Assessing the Effect of the U.S. Vaccination Program on the Coronavirus Positivity Rate With a Multivariate Framework.

The factors influencing the incidence of COVID-19, including the impact of the vaccination programs, have been studied in the literature. Most studies focus on one or two factors, without considering their interactions, which is not enough to assess a vaccination program in a statistically robust manner. We examine the impact of the U.S. vaccination program on the SARS-CoV-2 positivity rate while simultaneously considering a large number of factors involved in the spread of the virus and the feedbacks among them. We consider the effects of the following sets of factors: socioeconomic factors, public policy factors, environmental factors, and non-observable factors. A time series Error Correction Model (ECM) was used to estimate the impact of the vaccination program at the national level on the positivity rate. Additionally, state-level ECMs with panel data were combined with machine learning techniques to assess the impact of the program and identify relevant factors to build the best-fitting models. We find that the vaccination program reduced the virus positivity rate. However, the program was partially undermined by a feedback loop in which increased vaccination led to increased mobility. Although some external factors reduced the positivity rate, the emergence of new variants increased the positivity rate. The positivity rate was associated with several forces acting simultaneously in opposite directions such as the number of vaccine doses administered and mobility. The existence of complex interactions, between the factors studied, implies that there is a need to combine different public policies to strengthen the impact of the vaccination program.

The effect of the digital printing of fabric on the morphology of passive bloodstains.

Bloodstained fabrics found at crime scenes are likely to have had processing treatments, such as dyeing or printing, but the effect of the treatments on bloodstain morphology is not always considered. In order to study the effect of digital printing on bloodstain morphology, drip stains were created from five impact velocities (1.9-5.4 ms-1) on three different mass per unit areas (88-226 g/m²) of 100% cotton calico which had been digitally printed using reactive dye. Across all three printed fabrics, the bloodstains appeared visually similar, and no correlation was found between the dry bloodstain area and the impact velocity. When comparing the bloodstains on the printed fabric to those which had been created previously on the same fabric in a dyed and not-coloured state, the dry bloodstains on the printed fabric were statistically significantly larger (e.g. for the calico with the lightest mass per unit area, mean dry bloodstain area was 126.6, 64.4 and 44.3 mm² for the printed, dyed and not-coloured fabrics respectively). Examination of the larger bloodstains on the printed calico with the micro computed tomography scanner and scanning electron microscope, suggested that the printing process increased the wettability of the fabric, so the blood could spread more easily on the surface. This allowed the blood to coat the yarns, and wick into them before wicking along the intra-yarn spaces. The results presented in this paper showed that care must be taken when examining bloodstains at crime scenes. Depending on the fabric and the processing of the fabric the size of the blood stains may not increase with impact velocity as wicking may result in a larger bloodstain from a lower velocity. The bloodstain on the penetrated face of the fabric may be larger than on the impacted face and the same fabrics with different processing will produce different blood stain sizes and shapes.

The effect of reactive dyeing of fabric on the morphology of passive bloodstains.

The majority of fabrics at crime scenes have been coloured in some way. The effect of such treatments on resultant bloodstains has not been considered. In this work, horse blood was dropped onto reactively dyed calico fabrics (100% cotton, plain woven) with three different masses of 91 g m-², 171 g m-² and 243 g m-² and the results compared to previous work on the not-coloured calico fabric. Five impact velocities were used from 1.7 ms-1 to 5.4 ms-1. The use of reactive dye increased the thickness (from 0.38 - 0.56 mm to 0.39 - 0.6 mm) and mass per unit area (from 85.1 - 224.6 g/m² to 91 - 243 g/m²) of the calico fabrics. The reactively dyed fabrics had larger bloodstains (e.g. lightest calico 41.2 - 78.6 mm²) compares to the not-coloured fabrics (e.g. lightest calico 21.4 - 67.5 mm²) across all three mass per unit areas. The dyeing of the fabrics altered the intra-yarn spaces to a more optimum size for wicking blood, increasing the ease with which the blood could wick along the yarns in the dyed calico. The amount of wicking varied depending on individual variations within the fabrics and yarns. More variation in dry bloodstain area was seen among dyed calico specimens than for the not-coloured fabric. The amount of wicking which was seen on the dyed calico meant there was no correlation between dry bloodstain area and impact velocity, a correlation which was seen on the medium and heavy not-coloured calico in the previous work.

Pharmacogenomics of NSAID-Induced Upper Gastrointestinal Toxicity.

Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs which are widely used globally for the treatment of pain and inflammation, and in the case of aspirin, for secondary prevention of cardiovascular disease. Chronic non-steroidal anti-inflammatory drug use is associated with potentially serious upper gastrointestinal adverse drug reactions (ADRs) including peptic ulcer disease and gastrointestinal bleeding. A few clinical and genetic predisposing factors have been identified; however, genetic data are contradictory. Further research is needed to identify clinically relevant genetic and non-genetic markers predisposing to NSAID-induced peptic ulceration.

