Fatigue is common in the general population, and is the hallmark of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Although the occurrence of sleep difficulties is known to be common in subjects with fatigue, research on insomnia in such subjects is absent. The current study sought to examine the impact comorbid insomnia has on level of fatigue in subjects with chronic fatigue. The aim of this study is to assess the relationship between insomnia and chronic fatigue, and examine if the relationship is affected by the endocrine activity in the HPA axis. The following hypotheses were tested: 1) Do patients with chronic fatigue and comorbid insomnia experience more fatigue than patients with chronic fatigue without comorbid insomnia? 2) Do patients with chronic fatigue and with initially comorbid insomnia experience more fatigue after treatment than chronic fatigue patients without comorbid insomnia? 3) Do patients with chronic fatigue who experience improvement in insomnia after treatment also experience less fatigue by the end of treatment compared with patients who do not experience improvement in insomnia? 4) Is the potential relationship between insomnia and chronic fatigue influenced by the activity of the HPA axis as expressed by variation in cortisol output measured by Trier Social Stress Test for Groups (TSST-G)? The study sample consisted of 75 patients with chronic fatigue. Thirty-three met criteria for insomnia, while 42 did not. While staying at Hysnes Rehabilitation Center in Trondheim, Norway, they received a work-related Acceptance and Commitment Therapy (ACT) treatment intervention lasting 3.5 weeks. In addition, they participated in a standardized stress test (Trier Social Stress Test) pre- and post-treatment. Saliva cortisol samples were collected during the test in order to measure variation in cortisol output. The current finding is the first description of how insomnia in patients with chronic fatigue is associated with higher levels of fatigue (p < .05). Further, this study gives preliminary support indicating that remission of insomnia in patients with chronic fatigue can significantly reduce levels of fatigue (p < .05), and furthermore improve the physiological stress-response (p < .05). These results might encourage clinicians to assess and provide specific treatment for insomnia in patients with chronic fatigue as this might improve their treatment results. An aim for further research should be to investigate the effect of specified treatment for insomnia in patients with chronic fatigue.

Motor activities of daily life or sports are characterized by complex 3D rotational movements of the upper limbs can be done around distinct axes of rotation (i) joint (ii) inertia or (iii) through the center mass of arms, each under separate repositories. A recent study showed that within the constraints of speed, a change of axis of rotation occurs in the context of the implementation of a simple rotation of the arm relative to the trunk (Isableu et al., 2009) . In this context, the aim of the thesis was to complete this first analysis to evaluate the robustness of the assumption that the axes around which organizes the movement depends on the speed of motion and the constraints task in general. The assumption is that the axis corresponding to the minimum inertia reduced variability seen with speeds which increase with respect to a center axis associated with the mass (shoulder mass center of the upper limb) and geometric (pin-shoulder elbow). This study is done by considering "simple" and complex athletic movements including movements. Thus, studies have focused on the influence of the task constraints and their impact on the choice of axes of rotation. Firstly the role of initial instruction is tested. Secondly, the variability of the axis of minimum inertia is estimated in a precise task. Thirdly, the hypothesis is tested in an interception task that involves time constraints. Finally, we tested the role of axes in complex gestures, high speed, especially during launch and broken arm during the tennis serve. The results are used to discuss the hypothesis of the importance of the axis of minimum inertia during the execution of voluntary movements of the upper limb.

Playing violent video games may provoke aggression. Psycho-physiological methods may provide knowledge about the underlying psychological processes. Most previous studies have been performed in laboratory settings at daytime with adults. Thus the aim of this thesis was to investigate psycho-physiological (autonomic and HPA related reactions), sleep-related and emotional responses in teenage boys to playing a violent and a non-violent video game at home before going to sleep. In Study I the autonomic responses differed between the violent and the non-violent game during playing and more distinctly during sleep. In Study II the HPA axis was not affected by video gaming at all. In Study III, the effect of habits of playing violent games was assessed (≤ 1h/day and ≥ 3h/day). High versus low experience of violent gaming were related to different autonomic, sleep-related and emotional processes at exposure to a violent and a non-violent game, during playing and during sleep. The present thesis demonstrated that violent and non-violent games induce different autonomic responses during playing and – more distinctly – during sleep. Frequent gaming seems to influence physiological, sleep-related and emotional reactions, possibly as an expression of desensitization processes.

