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Introduction
Hip and knee osteoarthritis are associated with functional limitations, pain and restrictions in quality of life and the ability to work. Furthermore, with growing prevalence, osteoarthritis is increasingly causing (in)direct costs. Guidelines recommend exercise therapy and education as primary treatment strategies. Available options for treatment based on physical activity promotion and lifestyle change are often insufficiently provided and used. In addition, the quality of current exercise programmes often does not meet the changing care needs of older people with comorbidities and exercise adherence is a challenge beyond personal physiotherapy. The main objective of this study is to investigate the short- and long-term (cost-)effectiveness of the SmArt-E programme in people with hip and/or knee osteoarthritis in terms of pain and physical functioning compared to usual care.
Methods
This study is designed as a multicentre randomized controlled trial with a target sample size of 330 patients. The intervention is based on the e-Exercise intervention from the Netherlands, consists of a training and education programme and is conducted as a blended care intervention over 12 months. We use an app to support independent training and the development of self-management skills. The primary and secondary hypotheses are that participants in the SmArt-E intervention will have less pain (numerical rating scale) and better physical functioning (Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score) compared to participants in the usual care group after 12 and 3 months. Other secondary outcomes are based on domains of the Osteoarthritis Research Society International (OARSI). The study will be accompanied by a process evaluation.
Discussion
After a positive evaluation, SmArt-E can be offered in usual care, flexibly addressing different care situations. The desired sustainability and the support of the participants’ behavioural change are initiated via the app through audio-visual contact with their physiotherapists. Furthermore, the app supports the repetition and consolidation of learned training and educational content. For people with osteoarthritis, the new form of care with proven effectiveness can lead to a reduction in underuse and misuse of care as well as contribute to a reduction in (in)direct costs.
Trial registration
German Clinical Trials Register, DRKS00028477. Registered on August 10, 2022.
The Portable Document Format, better known as PDF, is one of themost widely used document formats worldwide, and in order to en-sure information confidentiality, this file format supports documentencryption. In this paper, we analyze PDF encryption and showtwo novel techniques for breaking the confidentiality of encrypteddocuments. First, we abuse the PDF feature ofpartially encrypteddocuments to wrap the encrypted part of the document withinattacker-controlled content and therefore, exfiltrate the plaintextonce the document is opened by a legitimate user. Second, we abusea flaw in the PDF encryption specification to arbitrarily manipulateencrypted content. The only requirement is that a single block ofknown plaintext is needed, and we show that this is fulfilled bydesign. Our attacks allow the recovery of the entire plaintext of en-crypted documents by using exfiltration channels which are basedon standard compliant PDF properties.We evaluated our attacks on 27 widely used PDF viewers andfound all of them to be vulnerable. We responsibly disclosed thevulnerabilities and supported the vendors in fixing the issue
OOXML and ODF are the de facto standard data formats for word processing, spreadsheets, and presentations. Both are XML-based, feature-rich container formats dating back to the early 2000s. In this work, we present a systematic analysis of the capabilities of malicious office documents. Instead of focusing on implementation bugs, we abuse legitimate features of the OOXML and ODF specifications. We categorize our attacks into five classes: (1) Denial-of-Service attacks affecting the host on which the document is processed. (2) Invasion of privacy attacks that track the usage of the document. (3) Information disclosure attacks exfiltrating personal data out of the victim's computer. (4) Data manipulation on the victim's system. (5) Code execution on the victim's machine. We evaluated the reference implementations – Microsoft Office and LibreOffice – and found both of them to be vulnerable to each tested class of attacks. Finally, we propose mitigation strategies to counter these attacks.
Im Rahmen der Implementierung eines Gesundheitsförderungsprogramms bei der Miele & Cie. KG wurde ein individuelles, arbeitsplatzbezogenes Training als Pilotprojekt für Bandarbeiter und Emaillierer über einen Zeitraum von 12 Wochen in Kombination mit einem persönlichen Heimtrainingsplan und ergonomischer Beratung angeboten. Zu Beginn und nach Abschluss der Intervention wurden der Rumpfkraftausdauertest nach McGill, der Functional Movement ScreenTM (FMSTM) sowie eine Gesundheitsfragebogenerhebung (SF-36) durchgeführt. In den motorischen Testverfahren konnte eine Reduzierung muskulärer Dysbalancen der Rumpfkraftausdauer im Rechts-links-Vergleich um 50 % (p = 0,006), eine Verbesserung des Summenscores im FMSTM um 2,0 ± 2,8 Punkte (p < 0,001) sowie eine Minimierung schmerzhafter Bewegungsabläufe um 40 % nachgewiesen werden. Die Ergebnisse des SF-36 deuten auf eine moderate Steigerung des subjektiv empfundenen Gesundheitszustands für die psychischen Items hin. Die Ergebnisse belegen, dass ein individualisiertes und arbeitsplatzbezogenes körperliches Training bereits über einen kurzen Zeitraum die Kraftausdauer der Rumpfmuskulatur und grundlegende Bewegungsmuster signifikant verbessern sowie schmerzhafte Bewegungsabläufe positiv beeinflussen und somit das Risiko für zukünftige Funktionsstörungen des Bewegungsapparates reduzieren kann.
Beim hier vorgestellten „functional warm-up“ werden die Muskeln durch eine Kombination aus Halteübungen, Abbremsen und Beschleunigungen erwärmt und gedehnt, um das Verletzungsrisiko im funktionellen Training („functional training“) zu verringern. Die dargestellte Übungsreihe folgt dem Grundsatz „vom Einfachen zum Schweren“ und wird im Gehen auf einer Strecke von 10 bis 20 Metern durchgeführt.