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PubMed2004

Fatal and non-fatal injuries among U.S. Air Force personnel resulting from the terrorist bombing of the Khobar Towers.

BACKGROUND: Culminating with the events of September 11, 2001, U.S. civilian and military populations are vulnerable to terrorist attacks. Information about the patterns of injuries and their causes inform disaster management planning and can improve structural and architectural design. This report documents the injuries following an estimated 20K bomb at the Khobar Towers military compound in Dhahran, Saudi Arabia. METHODS: US Air Force personnel in the compound at the time of the bombing were evaluated. Data were collected through a mail survey, and a review of military medical records and autopsy reports. Outcome measures included injury types, treatment status, severity, and causes of injuries. RESULTS: The study identified 574 persons who were injured in the bombing; 19 persons died. A total of 420 (73%) persons were injured directly in the blast and 154 (27%) persons were injured during evacuation, search and rescue, during cleanup, or sustained only auditory or inhalation trauma. Sixteen percent of survivors injured directly in the blast were hospitalized; 6% were critical. Soft tissue and foreign body injuries of the lower extremities were the most common injuries among survivors, most often caused by glass. Persons who died suffered extensive, multiple injuries from blunt trauma and one death was caused by glass. CONCLUSIONS: All deaths were immediate and the majority of survivors suffered minor to moderate injuries. Injuries and deaths were consistent with extensive glass damage in the compound and fragmentation of building concrete. Improved building designs and retrofits such as blast-resistant glass and prevention of structural collapse or building fragmentation should be considered in building design and construction in high threat areas.

Adult↗
PubMed2005

Impact of the terrorist bombings of the Hong Kong Shanghai Bank Corporation headquarters and the British Consulate on two hospitals in Istanbul, Turkey, in November 2003.

BACKGROUND: The authors sought to estimate the impact of the terrorist bombings of the Hong Kong Shanghai Banking Corporation headquarters and the British consulate in Istanbul, Turkey, on November 20, 2003, on two nearby hospitals, in terms of epidemiologic outcomes, resource utilization, and time course of emergency needs. METHODS: The authors used data from hospital records of injured survivors who used the emergency departments (EDs) at the Taksim Education and Research State Hospital (TERSH) and the American Hospital (AH) in Istanbul on November 20, 2003, to determine the totals and rates of mortality (early, late, and critical), injury, critical injury (Injury Severity Score > 15), ED use, hospitalization, operative care, and in-hospital overtriage and the time intervals of ED arrival. RESULTS: The TERSH received 184 victims in the first hour after the initial blast, of which 88 (48%) were brought by emergency medical services, 171 (93%) had lacerations, 7 (4%) had penetrating eye injuries, 28 (15%) were hospitalized, 18 (10%) received operative care, and 7 (4%) were critically injured. Three deaths occurred in critically injured survivors, including one early death in the operating room and two late deaths on days 5 and 6. The AH received 16 victims, of which 14 (88%) had lacerations, 3 (19%) were hospitalized, 2 (13%) received operative care, and 1 (6%) was critically injured. An additional 4 victims were transferred to the AH from other hospitals, of which 3 were hospitalized and none were critically injured. No early or late deaths occurred. CONCLUSION: Mortality, injury, and hospitalization rates at both hospitals were consistent with previous reports of open-air mass-casualty terrorist bombings. The TERSH experienced an unprecedented demand for ED surge capacity in an open-air bombing.

Blast Injuries↗
PubMed1984

Ultrasonic Acoustic Emissions from the Sapwood of Thuja occidentalis Measured inside a Pressure Bomb.

An improved method of counting acoustic emission (AE) events from water-stressed stems of cedar (Thuja occidentalis L.) is presented. Amplified AEs are analyzed on a real time basis by a microcomputer. The instrumentation counts AE events in a fashion nearly analogous to scintillation counting of radioactive materials.The technique was applied to measuring ultrasonic AEs from the stems of cedar inside a pressure bomb. The shoots were originally fully hydrated. When the shoots are dehydrated in the bomb by application of an overpressure very few AEs were detected. When the bomb pressure is reduced after dehydration of the shoot, AE events could be detected. We conclude that ultrasonic AEs are caused by cavitation events (= structural breakdown of water columns in the tracheids of cedar) and not by the breaking of cellulose fibers in the wood.

