Orientador: Silke Anna Theresa Weber / Coorientador: Sergio Henrique Kiemle Trindade / Banca: Silke Anna Theresa Weber / Banca: Gabriel Megnetti Guinado / Banca: José Vicente Taglianini / Resumo: Introdução: A Síndrome de Apneia Obstrutiva do Sono (SAOS) se caracteriza pela obstrução parcial e/ou completa intermitente da via aérea superior, causada pelo colabamento da musculatura faríngea, levando à cessação ou diminuição do fluxo aéreo respiratório e consequentemente à hipóxia intermitente e hipercapnia. A manifestação diurna mais comum de SAOS é a sonolência diurna, relatada já há mais de 2000 anos. A obesidade é o fator causal reversível mais frequente associado à SAOS, sendo a atividade física importante componente para o seu tratamento. A hipótese levantada neste estudo foi que pacientes com SAOS apresentariam alterações na sua qualidade do sono, com maior sonolência diurna e menor disposição de realização de atividade física, além de alterações na componente FEF25%-75% da espirometria, sendo essa a componente relacionada à fração expiratória involuntária sem interferência da musculatura respiratória. Nestes pacientes, o uso adequado do CPAP com pressão terapêutica poderia melhorar essas alterações, mesmo em curto prazo. Objetivo: Avaliar parâmetros da qualidade do sono, sonolência diurna, disposição para atividade física e da função pulmonar em pacientes com SAOS, antes e após o uso de CPAP. Métodos: Trata-se de estudo randomizado, duplo cego, com aprovação pelo comitê de Ética em Pesquisa local (protocolo nº41/2013. Foram convidados pacientes de ambos os gêneros, em acompanhamento no ambulatório de ventilação não invasiva, com idade entre 30 a 75 anos, com diagnóstico polissonográfico de SAOS. Os pacientes foram randomizados por sorteio pelo orientador sem conhecimento dos fisioterapeutas e foram alocados em dois grupos, sendo o Grupo I composto por pacientes em uso de CPAP em pressão mínima de 4 cmH2O e o Grupo II por pacientes em uso de CPAP na pressão terapêutica ideal. Todos pacientes receberam o equipamento de CPAP disponibilizado pelo serviço de ... / Abstract: Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is characterized by the complete or partial intermittent obstruction of the upper airway due to colapse of the pharyngeal muscles, causing the cessation or reduction of the respiratory airflow and, consequently, intermittent hypoxia and hipercapnia. The most common daytime symptom is excessive daytime sleepiness, reported already as long as 2000 years ago. Obesity is the most frequent reversibel causal fator, being physical activity an important component for its treatment. We hypothezised that OSA patients would show disordered sleep quality, higher daytime sleepiness and lower disposal for physical activity, beside changes at the spyrometric fraction FEF25%-75%, as being the componente related to unvoluntary expiration phase without interference of the expiration muscles. The adequate use o of nighttime CPAP would improve these conditions, even after a short period of intervention. Aims: To study the parameters for sleep quality, excessive daytime sleepiness, diposal for physical activity and of spirometry in OSA patients, before and after CPAP therapy. Methods: This double-blind, randomized study was approved by the local Ethics Comission. There were invited patients at follow-up at the ambulatory for non-invasive ventilation, aged 