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Frontal motor vehicle collisions (MVCs) resulted in 10,813 fatalities and 937,000 injuries in 2014, which is more than any other type of MVC. In order to mitigate the injuries and fatalities resulting from MVCs, new safety restraint technologies and more biofidelic anthropomorphic test devices (ATDs) have been developed. However, the biofidelity of these new ATDs must be evaluated, and the mechanisms of injury must be understood in order to accurately predict injury. Evaluating the biomechanical response, injury mechanisms, and injury threshold of the thorax are particularly important because the thorax is one of the most frequently injured body regions in MVCs. Furthermore, sustaining a severe thoracic injury in an MVC significantly increases mortality risk. The overall objective of this dissertation was to evaluate the biomechanical responses of human surrogates under various frontal loading conditions. This objective was divided into three sub-objectives: 1) to evaluate the biofidelity of the current frontal impact ATDs, 2) to evaluate the effect of different safety restraints on occupant responses, and 3) to evaluate rib material properties with respect to sex, age, structural response, and loading history. In order to meet sub-objectives 1 and 2, full-scale frontal sled tests were performed on three different human surrogates: the 50th percentile male Hybrid III (HIII) ATD, the 50th percentile male Test Device for Human Occupant Restraint (THOR-M) ATD, and approximately 50th percentile male post-mortem human surrogates (PMHS). All surrogates were tested under three safety restraint conditions: knee bolster (KB), KB and steering wheel airbag (KB/SWAB), and knee bolster airbag and SWAB (KBAB/SWAB). The kinematic, lower extremity, abdominal, thoracic, and neck responses were then compared between surrogates and restraint conditions. In order to assess biofidelity, the ATD responses were compared to the PMHS responses. For both the kinematic and thoracic responses, the HIII and THOR-M had comparable biofideltiy. However, the HIII responses were slightly more biofidelic. The ATDs experienced similar lower extremity kinetics, but very different kinetics at the upper and lower neck due to differences in design. Evaluation of the different restraint conditions showed that the SWAB and KBAB both affected injury risk. The SWAB decreased head injury risk for all surrogates, and increased or decreased thoracic injury risk, depending on the surrogate. The KBAB decreased the risk of femur injury, but increased or decreased tibia injury risk depending on the surrogate and injury metric used to predict risk. In order to meet sub-objective 3, the tensile material properties of human rib cortical bone and the structural properties of whole ribs were quantified at strain rates similar to those observed in frontal impacts. The rib cortical bone underwent coupon tension testing, while the whole ribs underwent bending tests intended to simulate loading from a frontal impact. The rib material properties accounted for less than 50% of the variation observed in the whole rib structural properties, indicating that other factors, such as rib geometry, were also influencing the structural response of whole ribs. Age was significantly negatively correlated with the modulus, yield stress, failure strain, failure stress, plastic strain energy density, and total strain energy density. However, sex did not significantly influence any of the material properties. Cortical bone material properties were quantified from the ribs that underwent the whole rib bending tests and subject-matched, untested (control) ribs in order to evaluate the effect of loading history on material properties. Yield stress and yield strain were the only material properties that were significantly different between the previously tested and control ribs. The results of this dissertation can guide ATD and safety restrain design. Additionally, this dissertation provides human surrogate response data and rib material property data for the validation of finite element models, which can then be used to evaluate injury mitigation strategies for MVCs. / PHD / Frontal motor vehicle collisions (MVCs) resulted in 10,813 fatalities and 937,000 injuries in 2014, which is more than any other type of MVC. In order to mitigate the injuries and fatalities resulting from MVCs, new safety restraint technologies, e.g., seat belts, and more biofidelic (human-like) anthropomorphic test devices (ATDs), i.e., crash test dummies, have been developed. However, the biofidelity of these new ATDs must be evaluated, and the mechanisms of injury must be understood in order to accurately predict injury. Evaluating the biomechanical response, injury mechanisms, and injury threshold of the thorax (chest) are particularly important because the thorax is one of the most frequently injured body regions in MVCs. Furthermore, sustaining a severe thoracic injury in an MVC significantly increases the risk of death. The overall objective of this dissertation was to evaluate the biomechanical responses of human surrogates under various frontal loading conditions. This objective was divided into three sub-objectives: 1) to evaluate the biofidelity of the current frontal impact ATDs, 2) to evaluate the effect of different safety restraints on occupant responses, and 3) to evaluate rib material properties with respect to sex, age, structural response, and loading history. In order to meet sub-objectives 1 and 2, frontal crash tests were simulated in the laboratory using a crash