Nonperforating ballistic impacts on thoracic armor can cause blunt injuries, known as behind-armor blunt trauma (BABT). To evaluate the potential for this injury, the back face deformation (BFD) ...imprinted into a clay backing is measured; however, the link between BFD and potential for injury is uncertain. Computational human body models (HBMs) have the potential to provide an improved understanding of BABT injury risk to inform armor design but require assessment with relevant loading scenarios. In this study, a methodology was developed to apply BABT loading to a computational thorax model, enhanced with refined finite element mesh and high-deformation rate mechanical properties. The model was assessed using an epidemiological BABT survivor database. BABT impact boundary conditions for 10 cases from the database were recreated using experimentally measured deformation for specific armor/projectile combinations, and applied to the thorax model using a novel prescribed displacement methodology. The computational thorax model demonstrated numerical stability under BABT impact conditions. The predicted number of rib fractures, the magnitude of pulmonary contusion, and injury rank, increased with armor BFD, back face velocity, and input energy to the thorax. In three of the 10 cases, the model overpredicted the number of rib fractures, attributed to impact location positional sensitivity and limited details from the database. The integration of an HBM with the BABT loading method predicted rib fractures and injury ranks that were in good agreement with available medical records, providing a potential tool for future armor evaluation and injury assessment.
Shear behavior of human skull bones Brown, A.D.; Rafaels, K.A.; Weerasooriya, T.
Journal of the mechanical behavior of biomedical materials,
April 2021, 2021-04-00, 20210401, Volume:
116
Journal Article
Peer reviewed
A shear-punch test (SPT) experimental method was developed to address the lack of shear deformation and failure response data for the human skull as a function of local bone microarchitecture. ...Improved understanding of skull deformation and fracture under varying stress-states helps implement mechanism-based, multi-axial material models for finite element analysis for optimizing protection strategies. Shear-punch coupons (N = 47 specimens) were extracted from right-parietal and frontal bones of three fresh-frozen-thawed human skulls. The specimens were kept as full through-thickness or segmented into the three skull constituent layers: the inner and outer cortical tables and the middle porous diploë. Micro-computed x-ray tomography (μCT) before and after SPT provided the bone volume fraction (BVF) as a function of depth for correlation to shear mechanisms in the punched volumes. Digital image correlation was used to track displacement of the punch above the upper die to minimize compliance error. Five full-thickness specimens were subjected to partial indentation loading to investigate the process of damage development as a function of BVF and depth. It was determined that BVF dominates the shear yield and ultimate strength of human skull bone, but the imposed uniaxial loading rate (0.001 and 0.1 s−1) did not have as strong a contribution (p = 0.181–0.806 > 0.05) for the shear yield and ultimate strength of the skull bone layer specimens. Shear yield and ultimate strength data were highly correlated to power law relationships of BVF (R2 = 0.917–0.949). Full-thickness and partial loaded SPT experiments indicate the diploë primarily dictates the shear strength of the intact structure.
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•Shear-punch experiments have been performed on human skull bones.•Shear failure strengths are significantly correlated to bone volume fraction.•Obtained a power law relationship between shear strength and bone volume fraction.•The inner-porous diploë governs full-thickness shear-punch failure strength.•Cortical tables and diploë strengths were not significantly rate dependent.
Objective: The neck injury index, NII, developed in ISO 13232 (2005) as a testing and evaluation procedure for assessing the risk of injury to the AO/C1/C2 region of the cervical spine in motorcycle ...riders is reevaluated using an existing postmortem human subjects (PMHS) data set and resulting in a reformulated NII criterion applicable to PMHS tests.
Methods: A recent series of 36 PMHS head/neck component tests was used to examine the risk of neck injury in frontal impacts and to assess the predictive capability of NII for impacts of various orientations. Using force and moment load cell PMHS experimental data, injury risk was assessed using NII evaluated with the ISO 13232-5 algorithms.
Results: The injury risk predictions are compared with the injury outcomes from the head/neck PMHS. The NII criterion underestimated the injury incidence of the PMHS experimental group. The average predicted risk of injuries for the experimental injury tests based on NII across the MAIS levels was 0.7 percent, though there were 11 AIS 3+ injuries observed in the actual testing (30.6%). Using the experimental injury outcomes and the experimental force and moment time histories, the normalizing coefficients from NII are reevaluated to minimize the difference between NII risk assessment and the experimental injury outcome in the least squares (L
2
) basis. This reanalysis is compared with existing human and PMHS neck injury criteria.
