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Inflammatory bowel disease (IBD) affects millions of people in the United States, with the number of diagnoses steadily rising. It has been associated with poor quality of life and a host of comorbidities. Most notably, IBD patients are at an increased risk of developing colorectal cancer (CRC). The American Gastroenterological Association (AGA) recommends that IBD patients with involvement of 1/3 or more of the colon undergo colonoscopy regularly to screen for CRC starting 8 years after initial IBD diagnosis. Colonoscopy techniques for IBD-related CRC screening are highly variable and differ widely between clinical practices. Currently, high-definition white-light colonoscopy (HD-WLC) and dye spraying chromoendoscopy (DCE) are both standard of care. The use of these technologies requires a high level of skill that is typically attained during clinicians’ 3-year gastroenterology (GI) fellowship. This study intends to compare outcomes of screening colonoscopies performed by GI fellows and attending physicians in patients with longstanding IBD (>8 years) and to assess the impact of GI fellow involvement on these procedures. Additionally, the current research intends to draw distinctions between HD-WLC and DCE procedures. The research was performed in the Division of Gastroenterology at Beth Israel Deaconess Medical Center (BIDMC) as part of a large randomized controlled trial (RCT) that aims to evaluate the comparative efficacy of HD-WLC and DCE. Patients were screened for study eligibility using relevant criteria and then randomized to undergo colonoscopy using HD-WLC technique or DCE technique. Data from 128 procedures were included in the study. Of these procedures, 59 (46.1%) were attending-performed procedures while 69 (53.9%) were fellow-performed, attending-supervised procedures. Of the attending-performed procedures, 30 (50.8%) were performed using the DCE technique and 29 (49.2%) were performed using the HD-WLC technique. Of the fellow-performed, attending-supervised procedures, 32 (46.4%) were performed using the DCE technique while 37 (53.6%) were performed using the HD-WLC technique. Fellow-performed, attending-supervised procedures were associated with longer total procedure time (TPT) and increased intra-procedure administration of sedation medications without superior lesion detection. Thus, fellows appear to be on par with attendings in terms of lesion detection but this level of proficiency comes at the cost of increased TPT. Assessing the short-term and long-term impacts of this could be a valuable area of future investigation. Also, DCE procedures took longer for all clinicians to perform, especially fellows, and are not associated with enhanced lesion detection. Further research is needed to understand the usefulness of DCE.

We propose a computer integrated endoscopic simulator for training in upper endoscopy as a low-cost alternative to the traditional training methods and virtual reality simulators. The use of a real endoscope in conjunction with our simulator and computer system in an actual operating room setup makes the training environment similar to a real procedure. Endoscopic surgery is the performance of surgery through a small incision with the aid of special medical equipment called a flexible endoscope. The advantage of this technique over open surgery is that there is significantly less operative trauma, resulting in less pain and a shorter recovery time. Side effects of the surgery, such as the risk of infection, are also reduced. While endoscopy procedure has tremendous benefits, surgeons require considerable practice and time to develop competency. Traditionally, the procedure has been taught at the expense of patient comfort and safety, in other words, gastroenterology training fellows have performed the surgery under the supervision of physicians. Patients who undergo the endoscopies performed by fellows, particularly early in the training period, have been more likely to suffer more discomfort and prolonged procedures. In this study, we introduce a new type of simulator which combines the use of mechanical model and computer system as an additional or low-cost alternative for training in upper endoscopy. Our approach is to integrate a computer system with a realistic mechanical model to create a computer-based simulator for upper endoscopy training. The simulator will cover the basics of flexible endoscopy and teach a trainee the skills required to perform upper endoscopy. The mechanical training model with a sensor system that simulates a human upper gastrointestinal tract, including pathologies such as ulcers and polyps, will be built and integrated with computer software. The software offers the following functions: provides help to the trainee, provides curriculum-required learning tasks, and assesses the performance and diagnostic skills. Due to the optical nature of an endoscopic lens, the obtained image suffers from a barrel-type spatial distortion, which results in an inconsistent measurement of object size and distance. Our distortion correction system with automatic calibration, based on least squares estimation, offers a better perception of size and distance from the endoscopic images. In order to examine the endoscopic maneuvering skills of the trainee, the automatic evaluation system is created. The system uses images from the exam procedure to verify the trainee skills. We use Support Vector Machine to classify endoscopic images of different regions in upper gastrointestinal tract. The experimental results on the distortion correction and image classification are reported. Simulator validation survey result from gastroenterology surgeons and fellows is included in this dissertation. A recommendation for further study is also enclosed.

Univ., Diss--Freiburg (Breisgau), 1998.