sled. These sled tests were performed on three different human surrogates: the Hybrid III (HIII) ATD, the Test Device for Human Occupant Restraint (THOR-M) ATD, and post-mortem human surrogates (PMHS), i.e., cadavers. All surrogates were tested under three safety restraint conditions: knee bolster (KB), KB and steering wheel airbag (KB/SWAB), and knee bolster airbag and SWAB (KBAB/SWAB). The kinematic (body movements), lower extremity, abdominal, thoracic, and neck responses were then compared between surrogates and restraint conditions. In order to assess biofidelity, the ATD responses were compared to the PMHS responses. For both the kinematic and thoracic responses, the HIII and THOR-M had comparable biofideltiy. However, the HIII responses were slightly more biofidelic. The ATDs experienced similar lower extremity kinetics (forces and moments), but very different kinetics at the upper and lower neck due to differences in design. Evaluation of the different restraint conditions showed that the SWAB and KBAB both affected injury risk. The SWAB decreased head injury risk for all surrogates, and increased or decreased thoracic injury risk, depending on the surrogate. The KBAB decreased the risk of femur injury, but increased or decreased tibia injury risk depending on the surrogate and how injury risk was predicted. In order to meet sub-objective 3, the material properties of human rib cortical bone and the structural response of whole ribs were quantified under experimental conditions reminiscent of what the bone would experience during a frontal impact. The rib cortical bone underwent material testing, while the whole ribs underwent bending tests intended to simulate a frontal impact. The rib material properties only partially influenced the structural response of the whole rib. This indicated that other factors, such as rib shape and thickness, were also influencing the structural response. Age was correlated to a decrease in several material properties. However, there was no significant difference between male and female material properties. Some differences in material properties were observed in cortical bone from fractured and intact ribs, indicating that the fracture influenced the rib material properties. results of this dissertation can guide ATD and safety restrain design. Additionally, this dissertation provides human surrogate response data and rib material property data for finite element (computer) models, which can then be used to evaluate injury prevention strategies for MVCs.

Articular cartilage covers the articulating ends of diarthrodial joints. It plays a vital role in the function of the musculoskeletal system by allowing almost frictionless motion to occur between the articular surfaces of a diarthrodial joint. Study of cartilage contact behavior will help to understand the intrinsic biomechanical properties related to cartilage degeneration and related pathology. In order to study the mechanical behavior of the cartilage a FEM based computational model of the knee-joint was developed from MRI data. A heuristic algorithm was developed based on Image processing techniques using Evolve2D toolbox and edge detection. An indigenous path following algorithm to capture minute details of bone and soft tissue curvature was developed using Image Processing Toolbox of Matlab. Parts including femur, tibia, femoral and tibial cartilages, lateral & medial menisci were extracted as a point cloud from each of the slices and rendered into a 3D model using GUI driven CAD package RHINOCEROS 4.0. Commercial FE software HYPERMESH 9.0 was used to develop FE model from geometric model. Cartilage and Menisci were modeled using eight node hexahedral elements and bones were modeled using four node quadrilateral elements. Bones were assumed to be rigid. Cartilage and menisci were assumed to be linearly elastic, isotropic and homogenous. The knee joint was subjected to a uniaxial compressive load with tibia remaining fixed and femur subjected to two primary boundary conditions: 1.Flexion - extension and Varus - Valgus rotation constrained; 2.Only Varus - Valgus rotation constrained. Parameters such as contact area, contact pressure, contact force, centre of contact pressure, mises stress distribution; maximum and minimum principal stresses were studied at maximum compressive load condition and also in intermittent steps. This model considered both geometric and contact non-linearity. From the FE analysis, it was observed that peak contact deformation and contact area on both femoral and tibial medial cartilage was found to be greater than the lateral side under full extension condition. More than 50% of the load transmission was through the medial side - which could be an indication of cartilage degeneration. Deformation of lateral meniscus was more than the medial meniscus under angular constrained conditions. Loading history during intermittent steps suggested that contact area on lateral tibial cartilage increased with load, indicating joint asymmetry. These results indicate the importance of the rotational constraints (boundary conditions) and represent more accurate physiological behavior of knee joint. Role of menisci in this study was analyzed, which indicated that consideration of menisci is essential in biomechanical estimation of load transmission. In conclusion, detailed segmentation to develop geometric model, precise boundary conditions & time dependent behavior of cartilage and menisci helped in understanding knee joint load bearing capacity to a better accuracy and can potentially give rise to designing better cartilage implants.

