Orientador: Jairo Aparecido Ayres / Coorientador: Lais Helena Camacho Navarro / Banca: Maria Belén Salazar Posso / Banca: Silmara Meneguin / Resumo: Comparar a eficiência dos dispositivos manta e colchão térmicos na manutenção da normotermia em pacientes nos períodos intra e pósoperatório; Analisar o período de tempo da recuperação pós-anestésica, com o uso dos dispositivos manta e colchão térmicos; relacionar a utilização dos dispositivos manta e colchão térmicos às variáveis: idade, índice de massa corpórea (IMC) e porte cirúrgico. Trata-se de estudo transversal, prospectivo, randomizado, de delineamento quantitativo, realizado na unidade de Centro Cirúrgico do Hospital das Clínicas de Botucatu, de janeiro a outubro de 2011. Participaram da pesquisa 38 pacientes que foram divididos em 2 grupos (G1 e G2), sendo ambos compostos por 19 pacientes. G1 utilizou a manta térmica com sistema de aquecimento Bair Hugger® modelo 750, sendo esta posicionada nos membros inferiores. G2 utilizou o colchão térmico com circulação de ar quente KanMedo WarmCloudTM. Inicialmente o colchão foi posicionado sobre a mesa cirúrgica a uma temperatura 37oC e insuflado, em seguida os pacientes foram posicionados em decúbito dorsal horizontal, em contato direto com o colchão. Para a coleta dos dados utilizou-se instrumento confeccionado pelo pesquisador, composto por 4 itens: caracterização do paciente, fatores relacionados ao procedimento cirúrgico, aspectos relacionados à recuperação pós-anestésica e tempo de internação. O tempo cirúrgico foi maior no grupo G2 (p=0,03), porém, não se observou aumento na incidência de hipotermia neste grupo; no G2 evidenciou-se uma tendência a menor tempo de recuperação pós-anestésica (p=0,06). A infusão de amido no intraoperatório do G2 foi maior (p=0,03), porém, não influenciou na ocorrência de hipotermia. No G2 a temperatura axilar foi maior aos 120 minutos do inicio do procedimento anestésico cirúrgico... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: surgical outcomes, and increased patient satisfaction. The use of perioperative forced-air warming devices is one way of preventing inadvertent hypothermia. There is scant evidence, however, on the best warming method or the acceptability of these methods to patients. The present study aimed to compare two forced-air warming devices to maintain perioperative normothermia: blanket versus mattress. Information was obtained from 38 patients underwent gastrointestinal surgical procedures. Skin and esophageal temperatures were compared for patients who were warmed with a warming blanket (Bair Hugger®), placed over the lower extremities (G1), versus patients who were warmed with a warming mattress (KanMedo WarmCloudTM) placed under the patient's body (G2). In addition to the temperature evaluation, length of the surgical procedure, total volume of intraoperative fluid replacement, and length of stay in the Post Anesthetic Care Unit (PACU) were also recorded. Although the length of surgery was longer in G2 (291.6±115.2 versus 214.6±91.1 minutes; p=0.03), there was no increase in the hypothermia incidence in this group. Skin temperature was higher at 120 minutes after anesthesia induction in G2 (35.3±0.9 versus 34.8±0.8; p=0.04). Esophageal temperature was also higher in G2 at 120 and at 180 minutes after anesthesia induction, as well as, at the end of the surgery (36.1±0.7 versus 35.4±0.6, p <0.001; 35.9±0.7 versus 35.3±0.7, p=0.03; and 36.1±0.7 versus 35.2±0.9, p<0.001 respectively). Although the patients in G2 had 30 minutes shorter length of stay in the PACU, there was no statistically significant difference between the two groups (115.4±47.3 versus 82.5±53.1 minutes; p=0.06). The infused volume of Hetarstarch was higher in G2 when compared with G1 (730.8±259.4 versus 541.7±144.3; p=0.03)... (Complete abstract click electronic access below) / Mestre

