Emotional Responses and Support Needs of Healthcare Professionals after Adverse or Traumatic Experiences in Healthcare-Evidence from Seminars on Peer Support.

The aim of this study was to identify (i) emotions experienced by healthcare professionals (HCPs) after adverse or traumatic events and (ii) needs for support after adverse or traumatic events. Data for this qualitative, descriptive study were collected at 27 seminars for 198 HCPs introducing a peer-support programme after adverse or traumatic events (The Buddy Study). Through interactive exercises, participants shared their experiences, and this study reports on the responses of an exercise identifying emotions and needs after an adverse or traumatic event. The top five emotions were anger, guilt, impotence, grief, and frustration and anxiety, and the top five needs were to be met with understanding, recognition, listening, care, and respect. Ten categories of emotions experienced by HCPs after adverse or traumatic events were constructed, and the five categories with the highest number of mentions were anger and impotence, fear and insecurity, negative self-evaluation, guilt and shame, and alone and overloaded. Nine categories relating to needs for support after adverse or traumatic events were constructed, and the five categories with the highest number of mentions were: being seen and understood, compassion, being respected, time to recover, and organisational support. The emotional disclosure promoted at the peer seminars of the Buddy Study revealed that all participants share the same emotional distress, being either second victims or potential second victims. Moreover, the support needed was of a human-to-human nature that all participants felt capable of providing as a "buddy" for a colleague. Both the identified emotions and needs for support identified in this study may contribute to qualifying the development of the content of support programmes for HCPs after traumatic or adverse events.

Prayer and meditation practices in the early COVID-19 pandemic: A nationwide survey among Danish pregnant women. The COVIDPregDK study.

BACKGROUND: The emergence of the COVID-19 pandemic and the derived changes in maternity care have created stress and anxiety among pregnant women in different parts of the world. In times of stress and crisis, spirituality, including spiritual and religious practices, may increase. OBJECTIVE: To describe if the COVID-19 pandemic influenced pregnant women's considerations and practises of existential meaning-making and to investigate such considerations and practices during the early pandemic in a large nationwide sample. METHODS: We used survey data from a nationwide cross-sectional study sent to all registered pregnant women in Denmark during April and May 2020. We used questions from four core items on prayer and meditation practices. RESULTS: A total of 30,995 women were invited, of whom 16,380 participated (53%). Among respondents, we found that 44% considered themselves believers, 29% confirmed a specific form of prayer, and 18% confirmed a specific form of meditation. In addition, most respondents (88%) reported that the COVID-19 pandemic had not influenced their responses. CONCLUSION: In a nationwide Danish cohort of pregnant women, existential meaning-making considerations and practices were not changed due to the COVID-19 pandemic. Nearly one in two study participants described themselves as believers, and many practised prayer and/or meditation.

From hospital to home following a lower limb amputation: A focus group study of healthcare professionals' views and experiences with transitioning.

INTRODUCTION: Patients undergoing major lower limb amputation often have multiple comorbidities, requiring care from numerous healthcare professionals (HCPs). Furthermore, they may experience physical, medical and practical challenges post-amputation. Patients with complex needs are particularly vulnerable during care transitions and may benefit from integrated care models. AIM: This study aimed to explore HCPs' views and experiences regarding the transition process after implementing an integrated care model for patients with lower limb amputation. METHODS: We conducted two focus groups with 13 HCPs from a Danish hospital and three surrounding districts; all working in the Safe Journey programme. The interviews were analysed using thematic analysis. RESULTS: Three themes were created: 1) becoming a team across sectors, 2) continuity of care as a driver for patient safety and 3) challenges in achieving safe transitions. The Safe Journey programme facilitated the construction of an interdisciplinary team, cross-sectoral communication and professional relations, increasing HCPs' sense of improved patient safety and care continuity. However, HCPs experienced an increased workload, including coordination and at-home patient visits. CONCLUSIONS: HCPs found the Safe Journey programme to be valuable for patients undergoing major lower limb amputation and promotive of cross-sectoral professional relations, communication, continuity and patient safety. However, the programme was time- and resource-consuming compared to conventional models.

Morphological and behavioral alterations in zebrafish larvae after exposure to contaminated river sediments collected in different weather conditions.

