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Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in trauma patients. The primary focus of treating TBI is to prevent additional injury to the damaged brain tissue, known as secondary brain injury. This treatment can include treating the body’s inflammatory response. Despite promise in animal models, anti-inflammatory therapy has failed to improve outcomes in human patients, suggesting a more targeted and precise approach may be needed. There is a bidirectional axis between the intestine and the brain that contributes to this inflammation in acute and chronic injury. The mechanisms for this interaction are not completely understood, but there is evidence that neural, inflammatory, endocrine, and microbiome signals all participate in this process. Therapies that target the intestine as a source of inflammation have potential to lessen secondary brain injury and improve outcomes in TBI patients, but to develop these treatments we need to better understand the mechanisms behind this intestinal inflammatory response.

The Institute of Medicine strongly recommends a health care system that supports family members. Nowhere is the need for family-centered care greater than with critically ill patients. Simplistically, family-centered care is primarily about communication. Unfortunately, family perception of communication in the intensive care unit (ICU) is quite poor. This article reviews some strategies to improve communication, including family meetings and family presence at resuscitation. It also highlights some of the areas within the realm of ICU care in which family engagement is particularly important, including advance directives, end-of-life care, brain death, and organ donation.

Invertebrate–dinoflagellate symbioses are responsible for the high productivity and structural complexity of the coral reef ecosystem. Coral reefs around the world are in decline with much of the mortality attributed to coral bleaching — the loss of photosynthetic algal symbionts — resulting from global warming [1–3]. These algae are essential to a host's survival, but many cnidarians must acquire their symbionts, members of the genus Symbiodinium referred to as zooxanthellae, anew at each generation.