Multifunctional redox modulator prevents blast-induced loss of cochlear and vestibular hair cells and auditory spiral ganglion neurons.

Blast wave exposure, a leading cause of hearing loss and balance dysfunction among military personnel, arises primarily from direct mechanical damage to the mechanosensory hair cells and supporting structures or indirectly through excessive oxidative stress. We previously reported that HK-2, an orally active, multifunctional redox modulator (MFRM), was highly effective in reducing both hearing loss and hair cells loss in rats exposed to a moderate intensity workday noise that likely damages the cochlea primarily from oxidative stress versus direct mechanical trauma. To determine if HK-2 could also protect cochlear and vestibular cells from damage caused primarily from direct blast-induced mechanical trauma versus oxidative stress, we exposed rats to six blasts of 186 dB peak SPL. The rats were divided into four groups: (B) blast alone, (BEP) blast plus earplugs, (BHK-2) blast plus HK-2 and (BEPHK-2) blast plus earplugs plus HK-2. HK-2 was orally administered at 50 mg/kg/d from 7-days before to 30-day after the blast exposure. Cochlear and vestibular tissues were harvested 60-d post-exposure and evaluated for loss of outer hair cells (OHC), inner hair cells (IHC), auditory nerve fibers (ANF), spiral ganglion neurons (SGN) and vestibular hair cells in the saccule, utricle and semicircular canals. In the untreated blast-exposed group (B), massive losses occurred to OHC, IHC, ANF, SGN and only the vestibular hair cells in the striola region of the saccule. In contrast, rats treated with HK-2 (BHK-2) sustained significantly less OHC (67%) and IHC (57%) loss compared to the B group. OHC and IHC losses were smallest in the BEPHK-2 group, but not significantly different from the BEP group indicating lack of protective synergy between EP and HK-2. There was no loss of ANF, SGN or saccular hair cells in the BHK-2, BEP and BEPHK-2 groups. Thus, HK-2 not only significantly reduced OHC and IHC damage, but completely prevented loss of ANF, SGN and saccule hair cells. The powerful protective effects of this oral MFRM make HK-2 an extremely promising candidate for human clinical trials.

Ocular Firework Injuries among Patients Presented to the Emergency Department During Festival Season in a Tertiary Eye Hospital.

Introduction: Fireworks can cause severe ocular injuries which can be prevented if used with proper precautions. It causes not only mechanical injuries but also thermal and chemical injuries. This study aimed to find out the prevalence of ocular firework injuries among patients presented to the emergency department during festival season in a tertiary eye hospital. Methods: This is a descriptive cross-sectional study done among patients presenting in the emergency department of a tertiary eye hospital after obtaining ethical approval from the Institutional Review Committee. Data of patients from medical records between 26 October 2021 to 28 November 2021 and 15 October 2022 to 17 November 2022 was collected. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 132 patients, the prevalence of ocular firework injuries was seen in 73 (55.30%) (46.82-63.78, 95% Confidence Interval). Closed globe injury was mostly observed in 56 (76.71%) patients with ocular injuries. The most common age group affected was those less than 30 years old 54 (73.97%). Conclusions: The prevalence of ocular firework injuries was found to be lower than other studies done in similar settings. Protective measures should be used to prevent ocular injuries. A public awareness program needs to be launched before such festivals. Keywords: festivals; injuries; prevalence.

Local Firework Restrictions and Ocular Trauma.

