L'imaginaire: quelle place l'imaginaire doit-il avoir dans les structures d'accueil auprès des enfants de deux à cinq ans ?

Ma recherche concerne la place que doit avoir l’imaginaire dans les structures d’accueil auprès des enfants de deux à cinq ans. Pour répondre à cette interrogation, je me suis appuyée à la fois sur les ressources théoriques et sur les données récoltées sur le terrain. Mon travail s’est axé sur plusieurs thèmes comme le rôle de l’imaginaire dans le développement global de l’enfant, la pédagogie de l’imaginaire et les limites de ce dernier, le rôle de l’EDE selon le plan d’étude cadre et l’accompagnement. Tous ces points se relient entre eux, ils se complètent et amènent des éclairages sur ma thématique. Je me suis intéressée à ce qui implique pour l’EDE de travailler avec l’imaginaire, les outils, l’attente de résultats, le regard des autres et le travail sur soi. Toutes ces recherches m’ont permis de faire ressortir la place qui doit être attribuée à l’imaginaire ainsi que d’éventuelles pistes d’action. Mes entretiens sur le terrain, m’ont permis de ressortir des points importants qui expliquent certainement pourquoi l’imaginaire n’a pas souvent de place dans les structures d’accueil

A combined inversion of Rayleigh wave dispersion and 2‐D resonance frequencies

Shear wave velocities of the sediment fill of a deep Alpine valley are estimated from ambient noise recorded on linear and circular arrays. We propose a combined inversion of 2‐D resonance frequencies identified from site‐to‐reference spectral ratios and Rayleigh wave dispersion curves obtained from frequency‐wavenumber analysis. The method is tested on synthetic noise data and on noise recorded at three sites in the Rhône valley in Southern Switzerland. Previous studies have shown that 2‐D resonance dominates the ambient vibration wavefield at low frequencies at the investigated sites. Inversion techniques which assume that the noise wavefield consists mainly of horizontally propagating surface waves will, therefore, fail to resolve shear wave velocities at depths below around 500 m. We show that standard techniques lead to an overestimation of shear wave velocities at depth when applied to synthetic and observed ambient noise. The combined inversion is able to resolve the shear wave velocities in the initial velocity model when applied to synthetic noise records. Application of the method to observed ambient noise improves resolution at depth and yields realistic shear wave velocities for the lower part of the sediment fil

Molar substitution and C2/C6 ratio of hydroxyethyl starch: influence of blood coagulation

Résumé Cette étude a démontré l'effet individuel sur la coagulation sanguine humaine des deux principales caractéristiques de la molécule d'hydroxyéthylamidon (HES) : la substitution molaire et le rapport C2/C6. L'analyse par thrombélastographe (TEG®) indique que la molécule de HES dont la substitution molaire est de 0.42 et le rapport C2/C6 de 2.7 a le moins d'effet sur la coagulation sanguine chez l'être humain. Objectifs de l'étude Le développement d'hydroxyéthylamidons (HES) qui ont à la fois peu d'impact sur la coagulation sanguine et une longue persistance intravasculaire est d'un grand intérêt clinique. Une précédente étude in vitro a démontré qu'une solution de HES de haut poids moléculaire et de bas degré de substitution molaire ne compromettait pas plus la coagulation sanguine qu'une solution HES de poids moléculaire moyen (1). La présente étude examine l'effet individuel de la substitution molaire et du rapport C2/C6 d'une solution de HES de haut poids moléculaire (700 kDa) sur la coagulation sanguine. Matériel et méthode Nous avons prélevé du sang chez 30 adultes en bonne santé; le sang a été mélangé avec 6 solutions de HES qui diffèrent par leur degré de substitution molaire (0.42 et 0.51) et leur rapport C2/C6 (2.7, 7 et 14) à trois degrés de dilution : 20%, 40% et 60%. Les échantillons ont ensuite été analysés par thrombélastographe. Les données ont été étudiées par analyse de variance à trois voies pour mesures répétées sur une voie (dilution). Résultats Plus la substitution molaire est élevée, plus la coagulation sanguine est compromise et ce concernant tous les paramètres du TEG® (tous les p sont < à 0.05). La solution HES avec le rapport C2/C6 le plus bas a l'effet le moins prononcé sur le temps r (p<0.001), l'angle α (p=0.003) et l'Index de Coagulation CI (p<0.001) ; on n'a pas observé d'effet sur le temps k (p=0.513) et l'amplitude maximale (p=0.699) concernant ce paramètre. Conclusion L'analyse par thrombélastographe révèle qu'une molécule de HES avec une substitution molaire de 0.42 et un rapport C2/C6 de 2.7 a un effet minimal sur la coagulation sanguine humaine in vitro

