Stenting of innominate vein compression syndrome.

We report the case of a 60-year-old woman who sought medical attention for left cervical and supraclavicular pain and swelling. Previous computed tomography, intravascular ultrasound, and venography studies were reviewed, confirming extrinsic compression of the left innominate vein by the left common carotid artery against the left clavicle head. Stenting of the lesion was performed, with good mid-term symptom relief and patency. It is, to the best of our knowledge, the first case study in the literature to report endovascular treatment of this syndrome.

Analyzing traffic conflicts and the behavior of motorcyclists at unsignalized three-legged and four-legged intersections in Cartagena, Colombia.

INTRODUCTION: The global motorcycle market has grown significantly, with over 770 million vehicles estimated to be in use worldwide. Motorcycle-related road traffic deaths in low and middle-income countries (LMICs) like Colombia are concerning, comprising 30% of all reported fatalities. Cartagena has an average of 70 motorcycle-related deaths annually between 2019 and 2022, making it a high-risk area for motorcyclists. OBJECTIVE: The study aimed to identify factors associated with motorcyclist safety at unsignalized three-legged and four-legged intersections in Cartagena by observing the behavior of the motorcyclists and the analysis of the potential traffic conflicts. The observational analysis focused on the access of motorcyclists from a secondary road to a main road since it is the behavior offered by the most significant road interaction and the potential risk of traffic conflicts due to crossing. METHODS: The observational process was consolidated at ten three-legged intersections and seven four-legged intersections. Thirty-six hours of videos were collected considering different time slots and weekdays randomly distributed during September 2019 and March 2020. The selection of the intersections included different vehicular flows and road safety conditions. The variables considered in the study were: interaction with other road users, motorcyclist behavior, vehicle handling, potential distractors, and safety elements. The study used the Swedish Traffic Conflict Technique to analyze conflict analysis, incorporating the Post Encroachment Time (PET) measurement. The analysis was developed with descriptive and inferential statistical techniques. The collected variables were analyzed individually (frequency analysis), and contrasts were conducted with the PET values. The study evaluated associations between motorcycles and other motorized road actors at intersections about behaviors and crossroads. RESULTS: In the Records, 10,281 motorcycle accesses at three and four-Legged Intersections were interactions with other road users, where 2417 and 1903 resulted in potential traffic conflicts, respectively. Average potential conflicts per hour were 115 and 127 at three and four-legged intersections. At the two intersections, the average PET values in motorcycles were between 2.09 and 2.10 s, while in the other motorized road users, it averaged around 2.67 to 2.71 s. In the road conditions, it was identified that intersections with a traffic flow of<10,000 vehicles/day and poor visibility to the left of the intersection lead to more unsafe conditions for motorcyclists. Motorcycle taxi drivers were the user group most frequently involved in traffic conflicts. Actions on the part of motorcyclists, such as risky behaviors, not using helmets, not using turn signals, and not waiting patiently for access, showed a relationship with the potential for traffic conflicts. Finally, turns to the left, particularly the indirect turn to the left on the opposite road, showed a greater risk of traffic conflicts. CONCLUSIONS: The study found that motorcycles exhibit more severe traffic conflicts than motorized vehicles at intersections. Infrastructure conditions significantly impact the risk of intersection conflicts. Individual behaviors such as not stopping at intersections and driving recklessly increased the risk of traffic conflicts. The study recommends improving infrastructure such as visibility and signaling and implementing separators to reduce travel speed and traffic conflicts for motorcycles.

The effect of seatbelt pre-tensioners and load limiters in the reduction of MAIS 2+, MAIS 3+, and fatal injuries in real-world frontal crashes.

