Variation in training requirements within general surgery: comparison of 23 countries.

Background: Many differences exist in postgraduate surgical training programmes worldwide. The aim of this study was to provide an overview of the training requirements in general surgery across 23 different countries. Methods: A collaborator affiliated with each country collected data from the country's official training body website, where possible. The information collected included: management, teaching, academic and operative competencies, mandatory courses, years of postgraduate training (inclusive of intern years), working-hours regulations, selection process into training and formal examination. Results: Countries included were Australia, Belgium, Canada, Colombia, Denmark, Germany, Greece, Guatemala, India, Ireland, Italy, Kuwait, the Netherlands, New Zealand, Russia, Saudi Arabia, South Africa, South Korea, Sweden, Switzerland, UK, USA and Zambia. Frameworks for defining the outcomes of surgical training have been defined nationally in some countries, with some similarities to those in the UK and Ireland. However, some training programmes remain heterogeneous with regional variation, including those in many European countries. Some countries outline minimum operative case requirement (range 60-1600), mandatory courses, or operative, academic or management competencies. The length of postgraduate training ranges from 4 to 10 years. The maximum hours worked per week ranges from 38 to 88 h, but with no limit in some countries. Conclusion: Countries have specific and often differing requirements of their medical profession. Equivalence in training is granted on political agreements, not healthcare need or competencies acquired during training.

Antecedentes: Existen muchas diferencias entre los programas de formación quirúrgica de posgrado del mundo. El objetivo de este estudio fue proporcionar una visión general de los requisitos formativos en cirugía general en 23 países diferentes. Métodos: En cada uno de los países participantes, un colaborador recopiló datos de la página web del organismo oficial encargado de la formación, si era posible. La información incluyó: gestión, formación, competencias académicas y operatorias, cursos obligatorios, años de formación de postgrado (que incluía el período de internado), regulaciones sobre las horas de trabajo, proceso de selección para la formación y existencia de un examen final. Resultados: Se incluyeron los datos de Australia, Bélgica, Canadá, Colombia, Dinamarca, Alemania, Grecia, Guatemala, India, Irlanda, Italia, Kuwait, Países Bajos, Nueva Zelanda, Rusia, Arabia Saudita, Sudáfrica, Corea del Sur, Suecia, Suiza, Reino Unido, Estados Unidos de América y Zambia. En algunos países existen los marcos normativos para definir los resultados del programa de formación, con ciertas semejanzas a los del Reino Unido e Irlanda. Sin embargo, algunos programas de formación, incluso en muchos países europeos, son muy heterogéneos con variaciones regionales. Pocos países describen el número mínimo de procedimientos quirúrgicos (rango 60 a 1.600), los cursos obligatorios o competencias quirúrgicas, académicos o de gestión exigidos. La duración de la formación postgraduada osciló de los 4 a los 10 años. El número de horas trabajadas máximas por semana oscilaron entre 38 y 88, sin límite en algunos países. Conclusión: Cada país tiene unos requisitos específicos, a menudo diferentes, para la formación de sus médicos. La convalidación se otorga por acuerdos políticos, más que por las necesidades médicas o por las competencias adquiridas durante la formación.

Environmental benefits and concerns on safety: communicating latest results on nanotechnology safety research-the project DaNa2.0.

The use of nanotechnology and advanced materials promises to revolutionise many areas of technology and improve our daily life. In that respect, many positive effects on the environment are expected, either directly, by developing new technologies for remediation, filtering techniques or energy generation, or indirectly, by e.g. saving resources due to lower consumption of raw materials, or lower energy and fuel consumption due to reduced weight of vehicles. However, such beneficial effects of new technologies are often confronted by concerns regarding the safety of novel substances or materials. During the past 10 years, great effort has been put into research on potential hazards of nanomaterials towards environmental organisms. As the methodology for reliable assessment of nanomaterials was immature, many studies reporting contradictory results have been published, hindering both risk assessment for nanomaterials, as well as the knowledge communication to all involved stakeholders. Thus, DaNa2.0 serves as a platform to implement trusted knowledge on nanomaterials for an objective discussion.

Surface induced vibrational modes in the fluorescence spectra of PTCDA adsorbed on the KCl(100) and NaCl(100) surfaces.

We report a combined experiment-theory study on low energy vibrational modes in fluorescence spectra of perylene-3,4,9,10-tetracarboxylic acid dianhydride (PTCDA) molecules. Using very low coverages, isolated molecules were adsorbed on terrace sites or at sites located at residual steps on (100) oriented alkali halide films (KCl and NaCl). The low energy modes couple to the optical transition only because the PTCDA molecule is geometrically distorted (C2v) upon adsorption on the surface; they would be absent for the parent planar (D2h) PTCDA molecule. The modes differ in number and energy for molecules adsorbed on regular terrace sites and molecules adsorbed at step edge sites. Modes appearing for step edge sites have the character of frustrated rotations. Their coupling to the optical transition is a consequence of the further reduced symmetry of the step edge sites. We find a larger number of vibrational modes on NaCl than on KCl. We explain this by the stronger electrostatic bonding of the PTCDA on NaCl compared to KCl. It causes the optical transition to induce stronger changes in the molecular coordinates, thus leading to larger Franck-Condon factors and thus stronger coupling. Our results demonstrate how optical spectroscopy can be used to gain information on adsorption sites of molecules at low surface concentrations.

The nucleotide excision repair protein XPC is essential for bulky DNA adducts to promote interleukin-6 expression via the activation of p38-SAPK.

Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants, and many are potent carcinogens. Benzo[a]pyrene (B[a]P), one of the best-studied PAHs, is metabolized ultimately to the genotoxin anti-B[a]P-7,8-dihydrodiol-9,10-epoxide (BPDE). BPDE triggers stress responses linked to gene expression, cell death and survival. So far, the underlying mechanisms that initiate these signal transduction cascades are unknown. Here we show that BPDE-induced DNA damage is recognized by DNA damage sensor proteins to induce activation of the stress-activated protein kinase (SAPK) p38. Surprisingly, the classical DNA damage response, which involves the kinases ATM and ATR, is not involved in p38-SAPK activation by BPDE. Moreover, the induction of p38-SAPK phosphorylation also occurs in the absence of DNA strand breaks. Instead, increased phosphorylation of p38-SAPK requires the nucleotide excision repair (NER) and DNA damage sensor proteins XPC and mHR23B. Interestingly, other genotoxins such as cisplatin (CDDP), hydrogen peroxide and ultraviolet radiation also enhance XPC-dependent p38-SAPK phosphorylation. In contrast, anti-benzo[c]phenanthrene-3,4-dihydrodiol-1,2-epoxide, the DNA adducts of which are not properly recognized by NER, does not trigger p38-SAPK activation. As a downstream consequence, expression and secretion of the pro-inflammatory cytokine interleukin-6 is induced by BPDE and CDDP in vitro and by CDDP in the murine lung, and depends on XPC. In conclusion, we describe a novel pathway in which DNA damage recognition by NER proteins specifically leads to activation of p38-SAPK to promote inflammatory gene expression.

MALDI imaging-based classification of hepatocellular carcinoma and non-malignant lesions in fibrotic liver tissue.

Histopathologic differentiation of nodular lesions in cirrhotic liver is difficult even for experienced hepatopathologists especially regarding diagnosis of hepatocellular carcinoma (HCC) in biopsies. For this reason, new tissue markers are needed to reinforce histopathologic decision-making. With advances in molecular techniques, proteomic analysis may help to confirm the diagnosis of HCC. Matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI IMS) is a powerful technology which allows to determine and to localize proteins directly in tissue sections. Using MALDI IMS proteomic patterns of cryosections with lesions of HCC (n = 15) and non-malignant fibrotic liver tissue (n = 11) were investigated to establish a classification model of HCC, which was validated in an independent set of tissue to distinguish HCC (n = 10) from regenerative nodules (n = 8). By correlating generated mass spectrometric images with the histology of the tissue sections we found that the expression of 4 proteins as indicated by m/z 6274, m/z 6647, m/z 6222 and m/z 6853 was significantly higher in HCC tissue than in non-tumorous liver tissue. The generated classification model based on the most significant 3 differentially expressed proteins allowed a reliable prediction of benign and malignant lesions in fibrotic liver tissue with a sensitivity and specificity of 90 % in the validation set. The identified MALDI IMS proteomic signature can be diagnostically helpful to allow simplifying the diagnostic process and minimize the risks of delays in establishing the objective final diagnosis and initiating treatment of patients with HCC.

Classification and prediction of HCC tissues by Raman imaging with identification of fatty acids as potential lipid biomarkers.

PURPOSE: Patients with hepatocellular carcinoma (HCC) can only be treated curatively at early stages and then have a favorable prognosis of this often fatal disease. For this reason, an early detection and diagnostic confirmation are crucial. Raman imaging spectroscopy is a promising technology for high-resolution visualization of the spatial distribution of molecular composition in tissue sections. The aim of this study was to investigate molecular information of liver tissue by Raman imaging for classification and diagnostic prediction. METHODS: Unstained cryosections of human hepatic tissues (23 patients) were measured by Raman spectroscope in the regions of HCC (n = 12) and fibrosis (n = 17). The acquired data set was used to generate a random forest classification model with 101 iterations of sevenfold cross-validation. The models obtained during cross-validation were also used to predict regions of tumor margin (n = 8) aside from independent testing. RESULTS: Raman spectra differed between malignant and non-malignant tissue regions. Based on these spectral data, a random forest classification model calculated a prediction accuracy of 86 % (76 % sensitivity and 93 % specificity). The ten most important variables were identified at 2895, 2856, 1439, 1298, 1080, 1063, 1023, 937, 920, and 719 cm(-1). CONCLUSIONS: In this study, Raman imaging spectroscopy was applied successfully for liver tissue to differentiate, classify, and predict with high accuracy malignant and non-malignant tissue regions. Furthermore, the most important differences were identified as the Raman signature of fatty acids. The demonstrated results highlight the enormous potential which vibrational spectroscopy techniques have for the future diagnostics and prognosis estimation of HCC.

Discrimination and classification of liver cancer cells and proliferation states by Raman spectroscopic imaging.

Discrimination of nodular lesions in cirrhotic liver is a challenge in the histopathologic diagnostics. For this reason, there is an urgent need for new detection methods to improve the accuracy of the diagnosis of liver cancer. Raman imaging allows to determine the spatial distribution of a variety of molecules in cells or tissue label-free and to correlate this molecular information with the morphological structures at the same sample location. This study reports investigations of two liver cancer cell lines, - HepG2 and SK-Hep1, - as well as HepG2 cells in different cellular growth phases using Raman micro-spectroscopic imaging. Spectral data of all cells were recorded as a color-coded image and subsequentially analyzed by hierarchical cluster and principal component analysis. A support vector machine-based classification algorithm reliably predicts previously unknown cancer cells and cell cycle phases. By including selectively the Raman spectra of the cytoplasmic lipids in the classifier, the accuracy has been improved. The main spectral differences that were found in the comparative analysis can be attributed to a higher expression of unsaturated fatty acids in the hepatocellular carcinoma cells and during the proliferation phase. This corresponds to the already examined de novo lipogenesis in cells of liver cancer.

Task specific grip force control in writer's cramp.

OBJECTIVE: Writer's cramp is defined as a task specific focal dystonia generating hypertonic muscle co-contractions during handwriting resulting in impaired writing performance and exaggerated finger force. However, little is known about the generalisation of grip force across tasks others than writing. The aim of the study was to directly compare regulation of grip forces during handwriting with force regulation in other fine-motor tasks in patients and control subjects. METHODS: Handwriting, lifting and cyclic movements of a grasped object were investigated in 21 patients and 14 controls. The applied forces were registered in all three tasks and compared between groups and tasks. In addition, task-specific measures of fine-motor skill were assessed. RESULTS: As expected, patients generated exaggerated forces during handwriting compared to control subjects. However there were no statistically significant group differences during lifting and cyclic movements. The control group revealed a generalisation of grip forces across manual tasks whereas in patients there was no such correlation. CONCLUSION: We conclude that increased finger forces during handwriting are a task-specific phenomenon that does not necessarily generalise to other fine-motor tasks. SIGNIFICANCE: Force control of patients with writer's cramp in handwriting and other fine-motor tasks is characterised by individualised control strategies.

Screening of different metal oxide nanoparticles reveals selective toxicity and inflammatory potential of silica nanoparticles in lung epithelial cells and macrophages.

In cell culture studies, foetal calf serum (FCS) comprising numerous different proteins is added, which might coat the surface of engineered nanomaterials (ENMs) and thus could profoundly alter their biological activities. In this study, a panel of industrially most relevant metal oxide nanoparticles (NPs) was screened for toxic effects in A549 lung epithelial cells and RAW264.7 macrophages in the presence and absence of FCS. In medium without FCS amorphous SiO2-NPs were the most cytotoxic NPs and induced a significant pro-inflammatory response in both cell types. An increased anti-oxidative response after exposure to SiO2-NPs was, however, only observed in RAW264.7 macrophages. Furthermore, pre-coating of SiO2-NPs with FCS proteins or simply bovine serum albumin abrogated responses in A549 lung epithelial cells. Thus, the protein corona bound to the surface of SiO2-NPs suppresses their biological effects, an issue which needs to be more carefully considered for in vitro-in vivo extrapolations.

Recovery from auditory and visual neglect after optokinetic stimulation with pursuit eye movements--transient modulation and enduring treatment effects.

Optokinetic stimulation (OKS) modulates many facets of the neglect syndrome. This sensory stimulation technique is known to activate multiple brain regions (temporo-parietal cortex, basal ganglia, brain stem, cerebellum) some of which are involved in auditory and visual space coding. Here, we evaluated whether OKS modulates auditory neglect transiently and induces a sustained effect (Study 1), and whether repetitive OKS permanently recovers auditory neglect (Study 2). In Study 1, 20 patients with visuospatial neglect and auditory neglect in an auditory midline task following rightsided stroke were randomly allocated to an experimental and a control group matched for neglect severity and socio-demographic factors. Both groups showed a stable, pathological shift of their auditory subjective median plane (ASMP) in front space to the right side. During leftward OKS the experimental group showed a complete normalization of the shift of the ASMP, which endured until 30 min poststimulation, and returned almost to baseline values 24h after OKS. In contrast, the control group who viewed the identical but static dot pattern, showed neither change in their ASMP during this condition, nor any significant change at 30 min or 24h poststimulation. In Study 2, we show in two samples of neglect patients (N = 3 each) that repetitive leftward OKS with smooth pursuit eye movements as a therapy induces lasting improvements in auditory (the ASMP) and visual neglect while visual scanning therapy yielded no measurable effects on auditory and significantly smaller effects on visual neglect. In conclusion, the experiments show that a single session of OKS induces rapid though transient recovery from auditory neglect including a sustained effect after termination of stimulation, while repetitive OKS therapy yields enduring and multimodal recovery from auditory and visual neglect. OKS therapy with pursuit eye movements therefore represents a multimodally effective and easily applicable technique for the treatment of auditory and visual neglect.

Writing kinematics and pen forces in writer's cramp: effects of task and clinical subtype.

OBJECTIVE: Writer's Cramp (WC) is defined as a task-specific form of focal-hand-dystonia generating hypertonic muscle co-contractions resulting in impaired handwriting. Little is known about kinematic and dynamic characteristics in handwriting in the different subtypes of WC. METHODS: In this study, kinematic and force analyses were used to compare handwriting capacity of 14 simple, 13 dystonic WC-patients and 14 healthy subjects. The effect of task-complexity was investigated using a simple repetitive writing-task, writing pairs of letters, a sentence and copying a text. RESULTS: In general, patients showed significant deficits in kinematic and force parameters during writing, but no consistent differences between the two subtypes of WC were found. The complexity of writing material modulated writing parameters in all groups, but less complex material did not ameliorate the patients' deficits relative to control subjects. CONCLUSIONS: The similarity of deficits in patients with simple and dystonic WC does not support the concept of a unitary progression of deficits causing a switch from simple to dystonic WC. Dystonic WC seems to be characterized by a spread of symptoms independent of severity. Obviously, the deficits concern elementary aspects of writing and are not modulated by more complex aspects. SIGNIFICANCE: Quantification of writing deficits by simple and short phrases with kinematic and force parameters can substantially improve the characterization of WC.

Evaluation of the tissue toxicity of antiseptics by the hen's egg test on the chorioallantoic membrane (HETCAM).

BACKGROUND: Antiseptics are frequently used for the prophylaxis and treatment of local infections of chronic wounds. Whereas local antiseptics in general have a positive effect on wound healing an uncritical use may impair wound healing due to toxic side effects. OBJECTIVE: We sought to assess the vascular irritation potential of different antiseptic solutions and ointments commonly used for short and long term application as a measure of tissue toxicity. METHOD: The vascular irritation was evaluated by the hen's egg test (HET) on the chorioallantoic membrane (CAM). The effects on the vessels of a mucous membrane were directly assessed by stereomicroscopic observation in vivo. RESULTS: Severe CAM irritation was observed after short-term applications of 1% octenidin-2HCl (Octenisept), 72% isopropanol (Cutasept), 0.35% chloroxylenol (Dettol) and 10% PVP-I ointment (Betaisodona). Medium irritations were observed for 10% PVP-I solution (Betaisodona), 3% lysosomal PVP-I ointment (Repithel), 1.8% cadexomer-iodine ointment (Iodosorb) and 1% cadexomer-iodine pellets (Iodosorb). Finally, slight irritations were observed for 1% PVP-I solution (Betaisodona), 0.1% polyhexanid plus betain (Prontosan) and 1% silver-sulfadiazine ointment (Flammazine), whereas 0.04% polyhexanid solution (Lavanid), washings from sterile maggots of Lucilia sericata and filtrated enzymes from Clostridium histolyticum (Iruxol-N) showed no effects of irritation. In the long-term approaches, no vascular irritations were found for polyhexanid, washings from Lucilia sericata and enzyme filtrations from Clostridium histolyticum. CONCLUSION: The vascular injuries caused by the studied antiseptics are an indirect indicator of their tissue toxicity. Strikingly, even therapeutic substances, which have been regarded as safe in their application for the treatment of chronic wounds in clinical studies, showed severe irritations on the CAM. We suggest that agents with no or low irritation potential on the CAM should be preferred in the clinical practice in order to obtain optimal results.

Naturally phase-matched second-harmonic generation in a whispering-gallery-mode resonator.

We demonstrate for the first time natural phase matching for optical frequency doubling in a high-Q whispering-gallery-mode resonator made of lithium niobate. A conversion efficiency of 9% is achieved at 30 microW in-coupled continuous wave pump power. The observed saturation pump power of 3.2 mW is almost 2 orders of magnitude lower than the state-of-the-art value. This suggests an application of our frequency doubler as a source of nonclassical light requiring only a low-power pump, which easily can be quantum noise limited. Our theoretical analysis of the three-wave mixing in a whispering-gallery-mode resonator provides the relative conversion efficiencies for frequency doubling in various modes.

Phonon-assisted electroluminescence from metallic carbon nanotubes and graphene.

We report on light emission from biased metallic single-wall carbon nanotube (SWNT), multiwall carbon nanotube (MWNT) and few-layer graphene (FLG) devices. SWNT devices were assembled from tubes with different diameters in the range 0.7-1.5 nm. They emit light in the visible spectrum with peaks at 1.4 and 1.8 eV. Similar peaks are observed for MWNT and FLG devices. We propose that this light emission is due to phonon-assisted radiative decay from populated pi* band states at the M point to the Fermi level at the K point. Since for most carbon nanotubes as well as for graphene the energy of unoccupied states at the M point is close to 1.6 eV, the observation of two emission peaks at approximately 1.6 +/- approximately 0.2 eV could indicate radiative decay under emission or absorption of optical phonons, respectively.

Correlation of cutaneous tension distribution and tissue oxygenation with acute external tissue expansion.

Today, the biomechanical fundamentals of skin expansion are based on viscoelastic models of the skin. Although many studies have been conducted in vitro, analyses performed in vivo are rare. Here, we present in vivo measurements of the expansion at the skin surface as well as measurement of the corresponding intracutaneous oxygen partial pressure. In our study the average skin stretching was 24%, with a standard deviation of 11%, excluding age or gender dependency. The measurement of intracutaneous oxygen partial pressure produced strong inter-individual fluctuations, including initial values at the beginning of the measurement, as well as varying individual patient reactions to expansion of the skin. Taken together, we propose that even large defect wounds can be closed successfully using the mass displacement caused by expansion especially in areas where soft, voluminous tissue layers are present.

[EYEMOVE. Standardized assessment and treatment of visual search disorders]. / EYEMOVE. Standardisierte Diagnostik und Therapie visueller Explorationsstörungen.

