Bombings specific triage(Bost Tool) tool and its application by healthcare professionals

BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives.METHODS: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic.RESULTS: By using the proportion test, we found that correct triaging was significantly different(P=0.005) in proportion between the two groups: group B(80%) with triage tool performed better in triaging the bomb blast victims than group A(50%) without the bombing specific triage tool performed.CONCLUSION: Development of bombing specific triage tool can reduce under triaging.

Epidemiology of civilian blast injuries inflicted by terrorist bombings from 1970-2016

An upsurge of terrorist activity has occurred in the past two decades. As part of this, explosive devices continue to be extensively deployed against civilians in wide-ranging environments. Bombings remain the leading worldwide cause of civilian fatalities due to terrorism. This demands an understanding of modern terrorist bombing trends to inform mitigation strategy. The objective of this study was to identify the occurrence and severity of bombings against civilian targets in diverse attack settings, and to establish corresponding blast injury profiles. Data was obtained from analysis of the Global Terrorism Database(GTD) and a meta-analysis of blast injury data derived from the PubMed database. Closed environment explosions were associated with significantly greater(p<0.05) mortality than in open spaces. The injury profiles were found to be influenced by attack setting, with higher rates of primary injury on trains and buses, and secondary injury in open space.

Prediction of Extremist Behaviour and Suicide Bombing from Terrorism Contents Using Supervised Learning

This study proposes an architecture for the prediction of extremist human behaviour from projected suicide bombings.By linking‘dots’of police data comprising scattered information of people,groups,logistics,locations,communication,and spatiotemporal characters on different social media groups,the proposed architecture will spawn beneficial information.This useful information will,in turn,help the police both in predicting potential terrorist events and in investigating previous events.Furthermore,this architecture will aid in the identification of criminals and their associates and handlers.Terrorism is psychological warfare,which,in the broadest sense,can be defined as the utilisation of deliberate violence for economic,political or religious purposes.In this study,a supervised learning-based approach was adopted to develop the proposed architecture.The dataset was prepared from the suicide bomb blast data of Pakistan obtained from the South Asia Terrorism Portal(SATP).As the proposed architecture was simulated,the supervised learning-based classifiers na飗e Bayes and Hoeffding Tree reached 72.17%accuracy.One of the additional benefits this study offers is the ability to predict the target audience of potential suicide bomb blasts,which may be used to eliminate future threats or,at least,minimise the number of casualties and other property losses.

Earthquakes induced by deep penetrating bombing

The data of M≥5 earthquakes occurred in one year before and after 4 deep penetrating bombs in the region within 500 km and 1 000 km from the shooting site are presented. The 4 bombs are those happened in 1999 Kosovo of Yugoslavia, the 1991 Baghdad of Iraq, the 2001 Tora Bora of Afghanistan, and the 2003 Kirkuk of Iraq, respec-tively. The data indicate that the deep penetrating bombs may have remotely triggered some earthquakes. The deep penetrating bombs in seismically active regions should be forbidden.

Medical aspects of terrorist bombings: A focus on damage control surgery and damage control resuscitation

Although terrorist bombings have tormented the world for a long time, currently they have reached unprecedented levels and become a continuous threat without borders, race or age. Almost all of them are caused by improvised explosive devices. The unpredictability of the terrorist bombings, leading to simultaneous generation of a large number of casualties and severe "multidimensional" blast trauma require a constant vigilance and preparedness of every hospital worldwide. Approximately 1.0%-2.6% of all trauma patients and 7% of the combat casualties require a massive blood transfusion. Coagulopathy is presented in 65% of them with mortality exceeding 50%. Damage control resuscitation is a novel approach, developed in the military practice for treatment of this subgroup of trauma patients. The comparison with the conventional approach revealed mortality reduction with 40%-74%, lower frequency of abdominal compartment syndrome(8% vs 16%), sepsis(9% vs 20%), multiorgan failure(16% vs 37%) and a significant reduction of resuscitation volumes, both crystalloids and blood products. Damage control surgery(DCS) and damage control resuscitation(DCR) are promising new approaches, contributing for the mortality reduction among the most severely wounded patients. Despite the lack of consensus about the optimal ratio of the blood products and the possible influence of the survival bias, we think that DCR carries survival benefit and recommend it in trauma patients with exsanguinating bleeding.