Conclusions: By reanalyzing the NII formulation using an existing PMHS injury data set with known forces and moments and known injury outcomes, a new NII
PMHS
is developed that uses PMHS loads to predict injury. This reformulation removes the dependency of the original NII formulation on the forces and moments from motorcyclist anthropomorphic test device (MATD) experiments and simulations yet retains the advantages of the multi-axial neck injury criterion.
Background:
Onychomycosis of the toenail caused by nondermatophyte molds alone or in combination with dermatophytes is difficult to eradicate with standard antifungal therapy.
Objective:
Our purpose ...was to determine the effectiveness of itraconazole in the treatment of toenail onychomycosis caused by molds alone or in combination with dermatophytes.
Methods:
We treated 36 patients with this drug given as continuous dosing (100 or 200 mg/day) for 6 to 20 weeks or as a 1-week pulse dosing (200 mg twice daily for 1 week per month) for two to four pulses.
Results:
Patients with toenail onychomycosis with the following organisms were treated:
Aspergillus spp. (eight patients),
Fusarium spp. (four patients),
Scopulariopsis brevicaulis (23 patients), and
Alternaria spp. (one patient). Nineteen patients had onychomycosis with a mixed origin. At follow-up, 12 months after therapy was initiated, clinical and mycologic cure was achieved in 15 of 17 patients (88%) with onychomycosis caused by a single mold. In patients with mixed infection, a clinical cure was obtained in 16 of 19 patients (84%) and a mycologic cure in 13 of 19 patients (68%).
Conclusion:
Itraconazole appears to be effective and safe for the treatment of toenail onychomycosis caused by some nondermatophyte molds alone or in combination with dermatophytes.
(J Am Acad Dermatol 1997;36:173-7.)
Thoracic and lumbar spinal impact tolerance Bass, Cameron R 'Dale'; Rafaels, Karin A; Salzar, Robert S ...
Accident analysis and prevention,
03/2008, Volume:
40, Issue:
2
Journal Article
Peer reviewed
Thoracolumbar injuries resulting from motor vehicle accidents, falls, and assaults have a high risk of morbidity and mortality. However, there are no biomechanically based standards that address this ...problem.
This study used four cadaveric porcine specimens as a model for direct spinal impact injuries to humans to determine an appropriate injury tolerance value. The anthropometric parameters of these specimens are compared with values found in a large human cadaveric dataset. Each specimen was subjected to five impacts on the dorsal surface of the lower thorax and abdomen.
The injuries ranged from mild spinous process fractures to endplate fractures with anterior longitudinal ligament (ALL) transactions with a maximum AIS=3. The average peak reaction force for the thoracic failure tests was 4720+/-1340 N, and the average peak reaction force for the lumbar failure tests was 4650+/-1590 N.
When scaled to human values using anthropometric parameters determined in this study, the force at which there is a 50% risk of injury is 10,200+/-3900 N. This value favorably compares to that found in the existing literature on isolated vertebral segments.
After demonstrating that the porcine model can be used as a spinal impact model for the human, the resulting injury risk value can be used in determining new standards for human injury risk or in guiding the design of safety equipment for the back.
To the Editor: Atopic dermatitis (AD) is the most common inflammatory skin disease, affecting up to 20% of children in the United States, and is characterized by an increased susceptibility to ...cutaneous infections.1,2 One in 10 subjects with AD has difficulty clearing cutaneous infections with a host of viruses including herpes simplex, vaccinia, human papilloma, and/or molluscum contagiosum.1 This typically manifests as more extensive cutaneous and sometimes systemic disease and/or resistance to standard therapies.