Contemporary research has pointed out that while newer cars are contributing to the decrease of AIS2+ and AIS3+ injuries in several body regions, this effect is not shown for thoracic injuries like rib or sternal fractures. The objective of this study is to assess the effectiveness of advanced seat belt systems incorporating pre-tensioners and load limiters in the prevention of fatal, AIS2+ and AIS3+ injuries overall and then focus only on the head-face-neck and thoracic areas. Data from the NASS CDS database between 2000 and 2015 was augmented with specific vehicle information taken from NHTSA's NCAP tests to identify the characteristics of the seat belt of each vehicle involved in a collision. Multivariate logistic regressions were developed to assess the likelihood of injuries for belted front seat occupants in frontal impacts. The presence of pre-tensioners and load limiters with a low load limiter (<4.5 kN) was significantly associated with a decreased risk of fatal and AIS3+ in the whole body (OR = 0.31 (p < 0.05) and OR = 0.70 (p < 0.1)), while high load limiters were significant in the prevention of fatal injuries (OR = 0.42). These effects should be considered always in combination with the delta-v of the collision, as the interaction term between delta-v and advanced seat belt features was significant. In the crashes considered, the model predicted a higher risk of injury for women compared to men, controlling for other occupant and crash factors. Impacts with a slightly oblique component increased the risk of injury compared to pure frontal impacts. After controlling for the presence of pre-tensioners and load limiters, the vehicle model year variable was found to be insignificant in any of the regression models. This study shows that the real-world effectiveness of advanced seat belts still requires further analysis. Other effects like age or impact direction might be more influential in the injury outcome than these seat belt features.

Assessment of the sensitivity of thoracic injury criteria to subject-specific characteristics using human body models.

Introduction: Chest deformation has been proposed as the best predictor of thoracic injury risk in frontal impacts. Finite Element Human Body Models (FE-HBM) can enhance the results obtained in physical crash tests with Anthropometric Test Devices (ATD) since they can be exposed to omnidirectional impacts and their geometry can be modified to reflect specific population groups. This study aims to assess the sensitivity of two thoracic injury risk criteria (PC Score and Cmax) to several personalization techniques of FE-HBMs. Methods: Three 30° nearside oblique sled tests were reproduced using the SAFER HBM v8 and three personalization techniques were applied to this model to evaluate the influence on the risk of thoracic injuries. First, the overall mass of the model was adjusted to represent the weight of the subjects. Second, the model anthropometry and mass were modified to represent the characteristics of the post-mortem human subjects (PMHS). Finally, the spine alignment of the model was adapted to the PMHS posture at t = 0 ms, to conform to the angles between spinal landmarks measured in the PMHS. The following two metrics were used to predict three or more fractured ribs (AIS3+) of the SAFER HBM v8 and the effect of personalization techniques: the maximum posterior displacement of any studied chest point (Cmax), and the sum of the upper and lower deformation of selected rib points (PC score). Results: Despite having led to statistically significant differences in the probability of AIS3+ calculations, the mass-scaled and morphed version provided, in general, lower values for injury risk than the baseline model and the postured version being the latter, which exhibited the better approximation to the PMHS tests in terms of probability of injury. Additionally, this study found that the prediction of AIS3+ chest injuries based on PC Score resulted in higher probability values than the prediction based on Cmax for the loading conditions and personalization techniques analyzed within this study. Discussion: This study could demonstrate that the personalization techniques do not lead to linear trends when they are used in combination. Furthermore, the results included here suggest that these two criteria will result in significantly different predictions if the chest is loaded more asymmetrically.

Variation in Juvenile Long Bone Properties as a Function of Age: Mechanical and Compositional Characterization.

Bone is a heterogeneous, hierarchical biocomposite material made of an organic matrix filled with a mineral component, which plays an important role in bone strength. Although the effect of the mineral/matrix ratio on the mechanical properties of bone during aging has been intensively investigated, the relationship between the mechanical properties and the chemical composition of bone with age requires additional research in juvenile individuals. In this study, bone coupons from bovine and ovine animal species were machined from cortical areas of long bones to quantify whether the variation in mechanical properties at different stages of development is related to the change in the composition of bone tissue. An energy-dispersive X-ray detector (EDX) attached to a scanning electron microscope (SEM) was used to perform a compositional analysis of the tissue. In addition, nanoindentation analyses were carried out to address how the elastic modulus changed with age. Nonparametric statistical analyses found significant differences (p < 0.05) in Ca content and elastic modulus between species, but no differences were found within each species with development. A multiple linear regression model found that the elastic modulus was significantly related to the decrease in P and C in the samples, to the animal species (larger in bovine), and development, although not linearly. This model also found an interaction between Ca and development that could explain the lack of significance of the relationship between the elastic modulus and development in the univariate models.

Analysis of the spinal 3D motion of postmortem human surrogates in nearside oblique impacts.

