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With the growing demand for high‐quality Organic Light Emitting Diode (OLED) display, the design of screen structure by panel manufacturers needs to consider optical performance optimization carefully, such as Wide Angle Difference (WAD). The users hope that visual color bias of the OLED display on different angles appears as small as possible, and no red visual test will be particularly accepted. The OLED display panel is usually composed of Array substrates, OLED devices, Thin Film Encapsulation (TFE) layers, touch units, Polarizers and top cover plates. The touch units contain a metal mesh, which is distributed throughout the display screen and has a great impact on the optical performance of large viewing angles. This paper aims to clarify the optical design requirements of metal mesh and provide reference for OLED optical display designers. [ABSTRACT FROM AUTHOR]

Abstract Background The underlying pathophysiological mechanisms of chronic Whiplash Associated Disorders (WAD) are not fully understood. More knowledge of morphology is needed to better understand the disorder, improve diagnostics and treatments. The aim was to investigate dorsal neck muscle volume (MV) and muscle fat infiltration (MFI) in relation to self-reported neck disability among 30 participants with chronic WAD grade II-III compared to 30 matched healthy controls. Methods MV and MFI at spinal segments C4 through C7 in both sexes with mild- to moderate chronic WAD (n = 20), severe chronic WAD (n = 10), and age- and sex matched healthy controls (n = 30) was compared. Muscles: trapezius, splenius, semispinalis capitis and semispinalis cervicis were segmented by a blinded assessor and analyzed. Results Higher MFI was found in right trapezius (p = 0.007, Cohen’s d = 0.9) among participants with severe chronic WAD compared to healthy controls. No other significant difference was found for MFI (p = 0.22–0.95) or MV (p = 0.20–0.76). Conclusions There are quantifiable changes in muscle composition of right trapezius on the side of dominant pain and/or symptoms, among participants with severe chronic WAD. No other statistically significant differences were shown for MFI or MV. These findings add knowledge of the association between MFI, muscle size and self-reported neck disability in chronic WAD. Trial registration NA. This is a cross-sectional case–control embedded in a cohort study.

Background: The underlying pathophysiological mechanisms of chronic Whiplash Associated Disorders (WAD) are not fully understood. More knowledge of morphology is needed to better understand the disorder, improve diagnostics and treatments. The aim was to investigate dorsal neck muscle volume (MV) and muscle fat infiltration (MFI) in relation to self-reported neck disability among 30 participants with chronic WAD grade II-III compared to 30 matched healthy controls. Methods: MV and MFI at spinal segments C4 through C7 in both sexes with mild- to moderate chronic WAD (n = 20), severe chronic WAD (n = 10), and age- and sex matched healthy controls (n = 30) was compared. Muscles: trapezius, splenius, semispinalis capitis and semispinalis cervicis were segmented by a blinded assessor and analyzed. Results: Higher MFI was found in right trapezius (p = 0.007, Cohen's d = 0.9) among participants with severe chronic WAD compared to healthy controls. No other significant difference was found for MFI (p = 0.22–0.95) or MV (p = 0.20–0.76). Conclusions: There are quantifiable changes in muscle composition of right trapezius on the side of dominant pain and/or symptoms, among participants with severe chronic WAD. No other statistically significant differences were shown for MFI or MV. These findings add knowledge of the association between MFI, muscle size and self-reported neck disability in chronic WAD. Trial registration: NA. This is a cross-sectional case–control embedded in a cohort study. [ABSTRACT FROM AUTHOR]

Background and Objective: Whiplash neck injury was described by Crowe in 1928. Whiplash-associated disorder (WAD) is defined as a cervical spinal injury following an acceleration-deceleration mechanism. It is a constellation of symptoms due to psychological factors and neural adaptations, with significant social costs. Review Summary: There are multiple classification systems for WAD in the literature. The Quebec Classification is most reported and is predictive of the likelihood of progression to chronicity. The facet joint has been identified as a pain generator in 50% of cases. We outline the likely anatomical cause of WAD and summarize the protocol of medial branch block injections for diagnostic and therapeutic purposes, as well as the indications for and published results of facet joint ablation in WAD. We also highlight the development of ultrasound as an alternative to computed tomography or fluoroscopy for injection guidance. Conclusions: WAD is a complex condition associated with sensory disturbance, pain, motor chronic pain, and psychological distress. The literature supports a single diagnostic medial branch block followed by a therapeutic facet joint ablation for chronic pain. WAD should be managed in a multidisciplinary fashion, with an early involvement of psychological specialists when required.

Objective: To evaluate the exercise‐induced hypoalgesic (EIH) effects of different types of physical exercise in individuals with neck pain. Design: Systematic review with meta‐analysis. Literature Search: An electronic search of six databases was completed to include studies assessing EIH effects on neck pain. Study Selection Criteria: Randomized controlled trials, controlled trials, and observational studies that assessed before and immediate after‐effects of a single session of physical exercise in people with neck pain were included. Two reviewers independently screened records, extracted outcomes, assessed the risk of bias, and rated the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data synthesis: EIH is characterized by increased pain threshold, pain tolerance, and/or decreased sensitivity to painful stimuli or unpleasantness, which may last up to 30 min after a single bout of exercise. EIH is usually measured with quantitative sensory testing (QST) and is mostly taken as the difference between pre‐ and postexercise pressure pain threshold (PPT). Data were pooled and analyzed using a fixed‐effect meta‐analysis. Results: Eleven articles were included in this review; nine with low risk of bias and two with some concerns about the risk of bias. Three studies with chronic whiplash‐associated disorders (WAD) were included in the meta‐analysis; isometric exercise had a larger EIH effect at the local testing site compared with submaximal aerobic exercises (MD = −0.21, [95% CI = −0.43, 0.00], p = 0.05, I2 = 92%), submaximal aerobic and isometric exercises had equal EIH effects at the remote testing site (MD = 0.01, [95% CI = −0.33, 0.35], p = 0.95, I2 = 0%), and submaximal aerobic exercises exerted comparably larger EIH effect at the remote testing site than local testing site (MD = −0.01, [95% CI = −0.20, 0.18], p = 0.93, I2 = 56%). The certainty of evidence (GRADE) for these analyses was low to very low. According to the descriptive analysis of the studies of chronic nonspecific neck pain, isometric and range of motion (ROM) exercises have shown EIH effects. Active stretching exercises have illustrated contradictory effects. Conclusion: Isometric and ROM exercises exerted hypoalgesia at local and remote sites. A larger EIH effect following submaximal aerobic exercises was exerted at the remote testing site compared with the local site. [ABSTRACT FROM AUTHOR]

