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Inhibitors of the arginine-vasopressin (AVP) V2 receptor (V2R) are key therapeutic compounds for treating hyponatremia or polycystic kidney diseases. Rational drug design based on experimental G protein-coupled receptor structures is a powerful avenue to develop better drugs. So far, the lack of inhibitor-bound V2R structures has impaired this strategy. Here we describe the cryo-electron microscopy structures of the V2R in complex with two selective inverse agonists, the non-peptide Tolvaptan (TVP) and the green mamba snake Mambaquaretin toxin (MQ1). Both ligands bind into the orthosteric binding site but with substantial differences. TVP binds deeper than MQ1, and directly contacts the toggle switch residue W2846.48 in the transmembrane domain 6. The Kunitz-fold toxin displays extensive contacts with extracellular and transmembrane residues. As anticipated from TVP and MQ1 pharmacological properties, both structures represent inactive V2R conformations. Their comparison with those of the active AVP-bound V2R reveals the molecular mechanisms modulating receptor activity. The mini-protein MQ1-bound V2R structure suggests a new pharmacology approach for treating water homeostasis and renal diseases.

The Great Curassow (Crax rubra) is an endangered species in Costa Rica due to habitat loss and hunting pressure. Little is known about the spatial ecology of cracids and there is a need to assess their distribution to establish efficient conservation strategies. In this study, we integrated camera trapping data with occupancy models to examine landscape factors that affect the distribution of the Great Curassow in the San Juan-La Selva Biological Corridor in Northeastern Costa Rica. We established remote camera traps at 38 sites within the corridor between July 2009 and July 2011. The Great Curassow was detected on 56 occasions at 19 of the 38 sites. Eight of the 19 occupancy models contained plausible support to predict Great Curassow occurrence, but distance to villages and forest cover were the most important factors positively related to their occurrence. These results suggest the distribution of the Great Curassow is largely susceptible to forest loss and human disturbance in the corridor. Both camera traps and occupancy analyses are useful tools to study medium to large terrestrial birds in the Neotropics.

Historically, research involving Indigenous peoples has been the scene of power imbalances between Indigenous communities and researchers. Indigenous peoples have often been put in the position of passive subjects of research rather than participants or collaborators with agency, a situation that the current movement of decolonisation of research and practices in the field of Indigenous health aims to counteract. Participatory research seeks a better balance of input, decision-making and power between research participants and research teams and values participants' knowledges. As such, it is a particularly relevant approach for researchers to involve community members and support self-determination of Indigenous people. Yet, if its explicit intentions are aiming at a decolonising approach, the socio-structural context of participatory research initiatives in Indigenous communities brings obstacles to the approach's success. The development and implementation of the participatory project Atautsikut: A Community of Practice in Youth Mental Health and Wellness in Nunavik, has been an occasion to document certain barriers that take place in participatory research. This article describes Atautsikut as a starting point for a reflection on the challenges of decolonising participatory research. It discusses how, despite intentions, structural barriers, blind spots and unexpected contextual elements may challenge the journey towards decolonising research.

This article presents an analysis of the lived experiences of youth mental health practitioners taking part in Transcultural Interinstitutional and Interdisciplinary Case Discussion Seminars (TIICDS), an intercultural training initiative developed in Montréal (Québec, Canada), while considering the current context of increasing social polarizations. Using insights from the community of practice (CoP) framework and drawing on the analysis of 21 seminar sessions and 26 semi-structured individual interviews, this article examines the relation between the local sociopolitical context, the participants’ verbalization about their identities, and the affect and cognition evoked by the training. Results indicate that TIICDSs present several features of a CoP and that intercultural training needs to build on both theoretical and experiential knowledge, while considering local contextual elements. These include historical and contemporary social representations and power differentials between groups, the cultural identities of trainees, and the institutions and sociopolitical structures in which clinical practices take place. These elements, we argue, are sensitive and potentially conflictual but can be addressed through supportive and reflexive group-based initiatives such as CoPs that bring together practitioners on a regular basis and provide them with a ‘culturally safe enough’ space in which they can learn to complexify their understanding of clinical situations.

