Palliativmedizinische Lehre in Deutschland - Planungen der Fakultäten zum zukünftigen Querschnittsfach 13.

[english] Background: Following recent modifications of the Medical Licensure Act (ÄApprO) in the year 2009, palliative care was introduced as a compulsory 13 cross-disciplinary subject (Q13) in the undergraduate curriculum. Its implementation must have taken place before the beginning of the final year (´practical year´) in August 2013 and has to be substantiated for the medical exams taking place in October 2014. Very diverse structures pertaining to palliative care teaching were described in previous surveys at various medical faculties in Germany. As a result, the current and future plans and concepts related to content and exams of a mandatory Q13 course at the respective faculty sites should be ascertained. Methods: Since 2006, the German Medical Students' Association (bvmd) has been carrying out a bi-annual survey at all medical faculties in Germany regarding the current situation of teaching in the field of palliative care. After designing and piloting an online survey in May 2010, a one-month online survey took place. The data was assessed using a descriptive approach. Results: 31 of 36 medical faculties took part in the survey. At the time of questioning, 15 faculties already taught courses according to the requirements of the new ÄApprO; at three sites the Q13 is yet to be introduced commencing in 2012. A teaching curriculum for Q13 already existed at 15 faculty sites, partly based on the curricular requirements of the German Association for Palliative Medicine (DGP). Six sites described an implementation process as yet without an independent curriculum. Most of the faculties aim for 21-40 course hours, which will for the most part be provided as lectures, seminars or less often in more assisted and intense formats. The majority of the participating faculties intend an examination containing multiple choice questions. At 8 universities there is an independent Chair for palliative medicine (5 more are planned); this was linked with a higher degree of mandatory teaching in alignment with the requirements of the ÄApprO. A broad spectrum of educationally-involved occupational groups, specialist disciplines and external co-operating partners, were mentioned. Conclusion: The infrastructural prerequisites of the present curricular concepts and the degree of implementation of the Q13 according to the requirements of the new ÄApprO diverge significantly among the various medical faculties. The efforts made to produce a qualitatively high standard of teaching with regard to the multifaceted questions concerning the support for severely and terminally ill patients is as much reflected in the survey, as the special implications of an independent Chair for palliative medicine for the implementation of the requirements by law. The participation of various occupational groups in this survey as well as the broad spectrum of those involved highlights the interdisciplinary and multi-professional dimension of teaching in palliative care. <br>[german] Fragestellung: Mit der Änderung der ärztlichen Approbationsordnung (ÄApprO) im Jahre 2009 wurde die Palliativmedizin als 13. Querschnittsfach (Q13) verpflichtend in das studentische Curriculum eingeführt. Die Umsetzung dieser Änderung muss bis zum Beginn des Praktischen Jahres im August 2013 oder bei der Meldung zum Zweiten Abschnitt der Ärztlichen Prüfung für den Prüfungstermin im Oktober 2014 erfolgen.In vorangegangenen Umfragen wurden an den medizinischen Fakultäten in Deutschland sehr heterogene palliativmedizinische Lehrstrukturen beschrieben. Daher sollten nun die curricularen und prüfungsbezogenen Planungen der jeweiligen Fakultäten zur Implementierung eines verpflichtenden Q13 Palliativmedizin erfragt werden.Methodik: Die Bundesvertretung der Medizinstudierenden Deutschlands (bvmd) führt seit 2006 zweijährliche Umfragen an allen medizinischen Fakultäten in Deutschland zum gegenwärtigen Stand der palliativmedizinischen Lehre durch.Nach Konzeption eines Online-Fragebogens und Pilotierung erfolgte im Mai 2010 eine einmonatige Online-Umfrage. Die Daten wurden deskriptiv ausgewertet.Ergebnisse: 31 von 36 medizinischen Fakultäten nahmen an der Befragung teil. An 15 Fakultäten existierten zum Befragungszeitpunkt bereits verpflichtende Lehrveranstaltungen entsprechend der Vorgabe der neuen ÄApprO; an drei Standorten soll das Q13 Palliativmedizin erst ab dem Sommersemester 2012 verpflichtend eingeführt werden. An 15 Fakultäten bestand bereits ein Lehrcurriculum für Q13, teils angelehnt an die curricularen Vorgaben der Deutschen Gesellschaft für Palliativmedizin. Sechs Standorte beschrieben einen begonnenen Implementierungsprozess noch ohne Curriculum. An den meisten Fakultäten werden 21-40 Lehrveranstaltungsstunden angestrebt, die überwiegend in Form von Vorlesungen oder Seminaren, seltener auch in betreuungsintensiveren Formaten angeboten werden sollen. Die Mehrzahl der teilnehmenden Fakultäten strebt eine Prüfung in Form von Multiple Choice Fragen an. An 8 Universitäten bestand ein eigenständiger Lehrstuhl für Palliativmedizin (5 weitere in Planung); dies war mit einem höheren Maß an Pflichtlehre analog der Vorgabe der ÄApprO verbunden. Ein breites Spektrum an lehrbeteiligten Berufsgruppen, Fachdisziplinen und externen Kooperationspartnern wurde angegeben.Schlussfolgerung: Die infrastrukturellen Voraussetzungen, die bisherigen curricularen Planungen und der Grad der Implementierung des Q13 analog der Vorgabe der neuen ÄApprO divergieren zwischen den einzelnen medizinischen Fakultäten erheblich. Die Bemühungen um eine qualitativ hochwertige Lehre in Hinblick auf die vielschichtigen Fragestellungen bei der Betreuung schwerst- und sterbenskranker Patienten spiegeln sich in der Umfrage ebenso wider wie der besondere Stellenwert eines eigenständigen Lehrstuhls für Palliativmedizin für die Umsetzung der gesetzlichen Vorgaben. Die Mitwirkung der verschiedenen Berufsverbände an dieser Umfrage sowie das große Spektrum der Lehrbeteiligten unterstreicht die interdisziplinäre und multiprofessionelle Dimension palliativmedizinischer Lehre

