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Background: Transverse mandibular discrepancies are often overlooked during orthodontic treatment. MSDO is a treatment to address this issue, but much debate exists over the long-term implications on the temporomandibular joint (TMJ). Few studies have sample sizes sufficient to draw clear conclusions about the impact of MSDO on TMJ health. Materials and Methods: This study evaluated private practice records including 49 MSDO patients and 57 traditionally-treated controls. The subjects were assessed by TMD exams that evaluated jaw pain and discomfort using visual analog scales, range of motion for opening, right and left lateral, and protrusive movements, and the presence of clenching, bruxism, clicking, crepitus, and pain on TMJ and muscle palpation. Results: No significant changes between the groups were noted during treatment or follow-up. Conclusions: Compared to controls, MSDO patients did not experience any increase in TMD symptoms. Distraction and control patients were not significantly different in any of the categories.

Cette thèse présente le produit d'un projet de recherche doctoral ambitieux qui a procédé à la réalisation des premières étapes cruciales de conception, développement et évaluation d'un test de mesure de l'impact de la distraction du conducteur (DDIAT). L'objectif de ce test est de mesurer l'impact que la distraction du conducteur a sur les performances de conduite et les comportements du conducteur. En outre, une présentation sera effectuée des étapes majeures qui restent encore à réaliser, et qui dépassent le cadre de cette thèse, pour entièrement valider et implémenter le test. Le DDIAT est composé de trois épreuves de conduite ou Drives (Drive 1, 2 et 3), qui ont été conçues à partir des principes de la littérature de la cognition et de l’attention. Les épreuves Drive 1 et Drive 2 ont été implémentées dans un environnement de conduite urbain et elles incluent des conditions de feux de circulation qui ont été conçues pour ressembler aux feux de circulation rencontrés dans des conditions de conduite réelles. De plus, l'épreuve Drive 1 inclut des scénarios de traversée d’une file de véhicules pour tourner à gauche à une intersection (gap acceptance), dans lesquels les participants doivent prendre la décision cruciale de sélectionner un intervalle entre deux véhicules pour traverser. L'épreuve Drive 2 inclut plusieurs instances de suivi de véhicule, dont certaines où le véhicule suivi freine brutalement et où le participant doit réagir de manière appropriée pour éviter une collision frontale. Enfin, l'épreuve Drive 3 a été conçue pour implicitement mesurer la conscience de la situation dans un environnement de conduite autoroutier, mais cette épreuve n'a pas été entièrement implémentée dans le cadre de cette thèse. Les épreuves Drive 1 et Drive 2 ont été évaluées dans une expérimentation sur un simulateur de conduite avancé. Les résultats de cette évaluation expérimentale ont montré que les deux épreuves Drive 1 et Drive 2 étaient capables de : a) représenter la conduite réelle (c.-à-d., elles vérifient la validité de contenu et la validité apparente), b) mesurer l'impact de la distraction du conducteur et c) de faire la distinction entre les deux tâches secondaires (l'une visuelle/manuelle, l'autre auditive/cognitive) à travers leur impact sur les performances de conduite. En conclusion, le travail complété dans le cadre de cette thèse constitue les premières étapes cruciales nécessaires au développement d'un DDIAT complet qui surpasse les limitations des outils et tests précédents et fournit également les bases d'une méthode standardisée pour aider à surpasser les incohérences qui existent entre les différentes études de mesure de l'impact de la distraction du conducteur. / This thesis describes the outcomes of an ambitious doctoral research program that carried out the initial critical steps in the design, development, and evaluation of a driver distraction impact assessment test (DDIAT). The purpose of this test has been to assess the impact driver distraction has on driving performance and driver behaviour. The thesis also describes the critical steps, beyond the scope of this thesis, that remain to be carried out in order to fully validate and implement the complete DDIAT proposed in this thesis. As part of the DDIAT proposed in this thesis, three Drives (Drive 1, 2, and 3) were designed and created from basic attention principles and by using a complex experimental design. Drive 1 and Drive 2 were implemented in an urban driving environment and included traffic light conditions that were designed to resemble real world traffic light conditions. Furthermore, Drive 1 included gap acceptance events in which participants had to make a crucial and important decision when selecting a gap to turn left though an oncoming stream of vehicles. Drive 2 included various car following instances and lead vehicle braking events, whereby participants had to react suddenly to avoid a frontal collision. Lastly, Drive 3 was designed to implicitly measure situation awareness on a highway driving environment – but was outside of the scope of the thesis to investigate. Drive 1 and Drive 2 were evaluated in an experiment implemented in an advanced driving simulator. The results from this evaluation experiment showed that both Drive 1 and Drive 2: a) represent real world driving (i.e., have content and face validity); b) are capable of measuring the impact of driver distraction; and c) are capable of distinguishing between the impact on driving of two secondary tasks (one visual/manual, the other auditory/cognitive). In conclusion, the work completed as part of this thesis provided a first and important step towards the development of a complete DDIAT that overcomes the shortcomings of previous tests and tools and also provides the beginnings of a standardised method to assist in overcoming the inconsistencies that exist across studies in the measurement of driver distraction.