Oncology Clinicians' Defenses and Adherence to Communication Skills Training with Simulated Patients: an Exploratory Study

The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms—defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient—on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N = 31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29) = 5.26, p = 0.03, d = 0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10-12 participants) and have a minimal duration of at least 3days in order to be effective. Several systematic reviews evaluated the impact of CST on clinicians' communication skills [9-11]. Effectiveness of CST can be assessed by two main approaches: participant-based and patient-based outcomes. Measures can be self-reported, but, according to Gysels et al. [10], behavioral assessment of patient-physician interviews [12] is the most objective and reliable method for measuring change after training. Based on 22 studies on participants' outcomes, Merckaert et al. [9] reported an increase of communication skills and participants' satisfaction with training and changes in attitudes and beliefs. The evaluation of CST remains a challenging task and variables mediating skills improvement remain unidentified. We recently thus conducted a study evaluating the impact of CST on clinicians' defenses by comparing the evolution of defenses of clinicians participating in CST with defenses of a control group without training [13]. Defenses are unconscious psychological processes which protect from anxiety or distress. Therefore, they contribute to the individual's adaptation to stress [14]. Perry refers to the term "defensive functioning” to indicate the degree of adaptation linked to the use of a range of specific defenses by an individual, ranging from low defensive functioning when he or she tends to use generally less adaptive defenses (such as projection, denial, or acting out) to high defensive functioning when he or she tends to use generally more adaptive defenses (such as altruism, intellectualization, or introspection) [15, 16]. Although several authors have addressed the emotional difficulties of oncology clinicians when facing patients and their need to preserve themselves [7, 17, 18], no research has yet been conducted on the defenses of clinicians. For example, repeated use of less adaptive defenses, such as denial, may allow the clinician to avoid or reduce distress, but it also diminishes his ability to respond to the patient's emotions, to identify and to respond adequately to his needs, and to foster the therapeutic alliance. Results of the above-mentioned study [13] showed two groups of clinicians: one with a higher defensive functioning and one with a lower defensive functioning prior to CST. After the training, a difference in defensive functioning between clinicians who participated in CST and clinicians of the control group was only showed for clinicians with a higher defensive functioning. Some clinicians may therefore be more responsive to CST than others. To further address this issue, the present study aimed to evaluate the relationship between the level of adherence to an "ideally conducted interview”, as defined by the teachers of the CST, and the level of the clinician' defensive functioning. We hypothesized that, after CST, clinicians with a higher defensive functioning show a greater adherence to the "ideally conducted interview” than clinicians with a lower defensive functionin

New, but improved? Comparison between first and revised version of the Helping Alliance questionnaire

