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We explore how improvisational (improv) theater can be used to illuminate the everyday performance of regional identity. This can help manage reactivity-related and counter-performative effects during qualitative research. By utilizing improv theater as a performative qualitative method, we highlight its analytical potential. We identify methodological gaps in existing qualitative research and human geography studies, and we propose a methodological framework for integrating improvisational theater into research practice. Participants of improv theater-workshops draw on personal and collective experiences rooted in their personal backgrounds to evoke emotions related to their home regions. By engaging in spontaneous and unscripted performances, individuals express nuanced perceptions of regional identity that may elude traditional qualitative approaches. Ultimately, we illuminate the complex interplay between individuals and the transformative potential of improvisational theater.

Spectroscopic photoemission microscopy is a well-established method to investigate the electronic structure of surfaces. In modern photoemission microscopes, the electron optics allow imaging of the image plane, momentum plane, or dispersive plane, depending on the lens setting. Furthermore, apertures allow filtering of energy-, real-, and momentum space. Here, we describe how a standard spectroscopic and low-energy electron microscope can be equipped with an additional slit at the entrance of the already present hemispherical analyzer to enable an angle- and energy-resolved photoemission mode with micrometer spatial selectivity. We apply a photogrammetric calibration to correct for image distortions of the projective system behind the analyzer and present spectra recorded on Au(111) as a benchmark. Our approach makes data acquisition in energy–momentum space more efficient, which is a necessity for laser-based pump–probe photoemission microscopy with femtosecond time resolution.

In der qualitativen Forschungspraxis müssen beim Datenschutz die gesetzlichen Rahmensetzungen beachtet werden; damit einhergehende Fragen der Anonymisierung gehen für qualitativ Forschende jedoch darüber hinaus. Denn will man Beforschte vor negativen Folgen durch eine Teilnahme schützen und dabei zugleich die eigenen Erkenntnismöglichkeiten ausschöpfen, müssen fall- und kontextspezifische Textveränderungen und andere Maßnahmen in den verschiedenen Phasen empirischer Praxis abgewogen werden. Dabei stellt das konkrete Vorgehen des Anonymisierens selbst jedoch häufig eine Blackbox dar, die in wissenschaftlichen Veröffentlichungen eher rudimentär Beachtung findet. Mit diesem Artikel stellen wir daher nicht nur die aktuellen rechtlichen Rahmenbedingungen dar, sondern fokussieren insbesondere die praktischen Aspekte des Anonymisierens von Transkripten. Mit dem Ziel, einen grundlegenden, zugänglichen und praktisch orientierten Einstieg in das Thema zu geben, systematisieren wir zunächst Datenarten, Anonymisierungsstrategien, und -techniken. Anschließend diskutieren wir praktische Umsetzungsmöglichkeiten und geben Interessierten die Möglichkeit, ein fiktives Transkript selbstständig zu bearbeiten bzw. in Workshops zum Thema einzubinden. Abschließend präsentieren wir grundlegende Schlussfolgerungen für die Methodenausbildung und plädieren für einen offenen kollegialen Austausch zu Anonymisierungspraktiken.

Sammendrag Lokalhistorie skrives som regel uten noen eller med lite informasjon om stedets spesielle lydbilde. Mulige årsaker til dette kan være at denne informasjonen vurderes som irrelevant, sjølsagt og uforanderlig, eller at en ikke vet hvordan et lydbilde kan beskrives. I denne artikkelen argumenteres det for at lydbildet er en viktig sanselig stedserfaring som ikke er sjølsagt eller uforanderlig. Dette demonstreres ved å kontrastere de fundamentalt forskjellige lydlandskapene eller klanguniversene i to ellers kommensurable norske lokalsamfunn (Florø og Lillehammer). Videre presenterer artikkelen modeller og begrep fra to sentrale lydteoretikere og -praktikere, Raymond Murray Schafer og Bernie Krause, som viser hvor lett og givende det kan være å beskrive lokale lydunivers. Artikkelen tar særlig sikte på å ta i bruk Bernie Krauses holistiske forestilling om lydøkologi, det vil si at et lokalt lydbilde er en integrert helhet av geofoni, biofoni og antropofoni. Et sentralt formål med artikkelen er å (1) kort presentere lydteoretikeren og -praktikeren Bernie Krauses arbeid, som er lite kjent i Norden, (2) plassere ham i forhold til andre lydteoretikere og -praktikere, særlig Raymond Murray Schafer, og (3) demonstrere det heuristiske potensialet i Krauses teori ved å kontrastere de fundamentalt forskjellige lydlandskapene i to ellers kommensurable norske lokalsamfunn (Florø og Lillehammer).

