Finding focus in a difficult landscape: Therapists’ experiences with challenging video guidance processes for parent–infant dyads

Marte Meo video guidance uses filmed interaction of the actual parent–infant dyad in the guidance of caregivers. Exploring the challenges that therapists meet in the guidance of parent–infant dyads may illuminate important aspects of the method itself as well as the therapists’ role and requirements. This could lead to method development and improved practice, but is hitherto little addressed. In this paper, we explore how skilled therapists experience and handle challenging or failing guidance processes with parent–infant dyads. We analyzed interviews with 13 Marte Meo therapists/supervisors using team-based reflexive thematic analysis. Four main themes were identified: promoting relational growth in a coercive context, building an alliance that feels safe for the parents, looking at positive moments in difficult lives, and handling intense feelings as a therapist. Our findings show that therapists experience specific therapeutic and ethical challenges with a vulnerable subgroup of parent–infant dyads where child protective issues arise, where caregivers’ insecurities impede the therapeutic relationship, and where caregivers have unsolved relational or mental health problems. The therapists’ role becomes pivotal and demanding with regard to the therapeutic alliance, the therapeutic interventions in the guidance process, and their own need for regulation, supervision, and structure. Identification of these vulnerable dyads early in the process could facilitate a better adaptation and practice of video guidance. Our findings suggest a need for supporting structures, clinical supervision, and training that address these challenges.publishedVersio

«La relation de limitation et d’exception dans le français d’aujourd’hui : excepté, sauf et hormis comme pivots d’une relation algébrique »

L’analyse des emplois prépositionnels et des emplois conjonctifs d’ “excepté”, de “sauf” et d’ “hormis” permet d’envisager les trois prépositions/conjonctions comme le pivot d’un binôme, comme la plaque tournante d’une structure bipolaire. Placées au milieu du binôme, ces prépositions sont forcées par leur sémantisme originaire dûment métaphorisé de jouer le rôle de marqueurs d’inconséquence systématique entre l’élément se trouvant à leur gauche et celui qui se trouve à leur droite. L’opposition qui surgit entre les deux éléments n’est donc pas une incompatibilité naturelle, intrinsèque, mais extrinsèque, induite. Dans la plupart des cas (emplois limitatifs), cette opposition prend la forme d’un rapport entre une « classe » et le « membre (soustrait) de la classe », ou bien entre un « tout » et une « partie » ; dans d’autres (emplois exceptifs), cette opposition se manifeste au contraire comme une attaque de front portée par un « tout » à un autre « tout ». De plus, l’inconséquence induite mise en place par la préposition/conjonction paraît, en principe, tout à fait insurmontable. Dans l’assertion « les écureuils vivent partout, sauf en Australie » (que l’on peut expliciter par « Les écureuils vivent partout, sauf [qu’ils ne vivent pas] en Australie »), la préposition semble en effet capable d’impliquer le prédicat principal avec signe inverti, et de bâtir sur une telle implication une sorte de sous énoncé qui, à la rigueur, est totalement inconséquent avec celui qui le précède (si « les écureuils ne vivent pas en Australie », le fait qu’ils « vivent partout » est faux). Néanmoins, l’analyse montre qu’alors que certaines de ces oppositions peuvent enfin être dépassées, d’autres ne le peuvent pas. C’est, respectivement, le cas des relations limitatives et des relations exceptives. La relation limitative, impliquant le rapport « tout » - « partie », permet de résoudre le conflit dans les termes d’une somme algébrique entre deux sous énoncés pourvus de différent poids informatif et de signe contraire. Les valeurs numériques des termes de la somme étant déséquilibrées, le résultat est toujours autre que zéro. La relation exceptive, au contraire, qui n’implique pas le rapport « tout » - « partie », n’est pas capable de résoudre le conflit entre deux sous énoncés pourvus du même poids informatif et en même temps de signe contraire : les valeurs numériques des termes de la somme étant symétriques et égales, le résultat sera toujours équivalent à zéro

Water Vapor Transport Across an Arid Sand Surface-Non-Linear Thermal Coupling, Wind-Driven Pore Advection, Subsurface Waves, and Exchange With the Atmospheric Boundary Layer

International audienceAlthough vapor exchanged across hyper-arid surfaces without free liquid affects the water budget of sand seas, its mechanism is poorly documented for want of accurate instruments with fine spatial resolution. To rectify this, we report bulk density profiles and spatiotemporal variations of vapor mass fraction just below the surface of a mobile dune, acquired with a multi-sensor capacitance probe sensitive to tiny water films adsorbed on sand grains. We also record wind speed and direction, ambient temperature and relative humidity, net radiation flux, and subsurface temperature profiles over 2 days. The data validate a non-linear model of vapor mass fraction. Unlike heat, which conducts through grains, vapor percolates across the interstitial pore space by advection and diffusion. On time scales longer than evaporation, adsorbed films equilibrate with their surroundings and hinder molecular diffusion. Their non-linear coupling with subsurface temperature generates inflections in vapor profiles without counterpart in simpler diffusive systems. Pore advection arises as wind induces subtle pressure variations over the topography. During periods of aeolian transport, flowing sand dehydrates the surface intermittently, triggering evanescent vapor waves of amplitude decaying exponentially downward on a characteristic length implying an adsorption rate governed by a kinetic-limited activated process. Finally, the probe yields diffusive and advective exchanges with the atmospheric boundary layer. During the day, their combined flux is smaller than expected, yet nearly proportional to the difference between vapor mass fraction at the surface and aloft. Under stabler stratification at night, or during aeolian sand transport, this relation no longer holds

Are sampling and hierarchical segmentation future tools for automated quantitative immunochemistry in oncology

International audienceImage analysis offers to pathologists a modern and attractive way of immunohistochemical quantification. However, the introduction of this technic in routine practice requires a full automation and standardization of handling, which goes together with a stabilization and standardization of the staining procedures. Two strategies of hierarchical segmentation are presented and discussed taking histological sections of breast carcimona as an example : i) low resolution; ii) high resolution

The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis

PURPOSE: There is no consensus on adequate negative margins in breast-conserving surgery (BCS) for ductal carcinoma in-situ (DCIS). We systematically review the evidence on margins in BCS for DCIS. METHODS: Study-level meta-analysis of local recurrence (LR), microscopic margin status and threshold distance for negative margins. LR proportion was modelled using random-effects logistic meta-regression (frequentist), and network meta-analysis (Bayesian) that allows for multiple margin distances per study, adjusting for follow-up time. RESULTS: Based on 20 studies (LR: 865 of 7,883), odds of LR were associated with margin status (logistic: odds ratio (OR) 0.53 for negative vs positive/close [P<0.001]; network: OR=0.45 for negative vs positive). In logistic meta-regression, relative to >0 or 1mm, ORs for 2mm (0.51), 3 or 5mm (0.42) and 10mm (0.60) showed comparable significant reductions in the odds of LR. In the network analysis, ORs relative to positive margins for 2mm (0.32), 3mm (0.30) and 10mm (0.32) showed similar reductions in the odds of LR that were greater than for >0 or 1mm (0.45). There was weak evidence of lower odds at 2mm compared to >0 or 1mm (Relative OR=0.72, 95% credible interval [CrI] 0.47-1.08), and no evidence of a difference between 2mm and 10mm (Relative OR=0.99, 95% CrI 0.61-1.64). Adjustment for covariates, and analyses based only on studies using whole-breast radiotherapy, did not change findings. CONCLUSION: Negative margins in BCS for DCIS reduce the odds of LR; however, minimum margins distances above 2mm are not significantly associated with further reduced odds of LR in women receiving radiation