Moral Distress Consultation Services: Insights From Unit- and Organizational-Level Leaders.

Goal: The objective of this study was to better understand how healthcare systems' unit- and system-level leaders perceive and experience moral distress consultation services, including their utility, efficacy, and sustainability.

Methods: A multimethod design was conducted in tandem across two academic medical centers with longstanding and active moral distress consultation services. Moral distress data for healthcare providers participating in moral distress consultation were collected.

Learning the Language of Medical Interpreters.

Every day, medical interpreters encounter the vulnerabilities of patients with limited English proficiency and systemic barriers to doing the right thing for patients. The narratives in this issue of NIB demonstrate a love of the interpretive practice. There are many stories of advocacy that go above and beyond what is expected of them.

Core psychosocial insights, challenges, and opportunities in the orthopedic surgery care of children and adolescents.

Purpose: This is the second phase in an investigation of the psychosocial impact of orthopedic surgery on adolescents. What are the core psychosocial factors that shape the experience of adolescent patients aged 11-18 who are undergoing orthopedic surgery?

Methods: Two 43-question surveys (preoperative and postoperative) were developed as modified versions of the survey used in phase 1. The preoperative survey was administered 2 weeks before surgery.

A20 intrinsically influences human effector T-cell survival and function by regulating both NF-κB and JNK signaling.

A20 is a dual-function ubiquitin-editing enzyme that maintains immune homeostasis by restraining inflammation. Although A20 serves a similar negative feedback function for T-cell receptor (TCR) signaling, the molecular mechanisms utilized and their ultimate impact on human T-cell function remain unclear. TCR engagement triggers the assembly of the CARD11-BCL10-MALT1 (CBM) protein complex, a signaling platform that governs the activation of downstream transcription factors including NF-κB and c-Jun/AP-1.

Moral Distress Consultation Services: Insights from Consultants.

Moral distress reflects often recurrent problems within a healthcare environment that impact the quality and safety of patient care. Examples include inadequate staffing, lack of necessary resources, and poor interprofessional teamwork. Recognizing and acting on these issues demonstrates a collaborative and organizational commitment to improve.

Spatial variation in genomic signatures of local adaptation during the cane toad invasion of Australia.

Adaptive evolution can facilitate species' range expansions across environmentally heterogeneous landscapes. However, serial founder effects can limit the efficacy of selection, and the evolution of increased dispersal during range expansions may result in gene flow swamping local adaptation. Here, we study how genetic drift, gene flow and selection interact during the cane toad's (Rhinella marina) invasion across the heterogeneous landscape of Australia.

Horizontal gene transfer of the Mer operon is associated with large effects on the transcriptome and increased tolerance to mercury in nitrogen-fixing bacteria.

Background: Mercury (Hg) is highly toxic and has the potential to cause severe health problems for humans and foraging animals when transported into edible plant parts. Soil rhizobia that form symbiosis with legumes may possess mechanisms to prevent heavy metal translocation from roots to shoots in plants by exporting metals from nodules or compartmentalizing metal ions inside nodules. Horizontal gene transfer has potential to confer immediate de novo adaptations to stress.

Molecular and temporal control of restimulation-induced cell death (RICD) in T lymphocytes.

For effective adaptive immunity, T lymphocytes must rapidly expand and contract in an antigen-specific manner to effectively control invading pathogens and preserve immunological memory, without sustaining excessive collateral damage to host tissues. Starting from initial antigen encounter, carefully calibrated programmed cell death pathways are critical for maintaining homeostasis over distinct phases of the T cell response. Restimulation-induced cell death (RICD), a self-regulatory apoptosis pathway triggered by re-engagement of the T cell receptor (TCR), is particularly important for constraining effector T cell expansion to preclude overt immunopathology; indeed, genetic disorders affecting key molecules involved in RICD execution can manifest in excessive lymphoproliferation, malignancy, and autoimmunity.

Resuscitate but not Intubate? Partial Codes in Pediatrics.

The use of partial code status in pediatric medicine presents clinicians with unique ethical challenges. The clinical vignette describes the presentation of a pulseless infant with a limited life expectancy. The infant's parents instruct the emergency medicine providers to resuscitate but not to intubate.

A Novel Web-Based and Mobile Application to Measure Real-Time Moral Distress: An Initial Pilot and Feasibility Study.

Problem Definition: Moral distress (MoD) is a vital clinical indicator linked to clinician burnout and provider concerns about declining patient care quality. Yet it is not routinely assessed. Earlier, real-time recognition may better target interventions aimed at alleviating MoD and thereby increase provider well-being and improve patient care quality.

Scoping review: Positive and negative impact of technology on clinicians.

Background: Unnecessary electronic health record (EHRs) documentation burden and usability issues have negatively impacted clinician well-being (e.g., burnout and moral distress).

