In this thesis by published work nine works are presented, prefaced by a Critical Summary and Review which discusses the genesis of the work and its theoretical presuppositions, and evaluates their contribution to knowledge. The work includes both sole-authored and collaborative writing. This published work adopts a social constructionist approach to knowledge in health and welfare. The first work explores critical approaches to child development and their relevance to professional practice. Subsequent work adopts a post-Wittgensteinian approach to language as practical activity, exploring how practitioners such as social workers and nurses do 'case work1 , making knowledge about people, events and situations in their talk and writing and, in doing so, enact the institutional order. An exploration of the ways in which practitioners construct their practice in reflective writing is a significant focus within several pieces of work. Attention is paid to what social actors (patients/service users and professionals) do in their interactions and communicative practices. Thus, talk and text are not treated as simple vehicles for conveying literal, factual descriptions but as the means by which moral adequacy is portrayed and authentic versions of events are established. These analyses draw inspiration from a variety of sources including micro sociology, discursive psychology and narrative analysis, emphasizing the practical-moral aspects of health and welfare practice in which the production of identity, for example as a caring practitioner, plays a key part. The published work has a strong practice orientation and the implications for professional education are highlighted throughout. 'Reflexive awareness' is promoted as a means by which health and welfare VIprofessionals may challenges tendencies to take practice for granted. By engaging in the processes of making the familiar strange, it is argued that better understandings of practice can be achieved and a stance of 'respectful uncertainty' deployed.

This study explores the challenges faced by Principal Stakeholders in achieving Scotland's strategic approach to health and social care integration. This is a developing area for academic literature, limited to, but not devoid of the experiences of integration of specific public sector areas and the experience of other countries that have implemented an integrated approach. The research studies the views and opinions of 12 Chief Officers from three areas of public sector provision; the Scottish Government, Heath Boards and Local Authorities to elicit their initial fears and concerns, approaches and development. This qualitative research approach provided a richness and depth of data which is presented within the thesis. The evidence gathered informed the design of the influencing factors and a conceptual model for health and social care integration and importantly for future integration models which may be applied to future projects. It is concluded from this study that health and social care integration while challenging, is achievable through a planned approach when considering the key influencing factors. The factors, are flexible depending on the stage of integration and the priorities of the Integration Board, and therefore should be used accordingly. The development of the factors would not have been achievable without the considerable input of the participants involved. The key contributions of this research span across academic literature, research methodology and professional practice. The study contributes to the current research considerations by developing an approach based on the work undertaken by the professionals and learning from the unintended consequences of the experiences of such early intervention. Finally, the influencing factors and conceptual model are offered as evidence of the research undertaken as a contribution to practice. The value to academics, practitioners and the wider public service and agencies involved in integration lies in the frameworks contextual factors and ultimately the flexibility of application.

Alkoholkonsum beginnt häufig bereits im Jugendalter. Allerdings fehlen bisher Erkenntnisse darüber, ob, wie häufig und aufgrund welcher Merkmale Jugendlichen und junge Erwachsene auch bereits klinisch definierte Mißbrauchs- und Abhängigkeitsdiagnosen entwickeln. In der vorliegenden Arbeit werden Ergebnisse einer repräsentativen Untersuchung an 3021 Jugendlichen im Alter von 14-24 Jahren vorgestellt. Neben der Prävalenz von Alkoholmißbrauch und -abhängigkeit nach DSM-IV werden Daten zur Häufigkeit und Menge des Alkoholkonsums berichtet sowie erste Symptome beschrieben. 9,7% der befragten Jugendlichen erhielten aufgrund von DSM-IV-Kriterien eine Mißbrauchsdiagnose, 6,2% eine Abhängigkeitsdiagnose. Bei männlichen Jugendlichen war die Prävalenz wesentlich höher als bei weiblichen. Die Prävalenz war in den älteren Geburtskohorten höher. Als erstes Missbrauchssymptom trat am häufigsten "Gebrauch mit körperlicher Gefährdung" (91,9%), als erstes Abhängigkeitssymptom "Toleranzentwicklung" (34,3%) auf. Erste diagnostische Kriterien einer Alkoholstörung traten zumeist deutlich vor dem 18. Lebensjahr auf. Diese Daten unterstreichen, daß Alkoholmißbrauch und -abhängigkeit bereits im Jugend- und frühen Erwachsenenalter häufig sind. / Alcohol use frequently begins in adolescence. However, only few studies have reported the prevalence of alcohol abuse disorders in adolescents. This paper reports results from a representative study in a sample of 3021 adolescents, aged 14-24 years. The Prevalence of alcohol abuse and dependence according to DSM-IV criteria, as well as the prevalence, frequency and quantity of alcohol abuse and a description of the first occuring symptoms, are presented here. Alcohol abuse was reported by 9.7% of respondents and alcohol dependence by 6.2%. Males were more likely to report an alcohol disorder than females, and the prevalence also increased in the older age cohorts. The most frequent initial symptoms were "hazardous use" (91.9%) for abuse and "tolerance" (34.3%) for dependence. First symptoms have been shown to occur long before the age of 18. These results show that even in adolescents and young adults alcohol abuse and dependence are frequent disorders.

