Improvements in the quality of the parent-child relationship following treatment with an integrated family approach

ObjectiveThis study investigated changes in the emotional availability of the parent and the child in the dyadic relationship, parental reflective functioning, and parental perception of the relationship with their child following treatment with an integrated family approach in adult and child mental health care services. The aim of the study was to investigate if an integrated family approach in treatment contributes to good practice in mental health care.BackgroundChildren of parents with a mental disorder are at increased risk for developing mental health problems themselves during lifetime. Infants are extremely vulnerable for environmental influences. Parents with mental disorders are at risk for mis-attuned behavior and non-optimal emotional availability. This increases the risk of adverse cascading effects on the parent-child relationship and child development. A secure parent-child relationship is an important protective factor against the intergenerational transmission of mental disorders. Although treatment of the parental mental disorder is important, it does not automatically change undesirable patterns in the parent-child relationship. Therefore, an integrated family approach to mental health treatment is recommended.MethodsThis study involved a mixed methods design using questionnaires, an observation instrument and semi-structured interviews. The variables examined were the quality of the parent-child interaction, the parental perspective on their relationship with the child, their problems with child upbringing, and on their parental reflective functioning. The clinical sample consisted of 50 patients with a variety of mental disorders and their young children.ResultsAfter finishing the integrated treatment the quality of the parent-child interaction had improved significantly. Likewise, we found a significant improvement in parental perception regarding the relationship with the child and the parental role. The majority of the parents interviewed showed that they were better able to mentalize about themselves, their child and their relationship with the child, but the data from the questionnaire showed mixed results regarding parents’ reflective functioning.ConclusionTreatment with an integrated family approach to mental health care in which the parental role of the patient, the young child, and the parent-child relationship are integrated in treatment, can be a valuable addition to the current practice of mental health care in which patients are commonly perceived as individuals

The sustainability of habitability on terrestrial planets: Insights, questions, and needed measurements from Mars for understanding the evolution of Earth-like worlds

What allows a planet to be both within a potentially habitable zone and sustain habitability over long geologic time? With the advent of exoplanetary astronomy and the ongoing discovery of terrestrial-type planets around other stars, our own solar system becomes a key testing ground for ideas about what factors control planetary evolution. Mars provides the solar system's longest record of the interplay of the physical and chemical processes relevant to habitability on an accessible rocky planet with an atmosphere and hydrosphere. Here we review current understanding and update the timeline of key processes in early Mars history. We then draw on knowledge of exoplanets and the other solar system terrestrial planets to identify six broad questions of high importance to the development and sustaining of habitability (unprioritized): (1) Is small planetary size fatal? (2) How do magnetic fields influence atmospheric evolution? (3) To what extent does starting composition dictate subsequent evolution, including redox processes and the availability of water and organics? (4) Does early impact bombardment have a net deleterious or beneficial influence? (5) How do planetary climates respond to stellar evolution, e.g., sustaining early liquid water in spite of a faint young Sun? (6) How important are the timescales of climate forcing and their dynamical drivers? Finally, we suggest crucial types of Mars measurements (unprioritized) to address these questions: (1) in situ petrology at multiple units/sites; (2) continued quantification of volatile reservoirs and new isotopic measurements of H, C, N, O, S, Cl, and noble gases in rocks that sample multiple stratigraphic sections; (3) radiometric age dating of units in stratigraphic sections and from key volcanic and impact units; (4) higher-resolution measurements of heat flux, subsurface structure, and magnetic field anomalies coupled with absolute age dating. Understanding the evolution of early Mars will feed forward to understanding the factors driving the divergent evolutionary paths of the Earth, Venus, and thousands of small rocky extrasolar planets yet to be discovered

The potential science and engineering value of samples delivered to Earth by Mars sample return

