Targeted parents’ perspective on the development of Parental Alienation: A grounded theory study

Parental alienation (PA) is a child’s unjustified rejection of a previously loved parent in the context of high-conflict divorce and child custody disputes. PA remains a significant problem for clinicians and judiciaries in the UK, due to definitional controversies and limited available research. Research on PA from the perspective of targeted parents has just started providing some insight on people’s experiences but has not adequately explored the psychological underpinnings of PA. The concept still stands outside developmental theory, thus impeding the provision of appropriate guidelines and interventions to support families that experience PA. PA can have devastating effects on both children and targeted parents and it is, therefore, important to shed more light on its mechanisms. The current study intended to fill this gap and explored the process of development of PA from the perspective of targeted parents. Nine parents, who self-identified as targeted parents participated in the study. Parents were recruited mainly from organisations and community groups, known to provide advocacy and support to targeted parents. One-off interviews were conducted with participants. Some of them were contacted again at a later point to provide additional written data. Constructive Grounded Theory was utilised for the data collection and analysis. The analysis was conducted following an iterative process of constant comparison, which led to the construction of a theoretical model, grounded in the data. The model integrates multiple interconnected intrapersonal, relational, intergenerational, and systemic factors that contribute to the development and perpetuation of PA. Findings are considered in relation to existing literature and implications for future research and clinical practice are discussed. It is hoped that the theoretical model suggested can contribute to prompt identification and assessment of families that are experiencing or are at risk of developing PA, as well as inform the clinical and socio-legal management of PA

Duration of remission after halving of the etanercept dose in patients with ankylosing spondylitis: a randomized, prospective, long-term, follow-up study

Fabrizio Cantini, Laura Niccoli, Emanuele Cassarà, Olga Kaloudi, Carlotta NanniniDivision of Rheumatology, Misericordia e Dolce Hospital, Prato, ItalyBackground: The aim of this study was to evaluate the proportion of patients with ankylosing spondylitis maintaining clinical remission after reduction of their subcutaneous etanercept dose to 50 mg every other week compared with that in patients receiving etanercept 50 mg weekly.Methods: In the first phase of this randomized, prospective, follow-up study, all biologic-naïve patients identified between January 2005 and December 2009 as satisfying the modified New York clinical criteria for ankylosing spondylitis treated with etanercept 50 mg weekly were evaluated for disease remission in January 2010. In the second phase, patients meeting the criteria for remission were randomized to receive subcutaneous etanercept as either 50 mg weekly or 50 mg every other week. The randomization allocation was 1:1. Remission was defined as Bath Ankylosing Spondylitis Disease Activity Index < 4, no extra-axial manifestations of peripheral arthritis, dactylitis, tenosynovitis, or iridocyclitis, and normal acute-phase reactants. The patients were assessed at baseline, at weeks 4 and 12, and every 12 weeks thereafter. The last visit constituted the end of the follow-up.Results: During the first phase, 78 patients with ankylosing spondylitis (57 males and 21 females, median age 38 years, median disease duration 12 years) were recruited. In January 2010, after a mean follow-up of 25 ± 11 months, 43 (55.1%) patients achieving clinical remission were randomized to one of the two treatment arms. Twenty-two patients received etanercept 50 mg every other week (group 1) and 21 received etanercept 50 mg weekly (group 2). At the end of follow-up, 19 of 22 (86.3%) subjects in group 1 and 19 of 21 (90.4%) in group 2 were still in remission, with no significant difference between the two groups. The mean follow-up duration in group 1 and group 2 was 22 ± 1 months and 21 ± 1.6 months, respectively.Conclusion: Remission of ankylosing spondylitis is possible in at least 50% of patients treated with etanercept 50 mg weekly. After halving of the etanercept dose, remission is maintained in a high percentage of patients during long-term follow-up, with important economic implications.Keywords: ankylosing spondylitis, anti-tumor necrosis factor, etanercept, remission, dose reductio

