Motivation The prevalence of cardiovascular disease is on the increase in sub-Saharan Africa largely owing to lifestyle changes associated with urbanisation. Traditional diets are being replaced with diets high in saturated fat and sugar. In addition to the nutritional transition, urbanisation in developing African countries also contributes to a more sedentary lifestyle. Together these trends contribute to a higher prevalence of obesity and hypertension that are major risk factors for the development of cardiovascular disease. Adipose tissue is now widely recognised as an endocrine organ that secretes numerous inflammatory mediators as well as adipocytokines such as leptin. The primary role of leptin is to induce satiety after a meal and to suppress appetite. However, in recent years the role of leptin in the development of obesity-related cardiovascular disease has gained increasing attention and interest. Furthermore, leptin levels not only differ with regard to gender but also ethnicity. Africans have higher leptin levels than Caucasians due to higher subcutaneous fat in Africans. Furthermore, the prevalence of hypertension and stroke are also greater in the African population. Taken together, it is important to investigate mechanisms by which elevated leptin may contribute to the development of cardiovascular disease, especially in cardiovascular disease-prone Africans. Aim The general aim of this study is to increase our understanding of the role of leptin in cardiovascular disease development by investigating associations of leptin with markers of sympathetic activity, endothelial dysfunction, and cardiovascular reactivity and recovery in Africans and Caucasians. Methodology Data from the SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) study was used and presented in the original research articles described in Chapter 2, 3 and 4. This study included 409 African and Caucasian schoolteachers working in the Potchefstroom district in the North West Province of South Africa. Groups were stratified by ethnicity, gender and ethnicity or obesity in order to demonstrate potential differences. We performed cardiovascular measurements and determined levels of leptin, renin, cortisol, plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF) and urinary albumin-to-creatinine ratio (ACR). Independent t-tests were done to compare means between groups and Chi-square tests to compare proportions. Pearson’s correlations were determined to investigate associations as well as partial correlations after minimal adjustment for potential confounders. Multiple regression analyses were performed to investigate independent associations of leptin with cardiovascular and biochemical markers according to the specific focus of each research manuscript. Results and conclusions of the individual manuscripts  Leptin may contribute to obesity-related hypertension through its sympatho-activating effects. In the first research article (Chapter 2), we compared mean leptin levels and markers of autonomic activity between Africans and Caucasians. We also investigated associations between markers of autonomic activity and leptin. Africans had higher leptin, body mass index, blood pressure and heart rate compared to Caucasians. Furthermore, Africans also demonstrated reduced heart rate variability that is indicative of autonomic imbalance. Markers of autonomic activity that collectively reflected sympathetic overactivity associated with leptin in both Africans and Caucasians, independent of significant covariates and confounders including body mass index. These findings suggest that leptin may contribute to the development of hypertension by inducing autonomic dysfunction.  Leptin exerts direct vascular effects and may thereby contribute to increased cardiovascular disease risk in the obese. We therefore investigated associations between circulating markers of endothelial dysfunction (PAI-1, vWF and ACR) and leptin in lean and obese groups, irrespective of ethnicity (Chapter 3). As expected, leptin and plasminogen activator inhibitor-1 antigen levels were higher in the obese group. We found no differences for von Willebrand factor antigen and urinary albumin-to-creatinine ratio. In the obese group, all markers of endothelial dysfunction were positively associated with leptin in univariate analysis. However, after full adjustment in multiple regression analyses, only the association with plasminogen activator inhibitor-1 remained significant. Higher leptin levels in the obese may possibly induce endothelial dysfunction through mechanisms related to thrombotic vascular disease.  Greater cardiovascular reactivity to stress and prolonged recovery thereafter associates with increased cardiovascular disease risk. In the final research article (Chapter 4), we therefore investigated the relationship between cardiovascular reactivity and recovery to acute stress, induced by the cold pressor test, and leptin in Africans and Caucasians. Africans demonstrated greater cardiovascular reactivity compared to Caucasians. Associations of blood pressure, stroke volume, cardiac output, total peripheral resistance and arterial compliance reactivity with leptin were investigated during the stressor application and 1, 3 and 5 minutes post-stressor. There were no independent associations between cardiovascular reactivity and leptin during the stressor, and a few correlations at 1 and 3 minutes post-stressor. Associations were mostly evident at 5 minutes post-stressor and in Africans. We argue that higher leptin levels relate to impaired post-stress recovery and thereby could contribute to hypertension development in Africans. General conclusion Elevated leptin relates to sympathetic overactivity, vascular damage and delayed post-stress recovery, and thereby could contribute to increased cardiovascular disease risk. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015