This thesis analyzes the wavering characteristic of the relations between the United States and the European powers by taking the Iraqi war of 2003 as a case in point. The tension in transatlantic relations that emerged with the US&rsquo / Iraqi invasion in March 2003 is analyzed within the framework of the structural analysis. The broader context of the causes of tension in transatlantic relations is further explored. The US&rsquo / Iraqi invasion has demonstrated us that she wants to reproduce her Middle Eastern policy by having a direct possession over the power structures. This fact led to the opposition of two main European powers, namely France and Germany. Those countries, which might be regarded as constituting the Franco-German axis, have been trying to involve into the US&rsquo / policy of reproducing the power structures. Whether the US is willing to give the Franco-German axis this role is also a key point, which is explored. Furthermore, in the thesis, attempts of the US and the Franco-German axis towards mending the fences in transatlantic relations that have been deteriorated with the Iraqi crisis are analyzed. The thesis seeks to show that the prospects for cooperation in transatlantic relations are an open-ended process due to the fact that there are both existing problems and opportunities for cooperation in transatlantic relations.

Five-axis CNC milling machine tools bring great facility to produce complex workpieces with increased dimensional accuracy and better surface quality in shorter machining times. However, kinematics of five-axis machine tools has a complex form which makes it difficult to operate these machine tools properly. The difficulty arises from the complexity of NC-Code generation and tool path verification. Collision of machine tool or setup components with each other is a severe problem in five-axis machining operations and usually results from inadequate postprocessors or insufficient collision checking due to absence of well-prepared simulation and verification programs. Five-axis CNC machine tool owners may get rid of this problem by purchasing commercial postprocessors, simulation and verification programs. However, these programs are expensive and small and medium enterprises (SME&rsquo / s) usually cannot afford the costs of these programs. In the related libraries of commercial programs, there is great number of CNC machine tools, which is generally unnecessary for SME&rsquo / s. An alternative to overcome this problem is to develop particular program, which is capable of postprocessing, simulating and verifying milling operations, for each certain five-axis CNC machine tool. In this study, a software named &ldquo / Manus 1.0&rdquo / , which performs postprocessing and simulation processes, has been developed for the high speed &ldquo / Mazak Variaxis 630-5X&rdquo / CNC five-axis machine tool, located in METU-BILTIR Center. Moreover, tool path verification algorithms have been developed to detect collisions. The software has been written in Borland C++ Builder5.0. The developed program has been tested in sample milling operations and satisfactory results have been achieved.

