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The primary goal of this project was to develop, implement, and evaluate a lifestyle modification intervention that did not require extensive, ongoing personal contact to improve lifestyle behaviors shown to lower blood pressure (BP) in adults with prehypertension (N=23, mean age=54, mean BP=126.7/75.1). Incorporating clinical practices and psychological approaches to behavior change, this intervention used primarily the DASH Eating Plan, coupled with a low-sodium diet and a walking program; it applied social cognitive theory to health behavior change, specifically self-regulation for self-monitoring and management of BP, diet, exericse, and weight. The study compared two conditions, the DASH 2 Wellness Only standard of care condition to the DASH 2 Wellness Plus treatment condition on the primary outcome measures of fruit and vegetable (servings/day), sodium consumption (milligrams/day), physical activity (steps/day), weight (kgs), and blood pressure (primarily systolic BP). Consistent with hypotheses, MANOVAs detected significant differences between the conditions with D2W Plus evidencing a larger increase in change of total daily steps (M= 2900.14, SD= 1903.83) than D2W Only, (M= 636.39, SD= 1653.26), a larger decrease in systolic BP change (MMHG) (M= 15.14, SD= 4.33) than D2W Only, (M= 4.61, SD= 8.28), and a larger decrease in weight change (kg) (M= 4.78, SD= 3.81) than D2W Only, (M= 1.47, SD= 2.57). While conditions did not significantly differ on daily sodium reduction or fruit and vegetable increase, D2W Plus evidenced a larger decrease in sodium (mg) (M= 932.22, SD= 1019.22) than D2W Only, (M= 423.64, SD= 749.15) and larger increase in fruit and vegetable increase, (M= 2.10, SD= 1.73) than D2W Only, (M= 1.02, SD= 2.24). It was also hypothesized that the D2W Plus condition would show greater improvements in nutrition-specific and PA-specific health beliefs of self-regulation, social support, self-efficacy, social support, and outcome-expectancy compared to those in the D2W Only condition. A MANOVA revealed significant group differences in PA-specific health beliefs primarily attributable to increased PA self-regulation in D2W Plus compared to D2W Only, (M= 1.78, SD= 0.75) and (M= 0.55, SD= 0.57), respectively. While no overall significant group differences were found for nutrition-specific health beliefs, analyses showed meaningful differences in nutrition-specific health beliefs attributable to increased nutrition self-regulation strategies in D2W Plus compared to D2W Only. Results provide preliminary support for the efficacy of an electronic delivery of an intervention aimed at improving lifestyle behaviors and lowering BP in middle-aged individuals with prehypertension. / Ph. D.

Atualmente existem inúmeros serviços multimídia que são transportados através da rede IP, dos quais, o tráfego dos serviços de vídeo experimentou um maior crescimento nos últimos anos. O sucesso de aplicações de streaming de vídeo é um dos fatores pelo qual, este tráfego se incrementou. Alguns recentes estudos projetam que este tipo de serviços no ano 2016, alcançará aproximadamente o 55% do tráfego total da Internet. Considerando a importância que os serviços de vídeo alcançarão nos próximos anos, este trabalho foca-se na avaliação da qualidade de experiência (QoE) dos usuários ao utilizar estes serviços. Assim, nesta tese é proposta uma métrica de avaliação de vídeo denominada eVsQM, do inglês enhanced Video streaming Quality Metric, a qual é baseada principalmente no número, duração e localização temporal dos congelamentos de imagens (pausas) durante uma transmissão de vídeo, considerando também o tipo de conteúdo do vídeo transmitido. Esta métrica foi determinada a partir de um modelo matemático que utilizou os resultados de testes subjetivos de avaliação de vídeo, pois, este tipo de testes são os que melhor se aproximam da QoE real do usuário. Cabe destacar, que na realização dos testes subjetivos foi utilizada uma metodologia concordante com o tipo de degradação que o vídeo possui, ou seja, a pausa. No streaming de vídeo novas soluções são criadas com a finalidade de melhorar a QoE do usuário. O DASH, do inglês Dynamic Adaptive Streaming over HTTP, muda a resolução do vídeo transmitido de acordo com as características da rede. Porém, se a rede é muito flutuante existirão muitas variações de resolução e a QoE do usuário será degradada. Neste trabalho é proposto um parâmetro a ser utilizado no algoritmo DASH que funciona como um limiar para controlar a frequência destas comutações de resolução. Este