Background Moral injury among physicians and other health professionals has attracted attention in the mainstream literature, this study aim to assess the psychometric properties of the 10-item Moral Injury Symptoms Scale-Health Professional (MISS-HP) among healthcare professionals in China. Methods A total of 583 nurses and 2423 physicians were recruited from across mainland China. An online survey was conducted from March 27 to April 26, 2020 (during the middle of the COVID-19 pandemic) using the Chinese version of the MISS-HP. Reliability was assessed by internal consistency reliability and test-retest reliability. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to determine scale structure. Results Cronbach’s α of the scale for both samples was acceptable (0.71 for nurses and 0.70 for physicians), as was test-retest reliability (ICCs for the individual items ranged from 0.41 to 0.74, with 0.77 for the overall scale in physicians). EFA suggested three factors, and the CFA indicated good fit to the data. Convergent validity was demonstrated with the 4-item Expressions of Moral Injury Scale (r = 0.45 for physicians, r = 0.43 for nurses). Discriminant validity was demonstrated by correlations with burnout and well-being (r = 0.34–0.47), and concurrent validity was suggested by correlations with depression and anxiety symptoms (r = 0.37–0.45). Known groups validity was indicated by a higher score in those exposed to workplace violence (B = 4.16, 95%CI: 3.21–5.10, p < 0.001). Conclusions The MISS-HP demonstrated acceptable reliability and validity in a large sample of physicians and nurses in mainland China, supporting its use as a screening measure for moral injury symptoms among increasingly stressed health professionals in this country during the COVID-19 pandemic.

Objective: Caring for patients during the COVID-19 pandemic has placed considerable stress on health care professionals (HCPs), increasing their risk of moral injury (MI) and clinician burnout. The present study sought to examine the prevalence and correlates of MI among physicians and nurses in mainland China during the pandemic. Method: A cross-sectional study was performed via an online survey conducted from March 27, 2020 to April 26, 2020. The 10-item Moral Injury Symptoms Scale-Health Professional version (MISS-HP) was administered along with measures of clinician mental health and burnout. A total of 3,006 physicians and nurses who completed the questionnaire were included in the final analysis. Unconditional logistic regression modeling was performed to determine the associations, including that between COVID-19 patient exposure and the risk of moral injury. Results: MISS-HP scores strongly and positively correlated with depression, anxiety, low well-being, and burnout symptoms. The estimated prevalence of MI in the total sample was 41.3%, 95% confidence interval (CI) [39.3%, 43.0%]. HCPs providing medical care to COVID-19 patients experienced a 28% greater risk of MI than those providing medical care to patients without the coronavirus (odds ratio = 1.28, 95% CI [1.05, 1.56], p = .01). Conclusions: A significant proportion of HCPs in mainland China are at risk for significant MI symptoms as well as mental health problems and burnout during the COVID-19 pandemic. MI symptoms are strongly correlated with higher clinician burnout, greater psychological distress, and lower level of subjective well-being. Effective strategies are needed to address MI and other mental health problems in frontline health care workers treating those with and without COVID-19 disease. Clinical Impact StatementMoral injury (MI) symptoms are correlated with higher clinician burnout, greater psychological distress, and lower level of subjective well-being. Strategies shown to be effective for MI in former military personnel might be used to address burnout and mental health problems in frontline health care workers tasked with treating those with and without COVID-19 disease. Our findings provide a profile of HCPs who are at risk for MI symptoms and may help to identify those at risk of downstream effects in terms of psychological health and patient safety.

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A real-time system operates under timing constraints which it may be unable to meet under some circumstances. The criticality of a timing constraint determines how a system is to react when a timing failure happens. For critical timing constraints, a timing failure should be detected as soon as possible. Howevel; early detection of timing failures requires more resource usage which may be deemed excessive. While work in real-time system monitoring has progressed in recent years, the issue of tradeoff between detection latency and resource overhead has not been adequately considered. This paper presents an approach for monitoring timing constraints in real-time systems which is based on a simple and expressive specification method for dejining the timing constraints to be monitored. ESJicient algorithms are developed to catch violations of timing constraints at the earliest possible time. These algorithms have been implemented in a tool called JRTM (Java Run-time Timing-constraint Monitor) in the language Java. This tool can be used to specify and monitor timing constraints of Java applications.

Puroindoline genes (Pina and Pinb) form the molecular basis of wheat grain hardness or texture. Variations in either gene are reported to be associated with grain hardness in wheat. Here, a modified denaturing PAGE was used to detect Pina and Pinb allelic variations in 102 common wheat cultivars and other species related to wheat. Two variations of Pina (Pina-D1b and Pina-D1p) and five variations of Pinb (null, Pinb-D1b, PinbD1u, Pinb-D1v and Pinb-D1w) were identified in common (T. aestivum) and spelt wheats (T. aestivum ssp. spelta). No allelic variation was found in Tibet semi-wild wheat (T. aestivum ssp. tibetanum), club wheat (T. compactum), or Aegilops tauschii. Puroindoline genes were absent in wild emmer (T. turgidum var. dicoccoides). The sequencing results of the PCR fragments from Pina and Pinb (except for null type) indicated allelic variants carrying single base mutation, such as Pina-D1p, Pinb-D1u, Pinb-D1v and Pinb-D1w were novel types. Our results showed that the modified PAGE used in this study provided a satisfactory resolving power for identifying single nucleotide mutations; therefore, it is a practical and simple tool to study allelic variation of Pina and Pinb in wheat and related species.