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Even though past research suggests that visual learning may benefit from conceptual knowledge, current interventions for medical image evaluation often focus on procedural knowledge, mainly by teaching classification algorithms. We compared the efficacy of pure procedural knowledge (three-point checklist for evaluating skin lesions) versus combined procedural plus conceptual knowledge (histological explanations for each of the three points). All students then trained their classification skills with a visual learning resource that included images of two types of pigmented skin lesions: benign nevi and malignant melanomas. Both treatments produced significant and long-lasting effects on diagnostic accuracy in transfer tasks. However, only students in the combined procedural plus conceptual knowledge condition significantly improved their diagnostic performance in classifying lesions they had seen before in the pre- and post-tests. Findings suggest that the provision of additional conceptual knowledge supported error correction mechanisms.

Background and purpose: Spinal cerebrospinal fluid (CSF) leaks may cause a myriad of symptoms, most common being orthostatic headache. In addition, ventral spinal CSF leaks are a possible etiology of superficial siderosis (SS), a rare condition characterized by hemosiderin deposits in the central nervous system (CNS). The classical presentation of SS involves ataxia, bilateral hearing loss, and myelopathy. Unfortunately, treatment options are scarce. This study was undertaken to evaluate whether microsurgical closure of CSF leaks can prevent further clinical deterioration or improve symptoms of SS. Methods: This cohort study was conducted using data from a prospectively maintained database in two large spontaneous intracranial hypotension (SIH) referral centers in Germany and Switzerland of patients who meet the modified International Classification of Headache Disorders, 3rd edition criteria for SIH. Patients with spinal CSF leaks were screened for the presence of idiopathic infratentorial symmetric SS of the CNS. Results: Twelve patients were included. The median latency between the onset of orthostatic headaches and symptoms attributed to SS was 9.5 years. After surgical closure of the underlying spinal CSF leak, symptoms attributed to SS improved in seven patients and remained stable in three. Patients who presented within 1 year after the onset of SS symptoms improved, but those who presented in 8–12 years did not improve. We could show a significant association between patients with spinal longitudinal extrathecal collections and SS. Conclusions: Long‐standing untreated ventral spinal CSF leaks can lead to SS of the CNS, and microsurgical sealing of spinal CSF leaks might stop progression and improve symptoms in patients with SS in a time‐dependent manner. [ABSTRACT FROM AUTHOR]

Background: Intussusception is a formof ileus of the intestines in which an oral intestinal segment slides into the adjacent aboral intestinal segment, causing obstruction of the bowel. Methods:We analysed themedical records of 126 cattle with intussusception of the small intestine. Results: Demeanour and appetite were abnormal in 123 cattle. Non-specific signs of pain occurred in 26.2%, signs of visceral pain in 46.8% and signs of parietal pain in 56.4%. Intestinal motility was decreased or absent in 93.7% of the cattle. The most common findings of transrectal palpation were rumen dilation (37.3%) and dilated small intestines (24.6%). In 96% of the cattle, the rectum was empty or contained little faeces. The principal laboratory findings were hypokalaemia (89.6%), hypocalcaemia (76.5%), base excess (72.9%), hypochloraemia (71.8%), azotaemia (62.1%) and haemoconcentration (61.1%). The main ultrasonographic findings were reduced or absent intestinal motility (98.2%) and dilated small intestines (96.0%). A diagnosis of ileus was made in 87.8% and a diagnosis of ileus attributable to intussusception was made in another 9.8%. Right-flank laparotomy was carried out in 114 cattle. Fifty-six (44.4%) cows were discharged. Conclusions: Clinical findings of intussusception in cattle are often non-specific. Ultrasonography may be required to diagnose ileus. [ABSTRACT FROM AUTHOR]

