Transverse cracking in bridge decks has been found to be a rising problem for slab-on-girder bridges. In response to the concern, this research examined the influence of structural parameters and developed an analytical truss model, based on finite element modelling responses, for predicting the condition of long term cracking. Crack widths predicted using the truss model are very similar to that measured in a recent survey of Ontario highway overpass bridges. The approach to control cracking in deck slabs through structural design decisions enables engineers to provide high cracking resistance at locations of the bridge deck that are most likely to crack. Recommendations were made, based on the findings obtained from two sets of parametric studies, to help ensure transverse cracking in bridge decks is properly controlled for typical slab-on-girder bridges designed using the empirical design method specified in the current Canadian Highway Bridge Design Code.

Transverse cracking in bridge decks has been found to be a rising problem for slab-on-girder bridges. In response to the concern, this research examined the influence of structural parameters and developed an analytical truss model, based on finite element modelling responses, for predicting the condition of long term cracking. Crack widths predicted using the truss model are very similar to that measured in a recent survey of Ontario highway overpass bridges. The approach to control cracking in deck slabs through structural design decisions enables engineers to provide high cracking resistance at locations of the bridge deck that are most likely to crack. Recommendations were made, based on the findings obtained from two sets of parametric studies, to help ensure transverse cracking in bridge decks is properly controlled for typical slab-on-girder bridges designed using the empirical design method specified in the current Canadian Highway Bridge Design Code.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18200号 / 人健博第17号 / 新制||人健||2(附属図書館) / 31058 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 三谷 章, 教授 杉本 直三 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

In recent years in many sectors the trend seemed to be to rationalise and increase efficiency toensure processes deliver the best possible outcome with the least required input. In a goaloriented and fast paced world, this seems to be a logic step. But what if the individual factorsfor reaching a goal are not known, acknowledged, or simply not respected? What if it occursthat not all actors seem to have understood where the journey should take them? Who takes adecision to hopefully achieve a state of self-sufficiency within the beneficiary community andtherefore resulting long-term sustainability of development interventions?These and some more questions are being touched in the following thesis as the phenomena ofsustainable development and its’ effects and outcomes are researched. The thesis is based onan extensive and critical review of academic work on different steps along the way of theimplementation of development work. To understand the challenges happening afterwithdrawal of external funding, it is crucial to first evaluate how projects and programs weredesigned and implemented to strategically achieve a sustainable outcome.

Physical inactivity, a modifiable risk factor for coronary heart disease (CHD) both in persons with intellectual disability (ID) and non-ID, is considered the fourth leading cause of death in the world. Long-term regular participation in physical activity is associated with a reduced risk for CHD. Literature currently lacks evidence on the effect of long-term physical activity on the functional capacity and risk factors for developing CHD in persons with ID. The purpose of this study was firstly, to determine the effect of a long-term physical activity intervention on the risk factors associated with developing CHD and secondly the effect of a combined aerobic and resistance physical activity intervention on the functional capacity of persons with ID. A cohort of seventy-four (74) participants living in a care facility in Potchefstroom, South Africa, participated in this study, a seven-year follow-up physical activity intervention study. To determine the effect of a seven-year combined aerobic and resistance exercise intervention programme, data was collected in 2006 and in 2013. At baseline (2006) and end (2013), a CHD risk profile was determined by means of a questionnaire and physical assessment. The physical assessment included resting blood pressure, peripheral glucose and cholesterol measurements, and body composition by means of body mass index (BMI), waist-to-hip ratio (WHR) and