30 to 75 years old, both genders, all diagnosed OSAS by full-night polysomnography. They were randomized for two groups without the knowledge ot the physical therapeut, Group I receiving the CPAP with minimal pressure at 4 cmH2O and Group II at ideal therapeutic pressure. An equipment with blinded visor was disposed to all patients, thus, nor the patients, neither the physical therapeut had access to the ventilatory data. At two moments, before and after 7 days of CPAP treatment, all patients answered the questionnaires for daytime sleepiniess (Epworth Sleepiniess Scale), sleep quality (Pittsburgh questionnaire) and disposal for physical activity ... / Mestre

研究背景與目的：近年來，有不少研究指出阻塞性睡眠呼吸中止疾患（簡稱OSA）患者呈現出高比例的憂鬱情緒，但其盛行率結果分歧，回顧過往文獻也發現OSA與憂鬱情緒的關聯性之結果亦呈現分歧的結果。值得注意的是，OSA與憂鬱情緒之間存在著類似的症狀表現——白天嗜睡，OSA患者可能依據OSA伴隨的嗜睡症狀，回應憂鬱問卷或診斷中的問題，而使其受到誤診或是使盛行率受到高估。為探討此議題，本研究進行兩項研究，分別以橫斷及長期追蹤的資料，探討（一）OSA患者的憂鬱情緒是否聚焦於身體面向，且OSA與憂鬱情緒之間是否受到白天嗜睡中介，以及（二）OSA患者睡眠檢查長期追蹤資料中憂鬱情緒的改變，是否與白天嗜睡程度有關。 研究方法：研究一以台北醫學大學附設醫院睡眠中心資料庫中，2010至2015年到台北醫學大學附設醫院睡眠中心看診並進行PSG檢測時所收集的資料（AHI、醒覺指標、缺氧指標、平均血氧飽和度、最低血氧飽和度、BDI-IA、ESS）進行分析，在排除小於20歲與睡眠疾患共病之後，共有2140位OSA（364女、1776男）患者資料被納入分析。本研究針對OSA患者的憂鬱情緒（BDI-IA）分數進行探索性因素分析，並以此因素結構與Beck與Steer（1993）所得之憂鬱情緒面向結構進行模型競爭，以求更適配於OSA患者之因素結構。再者，本研究取具輕度以上憂鬱情緒的OSA患者資料，以線性迴歸分析了解OSA嚴重度（AHI）、嗜睡程度（ESS得分）與憂鬱情緒（BDI-IA、身體面向、認知面向）之間的關聯性，並以拔靴法進行中介模型的檢定。此外，欲探討OSA患者的憂鬱情緒可能聚焦於身體面向，本研究亦將OSA患者依症狀嚴重度分組，並比較不同症狀嚴重度OSA患者的認知面向與身體面向憂鬱分數。研究二則是以台北醫學大學附設醫院睡眠中心資料庫追蹤一年至兩年間的OSA患者的資料進行資料分析，由於女性人數過少，因此僅納入81位男性OSA患者資料進行統計分析。 研究結果：研究一探索性因素分析結果顯示，「體重減輕」與「煩躁易怒」在因素分析結果的負荷量相當低，無法歸類至其一面向，予以排除，且「不滿自我」、「社交退縮」、「優柔寡斷」三題（原認知面向題項）在OSA患者樣本中被歸類至身體面向。競爭模型結果顯示，本研究所得之因素結構AIC值較低，因此以本研究所得之因素結構進行後續分析中認知面向與身體面向憂鬱情緒之計分與分析。以具憂鬱情緒的OSA患者資料進行相關分析結果發現，AHI 、覺醒指標、 缺氧指標、平均血氧飽和度、最低血氧飽和度皆與ESS呈現顯著相關；且ESS與BDI、身體面向、認知面向憂鬱情緒皆呈現顯著正相關。值得注意的是，OSA症狀嚴重度AHI雖未與BDI呈現顯著關聯性，但與身體面向憂鬱情緒達顯著正相關，且OSA病理機轉——醒覺指標、缺氧指標、平均血氧飽和度亦與身體面向憂鬱情緒達顯著關聯性。拔靴法結果顯示，在控制年齡與BMI後，ESS僅中介於醒覺指標與身體面向憂鬱情緒間的關聯性。將男女性分組後，女性患者的ESS中介於AHI與身體面向憂鬱情緒、醒覺指標與身體面向憂鬱情緒、以及缺氧指標與身體面向憂鬱情緒之間的關聯性，但男性OSA患者則無此中介效果。將OSA患者依症狀嚴重度分組，針對不同症狀嚴重度OSA患者的認知面向與身體面向憂鬱分數進行重複量數檢定，發現不論AHI為輕、中、重度，身體面向憂鬱分數皆較認知面向來得高。研究二檢視OSA患者一年至兩年間追蹤的結果，發現AHI改變量與BMI改變量，無論對於ESS的改變量、BDI-IA總分的改變量、認知面向以及身體面向憂鬱情緒的改變量，皆無顯著相關性；而ESS改變量則與BDI-IA總分的改變量、認知面向憂鬱情緒的改變量、身體面向憂鬱情緒的改變量呈現顯著相關性。依ESS改變量分組後，進一步以單因子變異數分析對BDI-IA改變量、認知面向憂鬱情緒改變量、身體面向憂鬱情緒改變量進行檢定，結果顯示，無論在BDI-IA改變量、認知面向憂鬱情緒改變量、或身體面向憂鬱情緒改變量，皆達顯著差異；而事後檢定顯示，無論在BDI-IA改變量、認知面向、身體面向憂鬱情緒，ESS升高組與ESS無變化組、ESS降低組呈現顯著差異，而ESS無變化組則與ESS降低組無顯著差異。 結論：本研究OSA患者自評BDI-IA的結果發現有高達35%的患者至少有輕度以上的憂鬱情緒，且本研究發現在女性OSA患者身上，OSA嚴重度、睡眠片段化病理機轉，與憂鬱情緒間，受到白天嗜睡程度中介；且OSA患者的憂鬱情緒明顯聚焦於身體面向上，此結果說明OSA患者的憂鬱情緒可能受到白天嗜睡程度所影響，本研究在於提醒臨床工作者對OSA患者進行憂鬱症臨床診斷時，需注意與釐清OSA患者是否以白天嗜睡的情況，來回應憂鬱症狀相關的嗜睡表現，以降低誤判OSA患者憂鬱情緒的可能性。 / Aims: Recent years, researchers found high prevalence of depression occurred in OSA patients. However, the inconsistency was also found in depression prevalence and in the association between OSA and depressive mood. Notably, excessive daytime sleepiness is one of common symptoms of both OSA and depression. High prevalence of depression might be an overestimation due to excessive daytime sleepiness reported by OSA patients. Two studies (cross-sectional and longitudinal studies) were conducted to examine (1) whether the depressive symptoms in OSA patients are more somatic in nature and whether mediation effect between OSA and depression exist, and (2) whether the changes in depressive mood correlate with the changes in excessive daytime sleepiness showed in long term follow-up data. Methods: Sleep test data (including AHI, arousal index, desaturation index, mean SaO2, lowest SaO2, BDI-IA, ESS) retrieved from database of Taipei Medical University Hospital Sleep Center from year 2010 to 2015 was used in Study 1. 