Preliminary effect of projectile yaw on extremity gunshot wounding in a cadaveric animal model: a serendipitous study

Gunshot wounding (GSW) is capable of causing devastating tissue injuries by delivering kinetic energy (KE) through the contact surface area of a projectile. The contact surface area can be increased by yaw, deformation and fragmentation, all of which may be caused by any intermediate layers struck by the projectile prior to entering its target. This study aims to describe whether projectile yaw occurring before penetration of a cadaveric animal limb model causes greater damage with or without clothing layers present using 5.45 × 39 mm projectiles. In total, 12 fallow deer hind limbs were shot, further divided into 4 with no clothing layers (Cnil), 4 with a single clothing layer (Cmin) and 4 with maximum clothing layers (Cmax) as worn on active duty by UK military personnel. Contrast computed tomography (CT) of limbs was used to measure permanent cavity size and the results were compared using analysis of variance (ANOVA). No significant differences were found among clothing states for each series of measurements taken, with greater cavity sizes noted in all clothing states. This is in contrast to previous work looking at symmetrically flying projectiles in the same model, where a larger permanent cavity was found only with Cmax present. Projectile yaw is therefore likely to be a key variable with regard to causation of damage within this extremity wound model

The effect of military clothing on gunshot wound patterns in a cadaveric animal limb model

The majority of injuries in survivors of gunshot wounds (GSW) are typically to the extremities. Novel wound ballistic research is encouraged to try and capture corporate knowledge on the management of these injuries gained during recent conflicts and understand the wounding patterns seen. With recent work examining the effect of UK military clothing on extremity GSW patterns in a synthetic model, a model with greater biofidelity is needed for ballistic testing. The aim of this study was to assess the effect of UK military clothing on GSW patterns within a cadaveric animal limb model using two types of ammunition commonly used in recent conflicts—7.62 × 39 mm and 5.45 × 39 mm. In total, 24 fallow deer hind limbs were shot, 12 by 7.62 mm projectiles and the remaining 12 shot by 5.45 mm projectiles, further divided into four with no clothing layers (Cnil), four with a single clothing layer (Cmin) and four with maximum clothing layers (Cmax) as worn on active duty by UK military personnel. Limbs were analysed after ballistic impact using contrast CT scanning to obtain measurements of permanent cavity damage, and results were compared using analysis of variance (ANOVA). Results showed significantly different damage measurements within limbs with Cmax for both ammunition types compared with the other clothing states. This may result in GSWs that require more extensive surgical management, and invites further study

A preliminary study into injuries due to non-perforating ballistic impacts into soft body armour over the spine

The UK Home Office test method for ballistic protective police body armours considers anterior torso impacts to be the worst-case scenario and tests rear armour panels to the same standards as front panels. The aim of this paper was to examine the injuries from spinal behind armour blunt trauma (BABT) impacts. This study used a cadaveric 65 kg, female pig barrel and 9 mm Luger ammunition (9 × 19 mm, FMJ Nammo Lapur Oy) into HG1/A + KR1 soft armour panels over the spine. Injuries were inspected and sections removed for x-radiography and micro-CT assessment. All shots over the spine resulted in deep soft tissue injuries from pencilling of the armour and the shirt worn under the armour. The wounds had embedded fabric debris which would require surgery to remove resulting in increased recovery time over injuries usually seen in anterior torso BABT impacts, which are typically haematoma and fractured ribs. The shot with the deepest soft tissue wound (41 mm) also resulted in a fractured spinous process. Shots were also fired at the posterior and anterior rib area of the pig barrel, for comparison to the spine. Similar wounds were seen on the shots to the posterior rib area while shallower, smaller wounds were seen on the anterior and one anterior rib shot resulted in a single, un-displaced rib fracture. The anatomical differences between pigs and humans would most likely mean that injury to a human from these impacts would be more serious

Adhesive Capsulitis in Eight Dogs: Diagnosis and Management

ABSTRACT:Objective: To describe clinical and diagnostic findings as well as management of adhesive capsulitis in dogs.Background: Adhesive capsulitis, also known as frozen shoulder, is a syndrome defined by loss of range of motion of the shoulder and may be the end-stage manifestation of several primary conditions.Evidentiary Value: This is a case report series of eight dogs with chronic forelimb lameness diagnosed with adhesive capsulitis.Methods: Medical records (June 1, 2010 to September 1, 2015) including, physical examination findings, radiographic findings, magnetic resonance imaging findings, arthroscopy findings, and treatment plans were reviewed. Results: All dogs presented with a chronic, grade III-VI/VI forelimb lameness. On orthopedic examination all dogs had moderate to significant discomfort on shoulder extension and flexion and severe restriction of range of motion. Six of the eight dogs had evidence of bone remodeling and sclerosis in the affected shoulder on radiographs. Six of had an initial diagnostic ultrasound performed, which revealed evidence of fibrous scar tissue. Five dogs had magnetic resonance imaging performed that revealed moderate shoulder effusion and enhancement of the synovial lining of the shoulder. Arthroscopy was performed in five of the eight patients. Three were noted to have significant contracture, adhesions and fibrous scar tissue of the joint capsule. Severe inflammation was noted throughout the synovium of two patients. All eight patients tried conservative management consisting of oral medications and rehabilitation therapy. Five of the eight patients received extracorporeal shockwave therapy. Three patients received regenerative medicine treatment in the affected supraspinatus and shoulder. Regardless of the treatment elected, none of the dogs were reported to have significant improvement. Conclusion: Adhesive capsulitis is an uncommon cause of chronic forelimb lameness. Further investigation is needed to describe the etiology and pathogenesis of adhesive capsulitis in dogs to evaluate the effectiveness of both non-surgical and surgical treatment modalities, establish treatment protocols, and evaluate short- and long-term clinical outcome of patients.Application: Adhesive capsulitis should be considered in patients with chronic forelimb lameness and moderate to significant discomfort and restriction on shoulder range of motion

