Simulating backspatter of blood from cranial gunshot wounds using pig models.

Few studies have examined the biomechanical basis for backspatter from cranial gunshot wounds. Backspatter is material which travels against the direction of fire following ejection from a gunshot entrance wound. Our paper focuses on the use of animals for reconstructing this phenomenon. Five live pigs and several slaughtered pigs were shot using either 9 × 19 mm, 115 grain, full metal jacketed ammunition or .22 long rifle, 40 grain, lead, round-nose ammunition. A high-speed camera was used to record the entrance wound formation and backspatter. A small amount of backspattered material was produced with all targets, and blood backspatter was seen in a few cases. However, we conclude that our model provides an understanding of the phenomenon of backspatter and the physical mechanisms associated with it. The various components of the mechanism of backspatter formation are complex and overlap. The principle mechanism observed in pig cranial gunshots was the high-speed impact response of the skin overlying the skull bone. This study has also produced evidence supporting the view that backspatter can result from the splashing of superficial blood if it is already present on the skin. Subcutaneous gas effects have been demonstrated for backspatter from contact shots. There has been no clear evidence of the role of the collapse of a temporary cavity within the brain.

The impact of national cancer awareness campaigns for bowel and lung cancer symptoms on sociodemographic inequalities in immediate key symptom awareness and GP attendances.

BACKGROUND: National campaigns focusing on key symptoms of bowel and lung cancer ran in England in 2012, targeting men and women over the age of 50 years, from lower socioeconomic groups. METHODS: Data from awareness surveys undertaken with samples of the target audience (n=1245/1140 pre-/post-bowel campaign and n=1412/1246 pre-/post-lung campaign) and Read-code data extracted from a selection general practitioner (GP) practices (n=355 for bowel and n=486 for lung) were analysed by population subgroups. RESULTS: Unprompted symptom awareness: There were no significant differences in the magnitude of shift in ABC1 vs C2DE groups for either campaign. For the bowel campaign, there was a significantly greater increase in awareness of blood in stools in the age group 75+ years compared with the 55-74 age group, and of looser stools in men compared with women. Prompted symptom awareness: Endorsement of 'blood in poo' remained stable, overall and across different population subgroups. Men showed a significantly greater increase in endorsement of 'looser poo' as a definite warning sign of bowel cancer than women. There were no significant differences across subgroups in endorsement of a 3-week cough as a definite warning sign of lung cancer. GP attendances: Overall, there were significant increases in attendances for symptoms directly linked to the campaigns, with the largest percentage increase seen in the 50-59 age group. For the bowel campaign, the increase was significantly greater for men and for practices in the most-deprived quintile, whereas for lung the increase was significantly greater for practices in the least-deprived quintile. CONCLUSIONS: The national bowel and lung campaigns reached their target audience and have also influenced younger and more affluent groups. Differences in impact within the target audience were also seen. There would seem to be no unduly concerning widening in inequalities, but further analyses of the equality of impact across population subgroups is warranted.

HIV/AIDS education: still an important issue for veterinarians.

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a significant cause of immunosuppression that puts infected individuals at higher risk for developing severe complications from zoonotic infections and other animal-related hazards. The number of people living with HIV grows each year, assuring that veterinary practitioners will have clients and/or employees who are afflicted with HIV/AIDS. Veterinarians need to better understand HIV/AIDS for many reasons: to dispel unfounded beliefs; to address discrimination and liability issues; to educate and protect the health of clients and employees; to help those with HIV/AIDS keep their pets; and to meet legal and professional requirements. To do this, veterinarians must become proactive in learning about HIV/AIDS and in reaching out to pet owners living with HIV/AIDS, as well as the physicians of those individuals. Through discussion on historical and contemporary issues surrounding HIV/AIDS, this article examines why veterinarians need to better understand HIV/AIDS, advocates for more time in the veterinary curriculum on the topic of HIV/AIDS, and provides resources for veterinarians and their clients.

Virtual international experiences in veterinary medicine: an evaluation of students' attitudes toward computer-based learning.

While many studies have evaluated whether or not factual information can be effectively communicated using computer-aided tools, none has focused on establishing and changing students' attitudes toward international animal-health issues. The study reported here was designed to assess whether educational modules on an interactive computer CD elicited a change in veterinary students' interest in and attitudes toward international animal-health issues. Volunteer veterinary students at seven universities (first-year students at three universities, second-year at one, third-year at one, and fourth-year at two) were given by random assignment either an International Animal Health (IAH) CD or a control CD, ParasitoLog (PL). Participants completed a pre-CD survey to establish baseline information on interest and attitudes toward both computers and international animal-health issues. Four weeks later, a post-CD questionnaire was distributed. On the initial survey, most students expressed an interest in working in the field of veterinary medicine in another country. Responses to the three pre-CD questions relating to attitudes toward the globalization of veterinary medicine, interest in foreign animal disease, and inclusion of a core course on international health issues in the veterinary curriculum were all positive, with average values above 3 (on a five-point scale where 5 represented strong agreement or interest). Almost all students considered it beneficial to learn about animal-health issues in other countries. After students reviewed the IAH CD, we found a decrease at four universities, an increase at one university, and no change at the remaining two universities in students' interest in working in some area of international veterinary medicine. However, none of the differences was statistically significant.

