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Background: Risk for violent victimization or crime perpetration after firearm-related hospitalization (FRH) must be determined to inform the need for future interventions. Objective: To compare the risk for subsequent violent injury, death, or crime perpetration among patients with an FRH, those hospitalized for non-injury reasons, and the general population. Design: Retrospective cohort study. Setting: All hospitals in Washington. Patients: Patients with an FRH and a random sample of those with a non–injury-related hospitalization in 2006 to 2007 (index hospitalization). Measurements: Primary outcomes included subsequent FRH, firearm-related death, and the combined outcome of firearm- or violence-related arrest ascertained through 2011. Results: Among patients with an index FRH (n = 613), rates of subsequent FRH, firearm-related death, and firearm- or violence-related arrest were 329 (95% CI, 142 to 649), 100 (CI, 21 to 293), and 4221 (CI, 3352 to 5246) per 100 000 person-years, respectively. Compared with the general population, standardized incidence ratios among patients with an index FRH were 30.1 (CI, 14.9 to 61.0) for a subsequent FRH and 7.3 (CI, 2.4 to 22.9) for firearm-related death. In survival analyses that accounted for competing risks, patients with an index FRH were at greater risk for subsequent FRH (subhazard ratio [sHR], 21.2 [CI, 7.0 to 64.0]), firearm-related death (sHR, 4.3 [CI, 1.3 to 14.1]), and firearm- or violence-related arrest (sHR, 2.7 [CI, 2.0 to 3.5]) than those with a non–injury-related index hospitalization. Limitation: Lack of information on whether patients continued to reside in Washington during follow-up may have introduced outcome misclassification. Conclusion: Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization or crime perpetration. Further research at the intersection of clinical care, the criminal justice system, and public health to evaluate the effectiveness of interventions delivered to survivors of firearm-related injury is warranted. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hospital-centered violence intervention programs (HVIPs) reduce violent injury recidivism. However, dedicated cost analyses of such programs have not yet been published. We hypothesized that the HVIP at our urban trauma center is a cost-effective means for reducing violent injury recidivism. METHODS: We conducted a cost-utility analysis using a state-transition (Markov) decision model, comparing participation in our HVIP with standard risk reduction for patients injured because of firearm violence. Model inputs were derived from our trauma registry and published literature. RESULTS: The 1-year recidivism rate for participants in our HVIP was 2.5%, compared with 4% for those receiving standard risk reduction resources. Total per-person costs of each violence prevention arm were similar: $3,574 for our HVIP and $3,515 for standard referrals. The incremental cost effectiveness ratio for our HVIP was $2,941. CONCLUSION: Our HVIP is a cost-effective means of preventing recurrent episodes of violent injury in patients hurt by firearms. [ABSTRACT FROM AUTHOR]

Firearm ( FA) injuries pose great health burden and presents enormous challenge for health and national economies. This study was undertaken to analyze the characteristics of fatal gunshot injuries, their pattern, associated factors, and postmortem findings in central India, to provide data for such fatalities in this region, which has not been reported earlier. This is a descriptive, retrospective cross-sectional study carried out on the victims of FA injuries referred to the mortuary. Of the autopsies conducted during study, 2.09% were firearm-related deaths. Of the cases, males (92.42%) notably outnumbered females in a ratio of 12.2:1. Homicidal attacks were maximum, and unlicensed, illegal country-made weapons were the preferred choice. Suicides were least. Result signifies that illegal country-made weapons should be strictly limited to save the precious lives. A holistic approach encompassing public awareness, behavioral modification, and stringent management of law and order is the need of the hour. [ABSTRACT FROM AUTHOR]

Firearm-related injuries are caused by a wide variety of weapons and projectiles. The kinetic energy of the penetrating projectile defines its ability to disrupt and displace tissue, whereas the actual tissue damage is determined by the mode of energy release during the projectile–tissue interaction and the particular characteristics of the tissues and organs involved. Certain projectile factors, namely shape, construction, and stability, greatly influence the rate of energy transfer to the tissues along the wound track. Two zones of tissue damage can be identified, the permanent cavity created by the passage of the bullet and a potential area of contused tissue surrounding it, produced mainly by temporary cavitation which is a manifestation of effective high-energy transfer to tissue. Due to the complex nature of these injuries, wound assessment and the type and extent of treatment required should be based on an understanding of the various mechanisms contributing to tissue damage. [ABSTRACT FROM AUTHOR]