2140 OSA patients (364 F、1776 M) were included after rule out patients who is under 20 year-old or comorbid with other sleep disorders. Exploratory factor analysis was conducted to extract the dimensions of depressive mood in OSA patients and the dimensions obtained were further compared with those of Beck and Steer (1993) through competing models. Furthermore, correlations between OSA severity, OSA pathological mechanism, excessive daytime sleepiness, and depressive mood were analyzed in the data of OSA patients with depressive mood, and boostrapping method was conducted to test mediation effect. For examining whether the depressive symptoms in OSA patients are more somatic in nature, cognitive dimension and somatic dimension were compared within different OSA severity. One to two year follow-up sleep test data retrieved from database of Taipei Medical University Hospital Sleep Center was analyzed in Study 2. There were only 81 male OSA patient data included due to the small numbers of female patients. Results: Exploratory factor analysis in Study 1 showed that “weight loss” and “irritability” should be excluded due to low factor loading in depressive mood of OSA patients. “Dissatisfaction”, “social withdrawal” and “indecisiveness” were categorized into somatic dimension in OSA patients. Competing models indicated the factors obtained in exploratory factor analysis were preferred due to lower AIC value, which suggested the model was better fit to OSA patients. Correlation analysis showed that AHI, arousal index, desaturation index, mean SaO2, lowest SaO2, BDI-IA score, somatic dimension and cognitive dimension significantly correlated with ESS. Notably, although the correlation between AHI and BDI-IA was non-significant, AHI positively correlated with somatic dimension. OSA pathological mechanism (arousal index, desaturation index, mean SaO2) also significantly correlated with somatic dimension on BDI-IA. After controlling age and BMI, mediation effects of excessive daytime sleepiness were only found on the relation of arousal index and somatic dimension. Mediation effects were also found on the relation of AHI and somatic dimension, on the relation of desaturation index and somatic dimension, and on the relation of arousal index and somatic dimension in female OSA patients, but the mediation effect was not found in male OSA patients. Furthermore, 3 X 2 ANOVA repeated measurement showed somatic dimension was significantly higher than cognitive dimension on BDI-IA in different AHI severity group. Follow-up data in Study 2 showed the change of AHI and BMI were not correlated with the change of ESS, BDI-IA, cognitive dimension and somatic dimension on BDI-IA. However, the change of ESS was significantly correlated with the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA. Furthermore, the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA were tested in different ESS change group. Results showed that the change of BDI-IA, cognitive dimension and somatic dimension on BDI-IA were significant in different ESS change group. Post-hoc analysis indicated the change of BDI-IA, cognitive dimension