Importance: Fireworks can cause vision-threatening injuries, but the association of local legislation with the mitigation of these injuries is unclear. Objective: To evaluate the odds of firework-related ocular trauma among residents of areas where fireworks are permitted vs banned. Design, Setting, and Participants: This case-control study was conducted at a level 1 trauma center in Seattle, Washington, among 230 patients presenting with ocular trauma in the 2 weeks surrounding the Independence Day holiday, spanning June 28 to July 11, over an 8-year period (2016-2022). Exposures: Firework ban status of patient residence. Main Outcomes and Measures: Odds of firework-related injuries among residents of areas where fireworks are legal vs where they are banned, calculated as odds ratios (ORs) and 95% CIs. Results: Of 230 consultations for ocular trauma during the study period, 94 patients (mean [SD] age, 25 [14] years; 86 male patients [92%]) sustained firework-related injuries, and 136 (mean [SD] age, 43 [23] years; 104 male patients [77%]) sustained non-firework-related injuries. The odds of firework-related ocular trauma were higher among those living in an area where fireworks were legal compared with those living in an area where fireworks were banned (OR, 2.0 [95% CI, 1.2-3.5]; P = .01). In addition, the odds of firework injuries were higher for patients younger than 18 years (OR, 3.1 [95% CI, 1.7-5.8]; P < .001) and for male patients (OR, 3.3 [95% CI, 1.5-7.1]; P = .004). Firework injuries were more likely to be vision threatening (54 of 94 [57%]) compared with non-firework-related injuries (54 of 136 [40%]; OR, 2.1 [95% CI, 1.2-3.5]; P = .01). Conclusions and Relevance: This case-control study suggests that the odds of firework-related ocular trauma were slightly higher among residents of areas where fireworks were legal compared with residents of areas where fireworks were banned. Although these results suggest that local firework bans may be associated with a small reduction in the odds of firework-related ocular trauma, additional studies are warranted to assess what actions might lead to greater reductions.

Recommendations for a Military Health System Auditory Blast Injury Prevention Standard.

INTRODUCTION: Although existing auditory injury prevention standards benefit warfighters, the Department of Defense could do more to understand and address auditory injuries (e.g., hearing loss, tinnitus, and central processing deficits) among service members. The Blast Injury Prevention Standards Recommendation (BIPSR) Process is designed to address the needs of all the Military Services for biomedically valid Military Health System (MHS) Blast Injury Prevention Standards. MATERIALS AND METHODS: Through the BIPSR Process, stakeholders provided their intended uses and requested functionalities for an MHS Blast Injury Prevention Standard. The BIPSR Process established a broad-based, non-advocacy panel of auditory injury Subject Matter Expert (SME) Panel with members drawn from industry, academia, and government. The SME Panel selected evaluation factors, weighted priorities, and then evaluated the resulting candidate MHS Auditory Blast Injury Prevention Standards against the evaluation criteria. The SME Panel members provided rationales for their decisions, documented discussions, and used iterative rounds of feedback to promote consensus building among members. The BIPSR Process used multi-attribute utility theory to combine members' evaluations and compare the candidate standards. RESULTS: The SME Panel identified and collated information about existing auditory injury datasets to identify gaps and promote data sharing and comprehensive evaluations of standards for preventing auditory blast injury. The panel evaluated the candidate standards and developed recommendations for an MHS Blast Injury Prevention Standard. CONCLUSIONS: The BIPSR Process illuminated important characteristics, capabilities, and limitations of candidate standards and existing datasets (e.g., limited human exposure data to evaluate the validity of injury prediction) for auditory blast injury prevention. The evaluation resulted in the recommendation to use the 8-hour Equivalent Level (LAeq8hr) as the interim MHS Auditory Blast Injury Prevention Standard while the community performs additional research to fill critical knowledge gaps.

Injury modelling for strategic planning in protecting the national infrastructure from terrorist explosive events.

Terrorist events in the form of explosive devices have occurred and remain a threat currently to the population and the infrastructure of many nations worldwide. Injuries occur from a combination of a blast wave, energised fragments, blunt trauma and burns. The relative preponderance of each injury mechanism is dependent on the type of device, distance to targets, population density and the surrounding environment, such as an enclosed space, to name but a few. One method of primary prevention of such injuries is by modification of the environment in which the explosion occurs, such as modifying population density and the design of enclosed spaces. The Human Injury Predictor (HIP) tool is a computational model which was developed to predict the pattern of injuries following an explosion with the goal to inform national injury prevention strategies from terrorist attacks. HIP currently uses algorithms to predict the effects from primary and secondary blast and allows the geometry of buildings to be incorporated. It has been validated using clinical data from the '7/7' terrorist attacks in London and the 2017 Manchester Arena terrorist event. Although the tool can be used readily, it will benefit from further development to refine injury representation, validate injury scoring and enable the prediction of triage states. The tool can assist both in the design of future buildings and methods of transport, as well as the situation of critical emergency services required in the response following a terrorist explosive event. The aim of this paper is to describe the HIP tool in its current version and provide a roadmap for optimising its utility in the future for the protection of national infrastructure and the population.

