[Psychological effects of preventive voice care training in student teachers]. / Psychologische Effekte eines präventiven Stimmtrainings im Lehramtsreferendariat.

BACKGROUND: Studies on the effectiveness of preventive voice care programs have focused mainly on voice parameters. Psychological parameters, however, have not been investigated in detail so far. OBJECTIVES: The effect of a voice training program for German student teachers on psychological health parameters was investigated in a longitudinal study. METHODS: The sample of 204 student teachers was divided into the intervention group (n = 123), who participated in the voice training program, and the control group (n = 81), who received no voice training. Voice training contained ten 90-min group courses and an individual visit by the voice trainer in a teaching situation with feedback afterwards. Participants were asked to fill out questionnaires (self-efficacy, Short-Form Health Survey, self-consciousness, voice self-concept, work-related behaviour and experience patterns) at the beginning and the end of their student teacher training period. RESULTS: The training program showed significant positive influences on psychological health, voice self-concept (i.e. more positive perception and increased awareness of one's own voice) and work-related coping behaviour in the intervention group. On average, the mental health status of all participants reduced over time, whereas the status in the trained group diminished significantly less than in the control group. Furthermore, the trained student teachers gained abilities to cope with work-related stress better than those without training. CONCLUSION: The training program clearly showed a positive impact on mental health. The results maintain the importance of such a training program not only for voice health, but also for wide-ranging aspects of constitutional health.

[Development of a questionnaire for the assessment of the voice self-concept]. / Entwicklung eines Fragebogens zur Erfassung des stimmlichen Selbstkonzepts.

BACKGROUND: Common self-assessment questionnaires on voice diagnostics focus mostly on functionality of the voice and the impact on the quality of life. Personal aspects such as the relationship with one's own voice and its self-perception are for the most part not taken into consideration. OBJECTIVES: In this article a questionnaire for the assessment of the voice self-concept (Fragebogen zur Erfassung des stimmlichen Selbstkonzepts, FESS) is introduced. MATERIALS AND METHODS: Reliability and validity were tested with a sample of 308 student teachers. For external validity, the scales were correlated with standardized questionnaires of vocal, physical, and mental health. The scale reliability was also retested in 94 participants. RESULTS: The principal component analysis confirmed the internal consistency of three subscales on the relationship with one's own voice, the awareness of the use of one's own voice, and the perception of the connection between voice and emotional changes. CONCLUSION: The FESS questionnaire was shown to be a reliable and valid instrument which supplements existing voice questionnaires by self-related aspects of the voice.

Motor functions in trumpet playing-a real-time MRI analysis.

INTRODUCTION: The function of the orofacial and pharyngeal musculature for sound generation in brass instruments is insufficiently investigated. The contribution of muscles defying direct observation remains poorly understood. Time-resolved magnetic resonance imaging (MRI) allows visualization of muscle function as well as changes of the oropharyngeal cavities during muscle activation. METHODS: We used fast 3-T MRI imaging to analyze motor activation during sound generation in brass instruments. Twelve professional trumpeters were analyzed at different pitch, loudness and dynamic. MR images were analyzed for position of the mouthpiece to lips and teeth, pivoting, nasopharyngeal closure and changes in the area of oral and pharyngeal cavity. RESULTS: Of the 12 subjects, eight positioned the mouthpiece mainly to the upper lip, three in equal parts to upper and lower lip, and only one mostly to the lower lip. The last turned out to be the only subject with upward pivoting. All subjects had a complete velopharyngeal closure. Measurements of the oral and pharyngeal cavities showed an increase when subjects were playing higher pitches. The increase in areas of oral and pharyngeal cavity was present also when switching from lower to higher loudness and when performing crescendo to decrescendo. Enlargement of the oral and pharyngeal cavity was less pronounced with increasing loudness. But no general difference in change of oral and pharyngeal cavity could be observed. CONCLUSIONS: The present study shows that it is possible to measure motor function and its implications on oral as well as pharyngeal cavities during sound generation in brass instruments. These changes seem to follow a reproducible pattern.

Perceived medical school stress and the development of behavior and experience patterns in German medical students.