© The Meteoritical Society, 2019. Executive Summary: Return of samples from the surface of Mars has been a goal of the international Mars science community for many years. Affirmation by NASA and ESA of the importance of Mars exploration led the agencies to establish the international MSR Objectives and Samples Team (iMOST). The purpose of the team is to re-evaluate and update the sample-related science and engineering objectives of a Mars Sample Return (MSR) campaign. The iMOST team has also undertaken to define the measurements and the types of samples that can best address the objectives. Seven objectives have been defined for MSR, traceable through two decades of previously published international priorities. The first two objectives are further divided into sub-objectives. Within the main part of the report, the importance to science and/or engineering of each objective is described, critical measurements that would address the objectives are specified, and the kinds of samples that would be most likely to carry key information are identified. These seven objectives provide a framework for demonstrating how the first set of returned Martian samples would impact future Martian science and exploration. They also have implications for how analogous investigations might be conducted for samples returned by future missions from other solar system bodies, especially those that may harbor biologically relevant or sensitive material, such as Ocean Worlds (Europa, Enceladus, Titan) and others. Summary of Objectives and Sub-Objectives for MSR Identified by iMOST: Objective 1 Interpret the primary geologic processes and history that formed the Martian geologic record, with an emphasis on the role of water. Intent To investigate the geologic environment(s) represented at the Mars 2020 landing site, provide definitive geologic context for collected samples, and detail any characteristics that might relate to past biologic processesThis objective is divided into five sub-objectives that would apply at different landing sites. 1.1 Characterize the essential stratigraphic, sedimentologic, and facies variations of a sequence of Martian sedimentary rocks. Intent To understand the preserved Martian sedimentary record. Samples A suite of sedimentary rocks that span the range of variation. Importance Basic inputs into the history of water, climate change, and the possibility of life 1.2 Understand an ancient Martian hydrothermal system through study of its mineralization products and morphological expression. Intent To evaluate at least one potentially life-bearing “habitable” environment Samples A suite of rocks formed and/or altered by hydrothermal fluids. Importance Identification of a potentially habitable geochemical environment with high preservation potential. 1.3 Understand the rocks and minerals representative of a deep subsurface groundwater environment. Intent To evaluate definitively the role of water in the subsurface. Samples Suites of rocks/veins representing water/rock interaction in the subsurface. Importance May constitute the longest-lived habitable environments and a key to the hydrologic cycle. 1.4 Understand water/rock/atmosphere interactions at the Martian surface and how they have changed with time. Intent To constrain time-variable factors necessary to preserve records of microbial life. Samples Regolith, paleosols, and evaporites. Importance Subaerial near-surface processes could support and preserve microbial life. 1.5 Determine the petrogenesis of Martian igneous rocks in time and space. Intent To provide definitive characterization of igneous rocks on Mars. Samples Diverse suites of ancient igneous rocks. Importance Thermochemical record of the planet and nature of the interior. Objective 2 Assess and interpret the potential biological history of Mars, including assaying returned samples for the evidence of life. Intent To investigate the nature and extent of Martian habitability, the conditions and processes that supported or challenged life, how different environments might have influenced the preservation of biosignatures and created nonbiological “mimics,” and to look for biosignatures of past or present life.This objective has three sub-objectives: 2.1 Assess and characterize carbon, including possible organic and pre-biotic chemistry. Samples All samples collected as part of Objective 1. Importance Any biologic molecular scaffolding on Mars would likely be carbon-based. 2.2 Assay for the presence of biosignatures of past life at sites that hosted habitable environments and could have preserved any biosignatures. Samples All samples collected as part of Objective 1. Importance Provides the means of discovering ancient life. 2.3 Assess the possibility that any life forms detected are alive, or were recently alive. Samples All samples collected as part of Objective 1. Importance Planetary protection, and arguably the most important scientific discovery possible. Objective 3 Quantitatively determine the evolutionary timeline of Mars. Intent To provide a radioisotope-based time scale for major events, including magmatic, tectonic, fluvial, and impact events, and the formation of major sedimentary deposits and geomorphological features. Samples Ancient igneous rocks that bound critical stratigraphic intervals or correlate with crater-dated surfaces. Importance Quantification of Martian geologic history. Objective 4 Constrain the inventory of Martian volatiles as a function of geologic time and determine the ways in which these volatiles have interacted with Mars as a geologic system. Intent To recognize and quantify the major roles that volatiles (in the atmosphere and in the hydrosphere) play in Martian geologic and possibly biologic evolution. Samples Current atmospheric gas, ancient atmospheric gas trapped in older rocks, and minerals that equilibrated with the ancient atmosphere. Importance Key to understanding climate and environmental evolution. Objective 5 Reconstruct the processes that have affected the origin and modification of the interior, including the crust, mantle, core and the evolution of the Martian dynamo. Intent To quantify processes that have shaped the planet's crust and underlying structure, including planetary differentiation, core segregation and state of the magnetic dynamo, and cratering. Samples Igneous, potentially magnetized rocks (both igneous and sedimentary) and impact-generated samples. Importance Elucidate fundamental processes for comparative planetology. Objective 6 Understand and quantify the potential Martian environmental hazards to future human exploration and the terrestrial biosphere. Intent To define and mitigate an array of health risks related to the Martian environment associated with the potential future human exploration of Mars. Samples Fine-grained dust and regolith samples. Importance Key input to planetary protection planning and astronaut health. Objective 7 Evaluate the type and distribution of in-situ resources to support potential future Mars exploration. Intent To quantify the potential for obtaining Martian resources, including use of Martian materials as a source of water for human consumption, fuel production, building fabrication, and agriculture. Samples Regolith. Importance Production of simulants that will facilitate long-term human presence on Mars. Summary of iMOST Findings: Several specific findings were identified during the iMOST study. While they are not explicit recommendations, we suggest that they should serve as guidelines for future decision making regarding planning of potential future MSR missions. The samples to be collected by the Mars 2020 (M-2020) rover will be of sufficient size and quality to address and solve a wide variety of scientific questions. Samples, by definition, are a statistical representation of a larger entity. Our ability to interpret the source geologic units and processes by studying sample sub sets is highly dependent on the quality of the sample context. In the case of the M-2020 samples, the context is expected to be excellent, and at multiple scales. (A) Regional and planetary context will be established by the on-going work of the multi-agency fleet of Mars orbiters. (B) Local context will be established at field area- to outcrop- to hand sample- to hand lens scale using the instruments carried by M-2020. A significant fraction of the value of the MSR sample collection would come from its organization into sample suites, which are small groupings of samples designed to represent key aspects of geologic or geochemical variation. If the Mars 2020 rover acquires a scientifically well-chosen set of samples, with sufficient geological diversity, and if those samples were returned to Earth, then major progress can be expected on all seven of the objectives proposed in this study, regardless of the final choice of landing site. The specifics of which parts of Objective 1 could be achieved would be different at each of the final three candidate landing sites, but some combination of critically important progress could be made at any of them. An aspect of the search for evidence of life is that we do not know in advance how evidence for Martian life would be preserved in the geologic record. In order for the returned samples to be most useful for both understanding geologic processes (Objective 1) and the search for life (Objective 2), the sample collection should contain BOTH typical and unusual samples from the rock units explored. This consideration should be incorporated into sample selection and the design of the suites. The retrieval missions of a MSR campaign should (1) minimize stray magnetic fields to which the samples would be exposed and carry a magnetic witness plate to record exposure, (2) collect and return atmospheric gas sample(s), and (3) collect additional dust and/or regolith sample mass if possible