Firework injuries remain high in years after legalisation: its impact on children.

PURPOSE: We evaluated the impact of Senate Bill 489 passed in May 2017, allowing the sale and use of fireworks in Iowa 1 June to 8 July and 10 December to 3 January, on hospital presentations for firework injuries in the state. To identify the public health implications of this law, we conducted a detailed subanalysis of hospital presentations to the two level I trauma centres. METHODS: Hospital presentations for firework injuries from 1 June 2014 to 31 July 2019 were identified using the Iowa Hospital Admission database and registries and medical records of Iowa's two level 1 trauma centres. Trauma centres' data were reviewed to obtain demographics, injury information and hospital course. Prefirework and postfirework legalisation state data were compared using negative binomial regression analysis. Trauma centre data detailing injuries were compared using χ2 and Mann-Whitney U tests as appropriate. RESULTS: Emergency department (ED) visits and hospital admissions for firework injuries increased in Iowa post-legalisation (B-estimate=0.598±0.073, p<0.001 and B-estimate=0.612±0.322, p=0.058, respectively). ED visits increased postlegalisation in July (73.6% vs 64.5%; p=0.008), reflecting an increase in paediatric admissions (81.8% vs 62.5%; p=0.006). Trauma centres' data showed similar trends. The most common injury site across both study periods was the hands (48.5%), followed by the eyes (34.3%) and face (28.3%). Amputations increased from 0 prelegalisation to 16.2% postlegalisation. CONCLUSION: Firework legalisation led to an increase in the number of admissions and more severe injuries.

Mitigation of Hearing Damage After Repeated Blast Exposures in Animal Model of Chinchilla.

High-intensity sound or blast-induced hearing impairment is a common injury for Service members. Epidemiology studies revealed that the blast-induced hearing loss is associated with the traumatic brain injury (TBI), but the mechanisms of the formation and prevention of auditory injuries require further investigation. Liraglutide, a glucagon-like peptide-1 receptor (GLP-1R) agonist, has been reported as a potential treatment strategy for TBI-caused memory deficits; however, there is no study on therapeutics of GLP-1R for blast-induced hearing damage. This paper reports our current study on progressive hearing damage after repeated exposures to low-level blasts in the animal model of chinchilla and the mitigation of hearing damage using liraglutide. Chinchillas were divided into three groups (N = 7 each): blast control, pre-blast treatment, and post-blast treatment. All animals were exposed to six consecutive blasts at the level of 3-5 psi (21-35 kPa) on Day 1. The auditory brainstem response (ABR) was measured on Day 1 (pre- and post-blast) and Days 4, 7, and 14 after blast exposure. Upon the completion of the experiment on Day 14, the brain tissues of animals were harvested for immunofluorescence studies. Significant damage was revealed in blast-exposed chinchillas by increased ABR thresholds, decreased ABR wave I amplitudes, and cell apoptosis in the inferior colliculus in the blast control chinchillas. Treatment with liraglutide appeared to reduce the severity of blast-induced hearing injuries as observed from the drug-treated chinchillas comparing to the blast controls. This study bridges the gap between TBI and hearing impairment and suggests a possible intervention for blast-induced hearing loss for Service members.

Protective Performance of Helmets and Goggles in Mitigating Brain Biomechanical Response to Primary Blast Exposure.

The current combat helmets are primarily designed to mitigate blunt impacts and ballistic loadings. Their protection against primary blast wave is not well studied. In this paper, we comprehensively assessed the protective capabilities of the advanced combat helmet and goggles against blast waves with different intensity and directions. Using a high-fidelity human head model, we compared the intracranial pressure (ICP), cerebrospinal fluid (CSF) cavitation, and brain strain and strain rate predicted from bare head, helmet-head and helmet-goggles-head simulations. The helmet was found to be effective in mitigating the positive ICP (24-57%) and strain rate (5-34%) in all blast scenarios. Goggles were found to be effective in mitigating the positive ICP in frontal (6-16%) and lateral (5-7%) blast exposures. However, the helmet and goggles had minimal effects on mitigating CSF cavitation and even increased brain strain. Further investigation showed that wearing a helmet leads to higher risk of cavitation. In addition, their presence increased the head kinetic energy, leading to larger strains in the brain. Our findings can improve our understanding of the protective effects of helmets and goggles and guide the design of helmet pads to mitigate brain responses to blast.