and somatic dimension in ESS elevated group were significantly different from ESS maintained group and ESS descend group but the difference between ESS maintained group and ESS descend group was non-significant. Conclusion: 35% of OSA patients were classified as co-occurring depressive mood using BDI-IA. However, mediation effect of excessive daytime sleepiness was found in female patients on the relation of OSA severity and depressive mood, and also on the relation of sleep fragmentation and depressive mood. Furthermore, depressive symptoms in OSA patients are more somatic in nature. The results showed depressive mood in OSA patients was probably affected by the excessive daytime sleepiness. The findings suggested the need to clarify the effect of excessive daytime sleepiness to prevent the overestimation of depressive mood in OSA patients.

O presente trabalho visa analisar em que medida a alteração das circunstâncias negociais que levem à situação de onerosidade excessiva prevista pelo Código Civil produz efeitos sobre a utilidade que as partes derivam dos contratos de engineering, considerados estes como contratos que têm por objeto o desenvolvimento de projetos industriais e de infraestrutura de grande porte. Situa esses contratos em seu contexto histórico e social, descrevendo seus principais elementos de distinção, especialmente a complexidade e risco das operações econômicas que lhes é subjacente e os qualifica como contratos socialmente típicos, sujeitos ao regime dos contratos de empreitada. A tese discute a adequação do tratamento jurisprudencial que vem sendo dado à onerosidade excessiva e descreve os esquemas negociais geralmente usados em tais contratos para fins de alocação de riscos. Finalmente, a tese discute a aplicação de modelos da Análise Econômica do Direito, como a Teoria dos Contratos Incompletos, como subsídio para a valoração de aplicabilidade das normas sobre onerosidade excessiva aos contratos de engineering e análise dos efeitos de sua aplicação sobre esses contratos. / The aim of this work is to analyze to what extent changed circumstances that are contractually relevant, so as to characterize the legal figure of excessive onerosity [a situation of material burden for complying with a given obligation on one of the contracting parties] pursuant to the Brazilian Civil Code, bring about effects on the payoffs the contracting parties derive from so-called engineering agreements, understood as agreements for the development of large-scale industrial and infrastructure projects. The work traces back the historical and social context of such agreements and describes their main distinguishing features, especially the complexity and risk elements of their underlying economic transactions. The work also describes such agreements as socially codified agreements, subject to the discipline of a legally codified figure called empreitada [or contractor agreement]. The work also discusses how court precedents deal with the legal figure of excessive onerosity and describes the deal structures normally used in such agreements for the purposes of risk allocation. Finally, the work discusses the application of Law & Economics models, such as the Theory of Incomplete Contracts, as a tool for evaluating the applicability of rules governing the legal figure of excessive onerosity to engineering agreements and analyzing their respective effects.