Hunting remains an extremely popular recreational activity, with nearly 15 million Americans receiving a hunting license annually. Precautions have helped decrease accidents, but hunting-related injuries remain relatively common. The majority of severe, hunting-related accidents involve either a fall from a hunting platform or an accidental shooting. Both of these mechanisms frequently result in orthopedic injuries, many of which require operative care. Although firearms-associated injury has seemingly decreased, hunting platform falls and their sequelae are increasing. Understanding the mechanisms of these injuries and increasing awareness of them may minimize their morbidity and mortality or help prevent them altogether. [ABSTRACT FROM AUTHOR]

The article presents information on the statements and recommendations of the American College of Physicians' Health and Public Policy Committee on the formation of policies to reduce the rate of firearm injuries in the U.S. Topics discussed include role of physicians in the counseling of patients to educate them about the risk of fire arms at home, strong criminal prosecution of people for selling firearms illegally and training of physicians to respond to patients with mental illness.

Background: Professional organizations have called for the medical community’s attention to the prevention of firearm injury. However, little is known about physicians’ attitudes and practices in preventing firearm injury. Objective: To determine internists’ attitudes and practices about firearms and to assess whether opinions differ according to whether there are gun owners in a physician’s home. Design: Cross-sectional survey. Setting: Internal medicine practices. Participants: 573 internists representative of American College of Physicians’ members. Measures: Respondents’ experiences and reported practice behaviors related to firearms and their opinions about contributors and public policies related to firearm violence, as well as physician education and training in firearm safety. Results: The survey response rate was 56.5%. Eighty-five percent of respondents believed that firearm injury is a public health issue, and 71% believed that it is a bigger problem today than a decade ago. Seventy-six percent of respondents believed that stricter gun control legislation would help reduce the risks for gun-related injuries or deaths. Although 66% of respondents believed that physicians should have the right to counsel patients on preventing deaths and injuries from firearms, 58% reported never asking whether patients have guns in their homes. Limitations: The generalizability of these findings to non–American College of Physicians’ member internists and other physicians is unknown. Responses may not reflect actual behavior. Conclusion: Most respondents believed that firearm-related violence is a public health issue and favored policy initiatives aimed at reducing it. Although most internists supported a physician’s right to counsel patients about gun safety, few reported currently doing it. [ABSTRACT FROM AUTHOR]

The purpose of this study was to delineate the epidemiology of pediatric firearm injuries, including ethno-demographic patterns with impact on years of potential life lost (YPLL). A 2-year review of the National Trauma Data Bank (2007 to 2008) was conducted. Firearm fatalities in records of patients younger than 18 years were identified. Data were analyzed by demographic and injury characteristics and YPLL was calculated by ethnicity. A total of 577 deaths were identified in the pediatric group. Blacks accounted for 49.7 per cent of the fatalities; Hispanics, 19.2 per cent; whites, 17.7 per cent, and other ethnicity, 13.4 per cent. Median Injury Severity Score was 25 with a median Glasgow Coma Scale score of 3. Traumatic brain injury was present in 84.2 per cent of the records. Assault accounted for 72.8 per cent, self-inflicted injury 12.7 per cent, and unintentional injuries were 8.2 per cent. Most firearm fatalities occurred at home (33.6%). By emergency department (ED) disposition, 29.3 per cent died in the ED, 32.9 per cent were admitted to the intensive care unit, and 30.0 per cent taken to the operating room. Blacks had a total of 17,446 YPLL, Hispanics 6,776 YPLL, and whites 6,718 YPLL. Pediatric firearm fatalities still remain an important public health concern. Inclusive gun control policies focused on primary prevention of accidental injuries may be more effective in mitigating its impact. [ABSTRACT FROM AUTHOR]

The article focuses on a 2007 New Zealand court case in which two tourists from outside of the country shot each other. Topics include accident compensation for the discharge of a firearm, the entitlement of statutory benefits by the victim, and common law actions in New Zealand. Information is provided on the New Zealand Accident Rehabilitation and Compensation Insurance Act of 1992.

Highlights: [•] We examined Swedish hunters’ safety habits and experiences of firearm incidents. [•] The responders reported good hunting safety habits and a high degree of compliance with weapon storage regulations. [•] Twenty-three percent of the responders had experienced another hunter causing a firearm incident, although such incidents seldom resulted in human injury or death. [•] An unsafetied weapon was the most commonly reported “cause” of firearm incidents. [ABSTRACT FROM AUTHOR]