body fat percentage derived from skinfold measurements. Cardiorespiratory fitness was assessed by means of the adapted sub-maximal YMCA bicycle ergometer protocol from which a physical work capacity (PWC) was calculated. The participants followed a structured physical activity intervention two days per week for at least 45 minutes for a seven year period. The exercise intervention consists of cardiorespiratory exercises, muscle stretches and muscle endurance exercises. All data analyses were performed with SPSS 22.0 (IBM SPSS Statistics, Armonk, NY) statistical analysis software programme. The descriptive statistics (mean and standard deviations) as well as frequencies were calculated to describe the characteristics of the participants and the point prevalence of the CHD risk factors. General Linier Model analyses were applied to determine the significant changes in CHD risk factors measured from baseline to end with adjustment for baseline measurements. McNemar exact test indicated significant changes in the point prevalence of the CHD risk factors from baseline to end. The relationship between the changes in the cardiorespiratory fitness and the measured risk factors were performed with a partial correlation analysis adjusting for age in 2013. The level of significance was set at p ≤ 0.05. The results indicate that the prevalence of inactivity decreased with 50% after the seven-year intervention program. Prevalence of age as a risk factor for developing CHD increased significantly post-intervention from 10% to 18%. Body mass decreased significantly in men (1.25 ± 5.43 kg) and increased significantly in women (0.15 ± 6.83kg). BMI changes reflect changes in body mass of the participants. Body fat percentages increased both in men (2.98%) and in women (0.95%). A significant increase in systolic blood pressure (6.2 ± 10.1 mmHg) for men and diastolic blood pressure (6.35 ± 10.42 mmHg) for women was found. Physical work capacity in both male (1.90 ± 0.73 watt/kg) and female (1.55 ± 0.43 watt/kg) participants decreased to 1.43 ± 0.45 watt/kg and 1.14 ± 0.46 watt/kg respectively during the intervention period. Although a correlation between changes in PWC and the risk factors for CHD was found, none of the correlations was significant when adjusted for age in 2013. The conclusion drawn from this study is that a long-term physical activity intervention in a population with ID reduced the point prevalence for physical inactivity and overweight and obesity, in spite of a decrease in cardiorespiratory fitness. The changes in cardiorespiratory fitness did not relate to the changes observed in the risk factors of CHD. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2015

Physical inactivity, a modifiable risk factor for coronary heart disease (CHD) both in persons with intellectual disability (ID) and non-ID, is considered the fourth leading cause of death in the world. Long-term regular participation in physical activity is associated with a reduced risk for CHD. Literature currently lacks evidence on the effect of long-term physical activity on the functional capacity and risk factors for developing CHD in persons with ID. The purpose of this study was firstly, to determine the effect of a long-term physical activity intervention on the risk factors associated with developing CHD and secondly the effect of a combined aerobic and resistance physical activity intervention on the functional capacity of persons with ID. A cohort of seventy-four (74) participants living in a care facility in Potchefstroom, South Africa, participated in this study, a seven-year follow-up physical activity intervention study. To determine the effect of a seven-year combined aerobic and resistance exercise intervention programme, data was collected in 2006 and in 2013. At baseline (2006) and end (2013), a CHD risk profile was determined by means of a questionnaire and physical assessment. The physical assessment included resting blood pressure, peripheral glucose and cholesterol measurements, and body composition by means of body mass index (BMI), waist-to-hip ratio (WHR) and body fat percentage derived from skinfold measurements. Cardiorespiratory fitness was assessed by means of the adapted sub-maximal YMCA bicycle ergometer protocol from which a physical work capacity (PWC) was calculated. The participants followed a structured physical activity intervention two days per week for at least 45 minutes for a seven year period. The exercise intervention consists of cardiorespiratory exercises, muscle stretches and muscle endurance exercises. All data analyses were performed with SPSS 22.0 (IBM SPSS Statistics, Armonk, NY) statistical analysis software programme. The descriptive