Communication Among Multidisciplinary Team Members Treating Patients with Disorders of Consciousness Following Traumatic Brain Injury

The purpose of this research is to understand how clinicians who work with patients with disorders of consciousness (DoC) following traumatic brain injury (TBI) communicate about patients’ behavior regarding changes in consciousness. Communication and collaboration among multidisciplinary teams is central for person-centered rehabilitation and clinical progress. A deficiency in person-centeredness may decrease the quality of care a patient receives (Epstein & Street, 2007). This process is more complicated in patients with DoC since these patients are unable to participate in the dialog (Papadimitriou & Cott, 2015). This qualitative analysis explores unique challenges clinicians face communicating with team members when treating patients with DoC following TBI in inpatient rehabilitation. A grounded theory interview study explored how clinician’s perceive they communicate patients’ changes in consciousness with team members (Green & Thorogood, 2014). Three hospital systems recruited twenty-one clinicians who have experience working with DoC patients. Clinicians participated in semi-structured interviews with two trained interviewers. Interviews were audio-recorded, transcribed verbatim, and NVivo 11 Plus software was used for open coding. The team developed a codebook using thematic analysis and constant comparative strategies to finalize the codebook (Glaser, 1965). Three major themes emerged: 1) clinicians’ difficulty interpreting patients’ behaviors of change in consciousness, 2) a lack of confidence when selecting a treatment, and 3) an uncertainty of how to leverage caregivers’ interpretation of patients’ behaviors. For example, the data describes challenges clinical teams face in discharge planning. A social worker perceives the caregiver to agree on what it takes to bring their family member home while the occupational therapist did not share this perception. The social worker tried to convey to the team that the caregiver was equipped to take the patient home, “I was turning blue in the face communicating to the team that I did strongly feel that his [caregiver] had a reasonable expectation and an understanding of the severity of his deficit”. This exemplifies how each discipline has a different vantage point surrounding a complex task such as discharge planning. Communication challenges for clinicians treating patients with DoC were grounded within the three themes, which conveyed uncertainty with interpreting patients’ behaviors and linking it to clinical progress, a lack of research to support interventions, and being cautious when talking to family. Uncovering how clinicians make sense of patient’s behaviors and how they communicate these behaviors can aide in creating a foundation for improving the exchange of information and person-centered rehabilitation

Neurobehavioral Function in Adults Recovering Consciousness after Severe Traumatic Brain Injury: A Scoping Review

This scoping review aims to report the findings of current literature examining the assessment of neurobehavioral function and recovery along the continuum of disorders of consciousness (DOC) from coma to full consciousness. •This study is designed to capture the range of constructs researchers have used to measure NBF during recovery of consciousness. •The research question for this review was: “What constructs are most frequently used to assess neurobehavioral function in adults recovering consciousness after severe TBI?

An injectable bone marrow-like scaffold enhances T cell immunity after hematopoietic stem cell transplantation.

Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for multiple disorders, but deficiency and dysregulation of T cells limit its utility. Here we report a biomaterial-based scaffold that mimics features of T cell lymphopoiesis in the bone marrow. The bone marrow cryogel (BMC) releases bone morphogenetic protein-2 to recruit stromal cells and presents the Notch ligand Delta-like ligand-4 to facilitate T cell lineage specification of mouse and human hematopoietic progenitor cells. BMCs subcutaneously injected in mice at the time of HSCT enhanced T cell progenitor seeding of the thymus, T cell neogenesis and diversification of the T cell receptor repertoire. Peripheral T cell reconstitution increased ~6-fold in mouse HSCT and ~2-fold in human xenogeneic HSCT. Furthermore, BMCs promoted donor CD4+ regulatory T cell generation and improved survival after allogeneic HSCT. In comparison to adoptive transfer of T cell progenitors, BMCs increased donor chimerism, T cell generation and antigen-specific T cell responses to vaccination. BMCs may provide an off-the-shelf approach for enhancing T cell regeneration and mitigating graft-versus-host disease in HSCT

Predictors of Unprotected Sex Among Female Sex Workers in Madagascar: Comparing Semen Biomarkers and Self-Reported Data

Research on the determinants of condom use and condom non-use generally has relied on self-reported data with questionable validity. We identified predictors of recent, unprotected sex among 331 female sex workers in Madagascar using two outcome measures: self-reports of unprotected sex within the past 48 h and detection of prostate-specific antigen (PSA), a biological marker of recent semen exposure. Multivariable logistic regression revealed that self-reported unprotected sex was associated with three factors: younger age, having a sipa (emotional partner) in the prior seven days, and no current use of hormonal contraception. The sole factor related to having PSA detected was prevalent chlamydial infection (adjusted odds ratio, 4.5; 95% confidence interval, 2.0–10.1). Differences in predictors identified suggest that determinants of unprotected sex, based on self-reported behaviors, might not correlate well with risk of semen exposure. Caution must be taken when interpreting self-reported sexual behavior measures or when adjusting for them in analyses evaluating interventions for the prevention of HIV/STIs

High rate of subclinical chikungunya virus infection and association of neutralizing antibody with protection in a prospective cohort in the Philippines.

