TRAUMATIC HEAD INJURY

To estimate the prognostic value of injury severity, location of event, and demographic parameters, for symptoms of pediatric traumatic head injury (THI) 4 years later. Methods: Data were collected prospectively from Reykjavik City Hospital on all patients age 0-19 years, diagnosed with THI (n = 408) during one year. Information was collected on patient demographics, location of traumatic event, cause of injury, injury severity, and ICD-9 diagnosis. Injury severity was estimated according to the Head Injury Severity Scale (HISS). Four years post-injury, a questionnaire on late symptoms attributed to the THI was sent. Results: Symptoms reported were more common among patients with moderate/severe THI than among others (p Ͻ 0.001). The event location had prognostic value (p Ͻ 0.05). Overall, 72% of patients with moderate/severe motor vehicle-related THI reported symptoms. There was a curvilinear age effect (p Ͻ 0.05). Symptoms were least frequent in the youngest age group, 0-4 years, and most frequent in the age group 5-14 years. Gender and urban/rural residence were not signifi cantly related to symptoms. Conclusions: Motor vehicle related moderate/severe THI resulted in a high rate of late symptoms. Location had a prognostic value. Patients with motor vehicle-related THI need special consideration regardless of injury severity.

To estimate the prognostic value of injury severity, location of event, and demographic parameters, for symptoms of pediatric traumatic head injury (THI) 4 years later. Methods: Data were collected prospectively from Reykjavik City Hospital on all patients age 0-19 years, diagnosed with THI (n = 408) during one year. Information was collected on patient demographics, location of traumatic event, cause of injury, injury severity, and ICD-9 diagnosis. Injury severity was estimated according to the Head Injury Severity Scale (HISS). Four years post-injury, a questionnaire on late symptoms attributed to the THI was sent. Results: Symptoms reported were more common among patients with moderate/severe THI than among others (p Ͻ 0.001). The event location had prognostic value (p Ͻ 0.05). Overall, 72% of patients with moderate/severe motor vehicle-related THI reported symptoms. There was a curvilinear age effect (p Ͻ 0.05). Symptoms were least frequent in the youngest age group, 0-4 years, and most frequent in the age group 5-14 years. Gender and urban/rural residence were not signifi cantly related to symptoms. Conclusions: Motor vehicle related moderate/severe THI resulted in a high rate of late symptoms. Location had a prognostic value. Patients with motor vehicle-related THI need special consideration regardless of injury severity.

Background Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial-a multicentre international collaboration-aimed to confirm or refute such an effect by recruiting 20 000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. Methods 10 008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Findings Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21•1%] vs 893 [17•9%] deaths; relative risk 1•18 [95% CI 1•09-1•27]; p=0•0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0•22) or time since injury (p=0•05). Interpretation Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear. We declare that we have no conflict of interest.

This case report details the presentation, diagnosis, and surgical management of a 45-year-old female with a history of severe head trauma presenting with a persistent dull headache. Imaging revealed a left parietal intradiploic meningioma, leading to surgical exploration and resection of the lesion. Histopathological analysis confirmed the diagnosis, highlighting the importance of considering intradiploic meningiomas in patients with skull lesions, particularly following head trauma. Surgical resection remains the treatment of choice, emphasizing the need for meticulous surgical technique to prevent complications. This case underscores the challenges and nuances in diagnosing and managing rare intradiploic meningiomas, contributing to our understanding of their clinical presentation and optimal treatment strategies.

Background: Social conflicts is one of the global challenges leading to setback of development and flourishing of human societies. Children are the most vulnerable group whenever it happens. In sub-Saharan Africa societies the competition for land between farmers and pastoralists has been experienced in various areas, and children have been affected since in most pastoralist societies children are involved in cattle grazing and other domestic activities. Case Report: Herein we have a case report of the eight years old boy who was injured by the neighbour due to land conflict. The child got penetrating head injury after being arrowed to right side of his head which resulted into permanent right eye blindness. Conclusion: Harm to children during social conflicts is often caused by direct or indirect attacks. There is a need to have national approaches to stop conflict of all kinds in our societies for the sake of new generation. This can be done at local as well as national level by having clear and functional laws to stop land based conflicts.

VM-153, a full-color wall chart by Jan K. Shearer and Paul Nicoletti, describes the correct way to humanely euthanize cattle using gunshot or penetrating captive bolt. Published by the UF Department of Veterinary Medicine -- Large Animal Clinical Sciences, April 2007.