statistics (mean and standard deviations) as well as frequencies were calculated to describe the characteristics of the participants and the point prevalence of the CHD risk factors. General Linier Model analyses were applied to determine the significant changes in CHD risk factors measured from baseline to end with adjustment for baseline measurements. McNemar exact test indicated significant changes in the point prevalence of the CHD risk factors from baseline to end. The relationship between the changes in the cardiorespiratory fitness and the measured risk factors were performed with a partial correlation analysis adjusting for age in 2013. The level of significance was set at p ≤ 0.05. The results indicate that the prevalence of inactivity decreased with 50% after the seven-year intervention program. Prevalence of age as a risk factor for developing CHD increased significantly post-intervention from 10% to 18%. Body mass decreased significantly in men (1.25 ± 5.43 kg) and increased significantly in women (0.15 ± 6.83kg). BMI changes reflect changes in body mass of the participants. Body fat percentages increased both in men (2.98%) and in women (0.95%). A significant increase in systolic blood pressure (6.2 ± 10.1 mmHg) for men and diastolic blood pressure (6.35 ± 10.42 mmHg) for women was found. Physical work capacity in both male (1.90 ± 0.73 watt/kg) and female (1.55 ± 0.43 watt/kg) participants decreased to 1.43 ± 0.45 watt/kg and 1.14 ± 0.46 watt/kg respectively during the intervention period. Although a correlation between changes in PWC and the risk factors for CHD was found, none of the correlations was significant when adjusted for age in 2013. The conclusion drawn from this study is that a long-term physical activity intervention in a population with ID reduced the point prevalence for physical inactivity and overweight and obesity, in spite of a decrease in cardiorespiratory fitness. The changes in cardiorespiratory fitness did not relate to the changes observed in the risk factors of CHD. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2015

Introduction: When planning Class II malocclusion treatment it is importat to consider the magnitude of the anteroposterior discrepancy, the treatment time, the amount of patient compliance needed and also the long-term stability of the results obtained. The aim of this study was to evaluate the Class II malocclusion nonextraction treatment stability, according to the initial anteroposterior discrepancy severity. Methods: Two groups of patients were selected according to the initial malocclusion severity. The Half-cusp Class II Group comprised 30 patients (16 boys, 14 girls) with an initial mean age of 13.15 years (S.D. 3.62) and the Complete Class II Group comprised 30 patients (15 boys, 15 girls) with an initial mean age of 11.99 years (S.D. 1.26). Lateral cephalograms, panoramic radiographs and dental casts were obtained at pretreatment (T1), posttreatment (T2), and at a minimum period of 2 years posttreatment (T3). Intragroup comparisons of changes in variables during the posttreatment period (T3T2) were made with paired t tests. The initial cephalometric characteristics and malocclusion severity, changes during the treatment period and during the posttreatment period were compared between groups using t tests. A multiple linear regression analysis was used to evaluate the influence of pretreatment characteristics and amount of treatment changes in the amount of posttreatment relapse. Results were regarded as significant at p<0.05. Results: During the posttreatment period (T2-T3) there were no significant differences between groups. The occlusal analysis demonstrated a small but significant relapse of molar relationship for both groups. The initial amount of overjet, the severity of canine and molar relationships and the amount of anteroposterior changes during treatment were significantly correlated to the amount of posttreatment molar relationship relapse. When subgroups of patients with matching treatment time were compared, there was significantly greater relapse in molar relationship in the Complete Class II Group. Conclusions: The initial Class II malocclusion anteroposterior discrepancy severity demonstrated a significant influence on the amount of posttreatment relapse. When treated without extractions, complete Class II malocclusion presented greater relapse than a less severe Class II molar relationship. / Introdução: Durante o planejamento do tratamento da má oclusão de Classe II é importante considerar a magnitude da discrepância ântero-posterior, o tempo de tratamento, a necessidade de cooperação do paciente, assim como a estabilidade em longo prazo dos resultados