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A comprehensive background is herein presented for lumbar skin strain and its effect on skin adhered wearable (SAW) products. A background of the development of computational models of the interaction of skin and novel SAWs being researched is also presented. These include products involving the use of high deflection strain gauges to measure skin strain during functional movements (FMs) as a method to address the complicated phenotyping of the etiological causes of low back pain (LBP). The background concludes with the mathematical calculation of the principal skin strain magnitudes and orientations using retroreflective marker coordinate data in a motion capture lab setting and the potential role of principal skin strain on the post-operative management of wounds to accelerate healing and minimize infection and scarring. The mechanics response of lumbar skin among 30 participants was measured during various FMs, for which high strain movements (Flexion, Flexion right/left, Sit To Stand) exhibited principal strain magnitudes repeatedly above 50% while others (Rotation right/left, Lateral Bending right/left, Extension, and Extension right/left) exhibited magnitudes repeatedly below 50%. Principal strain orientation was presented in easily visualizable mappings that demonstrated minimal variability both within and between participants for a given FM. Principal strain rates were measured, ranging between 25% and 151% per second among movements. The mechanics response of lumbar skin was again measured for a single participant, albeit this time between bare skin and skin with a SAW; which in this example was kinesiology tape with a high deflection nanocomposite strain gauge. Results indicated very significant skin restriction during Flexion, for which a macroscopic skin strain of 65% was reduced to 22% because of the KT tape and additionally down to 13% because of the addition of the sensor (on top of the KT tape). A FEM was created based off this scenario, for which it was shown that the mechanical properties of skin in vitro are insufficient in representing the mechanical response of skin due to its stiffness. This was hypothesized to be due to the increased hydration (lower stiffness) of in vivo skin, for which high deformation stiffness in the literature is not available. The thesis is concluded with future research directions that would benefit the design of SAWs where high deformation is considered. Future research directions are also discussed regarding post-operative wound healing and the potential role of repeated skin strains, such as concerning scarring and infection.

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Throughout time man has discovered that the human form, in all its harmonious proportion, can be used as a guide, gauge and tool to design and build structures. However, the human figure has not been the only organic form used to create architecture. Many animals create dwellings that synchronize with not only their own unique physical characteristics and survival instincts, but with their aesthetic preferences as well. It is logical that a design should respond to its surroundings, program and most importantly, its inhabitants. This thesis design is for two specific occupants: the cat and the human. They are both meant to inhabit the building wholly and simultaneously. The way each of them experiences and uses the space, however, differs greatly. For a building to survive it needs many of the same things as living creatures: sunlight, air and movement, to name a few. It also needs to function like a living creature. It must breathe, sleep, respond to the changing seasons, and adapt over time. This thesis is an investigation of how both human and cat can dwell in a building of harmonious proportion, scale, light, and material. / Master of Architecture

Les temps d’attente pour une prise en charge en orthopédie et en neurochirurgie ont considérablement augmenté au Québec et au Canada engendrant d’important problèmes d’accès aux soins. Face à ces délais déraisonnables, les modèles de pratiques avancées en physiothérapie (PAP), qui confèrent une plus grande autonomie et responsabilité aux physiothérapeutes, représentent une alternative prometteuse. Cette thèse vise à évaluer l'efficacité de ces modèles de soins dans la prise en charge des troubles musculosquelettiques (TMS). À cette fin, trois revues systématiques avec méta-analyses ont été conduites afin d’évaluer l’état des connaissances sur les modèles de PAP pour les TMS. De plus, trois études ont été menées au Québec avec le modèle de CareAxis, où des physiothérapeutes en pratiques avancées (PPA) effectuent l'évaluation, le diagnostic et le triage chirurgical de patients référés pour une consultation en chirurgie de la colonne. Celles-ci incluent une étude d’observations rétrospective évaluant l’efficacité du modèle, un essai contrôlé randomisé (ECR) pragmatique sur l’efficacité d’une prise en charge à séance unique comparée à une prise en charge