Sediment instability on the Portuguese continental margin under abrupt glacial climate changes (last 60 kyr)

13 pages, 6 figures, 1 table, appendix supplementary informationIt is well established that orbital scale sea-level changes generated larger transport of sediments into the deep-sea during the last glacial maximum than the Holocene. However, the response of sedimentary processes to abrupt millennial-scale climate variability is rather unknown. Frequency of distal turbidites and amounts of advected detrital carbonate are estimated off the Lisbon-Setúbal canyons (core MD03-2698, at 4602 mwd), within a chronostratigraphy based on radiometric ages, oxygen isotopes and paleomagnetic key global anomalies. We found that: 1) higher frequency of turbidites concurred with Northern Hemisphere coldest temperatures (Greenland Stadials [GS], including Heinrich [H] events). But more than that, an escalating frequency of turbidites starts with the onset of global sea-level rising (and warming in Antarctica) and culminates during H events, at the time when rising is still in its early-mid stage, and the Atlantic Meridional Overturning Circulation (AMOC) is re-starting. This short time span coincides with maximum gradients of ocean surface and bottom temperatures between GS and Antarctic warmings (Antarctic Isotope Maximum; AIM 17, 14, 12, 8, 4, 2) and rapid sea-level rises. 2) Trigger of turbidity currents is not the only sedimentary process responding to millennial variability; land-detrital carbonate (with a very negative bulk δ18O signature) enters the deep-sea by density-driven slope lateral advection, accordingly during GS. 3) Possible mechanisms to create slope instability on the Portuguese continental margin are sea-level variations as small as 20 m, and slope friction by rapid deep and intermediate re-accommodation of water masses circulation. 4) Common forcing mechanisms appear to drive slope instability at both millennial and orbital scales. © 2009The Commission Human Potential Programme Access to Research Infrastructures Activity (ARI) (through the Climate Variability and Abrupt Climate Changes off Portugal application) to support coring of Calypso MD03-2698 during the PICABIA cruise (F.G.A.); the use of XRF Core-Scanner from the University of Bremen (Ocean Drilling Program Repository) also through an ARI Paleostudies proposal (S.M.L.). The funding from ESF-Euromargins projects: SEDPORT – Sedimentation Processes on the Portuguese Margin: The Role of Continental Climate, Ocean Circulation, Sealevel, and Neo-tectonics (Fundaçâo para a Ciência e Tecnologia PDCTM/40017/2003) and SWIM (01-LEG-EMA09F and REN2002-11234E-MAR); and GRICES-CSIC (Cooperaçâo Científica e Técnica Luso-Espanhola). Funding support was also provided by LNEG. A.H.V. acknowledges the postdoctoral fellowship (SFRH/BPD/21691/2005)Peer Reviewe