Die depressive Störung stellt eine weltweit häufige Erkrankung dar, die trotz vieler therapeutischer Optionen zu chronischen Verläufen und Non-Response neigt. Zirka 30 bis 50% der Patienten mit einer akuten Depression respondieren nicht auf eine Behandlung mit einem Antidepressivum trotz ausreichender Dauer und Dosis, so dass nach neuen pharmakologischen Ansätzen gesucht wird. Zudem sind Prädiktionsmöglichkeiten, was wem wann hilft, kaum vorhanden, so dass die klinische Praxis ein Versuchs- und Irrtumsverfahren ist. Ätiologisch gibt es gut dokumentierte neuroendokrinologische Befunde, die für eine Dysregulation der Hypothalamus-Hypophysen-Nebennierenrinden-Achse (HPA-Achse) im Sinne einer erhöhten Aktivität und einer erhöhten Auslenkbarkeit bei Depressionen sprechen. Für verschiedene antidepressive medikamentöse Therapien ist eine Normalisierung dieser Dysregulation beschrieben worden. Der sensitivste und spezifischste Test zur Untersuchung der HPA-Achse bei psychiatrischen Patienten ist der kombinierte Dexamethason/CRH-Test. Hierbei zeigen Patienten während der depressiven Phase eine deutliche Überstimulierbarkeit, d. h. bei depressiven Patienten führte die Gabe von Dexamethason mit anschließender CRH-Injektion zu einer überschießenden ACTH- und auch Cortisol-Antwort. Der Einfluss einer Behandlung mit Antidepressiva auf die HPA-Achse und der Zusammenhang möglicher Veränderungen der HPA-Achsen-Regulation mit dem Ansprechen oder Nicht-Ansprechen auf die Pharmakotherapie ist noch unzureichend beforscht. Teilweise gibt es sogar divergierende Befunde. In der vorliegenden Arbeit wurde mit Hilfe des Dexamethason/CRH-Tests der Einfluss einer antidepressiven Pharmakotherapie mit Citalopram auf die Regulation der HPA-Achse bei 30 vorwiegend unbehandelten Patienten mit einer Majoren Depression untersucht. Die SSRI sind die am häufigsten angewendeten Antidepressiva. Citalopram ist neben seinem S-Enantiomer Escitalopram der selektivste SSRI, der gewählt wurde, um gezielt die Auswirkungen einer rein serotonergen antidepressiven Behandlung zu untersuchen. Vor Beginn der Therapie und nach vierwöchiger Behandlung wurden mittels kombinierten Dexamethason/CRH-Tests bei den Patienten Cortisol- und ACTH-Konzentrationen im Serum gemessen. Die Diagnosen wurden mit SKID I und II bestätigt. Im wöchentlichen Rhythmus wurde während des vierwöchigen Studienverlaufs die aktuelle depressive Symptomatik sowie der Gesamtkrankheitszustand der Patienten mittels Selbst- (BDI) und Fremdratingbögen(HAM-D, CGI) erhoben. Ebenfalls im wöchentlichen Rhythmus wurden medikamentenassoziierte Nebenwirkungen systematisch erfasst. Unter der Behandlung zeigten sich erfreulich viele Responder auf die antidepressive Pharmakotherapie mit Citalopram (23 von 30 Patienten). Eine Herabregulierung der HPA-Achse zeigte sich unter der Behandlung nur auf der Hypophysenebene für die ACTH-Antwort, allerdings nicht auf der Nebennierenrindenebene für die Cortisol-Antwort. Trotz geringerer ACTH-Konzentrationen wurde nach vier Wochen noch die gleiche Menge an Cortisol in der Nebennierenrinde produziert. Die AUC total für ACTH betrug vor der antidepressiven Behandlung mit Citalopram 2077 ± 1260. Nach vier Wochen antidepressiver Pharmakotherapie zeigte sich ein Wert von 1393 ± 485 und damit ein signifikanter Unterschied (p=0,010). Für die AUC total für Cortisol zeigte sich wie bereits erwähnt kein signifikanter Unterschied (AUC total vor Behandlung: 4755 ± 3411 und nach vier Wochen Behandlung: 4901 ± 3688; p=0,813). Möglicherweise ist dies auf einen direkten Effekt von Citalopram auf die Nebennieren im Sinne einer Sensibilisierung zu verstehen. Wirkungen in dieser Richtung wurden bislang nicht beschrieben. Ein prädiktiver Wert für das Ansprechen auf die Behandlung konnte für den Dex/CRH-Test nicht gefunden werden. Responder und Non-Responder unterschieden sich nicht. Auch das aufwendige Procedere des Testes limitiert ihn für eine regelhafte Anwendung in der Klinik. Allerdings besteht weiterhin in diesem Bereich Forschungsbedarf, um die unterschiedlichen Befunde einordnen zu können. Dabei wären z. B. Studien mit einer größeren Fallzahl sowie ein Vergleich mit einer Placebobehandlung wünschenswert.