obtidos. O objetivo do presente estudo foi avaliar a estabilidade do tratamento sem extrações da má oclusão de Classe II, de acordo com a severidade da discrepância ântero-posterior inicial. Métodos: Dois grupos de pacientes foram selecionados de acordo com a severidade inicial da má oclusão. O Grupo Meia Classe II compreendeu 30 pacientes (16 meninos, 14 meninas) com idade média inicial de 13,15 anos (D.P. 3,62) e o Grupo Classe II Completa compreendeu 30 pacientes (15 meninos, 15 meninas) com idade inicial média de 11,99 anos (D.P. 1,26). Radiografias em norma lateral, radiografias panorâmicas e modelos de estudo foram obtidos pré-tratamento (T1), pós-tratamento (T2), e após um período mínimo de 2 anos pós-tratamento (T3). As comparações intragrupos das alterações das variáveis durante o período de pós-tratamento (T3-T2) foram realizadas por testes t pareados. As características cefalométricas e severidade da má oclusão inicial, alterações durante os períodos de tratamento e pós-tratamento foram comparadas entre os grupos por testes t. Uma análise de regressão linear múltipla foi conduzida para avaliar a influência das características pré-tratamento e da quantidade de alterações com o tratamento sobre a recidiva pós-tratamento. Os resultados foram considerados significantes para p<0,05. Resultados: Durante o período de pós-tratamento (T2-T3) não foram encontradas diferenças significantes entre os grupos. A avaliação oclusal demonstrou discreta mas significante recidiva da relação molar em ambos os grupos. A severidade inicial da sobressaliência, das relações canino e molar e a quantidade de alteração anteroposterior com o tratamento foram significantemente correlacionadas à recidiva da relação molar. Quando subgrupos de pacientes com tempos de tratamento compatíveis foram comparados, foi encontrada recidiva significantemente maior da relação molar no Grupo Classe II Completa. Conclusões: A severidade da discrepância ânteroposterior inicial da má oclusão de Classe II demonstrou influenciar significantemente a quantidade de recidiva pós-tratamento. Quando tratada sem extrações, a má oclusão de Classe II completa apresentou maior recidiva que uma relação molar Classe II menos severa.

Bei fortgeschrittenen rektosigmoidalen Karzinomen sollte grundsätzlich die chirurgische Resektion angestrebt werden. Es gibt allerdings zahlreiche der zumeist alten Patienten, die einer solchen Therapieform nicht zugeführt werden können (Inoperabilität, Ablehnung der Operation). Für diese Patienten stellt die palliative, endoskopische Lasertherapie nach wie vor eine effiziente Alternative dar. Im Rahmen einer prospektiven Untersuchung von 61 Patienten wurde über einen 3jährigen Beobachtungszeitraum der Einfluß der palliativen Therapie mit dem Neodym:YAG-Laser auf die Symptomatologie fortgeschrittener rektosigmoidaler Tumore analysiert. Die Ergebnisse bestätigten den auch in anderen Studiengruppen beschriebenen Kurzzeiteffekt (Behandlungsdauer bis zu 3 Monaten), wonach die tumorbedingte Darmokklusion durch den Laser beherrscht werden kann und damit die Anlage eines Anus praeter vermieden wird. Besonderes Augenmerk wurde auf 32 Patienten gelegt, die längerfristig behandelt wurden, da bezüglich eines Langzeiteffekts in der Literatur kaum Angaben zu finden sind. Behandlungs-dauer: min. 3,5, max. 16,8 Monate. Tumorlokalisation: Rektum und rektosigmoidaler Übergang. Die Ergebnisse der ersten 3 Behandlungsmonate (statistisch signifikanter Rückgang für abdominale Beschwerden und peranale Blutungen) lassen sich nicht fortsetzen, aber es wird eine Art "steady state" erreicht. Die wichtigste Zielgröße der Therapie, die Sicherung der Darmpassage, konnte bei dieser Patientengruppe in 87,5 % erreicht werden. Die methodenbedingte Komplikationsrate liegt bei 6,3 %; die therapiebedingte Letalität beträgt 0 %. Problematisch ist der Anteil von Patienten mit Stuhlinkontinenz, der im Verlauf der Therapie von 6,2 % auf 40,6 % drastisch anstieg. Dennoch sahen nahezu 90 % der Patienten ihre Lebensqualität erhalten, da es sich meist um Inkontinenz I. oder II. Grades handelt, was von der Mehrzahl der Patienten angesichts ihrer Lebenssituation toleriert wird. Somit stellt die endoskopische Lasertherapie auch unter dem Aspekt der Langzeitpalliation die Behandlung der Wahl dar. Im Vergleich mit der palliativen Anlage eines Anus praeter besitzt der Laser trotz Wieder-holungsbehandlungen deutliche Vorteile: die Therapie ist ambulant durchführbar, kostengünstiger, komplikationsärmer und führt zur besseren Symptombeeinflussung. / The symptomatology of advanced rectosigmoid carcinomas by palliative therapy with the Neodymium:YAG-laser. In principle surgical resection should be aspired to in advanced