Bimodal distribution of seafloor microbiota diversity and function are associated with marine aquaculture.

The aim of the current work was to investigate the impact of marine aquaculture on seafloor biogeochemistry and diversity from pristine environments in the northern part of Norway. Our analytical approach included analyses of 182 samples from 16 aquaculture sites using 16S and 18S rRNA, shotgun analyses, visual examination of macro-organisms, in addition to chemical measurements. We observed a clear bimodal distribution of the prokaryote composition and richness, determined by analyses of 16S rRNA gene operational taxonomic units (OTUs). The high OTU richness cluster was associated with non-perturbed environments and farness from the aquaculture sites, while the low OTU richness cluster was associated with perturbed environments and proximity to the aquaculture sites. Similar patterns were also observed for eukaryotes using 18S rRNA gene analyses and visual examination, but without a bimodal distribution of OTU richness. Shotgun sequencing showed the archaeum Nitrosopumilus as dominant for the high OTU richness cluster, and the epsilon protobacterium Sulfurovum as dominant for the low OTU richness cluster. Metabolic reconstruction of Nitrosopumilus indicates nitrification as the main metabolic pathway. Sulfurovum, on the other hand, was associated with sulfur oxidation and denitrification. Changes in nitrogen and sulfur metabolism is proposed as a potential explanation for the difference between the high and low OTU richness clusters. In conclusion, these findings suggest that pollution from elevated loads of organic waste drives the microbiota towards a complete alteration of respiratory routes and species composition, in addition to a collapse in prokaryote OTU richness.

Male physicians' narratives about being in ethically difficult care situations in paediatrics.

This study is a part of a comprehensive investigation into the narratives of male and female physicians and nurses concerning their experience of being in ethically difficult care situations in paediatrics. Seventeen male physicians with a range of levels of expertise, working on various wards in paediatric clinics at two university hospitals in Norway, narrated 78 stories. The transcribed interview texts were subjected to hermeneutic analysis. All the interviewees related problems in both an action and a relation ethics perspective. The main focus was on ethical problems concerning life and death decisions. The central theme was overtreatment, which they felt they could easily slip into because of a lack of exact knowledge about the outcome of life-saving treatment. The less experienced physicians required criteria and ethical guidelines that could tell them when to stop treatment, and they expected the more experienced physicians to be able to teach them about such things. The more experienced physicians, however, told a different story about life-saving practices in paediatrics. They spoke of a very demanding life situation. In such a situation communication seems decisive, not only to clarify treatment questions, but primarily to cope with life. The physicians' main concern seemed to be the parents rather than the children. Both groups underlined the importance of professional distance to patients and to ethical problems.

Women physicians' narratives about being in ethically difficult care situations in paediatrics.

This study is part of a comprehensive investigation of ethical thinking among male and female physicians and nurses. Nine women physicians with different levels of expertise, working in various wards in paediatric clinics at two of the university hospitals in Norway, narrated 37 stories about their experience of being in ethically difficult care situations. All of the interviewees' narrations were concerned with problems relating to both action ethics and relation ethics. The main focus was on problems in a relation ethics perspective. The most common themes in an action ethics perspective were overtreatment and withholding treatment. The more experienced physicians reasoned differently from the group of less experienced physicians and they coped with pressure in different ways. The less experienced physicians disclosed their professional experience yet seemed uncertain, while putting on an air of certainty, but the more experienced physicians disclosed both their professional and personal experience of caregiving and they seemed to allow themselves to feel uncertain in their certainty. Both groups emphasized a need for deep discussion between colleagues about their being in ethically difficult care situations.

The meaning of suicidal psychiatric in-patients' experiences of being cared for by mental health nurses.

Twenty-one psychiatric in-patients who had thought about, expressed the wish or even attempted to commit suicide narrated their experiences of receiving care from mental health nurses. The interview texts were transcribed and interpreted using a phenomenological-hermeneutic method, inspired by Ricoeur's philosophy. Two main themes with subthemes were found: Confirming: attending to patients' basic needs; seeing patient; having time for patient; being with patient; listening to patient without prejudice; being open to patient; accepting patient's feelings; communicating hope to patient; and Lack of confirming: overlooking patient's basic needs; not seeing patient; not having time for patient; leaving patient to herself or himself; listening to patient with prejudice; not being open to patient; denying patient her or his feelings; communicating hopelessness to patient. These findings were interpreted in the light of Hegel's philosophy of mutual recognition and confirmation. When relating episodes of good or bad nursing care suicidal patients emphasized their need for confirmation during their interaction with nurses when in hospital after suicide attempts.

Registered nurses' and physicians' reflections on their narratives about ethically difficult care episodes.

Thirteen registered nurses and eight physicians in medical and oncological care reflected on their previous narratives about ethically difficult care situations. Although the interviewees had narrated different kinds of stories there were more similarities than differences in their reflections. Common themes were: meeting death, balancing between being open to one's own and others' reactions and being sheltered, handling advanced medical technology and grasping care as a whole. The two groups, however, disclosed different cognitive styles and types of rationality. The nurses referred to their personal experience of giving care and also receiving care very much within a praxis perspective, while physicians referred to science and proven experience within a poiesis perspective.

Ethical reasoning in nurses' and physicians' stories about care episodes.

Twenty-three registered nurses and nine physicians reported 43 stories about ethically difficult care situations. Themes in nurses' and physicians' stories were described by means of narrative ethical theory. It turned out that nurses and physicians related different kinds of stories. They also seemed to use different kinds of ethical reasoning. This result was interpreted as mainly connected to the fact that the two professions have different tasks to accomplish and are trained in disciplines with different foci; nursing and medicine. The need to find a common frame story covering the two professional stories was stressed.