Wastewater treatment plants (WWTPs) are the primary source of micropollutants in aquatic ecosystems. Many micropollutants tend to bind to sediments and persist until remobilizion by bioturbation or flood events. Advanced effluent treatment by ozonation has been proven to eliminate most micropollutants. The present study characterizes sediments' toxic potential regarding zebrafish embryo development, which highly complex nervous system is vulnerable to exposure to neurotoxic substances. Furthermore, behavioral changes can be induced even at low pollutant concentrations and do not cause acute toxicity. The study area includes stretches of the main waterbody, the Wurm River (sampling sites W1-W5), and its tributary the Haarbach River (sampling sites H1, and H2) in North-Rhine Westphalia, Germany. Both waterbodies serve as recipients of WWTPs' effluents. The effluent entering the Haarbach River is conventionally treated, while the Wurm River receives ozonated effluent from the Aachen-Soers WWTP. Seven sampling sites up- and downstream of the WWTPs were investigated in June of two subsequent years. The first sampling campaign in 2017 was characterized by prolonged dry weather. The second sampling campaign in 2018 occurred after prolonged rain events and the release of the rainwater overflow basin. Direct exposure of zebrafish embryos to native sediments using the sediment contact test represented an ecologically realistic scenario and showed no acute sublethal effects. Exposure of the zebrafish embryo to freeze-dried sediments representing the ecotoxicological status of sediments during flood events unfolded acute sublethal toxicity. Behavioral studies with zebrafish larvae were an essential part of environmental neurotoxicity testing. Zebrafish larvae exposed to sediments' concentrations causing no acute effects led to behavioral changes signalizing neurotoxic substances in sediments. Polyaromatic hydrocarbons, polychlorinated biphenyls, and nitroaromatic compounds were identified as potential toxicity drivers, whereby the rainwater overflow basin served as a possible source of pollution. Mixture toxicity, effect-directed analysis, and further sediment monitoring are needed.

Symbiotic Algae of Hydra viridissima Play a Key Role in Maintaining Homeostatic Bacterial Colonization.

The freshwater polyp Hydra viridissima (H. viridissima) harbors endosymbiotic Chlorella algae in addition to a species-specific microbiome. The molecular basis of the symbiosis between Hydra and Chlorella has been characterized to be metabolic in nature. Here, we studied the interaction between the extracellularly located microbiota and the algal photobiont, which resides in Hydra's endodermal epithelium, with main focus on Legionella bacterium. We aimed at evaluating the influence of the symbiotic algae on microbial colonization and in shaping the host microbiome. We report that the microbiome composition of symbiotic and aposymbiotic (algae free) H. viridissima is significantly different and dominated by Legionella spp. Hvir in aposymbiotic animals. Co-cultivation of these animals resulted in horizontal transmission of Legionella spp. Hvir bacteria from aposymbiotic to symbiotic animals. Acquisition of this bacterium increased the release of algae into ambient water. From there, algae could subsequently be taken up again by the aposymbiotic animals. The presence of algal symbionts had negative impact on Legionella spp. Hvir and resulted in a decrease of the relative abundance of this bacterium. Prolonged co-cultivation ultimately resulted in the disappearance of the Legionella spp. Hvir bacterium from the Hydra tissue. Our observations suggest an important role of the photobiont in controlling an invasive species in a metacommunity and, thereby, shaping the microbiome.

Evaluation of'the Buddy Study', a peer support program for second victims in healthcare: a survey in two Danish hospital departments.

BACKGROUND: Healthcare professionals involved in adverse events may suffer severe physical and emotional distress in the aftermath. Adequate support is critical to an overall culture of safety for any healthcare institution. This study evaluates a formalised peer support program, 'the Buddy Study', in two Danish university hospital departments. The program consists of a 2-h seminar about second victims and self-selected buddies to provide peer support after adverse events. METHODS: The study design involved a cross-sectional survey comprised of two close-ended questionnaires evaluating the Buddy Study seminar (Q1) and the Buddy Study program (Q2), along with two open-ended questions and three individual interviews for more elaborate answers. RESULTS: Out of the 250 HCPs employed in both departments, 191 midwives, physicians, and nursing assistants completed Q1 and 156 completed Q2. The seminars were evaluated positively; 91.6% were satisfied with the overall content of the seminar, and 69.1% agreed that insight into how other people may react to adverse events has helped them contain their own reactions or emotions. Assessments of having the Buddy Study program in the department or using or being used as a buddy were more diverse, yet overall positive. Three benefits of the program were identified: the program i) has encouraged an open and compassionate culture; ii) has caused attentiveness to the wellbeing of colleagues; and iii) the self-selected buddy relationship has created a safe space for sharing. Additionally, three challenges or shortcomings were identified: i) although peer support is valuable, it should not stand alone; ii) informal peer support is already in place, hence making a formalised system redundant; and iii) the buddy system requires continuous maintenance and visibility. CONCLUSIONS: The overall evaluation of the Buddy Study program was positive, suggesting that this type of formalised peer support may contribute to a rapid and accessible second-victim support program in healthcare institutions. A key principle for the Buddy Study program is that relationships are crucial, and all buddy relationships are based on self-selection. This seems to offer a safe space for health care professionals to share emotional vulnerability and professional insecurity after an adverse event.