Motivation The prevalence of cardiovascular disease is on the increase in sub-Saharan Africa largely owing to lifestyle changes associated with urbanisation. Traditional diets are being replaced with diets high in saturated fat and sugar. In addition to the nutritional transition, urbanisation in developing African countries also contributes to a more sedentary lifestyle. Together these trends contribute to a higher prevalence of obesity and hypertension that are major risk factors for the development of cardiovascular disease. Adipose tissue is now widely recognised as an endocrine organ that secretes numerous inflammatory mediators as well as adipocytokines such as leptin. The primary role of leptin is to induce satiety after a meal and to suppress appetite. However, in recent years the role of leptin in the development of obesity-related cardiovascular disease has gained increasing attention and interest. Furthermore, leptin levels not only differ with regard to gender but also ethnicity. Africans have higher leptin levels than Caucasians due to higher subcutaneous fat in Africans. Furthermore, the prevalence of hypertension and stroke are also greater in the African population. Taken together, it is important to investigate mechanisms by which elevated leptin may contribute to the development of cardiovascular disease, especially in cardiovascular disease-prone Africans. Aim The general aim of this study is to increase our understanding of the role of leptin in cardiovascular disease development by investigating associations of leptin with markers of sympathetic activity, endothelial dysfunction, and cardiovascular reactivity and recovery in Africans and Caucasians. Methodology Data from the SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) study was used and presented in the original research articles described in Chapter 2, 3 and 4. This study included 409 African and Caucasian schoolteachers working in the Potchefstroom district in the North West Province of South Africa. Groups were stratified by ethnicity, gender and ethnicity or obesity in order to demonstrate potential differences. We performed cardiovascular measurements and determined levels of leptin, renin, cortisol, plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF) and urinary albumin-to-creatinine ratio (ACR). Independent t-tests were done to compare means between groups and Chi-square tests to compare proportions. Pearson’s correlations were determined to investigate associations as well as partial correlations after minimal adjustment for potential confounders. Multiple regression analyses were performed to investigate independent associations of leptin with cardiovascular and biochemical markers according to the specific focus of each research manuscript. Results and conclusions of the individual manuscripts  Leptin may contribute to obesity-related hypertension through its sympatho-activating effects. In the first research article (Chapter 2), we compared mean leptin levels and markers of autonomic activity between Africans and Caucasians. We also investigated associations between markers of autonomic activity and leptin. Africans had higher leptin, body mass index, blood pressure and heart rate compared to Caucasians. Furthermore, Africans also demonstrated reduced heart rate variability that is indicative of autonomic imbalance. Markers of autonomic activity that collectively reflected sympathetic overactivity associated with leptin in both Africans and Caucasians, independent of significant covariates and confounders including body mass index. These findings suggest that leptin may contribute to the development of hypertension by inducing autonomic dysfunction.  Leptin exerts direct vascular effects and may thereby contribute to increased cardiovascular disease risk in the obese. We therefore investigated associations between circulating markers of endothelial dysfunction (PAI-1, vWF and ACR) and leptin in lean and obese groups, irrespective of ethnicity (Chapter 3). As expected, leptin and plasminogen activator inhibitor-1 antigen levels were higher in the obese group. We found no differences for von Willebrand factor antigen and urinary albumin-to-creatinine ratio. In the obese group, all markers of endothelial dysfunction were positively associated with leptin in univariate analysis. However, after full adjustment in multiple regression analyses, only the association with plasminogen activator inhibitor-1 remained significant. Higher leptin levels in the obese may possibly induce endothelial dysfunction through mechanisms related to thrombotic vascular disease.  Greater cardiovascular reactivity to stress and prolonged recovery thereafter associates with increased cardiovascular disease risk. In the final research article (Chapter 4), we therefore investigated the relationship between cardiovascular reactivity and recovery to acute stress, induced by the cold pressor test, and leptin in Africans and Caucasians. Africans demonstrated greater cardiovascular reactivity compared to Caucasians. Associations of blood pressure, stroke volume, cardiac output, total peripheral resistance and arterial compliance reactivity with leptin were investigated during the stressor application and 1, 3 and 5 minutes post-stressor. There were no independent associations between cardiovascular reactivity and leptin during the stressor, and a few correlations at 1 and 3 minutes post-stressor. Associations were mostly evident at 5 minutes post-stressor and in Africans. We argue that higher leptin levels relate to impaired post-stress recovery and thereby could contribute to hypertension development in Africans. General conclusion Elevated leptin relates to sympathetic overactivity, vascular damage and delayed post-stress recovery, and thereby could contribute to increased cardiovascular disease risk. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015