The ballistic performance of bone when impacted by fragments.

Physical models are required to generate the underlying algorithms that populate computer simulations of the effects of explosive fragmenting devices. These models and simulations are used for understanding weapon performance, designing buildings and optimising personal protective equipment. Previous experimental work has investigated the performance of skin and muscle when subjected to fragmentation threats, but limited evidence exists for the performance of bone when impacted by fragments. In the current work, ballistic testing was conducted using two types of internationally recognised steel fragment simulating projectiles (FSPs): (i) 5.5 mm diameter (0.68 g) ball bearing (BBs) and (ii) 1.10 g chisel nosed (CN). These projectiles were fired at isolated swine ribs at impact velocities between 99 and 1265 m/s. Impact events were recorded using a high-speed camera. Selected specimens were analysed post-impact with plain x-radiographs and micro-CT scanning to determine damage to the bone architecture. Bones were perforated with a kinetic energy density (KED) as low as 0.14 J/mm2. Energy transfer to the bone was greater for the CN FSPs, resulting in increased bone damage and the production of secondary bone fragments. The manner in which the bones failed with faster velocity impacts (> 551 m/s; KED > 6.44 J/mm2) was analogous to the behaviour of a brittle material. Slower velocity impacts (< 323 m/s; KED < 1.49 J/mm2) showed a transition in failure mode with the bone displaying the properties of an elastic, plastic and brittle material at various points during the impact. The study gives critical insight into how bone behaves under these circumstances.

Effect of ballistic impacts on batteries and the potential for injury.

INTRODUCTION: On military operations, ballistic impact damage is possible to lithium ion (Li-ion) batteries worn on the body by military personnel and the potential for exothermic reactions may result in injury. This paper investigated the effect of impact on batteries that might be worn in front or behind body armour. METHODS: Li-ion batteries were subjected to ballistic impact both without and in combination with body armour using 7.62×39 mm ammunition (mean velocity=769 m/s) at charge levels up to 40%. The effect of penetrating impacts on charged batteries was also investigated using an outdoor range. RESULTS: The backface signature due to ballistic impact was reduced by including a battery pack between fabric body armour and an armour plate, however the batteries were crushed and mechanically disrupted. Ballistic impacts on batteries mounted in front of an armour plate resulted in perforation of the batteries. Increases in temperature, fire and toxic gas emission were noted when batteries were penetrated by an impact. CONCLUSIONS: Batteries provided limited ballistic protection disproving the hypothesis that batteries could replace or enhance existing body armour solutions. Ballistic impact of charged batteries could lead to injury due to heat/flame and toxic discharge. It is recommended that batteries need to be carried in a position from which they can be rapidly removed from contact with the body.

Method for Recording Broadband High Resolution Emission Spectra of Laboratory Lightning Arcs.

Lightning is one of the most common and destructive forces in nature and has long been studied using spectroscopic techniques, first with traditional camera film methods and then digital camera technology, from which several important characteristics have been derived. However, such work has always been limited due to the inherently random and non-repeatable nature of natural lightning events in the field. Recent developments in lightning test facilities now allow the reproducible generation of lightning arcs within controlled laboratory environments, providing a test bed for the development of new sensors and diagnostic techniques to understand lightning mechanisms better. One such technique is a spectroscopic system using digital camera technology capable of identifying the chemical elements with which the lightning arc interacts, with these data then being used to derive further characteristics. In this paper, the spectroscopic system is used to obtain the emission spectrum from a 100 kA peak, 100 µs duration lightning arc generated across a pair of hemispherical tungsten electrodes separated by a small air gap. To maintain a spectral resolution of less than 1 nm, several individual spectra were recorded across discrete wavelength ranges, averaged, stitched, and corrected to produce a final composite spectrum in the 450 nm (blue light) to 890 nm (near infrared light) range. Characteristic peaks within the data were then compared to an established publicly available database to identify the chemical element interactions. This method is readily applicable to a variety of other light emitting events, such as fast electrical discharges, partial discharges, and sparking in electrical equipment, apparatus, and systems.

Investigating bloodstain dynamics at impact on the technical rear of fabric.

Using high speed video, the impact of blood drops falling at three velocities (1.9, 4.2 and 5.8ms-1) were filmed from both the technical face and for the first time the technical rear of three different mass per unit areas (85.1, 163.5 and 224.6g/m²) of 100% cotton calico. It was seen that there were two stages in the creation of a bloodstain on fabric; the impact dynamics, followed by wicking along the intra-yarn spaces. In the first stage, once the blood impacted the fabric, blood was visible on the technical rear of the fabrics with the medium and lightest mass per unit area within as little as 0.067ms after impact. No blood was visible on the technical rear of the fabric with the heaviest mass per unit area following impact or the medium mass per unit area from 1.7ms-1 impacts. On the technical face of the fabric, the blood drop spread laterally and then receded for 8ms following impact. The dynamics on the technical face were not affected by what was occurring on the technical rear of the fabric. The bloodstain on the technical rear initially only increased until 0.8ms following impact. The increase in technical rear bloodstain area was caused by continued movement of the blood through to the rear of the fabric as the blood drop spread on the technical face. Once the impact dynamics were concluded within 8ms of impact, there was no further change in the bloodstain for the remaining 67ms of high speed video. Following this the blood wicked into and along the yarns, resulting in a dry technical rear bloodstain on all fabrics at all velocities.