Using the Haddon matrix to explore medical response strategies for terrorist subway bombings

Background:Since the 1970 s,terrorist bombings in subways have been frequently occurring worldwide.To cope with this threat and to provide medical response countermeasures,we analyzed the characteristics of subway bombing terrorist attacks and used the Haddon matrix to explore medical response strategies.Methods:First,we analyzed 111 subway bombings from 1970 to 2017 recorded in the Global Terrorism Database to provide a reference for the strategy exploration.Then,we convened an expert panel to use the Haddon matrix to explore the medical response strategies to subway bombings.Results:In recent decades,at least one bombing attack occurs every 3 years.Summarized by the Haddon matrix,the influencing factors of medical responses to conventional subway bombings include the adequacy of first-aid kits and the medical evacuation equipment,the traffic conditions affecting the evacuation,the continuity and stability of communication,as well as the factors exclusively attributed to dirty bomb attacks in subways,such as ionizing radiation protection capabilities,the structure of the radiation sickness treatment network based on the subway lines,and the disposal of radioactive sewage.These factors form the basis of the strategy discussion.Conclusions:Since subway bombings are long-term threats,it is necessary to have proper medical response preparation.Based on the Haddon matrix,we explored the medical response strategies for terrorist subway bombings,especially dirty bomb attacks.Haddon matrix can help policymakers systematically find the most important factors,which makes the preparations of the response more efficient.

SubStop:An analysis on subscription email bombing attack and machine learning based mitigation

Email Bombing,a kind of denial-of-service(DoS)attack is crippling internet users and is on the rise recently.A particularly notorious type is the Subscription Bombing attack,where a victim user’s inbox is bombarded with a stream of subscription emails at a particular period.This kind of attack helps the perpetrator to hide their real motive in lieu of a barrage of legitimate-looking emails.The main challenge for detecting subscription bombing attacks is that most of the attacking email appears to be legitimate and benign and thus can bypass existing anti-spam filters.In order to shed some light on the direction of detecting the bombing attacks,in this paper we first conduct some reverse engineering study on the Gmail anti-spam mechanism(as the information is not publicly available)and in-depth feature analysis of real-life bombing attack emails.Leveraging the insights from our reverse engineering study and data analysis,we propose a novel layered detection architecture,termed as SubStop,to detect and mitigate subscription bombs.SubStop exploits the statistics of incoming volume,source domain distribution,the correlation among different features,and implements machine learning to achieve effective detection.In specific,we utilize the weighted support vector machine(WSVM)and properly tune the class weights to achieve high accuracy in detecting bombing attacks.Despite the scarcity of public email data sets,we conduct extensive experiments on a real-life subscription bomb attack and real-time attacks using our bombing simulation script(which is facilitated by our reverse engineering findings),on test email accounts.Detailed experimental results show that our proposed architecture is very robust and highly accurate in detecting and mitigating a subscription bombing attack.

BOMBING AT THE BOX OFFICE

Why the sudden downturn in China’s film industry may help save it当电影遇见资本Wolf Warrior 2 may have single-handedly saved the summer film market,but its sleeper success belies a general downturn in fortunes for Chinese cinema.The highest-grossing Chinese film ever,Warrior 2 has netted over 773.6 million USD at the box office;it now ranks just below the original 1977 Star Wars,and above2014’s Guardians of the Galaxy,in Box Office Mojo’s list of 100all-time biggest earners.

How Did Vinh Moc Village, Located near Vietnam DMZ, Protect Their Villagers from United States Air Force Bombardment during the Vietnam War?

The buried village is Vinh Moc where more than 1200 Vietnamese, including soldiers, who lived underground during the Vietnam War (1965 to 1972) were hand dug into red basalt bedrock. The Vinh Moc Village was strategically located on the border of North Vietnam and South Vietnam approximately 14 km north of the DMZ and along the shoreline of the South China Sea. During the Vietnam War, the US Air Force heavily bombed Vinh Moc. The North Vietnamese Army (NVA) had an important military base on nearby Con Co Island. Brave civil volunteers from Vinh Moc would make the 28 km dangerous journey to the island, disguised as fishermen, to deliver supplies to the soldiers stationed there. The people who remained at Vinh Moc dug tunnels into red basalt hills in order to survive this onslaught. The American forces assessed the villagers of Vinh Moc were supplying food and armaments to the NVA garrison on the island of Con Co, which was in turn hindering the American bombers on their way to bomb Hanoi. The US military objective was to force the villagers of Vinh Moc to leave the area. The villagers initially dug the tunnels to a 10 m depth but the American forces designed bombs that burrowed down 10 m before exploding. The soil tunnels were then deepened to 30 m to provide safety for the soldiers and civilians working there during the intense US Air Force bombing. The primary objective of the research study was to determine how the soils and parent material of Vinh Moc Village, protected their villagers from the United States Air Force bombardment during the Vietnam War. In addition, the natural parent material at both the Vinh Moc and Cu Chi were assessed to determine why the tunnels were so resilient. The Cu Chi and Iron Triangle soil tunnels were dug by hand in the Old Alluvium soils and parent material where iron in solution precipitated and became the soil binding material. The Vinh Moc tunnels were hand dug in porous, red basalt (bedrock) hills where the consolidated rock structure itself provided the required binding material. Neither site needed support beams to hold up the ceilings.