Abstract Background In settings like the ambulatory care sector in Germany, where data on the outcomes of interdisciplinary health services provided by multiple office-based physicians are not always readily available, our study aims to develop a set of indicators of health care quality and utilization for 14 groups of ambulatory-care-sensitive conditions based on routine data. These may improve the provision of health care by informing discussions in quality circles and other meetings of networks of physicians who share the same patients. Methods Our set of indicators was developed as part of the larger Accountable Care in Deutschland (ACD) project using a pragmatic consensus approach. The six stages of the approach drew upon a review of the literature; the expertise of physicians, health services researchers, and representatives of physician associations and statutory health insurers; and the results of a pilot study with six informal network meetings of office-based physicians who share the same patients. Results The process resulted in a set of 248 general and disease specific indicators for 14 disease groups. The set provides information on the quality of care provided and on patient pathways, covering patient characteristics, physician visits, ambulatory care processes, pharmaceutical prescriptions and outcome indicators. The disease groups with the most indicators were ischemic heart diseases, diabetes and heart failure. Conclusion Our set of indicators provides useful information on patients’ health care use, health care processes and health outcomes for 14 commonly treated groups of ambulatory-care-sensitive conditions. This information can inform discussions in interdisciplinary quality circles in the ambulatory sector and foster patient-centered care.

Abstract Background Patients in Germany are free to seek care from any office-based physician and can always ask for multiple opinions on a diagnosis or treatment. The high density of physicians and the freedom to choose among them without referrals have led to a need for better coordination between the multiple health professionals treating any given patient. The objectives of this study are to (1) identify informal networks of physicians who treat the same patient population, (2) provide these physicians with feedback on their network and patients, using routine data and (3) give the physicians the opportunity to meet one another in facilitated network meetings. Methods The Accountable Care Deutschland (ACD) study is a prospective, non-blinded, cluster-randomised trial comprising a process and economic evaluation of informal networks among 12,525 GPs and office-based specialists and their 1.9 million patients. The units of allocation are the informal networks, which will be randomised either to the intervention (feedback and facilitated meetings) or control group (usual care). The informal networks will be generated by identifying connections between office-based physicians using complete datasets from the Regional Associations of Statutory Health Insurance (SHI) Physicians in Hamburg, Schleswig Holstein, North Rhine and Westphalia Lip, as well as data from three large statutory health insurers in Germany. The physicians will (a) receive feedback on selected indicators of their own treatment activity and that of the colleagues in their network and (b) will be invited to voluntary, facilitated network meetings by their Regional Association of SHI physicians. The primary outcome will be ambulatory-care-sensitive hospitalisations at baseline, at the end of the 2-year intervention period, and at six months and at 12 months after the end of the intervention period. Data will be analysed using the intention-to-treat principle. A pilot study preceded the ACD study. Discussion Cochrane reviews show that feedback can improve everyday medical practice by shedding light on previously unknown relationships. Providing physicians with information on how they are connected with their colleagues and what the outcomes are of care delivered within their informal networks can help them make these improvements, as well as strengthen their awareness of possible discontinuities in the care they provide. Trial registration German Clinical Trials Register DRKS00020884 . Registered on 25 March 2020—retrospectively registered.

Die zunehmende Nutzung des Web 2.0 in verschiedenen Phasen des Forschungsprozesses führt dazu, dass qualitativ Forschende und Beforschte, teils unreflektiert, online Datenspuren ihrer Interaktionen erzeugen. Bisher wurde nur vereinzelt thematisiert, was das für veränderte Anonymitätsverhältnisse bedeutet. Mit unserem Artikel wollen wir zu der Debatte um Forschungsethik, Datenschutz und -management beitragen. Anhand eines fiktiven Fallbeispiels identifizieren wir drei Typen von Interaktionsspuren im digitalen Raum: Rekrutierungsspuren, Öffentlichkeitsarbeitsspuren und Teilnahmespuren. Diese Spuren können zur Deanonymisierung der Teilnehmenden entgegen deren Willen führen. Basierend auf einem systematischen Literaturreview zu Anonymität und Nutzung des Web 2.0 in der qualitativen Forschung schlagen wir forschungspraktische Umgangsweisen mit den identifizierten Interaktionsspuren im digitalen Raum vor und fassen diese in einer Checkliste zur Reflexion und Dokumentation eigener Tätigkeiten in den sozialen Medien zusammen. Wir wollen qualitativ Forschende für oft beiläufig online produzierte Daten sensibilisieren und zum Austausch über die vielfältigen Entscheidungen, die Forschende und Beforschte bei der Kommunikation und Selbstdarstellung im Web 2.0 treffen, anregen.

