[Surgical Therapy and Prognostic Factors for Carcinoma of Vater's Papilla]. / Chirurgische Therapie und prognostische Faktoren des Papillenkarzinoms.

BACKGROUND: Carcinoma of ampulla of Vater are rare tumours of the GI-tract with an improved prognosis compared to other periampullary tumours. Analysis of survival and prognostic factors are limited due to the low incidence of the carcinoma. The intention of this study in patients with papillary carcinoma was to evaluate short- and long-term survival and to identify prognostic factors for pancreatectomy and reconstruction using pancreatogastrostomy as treatment of carcinoma of Vater's ampulla. PATIENTS AND METHODS: Between 1989 and 2008 76 patients with a carcinoma of the ampulla of Vater were treated by oncological resection followed by pancreatogastrostomy. Various factors such as demographics, perioperative factors, histopathological findings as well as short- and long-term survival were evaluated retrospectively. Data were analysed statistically using Kaplan-Meier estimates of survival with log-rank test and uni- and multivariate analysis with Cox regression. RESULTS: The overall 5-year survival was 46 %, the 10-year survival 26 % for resected patients. By univariate analysis we could demonstrate that lymph node metastasis is the only predictor for outcome. In the multivariate analysis, age, sex, grading and especially lymph node status were a significant predictor for the survival of patients. CONCLUSION: In the current patient cohort lymph node status was the most important independent predictor of outcome after resection of carcinoma of Vater's papilla.

Comprehension of climate change and environmental attitudes across the lifespan.

Given the coincidence of the demographic change and climate change in the upcoming decades the aging voter gains increasing importance in climate change mitigation and adaptation processes. It is generally assumed that information status and comprehension of complex processes underlying climate change are prerequisites for adopting pro-environmental attitudes and taking pro-environmental actions. In a cross-sectional study, we investigated in how far (1) environmental knowledge and comprehension of feedback processes underlying climate change and (2) pro-environmental attitudes change as a function of age. Our sample consisted of 92 participants aged 25-75 years (mean age 49.4 years, SD 17.0). Age was negatively related to comprehension of system structures inherent to climate change, but positively associated with level of fear of consequences and anxiousness towards climate change. No significant relations were found between environmental knowledge and pro-environmental attitude. These results indicate that, albeit understanding of relevant structures of the climate system is less present in older age, age is not a limiting factor for being engaged in the complex dilemma of climate change. Results bear implications for the communication of climate change and pro-environmental actions in aging societies.

High cervical spinal cord stimulation (CSCS) increases regional cerebral blood flow after induced subarachnoid haemorrhage in rats.

The effects of high cervical spinal cord stimulation (cSCS) on regional cerebral blood flow (rCBF) were investigated after experimentally induced subarachnoid haemorrhage (SAH) in rats by the means of (99m)Tc-HMPAO. The experiments were carried out on a total of 24 Wistar rats, divided in three groups [group I: control without SAH, group II: SAH, group III: SAH and cSCS]. (99m)Tc-HMPAO was administered intravenously (group II/group III) 48 hours after induction of SAH. In group III, (99m)Tc-HMPAO was given after 3 hours of cSCS. All animals were sacrificed 30 minutes after application on (99m)Tc-HMPAO. Radioactivities were determined in blood, cerebrum and cerebellum. The ratio cerebrum/blood and cerebellum/blood was calculated to ascertain "extraction rate" in the sample differentially. The following mean values were calculated for the cerebellum/blood ratio: Group I: 1.06, SD: 0.21; Group II: 0.66, SD: 0.21; Group III: 1.00, SD: 0.37. Comparing the mean values a highly significant difference could be found between group II and III (p = 0.007) and between group I and II (p = 0.0019), respectively. Calculations of the cerebrum/blood ratio revealed similar results. After SAH cSCS enhances cerebral and cerebellar blood flow in rats. Possibly, cSCD constitutes a new therapeutic approach in the treatment of disturbed regional cerebral blood flow after SAH.

Negative correlations between control performance and verbalizable knowledge: indicators for implicit learning in process control tasks?

Negative correlations between task performance in dynamic control tasks and verbalizable knowledge, as assessed by a post-task questionnaire, have been interpreted as dissociations that indicate two antagonistic modes of learning, one being "explicit", the other "implicit". This paper views the control tasks as finite-state automata and offers an alternative interpretation of these negative correlations. It is argued that "good controllers" observe fewer different state transitions and, consequently, can answer fewer post-task questions about system transitions than can "bad controllers". Two experiments demonstrate the validity of the argument by showing the predicted negative relationship between control performance and the number of explored state transitions, and the predicted positive relationship between the number of explored state transitions and questionnaire scores. However, the experiments also elucidate important boundary conditions for the critical effects. We discuss the implications of these findings, and of other problems arising from the process control paradigm, for conclusions about implicit versus explicit learning processes.

[Discrete dynamic systems: the effect of perceptual structuring on composition and transfer of knowledge about operating sequences]. / Diskrete Dynamische Systeme: Der Einfluss perzeptueller Strukturierung auf Komposition und Transfer von Wissen über Bediensequenzen.

This paper reports two experiments in which we explored the impact of perceptual grouping of elements on the organization and use of knowledge about how to operate a device. Experiment 1 explored the effects of different perceptual display regions on the creation of chunks when sequences of inputs had to be reproduced. The effects of regions were not homogeneous, but rather their influence depended on interactions between different modalities and learning conditions. Experiment 2 investigated the influence of grouping-induced composition of knowledge elements on the transfer of sequential knowledge. Two different learning criteria were used in the acquisition phase to manipulate the degree of composition of knowledge elements. In the transfer phase, subjects could transfer (1) the whole sequence of one region, (2) two partial sequences of adjacent regions, or (3) single components. It was found that regional invariance and immediate succession of components were both important for transfer performance. These results suggests that the temporal order of regions is important for the organization and use of sequential knowledge, and not the grouping of elements by itself.

[A model of the influence of processing effort and number of changes on subjective time perception]. / Ein Modell zum Einfluss von Verarbeitungsaufwand und Veränderungsmenge auf das subjektive Zeitempfinden.

The paper is concerned with a model for subjective time estimation as determined by processing effort and number of changes. In a previous paper, a proposal was made that should solve a problem of confounded variables in the area of time estimation. An experimental design was developed to allow for the independent manipulation of processing effort and number of changes. It is shown that this proposal is valid only under the assumption that Stevens' law holds with exponent one. Therefore, another way of conceptualizing this problem is advanced in which one asks for the relative impact of processing effort and change on the parameters of Stevens' law. It can be demonstrated that this law yields considerable fit despite interindividual differences.

An instrument to assess the quality of maternal behavior.

Early assessment, detection, and therapeutic intervention in maladaptive maternal behavior can be facilitated by a simple nursing appraisal instrument employed initially on the third postpartum day. The Funke-Irby Interactional Assessment not only discriminates between early adaptive and maladaptive maternal behaviors, but it also illustrates a mother's progress or lack of progress toward adaptive mothering, making the instrument useful to the community health nurse during the early postdelivery weeks. This instrument has been effectively used as a screening device for nurses making decisions about the need for further referral for family therapy.