Comprehensive bioinformatic analysis of mind bomb 1 gene in stomach adenocarcinoma

BACKGROUND The carcinogenesis of stomach adenocarcinoma(STAD)involves many different molecules and multiple pathways,including the NOTCH signaling pathway.As a key factor that functions as a critical link in the NOTCH pathway,mind bomb 1(MIB1)is upregulated in various tumors and has been reported to promote cell metastasis and invasion.However,studies on the role of MIB1 in STAD are limited.Here,we evaluated the prognostic value of MIB1 in STAD and its association with immune infiltration and copy number variation.AIM To elucidate the relationship between MIB1 gene and gastric cancer(GC)and provide a new idea for the treatment of GC.METHODS We identified mutations in the MIB1 gene by searching the cBioPortal database and then analyzed their relationship with the overall survival rate and diseasefree survival rate using the Kaplan-Meier method.The Cancer Genome Atlas(TCGA)database provided transcript levels for MIB1 in STADs and normal tissues.As a method of distinguishing the STAD tissues from adjacent normal tissues,a receiver operating characteristic(ROC)curve was generated.Kaplan-Meier plotter was used to determine the effect of MIB1 expression on survival.Based on the LinkedOmics database,we were able to identify the coexpressed genes of the MIB1 gene,the top 50 positively correlated genes,and the top 50 negatively correlated genes.STRING was used to construct protein-protein interaction networks related to the MIB1 gene.An analysis of functional enrichment was carried out using the R package“Cluster Profiler”.The relationships between mRNA expression of MIB1 and immune infiltrates were assessed by Tumor IMmune Estimation Resource(TIMER)and the“GSVA package”in R.RESULTS According to the cBioPortal database,the MIB1 mutation rate in 287 patients in the TCGA dataset was approximately 6%.Kaplan-Meier survival analysis showed that patients with STAD in the mutated group had a worse prognosis than those in the unmutated group(P=0.0156).There was a significant upregulation of MIB1 expression in STAD tissues compared to adjacent normal tissues.A high T stage was associated with increased MIB1 mRNA expression.The ROC curve analysis revealed 59.4%sensitivity and 85.6%specificity of MIB1 for differentiating STAD tissues from adjacent normal tissues at a truncation level of 2.248.Kaplan-Meier plotter indicated that patients with higher MIB1 levels had a worse prognosis than those with lower levels(26.4 mo vs 56.2 mo,P=0.0330).A correlation analysis demonstrated an association between immune infiltrates and MIB1 mRNA expression.CONCLUSION Upregulation of MIB1 expression is significantly associated with poor survival rate and immune infiltration in gastric adenocarcinoma.MIB1 may be a biomarker for the poor prognosis of STAD patients and a potential immunotherapeutic target.

Review and Analysis: United States Cluster Munitions and Unexploded Ordnance Left in Laos after the Second Indochina War

Cluster munitions release dozens of smaller bomblets that rain deadly ammunition on armored tanks, vegetation and troops, effectively striking broad areas of war zone landscapes in one launch. However, only about 60% of bomblets detonate immediately and those that fail to detonate fall to the ground and can lie dormant for years. The legacy of cluster munitions in Laos from the Second Indochina War is unexploded bomblets across the landscape that unexpectedly detonate years later, injuring and killing children, farmers, and other civilians long after the war is over. In Laos, the United States (US) military operation against the Ho Chi Minh Trail, a network of foot and bicycle paths, waterways, and truck routes along the Laos, Cambodia and Vietnam borders linking North and South Vietnam began in 1959. By the 1960s, as the war escalated, trail traffic was interdicted frequently by CIA and US Air Force using tactical herbicide spraying to defoliate dense vegetation and bombing to disrupt supplies and North Vietnamese troops dispersed along the 16,000-kilometer trail. Unexploded ordinance (UXO), including cluster munitions, from U.S. bombings continued in recent years to detonate, kill, maim and injure Laotians and render agricultural lands too hazardous to cultivate. The primary objectives of this study are to document: 1) the long-term consequences and impacts of the US Air Force bombing of Laos during the Second Indochina War (1959 to 1973);2) the United States removal of unexploded ordnance and cluster munitions;and 3) worldwide relief efforts to help the Laotians maimed by unexploded ordnance and cluster munitions.