Lokalhistorie skrives som regel uten noen informasjon om stedets spesielle lydbilde. Mulige årsaker til dette kan være at denne informasjonen vurderes som irrelevant, sjølsagt og uforanderlig eller at en ikke vet hvordan et lydbilde kan beskrives. I denne artikkelen argumenteres det for at lydbildet er en viktig sanselig stedserfaring som ikke er sjølsagt eller uforanderlig. Dette demonstreres ved å kontrastere de fundamentalt forskjellige lydskapene eller klanguniversene i to ellers kommensurable norske lokalsamfunn (Florø og Lillehammer). Videre presenterer artikkelen modeller og begrep fra to sentrale lydteoretikere, Raymond Murray Schafer og Bernie Krause, som viser hvor lett og givende det kan være å beskrive lokale lydskap. Artikkelen tar særlig sikte på å ta i bruk Bernie Krauses holistiske forestilling om lydøkologi, det vil si at et lokalt lydbilde er en integrert helhet av geofoni, biofoni og antropofoni.

Introduction Clinically complex patients often require multiple medications. Polypharmacy is associated with inappropriate prescriptions, which may lead to negative outcomes. Few effective tools are available to help physicians optimise patient medication. This study assesses whether an electronic medication management support system (eMMa) reduces hospitalisation and mortality and improves prescription quality/safety in patients with polypharmacy.Methods and analysis Planned design: pragmatic, parallel cluster-randomised controlled trial; general practices as randomisation unit; patients as analysis unit. As practice recruitment was poor, we included additional data to our primary endpoint analysis for practices and quarters from October 2017 to March 2021. Since randomisation was performed in waves, final study design corresponds to a stepped-wedge design with open cohort and step-length of one quarter. Scope: general practices, Westphalia-Lippe (Germany), caring for BARMER health fund-covered patients. Population: patients (≥18 years) with polypharmacy (≥5 prescriptions). Sample size: initially, 32 patients from each of 539 practices were required for each study arm (17 200 patients/arm), but only 688 practices were randomised after 2 years of recruitment. Design change ensures that 80% power is nonetheless achieved. Intervention: complex intervention eMMa. Follow-up: at least five quarters/cluster (practice). recruitment: practices recruited/randomised at different times; after follow-up, control group practices may access eMMa. Outcomes: primary endpoint is all-cause mortality and hospitalisation; secondary endpoints are number of potentially inappropriate medications, cause-specific hospitalisation preceded by high-risk prescribing and medication underuse. Statistical analysis: primary and secondary outcomes are measured quarterly at patient level. A generalised linear mixed-effect model and repeated patient measurements are used to consider patient clusters within practices. Time and intervention group are considered fixed factors; variation between practices and patients is fitted as random effects. Intention-to-treat principle is used to analyse primary and key secondary endpoints.Ethics and dissemination Trial approved by Ethics Commission of North-Rhine Medical Association. Results will be disseminated through workshops, peer-reviewed publications, local and international conferences.Trial registration NCT03430336. ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03430336).

Introduction Women with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes mellitus compared with women who never had GDM. Consequently, the question of structured aftercare for GDM has emerged. In all probability, many women do not receive care according to the guidelines. In particular, the process and interaction between obstetrical, diabetic, gynaecological, paediatric and general practitioner care lacks clear definitions. Thus, our first goal is to analyse the current aftercare situation for women with GDM in Germany, for example, the participation rate in aftercare diabetes screening, as well as reasons and attitudes stated by healthcare providers to offer these services and by patients to participate (or not). Second, we want to develop an appropriate, effective and patient-centred care model.Methods and analysis This is a population-based mixed methods study using both quantitative and qualitative research approaches. In various working packages, we evaluate data of the GestDiab register, of the Association of Statutory Health Insurance Physicians of North Rhine and the participating insurance companies (AOK Rheinland/Hamburg, BARMER, DAK Gesundheit, IKK classic, pronova BKK). In addition, quantitative (postal surveys) and qualitative (interviews) surveys will be conducted with randomly selected healthcare providers (diabetologists, gynaecologists, paediatricians and midwives) and affected women, to be subsequently analysed. All results will then be jointly examined and evaluated.Ethics and dissemination The study was approved by the ethics committee of the Faculty of Medicine, Heinrich-Heine-University Düsseldorf (Ethics Committee No.: 2019-738). Participants of the postal surveys and interviews will be informed in detail about the study and the use of data as well as the underlying data protection regulations before voluntarily participating. The study results will be disseminated through peer-reviewed journals, conferences and public information.Trial registration number DRKS00020283.