This research aims to compare how adults use handheld and widescreen digital devices to distract children during painful medical procedures. Levels of pain and distress are compared to assess the effectiveness of each device medium. The behaviors of the adults using these devices were also examined in order to determine the quality of the distraction provided. Additionally, the observed behaviors of the adults are documented and analyzed to determine if the rates of specific action types are predictors of pain, distress, and quality of distraction provided. The results of this work show that children reported less pain when distracted by handheld devices compared to widescreens. Although children reported less pain with handheld devices they received lower quality distraction compared to when widescreen devices were used. Two types of actions were positively associated with higher quality distraction: those that demonstrated the adults’ interest in the devices and those that provided support to children interacting with the devices. Adults using widescreen devices performed these two types of actions more frequently than those using handheld devices. These findings indicate that when adults use handheld devices they tend to reduce pain and distress compared to widescreens. However, widescreen devices are more likely encourage actions that are linked to higher quality distraction. This interdependency of devices and coaching ability led to an interpretation of findings that presents a new theory called mediPLAYtion. MediPLAYtion recommends specific actions that promote cooperative engagement using digital devices for reducing pain during medical procedures.

Driver distraction contributes to approximately 43% of motor-vehicle crashes and 27% of near-crashes. Rapidly developing in-vehicle technology and electronic devices place additional demands on drivers, which might lead to distraction and diminished capacity to perform driving tasks. This situation threatens safe driving. Technology that can detect and mitigate distraction by alerting drivers could play a central role in maintaining safety. Correctly identifying driver distraction in real time is a critical challenge in developing distraction mitigation systems, and this function has not been well developed. Moreover, the greatest benefit may be from real-time distraction detection in advance of dangerous breakdowns in driver performance. Based on driver performance, two types of distraction - visual and cognitive - are identified. These types of distraction have very different effects on visual behavior and driving performance; therefore, they require different algorithms for detection. Distraction detection algorithms typically rely on either eye measures or driver performance measures because the effect of distraction on the coordination of measures has not been established. Combining both eye glance and vehicle data could enhance the ability of algorithms to detect and differentiate visual and cognitive distraction. The goal of this research is to examine whether poor coordination between visual behavior and vehicle control can identify diminished attention to driving in advance of breakdowns in lane keeping. The primary hypothesis of this dissertation is that detection of changes in eye-steering relationship caused by distraction could provide a prospective indication of vehicle state changes. Three specific aims are pursued to test this hypothesis. The first aim examines the effect of distracting activity on eye and steering movements to assess the degree to which the correlation parameters are indicative of distraction. The second aim applies a control-theoretic system identification approach to the eye movement and steering data to distinguish between distracted and non-distracted conditions. The third aim examines whether changes of eye-steering coordination associated with distraction provide a prospective indication of breakdowns in driver performance, i.e., lane departures. Together, the three aims show how that a combination of visual and steering behavior, i.e., eye-steering model, can differentiate between non-distracted and distracted state. This model revealed sensitivity to distraction associated with off-road glances. The models derived for different drivers have similar structure and fit to data from other drivers reasonably well. In addition, the differences in model order and model coefficients indicate the variability in driving behavior: some people generate more complex behavior than others. As was expected, eye-steering correlation on straight roads is not as strong as observed on curvy roads. However, eye-steering correlation measured through correlation coefficient and time delay between two movements is sensitive to different types of distraction. Time delay mediates changes in lane position and the eye-steering system predicts breakdowns in lane keeping. This dissertation contributes to developing a distraction detection system that integrates visual and steering behavior. More broadly, these results suggest that integrating eye and steering data can be helpful in detecting and mitigating impairments beyond distraction, such as those associated with alcohol, fatigue, and aging.