In this qualitative phenomenological study, the researcher interviewed 18 hospitalised patients and community members in rural Appalachia to learn about their mystical experiences in the context of health care. A loosely structured interview format addressed factors that initiate mystical experience and essential qualities of mystical experience. In addition, the researcher examined the nursing process, focusing on assessments and actions which supported the participants in sharing their experiences. The researcher also considered her response to being the recipient of these shared experiences. Data were analysed using the crystallisation/immersion method and concept mapping. Mystical experience was conceptualised as a process incorporating initiation, occurrence, maturation, and integration of mystical experience. Essential aspects of the mystical experience itself were found to include sensory-motor perception, interaction with the supernatural, interaction with dead and living members of the family, conviction of reality, cognition, dynamic tension and emotional intensity. Nursing actions which supported the participant included listening and support. The researcher's response to the participants' sharing their experiences included tension, intimacy and empathy, sense of awe and autonomic responses. In addition, the researcher developed an appreciation of the mystical in everyday experience. / Health Studies / D. Litt. et Phil. (Health Studies)

This study compared psychological and physiological differences between children diagnosed with migraine and their healthy peers. Physiological measures were obtained at baseline, after discussing an emotionally relevant stressor, and after recovery in 21 children with pediatric migraine and 32 healthy peers. Comparisons were also made on psychological measures investigating sleep problems, anxiety, and family stress. It was hypothesized that children with migraine compared to their peers 1) would report more sleep disturbances, anxiety, and family stress 2) would exhibit greater sympathetic activation at rest, in response to an emotional stressor, and after a recovery period and 3) that autonomic functioning would mediate the relation between the presence of pediatric migraine and sleep disturbances. Results indicated that the migraine group reported significantly greater anxiety compared to peers but there were no significant differences in sleep disturbances or family stress. Within the migraine group, migraine severity was significantly associated with total sleep disturbance and greater incidence of parasomnias, while migraine duration was significantly associated with greater night time awakenings. Migraine children also exhibited a significantly higher pulse rate compared to their peers at rest and a significantly higher diastolic blood pressure and marginally significant higher LF/HF ratio at recovery from an emotional stressor. These findings suggest that sleep disturbance and pediatric migraine are significantly related but the relation is unclear and warrants additional research. Results also indicate that children with migraine may experience more anxiety than peers. Of most interest, results suggest that children with migraine may experience a disinhibition of the autonomic nervous system characterized by a dominance of the sympathetic nervous system resulting in a longer recovery period following an emotional stressor.