Objective: The objective of this study is to analyze the 6 degrees of freedom (DOF) motion of the spine using the finite helical axis (FHA) in three postmortem human surrogates (PMHS) sled tests.Methods: The sled test configurations corresponded to a 30° nearside oblique impact at 35 km/h. Two different restraint system versions (RSv) were used. RSv1 was used for PMHS A and B while RSv2 was used for PMHS C. The 6 DOF motion of the head and three selected vertebrae have been analyzed using the FHA which describes the 3 D motion of a rigid body between two instants of time as a rotation about and a translation along a unit vector. A minimal amount of rotation is necessary to the FHA calculation, thus the FHA components have been calculated based on a pre-defined interval of 8° of rotation.Results: The analysis of the FHA components demonstrated right lateral bending until around 100 ms, when the rebound phase was reached and the head and the lower spine undergoes left lateral bending. The three PMHS exhibited, in general, flexion movement of the whole body and torsion to the right side of the occupant. This general motion can be associated to the effect of the seatbelt acting as a fulcrum of the rotational movement of the bony landmarks. The interaction of the PMHS with the retention system can be noted by analyzing the time in which the head and the upper spine initiated the rotation and the sudden changes of rotational direction of the three PMHS's head.Conclusions: The rotational analyses have shown to be more sensitive to experimental events than the trajectory analyses for the studied physical tests. Additionally, the results presented in the present study contributes to the analysis of the body kinematics during an oblique impact and adds new experimental data for Human Body Models (HBM) and Anthropometric Test Devices (ATD) benchmarking.

Acute Symptomatic Free-Floating Thrombus in the Innominate Artery, a Case Series.

BACKGROUND: Innominate artery embolism may result in upper extremity ischemia or stroke. A free-floating thrombus originating from the IA is an unusual and dangerous disorder with embolic potential. Only isolated cases have been described showing different treatment modalities. PURPOSE: To present 3 cases of free-floating thrombus in the IA treated at our institution with 3 different approaches. CASES: The first case is a patient with a free-floating thrombus in the IA treated with cervical debranching and ligation of the proximal right carotid artery; another case of a patient treated with a hybrid approach with deployment of an iliac limb in the IA plus right carotid to subclavian bypass; and a third case of a patient operated by open arch thrombectomy. CONCLUSIONS: Free-floating thrombus in the IA is a threatening condition feasible to be managed through different customized surgical approaches in specialized centers.

Assessment of in situ chest deflection of post mortem human subjects (PMHS) and personalized human body models (HBM) in nearside oblique impacts.

OBJECTIVE: The present study has three objectives: First, to analyze the chest deflection measured in nearside oblique tests performed with three post mortem human subjects (PMHS). Second, to assess the capability of a HBM to predict the chest deflection sustained by the PMHS. Third to evaluate the influence on chest deflection prediction of subject-specific HBM. METHODS: Three dimensional chest deformation of five anterior chest landmarks was extracted from three PMHS (A-C) in three sled tests. The sled test configurations corresponded to a 30 degree nearside oblique impact at 35 km/h. Two different restraint system versions (RSv) were used. RSv1 was used for PMHS A and B while RSv2 was used for PMHS C. The capability of the SAFER HBM (called baseline model) to predict PMHS chest deflection was benchmarked by means of the PMHS test results. In a second step, the anthropometry, mass and pre-impact posture of the baseline HBM were modified to the PMHS-specific characteristics to develop a model to assess the influence of personalization techniques in the capability of the human body model to predict PMHS chest deflection. RESULTS: In the sled tests, the measured sternum compression relative to the eighth thoracic vertebra in the PMHS tests was 49, 54 and 55 millimeters respectively. The HBM baseline model predicted 48%, 43% and 34% of the deflections measured in the PMHS tests, while the personalized version predicted 38%, 34% and 28%. When chest deflection was analyzed in x-, y- and z-direction for the five chest landmarks it was found that neither the baseline HBM nor the personalized model predicted x, y and z axis deflections. CONCLUSIONS: The PMHS in situ chest deflection was found to be sensitive to the variation in restraint system and the three PMHS exhibited greater values of lower right chest deflection compared to what was found in available literature. The baseline HBM underpredicted peak chest deflection obtained in the PMHS test. The personalized model was not capable of predicting the chest deflection sustained by the PMHS. Hence, further biofidelity investigations have to be carried out on the human body thorax model for oblique loading.

The rider behavior questionnaire to explore associations of motorcycle taxi crashes in Cartagena (Colombia).