Mes travaux de thèse se sont axés sur deux thématiques. Elles ont en commun un possible dysfonctionnement de la transmission dopaminergique. La première visait à étudier l’implication de la dopamine dans les troubles de la régulation veille/sommeil se produisant dans la maladie de Parkinson en utilisant le modèle de référence de cette pathologie, le primate non-humain (PNH) intoxiqué au 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP). Pour y parvenir, nous avons utilisé un système télémétrique totalement implantable autorisant des enregistrements électroencéphalographiques, électrooculographiques et électromyographiques de longue durée chez des animaux libres de leurs mouvements. L’induction d’un syndrome parkinsonien a eu pour conséquence une totale dérégulation de l’architecture des cycles veille/sommeil persistant durant des années après les injections de MPTP. La somnolence diurne excessive et la dérégulation du sommeil paradoxal sont les signes les plus marquants de l’intoxication au MPTP et apparaissent avant l’émergence des signes moteurs. Ces dérégulations précoces sont concomitantes d’une perturbation profonde de l’homéostasie dopaminergique qui se rétablit partiellement sur le long cours grâce à des mécanismes compensatoires au sein du système dopaminergique. L’ensemble étant responsable d’une réapparition partielle du sommeil paradoxal ainsi qu’une diminution de la somnolence diurne, parallèlement à la récupération motrice. En conclusion, ces résultats soulignent la validité du modèle du primate non-humain intoxiqué au MPTP pour la modélisation des troubles du sommeil de la maladie de Parkinson. Il permettra in fine de comprendre le rôle de la déplétion dopaminergique et, au-delà, de l’intervention des autres systèmes de neurotransmission dans la physiopathologie de ces troubles. La seconde partie de ma thèse a été consacrée à l’étude anatomo-fonctionnelle de la voie dopaminergique diencéphalospinale (groupe A11) chez le PNH. En effet, si cette voie semble impliquée dans les processus sensori-moteurs et son dysfonctionnement supposé dans de nombreuses pathologies, son organisation anatomique reste méconnue, à la fois chez l’homme et le PNH. L’hybridation in situ réalisée au niveau médullaire a révélé que le sous-type de récepteur dopaminergique D1 est absent alors que les récepteurs D2 et D5 sont exprimés au niveau des cornes dorsales et les récepteurs D3 dans l’ensemble de la substance grise. Des injections unilatérales du traceur rétrograde FluoroGold au niveau de la moelle cervicale ont quasi-exclusivement marqué les neurones hypothalamiques du groupe A11 parmi l’ensemble des régions dopaminergiques. Des analyses détaillées de ces neurones par immunohistochimie indiquent qu’ils sont positifs pour la tyrosine hydroxylase et négatifs pour la dopa-décarboxylase et le transporteur à la dopamine, suggérant un noyau de nature « L-Dopaergique ». Cependant, une intoxication au MPTP conduisant au développement d’un syndrome Parkinsonien a induit une perte de 50% des neurones de l’aire A11. En conclusion, la voie diencéphalospinale serait la source majeure de L-dopa dans la moelle épinière du PNH où elle jouerait un rôle dans la modulation de l’intégration sensori-motrice principalement au travers des récepteurs D2 et D3 soit directement, soit indirectement par conversion de la L-dopa en dopamine au niveau des cellules médullaires monoenzymatiques pour la dopa-décarboxylase. La remarquable correspondance anatomique entre l’homme et le PNH renforce la pertinence de cette espèce pour l’étude de la physiologie des circuiteries dopaminergiques hypothalamiques et des conséquences fonctionnelles de leurs dysfonctionnements. / My thesis work was based on two topics bridged by a common dopaminergic neurotransmission dysfunction. The first one aimed to investigate the role of dopaminergic denervation in the pathophysiology of the sleep-wake disorders that occur in Parkinson’s disease (PD) by using the gold-standard model of parkinsonism, the 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP)-treated non-human primate (NHP) model. To this end, we performed long-term continuous electroencephalographic monitoring of vigilance states in unrestrained rhesus monkeys using a completely implanted miniaturized telemetry device and tested the effect of MPTP intoxication on their sleep-wake organization. MPTP injection yielded a dramatic disruption of sleep-wake architecture with reduced sleep efficacy that persisted years after MPTP administration. Primary deregulation of REM sleep and increased daytime sleepiness occurring before the emergence of motor symptoms were the most striking features of the MPTP