Adolescence is an uphill struggle. Research abundantly displays that Adverse Childhood Experiences (ACEs) have a distinct and detrimental effect on adolescents and their development. Recent research has explored the perspectives, thoughts, behaviours, and beliefs of helping professionals who integrate spirituality into their work with adolescents. The purpose of this qualitative study is to develop a thematic analysis of helping professionals’ narratives of care with this population. The narratives of helping professionals’ care of adolescent males with ACEs points to the desire to connect with spiritual community and to make meaning. Helping professionals’ narratives also highlight the constraints of locating spirituality. Theological reflection on parrhesia focuses on developing open, unencumbered discussion as an ethical, professional, and spiritually-sensitive form of integration. / Thesis / Master of Arts (MA)

The purpose of this research study was to examine two specific pathways to resilience for Native American Indians (NAIs) that have experienced at least one adverse childhood experience (ACE) and are seeking behavioral health services on the Choctaw Indian reservation: empathy and cultural involvement. The study is an examination of the effects of empathy and cultural involvement on the resilience of NAIs with one or more ACEs. The researcher also investigated the type of ACEs reported among adult NAIs seeking behavioral health services on the Mississippi Band of Choctaw Indian (MBCI) Reservation. Lastly, the association between ACEs and resilience was explored. The population for this study consisted of NAIs that identified as being members of the Mississippi Band of Choctaw Indians, ages 18 and older completing the intake process for services at a behavioral health facility located on the reservation. Results from this study did not yield significant results regarding the effects of empathy and cultural involvement on resilience, nor was the regression model between ACES and resilience statistically significant. This study did reveal household dysfunction and abuse were the most commonly reported types of ACEs. Implications for practice and future studies were explored in this study. Implications for practice include taking a family-systems approach when providing therapeutic services to promote family system changes. Also, utilizing strengths-based approaches could be helpful in practice when working with this population. For future studies, researching the role of adverse community experiences could provide insight into the role of community-level risk factors within this population. Also, further research examining the role of empathy as it relates to this population is needed. Overall, more research is needed to provide a better understanding of components that can be used to strengthen resilience within this population.

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<p dir="ltr">Background—Adverse Childhood Experiences (ACEs) are events that occur before age 18, such as abuse and neglect, which are potentially traumatic. ACEs can lead to profound negative impacts on physical and psychological health and social relationships. Despite this, positive social connections can mitigate these effects. However, individuals with ACEs may struggle to form healthy relationships because of mistrust, leading to continued exposure to detrimental social environments. Additionally, ACE-exposed adults often internalize stigma.</p><p dir="ltr">Methods—Utilizing data spanning from 1995 to 2014, Chapter 2 examines 629 adults from the MIDUS II: Biomarker study. Employing counterfactual modeling, the study estimates the treatment effect of ACE exposure on well-being and employs weighted multilevel mixed models to analyze life course changes. Chapter 3 uses 1,243 respondents from the MIDUS II: Biomarker study, employing latent class analysis to identify social relationship patterns and assess their mediation between ACEs and the pursuit/enjoyment of new relationships. Chapter 4 uses experimental data from 493 respondents, employing vignette experiments to gauge perceptions of warmth and competence, with gender and happiness examined as moderators, and threat, status, four stigmatizing descriptions as mediators.</p><p dir="ltr">Results—ACE exposure is associated with increased chronic conditions, lower self-rated health, diminished psychological and social well-being. However, the strength of the treatment effects differs based on the type and number of ACE exposures. Latent Class Analysis of social relationships indicates four classes: healthy, ambivalent, kin-focused, and difficult, with higher ACEs linked to a decreased probability of being in the “healthy” class. ACEs also predict reduced enjoyment of interactions with new people, mediated 41% by the current social relationship class. ACE vignettes are perceived as less warm and competent, with happiness moderating some ACE-related perceptions. Status, “mentally ill”, and “damaged” emerged as strong mediators.</p><p dir="ltr">Conclusion—While ACE exposure is related to lower well-being, the rate of decline does not differ from non-ACE-exposed individuals across time. Those in strained relationships are less likely to enjoy new social interactions, potentially perpetuating ACE-related health consequences. Addressing interpersonal trust issues in ACE-exposed adults through social interventions may mitigate these effects. Additionally, there is stigma against each of the ten ACEs, and the medicalization of ACEs contributes to stigma.</p>