Gunshot wounds are the second leading cause of death after road traffic accidents within young population in many countries which is the most productive section of the society. This study describes demographics, causative factors, intent, incident locations of firearm injuries and gun-related activities in which patients were engaged at the time of injury among patients treated in hospital emergency departments for unintentional firearm-related injuries. It is a prospective study conducted over a period of 1 year i.e. May 1, 2007 to April 31, 2008 and all the cases of Gunshot Injuries (GSI) that presented to the casualty department of Jawaharlal Nehru Medical College & Hospital (JNMCH), Aligarh, INDIA were analysed. The information of the cases was obtained from casualty records, history and examination of patient and photograph of the patient's wounds. Parameters studied are age, sex, site of wounds, weapon used, circumstances leading to injury and shot by whom. A total of 198 cases of firearm related injuries reported and 50 were found to be due to unintentional causes. These injuries are most common in children (28%) and most common cause was ceremonial firing (40%). Head and neck region is most commonly affected (34%) followed by trunk (30%). Most frequently used weapon is shotgun (50%). Firearm injuries are one of the emerging causes of unintentional injuries to children and youth. This study suggests that efforts should be made to limit unsupervised access to firearms, to promote safe storage of firearm and apart from strict licensing law, medical assessment is recommended. [ABSTRACT FROM AUTHOR]

Background: Rubber bullets and pellet guns are considered non-lethal low-velocity weapons. They are used to disperse a mob during street protests. The present study was undertaken to analyze the pattern, presentation and management of vascular injuries caused by these weapons. Patients and Methods: This was a prospective study of patients with features of vascular injuries due to pellets and rubber bullets from June 2010 to November 2010. All patients with features of vascular injuries due to these non-lethal weapons were included in the study. Vascular injuries caused by other causes were excluded from the study. Results: A total of 35 patients who presented with features of vascular injury during this period were studied. All of them were males. The mean age was 22 years. Fifteen patients were revascularized primarily, 19 patients needed reverse saphenous vein graft and, in one, patient lateral repair was done. There were two mortalities in our series. Wound infection was the most common complication. The amputation rate was around 6%. Conclusion: Pellet and rubber bullets can cause serious life-threatening injuries. Vascular injury caused by these weapons need no different approach than other vascular injuries. Early revascularization and prompt resuscitation prevents the loss of limb or life. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this study is to provide estimates of firearm related injuries in children seeking care in hospital based emergency departments. Methods: The Nationwide Emergency Department Sample (NEDS) for the year 2008 was used for the current study. All ED visits occurring amongst children aged less than or equal to 18 years and that had an External Cause of Injury (E-Code) for any of the firearm related injuries were selected for analysis. Results: A total of 14,831 ED visits (in children) in the United States had a firearm injury. The average age of the ED visits was 15.9 years. Males constituted a predominant proportion of all ED visits (89.2%). A total of 494 patients died in the emergency departments (3.4% of all ED visits) whilst 323 died following in-patient admission into the same hospital (6% of all inpatient admissions). The most frequently documented firearms were assaults by firearms and explosives (55% of all ED visits), accidents caused by firearms and air gun missiles (33.6%), and injuries by firearms that were undetermined (7.4%). The average charge for each ED visit was $3642 (25th percentile is $1146, median is $2003, and 75th percentile is $4404). The mean charge for those visits that resulted in in-patient admission into the same hospital was $70,164 (25th percentile is $16,704, median is $36,111, and 75th percentile is $74,165) and the total charges for the entire United States was about $371.33 million. Conclusions: The current study used the largest all-payer hospital based emergency department dataset to provide national estimates of firearm related injuries amongst children in the United States during the year 2008 and highlights the public health impact of such injuries. [Copyright &y& Elsevier]

Introduction. Violence using firearms has been increasing in recent decades and thus the injuries that are suffered by this type of device. Unfortunately the pediatric population has also been affected in this situation. Material and method. In the pediatric orthopedic service became interested in knowing the magnitude of the problem and characteristics in the population that is received who suffer this type of injuries in the Hospital Central Militar: We reviewed retrospectively a clinical and radiological charts of patients between zero and eighteen years old with gunshot from January 2006 to December 2011. Results. Just ten were under eighteen years old. Patient's profile is an adolescent male, wounded in a public way, with low-velocity bullet, it is unknown caliber and the aggressor; the musculoskeletal system was affected by 40%, nobody died or developed an infectious process. Conclusion. Knowing the profile of adolescents who suffer these injuries helps the medial staff, health authorities and government to implement programs to reduce this important public health problem. [ABSTRACT FROM AUTHOR]

The article examines firearms ownership and storage patterns in North Carolina and its implications for child and adolescent safety. It notes that firearms ownership in the state is above national ownership rates. It explores the risks posed by household firearms to children as well as highlights the growth of firearms ownership and unsafe patterns as ages of children increases. The need for further interventions and policies to reduce youth access to household firearms is suggested.