BACKGROUND: Chikungunya virus (CHIKV) is a globally re-emerging arbovirus for which previous studies have indicated the majority of infections result in symptomatic febrile illness. We sought to characterize the proportion of subclinical and symptomatic CHIKV infections in a prospective cohort study in a country with known CHIKV circulation. METHODS/FINDINGS: A prospective longitudinal cohort of subjects ≥6 months old underwent community-based active surveillance for acute febrile illness in Cebu City, Philippines from 2012-13. Subjects with fever history were clinically evaluated at acute, 2, 5, and 8 day visits, and at a 3-week convalescent visit. Blood was collected at the acute and 3-week convalescent visits. Symptomatic CHIKV infections were identified by positive CHIKV PCR in acute blood samples and/or CHIKV IgM/IgG ELISA seroconversion in paired acute/convalescent samples. Enrollment and 12-month blood samples underwent plaque reduction neutralization test (PRNT) using CHIKV attenuated strain 181/clone25. Subclinical CHIKV infections were identified by ≥8-fold rise from a baseline enrollment PRNT titer 50 years old. Baseline CHIKV PRNT titer ≥10 was associated with 100% (95%CI: 46.1, 100.0) protection from symptomatic CHIKV infection. Phylogenetic analysis demonstrated Asian genotype closely related to strains from Asia and the Caribbean. CONCLUSIONS: Subclinical infections accounted for a majority of total CHIKV infections. A positive baseline CHIKV PRNT titer was associated with protection from symptomatic CHIKV infection. These findings have implications for assessing disease burden, understanding virus transmission, and supporting vaccine development

An expansive human regulatory lexicon encoded in transcription factor footprints.

Regulatory factor binding to genomic DNA protects the underlying sequence from cleavage by DNase I, leaving nucleotide-resolution footprints. Using genomic DNase I footprinting across 41 diverse cell and tissue types, we detected 45 million transcription factor occupancy events within regulatory regions, representing differential binding to 8.4 million distinct short sequence elements. Here we show that this small genomic sequence compartment, roughly twice the size of the exome, encodes an expansive repertoire of conserved recognition sequences for DNA-binding proteins that nearly doubles the size of the human cis-regulatory lexicon. We find that genetic variants affecting allelic chromatin states are concentrated in footprints, and that these elements are preferentially sheltered from DNA methylation. High-resolution DNase I cleavage patterns mirror nucleotide-level evolutionary conservation and track the crystallographic topography of protein-DNA interfaces, indicating that transcription factor structure has been evolutionarily imprinted on the human genome sequence. We identify a stereotyped 50-base-pair footprint that precisely defines the site of transcript origination within thousands of human promoters. Finally, we describe a large collection of novel regulatory factor recognition motifs that are highly conserved in both sequence and function, and exhibit cell-selective occupancy patterns that closely parallel major regulators of development, differentiation and pluripotency

GLOBE Observer Data: 2016–2019

This technical report summarizes the GLOBE Observer data set from 1 April 2016 to 1 December 2019. GLOBE Observer is an ongoing NASA‐sponsored international citizen science project that is part of the larger Global Learning and Observations to Benefit the Environment (GLOBE) Program, which has been in operation since 1995. GLOBE Observer has the greatest number of participants and geographic coverage of the citizen science projects in the Earth Science Division at NASA. Participants use the GLOBE Observer mobile app (launched in 2016) to collect atmospheric, hydrologic, and terrestrial observations. The app connects participants to satellite observations from Aqua, Terra, CALIPSO, GOES, Himawari, and Meteosat. Thirty‐eight thousand participants have contributed 320,000 observations worldwide, including 1,000,000 georeferenced photographs. It would take an individual more than 13 years to replicate this effort. The GLOBE Observer app has substantially increased the spatial extent and sampling density of GLOBE measurements and more than doubled the number of measurements collected through the GLOBE Program. GLOBE Observer data are publicly available (at observer.globe.gov)

The accessible chromatin landscape of the human genome

DNaseI hypersensitive sites (DHSs) are markers of regulatory DNA and have underpinned the discovery of all classes of cis-regulatory elements including enhancers, promoters, insulators, silencers, and locus control regions. Here we present the first extensive map of human DHSs identified through genome-wide profiling in 125 diverse cell and tissue types. We identify ~2.9 million DHSs that encompass virtually all known experimentally-validated cis-regulatory sequences and expose a vast trove of novel elements, most with highly cell-selective regulation. Annotating these elements using ENCODE data reveals novel relationships between chromatin accessibility, transcription, DNA methylation, and regulatory factor occupancy patterns. We connect ~580,000 distal DHSs with their target promoters, revealing systematic pairing of different classes of distal DHSs and specific promoter types. Patterning of chromatin accessibility at many regulatory regions is choreographed with dozens to hundreds of co-activated elements, and the trans-cellular DNaseI sensitivity pattern at a given region can predict cell type-specific functional behaviors. The DHS landscape shows signatures of recent functional evolutionary constraint. However, the DHS compartment in pluripotent and immortalized cells exhibits higher mutation rates than that in highly differentiated cells, exposing an unexpected link between chromatin accessibility, proliferative potential and patterns of human variation

A Kinome RNAi Screen Identified AMPK as Promoting Poxvirus Entry through the Control of Actin Dynamics

Poxviruses include medically important human pathogens, yet little is known about the specific cellular factors essential for their replication. To identify genes essential for poxvirus infection, we used high-throughput RNA interference to screen the Drosophila kinome for factors required for vaccinia infection. We identified seven genes including the three subunits of AMPK as promoting vaccinia infection. AMPK not only facilitated infection in insect cells, but also in mammalian cells. Moreover, we found that AMPK is required for macropinocytosis, a major endocytic entry pathway for vaccinia. Furthermore, we show that AMPK contributes to other virus-independent actin-dependent processes including lamellipodia formation and wound healing, independent of the known AMPK activators LKB1 and CaMKK. Therefore, AMPK plays a highly conserved role in poxvirus infection and actin dynamics independent of its role as an energy regulator