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[Biomechanical-clinical interpretation of firearm wounds. General problems. VIII. Propedeutic ABC of terminal ballistics].

The Authors, consistent with their aim to compare and contrast the two protagonists of bullet wounds, namely the bullet and its soft human target, delineating their respective profiles, strengths and weaknesses, feel obliged to dwell at some length on the most frequently pathogenetic regulation firearms. Up until the early twentieth century bullet wounds could be generically classified among the forms of open traumatism, but with the advent of high-speed bullets they have come to take on a unique profile of their own, setting against the old permanent cavity due to mechanical insult a new type of transitory ghost, the definition of which as a cavity would merely be an oversimplification in theoretical terms. Can we really attribute this somewhat privileged dimension to bullet wounds today or must we relegate them once again to the sphere of mechanical traumatisms, albeit with a new inflammatory key to their interpretation, making the most in this sense of the contribution provided by the speed of the bullet? The literature is abundant, but uncertain; we intend to attempt an answer to this tricky question in the following pages, devoted more properly to terminal ballistics. Undoubtedly, the new speeds have had a substantial impact on the wounds inflicted upon the soft target, but the streamlining of the jacket has modified and even offset the results, giving rise to the unexpectedly humanitarian bullet, later subject to reappraisal in military quarters as tactically more efficient, because it obliges the enemy to employ greater resources for recovering, assisting and healing the wounded. We can safely claim that ballistic science in the field of light or portable firearms is experiencing a contradiction between the speed of the bullet and the streamlining of the jacket which makes this speed possible, but which undermines the efficacy of the often unconfessable results. Short-barrelled firearms, which on account of their defensive role, the alibi of their problematic access to speed, and their characteristic use as "last-chance" weapons, are less subject to international constraints and enjoy an extensive civilian market with specific claims to stopping power, thus become the true witnesses to a reality no different to the one Dum-Dum interpreted: the field of modern regulation firearms is shrouded in similar doubts, strengthened by the increasingly short barrels of the weapons, remedies and temptations, with, in addition, the increasingly precarious nature of the human element behind the firearm.(ABSTRACT TRUNCATED AT 400 WORDS)

Biomechanical Phenomena↗
PubMed2003

"In the interest of humanity and the cause of science": the yellow fever volunteers.

The scientific discoveries of the U.S. Army Yellow Fever Board of 1900 are well known as are the Army physicians who led the board. Walter Reed, of course, is the best known, but James Carroll, Aristides Agramonte, and Jesse Lazear are also known, if not nationally, to their local communities. This article deals not with the known but with the unknown, meaning the volunteers who subjected themselves to the ravages of yellow fever and the real possibility of death. The year 1900 was known as a "yellow fever year" among the locals in Cuba because in the preceding year the epidemics had been relatively mild. Beginning its work in June 1900 in the midst of a deadly epidemic, the board conducted a truly remarkable set of experiments that set a benchmark for controlled clinical trials and informed consent. Because no animal model was known to be susceptible to yellow fever, they used human volunteers for their experiments. These volunteers were recruited from among Spanish immigrants and were accepted from soldiers and two civilians who volunteered. Over 30 men participated in the experiments, and 22 developed yellow fever. With expected death rates of 20% to 40%, it is incredible that none of these volunteers died. In 1929, the U.S. government honored the Americans who volunteered by placing their names on a Roll of Honor published annually in the Army Register. The successes of the 1900 U.S. Army Yellow Fever Board were truly remarkable, and many of the successes were made possible by the men who volunteered, some repeatedly, to risk their lives "in the interest of humanity and the cause of science."

Awards and Prizes↗
PubMed2004

Environmental fate and bioavailability of Agent Orange and its associated dioxin during the Vietnam War.