Ballistics is the study of the science of the motion and behavior of a projectile during its flight in any given medium. The flight path of a bullet in cases of firearms includes: traveling down the barrel, path through the air (or in a medium), and path through the target. The damage to the target by a hurling projectile depends upon various parameters like the type of the propellant charge used, type of the firearm, the distance of firing, etc. In some instances, it becomes difficult to estimate the range of firing when the projectile has been shot through the glass as an intermediate target. Present work is based upon the effect of 0.32 caliber bullets on fiberglass fired from different ranges and determination of range of firing from by studying the fracture pattern created on the fiberglass. The present study will be helpful for the investigator to estimate an approximate range of shooting when the firing is done through the fiberglass. It will also be utilized in the estimation of the point of entry and exit on the glass and the basis of the fracture produced will provide an idea of the type of firearm used can also be estimated.

A biomechanical model for traumatic brain injury and soft tissue damage is presented. A variational constitutive model for soft biological tissues is utilized to reproduce axonal damage and cavitation injury through inelastic deformation. The material response is split into elastoplastic and viscoelastic components, including rate effects, shear and porous plasticity, and finite viscoelasticity. Mechanical damage of brain tissue is classified as volumetric (compression/tension) and shear-type. Finite element simulations of brain injuries are presented, examining frontal and oblique head impacts with external objects. Localization, extension, intensity and reversibility/irreversibility of tissue damage are predicted. Future directions of this work, relating mechanical damage and physiological brain dysfunction, and application to relevant medical and engineering problems are discussed.

The death of King Charles XII of Sweden has remained as a mystery for more than three centuries. Was he assassinated by his own men or killed by the enemy fire? Charles was killed by a projectile perforating his skull from left to right. In this study, we utilized a Synbone ballistic skull phantom and modern radiological imaging to clarify the factors behind the observed head injuries. We examined whether a musket ball fired from the enemy lines would be the most potential projectile. Our experiments with a leaden 19.5 mm musket ball demonstrated that at velocities of 200 to 250 m/s, it could cause similar type of injuries as observed in the remains of Charles . The radiological imaging supported the theory that the projectile was not a leaden but of some harder metal, as we could detect remnants of lead inside the wound channel unlike in Charles’ case. In addition, our experiments showed that a 19.5mm musket ball  produces max. 17mm hole into a felt material  . The main evidence su...

To estimate the prognostic value of injury severity, location of event, and demographic parameters, for symptoms of pediatric traumatic head injury (THI) 4 years later. Methods: Data were collected prospectively from Reykjavik City Hospital on all patients age 0-19 years, diagnosed with THI (n = 408) during one year. Information was collected on patient demographics, location of traumatic event, cause of injury, injury severity, and ICD-9 diagnosis. Injury severity was estimated according to the Head Injury Severity Scale (HISS). Four years post-injury, a questionnaire on late symptoms attributed to the THI was sent. Results: Symptoms reported were more common among patients with moderate/severe THI than among others (p Ͻ 0.001). The event location had prognostic value (p Ͻ 0.05). Overall, 72% of patients with moderate/severe motor vehicle-related THI reported symptoms. There was a curvilinear age effect (p Ͻ 0.05). Symptoms were least frequent in the youngest age group, 0-4 years, and most frequent in the age group 5-14 years. Gender and urban/rural residence were not signifi cantly related to symptoms. Conclusions: Motor vehicle related moderate/severe THI resulted in a high rate of late symptoms. Location had a prognostic value. Patients with motor vehicle-related THI need special consideration regardless of injury severity.

When investigating officer-involved shootings, scientific input provides an unbiased perspective to case evidence that assist both the objectivity and credibility of associated reconstructions. This paper demonstrates this by detailing the reconstruction of a recent shooting where multiple scientific tools and methodology were implemented. In order to differentiate between different possible narratives, tools such as synthetic bones, ballistic soap, human dynamic testing as well as human body numerical modelling were used. These tools show how the narrative available can be tied to the injuries reported through the use of a model supported by simple yet robust laboratory testing. In the exemplary case presented, the method was shown to exonerate the response of a police officer who discharged their weapon in self-defence while trying to subdue a violent suspect.

The aim of this research is to study the behaviour of a human head during the event of an impact of a cricket ball. While many recent incidents were reported in relation to head injuries caused by the impact of cricket balls, there is no clear information available in the published literature about the possible threat levels and the protection level of the current protective equipment. This research investigates the effects of an impact of a cricket ball on a human head and the level of protection offered by the existing standard cricket helmet. An experimental program was carried out to measure the localised pressure caused by the impact of standard cricket balls. The balls were directed at a speed of 110 km/h on a 3D printed head model, with and without a standard cricket helmet. Numerical simulations were carried out using advanced finite element package LS-DYNA to validate the experimental results. The experimental and numerical results showed approximately a 60% reduction in th...