Encouraging Firework Safety Through Public Service Announcements.

A dramatic increase in firework-related blast injuries to the hand and upper extremity resulted in record-setting numbers at our institution over the July 4, 2018, holiday. This led our hand and upper extremity department to create a public service announcement (PSA) campaign regarding firework safety and injury prevention. This PSA was broadcast in advance of the next July 4 holiday via several media platforms including television, radio, and the internet. The following year only 4 patients required surgery for firework-related blast injuries to the hand and upper extremity over the same 10-day period, including the weekends before and after the July 4, 2019, holiday. This represented a considerable reduction compared with the 14 patients seen within the same time frame in 2018. The purpose of this article was to outline the process and report the impact of creating and disseminating a public service announcement for firework-related blast injury prevention.

Decrease in injuries from fireworks in Hawaii: associations with a county policy to limit access.

OBJECTIVE: To examine trends in fireworks-related injuries (FRI) before and after enactment of an ordinance to limit access in the City and County of Honolulu (the island of Oahu). METHODS: Surveillance of FRI treated in all emergency departments in the state, for 18 new year's periods (31 December through 1 January) from 2004 to 2021. Prelaw (2004 to 2011) and postlaw (2012 to 2021) number of FRI were compared, by patient age and county. RESULTS: The average annual number of FRI for all ages decreased significantly in Oahu, from 74 during the prelaw period to 27 during the postlaw period (p<0.01), but not in the remaining neighbour islands (p=0.07). Decreases were particularly evident for Oahu paediatric patients (under 18 years), among whom FRI declined from 42 to 10 per year (p<0.01). FRI were approximately halved for older Oahu patients and neighbour island paediatric patients. CONCLUSIONS: Legislation requiring permits for a specified number and type of fireworks, and limiting access to persons 18 years and older was associated with significant decreases in FRI in the City and County of Honolulu.

Comparing the medical coverage provided by four contemporary military combat helmets against penetrating traumatic brain injury.

INTRODUCTION: Modern military combat helmets vary in their shapes and features, but all are designed to protect the head from traumatic brain injury. Recent recommendations for protection against energised projectiles that are characteristic of secondary blast injury is to ensure coverage of both the brain and brainstem. METHOD: Graphical representations of essential coverage of the head (cerebral hemispheres, cerebellum and brainstem) within an anthropometrically sized model were superimposed over two standard coverage helmets (VIRTUS helmet, Advanced Combat Helmet (ACH)) and two 'high-cut' helmets (a Dismounted Combat Helmet (DCH)) and Combat Vehicle Crewman (CVC) helmet), both of which are designed to be worn with communications devices. Objective shotline coverage from representative directions of projectile travel (-30 to +30 degrees) was determined using the Coverage of Armour Tool (COAT). RESULTS: VIRTUS and ACH demonstrated similar overall coverage (68.7% and 69.5%, respectively), reflecting their similar shell shapes. ACH has improved coverage from below compared with VIRTUS (23.3% vs 21.7%) due to its decreased standoff from the scalp. The 'high-cut' helmets (DCH and CVC) had reduced overall coverage (57.9% and 52.1%), which was most pronounced from the side. CONCLUSIONS: Both the VIRTUS and ACH helmets provide excellent overall coverage of the brain and brainstem against ballistic threats. Coverage of both would be improved at the rear by using a nape protector and the front using a visor. This is demonstrated with the analysis of the addition of the nape protector in the VIRTUS system. High-cut helmets provide significantly reduced coverage from the side of the head, as the communication devices they are worn with are not designed to provide protection from ballistic threats. Unless absolutely necessary, it is therefore recommended that high-cut helmets be worn only by those users with defined specific requirements, or where the risk of injury from secondary blast is low.

Efficacy of Body Armor in Protection Against Blast Injuries Using a Swine Model in a Confined Space with a Blast Tube.