Benchmark reactive transport simulations of a column experiment in compacted bentonite with multispecies diffusion and explicit treatment of electrostatic effects

Bentonite clay is considered as a potential buffer and backfill material in subsurface repositories for high-level nuclear waste. As a result of its low permeability, transport of water and solutes in compacted bentonite is driven primarily by diffusion. Developing models for species transport in bentonite is complicated, because of the interaction of charged species and the negative surface charge of clay mineral surfaces. The effective diffusion coefficient of an ion in bentonite depends on the ion's polarity and valence, on the ionic strength of the solution, and on the bulk dry density of the bentonite. These dependencies need to be understood and incorporated into models if one wants to predict the effectiveness of bentonite as a barrier to radionuclides in a nuclear repository. In this work, we present a benchmark problem for reactive transport simulators based on a flow-through experiment carried out on a saturated bentonite core. The measured effluent composition shows the complex interplay of species transport in a charged medium in combination with sorption and mineral precipitation/dissolution reactions. The codes compared in this study are PHREEQC, CrunchFlow, FLOTRAN, and MIN3P. The benchmark problem is divided into four component problems of increasing complexity, leading up to the main problem which addresses the effects of advective and diffusive transport of ions through bentonite with explicit treatment of electrostatic effects. All codes show excellent agreement between results provided that the activity model, Debye-Hückel parameters, and thermodynamic data used in the simulations are consistent. A comparison of results using species-specific diffusion and uniform species diffusion reveals that simulated species concentrations in the effluent differ by less than 8 %, and that these differences vanish as the system approaches steady state

Benchmark reactive transport simulations of a column experiment in compacted bentonite with multispecies diffusion and explicit treatment of electrostatic effects

International audienceBentonite clay is considered as a potential buffer and backfill material in subsurface repositories for high-level nuclear waste. As a result of its low permeability, transport of water and solutes in compacted bentonite is driven primarily by diffusion. Developing models for species transport in bentonite is complicated, because of the interaction of charged species and the negative surface charge of clay mineral surfaces. The effective diffusion coefficient of an ion in bentonite depends on the ion’s polarity and valence, on the ionic strength of the solution, and on the bulk dry density of the bentonite. These dependencies need to be understood and incorporated into models if one wants to predict the effectiveness of bentonite as a barrier to radionuclides in a nuclear repository. In this work, we present a benchmark problem for reactive transport simulators based on a flow-through experiment carried out on a saturated bentonite core. The measured effluent composition shows the complex interplay of species transport in a charged medium in combination with sorption and mineral precipitation/dissolution reactions. The codes compared in this study are PHREEQC, CrunchFlow, FLOTRAN, and MIN3P. The benchmark problem is divided into four component problems of increasing complexity, leading up to the main problem which addresses the effects of advective and diffusive transport of ions through bentonite with explicit treatment of electrostatic effects. All codes show excellent agreement between results provided that the activity model, Debye-Hückel parameters, and thermodynamic data used in the simulations are consistent. A comparison of results using species-specific diffusion and uniform species diffusion reveals that simulated species concentrations in the effluent differ by less than 8 %, and that these differences vanish as the system approaches steady state