Existential aspects as an inevitable part of salutogenesis in maternity care - A discussion paper.

BACKGROUND: Poor mental health is considered a major health challenge globally, not least for young people, who will form families within forthcoming years. Research related to childbirth and parenthood transition has focused on how to promote good mental health by preventing mental illness. AIM: We discuss how a salutogenetic approach to mental health in parenthood transition is beneficial, and specifically how the component of meaningfulness in Sense of Coherence (SoC), could be investigated to optimize good mental health during parenthood transition. DISCUSSION: In more recent understandings of meaningfulness, ideas from existential philosophy and psychology have been included. We discuss how, from an existential psychological perspective, open and explorative questioning of life conditions and dilemmas may help to regain one's footing and get in touch with one's driving force - meaningfulness. Such questioning implies that someone, a professional or a friend, actively and relationally helps explore existential aspects of life. CONCLUSION: We believe that investigating and asking research questions pointing at optimizing a salutogenetic perspective, specifically focusing on the component of meaningfulness and its embedded existential aspects of life, could lead to new knowledge on how to promote good mental health in maternity care.

The COVIDPregDK Study: A national survey on pregnancy during the early COVID-19 pandemic in Denmark.

AIM: We aimed to describe the aim, data collection and content from a survey completed among pregnant women during the first peak of the COVID-19 pandemic in Denmark. METHODS: The declaration of the COVID-19 pandemic in early 2020 challenged pregnant women's mental well-being due to a concern for their unborn child and their need for healthcare services through pregnancy and birth. To explore how the COVID-19 pandemic and the intensified measures such as the lockdown of Denmark impacted pregnant women's well-being and mental health, we conducted a questionnaire survey in the spring of 2020 when the COVID-19 pandemic was at its first peak, and the consequences for pregnant women and the unborn child were very uncertain. All women residing in Denmark and registered with an ongoing pregnancy on 24 April 2020 were invited to participate. The questionnaire included background information, variables on COVID-19 symptoms and validated batteries of questions on loneliness, anxiety, stress, quality of life, meditation and prayers. Additional questions were included to examine concerns related to pregnancy and childbirth during the pandemic. COHORT CHARACTERISTICS: Almost 18,000 women answered the questionnaire, which represents 60% of all invited women who experienced a national lockdown for the first time. Their median age was 30 years, and they were more likely to be multiparous. CONCLUSIONS: Data from the COVIDPregDK Study will enable us to gain valuable knowledge on how the pandemic, the intensified measures from the health authorities and the national lockdown affected pregnant women's mental health and their concerns during the COVID-19 pandemic.

Validation of the Danish version of the Second Victim Experience and Support Tool.

OBJECTIVE: Health-care professionals (HCPs) who are involved in an unanticipated adverse patient event, a medical error or a patient-related injury can become second victims. Being a second victim can lead to various symptoms, affecting the well-being of HCPs and possible turnover intentions or absenteeism. An increasing number of hospitals have implemented a second-victim support programme. To achieve unique insights into what works and what does not work in second-victim support programmes, HCPs' perceptions are needed. The aim of this study was to translate the Second Victim Experience and Support Tool (SVEST) into Danish and test the psychometric properties of the Danish version (D-SVEST). METHODS: The SVEST self-administered questionnaire was translated into Danish following the World Health Organization's guidelines. Assessments of the content validity, construct validity and internal consistency were performed based on 171 participants. RESULTS: The study demonstrated that the D-SVEST is content valid and fits the a priori defined structure. Yet, four items revealed unacceptable factor loadings (<0.4) and item-rest correlations <0.3. All Cronbach's alpha estimates for these five dimensions exceeded 0.70. The dimensions on colleague and institutional support did not contribute to the validity. CONCLUSIONS: In conclusion, the D-SVEST is considered relevant and valid for measuring second-victim experiences and the adequacy of support resources. However, we recommend a modification of items 9 and 25 to enhance the measurement scale in a Danish context. The D-SVEST can be used by health-care management at Danish hospitals.