The purpose of this study was to clarify whether or not body armor would protect the body of a swine model using a blast tube built at National Defense Medical College, which is the first such blast tube in Japan. Seventeen pigs were divided into two groups: the body armor group and the non-body armor group. Under intravenous anesthesia, the pigs were tightly fixed in the left lateral position on a table and exposed from the back neck to the upper lumbar back to the blast wave and wind with or without body armor, with the driving pressure of the blast tube set to 3.0 MPa. When the surviving and dead pigs were compared, blood gas analyses revealed significant differences in PaO2, PaCO2, and pH in the super-early phase. All pigs injured by the blast wave and wind had lung hemorrhage. All 6 animals in the body armor group and 6 of the 11 animals in the control group survived for 3 hours after injury. Respiratory arrest immediately after exposure to the blast wave was considered to influence the mortality in our pig model. Body armor may have a beneficial effect in protecting against respiratory arrest immediately after an explosion.

Prevention of firecracker injuries via the digital platform: A Malaysian experience.

INTRODUCTION: Health campaigns include physical campaigns in schools, community halls, or community malls. They can also be broadcast via television, newspaper, and radio. We launched a health campaign on social media platforms that have a powerful impact in this digital era. METHODS: A three-dimensional short animation was developed for the Burn and Blast Injury Awareness campaign. It was launched during the fasting month and Eid 2020 when firecracker-related injuries are highly incident in Malaysia. The video was launched primarily on Universiti Sains Malaysia (USM) and Wau Animation Sdn Bhd social media platforms. Each party shared the video on the top 3 social media platforms, which are Facebook, Instagram, and YouTube. The numbers of viewers, reaches, and shares, and demographic data were captured at 1 month after the release. RESULTS: We recorded 29,585 views, 60,920 reach, and 874 shares from the USM and Wau Animation platforms alone. The USM Facebook platform showed predominant female viewership (60%), whereas the Wau Facebook platform showed predominant male viewership (66%). In both platforms, the viewers were aged 18-34 years. CONCLUSION: Health awareness campaigns on digital platforms are powerful because the message spreads faster, and it is also safe during the pandemic.

Helmet chinstrap protective role in maxillofacial blast injury.

BACKGROUND: The protective role of helmet accessories in moderating stress load generated by explosion shock waves of explosive devices is usually neglected. OBJECTIVE: In the presented study, the protective role of the helmet chinstrap against the impulse and overpressure experienced by the maxillofacial region were examined. METHODS: The explosion shock wave and skull interaction were investigated under three different configurations: (1) unprotected skull, (2) skull with helmet (3) skull with helmet and chinstrap. For this purpose, a 3D finite element model (FEM) was constructed to mimic the investigated biomechanics module. Three working conditions were set according to different explosive charges and distances to represent different load conditions. Case 1: 500 mg explosive trinitrotoluene (TNT), 3 cm, case 2: 1000 mg TNT, 3 cm, and case 3: 1000 mg TNT and 6 cm distance to the studied object. The explosion effect was discussed by examining the shock wave stress flow pattern. Three points were selected on the skull and the stress curve of each point position were illustrated for each case study. RESULTS: The results showed that the helmet chinstrap can reduce the explosive injuries and plays a protective role in the maxillofacial region, especially for the mandible.

Severe Fireworks-Related Injuries: Demographic Characteristics, Injury Patterns, and Firework Types in 294 Consecutive Patients.

OBJECTIVES: The relationship between fireworks and patient characteristics is not known. Our objective was to examine how severe fireworks-related injuries in children and teens compare to adults. METHODS: We conducted a retrospective case series (2005-2015) study of patients who sustained consumer fireworks-related injuries requiring hospital admission and/or operation at a single level 1 trauma/burn center. The distribution of race, use behavior, injury type, body region injured, and firework type was examined by age groups, 1 to 10 years, 11 to 17 years, and 18 years or older. RESULTS: Data from 294 patients 1 to 61 years of age (mean, 24 years) were examined. The majority (91%) were male. The proportion of injuries from different firework types varied by age, with rockets causing the highest proportion in children aged 1 to 10 years, homemade fireworks in those aged 11 to 17 years, and shells/mortars in adults 18 years or older. Compared with adults, children aged 1 to 10 years were more frequently American Indian/Alaska Native, Hispanic, or Asian than White. Compared with adults, children aged 1 to 10 years and 11 to 17 years were more frequently bystanders than active users. Compared with adults, children aged 1 to 10 years and 11 to 17 years had a greater proportion of burn and face injuries. Children aged 1 to 10 years had a decreased proportion of hand injuries. Three patients, 2 adults and 1 child aged 11 to 17 years, died. CONCLUSIONS: Children, teens, and adults experience severe fireworks-related injuries differently, by demographic characteristics, injury patterns, and firework types. Tailored public health interventions could target safety messaging and injury prevention outreach efforts to reduce firework injuries among children and adolescents.