The bacterial restriction–modification (R-M) system has evolved as a defense mechanism against infectious phages and other types of integration of foreign DNA fragments into the host chromosome through recombination. In this study, we identified two endonucleases (wheat endonuclease 1-WEN1 and wheat endonuclease 2-WEN2) and the adenine-DNA methyltransferase WAD (involved in mitochondrial DNA methylation) in the vesicular fraction of coleoptiles of wheat Triticum aestivum. WEN1 and WEN2 have multidirectional sensitivity to DNA methylation and to the presence of S-adenosyl-L-methionine and Ca2+ ions, which suggests their participation in the protection of mitochondrial DNA, similar to bacterial DNA. WEN2 has a GAT recognition site, which is part of the methylation site of adenine DNA methyltransferase (WAD-TGATCA) and hydrolyzes the CG (GC) bond upstream of the recognition site only if it is not methylated. Based on the interrelations between the two enzymes, we propose that an R-M system similar to that of the type IV observed in bacteria may exist in plants.

Assessment of wound characteristics and the identification of various constituents of firearm discharge at autopsy play a key role in the determination of range of fire. In relation to wounds caused by shotguns, identification of the wad within the wound track, or of injury caused by the wad, is typically thought to suggest a fairly close range of fire. We present a case of a fatality due to a shotgun slug wound where the presence of the wad within the decedent's body was proposed by defense at criminal trial to favor accidental close range discharge during a struggle for the weapon—as opposed to the prosecution's contention of intentional firing of the weapon from a greater range and through an intermediate target. We undertook test firing of a shotgun of similar design to that which was fired during the interaction (a 12‐gauge pump‐action shotgun) using shotshells consistent with the slug that was recovered from the body (Winchester Super X brand), which demonstrated that the non‐attached fiber wad present in this shotshell design can accompany the slug over distances of at least up to 22 feet (6.7 m) and even after transit through intermediate targets such as a vehicle headrest. These novel data provide assistance with estimation of range of fire in instances of injuries caused by shotgun slugs. [ABSTRACT FROM AUTHOR]

The prevalence of malingering among individuals presenting whiplash-related symptoms is significant and leads to a huge economic loss due to fraudulent injury claims. Various strategies have been proposed to detect malingering and symptoms exaggeration. However, most of them have been not consistently validated and tested to determine their accuracy in detecting feigned whiplash. This study merges two different approaches to detect whiplash malingering (the mechanical approach and the qualitative analysis of the symptomatology) to obtain a malingering detection model based on a wider range of indices, both biomechanical and self-reported. A sample of 46 malingerers and 59 genuine clinical patients was tested using a kinematic test and a self-report questionnaire asking about the presence of rare and impossible symptoms. The collected measures were used to train and validate a linear discriminant analysis (LDA) classification model. Results showed that malingerers were discriminated from genuine clinical patients based on a greater proportion of rare symptoms vs. possible self-reported symptoms and slower but more repeatable neck motions in the biomechanical test. The fivefold cross-validation of the LDA model yielded an area under the curve (AUC) of 0.84, with a sensitivity of 77.8% and a specificity of 84.7%. [ABSTRACT FROM AUTHOR]

The bacterial restriction-modification (R-M) system has evolved as a defense mechanism against infectious phages and other types of integration of foreign DNA fragments into the host chromosome through recombination. In this study, we identified two endonucleases (wheat endonuclease 1-WEN1 and wheat endonuclease 2-WEN2) and the adenine-DNA methyltransferase WAD (involved in mitochondrial DNA methylation) in the vesicular fraction of coleoptiles of wheat Triticum aestivum. WEN1 and WEN2 have multidirectional sensitivity to DNA methylation and to the presence of S-adenosyl-L-methionine and Ca2+ ions, which suggests their participation in the protection of mitochondrial DNA, similar to bacterial DNA. WEN2 has a GAT recognition site, which is part of the methylation site of adenine DNA methyltransferase (WAD-TGATCA) and hydrolyzes the CG (GC) bond upstream of the recognition site only if it is not methylated. Based on the interrelations between the two enzymes, we propose that an R-M system similar to that of the type IV observed in bacteria may exist in plants. [ABSTRACT FROM AUTHOR]

Background: Chronic whiplash-associated disorder (WAD) can develop after flexion/extension injuries and may be refractory to standard-of-care therapies. Aim: To present successful treatment of severe, longstanding, treatment resistant WAD with prolotherapy. Materials & methods: Four, monthly sessions of fluoroscopically guided prolotherapy with phenol-glycerin-glucose. Electronic data on pain (visual analog score), disability (Oswestry Disability Index), pain interference, depression, anxiety, sleep and quality of life were collected with University of Washington's (WA, USA) online tool for a total of 21 months. This study conforms to the Case Report Guidelines (CARE). Results: Significant improvement was achieved and maintained through 18 months after treatment in all assessed pain and functional measures. Conclusion: Regenerative medicine, including prolotherapy may be an appropriate treatment option for carefully selected patients with WAD. [ABSTRACT FROM AUTHOR]

