Abstract This study was undertaken to improve the diagnosis of otitis media and to investigate possible hearing loss caused by middle ear effusion (MEE) in small children. The accuracy of minitympanometry in detecting MEE was evaluated in 162 children. The finding was compared with the amount of effusion found in myringotomy. Minitympanometry proved to be an accurate method to detect MEE in young children, the sensitivity and specificity values being 79% and 93% in cooperative children but it had no value in non-cooperative children. Minitympanometric examination could be performed successfully with good cooperation in 87% of a total of 206 children in paediatric outpatient clinic. Impaired mobility of the tympanic membrane (TM) was the best sign of MEE in pneumatic otoscopy of 76 children, with sensitivity and specificity values of 75% and 90%, respectively. The influence of nitrous oxide (N2O) on MEE was tested by weighting the effusion found in myringotomy during general anaesthesia with and without N2O in 39 and 37 children, respectively. The mean weight of the effusion in the oxygen-air group did not differ from the weight in the N2O group, and thus peroperative findings in myringotomy are reliable. Studies on symptomatology and the temporal development of acute otitis media (AOM) during upper respiratory tract infection (URI) were based on three-month follow-up of 857 children. Symptoms of URI only were compared with symptoms of URI complicated by AOM in the same child in 138 children. The most important symptom associated with AOM was earache, with a relative risk of 21.3. Sore throat, night restlessness and fever at days 3-6 were also significantly associated with AOM, with relative risks of 3.2, 2.6 and 1.8, respectively. In 44 children under two years of age, earache, conjunctival symptoms and cloudy rhinitis were significantly associated with AOM. Temporal development of AOM was assessed from 250 episodes in 184 children. Sixty-three per cent of cases of AOM occurred during the first week after the onset of URI, peaking on days 2 to 5. The onset of AOM in children with a history of recurrent episodes of AOM did not differ from that in those who had experienced only a few episodes of AOM. No individual tendency was noticed among children suffering more than one AOM episode during follow-up. To assess the influence of the quantity and quality of MEE on hearing in small children, transient evoked otoacoustic emission (TEOAE) was performed under general anaesthesia before myringotomy in 185 ears of 102 children. Reduced TEOAEs indicating hearing loss were found in 83% of the ears with mucoid effusion and in 56% of the ears with non-mucoid effusion, the difference being statistically significant (p < 0.01). A significant negative correlation between the reproducibility of TEOAE responses and the amount of effusion was found (Spearman rank correlation coefficient r = -0.589, p < 0.001). Findings in minitympanometry correlated with the responses of TEOAE. Although parents are able to predict AOM quite reliably, various symptoms and the duration of URI seems to be of little value in helping the diagnosis of AOM. Detection of effusion in OM may be improven by minitympanometry in cooperative children. Any kind of effusion may cause hearing loss in small children, which must be considered when treating OM.

Abstract Gelatinases (MMP-2 and MMP-9) play a key role during invasion and metastazising of malignant cells and they have been shown to be associated to invasive phenotype and poor prognosis in several solid tumours. However little is known about their role in hematological malignancies. In the present work, gelatinase expression and its clinicopathological correlations were studied with immunohistochemical staining in 10 cases representing normal bone marrow aspirate smears, 123 cases representing diagnostic bone marrow samples of patients with different leukaemias (35 AML, 7 CLL, 6 CML, 75 ALL), 67 diagnostic paraffin-embedded lymph node biopsies from patients with Hodgkin's lymphoma and 57 biopsies from patients with non-Hodgkin's lymphomas. The lymphoma samples were also stained with factor VIII antibody to evaluate the extent of new vessel formation and the non-Hodgkin's lymphoma cases also with tissue inhibitor of metalloproteinases -1 (TIMP-1) antibody. CLL did not express either of the MMP enzymes, while CML in the chronic phase expressed strongly both of the enzymes. In ALL, gelatinase expression was weak and detectable in pediatric cases in only 12.7% and in the adults in 65% of the cases. In adult ALL, MMP-2 expression correlated strongly with an extramedullary and invasive pattern of disease presentation. In AML MMP-2 positivity had markedly favorable prognostic and predictive power. In lymphoma studies, no correlations could be detected between gelatinase expression and the clinical parameters of invasion. MMP-9 positivity was related to the presence of B symptoms, which difference was statistically significant in Hodgkin's lymphoma. In Hodgkin's lymphoma, strong MMP-9 expression also implicated decreased neovascularization. In both lymphoma types, strong MMP-9 expression correlated with unfavorable prognosis, which difference was statistically significant in non-Hodgkin's lymphomas and remained as a tendency in Hodgkin's lymphoma. MMP-2 had statistically significant association with a favorable prognosis in Hodgkin's lymphoma. Combination of the results of both stainings further increased prognostic power. All together these findings implicate that gelatinases could be used as prognostic tools in AML and lymphomas albeit this needs to be verified in larger materials.