administration. This was concomitant with a breakdown of the dopaminergic homeostasis, as evidenced by a decreased dopamine turnover measured after a single MPTP injection. In the long term, partial reemergence of REM sleep and resolution of excessive daytime sleepiness paralleled the partial adaptation to parkinsonism, the latter being known to result from compensatory mechanisms within the dopaminergic system. Altogether, these findings highlight the suitability of the MPTP model of PD as a valid tool to model the sleep/wake disturbances of the human disease. Ultimately, this may help in deciphering the specific role of dopamine depletion and the different interventions of other neurotransmitters in the occurrence of these disorders. The second part of my thesis was dedicated to an anatomical study of the diencephalospinal pathway (A11 cell group) in the NHP. This pathway is thought to be involved in sensorimotor integration and, when disrupted, in some pathological conditions such as PD or Restless Legs Syndrome. However, its anatomical organization is almost unknown both in human and NHP. In situ hybridization of dopamine receptors showed that D1 receptor mRNA is absent while D2 and D5 receptor mRNAs are expressed in the dorsal horn and D3 receptor mRNA in both the dorsal and ventral horns. Unilateral injections of the retrograde tracer FluoroGold (FG) into the cervical spinal enlargement labeled A11 neurons quasi-exclusively among all others dopamine areas. Detailed immunohistochemical analysis showed that these FG-labeled A11 neurons are tyrosine hydroxylase-positive and dopa-decarboxylase and dopamine transporter-negative, suggestive of a L-DOPAergic group. Nevertheless, MPTP intoxication with subsequent development of a parkinsonian syndrome produced a 50% neuronal cell loss in the A11 group. In conclusion, the diencephalic A11 area could be the major source of L-DOPA in the NHP spinal cord, where it may play a role in the modulation of sensorimotor processes through D2 and D3 receptors either directly or indirectly via dopamine formation in spinal monoenzymatic dopa-decarboxylase cells.

O presente trabalho visa analisar em que medida a alteração das circunstâncias negociais que levem à situação de onerosidade excessiva prevista pelo Código Civil produz efeitos sobre a utilidade que as partes derivam dos contratos de engineering, considerados estes como contratos que têm por objeto o desenvolvimento de projetos industriais e de infraestrutura de grande porte. Situa esses contratos em seu contexto histórico e social, descrevendo seus principais elementos de distinção, especialmente a complexidade e risco das operações econômicas que lhes é subjacente e os qualifica como contratos socialmente típicos, sujeitos ao regime dos contratos de empreitada. A tese discute a adequação do tratamento jurisprudencial que vem sendo dado à onerosidade excessiva e descreve os esquemas negociais geralmente usados em tais contratos para fins de alocação de riscos. Finalmente, a tese discute a aplicação de modelos da Análise Econômica do Direito, como a Teoria dos Contratos Incompletos, como subsídio para a valoração de aplicabilidade das normas sobre onerosidade excessiva aos contratos de engineering e análise dos efeitos de sua aplicação sobre esses contratos. / The aim of this work is to analyze to what extent changed circumstances that are contractually relevant, so as to characterize the legal figure of excessive onerosity [a situation of material burden for complying with a given obligation on one of the contracting parties] pursuant to the Brazilian Civil Code, bring about effects on the payoffs the contracting parties derive from so-called engineering agreements, understood as agreements for the development of large-scale industrial and infrastructure projects. The work traces back the historical and social context of such agreements and describes their main distinguishing features, especially the complexity and risk elements of their underlying economic transactions. The work also describes such agreements as socially codified agreements, subject to the discipline of a legally codified figure called empreitada [or contractor agreement]. The work also discusses how court precedents deal with the legal figure of excessive onerosity and describes the deal structures normally used in such agreements for the purposes of risk allocation. Finally, the work discusses the application of Law & Economics models, such as the Theory of Incomplete Contracts, as a tool for evaluating the applicability of rules governing the legal figure of excessive onerosity to engineering agreements and analyzing their respective effects.