Background and aims: Previous systematic reviews have considered that providing patient information is ineffective for patients with whiplash-associated disorders (WAD), with the exception of interventional educational videos. The aim of this randomised controlled clinical trial was to determine if use of an educational video as an intervention in the acute stage after a whiplash injury might improve self-reported recovery at 6 months after the injury. Methods: In total, 289 consecutive patients with a whiplash injury following a motor vehicle collision were randomised to an intervention group (educational video) or to a control group (written information sheet). The video focused on information about pain mechanisms, deep flexor physiotherapy and reassurance. Emailed questionnaires were used to collect baseline data within 2 weeks after the accident and then to collect outcome data at 6 months post-injury. Non-responders were followed up with a brief telephone interview regarding the outcome. The primary outcome measure was self-reported recovery (yes/no) at 6 months post-injury. The secondary outcomes measures were pain level according to a numeric rating scale (NRS) and the whiplash disability questionnaire (WDQ) score at the same time point. Results: The response rate for the baseline questionnaire was 70% (203/289). The follow-up rate was 97% (196/203). The non-recovery rates were similar between the intervention group, at 37.9% (39/103), and the control group, at 33.3% (31/93) (p = 0.55). No differences between the groups were noted in pain levels, NRS scores (1.9 vs. 2.2, p = 0.35) or the mean WDQ scores (17.5 vs. 21.2, p = 0.42). Conclusions: The intervention with the educational video used in this study had no effect on the non-recovery rate when compared to a basic written information sheet. Implications: The results of this trial add knowledge to the area of patient education for patients with acute WAD. Further studies are needed before the current recommendations for patient information are modified. [ABSTRACT FROM AUTHOR]

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Abstract Background The COMT (Catechol-O-Methyl Transferase) gene may influence a person’s vulnerability to develop long-term pain and some COMT single nucleotide polymorphisms (SNPs) may associate with patterns of acute or chronic pain. Many patients with whiplash-associated disorders (WADs) suffer from long-term pain and other related symptoms, but it is less known if genetic factors play a role in the recovery process. The primary aim of this study was to evaluate whether self-reported non-recovery, including pain, was related to COMT genotype in patients with WAD. The secondary aim was to investigate whether or not background factors, including mental health, were related to genotype and non-recovery. Methods A total of 133 patients with neck pain after a whiplash trauma were included. Background factors were collected and blood samples were taken during the acute phase after the accident. DNA was isolated from blood and used to genotype the SNPs rs6269, rs4633, rs4818 and rs4680 in the COMT gene; additionally haplotypes were estimated and haplogenotypes inferred. The patients were followed up after 12 months and asked to rate their recovery including pain, mental health and quality of life. Results The overall reported non-recovery rate at 12 months was 44% with no significant differences in distribution of the COMT haplotypes. High levels of self-reported pain (OR 7.2) and anxiety (OR 4.4) after the accident were associated with non-recovery, but not related to the haplotypes. None of the other background factors were related to the haplotypes or non-recovery. Conclusion No association between self-reported non-recovery or pain levels and COMT haplotypes in patients with acute whiplash injuries could be detected. Independent replications are necessary to discard the hypothesis that COMT haplotypes do not influence non-recovery or pain levels in patients with acute whiplash injuries. High levels of initial pain and anxiety were associated with non-recovery, thereby confirming previously published reports.

This paper investigates the firing of seventeenth Century musket balls. Prior to this research, the main concerns with making range predictions were associated with the deformed shape of the musket balls affecting their drag coefficient and therefore their distance to ground impact. However, the distance due to bounce and roll after initial impact has been unknown. In this work, the distance travelled after the first ground impact greatly exceeded expectations, with the musket balls approximately doubling the distance to their final resting positions. From these findings the initial factors thought to have had high relevance to the final resting position of the musket ball (velocity variation and drag co-efficient) become less significant and factors such as ground hardness become more prominent. The knowledge gained during this investigation will allow more accurate information to be obtained on the firing positions of opposing forces during conflicts in the English Civil War. [ABSTRACT FROM AUTHOR]

Highlights • Intraoral dental appliance reduced standing postural sway in neck pain patients. • Data indicate strong connection between the jaw and the postural control systems. • A potent impact on postural control by the jaw sensorimotor system is suggested. • The study gives new insight into postural control mechanisms and balance disorders. • The result may help developing programs for rehabilitation of balance disorders. Abstract Objectives This study tested the hypothesis that modulation of jaw sensorimotor control by intraoral dental appliance can reduce postural sway during quiet standing and hence improve standing balance, in patients with whiplash associated disorders (WAD) and non-trauma neck pain. Design Postural sway during quiet standing with feet together was examined in 54 WAD patients (40 females) and 10 non-trauma patients (8 females) using wireless 3D movement recording technique. Recordings were performed alternating without and with intraoral dental appliance, and with closed eyes and open eyes, respectively. In this protocol the participants served as their own controls. A reference group of 30 healthy subjects (17 females) was also recorded. Each recording lasted 120 s, followed by 3–5 min of rest. Speed, acceleration and perimeter of postural sway area were documented. Results In the patients, but not in the healthy group, the intraoral dental appliance instantly and significantly reduced standing postural sway in recordings with closed and open eyes. Conclusions The prompt reduction in standing postural sway from intervention by intraoral dental appliance i.e. improved standing balance, suggests a potent effect on the postural control system by modulation of the jaw sensorimotor system, probably involving reflex transmission. The result opens for new insight into mechanisms behind postural control and the pathophysiology of balance disorders, and adds to the knowledge on plasticity of the nervous system. It may help developing new procedures for assessment and management of impaired balance in WAD and non-trauma neck pain patients. [ABSTRACT FROM AUTHOR]

The lithostratigraphy of pedogenic manganese (Mn) nodules in the Carletonville area is similar to the Klipkuil, Ryedale, Wes Wits, and Houtkoppies deposits in the West Rand region of the Gauteng and North West Provinces and to a lesser extent the Bronkhorstfontein manganese deposit in the Limpopo Province of South Africa. The lithostratigraphy of the ore deposit at the General Nice Manganese Mine consists of a basal manganese wad, preserved in a typical karst setting on top of the underlying Malmani stromatolitic dolomites and Tertiary fluvial and secondary mineral deposits consisting of manganese nodules of variable size in a finer-grained soil matrix. At the top of the deposit is a Mn-depleted Quaternary sand cover. The Tertiary alluvial succession hosting Mn nodules was informally subdivided into A, B, C, D, E, F, G and H zones on the basis of geochemical analyses (XRD, XRF and SEM) of bulk zone samples and the manganese nodule size and concentration. [ABSTRACT FROM AUTHOR]