Teaching-only academics now constitute a significant proportion of the academic staff in UK higher education. This thesis is a three-part study in which I sought to contribute to a more indepth understanding of the teaching-only academic role. I did this through an investigation of the career trajectories, perceptions, work-related experiences and academic identity constructions of teaching-only academics working in a research-intensive institution in the UK. In the first part of the study I carried out a systematic review of the literature on teaching-only academics in the UK, Australia and Canada. In the second part of the study I investigated the virtual identity of teaching-only academics at the UK research-intensive institution. I did this by undertaking an analysis of how these teaching-only academics self-represented and projected themselves on their institutional webpages. In the third part of the study I carried out a life-history analysis of senior teaching-only academics in the engineering faculty of the case study institution. A principal finding from this thesis, which is collaborated across all the three parts of the study, is that the teaching-only academic role is a non-homogeneous role comprising individuals who come from different backgrounds, have followed different career trajectories into the role, and have different academic identities. Findings from this thesis also suggest that whilst teaching-only academics were introduced as an institutional response to the demands of the RAE/REF, the very act of creating the role has further exacerbated the separation between research and teaching, and between undergraduate and postgraduate teaching. Specifically, undergraduate teaching within the case study engineering department now tends to be the responsibility of teaching-only academics, with research-and-teaching academics increasingly focussing on research and postgraduate teaching. This separation has implications for research-led teaching, particularly in research-intensive institutions. The thesis also reveals that despite the pre-eminence of research, teaching remains important within the university, and individuals on the teaching-only academic role are able to accumulate substantial, and valued, teaching-related academic capital. This capital, in turn, is enabling them to secure and advance their positions within the same institution, and to pursue career advancement through seeking employment in other higher education institutions.

This research paper analyzes the strategies that translation students of a Peruvian university use to regulate their emotions. The results show the most common scenarios: getting lower grades than expected, the lack of confidence in their conceptual and thematic background, aspects of the course methodology, and their relationships with their professors and classmates. The students’ process starts with the use of maladaptive strategies, such as rumination and self-blame. However, students continue their process and then use adaptive strategies to fulfill their goals, such as refocusing on their planning.

Gräsrotsfinansiering är en relativt ny finansieringsform som etablerats på den svenska marknaden. Det finns flertalet olika varianter av gräsrotsfinansiering, men den som har behandlats i uppsatsen är den lånebaserade gräsrotsfinansieringen. Den konstellation vid lånebaserad gräsrotsfinansiering som har varit föremål för undersökning är den när privatpersoner lämnar kredit till andra privatpersoner, med en digital plattform som förmedlare av krediten. Eftersom finansieringsmetoden har varit, och fortfarande är, under ständig utveckling har det medfört en eftersläpning gällande lagstiftning för det aktuella. Det finns således i dagsläget ingen särskild lagstiftning på området. Emellertid har under år 2018 ett betänkande av statens utredning på finansieringsformen lagts fram i Sverige, samt ett förslag på förordning på EU-nivå framställts, varav en framtida reglering är att vänta. Syftet med uppsatsen är att undersöka vilken lagstiftning som blir tillämplig vid ovan nämnda partskonstellation samt att undersöka om kreditgivare erhåller något konsumentskydd. Om så inte är fallet ska en undersökning göras om det föreligger ett behov av konsumentskydd för kreditgivare gentemot plattformar. För att undersöka det har vi i uppsatsen redogjort för vilka skyldigheter och rättigheter som uppstår för respektive part i samband med avtalen jämte en undersökning och analys av den kreditgivande partens konsumentskydd. De två digitala plattformarna Lendify och Fellow Finance är de plattformarna som särskilt har undersökts, för att bringa klarhet om gällande lagstiftning för finansieringsformen. I uppsatsen har det framkommit att konsumentlagstiftning enligt konsumentkreditlagen endast blir tillämplig på kredittagares och plattformars förhållande. Däremot uppstår inget konsumenträttsligt ansvar enligt lagstiftning för plattformar gentemot kreditgivare, trots att det kan anses föreligga ett visst konsumentförhållande. Således föreligger en avsaknad av konsumentskydd för kreditgivare gentemot plattformar vid lånebaserad gräsrotsfinansiering. Vidare torde det föreligga ett behov av konsumentskydd för kreditgivaren.