The patient's voice as a parent in mental health care: A qualitative study

Objective: This study is an evaluation of patients in mental health care who have undertaken treatment with an integrated family approach. The treatment focuses on the mental disorders of patients, their role as parents, the development of their young children, and family relationships. The treatment was conducted by professionals from an adult and a child mental health service in the Netherlands. The aim of the study was to identify the key elements and processes of this approach in order to develop a theoretical model. Background: Parental mental disorders have an impact on parenting and child development. To stop detrimental cascade effects and prevent parents and children from being caught up in the intergenerational transmission of psychopathology, a family approach in mental health care is needed. Methods: A qualitative design was adopted using thematic analysis. Data were collected through 18 interviews with patients. The themes in the interviews were which outcomes the patients experienced and which key elements of the treatment contributed to these outcomes. Results: In general, patients were satisfied with the treatment offered. Improved outcomes were within the domain of the family, the parent-child relationship, individual symptoms, and the functioning of the parent and the child. Patients mentioned six key elements of success in treatment: focus on the whole family, flexible treatment tailored to the situation of the family, components of the whole treatment reinforcing each other, multi-disciplinary consultation among involved professionals, a liaison between adult and child mental health services, and attention to the social and economic environment. Conclusions: According to the majority of patients, treatment with an integrated family approach in mental health care is of value for themselves, their children, and family relationships, especially the parent-child relationship

Дослідження факторів, що впливають на вивільнення in vitro диклофенаку натрію з гелів на основі гіпромелози

