The impact of digital technology in care homes on unplanned secondary care usage and associated costs.

BACKGROUND: A substantial number of Emergency Department (ED) attendances by care home residents are potentially avoidable. Health Call Digital Care Homes is an app-based technology that aims to streamline residents' care by recording their observations such as vital parameters electronically. Observations are triaged by remote clinical staff. This study assessed the effectiveness of the Health Call technology to reduce unplanned secondary care usage and associated costs. METHODS: A retrospective analysis of health outcomes and economic impact based on an intervention. The study involved 118 care homes across the North East of UK from 2018 to 2021. Routinely collected NHS secondary care data from County Durham and Darlington NHS Foundation Trust was linked with data from the Health Call app. Three outcomes were modelled monthly using Generalised Linear Mixed Models: counts of emergency attendances, emergency admissions and length of stay of emergency admissions. A similar approach was taken for costs. The impact of Health Call was tested on each outcome using the models. FINDINGS: Data from 8,702 residents were used in the analysis. Results show Health Call reduces the number of emergency attendances by 11% [6-15%], emergency admissions by 25% [20-39%] and length of stay by 11% [3-18%] (with an additional month-by-month decrease of 28% [24-34%]). The cost analysis found a cost reduction of £57 per resident in 2018, increasing to £113 in 2021. INTERPRETATION: The introduction of a digital technology, such as Health Call, could significantly reduce contacts with and costs resulting from unplanned secondary care usage by care home residents.

Navigating data governance associated with real-world data for public benefit: an overview in the UK and future considerations.

Real-world data encompass data primarily captured for the provision or operation of services, for example, electronic health records for direct care purposes, but which may have secondary uses for informing research or commissioning. Public benefit is potentially forfeited by the underutilisation of real-world data for secondary uses, in part due to risk aversion when faced with the prospect of navigating necessary and important data governance processes. Such processes can be perceived as complex, daunting, time-consuming and exposing organisations to risk. By providing an overview description and discussion around the role of six key legal and information governance frameworks and their role regarding responsible data access, linkage and sharing, our intention is to make data governance a less daunting prospect and reduce the perception that it is a barrier to secondary uses, thus enabling public benefit.

A Visual-Vestibular Model to Predict Motion Sickness for Linear and Angular Motion.

OBJECTIVE: This study proposed a model to predict passenger motion sickness under the presence of a visual-vestibular conflict and assessed its performance with respect to previously recorded experimental data. BACKGROUND: While several models have been shown useful to predict motion sickness under repetitive motion, improvements are still desired in terms of predicting motion sickness in realistic driving conditions. There remains a need for a model that considers angular and linear visual-vestibular motion inputs in three dimensions to improve prediction of passenger motion sickness. METHOD: The model combined the subjective vertical conflict theory and human motion perception models. The proposed model integrates visual and vestibular sensed 6 DoF motion signals in a novel architecture. RESULTS: Model prediction results were compared to motion sickness data obtained from studies conducted in motion simulators as well as on-road vehicle testing, yielding trends that are congruent with observed results in both cases. CONCLUSION: The model demonstrated the ability to predict trends in motion sickness response for conditions in which a passenger performs a task on a handheld device versus facing forward looking ahead under realistic driving conditions. However, further analysis across a larger population is necessary to better assess the model's performance. APPLICATION: The proposed model can be used as a tool to predict motion sickness under different levels of visual-vestibular conflict. This can be leveraged to design interventions capable of mitigating passenger motion sickness. Further, this model can provide insights that aid in the development of passenger experiences inside autonomous vehicles.

Sharing real-world data for public benefit: a qualitative exploration of stakeholder views and perceptions.