Journal Article↗
PubMed1997

The casualty profile from the Manchester bombing 1996: a proposal for the construction and dissemination of casualty profiles from major incidents.

OBJECTIVE: To produce a casualty profile for the Manchester bombing and to illustrate the potential uses of such templates in major incident planning. METHODS: A retrospective review of casualty notes from the Manchester bombing. RESULTS: A complete anonymous casualty profile for the Manchester bombing is given with AIS90 coded injuries. The majority (129, 62%) of casualties sustained minor injuries from flying glass. A significant number of casualties (36, 18%) presented with emotional distress or medical problems. A wide age range of casualties was involved. Few patients (19, 9%) required admission to hospital. There were no deaths and no casualties sustained major trauma. CONCLUSIONS: Casualty profiles may be useful in the planning and testing of health service major incident plans. Such information should be easily accessible to all emergency planners.

Adolescent↗
PubMed1997

"Shattered illusions--the Thiepval Barracks bombing, 7 October 1996".

The provisional IRA's ceasefire ended abruptly with the Canary Wharf bombing in London in February 1996. Hopes that violence would not return to Northern Ireland were shattered by the explosion of two car bombs in the headquarters of the British Army in Ulster in October 1996. The second bomb specifically targeted medical staff treating casualties from the first explosion. This article describes the medical aspects of this incident, including the extensive use of critical incident stress debriefing, and emphasises the implications for the major incident plans of medical centres and military hospitals.

Blast Injuries↗
PubMed2000

Posttraumatic stress among young children after the death of a friend or acquaintance in a terrorist bombing.

The effects of traumatic loss on children who reported a friend or acquaintance killed in the 1995 Oklahoma City bombing of a federal office building were examined. Twenty-seven children who lost a friend or acquaintance and 27 demographically matched controls were assessed eight to ten months after the bombing. All but three of the children continued to experience posttraumatic stress symptoms. Those who lost a friend watched significantly more bombing-related television coverage than those without losses. Those who lost a friend had significantly more posttraumatic stress symptoms at the time of the assessment than those who lost an acquaintance. Parents and those working with children should be alert to the impact of loss even when it involves nonrelatives.

Attitude to Death↗
PubMed2005

The ubiquitin ligase Drosophila Mind bomb promotes Notch signaling by regulating the localization and activity of Serrate and Delta.

The receptor Notch and its ligands of the Delta/Serrate/LAG2 (DSL) family are the central components in the Notch pathway, a fundamental cell signaling system that regulates pattern formation during animal development. Delta is directly ubiquitinated by Drosophila and Xenopus Neuralized, and by zebrafish Mind bomb, two unrelated RING-type E3 ubiquitin ligases with common abilities to promote Delta endocytosis and signaling activity. Although orthologs of both Neuralized and Mind bomb are found in most metazoan organisms, their relative contributions to Notch signaling in any single organism have not yet been assessed. We show here that a Drosophila ortholog of Mind bomb (D-mib) is a positive component of Notch signaling that is required for multiple Neuralized-independent, Notch-dependent developmental processes. Furthermore, we show that D-mib associates physically and functionally with both Serrate and Delta. We find that D-mib uses its ubiquitin ligase activity to promote DSL ligand activity, an activity that is correlated with its ability to induce the endocytosis and degradation of both Delta and Serrate (see also Le Borgne et al., 2005). We further demonstrate that D-mib can functionally replace Neuralized in multiple cell fate decisions that absolutely require endogenous Neuralized, a testament to the highly similar activities of these two unrelated ubiquitin ligases in regulating Notch signaling. We conclude that ubiquitination of Delta and Serrate by Neuralized and D-mib is an obligate feature of DSL ligand activation throughout Drosophila development.

Animals↗
PubMed1991

Incidence of skin cancer among Nagasaki atomic bomb survivors.

Of the 66,276 Nagasaki atomic bomb survivors registered at the Scientific Data Center for the Atomic Bomb Disaster at the Nagasaki University School of Medicine, 140 were identified as having skin cancer from the records of 31 hospitals in Nagasaki City. From the cases of these survivors, a statistical analysis was made of the incidence of skin cancers by age, gender, histology and latency period in Nagasaki atomic bomb survivors. The results showed a high correlation between the incidence of skin cancer and distance from the blast hypocenter, and that the incidence of skin cancer in the Nagasaki survivors appears now to be increasing with exposure distance.