The aim of our study was to identify factors affecting the in vitro release of diclofenac sodium (DS) from hypromellose-based gels (HPMC). Materials and methods. Gels with HPMC and liquids without HPMC were studied by viscosity-rotating viscometer method and spin probe electron paramagnetic resonance spectroscopy. Rheograms were used to determine the flow behavior and the apparent viscosity, and the EPR spectra were used to determine the rotational correlation time (τ–1) of the dissolved spin probes. The in vitro release tests were performed using vertical diffusion cells according to a validated procedure. The assay of DS and isopropyl alcohol (IPA) in the receptor medium was performed by high performance liquid chromatography (HPLC) and gas chromatography (GC) according to validated procedures, and the water content was determined using semi-micro method. Results. The apparent viscosity of the gels increased with increasing HPMC content and depended on the HPMC grade. The high apparent viscosity of the gels did not affect the values of τ–1 of the dissolved spin probes. In viscous gels and Newtonian fluids, the composition of which corresponded to the dispersion medium of gels, the values of τ–1 were identical and were in the range of rapid rotation, which is a prerequisite for similar and rapid release of the dissolved substances from gels and liquids. It was shown that the HPMC-based gel and Newtonian liquid without HPMC in terms of in vitro release parameters DS and IPA were equivalent. During in vitro testing the release of dissolved DS increased with increasing its concentration in the gel and depended on the dispersed state of DS. When the content of IPA was changed from 45.0 % to 22.5 %, the water absorption by the gel and the release of IPA decreased, and the release of DS increased, which was due to the decrease in the solubility of DS in the gel. Conclusions. HPMC, which provided high apparent viscosity of the gels, did not affect the value of τ–1 of the dissolved spin probes and the in vitro release of DS from the gels. The gel and Newtonian liquid were equivalent in terms of in vitro release of DS and IPA. The release of DS altered proportionally with the concentration of DS and depended on its dispersed state. As the content of IPA decreased, the release of IPA decreased, but the release of DS increased because of the decrease in the solubility of the DS in the gelЦель. Определить факторы, влияющие на высвобождение in vitro диклофенака натрия (DS) из гелей на основе гипромеллозы (HPMC). Материалы и методы. Исследовали гели на основе HPMC и жидкости без HPMC методами ротационной вискозиметрии и спиновых зондов. По реограммам определяли тип течения и кажущуюся вязкость, а по спектрам электронного парамагнитного резонанса (ЭПР) – время корреляции вращательной диффузии (τ–1) растворённых спиновых зондов. Испытания по высвобождению in vitro проводили с использованием вертикальных диффузионных камер по валидированной методике. Содержание DS и изопропилового спирта (IPА) в диализате определяли соответственно методами высокоэффективной жидкостной хроматографии (ВЭЖХ) и газовой хроматографии (ГХ) по валидированным методикам, а содержание воды – полумикрометодом. Результаты. Кажущаяся вязкость гелей увеличивается с повышением содержания HPMC и зависит от марки HPMC. Высокая кажущаяся вязкость гелей не влияет на значения τ–1 растворённых в них спиновых зондов. В вязких гелях и ньютоновских жидкостях, соответствующих по составу дисперсионной среде гелей, значения τ–1 идентичны и находятся в области быстрых вращений, что является предпосылкой для одинакового и быстрого высвобождения in vitro растворённых веществ из гелей и жидкостей. Показано, что гель на основе НРМС и ньютоновская жидкость без НРМС по параметрам высвобождения in vitro DS и IPA являются эквивалентными. Высвобождение in vitro растворённого DS возрастает при повышении его концентрации в геле и зависит от дисперсного состояния DS. Если содержание ІРА изменяется от 45,0 % до 22,5 %, абсорбция воды гелем и высвобождение ІРА уменьшаются, а высвобождение DS возрастает, что связано с понижением растворимости DS в геле. Выводы. НРМС, обеспечивающая высокую кажущуюся вязкость гелей, не влияет на значения τ–1 растворённых спиновых зондов и на высвобождение in vitro DS из гелей. Гель и ньютоновская жидкость по высвобождению in vitro DS и ІРА эквивалентны. Высвобождение DS пропорционально изменяется с концентрацией DS и зависит от его дисперсного состояния. С уменьшением содержания ІРА высвобождение ІРА снижается, а высвобождение DS возрастает, что связано с понижением растворимости DS в геле.Мета. Визначити фактори, що впливають на вивільнення in vitro диклофенаку натрію (DS) з гелів на основі гіпромелози (HPMC). Матеріали та методи. Досліджували гелі на основі HPMC і рідини без HPMC методами ротаційної віскозиметрії та спінових зондів. За реограмами визначали тип течії й уявну в’язкість, а за спектрами електронного парамагнітного резонансу (ЕПР) – час кореляції обертальної дифузії (τ–1) розчинених спінових зондів. Випробування з вивільнення in vitro проводили з використанням вертикальних дифузійних камер за валідованою методикою. Вміст DS і ізопропілового спирту (IPА) в діалізаті визначали відповідно методами високоефективної рідинної хроматографії (ВЕРХ) і газової хроматографії (ГХ) за валідованими методиками, а вміст води – напівмікрометодом. Результати. Уявна в’язкість гелів збільшується з підвищенням вмісту HPMC і залежить від марки HPMC. Висока уявна в’язкість гелів не впливає на значення τ–1 розчинених в них спінових зондів. У в’язких гелях і ньютонівських рідинах, що за складом відповідають дисперсійному середовищу гелів, значення τ–1 ідентичні й знаходяться в області швидких обертань, що є передумовою для однакового та швидкого вивільнення in vitro розчинених речовин з гелів і рідин. Показано, що гель на основі НРМС і ньютонівська рідина без НРМС за параметрами вивільнення in vitro DS і IPА є еквівалентними. Вивільнення in vitro розчиненого DS зростає при підвищенні його концентрації в гелі і залежить від дисперсного стану DS. Якщо вміст ІРА змінюється від 45,0 % до 22,5 %, абсорбція води гелем і вивільнення ІРА зменшуються, а вивільнення DS зростає, що пов’язано зі зниженням розчинності DS в гелі. Висновки. НРМС, що забезпечує високу уявну в’язкість гелів, не впливає на значення τ–1 розчинених спінових зондів і на вивільнення in vitro DS з гелів. Гель й ньютонівська рідина за вивільненням in vitro DS та ІРА є еквівалентними. Вивільнення DS пропорційно змінюється з концентрацією DS і залежить від його дисперсного стану. Зі зменшенням вмісту ІРА вивільнення ІРА знижується, а вивільнення DS зростає, що пов’язано зі зниженням розчинності DS в гелі