Η ανάπτυξη επικοινωνιακών δεξιοτήτων στο μάθημα της Γλώσσας της ΣΤ΄ Δημοτικού

Η βιωματική εκπαίδευση επενδύει στην αμφίδρομη και ισχυρή σχέση που αναπτύσσεται μεταξύ μάθησης και εμπειρίας. Μια διδασκαλία που βασίζεται στις αρχές της βιωματικής εκπαίδευσης προσεγγίζει τους μαθητές με έναν τρόπο που τους ωθεί στην ενεργό συμμετοχή, τη δράση, την προσωπική εμπλοκή, την ενσυναίσθηση και τη δημιουργία. Οι μαθητές καλό είναι να αντιμετωπίζονται ως ξεχωριστές και μοναδικές προσωπικότητες, με διαφορετικές ικανότητες και διαφοροποιημένες ανάγκες. Η παρούσα εργασία παρουσιάζει μια σειρά από βιωματικές δραστηριότητες, σχεδιασμένες για το μάθημα της Γλώσσας της Στ΄ Δημοτικού και, ειδικότερα, για την Ενότητα 17 («Πόλεμος και Ειρήνη»). Προτείνεται ένας εναλλακτικός τρόπος προσέγγισης και διδασκαλίας της παραπάνω ενότητας, με στόχο να μεταφερθεί η διαδικασία της παραγωγής της γνώσης στους μαθητές, οι οποίοι καλούνται να συνεργαστούν, να σκεφτούν κριτικά, να επιχειρηματολογήσουν, να ευαισθητοποιηθούν, να συνθέσουν και να προβληματιστούν σχετικά με το αντικείμενο της μάθησης. Η εργασία σχεδιάστηκε εν είδει ενός οδηγού πρακτικής εφαρμογής για όσους εκπαιδευτικούς επιθυμούν να καλλιεργήσουν τις επικοινωνιακές δεξιότητες των μαθητών τους.Experiential education («Learning by doing» method) is investing in interactive and powerful relationship that develops between learning and experience. A teaching based on the principles of experiential education approaches students in a way that empowers them to active participation, action, personal engagement, empathy and creation. Students should be treated as distinct and unique personalities, with different abilities and differentiated needs. This paper presents a series of experiential activities, designed for the 6th Elementary Language lesson and, in particular, for Section 17 ("War and Peace"). An alternative way of approaching and teaching the above module is proposed in order to transfer the knowledge production process to the students, who are called to work together, to think critically, to argue, to raise awareness, to synthesize and to reflect on the subject of learning. The motivation for writing this work was the personal desire to design a comprehensive practical application guide for those who wish to cultivate the communication skills of their students individually

Η πρόσφατη νομολογία του Διαμερικανικού Δικαστηρίου για το Περιβάλλον και τα Ανθρώπινα Δικαιώματα (Γνωμοδότηση OC-23/17)