parâmetro é denominado como SDF (do inglês Switching Degradation Factor) e permite que a QoE mantida em níveis aceitáveis, inclusive em situações onde a rede é muito flutuante. Adicionalmente, neste trabalho é proposto um novo modelo de faturamento nos serviços de telecomunicações, que inclua no processo de tarifação um parâmetro relacionado com a QoE, visando ter uma tarifação de serviços de comunicações mais justa do ponto de vista dos usuários. Desta forma, usuários que recebem uma menor qualidade no serviço devem pagar menos em relação aos usuários que recebem uma melhor qualidade do mesmo serviço. / Nowadays, there are several multimedia services, which are carried via IP networks. From these all services; the traffic regarding video applications had the greatest growth in the last years. The success of video streaming applications is one of the major contributors to video traffic growth. Some recent studies project that video services, will reach approximately 55% of the total Internet traffic in 2016. Considering the relevance that video services will achieve in the coming years, this work focuses on the users Quality of Experience (QoE) when using these services. Thus, this thesis proposes an evaluation metric named enhanced Video streaming Quality Metric (eVsQM), which is based primarily on the number, duration and temporal location of the image freezes (pauses) during a video transmission. Also, this metric considers the video content type and was determined from a mathematical model that used as inputs, the video quality assessment results from subjective tests due, these types of test are the most correlated with real users QoE. It is worth noting that to perform these subjective tests was used a methodology consistent with the kind of video degradation (pause). For another hand, new video streaming solutions are created for the purpose of improving the users QoE of the user. Dynamic Adaptive Streaming over HTTP (DASH) changes the video resolution according to the network characteristics. However, if the network is very fluctuant, many video resolution switching events will be performed and users QoE will be degraded. This thesis proposes a parameter to be used in DASH algorithms that works as a threshold to control the resolution switching frequency. This parameter is named Switching Degradation Factor (SDF) and is responsible to maintain the QoE in acceptable levels, inclusive in scenarios in which the network capacity is very fluctuating.

Atualmente existem inúmeros serviços multimídia que são transportados através da rede IP, dos quais, o tráfego dos serviços de vídeo experimentou um maior crescimento nos últimos anos. O sucesso de aplicações de streaming de vídeo é um dos fatores pelo qual, este tráfego se incrementou. Alguns recentes estudos projetam que este tipo de serviços no ano 2016, alcançará aproximadamente o 55% do tráfego total da Internet. Considerando a importância que os serviços de vídeo alcançarão nos próximos anos, este trabalho foca-se na avaliação da qualidade de experiência (QoE) dos usuários ao utilizar estes serviços. Assim, nesta tese é proposta uma métrica de avaliação de vídeo denominada eVsQM, do inglês enhanced Video streaming Quality Metric, a qual é baseada principalmente no número, duração e localização temporal dos congelamentos de imagens (pausas) durante uma transmissão de vídeo, considerando também o tipo de conteúdo do vídeo transmitido. Esta métrica foi determinada a partir de um modelo matemático que utilizou os resultados de testes subjetivos de avaliação de vídeo, pois, este tipo de testes são os que melhor se aproximam da QoE real do usuário. Cabe destacar, que na realização dos testes subjetivos foi utilizada uma metodologia concordante com o tipo de degradação que o vídeo possui, ou seja, a pausa. No streaming de vídeo novas soluções são criadas com a finalidade de melhorar a QoE do usuário. O DASH, do inglês Dynamic Adaptive Streaming over HTTP, muda a resolução do vídeo transmitido de acordo com as características da rede. Porém, se a rede é muito flutuante existirão muitas variações de resolução e a QoE do usuário será degradada. Neste trabalho é proposto um parâmetro a ser utilizado no algoritmo DASH que funciona como um limiar para controlar a frequência destas comutações de resolução. Este parâmetro é denominado como SDF (do inglês Switching Degradation Factor) e permite que a QoE mantida em níveis aceitáveis, inclusive em situações onde a rede é muito flutuante. Adicionalmente, neste trabalho é proposto um novo modelo de faturamento nos serviços de telecomunicações, que