BACKGROUND: There has been an increasing interest in the use of "real-world" data to inform care decision making that could lead to public health benefit. Routinely collected service and activity data associated with the administration of care services and service-users (such as electronic health records or electronic social care records), hold potential to better inform effective and responsive decision-making about health and care services provided to national and local populations. This study sought to gain an in-depth understanding regarding the potential to unlock real world data that was held in individual organisations, to better inform public health decision-making. This included sharing data between and within health service providers and local governing authorities, but also with university researchers to inform the evidence base. METHODS: We used qualitative methods and carried out a series of online workshops and interviews with stakeholders (senior-level decision-makers and service leads, researchers, data analysts, those with a legal and governance role, and members of the public). We identified recurring themes in initial workshops, and explored these with participants in subsequent workshops. By this iterative process we further refined the themes identified, compared views and perceptions amongst different stakeholder groups, and developed recommendations for action. RESULTS: Our study identified key elements of context and timing, the need for a different approach, and obstacles including governmental and legal, organisational features, and process factors which adversely affect the sharing of real world data. The findings also highlighted a need for improved communication about data for secondary uses to members of the public. CONCLUSION: The Covid-19 pandemic context and changes to organisational structures in the health service in England have provided opportunities to address data sharing challenges. Change at national and local level is required, within current job roles and generating new jobs roles focused on the use and sharing of real-world data. The study suggests that actions can be taken to unlock the potential of real-world data for public health benefit, and provides a series of recommendations at a national level, for organisational leaders, those in data roles and those in public engagement roles.

Does the fit of personal protective equipment affect functional performance? A systematic review across occupational domains.

OBJECTIVE: To explore the effect of personal protective equipment (PPE) fit on functional performance across a range of occupational domains. BACKGROUND: PPE introduces an ergonomic, human systems integration, and mass burden to the wearer, and these factors are thought to be amplified if PPE is ill-fitting. However, few studies have considered the role of fit (static, dynamic, and cognitive) when evaluating PPE-related performance detriments in occupational settings. METHOD: A systematic literature review was conducted to identify relevant studies, which were then critically appraised based on methodological quality and collated to compare key findings and present evidence-based recommendations for future research directions across a range of occupational domains. RESULTS: 16 published studies met the inclusion criteria, 88% of which found that the fit of PPE had a statistically significant effect on occupational performance. Poorly sized PPE resulted in slower or increased reaction time; decreased range of motion or mobility; decreased endurance or tolerance; decreased pulmonary function; and altered muscle activation. Limited research met the inclusion criteria and those that did had risks of bias in methodology quality. CONCLUSION: Future research evaluating the effect of PPE on performance in occupational settings should aim to recruit a more representative population; consider sex as a covariate; quantify and evaluate PPE fit and performance when integrated with all relevant equipment items; include outcome measures related to all three categories of fit (static, dynamic, cognitive); and assess performance of operationally relevant tasks.

The whore gaze as the world burns: A conversation between PJ Starr, Monica Jones, The Incredible, Edible, Akynos and Bambi Katsura.

This illustrated conversation between The Incredible, Edible, Akynos, Monica Jones, PJ Starr and Bambi Katsura unpacks how we use media to continue our sex worker activism during the multiple pandemics of COVID-19, police violence and environmental disasters. We each bring our histories and theoretical innovations to the table including the framework of the 'Whore Gaze' developed by PJ, Monica's approach to documentary that ensures trans people narrate their own lives, Akynos' scripted film series Chronicles of a Black Heaux that may re-imagine the 'melomentary form' for sex worker representation and Bambi's experience as a filmmaker and curator. In our conversation, we discuss how we use film, photography, film festivals, animation and other forms for our activism to promote social justice. We also describe how we are systematically unlearning the codes of representation of research and human rights documentation, so that we can create materials that are accessible to our communities, to people with disabilities and be freed from the dead-end of respectability politics.

A naturalistic study of passenger seating position, posture, and restraint use in second-row seats.

OBJECTIVE: The objective of the current study was to increase scientific understanding of rear-seat passenger seating position, postures, CRS use, and belt use through a naturalistic study. A secondary objective was to compare data from vehicles used in ride-hailing with data from other vehicles. METHOD: Video cameras were installed in the passenger cabins of the vehicles of 75 drivers near the center of the windshield. The video data were downloaded after the vehicles were operated by their owners for two weeks. Video frames were sampled from near the ends and in the middle of each trip, and at five-minute intervals in trips longer than 15 min. A total of 7,323 frames with second-row passengers were manually coded. RESULTS: A total of 444 unique second-row passengers were identified in video frames from 1,188 trips taken in 65 of the 75 vehicles in the study. Two of the vehicles that were driven for commercial ride-hailing during the study period accounted for 199 (45%) of the passengers. Considering multiple passengers in some trips, a total of 1,899 passenger-trips were identified. For passengers not using child restraint systems (CRS), the belt use rate was 65% in the non-ride-hailing vehicles versus 32% among passengers in the ride-hailing vehicles. No CRS use was observed in the ride-hailing vehicles. Among children using backless boosters, the shoulder belt was lateral to the clavicle or under the arm in 26% of frames. Among belted passengers not using CRS, the belt was lateral to the clavicle or on the neck about 6% of the time. Belted passengers not using CRS were observed leaning to the left or right about 27% of the time, with leaning away from the shoulder belt more common than leaning into the belt. CONCLUSIONS: This study is the first to report seating position, posture, and belt fit observations for a large naturalistic sample of second-row passengers that includes adult occupants. The data suggest that low rear seat belt use rates remain a concern, particularly in ride-hailing vehicles. Non-nominal belt placement and posture may also be common in second-row seating positions.