Three-dimensional movement analysis was used to evaluate head and neck movement in patients with neck pain and matched controls. The aims were to further develop biomechanical models of head and neck kinematics, to investigate differences between subjects with non-specific neck pain and whiplash associated disorders (WAD), and to evaluate the potential of objective movement analysis as a decision support during diagnosis and follow-up of patients with neck pain. Fast, repetitive head movements (flexion, extension, rotation to the side) were studied in a group of 59 subjects with WAD and 56 controls. A back propagation artificial neural network classified vectors of collected movement variables from each individual according to group membership with a predictivity of 89%. The helical axis for head movement were analyzed in two groups of neck pain patients (21 with non-specific neck pain and 22 with WAD) and 24 matched controls. A moving time window with a cut-off angle of 4° was used to calculate finite helical axes. The centre of rotation of the finite axes (CR) was derived as the 3D intersection point of the finite axes. A downward migration of the axis during flexion/extension and a change of axis direction towards the end of the movements were observed. CR was at its most superior position during side rotations and at its most inferior during ball catching. This could relate to that side rotation was mainly done in the upper spine, while all cervical vertebrae were recruited to stabilize the head in the more complex catching task. Changes in movement strategy were observed in the neck pain groups: Neck pain subjects had lower mean velocities and ranges of movements as compared with controls during ball catching, which could relate to a stiffer body position in neck pain patients in order to stabilize the neck. In addition, the WAD group had a displaced axis position during head repositioning after flexion, while CR was displaced during fast side rotations in the non-specific neck pain group. Pain intensity correlated with axis and CR position, and may be one reason for the movement strategy changes. Increased amount of irregularities in the trajectory of the axis was found in the WAD group during head repositioning, fast repetitive head movements and catching. This together with an increased constant repositioning error during repositioning after flexion indicated motor control disturbances. A higher group standard deviation in neck pain groups indicated heterogeneity among subjects in this disturbance. Wireless motion sensors and electro-oculography was used simultaneously, as an initial step towards a portable system and towards a method to quantify head-eye co-ordination deficits in individuals with WAD. Twenty asymptomatic control subjects and six WAD subjects with eye disturbances (e.g. dizziness and double vision) were studied. The trial-to-trial repeatability was moderate to high for all evaluated variables (single intraclass correlation coefficients >0.4 in 28 of 32 variables). The WAD subjects demonstrated decreased head velocity, decreased range of head movement during gaze fixation and lowered head stability during head-eye co-ordination as possible deficits. In conclusion, kinematical analyses have a potential to be used as a support for physicians and physiotherapists for diagnosis and follow-up of neck pain patients. Specifically, the helical axis method gives information about how the movement is performed. However, a flexible motion capture system (for example based on wireless motion sensors) is needed. Combined analysis of several variables is preferable, as patients with different neck pain disorders seem to be a heterogeneous group.

Free-flowing water currents such as tides and unregulated water courses could contribute to world electricity production given the emergence of robust technical solutions for extracting the energy. At Uppsala University, a concept for converting the energy in water currents to electricity using a vertical axis turbine with fixed blade-pitch and a direct-drive permanent magnet generator is studied. Technological equipment for extracting energy from water currents can be studied at desktop to some extent, but physical realizations, first in a laboratory setting, and later in a natural aquatic setting, are necessary. For this reason, a laboratory generator has been constructed and evaluated, and an experimental setup comprising turbine, generator and control system has been constructed. The turbine and generator are to be deployed in the Dalälven River in Söderfors, and operated from an on-land control station. The author has worked with constructing and evaluating the low-speed laboratory generator, participated in the design and construction of the Söderfors generator, and designed and constructed the control system for Söderfors. The generator design incorporates a low rotational speed, permanent magnets, and many poles, in order to adapt the generator to the nature of water currents. Simulations and experimental data for the laboratory prototype have been compared and show that the simulation tool used is adequate for design studies of this type of generator. The generator has also been shown to be able to operate with the intended turbine design and range of water velocities. The control system to be used in Söderfors has been tested in a laboratory environment. Simulations of the control system show that it should be able to operate the turbine and generator at the desired rotational speeds in water velocities up to about 1.8 m/s. Simulations of the system have also shown that maximizing system power output may not correspond with maximizing turbine power.