Ballistic research techniques: visualizing gunshot wounding patterns

There are difficulties associated with mapping gunshot wound (GSW) patterns within opaque models. Depending on the damage measurement parameters required, there are multiple techniques that can provide methods of “seeing” the GSW pattern within an opaque model. The aim of this paper was to test several of these techniques within a cadaveric animal limb model to determine the most effective. The techniques of interest were flash X-ray, ultrasound, physical dissection, and computed-tomography (CT). Fallow deer hind limbs were chosen for the model with four limbs used for each technique tested. Quarantined 7.62 × 39 mm ammunition was used for each shot, and each limb was only shot once, on an outdoor range with shots impacting at muzzle velocity. Flash X-ray provided evidence of yaw within the limb during the projectile’s flight; ultrasound though able to visualise the GSW track, was too subjective and was abandoned; dissection proved too unreliable due to the tissue being cadaveric so also too subjective; and lastly, CT with contrast provided excellent imaging in multiple viewing planes and 3D image reconstruction; this allowed versatile measurement of the GSW pattern to collect dimensions of damage as required. Of the different techniques examined in this study, CT with contrast proved the most effective to allow precise GSW pattern analysis within a cadaveric animal limb model. These findings may be beneficial to others wishing to undertake further ballistic study both within clinical and forensic fields

The effect of underwired and sports bras on breast shape, key anthropometric dimensions, and body armour comfort

This study follows on previous research which investigated the comfort and types of bras worn by UK female police officers when wearing body armour and performing typical activities. This controlled study involved a cohort of 31 female police officers and investigated three main areas. Firstly the effect of professional bra fitting on size and comfort, secondly the effect of wearing an underwired bra or a sports bra on comfort and ability to perform certain actions, and thirdly the effect of an underwired bra and sports bra on key anthropometric data in relation to the fitting of body armour

The effect of reactive dyeing of fabric on the morphology of passive bloodstains

The majority of fabrics at crime scenes have been coloured in some way. The effect of such treatments on resultant bloodstains has not been considered. In this work, horse blood was dropped onto reactively dyed calico fabrics (100% cotton, plain woven) with three different masses of 91 g m-², 171 g m-² and 243 g m-² and the results compared to previous work on the not-coloured calico fabric. Five impact velocities were used from 1.7 ms−1 to 5.4 ms−1. The use of reactive dye increased the thickness (from 0.38 – 0.56 mm to 0.39 – 0.6 mm) and mass per unit area (from 85.1 – 224.6 g/m² to 91 – 243 g/m²) of the calico fabrics. The reactively dyed fabrics had larger bloodstains (e.g. lightest calico 41.2 – 78.6 mm²) compares to the not-coloured fabrics (e.g. lightest calico 21.4 – 67.5 mm²) across all three mass per unit areas. The dyeing of the fabrics altered the intra-yarn spaces to a more optimum size for wicking blood, increasing the ease with which the blood could wick along the yarns in the dyed calico. The amount of wicking varied depending on individual variations within the fabrics and yarns. More variation in dry bloodstain area was seen among dyed calico specimens than for the not-coloured fabric. The amount of wicking which was seen on the dyed calico meant there was no correlation between dry bloodstain area and impact velocity, a correlation which was seen on the medium and heavy not-coloured calico in the previous work

The effect of breast size and bra type on comfort for UK female police officers wearing body armour

Within the Police service of England and Wales the wearing of ballistic and stab resistant body armour is common, with most police forces mandating its usage when away from the police station. Of all the serving police officers in England and Wales 29.1% are female (Hargreaves et al., 2017). A survey was developed and then distributed by the Police Federation of England and Wales to all servicing police officers up to the rank of Inspector. The survey returned 2633 responses after cleaning of the data. From the responses it was seen that the predominant bra type worn is underwired (71%) and the predominant UK bra size is 34B (9%). It was also determined that the predominant areas where the body armour either rubbed or caused discomfort were the left and right anterior mammary regions and the posterior lateral sacral region. By understanding the distribution of bra size, type of bra worn and areas of discomfort or rubbing it helps further understand the issues faced by female police officers and how body armour design could be improved

Core competencies for pain management: results of an interprofessional consensus summit.

ObjectiveThe objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported.MethodsAn interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached.ResultsThe consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain.ConclusionsThese competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain

Ballistic protective properties of material representative of English civil war buff-coats and clothing

One type of clothing system used in the English Civil War, more common amongst cavalrymen than infantrymen, was the linen shirt, wool waistcoat and buff-coat. Ballistic testing was conducted to estimate the velocity at which 50% of 12-bore lead spherical projectiles (V50) would be expected to perforate this clothing system when mounted on gelatine (a tissue simulant used in wound ballistic studies). An estimated six-shot V50 for the clothing system was calculated as 102 m/s. The distance at which the projectile would have decelerated from the muzzle of the weapon to this velocity in free flight was triple the recognised effective range of weapons of the era suggesting that the clothing system would provide limited protection for the wearer. The estimated V50 was also compared with recorded bounce-and-roll data; this suggested that the clothing system could provide some protection to the wearer from ricochets. Finally, potential wounding behind the clothing system was investigated; the results compared favourably with seventeenth century medical writings