OBJECTIVE: This study aimed to identify the association between behavioral factors and crashes of motorcycle taxi riders using the Motorcycle Rider Behavior Questionnaire (MRBQ). METHODS: This study was a cross-sectional survey of motorcycle taxi riders in Cartagena. The MRBQ was adapted to the socio-cultural context and contained 45 items. The survey was conducted between February 2019 and May 2019. The items of the MRBQ were processed using factor analysis. Four logistic regression models were used to analyze the association between behavioral factors and aspects of demographics, operating conditions, and experiencing near-crashes, crashes, traffic tickets, and at-fault crashes. RESULTS: Four hundred and thirty-eight motorcyclists participated. The exploratory factor analysis extracted five elements: stunts, speed violations, traffic errors, control errors, and safety, explaining 42% of the variance. The increase in riding per week showed significant differences with stunts, speed violations, and traffic errors. Riding experiences, traffic errors, control errors, and safety were significantly associated with crashes and near-crashes. Stunts were the strongest factors related to traffic tickets. Speed violations were the strongest factors associated with at-fault accidents. CONCLUSIONS: The study showed recent results considering behavioral, exposure, and operational conditions in a group of motorcycle taxi riders. The study recommends some practical implications for the well-being of motorcyclists and road safety.

Comparison of Upper Neck Loading in Young Adult and Elderly Volunteers During Low Speed Frontal Impacts.

Cervical pain and injuries are a major health problem globally. Existing neck injury criteria are based on experimental studies that included sled tests performed with volunteers, post-mortem human surrogates and animals. However, none of these studies have addressed the differences between young adults and elderly volunteers to date. Thus, this work analyzed the estimated axial and shear forces, and the bending moment at the craniocervical junction of nine young volunteers (18-30 years old) and four elderly volunteers (>65 years old) in a low-speed frontal deceleration. Since the calculation of these loads required the use of the mass and moment of inertia of the volunteers' heads, this study proposed new methods to estimate the inertial properties of the head of the volunteers based on external measurements that reduced the error of previously published methods. The estimated mean peak axial force (Fz) was -164.38 ± 35.04 N in the young group and -170.62 ± 49.82 N in the elderly group. The average maximum shear force (Fx) was -224.42 ± 54.39 N and -232.41 ± 19.23 N in the young and elderly group, respectively. Last, the estimated peak bending moment (My) was 13.63 ± 1.09 Nm in the young group and 14.81 ± 1.36 Nm in the elderly group. The neck loads experienced by the elderly group were within the highest values in the present study. Nevertheless, for the group of volunteers included in this study, no substantial differences with age were observed.

Real-time CO2 emissions estimation in Spain and application to the COVID-19 pandemic.

CO2 emissions are one of the major contributors to global warming. The variety of emission sources and the nature of CO2 hinders estimating its concentration in real time and therefore to adopt flexible policies that contribute to its control and, ultimately, to reduce its effects. Spain is not exempted from this challenge and CO2 emissions are published only at the end of the year and as an aggregated value for the whole country, without recognising the existing differences between the regions (the so-called, Autonomous Communities). The recent COVID-19 pandemic is a clear example of the need of accurate and fast estimation methods so that policies can be tailored to the current status and not to a past one. This paper provides a method to estimate monthly emissions of CO2 for each AACC in Spain based on data that are published monthly by the relevant administrations. The paper discusses the approximations needed in the development of the method, predicts the drop in emissions due to the reduced industrial activity during the pandemic in Spain and provides the estimation of future emissions under three recovery scenarios after the pandemic.

Manejo endovascular de la isquemia crítica distal: análisis de una serie contemporánea

Background: Chronic limb ischemia can lead to high rates of limb loss and mortality. Open surgery is the gold standard for treatment of distal disease. Endovascular surgery should have less complications with similar outcomes. Aim: To report a cohort of patients with distal arterial disease treated with endovascular surgery at our institution. Material and Methods: Review of angioplasty records of patients undergoing distal lower extremity endovascular procedures between 2016 and 2019. Demographics, comorbidities, form of presentation, type of intervention, perioperative complications, and length of stay were analyzed. The primary outcomes were wound healing, reinterventions and freedom from major amputation. Secondary outcomes were overall survival and amputation-free survival. Results: Forty-eight limbs of 41 patients with a mean age 75 years (78% males) were treated. Ninety-three percent had hypertension, 88% diabetes, 30% chronic kidney disease. 73% presented with major wounds. Plain balloon and drug coated balloon angioplasties were carried out in 65 and 31% of procedures respectively, with no difference in results. In 46% of the cases, only chronic total occlusions were treated. Wound healing was achieved in 85% of procedures and 90% of patients were free from amputation at one year of follow up. Complications were observed in 18% of procedures, perioperative mortality was 2% and one-year survival was 76%. Conclusions: Endovascular therapy achieves high rates of wound healing and freedom from amputation with low perioperative mortality and moderate complication rates.