Carotid and vertebral artery injury is uncommon but may lead to stroke and death. We reported our experience over the last five years in our center. There were 14 cases: 11 cases with trauma and 3 cases with iatrogenic injury. Three cases had stroke and two cases died. The most common traumatic cases were penetrating injuries. Stab wound injuries had better prognosis than firearm injuries. Blunt trauma had the worst outcome due to severe organ injury. All iatrogenic cases were due to central line cannulation and all recovered uneventfully. Early recognition and proper treatment were crucial in these patients. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this study was to assess physician assistant training programs incorporation of firearm injury prevention training in their curricula. Also, content of such programs as well as perceived benefits and barriers of providing such training were explored. Methods: A three-wave postal mailing of a 24-item questionnaire was sent to the population (n =145) of physician assistant program directors. Results: The majority (77%) of directors responded. The majority (81.3%) reported they had not seriously thought about providing such training (pre-contemplation). The three most important barriers to providing firearm injury prevention training were: lack of time, lack of faculty expertise on the topic, and lack of standardized teaching materials. Those programs that offered training averaged one-half hour. Yet, 77.7% thought that firearm injuries were a very large or large problem to the health and wellbeing of the U.S. population. Conclusion: There is a paucity of professional training for physician assistants regarding firearm injury prevention. It appears unlikely that physician assistants are playing a role in helping to reduce one of the leading causes of death in the U.S., firearm trauma. The American Academy of Physician Assistants needs to take the lead in improving training in this area for physician assistants. Practice Implications: Physician Assistant training program directors should consider offering firearm injury prevention training to help reduce patient suicides and homicides. [Copyright &y& Elsevier]

Abstract: Country made scare gun also called as bandook in the vernacular language designed with an intention of scaring away the menacing animals is not only unique and effective but also potentially lethal and has found wide spread usage in the rural parts of India. Here an attempt has been made to study the characteristic features such as physical dimensions, mechanism of action of this weapon and to compare its penetrating ability with that of air gun, whose potential lethality is a well-documented fact, using the ballistic gelatine blocks at various ranges. It is hoped that keeping the existence of such firearms in mind by the forensic experts might help to solve the unexplained and bizarre firearm injuries encountered in day to day practice. [Copyright &y& Elsevier]

Social, economic, violence, political, and gun access predictors of suicide and gun suicide were examined via sociological autopsy. The model predicting suicide rates overall had the best results, χ2(9, N = 50) = 5.279 (CMIN, the goodness of fit statistic that represents the minimum discrepancy between the unrestricted sample covariance matrix and the restricted covariance matrix) p = .809, [the goodness of fit statistic that represents the minimum discrepancy between the unrestricted sample covariance matrix and the restricted covariance matrix] indicating an excellent fit of the data and theoretical model. The model explained 76% of the variance in state suicide rates and was a significantly better predictor than one could expect by chance, F(6,43) = 22.889, p < .001). All path coefficients were significant predictors of suicide with the exception of violence climate, which was not included. This study contributes to the theoretical knowledge by adding a comprehensive framework of analysis and model useful for prevention. [ABSTRACT FROM AUTHOR]

Abstract: We examined the accuracy of data on unintentional firearm fatalities in the United States. We began with data from the National Violent Death Reporting System (NVDRS) and examined every firearm death reported as an accident by any NVDRS data source – the NVDRS abstracter, the State Vital Statistics Registry (i.e., the ICD-10 Underlying Cause of Death code and manner of death from the death certificate), the medical examiner or coroner report, and the police Supplementary Homicide Report. After carefully reading the information from all sources, we then classified each case as either unintentional or intentional using NVDRS definitions. Comparing our classification with that of the NVDRS abstracter, we conclude that NVDRS data accurately report unintentional firearm deaths (sensitivity 98%; positive predictive value [PPV] 99%). We then compared our classification with that of the State Vital Statistics Registry based on the ICD-10 Underlying Cause of Death code and found great inaccuracy (sensitivity 62%; PPV 58%). Thirty-eight percent of true cases were missed and 42% of reported cases were false positives. As has been previously reported in the literature, over half of unintentional shootings that were inflicted by another person were classified as homicides, not accidents. This is a particular problem for the data on young victims. What was unexpected, however, was the opposite problem: we found many unambiguous suicides and homicides that were reported as accidents. We believe this is due to the ICD-10 coding practice of assigning injury deaths to the “accident” category when manner of death is “pending” or left blank. Finally, at the state-level, we compared our overall results for each state and year with the official National Vital Statistics System count (reported on CDC''s WONDER website). We found evidence of even greater over-reporting of unintentional firearm deaths there. In answer to the question, “Are there too many or too few unintentional firearm deaths in official mortality data?” the best answer is, “Both.” Many true accidents are missed, while many suicides and homicides are mistakenly reported as accidents. By contrast, the NVDRS applies a case definition for unintentional firearm deaths with consistency and accuracy. [Copyright &y& Elsevier]