Η παρούσα εργασία πραγματεύεται το ζήτημα της σχέσης των ανθρωπίνων δικαιωμάτων με την περιβαλλοντική προστασία μέσα από την ανάλυση της πρόσφατης Γνωμοδότησης OC-23/17 που εξέδωσε το Διαμερικανικό Δικαστήριο με αίτημα της Κολομβίας. Με την συνδυαστική και προοδευτική ερμηνεία της Αμερικανικής Σύμβασης και των άλλων διεθνών κειμένων περιβαλλοντικής προστασίας, η Γνωμοδότηση λειτουργεί διορθωτικά στο κενό προστασίας όσον αφορά στη σχέση Φύσης και ανθρώπου και τη δυνατότητα παροχής δικαστικής προστασίας με αμιγώς περιβαλλοντική κατεύθυνση. Η Γνωμοδότηση συνδυάζει την ανθρώπινη με την περιβαλλοντική υπόσταση και ανάγκη προστασίας και θέτει τον προβληματισμό για το εάν το περιβάλλον μπορεί να προστατευθεί διαμέσου του ανθρώπου ή και ξεχωριστά από εκείνον ως αυτόνομο αγαθό. Η υπό ανάλυση Γνωμοδότηση συμβάλλει στην αναμόρφωση του τοπίου όσον αφορά την προστασία των ανθρωπίνων δικαιωμάτων από την περιβαλλοντική υποβάθμιση και την κλιματική αλλαγή. Οι δικαστές δεν έμειναν μόνο στο περιεχόμενο της αίτησης της Κολομβίας, αλλά επαναπροσδιόρισαν κάποιες έννοιες κάνοντας για παράδειγμα διασταλτική ερμηνεία στην έννοια της δικαιοδοσίας σε περίπτωση πρόκλησης διασυνοριακής ζημίας. Καταδεικνύεται επίσης γλαφυρά η σχέση και ο ρόλος της περιβαλλοντικής προστασίας στην πραγμάτωση των ανθρωπίνων δικαιωμάτων, μέσα από διεθνή και ευρωπαϊκή σκοπιά με έμφαση στους αυτόχθονες πληθυσμούς και τις κοινότητες άξιες προστασίας. Από πρακτικής απόψεως υλοποίησης αυτών των στόχων προβλέπονται οι βασικές υποχρεώσεις πρόληψης, προφύλαξης, συνεργασίας καθώς και οι ειδικότερες διαδικαστικές εκφάνσεις τους προκειμένου ένα κράτος να εξασφαλίσει την ουσιαστική προστασία του περιβάλλοντος και των ανθρωπίνων δικαιωμάτων. Τέλος, η γράφουσα θεωρεί σημαντικό να κάνει μία σύντομη αναφορά στη σύγχρονη τάση του περιβαλλοντικού δικαίου εν γένει με την ολοένα αυξανόμενη αναγνώριση της νομικής προσωπικότητας της Φύσης ως αυτόνομο υποκείμενο δικαίου από Συντάγματα και εθνικά δικαστήρια.The present paper addresses the issue of the relationship of human rights to environmental protection through the analysis of the recent Opinion OC-23/17 issued by the Inter-American Court of Justice by a Request of Colombia. With the combined and progressive interpretation of the American Convention and other international environmental protection legal texts, the Opinion corrects the gap of protection regarding the relationship between Nature and Man and opens the possibility of providing judicial protection in a purely environmental direction. The Opinion combines the human with the environmental nature and shows the need for protection and raises the question of whether the environment can be protected through humans or even separately from them as an autonomous good. The Opinion under review contributes to reshaping the landscape in terms of protecting human rights from environmental degradation and climate change. The judges did not just stick to the content of Colombia's Application, but redefined some concepts by, for example, interpreting the concept of jurisdiction in the event of transboundary damage. The relationship and role of environmental protection in the realization of human rights through an international and european perspective with an emphasis on indigenous peoples and communities deserving protection is also demonstrated. From the practical point of view of achieving these objectives, the basic obligations of prevention, precaution, cooperation and their specific procedural manifestations are envisaged in order for a State to ensure effective protection of the environment and human rights. Finally, the author considers it important to make a brief reference to the modern trend of environmental law in general with the increasing recognition of the legal personality of Nature as an autonomous subject of law by constitutions and national courts

Ultrasound elastography assessment of skin involvement in systemic sclerosis: Lights and shadows

Objective. To assess skin elasticity in systemic sclerosis (SSc) by using a new imaging modality, ultrasound elastography (UE). Methods. Our study included 18 consecutive patients with SSc and 15 healthy controls. Modified Rodnan skin score, physical examination, and assessment of organ involvement were performed. UE was carried out on the middle forearm and on the fingers of the dominant arm. The echo signals recorded in real time during freehand operations of probe compression and relaxation produced images representing tissue elasticity, consisting of translucent colored bands superimposed on the B-mode ultrasonographic images. The color scale varied within a large band spectrum from red, indicative of soft and highly elastic tissue, to blue, which denoted hard and barely elastic tissue. Results. On the forearm of all patients, UE showed a homogeneous blue area corresponding to the dermis visualized in a B-mode ultrasonographic image; in controls, a blue pattern was never detected and a predominance of green with sporadic areas of pale blue was observed. At sequential evaluations, UE of fingers produced inconstant and changeable colored areas. Conclusion. The imaging pattern observed in the forearm of patients with SSc may represent the reduction of strain in the dermis clue to loss of elasticity. The variable pattern obtained by finger evaluation demonstrated that UE can assess skin involvement in SSc only in those areas where the dermis is known to be thicker and where the bone hyperreflection is minimal. Further studies are needed to confirm our results and determine the validity of this new imaging modality. (First Release June 15 2010; J Rheumatol 2010;37: 1688-91: doi:10.3899/jrheum.090974

Key-protease inhibition regimens promote tumor targeting of neurotensin radioligands