BACKGROUND: In 1996, the Committee on the Assessment of Wartime Exposure to Herbicides in Vietnam of the National Academy of Sciences' Institute of Medicine (IOM) issued a report on an exposure model for use in epidemiological studies of Vietnam veterans. This exposure model would consider troop locations based on military records; aerial spray mission data; estimated ground spraying activity; estimated exposure opportunity factors; military indications for herbicide use; and considerations of the composition and environmental fate of herbicides, including changes in the TCDD content of the herbicides over time, the persistence of TCDD and herbicides in the environment, and the degree of likely penetration of the herbicides into the ground. When the final report of the IOM Committee was released in October 2003, several components of the exposure model envisioned by the Committee were not addressed. These components included the environmental fate of the herbicides, including changes in the TCDD content over time, the persistence of TCDD and herbicides in the environment, and the degree of likely penetration of herbicides into the ground. This paper is intended to help investigators understand better the fate and transport of herbicides and TCDD from spray missions, particularly in performing epidemiological studies. METHODS: This paper reviews the published scientific literature related to the environmental fate of Agent Orange and the contaminant, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), and discusses how this affected the potential exposure to TCDD of ground troops in Vietnam. Specifically, the mechanisms of dissipation and degradation as they relate to environmental distribution and bioavailability are addressed. RESULTS: The evaluation of the spray systems used to disseminate herbicides in Vietnam showed that they were capable of highly precise applications both in terms of concentrations sprayed and area treated. Research on tropical forest canopies with leaf area indices (a measure of foliage density) from 2 to 5 indicated that the amount of herbicide and associated TCDD reaching the forest floor would have been between 1 and 6% of the total aerial spray. Studies of the properties of plant surface waxes of the cuticle layer suggested that Agent Orange, including the TCDD, would have dried (i.e., be absorbed into the wax layer of the plant cuticle) upon spraying within minutes and could not be physically dislodged. Studies of Agent Orange and the associated TCDD on both leaf and soil surface have demonstrated that photolysis by sunlight would have rapidly decreased the concentration of TCDD, and this process continued in shade. Studies of 'dislodgeable foliar residues' (DFR, the fraction of a substance that is available for cutaneous uptake from the plant leaves) showed that only 8% of the DFR was present 1 hr after application. This dropped to 1% of the total 24 hrs after application. Studies with human volunteers confirmed that after 2 hrs of saturated contact with bare skin, only 0.15-0.46% of 2,4,5-T, one of the phenoxy acetic acid compounds that was an active ingredient of Agent Orange, entered the body and was eliminated in the urine. CONCLUSIONS: The prospect of exposure to TCDD from Agent Orange in ground troops in Vietnam seems unlikely in light of the environmental dissipation of TCDD, little bioavailability, and the properties of the herbicides and circumstances of application that occurred. Photochemical degradation of TCDD and limited bioavailability of any residual TCDD present in soil or on vegetation suggest that dioxin concentrations in ground troops who served in Vietnam would have been small and indistinguishable from background levels even if they had been in recently treated areas. Laboratory and field data reported in the literature provide compelling evidence on the fate and dislodgeability of herbicide and TCDD in the environment. This evidence of the environmental fate and poor bioavailability of TCDD from Agent Orange is consistent with the observation of little or no exposure in the veterans who served in Vietnam. Appreciable accumulation of TCDD in veterans would have required repeated long-term direct skin contact of the type experienced by United States (US) Air Force RANCH HAND and US Army Chemical Corps personnel who handled or otherwise had direct contact with liquid herbicide, not from incidental exposure under field conditions where Agent Orange had been sprayed.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed2005

Constructing clinical science.

Clinical practice became clinical science in the years 1720-1820. There were many reasons for this transformation. The discoveries by Santorio Santorio, William Harvey, Marcello Malpighi, Giovanni Alfonso Borelli, Lorenzo Bellini, Thomas Sydenham, Giovanni Maria Lancisi, were perceived by students who asked for changes in the medical curriculum. In 1761 Morgagni centered the study of diseases on morbid anatomy, a way to control at autopsy the validity of diagnosis. J.P. Frank who worked on public health and John Locke who supported a method of scientific reasoning based on asking questions were also instrumental for changes. Hospitals, formerly hospices for the poor, became places for curing and healing. Military hospitals represented models to be followed. In Vienna Marie Therese inaugurated the Allegemein Krankenhaus in 1785. In revolutionary France Fourcroy with the law Frimaire An III, 1794 gave a new rationale. Medicine and surgery were unified in the curriculum. Basic sciences were introduced. Dissection became compulsory, practical teaching became the rule. But it was with John Hunter, Domenico Cotugno and P. Joseph Desault that the great advancement was achieved. They were anatomists and therefore they made the knowledge of human body the core of medical curriculum. However experimentation on animals, as well as practical bedside teaching at the hospital also became important. Through their work hospitals and universities were associated in a common goal.

Anatomy↗
PubMed2002

How virtual reality may enhance training in obstetrics and gynecology.

OBJECTIVE: Contemporary training in obstetrics and gynecology is aimed at the acquisition of a complex set of skills oriented to both the technical and personal aspects of patient care. The ability to create clinical simulations through virtual reality (VR) may facilitate the accomplishment of these goals. The purpose of this paper is 2-fold: (1) to review the circumstances and equipment in industry, science, and education in which VR has been successfully applied, and (2) to explore the possible role of VR for training in obstetrics and gynecology and to suggest innovative and unique approaches to enhancing this training. MATERIAL AND METHODS: Qualitative assessment of the literature describing successful applications of VR in industry, law enforcement, military, and medicine from 1995 to 2000. Articles were identified through a computer-based search using Medline, Current Contents, and cross referencing bibliographies of articles identified through the search. RESULTS: One hundred and fifty-four articles were reviewed. This review of contemporary literature suggests that VR has been successfully used to simulate person-to-person interactions for training in psychiatry and the social sciences in a variety of circumstances by using real-time simulations of personal interactions, and to launch 3-dimensional trainers for surgical simulation. These successful applications and simulations suggest that this technology may be helpful and should be evaluated as an educational modality in obstetrics and gynecology in two areas: (1) counseling in circumstances ranging from routine preoperative informed consent to intervention in more acute circumstances such as domestic violence or rape, and (2) training in basic and advanced surgical skills for both medical students and residents. CONCLUSION: Virtual reality is an untested, but potentially useful, modality for training in obstetrics and gynecology. On the basis of successful applications in other nonmedical and medical areas, VR may have a role in teaching essential elements of counseling and surgical skill acquisition.

