Evaluation of bone excision on occipital area of simulated human skull

Surgical effects of bone and soft tissue tumours, whether for biopsy or full excision have been researched from as early as the 1970’s [1]. These researches though have as main focus the biological (histological) rather the mechanical aspects of the effects [2]. With technological advances in biomedical and biomechanical modelling, a plethora of researchers have been exploring the possibilities of understanding [3] or even predicting musculoskeletal behaviour under different loading conditions [4]. This research is seeking to bridge these two different facets by looking into the mechanical effects bone tumour surgery might have to the structural rigidity of a simulated human skull

The injury mechanism of traumatic amputation

Traumatic amputation has been one of the most defining injuries associated with explosive devices. An understanding of the mechanism of injury is essential in order to reduce its incidence and devastating consequences to the individual and their support network. In this study, traumatic amputation is reproduced using high-velocity environmental debris in an animal cadaveric model. The study findings are combined with previous work to describe fully the mechanism of injury as follows. The shock wave impacts with the casualty, followed by energised projectiles (environmental debris or fragmentation) carried by the blast. These cause skin and soft tissue injury, followed by skeletal trauma which compounds to produce segmental and multifragmental fractures. A critical injury point is reached, whereby the underlying integrity of both skeletal and soft tissues of the limb has been compromised. The blast wind that follows these energised projectiles completes the amputation at the level of the disruption, and traumatic amputation occurs. These findings produce a shift in the understanding of traumatic amputation due to blast from a mechanism predominately thought mediated by primary and tertiary blast, to now include secondary blast mechanisms, and inform change for mitigative strategies

What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort?

Background Personal protection equipment, improved early medical care, and rapid extraction of the casualty have resulted in more injured service members who served in Afghanistan surviving after severe military trauma. Many of those who survive the initial trauma are faced with complex wounds such as multiple amputations. Although costs of care can be high, they have not been well quantified before. This is required to budget for the needs of the injured beyond their service in the armed forces. Question/purposes The purposes of this study were (1) to quantify and describe the extent and nature of traumatic amputations of British service personnel from Afghanistan; and (2) to calculate an estimate of the projected long-term cost of this cohort. Methods A four-stage methodology was used: (1) systematic literature search of previous studies of amputee care cost; (2) retrospective analysis of the UK Joint Theatre Trauma and prosthetic database; (3) Markov economic algorithm for healthcare cost and sensitivity analysis of results; and (4) statistical cost comparison between our cohort and the identified literature. Results From 2003 to 2014, 265 casualties sustained 416 amputations. The average number of limbs lost per casualty was 1.6. The most common type of amputation was a transfemoral amputation (153 patients); the next most common amputation type was unilateral transtibial (143 patients). Using a Markov model of healthcare economics, it is estimated that the total 40-year cost of the UK Afghanistan lower limb amputee cohort is £288 million (USD 444 million); this figure estimates cost of trauma care, rehabilitation, and prosthetic costs. A sensitivity analysis on our model demonstrated a potential ± 6.19% variation in costs. Conclusions The conflict in Afghanistan resulted in high numbers of complex injuries. Our findings suggest that a long-term facility to budget for veterans’ health care is necessary

Protective clothing reduces lower limb injury severity against propelled sand debris in a laboratory setting

The contribution of energised environmental debris to injury patterns of the blast casualty is not known. The extent to which personal protective equipment (PPE) limits the injuries sustained by energised environmental debris following an explosive event is also not known. In this study, a cadaveric model exposed to a gas-gun mediated sand blast was utilised which reproduced soft-tissue injuries representative of those seen clinically following blast. Mean sand velocity across experiments was 506 ± 80 ms−1. Cadaveric samples wearing standard-issue PPE were shown to have a reduced injury severity to sand blast compared to control: a statistically significant reduction was seen in the total surface area (143 mm2 vs. 658 mm2, p = 0.004) and depth of injuries (0 vs. 23 deep injuries, odds ratio = 0.0074, 95% confidence intervals 0.0004–0.1379). This study is the first to recreate wounds from propelled sand in a human cadaveric model. These findings implicate environmental debris, such as sand ejected from a blast event, as a critical mechanism of injury in the blast casualty. Tier 1 pelvic PPE was shown to reduce markedly the severity of injury. This injury mechanism should be a key focus of future research and mitigation strategies