Väitekirja elektrooniline versioon ei sisalda publikatsioone.Töö eesmärgiks oli kuuli sisenemisavade võrdlemisel välja selgitada riide- ja nahavigastuste/sadestuste suhe laskekaugusega ning näidata, et relvaraua õõne ehitus mõjutab tahmasadestuse mustrit. Eksperimentaallasud sooritati püstolitest Tokarev, Makarov ja Glock 19 standardse laskemoonaga 1 cm kuni 100 cm kauguselt. Võrreldi puuvillasele ja polüesterriidele ning nahale (lahangumaterjal) tekitatud vigastusi/sadestusi. Järeldused: 1. Tulemused riietel ja nahal olid sarnased. 2. Erinevused leius olid tingitud laskekaugusest ja relvast. 3. Statistiliselt oluline seos oli laskekauguse ja riietel oleva tahmasadestuse läbimõõdu vahel, samuti laskekauguse ja püssirohuosakeste arvu vahel. Negatiivses seoses oli püssirohuosakeste arv ja nende paiknemiskoha kaugus riidedefekti keskkohast. Uurides laskekauguse ja püssirohu nahakihtides leidumise vahelist seost, ilmnes et püssirohuosakesed võivad tungida epidermisesse ja dermasse või j...

Forensic investigation has the primary challenge of assessing cause from limited evidence. The use of computational modelling can play a role in assessing potential ballistic pathways in a crime investigation by analysing; (a) the entry wound and blood spatter patterns; (b) the influence of target materials; and (c) the cranial geometry, to inform the investigation process. In particular, the retrograde ejection of blood and tissue from the entry wound following projectile impact, called 'backspatter', and can help inform the proximity of the shooter and potentially differentiate between suicide and homicide, while providing other important forensic information. However, the 'backspatter' phenomenon is not well understood due to the lack of viable surrogate models and the difficulties of analysing the high-speed, extreme-force impact. This study presents (i) the development of an anatomically based model of cranial ballistic injury using the Smoothed Particle Hydrodynamics (SPH) method; (ii) the simulation of the tail splashing and temporary cavitation mechanisms and the effect of different cranial skin and cranium simulants on backspatter generation; (iii) an evaluation of anatomical geometry simulation results such as stress and strain and velocity of the particles ejected as backspatter; and (iv) a parametric study of the effect of bullet calibre and speed on the ballistic response of the anatomical geometry computational model.

Background: Glass is the hard, amorphous solid. Glass fragments may be an evidence of great value encountered in the investigation of various types of offences. At the scene of occurrence, the glass may be fractured either as an intentional act or due to accident. Glass fractures are of paramount importance in shooting cases where firearm is used as it can provide significant information related to the occurrence and facilitates a variety of evaluations. In fact, fractography i.e. analysis of fracture pattern, is the means and methods for characterization of fractured units or fragments in order to study or identify the mechanism of such fractures. The study of fracture pattern of glass has been of long interest to the forensic community. The glass fracture pattern analysis is very useful to establish the sequence of events and to link together items of evidence and it is of paramount importance in such cases where firearm is used. Now, the use of air guns in criminal activities is an alarm to the law enforcement agencies. The main objective of this work is to analyze the pattern of the fractures on windowpane of various thicknesses with regular .177″/ 4.5 mm lead pellet fired through the .177″/ 4.5 mm caliber Air Rifle manufactured in India. The window panes were kept at front, perpendicularly and away at a fixed distance from the muzzle end of Air Rifle. Samples were measured and analyzed on some fixed parameters. To analyze the consistency, measurements were analyzed graphically and statically checked for the goodness of fit (Chi-Square Test). Result: The graphical representation of the measurements of different samples shows regularity in the features and Chi Square test gives very significant information regarding the consistency. Conclusion: The hole diameter is ranging from 4.77 to 7.5 mm in case of air rifle. It can lead to distinguish the weapon by which fracture was made, whether it is standard or air weapon. The outcomes of this work on the windowpane by .177″/4.5 mm air rifles may be efficacious to forensic community.

It has been hypothesised that the impact duration of a blunt head impact significantly affects the peak intracranial pressures, and that for short impact durations these pressure peaks could reach sufficient magnitude to cause cavitation in the blood vessels of the brain. Two finite element models of pressure wave propagation in the brain have been developed to explore the pressure response to blunt impacts of varying force time history. An analytical model has also been developed which combines the Hertzian contact stiffness and local bending and membrane stiffness of a fluid-filled sphere in order to predict the pressures produced in the brain. This model has been validated experimentally by studying the pressures induced in fluid contained within a cadaveric skull subjected to blunt impacts. The authors aim to further validate and explore the hypothesised link between short impact duration and magnified intracranial pressure peaks using a finite element model of increased biofidelity.