Supplementary Online Materials ixAcknowledgments xAbbreviations xiiExecutive summary xiiiChapter 1 ntroduction 2Chapter 2 Nutrition Is Central to Sustainable Development 7Chapter 3 Progress toward ...the World Health Assembly Nutrition Targets Is Too Slow1 5Chapter 4 The Coexistence of Different Forms of Malnutrition Is the “New Normal” 22Chapter 5 The Coverage of Nutrition-Specific Interventions Needs to Improve 29Chapter 6 Interventions Addressing the Underlying Determinants of Nutrition Status Are Important, but They Need to Be More Nutrition sensitive 38Chapter 7 The Enabling Environment Is Improving, but Not Quickly Enough 47Chapter 8 The Need to Strengthen Accountability in Nutrition 56Chapter 9 What Are the Priorities for Investment in Improved Nutrition Data? 67Chapter 10 Key Messages and Recommendations 71Appendix 1 The Nutrition Country Profile: A Tool for Action 75Appendix 2 Which Countries Are on Course to Meet Several WHA Targets? 77Appendix 3 Which Countries Are on Course for Which WHA Targets? 79Appendix 4 Donor Spending on Nutrition-Specific and Nutrition-Sensitive Interventions and Programs 84Appendix 5 How Accountable Is the Global Nutrition Report? 86Appendix 6 Availability of Data for Nutrition Country Profile Indicators 88Notes 91References 95PANELSPanel 11 Types of Nutrition Investment, Lawrence Haddad 4Panel 21 Nutrition and the Sustainable Development Goals—No Room for Complacency, Michael Anderson 11Panel 22 Some New Data from India: What If?, Lawrence Haddad, Komal Bhatia, and Kamilla Eriksen 12Panel 23 How Did Maharashtra Cut Child Stunting?, Lawrence Haddad 13Panel 24 Can Improving the Underlying Determinants of Nutrition Help Meet the WHA Targets?, Lisa Smith and Lawrence Haddad 14Panel 41 Malnutrition in the United States and United Kingdom, Jessica Fanzo 25Panel 42 Regional Drivers of Malnutrition in Indonesia, Endang Achadi with acknowledgment to Sudarno Sumarto and Taufik Hidayat 26Panel 43 Compiling District-Level Nutrition Data in India, Purnima Menon and Shruthi Cyriac 27Panel 44 Targeting Minority Groups at Risk in the United States, Jennifer Requejo and Joel Gittelsohn 28Panel 51 Measuring Coverage of Programs to Treat Severe Acute Malnutrition, Jose Luis Alvarez 37Panel 61 Trends in Dietary Quality among Adults in the United States, Daniel Wang and Walter Willett 41Panel 62 How Did Bangladesh Reduce Stunting So Rapidly?, Derek Headey 43Panel 63 Using an Agricultural Platform in Burkina Faso to Improve Nutrition during the First 1,000 Days, Deanna Kelly Olney, Andrew Dillon, Abdoulaye Pedehombga, Marcellin Ouédraogo, and Marie Ruel 45Panel 71 Is There a Better Way to Track Nutrition Spending? 48Panel 72 Tracking Financial Allocations to Nutrition: Guatemala’s Experience, Jesús Bulux, Otto Velasquez, Cecibel Juárez, Carla Guillén, and Fernando Arriola 49Panel 73 A Tool for Assessing Government Progress on Creating Healthy Food Environments, Boyd Swinburn 51Panel 74 Engaging Food and Beverage Companies through the Access to Nutrition Index, Inge Kauer 52Panel 75 How Brazil Cut Child Stunting and Improved Breastfeeding Practices, Jennifer Requejo 54Panel 81 Scaling Up Nutrition through Business, Jonathan Tench 61Panel 82 How Civil Society Organizations Build Commitment to Nutrition, Claire Blanchard 62Panel 83 Building Civil Society’s Capacity to Push for Policies on Obesity and Noncommunicable Diseases, Corinna Hawkes 63Panel 84 Can Community Monitoring Enhance Accountability for Nutrition?, Nick Nisbett and Dolf te Lintelo 64Panel 85 National Evaluation Platforms: Potential for Nutrition, Jennifer Bryce and colleagues 65Panel 86 The State of African Nutrition Data for Accountability and Learning, Carl Lachat, Joyce Kinabo, Eunice Nago, Annamarie Kruger, and Patrick Kolsteren 66
CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)
The Global Nutrition Report (GNR) provides a global profile and country profiles on nutrition for each of the United Nations’ 193 member states, and includes specific progress for each country. It will be a centerpiece of the Second International Conference on Nutrition (ICN2) in Rome on 19-21 November, organized by the UN Food and Agriculture Organization and the World Health Organization.