BACKGROUND: Longitudinal data about the development of health risks and resources in relation to the performance of medical students are limited. AIMS: To evaluate the development of study-related experience and the correlation to performance. METHOD: Medical students in the first (2006), second (2008), and fifth years (2011) of their studies were surveyed with standard instruments for quality of life, study-related behavior and experience, perceived medical school stress, anxiety and depression, and grades in their first major exam. RESULTS: The proportion of students with a healthy behavior and experience pattern decreased from 47.3% in the first year to 36.9% in the second year and 17.6% in the fifth year. This corresponded to an increase in the proportion of students at risk for burnout (7.1% first, 20% second, 19% fifth year). Students with a healthy behavior and experience pattern scored higher in self-perceived performance (p < 0.05) and objective grades. Stress and risk for burnout were important predictors for anxiety and depression. CONCLUSIONS: The decrease in health and the increase in risk patterns indicate a need for prevention and health promotion that should not only focus on individual behavior but also address the contextual factor of study organization within medical school.

[Hearing protectors in musicians]. / Gehörschutz bei Musikern.

The ENT physician and specialist in musician's medicine is consistently confronted with the issue of hearing protection, since musicians exposed to high sound levels due to their profession, and who are often concerned about their hearing, refer to him. Furthermore, this topic has gained more relevance since a noise exposure limit for professional musicians was issued in February 2008 by the EC guidelines for occupational health and safety regarding "Noise" (2003/10/EC). The present article gives an outline of the recent state of knowledge about sound pressure levels, hearing risks, as well as the use of hearing protection for musicians.

[Psychosomatic aspects in the treatment of the singing voice]. / Psychosomatische Aspekte bei der Behandlung der Sängerstimme.

Voice and person form a unity and consequently, psychological factors always play a role in the treatment of voice disorders, especially in the area of the arts. This fact has to be taken into account in musician's medicine and it leads to integrating psychosomatic principles within the medical consultation, such as sufficient time, open structured communication, as well as empathy in the doctor-patient relationship. Furthermore, another important aspect of the treatment of singers is the understanding, based on musical expertise, towards the emotional requirements of the profession. If there is a distinct psychological component in the voice disorder it has to be included as a cofactor in the diagnostics. In such a case, the decision of the otorhinolaryngologist should be to include the treatment of the psychological factors within the voice therapy or to initiate parallel treatment in close cooperation with a specialist in psychosomatic medicine or a clinical psychologist specialized in musician's medicine. For singers, performance anxiety represents the additional frequent diagnosis and it should also be treated in this cooperation.

Specific recognition and inhibition of Ewing tumour growth by antigen-specific allo-restricted cytotoxic T cells.

BACKGROUND: The development of a successful immunotherapy is hampered by an ineffective T-cell repertoire against tumour antigens and the inability of the patient's immune system to overcome tolerance-inducing mechanisms. Here, we test the specific recognition and lytical potential of allo-restricted CD8(+) T cells against Ewing tumour (ET) associated antigens Enhancer of Zeste, Drosophila Homolog 2 (EZH2), and Chondromodulin-I (CHM1) identified through previous microarray analysis. METHODS: Following repetitive CHM1(319) (VIMPCSWWV) and EZH2(666) (YMCSFLFNL) peptide-driven stimulations with HLA-A 0201(+) dendritic cells (DC), allo-restricted HLA-A 0201(-) CD8(+) T cells were stained with HLA-A 0201/peptide multimers, sorted and expanded by limiting dilution. RESULTS: Expanded T cells specifically recognised peptide-pulsed target cells or antigen-transfected cells in the context of HLA-A 0201 and killed HLA-A 0201(+) ET lines expressing the antigen while HLA-A 0201(-) ET lines were not affected. Furthermore, adoptively transferred T cells caused significant ET growth delay in Rag2(-/-)γ(C)(-/-) mice. Within this context, we identified the CHM1(319) peptide as a new candidate target antigen for ET immunotherapy. CONCLUSION: These results clearly identify the ET-derived antigens, EZH2(666) and CHM1(319), as suitable targets for protective allo-restricted human CD8(+) T-cell responses against non-immunogenic ET and may benefit new therapeutic strategies in ET patients treated with allogeneic stem cell transplantation.

["Your child is hard of hearing" - a longitudinal study of parental distress]. / "Ihr Kind ist schwerhörig" - Eine Verlaufsuntersuchung zum elterlichen Befinden.