Background. It is well known that cancer patients more seldom have a psychiatric disorder than noncancer patients with chronic pain. Conversely, earlier studies have suggested that, at the psychiatric level, long-term cancer survivors (LCSs) have more in common with noncancer patients affected by chronic pain. Materials and Methods. We investigated 89 cancer patients with acute pain (Acute Cancer Pain Patients, ACPPs) treated at a university outpatient chemotherapy department and compared these with 61 LCSs (living >5 yr after the first diagnosis) admitted by general practitioners for the treatment of noncancer pain. Upon administration, each patient was psychiatrically assessed by a liaison-psychiatrist conducting a semistructured interview. In a second step, we compared the LCS patients with hitherto treated noncancer patients suffering from chronic pain and ACPPs with data published by Derogatis in 1983. Results. In a comparison of LCSs with ACPPs, LCSs have more patients with brain organic disorders and more addictions. The largest cancer group within the LCSs is patients with urogenital (Uro) cancer (44.3%), while within the ACPPs, these are patients with cancer of the gastrointestinal (GI) tract (ACPP-GI, 57.2%). As far as the distribution of mental disorders is concerned, long-term cancer survivors show some similarities to noncancer patients. The data of ACPPs are similar to those of cancer patients, published by Derogatis. Discussion. The higher values of addiction and brain organic disorders, in particular, and the slight differences for psychic disorders in general of LCSs vs. ACPPs may result from the different cancer types and a longer survival time for urogenital tract cancer compared to GI cancer. In an additional examination, we compared patients with acute cancer of the GI tract (ACPP-GI, n = 50) with those of the urogenital tract (ACPP-Uro, n = 43). ACPP-Uro had the lowest percentage of patients with psychiatric disorders in general (ACPP-Uro 37.2%, ACPP-GI 50.0%, all LCSs 65.6%, and LCS-Uro 74.1%) and addiction, in particular (ACPP-Uro 2.3%, ACPP-GI 4.0%, and LCSs 13.1%). Conclusion. Cancer patients can develop a process of chronification with an increase in the prevalence of mental disorders. For urogenital cancer, an increase in the probability to develop mental disorders is a function of time.

Abstract Childhood experiences are considered to be of crucial importance in the formation of maladaptive schemas, according to Young’s concept. Although some schema questionnaires already exist for children, these instruments differ in their schema structures with between 8 and 12 identified factors. To obtain a deeper understanding of early maladaptive schemas in childhood an instrument based on Young’s 18-schema model was constructed (Dusseldorf Illustrated Schema Questionnaire for Children (DISC)). Cartoons were designed which represented each schema, providing children with a visual impression of what was meant by the schema, and thus the questions that they had to answer. The items were phrased as self-report statements and children’s approval of the statements was assessed using a 4-point rating scale. The resulting preliminary questionnaire (18 cartoons, 90 items) was presented in classrooms across different school types (N = 569, between 8 and 13 years). A confirmatory factor analysis (CFA) was performed on this data to confirm the factorial structure of the questionnaire and to reduce the number of items to two items per schema. The DISC in its final version included 36 items and showed a sufficiently high test-retest reliability and convergent validity when assessed in comparison to another schema questionnaire for children. In addition, the present test is of predictive value since the DISC sum score correlated with ratings on the children’s behavioral problems. CFA showed a satisfactory goodness-of-fit based on the original 18-factor model, providing a compact instrument to assess schema representations and to evaluate the dynamics of maladaptation during child development.

