Stress and recovery from stress significantly affect interactions between the central nervous system, endocrine pathways, and the immune system. However, the influence of acute stress on circulating immune-endocrine mediators in humans is not well known. Using a double-blind, randomized study design, we administered a CO2 stress test to n = 143 participants to identify the effects of acute stress, and recovery from stress, on serum levels of several mediators with immune function (IL-6, TNF-α, leptin, and somatostatin), as well as on noradrenaline, and two hypothalamic–pituitary–adrenal axis hormones (ACTH and cortisol). Moreover, during a 1 h-recovery period, we repeatedly measured these serum parameters, and administered an auditory mood-induction protocol with positive music and a neutral control stimulus. The acute stress elicited increases in noradrenaline, ACTH, cortisol, IL-6, and leptin levels. Noradrenaline and ACTH exhibited the fastest and strongest stress responses, followed by cortisol, IL-6 and leptin. The music intervention was associated with more positive mood, and stronger cortisol responses to the acute stressor in the music group. Our data show that acute (CO2) stress affects endocrine, immune and metabolic functions in humans, and they show that mood plays a causal role in the modulation of responses to acute stress.

Localization accuracy and acuity for low- (0.375-0.75 kHz; LN) and high-frequency (2.25-4.5 kHz; HN) noise bands were examined in young (20-29 years) and older adults (65-83 years) in the acoustic free-field. A pointing task was applied to quantify accuracy, while acuity was inferred from minimum audible angle (MAA) thresholds measured with an adaptive 3-alternative forced-choice procedure. Accuracy decreased with laterality and age. From young to older adults, the accuracy declined by up to 23 % for the low-frequency noise band across all lateralities. The mean age effect was even more pronounced on MAA thresholds. Thus, age was a strong predictor for MAA thresholds for both LN and HN bands. There was no significant correlation between hearing status and localization performance. These results suggest that central auditory processing of space declines with age and is mainly driven by age-related changes in the processing of binaural cues (interaural time difference and interaural intensity difference) and not directly induced by peripheral hearing loss. We conclude that the representation of the location of sound sources becomes blurred with age as a consequence of declined temporal processing, the effect of which becomes particularly evident for MAA thresholds, where two closely adjoining sound sources have to be separated. While localization accuracy and MAA were not correlated in older adults, only a weak correlation was found in young adults. These results point to an employment of different processing strategies for localization accuracy and acuity.

An ALS manikin can be an effective tool in teaching clinical pharmacology.

No abstract

Problem-based learning (PBL) within a tutorial is the core element in a 6-week block course "Basics in Drug Therapy" recently introduced into the medical curriculum of an eastern German university. Under the supervision of one tutor a group of 6-9 students solved a total of six clinical cases related to drugs used in general anaesthetics; to analgetic/antiphlogistic, antihypertensive, cardiovascular and lipid-lowering drugs; to drugs acting on the central nervous system; and to intoxicating agents. By answering questionnaires students and tutors extensively evaluated each individual case as well as the whole block course. Factors evaluated also included students' and tutors' behaviour during sessions. The purpose of the analysis was to identify factors associated with the students' perception of tutorials with the aim of improving future courses. The ratings which tutorials, cases and tutor performance received by the students differed significantly between 14 groups that could be analysed. A ranking order of groups was established according to the scores they gave for the cases and the three groups with top ratings were further compared with the three groups with lowest ratings. We found significant differences between the two groups in their assessment of tutor performance and perception of team-work during tutorials. The tutors of the groups giving top ratings were considered to have more effectively supported the students' work during tutorials. Furthermore, self-assessment of the tutors judging their own ability to facilitate PBL correlated with their familiarity with case content. The marks achieved in the first national exam (i.e. "Physikum", equivalent to medical school entrance exams), performance in triple jump examination and multiple choice test at the end of the course, or marks obtained in the first state board exam after the course, did not differ between the two groups. From students' point of view, the main characteristics for a good tutorial as far as tutors are concerned consist of allowing enough time for discussion, accepting students as partners, refraining from interference and having expertise. As a consequence we will increase our efforts to optimise case quality as well as support and training of tutors in order to improve our new PBL course.

A federal law, the "Approbationsordnung für Arzte", regulates Medical education in Germany. In 2002 a revised version of this law demanded of the medical faculties to implement interdisciplinary and problem-based (PBL) courses in their curriculum. Already in 1998 the faculty of medicine of the TU Dresden decided to reform the traditional curriculum. The reform-curriculum is being created in close co-operation with the Harvard Medical School. It is a hybrid curriculum retaining traditional elements as lectures and bedside teaching with PBL-tutorials and a special doctor-patient-communication-training, which is based on role-play exercises. Psychosomatic Medicine is taught together with neurology and psychiatry as a major topic of the 7,5-week PBL-course "Nervous System and Psyche" but there are also lectures and special skills training exercises in other PBL-courses like "Oncology" or "Emergency medicine". Data of the external evaluation showed, that the students accepted psychosomatic topics of the curriculum very well. This paper describes concept, implementation and evaluation data of the PBL-course "Nervous System and Psyche".

No abstract

No abstract