“Trečio fronto” žurnalas (1930-1931 m.) ir jo leidėjų grupė yra susilaukusi plataus literatūrologų ir istorikų dėmesio. Visgi, galimos naujos tyrimų perspektyvos, leidžiančios sukonstruoti platesnį šios grupės veiklos kontekstą bei įvesti naujus personažus – aktorius ir menininkus. Dėl to pats reiškinys įvardijamas kaip revoliucinės kultūros eksperimentas, netolygiai vystęsis tarp 1927 ir 1935 m. Tyrimo objektu tapo apie dvidešimt herojų. Jų biogramų lyginamoji rekonstrukcija atskleidė išskirtinę draugystės ryšių įtaką politinių-socialinių pažiūrų tapsmui bei viešajai veiklai. Dauguma šios grupės narių mėgino tapti komunistų pakeleiviais. Lietuvos komunistų partijos vadovybė Maskvoje ir Lietuvoje nesutarė kaip vertinti šį šliejimąsi. Visgi nulėmė neigiamos nuostatos ir šliejimosi pastangos buvo sužlugdytos. Šis aspektas esamoje istoriografijoje nebuvo iki šiol atskleistas. Mažuma analizuojamos grupės aktyvistų tapo nemarksistinio socializmo šalininkais, o jų išskirtinai sunki veikla buvo paženklinta emigracijos ir kalėjimo bausmių. Egzistuojanti istoriografija pabrėžia trečiafrontininkų komunistinio pakeleiviavimo aspektą, bet šiame tyrime analizuojamų personažų atžvilgiu laikomasi platesnės kairėjimo perspektyvos. Taigi, iki šiol tyrinėtojų nepanaudotos archyvinės medžiagos gausa leido papildyti trečiafrontininkų istorijas naujais faktais, įvesti naujų personažų, išplėsti kontekstus bei siūlyti naujus jų veiklos vertinimus. / The “Trečias frontas” journal (1930-1931) and its group have a wide historiographical layer. Nevertheless, there is a possibility to recreate wider context of the group’s activities and analyse this in the connection with activities of some artists and theatre actors. Therefore, this phenomenon could be named as the “experiment of revolutionary culture” and dated between 1927 and 1935. About twenty persons became the object of this research. Reconstruction of group members’ biographies in comparative mode reveals close personal ties and communication networks which affected political-social visions and were the core of complex public activities. Majority of the group members’ tried to become communist fellow-travellers. The corpus of Lithuanian Communist party leadership has had diverse attitudes towards these attempts and that initiated internal conflicts. Nevertheless, prevailed negative position and attempts failed. Minority of these revolutionary culture sympathizers became nonmarxist socialism supporters and their activities were especially difficult because of emigration and imprisonments. Existing historiography emphasizes these group members’ connections with communists. The perspective of this research is more about the difficult path of going left. Untapped archival material and its abundance enabled to enrich the existing historical narrative with new facts, characters, wider contexts, different perspectives and fresh analysis of their activities.

The “Trečias frontas” journal (1930-1931) and its group have a wide historiographical layer. Nevertheless, there is a possibility to recreate wider context of the group’s activities and analyse this in the connection with activities of some artists and theatre actors. Therefore, this phenomenon could be named as the “experiment of revolutionary culture” and dated between 1927 and 1935. About twenty persons became the object of this research. Reconstruction of group members’ biographies in comparative mode reveals close personal ties and communication networks which affected political-social visions and were the core of complex public activities. Majority of the group members’ tried to become communist fellow-travellers. The corpus of Lithuanian Communist party leadership has had diverse attitudes towards these attempts and that initiated internal conflicts. Nevertheless, prevailed negative position and attempts failed. Minority of these revolutionary culture sympathizers became nonmarxist socialism supporters and their activities were especially difficult because of emigration and imprisonments. Existing historiography emphasizes these group members’ connections with communists. The perspective of this research is more about the difficult path of going left. Untapped archival material and its abundance enabled to enrich the existing historical narrative with new facts, characters, wider contexts, different perspectives and fresh analysis of their activities. / “Trečio fronto” žurnalas (1930-1931 m.) ir jo leidėjų grupė yra susilaukusi plataus literatūrologų ir istorikų dėmesio. Visgi, galimos naujos tyrimų perspektyvos, leidžiančios sukonstruoti platesnį šios grupės veiklos kontekstą bei įvesti naujus personažus – aktorius ir menininkus. Dėl to pats reiškinys įvardijamas kaip revoliucinės kultūros eksperimentas, netolygiai vystęsis tarp 1927 ir 1935 m. Tyrimo objektu tapo apie dvidešimt herojų. Jų biogramų lyginamoji rekonstrukcija atskleidė išskirtinę draugystės ryšių įtaką politinių-socialinių pažiūrų tapsmui bei viešajai veiklai. Dauguma šios grupės narių mėgino tapti komunistų pakeleiviais. Lietuvos komunistų partijos vadovybė Maskvoje ir Lietuvoje nesutarė kaip vertinti šį šliejimąsi. Visgi nulėmė neigiamos nuostatos ir šliejimosi pastangos buvo sužlugdytos. Šis aspektas esamoje istoriografijoje nebuvo iki šiol atskleistas. Mažuma analizuojamos grupės aktyvistų tapo nemarksistinio socializmo šalininkais, o jų išskirtinai sunki veikla buvo paženklinta emigracijos ir kalėjimo bausmių. Egzistuojanti istoriografija pabrėžia trečiafrontininkų komunistinio pakeleiviavimo aspektą, bet šiame tyrime analizuojamų personažų atžvilgiu laikomasi platesnės kairėjimo perspektyvos. Taigi, iki šiol tyrinėtojų nepanaudotos archyvinės medžiagos gausa leido papildyti trečiafrontininkų istorijas naujais faktais, įvesti naujų personažų, išplėsti kontekstus bei siūlyti naujus jų veiklos vertinimus.