Background: Glass is the hard, amorphous solid. Glass fragments may be an evidence of great value encountered in the investigation of various types of offences. At the scene of occurrence, the glass may be fractured either as an intentional act or due to accident. Glass fractures are of paramount importance in shooting cases where firearm is used as it can provide significant information related to the occurrence and facilitates a variety of evaluations. In fact, fractography i.e. analysis of fracture pattern, is the means and methods for characterization of fractured units or fragments in order to study or identify the mechanism of such fractures. The study of fracture pattern of glass has been of long interest to the forensic community. The glass fracture pattern analysis is very useful to establish the sequence of events and to link together items of evidence and it is of paramount importance in such cases where firearm is used. Now, the use of air guns in criminal activities is an alarm to the law enforcement agencies. The main objective of this work is to analyze the pattern of the fractures on windowpane of various thicknesses with regular .177″/ 4.5 mm lead pellet fired through the .177″/ 4.5 mm caliber Air Rifle manufactured in India. The window panes were kept at front, perpendicularly and away at a fixed distance from the muzzle end of Air Rifle. Samples were measured and analyzed on some fixed parameters. To analyze the consistency, measurements were analyzed graphically and statically checked for the goodness of fit (Chi-Square Test). Result: The graphical representation of the measurements of different samples shows regularity in the features and Chi Square test gives very significant information regarding the consistency. Conclusion: The hole diameter is ranging from 4.77 to 7.5 mm in case of air rifle. It can lead to distinguish the weapon by which fracture was made, whether it is standard or air weapon. The outcomes of this work on the windowpane by .177″/4.5 mm air rifles may be efficacious to forensic community.

The objective of the present study is to obtain a better understanding of the possible impfiance ufskU!l-brain interface conditions, a neck constraint and brain material properties for the response of the human head to transient loadings. To that end, a two-dimensional plane strain finite element model of a para-sagittal section of a human head has been developed. Firstfor the purpose of validationthe loading conditions, realized in experiments reported in literature, were used as input to a completely linear elastic model having no neck restraint. This was done for both rigid coupling and no coupIing at the skull-brain interface. Next, simulations were performed with various versions of the model. These versions were obtained by using different combinations of the following features; linear elastic or visco-elastic brain material properties, different contact conditions at the skullbrain interface and incorporation of a neck restriction. The results of these simulations are discussed.

Traumatic chiasm transection is a rare condition characterized by bitemporal hemianopsia following head trauma. In a study of visual complications following head trauma, only 4.4% of patients suffered from chiasmal injuries. Complete transection of the chiasm is even more rare and best visualized using magnetic resonance imaging (MRI). We report the one-year follow-up of clinical, visual field, and MRI findings of a patient with complete transection of the optic chiasm following head trauma.

In this study, the finite element (FE) method is implemented in order to examine the reaction of the brain under a fall and impact loading. The head and its constituent parts are designed by three-dimensional (3-D) FEs. Soft tissues and the brain are modeled as viscoelastic material and assembled by various types of elements. In the analysis, the ground is regarded as the impactor and is also simulated by 3-D FEs. The fall, or accident, is assumed to happen under different heights, or velocities. Such scenarios are considered to represent the realistic falls, or accidents, which might occur in sports, or in other situations. The impacting ground might be of different material, rigidity and stiffness. In this study, the sensitivity of the injury in the brain is studied using different materials, different heights of the fall and different velocities. The materials used for the ground are wood, polymer carpet, soil and concrete slabs. The intracranial coup pressure, contrecoup pressure and shear stresses in the brain and skull are monitored during the impact and are recorded for the analysis. Under each impact, the coup pressure and shear stress peaks in the brain are observed. Such results are proportional functions to the stiffness of the ground and the velocity of the head. The computational results of this FE head model are consistent with the cadaveric experiments of previous studies.

Background Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial-a multicentre international collaboration-aimed to confirm or refute such an effect by recruiting 20 000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. Methods 10 008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Findings Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21•1%] vs 893 [17•9%] deaths; relative risk 1•18 [95% CI 1•09-1•27]; p=0•0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0•22) or time since injury (p=0•05). Interpretation Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear. We declare that we have no conflict of interest.

This paper aims to provide an overview of the literature on the mechanics and diagnosis of traumatic brain injuries (TBI). The understanding of TBI is of prime importance for diagnosis and subsequent treatment and rehabilitation of those affected. The mechanism of a brain injury may be any of the following: head acceleration-deceleration,thoracic pressure surge, anddirect transmission through cranial bone. Researchers have used experimental methods such as shock generation via shock tube to simulate trauma conditions and computational tools such as Finite Element Modeling tomodel the brain tissue and analyze the effects of various brain injury mechanisms. Through the study of the literature available an attempt has been made to gain an insight into the qualitative aspect of mechanics of traumatic brain injuries and to consolidate the findings so far, in order to assist the diagnosis and treatment.