The evolution of pituitary cysts in growth hormone-treated children.

Objectives: We have previously shown that pituitary cysts may affect growth hormone secretion. This study sought to determine cyst evolution during growth hormone treatment in children.

Methods: Forty-nine patients with short stature, a pituitary cyst, and at least two brain MRI scans were included.

Discordant population structure among rhizobium divided genomes and their legume hosts.

Symbiosis often occurs between partners with distinct life history characteristics and dispersal mechanisms. Many bacterial symbionts have genomes comprising multiple replicons with distinct rates of evolution and horizontal transmission. Such differences might drive differences in population structure between hosts and symbionts and among the elements of the divided genomes of bacterial symbionts.

Combining GWAS and population genomic analyses to characterize coevolution in a legume-rhizobia symbiosis.

The mutualism between legumes and rhizobia is clearly the product of past coevolution. However, the nature of ongoing evolution between these partners is less clear. To characterize the nature of recent coevolution between legumes and rhizobia, we used population genomic analysis to characterize selection on functionally annotated symbiosis genes as well as on symbiosis gene candidates identified through a two-species association analysis.

Developmental Language Disorder as Syntactic Prediction Impairment.

We provide evidence that children with Developmental Language Disorder (DLD) are impaired in predictive syntactic processing. In the current study, children listened passively to auditorily-presented sentences, where the critical condition included an unexpected "filled gap" in the direct object position of the relative clause verb. A filled gap is illustrated by the underlined phrase in "…", rather than the expected "", where [] denotes the gap.

Analysis of sysdiagnose in iOS 15 to identify the sending phone number of AirDrop data.

Modern cell phones allow for easy communication and transfer of data between devices. Unfortunately, some of the data transferred can be of unwelcomed, illicit, or threatening imagery and other files; digital forensic examiners are often asked to identify the source of these files. In this project, we developed a method to gain insights into the device used to send a file via Apple AirDrop.

A Closer Look at Feticide and Moral Distress.

Moral distress arises when healthcare providers recognize that a professional ethical obligation cannot be met due to constraints beyond their perceived or actual control. In this commentary, I expand a bit on the meaning and implications of moral distress identified among Israeli maternal-fetal medicine (MFM) physicians who participate in feticide. I examine briefly how exploring unmet professional obligations (for example, preventing harm), identifying who is burdened by the decisions of others, and drawing attention to what is owed to the woman, fetus, and physician may illuminate relevant ethical issues not currently considered in the calculus of late-term abortion decisions.

Contemporary and historical selection in Tasmanian devils () support novel, polygenic response to transmissible cancer.

Tasmanian devils () are evolving in response to a unique transmissible cancer, devil facial tumour disease (DFTD), first described in 1996. Persistence of wild populations and the recent emergence of a second independently evolved transmissible cancer suggest that transmissible cancers may be a recurrent feature in devils. Here, we compared signatures of selection across temporal scales to determine whether genes or gene pathways under contemporary selection (six to eight generations) have also been subject to historical selection (65-85 Myr).

The Nurse Manager's Experience of Moral Distress.

The purpose of this study was to describe the moral distress experiences of nurse managers. Moral distress has been studied among direct patient care providers including nurses and physicians. The moral distress experience among nurse managers is less understood.

Comparative genomics reveals high rates of horizontal transfer and strong purifying selection on rhizobial symbiosis genes.

Horizontal transfer (HT) alters the repertoire of symbiosis genes in rhizobial genomes and may play an important role in the on-going evolution of the rhizobia-legume symbiosis. To gain insight into the extent of HT of symbiosis genes with different functional roles (nodulation, N-fixation, host benefit and rhizobial fitness), we conducted comparative genomic and selection analyses of the full-genome sequences from 27 rhizobial genomes. We find that symbiosis genes experience high rates of HT among rhizobial lineages but also bear signatures of purifying selection (low Ka : Ks).

Host plants and shape the population genetics of sympatric herbivore populations.

Changing climate and land-use practices have the potential to bring previously isolated populations of pest insects into new sympatry. This heightens the need to better understand how differing patterns of host-plant association, and unique endosymbionts, serve to promote genetic isolation or integration. We addressed these factors in populations of potato psyllid, (Šulc), a generalist herbivore that vectors a bacterial pathogen ( Liberibacter solanacearum, causal pathogen of zebra chip disease) of potato ( L.

Disease swamps molecular signatures of genetic-environmental associations to abiotic factors in Tasmanian devil (Sarcophilus harrisii) populations.

Landscape genomics studies focus on identifying candidate genes under selection via spatial variation in abiotic environmental variables, but rarely by biotic factors (i.e., disease).

Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women.

Background: It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death.

Methods: Among 549,091 women, covering approximately 30% of the Swedish screening-eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers.