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Objective: To assess the psychological distress, the ways of coping with that stress, and the selfesteem of patients with facial paralysis after acoustic neuroma surgery. Possible predictors and associations between these measures were also explored. Study Design: Four validated questionnaires were completed by patients with facial paralysis after acoustic neuroma surgery: 1) the Derriford Appearance Scale (DAS) to measure psychological distress, 2) the COPE questionnaire to measure how patients cope with facial paralysis, 3) the Personal Report questionnaire to measure the self-esteem of patients, and 4) the Facial Paralysis Questionnaire (FPQ) to measure the severity of facial paralysis. Patients: One hundred three patients with facial paralysis after surgical removal of acoustic tumors. Results: Distress spanned a wide range in these patients. There was no statistically significant association between the level of distress and the grade of facial paralysis or between time since operation and levels of distress. Women had higher levels of distress (P ‫؍‬ .02) and a significant negative correlation was found between levels of distress and age (r ‫؍‬ ؊0.28, P ‫؍‬ .005). High levels of distress were associated with low levels of self-esteem, as shown by the significant negative correlation between level of distress and self-esteem (r ‫؍‬ ؊0.59, P ‫؍‬ .01). A significant correlation between distress and maladaptive coping (r ‫؍‬ 0.31, P ‫؍‬ .002) was also found. Stepwise multiple regression of the distress scores revealed that self-esteem was the most important contributing factor (standardized coefficient ␤ ؊0.60, P ‫؍‬ .0001), followed by age (␤ ؊0.24, P ‫؍‬ .006) and sex (␤ ؊0.21, P ‫؍‬ .04). This model explained 44% of the distress variance. Conclusion: Clinicians must be aware of the distress felt by some patients experiencing facial palsy after acoustic neuroma surgery and that the level of distress may not be related to the clinical grade of the facial nerve paralysis. People with low self-esteem, young people, and women suffer from more distress due to the facial palsy. Clinicians should thoroughly counsel patients before and after surgery and should implement measures that increase patients' self-esteem and decrease their distress, especially in these high-risk groups.

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Research shows that students' conceptions of what 'learning' is influences both their approaches to learning and their learning outcomes. Lower level conceptions of learning are associated with surface approaches to learning, encouraging poor quality learning outcomes. However, more advanced conceptions are associated with deep learning approaches and high-quality learning outcomes. The Structure of Observed Learning Outcomes (SOLO) taxonomy was used to analyse the conceptions of learning of a new intake of physiotherapy students. The presence of a relationship between these and assessment outcomes was also investigated. As in other studies, a majority of students had lower level conceptions of learning than desired in higher education. However, a larger proportion of students had higher levels of conception than has been found in other research. A direct relationship between conceptions of learning and learning outcomes was also identified. The implications of these findings for achievement of high-quality learning are discussed.