In this study, the finite element (FE) method is implemented in order to examine the reaction of the brain under a fall and impact loading. The head and its constituent parts are designed by three-dimensional (3-D) FEs. Soft tissues and the brain are modeled as viscoelastic material and assembled by various types of elements. In the analysis, the ground is regarded as the impactor and is also simulated by 3-D FEs. The fall, or accident, is assumed to happen under different heights, or velocities. Such scenarios are considered to represent the realistic falls, or accidents, which might occur in sports, or in other situations. The impacting ground might be of different material, rigidity and stiffness. In this study, the sensitivity of the injury in the brain is studied using different materials, different heights of the fall and different velocities. The materials used for the ground are wood, polymer carpet, soil and concrete slabs. The intracranial coup pressure, contrecoup pressure and shear stresses in the brain and skull are monitored during the impact and are recorded for the analysis. Under each impact, the coup pressure and shear stress peaks in the brain are observed. Such results are proportional functions to the stiffness of the ground and the velocity of the head. The computational results of this FE head model are consistent with the cadaveric experiments of previous studies.

Background Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial-a multicentre international collaboration-aimed to confirm or refute such an effect by recruiting 20 000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. Methods 10 008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Findings Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21•1%] vs 893 [17•9%] deaths; relative risk 1•18 [95% CI 1•09-1•27]; p=0•0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0•22) or time since injury (p=0•05). Interpretation Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear. We declare that we have no conflict of interest.

The aim of this research is to study the behaviour of a human head during the event of an impact of a cricket ball. While many recent incidents were reported in relation to head injuries caused by the impact of cricket balls, there is no clear information available in the published literature about the possible threat levels and the protection level of the current protective equipment. This research investigates the effects of an impact of a cricket ball on a human head and the level of protection offered by the existing standard cricket helmet. An experimental program was carried out to measure the localised pressure caused by the impact of standard cricket balls. The balls were directed at a speed of 110 km/h on a 3D printed head model, with and without a standard cricket helmet. Numerical simulations were carried out using advanced finite element package LS-DYNA to validate the experimental results. The experimental and numerical results showed approximately a 60% reduction in th...

Gunshot fractures are increasing in frequency in most of the European countries. In Italy, injuries because of multiple actions guns continue to be high, particularly in Sicily, where they are the weapons of choice used in mafia-style crimes. Their impact on the body produce severe injuries and fractures because of the large amount of pellets and the extension of the impact. Retention of the lead pellets can be a serious concern, for the importance of lead intoxication.

Gun violence is a global phenomenon with regional variation in frequency and severity. Handguns are often used in violent deaths such as suicides and homicides. Hence, ballistic trauma is a critical subject of forensic investigations. Trauma patterns are fundamental evidence for the reconstruction of the incident and for the determination of the manner of death. This study investigated the differences in trauma patterns with a series of experiments using six different calibers (.22 LR, .38 Special, .380 ACP, 9×19mm, .40 S&W, and .45 ACP) and four different bullet types. Synbone® spheres (polyurethane bone proxies) were used for close range 30cm simulated executions. The polyurethane spheres constitute an excellent proxy for human crania at the macroscopic level as suggested by other studies. The results showed that the radius of the entrance wound is positively correlated (Pearson's correlation coefficient R=0.846, p<0.05) with the caliber dimension. As muzzle velocity increa...

The modeling of human body biomechanics resulting from blast exposure poses great challenges because of the complex geometry and the substantial material heterogeneity. We developed a detailed human body finite element model representing both the geometry and the materials realistically. The model includes the detailed head (face, skull, brain and spinal cord), the neck, the skeleton, air cavities (lungs) and the tissues. Hence, it can be used to properly model the stress wave propagation in the human body subjected to blast loading. The blast loading on the human was generated from a simulated C4 explosion. We used the highly scalable solvers in the multi-physics code CoBi for both the blast simulation and the human body biomechanics. The meshes generated for these simulations are of good quality so that relatively large time-step sizes can be used without resorting to artificial time scaling treatments. The coupled gas dynamics and biomechanics solutions were validated against the shock tube test data. The human body models were used to conduct parametric simulations to find the biomechanical response and the brain injury mechanism due to blasts impacting the human body. Under the same blast loading condition, we showed the importance of inclusion of the whole body.

Background Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial-a multicentre international collaboration-aimed to confirm or refute such an effect by recruiting 20 000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. Methods 10 008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Findings Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21•1%] vs 893 [17•9%] deaths; relative risk 1•18 [95% CI 1•09-1•27]; p=0•0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0•22) or time since injury (p=0•05). Interpretation Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear. We declare that we have no conflict of interest.

Background Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial-a multicentre international collaboration-aimed to confirm or refute such an effect by recruiting 20 000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. Methods 10 008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Findings Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21•1%] vs 893 [17•9%] deaths; relative risk 1•18 [95% CI 1•09-1•27]; p=0•0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0•22) or time since injury (p=0•05). Interpretation Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear. We declare that we have no conflict of interest.