Purpose: The long-term outcome of Whiplash-associated disorder (WADs) has been reported to be poor in populations from medical settings. However, no trials have investigated the long-term prognosis of patients from medico-legal environment. For this group, the "compensation hypothesis" suggests financial compensation being associated with worsened outcome. The aims of this study were to describe long-term (2-4 years) non-recovery rates in participants with WAD recruited from insurance companies and to investigate the association between self-reported non-recovery and financial compensation.Methods: 144 participants, reporting neck pain after a motor vehicle accident, were recruited from two major insurance companies in Sweden. Self-reported recovery was measured at 6 months and 2-4 years. Those who received financial compensation from an insurance company were compared with those who received no compensation.Results: The overall non-recovery rate after 2-4 years was 55.9% (66/118). In the non-compensated group, the non-recovery rate was 51.0% (25/49) and in the compensated group 73% (27/37) (p = 0.039). Adjusted OR was 4.33 (1.37-13.66). High level of pain at baseline was a strong predictor of non-recovery [OR 46 (4.7-446.0)]. However, no association was found between pain level at baseline and financial compensation.Conclusions: The non-recovery rate among patients making insurance claims is high, especially among those receiving financial compensation even if causal relationship cannot be determined based on this study. However, lack of association between baseline level of pain and compensation supports the compensation hypothesis. [ABSTRACT FROM AUTHOR]

Background: The COMT (Catechol-O-Methyl Transferase) gene may influence a person's vulnerability to develop long-term pain and some COMT single nucleotide polymorphisms (SNPs) may associate with patterns of acute or chronic pain. Many patients with whiplash-associated disorders (WADs) suffer from long-term pain and other related symptoms, but it is less known if genetic factors play a role in the recovery process. The primary aim of this study was to evaluate whether self-reported non-recovery, including pain, was related to COMT genotype in patients with WAD. The secondary aim was to investigate whether or not background factors, including mental health, were related to genotype and non-recovery.Methods: A total of 133 patients with neck pain after a whiplash trauma were included. Background factors were collected and blood samples were taken during the acute phase after the accident. DNA was isolated from blood and used to genotype the SNPs rs6269, rs4633, rs4818 and rs4680 in the COMT gene; additionally haplotypes were estimated and haplogenotypes inferred. The patients were followed up after 12 months and asked to rate their recovery including pain, mental health and quality of life.Results: The overall reported non-recovery rate at 12 months was 44% with no significant differences in distribution of the COMT haplotypes. High levels of self-reported pain (OR 7.2) and anxiety (OR 4.4) after the accident were associated with non-recovery, but not related to the haplotypes. None of the other background factors were related to the haplotypes or non-recovery.Conclusion: No association between self-reported non-recovery or pain levels and COMT haplotypes in patients with acute whiplash injuries could be detected. Independent replications are necessary to discard the hypothesis that COMT haplotypes do not influence non-recovery or pain levels in patients with acute whiplash injuries. High levels of initial pain and anxiety were associated with non-recovery, thereby confirming previously published reports. [ABSTRACT FROM AUTHOR]

Whiplash is a compensable injury in many jurisdictions, but there is considerable heterogeneity in the compensation arrangements that apply across jurisdictions, even within some countries. These compensation schemes have, however, been subject to a common set of interrelated concerns, chiefly concerning the incentives, behaviors, and outcomes that may arise when financial compensation for injuries is available to injured parties. This article provides a nontechnical overview of some of those concerns through the lens of economics: principally, insurance economics and health economics, including related subsets such as information economics and agency theory, as well as economics and the law. It notes that because it is generally infeasible to randomize the treatment (ie, compensation) via trials, analyses of observational data are necessary to discover more about the relationship between compensation and health outcomes. This poses the analytical challenge of discovering causal connections between phenomena from nonrandomized data sets. The present article calls for further research that would enable convincing causal interpretations of such relationships via the careful analysis of rich observational data sets using modern econometric methods. [ABSTRACT FROM AUTHOR]

There is considerable evidence to support the importance of cervical afferent dysfunction in the development of dizziness, unsteadiness, visual disturbances, altered balance, and altered eye and head movement control following neck trauma, especially in those with persistent symptoms. However, there are other possible causes for these symptoms, and secondary adaptive changes should also be considered in differential diagnosis. Understanding the nature of these symptoms and differential diagnosis of their potential origin is important for rehabilitation. In addition to symptoms, the evaluation of potential impairments (altered cervical joint position and movement sense, static and dynamic balance, and ocular mobility and coordination) should become an essential part of the routine assessment of those with traumatic neck pain, including those with concomitant injuries such as concussion and vestibular or visual pathology or deficits. Once adequately assessed, appropriate tailored management should be implemented . Research to further assist differential diagnosis and to understand the most important contributing factors associated with abnormal cervical afferent input and subsequent disturbances to the sensorimotor control system, as well as the most efficacious management of such symptoms and impairments, is important for the future. [ABSTRACT FROM AUTHOR]

The majority of people with whiplash-associated disorder do not have neurological deficit or fracture and are therefore largely managed with nonsurgical interventions such as exercise, patient education, and behavioral-based interventions. To date, clinical guidelines, systematic reviews, and the results of high-quality randomized controlled trials recommend exercise and patient education as the primary interventions for people in both acute and chronic stages after injury. However, the relatively weak evidence and small effect sizes in individual trials have led authors of some systematic reviews to reach equivocal recommendations for either exercise or patient education, and led policy makers and funders to question whether the more expensive intervention (exercise) should be funded at all. Physical therapists, one of the most commonly consulted professionals treating individuals with whiplash-associated disorder, need to look beyond the evidence for insights as to what role patient education and exercise should play in the future management of whiplash. This clinical commentary therefore will review the evidence for exercise, patient education, and behavioral-based interventions for whiplash and provide clinical insight as to the future role that exercise and patient education should play in the management of this complex condition. Possible subgroups of patients who may best respond to exercise will be explored using stratification based on impairments, treatment response, and risk/prognostic factors. [ABSTRACT FROM AUTHOR]