BACKGROUND: In models, hearing impairment in children is linked to parental distress. Empiric data about coping with this stress is small, however, as there are virtually only cross section studies which we can refer to. METHODS: 124 mothers and fathers of 61 children with a hearing impairment, who had their first hearing aid fitted respectively, had been presented to the pre-examination for a Cochlear Implantation (CI). Over a period of two years five respectively six measurements of their psycho-social distress were taken. In addition, the speech status of the children was evaluated. RESULTS: Shortly after the diagnosis and before implantation parental quality of life is significantly reduced. Enduring parental distress could not be established. However, particularly when the CI-indication is unclear parents were found to be negatively affected in their well-being. Social support and positive self-awareness were found to moderate parental distress. CONCLUSIONS: The significant reduction of parental quality of life at the onset of the treatment would indicates the need of special psychological support of the parents in this phase. The stabilisation of the parents' well-being over the course of the treatment signifies that a "normal every day life" can be attained for affected families despite the impairment.

[Psychosocial behaviour and subjective experience specific to the course of study of medical students in their first and fifth years of study]. / Studienbezogenes psychosoziales Verhalten und Erleben von Medizinstudenten im ersten und fünften Studienjahr.

AIM: This study concerns the evaluation of study-related psychosocial risk factors and resources in medical students at the beginning and before the end of their course of studies. METHODS: Written questionnaires were filled out by medical students in Lübeck and Freiburg in their first and fifth years of study and analysed with three standard instruments (AVEM, SAM, F-Sozu). The response rate was 84.5% (n=435) in the first and 83.0% (n=351) in the fifth year of study. RESULTS: At the outset of their course of study, most of the students evinced behaviour and subjective experience patterns which were not deleterious to their health. Nevertheless, even at this point in time, 22.9% of the students showed a risk constellation with an excessive commitment to work and readiness to overstrain themselves. With 17.9% resignatory exhaustion with a highly restrictive subjective quality of life was found. In the fifth year of study, this proportion had increased to 23.3%, while the quality of health behaviour and subjective experience patterns deteriorated. Self-awareness and social support were augmented by comparison with norm samples. CONCLUSION: A portion of the medical students showed a risk constellation in behaviour and subjective experience at the very beginning of their studies. At the end, this tendency has significantly strengthened. The integration of teaching contents dealing with health promotion and successful coping with stress for the medical students themselves would therefore seem essential for the conservation of the health and working capacity of the students, as well as in order to prevent subsequent profession-specific mental stress and burn-out.

[Need for and use of a university clinic mental health liaison service]. / Psychosomatischer Liaisondienst am Universitätsklinikum. Bedarf und Inanspruchnahme.

BACKGROUND: Little is known about the complex decision-making process involving recognition of psychosocial stress, its diagnosis, and psychotherapeutic intervention within the framework of a psychosomatic consulting and liaison service. PATIENTS AND METHODS: Psychosocial stress was recorded using a psychometric questionnaire for 392 patients on admission to hospital, the estimated need of psychotherapeutic treatment, and the application of a psychosomatic liaison service. RESULTS: Of the examined patients, 44% presented with at least one mental disorder requiring treatment according to ICD-10 criteria. According to the expert opinions, a need for psychotherapeutic treatment was present in 41%, while 54% were themselves motivated for at least one of the psychotherapeutic treatments offered. Psychotherapy was actually received by 35% of the patients. While mental disorders and emotional distress were significant predictors of the need for treatment as rated by experts, they played no genuine role in determining indication or whether a patient accepts the use of psychotherapy CONCLUSION: Psychotherapeutic interventions in the liaison service are not always effective or related to the indication.

Psychosomatic aspects in patients with central serous chorioretinopathy.

AIMS: Patients with central serous chorioretinopathy were tested for psychosomatic symptoms and social support at the onset of their ailments; their personality profiles were also tested. METHODS: 24 consecutive outpatients at the department of ophthalmology, Freiburg University Hospital, Freiburg, Germany, presenting with central serous chorioretinopathy filled in the following standardised questionnaires: Symptom Checklist 90-R (SCL 90-R), Symptom List, Questionnaire on Social Support, and Sixteen Personality Factor Questionnaire. RESULTS: The sample (n=24) included 22 male patients with an average age of 44.1 years. Three quarters of the patients have children and live with their families; three quarters are white collar workers or self employed; one quarter are skilled blue collar workers. 12 patients were suffering from the ailment for the first time; 12 patients were undergoing a relapse. Mean visus of the affected eye was 0.8. The Symptom List yielded an inconspicuous total score for psychosomatic symptoms. In the SCL 90-R, nine out of 24 patients (37%) evinced elevated psychic stress. The total value of the questionnaire on social support showed good social support. In the Sixteen Personality Factor Questionnaire, the patients showed heightened emotional instability and insecurity as well as flexibility and spontaneity. CONCLUSION: The sociodemographic data confirm that central serous chorioretinopathy is predominantly an ailment of middle aged, socially well integrated men. This study suggests elevated psychic stress a few weeks after the onset of the ailment. The personality factors in the patients with central serous chorioretinopathy found in this study have to be verified with other populations. These results did not clearly show that psychosocial factors have a definite role in the aetiology of central serous chorioretinopathy. In order to make any clear assertions about this matter, further longitudinal studies on the progression of psychosocial parameters with larger patient samples would be indispensable.