Impact of the SARS-CoV-2 pandemic on female breast, colorectal and non-small cell lung cancer incidence, stage and healthcare pathway to diagnosis during 2020 in Wales, UK, using a national cancer clinical record system.

BACKGROUND: COVID-19 pandemic responses impacted behaviour and health services. We estimated the impact on incidence, stage and healthcare pathway to diagnosis for female breast, colorectal and non-small cell lung cancers at population level in Wales. METHODS: Cancer e-record and hospital admission data linkage identified adult cases, stage and healthcare pathway to diagnosis (population ~2.5 million). Using multivariate Poisson regressions, we compared 2019 and 2020 counts and estimated incidence rate ratios (IRR). RESULTS: Cases decreased 15.2% (n = -1011) overall. Female breast annual IRR was 0.81 (95% CI: 0.76-0.86, p < 0.001), colorectal 0.80 (95% CI: 0.79-0.81, p < 0.001) and non-small cell lung 0.91 (95% CI: 0.90-0.92, p < 0.001). Decreases were largest in 50-69 year olds for female breast and 80+ year olds for all cancers. Stage I female breast cancer declined 41.6%, but unknown stage increased 55.8%. Colorectal stages I-IV declined (range 26.6-29.9%), while unknown stage increased 803.6%. Colorectal Q2-2020 GP-urgent suspected cancer diagnoses decreased 50.0%, and 53.9% for non-small cell lung cancer. Annual screen-detected female breast and colorectal cancers fell 47.8% and 13.3%, respectively. Non-smal -cell lung cancer emergency presentation diagnoses increased 9.5% (Q2-2020) and 16.3% (Q3-2020). CONCLUSION: Significantly fewer cases of three common cancers were diagnosed in 2020. Detrimental impacts on outcomes varied between cancers. Ongoing surveillance with health service optimisation will be needed to mitigate impacts.

A parametric head geometry model accounting for variation among adolescent and young adult populations.

BACKGROUND AND OBJECTIVE: Modeling the size and shape of human skull and scalp is essential for head injury assessment, design of helmets and head-borne equipment, and many other safety applications. Finite element (FE) head models are important tools to assess injury risks and design personal protective equipment. However, current FE head models are mainly developed based on the midsize male, failing to account for the significant morphological variation that exists in the skull and brain. The objective of this study was to develop a statistical head geometry model that accounts for size and shape variations among the adolescent and young adult population. METHODS: To represent subject-specific geometry using a homologous mesh, threshold-based segmentation of head CT scans of 101 subjects between 14 and 25 years of age was performed, followed by landmarking, mesh morphing, and projection. Skull and scalp statistical geometry models were then developed as functions of age, sex, stature, BMI, head length, head breadth, and tragion-to-top of head using generalized Procrustes analysis (GPA), principal component analysis (PCA) and multivariate regression analysis. RESULTS: The statistical geometry models account for a high percentage of morphological variations in scalp geometry (R2=0.63), outer skull geometry (R2=0.66), inner skull geometry (R2=0.55), and skull thickness (error < 1 mm) CONCLUSIONS: Skull and scalp statistical geometry models accounts for size and shape variations among the adolescent and young adult population were developed as functions of subject covariates. These models may serve as the geometric basis to develop individualized head FE models for injury assessment and design of head-borne equipment.

A parametric modeling of adult body shape in a supported seated posture including effects of age.