<p>Large-scale deployment of IEEE 802.11 wireless LANs (WLANs) remains a significant challenge. Many access points (APs) must be deployed and interconnected without a-priori knowledge of the demand. We consider that the deployment should be iterative, as follows. At first, access points are deployed to achieve partial coverage. Then, usage statistics are collected while the network operates. Overloaded and under-utilized APs would be identified, giving the opportunity to relocate, add or remove APs. In this thesis, we propose extensions to the WLAN architecture that would make our vision of iterative deployment feasible.</p><p>One line of work focuses on self-configuration, which deals with building a WLAN from APs deployed without planning, and coping with mismatches between offered load and available capacity. Self-configuration is considered at three levels. At the network level, we propose a new distribution system that forms a WLAN from a set of APs connected to different IP networks and supports AP auto-configuration, link-layer mobility, and sharing infrastructure between operators. At the inter-cell level, we design a load-balancing scheme for overlapping APs that increases the network throughput and reduces the cell delay by evenly distributing the load. We also suggest how to reduce the handoff time by early detection and fast active scanning. At the intra-cell level, we present a distributed admission control that protects cells against congestion by blocking stations whose MAC service time would be above a set threshold.</p><p>Another line of work deals with self-deployment and investigates how the network can assist in improving its continuous deployment by identifying the reasons for low cell throughput. One reason may be poor radio conditions. A new performance figure, the Multi-Rate Performance Index, is introduced to measure the efficiency of radio channel usage. Our measurements show that it identifies cells affected by bad radio conditions. An additional reason may be limited performance of some AP models. We present a method to measure the upper bound of an AP’s throughput and its dependence on offered load and orientation. Another reason for low throughput may be excessive distance between users and APs. Accurate positioning of users in a WLAN would permit optimizing the location and number of APs. We analyze the limitations of the two most popular range estimation techniques when used in WLANs: received signal strength and time of arrival. We find that the latter could perform better but the technique is not feasible due to the low resolution of the frame timestamps in the WLAN cards.</p><p>The combination of self-configuration and self-deployment enables the autonomic operation of WLANs.</p>

<p>Advanced architectures for cluster-based services that have been recently proposed allow for service differentiation, server overload control and high utilization of resources. These systems, however, rely on centralized functions, which limit their ability to scale and to tolerate faults. In addition, they do not have built-in architectural support for automatic reconfiguration in case of failures or addition/removal of system components.</p><p>Recent research in peer-to-peer systems and distributed management has demonstrated the potential benefits of decentralized over centralized designs: a decentralized design can reduce the configuration complexity of a system and increase its scalability and fault tolerance.</p><p>This research focuses on introducing self-management capabilities into the design of cluster-based services. Its intended benefits are to make service platforms dynamically adapt to the needs of customers and to environment changes, while giving the service providers the capability to adjust operational policies at run-time.</p><p>We have developed a decentralized design that efficiently allocates resources among multiple services inside a server cluster. The design combines the advantages of both centralized and decentralized architectures. It allows associating a set of QoS objectives with each service. In case of overload or failures, the quality of service degrades in a controllable manner. We have evaluated the performance of our design through extensive simulations. The results have been compared with performance characteristics of ideal systems.</p>

Despite recent research advances, there are still several common medical conditions whose underlying mechanisms are poorly understood. In conditions with few or diffuse physical findings, it can be difficult to diagnose and determine the state of the condition and its effects on working ability or performance, and the health care practitioners have to rely on the patient’s self-reports. Identification of objective measurements that are sensitive enough to aid in diagnosis or determination of the state of these conditions would thus be valuable. Psychophysiological measurements are generally non-invasive and have the potential to serve as such diagnostic or prognostic tools. In this thesis, psychophysiological reactions to different stressors were recorded in two selected medical conditions; namely motion sickness and chronic trapezius myalgia (musculoskeletal pain). These subjective conditions are unpleasant, unwanted and apparently serve no survival purpose. It is therefore important to elucidate any physical findings associated with them to, eventually, find new means to prevent the development of these conditions or to ameliorate symptoms. The overall aim of the thesis was to explore the development of psychophysiological responses to stressors in relation to performance and subjective reports in healthy individuals and in women with chronic trapezius myalgia. More in detail, the purpose was to identify psychophysiological responses that could provide information about the mechanisms behind, or serve as candidates for characterization of motion sickness and chronic trapezius myalgia, respectively. Responses to motion sickness, triggered by optokinetic stimulation, were studied in healthy individuals, whereas responses to repetitive low-force work and psychosocial stress were studied in women with chronic trapezius myalgia and in pain-free controls. In both medical conditions, the psychophysiological responses were accompanied by subjective reports. The effects of motion sickness on two different aspects of memory performance were tested during exposure to optokinetic stimulation. In the studies of chronic trapezius myalgia, psychophysiological responses were also related to health status, i.e., being a patient or a pain-free control and measurements of pain intensity, psychological symptoms, sleep-related problems and quality of life. The psychophysiological responses to optokinetic stimulation were inconclusive. Moderate levels of motion sickness did not affect memory performance, whereas decreased short term memory performance was seen in subjects reporting high levels of motion sickness. The autonomic responses and stress hormone secretion in response to low-force repetitive work and psychosocial stress in the chronic trapezius myalgia group were similar to those of the pain-free controls. However, muscle activity in the trapezius muscle was generally higher in the chronic trapezius myalgia group. There were indications of negative psychological states being related to a slower response and lower circadian variations of stress hormone secretion. With the present methods, it was possible to measure general stress responses but none of the measurements showed sufficient specificity to serve as predictors or indicators of motion sickness and chronic musculoskeletal pain, respectively. Summarizing, I cannot objectively measure how you feel; I still have to rely on your description of your condition.