Enterprise Database Management Systems (DBMSs) have to contend with resource-intensive and time-varying workloads, making them well-suited candidates for migration to cloud plat-forms { specifically, they can dynamically leverage the resource elasticity while retaining affordability through the pay-as-you-go rental interface. The current design of database engine components lays emphasis on maximizing computing efficiency, but to fully capitalize on the cloud's benefits, the outlays of these computations also need to be factored into the planning exercise. In this thesis, we investigate this contemporary problem in the context of industrial-strength deployments of relational database systems on real-world cloud platforms. Specifically, we consider how the traditional metric used to compare query execution plans, namely response-time, can be augmented to incorporate monetary costs in the decision process. The challenge here is that execution-time and monetary costs are adversarial metrics, with a decrease in one entailing a rise in the other. For instance, a Virtual Machine (VM) with rich physical resources (RAM, cores, etc.) decreases the query response-time, but is expensive with regard to rental rates. In a nutshell, there is a tradeoff between money and time, and our goal therefore is to identify the VM that others the best tradeoff between these two competing considerations. In our study, we pro le the behavior of money versus time for a given query, and de ne the best tradeoff as the \knee" { that is, the location on the pro le with the minimum Euclidean distance from the origin. To study the performance of industrial-strength database engines on real-world cloud infrastructure, we have deployed a commercial DBMS on Google cloud services. On this platform, we have carried out extensive experimentation with the TPC-DS decision-support benchmark, an industry-wide standard for evaluating database system performance. Our experiments demonstrate that the choice of VM for hosting the database server is a crucial decision, because: (i) variation in time and money across VMs is significant for a given query, (ii) no one VM offers the best money-time tradeoff across all queries. To efficiently identify the VM with the best tradeoff from a large suite of available configurations, we propose a technique to characterize the money-time pro le for a given query. The core of this technique is a VM pruning mechanism that exploits the property of partially ordered set of the VMs on their resources. It processes the minimal and maximal VMs of this poset for estimated query response-time. If the response-times on these extreme VMs are similar, then all the VMs sandwiched between them are pruned from further consideration. Otherwise, the already processed VMs are set aside, and the minimal and maximal VMs of the remaining unprocessed VMs are evaluated for their response-times. Finally, the knee VM is identified from the processed VMs as the one with the minimum Euclidean distance from the origin on the money-time space. We theoretically prove that this technique always identifies the knee VM; further, if it is acceptable to and a \near-optimal" knee by providing a relaxation-factor on the response-time distance from the optimal knee, then it is also capable of finding more efficiently a satisfactory knee under these relaxed conditions. We propose two favors of this approach: the first one prunes the VMs using complete plan information received from database engine API, and named as Plan-based Identification of Knee (PIK). On the other hand, to further increase the efficiency of the identification of the knee VM, we propose a sub-plan based pruning algorithm called Sub-Plan-based Identification of Knee (SPIK), which requires modifications in the query optimizer. We have evaluated PIK on a commercial system and found that it often requires processing for only 20% of the total VMs. The efficiency of the algorithm is further increased significantly, by using 10-20% relaxation in response-time. For evaluating SPIK , we prototyped it on an open-source engine { Postgresql 9.3, and also implemented it as Java wrapper program with the commercial engine. Experimentally, the processing done by SPIK is found to be only 40% of the PIK approach. Therefore, from an overall perspective, this thesis facilitates the desired migration of enterprise databases to cloud platforms, by identifying the VM(s) that offer competitive tradeoffs between money and time for the given query.

Background: Patient reports of pain and function are used to inform the need for and timing of total knee replacement (TKR) and evaluate TKR outcomes. This dissertation compared measurement properties of commonly-used patient surveys in TKR and explored ways to develop more efficient knee-specific function measures. Methods: 1,179 FORCE-TJR patients (mean age=66.1, 61% female) completed questionnaires before and 6 months after TKR. Patient surveys included the knee-specific Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and generic SF-36 Health Survey. Tests of KOOS and WOMAC measurement properties included evaluations of scaling assumptions and reliability. Item response theory methods were used to calibrate 22 KOOS function items in one item bank; simulated computerized adaptive tests (CAT) then were used to evaluate shorter function scores customized for each patient. Validity and responsiveness of measures varying in attributes (knee-specific versus generic, longer versus shorter, CAT versus fixed-length) were compared. Results: KOOS and WOMAC scales generally met tests of scaling assumptions, although many pain items were equally strong measures of pain and physical function. Internal consistency reliability of KOOS and WOMAC scales exceeded minimum levels of 0.70 recommended for group-level comparisons across sociodemographic and clinical subgroups. Function items could be calibrated in one item bank. CAT simulations indicated that reliable knee-specific function scores could be estimated for most patients with a 55-86% reduction in respondent burden, but one-third could not achieve a reliable (≥ 0.95) CAT score post-TKR because the item bank did not include enough items vi measuring high function levels. KOOS and WOMAC scales were valid and responsive. Short function scales and CATs were as valid and responsive as longer KOOS and WOMAC function scales. The KOOS Quality of Life (QOL) scale and SF-36 Physical Component Summary discriminated best among groups evaluating themselves as improved, same or worse at 6 months. Conclusions: Results support use of the KOOS and WOMAC in TKR. Improved knee-specific function measures require new items that measure higher function levels. TKR outcomes should be evaluated with a knee-specific quality of life scale such as KOOS QOL, as well as knee-specific measures of pain and function and generic health measures.