Architecture of the protein-conducting channel associated with the translating 80S ribosome.

In vitro assembled yeast ribosome-nascent chain complexes (RNCs) containing a signal sequence in the nascent chain were immunopurified and reconstituted with the purified protein-conducting channel (PCC) of yeast endoplasmic reticulum, the Sec61 complex. A cryo-EM reconstruction of the RNC-Sec61 complex at 15.4 A resolution shows a tRNA in the P site. Distinct rRNA elements and proteins of the large ribosomal subunit form four connections with the PCC across a gap of about 10-20 A. Binding of the PCC influences the position of the highly dynamic rRNA expansion segment 27. The RNC-bound Sec61 complex has a compact appearance and was estimated to be a trimer. We propose a binary model of cotranslational translocation entailing only two basic functional states of the translating ribosome-channel complex.

Structure of the 80S ribosome from Saccharomyces cerevisiae--tRNA-ribosome and subunit-subunit interactions.

A cryo-EM reconstruction of the translating yeast 80S ribosome was analyzed. Computationally separated rRNA and protein densities were used for docking of appropriately modified rRNA models and homology models of yeast ribosomal proteins. The core of the ribosome shows a remarkable degree of conservation. However, some significant differences in functionally important regions and dramatic changes in the periphery due to expansion segments and additional ribosomal proteins are evident. As in the bacterial ribosome, bridges between the subunits are mainly formed by RNA contacts. Four new bridges are present at the periphery. The position of the P site tRNA coincides precisely with its prokaryotic counterpart, with mainly rRNA contributing to its molecular environment. This analysis presents an exhaustive inventory of an eukaryotic ribosome at the molecular level.

Clinical profile and outcomes of obese patients in cardiac rehabilitation stratified according to National Heart, Lung, and Blood Institute criteria.

PURPOSE: Obesity is a major health problem and must be evaluated and treated in cardiac rehabilitation patients. The purpose of this study was to identify the scope of this problem in an urban-based cardiac rehabilitation program by evaluating the prevalence of obesity, and comparing the clinical and risk factor profiles and outcomes of patients stratified according to National Heart, Lung, and Blood Institute (NHLBI) weight classifications. METHODS: Four hundred forty-nine consecutive cardiac rehabilitation patients, aged 57 +/- 11 years, were stratified according to the NHLBI criteria as: normal (body mass index [BMI] 18-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), class I/II obese (BMI 30-39.9 kg/m2), and class III morbidly obese (BMI > or = 40 kg/m2). Baseline cardiac risk factors and dietary habits were identified, and both pre- and postexercise training measurements of exercise tolerance, weight, and lipid profile were obtained. RESULTS: Overweight and obesity (BMI > or = 25 kg/m2) were present in 88% of patients. Compared to normal weight patients, obese patients were younger and had a greater adverse risk profile (higher prevalence of diabetes and hypertension, larger waist circumference, lower exercise capacity, lower high-density lipoprotein cholesterol level) at entry. After 10 weeks, all groups had a significant increase in exercise capacity, and on average obese patients in each category lost weight (Class I/II--4 lbs and Class III--12 lbs). Dropout rates were similar among the groups. CONCLUSION: Overweight and obesity are highly prevalent in cardiac rehabilitation. Overweight and obese patients had a greater adverse cardiovascular risk profile, including a lower exercise capacity in the latter. Thus, targeted interventions toward weight management in contemporary cardiac rehabilitation programs are important. Although short-term outcomes appear promising, greater efforts to improve these outcomes and to support long-term management are needed.

Localization of the ribosomal protection protein Tet(O) on the ribosome and the mechanism of tetracycline resistance.

Tet(O) belongs to a class of ribosomal protection proteins that mediate tetracycline resistance. It is a G protein that shows significant sequence similarity to elongation factor EF-G. Here we present a cryo-electron microscopic reconstruction, at 16 A resolution, of its complex with the E. coli 70S ribosome. Tet(O) was bound in the presence of a noncleavable GTP analog to programmed ribosomal complexes carrying fMet-tRNA in the P site. Tet(O) is directly visible as a mass close to the A-site region, similar in shape and binding position to EF-G. However, there are important differences. One of them is the different location of the tip of domain IV, which in the Tet(O) case, does not overlap with the ribosomal A site but is directly adjacent to the primary tetracycline binding site. Our findings give insights into the mechanism of tetracycline resistance.