inclua no processo de tarifação um parâmetro relacionado com a QoE, visando ter uma tarifação de serviços de comunicações mais justa do ponto de vista dos usuários. Desta forma, usuários que recebem uma menor qualidade no serviço devem pagar menos em relação aos usuários que recebem uma melhor qualidade do mesmo serviço. / Nowadays, there are several multimedia services, which are carried via IP networks. From these all services; the traffic regarding video applications had the greatest growth in the last years. The success of video streaming applications is one of the major contributors to video traffic growth. Some recent studies project that video services, will reach approximately 55% of the total Internet traffic in 2016. Considering the relevance that video services will achieve in the coming years, this work focuses on the users Quality of Experience (QoE) when using these services. Thus, this thesis proposes an evaluation metric named enhanced Video streaming Quality Metric (eVsQM), which is based primarily on the number, duration and temporal location of the image freezes (pauses) during a video transmission. Also, this metric considers the video content type and was determined from a mathematical model that used as inputs, the video quality assessment results from subjective tests due, these types of test are the most correlated with real users QoE. It is worth noting that to perform these subjective tests was used a methodology consistent with the kind of video degradation (pause). For another hand, new video streaming solutions are created for the purpose of improving the users QoE of the user. Dynamic Adaptive Streaming over HTTP (DASH) changes the video resolution according to the network characteristics. However, if the network is very fluctuant, many video resolution switching events will be performed and users QoE will be degraded. This thesis proposes a parameter to be used in DASH algorithms that works as a threshold to control the resolution switching frequency. This parameter is named Switching Degradation Factor (SDF) and is responsible to maintain the QoE in acceptable levels, inclusive in scenarios in which the network capacity is very fluctuating.

Les vidéos omnidirectionnelles, également appelées vidéos sphériques ou vidéos360°, sont des vidéos avec des pixels enregistrés dans toutes les directions de l’espace. Un utilisateur qui regarde un tel contenu avec un Casques de Réalité Virtuelle (CRV) peut sélectionner la partie de la vidéo à afficher, usuellement nommée viewport, en bougeant la tête. Pour se sentir totalement immergé à l’intérieur du contenu, l’utilisateur a besoin de voir au moins 90 viewports par seconde en 4K. Avec les technologies de streaming traditionnelles, fournir une telle qualité nécessiterait un débit de plus de100 Mbit s−1, ce qui est bien trop élevé. Dans cette thèse, je présente mes contributions pour rendre possible le streaming de vidéos omnidirectionnelles hautement immersives sur l’Internet. On peut distinguer six contributions : une proposition d’architecture de streaming viewport adaptatif réutilisant une partie des technologies existantes ; une extension de cette architecture pour des vidéos à six degrés de liberté ; deux études théoriques des vidéos à qualité spatiale non-homogène; un logiciel open source de manipulation des vidéos 360°; et un jeu d’enregistrements de déplacements d’utilisateurs regardant des vidéos 360°. / Omnidirectional videos, also denoted as spherical videos or 360° videos, are videos with pixels recorded from a given viewpoint in every direction of space. A user watching such an omnidirectional content with a Head Mounted Display (HMD) can select the portion of the videoto display, usually denoted as viewport, by moving her head. To feel high immersion inside the content a user needs to see viewport with 4K resolutionand 90 Hz frame rate. With traditional streaming technologies, providing such quality would require a data rate of more than 100 Mbit s−1, which is far too high compared to the median Internet access band width. In this dissertation, I present my contributions to enable the streaming of highly immersive omnidirectional videos on the Internet. We can distinguish six contributions : a viewport-adaptive streaming architecture proposal reusing a part of existing technologies ; an extension of this architecture for videos with six degrees of freedom ; two theoretical studies of videos with non homogeneous spatial quality ; an open-source software for handling 360° videos ; and a dataset of recorded users’ trajectories while watching 360° videos.

