A current assessment of the THOR 50M in rear impacts.

OBJECTIVE: This study presents a comparison of the Test Device for Human Occupant Restraint (THOR) 50M and Hybrid III (HIII) 50M anthropomorphic test device (ATD) geometries and rear impact head and neck biofidelity to each other and to postmortem human surrogate (PMHS) data to evaluate the usefulness of the THOR in rear impact testing. METHODS: Both ATDs were scanned in a seated position on a rigid bench seat. A series of rear impact sled tests with the rigid bench seat with no head restraint support were conducted with a HIII-50M at 16 and 24 kph. Tests at each speed were performed twice with the THOR-50M to allow an assessment of the repeatability of the THOR-50M. A comparison of the test results from THOR-50M testing were made to the results of a previous study that included PMHS. Rear impact sled tests with both ATDs in a modern seat were then conducted at 40 kph. RESULTS: The THOR-50M head was 48.4 mm rearward and 60.1 mm higher than the HIII-50M head when seated in the rigid bench seat. In the repeated rigid bench testing at 16 and 24 kph, the THOR-50M head longitudinal and vertical accelerations, upper neck moment, and overall kinematics showed good test-to-test repeatability. In the rigid bench tests, the THOR-50M neck experienced flexion prior to extension in the 16 kph tests, where the neck of the HIII only experienced extension. At 24 kph both ATDs only experienced extension. The THOR-50M head displaced more rearward at both test velocities. The rigid bench tests show that the THOR-50M neck allows for more extension motion or articulation than the HIII-50M neck. The rigid bench test also shows that the head longitudinal and vertical accelerations, angular head kinematics, and upper neck moments were reasonably comparable between the ATDs. The THOR-50M results were closer to the average of the PMHS results than the HIII-50-M results, with the exception of the upper neck. In the 40 kph tests, with a modern seat design, the THOR-50M resulted in more deformation of the seatback with greater head restraint loading than the HIII-50M. The THOR-50M head backset distance was less. CONCLUSION: This study provides insight into the differences and similarities between the THOR and the HIII-50M ATD geometries, instrumentation responses, and kinematics, as well as the repeatability of the THOR-50M in rear impacts testing. The overall geometries of the THOR-50M and the HIII-50M are similar. The seated head position of the THOR-50M is slightly further rearward and higher than the HIII-50M. The results indicate that the THOR-50M matches the PMHS results more closely than the HIII-50M and may have improved neck biofidelity in rear impact testing. The results indicate that the studied THOR-50M responses are repeatable within expected test-to-test variations in rear impacts. Early data suggest that the THOR-50M can be used in rear impact testing, though a more complete understanding of the THOR-50M differences to the HIII ATDs will allow for better correlation to the existing body of HIII rear impact testing.

Sleep Health Assessment and Treatment in Children and Adolescents with Chronic Pain: State of the Art and Future Directions.

Sleep is interrelated with the experience of chronic pain and represents a modifiable lifestyle factor that may play an important role in the treatment of children and adolescents with chronic pain. This is a topical review of assessment and treatment approaches to promote sleep health in children and adolescents with chronic pain, which summarizes: relevant and recent systematic reviews, meta-analyses, and methodologically sound prospective studies and clinical trials. Recommendations are provided for best practices in the clinical assessment and treatment of sleep health in youth with chronic pain. This overview can also provide researchers with foundational knowledge to build upon the best evidence for future prospective studies, assessment and intervention development, and novel clinical trials.

P wave area for quantitative electrocardiographic assessment of left atrial remodeling.

BACKGROUND: Left atrial (LA) dilation provides a substrate for mitral regurgitation (MR) and atrial arrhythmias. ECG can screen for LA dilation but standard approaches do not assess LA geometry as a continuum, as does non-invasive imaging. This study tested ECG-quantified P wave area as an index of LA geometry. METHODS AND RESULTS: 342 patients with CAD underwent ECG and CMR within 7 (0.1±1.4) days. LA area on CMR correlated best with P wave area in ECG lead V1 (r = 0.42, p<0.001), with lesser correlations for P wave amplitude and duration. P wave area increased stepwise in relation to CMR-evidenced MR severity (p<0.001), with similar results for MR on echocardiography (performed in 86% of patients). Pulmonary arterial (PA) pressure on echo was increased by 50% among patients in the highest (45±14 mmHg) vs. the lowest (31±9 mmHg) P wave area quartile of the population. In multivariate regression, CMR and echo-specific models demonstrated P wave area to be independently associated with LA size after controlling for MR, as well as echo-evidenced PA pressure. Clinical follow-up (mean 2.4±1.9 years) demonstrated ECG and CMR to yield similar results for stratification of arrhythmic risk, with a 2.6-fold increase in risk for atrial fibrillation/flutter among patients in the top P wave area quartile of the population (CI 1.1-5.9, p = 0.02), and a 3.2-fold increase among patients in the top LA area quartile (CI 1.4-7.0, p = 0.005). CONCLUSIONS: ECG-quantified P wave area provides an index of LA remodeling that parallels CMR-evidenced LA chamber geometry, and provides similar predictive value for stratification of atrial arrhythmic risk.

Endometrial cancer survivors are unsatisfied with received information about diagnosis, treatment and follow-up: a study from the population-based PROFILES registry.

OBJECTIVE: To evaluate perceived level of and satisfaction with information received by endometrial cancer survivors, and to identify associations with socio-demographic and clinical characteristics. METHODS: All patients diagnosed with endometrial cancer between 1998 and 2007, registered in the Eindhoven Cancer Registry, received a questionnaire including EORTC-QLQ-INFO25. RESULTS: Seventy-seven percent responded (n=742). Most patients indicated receiving quite a bit information about their disease and medical tests. However, most patients were not (54%) or a little (24%) informed about the cause of their disease, and possible side effects (36%; 27%). Especially information about additional help, rehabilitation, psychological assistance, and expected results on social and sexual life was lacking. Five percent was not or a little (36%) satisfied. Four percent found the information not or a little (35%) helpful. Fifteen percent preferred more information. Younger age, more recent diagnosis, radiotherapy, absence of comorbidities, having a partner, having received written information, and higher educational level were associated with higher perceived information receipt. CONCLUSION: Many endometrial cancer survivors are unsatisfied with received information. Several areas of information provision are experienced as insufficient. PRACTICE IMPLICATIONS: More patient-tailored information is probably needed to provide optimal information. Implementation of Survivorship Care Plans might be a way to achieve this.