possible that other adoptive families with older children have had different experiences and would have changed the results of this study. In addition, all focus group participants resided in one Midwestern area in the United States and were recruited from one agency in which they were recipients of post finalization services. Supports and services provided to families’ post- finalization vary by state and agency (Fuller, Bruhn, Cohen, Lis, Rolock, & Sheridan, 2006; Houston & Kramer, 2008; Merritt & Festinger, 2013; Smith & Howard, 1991). The experiences of study participants may be different than families living in other areas, or those who do not receive post-adoption services. Despite this limited sample, these findings are consistent with the literature.
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children and their families is related to the challenges of transracial adoptions. One of the findings that emerged from the research projects developed by the group between 2009 and 2013 was that racism was highly downplayed by families, teachers and adoption practitioners. AFIN devoted three issues (September 2010, November 2012, March 2013) of its monthly newsletter to this concern, offering strategies for families and professionals. AFIN co-organized workshops on the subject with ten adoptive family associations and developed materials for teachers distributed in special sessions in schools of education. In 2014, the federation of adoptive families association commissioned AFIN to write a handbook entitled “How to talk about adoption, even when it´s difficult” (San Román, Grau y Barcons, 2014) and requested that AFIN include a section about difference and racism.
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with the biological family may be re- warding, but there may also be some pitfalls. In preparing for contact and reunion, adopted people (and birth parents) should prepare for a whole range of realities, including rejection by the biological parent(s) and family members. Pediatricians need to be aware of the feelings the adopted child may have after meeting a sibling — either one who is older and remained with the biological parent(s) or one who was born after the adopted child was placed. All members of the adop- tion triad may need the help of mental health professionals to work through these situations. Pediatricians are en- couraged to become aware of local community resources for adoptive families, including resources for locating information about biological fami- lies, support groups, adoption confer- ences and services, and mental health professionals.
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Adoption is a way of growing a family which is ever more on the rise. In Portugal, every year, about 400 children are legally adopted and around 500 are placed in selected adoptive families, in order to be legally adopted by them in the near future. In this way, it can be said that adoption is the third highest chance that a child has to quit the Portuguese welfare system, of which he/she has been a part of, ever since his/her birth family was proven incapable of providing for, in terms of his/ her overall development. Presently, 8470 Portuguese children and youngsters are in residential or foster care. This number represents 0.36 % of the overall population under the age of 18 (Instituto de Segurança Social, Insti- tuto Público [Institute of Social Security, Public Insti- tute] (ISS, IP, 2015). Only 8.7 % of these children can eventually leave out-of-home care in order to be adopted. Nevertheless, for each adopted child, there is a possibility of growing up in an environment which fits
necessarily play out in their later lives, often in the form of attachment difficulties resulting in ‘challenging’ behaviours (Elliot, 2013). In anticipation of these behaviours, adoptive parents are routinely steered towards ‘therapeutic parenting’ approaches based on attachment and neuro-scientific understandings of children’s emotional and cognitive development (Mackenzie and Roberts, 2017). Increasing media and policy attention is being paid to the common and often serious difficulties faced by adoptive families, including Child to Parent Violence (Thorley and Coates, 2018) and a rise in adoption breakdowns where the child is no longer able to live with their adoptive family (Selwyn et al., 2015). There has been targeted funding (in England only) enabling adopters to access therapeutic support for their children in the form of a national Adoption Support Fund, though many see this as barely scratching the surface of the problem and its future is uncertain (Harte, 2017).
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Our analyses regarding the possible impact of secrecy on other interpersonal relationships were exploratory. Results from our quantitative data indicated that greater secrecy by adoptive parents was related to greater social loneliness, risk in intimacy, and anxious and avoidant attachment. However, secrecy was not significantly related to any of the romantic variables (i.e., romantic loneliness or satisfaction, commitment, and trust in romantic relationships). At first it seems surprising that secrecy would be unrelated to trust. However, the items on the trust scale relate specifically to trust with a particular spouse or romantic partner, rather than trust in general. If adoptive parents are secretive regarding adoption-related issues, the violation of trust seems to relate more directly to the relationship between the adoptee and the adoptive parents. Still, our qualitative data reveal that at least for some adoptees, problems in trust did transfer to other relationships including romantic relationships. For others, the secrecy in their adoptive families actually prompted them be more open in their interpersonal relationships. This underscores the importance of considering each adoptee’s individual narrative in a counselling situation, as different issues will arise for different individuals.