rectosigmoid carcinomas. Nevertheless, there are numerous, mostly older patients, who cannot receive such a therapy (inoperability, refusal of operation). For those patients palliative, endoscopical lasertherapy is still an efficient alternative. The influence of the palliative therapy with the Nd:YAG-laser on the symptomatology of advanced rectosigmoid tumours was investigated in a prospective study of 61 patients over a 3-year period. The results also confirm the short-term effect reported by other study groups (duration of treatment up to 3 months) that occlusion of the colon can be controlled by laser-therapy and thereby the application of a colostomy may be avoided. Special attention was given to 32 patients treated for a longer duration, since reference in the medical literature relating to long-term effects of lasertherapy are rarely to be found. Duration of treatment: 3,5 to 16,8 months. Tumour location: rectum and rectosigmoid. The results of lasertherapy during the first 3 months (statistically significant reduction of abdominal symptoms and bleeding) cannot continue but it can be achieve a steady state. The maintenance of luminal patency as the most important aim of therapy in these group of patients was achieved in 87,5 %. The rate of method-related complication was 6,3 %; the treatment-related mortality was 0 %. Problematic is the increase in fecal incontinence from 6,2 % to 40,6 % seen in the patient group during the therapy. However nearly 90 % of the patients did not report significant reduction in life quality, since most fecal incontinence can be classified as first or second degree, which is tolerated by the patients in their current life situation. Consequently, the endoscopical laser-therapy is the treatment of choice also under the aspect of long-term palliation. The laser has clear advantages in comparison with the palliative colostomy in spite of the need for repeated applications: possibility of outpatient treatment, cost-effectiveness, low complication rate and better influence on symptomatology.

Chronic obstructive pulmonary disease, COPD, places a substantial burden of disability on the growing number of patients and causes large costs for the society. Tobacco smoke is the most important risk factor. Progressive exertional dyspnea is the major symptom which leads to diminished physical and social activities, reduced physical capacity and decreased health related quality of life, HRQoL. The aim of this thesis was to evaluate different physical training modalities in patients with COPD with regard to physical capacity and HRQoL. Patients with moderate to severe COPD were included in the studies. In the first intervention, 20 patients trained on a treadmill with or without supplemental oxygen, three times per week, during eight weeks. In the second intervention, 30 patients were randomised to high-intensity group training either in water or on land, and 13 patients were included in a control group. The patients in the water and land groups trained three times per week during three months and once a week during the following six months. Oxygen supplementation during physical training did not enlarge the positive effects of the same training with air in patients with exercise-induced hypoxaemia. Both groups improved the distance walked after training. High-intensity group training in water and on land was found to be effective with regard to walking distance and HRQoL compared to the control group. Training in water seemed to be of greater benefit compared to training on land concerning walking distance and experienced physical health when the training was accomplished three times per week. The thigh muscle strength increased after training in both the water and the land group. The muscle endurance in knee extension was low in the majority of the patients and was not improved after the training intervention. An evaluation of the long-term effects of physical group training and the effects of decreased training frequency showed that training with low frequency (once a week) during six months did not seem to be sufficient to maintain the level achieved after a three months period of higher frequency training (three times per week). However, the two periods combined seemed to prevent decline in physical capacity and HRQoL compared to baseline. The conclusion is that physical training is of benefit for patients with COPD with regard to physical capacity and HRQoL. Training can be performed individually or in groups, with high intensity, in water and on land. It is also concluded that the training can, under controlled conditions, be performed without supplemental oxygen even in patients with exercise-induced hypoxaemia.