In many parts of Australia the climate is such that people are working long hours in the heat. Consequences of excessive environmental heat stress range from reduction in safety due to impairment of concentration, to heat illness, which in extreme cases can be fatal. A critical factor in tolerance of workers to environmental heat stress is their level of hydration. Maximising productivity without compromising the health and safety of the work force requires quantification of the degree of stress posed by the thermal environment. For this purpose a number of heat stress indices have been developed. A recently introduced index is the Thermal Work Limit (TWL), which has been widely adopted and implemented in the underground mining industry in Australia. The field use of TWL and protocols in the mining industry with resultant reduction in heat illness and lost production is a practical endorsement of the index, and its validity under controlled conditions has been confirmed by a preliminary study. The further work needed to complete this validation forms part of this thesis. TWL was found to reliably predict the limiting workload in the controlled environment, reinforcing the validity of the algorithm and its application in the workplace. To date TWL has largely been used in the underground environment, however as the algorithm is equally applicable to the above ground environment where radiant heat forms a significant component of the thermal load, field studies were carried out at mining installations in the Pilbara region of Western Australia to evaluate this application of the index. The current industry standard index of heat stress is the Wet bulb Globe Temperature (WBGT). / The shortcomings of this index are widely acknowledged and in practice it is frequently ignored as it is seen to be unnecessarily conservative in many situations. The sensitivity of TWL to the cooling effect of air movement implied that TWL would be more relevant than WBGT as a predictor of the impact of environmental heat stress in outdoor work environments and this was supported by the results. On the strength of this, recommended management protocols linked to TWL similar to those already in place in many underground workplaces, were developed for the management of thermal risk in outdoor work environments. Maintaining adequate hydration is the single most important strategy to counteract the effects of thermal stress. No heat stress index can protect workers from the combined effects of dehydration and thermal stress. To document the hydration status of the outdoor workforce in the Pilbara, the hydration level of groups of workers was assessed from the specific gravity of their urine. To further evaluate whether the fluid replacement behaviour of the workers is adequate to replace fluids lost in sweat, a fluid balance study was carried out to quantify average fluid intakes and sweat fluid losses. The majority of workers were found to be inadequately hydrated at the start of the shift and their fluid intakes were in general well below the requirements to replace sweat losses - let alone improve hydration. Recommendations for fluid intakes based on documented rates of sweat loss are included in the thesis. Based on the findings of this study workable management strategies have been recommended to minimise the risk to outdoor workers in thermally stressful environments.

Dataspelsproblematik är ett eskalerande problem som har visat sig påverka många unga människors utveckling och välbefinnande. Syftet med denna studie var därför att undersöka ungas dataspelsproblematik, vilka konsekvenser ett överdrivet dataspelande medför samt vilken behandling som ges till unga med dataspelsproblematik. Empirin erhölls genom kvalitativa intervjuer med professionella som arbetar med denna typ av problematik vid verksamheterna Game Over och Theory in Action. Resultatet visade att dataspelsproblematik idag inte har en bestämd definition och att det är ett problem som inte är tillräckligt uppmärksammat. Synen på orsaker till dataspelsproblematik hos unga är komplext då det kan tänkas bero på många olika faktorer. Konsekvenserna av ett problematiskt dataspelande är många och allvarliga och kan påverka den unges hela livssituation. Behandling av unga med dataspelsproblematik har visats sig ske på varierande sätt med olika utgångspunkter beroende på vad man anser är orsaken till problematiken. / Computer game related problems are an escalating problem that has been shown to affect many young people's development and well-being. The purpose of this study was to investigate young people's computer game problems, the consequences of excessive computer game playing and the treatment that is given to young people with computer game related problems. The empirical data were obtained through interviews with professionals who work with this type of problem in the institutions Game Over and Theory in Action. The results showed that computer game related problems do not today have a specific definition, as well as it is a problem that is not sufficiently recognized. The view of the causes of young people’s computer game related problems is complex as it may be caused by many different factors. The consequences of a problematic computer game playing are many and serious, which can affect a young person's entire life situation. Treatment of young people with computer game related problems have been shown to occur in various ways with different starting points depending on what you believe is the cause of the problem.

This dissertation study attempts to understand excessive buying, a phenomenon of both theoretical and practical interest. I define excessive buying as "an individual type of buying behavior whereby consumers repetitively spend more than they should based on financial considerations". I develop a conceptual typology of excessive buying, building on the time-inconsistent preferences and automaticity theory. The new typology categorizes five specific types of excessive buying behavior: 1) habitual, 2) possessive, 3) remedial, 4) rewarding, and 5) out-of-control. Based on past literature and the typology, I generate scale items to capture the conceptual and logical variance in excessive buying. Psychometric properties of the scale are tested via Confirmatory Factor Analysis using a student and random adult sample. Nomological validity of the scale is confirmed by testing hypotheses formulated based on hedonic shopping values and the self-defeating behavior theory. The empirical analyses suggest that excessive buying results from stress, using shopping as an escape from reality, and little consideration for the potential outcomes of one's current behavior. Excessive buying leas to both financial problems and negative emotions.