Abstract: Background: The objective was to investigate the relationship of high gun ownership and gun death rate on children and determine predictors influencing the incidence and outcome of pediatric firearm injuries in a major pediatric level 1 trauma center. Methods: We performed a retrospective review of our trauma registry to identify hospital admissions between April 1999 and March 2010. We extracted demographic and geographic data, seasonal variation, injury type, firearm type, and outcome. Results: We identified 194 firearm injuries. The incidence did not change during the past decade. Most occurred during the second half of the year (61.4%). Mean age was 12.2 ± 4.6 years (range, 0.4-19.2 years). Unintentional shootings accounted for 100 injuries followed by assaults (n = 55) and innocent bystanders (n = 39). African American children were most often injured because of a violent cause (60.3%), whereas white children were shot unintentionally (80.1%). Powder-propelled firearms caused 82.5% of injuries. Overall, 17.5% of children required an operation, and 9.3% died. Conclusions: The overwhelming majority of children were injured after a gun went off unintentionally, whereas most African American children were shot violently. We identified certain seasonal and geographic clusters. These data can be used to target gun injury prevention programs. [Copyright &y& Elsevier]

To the author's knowledge, this is the first study to longitudinally explore the impact of perceived health on the perceived sleepiness of Emergency Medical Service (EMS) personnel. A repeat-respondent complete data sample of 215 U.S. EMS personnel was used. This sample was found to be representative of a much larger incomplete data group. After controlling for prior sleepiness, study results suggest a small but robust effect for health on sleepiness, that is, better perceived health leads to less sleepiness. Study limitations are acknowledged to help in future research. It is hoped that this study stimulates additional international research investigating variables affecting sleeping-related issues for EMS workers. [ABSTRACT FROM AUTHOR]

Genitourinary system injuries generally occur due to blunt and penetrating trauma. Approximately 10% of all injuries encountered in the emergency department are related to the genitourinary system. Male genital trauma is a urological emergency because of the high risk of infection and the priority of protecting the sexual, endocrine, and reproductive functions. Blunt injuries to the penis are more often seen due to the mobility and localization of the penis than due to penetrating injuries caused by firearms or cutting instruments. We aimed to present and discuss a case involving shrapnel that became lodged in the penis of a child in a war zone. After 2 weeks of medical treatment, the patient underwent surgery. Surgery includes primary repair to the penis and urethra. [ABSTRACT FROM AUTHOR]

The authors discuss what they refer to as the American public's preference for safer firearms (guns) as of 2016, and it mentions statistics regarding gun violence, suicides, and homicides in the U.S. According to the article, more than 500 people died as as result of unintentional shootings in America in 2013. Handgun personalization is examined in relation to radio frequency identification and biometric recognition technologies such as fingerprint readers. Childproof firearms are assessed.

Preventive medicine plays a central role in the reducing the number of deaths due to preventable causes of premature deaths. General Preventive Medicine Residency programs have not been studied in relation to training in this area. A three-wave mail survey was conducted with email and telephone follow-ups. The outcome measures were the portion of program directors involved in training residents on firearm injury prevention issues and their perceived benefits and barriers of training residents on firearm injury prevention issues. Only 25% of the programs provided formal training on firearm injury prevention. Program directors who provided formal training perceived significantly higher number of benefits to offering such training than did directors who did not provide such training but no significant difference was found between the two for number of perceived barriers. If preventive medicine residency graduates are to play a role in reducing premature morbidity and mortality from firearms it will require more residencies to offer formal training in this area. The Association for Prevention Teaching and Research needs to develop guidelines on specific curriculum topics regarding firearm injury prevention. [ABSTRACT FROM AUTHOR]

The article presents brief updates about topics in global public health including alleged COVID-19 misinformation and threats against physicians in Latin America, a cholera vaccination effort in Cameroon, and violence against health care personnel in Chinese hospitals. It also notes a study concerning firearm-related in juries in Australia.

The article offers the study published in "JAMA Network Open" which discusses the 2016 California law that allows courts to temporarily take firearms from people deemed a significant danger, did not reduce the rate of firearm injuries in one metropolitan county.