Disorders of visual search by coordinated eye and head movements are frequently encountered in patients with brain damage. Homonymous visual field disorders, impaired elementary visual capacities (e.g. acuity, contrast sensitivity, convergent fusion, oculomotor disorders), visual neglect, Balint-Holmes syndrome or dementia (e.g. Alzheimer's disease) are the most frequent causes of such disorders. Efficient visual search is necessary to select salient stimuli and bring them onto the fovea in order to perform an in-depth analysis. Visual search is not only an indispensible capacity for visual activities in vocational and private life but is also important for many motor and cognitive abilities such as reaching, grasping, standing, spatial perception, route navigation as well as mobility. Despite this importance no comprehensive system exists for the standardized assessment and treatment of visual search disorders in the German-speaking area. In this article, we describe the basic properties of such a system (EYEMOVE). After a short survey of the main causes of visual search disorders following brain damage, the diagnostic facilities, normative data as well as a variety of treatment techniques of this novel system are described. Selected results from on-going clinical studies highlight the practicability and effectiveness of this novel system which contributes to a better management of visual search disorders in neuro-visual rehabilitation.

[Visually based reading disorders after brain damage. Standardised assessment and treatment with READ]. / Erworbene, visuell bedingte Lesestörungen. Standardisierte Diagnostik und Therapie mit READ.

Visually based reading disorders are frequently encountered in patients with acquired brain damage. Homonymous visual field defects, impaired elementary visual capacities (acuity, contrast sensitivity, convergent fusion, ocular motor disorders), visual neglect or Balint-Holmes syndrome are the most frequent causes of such reading disorders. Reading is not only an important prerequisite for vocational and private life, but is also indispensable for subsequent cognitive abilities such as verbal working memory and long-term memory. Despite this importance no comprehensive system exists for the standardised assessment and treatment of visually based reading capacities in the German-speaking area. Here, we describe the basic properties of such a system (READ). After a short survey of the main causes of visually based reading disorders after brain damage, the anamnesis, diagnostic facilities, normative data as well as a variety of treatment techniques of the novel system are described. Selected results from ongoing clinical group studies as well as case examples highlight the diagnostic sensitivity and therapeutic efficiency of the new system for better management of visually based reading disorders after brain damage.

Impairments of prehension kinematics and grasping forces in patients with cerebellar degeneration and the relationship to cerebellar atrophy.

OBJECTIVE: This study established the relationship between kinematic and grip force parameters in prehension tasks, disease severity and cerebellar atrophy in patients with cerebellar degeneration. METHODS: Prehension was tested in a condition during which the hand reached out, grasped, and lifted an object. Task complexity was modified by limiting the transport component to a single-joint movement, and introducing a bimanual condition. RESULTS: Compared to controls the cerebellar patients showed disturbances in hand transport, in hand shaping and the most pronounced in time to peak grip force and the grip/load force coupling. Task-dependent changes did not differ between groups. Ataxia scores revealed significant correlations with hand transport and shaping measures only. Ataxia subscores correlated with volume reduction of appropriate longitudinal cerebellar zones. Volume reduction of the intermediate zone was associated with grip force coordination deficits. CONCLUSIONS: Results indicate that the cerebellum may have a more general role in motor control of grasping independent of task complexity. Temporal and coordinative measures of grip force appear to be most useful to assess the severity of grasping deficits in patients with cerebellar degeneration not detectable by clinical ataxia scales. SIGNIFICANCE: To assess the severity and course of cerebellar disease grip force control in a standard prehension task is a sensitive quantitative measure.

Repetitive optokinetic stimulation induces lasting recovery from visual neglect.

PURPOSE: To evaluate whether repetitive optokinetic stimulation with active pursuit eye movements leads to substantial and greater recovery from visual neglect as compared to conventional visual scanning training. METHODS: Two groups of five patients with leftsided hemineglect were consecutively collected and matched for clinical and demographic variables as well as neglect severity. One group received five treatment sessions of repetitive optokinetic stimulation (R-OKS) within one week, while the other group received the same amount of conventional visual scanning training (VST) using identical visual stimuli and setup. All patients were treated in a single-subject baseline design with treatment-free intervals before (14 days) and after specific neglect therapy (14 days). Dependent variables were the improvements in digit cancellation, visuoperceptual and visuomotor line bisection and visual size distortion during treatment. The transfer of treatment effects was assessed by a paragraph reading test. RESULTS: The results showed superior effects of OKS treatment in all five patients which generalized across all tasks administered and remained stable at follow-up. In contrast, no significant improvements were obtained after VST training in any of these tasks, except in line bisection. CONCLUSION: We conclude that the presentation of moving visual stimulus displays with active smooth pursuit eye movements can be more efficient than conventional visual scanning training using static visual displays.