The overarching aim of this thesis is to critically evaluate the implementation of Lean in NHS Lothian, a National Health Service (NHS) Health Board in Scotland. Against challenging financial times, Lean has been endorsed for adoption in the provision of healthcare by The Scottish Government and NHS Scotland and so the objectives are to understand how Lean is implemented in healthcare, the impact on the organisation and what role(s) are held by front-line staff including medical staff, in this implementation. This is an exploratory and descriptive interpretivist case study incorporating content analysis, observational and interview data which is based on a qualitative and inductive approach. The interpretative and inductive nature of the research is used to identify emergent themes and to afford greater insight into the implementation process, outcomes and the role of healthcare staff. The sociology of professions is used to evaluate the role of the medical professional within Lean from the emergent data, with the focus being on behaviours expected and demonstrated in Lean implementations. The findings provide a mapping of the process for implementing Lean. It is also demonstrated that although medical professionals are expected to hold a crucial role in Lean implementations, their identity as a professional with corresponding power and autonomy provides challenges for implementing Lean in hierarchical areas such as healthcare. This professional identity also impacts on project initiation and sustainability as other stakeholders recognise hierarchical constraints. However, evidence grounded in the data illustrates that Lean breaks down hierarchies and has resulted in improved working in services. The implementation of Lean has been programmatic in line with best-practice case examples and has been driven by strategy and target pressures faced by services. This research provides a contribution to knowledge in three key areas: firstly through mapping the approach to Lean implementation which is a contribution to Programme Theory. Secondly medical professionals are explored through the lens of professionalism which has received limited attention to date within Lean; and finally a set of propositions are generated as a framework for Lean implementation in healthcare.

Alcohol use disorder (AUD) is a widespread mental disease denoted by chronic alcohol use despite significant negative consequences for a person’s life. It affected more than 14 million persons in Europe alone and accounted for more than 5% of deaths worldwide in 2011-2012. Understanding the psychological and neurobiological mechanisms driving the development and maintenance of pathological alcohol use is key to conceptualizing new programs for prevention and therapy of AUD. There has been a variety of etiological models trying to describe and relate these mechanisms. Lately, the view of AUD as a disorder of learning and decision making has received much support proposing dual systems to be at work in AUD – one system being deliberate, forward-planning, and goal-directed and the other one reflexive, automatic, and habitual. Both systems supposedly work in parallel in a framework of value-based decision making and their balance can be flexibly adjusted in healthy agents, while a progressive imbalance favoring habitual over goal-directed choice strategies is assumed in AUD. This imbalance has been theoretically associated to neural adaptations to chronic alcohol use in corticostriatal pathways involved in reward processing, especially in ventral striatum. However, these theoretical models are grounded strongly on animal research while empirical research in the human domain remains rather sparse and inconclusive. Furthermore, alterations in value-based decision-making processes and their neural implementation might not only result from prolonged alcohol misuse but may also represent premorbid interindividual differences posing a risk factor for the development of AUD. Therefore, I here present three studies investigating the relation of alcohol use with the balance between goal-directed and habitual decision systems and with parameters modulating option valuation processes of these systems, namely delay, risk, and valence of option outcomes. To separate the investigation of these decision processes as predisposing risk for or consequence of alcohol use, two samples were examined: one sample of 201 eighteen-year-old men being neither abstinent from nor dependent on alcohol as well as one sample of 114 AUD patients in detoxification treatment and 98 control participants matched for age, sex, educational