’N GEÏNTEGREERDE GESINSTERAPEUTIESE WERKWYSE MET HERSAAMGESTELDE GESINNE

By using an integrative family therapy model, this article addresses the multiple problems a stepfamily may encounter. The stepfamily is a rapidly growing family structure in modern society. The stepfamily's unique problems, for instance, life-cycle discrepancies and loyalty conflicts, begin when they start functioning together as a family. The problematic foundation of a stepfamily and its unique composition require a specific therapeutic method that will take the complexities of those families into account. The researchers used the integrative family therapy model of David C. Olsen. This model is constructed out of six accredited methods in the field of family therapy: the problem solving, structural, interactional, cognitive, multigenerational and object-relation method

Tectonic evolution of the early Mesozoic blueschist-bearing Qiangtang metamorphic belt, central Tibet

This is the published version. Copyright 2003 American Geophysical Union. All Rights Reserved.A >500-km-long east-west trending metamorphic belt in the Qiangtang terrane of central Tibet consists of tectonic melange that occurs in the footwalls of Late Triassic–Early Jurassic domal low-angle normal faults. The melange is comprised of a strongly deformed matrix of metasedimentary and mafic schists that encloses lesser-deformed blocks of metabasites, Carboniferous–Triassic metasedimentary rocks, and early Paleozoic gneiss. Both the blocks and melange matrix exhibit greenschist, epidote-blueschist, and locally, epidote-amphibolite facies mineral assemblages. Thermobarometry reveals that the metamorphic belt experienced pressures of >10 kbar. Maximum equilibration temperatures for mafic schists in the melange matrix decrease from east to west, from ∼660°C near Shuang Hu (33°N, 89°E), ∼500°C near Rongma (33°N, 87°E), to ∼425°C near Gangma Co (34°N, 84°E). Equilibration at consistently high pressures over a large range of temperatures is compatible with metamorphism of Qiangtang melange within a low-angle subduction zone beneath a continental margin. Coupled structural, thermobarometric, and 40Ar/39Ar studies suggest that Qiangtang melange was exhumed in an intracontinental setting from depths of >35 km to upper crustal levels in <12 Myr by Late Triassic–Early Jurassic crustal-scale normal faulting. Detrital zircons from metasandstones within the melange matrix yield U-Pb ion-microprobe ages that range from early Paleozoic to Early Archean, and could have been sourced from terranes to the north of the Jinsha suture. Our results support a model in which Qiangtang melange was underthrust ∼200 km beneath the Qiangtang terrane during early Mesozoic flat-slab southward subduction of Paleo-Tethyan oceanic lithosphere along the Jinsha suture. This model predicts that significant portions of the central Tibetan continental mantle lithosphere were removed during early Mesozoic low-angle oceanic subduction and that the present-day central Tibetan deeper crust includes large volumes of underthrust early Mesozoic melange

Orthovoltage intraoperative radiation therapy for pancreatic adenocarcinoma

<p>Abstract</p> <p>Purpose</p> <p>To analyze the outcomes of patients from a single institution treated with surgery and orthovoltage intraoperative radiotherapy (IORT) for pancreatic adenocarcinoma.</p> <p>Methods</p> <p>We retrospectively reviewed 23 consecutive patients from 1990-2001 treated with IORT to 23 discrete sites with median and mean follow up of 6.5 and 21 months, respectively. Most tumors were located in the head of the pancreas (83%) and sites irradiated included: tumor bed (57%), vessels (26%), both the tumor bed/vessels (13%) and other (4%). The majority of patients (83%) had IORT at the time of their definitive surgery. Three patients had preoperative chemoradiation (13%). Orthovoltage X-rays (200-250 kVp) were employed via individually sized and beveled cone applicators. Additional mean clinical characteristics include: age 64 (range 41-81); tumor size 4 cm (range 1.4-11); and IORT dose 1106 cGy (range 600-1500). Post-operative external beam radiation (EBRT) or chemotherapy was given to 65% and 76% of the assessable patients, respectively. Outcomes measured were infield control (IFC), loco-regional control (LRC), distant metastasis free survival (DMFS), overall survival (OS) and treatment-related complications.</p> <p>Results</p> <p>Kaplan-Meier (KM) 2-year IFC, LRC, DMFS and OS probabilities for the whole group were 83%, 61%, 26%, and 27%, respectively. Our cohort had three grade 3-5 complications associated with treatment (surgery and IORT).</p> <p>Conclusions</p> <p>Orthovoltage IORT following tumor reductive surgery is reasonably well tolerated and seems to confer in-field control in carefully selected patients. However, distant metastases remain the major problem for patients with pancreatic adenocarcinoma.</p

Qualités psychométriques du Consumer satisfaction questionnaire (CSQ-8) et du Helping alliance questionnaire (HAQ) [Psychometric properties of the Consumer Satisfaction Questionnaire (CSQ-8) and the Helping Alliance Questionnaire (HAQ)].

BACKGROUND: This study was based on data from a quality of care assessment survey conducted in 2011 in outpatient polyclinics of the Vaud Canton in Switzerland, comprising questionnaires completed by 568 children over the age often and 672 parents of children of all ages. The objective of this study was to evaluate the psychometric qualities of the eight-item French versions for children of the Helping Alliance Questionnaire (HAQ) and the Consumer Satisfaction Questionnaire (CSQ-8) to allow formal validation and clinical application of these tools in the context of French-speaking child psychiatry. METHODOLOGY: Responses from children over the age often to the HAQ and CSQ-8 questionnaires were submitted to confirmatory factorial analysis (CFA) for ordinal data to verify their good fit with the original long versions. Construct validity (correspondence between scores on the scales and other external criteria considered to evaluate similar concepts) of the child questionnaires was tested by Spearman's correlation with the parents' responses and their feeling of being reassured or in agreement with respect to the first visit, and with the perception of the help provided by individual and family interviews. RESULTS: CFA showed an acceptable fit with the one-dimensional model of the original scales, both for the HAQ and the CSQ-8. Significant positive correlations of the scales with the parents' responses and with other convergent external criteria confirmed the good construct validity. CONCLUSIONS: These psychometric analyses provide a basis for the validation and clinical application of the abridged French versions of the HAQ and CSQ-8 in quality of care assessment in child psychiatry

Музейна справа сучасної Франції на прикладі музею Бранлі

The article sums up the results of the first year of operation du quai Braniy. It also sheds light on multicultural image of modern France