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Moral distress is a harmful emotional experience that often afflicts health care providers who care for dying patients. First described among nurses, morally distressing situations are particularly common in critical care, where nurses and other providers can feel forced to prolong their patients’ d

The fireworm Hermodice carunculata is a facultative corallivore on coral reefs. It can interact with algal overgrowth to cause coral mortality. However, because of its cryptic nature, little is known about its ecology. We used micropredator attracting devices (MADs) and stable isotope analyses to provide insights into the distribution and diet of H. carunculata in a coral reef on Curacao, southern Caribbean. MADs consisted of algal clumps inside accessible mesh nets which H. carunculata could use as refuge. To obtain indications on its distribution pattern, MADs filled with Halimeda opuntia were deployed in different reef habitats ranging from 0 to 16 m water depth. Fireworms were found inside MADs in all reef habitats, indicating that they have a widespread horizontal and vertical distribution, ranging from the shoreline to the deeper reef slope. On the reef crest, MADs were filled using different algal species and deployed on dead or live scleractinian corals. MADs hosted more fireworms when placed on live corals, regardless of algal species used, suggesting that algal-induced corallivory may be widespread. To test for food preferences, different food sources were added inside the MADs. Fireworms detected potential prey within 6 h and were significantly more attracted by decaying corals and raw fish than by live corals, hydrozoans, or gorgonians. Stable isotope analyses indicated detritus, macroalgae, and scleractinian corals as potential food sources and revealed an ontogenetic dietary shift toward enriched δ 13C and δ 15N values with increasing fireworm size, suggesting that large-sized individuals feed on food sources of higher trophic levels. Our findings highlight H. carunculata as a widespread, and omnivorous scavenger that has the potential to switch feeding toward weakened or stressed corals, thereby likely acting as a harmful corallivore on degraded reefs.

Navigating the biomedical, emotional, and logistical complexity of end-of-life (EOL) care requires seamless interprofessional teamwork. Unfortunately, EOL care, interprofessional collaboration, and the role of support services such as hospice are not adequately emphasized in nursing and medical curricula. This article describes a student-run program, entitled the "HeArt of Medicine", which was designed to foster a reflective and collaborative approach to EOL care. The program consists of three workshops with a novel blend of art, science, and practical information, highlighting the need for interprofessional teamwork. Participants were surveyed before and after the workshops on their attitudes toward EOL care. Composite participant scores after workshops demonstrated increased comfort with and knowledge of EOL care topics (p = 0.001). The results show that this program has had a positive impact on participants' knowledge, comfort, and collaboration in EOL settings.

Indirect biotic interactions play a crucial role in structuring ecological communities, but many of these interactions have not been explored. Algal competition and corallivory are two major stressors contributing to the decline of coral reefs. Here, we provide the first evidence of algal-induced corallivory and synergistic effects between the two stressors on corals. When corals (Montastraeafaveolata) were placed in contact with algae (Halimeda opuntia) together with corallivorous fireworms (Hermodice carunculata) in aquaria, corals suffered high tissue mortality. This mortality was reduced in the presence of algae only, and no mortality occurred in the presence of fireworms only or when excluding both algae and fireworms. These findings were supported by field observations showing a predominance of fireworms inside algae contacting live corals, and by an in situ experiment demonstrating higher coral mortality in contact with algae left undisturbed than with algae from which all mobile epifauna were periodically removed. Among the main contributing mechanisms, we suggest that algal contact produces decaying coral tissue that attracts the corallivore and enhances its aggregation behavior. Our study demonstrates an indirect effect pathway by which algae can impact corals, which shares similarities with the classic models of apparent competition and habitat facilitation.

Over the last few decades, advances in molecular techniques have led to the detection of strong geographic population structure and cryptic speciation in many benthic marine taxa, even those with long-lived pelagic larval stages. Polychaete annelids, in particular, generally show a high degree of population divergence, especially in mitochondrial genes. Rarely have molecular studies confirmed the presence of 'cosmopolitan' species. The amphinomid polychaete Hermodice carunculata was long considered the sole species within its genus, with a reported distribution throughout the Atlantic and adjacent basins. However, recent studies have indicated morphological differences, primarily in the number of branchial filaments, between the East and West Atlantic populations; these differences were invoked to re-instate Hermodice nigrolineata, formerly considered a junior synonym of H. carunculata. We utilized sequence data from two mitochondrial (cytochrome c oxidase subunit I, 16S rDNA) markers and one nuclear (internal transcribed spacer) marker to examine the genetic diversity of Hermodice throughout its distribution range in the Atlantic Ocean, including the Mediterranean Sea, the Caribbean Sea, the Gulf of Mexico and the Gulf of Guinea. Our analyses revealed generally low genetic divergences among collecting localities and between the East and West Atlantic, although phylogenetic trees based on mitochondrial data indicate the presence of a private lineage in the Mediterranean Sea. A re-evaluation of the number of branchial filaments confirmed differences between East and West Atlantic populations; however, the differences were not diagnostic and did not reflect the observed genetic population structure. Rather, we suspect that the number of branchial filaments is a function of oxygen saturation in the environment. Our results do not support the distinction between H. carunculata in the West Atlantic and H. nigrolineata in the East Atlantic. Instead, they re-affirm the older notion that H. carunculata is a cohesive species with a broad distribution across the Atlantic Ocean.

Coral predation by the fireworm Hermodice carunculata was investigated by presenting settlers ( 90 %) in the presence of small-, mid- and large-sized fireworms, respectively. In contrast, fireworms hardly preyed on adult corals, irrespective of their sizes. Our results suggest an ontogenic shift in the diet of H. carunculata and in the susceptibility of corals to predation by fireworms. H. carunculata, in particular small-sized individuals, could be an important cause for early post-settlement mortality in corals. The corallivore could reinforce recruitment bottlenecks and reduce coral recovery after disturbances.