Clinical Competence↗
PubMed2003

D.A. Henderson: acting globally, thinking locally.

They had said that it couldn't be done-the worldwide eradication of smallpox. To hear D.A. Henderson tell it, the job of leading the World Health Organization's initiative to conquer the disease in the 1960s and 1970s rather fell into his lap. In fact, he describes each of the posts that he has held with great modesty, beginning with his military service at the Centers for Disease Control and Prevention all the way through his assignments as Dean of Public Health at Johns Hopkins, Associate Director of the Office of Science and Technology Policy in the Executive Office of the President, and more recently as Director of the Office of Public Health Preparedness under Secretary Thompson at the Department of Health and Human Services. Confronted with enormous challenges in terms of public health initiatives, Henderson describes each assignment as a matter of communicating with the people he works with and the people that he serves, and drawing on their insights to devise strategies for accomplishing the task at hand. With bioterrorism posing one of the major public health concerns to face the United States and the world, it's gratifying to know that someone with Henderson's track record and wide-ranging expertise is paying attention and making sure that medical and government officials are preparing to respond to the threat. Again and again, Henderson appears to have the knack for showing up in the right place at the right time with just the right idea.

Bioterrorism↗
PubMed1985

[On the economy of "wealth of people": demographic-political theories in the Austria of enlightened absolutism].

"This essay focuses on mercantilist theories and interpretations of demographic trends [in Austria] in the late 18th century." The writings of several mercantilist authors are summarized, and the influence of their views on population policy is discussed. It is noted that the official population policy, which aimed at fast population growth to strengthen the economy and increase the number of soldiers, was based on the mercantilist theory that greater population size means higher per capita incomes. (summary in ENG)

Austria↗
PubMed2002

[Ottomane's pharmacies in Istanbul].

In the middle of the XIXth century, we notice that the pharmacies in Istanbul are the same as European pharmacies. The French scientific influency is very important: French language is officially used for the medicines, the instruction at school, in the publications and the business meetings. Until 1890, the owners of pharmacies are generally foreigners or persons of minorities with Ottomane nationality. After this date, pharmacies belonging to Turkish people are more numerous. We notice that military and public hospital pharmacies were quite well organized. There is two imperial pharmacies inside of Topkapï Palace and Yïldïz Palace, created by the Sultan Abdülhamid. The teachers in pharmaceutical science were very famous: Bonkowsi Pacha, Giorgio Della Sudda, Antoine Calleja.

Europe↗
PubMed2005

Funding agendas: has bioterror defense been over-prioritized?

Post-9/11, concern about bioterrorism has transformed public health from unappreciated to a central component of national security. Within the War on Terror, bioterrorism preparedness has taken a back seat only to direct military action in terms of funding. Domestically, homelessness, joblessness, crime, education, and race relations are just a few of a litany of pressing issues requiring government attention. Even within the biomedical sciences and healthcare, issues surrounding the fact that more than 40 million Americans lack health insurance, the rising cost of prescription medications, and the use of government funds for research using embryonic stem cells remain unresolved. Should we prioritize a hypothetical threat (bioterrorism), or existing conditions that have implications for identifiable individuals? Even more fundamentally, should we prioritize research aimed at defense from bioterrorism (or even terrorism in general) when there are so many pressing social problems that affect the U.S. population?

Biomedical Research↗
PubMed2003

A geographic information system for characterizing exposure to Agent Orange and other herbicides in Vietnam.

Between 1961 and 1971, U.S. military forces dispersed more than 19 million gallons of phenoxy and other herbicidal agents in the Republic of Vietnam, including more than 12 million gallons of dioxin-contaminated Agent Orange, yet only comparatively limited epidemiologic and environmental research has been carried out on the distribution and health effects of this contamination. As part of a response to a National Academy of Sciences' request for development of exposure methodologies for carrying out epidemiologic research, a conceptual framework for estimating exposure opportunity to herbicides and a geographic information system (GIS) have been developed. The GIS is based on a relational database system that integrates extensive data resources on dispersal of herbicides (e.g., HERBS records of Ranch Hand aircraft flight paths, gallonage, and chemical agent), locations of military units and bases, dynamic movement of combat troops in Vietnam, and locations of civilian population centers. The GIS can provide a variety of proximity counts for exposure to 9,141 herbicide application missions. In addition, the GIS can be used to generate a quantitative exposure opportunity index that accounts for quantity of herbicide sprayed, distance, and environmental decay of a toxic factor such as dioxin, and is flexible enough to permit substitution of other mathematical exposure models by the user. The GIS thus provides a basis for estimation of herbicide exposure for use in large-scale epidemiologic studies. To facilitate widespread use of the GIS, a user-friendly software package was developed to permit researchers to assign exposure opportunity indexes to troops, locations, or individuals.

2,4,5-Trichlorophenoxyacetic Acid↗