*STUDY DESIGN: Systematic review of randomized controlled trials. * BACKGROUND: General exercise, defined as purposeful physical activity involving repetitive exercises and incorporating multiple muscle groups, is frequently used in the management of whiplash-associated disorders (WADs). Evidence supporting its efficacy is not well established. * OBJECTIVES: To determine whether general exercise is effective in reducing pain and disability in people with WAD. * METHODS: Studies published in English in peer-reviewed journals between January 1990 and May 2015 were eligible if they evaluated a general exercise intervention compared with a different intervention or control. Studies were required to evaluate pain and disability at medium-term (6-14 weeks) and long-term (52 weeks) follow-ups. The mean ± SD and sample size were recorded for follow-up scores and for change scores from baseline to follow-up. * RESULTS: Of the 3 high-quality studies that were eligible for inclusion, none investigated general exercise alone. There were no clinically meaningful differences between comprehensive exercise programs, which included general exercise, and minimal intervention controls in the medium and long term. No studies directly compared general exercise with a no-treatment control. All included studies used different control interventions, preventing meta-analysis. * CONCLUSION: A lack of significant long-term improvements from general exercise interventions in individuals with WAD was identified. This finding differs from the positive benefits of general exercise for other musculoskeletal conditions. This may, in part, relate to the complexity of whiplash conditions. This may also reflect the challenge of exercise prescription in this population, where the need for sufficient intensity is balanced against the impact that exercise has on pain. * LEVEL OF EVIDENCE: Therapy, level la. [ABSTRACT FROM AUTHOR]

The development of persistent symptoms following whiplash injury from a motor vehicle collision is common and contributes substantially to societal and personal costs. The popular Quebec Task Force classification system of whiplash-associated disorders (WADs) was meant to function as a prognostic and intervention decision aid, but its usefulness has been questioned. Emerging evidence highlights the heterogeneity of WAD by demonstrating physical and psychological impairments that are unique to those who develop persistent symptoms. These impairments are not recognized in the Quebec Task Force classification system. The purpose of this clinical commentary is to describe an integrated model that focuses on how psychological and neurobiological factors interact with, and are influenced by, existing personal and environmental factors to contribute to the development of chronic WAD. The model has been developed through more than 20 years of work in the field, consultation with experts, in-depth synthesis of existing evidence, and new evidence from the authors' own research programs. A subtheme is that a point of convergence currently exists between the psychological, physiological, and social determinants of health literature that can further explain the complex presentation of WAD. The new model is proposed to orient future research toward more interdisciplinary efforts across nontraditional fields, including data scientists and consumers, to clarify the WAD condition. [ABSTRACT FROM AUTHOR]

Convulxin (CVX), a C-type lectin-like protein (CLPs), is a potent platelet aggregation inducer. To evaluate its potential applications in angiogenic diseases, the multimeric CVX were further explored on its mode of actions toward human coronary artery smooth muscle cells (HCASMCs). The N-terminus of β-chain of CVX (CVX-β) contains a putative disintegrin-like domain with a conserved motif upon the sequence comparison with other CLPs. Importantly, native CVX had no cytotoxic activity as examined by electrophoretic pattern. A Trp-Ala–Asp (WAD)-containing octapeptide, MTWADAEK, was thereafter synthesized and analyzed in functional assays. In the case of specific integrin antagonists as positive controls, the anti-angiogenic effects of CVX on HCASMCs were investigated by series of functional analyses. CVX showed to exhibit multiple inhibitory activities toward HCASMCs proliferation, adhesion and invasion with a dose- and integrin αvβ3-dependent fashion. However, the WAD-octapeptide exerting a minor potency could also work as an active peptidomimetic. In addition, flow cytometric analysis demonstrated both the intact CVX and synthetic peptide can specifically interact with integrin-αv on HCASMCs and CVX was shown to have a down-regulatory effect on the gene expression of CXC-chemokines, such as growth-related oncogene and interleukin-8. According to nuclear factor-κB (NF-κB) p65 translocation assay and Western blotting analysis, the NF-κB activation was not involved in the signaling events of CVX-induced gene expression. In conclusion, CVX may act as a disintegrin-like protein via the interactions of WAD-motif in CVX-β with integrin-αv on HCASMCs and it also is a gene suppressor with the ability to diminish the expression of two CXC-chemokines in a NF-κB-independent manner. Indeed, more extensive investigations are needed and might create a new avenue for the development of a novel angiostatic agent. [ABSTRACT FROM AUTHOR]

The genetic evolution of three types of reworked manganese ore bodies namely: Detrital, Concretionary (Mangcrete) and Wad in the Precambrian Iron Ore Group occurring in Bonai-Keonjahr belt, Singhbhum Craton, India are reported. All the reworked Mn-ore bodies are developed in a restricted area and have a limited resource. Mangcrete and wad are commonly exposed at the surface and extend to a maximum depth of 10 m while detrital ores are observed below 10–20 m from the surface. Detrital ore bodies occur as large boulders and are buried under a thick zone of laterite. Mangcrete is concretionary in nature; oolitic, spherulitic and nodular in shape. Broken fragmented of ooloids and pisoloids, often observed in mangcrete, are indications of reworking. Wad exposures are noticed above low to medium-grade bedded manganese ore bodies. Among three reworked ore types, the detrital is of low to medium-grade having Mn:Fe ratio > 5, while wad and mangcrete are of sub-grade (Mn:Fe ~ 1) and off-grade type (Mn:Fe < 1) respectively. Detrital ore bodies are of allochthonous nature and developed through several stages such as fragmentation of pre-existing ore, leaching and cementation followed by transportation and deep burial. Mangcrete represent chemogenic precipitates at several stages of contemporary Mn-Fe-Al rich fluid under supergene environment. Wad is of bio-chemogenic origin and developed in a swampy region under marine environment due to slow chemical precipitation of Mn-Fe enriched fluid, in several stages nucleating quartz/hematite/cryptomelane detritals. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Prospective human cohort study combined with molecular studies. BACKGROUND: A microRNA is a small, noncoding RNA molecule that can play a role in disease onset. Recent studies found that circulating levels of microRNA 320a (miR-320a) are associated with musculoskeletal pain conditions and that miR-320a is stress responsive. OBJECTIVES: To investigate whether circulating expression levels of miR-320a in the peritraumatic period predict persistent axial musculoskeletal pain 6 months after motor vehicle collision (MVC). METHODS: We evaluated whether (1) circulating miR-320a and related members of the miR-320a family predict axial musculoskeletal pain and other musculoskeletal pain outcomes 6 months following MVC, and (2) miR-320a regulates stress system and pain-related transcripts in cell culture. Given the wealth of data suggesting that biological mechanisms influencing pain outcomes are often sex and/or stress dependent, interactions between miR-320a, stress, and sex were evaluated. RESULTS: In primary analyses (n = 69), a significant crossover interaction was observed between the influence of circulating miR-320a and peritraumatic distress (β = -0.01, P = .002) on post-MVC axial musculoskeletal pain. Reduced peritraumatic miR-320a expression levels predicted axial musculoskeletal pain in distressed individuals (β = -0.12, P = .006) but not nondistressed individuals. In secondary analyses, miR-320a predicted widespread musculoskeletal pain, and related members of the miR-320a family also predicted axial and widespread musculoskeletal pain. In cell culture, miR-320a bound stress and pain-associated 3'UTR transcripts (FKBP5, ADCYAP1, PER2, and NR3C1). CONCLUSION: These data suggest that miR-320a may help mediate regional and widespread changes in pain sensitivity after MVC. [ABSTRACT FROM AUTHOR]