Artikkelen tar for seg arbeiderbevegelsens regionale arkiver i Norge, deres framvekst og utvikling fra 1950-årene til i dag. Hvilke krefter var det som sto bak opprettelsen av disse arkivene rundt om i landet, og hva var grunnene til at de følte behov for denne typen organisasjoner? I artikkelen hevdes det at det var arbeiderbevegelsens egne aktivister som i mange tilfeller ønsket å finne ordninger for å ta vare på sitt historiske materiale, noe som falt ganske naturlig med den sterke organisasjonskulturen som bevegelsen har hatt. I tillegg førte endringer i arbeidslivet og ikke minst nedgangen i industrisysselsettingen til at det oppsto et behov for å ta vare på arkiv etter nedlagte bedrifter og foreninger. Med støtte fra AOF og Arbeiderbevegelsens Arkiv og Bibliotek i Oslo ble det opprettet 12 slike regionale arkiver. Situasjonen varierte fra fylke til fylke, og både enkeltpersoner og institusjoner som statsarkiv, fylkesarkiv og høgskoler har spilt viktige roller enkelte steder. Et utviklingstrekk som er felles for de regionale arkivene, er at de aller fleste søkte samarbeid med større arkivinstitusjoner etter hvert, hvis de ikke hadde det fra starten. Profesjonaliseringen i arkivbransjen og økende krav til faglig standard innen registrering og magasinering førte til at oppgaven ble for krevende for de lokale ildsjelene. Motiveringsarbeidet i egne rekker og selve innsamlingen av arbeiderbevegelsens minner har de opprettholdt ansvaret for.

Artikkelen tar for seg etableringen og utviklingen av to norske fagtidsskrifter for arbeiderhistorie: Tidsskrift for arbeiderbevegelsens historie (TFAH, 1976–1986) og Arbeiderhistorie (1987–). Artikkelen vurderer også de to tidsskriftene i forhold til andre tidsskrifter innenfor det norske historiske felt. Parallelt med framveksten av liknende tidsskrifter i andre land, markerte etableringen av TFAH både et startpunkt og en nyorientering. Sett under ett ble TFAH og etterfølgeren Arbeiderhistorie viktige fora for en ny generasjon historikere, hvorav mange var født mellom 1940 og 1950, og mange var kvinner. En opprinnelig ny-marxistisk forventning om at TFAH skulle være et virkemiddel for å oppnå sosial revolusjon forsvant raskt, og rundt 1980 endret tidsskriftets epistemologiske tilnærming seg i retning av kritisk rasjonalisme. I 1986 måtte TFAH gå inn som følge av sviktende inntekter, men allerede året etter ble det funnet en bærekraftig modell for en fortsatt publisering av forskning i arbeiderbevegelsens historie. Da begynte Arbeiderbevegelsens arkiv og bibliotek å utgi Arbeiderhistorie. Til sammen har begge tidsskriftene fungert som vitenskapelige fora for forskning innen arbeidsliv, arbeiderhistorie og relaterte sosiale bevegelser i vid forstand.

For several years now, volunteer activity has been increasingly placed at the center of a political discourse monopolizing it for politics of dealing with socio- and spatio-political problems. It is particularly in those rural regions affected by out-migration and an ageing population that volunteering is considered an advisable way for securing local public responsibilities. Based on a critical reflection and discussion of these political positions we plead for a subject-oriented research approach in order to understand regionally problematised conditions not primarily as static parameters, but as individually negotiated aspects of everyday life. Accordingly, voluntary activity is investigated in terms of individually perceived challenges and underlying logics of action as a social practice of collaboratively organising everyday life in a shrinking rural region. Hence, using a case study conducted in the Altenburger Land in Thuringia we analyse the socially embedded negotiation of responsibilities between municipal actors and voluntary workers on the one hand and trace the influencing factors on voluntary activities considered relevant by involved actors on the other hand. Those factors include institutional and political support, municipality reforms, regional education and working conditions in the light of a problematic regional labour market, for example. Building on the results of our empirical research we finally discuss the political and analytical-conceptual implications resulting from the notion of a homogeneous community of voluntary workers and their political-strategic invocation and activation.

Background: The epidemic growth of morbid obesity has led to an increase in the number of bariatric interventions. During the distribution process of bariatric surgical interventions, the risk for severe nutritious complications such as bariatric beriberi can rise. Methods: By means of systematic literature review, epidemiological data, clinical characteristics and diagnostic as well as therapeutic recommendations for bariatric beriberi were elicited. Databases and registries such as PubMed, Cochrane and Ovid were searched for a defined time period with the key words ‘lack of thiamine' / ‘Wernicke-Korsakoff syndrome' / ‘encephalopathy' after bariatric surgical interventions. Results: Up to December 2013, overall 255 patients had been found as published cases, indicating that the risk for the postoperative occurrence of thiamine deficiency and Wernicke-Korsakoff syndrome is increased in women. In addition, the risk correlates with patient's age. The majority of patients developed symptoms of a dry beriberi with peripheral neuritis, ataxia and paraplegia, indicating an advanced stage of disease approximately 4-12 weeks postoperatively. Laboratory analysis in case of a suspicious clinical finding is the appropriate diagnostics. As treatment, prompt initiation of parenteral thiamine substitution under clinical monitoring is required. Conclusion: Bariatric beriberi can occur within the first 1-3 postoperative months. To minimize the risk of severe consequences, immediate substitution of thiamine in clinical suspicion or prolonged parenteral nutrition is necessary. A delayed diagnosis or missing the correct diagnosis can lead to irreversible damages of the CNS with coma and fatal outcome. Knowledge on the subject, including development of thiamine deficiency, symptomatology and emergency treatment, are considered essential for bariatric surgeons but also for further medical disciplines involved in treatment.