Crianças frequentemente realizam atividades físicas em ambientes quentes. O calor pode afetar o desempenho, conforto subjetivo, tolerância ao exercício e ser preocupante para a saúde. Além disso, parece que crianças obesas, comparadas com as magras, apresentam desvantagens ao se exercitarem no calor. Devido à importância do exercício aeróbio para o manejo da obesidade e promoção da saúde, essas diferenças merecem ser elucidadas, principalmente em meninas, devido à escassez de informações. Objetivo: Comparar as respostas termorregulatórias e perceptivas de meninas pré-púberes magras e obesas durante e após uma sessão de exercício, de similar intensidade relativa, em condição ambiental termoneutra e de calor. Métodos: Para a revisão da literatura, foram selecionados artigos com as palavras chaves: thermoregulation, obesity, children, girls, sweating, exercise, heat, hydration e acclimatization. No estudo experimental, vinte e sete meninas ativas e aclimatizadas, alocadas nos grupos magras e obesas conforme a adiposidade (≤ 25% para as magras e  30% para as obesas) medida pelo DXA, participaram do estudo. Elas pedalaram (carga de 55% do VO2pico) e recuperaram (sentadas) por 30 minutos numa condição termoneutra e outra de calor, com água disponível para ser ingerida à vontade. A temperatura retal (Tre), frequência cardíaca (FC), taxa de percepção de esforço (TPE), sensação térmica, conforto térmico e irritabilidade foram avaliados periodicamente. A sudorese foi avaliada, e durante o exercício no calor foi coletada uma amostra de suor para análise da concentração de eletrólitos (Na+, Cl- e K+). Resultados: Revisão — estudos com meninos indicam que os obesos parecem ser prejudicados nas respostas termorregulatórias durante exercício no calor relacionado: prejuízos na dissipação por convecção devido à menor área de superfície corporal (ASC) pela massa corporal; a menor taxa de sudorese, condicionamento físico, tolerância ao exercício e capacidade de aclimatação ao calor; ao maior custo metabólico para locomoção; e prejuízo na dissipação de calor pela maior gordura subcutânea. Não foram encontrados estudos comparando as respostas termorregulatórias de meninas magras e obesas no calor; e os estudos com o sexo feminino apresentam resultados parcialmente contraditórios ao masculino. Experimento — a Tre inicial foi maior nas obesas nas duas sessões (no calor 37,5 ± 0,3 vs. 37,3 ± 0,3 ºC, e na termoneutra 37,6 ± 0,3 vs. 37,3 ± 0,2 ºC; p = 0,03) e se manteve durante o exercício; e a magnitude do aumento foi maior nas magras, sendo que no calor a Tre final ultrapassou a das obesas (37,8 ± 0,2 vs. 38,0 ± 0,2 ºC; p = 0,04). As magras relataram diminuição do conforto térmico (p = 0,009) e aumento da irritação (p = 0,02) no decorrer do exercício. A FC, respostas perceptivas de TPE e sensação térmica foram semelhantes entre os grupos, assim como as respostas de sudorese. Observou-se maior concentração de Na+ no suor nas obesas (78,7 ± 47,5 vs. 50,5 ± 12,1 mEql-1; p = 0,04). Conclusão: Meninas obesas apresentaram maior Tre inicial, e as magras apresentaram uma maior magnitude de aumento na Tre, principalmente no calor, acompanhada de maior desconforto térmico e irritabilidade. / Children often perform physical activities in hot environments. The heat can affect performance, subjective comfort, exercise tolerance and cause concern for health. Moreover, it seems that obese children, compared with the lean, have disadvantages while exercising in the heat. Given the importance of aerobic exercise for obesity management and health promotion, these differences should be elucidated, especially in girls due to the information lack. Aim: To compare the thermoregulatory responses and perceptual between lean and obese pre-pubertal girls during and after an exercise session, at similar relative effort intensity in the thermoneutral environmental and heat. Methods: For the literature review, articles were selected using the keywords: thermoregulation, obesity, children, girls, sweating, exercise, heat, hydration and acclimatization. In the experimental trial, twenty-seven active and acclimatized girls, placed in groups lean and obese