SYNOPSIS: Recovery from a whiplash injury is varied and complex. Some individuals recover quickly and fully, while others experience ongoing pain and disability. Three distinct patterns of predicted recovery (trajectories) have been identified using disability and psychological outcome measures. These trajectories are not linear, and show that recovery, if it is going to occur, tends to happen within the first 3 months of the injury, with little improvement after this period. Identification of factors associated with poor recovery is accumulating, and since 2000 there have been at least 10 published systematic reviews on prognostic factors for whiplash-associated disorder. Poor recovery has been consistently reported to be associated with high initial neck pain intensity and neck-related disability, posttraumatic stress symptoms, pain catastrophizing, and, to a lesser extent, low self-efficacy and cold hyperalgesia. Evidence regarding factors, including compensation status, psychological factors, structural pathology, and preinjury health status, remains equivocal. Given the huge number of predictive factors and various interpretations of recovery, adapting these data for use in clinical practice is difficult. Tools such as clinical prediction rules (CPRs), by statistically quantifying relevant data, may help to predict the probability of diagnosis, prognosis, or response to treatment. Numerous CPRs have been derived for individuals with whiplash; however, to date, only 3 prognostic CPRs have undergone external validation, and none have yet undergone impact analysis, a necessary step in providing information about the rules' ability to improve clinically relevant outcomes. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Cross-sectional study. BACKGROUND: Findings of fat infiltration in cervical spine multifidus, as a sign of degenerative morphometric changes due to whiplash injury, need to be verified. OBJECTIVES: To develop a method using water/fat magnetic resonance imaging (MRI) to investigate fat infiltration and cross-sectional area of multifidus muscle in individuals with whiplash-associated disorders (WADs) compared to healthy controls. METHODS: Fat infiltration and cross-sectional area in the multifidus muscles spanning the C4 to C7 segmental levels were investigated by manual segmentation using water/fat-separated MRI in 31 participants with WAD and 31 controls, matched for age and sex. RESULTS: Based on average values for data spanning C4 to C7, participants with severe disability related to WAD had 38% greater muscular fat infiltration compared to healthy controls (P = .03) and 45% greater fat infiltration compared to those with mild to moderate disability related to WAD (P = .02). There were no significant differences between those with mild to moderate disability and healthy controls. No significant differences between groups were found for multifidus cross-sectional area. Significant differences were observed for both cross-sectional area and fat infiltration between segmental levels. TCONCLUSION: Participants with severe disability after a whiplash injury had higher fat infiltration in the multifidus compared to controls and to those with mild/moderate disability secondary to WAD. Earlier reported findings using T1-weighted MRI were reproduced using refined imaging technology. The results of the study also indicate a risk when segmenting single cross-sectional slices, as both cross-sectional area and fat infiltration differ between cervical levels. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Secondary analysis of a prospective cohort study with cross-sectional and longitudinal analyses. BACKGROUND: The clinical importance of a history of whiplash-associated disorder (WAD) in people with neck pain remains uncertain. OBJECTIVE: To compare people with WAD to people with nonspecific neck pain, in terms of their baseline characteristics and pain and disability outcomes over 1 year. METHODS: Consecutive patients with neck pain who presented to a secondary-care spine center answered a comprehensive self-report questionnaire and underwent a physical examination. Patients were classified into a group of either those with WAD or those with nonspecific neck pain. We compared the outcomes of baseline characteristics of the 2 groups, as well as pain intensity and activity limitation at follow-ups of 6 and 12 months. RESULTS: A total of 2578 participants were included in the study. Of these, 488 (19%) were classified as having WAD. At presentation, patients with WAD were statistically different from patients without WAD for almost all characteristics investigated. While most differences were small (1.1 points on an 11-point pain-rating scale and 11 percentage points on the Neck Disability Index), others, including the presence of dizziness and memory difficulties, were substantial. The between-group differences in pain and disability increased significantly (P<.001) over 12 months. At 12-month follow-up, the patients with WAD had on average approximately 2 points more pain and 17 percentage points more disability than those with nonspecific neck pain. CONCLUSION: People referred to secondary care with WAD typically had more self-reported pain and disability and experienced worse outcomes than those with nonspecific neck pain. Caution is required when interpreting the longitudinal outcomes due to lower-than-optimal follow-up rates. [ABSTRACT FROM AUTHOR]

The fear avoidance model (FAM) has been proposed to explain the development of chronic disability in a variety of conditions including whiplash-associated disorders (WADs). The FAM does not account for symptoms of posttraumatic stress and sensory hypersensitivity, which are associated with poor recovery from whiplash injury. The aim of this study was to explore a model for the maintenance of pain and related disability in people with WAD including symptoms of PTSD, sensory hypersensitivity, and FAM components. The relationship between individual components in the model and disability and how these relationships changed over the first 12 weeks after injury were investigated. We performed a longitudinal study of 103 (74 female) patients with WAD. Measures of pain intensity, cold and mechanical pain thresholds, symptoms of posttraumatic stress, pain catastrophising, kinesiophobia, and fear of cervical spine movement were collected within 6 weeks of injury and at 12 weeks after injury. Mixed-model analysis using Neck Disability Index (NDI) scores and average 24-hour pain intensity as the dependent variables revealed that overall model fit was greatest when measures of fear of movement, posttraumatic stress, and sensory hypersensitivity were included. The interactive effects of time with catastrophising and time with fear of activity of the cervical spine were also included in the best model for disability. These results provide preliminary support for the addition of neurobiological and stress system components to the FAM to explain poor outcome in patients with WAD. [ABSTRACT FROM AUTHOR]