Understanding users' characteristics in the selection of vehicle seating configurations and positions in fully automated vehicles.

OBJECTIVE: To understand which users' characteristics influence their preferences in the selection of vehicle seating configurations and positions across different traveling scenarios involving a fully automated vehicle (FAV). METHODS: Participants (n = 730) completed an online survey in which they were asked to imagine traveling in a FAV across three hypothetical scenarios. Participants were asked to select between five different seating configurations and four positions for each scenario and about their anthropometry and their driving/riding experience. Multinomial regression analyses were conducted to identify the factors that influenced users' preferences. RESULTS: FAV Configuration #3 (traditional light vehicle seating configuration) was the preferred seating configuration for 74% of the participants, followed by FAV #2 (in which the two seating rows face each other, 13%) in Scenario 1 (riding by oneself). Similar numbers were observed in Scenario 3 (riding with an unknown person). In Scenario 2 (riding with their partner), participants preferred FAV #2 (12.5%) and FAV #5 (in which the front seat passengers point toward a common point in the front, conventional rear seat configuration, 17.5%). Having close family was significant to choose the traditional vehicle configuration over other vehicle configurations, but only when the participants were driving by themselves. Having previously experienced motion sickness was significant to prefer a forward seating configuration when the trip was shared with partners. Belonging to a particular height or weight group was significantly associated with the preferred seat within the preferred FAV configuration (the driver's position in FAV #3; a rear-facing seat in FAV #2), although there was not a clear trend between increasing weight and/or height and preferring one seating position over the others. CONCLUSIONS: Previous work had shown differences in participants' preferences for seating configurations and positions depending on age, sex and country. While increasing the sample size, the current study analyses other factors that were associated with choosing one vehicle configuration and seating position over others. As these factors are directly related to the likelihood of sustaining injuries in the event of a crash, the current study provides important insights regarding the potential risk factors for FAV occupants.

Endovascular Management of a Ruptured Iliac Aneurysm With an Inferior Vena Cava Fistula.

Aortocaval fistula is uncommon and often associated with a ruptured iliac or abdominal aortic aneurysm. It has a high mortality secondary to the aneurysmal rupture but also to a high output heart failure. Open surgery has been the standard; however, endovascular management has emerged with lower mortality. We present a patient with a ruptured iliac aneurysm and an inferior vena cava fistula successfully treated with an endograft with embolization of the right hypogastric artery. The patient arrested on induction and was resuscitated with aortic balloon inflation. Endovascular therapy can be safely used in the management of iliac/aortocaval fistula.

Understanding motorcyclist-related accidents in Colombia.

In 2016, Colombia's position regarding motorcyclist fatalities per 100,000 inhabitants was tenth worldwide and second in South America. In the seven years from 2012-2018, the proportion of deceased and injured motorcyclists among all road users was 50%. To analyse the significant aspects of the accident rate of motorcyclists in Colombia from 2016 to 2018 and estimate cost social value of motorcycle-related deaths. The global numbers of fatalities and injuries were compared to the Colombian context. Descriptive and inferential statistics were conducted to explore the association of fatal trauma and motorcycle accidents. P values and odds ratios were calculated. Bogotá, Cali, and Medellín were the cities with the most accidents. The month, day, time, age of the victims, and climatic conditions had a statistically significant association with the fatal trauma. Most victims were between the ages of 20-29 years. Motorcycles were involved in more than 60% of accidents. The social cost of a life lost in a motorcycle accident was estimated at $2,418 million Colombian pesos (725,400 USD) per year. The establishment of countermeasures for the road safety of vulnerable users should focus on associated causal factors in order to develop strategies to effectively reduce the number of accidents.

[Endovascular management of chronic limb ischemia. Experience in 48 procedures]. / Manejo endovascular de la isquemia crítica distal: análisis de una serie contemporánea.