background, and smoking status. Both samples had a baseline assessment of several behavioral tasks, questionnaires, and neuropsychological testing and were followed-up over one year to examine drinking trajectories in the sample of young men and relapse in detoxified patients. The behavioral tasks included a sequential choice task using model-free and model-based reinforcement learning as operationalization of habitual and goal-directed decision making, respectively, during functional magnetic resonance imaging and four tasks probing participants’ delay discounting, probability discounting for gains and losses, and loss aversion. Study 1 presents the cross-sectional analysis of the sequential choice task in relation to baseline drinking behavior of the young-adult sample. These analyses did not reveal an association between non-pathological alcohol use and habitual and goal-directed control on neither a behavioral nor neural level except for one exploratory finding of increased BOLD responses to model-free habitual learning signals in participants with earlier onset of drinking. Study 2 examined the same task in AUD patients compared to control participants showing no difference in behavioral control or neural correlates between those groups. However, prospectively relapsing AUD patients showed lower BOLD responses associated to model-based goal-directed control than abstaining patients and control participants. Additionally, the interaction of goal-directed control and positive expectancies of alcohol effects discriminated subsequently relapsing and abstaining patients revealing an increased risk of relapse for those patients who showed higher levels of goal-directed control and low alcohol expectancies or low levels of goal-directedness and high expectancies. Study 3 examined modulating features of goal-directed and habitual option valuation – delay, risk, and valence of options – in association to alcohol use in the young-adult sample and AUD status in the sample of patients and matched control participants on a cross-sectional as well as longitudinal level. This study revealed no relation of delay, risk, and loss aversion with current alcohol use and consumption one year later in the young men. In contrast, AUD patients showed systematically more impulsive choice behavior than control participants in all four tasks: a higher preference for immediate rewards, more risky choices when facing gains and less when facing losses, and lower loss aversion. Furthermore, a general tendency to overestimate the probability of uncertain losses could predict relapse risk over the following year in AUD patients. Taken together, these results do not support the hypothesis that mechanisms of value-based decision making might be predisposing risk factors for alcohol consumption. The findings for patients already suffering from AUD are mixed: while choice biases regarding delays, risks, and valence of option outcomes seem to be altered systematically in AUD, there was no indication of an imbalance of habitual and goal-directed control. These findings challenge the assumption of a generalized outcome-unspecific shift of behavioral control from goal-directed to habitual strategies during the development of AUD and point towards several possible future avenues of research to modify or extend the theoretical model.:Table of Contents List of Figures List of Tables List of Abbreviations Abstract Chapter 1. Perspectives on alcohol use disorder 1.1 The size of alcohol use disorder 1.1.1 Terminology of alcohol-use related disorders 1.1.2 Size and burden of alcohol consumption and alcohol use disorders 1.2 Cognitive psychological perspectives on alcohol use disorder 1.2.1 A unified framework for addiction 1.2.2 Value-based decision making 1.2.3 Goal-directed and habitual systems 1.3 Neurobiological perspectives on alcohol use disorders 1.3.1 Neural underpinnings of the reward circuit 1.3.2 Neural underpinning of goal-directed and habitual decision making 1.3.3 Striatal adaptations associated with chronic alcohol consumption 1.4 Synopsis and research questions Chapter 2. Study 1 2.1 Abstract 2.2 Introduction 2.3 Material and methods 2.3.1 Participants and procedure 2.3.2 Measures of goal-directed and habitual behavioral control 2.3.3 Measure of alcohol consumption 2.3.4 Behavioral statistical analyses 2.3.5 Functional magnetic resonance imaging data acquisition and analysis 2.4 Results 2.4.1 Sample characteristics 2.4.2 Behavioral results 2.4.3 Functional magnetic resonance imaging results 2.5 Discussion Chapter 3. Study 2 3.1 Abstract 3.2 Introduction 3.3 Methods and materials 