Firearm-related injury and death continue to be a significant problem in Canada. Since the 1990s Canadian emergency physicians (EPs) have played an active role in advocating for gun control. This paper updates the Canadian Association of Emergency Physician's (CAEP's) position on gun control. Despite a media focus on homicide, the majority of firearm-related deaths are a result of suicide. Less than 40% of firearm-related injuries are intentionally inflicted by another person. Since the implementation of Canada's gun registry in 1995, there has been a significant reduction in firearm-related suicides and intimate partner homicides. Proposed weakening of gun laws in Canada will have a significant impact on firearm-related mortality and injury. There must be instead an expansion of programs focused on prevention of suicide, intimate partner violence and gang-related violence. The majority of intentional or unintentional firearm-related injuries involve a violation of safe storage or handling practice. The potential for future harm because of unsafe storage or handling or through gang conflict retribution supports our position that health care facilities report gunshot wounds (GSWs). Moreover, a nationwide surveillance system is necessary to support research and to guide future public policy development and legislation. As EPs we must advocate for injury control. All firearm injuries and deaths are preventable, and we must advocate for a multifaceted approach in order to minimize this risk to our patients. CAEP POSITION The Canadian Association of Emergency Physicians recommends the following measures: 1. Continued support for the original provisions of Bill C-68 and the gun control law, and active opposition to any attempt at repealing the national firearms registry (including the long gun registry). 2. Advocacy for the implementation by the government of a nationwide surveillance system for firearm-related injury and mortality. 3. Expansion of programs focused on the prevention of suicide, intimate partner violence and gang-related violence. 4. Support for legislation mandating that health care facilities report GSWs, but not knife injuries or other violent injuries. 5. Continued support for research into firearm-related injury and death in order to guide further public policy development and future legislation. [ABSTRACT FROM AUTHOR]

Firearms trigger operating characteristics have long been evaluated using inappropriate rudimentary equipment that yields incomplete and inconsistent data. These commonly used, and widely accepted, peak force techniques yield minimal data that are inappropriate for their intended purpose and, consequently, often result in erroneous conclusions being drawn. The majority of those performing the tests and presenting their analyses in courts are not engineers, and typically refuse to acknowledge the shortcomings of their test procedures and analytical techniques, even after detailed explanation has been provided. Historically, scientifically valid trigger mechanism evaluation techniques were slow and labor intensive to perform. The advent of micro-electronics has resulted in the availability of cost effective, portable, scientifically valid, accurate, fast, and reliable, trigger mechanism evaluation equipment. This equipment minimizes the need for firearm disassembly and, consequently, greatly diminishes evidence spoliation concerns. This Paper contrasts the results obtained from the use of inappropriate and outdated peak force techniques when compared to modern computerized electromechanical techniques. Actual case studies are used to illustrate how inappropriately qualified crime lab personnel using the established, though scientifically invalid, peak force evaluation techniques may lead to injustice in both criminal and civil litigation. It is recommended that the scientifically invalid peak force test procedures be abandoned, and that appropriately qualified and trained professionals adopt the scientifically valid electro-mechanical trigger test and evaluation techniques described in this Paper. [ABSTRACT FROM AUTHOR]

Firearm wounds caused by high-velocity projectiles cause enormous losses of bone and soft tissue. The deferred treatment of these cases (delayed reconstruction) in most cases requires the transfer of free tissue from other areas of the body. The use of scapular and parascapular free flaps with scapular bone for the reconstruction of large lateral mandibular defects with extensive soft-tissue avulsion is reported. The technical details of a free flap are offered with illustrations in the case report of a 19-year-old male who was shot at close range in the lower third of the left lateral face. Avulsion of the left mandibular body and soft tissue occurred in the region from the cheek to the oral commissure. The initial treatment was tracheostomy, cleaning of necrotic and devitalized tissues, wiring of a mandible-to-maxilla arch bar and intermaxillary fixation, rigid fixation with a reconstructive mandibular plate, and a regional cervical flap to close the skin wound. The cervical flap was lost and a postoperative oral-cervical fistula appeared. Scar contraction limited the mouth opening to 0.8 cm. In deferred treatment, a scapular and parascapular free flap with scapular bone from the left shoulder was used to reconstruct the mandibular and intraoral-facial soft-tissue defects. The aesthetic and functional results were optimal. Some complications occurred: postoperative salivary fistula, deinsertion of the long head of the brachial triceps, and scapular wound dehiscence, which will be closed surgically with a local flap. [ABSTRACT FROM AUTHOR]

Abstract: In airgun injuries, the removal of the projectile is often recommended. The material properties of airgun projectiles make it difficult to determine their precise anatomical location using conventional radiological techniques. Conventional X-rays give only a two-dimensional representation of projectiles and do not allow a foreign object to be located precisely. Multi-slice computed tomography (CT) has become a standard tool in diagnosis. Metal objects can cause artefacts in CT scans and make it difficult to identify adjacent anatomical structures. By contrast, cone-beam CT (CBCT) provides three-dimensional images largely free from metal artefacts. The authors present three cases of airgun injuries and discuss the diagnostic and treatment approaches used. CBCT has proved to be a useful diagnostic tool in planning the treatment of craniofacial airgun injuries. It is superior to CT in detecting hard-tissue structural damage in the immediate vicinity of high-density metal projectiles. [Copyright &y& Elsevier]