Coping with multimorbidity in old age – a qualitative study

Abstract Background Comparatively few studies address the problems related to multimorbidity. This is surprising, since multimorbidity is a particular challenge for both general practitioners and patients. This study focuses on the latter, analyzing the way patients aged 65–85 cope with multimorbidity. Methods 19 narrative in-depth interviews with multimorbid patients were conducted. The data was analysed using grounded theory. Of the 19 interviewed patients 13 were female and 6 male. Mean age was 75 years. Participating patients showed a relatively homogeneous socio-economic status. Patients were recruited from the German city of Hamburg and the state of North Rhine-Westphalia. Results Despite suffering from multimorbidity, interviewees held positive attitudes towards life: At the social level, patients tried to preserve their autonomy to the most possible extent. At the emotional level, interviewees oscillated between anxiety and strength - having, however, a positive approach to life. At the practical level, patients aimed at keeping their diseases under control. The patients tended to be critical in regards to medication. Conclusions These findings might have implications for the treatment of multimorbid patients in primary care and further research: The generally presumed passivity of older individuals towards medical treatment, which can be found in literature, is not evident among our sample of older patients. In future, treatment of these patients might take their potential for pro-active cooperation more strongly into account than it is currently the case.</p

Quantifying geological processes on Mars—Results of the high resolution stereo camera (HRSC) on Mars express

This review summarizes the use of High Resolution Stereo Camera (HRSC) data as an instrumental tool and its application in the analysis of geological processes and landforms on Mars during the last 10 years of operation. High-resolution digital elevations models on a local to regional scale are the unique strength of the HRSC instrument. The analysis of these data products enabled quantifying geological processes such as effusion rates of lava flows, tectonic deformation, discharge of water in channels, formation timescales of deltas, geometry of sedimentary deposits as well as estimating the age of geological units by crater size–frequency distribution measurements. Both the quantification of geological processes and the age determination allow constraining the evolution of Martian geologic activity in space and time. A second major contribution of HRSC is the discovery of episodicity in the intensity of geological processes on Mars. This has been revealed by comparative age dating of volcanic, fluvial, glacial, and lacustrine deposits. Volcanic processes on Mars have been active over more than 4 Gyr, with peak phases in all three geologic epochs, generally ceasing towards the Amazonian. Fluvial and lacustrine activity phases spread a time span from Noachian until Amazonian times, but detailed studies show that they have been interrupted by multiple and long lasting phases of quiescence. Also glacial activity shows discrete phases of enhanced intensity that may correlate with periods of increased spin-axis obliquity. The episodicity of geological processes like volcanism, erosion, and glaciation on Mars reflects close correlation between surface processes and endogenic activity as well as orbit variations and changing climate condition