3.3.1 Participants 3.3.2 Procedure 3.3.3 Alcohol Expectancy Questionnaire 3.3.4 Task 3.3.5 Magnetic Resonance Imaging 3.3.6 Follow-up procedure 3.3.7 Data analysis 3.3.8 fMRI analysis 3.4 Results 3.4.1 Sample characteristics 3.4.2 Task-related group differences 3.4.3 Interaction between alcohol expectancies and model-based control 3.4.4 fMRI results 3.5 Discussion Chapter 4. Study 3 4.1 Abstract 4.2 Introduction 4.3 Study 3.1 4.3.1 Material and methods 4.3.2 Results 4.4 Study 3.2 4.4.1 Material and methods 4.4.2 Results 4.5 Discussion Chapter 5. General discussion 5.1 Summary of findings and discussion 5.1.1 Goal-directed and habitual decision making and alcohol use (disorder) 5.1.2 Neuroimaging correlates of goal-directed and habitual control 5.1.3 Modulators of the valuation systems and alcohol use (disorders) 5.1.4 Integration of findings 5.2 Limitations 5.2.1 Methodological critique of the Two-Step task 5.3 Outlook for future studies 5.3.1 Tentative framework for future studies 5.4 Conclusions References Appendix A Supplementary Information of Study 1 A.1 Supplementary Methods 1 - behavioral A.2 Supplementary Methods 2 - fMRI A.3 Supplementary Results - behavioral A.4 Supplementary results - fMRI B Supplementary Information of Study 2 B.1 Computational fits B.2 Preprocessing of the functional imaging data B.3 Exclusion criteria for different analyses B.4 First level analysis of the functional imaging analysis B.5 Voxel-based morphometry B.6 Drinking Motives Questionnaire B.7 Model-free comparisons B.8 Association with time to relapse B.9 Number of detoxifications and model-based control: behavioral and neuroimaging analyses C Supplementary Information of Study 3 C.1 Differences between VBDM version used in this study compared to the VBDM version reported in Pooseh et al. (under review) C.2 Additional correlational analyses D Supplementary Information for additional analyses

Anhand einer prospektiven epidemiologischen Verlaufsstudie an einer repräsentativen Bevölkerungsstichprobe von ursprünglich 14- bis 17jährigen Jugendlichen (N=1395) werden die Häufigkeit und die Verlaufsmuster des Konsums, des Mißbrauchs und der Abhängigkeit von Cannabis untersucht. Die Jugendlichen wurden persönlich mit Hilfe eines Interviews befragt, wobei als diagnostisches Instrument das M-CIDI mit seinen DSM-IV Algorithmen verwendet wurde. Die Ergebnisse aus der Basiserhebung ergaben, daß 1995 etwa 20% aller 14- bis 17jährigen - in der Mehrzahl wiederholt - Cannabis probiert hatten und 6% der Population einen regelmäßigen Gebrauch aufweisen. Die Einjahres-Inzidenz (= Auftreten neuer Fälle) für den Cannabisgebrauch der nun 15- bis 19jährigen betrug zum Zeitpunkt der Nachuntersuchung 20,1% für die Männer und 16,3% für die Frauen. Für den regelmäßigen Gebrauch wurden Inzidenzraen von 12% (Männer) und 8,4% (Frauen) ermittelt. Die Stabilität des Konsumverhaltens zwischen der Basis- und der Nachuntersuchung war relativ hoch un stieg mit höherem Initialkonsum an. Angesichts der hohen Gebrauchsrate von 32,4% bei den 15- bis 19jährigen bei der Nachuntersuchung ergab sich im Vergleich zu anderen psychotropen Substanzen eine relativ niedrige Prävalenz für Mißbrauch und Abhängigkeit (4%). Das Vorliegen einer Diagnose bei der Erstuntersuchung weist allerdings eine relativ hohe Stabilität über die Nachuntersuchungskette auf. / The paper examines the prevalence, incidence and stability patterns of cannabis use and dependence in a prospective epidemiological study of a random community sample of adolescents, aged 14 to 17 years (N=1395) at time 1. Assesments are based on personal interviews by trained clinical psychologists using the computerized DSM-IV lifetime and 12-month change version of the M-CIDI. Results indicate that in 1995 every fifth person aged 14 to 17 years had used cannabis at least once and 6% reported regular use. The 12-month incidence rates (i.e. proportion of the sample reporting first cannabis use in the last year) among subjects, 15 to 19 years of age at time 2, was high, with 20,1% of males and 16,3% of females reporting first use. The incidence of regular use was 12,0% (males) and 8,4% (females). The stability of consumption patterns from time 1 to time 2 was high. Increasing with higher initial consumption. Given the reexamined samples overall high cannabis consumption rates of 32,4%, the prevalence of clinically manifest DSM-IV abuse and dependence was low in comparison to other psychologic drugs (4%). However there was remarkable diagnostic stability over time in this age group of those with an initial diagnosis at time 1 receiving a diagnosis again at time 2.