according to fat percentage (≤ 25% for lean and  30% for the obese) measured by DXA, participated in this study. They cycled (charge 55% of VO2peak) and recovered (seated) for 30 minutes in a thermoneutral condition and in the heat, with hydration ad libitum. Rectal temperature (Tre), heart rate (HR), rate of perceived exertion (RPE), thermal sensation, thermal comfort and irritability were assessed periodically. Sweating was evaluated, and during exercise in the heat a sample sweat was collected to electrolytes concentration (Na+, Cl- and K+) analysis. Results: Review — obese children appear to be impaired in thermoregulatory responses during exercise in the heat related to: the convection damage dissipation due to less body surface area (BSA) by body mass, the lower sweating rate, fitness, exercise tolerance and to heat acclimation ability, the higher locomotion metabolic cost, and heat dissipation loss for greater subcutaneous fat. Any study had compared the thermoregulatory responses between lean and obese girls in heat. Trial — the initial Tre was higher in obese in both sessions (in the heat 37.5 ± 0.3 vs 37.3 ± 0.3 ºC and in thermoneutral 37.6 ± 0.3 vs. 37.3 ± 0 2 º C, p = 0.03) and was maintained during exercise, and magnitude of the increase was greater in lean, mainly in the heat when the final Tre surpassed the obese (37.8 ± 0.2 vs. 38.0 ±0.2 ºC, p = 0.04). The thermal comfort has decreased (p = 0.009) and irritation has increased (p = 0.02) in the lean during the exercise. HR, sweating responses and perceptual responses of TPE and thermal sensation were similar between groups. A higher concentration of Na+ in sweat was observed in obese (78.7 ± 47.5 vs 50.5 ± 12.1 mEql-1, p = 0.04). Conclusion: Initial Tre were higher in obese group, and lean had a greater magnitude of increase in Tre, especially during exercise in the heat, accompanied by thermal discomfort and irritability increased.

Crianças frequentemente realizam atividades físicas em ambientes quentes. O calor pode afetar o desempenho, conforto subjetivo, tolerância ao exercício e ser preocupante para a saúde. Além disso, parece que crianças obesas, comparadas com as magras, apresentam desvantagens ao se exercitarem no calor. Devido à importância do exercício aeróbio para o manejo da obesidade e promoção da saúde, essas diferenças merecem ser elucidadas, principalmente em meninas, devido à escassez de informações. Objetivo: Comparar as respostas termorregulatórias e perceptivas de meninas pré-púberes magras e obesas durante e após uma sessão de exercício, de similar intensidade relativa, em condição ambiental termoneutra e de calor. Métodos: Para a revisão da literatura, foram selecionados artigos com as palavras chaves: thermoregulation, obesity, children, girls, sweating, exercise, heat, hydration e acclimatization. No estudo experimental, vinte e sete meninas ativas e aclimatizadas, alocadas nos grupos magras e obesas conforme a adiposidade (≤ 25% para as magras e  30% para as obesas) medida pelo DXA, participaram do estudo. Elas pedalaram (carga de 55% do VO2pico) e recuperaram (sentadas) por 30 minutos numa condição termoneutra e outra de calor, com água disponível para ser ingerida à vontade. A temperatura retal (Tre), frequência cardíaca (FC), taxa de percepção de esforço (TPE), sensação térmica, conforto térmico e irritabilidade foram avaliados periodicamente. A sudorese foi avaliada, e durante o exercício no calor foi coletada uma amostra de suor para análise da concentração de eletrólitos (Na+, Cl- e K+). Resultados: Revisão — estudos com meninos indicam que os obesos parecem ser prejudicados nas respostas termorregulatórias durante exercício no calor relacionado: prejuízos na dissipação por convecção devido à menor área de superfície corporal (ASC) pela massa corporal; a menor taxa de sudorese, condicionamento físico, tolerância ao exercício e capacidade de aclimatação ao calor; ao maior custo metabólico para locomoção; e prejuízo na dissipação de calor pela maior gordura subcutânea. Não