Background: Glass is the hard, amorphous solid. Glass fragments may be an evidence of great value encountered in the investigation of various types of offences. At the scene of occurrence, the glass may be fractured either as an intentional act or due to accident. Glass fractures are of paramount importance in shooting cases where firearm is used as it can provide significant information related to the occurrence and facilitates a variety of evaluations. In fact, fractography i.e. analysis of fracture pattern, is the means and methods for characterization of fractured units or fragments in order to study or identify the mechanism of such fractures. The study of fracture pattern of glass has been of long interest to the forensic community. The glass fracture pattern analysis is very useful to establish the sequence of events and to link together items of evidence and it is of paramount importance in such cases where firearm is used. Now, the use of air guns in criminal activities is an alarm to the law enforcement agencies. The main objective of this work is to analyze the pattern of the fractures on windowpane of various thicknesses with regular .177″/ 4.5 mm lead pellet fired through the .177″/ 4.5 mm caliber Air Rifle manufactured in India. The window panes were kept at front, perpendicularly and away at a fixed distance from the muzzle end of Air Rifle. Samples were measured and analyzed on some fixed parameters. To analyze the consistency, measurements were analyzed graphically and statically checked for the goodness of fit (Chi-Square Test). Result: The graphical representation of the measurements of different samples shows regularity in the features and Chi Square test gives very significant information regarding the consistency. Conclusion: The hole diameter is ranging from 4.77 to 7.5 mm in case of air rifle. It can lead to distinguish the weapon by which fracture was made, whether it is standard or air weapon. The outcomes of this work on the windowpane by .177″/4.5 mm air rifles may be efficacious to forensic community.

Background Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial-a multicentre international collaboration-aimed to confirm or refute such an effect by recruiting 20 000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. Methods 10 008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Findings Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21•1%] vs 893 [17•9%] deaths; relative risk 1•18 [95% CI 1•09-1•27]; p=0•0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0•22) or time since injury (p=0•05). Interpretation Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear. We declare that we have no conflict of interest.

Background Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial-a multicentre international collaboration-aimed to confirm or refute such an effect by recruiting 20 000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. ) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Findings Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21•1%] vs 893 [17•9%] deaths; relative risk 1•18 [95% CI 1•09-1•27]; p=0•0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0•22) or time since injury (p=0•05). Interpretation Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear.

Gun violence is a global phenomenon with regional variation in frequency and severity. Handguns are often used in violent deaths such as suicides and homicides. Hence, ballistic trauma is a critical subject of forensic investigations. Trauma patterns are fundamental evidence for the reconstruction of the incident and for the determination of the manner of death. This study investigated the differences in trauma patterns with a series of experiments using six different calibers (.22 LR, .38 Special, .380 ACP, 9×19mm, .40 S&W, and .45 ACP) and four different bullet types. Synbone® spheres (polyurethane bone proxies) were used for close range 30cm simulated executions. The polyurethane spheres constitute an excellent proxy for human crania at the macroscopic level as suggested by other studies. The results showed that the radius of the entrance wound is positively correlated (Pearson's correlation coefficient R=0.846, p<0.05) with the caliber dimension. As muzzle velocity increa...

Introduction: Broken glass exhibits unique fracture patterns depend upon the nature of the impact. The fracture patterns provide information like point and angle of impact, direction of force and sequence of firing. Recent studies have shown that the use of shotgun in Malaysia is increasing, yet, the relationship existing among the fracture pattern and the projectile impact factors are not well documented. The objective was to analyse the fracture characteristics on different glass types of variable thickness and distance made by shotgun ammunition. Methods: Soda lime and tempered glass panel with dimension of 12’x 12’ with 3 or 4 mm thickness were shot from various distances of 4, 6 and 8 m from the muzzle end of the shotgun. Samples were analysed under fixed parameters and observations were recorded. Results: It is found that the bullet hole diameter of 4 mm tempered glass were larger compared to 4 mm soda lime glass ranged from 14.33 to 24.17 cm as distance increased. Tempered gl...

An idealized finite element human head model was constructed to study biomechanical responses in the brain due to blast overpressure loading from a blast of 10 kg TNT at 1 meter. Brain strain in the coup and contrecoup regions were 4-7x higher than the central region, and high brain strain (15%) large deformation (4 mm) occurred in the brainstem region, indicating a higher probability of injury in the peripheral brain and brainstem regions due to blast overpressure loading.