Adult↗
PubMed1991

Cytogenetic and molecular changes in leukemia among atomic bomb survivors.

Seventy five radiation-related leukemia patients in Hiroshima including 16 patients exposed to more than one Gray were cytogenetically examined. Statistical analysis of data on the frequencies of chromosomal aberrations in the survivor groups according to bone marrow doses by DS86 estimation revealed that the heavily exposed group tended to have significantly higher aberration rates compared to the non-exposed group. Furthermore, the chromosomal aberrations in the survivors were observed to be of a more complex nature and had the characteristic findings of secondary leukemia. These observations therefore suggest that patients with a history of heavy exposure to atomic bomb radiation had leukemic cells originating from a stem cell which had been damaged by irradiation at the time of the bombing as well as cells involved in complex chromosome abnormalities. Molecular biologic studies on ras genes in acute and chronic leukemias and the bcr gene in chronic myelocytic leukemia were performed in exposed and non-exposed groups. So far, no distinctive differences have been observed in the frequency and sites of point mutations in N- and K-ras genes or in the rearrangement of the bcr gene. Further, retrospective analysis using DNA from leukemia patients who developed this disease in the early period from atomic bomb radiation exposure would be useful for the elucidation of the mechanisms of radiation-induced leukemia.

Aged↗
PubMed1991

Cytogenetic and molecular changes in leukemia found among atomic bomb survivors.

Seventy five radiation-related leukemias (acute non-lymphocyte) in Hiroshima including 16 patients exposed to more than one Gray were cytogenetically examined. Statistical analysis of the data on the frequencies of chromosomal aberrations in survivors according to the bone marrow doses of DS86 estimation revealed that heavily exposed patients tended to have significantly higher aberration rates as compared with non-exposed patients. Furthermore, the chromosomal aberrations in the survivors were observed to be of a more complex nature and had characteristic findings of secondary leukemia. These observations therefore suggest that patients with a history of heavy exposure to atomic bomb radiation exhibit leukemic cells that originated from a stem cell which had been damaged by irradiation at the time of bombing and had been involved in the complex chromosome abnormalities. Molecular biological studies on transforming genes in acute and chronic leukemia and the bcr gene in chronic myelocytic leukemia have been performed in exposed and non-exposed groups. So far, no distinctive differences have been observed in the frequency and the sites of point mutations in N- and K-ras genes or in the rearrangement of the bcr gene, for a final conclusion of the specificity of radiation induced leukemia. Further retrospective studies require patient DNAs that developed in the early period of the atomic bomb exposure.

Chromosome Aberrations↗
PubMed1991

Mortality among atomic bomb survivors.

The Atomic Bomb Casualty Commission and its successor, the Radiation Effects Research Foundation, have conducted a long-term follow-up study of a cohort of 120,000 atomic bomb survivors and non-exposed controls since 1950. The most recent findings regarding cancer mortality during the period 1950-85 in this cohort, based on the DS86 doses are as follows: 1) The dosimetry change does not alter the list of radiation-related cancers. Some city differences in dose-response previously thought to be real are no longer significant with the DS86 doses. Assuming a linear dose-response, and using estimated organ-absorbed doses, the risk coefficients derived from the two dosimetries are very similar. If larger RBE values are assumed, the disparity between the two dosimetries increases because the neutron dose is much greater in the T65 dosimetry. 2) Besides the well-known increase of leukemia, there also have been demonstrated increases in cancers of the lung, breast, esophagus, stomach, colon, ovary, urinary bladder, and of multiple myeloma, but no increase has yet been observed in mortality from cancer of the rectum, gallbladder, pancreas, prostate and uterus, and of malignant lymphoma. In general, radiation-induced solid cancer begins to appear after attaining the age at which the cancer is normally prone to develop (the so-called "cancer age"), and continues to increase proportionately with the increase in mortality in the control group as it ages. Sensitivity to radiation, in terms of cancer induction, is higher generally for persons who were young at the time of the bomb (ATB) than for those who were older ATB. Non-cancer mortality in the period 1950-78, based on the T65 doses, which is the most recent published report, did not show an increase with dose, but now, with the accumulation of seven more years of follow-up, there seems to be an excess in the very high dose range, particularly for the younger age ATB cohort. Further follow-up is called for to confirm this suggestion.