Generating vague neighbourhoods through data mining of passive web data

Neighbourhoods have been described as \the building blocks of public services society". Their subjective nature, however, and the resulting difficulties in collecting data, means that in many countries there are no officially defined neighbourhoods either in terms of names or boundaries. This has implications not only for policy but also business and social decisions as a whole. With the absence of neighbourhood boundaries many studies resort to using standard administrative units as proxies. Such administrative geographies, however, often have a poor fit with those perceived by residents. Our approach detects these important social boundaries by automatically mining the Web en masse for passively declared neighbourhood data within postal addresses. Focusing on the United Kingdom (UK), this research demonstrates the feasibility of automated extraction of urban neighbourhood names and their subsequent mapping as vague entities. Importantly, and unlike previous work, our process does not require any neighbourhood names to be established a priori

Knowledge, attitudes and other factors associated with assessment of tobacco smoking among pregnant Aboriginal women by health care providers: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>As with many Indigenous peoples, smoking rates among Aboriginal Australians are considerably higher than those of the non-Indigenous population. Approximately 50% of Indigenous women smoke during pregnancy, a time when women are more motivated to quit. Antenatal care providers are potentially important change agents for reducing the harms associated with smoking, yet little is known about their knowledge, attitudes or skills, or the factors associated with providing smoking cessation advice.</p> <p>Methods</p> <p>This paper aimed to explore the knowledge and attitudes of health care providers caring for pregnant Australian Aboriginal women with regard to smoking risks and cessation; and to identify factors associated with self-reported assessment of smoking. A cross-sectional survey was undertaken with 127 staff providing antenatal care to Aboriginal women from two jurisdictions: the Northern Territory and New South Wales, Australia. Measures included respondents' estimate of the prevalence of smoking among pregnant women; optimal and actual assessment of smoking status; knowledge of risks associated with antenatal smoking; knowledge of smoking cessation; attitudes to providing cessation advice to pregnant women; and perceived barriers and motivators for cessation for pregnant women.</p> <p>Results</p> <p>The median provider estimate of the smoking prevalence was 69% (95%CI: 60,70). The majority of respondents considered assessment of smoking status to be integral to antenatal care and a professional responsibility. Most (79%) indicated that they assess smoking status in 100% of clients. Knowledge of risks was generally good, but knowledge of cessation was poor. Factors independently associated with assessing smoking status among all women were: employer service type (<it>p </it>= 0.025); cessation knowledge score (<it>p </it>= 0.011); and disagreeing with the statement that giving advice is not worth it given the low level of success (<it>p </it>= 0.011).</p> <p>Conclusions</p> <p>Addressing knowledge of smoking risks and cessation counselling is a priority and should improve both confidence and ability, and increase the frequency and effectiveness of counselling. The health system must provide supports to providers through appropriate policy and resourcing, to enable them to address this issue.</p

The Extra Domain A of Fibronectin Increases VEGF-C Expression in Colorectal Carcinoma Involving the PI3K/AKT Signaling Pathway

The extra domain A (EDA)-containing fibronectin (EDA-FN), an alternatively spliced form of the extracellular matrix protein fibronectin, is predominantly expressed in various malignancies but not in normal tissues. In the present study, we investigated the potential pro-lymphangiogenesis effects of extra domain A (EDA)-mediated vascular endothelial growth factor-C (VEGF-C) secretion in colorectal carcinoma (CRC). We detected the expressions of EDA and VEGF-C in 52 human colorectal tumor tissues and their surrounding mucosae by immunohistochemical analysis, and further tested the correlation between the expressions of these two proteins in aforementioned CRC tissues. Both EDA and VEGF-C were abundantly expressed in the specimens of human CRC tissues. And VEGF-C was associated with increased expression of EDA in human CRC according to linear regression analysis. Besides, EDA expression was significantly correlated with lymph node metastasis, tumor differentiation and clinical stage by clinicopathological analysis of tissue microarrays containing tumor tissues of 115 CRC patients. Then, human CRC cell SW480 was transfected with lentivectors to elicit expression of shRNA against EDA (shRNA-EDA), and SW620 was transfected with a lentiviral vector to overexpress EDA (pGC-FU-EDA), respectively. We confirmed that VEGF-C was upregulated in EDA-overexpressed cells, and downregulated in shRNA-EDA cells. Moreover, a PI3K-dependent signaling pathway was found to be involved in EDA-mediated VEGF-C secretion. The in vivo result demonstrated that EDA could promote tumor growth and tumor-induced lymphangiogenesis in mouse xenograft models. Our findings provide evidence that EDA could play a role in tumor-induced lymphangiogenesis via upregulating autocrine secretion of VEGF-C in colorectal cancer, which is associated with the PI3K/Akt-dependent pathway