the respective normalized final score for the two examined buildings

A Generalization of the Cors Method to Determine Cepheid Radii: Theory and Application

The CORS method for the empirical determination of the radii of pulsating variables (Caccin et al., 1981; Sollazzo et al., 1981) is discussed in the framework of the quasistatlc approximation to the variations of the atmospheric parameters (Unno, 1965) and reformulated in a way that does not make direct use of theoretical calibrations of the photometric system in terms of model atmospheres. The radii calculated with this approach are in good agreement with those previously obtained by means of Pel's calibrations of the VBLUW system (Sollazzo et al.,1981) which lead to a period-radius relation coinciding, within the errors, with the theoretical one (Cogan, 1978) and, consequently, mass determinations consistent with pulsational masses (Cox, 1979). The method can be immediately applied to any other multicolour system, and very promising preliminary results are obtained by using recent UBV data by Gieren (1982)

Anatomical and biochemical studies of Spartium junceum infected by Xylella fastidiosa subsp. multiplex ST 87

Spartium junceum L. is a typical species of Mediterranean shrubland areas, also grown in gardens and parks as an ornamental. In recent years in Europe, S. junceum has been recurrently found to be infected by different subspecies and genotypes of the quarantine regulated bacterium Xylella fastidiosa (Xf). This work presents for the first time the anatomy of S. junceum plants that we found, by means of genetic and immunochemistry analysis, to be naturally infected by Xf subsp. multiplex ST87 (XfmST87) in Monte Argentario (Grosseto, Tuscany, Italy), a new outbreak area within the EU. Our anatomical observations showed that bacteria colonized exclusively the xylem conductive elements and moved horizontally to adjacent vessels through pits. Interestingly, a pink/violet matrix was observed with Toluidine blue staining in infected conduits indicating a high content of acidic polysaccharides. In particular, when this pink-staining matrix was observed, bacterial cells were either absent or degenerated, suggesting that the matrix was produced by the host plant as a defense response against bacterial spread. In addition, a blue-staining phenolic material was found in the vessels and, at high concentration, in the pits and inter-vessels. SEM micrographs confirmed that polysaccharide and phenolic components showed different structures, which appear to be related to two different morphologies: fibrillary and granular, respectively. Moreover, our LM observations revealed bacterial infection in xylem conductive elements of green shoots and leaves only, and not in those of other plant organs such as roots and flowers. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00709-021-01640-2