IFPRI1; CRP4; B Promoting healthy food systems
The genetic make-up of an individual contributes to the susceptibility and response to viral infection. Although environmental, clinical and social factors have a role in the chance of exposure to ...SARS-CoV-2 and the severity of COVID-19
, host genetics may also be important. Identifying host-specific genetic factors may reveal biological mechanisms of therapeutic relevance and clarify causal relationships of modifiable environmental risk factors for SARS-CoV-2 infection and outcomes. We formed a global network of researchers to investigate the role of human genetics in SARS-CoV-2 infection and COVID-19 severity. Here we describe the results of three genome-wide association meta-analyses that consist of up to 49,562 patients with COVID-19 from 46 studies across 19 countries. We report 13 genome-wide significant loci that are associated with SARS-CoV-2 infection or severe manifestations of COVID-19. Several of these loci correspond to previously documented associations to lung or autoimmune and inflammatory diseases
. They also represent potentially actionable mechanisms in response to infection. Mendelian randomization analyses support a causal role for smoking and body-mass index for severe COVID-19 although not for type II diabetes. The identification of novel host genetic factors associated with COVID-19 was made possible by the community of human genetics researchers coming together to prioritize the sharing of data, results, resources and analytical frameworks. This working model of international collaboration underscores what is possible for future genetic discoveries in emerging pandemics, or indeed for any complex human disease.
Pulmonary arterial hypertension (PAH) is a medically incurable disease resulting in death from right ventricular (RV) failure. Both pulmonary vascular and RV remodeling are linked to dynamic changes ...in the microvasculature. Therefore, we hypothesized that circulating angiostatic factors could be linked to outcomes and represent novel biomarkers of disease severity in PAH.
We sought to determine the relationship of a potent angiostatic factor, endostatin (ES), with disease severity and mortality in PAH. Furthermore, we assessed genetic predictors of ES expression and/or function and their association with outcomes in PAH.
We measured levels of serum ES in two independent cohorts of patients with PAH. Contemporaneous clinical data included New York Heart Association functional class, 6-minute-walk distance, invasive hemodynamics, and laboratory chemistries.
Serum ES correlated with poor functional status, decreased exercise tolerance, and invasive hemodynamics variables. Furthermore, serum ES was a strong predictor of mortality. A loss-of-function, missense variant in the gene encoding ES, Col18a1, was linked to lower circulating protein and was independently associated with reduced mortality.
Our data link increased expression of ES to disease severity in PAH and demonstrate a significant relationship with adverse outcomes. Circulating ES levels can be genetically influenced, implicating ES as a genetically determined modifier of disease severity impacting on survival. These observations support serum ES as a potential biomarker in PAH with the capacity to predict poor outcomes. More importantly, this study implicates Col18a1/ES as a potential new therapeutic target in PAH.
Long-duration blasts are an increasing threat with the expanded use of thermobaric and other novel explosives. Other potential long-duration threats include large explosions from improvised explosive ...devices, weapons caches, and other explosives including nuclear explosives. However, there are very few long-duration pulmonary blast injury assessments, and use of short-duration exposure injury metrics is inappropriate as the injury mechanism for long-duration exposures is likely different from that of short-duration exposures.
This study develops an injury model for long-duration (>10 milliseconds positive overpressure phase) blasts with sharp rising overpressures. For this study, data on more than 2,730 large animal experiments were collected from more than 55 experimental studies on blast. From this dataset, nearly 850 large animal experiments were selected with positive phase overpressure durations of 10 milliseconds or more. Various models were evaluated to determine the best fit of injury risk as a function of pressure and duration. A linear logistic regression was performed on the experimental data for threshold injury and lethality in terms of pressure and duration. The effects of mass, pressure, and duration scaling were all evaluated, and two goodness-of-fit indicators were used to assess the different models.
New injury risk assessment curves were determined for both incident and reflected pressure conditions for reflecting surface and free-field exposures. Position dependent injury risk curves were also determined. The resulting curves are an improvement to existing assessments, because they use actual data to demonstrate theoretical assumptions on the injury risk.
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