An Herzinsuffizienz sind in Deutschland weit mehr als 1 Mio. Menschen erkrankt. Ihre Häufigkeit steigt stetig an. Die Herzinsuffizienz wird als dominierende Herz-Kreislauf-Erkrankung des 21. Jahrhunderts angesehen. Die Hauptursache der Herzinsuffizienz ist die koronare Herzerkrankung besonderes nach stattgehabtem Myokardinfarkt. Sowohl für den akuten Myokardinfarkt als auch für die sich auf dieser Basis entwickelnde Herzinsuffizienz werden Veränderungen im Stoffwechsel der Sauerstoffradikale als pathophysiologisch bedeutsam angesehen. Es wird angenommen, dass als Folge der akuten Myokardischämie oxidativer Stress im Myokard hervorgerufen wird. Dieser kann über die akute Infarktphase hinaus prolongieren. Dadurch werden Mechanismen induziert (Hypertrophie und Apoptose, Störung myokardialer Signaltransduktion), die letztlich zur Herzinsuffizienz führen. Folgerichtig sollten therapeutische Maßnahmen, die zu einer Minimierung von oxidativem Stress führen, protektiv wirken. Im Rahmen dieser Arbeit wurde am Modell des Ligaturinfarktes der Ratte gezeigt, dass es in der Akutphase des Infarktes (30-36 h nach Ligatur) zu gesteigertem oxidativen Stress kommt. Dieser ließ sich anhand gesteigerter myokardialer Konzentration an Lipidperoxiden, die mit einer verminderten Konzentration antioxidativer Enzyme im Herz kombiniert war, dokumentieren. Werden solche Tiere 6 Wochen nach Ligatur untersucht, weisen sie im Herz im Vergleich zu scheinoperierten Tieren eine signifikant erhöhte Konzentration von Lipidperoxiden als Zeichen gesteigerten oxidativen Stresses auf. Parallel dazu werden typische Zeichen einer Herzinsuffizienz (Herzhypertrophie, erhöhter LVEDP, verminderte Kontraktilität) beobachtet. Wurden solche Tiere beginnend nach der akuten Myokardphase mit dem ACE-Hemmer Ramipril und dem Beta-Blocker Metoprolol behandelt - von beiden ist bekannt, dass sie protektiv in den Stoffwechsel der Sauerstoffradikale eingreifen können - wurde ein geringerer myokardialer oxidativer Stress beobachtet, der mit einer verminderten Ausprägung der morphologischen und funktionellen Herzinsuffizienzzeichen einherging. Die kombinierte Gabe von Beta-Blocker und ACE-Hemmer erwies sich dabei sowohl in der Reduktion von oxidativem Stress als auch in ihrem Einfluss auf Herzfunktion und Morphologie den Einzeltherapien überlegen. Als wesentlich für die Reduktion von oxidativem Stress durch Beta-Blockade und ACE-Hemmung wurde die kompensatorische Zunahme des enzymatischen antioxidativen Schutzes im Herz (GSH-Px, SOD) ausgewiesen. / In Germany, more than 1 million people suffer from heart failure and the incidence is continuously growing. Consequently, heart failure is accepted to be the dominant disease of the heart and circulatory system in the 21st century. The main reason for heart failure is coronary heart disease in general, and especially myocardial infarction (MI). Changes in the oxygen radical metabolism are thought to be essential in the pathogenesis of myocardial infarction and heart failure as its important consequence. It is supposed that, as a result of myocardial ischemia, oxidative stress arises in the heart, which can activate and prolong mechanisms (hypertrophy, apoptosis, disturbed signal transduction) well documented to result in heart failure. Consequently, treatment, which reduces the myocardial oxidative stress, should be beneficial. Using the model of ligature infarction in rats, our study shows increased myocardial oxidative stress in the acute phase of MI (30-36 h after ligature) documented by increased concentration of lipid peroxides (LPO) combined with reduced activity of the antioxidative enzymes. When the animals were analyzed 6 weeks after ligature in comparison to sham operated animals, increased oxidative stress and in parallel typical signs for heart failure (myocardial hypertrophy, increased LVEDP, reduced contractility) were observed. Treatment of the animals starting after acute myocardial infarction with the ACE-inhibitor Ramipril and the beta-blocker Metoprolol - both are known to interfere protectively with the oxygen radical metabolism - reduced the myocardial oxidative stress and the morphological and functional signs of failing heart. This effect was most impressive after combined treatment with Metoprolol and Ramipril. The elevated enzymatic antioxidative defense (GSH-Px, SOD) which we found in the heart after beta-blockade and ACE inhibition could be the reason.