Context: The detailed course of recovery following compensable whiplash associated disorders (WAD) is not well understood. Some people recover within months and others report symptoms for extended periods. Recent research identified distinct recovery pathways. Identifying recovery pathways for people with this condition in compensable settings could assist clinical and claim management.Study Objective: This study aimed to identify recovery trajectories based on disability, pain catastrophising and mental health and, secondly, to examine developmental linkages between the trajectories.Study Design: A cohort of 246 people with compensable WAD were followed for 24 months after a motor vehicle related injury.Outcome Measures: Functional Rating Index (FRI), Pain Catastrophising Scale (PCS) and the SF36 Mental Component Score (SF 36 MCS).Method: Group-based trajectory analytical techniques were used to identify distinct post-injury profiles. Multinominal logistic regression modelling identified factors associated with membership of different trajectories.Results: 246 people were enrolled a median of 72 days after injury. Three trajectories were identified for the measures used and their prevalences, respectively, were: for disability (FRI) they were mild (47%), moderate (31%), and severe (22%); for pain catastrophising (PCS) they were non-catastrophisers (55%), moderate-low catastrophisers (32%) and clinically significant catastrophisers (13%); and, for mental health (SF36 MCS) they were good mental health (40%), moderately low mental health (42%) and severely low mental health (18%). All groups showed no further recovery beyond 12 months after injury. The significant baseline predictors of the severe disability trajectory were: lower (that means worse) bodily pain scores (SF 36 BPS) (p≤0.01); high pain catastrophising (p≤0.01); and, self-reported fair or poor general health (p=0.03). Conditional probabilities for group membership showed that the three trajectories for both PCS and FRI were linked. Dual membership was high for the mild disability and mild pain catastrophising trajectories and, for the severe disability and clinically significant pain catastrophising trajectories.Conclusions: There is a strong and plausible association between severe disability, clinical levels of pain catastrophising and low mental health. Claimants can be identified at claim notification based on three estimated recovery trajectories. Claim and clinical interventions can be targeted to the profile within each recovery trajectory. [ABSTRACT FROM AUTHOR]

Context Continued exposure to compensation systems has been reported as deleterious to the health of participants. Understanding the associations with time to claim closure could allow for targeted interventions aimed at minimising the time participants are exposed to the compensation system. Study objective To identify the associations of extended time receiving compensation benefits with the aim of developing a prognostic model that predicts time to claim closure. Study design Prospective cohort study in people with whiplash associated disorder. Outcome measures Time to claim closure, in a privately underwritten fault based third party traffic crash insurance scheme in New South Wales, Australia. Method Cox proportional hazard regression modelling. Results Of the 246 participants, 25% remained in the compensation system longer than 24 months with 15% remaining longer than three years. Higher initial disability (Functional Rating Index ≥ 25 at baseline) (HRR: 95% CI, 1.916: 1.324–2.774, p < 0.001); and lower initial mental health as measured by SF-36 Mental Component Score (HRR: 95% CI, 0.973: 0.960–0.987, p < 0.001) were significantly and independently associated with an increased time-to-claim closure. Shorter time to claim closure was associated with having no legal involvement (HRR: 95% CI, 1.911: 1.169–3.123, p = 0.009); and, not having a prior claim for compensation (HRR: 95% CI, 1.523: 1.062–2.198, p = 0.022). Conclusions Health and insurance related factors are independently associated with time to claim closure. Both factors need to be considered by insurers in their assessment of complexity of claims. Interventions aimed at minimising the impact of these factors could reduce claimants’ exposure to the compensation system. In turn insurers can potentially reduce claims duration and cost, while improving the health outcomes of claimants. [ABSTRACT FROM AUTHOR]

Context Many people with Whiplash Associated Disorder (WAD) seek treatment though a compensation system where factors such as legal involvement have been reported as having a negative impact on recovery outcomes. Objective To compare those with and without legal involvement in their compensation claim, and identify associations with legal involvement at 12 months post injury; and longer term disability. Study design Inception cohort study. Participants 246 people with WAD compensation claim. Outcome measures Legal involvement and Functional Rating Index at 12 months post injury. Methods Participants were recruited from an insurance database. Baseline health (Functional Rating Index, Pain Catastrophising Scale and SF-36), socio-economic, work capacity, and claims data were collected within three months of injury and 12 months. Logistic regression models were used to identify associations with legal involvement at 12 months; and disability (FRI) at 12 months. Results At baseline 246 participants were enrolled into the study in a median 72 days post injury. At 12 months post injury 52 (25%) had engaged a lawyer. The significant independent associations with legal involvement at 12 months were higher levels of initial disability, work disability, speaking a language other than English at home and lower levels of mental health. Specifically, the odds of lawyer involvement at 12 months post injury was 4.9 times greater for those with work disability; 2.3 times greater for those who spoke a language other than English at home. In terms of health, they had poorer mental health and for every 10 unit increase in the baseline FRI score the odds of having lawyer involvement increased by 38%. Disability at 12 months (FRI) was significantly independently associated with, PCS-helplessness ( p < 0.001), age ( p < 0.001) and prior claim ( p = 0.001). Conclusion This study suggests the people with lawyer involvement in their claim 12 months after injury have socio-economic disadvantage, have had a prior claim and a worse baseline health profile compared to those without a lawyer. Understanding this profile could allow for improved claims processes and targeted interventions to assist this group through any perceived complexities in the system and address the underlying reasons for lawyer participation within compensation schemes. [ABSTRACT FROM AUTHOR]