Exercise is an important part of well-being. However, when performed excessively, it can lead to negative consequences such as anxiety, depression and feelings of guilt. This study aimed to qualitatively investigate what motivational regulations, defined by the Self-determination theory, that may provide an insight into why young women engage in excessive exercise. Data from seven participants was analyzed through a thematic analysis and resulted in four themes: Exercise affected by social influence, Ambivalence toward the amount of exercise, Benefits of exercise and Exercise affecting the sense of self. All of the motivational regulations belonged to the extrinsic type of motivation, ranging from external to integrated regulation, with social influence and health benefits being the most frequently mentioned reasons for exercise. Also, the informants were able to explain why they exercise, but less so in regard to the amount of exercise. / Träning är en förutsättning för välbefinnande. När träning utförs i en överdriven mängd kan det dock leda till negativa konsekvenser som ångest, depression och skuldkänslor. Syftet med denna studie var att kvalitativt undersöka vilka motivationsregleringar definierade av Självbestämmande teori som kan ge en inblick i varför unga kvinnor tränar i en överdriven omfattning. Materialet från sju deltagare analyserades genom en tematisk analys och resulterade i fyra teman: Social påverkan på träning, Ambivalens till träningsmängden, Fördelar med träning och Träning påverkar uppfattningen om sig själv. Alla motivationsregleringar tillhörde den yttre typen av motivation och sträckte sig från extern till integrerad reglering, där social påverkan och hälsofördelar var de mest frekvent nämnda anledningarna till träning. Informanterna kunde ge en förklaring till varför de tränar, men inte avseende deras träningsmängd.

Šiame darbe analizuojamas Europos Bendrijos ir Lietuvos Respublikos konkurencijos teisės normų, reglamentuojančių piktnaudžiavimą dominuojančia padėtimi nustatant nesąžiningas kainas, taikymas. Analizuojama nesąžiningų kainų sąvoka, išskiriant pagrindines tokių kainų rūšis – nepagristai didelės kainos, „grobuoniškos” kainos, diskriminacinės kainos bei nesąžiningas nuolaidų taikymas. Darbe aptariama Europos Teisingumo teismo, Europos Komisijos bei Lietuvos Respublikos Konkurencijos Tarybos bei administracinių teismų praktika, nagrinėjant nesąžiningų kainų taikymo bylas ir pateikiamos pagrindinės taisyklės, pagal kurias nesąžiningas kainas galima atskirti nuo sąžiningų, taip pat trečiame šio darbo skyriuje įvardijamos pagrindinės šių taisyklių taikymo praktikoje problemos. Paskutiniame skyriuje apžvelgiama konkurencijos teisės normų, susijusių su nesąžiningomis kainomis, įgyvendinimas Lietuvoje po įstojimo į ES, analizuojama konkurencijos politikos įgyvendinimo efektyvumas, kokybė, pateikiami pagrindiniai sprendimai bei išaiškinimai, nustatant piktnaudžiavim�� dominuojančia padėtimi taikant nesąžiningas kainas. / This thesis was set out to analyse the application of competition law on unfair pricing related to the abuse of dominant positions in the European Community and the Republic of Lithuania. Firstly, the study gives a definition of unfair pricing and identifies four types of such pricing: excessive pricing, “predatory” pricing, discriminatory pricing and unfair discounts and rebates. Then, it overviews the practice of the European Court of Justice, the European Commission and the Competition Council and the administrative courts of the Republic of Lithuania in hearing cases on unfair pricing. The author then lists the fundamental rules that may help to distinguish between fair and unfair pricing. The third chapter indicates the main problems faced when applying these rules in practice. The last chapter gives an overview of the application of competition law on unfair pricing following Lithuania’s accession to the EU. The author also analyses the effectiveness and quality of the implementation of competition policy and presents the fundamental judgements on and interpretations of unfair pricing in relation to the abuse of dominant positions.