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Aims There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as “recommended” or “discouraged” if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled “acceptable” (neither recommended nor discouraged). Results Seventy-two surgeons with a median (IQR) experience of 23 (14–30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15–36) and 40 (28–60) pHH-surgeries, respectively. After Delphi round 2, “recommended” strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified “discouraged” strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were “acceptable”. Conclusions This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.

This study overturns the prevailing understanding of the effect of CO2-switchable water additives: the switching does not only alter the ionic strength of the solution but also the composition of the surface thus affecting foam stability.

Working children are commonly not considered as active political subjects. Yet, many of them have organised themselves as local groups that cooperate across borders. As a transnational network, they advocate for a right to work and political participation. In ir, these actors were accurately analysed as ‘governed’ actors proactively engaging in (inter-)national norm dynamics. Yet, their situatedness in local and global power relations (shaped by colonialism) remains understudied. Analysing how working children in Bolivia discursively shape their subjectivity in such hierarchical processes, it is argued that their norm engagement is intertwined with how they are situated in this context. Looking beyond proactive norm engagement, the paper argues for a broader conceptual understanding of the ‘agency of the governed’ in norm dynamics emerging in narrative practices. Special emphasis is placed on how working children in Bolivia (re)create their subjectivity through everyday practices interacting with institutional, material, and social structures which in turn are embedded within broader narrative frameworks.

Este artigo realiza uma investigação sobre a evolução histórica dos projetos de Engenharia, com ênfase particular na transição do desenho manual para a implementação de softwares e, finalmente, à adoção de tecnologias avançadas como, o Building Information Modeling (BIM). O presente artigo teve como escopo explorar a transição dos métodos de desenho manual para os softwares de engenharia, traçando os principais marcos desta transição e discutindo como esses desenvolvimentos transformaram a maneira como os projetos são realizados, e enfatizar o impacto transformador do BIM na integração e sincronização de diversas disciplinas, como arquitetura, engenharia civil, elétrica, estrutural e hidro sanitária, bem como, a proteção contra descargas atmosféricas (SPDA). A era do BIM, em particular, inaugurou uma nova fase na engenharia de projetos, caracterizada por uma maior colaboração e integração. A capacidade do BIM de incorporar e sincronizar informações de várias disciplinas em um único modelo 3D trouxe uma melhoria significativa na coordenação e eficiência dos projetos. Além disso, enfatizou a importância crítica da inovação tecnológica na eficiência e aprimoramento contínuo da engenharia de projetos. Espera-se que este estudo forneça insights valiosos para acadêmicos e profissionais da engenharia, ao mesmo tempo em que destaca a necessidade de uma maior compreensão e adoção de inovações tecnológicas nesse campo.

The ExoMars Rover instrument WISDOM (“Water Ice and Subsurface Deposit Observations on Mars”) is a ground penetrating radar (GPR) designed to investigate the shallow subsurface of Oxia Planum, the ExoMars mission’s designated landing site. Using a frequency range from 0.5 GHz to 3.0 GHz the electromagnetic waves penetrate the subsurface via a wideband antenna assembly. The achieved penetration depth is at least three meters, with a depth resolution of a few centimeters. The dual-polarimetric design of the antenna allows to measure four different channels during probing the Mars soil.The WISDOM radar will give access to the geological structure, electromagnetic nature, and possibly hydrological state of the shallow subsurface by retrieving the layering and properties of the buried reflectors. A short-term subsurface analysis will support the tight schedules of the rover operations both for science and drill operations in finding places of high scientific interest and low risk.In order to achieve these short times for decision making the incoming data at the remote operation control center (ROCC) will be automatically processed through a predefined pipeline. The processing is written in Python, which uses a self-developed framework. The basic process consists of a chain of filters that produces several radargrams at different states of processing. Further, it prepares the data for storage in PDS4 format for long-term archiving.In this work, automatic processing is introduced and results of processed measurement data acquired during a WISDOM field test in Svalbard are presented.

Zusammenfassung Einleitung Eine Anastomoseninsuffizienz nach Ösophagusresektion trägt wesentlich zu Morbidität und Mortalität der betroffenen Patienten bei. Eine sichere Operationstechnik kann das Auftreten solcher Anastomoseninsuffizienzen reduzieren. Indikation Bei der Behandlung von Ösophaguskarzinomen empfiehlt die deutsche Leitlinie minimalinvasive oder Hybrid-Operationsverfahren. Hierbei wird in den meisten Fällen eine Ivor-Lewis-Ösophagektomie und eine Kontinuitätsrekonstruktion mittels Magenschlauch durchgeführt. Die präferierte Vorgehensweise scheint dabei die Zirkularstapleranastomose zu sein. Methode Die Vorbereitung der Anastomose beginnt bereits intraabdominell mit Mobilisation des Magens und Schonung der gastroepiploischen Gefäße. Nach der anschließenden intrathorakalen Mobilisation des Ösophagus kann die eigentliche Anastomosenanlage erfolgen. Hierbei wird der Ösophagus entweder mit einem Stapler durchtrennt oder offen mit der Schere abgesetzt. Anschließend erfolgt eine Tabaksbeutelnaht am offenen Ösophagusstumpf. Alternativ kann eine partielle Ösophaguseröffnung mit vorheriger Tabaksbeutelnaht später das Einbringen der Staplerandruckplatte vereinfachen. Diese kann über eine zur Minithorakotomie erweiterte Trokarstelle im Ösophagusstumpf oder mithilfe eines speziellen Systems auch transoral platziert werden. Die Fixation der Staplerandruckplatte erfolgt durch die Tabaksbeutelnaht. Nun kann der Magenschlauch nach intrathorakal hochgezogen werde. Ösophagus und kleine Magenkurvatur werden über die Minithorakotomie nach extrathorakal verlagert und ein Zirkularstapler über eine Eröffnung der kleinen Kurvatur in den Magenschlauch eingeführt. Die Anastomosenanlage erfolgt dann fern der gastroepiploischen Arkade. Abschließend muss der Magenschlauch noch mittels Stapler abgesetzt werden. Erst jetzt können Ösophagus und kleine Magenkurvatur komplett geborgen werden. Optional können Übernähungen an Anastomose und Magenschlauchabsetzungsrand erfolgen. Schlussfolgerung Die roboterassistierte Anastomosenanlage mittels Zirkularstapler im Rahmen der Ösophagusresektion ist gut möglich und standardisierbar. Dennoch sind innerhalb dieses Verfahrens noch Variationen möglich. Einen wissenschaftlich evidenten Vorteil gibt es hierbei jedoch für keine Methode im direkten Vergleich.