à séances multiples, ainsi qu’une étude qualitative visant à explorer les perceptions des patients et des PPA envers ce nouveau modèle de soins. Les trois revues systématiques ont montré que les modèles de PAP améliorent l’accès aux soins, que le diagnostic et le triage des candidats potentiellement chirurgicaux émis par les PPA sont valides et concordants avec ceux des médecins spécialistes et que l’efficacité clinique, en termes de douleur et d’incapacité, des modèles de PAP est au moins comparable aux soins médicaux standard, tout en réduisant les coûts par patient pour le système de santé. Par ailleurs, les patients ont rapporté des niveaux de satisfaction plus élevés envers les modèles PAP qu’envers les modèles standards. Pour ce qui est du modèle de CareAxis, l’étude d’observations démontre que le modèle a le potentiel d’améliorer l’accès aux soins en réduisant les temps d’attente. De plus, les diagnostics et les décisions de triage chirurgical des PPA sont comparables à ceux des chirurgiens de la colonne. Des améliorations significatives en termes de réduction de la douleur et des incapacités ont été rapportées, tant dans l’étude d’observations que dans l’ECR. Ce dernier a permis de conclure que l’ajout de cinq séances de suivis incluant de la physiothérapie multimodale n’apporte pas de bénéfices significatifs lorsque comparé à l’approche d’une seule séance, et ce, malgré une préférence des patients pour l’approche à séances multiples. Cette préférence a également été observée dans l’étude qualitative, où les patients et PPA ont souligné les bénéfices du modèle de CareAxis en comparaison au modèle standard, tout en soulignant que le modèle présente certaines limites. En conclusion, les modèles de PAP, dont le modèle de CareAxis, ont le potentiel d’améliorer l’accès aux soins tout en offrant une qualité de soins en termes de diagnostic, de triage chirurgical et d’évolution des patients au moins comparable au modèle médical standard. L’efficacité clinique des approches à séance unique ou multiples est comparable. Les patients ont rapporté des taux élevés de satisfaction envers le modèle de CareAxis. / Waiting times for orthopedic and neurosurgery care have significantly increased in Quebec and Canada, leading to significant health care access problems. Faced with these unreasonable delays, advanced practice physiotherapy (APP) models, which included increased autonomy and responsibilities for physiotherapists, represent a promising alternative. The aim of this thesis is to evaluate the effectiveness of these models of care in managing musculoskeletal disorders (MSKDs). Three systematic reviews with meta-analyses were conducted to assess the state of knowledge on APP models of care for MSKDs. In addition, three studies were carried out in Quebec using the CareAxis model, in which advanced practice physiotherapists (APPT) perform the assessment, diagnosis, and surgical triage of patients referred for a spinal surgery consultation. These included a retrospective observational study evaluating the APP model effectiveness, a pragmatic randomized controlled trial (RCT) on the effectiveness of a single session versus multiple sessions of care, and a qualitative study aimed at exploring the perceptions of patients and APPTs towards this new model of care. The three systematic reviews showed that APP models improve health care access, the diagnosis and triage of potential surgical candidates performed by the APPTs are valid and concordant with those of medical specialists. The clinical effectiveness, in terms of pain and disability, of APP models is at least comparable to standard medical care, while reducing health care cost per patient. Furthermore, patients reported higher levels of satisfaction with the APP models than with standard medical models. As for the CareAxis model, the observational study demonstrates that the model has the potential to improve health care access by reducing waiting times. Moreover, the diagnoses and surgical triage decisions of the APPTs are comparable to those of spine surgeons. Significant improvements in terms of pain and disability reduction were reported, both in the observational study and in the RCT. The RCT concluded that adding five follow-up sessions including multimodal physiotherapy does not provide significant benefits compared to the single-session approach, despite patients' preference for the multiple-session approach. This preference was also observed in the qualitative study, where patients and APPTs highlighted the benefits of the CareAxis model compared to the standard model, while noting that the model has certain limitations. In conclusion, APP models, including the CareAxis model, have the potential to improve health care access while offering a quality of care in terms of diagnosis, surgical triage, and patient outcomes that is at least comparable to the standard medical model. The clinical effectiveness of single or multiple session approaches is comparable. Patients reported high satisfaction rates with the CareAxis model.

