SH2D1A Regulates T-dependent Humoral Autoimmunity

The signaling lymphocytic activation molecule (SLAM)/CD150 family includes a family of chromosome 1–encoded cell surface molecules with costimulatory functions mediated in part by the adaptor protein SH2D1A (SLAM-associated protein, SAP). Deficiency in SH2D1A protects mice from an experimental model of lupus, including the development of hypergammaglobulinemia, autoantibodies including anti–double stranded DNA, and renal disease. This protection did not reflect grossly defective T or B cell function per se because SH2D1A-deficient mice were susceptible to experimental autoimmune encephalomyelitis, a T cell–dependent disease, and they were capable of mounting normal T-independent antigen-specific immunoglobulin responses. Instead, T-dependent antibody responses were impaired in SH2D1A-deficient mice, reflecting defective germinal center formation. These findings demonstrate a specific role for the SLAM–SH2D1A system in the regulation of T-dependent humoral immune responses, implicating members of the CD150–SH2D1A family as targets in the pathogenesis and therapy of antibody-mediated autoimmune and allergic diseases

Characteristics of the National Applicant Pool for Clinical Informatics Fellowships (2016-2017)

We conducted a national study to assess the numbers and diversity of applicants for 2016 and 2017 clinical informatics fellowship positions. In each year, we collected data on the number of applications that programs received from candidates who were ultimately successful vs. unsuccessful. In 2017, we also conducted an anonymous applicant survey. Successful candidates applied to an average of 4.2 and 5.5 programs for 2016 and 2017, respectively. In the survey, unsuccessful candidates reported applying to fewer programs. Assuming unsuccessful candidates submitted between 2-5 applications each, the total applicant pool numbered 42-69 for 2016 (competing for 24 positions) and 52-85 for 2017 (competing for 30 positions). Among survey respondents (n=33), 24% were female, 1 was black and none were Hispanic. We conclude that greater efforts are needed to enhance interest in clinical informatics among medical students and residents, particularly among women and members of underrepresented minority groups

Inpatient Telehealth Experience of Patients With Limited English Proficiency: Cross-sectional Survey and Semistructured Interview Study

BackgroundPatients with limited English proficiency (LEP) are at a higher risk of poor health outcomes and are less likely to use telehealth than English-speaking patients. To date, there is no formal evaluation of inpatient (IP) telehealth user experience of patients and their families by language preference during visits with their clinicians. ObjectiveThis study aims to compare the experiences of English- and Spanish-speaking patients and their families using IP telehealth, as well as to evaluate the experience of Spanish interpreters providing services through IP telehealth. MethodsWe prospectively administered a survey to English- and Spanish-speaking patients and their families who used IP telehealth from October 1, 2020, to March 31, 2021. We performed semistructured phone interviews of hospital-based Spanish interpreters who provided services through IP telehealth. ResultsA total of 661 surveys were administered, with completion rates of 18% (112/621) in English and 62% (25/40) in Spanish. On a 10-point scale, the overall satisfaction of Spanish speakers (median 10, IQR 10-10) was higher than that of English speakers (median 9, IQR 8-10; P=.001). Both English- and Spanish-speaking patients used IP telehealth for visits with their primary IP care team, subspecialty consultants, and other clinicians. Hospital tablets were used more often than personal devices, and only English-speaking patients used personal laptops. Patients and their families encountered challenges with log-in, team coordination with multiple users, and equipment availability. Interpreters encountered challenges with audio and video quality, communication, safety, and Wi-Fi access. ConclusionsBoth English- and Spanish-speaking patients reported high satisfaction using IP telehealth across multiple disciplines despite the workflow challenges identified by interpreters. Significant investment is needed to provide robust infrastructure to support use by all patients, especially the integration of multiple users to provide interpreter services for patients with LEP

Paging the Clinical Informatics Community: Respond STAT to Dobbs v Jackson's Women's Health Organization

If the coronavirus disease 2019 (COVID-19) pandemic was a wake-up call that clinical informatics and digital health play vital roles in our future, the 2022 U.S. Supreme Court ruling in Dobbs v. Jackson Women's Health Organization (Dobbs)[1] is a blaring alarm. Dobbs, which overturned Roe v Wade and Planned Parenthood v. Casey, allows states to individually regulate access to abortion. This ruling has triggered the enforcement of existing state laws that ban or restrict abortion and efforts to pass similar new laws

Preliminary design of the COMPASS upgrade tokamak

COMPASS Upgrade is a new medium size, high magnetic field tokamak (R = 0.9 m, Bt = 5 T, Ip = 2 MA) currently under design in the Czech Republic. It will provide unique capabilities for addressing some of the key challenges in plasma exhaust physics, advanced confinement modes and advanced plasma configurations as well as testing new plasma facing materials and liquid metal divertor concepts. This paper contains an overview of the preliminary engineering design of the main systems of the COMPASS Upgrade tokamak (vacuum vessel, central solenoid and poloidal field coils, toroidal field coils, support structure, cryostat, cryogenic system, power supply system and machine monitoring and protection system). The description of foreseen auxiliary plasma heating systems and plasma diagnostics is also provided as well as a summary of expected plasma performance and available plasma configurations

Overview of the COMPASS results

COMPASS addressed several physical processes that may explain the behaviour of important phenomena. This paper presents results related to the main fields of COMPASS research obtained in the recent two years, including studies of turbulence, L–H transition, plasma material interaction, runaway electron, and disruption physics: • Tomographic reconstruction of the edge/SOL turbulence observed by a fast visible camera allowed to visualize turbulent structures without perturbing the plasma. • Dependence of the power threshold on the X-point height was studied and related role of radial electric field in the edge/SOL plasma was identified. • The effect of high-field-side error fields on the L–H transition was investigated in order to assess the influence of the central solenoid misalignment and the possibility to compensate these error fields by low-field-side coils. • Results of fast measurements of electron temperature during ELMs show the ELM peak values at the divertor are around 80% of the initial temperature at the pedestal. • Liquid metals were used for the first time as plasma facing material in ELMy H-mode in the tokamak divertor. Good power handling capability was observed for heat fluxes up to 12 MW m−2 and no direct droplet ejection was observed. • Partial detachment regime was achieved by impurity seeding in the divertor. The evolution of the heat flux footprint at the outer target was studied. • Runaway electrons were studied using new unique systems—impact calorimetry, carbon pellet injection technique, wide variety of magnetic perturbations. Radial feedback control was imposed on the beam. • Forces during plasma disruptions were monitored by a number of new diagnostics for vacuum vessel (VV) motion in order to contribute to the scaling laws of sideways disruption forces for ITER. • Current flows towards the divertor tiles, incl. possible short-circuiting through PFCs, were investigated during the VDE experiments. The results support ATEC model and improve understanding of disruption loads