Assessing the genotoxic potential of freshwater sediments after extensive rain events - Lessons learned from a case study in an effluent-dominated river in Germany.

Wastewater treatment plant effluents and releases from rainwater overflow basins can contribute to the input of genotoxic micropollutants in aquatic ecosystems. Predominantly lipophilic genotoxic compounds tend to sorb to particulate matter, making sediment a source and a sink of pollution. Therefore, the present study aims to investigate the genotoxic potential of freshwater sediments (i) during the dry period and (ii) after extensive rain events by collecting sediment samples in one small anthropogenically impacted river in Germany up- and downstream of the local wastewater treatment plant. The Micronucleus and Ames fluctuation assays with Salmonella typhimurium strains TA98, TA100, YG1041, and YG1042 were used to assess the genotoxic potential of organic sediment extracts. For evaluation of possible genotoxicity drivers, target analysis for 168 chemical compounds was performed. No clastogenic effects were observed, while the genotoxic potential was observed at all sampling sites primarily driven by polycyclic aromatic hydrocarbons, nitroarenes, aromatic amines, and polycyclic heteroarenes. Freshwater sediments' genotoxic potential increased after extensive rain events due to sediment perturbation and the rainwater overflow basin release. In the present study, the rainwater overflow basin was a significant source for particle-bound pollutants from untreated wastewater, suggesting its role as a possible source of genotoxic potential. The present study showed high sensitivity and applicability of the bacterial Salmonella typhimurium strains YG1041 and YG1042 to organic sediment extracts to assess the different classes of genotoxic compounds. A combination of effect-based methods and a chemical analysis was shown as a suitable tool for a genotoxic assessment of freshwater sediments.

Concerns about transmission, changed services and place of birth in the early COVID-19 pandemic: a national survey among Danish pregnant women. The COVIDPregDK study.

BACKGROUND: The outbreak of the COVID-19 pandemic caused great uncertainty about causes, treatment and mortality of the new virus. Constant updates of recommendations and restrictions from national authorities may have caused great concern for pregnant women. Reports suggested an increased number of pregnant women choosing to give birth at home, some even unassisted ('freebirth') due to concerns of transmission in hospital or reduction in birthplace options. During April and May 2020, we aimed to investigate i) the level of concern about coronavirus transmission in Danish pregnant women, ii) the level of concern related to changes in maternity services due to the pandemic, and iii) implications for choice of place of birth. METHODS: We conducted a nationwide cross-sectional online survey study, inviting all registered pregnant women in Denmark (n = 30,009) in April and May 2020. RESULTS: The response rate was 60% (n = 17,995). Concerns of transmission during pregnancy and birth were considerable; 63% worried about getting severely ill whilst pregnant, and 55% worried that virus would be transmitted to their child. Thirtyeight percent worried about contracting the virus at the hospital. The most predominant concern related to changes in maternity services during the pandemic was restrictions on partners' attendance at birth (81%). Especially nulliparous women were concerned about whether cancelled antenatal classes or fewer physical midwifery consultations would affect their ability to give birth or care for their child postpartum.. The proportion of women who considered a home birth was equivalent to pre-pandemic home birth rates in Denmark (3%). During the temporary discontinue of public home birth services, 18% of this group considered a home birth assisted by a private midwife (n = 125), and 6% considered a home birth with no midwifery assistance at all (n = 41). CONCLUSION: Danish pregnant womens' concerns about virus transmission to the unborn child and worries about contracting the virus during hospital appointments were considerable during the early pandemic. Home birth rates may not be affected by the pandemic, but restrictions in home birth services may impose decisions to freebirth for a small proportion of the population.

Towards bio-upcycling of polyethylene terephthalate.

Over 359 million tons of plastics were produced worldwide in 2018, with significant growth expected in the near future, resulting in the global challenge of end-of-life management. The recent identification of enzymes that degrade plastics previously considered non-biodegradable opens up opportunities to steer the plastic recycling industry into the realm of biotechnology. Here, the sequential conversion of post-consumer polyethylene terephthalate (PET) into two types of bioplastics is presented: a medium chain-length polyhydroxyalkanoate (PHA) and a novel bio-based poly(amide urethane) (bio-PU). PET films are hydrolyzed by a thermostable polyester hydrolase yielding highly pure terephthalate and ethylene glycol. The obtained hydrolysate is used directly as a feedstock for a terephthalate-degrading Pseudomonas umsongensis GO16, also evolved to efficiently metabolize ethylene glycol, to produce PHA. The strain is further modified to secrete hydroxyalkanoyloxy-alkanoates (HAAs), which are used as monomers for the chemo-catalytic synthesis of bio-PU. In short, a novel value-chain for PET upcycling is shown that circumvents the costly purification of PET monomers, adding technological flexibility to the global challenge of end-of-life management of plastics.