Ballistics is the study of the science of the motion and behavior of a projectile during its flight in any given medium. The flight path of a bullet in cases of firearms includes: traveling down the barrel, path through the air (or in a medium), and path through the target. The damage to the target by a hurling projectile depends upon various parameters like the type of the propellant charge used, type of the firearm, the distance of firing, etc. In some instances, it becomes difficult to estimate the range of firing when the projectile has been shot through the glass as an intermediate target. Present work is based upon the effect of 0.32 caliber bullets on fiberglass fired from different ranges and determination of range of firing from by studying the fracture pattern created on the fiberglass. The present study will be helpful for the investigator to estimate an approximate range of shooting when the firing is done through the fiberglass. It will also be utilized in the estimation of the point of entry and exit on the glass and the basis of the fracture produced will provide an idea of the type of firearm used can also be estimated.

the opportunity and invaluable guidance throughout this research. His dynamism, vision, sincerity and motivation have deeply inspired me. It was a great privilege and honor to carry out my work under his guidance. I am extremely grateful for what he has offered me not only as a mentor but also as a human being. I would also like to thank him for his patience, empathy, and most importantly, understanding me as a person. My Special thanks go to Prof. Steven Shaw for his support in gunshot recordings. I am extremely grateful to Angelo Borzino, for his support in the interpretation of recorded signals. I am extending my gratitude to Tyler Davis, for his assistance during the whole period. Finally, my thanks go to my parents and all my friends and staff of this department, who has directly and indirectly, supported me to complete the research work.

Primary Objective: The interaction of cerebrospinal fluid with the brain parenchyma in an impact scenario is studied. Research Design: A computational fluid-structure interaction model is used to simulate the interaction of cerebrospinal fluid with a comprehensive brain model. Methods and Procedures: The method of smoothed particle hydrodynamics is used to simulate the fluid flow, induced by the impact, simultaneously with finite element analysis to solve the large deformations in the brain model. Main Outcomes and Results: Mechanism of injury resulting in concussion is demonstrated. The locations with the highest stress values on the brain parenchyma are shown. Conclusions: Our simulations found that the damage to the brain resulting from the contrecoup injury is more severe than that resulting from the coup injury. Additionally, we show that the contrecoup injury does not always appear on the side opposite from where impact occurs.

Crimes involving the use of firearms represent a significant area of forensic investigation. In legal proceedings of criminal events that involve the use of firearms and ammunitions, the expert forensic officer should be able to produce crucial information to the court. The existence of bullet holes is a significant aspect in crime scene reconstruction. It is a terminal ballistics study using various solid targets. The study is aimed to conduct an experimental firing study by using 9 mm pistol fired on selected solid targets viz. plywood, ceramic tiles, glass plate, aluminium metal sheet and PVC sheet and examined the damaged characteristics. The range of firing was fixed as 10m in all shooting exercises. The shooting exercise was conducted at Sungai Buloh shooting range by trained firearms experts, Polis Di Raja Malaysia, Bukit Aman. Kuala Lumpur. The result of the investigation showed that the angle of impact is below 90 degree in all the targets.

Background: Glass is the hard, amorphous solid. Glass fragments may be an evidence of great value encountered in the investigation of various types of offences. At the scene of occurrence, the glass may be fractured either as an intentional act or due to accident. Glass fractures are of paramount importance in shooting cases where firearm is used as it can provide significant information related to the occurrence and facilitates a variety of evaluations. In fact, fractography i.e. analysis of fracture pattern, is the means and methods for characterization of fractured units or fragments in order to study or identify the mechanism of such fractures. The study of fracture pattern of glass has been of long interest to the forensic community. The glass fracture pattern analysis is very useful to establish the sequence of events and to link together items of evidence and it is of paramount importance in such cases where firearm is used. Now, the use of air guns in criminal activities is an alarm to the law enforcement agencies. The main objective of this work is to analyze the pattern of the fractures on windowpane of various thicknesses with regular .177″/ 4.5 mm lead pellet fired through the .177″/ 4.5 mm caliber Air Rifle manufactured in India. The window panes were kept at front, perpendicularly and away at a fixed distance from the muzzle end of Air Rifle. Samples were measured and analyzed on some fixed parameters. To analyze the consistency, measurements were analyzed graphically and statically checked for the goodness of fit (Chi-Square Test). Result: The graphical representation of the measurements of different samples shows regularity in the features and Chi Square test gives very significant information regarding the consistency. Conclusion: The hole diameter is ranging from 4.77 to 7.5 mm in case of air rifle. It can lead to distinguish the weapon by which fracture was made, whether it is standard or air weapon. The outcomes of this work on the windowpane by .177″/4.5 mm air rifles may be efficacious to forensic community.