This study compares the surface wind speed and forest damage data of two exceptionally severe winter storms, Vivian 1990 and Lothar 1999. The study area comprises the region that suffered damage in Switzerland. The wind speed data were derived from simulations of MeteoSwiss (Federal Office of Meteorology and Climatology), measurements during the storm periods and expert analyses of the data. The remotely sensed forest damage data were provided by the Federal Office for the Environment and the forest cover data by Swiss Federal Statistical Office. We compared data on the peak gust and maximum average wind speed, with data on the spatially related forest area and forest damage area, and found some clear differences in the correlations between the different wind data and forest damage. Our results point generally to the damage-causing role of near-surface gusts at maximum wind speeds during the storm. These tended to be spatially distributed on a fine scale. In only a few cases were the results statistically significant. However, these results could probably be improved with better wind data. For example, gust measurements spatially closer to forests or simulations of gusts at maximum wind speed could be produced with a spatially higher resolution. [ABSTRACT FROM AUTHOR]

Psychological distress is common in patients with chronic heart failure. The impact of different psychological variables on prognosis has been shown but the comparative effects of these variables remain unclear. This study examines the impact of depression, anxiety, vital exhaustion, Type D personality, and social support on prognosis in chronic heart failure patients. One hundred eleven patients (mean age 57 ± 14 years) having participated in an exercise based ambulatory cardiac rehabilitation program were enrolled in a prospective cohort study. Psychological baseline data were assessed at program entry. Mortality, readmission, and health-related quality of life were assessed at follow up (mean 2.8 ± 1.1 years). After controlling for disease severity none of the psychological variables were associated with mortality, though severe anxiety predicted readmission [HR = 3.21 (95% CI, 1.04-9.93; P = .042)]. Health-related quality of life was independently explained by vital exhaustion, anxiety and either body mass index (physical dimension) or sex (emotional dimension). As psychological variables have a strong impact on health-related quality of life they should be routinely assessed in chronic heart failure patients` treatment. [ABSTRACT FROM AUTHOR]

In a network of permanent observation plots in Switzerland, the storm `Lothar' uprooted 18.7% of Fagus sylvatica and 14.8% of Picea abies. The percentage of uprooting was significantly inversely correlated with actual soil base saturation (NH4Cl-extract). At a base saturation of ≤40% (calculated as an average over 0–40cm depth) uprooting was increased by a factor of 4.8 in beech and by a factor of 3.6 in Norway spruce compared to less acidic soils. In beech, the percentage of uprooted trees was also significantly correlated with nitrogen concentration in the leaves (positively) and with coarse pore volume in the soil (negatively). There was neither a relation with seasonal ozone dose nor a relation with crown transparency, stem diameter, crown size, slenderness, social position and position within the stand. The results suggest that anthropogenic stress factors play an important role in the extent of the `Lothar' damages in Switzerland. [ABSTRACT FROM AUTHOR]

Background: Psychological factors are important in the etiology and prognosis of coronary heart disease (CHD). Cardiac rehabilitation (CR) aims to reduce psychological distress, besides other somatic risk factors. Studies have shown that CR is effective in reducing psychological distress, but little is known about gender-specific outcome differences. Our objective was to examine whether women and men benefit equally from outpatient CR in terms of reduction in psychological distress and whether women show more impaired psychological health at baseline of CR than do men., Methods: We enrolled 441 CHD patients (mean age 58+/-11 years, 79.8% men) who underwent a 12-week outpatient CR program. Psychological dimensions, namely, anxiety, depression, vital exhaustion, social inhibition, and negative affect, were assessed at baseline and post-CR. Multivariate analysis of variance (MANOVA), controlling for age, disease severity, and exercise capacity, was applied to test for gender-specific differences at baseline and change between baseline and post-CR. In addition, gender-specific effect sizes were calculated for the change on psychological dimensions., Results: Women and men did not differ on any psychological measure at baseline of CR. The effect sizes show small to moderate treatment effects on the psychological dimensions assessed. Gender had a significant impact on change on the dimensions vital exhaustion (F=5.040(df=1), p<0.05) and social inhibition (F=5.74(df=1), p<0.05). Women showed larger change on social inhibition and smaller change on vital exhaustion than men., Conclusions: Women and men do not differ in the extent of psychological distress at baseline of CR, which could be explained also by the exclusion of highly distressed women from treatment. CR is less effective among women with regard to vital exhaustion and more effective with regard to social inhibition compared with men in a sample of low distressed patients.