Bone bruise lesions (BBL) are documented on MRIs diagnosing acute knee ligament injury (AKLI). Recent evidence has indicated that a majority of patients that sustain an AKLI, especially anterior cruciate ligament (ACL) knee injury, will develop post-traumatic osteoarthritis (PTOA) 10-20 years following injury. It has been proposed that the initial damage sustained to the articular cartilage overlying BBL causes a cascade of events that may result in PTOA. Researchers have proposed a modification to treatment protocols for more severe BBL, or have stressed the need for the development of protective therapies to protect the articular cartilage. However, there are limited tools available to evaluate the clinical outcome of articular cartilage overlying BBL. Furthermore, damage to the cartilage overlying BBL may be different according to differing BBL severities. Therefore, the use of a cartilage degradation biomarker, serum cartilage oligomeric matrix protein (sCOMP) and the use of a BBL severity classification system may be useful to determine if differences exist between patients with and without BBL, and with differing BBL severities. The purpose of this dissertation was to investigate the utility of sCOMP as a biomarker for acute articular cartilage damage. The purposes of these studies were to determine the inter and intraday reliability of this marker, to document sCOMP longitudinally in collegiate athletes and following AKLI, and to determine if differences in sCOMP and self-reported pain and function exist for patients with and without BBL, and differing BBL following AKLI. The results of these studies indicated sCOMP measures had strong inter and intraday reliability. Additionally, exercise does seem to influence sCOMP levels; however, these elevations may not be clinically meaningful. Furthermore, sCOMP levels were not different between patients with BBL and without, and between differing BBL severities. The results of these studies support the use of a BBL severity classification for future research studies in order to further elucidate the outcomes of these lesions.

This thesis is a collection of poems.

Amid the COVID-19 pandemic, there has been an increase in the number of abuse cases, with bruising being the most common indicator. Often when a victim comes forward to report an assault, only slight redness may be observed, which may not accurately represent the injury severity. This study focuses on the use of Alternate Light Source (ALS) to detect and document such injuries more effectively. Following institutional approval, blunt trauma was inflicted on fifty-five healthy participants with no known medical conditions. The participant was seated while a spherical object weighing 465 grams was dropped at a height of 1.5 meters through a vertical tube onto the ventral/anterior surface of the participant’s forearm. The injury site was observed under four different lighting conditions. Findings were documented with photography over specific time intervals over 21 days. A comparison was made between body composition and skin tone on their effect on the visibility of the bruise. Our findings concluded that bruising in females persisted for a longer period, and the optimal wavelength for documentation of bruises is 415 nanometers with a yellow filter. A blinded study was conducted using the same methodology to assess the accuracy of ALS for detection of bruises. The blinded study results showed an accuracy of 75%. Although the results showed high accuracy, it was determined that the results rely on the researcher’s perception of bruising. Therefore, the results of the blinded study were inconclusive. Subsequently, peer review of the photographs was conducted to evaluate the effect of bias in detection of bruises. Similar to the results from the blinded study, the observation of the bruise remains highly subjective. The representative sample size was insufficient to provide statistical analysis between the observations of each reviewer. Therefore, the results from the peer review study were also inconclusive. Although ALS is effective in the documentation of bruises, caution is advised when using ALS to detect bruises as skin pigments, and pre-existing skin conditions may interfere with the interpretation.