Adverse events as transitional markers - Using liminality to understand experiences of second victims.

Healthcare professionals are socialized into a tacit, professional identity of competences and skills - to save lives, repair trauma and facilitate good and trustful relational care. When severe adverse events happen, healthcare professionals may struggle to accept their own fallibility, and the event may pose a threat to the selfdeclared 'superior' or 'infallible' professional identity. The consequences of a sudden identity shift between the 'potentially infallible HCP' and 'potentially fallible HC P' caused by an adverse event is the analytical object of this study. The aim of the paper is to derive new understandings of how HCPs in maternity services experience adverse events by using Arnold van Gennep's and Victor Turner's 'rites of passage' theorizations and the concept of liminality to explain the process of transition between the two professional identities. Through five focus groups conducted in June 2018 with midwives and obstetricians-gynecologists, we have examined i) how second victim experiences can be understood using theories of transition and liminality, and ii) how the organizational procedures in a Danish university hospital may serve as a ritual for the involved HCPs in the aftermath of adverse events. The findings suggest that the inconsistency in the level of support contributes to the chaos that may be experienced by the healthcare professional. The organizational structure does not provide rites of transition or any other ritual processes, except for debriefings that, in many cases, are experienced as deficient. Since liminal states suggest danger and threat, because the previous professional identity is replaced by ambiguity and separation, the lack of clear rituals and support may put further strain on the HCP adding to the associated psychological and social distress. Considering the liminality and the need for structured transition rites within the work environment may prove useful when constructing adequate second victim support programs.

What is spiritual care? Professional perspectives on the concept of spiritual care identified through group concept mapping.

OBJECTIVES: The overall study aim was to synthesise understandings and experiences regarding the concept of spiritual care (SC). More specifically, to identify, organise and prioritise experiences with the way SC is conceived and practised by professionals in research and the clinic. DESIGN: Group concept mapping (GCM). SETTING: The study was conducted within a university setting in Denmark. PARTICIPANTS: Researchers, students and clinicians working with SC on a daily basis in the clinic and/or through research participated in brainstorming (n=15), sorting (n=15), rating and validation (n=13). RESULTS: Applying GCM, ideas were identified, organised and prioritised online. A total of 192 unique ideas of SC were identified and organised into six clusters. The results were discussed and interpreted at a validation meeting. Based on input from the validation meeting a conceptual model was developed. The model highlights three overall themes: (1) 'SC as an integral but overlooked aspect of healthcare' containing the two clusters SC as a part of healthcare and perceived significance; (2) 'delivering SC' containing the three clusters quality in attitude and action, relationship and help and support, and finally (3) 'the role of spirituality' containing a single cluster. CONCLUSION: Because spirituality is predominantly seen as a fundamental aspect of each individual human being, particularly important during suffering, SC should be an integral aspect of healthcare, although it is challenging to handle. SC involves paying attention to patients' values and beliefs, requires adequate skills and is realised in a relationship between healthcare professional and patient founded on trust and confidence.

Second victims in the labor ward: Are Danish midwives and obstetricians getting the support they need?

OBJECTIVE: To describe midwives' and obstetricians' experiences on the level of support from colleagues and managers in Danish labor wards following adverse events. DESIGN, SETTING AND PARTICIPANTS: A 2012 National survey of Danish obstetricians and midwives was conducted to assess the level of support received in the workplace. MAIN OUTCOME MEASURES: Scales on social community at work, social support from colleagues and immediate superiors, and use of support mechanisms on labor wards after serious adverse events were assessed. RESULTS: 2098 midwives and obstetricians were invited to complete the survey (response rate 59%), and the analyses were carried out on the 593 respondents who had been involved in at least one traumatic childbirth at their current place of work. Respondents experienced high levels of social support from colleagues and social community at work, midwives significantly higher than obstetricians, and 95% of respondents had talked to colleagues about an adverse event. Respondents generally experienced low levels of social support and feedback from immediate superiors, and only 49% had talked to their immediate superior about an adverse event. Fifty% believed that the hospital had a clear process through which they could report adverse events, and 44% knew how to access the necessary confidential emotional support at work. CONCLUSIONS: Midwives and obstetricians experienced high levels of social support and feedback from colleagues who are the most frequent individuals to consult after adverse events. We strongly suggest developing second victim support programmes with a focus on offering peer support from qualified and trained peers.