Female↗
PubMed1991

Persistent chromosome aberrations in the somatic cells of A-bomb survivors, Hiroshima and Nagasaki.

Current status of knowledge on the radiation-induced chromosome aberrations persisting since their induction in 1945 to date in the somatic cells of A-bomb survivors in Hiroshima and Nagasaki is reviewed. Dose-response relationship for chromosome aberration frequencies observed with the use of the old A-bomb dosimetry system (T65D) is also demonstrable based on the new dosimetry system (DS86). Despite the fact that the remarkable decrease in the amount of neutron component relative to the total dose in Hiroshima, there still exist inter-city differences in aberration frequency per unit dose both for kerma and bone marrow dose; the dose-square term is smaller in Hiroshima than in Nagasaki. The differential contribution of neutron radiation may be responsible in some part for the observed difference between Hiroshima and Nagasaki, although proof still remains to be obtained. There is a wide variability of the frequency of cells with chromosome aberrations between survivors within a given dose range. Random errors in the dose estimates assigned to individual survivors seem responsible, to a large extent, for the observed overdispersions in aberration frequencies in both cities. New molecular biology-oriented techniques to differentially stain specific chromosomes using fluorescence in situ hybridization with chromosome-specific composite DNA probes seem extremely promising for future rapid, accurate and extensive screening of reciprocal translocations observed predominantly in A-bomb survivors. Such data may be utilized to establish a better biological dosimetry system, especially for those persons who are irradiated in vivo many years before cytogenetic examinations.

Chromosome Aberrations↗
PubMed1991

Mortality and cancer risk among the offspring (F1) of atomic bomb survivors.

The Atomic Bomb Casualty Commission (ABCC) and its successor Radiation Effect Research Foundation (RERF) has over the years conducted many studies to determine possible genetic effects of atomic bomb radiation among the offspring of atomic bomb survivors. Findings concerning mortality and cancer incidence of the offspring are summarized in this chapter.

Child↗
PubMed1991

A review of forty-five years study of Hiroshima and Nagasaki atomic bomb survivors. Aging.

The hypothesis that exposure to ionizing radiation accelerates the aging process has been actively investigated at ABCC-RERF since 1958, when longitudinal cohort studies of the Adult Health Study (AHS) and the Life Span Study (LSS) were initiated. In their 1975 overall review of aging studies related to the atomic bomb (A-bomb) survivors, Finch and Beebe concluded that while most studies had shown no correlation between aging and radiation exposure, they had not involved the large numbers of subjects required to provide strong evidence for or against the hypothesis. Extending LSS mortality data up to 1978 did not alter the earlier conclusion that any observed life-shortening was associated primarily with cancer induction rather than with any nonspecific cause. The results of aging studies conducted during the intervening 15 years using data from the same populations are reviewed in the present paper. Using clinical, epidemiological, and laboratory techniques, a broad spectrum of aging parameters have been studied, such as postmortem morphological changes, tests of functional capacity, physical tests and measurements, laboratory tests, tissue changes, and morbidity. With respect to the aging process, the overall results have not been consistent and are generally thought to show no relation to radiation exposure. Although some preliminary results suggest a possible radiation-induced increase in atherosclerotic diseases and acceleration of aging in the T cell-related immune system, further study is necessary to confirm these findings. In the future, applying the latest gerontological study techniques to data collected from subjects exposed 45 years ago to A-bomb radiation at relatively young ages will present a new body of data relevant to the study of late radiation effects.

Aging↗
PubMed2005

The Oklahoma City bombing study and methodological issues in longitudinal disaster mental health research.

Several methodological issues may affect the findings of studies of the mental health effects of disasters over time. These issues include analysis of the course of individual disorders over time that may be lost when they are presented embedded in general summary statistics, consideration of assessment of psychiatric disorders versus symptoms, adherence to established criteria in assigning psychiatric diagnoses, and orientation of mental health issues to the type of disaster exposure of the sample. This report will explore these methodological issues in a review of disaster literature and in data obtained from study of survivors of the Oklahoma City bombing. Clinical implications of the data obtained from the Oklahoma City bombing study of survivors of the direct bomb blast are presented in the context of these methodological concerns.

Chronic Disease↗
PubMed2006

Suicide bombing: a psychodynamic view.