Although safe firearm storage is a promising injury prevention strategy, many parents do not keep their firearms unloaded and locked up. Using the theory of planned behavior as a guiding conceptual framework, this study examines factors associated with safe storage among married women with children and who have firearms in their homes. Data come from a national telephone survey (n = 185). We ex- amined beliefs about defensive firearm use, subjective norms, perceived behavioral control and firearm storage practices. A Wilcoxon—Mann—Whitney test was conducted to assess associations between psychosocial factors and firearm storage practices. Women were highly motivated to keep firearms stored safely. Those reporting safe storage practices had more favorable attitudes, more supportive subjective norms and higher perceptions of behavioral control than those without safe storage. One-fourth believed a firearm would prevent a family member from being hurt in case of a break-in, 58% believed a firearm could scare off a burglar. Some 63% said they leave decisions about firearm storage to their husbands. Women were highly motivated to store firearms safely as evidenced by favorable attitudes, supportive subjective norms and high perceptions of behavioral control. This was especially true for those reporting safer storage practices. [ABSTRACT FROM AUTHOR]

Objective: Our primary objective was to evaluate demographic and causal factors of inhospital mortality for significant firearm-related injuries (i.e., those with an Injury Severity Score [ISS] > 12) in Canadian trauma centres. Methods: We analyzed data submitted to the Canadian Institute for Health Information (CIHI) in the National Trauma Registry for all firearm-injured patients for fiscal years 1999-2003. Univariate and bivariate adjusting for ISS and multivariate logistic regression were performed. Results: Men accounted for 94% of the 784 injured. In all patients, the percentages of selfinflicted, intentional, unintentional and unknown injuries were 27.8%, 60.3%, 6.1% and 5.7%, respectively. The inhospital fatality rate was 39.8%, with 83% of fatalities occurring on the first day. Two-thirds of patients were discharged home. Univariate and adjusted analysis found that ISS, first systolic blood pressure (BP), first systolic BP under 100, first Glasgow Coma Scale (GCS) score, age over 45 years, self-inflicted injury, intentional injury and injury at home significantly worsened the odds ratio of death in hospital and that police shooting was relatively beneficial. BP under 100, age over 45 years and a low GCS score had an adjusted odds ratio of death of 4.12, 1.99 and 0.64 per point increase, respectively. The multivariate model showed that ISS, BP under 100, first GCS score, sex and self-inflicted injury were significant in predicting inhospital death. Conclusion: A predominance of young men are injured intentionally with handguns in Canada, whereas older patients suffer self-inflicted injuries with long guns. The significant number of firearm deaths, largely in the first day, highlights the importance of preventative strategies and the need for rapid transport of patients to trauma centres for urgent care. [ABSTRACT FROM AUTHOR]

Abstract  This study reviews firearm-related deaths (homicidal, suicidal and accidental) from 1994 to 2003 in the Western Sidney area, Australia, serviced by the Westmead Department of Forensic Medicine, in order to document the features of the cases and to assess the effect of the introduction of the NSW Firearms Act in 1996. There were 211 fatalities involving firearms (1.8% of all of the Coroner’s cases for the period); firearm deaths were classified as homicide (75), suicide (134) or accidental (2). There was a clear peak of homicide deaths by firearm in the 20–29 age group, whereas the suicide peak was broad, spanning the ages 20–69 years. More suicides occurred at home than homicides and a higher proportion of suicides were by rifle than homicides, which favoured hand guns. Entry wounds in suicides mostly involved the head, with the chest being the commonest entry site in homicides. The only statistically significant trend was for an increase in the number of firearm-related suicides in males, comparing the number of deaths pre- and post-firearm law introduction. The study includes reports of two suicides by unusual weapons: a home-made pipe gun and a spear gun. [ABSTRACT FROM AUTHOR]

Recent research has shown that behavioral skills training with in situ training is an effective strategy to teach children the safety skills needed if they ever encounter an unattended firearm. The current study evaluated the use of parents as trainers to increase the efficiency of training. The success of parent training on their children's safety skills was evaluated in a multiple baseline across participants design. The results showed that the training was effective for 3 of the 4 children. [ABSTRACT FROM AUTHOR]

