Analysis of 983 civilian blast and ballistic casualties and the generation of a template of injury burden : an observational study

Funding: The work was supported in part by a grant to LM from School of Medicine, University of St Andrews.Background Terrorism and armed conflict cause blast and ballistic casualties that are unusual in civilian practice. The immediate surgical response to mass casualty events, with civilians injured by these mechanisms, has not been systematically characterised. Standardising an approach to reacting to these events is challenging but is essential to optimise preparation for them. We aimed to quantify and assesses the surgical response to blast and ballistic injuries managed in a world-class trauma unit paradigm. Methods This was an observational study conducted at the UK-led military Medical Treatment Facility, Camp Bastion, Afghanistan from original theatre log-book entries between Nov 5, 2009, and Sept 21, 2014; a total of 10,891 consecutive surgical cases prospectively gathered by surgical teams were catalogued. Patients with combatant status/wearing body-armour to various degrees including interpreters were excluded from the study. Civilian casualties that underwent primary trauma surgery for blast and ballistic injuries were included (n=983). Surgical activity was analysed as a rate per 100 casualties, and patients were grouped according to adult vs. paediatric and ballistic vs. blast injury mechanisms to aid comparison. Findings The three most common surgical procedures for civilian blast injuries were debridement, amputation, and laparotomy. For civilian ballistic injuries, these were debridement, laparotomy and vascular procedures. Blast injuries generated more amputations in both adults and children compared to ballistic injuries. Blast injuries generated more removal of fragmentation material compared to ballistics injuries amongst adult casualties. Ballistic injuries lead to more chest drain insertions in adults. As a rate per 100 casualties, adults injured by blast underwent significantly more debridement (63·5); temporary skeletal stabilisation (13·2) and vascular procedures (12·8) compared to children (43·4, z=4·026, p=0·00007; 5·7, z=2·230, p=0·022; 4·9, z=2·468, p=0·014). Adults injured by ballistics underwent significantly more debridement (63·4); chest drain (12·3) and temporary skeletal fixation procedures (11·4) compared to children (50·0, z=2·058, p=0.040, p<0·05; 2·9, z=2·283, p=0.0230; 2·9, z=2·131, p=0.034 respectively). By comparison, children injured by ballistics underwent significantly more removal of fragmentation and ballistic materials (20·6) when compared to adults (7·7, z=−3·234; p=0.001). Interpretation This is the first evidence-based, template of the immediate response required to manage civilians injured by blast and ballistic mechanisms. The template presented can be applied to similar conflict zones and to prepare for terror attacks on urban populations.Publisher PDFPeer reviewe

Water Sensitive Urban Design: An Investigation of Current Systems, Implementation Drivers, Community Perceptions and Potential to Supplement Urban Water Services

Special Issue: Urban Drainage and Urban Stormwater Managemen

Exposing the human nude phenotype [4]

Peer reviewedSubmitted Versio

Alzheimer’s Disease (AD) Detect & Prevent: presymptomatic AD detection and prevention

Alzheimer’s disease (AD) is a major cause of the rapidly growing and crushing aging challenge that threatens to economically undermine today’s healthcare system. AD prevalence will grow to over 100 million cases in 2050. AD is incurable but can be prevented. Therefore, the most viable solution may be to detect very early signs of AD (presymptomatically) in citizens-at-risk and to intervene in time to reduce AD risk or prevent it entirely. The present project will refine and validate two breakthrough innovations for AD detection and AD prevention and commercialize them as a one-stop digital medical device, named ‘AD Detect & Prevent’. The first innovation is a highly sensitive cognitive assessment method recently pioneered by a group of researchers that has been shown to detect subtle presymptomatic stage cognitive decline specific to AD. This will be integrated with the second innovation – a digital AD prevention programme delivered on an award-winning computerized cognitive training and rehabilitation platform (app + web) that uses high intensity immersive and adaptive ‘neurogames’ and audio-based therapy for behavioural intervention, designed for strengthening core cognitive functions, building cognitive reserve, changing lifestyle and thus reducing the overall AD risk in individuals. The detection and prevention methods will undergo vigorous scientific validation, and the ambition is to create and become the global standard of care for precise presymptomatic detection of AD and effective AD prevention