Ein System zur automatischen Erfassung der Klauengesundheit von Milchkühen kann durch möglichst frühzeitige präventive und kurative Eingriffe sowohl das Tierwohl steigern als auch ökonomische Verluste minimieren. Ziel war die Entwicklung eines automatischen Systems, dass mittels 3D Sensordaten die Rückenkrümmung einer Kuh erfassen kann und einen entsprechenden Locomotion Score ausgibt. In dieser Studie wurden von August bis Dezember 2016 auf einem Milchviehbetrieb mit Boxenlaufstallhaltung 200 Kühe der Rasse Deutsche Holstein automatisch von einem System nach Verlassen des Melkstandes erfasst. Das System bestand aus zwei RFID-Antennen zur Tiererkennung, einem 3D Sensor zur Lahmheitsbeurteilung und zwei 2D Kameras zur visuellen Bonitur und Validierung. Anhand der 2D Videos wurde nach der Methode von SPRECHER et al. (1997) für 1489 Datensätze ein Locomotion Scores vergeben. Im 2,5D-Tiefenbild wurden zunächst die Hüfthöcker als höchste, äußerste Punkte im Bild identifiziert. Ausgehend von einer Verbindungslinie zwischen den Hüfthöckern, wurde die Wirbelsäule als Polylinie der höchsten Punkte in Richtung Bildanfang ermittelt. Im 3D-Raum wurde dann an die gefundene Rückenlinie ein Kreis approximiert, dessen Radius umgekehrt proportional zur Krümmung des Kuhrückens ist. Der Vergleich der visuell vergebenen und der automatisch gemessenen Scores ergab für das Modell mit fünf Stufen eine Übereinstimmung von 59 % und für das Modell mit drei Stufen 65 %. Die Korrelation nach Spearman (rs = 0,73) zeigte einen deutlichen Zusammenhang zwischen den berechneten und den visuellen Scores. Mit einer Genauigkeit von 82 % wurden 96 % der lahmen Kühe auch als lahm erkannt. Die größte Übereinstimmung wurde für den Locomotion Score 2 erreicht (80 %). In dieser Arbeit wurde ein automatisches System entwickelt, welches durch die Berechnung der Krümmung der Rückenlinie insbesondere beginnende Lahmheiten sehr gut erkennen kann. / A system for automatic detection of lameness in dairy cows can increase animal welfare as well as minimize economic losses through early preventative and curative treatments. The aim of this study was to develop an automatic system that uses 3D sensor data to detect the spine curve of a cow and generate a corresponding locomotion score. In the present study 200 German Holstein cows housed in a free stall barn were recorded via an automatic system after leaving the milking parlour from August to December 2016 on a dairy farm. The system consisted of two RFID-antennas, a 3D depth camera for automatic lameness detection and two standard 2D cameras for visual classification and validation. An amount of 1,489 2D sets of data were locomotion scored according to the method of SPRECHER et al. (1997). Locomotion Score 1 was used to score a healthy cow and Locomotion Score 2 – 5 for lameness with increasing severity. In the analysis five levels (score 1 – 5) as well as three levels (score 1, 2, and ≥ 3) were compared. In the 2.5D depth image the hip joints were identified as the highest, outermost points in the image. Starting from a connection line between the hip joints, the spine was determined as a polyline of the highest points in anterior direction. On the 3D surface, a circle was approximated to the detected back line whose radius is inversely proportional to the curvature of the cow´s back. A comparison of the visually assigned and automatically detected scores showed a 59 % match of the five-level model and 65 % for the three-level model. The Spearman correlation (rs = 0.73) showed a clear correlation between the calculated and the visual scores. With an accuracy of 82 %, 96 % of lame cows were identified as lame. The highest agreement was reached for locomotion Score 2 (80 %). In the present study an automatic system was developed, which can recognize in particular beginning lameness by calculating the curvature of the back.