Young adults' dynamic relationships with their families in early psychosis:Identifying relational strengths and supporting relational agency

OBJECTIVES: Most existing research on the family context of psychosis focuses on the 'burden' of caring for people experiencing psychosis. This research is the first to ask young people experiencing early psychosis to 'map' and describe their experiences and understandings of their family relationships, and how they have related to their psychosis and recovery. DESIGN: The research took an inductive, multimodal hermeneutic-phenomenological approach (Boden, Larkin & Iyer, 2019, Qual. Res. Psychology, 16, 218-236; Boden & Larkin, 2020, A handbook of visual methods in psychology, 358-375). METHOD: Ten young adults (18-23), under the care of early intervention in psychosis services in the UK, participated in an innovative relational mapping interview (Boden, Larkin & Iyer, 2018), which invited participants to draw a subjective 'map' of their important relationships. This visual methodology enables subtle, complex, ambivalent, and ambiguous aspects of the participants' experiences to be explored. RESULTS: Findings explore the participants' accounts of how they love, protect, and care for their families; how they wrestle with family ties as they mature; and their feelings about talking about their mental health with loved ones, which was typically very difficult. CONCLUSIONS: This paper advances understanding of recovery in psychosis through consideration of the importance of reciprocity, and the identification and nurturance of relational strengths. The capacity of a young person to withdraw or hold back when trying to protect others is understood as an example of relational agency. The possibility for extending strengths-based approaches and family work within the context of early intervention in psychosis services is discussed. PRACTITIONER POINTS: Young adults experiencing early psychosis may benefit from support to identify their relational strengths and the opportunities they have for reciprocity within their family structures, where appropriate. Relational motivations may be important for a range of behaviours, including social withdrawal and non-communication. Services may benefit from exploring the young person's relational context and subjective meaning-making in regard to these actions. Young adults experiencing early psychosis may benefit from opportunities to make sense of their family dynamics and how this impacts on their recovery. Attachment-based and relationally oriented interventions that increase trust and openness, and reduce feelings of burdensomeness are likely to support family functioning as well as individual recovery

Phase II trial of Modified Vaccinia Ankara (MVA) virus expressing 5T4 and high dose Interleukin-2 (IL-2) in patients with metastatic renal cell carcinoma

<p>Abstract</p> <p>Background</p> <p>Interleukin-2 (IL-2) induces durable objective responses in a small cohort of patients with metastatic renal cell carcinoma (RCC) but the antigen(s) responsible for tumor rejection are not known. 5T4 is a non-secreted membrane glycoprotein expressed on clear cell and papillary RCCs. A modified vaccinia virus Ankara (MVA) encoding 5T4 was tested in combination with high-dose IL-2 to determine the safety, objective response rate and effect on humoral and cell-mediated immunity.</p> <p>Methods</p> <p>25 patients with metastatic RCC who qualified for IL-2 were eligible and received three immunizations every three weeks followed by IL-2 (600,000 IU/kg) after the second and third vaccinations. Blood was collected for analysis of humoral, effector and regulatory T cell responses.</p> <p>Results</p> <p>There were no serious vaccine-related adverse events. While no objective responses were observed, three patients (12%) were rendered disease-free after nephrectomy or resection of residual metastatic disease. Twelve patients (48%) had stable disease which was associated with improved median overall survival compared to patients with progressive disease (not reached vs. 28 months, p = 0.0261). All patients developed 5T4-specific antibody responses and 13 patients had an increase in 5T4-specific T cell responses. Although the baseline frequency of Tregs was elevated in all patients, those with stable disease showed a trend toward increased effector CD8+ T cells and a decrease in Tregs.</p> <p>Conclusion</p> <p><b>V</b>accination with MVA-5T4 did not improve objective response rates of IL-2 therapy but did result in stable disease associated with an increase in the ratio of 5T4-specific effector to regulatory T cells in selected patients.</p> <p>Trial registration number</p> <p>ISRCTN83977250</p

Impressions: Whales and Human Relationship in Myth, Tradition and Law

The predicament of whales and whaling provides a focus for very different perspectives and a battle ground for a range of epistemic groups that are shaped and informed by multiple influences: myths, traditions, heritage, practices, ethics, laws and aspects of knowledge. These different perspectives are guarded and reinforced and provide the basis for validation of each group’s political stance within the International Whaling Commission and other regulatory fori dealing with the predicament of whales. In this chapter samples of these perspectives are examined as they relate particularly to controversial aspects of polar whaling where a low-key battle has been fought for some years now albeit with sporadic skirmishes rather than constant fighting. A key area for conflict is the granting by the IWC of aboriginal subsistence exemptions for whaling. Specific questions may be extracted from the political haze that beleaguers whaling politics. These include the need to define the meaning of “aboriginal” in the context of the loss of traditions and the developmental transitions of indigenous people and the need to determine the extent to which traditional whaling may cross-over from the status of "subsistence" to "commercial" . By examining aspects of the root perspectives and influences that relate to these questions it is hoped that some meaning may be discerned which may contribute to shortening, if only by minutes, the long days spent debating the fate of the great whales

Traditional agricultural landscapes as protected areas in international law and policy

The protected area approach to conservation of habitats and species emphasises a natural world shaped without human influence. Despite the debates relating to community conservation, stakeholder involvement in conservation and equitable benefit sharing, progressive approaches to community conservation tend to permit traditional agricultural practises, that support biodiversity preservation, to operate only in land outside core conservation areas. Nevertheless, there are many ingenious agricultural systems that have shaped novel, resilient landscapes for centuries and in so doing have also sustained high levels of biodiversity. The traditional practices deployed also constitute a wealth of unique cultural heritage. These systems are of such importance that they merit primary support in protected areas and should not be relegated to operate only in formal and informal buffer zones. Further, some of these systems may be internationally important and capable of fulfilling aspects of key global policy mandates established at the Earth and World Summits held respectively in Rio de Janeiro and Johannesbur