LemurFaceID: a face recognition system to facilitate individual identification of lemurs

Background: Long-term research of known individuals is critical for understanding the demographic and evolutionary processes that influence natural populations. Current methods for individual identification of many animals include capture and tagging techniques and/or researcher knowledge of natural variation in individual phenotypes. These methods can be costly, time-consuming, and may be impractical for larger-scale, populationlevel studies. Accordingly, for many animal lineages, long-term research projects are often limited to only a few taxa. Lemurs, a mammalian lineage endemic to Madagascar, are no exception. Long-term data needed to address evolutionary questions are lacking for many species. This is, at least in part, due to difficulties collecting consistent data on known individuals over long periods of time. Here, we present a new method for individual identification of lemurs (LemurFaceID). LemurFaceID is a computer-assisted facial recognition system that can be used to identify individual lemurs based on photographs. Results: LemurFaceID was developed using patch-wise Multiscale Local Binary Pattern features and modified facial image normalization techniques to reduce the effects of facial hair and variation in ambient lighting on identification. We trained and tested our system using images from wild red-bellied lemurs (Eulemur rubriventer) collected in Ranomafana National Park, Madagascar. Across 100 trials, with different partitions of training and test sets, we demonstrate that the LemurFaceID can achieve 98.7% ± 1.81% accuracy (using 2-query image fusion) in correctly identifying individual lemurs. Conclusions: Our results suggest that human facial recognition techniques can be modified for identification of individual lemurs based on variation in facial patterns. LemurFaceID was able to identify individual lemurs based on photographs of wild individuals with a relatively high degree of accuracy. This technology would remove many limitations of traditional methods for individual identification. Once optimized, our system can facilitate long-term research of known individuals by providing a rapid, cost-effective, and accurate method for individual identification

Market Sensing, Dynamic Capability, and Competitive Dynamics

This is a research commentary to the following article: Hunt, S. D., & Madhavaram, S. (2019). Adaptive marketing capabilities, dynamic capabilities, and renewal competences: The “outside vs. inside” and “static vs. dynamic” controversies in strategy, Industrial Marketing Management, in press. https://doi.org/10.1016/j.indmarman.2019.07.004

A modified Delphi study to identify which items should be evaluated in shoulder instability research:a first step in developing a core outcome set

Background: The aim of this study was to identify items that healthcare providers and/or patients consider important to include in a questionnaire for clinical trials and cohort studies in shoulder instability research. This could serve as a basis to develop a core outcome set for shoulder instability research. Methods: Healthcare providers and patients were included in a panel for a modified Delphi consensus study. The study consisted of three rounds, comprising (1) identifying items, (2) rating the importance of the items, and (3) rating the importance again after seeing a summary of the results of round two. Importance was rated on a 9-point Likert scale. Consensus was defined as ≥ 80% of the panel giving a score of 7 or higher. Results: In total, 44 healthcare providers and 30 patients completed all three rounds. Round one identified 54 items. After round three, the panel reached a consensus on 11 items that should be included in a questionnaire, comprising re-dislocation (99%), instable feeling of the shoulder (96%), limitations during sport (93%), patient satisfaction with the shoulder (93%), fear/anxiety for re-dislocation (91%), range of motion (88%), return to old level of functioning (85%), performing daily activities (85%), return to sport (82%), return to work (82%), and trusting the shoulder (81%). Conclusion: Healthcare providers and patients reached a consensus on 11 items that should be included in a questionnaire for shoulder instability research. These items can facilitate design and development of future clinical trials and form the basis for the development of a core outcome set.</p