Objective:As fatalities from car crashes decrease, focus on medical impairment following car crashes becomes more essential. This study assessed the risk of permanent medical impairment based on car occupant injuries. The aim was to study whether the risk of permanent medical impairment differs depending on age and gender. Methods:In total, 36,744 injured occupants in car crashes that occurred between 1995 and 2010 were included. All initial injuries (n= 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. If a car occupant still had residual symptoms 3 years after a crash, the case was classed as a permanent medical impairment. In total, 5,144 injuries led to permanent medical impairment. The data were divided into different groups according to age and gender as well as levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to the AIS. Results:The cervical spine was the body region that had the highest number of diagnoses, and occupants who sustained injuries to the upper and lower extremities had the highest risk of medical impairment for both genders. Females aged 60 and above had a higher risk of permanent medical impairment from fractures in the extremities compared to males in the same age group and younger females. Females aged 44 or younger had a higher risk of permanent medical impairment from whiplash-associated disorders (WAD) than males in the same age group. Minor and moderate injuries (AIS 1–2) had a higher risk of permanent medical impairment among older car occupants compared to younger ones. Conclusions:Differences in long-term outcome were dependent on both gender and age. Differences between age groups were generally greater than between genders. The vast majority of permanent medical impairments resulted from diagnoses with a low risk of fatality. The results emphasize the impact of age and gender in long-term consequences from car crashes. They could be used when designing safety technology in cars as well as to improve health care by contributing to better allocation of rehabilitation resources following trauma. [ABSTRACT FROM AUTHOR]

Objective:There is limited knowledge of the long-term medical consequences for children injured in car crashes. Thus, in the event of injury, the aim of the study was to specify patterns and risks of injuries resulting in permanent medical impairment of children (0–12 years) for different body regions and injury severity levels, according to Abbreviated Injury Scale (AIS). The aim was also to compare the impairment outcome with adults. Methods:Data were obtained from the Folksam insurance company, including reported car crashes from 1998 to 2010 with at least one injured child 0–12 years of age. In all, 2619 injured children with 3704 reported medical diagnoses were identified. All injuries were classified according to the AIS 2005 revision. If the child had not recovered within 1 year postinjury an assessment of permanent medical impairment (PMI) was made by one or several medical specialists. Results:In all, 55 children sustained 59 injuries resulting in PMI of which 75 percent were at AIS 1 or AIS 2. The head and cervical spine were the body regions sustaining the most injuries resulting in PMI. Sixty-eight percent of all injuries resulting in PMI were AIS 1 injuries to the cervical spine, with the majority occurring in frontal or rear impacts. Given an injury to the cervical spine, the risk of injuries resulting in PMI was 3 percent, and older children (≥6 years) had a significantly higher risk (3% versus 1%) than younger children. The head was the second most commonly injured body region with injuries resulting in PMI (12/59), which were predominantly AIS 2+. In addition, mild traumatic brain injuries at AIS 1 were found to lead to PMI. Whereas for children the injuries leading to PMI were primarily limited to the head and cervical spine, adults sustained injuries that led to PMI from a more diverse distribution of body regions. Conclusion:The pattern of injuries resulting in permanent medical impairment is different for children and adults; therefore, safety priorities for children need to be based on child data. The majority of those injuries leading to PMI were at lower AIS levels. Furthermore, AIS 1 cervical spine and AIS 1+ head injuries should be given priority concerning mitigation of long-term consequences for children. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study that examined the risk factors for persistent problems after a whiplash secondary to a motor vehicle accident. The study shows several variables that are significant predictors of poor outcome in whiplash-associated disorder (WAD) including high baseline pain intensity and report of headache inception. Existing variables that were refined or added included preaccident history of headache, rear-end collision and older age.

Purpose: To investigate the presence of subgroups in chronic whiplash-associated disorders (WAD) based on pain thresholds for pressure (PPT), cold (CPT), and heat (HPT) and to compare these subgroups with respect to symptomatology, disability, and health aspects. Methods: Two groups of female subjects - patients with chronic WAD (n = 28) and healthy controls (CON; n = 29) - were investigated. Quantitative sensory testing (QST) for thermal thresholds and algometry for PPT at four sites in the body (over the trapezius and tibialis anterior bilaterally) were determined. Habitual pain intensities, psychological strain, disability, and health aspects were registered using a questionnaire. Results: A cluster analysis based on PPT, CPT, and HPT identified two subgroups of chronic WAD: one sensitive subgroup (s-WAD; n = 21), and one less sensitive subgroup (ls-WAD; n = 6). S-WAD displayed widespread hyperalgesia, whereas ls-WAD had localized hyperalgesia in the neck area, with tendencies to supernormal values in remote areas of the body. Generally, s-WAD had a significantly worse situation than the CON with respect to symptomatology, disability, and health aspects. The ls-WAD group was intermediary between s-WAD and CON in these aspects. Conclusion: Different explanations, eg, severity of the pain condition per se, etiological factors, and pre-trauma differences in pain sensitivity, may exist for the differences in pain thresholds between the two subgroups. Future research should investigate the role of pain thresholds in the chronic stage to determine the efficacy of treatment interventions. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Objective of this investigation was to evaluate the rotational mobility at the craniocervical junction and changes in the width of the subarachnoid space during head rotation in healthy volunteers using Magnetic Resonance Imaging (MRI). Materials and Methods: In 30 healthy volunteers axial 3mm Half-Fourier Acquisition Single-Shot Turbo Spin-Echo (HASTE) sequences were obtained with the subject''s head in neutral position, and in maximal rotation to the left and right respectively. All MRI examinations were evaluated by two neuroradiologists in consensus. The ranges of axial rotation at C0–C2 as well as the width of the subarachnoid space in neutral, and in maximal rotated position were measured. Student''s t-tests were used to compare group differences. Results: Total range of right-to-left-rotation at C0–C2 was 59–183° with mean rotation to the right and left side of 70° (±12.7°) and 75° (±13.0°). Difference between degrees of rotation to both sides was on average 4.9° (±7.1°) with a significantly greater rotational range to the left compared to the right. In neutral position, distance between the dura and the ventral wall of the cervical spinal cord was 1.6–4.2mm. In active rotation interface between dura and myelon was evident in 19 volunteers with unilateral contact in 7, and bilateral contact in 12 cases. Conclusions: High variablity of rotational mobility at the craniocervical junction and attenuation of width of the subarachnoid space during head rotation are frequent findings in an asymptomatic population. Our results indicate that the assessment of these parameters is of limited diagnostic value in patients with whiplash-associated disorders. [Copyright &y& Elsevier]