The research developed, in a perspective of the psychoanalysis, analyses concerning the relations between the citizen-fellow of the Psychoanalysis and the democratic management. It was broken of the following problem: considering the citizen-fellow of the Psychoanalysis, which (in) possibilities of the democratic management of the pertaining to school education to consist as transforming public politics of the hegemonic speech of the social one? The inquiry was cut from a historical criterion, including the analysis of twenty and two articles on pertaining to school democratic management, published in the RBPAE Revista Brasileira de Política e Administração da Educação (1997-2009), that is, after LDB 9394/96, when, for act of law, the democratic management if became principle of the pertaining to school organization. In this context, the importance appears of inside in the context the citizen-fellow of the pertaining to school democratic management, in an attempt of understanding of the subjective elements that operate in the determination of this process politician. This perspective, it is given credit that the Psychoanalysis can contribute for this agreement, to the measure that describes the citizen-fellow as to be of a culture, that is, emphasizes the social factors in its constitution. The democratic management, in the legal texts, serves as instrument politician for the State. When instituting a new form of management that give a oportunity the pertaining to school community to be part of the government , collaborates with the announced democratic action in the Constitution, democracy this that watches over for the right of voice and justice in relation to the representation conditions. What if it concludes, preliminarily, of the readings and the analysis of the speeches that circulate in the education is that a better life would be of the chance since that the pertaining to school education if accomplished for the bias of the democratic management, that is, on condition that representation of the citizen-fellow in the plans and action inside of the school. It was considered that the school seems to have if configured in one of the spaces announced in the culture as a place of the Social Speech, but not of the desire, what would compromise the reach of the objectives of participation of the citizens-fellows. / A pesquisa desenvolveu, em uma perspectiva psicanalítica, análises acerca das relações entre o sujeito da Psicanálise e a gestão democrática. Partiu-se da seguinte problematização: considerando o sujeito da Psicanálise, quais (im) possibilidades da gestão democrática da educação escolar constituir-se como política pública transformadora do discurso hegemônico do social? A investigação foi recortada a partir de um critério histórico, incluindo a análise de vinte e dois artigos sobre gestão democrática escolar, publicados na RBPAE Revista Brasileira de Política e Administração da Educação (1997-2009), ou seja, após a LDB 9394/96, quando, por força de Lei, a gestão democrática se tornou princípio da organização escolar. Neste contexto, surge a importância de contextualizar o sujeito da gestão democrática escolar, em uma tentativa de compreensão dos elementos subjetivos que operam nas determinações deste processo político. Nesta perspectiva, acredita-se que a Psicanálise pode contribuir para este entendimento, à medida que descreve o sujeito como ser de uma cultura, isto é, enfatiza os fatores sociais na sua constituição. A gestão democrática, nos textos legais, serve como instrumento político para o Estado. Ao instituir uma nova forma de gestão que oportuniza a comunidade escolar a fazer parte do governo , colabora com a ação democrática anunciada na Constituição, democracia esta que zela pelo direito de voz e justiça em relação às condições de representatividade. O que se conclui, preliminarmente, das leituras e da análise dos discursos que circulam na educação é que uma vida melhor seria oportunizada desde que a educação escolar se efetivasse pelo viés da gestão democrática, isto é, com a condição de representatividade do sujeito nos planos e ações dentro da escola. Foi considerado que a escola parece ter se configurado em um dos espaços anunciados na cultura como um lugar do Discurso Social, mas não do desejo, o que comprometeria o alcance dos objetivos de participação dos sujeitos.