Neurotensin subtype 1 receptors (NTS1R) represent attractive molecular targets for directing radiolabeled neurotensin (NT) analogs to tumor lesions for diagnostic and therapeutic purposes. This approach has been largely undermined by the rapid in vivo degradation of linear NT-based radioligands. Herein, we aim to increase the tumor targeting of three99mTc-labeled NT analogs by the in-situ inhibition of two key proteases involved in their catabolism. DT1 ([N4- Gly7]NT(7-13)), DT5 ([N4-βAla7,Dab9]NT(7-13)), and DT6 ([N4-βAla7,Dab9,Tle12]]NT(7-13)) were labeled with99mTc. Their profiles were investigated in NTS1R-positive colon adenocarcinoma WiDr cells and mice treated or not with the neprilysin (NEP)-inhibitor phosphoramidon (PA) and/or the angiotensin converting enzyme (ACE)-inhibitor lisinopril (Lis). Structural modifications led to the partial stabilization of99mTc-DT6 in peripheral mice blood (55.1 ± 3.9% intact), whereas99mTc-D

Impact of clinically tested NEP/ACE inhibitors on tumor uptake of [111In-DOTA]MG11

Background: We have recently shown that treatment of mice with the neutral endopeptidase (NEP) inhibitor phosphoramidon (PA) improves the bioavailability and tumor uptake of biodegradable radiopeptides. For the truncated gastrin radiotracer [111In-DOTA]MG11 ([(DOTA)DGlu10]gastrin(10–17)), this method led to impressively high tumor-to-kidney ratios. Translation of this concept in the clinic requires the use of certified NEP inhibitors, such as thiorphan (TO) and its orally administered prodrug racecadotril (Race). Besides NEP, angiotensin-converting enzyme (ACE) has also been implicated in the catabolism of gastrin analogs. In the present study, we first compared the effects induced by NEP inhibition (using PA, TO, or Race) and/or by ACE inhibition (using lisinopril, Lis) on the biodistribution profile of [111In-DOTA]MG11 in mice. In addition, we compared the efficacy of PA and TO at different administered doses to enhance tumor uptake. Methods: [111In-DOTA]MG11 was coinjected with (a) vehicle, (b) PA (300 μg), (c) TO (150 μg), (d) Lis (100 μg), (e) PA (300 μg) plus Lis (100 μg), or (f) 30–40 min after intraperitoneal (ip) injection of Race (3 mg) in SCID mice bearing AR42J xenografts. In addition, [111In-DOTA]MG11 was coinjected with vehicle, or with progressively increasing amounts of PA (3, 30, or 300 μg) or TO (1.5, 15, and 150 μg) in SCID mice bearing twin A431-CCK2R(+/−) tumors. In all above cases, biodistribution was conducted at 4 h postinjection (pi). Results: During NEP inhibition, the uptake of [111In-DOTA]MG11 in the AR42J tumors impressively increased from 1.8 ± 1.0 % ID/g (controls) to 15.3 ± 4.7 % ID/g (PA) and 12.3 ± 3.6 % ID/g (TO), while with Race tumor values reached 6.8 ± 2.8 % ID/g. Conversely, Lis had no effect on tumor uptake and no additive effect when coinjected with PA. During the dose dependence study in mice, PA turned out to be more efficacious in enhancing tumor uptake of [111In-DOTA]MG11 in the CCK2R-positive tumors compared to equimolar amounts of TO. In all cases, renal accumulation remained low, resulting in notable increases of tumor-to-kidney ratios. Conclusions: This study has confirmed NEP as the predominant degrading enzyme of [111In-DOTA]MG11 and ruled out the involvement of ACE in the in vivo catabolism of the radiotracer. NEP inhibition with the clinically tested NEP

Preclinical pharmacokinetics, biodistribution, radiation dosimetry and toxicity studies required for regulatory approval of a phase I clinical trial with 111In-CP04 in medullary thyroid carcinoma patients

Introduction: From a series of radiolabelled cholecystokinin (CCK) and gastrin analogues, 111In-CP04 (111In-DOTA-(DGlu)6-Ala-Tyr-Gly-Trp-Met-Asp-Phe-NH2) was selected for further translation as a diagnostic radiopharmaceutical towards a first-in-man study in patients with medullary thyroid carcinoma (MTC). A freeze-dried kit formulation for multicentre application has been developed. We herein report on biosafety, in vivo stability, biodistribution and dosimetry aspects of 111In-CP04 in animal models, essential for the regulatory approval of the clinical trial. Materials and methods: Acute and extended single dose toxicity of CP04 was tested in rodents, while the in vivo stability of 111In-CP04 was assessed by HPLC analysis of mouse blood samples. The biodistribution of 111In-CP04 prepared from a freeze-dried kit was studied in SCID mice bearing do