Prevention of Blast-induced Auditory Injury Using 3D Printed Helmet and Hearing Protection Device - A Preliminary Study on Biomechanical Modeling and Animal.

INTRODUCTION: Repeated blast exposures result in structural damage to the peripheral auditory system (PAS) and the central auditory system (CAS). However, it is difficult to differentiate injuries between two distinct pathways: the mechanical damage in the PAS caused by blast pressure waves transmitted through the ear and the damage in the CAS caused by blast wave impacts on the head or traumatic brain injury. This article reports a preliminary study using a 3D printed chinchilla "helmet" as a head protection device associated with the hearing protection devices (e.g., earplugs) to isolate the CAS damage from the PAS injuries under repeated blast exposures. MATERIALS AND METHODS: A finite element (FE) model of the chinchilla helmet was created based on micro-computed tomography images of a chinchilla skull and inputted into ANSYS for FE analysis on the helmet's protection against blast over pressure. The helmet was then 3D printed and used for animal experiments. Chinchillas were divided into four cases (ears open, with earplug only, with both earplug and helmet, and with helmet only) and exposed to three blasts at blast over pressure of 15 to 20 psi. Hearing function tests (e.g., auditory brainstem response) were performed before and after blast on Day 1 and Days 4 and 7 after blasts. RESULTS: The FE model simulation showed a significant reduction in intracranial stress with the helmet, and the animal results indicated that both earplug and helmet reduced the severity of blast-induced auditory injuries by approximately 20 dB but with different mechanisms. CONCLUSIONS: The biomechanical modeling and animal experiments demonstrated that this four-case study in chinchillas with helmet and hearing protection devices provides a novel methodology to investigate the blast-induced damage in the PAS and CAS.

Optimizing Helmet Pad Placement Using Computational Predicted Injury Pattern to Reduce Mild Traumatic Brain Injury.

INTRODUCTION: This effort, motivated and guided by prior simulated injury results of the unprotected head, is to assess and compare helmet pad configurations on the head for the effective mitigation of blast pressure transmission in the brain in multiple blast exposure environments. MATERIALS AND METHODS: A finite element model of blast loading on the head with six different helmet pad configurations was used to generate brain model biomechanical responses. The blast pressure attenuation performance of each pad configuration was evaluated by using the calculated pressure exposure fraction in the brain model. Monte Carlo simulations generated repetitive blast cumulative exposures. RESULTS: Significant improvement of a 6-Pad Modified configuration compared to a 6-Pad Baseline configuration indicates the importance of providing protection against the side blast. Both 12-Pad configurations are very effective in mitigating pressure in the brain. Repetitive blast exposure statistics for operational exposures shows that pad configurations with a larger number of pads and smaller gaps between pads perform better than the configurations with a smaller number of pads and larger gaps between pads. CONCLUSIONS: Optimizing helmet pad size and/or placement could provide an improved protection by minimizing the side blast orientation effects and mitigating high-pressure fields in the brain from repeated blast exposures.

Ocular injuries incurred by Israeli defense forces during low-intensity conflicts.