foram encontrados estudos comparando as respostas termorregulatórias de meninas magras e obesas no calor; e os estudos com o sexo feminino apresentam resultados parcialmente contraditórios ao masculino. Experimento — a Tre inicial foi maior nas obesas nas duas sessões (no calor 37,5 ± 0,3 vs. 37,3 ± 0,3 ºC, e na termoneutra 37,6 ± 0,3 vs. 37,3 ± 0,2 ºC; p = 0,03) e se manteve durante o exercício; e a magnitude do aumento foi maior nas magras, sendo que no calor a Tre final ultrapassou a das obesas (37,8 ± 0,2 vs. 38,0 ± 0,2 ºC; p = 0,04). As magras relataram diminuição do conforto térmico (p = 0,009) e aumento da irritação (p = 0,02) no decorrer do exercício. A FC, respostas perceptivas de TPE e sensação térmica foram semelhantes entre os grupos, assim como as respostas de sudorese. Observou-se maior concentração de Na+ no suor nas obesas (78,7 ± 47,5 vs. 50,5 ± 12,1 mEql-1; p = 0,04). Conclusão: Meninas obesas apresentaram maior Tre inicial, e as magras apresentaram uma maior magnitude de aumento na Tre, principalmente no calor, acompanhada de maior desconforto térmico e irritabilidade. / Children often perform physical activities in hot environments. The heat can affect performance, subjective comfort, exercise tolerance and cause concern for health. Moreover, it seems that obese children, compared with the lean, have disadvantages while exercising in the heat. Given the importance of aerobic exercise for obesity management and health promotion, these differences should be elucidated, especially in girls due to the information lack. Aim: To compare the thermoregulatory responses and perceptual between lean and obese pre-pubertal girls during and after an exercise session, at similar relative effort intensity in the thermoneutral environmental and heat. Methods: For the literature review, articles were selected using the keywords: thermoregulation, obesity, children, girls, sweating, exercise, heat, hydration and acclimatization. In the experimental trial, twenty-seven active and acclimatized girls, placed in groups lean and obese according to fat percentage (≤ 25% for lean and  30% for the obese) measured by DXA, participated in this study. They cycled (charge 55% of VO2peak) and recovered (seated) for 30 minutes in a thermoneutral condition and in the heat, with hydration ad libitum. Rectal temperature (Tre), heart rate (HR), rate of perceived exertion (RPE), thermal sensation, thermal comfort and irritability were assessed periodically. Sweating was evaluated, and during exercise in the heat a sample sweat was collected to electrolytes concentration (Na+, Cl- and K+) analysis. Results: Review — obese children appear to be impaired in thermoregulatory responses during exercise in the heat related to: the convection damage dissipation due to less body surface area (BSA) by body mass, the lower sweating rate, fitness, exercise tolerance and to heat acclimation ability, the higher locomotion metabolic cost, and heat dissipation loss for greater subcutaneous fat. Any study had compared the thermoregulatory responses between lean and obese girls in heat. Trial — the initial Tre was higher in obese in both sessions (in the heat 37.5 ± 0.3 vs 37.3 ± 0.3 ºC and in thermoneutral 37.6 ± 0.3 vs. 37.3 ± 0 2 º C, p = 0.03) and was maintained during exercise, and magnitude of the increase was greater in lean, mainly in the heat when the final Tre surpassed the obese (37.8 ± 0.2 vs. 38.0 ±0.2 ºC, p = 0.04). The thermal comfort has decreased (p = 0.009) and irritation has increased (p = 0.02) in the lean during the exercise. HR, sweating responses and perceptual responses of TPE and thermal sensation were similar between groups. A higher concentration of Na+ in sweat was observed in obese (78.7 ± 47.5 vs 50.5 ± 12.1 mEql-1, p = 0.04). Conclusion: Initial Tre were higher in obese group, and lean had a greater magnitude of increase in Tre, especially during exercise in the heat, accompanied by thermal discomfort and irritability increased.

No description available.