Abstract: This study was designed to investigate the effects of ligustrazine on burn-induced myocardiac injury as well as TNF-α levels in severely burned rats. Sprague–Dawley rats were divided into four groups: (1) sham group, rats who underwent sham burn; (2) fluid-resuscitated sham group (FRsham), rats who underwent sham burn, and lactated Ringer''s solution for resuscitation; (3) control group, rats given third-degree burns over 30% total body surface area (TBSA) and lactated Ringer''s solution for resuscitation; (4) ligustrazine group, rats given burn and lactated Ringer''s solution with ligustrazine inside for resuscitation. Myocardial injury was assessed at 6h after burn by detecting serum levels of creatine kinase MB fraction (CK-MB) and lactate dehydrogenase (LDH), as well as water content, histological score, and ultrastructure change of cardiac tissue. In addition, myocardium ATP content was analyzed. Enzyme-linked immunosorbent assay (ELISA) was used to examine cardiac tumor necrosis factor-α (TNF-α) levels. The results showed that burn trauma resulted in the increasing serum LDH and CK-MB, elevated myocardial water content, aggravated myocardial histological and ultrastructural lesions, increased myocardium ATP, and serum TNF-α. Ligustrazine 10mg/kg iv markedly inhibited increases in serum CK-MB and LDH, reduced myocardial water content from 76.91±0.19% in control group to 75.40±0.57%, significantly decreased the histologic scores of myocardium, and mollified the ultrastructural damage in cardiac myocytes. Ligustrazine significantly attenuated elevations in serum TNF-α level and myocardial ATP quantity. Therefore, our results demonstrate that ligustrazine exhibits significant protective effects on burn-induced myocardial injury via inhibiting the release of TNF-α and improving utilization of ATP. [Copyright &y& Elsevier]

Abstract: This study investigated the prevalence of symptoms of depression in patients hospitalized with severe burns and the association of symptoms of depression in the hospital with physical health 2 months after discharge, controlling for pre-burn physical health as measured by the SF-36 physical composite score. Survivors of acute burns were evaluated during the hospitalization (N =262) and at 1 week (N =165) and 2 months (N =100) after discharge. The prevalence of at least mild to moderate symptoms of depression (Beck Depression Inventory≥10) ranged from 23% to 26%. In-hospital symptoms of depression predicted change in physical health from pre-burn to 2 months post-discharge (p =.02), controlling for patient demographics, burn severity, and symptoms of PTSD. These results suggest that patients should be screened for depression, both in-hospital and during rehabilitation after discharge. [Copyright &y& Elsevier]

This article explores the possible risks associated with gun ownership by older adults. We summarize existing regulations on who may own firearms, especially with respect to age. We then present data on older gun owners and violence committed by older adults in general, followed by a discussion of gun violence perpetrated by gun owners whose functional and cognitive abilities have declined, perhaps as a result of dementia. For comparison purposes, we review regulations on driving among older adults, drawing parallels to gun ownership. The paper concludes with recommendations for ensuring the safety of older gun owners and others, balanced against citizens' right to bear arms, and with some directions for research. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

There has been a transition in US firearm injuries from an epidemic phase (mid-1980s to early 1990s) to an endemic one (since the mid-1990s). Endemic US firearm injuries merit public health attention because they exact an ongoing toll, may give rise to new epidemic outbreaks, and can foster firearm injuries in other parts of the world. [ABSTRACT FROM AUTHOR]

Background: In juries from small arms are of concern internationally. The health perspective is an emerging aspect of international work to reduce these injuries. This aspect has been evident in US firearm injury prevention work for over a decade, exhibited by strong statements from the American Academy of Pediatrics (AAP) to remove firearms from children's environments. Objectives: To assess trends among US pediatricians related to firearm injury prevention counseling practices and attitudes toward gun legislation. Design: National random sample, mailed surveys of AAP members: (1) 1994 (response rate = 68.9%, = 982); (2) 2000 (response rate = 62.4%, n = 922). χ² Tests were used to assess bivariate relationships and logistic regression to assess multivariate relationships regarding counseling practices. Results: Respondents in both years believed that violence prevention should be a priority for pediatricians (91 .4% and 92.0%) and reported always or sometimes recommending handgun removal from the home (46.2% and 55.9%, respectively). In 2000, 74% of the respondents were comfortable discussing firearm safety; fewer thought they had sufficient training (32.7%) or time (27.5%) to discuss firearms. In 1994 and 2000, the likelihood of counseling on handgun removal was positively related to recent experience treating a gun in jury, female sex and not owning a gun. In both years, >80% of pediatricians thought that gun control legislation or regulations would reduce injury and death. Conclusions: US pediatricians continue to adopt policies promoting gun injury prevention. The practices and attitudes of pediatricians may be important for public education strategies regarding firearm injury prevention in the US and internationally. [ABSTRACT FROM AUTHOR]