Are medical students in prehospital care at risk of moral injury?

Background The term 'moral injury' may be useful in conceptualising the negative psychological effects of delivering emergency and prehospital medicine as it provides a non-pathological framework for understanding these effects. This is in contrast to concepts such as burnout and post-Traumatic stress disorder which suggest practitioners have reached a crisis point. We conducted an exploratory, pilot study to determine whether the concept of moral injury resonated with medical students working in emergency medicine and what might mitigate that injury for them. Methods Structured interviews and focus groups were carried out with medical students involved in the delivery of prehospital and emergency medicine. The study was carried out at Barts and the London School of Medicine and Dentistry in May and June 2017. The data were analysed using theoretically driven thematic analysis. Results Concepts of moral injury such as witnessing events which contravene one's moral code, especially those involving children, or acts of violence, resonated with the experiences of medical students in this study. Participants stated that having more medical knowledge and a clear sense of a job to do on scene helped reduce their distress at the time. While social support was a protective factor, not all students found the process of debrief easy to access or undergo, those with more established relationships with colleagues fared better in this regard. Conclusions The term moral injury is useful in exploring the experience of medical students in emergency medicine. More effort should be made to ensure that students effectively access debrief and other support opportunities. It is hoped that future work will be undertaken with different professional groups and explore the potential psychological and neuropsychological impact of witnessing trauma

Tree defence and bark beetles in a drying world: carbon partitioning, functioning and modelling.

Drought has promoted large-scale, insect-induced tree mortality in recent years, with severe consequences for ecosystem function, atmospheric processes, sustainable resources and global biogeochemical cycles. However, the physiological linkages among drought, tree defences, and insect outbreaks are still uncertain, hindering our ability to accurately predict tree mortality under on-going climate change. Here we propose an interdisciplinary research agenda for addressing these crucial knowledge gaps. Our framework includes field manipulations, laboratory experiments, and modelling of insect and vegetation dynamics, and focuses on how drought affects interactions between conifer trees and bark beetles. We build upon existing theory and examine several key assumptions: (1) there is a trade-off in tree carbon investment between primary and secondary metabolites (e.g. growth vs defence); (2) secondary metabolites are one of the main component of tree defence against bark beetles and associated microbes; and (3) implementing conifer-bark beetle interactions in current models improves predictions of forest disturbance in a changing climate. Our framework provides guidance for addressing a major shortcoming in current implementations of large-scale vegetation models, the under-representation of insect-induced tree mortality

Tree defence and bark beetles in a drying world: carbon partitioning, functioning and modelling

Drought has promoted large‐scale, insect‐induced tree mortality in recent years, with severe consequences for ecosystem function, atmospheric processes, sustainable resources and global biogeochemical cycles. However, the physiological linkages among drought, tree defences, and insect outbreaks are still uncertain, hindering our ability to accurately predict tree mortality under on‐going climate change. Here we propose an interdisciplinary research agenda for addressing these crucial knowledge gaps. Our framework includes field manipulations, laboratory experiments, and modelling of insect and vegetation dynamics, and focuses on how drought affects interactions between conifer trees and bark beetles. We build upon existing theory and examine several key assumptions: 1) there is a trade‐off in tree carbon investment between primary and secondary metabolites (e.g. growth vs. defence); 2) secondary metabolites are one of the main component of tree defence against bark beetles and associated microbes; and 3) implementing conifer‐bark beetle interactions in current models improves predictions of forest disturbance in a changing climate. Our framework provides guidance for addressing a major shortcoming in current implementations of large‐scale vegetation models, the under‐representation of insect‐induced tree mortality