Torpor and hibernation, two distinct forms of heterothermy, are physiological responses employed by many endotherms to save energy during periods of cold, climatic unpredictability and food shortage. Heterothermy is characterized by varying body temperature and has been found to occur in various subtropical mammals. However, studies on thermoregulatory capabilities of South African Microchiroptera remain relatively scant. In this study, the capacity for use of heterothermy, the seasonal metabolic rates, and capacity for non-shivering thermogenesis were studied in four species of bats, namely Rhinolophus clivosus, Rhinolophus capensis, Miniopterus natalensis and Myotis tricolor. Animals were collected from a group of three mines in Sleepy Hollow Farm, 30km from Port Elizabeth, South Africa. All species demonstrated bouts of torpor in the winter while R. clivosus interestingly established a high propensity for torpor in the summer and normothermia in the winter. To my knowledge, this is the first study that has shown the down-regulation of metabolism and body temperature in summer and constant maintenance of normothermic body temperature in winter in a species of Microchiroptera. M. natalensis was thermolabile in both summer and winter and body temperatures closely tracked ambient temperatures. Mean ± SD normothermic body temperature measured of wild-caught R. clivosus and M. natalensis was 38.6 ± 1.7°C and 37.3 ± 2.2°C, respectively. Mean torpid body temperature measured of wild-caught R. clivosus, R. capensis and M. natalensis was 22.7 ± 3.3°C, 21.1 ± 3.2 °C, and 22.6 ± 3.1°C, respectively. Non-shivering thermogenesis was measured in R. clivosus and M. natalensis to determine the role of endogenous heat production in a volant mammal. The mean noradrenalineinduced thermogenesis ± SD in R. clivosus and M. natalensis was 2.6 ± 0.8 ml g-1 hr-1 and 2.7 ± 0.6 ml O2 g-1 hr-1, respectively. Both species demonstrated capacity for non-shivering thermogenesis, and this is the first study that has quantified the maximal response to noradrenaline in an Afrotropical Microchiropteran species. Physiology of Afrotropical bats is understudied and the extent to which torpor and/or hibernation is utilized amongst them remains relatively unknown. Heterothermy clearly plays a significant role in the energetic savings and balance of all four species in the study.

Six adult male volunteers of similar body composition and physical fitness were tested to determine plasma immunoreactive β-endorphin (Piβ-EN) response under three conditions of exercise thermoregulatory stress. The experimental protocol consisted of 120 min of stationary upright cycling at 50% Vo₂max under conditions of neutral (24ºC, 50% RH)/euhydration (NE), hot (35°C, 50% RH)/euhydration (HE), and hot/dehydration (HD). Piβ-EN was measured by radioimmunoassay at -30 min, 0 min, and at 15 min intervals thereafter. Change in plasma volume (ΔPV) was measured to determine its effect on Piβ-EN concentration. Preexercise Piβ-EN levels averaged 23.7 ± 2.6 pg•ml⁻¹ in all conditions. The greatest Piβ-EN response occurred at 105 min in HD conditions when levels rose to 43.2 ± 6.9 pg•ml⁻¹. Exercise in HD and HE conditions resulted in significantly (p < 0.05) elevated Piβ-EN above levels observed in NE. ΔPV did not account for more than 10% of Piβ-EN changes at any interval. The Piβ-EN response pattern closely resembled rectal temperature changes in all conditions. These data suggest that conditions of increasing exercise thermoregulatory stress are associated with increasing peripheral β-endorphin concentration. / Master of Science

Tang Chi-wing, Wendy = 飲品味道對炎熱中運動的華籍男女小童之體液平衡及體温調節之影響 / 鄧稚穎. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 74-86). / Text in English; abstracts in English and Chinese. / Tang Chi-wing, Wendy = Yin pin wei dao dui yan re zhong yun dong de hua ji nan nü xiao tong zhi ti ye ping heng ji ti wen diao jie zhi ying xiang / Deng Zhiying. / Dedication --- p.i / Acknowledgements --- p.ii / Abstract --- p.iii / Table of Contents --- p.vi / List of Tables --- p.viii / List of Figure --- p.ix / Chapter CHAPTER ONE --- INTRODUCTION --- p.1 / Chapter 1.1 --- Background --- p.1 / Chapter 1.2 --- Purpose of the Study --- p.4 / Chapter 1.3 --- Hypotheses --- p.5 / Chapter 1.4 --- Definition of Terms --- p.6 / Chapter 1.5 --- Assumptions --- p.7 / Chapter 1.6 --- Delimitations --- p.7 / Chapter 1.7 --- Limitations --- p.8 / Chapter 1.8 --- Significance of Study --- p.8 / Chapter CHAPTER TWO --- REVIEW OF LITERATURE --- p.9 / Chapter 2.1 --- Water Balance during Exercise --- p.9 / Chapter 2.2 --- Effect of Dehydration on Human Body during Exercise --- p.11 / Chapter 2.3 --- Physiological Responses of Dehydration for Children when Exercising in the Heat --- p.17 / Chapter 2.4 --- Effect of Fluid Ingestion during Exercise --- p.20 / Chapter 2.5 --- Drivers of Fluid Replacement --- p.23 / Chapter CHAPTER THREE --- METHODOLOGY --- p.30 / Chapter 3.1 --- Participants --- p.30 / Chapter 3.2 --- Equipment and Instrumentation --- p.31 / Chapter 3.3 --- Preliminary Measurement --- p.31 / Chapter 3.4 --- Study Design and Procedures --- p.35 / Chapter 3.5 --- Collection and Analysis of Blood Samples --- p.44 / Chapter 3.6 --- Statistical Analysis --- p.44 / Chapter CHAPTER FOUR --- RESULTS --- p.46 / Chapter 4.1 --- Exercise Intensity --- p.46 / Chapter 4.2 --- Body Fluid Balance --- p.50 / Chapter 4.3 --- Thermoregulatory Responses --- p.61 / Chapter 4.4 --- Taste Perception Analysis --- p.62 / Chapter 4.5 --- Summary of the Results --- p.66 / Chapter CHAPTER FIVE --- DISCUSSION --- p.67 / Recommendations and Applications --- p.73 / REFERENCES --- p.74 / APPENDIXES --- p.87