Die Arbeit gibt einen methodenkritischen Überblick über die in Deutschland vorliegenden Ergebnisse zur Prävalenz sowie Risikofaktoren von Substanzmißbrauch und -abhängigkeit (SMA). Es wird gezeigt, daß die vorliegenden epidemiologischen Studien unvollständig und methodisch unbefriedigend sind. Vor allem die fehlende Erfassung spezifischer diagnostischer Kriterien zur Ableitung klinisch relevanter Mißbrauchs- und Abhängigkeitsstörungen erschwert eine Interpretation der Ergebnisse der vorliegenden Repräsentativerhebungen. Diese geben zwar aussagekräftige populationsbezogene Informationen über die Häufigkeit und Verteilungsmuster von legalen und illegalen Substanzen, klinisch relevante Beurteilungsaspekte wie z.B. zu Schweregrad, Toleranz und Abstinenzproblemen sowie zu Einstieg und Verlauf der "Sucht"-Problematik fehlen jedoch vollständig. Dies trifft auch für Untersuchungen zu Risikofaktoren zu. Als ein durchgängiger Mangel wird ferner die Erfassungsmethodologie angesehen, die sich bislang fast ausschließlich auf Fragebögen oder Interviews stützt, über deren Reliabilität und Validität nur unzureichende psychometrische Daten vorliegen. / A critical review of prevalence and risk factor studies of substance abuse and dependence in Germany is presented. It is shown that currently available epidemiological data are incomplete due to the failure of instruments to allow for a detailed assessment of specific substance use disorders. The neglect of diagnostic criteria for clinically significant abuse and dependence disorders makes it especially difficult to draw conclusions about the results of representative surveys. Although the give clear population-related information about frequency and distribution patterns of legal and illegal substancees, relevant clinical data regarding aspects such as severity, tolerance, problems of abstinence, onset and course of abuse and dependence are completely lacking. This is also true of studies on risk factors. An additional problem is diagnostic assessment based almost exclusively on questionnaires and interviews whose reliability and validity have not been sufficiently established.

This report presents findings of a community survey of 3,021 adolescents and young adults aged 14–24 years in Munich, Germany, carried out to determine the prevalence of use and abuse of and dependence on ecstasy, amphetamines and hallucinogens. The response rate was 71%. Results: (1) In 1995, 4% of the male and 2.3% of the female respondents aged 14–24 reported the use of ecstasy. Ecstasy-related substances (amphetamines and chemically related substances) were reported by 3.6% of men and 1.6% of women. Hallucinogens were reported slightly less frequently by 3% of men and about 2% of women (LSD combined with others). (2) Compared to findings from a 1990 survey this constitutes a substantial, at least twofold, increase in consumption rate of both types of substances. (3) Among lifetime users of both ecstasy and related substances as well as hallucinogens about two thirds could be regarded as regular users. (4) The prevalence of DSM-IV abuse and dependence on ecstasy and related substances is about 1%, identical to rates of hallucinogen abuse and dependence. Findings also point to a significant dependence potential for both substances. (5) Furthermore, considerable overlap between the two substances was found. Conclusion: Our study suggests a substantial increase in both the use of ecstasy and related substances as well as hallucinogens. The data further suggest that the increase is strongest in younger age groups, but the risk of first use of these substances continues to be present up to the age of 24 years. The higher proportion of women contributing to this increase is noteworthy.

The primary and secondary objectives of the Early Developmental Stages of Substance Abuse Study (EDSP) are described along with a detailed description of the overall design, special design features and instruments used. The EDSP is a 5-year prospective study with three waves of assessments. Special design features are the linkages with family genetic investigations as well as neuroendocrinological stress tests in high-risk subjects. Overall, 3,021 adolescents and young adults aged 14–24 years are included. The response rate for the baseline investigation was 71%. Diagnostic assessments were made by using a modified lifetime (baseline) and 12-month change version of the WHO-CIDI, adjusted for DSM-IV. Modifications refer to a more detailed quantitative assessment of symptoms and substance use variables as well as the inclusion of questions to assess course of disorders and subthreshold diagnostic conditions.