Les variables neurovégétatives permettent d’évaluer l’état fonctionnel de l’individu, et représentent un intérêt pour mieux comprendre le comportement du conducteur, facteur déterminant de la sécurité routière. Ce travail est centré sur l’évaluation de la charge mentale du conducteur automobile par l’analyse de l’activité électrodermale. L’objectif est d’extraire les meilleurs indicateurs du signal électrodermal pour différencier la charge mentale induite par des situations de conduite réelle. L’analyse d’une trentaine d’indicateurs phasiques a permis de différencier des situations de conduite nominale, comparables en termes d’exigence comportementale mais différentes au niveau cognitif. Après traitement approprié du signal, en particulier en appliquant des transformations log, l’amplitude des réponses électrodermales est apparue comme un des indices les plus discriminants. Toutefois, les différences de charge mentale induites par les situations de conduite n’ont pas exactement correspondu à celles qui avaient été supposées. Une explication alternative mettant en avant des processus d’anticipation est proposée. Trois indicateurs toniques, dont deux sont nouveaux, ont ensuite été testés dans une expérience de double tâche, où une activité secondaire distractive était effectuée simultanément à la conduite. L’un s’est révélé inadapté au profil des signaux, mais les deux autres ont permis d’établir une hiérarchisation partielle de la surcharge induite. Particulièrement sensible à l’aspect cognitif de la distraction, l’évaluation psychophysiologique de la charge mentale par l’activité électrodermale apparaît complémentaire de l’analyse de la performance de conduite. / As an assessment tool for individual’s functional state, autonomic indices can help improving our knowledge of drivers’ behaviour, which is a central road safety causal factor. This work is focused on driver’s mental workload assessment, relying on electrodermal activity analysis. This is an attempt to highlight the most reliable electrodermal indices with the aim to distinguish accurately mental workload elicited by actual driving situations. The analysis of about thirty phasic indices, led to differentiate nominal driving situations. These were selected on the basis of comparable behavioural requirements, but of differences cognitive processes. After appropriate signal processing, (using log transformations in particular), electrodermal responses amplitude has the most potential to distinguish among experimental conditions. However, some of the differences about mental workload were not exactly those which were previously expected. An alternative interpretation of results highlighting anticipation processes is thus proposed. Tonic variations were then studied in a dual task experiment, including two new indices. The distractive power of several secondary tasks, performed while driving, was to be evaluated using these indices. One of the indices was unrelated to signals’ profile. Conversely, the two others gave a clear distinction of potential distraction elicited selectively by each secondary task. Mental workload was thus showed as being evaluated accurately using electrodermal activity analysis. Using objective physiological data and defining new electrodermal indices brought more reliability in the field of mental workload. Thus, electrodermal activity is a good candidate to complete data usually brought by tests or questionnaires.

This study aims to evaluate algorithms designed to detect distracted driving. This includes the comparison of how efficiently they detect the state of distraction and likelihood of a crash. Four algorithms that utilize measures of cumulative glance, past glance behavior, and glance eccentricity were used to understand the distracted state of the driver and were validated on two separate data sources (i.e., simulator and naturalistic data). Additionally, an independent method for distraction detection was designed using data mining methods. This approach utilized measures like steering degree, lane offset, lateral and longitudinal velocity, and acceleration. The results showed a higher likelihood of distracted events when cumulative glances were considered. However, the state of distraction was observed to be higher when glance eccentricity was added. Additionally, it was observed that glance behavior using the four legacy algorithms were better detectors of the state of distraction as compared to the data mining method that used vehicular measures. This research has implications in understanding the state of distraction, predicting the power of different methods, and comparing approaches in different contexts (naturalistic vs simulator). These findings provide the fundamental building blocks towards designing advanced mitigation systems that give drivers feedback in instances of high crash likelihood.

Barn som undersöks, vårdas eller behandlas, genomgår olika procedurer och kan då uppleva smärta, oro och rädsla. För att minska och avleda dessa för barnet obehagliga upplevelser finns det olika distraktionsmetoder som kan användas. Clownintervention är en av dessa metoder. Syftet med studien var att beskriva clowninterventionens effekt på barns smärta, oro och rädsla. Metoden som användes var litteraturstudie. De artiklar som analyserats var huvudsakligen med kvantitativ metod men en hade mixad metod. Alla artiklar var publicerade de senaste fem åren. Resultatet visar framför allt att clownintervention hade effekt på barns oro och rädsla. Det utvärderades genom självskattning av de barn som var kapabla att använda mätinstrumenten och genom observationer av de barn som inte klarade av självskattning. Det gick dock inte lika tydligt att påvisa effekt på smärta med hjälp av clownintervention då endast tre studier visat på dess effekt. Detta kan bero på att materialet var litet. Konklusionen är att det är viktigt att för sjuksköterskor medvetandegöra clowninterventionens effekt hos barn och implementera denna distraktionsmetod i klinisk verksamhet. Dessutom skulle det vara av värde om det genomfördes mer forskning i större grupper för att se effekten av clowners medverkan för att reducera barns smärtupplevelse. / Children who undergoes examinations, care or treatment goes through different procedures that may give them experience of pain, anxiety and fear. There are different methods of distraction to decrease and distract those unpleasent experiences. Clownintervention is one of those methods. The aim of this study is to describe the effect of clownintervention on childrens pain, anxiety and fear. The method used is litterature study. The articles analysed was mainly quantitative method however one was with a mixed method. All articles were published the latest five years. The main result showed that clownintervention had effect on childrens anxiety and fear. It was evaluated through self- report assessment in the children who were able to use this and through observation of those children who were not able to use self- report assessment. It did not, however, equally clearly demonstrate effect on pain using clownintervention when only three studies demonstrated positive effect. It may be that the material was small. The conclusion is that nurses need to be aware of the importence about the effect of clownintervention and to implement this method of distraction in to clinical work. Furthermore it would be of great importance if more research could be done in larger populations to examine the effect of clowns assistance to reduce childrens experience of pain.