Statistical body shape models (SBSM) provide compact, flexible representations of body shape that can be implemented in design software. However, few SBSMs have been created to represent adults in supported seated postures that are relevant for the design of seated environments, and none has incorporated the effects of age. This paper presents an SBSM based on surface laser-scan data from 155 U.S. adults. The data were processed to obtain homologous mesh structure and symmetric geometry, and the processed data were statistically analysed using principal component analysis to obtain a compact representation of the data variance. Regression analysis was conducted to predict body size and shape from stature, body mass index, ratio of sitting height to stature, sex, and age. The resulting model allows rapid generation of realistic body models for applications, including product design, accommodation assessment, and safety system optimisation. The model is publicly accessible at HumanShape.org. Practitioner summary: This paper presents a statistical model that represents adult body shapes in a supported seated posture based on 3 D anthropometric measurements. This model is the first whole-body parametric model known to incorporate age effects based on data extending beyond 65 years of age.

Comparison of a U.S. and Zambian Ob/Gyn Residency Training Programme.

Introduction: The major objective of the study was to compare and contrast a U.S. and Zambian Ob/Gyn residency programme, using uniform metrics, as the basis for an initial exploration of perceived inequities in post-graduate medical education between low- and high-income countries. Methods: Measurements of the following procedures were used to indicate whether minimum standards had been met by trainees in their respective postgraduate programmes: vaginal deliveries; C-sections; abdominal, vaginal and laparoscopic hysterectomies; other laparoscopic surgeries; cancer cases; abortions; obstetrical ultrasounds; cystoscopies; incontinence and pelvic floor surgeries. Evaluations were also made with respect to the presence or absence of an official ultrasound rotation, subspeciality and off-service rotations, protected didactic time and exclusive time on obstetrics and gynaecologic clinical services. Comparisons were made relative to these various categories and the average procedural numbers at each level of training to determine differences in trends and degree of exposure. Results: Minimal procedural requirements were met by both the U.S. and Zambian programmes. For open surgical cases, the minimum standards were higher for the Zambian programme, whereas for procedures associated with the use of high-end technology, such as ultrasound and minimally invasive surgery, minimum standards were higher for the U.S. programme. Conclusion: There were no significant differences in the Zambian and U.S. Ob/Gyn post-graduate training programmes, relative to their respective metrics. A more extensive analysis is required to determine the actual competency levels that are produced by the respective training systems.

Post-Drive Standing Balance of Vehicle Passengers Using Wearable Sensors: The Effect of On-Road Driving and Task Performance.

Postural sway has been demonstrated to increase following exposure to different types of motion. However, limited prior studies have investigated the relationship between exposure to normative on-road driving conditions and standing balance following the exposure. The purpose of this on-road study was to quantify the effect of vehicle motion and task performance on passengers' post-drive standing balance performance. In this study, trunk-based kinematic data were captured while participants performed a series of balance exercises before and after an on-road driving session in real-time traffic. Postural sway for all balance exercises increased following the driving session. Performing a series of ecologically relevant visual-based tasks led to increases in most post-drive balance metrics such as sway position and velocity. However, the post-drive changes following the driving session with a task were not significantly different compared to changes observed following the driving session without a task. The post-drive standing balance performance changes observed in this study may increase vulnerable users' risk of falling. Wearable sensors offer an opportunity to monitor postural sway following in-vehicle exposures.

Effect of Class I-III obesity on driver seat belt fit.

OBJECTIVE: Approximately 40% of the U.S. adult population are obese. An issue associated with this trend is proper seat belt fit for obese occupants. This study extends previous research, in which few individuals with high BMI (> 40 kg/m2) were included, by examining the relationship between participant and belt factors on belt fit for drivers with Class I-III obesity. METHODS: Posture and belt fit of 52 men and women with BMI from 31 to 59 kg/m2 (median 38 kg/m2) were measured in a laboratory vehicle mockup. Five seat belt configurations were achieved by manipulating the belt anchorage locations. Body and belt landmark locations were recorded using a three-dimensional coordinate measuring machine. RESULTS: Higher BMI was associated with a lap belt position further forward and higher relative to the pelvis. On average, the lap belt was positioned an additional 32 mm forward and 13 mm above the ASIS with each increasing level of obesity classification. Sex had a small effect after accounting for BMI and stature. The mean fore-aft location of the lap belt was 24 mm more forward for men vs. women and 12 mm higher for women vs. men at the same stature and BMI. On average, women used 50 mm more belt webbing in the lap and 92 mm more in the shoulder vs. men. CONCLUSIONS: The results suggest that increasing levels of obesity class effectively introduces slack in the seat belt system by routing the belt further away from the skeleton. Because the belt is designed to engage the pelvis during a frontal crash, belt placements that are higher and further forward may increase injury risk by allowing excursions or submarining. Unique to this cohort, sex had an important effect on belt fit measures after taking into account stature and BMI. The participant and belt factors considered explained only about 40% of the variance in belt fit. The remaining variance may be due to preference or exogenous body shape effects. Further research is needed to assess methods for enhanced seat belt fit for people with obesity, including addressing sex differences in belt routing.