The change in R-R intervals between adjacent heartbeats is referred to as Heart Rate Variability (HRV). HRV data provides information regarding an individual’s Autonomic Nervous System (ANS), specifically the ANS’s two branches, the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). The HRV of a healthy, well-conditioned heart is large at rest, while low HRV is associated with adverse health outcomes such diabetes, heart disease and early mortality. There has been a substantial amount of HRV research conducted with typically developing individuals. One group who is greatly underrepresented in research is individuals with intellectual disabilities. Currently, no studies have been undertaken with Special Olympics athletes. Therefore, the purpose of this study was to create HRV profiles at rest, during submaximal exercise, and at recovery of adult Special Olympic athletes. The study also sought to examine the impact that Down syndrome, age, sex, and medication on HRV profiles. The current study found that although heart rate responded appropriately during the three testing conditions (rest, exercise, recovery) the athletes were sympathetically dominated across all three conditions, indicating an imbalance between the SNS and the PNS. In addition, male and female athletes were significantly different with regards to low frequency and high frequency power. It is possible that anxiety or excitement about the testing influenced some athletes, and future research should examine how additional protocol familiarization could impact the HRV profiles within this population. Additionally, more research with larger sample sizes is needed to more fully understand the impact that age, etiology of intellectual disability, and medication use may be having on HRV profiles. / Graduate

Takotsubo cardiomyopathy (TTC) is a disease characterized by transient left ventricular (LV) dysfunction and typical wall motion abnormalities in apical parts, without obvious signs of coronary influence. Due to its elusive natural cause and the lack of clarified pathology, further studies are needed. Thirteen patients presented with an episode of TTC, and referred to Örebro University Hospital (USÖ), were prospectively included and investigated by comparisons made at onset (acute phase) against at follow-up three months later (recovery phase). Including echocardiographic measurements, focused on biventricular systolic long-axis function and conventional diastolic function (DF) variables. Systolic improvement was shown, while most DF data were unchanged, suggesting that TTC is mainly a systolic disease affecting both ventricles. Diagnosis should include multidisciplinary engagement, as TTC associates both with emotional stress and pathological markers of physiological stress. In this thesis, such approach was offered to the aforementioned patients; to see if a common denominator could be found, thus, contributing to better handling. Emotional state was assessed, along with an array of cardiac investigations in addition to echocardiography. Acutely, imbalance in the autonomic cardiac control was shown, as well as a trend toward posttraumatic stress, but specific findings allowing conclusions on differential diagnosis could not be demonstrated. By adding another 15 TTC patients (i.e. 28 in total), through collaboration with observers from USA, a retrospective echocardiographic analysis could be done to further study DF; concluding that TTC associates with impairment of conventional DF variables which tends to parallel the systolic recovery, in contrary to the initial result but in line with other causesof LV dysfunction. Magnetic resonance imaging (MRI) is another method of choice at TTC. The USÖ patients had cardiac MRI, thus, a retrospective analysis was done to investigate the effect on LV geometry, both echocardiographic and by MRI; suggesting that TTC is consistently associated with increased LV mass, due to a local impact that seems to follow the change in LVconcentric wall motion.

This study examined the effects of fluency-based instruction on the identification of six component-composite relations for early reading skills. Five participants (ages 5-8) who struggled with reading participated. A multiple probe design was used to assess the effects of frequency building on prerequisite skills on the emergence of composite reading skills. The results show that the prerequisite skills taught did not have an effect on the composite skill probes but did have an effect on the assessment scores. The data expand the research pertaining to Precision Teaching, fluency-based instruction, and component-composite relations. These data suggest that additional skills may be needed to be taught in order to effects on the composite skills. In addition, these authors identify the need for the identification of the component skills necessary to teach rapid autonomic naming.