In der randomisierten, multizentrischen DASH-Studie (Dietary Approaches to Stop Hy-pertension), die unter kontrollierten Bedingungen stattfand, führte eine fettreduzierte Mischkost, reich an Obst, Gemüse und Milchprodukten, bei Borderline-Hypertonikern zu einer signifikanten Blutdrucksenkung. Während der Studienphase wurden Körpermasse, Natrium-Aufnahme sowie Alkoholzufuhr aufgrund der bekannten Einflussnahme auf den Blutdruck konstant gehalten. In der eigenen Pilot-Studie sollte untersucht werden, ob das Ergebnis der DASH-Studie (i) mit deutschen Hypertonikern und (ii) unter habituellen Ernährungs- und Lebensbedingungen mit regelmäßig durchgeführter Ernährungsberatung und ad libitum Verzehr anstelle des streng kontrollierten Studienansatzes bestätigt werden kann. Eine Konstanz der Körpermasse, der Natrium-Urinausscheidung (unter diesem Studienansatz valider als die Aufnahme) und des Alkoholkonsums wurde vorausgesetzt.<br /> Die Studienpopulation setzte sich aus 53 übergewichtigen Probanden mit einer nicht medikamentös therapierten Borderline-Hypertonie und ohne Stoffwechselerkrankungen zusammen. Die Studienteilnehmer wurden randomisiert entweder der Idealgruppe mit einer fettarmen Kost reich an Milchprodukten, Obst und Gemüse (ähnlich der DASH-Idealgruppe) oder der Kontrollgruppe mit habitueller Ernährungsweise zugeteilt. Über einen Zeitraum von fünf Wochen wurde den Probanden etwa 50% ihres täglichen Lebensmittelbedarfes entsprechend ihrer Gruppenzugehörigkeit kostenfrei zur Verfügung gestellt. Gelegenheitsblutdruckmessungen und 24h-Blutdruckmessungen, Ernährungs- und Aktivitätsprotokolle, Blut- und Urinproben sowie anthropometrische Messungen wurden vor, während und fünf Wochen nach der Interventionsphase durchgeführt.<br /> Die Ergebnisse zeigen, dass in der Idealgruppe keine signifikante Blutdrucksenkung beobachtet werden konnte. Dies lässt sich durch die Tatsache erklären, dass die Lebens-mittel- und Nährstoffaufnahme der deutschen Kontrollgruppe eher der amerikanischen Idealgruppe entsprach. In der Pilot-Studie waren die Unterschiede in der Nährstoffzufuhr zwischen den beiden Gruppen viel geringer als in der DASH-Studie; für eine blutdrucksenkende Ernährungsumstellung bestand somit nur ein geringer Spielraum. Eine weitere Erklärung besteht in der unterschiedlichen Zusammensetzung der Studienpopulation. Bei DASH wurden vorwiegend farbige Probanden (40% höhere Hypertonieprävalenz) untersucht. Die Studienergebnisse lassen also den Schluss zu, dass Ernährungs- und Lebensstilgewohnheiten sowie der genetische Hintergrund der entsprechenden Bevölkerungsgruppe bei der Formulierung von nährstoff- oder lebensmittelbezogenen Empfehlungen zur Senkung des Bluthochdruckes Berücksichtigung finden müssen. / The Dietary Approaches to Stop Hypertension trial (DASH), a randomized well-controlled feeding study conducted at 4 medical centers, demonstrated that a low-fat diet, rich in fruits, vegetables and dairy products is able to lower blood pressure of borderline-hypertensive people significantly. Body weight, sodium intake and alcohol consumption were kept constant during the whole study period, due to the known influence on hypertension. Aim of our study project was to investigate whether the results of the DASH study can be confirmed by (i) using a German hypertensive population and (ii) replacing the well-controlled feeding design by allowing ad libitum intake according to dietary ad-vice. The participants were asked to keep their body weight, sodium urine excretion (un-der this study design more valid than sodium intake) and their alcohol consumption con-stant.<br /> Our pilot study population consisted of 53 mainly overweight participants with borderline hypertension and without medication or any metabolic disorders. They were randomly assigned to either an ideal diet low in fat and rich in dairy products, fruits and vegetables (similar to the DASH I-group) or a habitual diet as control (C-group). During five weeks the subjects were provided 50 % of their daily intake for free according to their dietary pattern. Single and 24h-blood pressure measurements, dietary weighed and physical activity records, blood and urine samples and anthropometric measurements were collected before, during and five weeks after the intervention period.<br /> The study results indicated that no significantly reduction of blood pressure could be observed for both methods in the I-group of our trial. This is due to the fact that the baseline intake of foods and nutrients of the German subjects was nearly corresponding to the intake targeted for the DASH I-group. Therefore, it was impossible to increase the intake of these nutrients in our I-group by the same percentage as in the DASH study. Another explanation may be the different consistency of the study population. About 60% of the DASH study population were African Americans with a known higher prevalence of hy-pertension (about 40%) than Caucasians.<br /> The conclusion is that even convincing results of a controlled trial cannot be simply transferred into dietary advice for the general public. For addressing food-based dietary guidelines to reduce the risk of hypertension it is necessary to consider the genetic background as well as the dietary and the lifestyle situation of the target population carefully.