M.Tech. (Homoeopathy) / Please refer to full text to view abstract

Submitted in fulfillment of the requirements for the degree of Master of Technology: Homoeopathy, Durban University of Technology, Durban, South Africa, 2017. / AIM The aim of this study was to determine whether a radionically prepared remedy would elicit symptomatology similar to the existing materia medica of the same remedy during a triple-blind proving. METHODOLOGY This homoeopathic proving of a radionically prepared remedy in 30C-equivalent (CR) potency was of a true experimental design, conducted in the form of a randomized, triple-blind, placebo-controlled trial. Thirty proving participants (20 verum and 10 placebo) were selected according to defined inclusion criteria, and were closely monitored by the researcher throughout the proving to ensure prover compliance and wellbeing. Data was collected in the form of prover journals, in which provers recorded their symptoms experienced over the pre-proving observation period, the duration of the proving and the post-proving observation period. The proving symptomatology was collated into standard materia medica and repertory formats, following the CHROMA-Prove© method. Twenty keynote rubrics were selected according to criteria, which included symptoms ‘Grade 2’ or higher, PQRS (peculiar, queer, rare, strange) symptoms and general symptoms, and were subjected to repertorial analysis using RadarOpus software program (version 1.38). The nature of the proving substance was unblinded only after an estimation of the substance by repertorial overlap was made by the principal researcher, following which qualitative and quantitative comparisons of the proving materia medica and repertory were made against the existing materia medica of the same remedy accordingly. Results The proving of the radionically prepared remedy produced observable symptoms that resulted in a total of 332 materia medica entries, which translated into 563 rubrics distributed across 32 chapters. Five repertorial techniques were applied to the twenty rubrics selected and the researcher was able to correctly identify the radionically prepared proving substance, which was revealed to be Cantharis vesicatoria. Conclusion From the results of this study, it was evident that the proving of Cantharis vesicatoria 30CR produced symptomatology that was sufficiently characteristic to enable the researcher to correctly identify the remedy. The repertorial and materia medica comparisons to the existing materia medica of Cantharis vesicatoria, however, highlighted several similarities and differences that need to be explored further in order to bridge the observations and questions posed in this study. / M

Previous findings on the relationship between self-esteem and psychological outcomes are inconsistent. Therefore it appears that self-esteem, while related to crucial variables, does not provide a clear, direct, and comprehensive prediction of psychological symptoms. Thus, it was hypothesized that the relationship between self-esteem and symptomatology would be moderated by broader measures of how one interacts with emotional and cognitive stimuli.The purpose of this study was to examine the influence of self-esteem, psychological flexibility, and cognitive flexibility on psychological symptomatology. A sample of 82 undergraduate students at the University of North Texas completed self-report questionnaires measuring low self-esteem, psychological flexibility, measured inversely as inflexibility, cognitive flexibility, and psychological symptoms. Results of the study suggest that self-esteem (?= -0.59, p < 0.001) and flexibility (both psychological (?= 0.36, p = 0.001) and cognitive (?= 0.21, p < 0.05) are significant predictors of psychological symptoms. In other words, self-esteem is positively correlated with psychological symptoms, while psychological and cognitive flexibility are negatively correlated with psychological symptoms. Neither form of flexibility moderated the relationship between self-esteem and psychological symptoms in this sample. The findings of the current study are discussed as well as suggestions for further research related to self-esteem, psychological and cognitive flexibility, and their impact on psychological outcomes.

This study examined the links among child maltreatment (i.e., child sexual abuse, child physical abuse, child emotional abuse, and child neglect), eating disorder symptoms, problematic use of drugs and alcohol, coping strategies, and emotion regulation in women. This study also examined coping strategies and emotion regulation as potential moderators of the links among child maltreatment, eating disorder symptoms, and problematic substance use. Maltreatment in childhood is linked with numerous adverse outcomes across the lifespan. For instance, the development of maladaptive coping styles, poor emotion regulation, substance use problems, and eating disorders all are linked to a history of child maltreatment, but how these factors interact has yet to be investigated. These constructs were examined through hierarchical multiple regressions in a sample of 383 women age 19 or older, recruited online. Results indicated that women who experienced greater overall child maltreatment engaged in more problematic drug use and more problematic alcohol use and women with child sexual abuse (CSA) engaged in greater levels of problematic drug use. Avoidance coping was associated with greater levels of problematic drug use, dieting, bulimia and food preoccupation, and overall eating disorder symptoms. Women with more severe eating disorder symptoms and who used greater expressive suppression, also engaged in more problematic alcohol use. When considered together, all forms of child maltreatment were associated with greater avoidance and problematic drug and alcohol use, CSA survivors used less avoidance and expressive suppression, and child neglect (CN) survivors used more avoidance and expressive suppression. These findings suggest that health care professionals working with women survivors of child maltreatment should be aware of increased risk of developing substance use problems as well as less effective coping and emotion regulation strategies that may be stemming from victimization experiences. In addition, it may be helpful for clinicians working with women with eating disorders or problematic substance use to focus on improving coping and emotion regulation skills. / Graduate

Internalizing disorders can have negative effects ranging from diminished self-esteem to suicidal thoughts and behaviors . Native American children and adolescents often face pressures that put them at increased risk for the development of internalizing disorders, yet research within this population is almost nonexistent. Given the serious implications of and the lack of research on internalizing disorders among this minority group, the present study was designed to provide information on the rate of internalizing symptoms in a sample of Native American adolescents, and provide normative data utilizing this sample for the Internalizing Symptoms Scale for Adolescents. Data were collected using the Internalizing Symptoms Scale for Adolescents, the Reynolds Adolescent Depression Scale, the Revised Children's Manifest Anxiety Scale, and the State-Trait Anxiety Inventory for Children. Findings indicate that the Native American sample of adolescents are endorsing clinically significant levels internalizing symptoms at rates similar to those found in the general population.

This project proposed to examine school counselors' knowledge of and experiences with internalizing issues in children. The sample included all elementary and middle/secondary school counselors employed in Utah. The measure used in the present study was a questionnaire adapted from a study by Green, Clopton, and Pope. Analyses revealed that few elementary school counselors would meet with a student struggling with internalizing symptoms, but many would meet with the students' teacher(s) and parents. Overall, fewer secondary school counselors endorsed the presented responses as compared to elementary school counselors. More than half of both elementary and secondary school counselors indicated they had encountered one to five students struggling with internalizing issues during the past year. The knowledge gained from this research highlights changes that need to be made to preservice and inservice training of school counselors in order to aid in the identification and intervention of internalizing disorders in students.

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