Cette thèse porte sur la construction du nombre dans une classe de cours préparatoire. Une de noshypothèses est de favoriser l'étude de l'élève dans sa propre temporalité. Pour cela, la thèse étudie lamise en place, dans la classe, d'un cahier de recherche nommé le « Journal du Nombre » et d'unemodalité d'organisation spécifique de travail appelée le « groupe d'anticipation », l'enjeu de cesdispositifs étant le devancement du temps didactique. Les situations sont analysées à l'aide de laThéorie de l'Action Didactique Conjointe (TACD) dont les notions de contrat-milieu, expressionréticenceet incitation productive collective mises en synergie rendent compte de l'élaboration dusavoir pour tous les élèves à partir de situations répétitives et évolutives construites au sein del'ingénierie didactique Arithmétique et Compréhension à l'École élémentaire (ACE). Cetterecherche s'inscrit dans le temps long et permet l'analyse de productions d'élèves avancés et moinsavancés. / This thesis focuses on student's building of number sense at primary school (first grade).The mainhypothesis consists of fostering the students' study by enabling them to learn in their own time. Forthis, the thesis explores the implementation, in a first grade class, of a research workbook, the"Journal of the Number” and a model of study organisation called the "Anticipatory Group". Theaim of these designs lies in the anticipating of the didactic time. The situations are analysed with thehelp of the Joint Action Theory in Didactics, notably by relying on the twofold dialectics ofcontract-milieu and reticence-expression, and by proposing the notion of collective productiveincentive. This reflects the development of knowledge of all students through repeated andprogressive situations elaborated within the didactic engineering ACE (Arithmetics andComprehension at Primary School). This long-term research allows the analysis of advanced andless advanced students' productions.