Hepatitis C virus IRES RNA-induced changes in the conformation of the 40s ribosomal subunit.

Initiation of protein synthesis in eukaryotes requires recruitment of the 40S ribosomal subunit to the messenger RNA (mRNA). In most cases, this depends on recognition of a modified nucleotide cap on the 5' end of the mRNA. However, an alternate pathway uses a structured RNA element in the 5' untranslated region of the messenger or viral RNA called an internal ribosomal entry site (IRES). Here, we present a cryo-electron microscopy map of the hepatitis C virus (HCV) IRES bound to the 40S ribosomal subunit at about 20 A resolution. IRES binding induces a pronounced conformational change in the 40S subunit and closes the mRNA binding cleft, suggesting a mechanism for IRES-mediated positioning of mRNA in the ribosomal decoding center.

The need for psychosocial support in parents with cochlear implanted children.

OBJECTIVE: The aim of the study was to assess the need of parents with Cochlear implanted children for psychosocial support, based on psychic symptoms reported by these parents and their motivation to make use of psychosocial interventions. METHODS: Fifty seven mothers and 46 fathers of 57 Cochlear implanted children were evaluated separately, employing validated questionnaires (Symptom Checklist-90-R and Questionnaire on Psychosocial Support). RESULTS: 26% of the mothers and 25% of the fathers showed severe psychic symptoms as reflected in the Symptom Checklist-90-R. Fifty nine percent of the mothers and 60% of the fathers were highly motivated to participate in psychosocial interventions--especially in the form of further information on their children's ailment and in parents' groups. CONCLUSIONS: The data presented suggest that there is a need for psychosocial support in 18% of the parents; 8% of the parents show high psychic stress, but low motivation. The rest of the parents are not in need of support; nevertheless, 42% of the parents are highly motivated in favor of psychosocial interventions.

[Psychological stress, knowledge and treatment expectation of parents with a child managed by cochlear implant]. / Psychische Belastung, Informiertheit und Behandlungserwartung von Eltern mit einem Cochlear Implant versorgten Kind.

UNLABELLED: ESTABLISHED KNOWLEDGE: It is known that parents of hard-of-hearing children suffer from an increase in psychosocial stress. SCIENTIFIC QUESTION: How does the psychosocial situation of parents with children who have cochlear implants change during rehabilitation? AIM OF STUDY: It was the aim of this study to demonstrate how parents evaluate retrospectively their own psychological well-being during the process of rehabilitation. METHODS AND RESULTS: We interviewed 87 parents by questionnaires which were mailed to them. Fifty-seven mothers and 46 fathers responded (59% return rate). Parents reported a significant increase in stress, as perceived by themselves, after the time of diagnosis. Of the parents, 25% continued to suffer from psychic stress during rehabilitation as could be demonstrated by the SCL-90-R questionnaire criteria. The expectations by parents were realistic prior to implantation but thereafter increased significantly with time. CONCLUSIONS: The psychological state of parents during the critical phase, after a diagnosis of deafness has been made for their child, has to be considered. Even after an initial phase of shock, parents seemed to be stressed to an extent that required therapeutic intervention.

Ribosomal protein L2 is involved in the association of the ribosomal subunits, tRNA binding to A and P sites and peptidyl transfer.

Ribosomal proteins L2, L3 and L4, together with the 23S RNA, are the main candidates for catalyzing peptide bond formation on the 50S subunit. That L2 is evolutionarily highly conserved led us to perform a thorough functional analysis with reconstituted 50S particles either lacking L2 or harboring a mutated L2. L2 does not play a dominant role in the assembly of the 50S subunit or in the fixation of the 3'-ends of the tRNAs at the peptidyl-transferase center. However, it is absolutely required for the association of 30S and 50S subunits and is strongly involved in tRNA binding to both A and P sites, possibly at the elbow region of the tRNAs. Furthermore, while the conserved histidyl residue 229 is extremely important for peptidyl-transferase activity, it is apparently not involved in other measured functions. None of the other mutagenized amino acids (H14, D83, S177, D228, H231) showed this strong and exclusive participation in peptide bond formation. These results are used to examine critically the proposed direct involvement of His229 in catalysis of peptide synthesis.