This government wants to do everything we can to help these parents, and is working with the wonderful sector to support more young people into the comfort and stability of an adoptive home. However in recent years, the trend that concerns us all is the disparity between numbers of children awaiting adoption and adoptive families ready to take them. There are simply not enough of you to go around and we desperately need to get more people like you. This is a trend that must change and I want to do everything I can to help you do that.
• Identity development encompasses at least two key questions for an adoptive child. The first is to understand ‘Who am I?’ This is essentially about knowing one’s own history, including the history and characteristics of one’s birth family. Life story books, memorabilia and other personal items are a key part of helping an adoptive child develop their sense of identity. Adoptive parents may value support in helping to use a life story book as part of responding to a child’s identity needs. For an adoptive child, understanding information about their personal history and birth family is likely to involve incorporating information about difficult events and parental characteristics such as mental illness, substance misuse or abusive behaviour. Consideration should be given to how the adoptive child can be supported in incorporating this type of information into their history without undermining their self-esteem.This issue is primarily one for adoptive parents with their child although they may need help with this.
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As shown in Chart 4 below, the largest number of adoptive families was in the North West region, with 623 families accounting for 15% of the 4,195 total families who were approved by LAs. However, this region had the lowest proportion of ‘available’ families, 172 families (28%) were waiting to be matched to children. The North East region had the smallest number of approved adoptive families. (B1.2-1.4)
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MODELING POSITIVE ADOPTION LANGUAGE Pediatricians are encouraged to model positive adoption language for all families. Adoptive families are “real” families; siblings who joined a family through adoption are “real siblings.” Biological par- ents do not “give up a child for adoption,” which might imply to the child that he or she was of less worth and was given away. Rather, they “make an adoption plan for a child.” A biological mother should not be identified as a “natural parent,” as this implies that adoptive families are “unnatural.” A child’s racial identity, adoption, or birth in another country should never be the identifying characteris- tics for any child. It is never appropriate to ask how much a child “cost.” In modeling positive adoption language, pediatricians can use vocabulary that re- flects respect and permanency about children and their families. 13
The fluid nature of sibling relationships, that is, the varying significance or meaning of relationships at different points in time and in different contexts was a theme that recurred in studies. Angel’s (2014) work suggested that connections to biological siblings can retain significance even when in separate households or where a sibling remains in the birth family but that a ‘mutual sense of belonging and care’ was not universal across all sibling relationships. This fluidity of the meaning of family relationships was also evident in Berge et al’s (2006) study of contact between birth and adoptive families. Berge et al (2006) found that crossover contact, that is, an adoptive sibling being included in the contact arrangement between their adoptive brother or sister and that sibling’s biological relative, was common and unproblematic. Where only one sibling had contact the other sibling often looked forward to contact and considered their siblings’ birth mother as a friend. Where crossover contact occurred, conversations about adoption were seen as a vehicle to closeness between adopted siblings. One of the studies reviewed focused on sibling closeness in biological compared to adoptive families, relating this to wellbeing (Samek & Rueter, 2011). The study hypothesized that closeness (emotional and behavioural) between siblings would be different in biologically and non- biologically related families. They found no differences in emotional closeness but less behavioural closeness for adoptive siblings. The importance of sibling-like relationships such as relationships between foster siblings was reported in some qualitative studies (Angel, 2014; James and others, 2008) though when measured there was some evidence of less warmth or closeness expressed by birth children of foster carers towards foster children than towards biologically-related siblings (Mosek, 2014).