Introduction: When planning Class II malocclusion treatment it is importat to consider the magnitude of the anteroposterior discrepancy, the treatment time, the amount of patient compliance needed and also the long-term stability of the results obtained. The aim of this study was to evaluate the Class II malocclusion nonextraction treatment stability, according to the initial anteroposterior discrepancy severity. Methods: Two groups of patients were selected according to the initial malocclusion severity. The Half-cusp Class II Group comprised 30 patients (16 boys, 14 girls) with an initial mean age of 13.15 years (S.D. 3.62) and the Complete Class II Group comprised 30 patients (15 boys, 15 girls) with an initial mean age of 11.99 years (S.D. 1.26). Lateral cephalograms, panoramic radiographs and dental casts were obtained at pretreatment (T1), posttreatment (T2), and at a minimum period of 2 years posttreatment (T3). Intragroup comparisons of changes in variables during the posttreatment period (T3T2) were made with paired t tests. The initial cephalometric characteristics and malocclusion severity, changes during the treatment period and during the posttreatment period were compared between groups using t tests. A multiple linear regression analysis was used to evaluate the influence of pretreatment characteristics and amount of treatment changes in the amount of posttreatment relapse. Results were regarded as significant at p<0.05. Results: During the posttreatment period (T2-T3) there were no significant differences between groups. The occlusal analysis demonstrated a small but significant relapse of molar relationship for both groups. The initial amount of overjet, the severity of canine and molar relationships and the amount of anteroposterior changes during treatment were significantly correlated to the amount of posttreatment molar relationship relapse. When subgroups of patients with matching treatment time were compared, there was significantly greater relapse in molar relationship in the Complete Class II Group. Conclusions: The initial Class II malocclusion anteroposterior discrepancy severity demonstrated a significant influence on the amount of posttreatment relapse. When treated without extractions, complete Class II malocclusion presented greater relapse than a less severe Class II molar relationship. / Introdução: Durante o planejamento do tratamento da má oclusão de Classe II é importante considerar a magnitude da discrepância ântero-posterior, o tempo de tratamento, a necessidade de cooperação do paciente, assim como a estabilidade em longo prazo dos resultados obtidos. O objetivo do presente estudo foi avaliar a estabilidade do tratamento sem extrações da má oclusão de Classe II, de acordo com a severidade da discrepância ântero-posterior inicial. Métodos: Dois grupos de pacientes foram selecionados de acordo com a severidade inicial da má oclusão. O Grupo Meia Classe II compreendeu 30 pacientes (16 meninos, 14 meninas) com idade média inicial de 13,15 anos (D.P. 3,62) e o Grupo Classe II Completa compreendeu 30 pacientes (15 meninos, 15 meninas) com idade inicial média de 11,99 anos (D.P. 1,26). Radiografias em norma lateral, radiografias panorâmicas e modelos de estudo foram obtidos pré-tratamento (T1), pós-tratamento (T2), e após um período mínimo de 2 anos pós-tratamento (T3). As comparações intragrupos das alterações das variáveis durante o período de pós-tratamento (T3-T2) foram realizadas por testes t pareados. As características cefalométricas e severidade da má oclusão inicial, alterações durante os períodos de tratamento e pós-tratamento foram comparadas entre os grupos por testes t. Uma análise de regressão linear múltipla foi conduzida para avaliar a influência das características pré-tratamento e da quantidade de alterações com o tratamento sobre a recidiva pós-tratamento. Os resultados foram considerados significantes para p<0,05. Resultados: Durante o período de pós-tratamento (T2-T3) não foram encontradas diferenças significantes entre os grupos. A avaliação oclusal demonstrou discreta mas significante recidiva da relação molar em ambos os grupos. A severidade inicial da sobressaliência, das relações canino e molar e a quantidade de alteração anteroposterior com o tratamento foram significantemente correlacionadas à recidiva da relação molar. Quando subgrupos de pacientes com tempos de tratamento compatíveis foram comparados, foi encontrada recidiva significantemente maior da relação molar no Grupo Classe II Completa. Conclusões: A severidade da discrepância ânteroposterior inicial da má oclusão de Classe II demonstrou influenciar significantemente a quantidade de recidiva pós-tratamento. Quando tratada sem extrações, a má oclusão de Classe II completa apresentou maior recidiva que uma relação molar Classe II menos severa.