The horror and macabre images of suicide bombings appear regularly on television news programs around the world. A focused literature review of psychiatric interview and demographic data about suicide bombers is presented. Of particular clinical interest are the findings from the study of potential suicide bombers who were apprehended before they could act on their suicide bombing plans. The authors offer psychodynamic and social self-psychological theories explaining the phenomenon of suicide bombing behavior.

Explosions↗
PubMed2002

Uneven distributions of naïve and memory T cells in the CD4 and CD8 T-cell populations derived from a single stem cell in an atomic bomb survivor: implications for the origins of the memory T-cell pools in adulthood.

The processes that lead to the establishment and maintenance of memory T-cell pools in humans are not well understood. In this study, we examined the emergence of naïve and memory T cells in an adult male who was exposed to an atomic bomb radiation dose of approximately 2 Gy in 1945 at the age of 17. The analysis presented here was made possible by our earlier observation that this particular individual carries a hematopoietic stem cell mutation at the hypoxanthine phosphoribosyltransferase (HPRT) locus that is almost certainly a result of his exposure to A-bomb radiation. Our key finding is that we detected a very much higher HPRT mutant frequency in the naive (CD45RA(+)) cell component of this individual's CD4 and CD8 T-cell populations than in the memory (CD45RA(-)) cell component of his CD4 and CD8 T-cell populations. This stands in marked contrast to our finding that HPRT mutant frequencies are fairly similar in the naïve CD45RA(+) and memory CD45RA(-) components of the CD4 and CD8 T-cell populations of three unexposed individuals examined concurrently. In addition we found that the HPRT mutant frequencies were about 30-fold higher in the naïve (CD45RA(+)) CD4 T cells of the exposed individual than in his memory (CD45RA(-)) cell populations, but that the effect was a little less striking in his CD8 cell populations, where the HPRT mutant frequencies were only about 15-fold higher in his naïve T-cell pools than in his memory T-cell pools. We further found that 100% of the HPRT mutant cells in both his CD4 and CD8 naïve cell subsets appeared to have originated from repeated divisions of the initial HPRT mutant stem cell, whereas only 4 of 24 and 5 of 6 mutant cells in his CD4 and CD8 memory cell subsets appeared to have originated from that same stem cell. The most straightforward conclusion may be that the great majority of the T cells produced by this individual since he was 17 years old have remained as naïve-type T cells, rather than having become memory-type T cells. Thus the T cells that have been produced from the hematopoietic stem cells of this particular A-bomb-exposed individual seldom seem to enter and/or to remain in the memory T-cell pool for long periods. We speculate that this constraint on entry into memory T-cell pools may also apply to unirradiated individuals, but in the absence of genetic markers to assist us in obtaining evidential support, we must await clarifying information from radically different experimental approaches.

Adult↗
PubMed2002

Effect of radiation dose on the height of atomic bomb survivors: a longitudinal study.

We conducted a longitudinal analysis of height after age 20 for atomic bomb survivors in the Adult Health Study (AHS) cohort. The measurements we used were made from July 1958 to June 1998 (AHS examination cycles 1-20). We analyzed only the subjects with known atomic bomb radiation doses, excluding those who were not in the city at the time of bombing (ATB) and those exposed in utero. We also excluded from the analysis measurements made after the occurrence of vertebral fracture. The total number of subjects was 11,862, and the total number of measurements was 109,770; the mean number of measurements per subject was 9.25. Assuming that stature after age 20 is approximately constant, a simple mixed-effects model was fitted to stature after age 20, and linear dose effects for young ATB subjects were modeled for both sexes. The estimated mean heights for subjects born in 1945 in Hiroshima were 166.0 cm for men and 155.4 cm for women. The sex difference in height was 10.6 cm, with men significantly taller than women (P < 0.001). The difference between the cities was not significant (P = 0.162). The birth cohort effects per decade were -1.7 cm for men (P < 0.001) and -2.1 cm for women (P < 0.001). A reduction of stature due to radiation exposure was observed for individuals of both sexes who were below 19 years of age ATB (95% confidence interval, 17-21 years), and the dose effect was larger for women than for men (P = 0.028). The estimated effects per gray for those who were age 0 ATB were -1.2 cm for men and -2.0 cm for women and for those who were age 10 ATB were-0.57 cm for men and -0.96 cm for women.

Adolescent↗