Background: Historically, many reference lines and planes of the human skull have been used in an attempt to depict the head in a natural head position (NHP) which is a relaxed/balanced position when looking ahead at their eye level. Head position correction has been attempted in fields such as anatomy, art, anthropology, orthodontics, oral and maxillofacial surgery, plastic surgery, and forensics. In orthodontics, oral and maxillofacial surgery, and plastic surgery, corrected head position (CHP) is particularly important for diagnosis of the normality/protrusion/retrusion of the patient’s facial skeleton. Usually a single plane, such as Frankfurt horizontal, is used to correct head position, but its angulation is variable between individuals, because each individual’s anatomy is unique. It has been found previously that the Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism, and these planes averaged -1 to -2 degrees from the true horizontal (HOR, which is a horizontal plane determined as being perpendicular to the earth’s gravitational force) with subjects in NHP. Methods: Craniofacial planes were measured in an Aboriginal Australian sample and in two contemporary samples obtained from Australian orthodontic practices, and the findings were compared with previous studies. Each sample consisted of 40 individuals (20 males and 20 females) with subjects in NHP. The Aboriginal Australian sample was longitudinal (T1, mean age 10 years; T2, mean age 14 years, and T3, mean age 18 years) enabling NHP to be assessed over approximately 8 years. A soft tissue Ear - nose plane (EN plane) was also investigated. Results: NHP reproducibility over 8 years demonstrated a mean of absolute difference of 2.9 degrees, with a range of differences from -7.9 to 8.2 degrees and a standard deviation of differences equal to 3.6 degrees. The Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism with each other, and averaged between 0 and -3 degrees from HOR. On average, EN plane was horizontal but was variable. Conclusions: NHP is not consistently reproducible at the individual level. For hard tissue images, the combined use of NHA, FH, KW plane, and P plane enables prediction of CHP. Additionally, the rectangular shape of the lower orbit - nasal airway region appears to be useful for correcting head position. In facial soft tissue images, EN plane in combination with other visual factors helps to correct head position. Simple geometry enables this head position correction to be performed from any view of the head where relevant landmarks are seen. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346599 / Thesis (D.Clin.Dent.) - University of Adelaide, School of Dentistry, 2008

Background: Historically, many reference lines and planes of the human skull have been used in an attempt to depict the head in a natural head position (NHP) which is a relaxed/balanced position when looking ahead at their eye level. Head position correction has been attempted in fields such as anatomy, art, anthropology, orthodontics, oral and maxillofacial surgery, plastic surgery, and forensics. In orthodontics, oral and maxillofacial surgery, and plastic surgery, corrected head position (CHP) is particularly important for diagnosis of the normality/protrusion/retrusion of the patient’s facial skeleton. Usually a single plane, such as Frankfurt horizontal, is used to correct head position, but its angulation is variable between individuals, because each individual’s anatomy is unique. It has been found previously that the Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism, and these planes averaged -1 to -2 degrees from the true horizontal (HOR, which is a horizontal plane determined as being perpendicular to the earth’s gravitational force) with subjects in NHP. Methods: Craniofacial planes were measured in an Aboriginal Australian sample and in two contemporary samples obtained from Australian orthodontic practices, and the findings were compared with previous studies. Each sample consisted of 40 individuals (20 males and 20 females) with subjects in NHP. The Aboriginal Australian sample was longitudinal (T1, mean age 10 years; T2, mean age 14 years, and T3, mean age 18 years) enabling NHP to be assessed over approximately 8 years. A soft tissue Ear - nose plane (EN plane) was also investigated. Results: NHP reproducibility over 8 years demonstrated a mean of absolute difference of 2.9 degrees, with a range of differences from -7.9 to 8.2 degrees and a standard deviation of differences equal to 3.6 degrees. The Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism with each other, and averaged between 0 and -3 degrees from HOR. On average, EN plane was horizontal but was variable. Conclusions: NHP is not consistently reproducible at the individual level. For hard tissue images, the combined use of NHA, FH, KW plane, and P plane enables prediction of CHP. Additionally, the rectangular shape of the lower orbit - nasal airway region appears to be useful for correcting head position. In facial soft tissue images, EN plane in combination with other visual factors helps to correct head position. Simple geometry enables this head position correction to be performed from any view of the head where relevant landmarks are seen. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346599 / Thesis (D.Clin.Dent.) - University of Adelaide, School of Dentistry, 2008