Biomechanical approach to human bitemark reconstruction.

UNLABELLED: This paper investigates the changes in upper and lower dental bite records that occur when the anterior teeth occlude into a three-dimensional rather than a flat object. METHODS: anterior bite registrations were obtained from 20 volunteers with full and unrestored dentitions. As a three- dimensional, life-like bite target we cast a silicone replica from the impression of an actual arm, fitted with a rigid bony interior. Each participant was asked to bite into a single layer of softened bite registration wax wrapped around the same location on the fake arm, as well as into a flat wafer of the same material. Upper and lower bite registrations were then scanned in the same location on a flat bed scanner. We analysed the sizes of the different bite marks by means of landmark- and semi-landmark analysis to calculate Procrustes distances between tooth outlines. In order to analyse shape variation between the two types of bite registration we carried out principal components analyses on the partial warp scores. These were derived from partial Procrustes coordinates aligned by means of thin-plate spline decomposition based on a bending energy matrix. Our results show that there are significant differences in the shape of the upper or lower teeth when they occlude into a flat or three- dimensional target. We conclude that the use of a traditional flat bite registration in human bitemark reconstruction and analysis has to be seriously questioned.

The South West Thames Regional Health Authority approach to the method of audit in public health medicine.

Following the Faculty Training Conference on Audit in March 1990, South West Thames Region set up a Working Group to develop a framework for audit in Public Health Medicine that could be adopted across the Region. This paper outlines the methodology used by the Working Group, introducing the concept of an 'Audit Tree', and describes how audit in Public Health Medicine can be approached using such a model.

Evaluation of peer review of infection control arrangements for healthcare-associated infection in four acute care trusts in the East of England.

In order to constructively use Department of Health surveillance data to address the issue of healthcare-associated infection, a peer review process investigating infection control arrangements for healthcare-associated infection in acute care trusts was initiated in the East of England. This study set out to evaluate that process and determine if it should be rolled out regionwide. A questionnaire survey of infection control doctors at trusts visited was conducted by telephone. Respondents commented that the peer review process raised the profile of infection control and healthcare-associated infection in participating trusts, and that a review of routine surveillance data was a useful way to initiate discussion about and focus attention on hospital infection control. Respondents felt the forum for discussion of infection control was most beneficial. A peer review process utilising routine surveillance data is of value in addressing issues related to infection control arrangements for healthcare-associated infection in acute care trusts.

Needs assessment at a practice level; using routine data in a meaningful way.

BACKGROUND: General practitioners and primary health care teams are asked to take an increasing role in assessing needs and priorities for the people they serve. We describe a model, using routinely available data, to provide health and social information to all general practices in an English Health Authority (South & West Devon, population 586,000, containing 103 general practices) to inform practice-based needs assessment. METHOD: Practice-coded hospital activity information was used where available, otherwise the FHSA population register was used to assign spatially referenced data (OPCS birth files, OPCS mortality files, cancer registration files and census information) to practices. Additionally, indicative incidences and prevalences were calculated for each practice using age- and sex-specific rates derived from national surveys (Survey of Morbidity Statistics from General Practice and the OPCS Health Survey for England). RESULTS: Information was produced for each practice on births, lifestyle, social factors, incidence and prevalence, hospital activity and mortality. Patient numbers rather than rates were presented. General practitioners commented that this approach gave an understanding of the size of health and social problems and fitted with the concept of numbers needed to treat. CONCLUSION: Public health involvement in practice-based needs assessment is essential. Current public health input has mainly been on a selective individual practice basis and is very resource intensive. This approach allows all practices to have immediate access to a wide range of health and social information presented in a way that is easily understood and informs debate on health needs within the practice.

'My ward is more deprived than yours'.

BACKGROUND: Increasingly, additional resources for infrastructure development and healthcare are directed at deprived areas. The commitment of the present government to reducing inequalities in health is likely to focus attention on identifying and providing special help to areas considered to be particularly deprived. This study compares the use of different deprivation measures at electoral ward level to rank wards according to deprivation and illustrates how the use of different deprivation measures may influence resourcing decisions. METHODS: The 20 local authority electoral wards making up the city of Plymouth, Devon, were studied. Some of the wards within Plymouth are amongst the most deprived in England. The scores for each ward for different measures of deprivation--Townsend, Jarman, the Department of Environment's Index of Local Conditions and Breadline Britain--were calculated and the wards ranked according to the deprivation score for each measure. Decisions on funding bids and resource allocation for wards within Plymouth were reviewed in the light of the relative deprivation status of the wards according to the various measures. RESULTS: The ranking of electoral wards for the selected measures of deprivation showed variation according to the measure used. The measure of deprivation chosen may have influenced resourcing decisions. CONCLUSION: Measures of deprivation are closely correlated one with another. However, by judicious choice of the deprivation measure used a ward can achieve a marked change in rank order. This may exert considerable influence on the decisions made by government departments, local authorities and health authorities when allocating resources.