Cryptosporidium Priming Is More Effective than Vaccine for Protection against Cryptosporidiosis in a Murine Protein Malnutrition Model

Cryptosporidium is a major cause of severe diarrhea, especially in malnourished children. Using a murine model of C. parvum oocyst challenge that recapitulates clinical features of severe cryptosporidiosis during malnutrition, we interrogated the effect of protein malnutrition (PM) on primary and secondary responses to C. parvum challenge, and tested the differential ability of mucosal priming strategies to overcome the PM-induced susceptibility. We determined that while PM fundamentally alters systemic and mucosal primary immune responses to Cryptosporidium, priming with C. parvum (106 oocysts) provides robust protective immunity against re-challenge despite ongoing PM. C. parvum priming restores mucosal Th1-type effectors (CD3+CD8+CD103+ T-cells) and cytokines (IFNγ, and IL12p40) that otherwise decrease with ongoing PM. Vaccination strategies with Cryptosporidium antigens expressed in the S. Typhi vector 908htr, however, do not enhance Th1-type responses to C. parvum challenge during PM, even though vaccination strongly boosts immunity in challenged fully nourished hosts. Remote non-specific exposures to the attenuated S. Typhi vector alone or the TLR9 agonist CpG ODN-1668 can partially attenuate C. parvum severity during PM, but neither as effectively as viable C. parvum priming. We conclude that although PM interferes with basal and vaccine-boosted immune responses to C. parvum, sustained reductions in disease severity are possible through mucosal activators of host defenses, and specifically C. parvum priming can elicit impressively robust Th1-type protective immunity despite ongoing protein malnutrition. These findings add insight into potential correlates of Cryptosporidium immunity and future vaccine strategies in malnourished children

Towards successful coordination of electronic health record based-referrals: a qualitative analysis

<p>Abstract</p> <p>Background</p> <p>Successful subspecialty referrals require considerable coordination and interactive communication among the primary care provider (PCP), the subspecialist, and the patient, which may be challenging in the outpatient setting. Even when referrals are facilitated by electronic health records (EHRs) (<it>i.e</it>., e-referrals), lapses in patient follow-up might occur. Although compelling reasons exist why referral coordination <it>should </it>be improved, little is known about which elements of the complex referral coordination process should be targeted for improvement. Using Okhuysen & Bechky's coordination framework, this paper aims to understand the barriers, facilitators, and suggestions for improving communication and coordination of EHR-based referrals in an integrated healthcare system.</p> <p>Methods</p> <p>We conducted a qualitative study to understand coordination breakdowns related to e-referrals in an integrated healthcare system and examined work-system factors that affect the timely receipt of subspecialty care. We conducted interviews with seven subject matter experts and six focus groups with a total of 30 PCPs and subspecialists at two tertiary care Department of Veterans Affairs (VA) medical centers. Using techniques from grounded theory and content analysis, we identified organizational themes that affected the referral process.</p> <p>Results</p> <p>Four themes emerged: lack of an institutional referral policy, lack of standardization in certain referral procedures, ambiguity in roles and responsibilities, and inadequate resources to adapt and respond to referral requests effectively. Marked differences in PCPs' and subspecialists' communication styles and individual mental models of the referral processes likely precluded the development of a <it>shared </it>mental model to facilitate coordination and successful referral completion. Notably, very few barriers related to the EHR were reported.</p> <p>Conclusions</p> <p>Despite facilitating information transfer between PCPs and subspecialists, e-referrals remain prone to coordination breakdowns. Clear referral policies, well-defined roles and responsibilities for key personnel, standardized procedures and communication protocols, and adequate human resources must be in place before implementing an EHR to facilitate referrals.</p

Crowdsourcing Coordination: A Review and Research Agenda for Crowdsourcing Coordination Used for Macro-tasks

Crowdsourcing has become a widely accepted approach to leveraging the skills and expertise of others to accomplish work. Despite the potential of crowdsourcing to tackle complex problems, it has often been used to address simple micro-tasks. To tackle more complex macro-tasks, more attention is needed to better comprehend crowd coordination. Crowd coordination is defined as the synchronization of crowd workers in an attempt to direct and align their efforts in pursuit of a shared goal. The goal of this chapter is to advance our understanding of crowd coordination to tackle complex macro-tasks. To accomplish this, we have three objectives. First, we review popular theories of coordination. Second, we examine the current approaches to crowd coordination in the HCI and CSCW literature. Finally, the chapter identifies shortcomings in the literature and proposes a research agenda directed at advancing our understanding of crowd coordination needed to address complex macro-tasks.National Science Foundation grant CHS-1617820Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150620/1/Kim and Robert 2019 Preprint Chapter 2.pdfDescription of Kim and Robert 2019 Preprint Chapter 2.pdf : Preprint Versio

Interdisciplinary and transdisciplinary research: Finding the common ground of multi-faceted concepts

Inter- and transdisciplinarity are increasingly relevant concepts and practices within academia. While various definitions exist, a clear distinction between inter- and transdisciplinarity remains difficult. Although there is a wide consensus about the need to define and apply these approaches, there is no agreement over definitions. Building on data collected during the first year of the COST Action TD1408 “Interdisciplinarity in research programming and funding cycles” (INTREPID), this paper describes both tensions and common ground about the characteristics and building blocks of interand trans-disciplinarity. Drawing on empirical data from participatory workshops involving INTREPID network members coming from 27 different countries, the paper shows that diverse definitions of inter and trans-disciplinarity coexist within scientific literature and in the mind of researchers and practitioners. The understanding about the involvement of actors outside of academia also differs widely across scientific communities irrespective of disciplinary training or the research subjects. The focus should be on the knowledge that is required to deal with a specific problem, rather than discussing “if” and “how” to integrate actors outside the academia, and collaboration should start with joint problem framing. This diversity is, however, not an absolute obstacle to practice, since the latter is made possible through building blocks such as knowledge domains, problem- and solution- oriented approaches, common goals, as well as target knowledge. In order to move towards more effective inter- and transdisciplinary research, we identify the need for trained interdisciplinarity facilitators and ‘accompanying research’ (derived from the Danish term ‘følgeforskning’). These two roles can be essential to inter- and transdisciplinarity practices including the promotion of reflexivity

Time Matters in Team Performance: Effects of Member Familiarity, Entrainment, and Task Discontinuity on Speed and Quality

We compared the speed and quality of performance for familiar, initially unfamiliar but continuing, and one-shot (single session) teams. We also proposed and observed entrainment effects for task time limits. Over the course of weekly sessions with changing tasks, continuing teams reached speed levels of the initially familiar teams, but the one-shot teams were consistently slower. Continuing teams also tended to have higher-quality output than the one-shot teams. There were no differences in how quickly each type of group entrained to time limits on the tasks. Entrainment was not robust to task discontinuity (Task A, then B). However, entrainment on repeated trials of a task persisted even when a different type of task “interrupted” those repeated trials (Task A, then B, then A again). Results compel a richer incorporation of time as a medium for complex task sequences, and time-based constructs as a feature of team membership in the study of group effectiveness