Background: Glass is the hard, amorphous solid. Glass fragments may be an evidence of great value encountered in the investigation of various types of offences. At the scene of occurrence, the glass may be fractured either as an intentional act or due to accident. Glass fractures are of paramount importance in shooting cases where firearm is used as it can provide significant information related to the occurrence and facilitates a variety of evaluations. In fact, fractography i.e. analysis of fracture pattern, is the means and methods for characterization of fractured units or fragments in order to study or identify the mechanism of such fractures. The study of fracture pattern of glass has been of long interest to the forensic community. The glass fracture pattern analysis is very useful to establish the sequence of events and to link together items of evidence and it is of paramount importance in such cases where firearm is used. Now, the use of air guns in criminal activities is an alarm to the law enforcement agencies. The main objective of this work is to analyze the pattern of the fractures on windowpane of various thicknesses with regular .177″/ 4.5 mm lead pellet fired through the .177″/ 4.5 mm caliber Air Rifle manufactured in India. The window panes were kept at front, perpendicularly and away at a fixed distance from the muzzle end of Air Rifle. Samples were measured and analyzed on some fixed parameters. To analyze the consistency, measurements were analyzed graphically and statically checked for the goodness of fit (Chi-Square Test). Result: The graphical representation of the measurements of different samples shows regularity in the features and Chi Square test gives very significant information regarding the consistency. Conclusion: The hole diameter is ranging from 4.77 to 7.5 mm in case of air rifle. It can lead to distinguish the weapon by which fracture was made, whether it is standard or air weapon. The outcomes of this work on the windowpane by .177″/4.5 mm air rifles may be efficacious to forensic community.

An idealized finite element human head model was constructed to study biomechanical responses in the brain due to blast overpressure loading from a blast of 10 kg TNT at 1 meter. Brain strain in the coup and contrecoup regions were 4-7x higher than the central region, and high brain strain (15%) large deformation (4 mm) occurred in the brainstem region, indicating a higher probability of injury in the peripheral brain and brainstem regions due to blast overpressure loading.

Various types of tuberculosis treated in our centre between January 2005 to April 2006 were studied and subjected to statistical analysis to determine the pattern of TB presentation in our centre. A total or 6 patients were seen of which 52% were males and 48% females. The mean age was 34.17 + - 3.8 years. Pulmonary tuberculosis accounted for 87% of the cases followed by abdominal tuberculosis (3.5%) and disseminated tuberculosis (2.5%). Microbiological investigation (sputum examination for acid and alcohol fast bacilli) was the most used diagnostic tool followed by chest radiography. Thirty four percent of the patients completed treatment while 24% defaulted treatment and were lost to follow up. Effective weapons such as identification and prophylactic treatment of all contacts of patients with active tuberculosis; institution of directly observed therapy (DOT) in the management of tuberculosis cases; provision of genuine antituberculous drugs promptly to patients that report to the hospital; and improving the living standards of the populace to reduce overcrowding arc some of the factors that can lead to a reduction in the incidence of this infection.

The objective of the present study is to obtain a better understanding of the possible impfiance ufskU!l-brain interface conditions, a neck constraint and brain material properties for the response of the human head to transient loadings. To that end, a two-dimensional plane strain finite element model of a para-sagittal section of a human head has been developed. Firstfor the purpose of validationthe loading conditions, realized in experiments reported in literature, were used as input to a completely linear elastic model having no neck restraint. This was done for both rigid coupling and no coupIing at the skull-brain interface. Next, simulations were performed with various versions of the model. These versions were obtained by using different combinations of the following features; linear elastic or visco-elastic brain material properties, different contact conditions at the skullbrain interface and incorporation of a neck restriction. The results of these simulations are discussed.

Background: Glass is the hard, amorphous solid. Glass fragments may be an evidence of great value encountered in the investigation of various types of offences. At the scene of occurrence, the glass may be fractured either as an intentional act or due to accident. Glass fractures are of paramount importance in shooting cases where firearm is used as it can provide significant information related to the occurrence and facilitates a variety of evaluations. In fact, fractography i.e. analysis of fracture pattern, is the means and methods for characterization of fractured units or fragments in order to study or identify the mechanism of such fractures. The study of fracture pattern of glass has been of long interest to the forensic community. The glass fracture pattern analysis is very useful to establish the sequence of events and to link together items of evidence and it is of paramount importance in such cases where firearm is used. Now, the use of air guns in criminal activities is an alarm to the law enforcement agencies. The main objective of this work is to analyze the pattern of the fractures on windowpane of various thicknesses with regular .177″/ 4.5 mm lead pellet fired through the .177″/ 4.5 mm caliber Air Rifle manufactured in India. The window panes were kept at front, perpendicularly and away at a fixed distance from the muzzle end of Air Rifle. Samples were measured and analyzed on some fixed parameters. To analyze the consistency, measurements were analyzed graphically and statically checked for the goodness of fit (Chi-Square Test). Result: The graphical representation of the measurements of different samples shows regularity in the features and Chi Square test gives very significant information regarding the consistency. Conclusion: The hole diameter is ranging from 4.77 to 7.5 mm in case of air rifle. It can lead to distinguish the weapon by which fracture was made, whether it is standard or air weapon. The outcomes of this work on the windowpane by .177″/4.5 mm air rifles may be efficacious to forensic community.

Primary and secondary efficacy analyses showed no clinical benefit of progesterone in patients with severe TBI. These data stand in contrast to the robust preclinical data and results of early single-center trials that provided the impetus to initiate phase 3 trials. (Funded by BHR Pharma; SYNAPSE ClinicalTrials.gov number, NCT01143064.