L’objectif de la présente étude est d’étudier les différences entre les homicides par strangulation et les suicides par pendaison ainsi que l’importance du rôle que jouent les lésions dans la détermination du mode de décès dans les cas apparents de pendaison, et ce dans l’optique d’établir un outil permettant de renseigner le coroner ou médecin légiste sur le mode de décès probable dans les cas apparents de pendaison. Deux cent quatorze cas de suicide par pendaison ont été révisés rétrospectivement et comparés à 51 cas d’homicide par strangulation. La fréquence d’ecchymoses (6,1 %), d’abrasions (4,7 %) et de lacérations (0,5 %) était significativement plus faible chez les victimes de suicide par pendaison que chez les victimes d’homicides par strangulation (58,8 %, 51,0 % et 5,9 % respectivement). Les ecchymoses, chez les victimes de suicide par pendaison, se trouvent habituellement sur les membres supérieurs antérieurs et postérieurs ou sur les membres inférieurs antérieurs. Elles se situent généralement soit sur les membres supérieurs, soit sur les membres inférieurs, et non aux deux endroits à la fois. Les abrasions sont davantage susceptibles de se trouver sur la face postérieure des membres supérieurs et sur la face antérieure des membres inférieurs. Cette concentration préférentielle n’est pas observée chez les victimes d’homicide par strangulation. De possibles critères de suspicion et des modèles de prédiction du mode de décès sont évalués. / The objective of the present study is to study the differences between the suicidal hangings and the homicidal nonhanging strangulations as well as the lesion’s role in the manner of death determination in apparent hanging cases, in order to create a decision tool that will inform the coroner or medical examiner on the probable manner of death in apparent hanging cases. Two hundred and fourteen cases of suicidal hanging were retrospectively reviewed and compared to 51 homicidal nonhanging strangulation victims. Bruises, abrasions and lacerations incidence were significantly lower in hanging victims (6.1 %, 4.7 % and 0.5 % respectively) compared to homicidal strangulation victims (58.8 %, 51.0% and 5.9 % respectively). Limb bruises were found as much on the anterior part of upper limbs as on posterior part, whereas limb abrasions were located mostly on the posterior aspect of upper limbs. Bruises and abrasions were also found exclusively on the anterior aspect of the lower limbs. Bruises are generally observed either exclusively on upper limbs, either exclusively on lower limbs, but rarely on both in a single case. In homicidal nonhanging strangulation cases, this preferential lesions concentration was not observed. Possible criteria for limb lesions distribution are discussed and prediction models of the manner of death are evaluated.

Äpfel müssen für die Verwendung als Tafelobst in einen den Handelsgütebestimmungen entsprechenden Zustand aufbereitet werden. Die Anforderungen an die Äpfel der einzelnen Klassen sind in den Qualitätsnormen und Handelsklassen für die EG festgelegt. Automatische Verfahren zur Sortierung von Äpfeln nach Größe, Farbe und Form kommen zum Einsatz. Qualitätsfehler auf der Apfeloberfläche ohne Farbveränderungen der Fruchtoberfläche werden nicht erkannt. Ausgehend von der auf dem Markt vorhandenen Sortiertechnik für Obst und Gemüse sowie den aktuellen technischen Möglichkeiten der Oberflächenerkennung bzw. -prüfung wurde nach einer Lösung gesucht, auch unverfärbte Oberflächenformveränderungen zu erkennen. Unverfärbte Oberflächenformveränderungen sind häufig die Ursache von größeren, oft infektiösen Schadstellen nach der Apfelaufbereitung. Sie führen zu Ausfällen für die Erzeuger und den Handel. Verbraucherbefragungen ergaben Interesse für den Handel an einer Erkennung unverfärbter Oberflächenformveränderungen zur Qualitätsverbesserung des Marktangebotes. Dabei sind breite flache, breite tiefe und tiefe schmale unverfärbte Oberflächenformveränderungen von besonderem Interesse. Nach bisher vorliegenden Untersuchungsergebnissen können mit Hilfe des Reflexionsmeßverfahrens Qualitätsfehler erkannt werden, die mit Verfärbung der Schale oder des schalennahen Fruchtfleisches einhergehen. Für die Erkennung von Druckstellen, die nicht mit Verfärbung verbunden sind, ist das Reflexionsmeßverfahren daher nur bedingt geeignet. Zur Problemlösung wurde ein Versuchsstand für Triangulationsmessungen mit Liniengitterprojektion aufgebaut. Es wurden 900 Apfelstreifenbilder der Apfelsorten "Golden Delicious", "Red Delicious" und "Braeburn" mit Hilfe des Versuchsaufbaus und dem zur Bilderkennung entwickelten Erkennungsalgorithmus untersucht. Zur Gewinnung der Merkmale aus dem Streifenbild wurde auf die Anzahl bzw. die Abstände der Streifen zurückgegriffen. Die aufgenommenen Apfelstreifenbilder wurden durch den Erkennungsalgorithmus in die Merkmalsklassen "gesunde Oberfläche", "Stiel- und Kelchgrube" und "Druckstelle" gruppiert. Nach den erfolgten Untersuchungen ist das Streifenprojektionsverfahren für die Sortierprozesse von Fruchtoberflächen geeignet, wenn die effektive optische Auflösung des Gesamtsystems, die von der Paßfähigkeit der Rastergrößen der einzelnen Baugruppen des Systems (Streifengitter, Kamerachip, Bildspeicher) abhängt, angepaßt werden kann (Ausschalten störender Moiré-Effekte im erforderlichen Auflösungsbereich). Die dreidimensionale Oberflächenkontur des Apfels moduliert das Abbild der projizierten Streifen, wodurch dreidimensionale Informationen der Oberflächentopographie in einem zweidimensionalen Bild impliziert werden können. Unverfärbte Oberflächenformveränderungen sind mit dem beschriebenen Erkennungsalgorithmus zu klassifizieren. Der Einsatz der Bilderkennung in dieser zeitkritischen Anwendung kann nur hardware-orientiert gelöst werden. Ein prinzipieller funktionsfähiger Lösungsansatz ist mit dem Erkennungsalgorithmus geschaffen. / Apples must conform to the trade quality regulations to be deemed fit for consumption. The EU requirements for each individual class of apple are specified in quality standards and trade classifications. Automatic processes are used to sort apples by size, colour and shape. Non-discoloured surface discrepancies of the fruit are not identified. This paper aims to find a system which allows non-discoloured surface discrepancies based on the sorting method for fruit and vegetables available on the market and state-of-the-art technology. Non-discoloured surface discrepancies often caused by serious, and in many cases, infectious areas of damage after the apples are processed. They result in losses for the grower and the trade. Consumer research revealed trade interest in a system which could identify non-discoloured surface discrepancies, leading to an increase in the quality of goods supplied to the market. Broad shallow, broad deep and shallow narrow non-discoloured discrepancies are of particular relevance. Previous studies have shown that discoloured discrepancies (discrepancies involving discoloration of the skin, or the fruit tissue immediately below the skin) can be identified using reflection measurement procedures. Such procedures have limited applicability for evaluating bruises which do not result in skin discoloration. An experiment bench was constructed for triangulation readings of projected line patterns in an attempt to solve this problem. Altogether 900 stripe images of apples of the "Golden Delicious", "Red Delicious" and "Braeburn" varieties were analysed using the experiment design and the algorithm developed for evaluating the images. The characteristics of the stripe image were determined on the basis of the number of stripes, or the spacing between the stripes. The recorded apple stripe images were grouped into the following characteristic categories by the evaluation algorithm: "healthy surface", "stalk and calyx" and "bruise". The study shows that the stripe projection procedure is suitable for sorting fruit by surface quality if the effective optical resolution of the overall system can be adapted accordingly (i.e. if the interfering Moiré effects can be eliminated in the required resolution range). This resolution depends on the grid sizes of individual system components (stripe pattern, camera chip, image memory). The three-dimensional contours of the apple surface alter the reflection of the projected stripes, which allows three-dimensional information regarding the surface topography to be indicated in a two-dimensional image. Non-discoloured surface discrepancies may be classified with the evaluation algorithm described above. The only viable method of applying image evaluation procedures requires substantial hardware. The evaluation algorithm is one solution which functions in principle.