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Initial investigations of adoptive gay father fami- lies have reported positive family functioning with respect to quality of parenting and children’s psychological well-being (Averett, Nalavany, & Ryan, 2009; Erich, Kanenberg, Case, Allen, & Bogdanos, 2009; Erich, Leung, & Kindle, 2005; Leung, Erich, & Kanenberg, 2005; Ryan, 2007). However, reliance on self-report questionnaires administered to convenience samples, and either the absence of a comparison group of heterosexual adoptive families or the wide age range of children studied, limit the conclusions that may be drawn. The ﬁrst systematic study was carried out by Farr, Forsell, and Patterson (2010a, 2010b). Using parent and teacher questionnaires, preschool children adopted in infancy by gay fathers in the United States were found to be as well adjusted as those adopted by lesbian or heterosexual parents, with no differences in parenting stress, parental discipline, or parental relationship satisfaction according to family type. In terms of gender development, no differences were identiﬁed in the sex-typed behav- ior of either boys or girls between gay father, lesbian mother, and heterosexual parent families. In contrast, Goldberg et al. (2012) found that children in adoptive same-sex parent families showed less
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The transfusion of lymphocytes, referred to as adoptive T cell therapy, is being tested for the treat- ment of cancer and chronic infections. Adoptive T cell therapy has the potential to enhance antitu- mor immunity, augment vaccine efficacy, and limit graft-versus-host disease. This form of personal- ized medicine is now in various early- and late-stage clinical trials. These trials are currently testing strategies to infuse tumor-infiltrating lymphocytes, CTLs, Th cells, and Tregs. Improved molecular biology techniques have also increased enthusiasm and feasibility for testing genetically engineered T cells. The current status of the field and prospects for clinical translation are reviewed herein.
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The AAP recommends a comprehensive health evaluation of all children at the time of entrance into foster care. 26 The medical records from all previous health care providers should be made available for review for the adoptive parents as soon as possible after placement into an adoptive home and before ﬁ nalization of adoption from foster care. Lack of availability of medical records should not delay the timing of the initial comprehensive health evaluation. Parents, working in collaboration with their legal repre- sentative, their pediatrician, and local child welfare and adoption agencies, should obtain the child ’ s complete medical records, including (if possi- ble) developmental, educational, and mental health assessments. 1,27 For children being adopted from foster care, equal emphasis should be placed on review of the medical history and the physical examination of the child. 1,19
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Reoviruses are encapsidated double-stranded RNA viruses that cause systemic disease in mice after peroral (p.o.) inoculation and primary replication in the intestine. In this study, we define components of the immune system involved in the clearing of reovirus from the proximal small intestine. The intestines of immunocom- petent adult CB17, 129, and C57BL/6 mice were cleared of reovirus serotype 3 clone 9 (T3C9) within 7 days of p.o. inoculation. Antigen-specific lymphocytes were important for the clearance of intestinal infection, since severe combined immunodeficient (SCID) mice failed to clear T3C9 infection. To define specific immune components required for intestinal clearance, reovirus infection of mice with null mutations in the immuno- globulin M (IgM) transmembrane exon (MuMT; B cell and antibody deficient) or b 2 microglobulin gene ( b 2-/-; CD8 deficient) was evaluated. b 2-/- mice cleared reovirus infection with normal kinetics, while MuMT mice showed delayed clearance of T3C9 7 to 11 days after p.o. inoculation. Adoptive transfer of splenic lymphocytes from reovirus-immune CB17 mice inhibited growth of T3C9 in CB17 SCID mouse intestine 11 days after p.o. inoculation. The efficiency of viral clearance by adoptively transferred cells was significantly diminished by depletion of B cells prior to adoptive transfer. Results in SCID and MuMT mice demonstrate an important role for B cells or IgG in clearance of reovirus from the intestines. Polyclonal reovirus-immune rabbit serum, protein A-purified immune IgG, and murine monoclonal IgG2a antibody specific for reovirus outer capsid protein s 3 administered intraperitoneally all normalized clearance of reovirus from intestinal tissue in MuMT mice. This result demonstrates an IgA-independent role for IgG in the clearance of intestinal virus infection. Polyclonal reovirus-immune serum also significantly decreased reovirus titers in the intestines of SCID mice, demonstrating a T-cell-independent role for antibody in the clearance of intestinal reovirus infection. B cells and circulating IgG play an important role in the clearance of reovirus from intestines, suggesting that IgG may play a more prominent functional role at mucosal sites of primary viral replication than was previously supposed.
Adoptive transfer EAE in Lewis rat is a monophasic disease which follows a highly predictable disease course. Intriguingly, the onset of the disease occurs only after an obligatory latency of at least 3 days, irrespective of the number of autoreactive T cells injected (44). At the time of injection, encephalitogenic T cells are maximally activated and characterized by upregulation of activation markers such as IL2R, IFN γ and OX40 antigen. Before migrating to target organ, they accumulate in the spleen, where aforementioned activation markers are downregulated. Instead, migratory molecules such as CCR1, CCR2, CCR3, CCR5, and CXCR4 are upregulated (44). Once in their target organ, these T cells are reactivated but keep their migratory molecules high. Nevertheless, the molecular and cellular mechanisms which guide migration of encephalitogenic T cells to CNS are largely unknown.