Die Basis der vorliegenden kumulativen Arbeit bilden vier wissenschaftliche Publikationen. Im Mittelpunkt steht dabei die Vibrationssensibilität des Menschen. Diese Modalität der Hautwahrnehmung besitzt insbesondere am Fuß eine große Relevanz für jegliche Bewegung und Haltung. Die ersten zwei Publikationen thematisieren Anpassungen der Haut der Fußsohle an physiologische Belastungen bei Gesunden (Publikation 1) und erkrankungsbezogene Prozesse im Zuge eines Diabetes mellitus bzw. einer diabetischen peripheren Neuropathie (Publikation 2) und deren Zusammenhänge mit der Vibrationssensibilität. Da die Vibrationssensibilität im Anwendungsfall Diabetes mellitus zur Diagnose neuronaler Abbauprozesse dient, diskutiert Publikation drei das Potential zusätzlicher, niedriger und hoher Vibrationsfrequenzen zur Frühdiagnose neurodegenerativer Prozesse. Die vierte Publikation beleuchtet schließlich die Wirkung einer nicht spürbaren, elektrischen Rauschstimulation auf die durch Diabetes mellitus herabgesetzte Vibrationssensibilität. Die übergreifende Diskussion im Rahmen dieser Arbeit verbindet genannte Veröffentlichungen und leitet praxisbezogene Schlussfolgerungen ab.:Inhaltsverzeichnis Bibliografische Beschreibung III Abstract IV Inhaltsverzeichnis V Abbildungsverzeichnis VI Tabellenverzeichnis VII Abkürzungsverzeichnis VIII 1. Einleitung 2 1.1 Struktur der Arbeit 9 2. Theorie der Arbeit 11 2.1 Diabetes mellitus 11 2.2 Diabetische periphere Neuropathie 13 2.3 Die unbehaarte Haut 17 2.4 Die kutane Sensibilität 20 2.5 Die Mechanorezeptoren der unbehaarten Haut (LTMR) 21 Merkel-Zellen-Neuriten-Komplex (SA I-LTMR) 21 Ruffini-Körperchen (SA II-LTMR) 22 Meissner-Körperchen (FA I-LTMR) 22 Pacini-Körperchen (FA II-LTMR) 23 2.6 Reizleitung und zentrale Verschaltung der Mechanorezeptoren 24 3. Methodische Hinweise 27 3.1 Das Shaker- Messsystem 27 3.2 Die Erfassung der mechanischen Hauteigenschaften 30 4. Eigene Beiträge 33 4.1 Erste Publikation 33 4.2 Zweite Publikation 37 4.3 Dritte Publikation 41 4.4 Vierte Publikation 46 5. Diskussion 52 5.1 Biomechanische Hauteigenschaften und Vibrationssensibilität 53 5.2 Biomechanische Beiträge zur Früherkennung 63 5.3 Unterschwelliges, elektrisches Rauschen 73 6. Schlussbemerkung 81 Literaturverzeichnis 83 Anhang 104 / This cumulative dissertation is based on four scientific publications. The focus hereby is on vibration sensitivity. This modality of skin perception, especially at the foot, has a great relevance for any movement and posture. The first two publications address adaptations of plantar skin to physiological load in healthy subjects (publication 1) and disease-related processes in the course of diabetes mellitus and diabetic peripheral neuropathy (publication 2) and their correlations with vibration sensitivity. Since vibration sensitivity is used to diagnose neural degeneration processes in diabetes mellitus, publication three discusses the potential of additional low and high vibration frequencies for the early diagnosis of neurodegenerative processes. Finally, the fourth publication highlights the effect of subliminal electrical noise stimulation on vibration sensitivity, which is decreased by diabetes mellitus. The overarching discussion in this work connects the publications mentioned and derives practice-related conclusions.:Inhaltsverzeichnis Bibliografische Beschreibung III Abstract IV Inhaltsverzeichnis V Abbildungsverzeichnis VI Tabellenverzeichnis VII Abkürzungsverzeichnis VIII 1. Einleitung 2 1.1 Struktur der Arbeit 9 2. Theorie der Arbeit 11 2.1 Diabetes mellitus 11 2.2 Diabetische periphere Neuropathie 13 2.3 Die unbehaarte Haut 17 2.4 Die kutane Sensibilität 20 2.5 Die Mechanorezeptoren der unbehaarten Haut (LTMR) 21 Merkel-Zellen-Neuriten-Komplex (SA I-LTMR) 21 Ruffini-Körperchen (SA II-LTMR) 22 Meissner-Körperchen (FA I-LTMR) 22 Pacini-Körperchen (FA II-LTMR) 23 2.6 Reizleitung und zentrale Verschaltung der Mechanorezeptoren 24 3. Methodische Hinweise 27 3.1 Das Shaker- Messsystem 27 3.2 Die Erfassung der mechanischen Hauteigenschaften 30 4. Eigene Beiträge 33 4.1 Erste Publikation 33 4.2 Zweite Publikation 37 4.3 Dritte Publikation 41 4.4 Vierte Publikation 46 5. Diskussion 52 5.1 Biomechanische Hauteigenschaften und Vibrationssensibilität 53 5.2 Biomechanische Beiträge zur Früherkennung 63 5.3 Unterschwelliges, elektrisches Rauschen 73 6. Schlussbemerkung 81 Literaturverzeichnis 83 Anhang 104