BackgroundAlthough the literature in medical anthropology and transcultural psychiatry has documented how cultural representations shape individual experiences and perceptions of psychosocial distress and its management, less attention has been given to what is actually meant when the concept of culture is used in professional practice, and how this may influence experience of care.ObjectiveThe objective of this article is to explore what understandings of culture circulate in youth mental health practitioners’ and families’ narratives, and to analyse how different operationalizations of the concept may affect experience of services.MethodsThis article draws upon the qualitative components of a larger mixed-methods research program on collaborative care in youth mental health. Semi-structured interviews were conducted in Montréal (Québec, Canada) with 39 parents, 48 youths and 29 practitioners about their experience of services, and with 26 practitioners about their experience of intercultural training. Data was analyzed using thematic and narrative approaches.ResultsResults show that families and practitioners use a multiplicity of understandings of the concept of culture in their discourses as a narrative strategy to mediate dialogue in clinical encounters, either by engaging in it, avoiding it, or refusing it.ConclusionsThe concept of culture and its use in the clinical realm can be seen a double-edged sword, both as a tool to reify stereotypes and inequalities, and as a means to mobilize representations towards cultural safety and transformative practices. Minority families’ experiences of services may be improved by providing intercultural training and a supportive work environment to clinicians.

Youth mental health (YMH) services are greatly underutilized, particularly for migrant youth. Collaborative models of care offer promising avenues, but research on these treatment modalities is still scarce, particularly for migrants. The goal of this exploratory study is to better understand quality of care including factors improving access to care and collaborative YMH services use, efficacy and satisfaction, for this vulnerable population. This qualitative study relies on a multi-informants (youth, parents, clinicians) and multiple case study design to explore YMH collaborative services for migrant youth living in an urban setting (Montreal, Canada). Participants are five young patients (12–15 years old), one of their parents and their primary care therapist ( N  = 15). They come from migrant families, have a psychiatric diagnosis and have been receiving mental health services in a collaborative care setting for at least 6 months. Transcripts of semi-structured interviews for the five triads were thematically analyzed to draw similarities and contrasts between actors, across and within case-studies. Based on these findings, four themes emerged concerning the optimal care setting for collaborative YMH services for migrant families: (1) providing an equilibrium between communication, collaboration and privacy/confidentiality, (2) special attention to ensuring the continuity of care and the creation of a welcoming environment where trusting relationships can develop, (3) the inclusion of family intervention, and (4) the provision of collaborative decision-making pathways to care, addressing interprofessional and interinstitutional collaboration as well as cultural differences in explanatory models and values.

Abstract Background: Inhaler technique and patient preferences are often overlooked when selecting maintenance treatments for patients with chronic obstructive pulmonary disease (COPD), but are important issues in ensuring drug efficacy and patient adherence. Few data on these issues are available for new inhalation devices. Objectives: To evaluate the inhalation techniques for the HandiHaler®, Breezhaler®, Genuair®, and Respimat® inhalation devices, and patient preferences for the three latter inhalers that were recently developed. Methods: A prospective two-center cross-sectional study of COPD patients was conducted. The patients were required to be current HandiHaler users who had not previously used the new inhalers (Breezhaler, Genuair, Respimat). The patients were given the new devices and asked to identify the one they preferred before and after using the inhaler. Each patient tried the HandiHaler and two devices out of the three new inhalers: one preferred by the patient and one imposed by the investigator. Their inhalation technique was evaluated using an assessment checklist. A logistic regression model was used to determine which device was used with the fewest errors. Results: Of the 98 patients who completed the study, 57.1% (95% CI: 47.4–66.9) had an adequate HandiHaler technique. There was no difference between the proportions of patients with an adequate Breezhaler and Genuair inhalation technique (aOR 1.08, 95% CI: 0.51–2.30), but 62% fewer patients using Respimat had an adequate technique than those using Genuair (aOR for adequate technique 0.38, 95% CI: 0.18–0.82). There were no significant differences in the initial patient preferences for the three new inhalers, and no association between the patient's preference and an adequate inhaler technique. Conclusion: Inhalation techniques were suboptimal and varied between inhalers. The arrival of new inhalers is an opportunity to reassess patient techniques and preferences. Further studies should also explore the association between the inhaler preferences and treatment adherence of patients.