Terrorist Networks, Network Energy and Node Removal: A New Measure of Centrality Based on Laplacian Energy

In this work we propose a centrality measure for networks, which we refer to as Laplacian centrality, that provides a general framework for the centrality of a vertex based on the idea that the importance (or centrality) of a vertex is related to the ability of the network to respond to the deactivation or removal of that vertex from the network. In particular, the Laplacian centrality of a vertex is defined as the relative drop of Laplacian energy caused by the deactivation of this vertex. The Laplacian energy of network G with?n?vertices is defined as , where ?is the eigenvalue of the Laplacian matrix of G. Other dynamics based measures such as that of Masuda and Kori and PageRank compute the importance of a node by analyzing the way paths pass through a node while our measure captures this information as well as the way these paths are “redistributed” when the node is deleted. The validity and robustness of this new measure are illustrated on two different terrorist social network data sets and 84 networks in James Moody’s Add Health in school friendship nomination data, and is compared with other standard centrality measures.

On Indiscriminate Bombardment during World War II: Opposition between Human Rights and Human Rights Abuse

Base on the strategic bombardment to destroy willpower of Chinese Anti-Japanese war, in the Second World War, Japanese aircrafts were nondiscriminatorily bombing China’s cities, which committed crimes against humanity. Actually, the US army nondiscriminatorily bombed Hiroshima and Nagasaki and damaged the human rights too. The US army, however, speeded up Japanese surrender and protected more people’s rights to life. It is never forgotten that the painful game of protecting and damaging human rights between Japanese militarism and anti-fascist alliance.

Numerical study on the case effect of a bomb air explosion

When considering the bomb explosion damage effect,the air shock wave and high-speed fragments of the bomb case are two major threats.In experiments,the air shock wave was studied by the bare explosives superseding the real cased bomb;in contrast,the bomb case influence was ignored to reduce risk.The air explosion simulations of the MK84 warhead with and without the case were conducted.The numerical simulation results showed that the bomb case significantly influenced the shock wave generated by the bomb:the spatial distribution of shock wave in the near field changed,and the peak value of shock wave was reduced.Breakage of the case and kinetic energy of the fragmentation consumed 3 and 38% of the explosion energy,respectively.The increasing factors of the peak overpressure induced by the bare explosive on the ground and in the air were 1.43-3.04 and 1.37-1.57,respectively.Four typical stages of case breakage were defined.The mass distribution of the fragments follows the Mott distribution.The initial velocity distribution of the fragments agreed well with the Gurney equation.

Underwater explosion effects of 60 mm H.E. mortar bomb on a cylindrical concrete structure-PIT

PIT tests are usually performed when a mass distribution of High Explosive(H.E) projectile fragments is required. This paper shows the underwater detonation effects of 60 mm, M90 H.E. mortar bomb filled with Comp. B on cylindrical concrete structure(concrete pipe closed at one end-similar to a PIT test)which is 2 m high(inner height) with inner diameter of also 2 m. Thickness of both wall and bottom of a pipe is 0.35 m. Detailed characteristics of concrete which is used for manufacturing of a pipe are specified. Mortar bomb is submerged directly in to the water(no free airspace around the bomb) with the nose pointing to the bottom of a pipe. Number and mass of fragments after detonation are presented by table and photographs. Fragments of dummy fuze, through which blasting cap was protruded, are collected and reassembled to form a shape of a fuze after detonation where expanding of fuze material due to a detonation products is visualized. After underwater detonation, detonation of the same mortar bomb is performed in an empty pipe and the effects of this kind of detonation are observed. Distance at which fragments generated from submerged mortar bomb will not reach concrete pipes wall is also determined.

Structure Analyses of the Explosive Extratropical Cyclone:A Case Study over the Northwestern Pacific in March 2007

The synoptic situation and mesoscale structure of an explosive extratropical cyclone over the Northwestern Pacific in March 2007 are investigated through weather station observations and data reanalysis. The cyclone is located beneath the poleward side of the exit of a 200 hPa jet, which is a strong divergent region aloft. At mid-level, the cyclone lies on the downstream side of a well-developed trough, where a strong ascending motion frequently occurs. Cross-section analyses with weather station data show that the cyclone has a warm and moist core. A ‘nose' of the cold front, which is characterized by a low-level protruding structure in the equivalent potential temperature field, forms when the cyclone moves offshore. This ‘nose' structure is hypothesized to have been caused by the heating effect of the Kuroshio Current. Two low-level jet streams are also identified on the western and eastern sides of the cold front. The western jet conveys cold and dry air at 800–900 hPa. The wind in the northern part is northeasterly, and the wind in the southern part is northwesterly. By contrast, the eastern jet carries warm and moist air into the cyclone system, ascending northward from 900 hPa to 600–700 hPa. The southern part is dominated by the southerly wind, and the wind in the northern part is southwesterly. The eastern and western jets significantly increase the air temperature and moisture contrast in the vicinity of the cold front. This increase could play an important role in improving the rapid cyclogenesis process.