Inflammatory myofibroblastic tumors (IMTs) are a rare cause of echo-poor pancreatic head enlargement. Histologically, IMTs are characterized by spindle-shaped myofibroblasts or fibroblasts accompanied by a mixed immune cell infiltration. The most common localizations of IMTs have been reported in lung, mesentery and omentum, especially in children and young adults. IMTs show infiltrating growth, multilocular appearance and also metastasis have been reported. Curative resection is the only therapeutic option so far. In the palliative situation, evident data and clear guidelines for this rare tumor entity are missing. We report on a 44-year-old male with an unresectable IMT of the pancreatic head causing recurrent episodes of acute pancreatitis that resulted in a chronic obstructive course of the disease. The patient entered a palliative therapeutic regimen including radiation therapy and antiinflammatory medication. In a regular follow-up of 12 months, he presented with stable disease after initial progression. This case of local progressive IMT of the pancreatic head was managed with a palliative therapeutic regimen and is discussed based on the current literature.

Based on the project “Discourse and practices in shrinking regions”, we analyse the subjective relevance of derogative discourses using the example of the district of Altenburger Land (Germany). The article combines three aspects: First, it focuses on how young people’s representations of practices of social differentiation are informed by regionalised discourses about and conditions of shrinkage. Second, it identifies two rhetoric strategies by which young people distance themselves from perceived deviance. Finally, it asks how perceptions and rhetoric strategies are connected to desires to out-migrate. We assume that stigmatisation is a powerful means of producing and circulating socio-spatial differentiation, especially under conditions of socio-economic crisis and deprivation. Our principal hypothesis is that socio-spatial stigmatisation is effective (and destructive) in terms of how people perceive themselves within their home region, in relation to other inhabitants and regarding their prospective future plans. In order to address this aspect methodologically, we compose an epistemological framework to grasp how socio-spatial stigmatisation is articulated and circulates in the light of specific socio-economic conditions. Here, we conceptually draw from social psychology and social geography. Our empirical findings, which stem from a series of focus groups, show that – while sharing some widely spread notions about the Altenburger Land – our respondents make use of two rhetoric strategies: They deflect derogative stigmas by, firstly, further specifying these groups in order to distinguish themselves from the stigmatised groups, and, secondly, by localising deviant behaviour within almost uncontested socio-spatial boundaries. Additionally, they construct causal connections between these aspects in order to re-affirm the validity of such stigmas.

Esophageal Barrett's adenocarcinoma (BA) develops through a multistage process, which is associated with the transcriptional silencing of tumor-suppressor genes by promoter CpG island hypermethylation. In this study, we explored the promoter hypermethylation and protein expression of proapoptotic deathassociated protein kinase (DAPK) during the multistep Barrett's carcinogenesis cascade. Early BA and paired samples of premalignant lesions of 61 patients were analyzed by methylation-specific polymerase chain reaction and immunohistochemistry. For the association of clinicopathological markers and protein expression, an immunohistochemical tissue microarray analysis of 66 additional BAs of advanced tumor stages was performed. Hypermethylation of DAPK promoter was detected in 20% of normal mucosa, 50% of Barrett's metaplasia, 53% of dysplasia, and 60% of adenocarcinomas, and resulted in a marked decrease in DAPK protein expression (P < .01). The loss of DAPK protein was significantly associated with advanced depth of tumor invasion and advanced tumor stages (P < .001). Moreover, the severity of reflux esophagitis correlated significantly with the hypermethylation rate of the DAPK promoter (P < .003). Thus, we consider DAPK inactivation by promoter hypermethylation as an early event in Barrett's carcinogenesis and suggest that a decreased protein expression of DAPK likely plays a role in the development and progression of BA.