Die Anwendung von Birkenblättern (Betulae folium) erfolgt zur Durchspülung der Harnwege. In der vorliegenden Arbeit wurde die Wirkungsweise der Birkenblätter auf verschiedenen Ebenen der Phytopharmakaforschung untersucht. Zunächst wurde in-vitro die Beeinflussung der Metallopeptidasen Neutrale Endopeptidase (NEP, EC 3.4.24.11), Angiotensin-Converting-Enzym (ACE, EC 3.4.15.1) und Leucin-Aminopeptidase (LAP, EC 3.4.11.2) durch Birkenblätterextrakte, -fraktionen und reine Naturstoffe untersucht. Die Auftrennung eines Methanol- und eines Ethylacetatextraktes führte nicht zur Gewinnung einzelner, für die Gesamtwirkungen der Extrakte verantwortlicher Fraktionen bzw. Komponenten. Die Eigenschaft der Flavonoide als wirksamkeitsmitbestimmende Inhaltsstoffe konnte jedoch bestätigt werden. Ein systematisches Screening von Flavonoiden ergab u.a., dass das Ausmaß der Enzymhemmung von der Anzahl der freien phenolischen OH-Funktionen bestimmt wurde und dass Flavonoidaglyka stärker die Enzyme hemmten, als die im Pflanzenmaterial vorliegenden Glykoside (IC50 NEP: Myricetin 42 Mikromol/L, Quercetin 192 Mikromol/L). Die in der Birkenrinde vorkommenden Triterpene Betulinsäure und Betulinol wurden als starke Inhibitoren der LAP erkannt (IC50 LAP: 7,3 +/- 1,4 bzw. 8,8 +/- 1,78 Mikromol/L). In einem nächsten Abschnitt der Arbeit wurden die Absorptionseigenschaften von Hyperosid und Rutin mit einem In-vitro-Perfusionsmodell am isolierten Rattendünndarm untersucht. Sowohl Rutin als auch Hyperosid traten unverändert als Glykoside durch den Darm in das Akzeptorkompartiment über. Auch in Form eines Birkenblätterextraktes wurde Hyperosid am Rattendünndarm absorbiert, der Extrakt veränderte jedoch nicht die Absorptionsrate. Als Mechanismus wurde der passive Transport durch die Poren der Tight junctions der Dünndarmzellen angenommen. Abschließend wurde eine Pilotstudie (n=14) durchgeführt, in der das ausgeschiedene Harnvolumen nach einmaliger Einnahme eines Birkenblättertees im Vergleich zu einer entsprechenden Menge Leitungswasser bestimmt wurde. Bei 50 % der Probanden wurde innerhalb der vierstündigen Testphase eine Zunahme der Harnproduktion beobachtet, bei den anderen 50 % stellte sich eine gegensätzliche Reaktion auf Tee und Placebo ein. Eine signifikante Erhöhung der Harnproduktion konnte somit, unter dem angegebenen Studiendesign, nicht nachgewiesen werden. / Irrigation of the urinary tract is the therapeutic indication for Birch leaf (Betulae folium). In the present thesis, effects and efficacy of Birch leaves were investigated in various fields of medicinal plant research. The effects of Birch leaf extracts, their fractions, and pure natural compounds on the metallopeptidases - Neutral Endopeptidase (NEP, EC 3.4.24.11), Angiotensin Converting Enzyme (ACE, EC 3.4.15.1), and Leucine Aminopeptidase (LAP, EC 3.4.11.2) - were investigated in vitro. Phytochemical separation of extracts obtained by methanol and ethyl acetate did not result in more active fractions compared to those of the whole extracts. The ability of flavonoids to contribute to the efficacy reached by Birch leaf extracts, could be confirmed. A systematic screening could show that the inhibitory potency of flavonoids is dependent on the number of phenolic hydroxyl functions in their chemical structure. Aglycones of flavonoids were more active than their corresponding glycosides occurring in the plant material (IC50 NEP: myricetin 42 mikromol/L, quercetin 192 mikromol/L). Betulinic acid and betulinol, triterpenes of the bark of Betula, inhibited LAP strongly by reaching an IC50 of 7,3 +/- 1,4 mikromol/L and 8,8 +/- 1,78 mikromol/L, respectively. Furthermore, this thesis showed the absorption profiles of hyperoside and rutin in an isolated small intestine model of the rat. Both glycosides were detected in the acceptor compartment without being metabolised. Administration of hyperoside by a Birch leaf extract did not influence the absorption rate. A passive transport through the pores of the tight junctions, localized between the intestinal cells, was considered to be the mechanism of absorption of the flavonol glycosides. Finally, a human pilot study (n=14) was carried out. The excreted urinary volume was determined after a single intake of a Birch leaf infusion or tap water. An increased urine output after 4 hours of the test period was found in 50% of the volunteers. In the contrary, an opposite effect was determined in 50% of the volunteers after administration of the herbal infusion and of a placebo solution. Thus, no significant increase of urine volume could be observed under these test conditions.

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