Mechanisms of a coniferous woodland persistence under drought and heat

Predictions of warmer droughts causing increasing forest mortality are becoming abundant, yet few studies have investigated the mechanisms of forest persistence. To examine the resistance of forests to warmer droughts, we used a five-year precipitation reduction (~45% removal), heat (+4 °C above ambient) and combined drought and heat experiment in an isolated stand of mature Pinus edulis-Juniperus monosperma. Despite severe experimental drought and heating, no trees died, and we observed only minor evidence of hydraulic failure or carbon starvation. Two mechanisms promoting survival were supported. First, access to bedrock water, or 'hydraulic refugia' aided trees in their resistance to the experimental conditions. Second, the isolation of this stand amongst a landscape of dead trees precluded ingress by Ips confusus, frequently the ultimate biotic mortality agent of piñon. These combined abiotic and biotic landscape-scale processes can moderate the impacts of future droughts on tree mortality by enabling tree avoidance of hydraulic failure, carbon starvation, and exposure to attacking abiotic agents.This project was supported by the Department of Energy, Office of Science, and Pacific Northwest National Lab’s LDRD program. DDB participation was supported via NSF EF-1340624; EF-1550756, and EAR-1331408, DEB-1824796 and DEB-1833502. CG was supported by a Director’s Fellowship from the Los Alamos National Laboratory and by the Swiss National Science Foundation SNF (PZ00P3_174068). AV was supported by a fellowship from Generalitat Valenciana (BEST/2016/289) and the project Survive-2 (CGL2015-69773-C2-2-P MINECO/FEDER) from the Spanish Government. DSM was supported via NSF IOS-1450679, IOS-1444571, and IOS-1547796

Summerhill Theory and practice

SIGLEAvailable from British Library Document Supply Centre-DSC:DX203469 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Are medical students in prehospital care at risk of moral injury?

BACKGROUND: The term 'moral injury' may be useful in conceptualising the negative psychological effects of delivering emergency and prehospital medicine as it provides a non-pathological framework for understanding these effects. This is in contrast to concepts such as burnout and post-traumatic stress disorder which suggest practitioners have reached a crisis point. We conducted an exploratory, pilot study to determine whether the concept of moral injury resonated with medical students working in emergency medicine and what might mitigate that injury for them. METHODS: Structured interviews and focus groups were carried out with medical students involved in the delivery of prehospital and emergency medicine. The study was carried out at Barts and the London School of Medicine and Dentistry in May and June 2017. The data were analysed using theoretically driven thematic analysis. RESULTS: Concepts of moral injury such as witnessing events which contravene one's moral code, especially those involving children, or acts of violence, resonated with the experiences of medical students in this study. Participants stated that having more medical knowledge and a clear sense of a job to do on scene helped reduce their distress at the time. While social support was a protective factor, not all students found the process of debrief easy to access or undergo, those with more established relationships with colleagues fared better in this regard. CONCLUSIONS: The term moral injury is useful in exploring the experience of medical students in emergency medicine. More effort should be made to ensure that students effectively access debrief and other support opportunities. It is hoped that future work will be undertaken with different professional groups and explore the potential psychological and neuropsychological impact of witnessing trauma

Does the Relationship Between Tree Vigor and Defense Respond to Fertilization and Thinning?

Waring and Pitman suggested that high growth efficiency (GE) (i.e. basal area increment/sapwood area - considered a measure of tree vigor) is related to the ability of lodgepole pine to defend against mountain pine beetles (Dendroctonus ponderosae Hopkins) (MPB). In this study we explore the relationship between GE, and other measures of vigor such as tree size, live crown ratio, growth increment, stem, foliage nutrients and root carbohydrate reserves. We then compare these measures of vigor with characteristics of tree defense such as density of resin ducts, monoterpenes and size of phloem lesions after inoculation with Grossmania clavigera (a blue stain fungus associated with MPB). In a field experiment we tested the suggested relationship between vigor and defense by thinning and fertilization in ten pure lodgepole pine stands in central Alberta. In the third summer after the fertilization and thinning treatment we inoculated trees with the blue stain fungus. The combination of fertilization and thinning increased GE and resin duct density but negatively impacted starch reserves. Lesion size increased with tree size in control plots, however, this relationship was lost when trees were fertilized and thinned. This suggests that treatments to increase growth rate also increased constitutive defenses in larger trees