Nach Operationen am Schultergelenk ist die Rehabilitation von entscheidender Bedeutung, um das operative Ergebnis zu sichern und die Schulterfunktion wiederherzustellen. Die dafür erforderliche funktionelle Kraft, Mobilität, Stabilität und Schmerzfreiheit soll mittels adäquater Maßnahmen im Therapieprozess entwickelt werden. Einen Untersuchungsschwerpunkt dieser Arbeit stellte die Erhebung von indikationsspezifischen isokinetischen Referenzwerten dar, die als schädigungsfrei erreichbare Steigerungsraten der Kraft innerhalb eines definierten Rehabilitationsprogrammes anzusehen sind. Dafür wurden jeweils 30 Patienten mit ventraler Schulterstabilisierung, arthroskopisch subakromialer Dekompression und Rekonstruktion der Rotatorenmanschette unter Verwendung des Seilzugisokinetikgerätes „Moflex®“ für die Bewegungen Adduktion, Innen- und Außenrotation untersucht. Zusätzlich galten die tägliche Schmerzquantifizierung, die Erfassung der aktiven Beweglichkeit und die subjektive Einschätzung mittels Fragebögen zum Gesundheitszustand (SF-36-Health-Survey) und zur Schulterfunktion (DASH-Score) zu definierten Zeitpunkten der Rehabilitation als obligate Bestandteile der Untersuchung. Auf der Grundlage der ermittelten Referenzwerte werden Empfehlungen für die praktische Anwendung eines therapeutischen Aufbautrainings mit dem Therapieband und dem Seilzugsystem abgeleitet. Einen weiteren Schwerpunkt der Arbeit bildete die Leistungsdiagnostik mit der Überprüfung der körperlichen Leistungsfähigkeit und der kardiopulmonalen Belastung während einer orthopädisch ausgerichteten Rehabilitation. Dafür absolvierten 20 männliche Patienten nach einer Operation am Schultergelenk zu Beginn und zum Abschluss der Rehabilitation einen Spiroergometrietest auf dem Fahrradergometer und eine Spirometrieuntersuchung mit dem „K4b2“ während der Krankengymnastik und der Medizinischen Trainingstherapie. Mit den Resultaten ist erstmalig eine Beurteilung der kardiopulmonalen Belastung von Patienten bei differenten Therapiemaßnahmen möglich. Die Ergebnisse können als Handlungsanleitung für die Belastungsgestaltung im Rahmen der postoperativen Rehabilitation von Schulterpatienten betrachtet werden.

Fractures of the distal radius are the most common fractures treated at our clinics . It accounts for around 16 % of all fractures. Most often we meet them in two age groups - children and especially in postmenopausal women. In this group the fractures are frequently associated with osteoporosis. The most common cause of fracture is a fall on the outstretched extremity. Together with fractures of the proximal humerus, proximal femur and vertebral fractures they are the most common gerontotraumatologic fractures. The frequency of fractures of the distal radius gradually increasing. The reason is the increasing average age of the population and their active way of life. Our group consists of 5,359 patients treated for a fracture of the distal radius in 1998 and from 2001 to 2013 . During this time , the frequency of fractures increased by 19,7%. For women with distal radius fractures occur 3 times more frequently, the average age of treated was 59,1 years. About 80 % of distal radius fractures are treated conservatively. The surgical treatment of seniors decide not only the type and stability of the fracture, bone quality, but especially the overall condition of the patient and his claims to a final functional outcome. Long-term functional results after conservative treatment in the elderly are nearly the...

Fractures of the distal radius are the most common fractures treated at our clinics . It accounts for around 16 % of all fractures. Most often we meet them in two age groups - children and especially in postmenopausal women. In this group the fractures are frequently associated with osteoporosis. The most common cause of fracture is a fall on the outstretched extremity. Together with fractures of the proximal humerus, proximal femur and vertebral fractures they are the most common gerontotraumatologic fractures. The frequency of fractures of the distal radius gradually increasing. The reason is the increasing average age of the population and their active way of life. Our group consists of 5,359 patients treated for a fracture of the distal radius in 1998 and from 2001 to 2013 . During this time , the frequency of fractures increased by 19,7%. For women with distal radius fractures occur 3 times more frequently, the average age of treated was 59,1 years. About 80 % of distal radius fractures are treated conservatively. The surgical treatment of seniors decide not only the type and stability of the fracture, bone quality, but especially the overall condition of the patient and his claims to a final functional outcome. Long-term functional results after conservative treatment in the elderly are nearly the...