Metabolic co-dependence drives the evolutionarily ancient Hydra-Chlorella symbiosis.

Many multicellular organisms rely on symbiotic associations for support of metabolic activity, protection, or energy. Understanding the mechanisms involved in controlling such interactions remains a major challenge. In an unbiased approach we identified key players that control the symbiosis between Hydra viridissima and its photosynthetic symbiont Chlorella sp. A99. We discovered significant up-regulation of Hydra genes encoding a phosphate transporter and glutamine synthetase suggesting regulated nutrition supply between host and symbionts. Interestingly, supplementing the medium with glutamine temporarily supports in vitro growth of the otherwise obligate symbiotic Chlorella, indicating loss of autonomy and dependence on the host. Genome sequencing of Chlorella sp. A99 revealed a large number of amino acid transporters and a degenerated nitrate assimilation pathway, presumably as consequence of the adaptation to the host environment. Our observations portray ancient symbiotic interactions as a codependent partnership in which exchange of nutrients appears to be the primary driving force.

A secreted antibacterial neuropeptide shapes the microbiome of Hydra.

Colonization of body epithelial surfaces with a highly specific microbial community is a fundamental feature of all animals, yet the underlying mechanisms by which these communities are selected and maintained are not well understood. Here, we show that sensory and ganglion neurons in the ectodermal epithelium of the model organism hydra (a member of the animal phylum Cnidaria) secrete neuropeptides with antibacterial activity that may shape the microbiome on the body surface. In particular, a specific neuropeptide, which we call NDA-1, contributes to the reduction of Gram-positive bacteria during early development and thus to a spatial distribution of the main colonizer, the Gram-negative Curvibacter sp., along the body axis. Our findings warrant further research to test whether neuropeptides secreted by nerve cells contribute to the spatial structure of microbial communities in other organisms.Certain neuropeptides, in addition to their neuromodulatory functions, display antibacterial activities of unclear significance. Here, the authors show that a secreted neuropeptide modulates the distribution of bacterial communities on the body surface during development of the model organism Hydra.

Guilt without fault: A qualitative study into the ethics of forgiveness after traumatic childbirth.

When a life is lost or severely impaired during childbirth, the midwife and obstetrician involved may experience feelings of guilt in the aftermath. Through three empirical cases, the paper examines the sense of guilt in the context of the current patient safety culture in healthcare where a blame-free approach is promoted in the aftermath of adverse events. The purpose is to illustrate how healthcare professionals may experience guilt without being at fault after adverse events, and Gamlund's theory on forgiveness without blame is used as the theoretical framework for this analysis. Philosophical insight has proven to be a useful resource in dealing with psychological issues of guilt and Gamlund's view on error and forgiveness elucidates an interesting dilemma in the field of traumatic events and medical harm in healthcare, where healthcare professionals experience that well-intended actions may cause injury, harm or even death to their patients. Failing to recognise and acknowledge guilt or guilty feelings may preclude self-forgiveness, which could have a negative impact on the recovery of midwives and obstetricians after adverse events. Developing and improving support systems for healthcare professionals is a multi-factorial task, and the authors suggest that the narrow focus on medico-legal and patient safety perspectives is complemented with moral philosophical perspectives to promote non-judgemental recognition and acknowledgement of guilt and of the fallible nature of medicine.

Back to the Basics: Cnidarians Start to Fire.

The nervous systems of cnidarians, pre-bilaterian animals that diverged close to the base of the metazoan radiation, are structurally simple and thus have great potential to reveal fundamental principles of neural circuits. Unfortunately, cnidarians have thus far been relatively intractable to electrophysiological and genetic techniques and consequently have been largely passed over by neurobiologists. However, recent advances in molecular and imaging methods are fueling a renaissance of interest in and research into cnidarians nervous systems. Here, we review current knowledge on the nervous systems of cnidarian species and propose that researchers should seize this opportunity and undertake the study of members of this phylum as strategic experimental systems with great basic and translational relevance for neuroscience.