Moral Distress in Critical Care Nursing: The State of the Science

Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. Results: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. Conclusion: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended

Polyfunctional Hiv-Specific Antibody Responses Are Associated with Spontaneous Hiv Control

Elite controllers (ECs) represent a unique model of a functional cure for HIV-1 infection as these individuals develop HIV-specific immunity able to persistently suppress viremia. Because accumulating evidence suggests that HIV controllers generate antibodies with enhanced capacity to drive antibody-dependent cellular cytotoxicity (ADCC) that may contribute to viral containment, we profiled an array of extra-neutralizing antibody effector functions across HIV-infected populations with varying degrees of viral control to define the characteristics of antibodies associated with spontaneous control. While neither the overall magnitude of antibody titer nor individual effector functions were increased in ECs, a more functionally coordinated innate immune–recruiting response was observed. Specifically, ECs demonstrated polyfunctional humoral immune responses able to coordinately recruit ADCC, other NK functions, monocyte and neutrophil phagocytosis, and complement. This functionally coordinated response was associated with qualitatively superior IgG3/IgG1 responses, whereas HIV-specific IgG2/IgG4 responses, prevalent among viremic subjects, were associated with poorer overall antibody activity. Rather than linking viral control to any single activity, this study highlights the critical nature of functionally coordinated antibodies in HIV control and associates this polyfunctionality with preferential induction of potent antibody subclasses, supporting coordinated antibody activity as a goal in strategies directed at an HIV-1 functional cure

Growth rate and heterozygosity in the plaice, Pleuronectes platessa

Samples of young plaice were examined to see if there was any relationship between growth rate and individual heterozygosity, screened across five polymorphic enzyme loci (Pgm-1, Ada, Mdh-2, Pgi-2, Gpdh-l). Two out of 46 samples showed a significant negative correlation between growth rate and multi-locus heterozygosity; none showed a significant positive correlation. There was no overall tendency to negative or positive correlations. The largest sample (N=689) showed no relationship between multi-locus heterozygosity and growth rate, although one of the five loci, Gpdh-1, showed a significant positive correlation. The only significant correlation in the next largest sample (N= 248) was between multi-locus heterozygosity and growth rate, and that was negative. Fish of intermediate growth rate were not significantly different in heterozygosity from faster or slower growing fish. There was no relationship between variability in growth rate and multi-locus heterozygosity. These findings are discussed in the context of similar surveys from other species, and the conclusion drawn that the universality of a positive relationship between growth rate and multi-locus heterozygosity remains to be established