Preparing for a “dirty bomb” attack: The optimum mix of medical countermeasure resources

Background: In radiological emergencies with radionuclide incorporation, decorporation treatment is particularly effective if started early. Treating all people potentially contaminated("urgent treatment") may require large antidote stockpiles. An efficacious way to reduce antidote requirements is by using radioactivity screening equipment. We analyzed the suitability of such equipment for triage purposes and determined the most efficient mix of screening units and antidote daily doses.Methods: The committed effective doses corresponding to activities within the detection limits of monitoring portals and mobile whole-body counters were used to assess their usefulness as triage tools. To determine the optimal resource mix, we departed from a large-scale scenario(60,000 victims) and based on purchase prices of antidotes and screening equipment in Germany, we calculated efficiencies of different combinations of medical countermeasure resources by data envelopment analysis. Cost-effectiveness was expressed as the costs per life year saved and compared to risk reduction opportunities in other sectors of society as well as the values of a statistical life.Results: Monitoring portals are adequate instruments for a sensitive triage after cesium-137 exposure with a high screening throughput. For the detection of americium-241 whole-body counters with a lower daily screening capacity per unit are needed. Assuming that 1% of the potentially contaminated patients actually need decorporation treatment, an efficient resource mix includes 6 monitoring portals and 25 mobile whole-body counters. The optimum mix depends on price discounts and in particular the fraction of victims actually needing treatment. The costeffectiveness of preparedness for a "dirty bomb" attack is less than for common health care, but costs for a life year saved are less than for many risk-reduction interventions in the environmental sector.Conclusion: To achieve economic efficiency a high daily screening capacity is of major importance to substantially decrease the required amount of antidote doses. Among the determinants of the number of equipment units needed, the fraction of the potentially contaminated victims that actually needs treatment is the most difficult to assess. Judging cost-effectiveness of the preparedness for "dirty bomb" attacks is an issue of principle that must be dealt with by political leaders.

Nursing Activities at Health Surveys and Health Checkups during the Early Period of Operation of the Hiroshima ABCC—Oral History Study Based on Narratives of Three Japanese Nurses

Using an oral history approach, this study analyzed the narratives obtained from semi-structured interviews administered to three Japanese women who worked as nurses for the Hiroshima Atomic Bomb Casualty Commission (ABCC). The analysis of the data in the narratives showed details of the health surveys and health checkups conducted during the early period of operation of ABCC. During the early period of operation of ABCC some survivors showed negative behaviors toward the health surveys and health checkups at the ABCC. However, it can be inferred that dedicated nursing played an important role in alleviating the stress and emotional issues of survivors at the health surveys and health checkups. The findings of the study could be beneficial to research into nursing activities for patients exposed to radiation at the present day.

An Experimental Determination of Gross Calorific Value of Different Agroforestry Species and Bio-Based Industry Residues

Solid biomass fuels are useful and cost effective renewable energy source. The energy content of biomass is determined by its calorific value. The objective of this study was to determine experimentally the gross calorific value (GCV) of different agroforestry species and bio-based industry residues that could be used by: a) companies specialized in processing raw biomass solid biofuel production, b) small-scale consumers (households, medium-sized residential buildings, etc.). The fuel samples used were from agricultural residues and wastes (rice husks, apricot kernels, olive pits, sunflower husks, cotton stems, etc.), energy crops and wetland herbs (cardoon, switchgrass, common reed, narrow-leaf cattail), and forest residues (populus, fagus, pinus). The GCV of the bio-mass samples was experimentally determined based on CEN/TS 14918:2005, and an oxygen bomb calorimeter was used (Model C5000 Adiabatic Calorimeter, IKA?-Werke, Staufen, Germany). The GCV of different agroforestry species and residues ranges from 14.3 - 25.4 MJ?kg–1. The highest GCV was obtained by seeds and kernels due to higher unit mass and higher lipid content. Pinus sylvestris with moisture content 24.59% obtained the lowest GCV (13.973 MJ?kg–1).