BACKGROUND: Chronic limb ischemia can lead to high rates of limb loss and mortality. Open surgery is the gold standard for treatment of distal disease. Endovascular surgery should have less complications with similar outcomes. AIM: To report a cohort of patients with distal arterial disease treated with endovascular surgery at our institution. MATERIAL AND METHODS: Review of angioplasty records of patients undergoing distal lower extremity endovascular procedures between 2016 and 2019. Demographics, comorbidities, form of presentation, type of intervention, perioperative complications, and length of stay were analyzed. The primary outcomes were wound healing, reinterventions and freedom from major amputation. Secondary outcomes were overall survival and amputation-free survival. RESULTS: Forty-eight limbs of 41 patients with a mean age 75 years (78% males) were treated. Ninety-three percent had hypertension, 88% diabetes, 30% chronic kidney disease. 73% presented with major wounds. Plain balloon and drug coated balloon angioplasties were carried out in 65 and 31% of procedures respectively, with no difference in results. In 46% of the cases, only chronic total occlusions were treated. Wound healing was achieved in 85% of procedures and 90% of patients were free from amputation at one year of follow up. Complications were observed in 18% of procedures, perioperative mortality was 2% and one-year survival was 76%. CONCLUSIONS: Endovascular therapy achieves high rates of wound healing and freedom from amputation with low perioperative mortality and moderate complication rates.

Feasibility study of a safe sled environment for reclined frontal deceleration tests with human volunteers.

Objective: The goal of the study was to assess the feasibility of a safe crash environment for volunteer tests in reclined seating positions. An iterative multimodal approach was chosen, consisting of full-body human body model (HBM) simulations, anthropomorphic test device (ATD) physical testing, and volunteer testing.Methods: To estimate a noninjurious deceleration pulse, the iterative inclination of the seat was supported through HBM simulations and physical ATD testing. One male volunteer was exposed to 5 low-speed frontal sled impacts with stepwise reclined seat angles. The volunteer was restrained with a non-pretensioned 3-point seat belt. All procedures were approved by the relevant ethics boards.Results: Volunteer sled tests in 3 different seat configurations were performed with one volunteer at noninjurious deceleration levels. Inclination of the seat and the absence of a footrest resulted in elevated axial seat reaction forces and almost pure translational motion of the human body.Conclusions: A maximum speed of 7.1 km/h and peak deceleration of 3.0 g was found to be a safe pulse for volunteer testing in frontal impacts with a rigid reclined seat. Larger soft tissue deformations were observed when reclined, possibly associated with higher shear loads within the soft tissue. Preliminary results highlight trade-offs between the degree of seat angulation, friction force, and restraint capability of a 3-point seat belt, thus causing forward translation and/or axial spinal compression of the occupant that may need to be addressed in the future.

Chest injuries of elderly postmortem human surrogates (PMHSs) under seat belt and airbag loading in frontal sled impacts: Comparison to matching THOR tests.

OBJECTIVE: The goal of the study was to develop experimental chest loading conditions that would cause up to Abbreviated Injury Scale (AIS) 2 chest injuries in elderly occupants in moderate-speed frontal crashes. The new set of experimental data was also intended to be used in the benchmark of existing thoracic injury criteria in lower-speed collision conditions. METHODS: Six male elderly (age >63) postmortem human subjects (PMHS) were exposed to a 35 km/h (nominal) frontal sled impact. The test fixture consisted of a rigid seat, rigid footrest, and cable seat back. Two restraint conditions (A and B) were compared. Occupants were restrained by a force-limited (2.5 kN [A] and 2 kN [B]) seat belt and a preinflated (16 kPa [A] and 11 kPa [B]; airbag). Condition B also incorporated increased seat friction. Matching sled tests were carried out with the THOR-M dummy. Infra-red telescoping rod for the assessment of chest compression (IRTRACC) readings were used to compute chest injury risk. PMHSs were exposed to a posttest injury assessment. Tests were carried out in 2 stages, using the outcome of the first one combined with a parametric study using the THUMS model to adjust the test conditions in the second. All procedures were approved by the relevant ethics board. RESULTS: Restraint condition A resulted in an unexpected high number of rib fractures (fx; 10, 14, 15 fx). Under condition B, the adjustment of the relative airbag/occupant position combined with a lower airbag pressure and lower seat belt load limit resulted in a reduced pelvic excursion (85 vs. 110 mm), increased torso pitch and a substantially lower number of rib fractures (1, 0, 4 fx) as intended. CONCLUSIONS: The predicted risk of rib fractures provided by the THOR dummy using the Cmax and PC Score injury criteria were lower than the actual injuries observed in the PMHS tests (especially in restraint condition A). However, the THOR dummy was capable of discriminating between the 2 restraint scenarios. Similar results were obtained in the parametric study with the THUMS model.