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Thesis (PhD)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The knee is the largest, most complicated and incongruent joint in the human body. It sustains very high forces and is susceptible to injury and disease. Osteoarthritis is a common disease prevalent among the elderly and causes softening or degradation of the cartilage and subcondral bone in the joint, which leads to a loss of function and pain. This problem can be alleviated through a surgical intervention commonly termed a “knee replacement”. The aim of a knee replacement procedure is to relieve pain and restore normal function. Ideally, the knee replacement prosthesis should have an articulating geometry similar to that of the patient’s healthy knee, and must allow for normal motion. Unfortunately, this is often problematic since knee prostheses are supplied in standard sizes from a variety of manufacturers and each one has a slightly different design. Furthermore, commercial prostheses are not always able to restore the complex geometry of an individual patient’s original articulating surfaces. This dissertation shows that there is a significant variation between knee geometries, regardless of gender and race. This research aims to resolve the problem in two parts: Firstly by presenting a method for preoperatively selecting the optimal knee prosthesis type and size for a specific patient, and secondly by presenting a design procedure for designing and manufacturing patient-specific unicompartmental knee replacements. The design procedure uses mathematical modelling and an artificial neural network to estimate the original and healthy articulating surfaces of a patient’s knee. The models are combined with medical images from the patient to create a knee prosthesis that is patient-specific. These patient-specific implants are then compared to conventional implants with respect to contact stresses and kinematics. The dissertation concludes that patient-specific implants can have characteristics that are comparable to or better than conventional prostheses. The unique design methodology presented in this dissertation introduces a significant advancement in knee replacement technology, with the potential to dramatically improve clinical outcomes of knee replacement surgery. / AFRIKAANSE OPSOMMING: Die knie is die grootste, mees komplekse en mees ongelyksoortige gewrig in die liggaam. Osteoarthritis is ’n siekte wat algemeen by bejaardes voorkom en die versagting of agteruitgang van die kraakbeen en subchondrale bene in die gewrig tot gevolg het, wat tot ’n verlies van funksionering en pyn lei. Hierdie probleem kan verlig word deur ’n chirurgiese ingryping wat algemeen as ’n “knievervanging” bekend staan. Die doel van ’n knievervangingsprosedure is om pyn te verlig en normale funksionering te herstel. Ideaal gesproke behoort die knievervangingsprostese ’n gewrigsgeometrie te hê wat soortgelyk aan die pasiënt se gesonde knie is, en normale beweging moontlik maak. Ongelukkig is dit dikwels problematies aangesien knieprosteses in standaardgroottes en deur ’n verskeidenheid vervaardigers verskaf word, wat elkeen se ontwerp effens anders maak. Verder kan kommersiële prosteses nie altyd die komplekse geometrie van ’n individuele pasiënt se oorspronklike gewrigsoppervlakke vervang nie. Hierdie proefskrif wys dat daar ’n betekenisvolle variasie tussen knieafmetings is, afgesien van geslag en ras. Hierdie navorsing is daarop gemik om die problem op tweërlei wyse te benader: Eerstens deur ’n metode aan te bied om die optimal knieprostesetipe en -grootte vir ’n spesifieke pasiënt voor die operasie uit te soek, en tweedens om ’n ontwerpprosedure aan te bied vir die ontwerp en vervaardiging van pasiëntspesifieke unikompartementele knievervangings. Die ontwerpprosedure gebruik wiskundige modellering en ’n kunsmatige neurale netwerk om die oorspronklike en gesonde gewrigsoppervlakke van ’n pasiënt se knie te bepaal. Die modelle word met mediese beelde van die pasiënt gekombineer om ’n knieprostese te skep wat pasiëntspesifiek is. Hierdie pasiëntspesifieke inplantings word dan met konvensionele inplantings vergelyk wat kontakstres en kinematika betref. Daar word tot die slotsom gekom dat die pasiëntspesifieke inplantings oor eienskappe kan beskik wat vergelykbaar is met of selfs beter is as dié van konvensionele prosteses. Die unieke ontwerpmetodologie wat in hierdie proefskrif aangebied word, stel beduidende vordering in knievervangingstegnologie bekend, met die potensiaal om die kliniese uitkomste van knievervangingsoperasies dramaties te verbeter.