'I was lost in my life and they helped me find my way again': Befriendee and befriender experiences of the Spirasi Befriending Programme for survivors of torture in Ireland.

INTRODUCTION: Befriending is one of the rehabilitative services embedded in the holistic approach adopted by Spirasi, the Irish National Centre for the Rehabilitation of Survivors of Torture. Their befriending programme offers survivors one-to-one companionship from trained volunteer befrienders. The literature suggests that befriending programmes can improve quality of life, provide emotional support and combat loneliness. However, there is little empirical research of the effectiveness of befriending programmes for torture survivors. OBJECTIVE: The main objective was to explore, in complementary ways, the impact of the Spirasi befriending programme on befrienders and befriendees and to incorporate their voices into recommendations for optimising the service. METHODS: The methodology consisted of five focus groups (two with befriendees, two with befrienders and one with both) and a portrait workshop facilitated by two community artists, where each befriending pair member created a portrait of their partner to express and visually explore the befriending relationship. Data comprised the focus group transcripts and written feedback on the portrait-creation process. RESULTS: The themes identified in both data sets firmly ground the befriending programme in Spirasi's holistic approach to recovery. For the focus group participants, befriending promotes integration; models trusting, kind and reciprocal relationships; combats loneliness and protects against suicide. They also highlighted the importance of regular befriender training, increasing the programme's reach and developing a befriender community of practice. The portrait workshop was found to strengthen relationships and provide a context of normality, acceptance and shared humanity through compassionate and creative exchanges. CONCLUSIONS: This paper highlights the benefits of the befriending programme within Spirasi's holistic approach and the importance of collaborative expressive arts activities in building befriending relationships. It provides recommendations for good befriending practice which are relevant to all organisations working with survivors of torture as well as those working with people seeking international protection more broadly.

Using composite case material to develop trauma-informed psychoeducation for social care workers looking after unaccompanied minors in residential care in Ireland.

Although the provision of trauma-informed psychoeducation for carers of adolescents who have experienced traumatic events has been shown to be a fundamental aspect of the recovery process, it is not routinely made available to the social care workers who look after unaccompanied asylum-seeking adolescents living in residential care. Furthermore, the development of the content of trauma-informed psychoeducation is rarely informed by those who have experienced trauma or the professionals who support them. This paper documents the process of ensuring that these voices inform the development and delivery of trauma-informed psychoeducation for the social care workers working in this context. Four clinical reflection and three professional reflection composites were developed from the reflexive clinical journal data of the author's clinical practice as an expressive arts psychotherapist working with 28 unaccompanied minors during a 4-year period. As well as drawing on clinical reflections from therapy sessions (one to two paragraphs per session), the composite material drew on notes on informal conversations between the author and the professionals involved in the lives of unaccompanied minors (one to two paragraphs weekly). The latter was often a response to different situations which arose with the unaccompanied minors in their care, thereby demonstrating the need for a more structured and formalised delivery of psychoeducation for these professionals. The composite material was complemented with a training needs assessment in the form of a vignette and accompanying open questions conducted with 30 social care workers looking after unaccompanied minors in residential care. Reflexive thematic analysis on combined data sets identified the following themes: Impact of trauma on everyday lives Trauma-informed engagement Helping with difficult feelings and loss Reducing the stigma of therapy The resulting training content was enhanced by the selection of tools and techniques developed by a number of clinicians-researchers with expertise in healing post-traumatic stress.

Patient Derived Organoids Confirm That PI3K/AKT Signalling Is an Escape Pathway for Radioresistance and a Target for Therapy in Rectal Cancer.

Objectives: Partial or total resistance to preoperative chemoradiotherapy occurs in more than half of locally advanced rectal cancer patients. Several novel or repurposed drugs have been trialled to improve cancer cell sensitivity to radiotherapy, with limited success. We aimed to understand the mechanisms of resistance to chemoradiotherapy in rectal cancer using patient derived organoid models. Design: To understand the mechanisms underlying this resistance, we compared the pre-treatment transcriptomes of patient-derived organoids (PDO) with measured radiotherapy sensitivity to identify biological pathways involved in radiation resistance coupled with single cell sequencing, genome wide CRISPR-Cas9 and targeted drug screens. Results: RNA sequencing enrichment analysis revealed upregulation of PI3K/AKT/mTOR and epithelial mesenchymal transition pathway genes in radioresistant PDOs. Single-cell sequencing of pre & post-irradiation PDOs showed mTORC1 and PI3K/AKT upregulation, which was confirmed by a genome-wide CRSIPR-Cas9 knockout screen using irradiated colorectal cancer (CRC) cell lines. We then tested the efficiency of dual PI3K/mTOR inhibitors in improving cancer cell sensitivity to radiotherapy. After irradiation, significant AKT phosphorylation was detected (p=0.027) which was abrogated with dual PI3K/mTOR inhibitors and lead to significant radiosensitisation of the HCT116 cell line and radiation resistant PDO lines. Conclusions: The PI3K/AKT/mTOR pathway upregulation contributes to radioresistance and its targeted pharmacological inhibition leads to significant radiosensitisation in CRC organoids, making it a potential target for clinical trials.