According to recent reports, some cancer types exhibit nonrandom allele loss at codon 72 in exon 4 of the p53 gene [coding for proline (72Pro) or arginine (72Arg)]. To clarify this phenomenon for colorectal cancer and to find out if this preferential loss might have any functional significance, p53 loss of heterozygosity (LOH) and p53 mutations were investigated in a group of 61 colorectal cancers and 28 liver metastases, and were correlated with clinicopathologic factors. A comparison of a patient's blood codon 72 status with a healthy control group did not reveal an enhanced risk of developing colorectal tumors for one of the two isoforms. p53-LOH and p53 mutations were found in 62.2% and 39.4% of primary tumors, respectively, and in 57.9% and 25% of hepatic metastases, respectively. In 14 heterozygous cases showing exon 4-LOH, only the 72Pro allele was lost and the retained 72Arg was preferentially mutated. In general, p53 mutations were significantly associated with the 72Arg tumor status (P < .001). Distal tumors showed allelic losses of the p53 gene more commonly than proximal tumors (P = .054). The prevalence of 72Arg increased in frequency with higher Dukes stage (P = .056). We suggest that either the preferential loss of 72Pro or the mutation of the 72Arg in colorectal cancer and hepatic metastases is associated with malignant potential and might reflect carcinogenic exposure, particularly in the distal part of the large intestines.

Based on qualitative research on livescapes in peripheralized regions, claims have surfaced within the recently rejuvenated debate on peripheralization to not only focus on socio-structural aspects of spatial disparities, but also to consider the effects of discursive ascriptions. Using early findings from the research project “Discourse and practices in shrinking regions. An analysis of the subjective relevance of shrinkage discourses using the example of the municipality of Altenburger Land”, we demonstrate how different professionals conceptualize alleged causal relations between financial subsidies for “culture” or “infrastructure” and migration-related decisions. Furthermore, we illuminate their rationalizations of these decisions and take also the subjective aspects of migrations that may contradict their views into consideration. We conclude our chapter with a summary of the important uncertainties in the research of migration as well as regarding the political practice of dealing with migration-related decisions.

In the title compound, C40H76Si, the Si atom is located on a special position of site symmetry -4. Thus, there is just a quarter of a molecule in the asymmetric unit. The C=C double bonds exhibit a trans configuration. The Si atom and the tert-butyl group are located on the same side of the plane formed by the C=C double bond and its four substituents. The crystal packing shows no short contacts between the molecules and despite the low crystal density (0.980 Mg m−3), there are no significant voids in the structure.

The title complex, [PdCl2(C18H15P)2]·0.5C6H6, has the PdII ion in a square-planar coordination mode (r.m.s. deviation for Pd, P and Cl atoms = 0.024 Å) with the PPh3 and Cl ligands mutually trans. The benzene solvent molecule is located about a crystallographic inversion centre. The title complex is isostructural with trans-dichloridobis(triphenylphosphane)palladium(II) 1,4-dichlorobenzene sesquisolvate [Kitano et al. (1983). Acta Cryst. C39, 1015–1017].

Molecules of the title compound, [HgBr(C9H11)], are located on a crystallographic twofold rotation axis. Due to the molecular symmetry, the HgII atom is linearly coordinated by the ipso-C of the mesityl group and the Br atom. In the crystal, molecules lie in planes parallel to (001).

Background. The aim of this study was to investigate patient outcomes and nutritional deficiencies following sleeve gastrectomy (SG) during a follow-up of two years. Methods. Over a period of 56 months, all consecutive patients who underwent SG were documented in this prospective, single-center, observational study. The study endpoints included operative time, complication rates, nutritional deficiencies and percentage of excess weight loss (%EWL). Results. From September 26, 2005 to May 28, 2009, 82 patients (female : male = 48 : 34) with a mean age of 43.3 years (range: 22–64) and a preoperative BMI of 52.5 kg/m² (range: 36.8–77.0) underwent SG. Major complications were observed in 9.8% of the patients, with 1 death. During follow up 51.2% of patients were supplemented with iron, 36.6% with zinc, 37.8% with calcium, 26.8% with vitamin D, 46.3% with vitamin B12 and 41.5% with folic acid. %EWL was 54.3, 65.3 and 62.6% after 6, 12 and 24 months. Conclusion. SG as a single step procedure is an effective bariatric intervention. Nutritional deficiencies after SG can be detected by routine nutritional screening. Our results show that Vitamin B12 supplementation should suggest routinely after SG.