BACKGROUND: To describe ocular injuries sustained by Israeli Defense Forces (IDF) soldiers during low-intensity conflicts from 1998 to 2017, and to evaluate the use of protective eyewear. METHODS: Retrospective analysis of data retrieved from two tertiary Israeli medical centers and the military trauma registry. The analysis included all IDF soldiers with ocular injuries who were referred to these centers between 1998 and 2017. Data on injury type, the use of protective eyewear, and interventions were retrieved and analyzed. Additional data regarding the use of protective eyewear and ocular injuries in 108 patients with head and neck injuries in one operation was analyzed. RESULTS: A total of 126 soldiers, all males, mean age 22 (SD 5.3) years, sustained ocular injuries during low-intensity conflicts and treated at one of the two participating medical centers. Blast was the most common type of injury (n = 70/126, 56%), followed by shrapnel (n = 37/126, 29%) and gunshot wound (n = 12/126, 9%). The Birmingham Eye Trauma Terminology System (BETTS) injury pattern disclosed lamellar laceration (n = 34/126, 27%), intraocular foreign body (n = 27/126, 21%), penetrating (n = 10/126, 8%), and perforating (n = 7/126, 6%) injuries. Average VA improved from 20/140 at presentation to 20/60 after surgical or conservative intervention, the median VA improved from 20/40 to 20/30 (P < 0.001). Forty-nine patients (49/126, 39%) had poor visual outcome. The mean follow-up lasted 22 (SD 31) months. The use of protective eyewear was correlated with better initial VA(20/30 vs 20/217, P = 0.07). Among 108 patients with head and neck injuries, there was a higher rate of ocular injuries in the group of patients who did not use protective eyewear (n = 26/73, 36% vs n = 4/35, 11%, P = 0.016). CONCLUSIONS: Ocular injuries are common occurrences in low-intensity conflicts. The use of protective eyewear significantly reduces these injuries and should be mandatory. LEVEL OF EVIDENCE: III, prognostic.

Determining the optimum anatomical coverage of side plates for the VIRTUS body armour and load carriage system.

INTRODUCTION: Side plates are worn by UK Armed Forces as part of the VIRTUS body armour and load carriage systems to protect the thorax and abdomen from high-velocity threats. The VIRTUS project has provided the impetus to objectively demonstrate the anatomical coverage provided by side plates. METHOD: CT scans of 120 male UK Armed Forces personnel were analysed to ascertain the vertical distance between the anterior axillary fold and iliac crest, and horizontal distance between anterior and posterior borders of the liver, delineating the boundaries of essential medical coverage from the side aspects. The percentage of shot-lines intersected by the existing Enhanced Combat Body Armour (ECBA) plates as well as an optimised plate based on the maximum potential dimensions of essential coverage was determined in the Coverage of Armour Tool. RESULTS: ECBA plates were 101 mm shorter and 4 mm narrower than a plate with dimensions providing essential medical coverage for the 50th percentile subject (157×315 mm). Coverage increased by 35% when using two ECBA plates as side coverage in addition to using the front and rear OSPREY plates in the VIRTUS vest. Two side plates with dimensions providing essential medical coverage for the 50th percentile increased anatomical coverage by a further 16%. CONCLUSIONS: This analysis has provided strong evidence that ECBA plates are already optimised for side protection, despite not being originally designed for this purpose. They are correctly positioned within the VIRTUS soft body armour vest and the width of the ECBA plate is only 3% less than what would be optimum size for the 50th percentile. Although the height of the plate could be increased to further enhance the anatomical coverage, it is unlikely that this would be acceptable in terms of the human factors, equipment integration or additional mass.

Blast Suppression Foam, Aqueous Gel Blocks, and their Effect on Subsequent Analysis of Forensic Evidence.

In addition to having blast mitigation properties, aqueous foam concentrate AFC-380 blast suppression foam is designed to capture aerosolized chemical, biological, and radioactive particles during render-safe procedures of explosive devices. Exposure to aqueous environments and surfactants may negatively affect forensic evidence found at the scene, but the effects of AFC-380 foam and aqueous gel on the preservation and subsequent analysis of forensic evidence have not previously been investigated. Sebaceous finger and palm prints and DNA samples on paper, cardboard, tape, and various metal and plastic items, along with hairs, carpet and yarn fibers, and inks and documents, were exposed to AFC-380 foam. Similar mock evidence was also exposed to a superabsorbent gel of the type found in aqueous gel blocks used for shrapnel containment. Exposure to foam or aqueous gel was associated with a dilution effect for recovered DNA samples, but quality of the samples was not substantially affected. In contrast, exposure to AFC-380 foam or gel was detrimental to development of latent finger and palm prints on any substrate. Neither the hair nor the fiber samples were affected by exposure to either the foam or gel. Indented writing on the document samples was detrimentally affected by foam or gel exposure, but not inks and toners. The results from this study indicate that most types of forensic evidence recovered after being exposed to aqueous gel or blast suppression foam can be reliably analyzed, but latent finger and palm prints may be adversely affected.