There is a consensus in the psychotherapy research field to consider the therapeutic alliance, broadly defined as the mutual collaboration between the therapist and the patient, as a robust and consistent predictor of therapy outcome. There is little agreement, however, on the best way to operationalise and measure it. Several instruments are available, each of them displaying some unique features so that investigators have problems to choose among them on the basis of considerations other than ease of administration, continuity with previous research or availability. One of the early self-report measures and widely used instruments was the Helping Alliance questionnaire (HAq-I) (Alexander and Luborsky, 1986). In recent years, we have become aware that it was limited by the presence of items that were explicitly assessing early symptomatic improvement and by the fact that all the items were worded positively. A revised version (HAq-II) was developed (Luborsky et al., 1996), guided by two main goals: (1) to reduce the inclination of the scale toward measuring early symptomatic improvement and thus confusing these two dimensions, and (2) to better incorporate the various aspects of the alliance related to the collaborative effort of patient and therapist. The new instrument includes 5 from the 11 items of the HAq-I and 14 new items - 5 of them worded negatively. The aim of the study is twofold: to validate the French version of the new HAq-II and to investigate empirically to what extent the HAq-II has improved over the HAq-I. The sample included 60 self-referred outpatients assigned to a Brief Psychodynamic Investigation (BPI), a manual-based investigation procedure in four sessions guided by psychodynamic principles. We looked at the correlation between the two HAq (I and II) and the Working Alliance Inventory (WAI), patient pretreatment characteristics (SCL-90, HDRS, HAMA, IIP) and outcome (SCL-90, SAS and patient satisfaction). Results showed that the French version of the HAq-II has good psychometric properties. Estimates of internal consistency and test-retest reliability were fairly similar to the original English version. Indication of its validity included high correlation with other alliance measures and independence from patient pretreatment characteristics. Surprisingly, HAq-II score predicted patient's satisfaction with the treatment but not symptomatic improvement. Taken together, these first results are promising and indicate that the translated version of the HAq-II is a valid instrument for measuring the helping alliance. Concerning the comparison between the two versions of the HAq, HAq-II has proved to be an improvement compared to the original HAq-I scale: it better relates to the alliance construct and it is less influenced by the symptoms of the patient. Considering also its better construct validity (Luborsky et al., 1996), we definitely recommend the use of the revised HAq-II instead of the initial version of the scale. (PsycINFO Database Record (c) 2006 APA, all rights reserved

Two-dimensional resonances in Alpine valleys identified from ambient vibration wavefields

Although numerical simulations have for long shown the importance of 2-D resonances in site effect estimations of sediment-filled valleys, this phenomenon is usually not taken into account by current hazard assessment techniques. We present an approach to identify the resonance behaviour of a typical Alpine valley by analysis of ambient noise recorded simultaneously on a dense array. The applicability of the method is evaluated further using synthetic ambient noise acquired with current 3-D numerical simulation techniques. Resonance frequencies of the fundamental mode SV and the fundamental and first higher mode of SH are identified from measured data with the reference station method, verifying results of previous studies. Patterns of spectral amplitude and phase behaviour obtained from observed and synthetic noise correlate well with properties expected for 2-D resonance. Application of a frequency-wavenumber technique shows that the noise wavefield is dominated by standing waves at low frequencies (0.25 to 0.50 Hz). The different 2-D resonance modes are creating prominent peaks in horizontal-to-vertical spectral ratios, which can not be interpreted in terms of 1-D resonance. We conclude that ambient noise records measured simultaneously on a linear array perpendicular to the valley axis may be used for identification of resonance modes in sediment-filled valley

High-frequency ground motion amplification during the 2011 Tohoku earthquake explained by soil dilatancy

Ground motions of the 2011 Tohoku earthquake recorded at Onahama port (Iwaki, Fukushima prefecture) rank among the highest accelerations ever observed, with the peak amplitude of the 3-D acceleration vector approaching 2g. The response of the site was distinctively non-linear, as indicated by the presence of horizontal acceleration spikes which have been linked to cyclic mobility during similar observations. Compared to records of weak ground motions, the response of the site during the Mw 9.1 earthquake was characterized by increased amplification at frequencies above 10 Hz and in peak ground acceleration. This behaviour contrasts with the more common non-linear response encountered at non-liquefiable sites, which results in deamplification at higher frequencies. We simulate propagation of SH waves through the dense sand deposit using a non-linear finite difference code that is capable of modelling the development of excess pore water pressure. Dynamic soil parameters are calibrated using a direct search method that minimizes the difference between observed and simulated acceleration envelopes and response spectra. The finite difference simulations yield surface acceleration time-series that are consistent with the observations in shape and amplitude, pointing towards soil dilatancy as a likely explanation for the high-frequency pulses recorded at Onahama port. The simulations also suggest that the occurrence of high-frequency spikes coincided with a rapid increase in pore water pressure in the upper part of the sand deposit between 145 and 170 s. This sudden increase is possibly linked to a burst of high-frequency energy from a large slip patch below the Iwaki regio