Defining the experience: How do you know you are practicing Whole Person Care?

Introduction: Whole Person Care (WPC) is a growing movement in health care recognized as an important tool for both practitioners and patient outcomes. What remains unclear is what WPC looks like in practice and how providers know they are practicing it successfully. Methods: Researchers conducted in-depth interviews with 30 healthcare providers during the WPC congress in 2017. An iterative qualitative process was used to code and analyze the data using qualitative research software.The primary research question explored how practitioners know that they are practicing WPC. Results: Our analysis revealed that the practice of WPC is an individual experiential process appreciated through self-awareness and connection. Most practitioners reported the importance of i) their ability to be present in an interaction and to acknowledge their own emotions, ii) the relationship between practitioner and patient, characterized by a feeling of trust and of mutual impact, and iii) relying on external cues, such as explicit patient feedback and body language. In this workshop, attendees will be prompted to reflect on their experiences of providing WPC through individual and group exercises. Attendees will be invited to reflect on the above results and discuss emerging themes. This participatory research model creates an interactive space for workshop attendees to build on our data and guide further analysis. Conclusion: Cues to whether you are practicing WPC rely on practitioner self-awareness and perceptions of how interactions transpire. This workshop offers an opportunity to create an experiential map of the elements contributing to the growing practice of WPC.

FcγR-mediated SARS-CoV-2 infection of monocytes activates inflammation

SARS-CoV-2 can cause acute respiratory distress and death in some patients1. Although severe COVID-19 disease is linked to exuberant inflammation, how SARS-CoV-2 triggers inflammation is not understood2. Monocytes and macrophages are sentinel cells that sense invasive infection to form inflammasomes that activate caspase-1 and gasdermin D (GSDMD), leading to inflammatory death (pyroptosis) and release of potent inflammatory mediators3. Here we show that about 6% of blood monocytes in COVID-19 patients are infected with SARS-CoV-2. Monocyte infection depends on uptake of antibody-opsonized virus by Fcγ receptors. Vaccine recipient plasma does not promote antibody-dependent monocyte infection. SARS-CoV-2 begins to replicate in monocytes, but infection is aborted, and infectious virus is not detected in infected monocyte culture supernatants. Instead, infected cells undergo inflammatory cell death (pyroptosis) mediated by activation of NLRP3 and AIM2 inflammasomes, caspase-1 and GSDMD. Moreover, tissue-resident macrophages, but not infected epithelial and endothelial cells, from COVID-19 lung autopsies have activated inflammasomes. These findings taken together suggest that antibody-mediated SARS-CoV-2 uptake by monocytes/macrophages triggers inflammatory cell death that aborts production of infectious virus but causes systemic inflammation that contributes to COVID-19 pathogenesis

Using Play to Improve Infant Sleep: A Mixed Methods Protocol to Evaluate the Effectiveness of the Play2Sleep Intervention

BackgroundOne in four Canadian families struggle with infant sleep disturbances. The aim of this study is to evaluate Play2Sleep in families of infants with sleep disturbances. In addition to parental education on infant sleep, Play2Sleep uses examples from a video-recorded, structured play session with mothers and fathers separately to provide feedback on parent–infant interactions and their infant’s sleep-related social cues. The quantitative phase will answer the research question: Does one dose of Play2Sleep delivered during a home visit with mothers and fathers of infants aged 5 months reduce night wakings at age 7 months? The qualitative phase will answer the research question: What are parental perceptions of family experiences, processes, and contexts related to Play2Sleep and infant sleep? The overarching mixed methods research question is as follows: How do parental perceptions of family experiences, processes, and contexts related to infant sleep explain the effectiveness of Play2Sleep?Method and analysisAn explanatory sequential mixed methods design will be used. In the quantitative phase, a randomized controlled trial and RM-ANOVA will compare night wakings in infants whose parents receive Play2Sleep versus standard public health nursing information. Sixty English-speaking families (mothers and fathers) of full-term, healthy, singleton, 5-month-old infants who perceive that their infant has sleep disturbances will be recruited. The primary outcome measure will be change in the number of night wakings reported by parents. The qualitative component will use thematic analysis of family interviews to describe parental perceptions and experiences of infant sleep. Mixed methods integration will use qualitative findings to explain quantitative results.DiscussionPlay2Sleep is a novel approach that combines information about infant sleep with personalized feedback on parent–infant interactions and infant cues. Including fathers and mixed methods should capture complex family experiences of infant sleep disturbances and Play2Sleep. If effective, Play2Sleep has possible application for preventing infant sleep disturbance and tailoring for other populations.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT02742155. Registered on 2016 April 23

Genetic and functional characterization of the RTM-mediated resistance

International audienc

Genetic sex determination in three closely related hydrothermal vent gastropods, one of which has intersex individuals

Molluscs have a wide variety of sexual systems and have undergone many transitions from separate sexes to hermaphroditism or vice versa, which is of interest for studying the evolution of sex determination and differentiation. Following the serendipitous observation that sex was the primary driver of genetic structure in the hydrothermal vent gastropodAlviniconcha boucheti, we investigated sexual systems and sex determination in this species and two others of the same genus. We combined genome-wide multi-locus genotypes obtained from RAD sequencing with anatomical observations of the gonads of the threeAlviniconchaspecies occurring in the southwest Pacific Ocean:A. boucheti(n=207),A. strummeri(n=41 ind.) andA. kojimai(n=251). In two of the species (A. bouchetiandA. strummeri), the sexes are separate and genetically determined by a male-heterogametic (XY) system. External observation of the gonads in the third species (A. kojimai) also suggested that the sexes were separate, but histological analyses revealed that 76% of the individuals classified as females from external observation of the gonads presented a mosaic of male and female reproductive tissue. Empirical analyses and simulations showed nonetheless that 14 RAD loci were sex-linked with an XY signature inA. kojimai(as compared with 64 inA. strummeriand 373 inA. boucheti). Comparison across species and mapping of RAD loci to a non-contiguous reference genome assembly of the related speciesA. marisindicashowed that all sex-linked loci identified inA. kojimaiare located on five scaffolds that also contain 25 and 73 sex-linked RAD loci in the other two species, respectively. These results suggest that all threeAlviniconchaspecies share the same XY sex determination system, but that the gonad of XXA. kojimaiindividuals are invaded by a variable proportion of male reproductive tissue. It remains to be seen whether the male tissue in these intersex individuals is functional or not. This situation of three species showing variation in gonadal development around a probably common sex determination system provides new insights into the reproductive mode of poorly known deep-sea species and questions the evolution of gametogenetic polymorphism in these species