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It was reported that tumor infiltrating CD8+ effector T cells in EOC correlate with improved progression free sur- vival (PFS) [6, 19]. On the contrary, the presence of CD4 + CD25 + FoxP3 T regulatory cells (Tregs), recruited by tumor cells, and the activation of immune evasion mecha- nisms (e.g., negative Immune checkpoint regulators (i.e., B7-H1 and endothelin B repressors) are associated with poor clinical outcome [4, 20–22]. Cancer immunotherapy has recently emerged as a clinically effective tool in several solid tumors . Among all the possible immunothera- peutic strategies, adoptive immunotherapy is considered one of the most promising options. Adoptive immunother- apy has shown encouraging activity mainly in melanoma and soft tissue sarcomas  and hopes are hold for a pos- sible extension to other histotypes such as ovarian cancer. Adoptive immunotherapy is based on the infusion of ex vivo expanded and/or activated immune effectors able to identify and destroy neoplastic cells [6, 24, 25]. Adoptive immunotherapy may be based either on HLA-restricted or unrestricted strategies . The first focuses on T lympho- cytes capable of recognizing tumor associated antigens (TAA) through their specific T cell receptor (TCR); the sec- ond focuses on elements of the innate immune system that that do not rely on HLA-mediated recognition of tumor targets; these effectors are natural killer (NK) cells, Lymphokine Activated Killer cells (LAKs), cytokine- induced killer (CIK) cells. Anti-tumor lymphocytes may be adoptively infused unmodified or previously engineered with TAA-specific TCRs or chimeric antigene receptors (CARs) . In this review, we will focus on the prelimin- ary clinical evidence and perspectives offered by adoptive immunotherapy in the field of EOC. To identify ongoing clinical trials with adoptive immunotherapy we operated a search on clinicaltrials.gov with “ovarian cancer” and “adop- tive” as keywords. The work is dedicated to adoptive im- munotherapies based on unmodified immune effectors (TILs, NK cells, LAK cells, CIK). Strategies with genetically engineered lymphocytes will not be included in the present work due to limited space and current absence of clinical evidence in EOC (Fig. 1).
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lymphocytes than TILs. The major subtypes of expanded cells from LNLs were tumor-specific effector and central memory T cells. The OS of the patients in the LNL group improved significantly as compared to the control group (28 vs 14 months), and no side effects were observed . Because the LNLs show similar or even better effects of ACT in CRC without the problem of contamination, they could be the major source of TIL-like cells for CRC adoptive therapy. Further investigations are warranted to address some hurdles for the use of TILs and LNLs as the ACT for CRC as these cell types occur naturally and have no immunogenicity and little adverse effects. More importantly, there exist tumor-specific TCRs against thousands of unknown TAAs. Liver metastasis is the most frequent complication in patients with advanced CRC ultimately leading to death. However, it is feasible to eliminate liver metastasis using the improved technique developed recently. Liver metastases may be an ideal source of TILs that can be harvested aseptically without contamination with the intestinal flora and used for the ACT to treat patients with CRC.
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The transfusion of T cells, also called adoptive T cell therapy, is an effective treatment for viral infections and has induced regression of cancer in early-stage clinical trials. However, recent advances in cellular immunology and tumor biology are guiding new approaches to adoptive T cell therapy. For example, use of engineered T cells is being tested as a strategy to improve the functions of effector and memory T cells, and manipulation of the host to overcome immunotoxic effects in the tumor microenvironment has led to promising results in early-stage clinical trials. Challenges that face the field and must be addressed before adoptive T cell therapy can be translated into routine clinical practice are discussed.
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Researchers have also started looking at interventions for transracial adoptive parents that will assist them in exploring their cultural competence in an effort to cultivate healthy cultural identity development in their children. Smith (1994) suggests that prospective adoptive parents consider their current lifestyle prior to committing to a transracial adoption. Important factors include whether the family lives in an integrated neighborhood, so that the child will be able to attend an integrated school, and if not, would they consider moving to a new neighborhood. Prospective parents would also consider whether they already have friends of different races and ethnic groups, if they attend multicultural festivals, if they enjoy different kinds of ethnic foods, and how much of a leap it would be to start doing some of these things (Smith 1994).
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