Gastric carcinoma is frequently diagnosed with an advanced stage of non-curable tumor growth characterized by infiltration of the gastric serosa, peritoneal tumor spread and/or metastases within lymph nodes and liver. Currently, there is a controversy on the value of palliative resection with regard to the safety and benefit to the patient outcome. Based on the available literature, this overview summarizes the various aspects and interprets the limited data on the palliative resection of gastric carcinoma. It turns out that the available study results may indicate potential for an improved quality of life and a prolongation of survival if an acceptable morbidity and mortality are present.

Background. Gastric banding (GB) is a common bariatric procedure that is performed worldwide. Weight loss can be substantial after this procedure, but it is not sufficient in a significant portion of patients. Long-term rates for associated complications increase with every year of follow up, and only a few long-term studies have been published that examine these rates. We present our results after 14 years of postoperative follow up. Methods. Two hundred patients were operated upon form 01.02.1995 to 31.01.2009. Data collection was performed prospectively. In retrospective analysis, we analyzed weight loss, short- and long-term complications, amelioration of comorbidities and long-term outcome. Results. The mean postoperative follow up time was 94.4 months (range 2–144). The follow up rate was 83.5%. The incidence of postoperative complications for slippage was 2.5%, for pouch dilatation was 9.5%, for band migration was 5.5% and 12.0% for overall band removal. After 14 years, the reoperation rate was 30.5% with a reoperation rate of 2.2% for every year of follow up. Excess weight loss was 40.2% after 1 year, 46.3% after 2 years, 45.9% after 3 years, 41.9% after five years, 33.3% after 8 years, 30.8% after 10 years, 33.3% after 12 years and 15.6% after 14 years of follow up. Conclusion. The complication and reoperation rate after GB is high. Nevertheless, GB is still a therapeutic option in morbid obese patients, but the criteria for patient selection should be carefully evaluated.

Abstract Endoscopic papillectomy is a promising and challenging endoscopic intervention. The aim of this study was i) to classify the differential indication, and ii) to study the outcome in papillectomy of suspicious tumor lesions of the papilla of Vater (papilla). Methods Thirty nine patients were enrolled (22 males/17 females; range of age, 21-88 years) who underwent endoscopic papillectomy because of a polypoid tumor at the papilla revealed by previous endoscopic ultrasonography (EUS) over a time period of 5 years. Follow-up EUS and histologic investigation were performed within 28 days(d). Results I) All tumors were detectable using EUS (range of tumor size, 1-4.5 cm). II) Indications, histologic diagnoses and their distribution were as follows: Group(Gr.)1 ( n = 21): Adenoma ( n = 18), uT1 carcinoma(Ca) of high risk patients ( n = 3) with R0 resection ( n = 17) vs. R1 ( n = 4; all reapproached using argon beamer). On the 28th postinterventional d, all subjects were free of tumor. Recurrent tumor growth was found in 3 cases after 6, 18 and 26 months respectively (range of endoscopic follow up [ n = 14], 3-60 months). Three patients (free of tumor) died from other causes after 3, 8 and 18 months, respectively. Gr. 2 ( n = 8): Contradiction between EUS (infiltrating tumor growth) and histologic finding (adenoma or unspecific inflammation); histological findings were: Adenomyomatosis of the papilla ( n = 5), infiltrating Ca of the papilla or peripapillary region ( n = 3). Gr. 3 ( n = 4): Neuroendocrine tumors of the major ( n = 2) or minor papilla ( n = 2): 2 benign, 1 Ca and 1 carcinoid tumor. Gr. 4 ( n = 6): Non-introducible catheter through the minor papilla in case of suspected pancreas divisum ( n = 2) or through the major papilla ( n = 1) after previous gastric resection (Billroth II) or because of Ca of the papilla with no successful attempts to drain the bile duct ( n = 3): Catheter insertion was achieved after papillectomy ( n = 3) or partial tumor resection ( n = 3). III) Complications: 8 of 39 patients (20.5%) developed postinterventional pancreatitis (severe course, n = 1); in 7 cases, bleeding occurred, no perforation was seen. The rate of recurrent tumor growth after R0 resection was 17.6% (3 of 17 subjects). In summary papillectomy is feasible in the case of i) polypoid tumor of the papilla, ii) infiltrating tumor growth revealed by EUS and negative histologic investigation (optional: plus deep biopsy), and iii) tumor lesion, through which catheter can not be placed to get access to the pancreatobiliary system. In conclusion endoscopic papillectomy fulfills diagnostic as well as therapeutic requirements and can be recommended as minimally invasive but appropriate method for well-defined indications of papillary tumor lesions.