During flight missions, fighter pilots are in general exposed to vast amounts of stress including mild hypoxia, vibrations, high accelerations, and thermal discomfort. It is interesting to predict potential risks with a certain mission or flight case due to these stresses to increase safety for fighter pilots. The most predominant risk is typically thermal discomfort which can lead to serious health concerns. Extensive exposure to high or low temperature in combination with a demanding work situation weakens the physical and mental state of the pilot and can eventually lead to life-threatening conditions. One method to estimate the physical and mental state of a person is to measure the body core temperature. The body core temperature cannot be measured continuously during flight and needs to be estimated by using for instance a human thermoregulatory model. In this study, a model of the human thermoregulatory system and the cockpit environment is developed. Current thermoregulatory models are not customized for fighter pilots but a model developed by Fiala et al. in 2001, which has previously shown good performance in both cold and warm environments as well as for various activation levels for the studied person, is used as a theoretical foundation. Clothing layers are implemented in the model corresponding to clothes used by pilots in the Swedish air force flying the fighter aircraft Gripen E in warm outside conditions. Cooling garments and air conditioning systems as well as avionics, canopy, and cockpit air are included in the model to get a realistic description of the cockpit environment. Input to the model is a flight case containing data with altitude and velocity of the fighter during a mission. human heat transfer; body temperature regulation; physiological model;cooling garment; cockpit modeling

A skill instruction technique based on cognitive behavioral principles was applied to thermal imagery to determine if it could enhance either subjective or physiological responsiveness. The effects of imagery instruction were compared with the effects of muscle relaxation on imagery vividness, thermal imagery involvement, and the finger temperature response. The subjects were 39 male and 29 female volunteers from a minimum security federal prison. The personality characteristic of absorption was used as a classification variable to control for individual differences. It was hypothesized that high absorption individuals would reveal higher levels of imagery vividness, involvement, and finger temperature change; that imagery skill instruction and muscle relaxation would be more effective than a control condition; and that the low absorption group would derive the greatest benefit from the imagery task instruction condition. None of the hypotheses was supported. Finger temperature increased over time during the experimental procedure but remained stable during thermal imagery. The results suggest that nonspecific relaxation effects may best account for finger temperature increases during thermal imagery. Results were discussed in relation to cognitive-behavioral theory and the characteristic of absorption.

Serotonin syndrome (SS) is a drug-induced toxicity caused by an excess of serotonin (5-HT) in the central nervous system (CNS). The symptoms of the disorder range from mild to severe, with the severe state evoking life-threatening hyperthermia. Autonomic dysfunction is controlled in part by serotonin receptors, with the 5-HT2A receptor responsible for increasing core body temperature (Tcor). Our results show that the 5-HT2A receptors on the preoptic/anterior hypothalamus (PO/AH) and prefrontal cortex (PFC), in particular, are sensitive to changes in ambient temperature (Tamb). The toxic increase of 5-HT is postulated to occur due to the temperature-dependent activation of these receptors that promotes a positive feedback mechanism. Our results suggest that changes in Tamb can either exacerbate or alleviate the symptom and that this is mediated by the 5-HT2A receptors. Understanding the mechanism involved in elevating Tcor is imperative in treating and preventing the disorder. / by Swapna Krishnamoorthy. / Vita. / Thesis (M.S.)--Florida Atlantic University, 2008. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2008. Mode of access: World Wide Web.