Development of a data utility framework to support effective health data curation.

OBJECTIVES: The value of healthcare data is being increasingly recognised, including the need to improve health dataset utility. There is no established mechanism for evaluating healthcare dataset utility making it difficult to evaluate the effectiveness of activities improving the data. To describe the method for generating and involving the user community in developing a proposed framework for evaluation and communication of healthcare dataset utility for given research areas. METHODS: Aninitial version of a matrix to review datasets across a range of dimensions wasdeveloped based on previous published findings regarding healthcare data. Thiswas used to initiate a design process through interviews and surveys with datausers representing a broad range of user types and use cases, to help develop afocused framework for characterising datasets. RESULTS: Following 21 interviews, 31 survey responses and testing on 43 datasets, five major categories and 13 subcategories were identified as useful for a dataset, including Data Model, Completeness and Linkage. Each sub-category was graded to facilitate rapid and reproducible evaluation of dataset utility for specific use-cases. Testing of applicability to >40 existing datasets demonstrated potential usefulness for subsequent evaluation in real-world practice. DISCUSSION: Theresearch has developed an evidenced-based initial approach for a framework tounderstand the utility of a healthcare dataset. It likely to require further refinementfollowing wider application and additional categories may be required. CONCLUSION: The process has resulted in a user-centred designed framework for objectively evaluating the likely utility of specific healthcare datasets, and therefore, should be of value both for potential users of health data, and for data custodians to identify the areas to provide the optimal value for data curation investment.

Understanding the nature and impact of occupational stress on Australian rural aged care workers.

This study explored the nature and impact of occupational stress on direct-care workers employed by aged care providers in rural Australia. The Job demands-Resources (JD-R) model of occupational stress provided the theoretical framework to guide this qualitative investigation. A series of four FGs were conducted with direct-care workers (n = 23), who reported their job demands, job resources and personal resources. Direct-care workers identified six themes related to job demands: time pressure, physical demands, hindrance demands, an inadequate mix of staff, insufficient training to deal with complex conditions and work schedule demands. Four themes related to job resources were identified: collaboration with colleagues, equipment, opportunities for development and work schedule control. Disposition and self-care were identified as necessary personal resources for aged care workers. While the generic JD-R questionnaire captures many relevant workplace characteristics, further investigations with this work group should also consider the inclusion of items related to shift work, disposition and self-care.

Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study.

OBJECTIVES: To estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer. METHODS: We employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England. RESULTS: Declines in urgent referrals (median=-70.4%) and chemotherapy attendances (median=-41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=-44.5%) and chemotherapy attendances (median=-31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity. CONCLUSIONS: Dramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.

PARP Inhibitors in the Management of Ovarian Cancer: ASCO Guideline.