<p>Introduction</p> <p>The most common complication following invasive cardiac procedures is the development of vascular access site (VAS) bruising. The extent and impact of VAS bruising is poorly understood and minimally reported in the literature. Research into this common post-procedure complication is hindered by the lack of a reliable bruise measurement tool, and the concept that VAS bruising is a minor complication. This mixed methods study examined the inter-rater reliability of two methods to measure VAS bruise size. The embedded qualitative descriptive study explored patient perceptions of VAS bruising.</p> <p>Methods</p> <p>Participants having femoral or radial artery puncture for invasive cardiac procedures were included in this study. Participants reporting VAS bruising completed self measurement of bruise size using two methods, linear measurement and planimetry. The principal investigator and research assistant completed bruise measurements at the same time, and were blinded to participant and each others’ measurements. Following bruise measurement, the principal investigator conducted semi-structured interviews on a convenience sample of participants; including both sexes, a range of ages, and bruise sizes.</p> <p>Results</p> <p>Measurements were completed on 40 participants with VAS bruises. Analysis of inter-rater reliability was done using the intraclass correlation coefficient (ICC), two-way random effects model. The inter-rater reliability for both linear measurement and planimetry between all three measurers was high (.929; .914 respectively). Analysis of participant narratives uncovered three major themes concerns, impact and mediating factors, with several sub-themes.</p> <p>The findings of this study support the reliability of patient VAS bruise measurement using linear measurement and planimetry. The goals and available resources for VAS research may determine the choice of measurement approach. Qualitative descriptive results indicate that patients have concerns related to VAS bruising and that this bruising may impact activities of daily living. Future research examining VAS complications should include evaluation of VAS bruising as significant patient outcome.</p> / Doctor of Philosophy (PhD)