A simple evaluation tool (ET-CET) indicates increase of diagnostic skills from Small bowel capsule endoscopy training courses: A prospective observational european multicenter study

Small bowel capsule endoscopy (SBCE) has become a first line diagnostic tool. Several training courses with a similar format have been established in Europe; however, data on learning curve and training in SBCE remain sparse. Between 2008 and 2011, different basic SBCE training courses were organized internationally in UK (n=2), Italy (n= 2), Germany (n=2), Finland (n=1), and nationally in Germany (n=10), applying similar 8-hour curricula with 50% lectures and 50% hands-on training. The Given PillCam System was used in 12 courses, the Olympus EndoCapsule system in 5, respectively. A simple evaluation tool for capsule endoscopy training (ET-CET) was developed using 10 short SBCE videos including relevant lesions and normal or irrelevant findings. For each video, delegates were required to record a diagnosis (achievable total score from 0 to 10) and the clinical relevance (achievable total score 0 to 10). ET-CET was performed at baseline before the course and repeated, with videos in altered order, after the course. Two hundred ninety-four delegates (79.3% physicians, 16.3% nurses, 4.4% others) were included for baseline analysis, 268 completed the final evaluation. Forty percent had no previous experience in SBCE, 33% had performed 10 or less procedures. Median scores for correct diagnosis improved from 4.0 (IQR 3) to 7.0 (IQR 3) during the courses (P<0.001, Wilcoxon), and for correct classification of relevance of the lesions from 5.0 (IQR 3) to 7.0 (IQR 3) (P<0.001), respectively. Improvement was not dependent on experience, profession, SBCE system, or course setting. Previous experience in SBCE was associated with higher baseline scores for correct diagnosis (P< 0.001; Kruskal-Wallis). Additionally, independent nonparametric partial correlation with experience in gastroscopy (rho 0.33) and colonoscopy (rho 0.27) was observed (P<0.001). A simple ET-CET demonstrated significant improvement of diagnostic skills on completion of formal basic SBCE courses with hands-on training, regardless of preexisting experience, profession, and course setting. Baseline scores for correct diagnoses show a plateau after interpretation of 25 SBCE before courses, supporting this number as a compromise for credentialing. Experience in flexible endoscopy may be useful before attending an SBCE course

Long journey home: Family reunification experiences of the disappeared children of El Salvador

Established in 1994, Salvadoran Asociación Pro-Búsqueda de Niñas y Niños Desaparecidos (Association for the Search of Disappeared Children) has located 384 children, often with the aid of DNA evidence, of the more than 500 who went missing or were abducted during El Salvador’s civil war. Families in other countries who were unaware of the forced separations adopted many of these children. Between 2005 and 2009, we conducted semi-structured interviews with twenty-six children, now young adults aged twenty-four to thirty-four years, who had been reunited with their biological families. We found that we could conceptually categorize the process of separation and reunifcation into six phases: pre-disappearance, disappearance, separation, searching, reunion, and reunifcation. While these young adults said that reunifcation was extremely important, they often found this stage psychologically challenging, given their new identities and their uncertainty about how they would reintegrate back—if at all—into their biological families. We call this process “ambiguous reunifcation.”

Long journey home: Family reunification experiences of the disappeared children of El Salvador

Established in 1994, Salvadoran Asociación Pro-Búsqueda de Niñas y Niños Desaparecidos (Association for the Search of Disappeared Children) has located 384 children, often with the aid of DNA evidence, of the more than 500 who went missing or were abducted during El Salvador’s civil war. Families in other countries who were unaware of the forced separations adopted many of these children. Between 2005 and 2009, we conducted semi-structured interviews with twenty-six children, now young adults aged twenty-four to thirty-four years, who had been reunited with their biological families. We found that we could conceptually categorize the process of separation and reunifcation into six phases: pre-disappearance, disappearance, separation, searching, reunion, and reunifcation. While these young adults said that reunifcation was extremely important, they often found this stage psychologically challenging, given their new identities and their uncertainty about how they would reintegrate back—if at all—into their biological families. We call this process “ambiguous reunifcation.”

Die CO2_{2}-Problematik: Sachverhalte, Zusammenhänge, Hypothesen, Argumente

Seit hunderten von Millionen Jahren verändert sich die Luftzusammensetzung. Im Laufe der Erdgeschichte ist der Kohlendioxidgehalt der Luft allmählich geringer geworden, während der Sauerstoffgehalt entsprechend stieg. Die gesamte lebende Welt mußte sich anpassen.Hier liegt der Schlüssel zu einem neuen Verständnis der Evolution unserer Biosphäre. Die in der Gegenwart beobachtete Veränderung ist vom Menschen gemacht somit nicht natürlich. Sie unterscheidet sich von den erdgeschichtlichen Veränderungen durch ihre enorme, um zwei bis vier Größenordnung höhere Geschwindigkeit. Schreitet sie in der bisherigen Tendenz und Geschwindigkeit weiter fort, muß nicht nur mit Klimaänderungen, sondern auch mit schwerwiegenden Schädigungen der Biosphäre gerechnet werden, die evolutionsbiologische Ursachen haben, aber auch hervorgerufen und verstärkt werden durch direkte Wirkungen von Kohlendioxid auf die Lebensfunktionen von Organismen. Eine Problemlösung nur mit technischen Mitteln erscheint ausgeschlossen

Untersuchungen zur Wasserdampf Kohle Teilvergasung in einem primärheliumbeheizten, stehenden Gasgenerator

Verfahrenstechnische Auslegungsdaten und Konzeptentwürfe für den Gasgenerator in stehender Bauart (im Gegensatz zur bisherigenliegenden Bauart) des Verfahrens der "Wasserdampf-Kohle-Vergasung" zur nicht-katalytischen Teil-(und Voll-)Vergasung von Steinkohlein Pilotgröße für die Systemerprobung am erweiterten AVR und in Produktionsgröße für Heliumeintrittstemperaturen von 900 °C und höheren Temperaturen