PURPOSE: To provide recommendations on the use of poly(ADP-ribose) polymerase inhibitors (PARPis) for management of epithelial ovarian, tubal, or primary peritoneal cancer (EOC). METHODS: Randomized, controlled, and open-labeled trials published from 2011 through 2020 were identified in a literature search. Guideline recommendations were based on the review of the evidence, US Food and Drug Administration approvals, and consensus when evidence was lacking. RESULTS: The systematic review identified 17 eligible trials. RECOMMENDATIONS: The guideline pertains to patients who are PARPi naïve. All patients with newly diagnosed, stage III-IV EOC whose disease is in complete or partial response to first-line, platinum-based chemotherapy with high-grade serous or endometrioid EOC should be offered PARPi maintenance therapy with niraparib. For patients with germline or somatic pathogenic or likely pathogenic variants in BRCA1 (g/sBRCA1) or BRCA2 (g/sBRCA2) genes should be treated with olaparib. The addition of olaparib to bevacizumab may be offered to patients with stage III-IV EOC with g/sBRCA1/2 and/or genomic instability and a partial or complete response to chemotherapy plus bevacizumab combination. Maintenance therapy (second line or more) with single-agent PARPi may be offered for patients with EOC who have not received a PARPi and have responded to platinum-based therapy regardless of BRCA mutation status. Treatment with a PARPi should be offered to patients with recurrent EOC that has not recurred within 6 months of platinum-based therapy, who have not received a PARPi and have a g/sBRCA1/2, or whose tumor demonstrates genomic instability. PARPis are not recommended for use in combination with chemotherapy, other targeted agents, or immune-oncology agents in the recurrent setting outside the context of a clinical trial. Recommendations for managing specific adverse events are presented. Data to support reuse of PARPis in any setting are needed.Additional information is available at www.asco.org/gynecologic-cancer-guidelines.

Prevalence of non-nominal seat positions and postures among front-seat passengers.

OBJECTIVE: Recent studies have suggested that a relationship exists between crash injury risk and occupant posture, particularly in postures different from those used with anthropomorphic test devices (ATDs) in crash testing. The objective of this study was to increase scientific understanding of typical front-seat passenger postures through a naturalistic study. METHOD: Video cameras were installed in the passenger cabins of the vehicles of 75 drivers. Reflective targets were attached to the seats and the seat position and seat back angle was moved through their available ranges during instrumentation. The video data, along with vehicle acceleration and location data, were downloaded after the vehicles were operated as usual by their owners for two weeks. Video frames were manually coded to identify characteristics of front-seat passenger posture and position. Seat position and seat back angle were estimated using the calibration data obtained during vehicle instrumentation. RESULTS: Video frames from a total of 2733 trips were coded for 306 unique front-seat passengers. For these trips, a total of 13638 frames were coded; each frame represents about four minutes of travel time. The head was rotated left or right in 33% of frames, and the torso was rotated left or right about 10% of the time and pitched forward in almost 10% of frames. No seat position or seat back angle change was noted in 40 (53%) of vehicles and the distributions of seat position and seat back angle on arrival were essentially unchanged during travel. The seat was positioned full-rear on the seat track about 23% of the time and rearward of the mid-track position in 92% of frames. The mean seat back angle was 25.4 degrees (standard deviation 6.4 degrees); seat back angle was greater than 30 degrees in 15% of frames and greater than 35 degrees in less than 1% of frames. CONCLUSIONS: This study is the first to report distributions of postures, seat positions, and seat back angles for front-seat passengers. Seat positions rearward of the middle of the seat adjustment range are common, but highly reclined postures are infrequent. Non-nominal torso and head postures also are nontrivial.

Child Posture and Belt Fit in a Range of Booster Configurations.

Belt positioning boosters reduce injury risk for child occupants compared with seat belts alone. While boosters shorten the effective seat length (and thus reduce slouching), "boosting" the child relative to the vehicle interior components also achieves additional safety benefits. First, the increase of the lap belt angle usually improves belt fit across the pelvis and reduces the risk of the occupant slipping ("submarining") under the belt. Second, the torso belt is re-centered over the bony landmarks of the shoulder for more effective/secure restraint. Third, the child's head is relocated in a range better protected by side airbags. The objective of this research was to quantify differences in posture and belt fit across a range of booster designs that provide different levels of boosting. Posture and belt fit were measured in 25 child volunteers aged four to 12. Children were measured in three laboratory seating conditions selected to provide a range of cushion lengths and belt geometries. Six different boosters, as well as a no-booster condition, were evaluated. The low height boosters produced postures that were more slouched, with the hips further forward than in other more typical boosters. Lap belt fit in the low height boosters was not meaningfully different from the other boosters. Shoulder belt fit produced by the lowest height booster was similar to the no-booster condition. Belt positioning boosters that boost the child less than 70 mm produced postures similar to the no-booster condition. While lap belt guides on these products can produce a similar static lap belt fit, they may not provide adequate dynamic performance and do not achieve the other benefits that come with raising the child to a more advantageous location relative to interior components and belts.