Benchmarking of reactive transport codes for 2D simulations with mineral dissolution–precipitation reactions and feedback on transport parameters

Porosity changes due to mineral dissolution–precipitation reactions in porous media and the resulting impact on transport parameters influence the evolution of natural geological environments or engineered underground barrier systems. In the absence of long-term experimental studies, reactive transport codes are used to evaluate the long-term evolution of engineered barrier systems and waste disposal in the deep underground. Examples for such problems are the long-term fate of CO2 in saline aquifers and mineral transformations that cause porosity changes at clay–concrete interfaces. For porosity clogging under a diffusive transport regime and for simple reaction networks, the accuracy of numerical codes can be verified against analytical solutions. For clogging problems with more complex chemical interactions and transport processes, numerical benchmarks are more suitable to assess model performance, the influence of thermodynamic data, and sensitivity to the reacting mineral phases. Such studies increase confidence in numerical model descriptions of more complex, engineered barrier systems. We propose a reactive transport benchmark, considering the advective–diffusive transport of solutes; the effect of liquid-phase density on liquid flow and advective transport; kinetically controlled dissolution–precipitation reactions causing porosity, permeability, and diffusivity changes; and the formation of a solid solution. We present and analyze the results of five participating reactive transport codes (i.e., CORE2D, MIN3P-THCm, OpenGeoSys-GEM, PFLOTRAN, and TOUGHREACT). In all cases, good agreement of the results was obtained

HEATSTORE SWITZERLAND: New Opportunities of Geothermal District Heating Network Sustainable Growth by High Temperature Aquifer Thermal Energy Storage Development

HEATSTORE is a GEOTHERMICA ERA-NET co-funded project, aiming at developing High Temperature (~25°C to ~90°C) Underground Thermal Energy Storage (HT-UTES) technologies by lowering the cost, reducing risks, improving the performance, and optimizing the district heating network demand side management at 6 new pilot and demonstration sites, two of which are in Switzerland, plus 8 case studies. The European HEATSTORE consortium includes 24 contributing partners from 9 countries, composing a mix of scientific research institutes and private companies. The Swiss consortium, developing HEATSTORE in Switzerland, involves of two industrial partners (Services Industriels de Geneva - SIG and Energie Wasser Bern - EWB) and four academic partners (Universities of Geneva, Bern, Neuchâtel and ETH Zurich), with support from the Swiss Federal Office of Energy. The aims are to develop two demonstration projects for High Temperature Aquifer Thermal Energy Storage (HT-ATES) in the cantons of Geneva and Bern such that industrial waste heat can be converted into a resource. This paper presents the results of the first year of activities in the Swiss projects. The activities planned cover subsurface characterization, energy system analysis, surface implementation design, legal framework improvement and business modelling to ensure the sustainability of the projects. This approach is supported by large industrial investments for subsurface characterization. Two wells, down to 1200m below surface level (bsl) are being drilled in the Geneva area to tap potential targets in the carbonate Mesozoic units and at least three additional wells, down to 500m bsl will target the Molasse sediments in the Bern area next year. These wells allow subsurface exploration and characterization and will provide data, used for detailed THMC modelling to assess the thermal energy storage potential at the two sites in Switzerland. The results of such numerical modelling are combined with energy system analysis to quantify the waste heat availability and heat demand and hence optimize the production and injection operations. The outcomes of the coupled assessments will aid in designing the integration of the new installations into the districtheating network. Legal framework improvements, based on complete technical evaluation and on the best-practice sharing with the other European partners, will be an enabling tool to accelerate the implementation of the HT-ATES systems, while business modelling helps calibrate the economic feasibility of the projects and helps industrial partners to plan future investments