Is your drinking-water safe? A rotavirus outbreak linked to water refilling stations in the Philippines, 2016.

INTRODUCTION: In April 2016, the Department of Health in Zamboanga Peninsula reported an increase in the number of acute gastroenteritis cases reported from Zamboanga City. An epidemiologic investigation was conducted to verify the existence of an outbreak, determine source/mode of transmission and recommend control measures. METHODS: A line list of cases was compiled from the 11 hospitals within Zamboanga City and a case-series study was conducted. Suspected cases were any persons from Zamboanga City who had three or more episodes of acute diarrhoea within 24 hours from 15 March to 29 May 2016. Confirmed cases were suspected cases with active symptoms during the investigation who had a stool sample collected with rotavirus detected. Water samples were also collected for viral detection. RESULTS: There were 2936 suspected cases with 22 deaths (case fatality rate: 0.75%), an age range of 8 days to 89 years (median: 2 years), with those aged less than 5 years the most affected age group (1903/2936, 65%). The majority were males (1549/2936, 53%). From the 138 active case patients included in the case-series study, the majority reported contact with a family member who had diarrhoea (89/138, 64%) and using water refilling stations as their major source of drinking-water (88/134, 64%). Of the 93 stool specimens collected, 56 (60%) were positive for rotavirus. Five samples from water refilling stations where case patients reported collecting drinking-water were all positive for rotavirus. DISCUSSION: Strict regulation of water refilling stations and boiling drinking-water in households were implemented, immediately controlling the outbreak. After complying with all the requirements set by the Department of Health, a water safety certificate was awarded to Zamboanga City in September 2018.

The effect of fabric mass per unit area and blood impact velocity on bloodstain morphology.

This paper discusses the effects of thickness, mass per unit area, sett, yarn linear density and twist of calico fabrics (100% cotton, plain woven) on the morphology of passive bloodstains. Horse blood was dropped vertically onto three calico fabrics with different mass per unit areas (85.1 g/m², 163.5 g/m² and 224.6 g/m²). Six different impact velocities were used (1.7 ms-1, 2.9 ms-1, 4.1 ms-1, 4.9 ms-1, 5.1 ms-1 and 5.4 ms-1). The dry bloodstains were largest on the calico with the lightest mass per unit area. The low yarn linear density and large inter-yarn spaces meant that the blood could wick into the yarns from all directions and along the intra-yarn spaces. The calico with the middle mass per unit area had the smallest mean dry bloodstain area for four out of the six velocities. The twist level for this calico was greater than for the calicos with a heavier or lighter mass per unit area. This reduced the amount of wicking which occurred along the yarns due to the tighter yarn structure. The calico with the heaviest mass per unit area had the highest yarn linear density resulting in a thicker fabric, so the blood could not as easily penetrate into the fabric. This resulted in a thicker wet blood layer remaining on the fabric surface, where it gradually wicked vertically into the yarns under gravity. Less wicking along the yarns occurred, resulting in a smaller bloodstain than on the fabric with the lightest mass per unit area. The correlation between impact velocity and mean dry bloodstain area was greater for the calicos with the medium and heaviest mass per unit area than for the calico with the lightest mass per unit area. For the calicos with the medium and heaviest mass per unit area, the distance the blood spread laterally at impact, which increased with the increase in impact velocity, had a greater influence on the dry bloodstain area than the amount of wicking.

Serum and blister-fluid elevation and decreased epidermal content of high-mobility group box 1 protein in drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis.

BACKGROUND: High-mobility group box 1 (HMGB1) is a damage-associated molecular-pattern protein. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) are serious, immune-mediated skin-blistering conditions. OBJECTIVES: To determine serum and/or blister-fluid total HMGB1 levels in SJS/TEN cohorts, and HMGB1 expression in formalin-fixed, paraffin-embedded (FFPE) SJS/TEN skin vs. healthy and maculopapular exanthema (MPE) skin. Methods Serum HMGB1 was quantified in Malawian nevirapine-induced hypersensitivity, Taiwanese SJS/TEN and Spanish SJS/TEN cohorts. FFPE skin (healthy skin, MPE, SJS/TEN) was stained and assessed for HMGB1 expression. RESULTS: Serum total HMGB1 was not significantly elevated in patients with nevirapine-induced SJS/TEN (3·98 ± 2·17 ng mL-1 ), MPE (3·92 ± 2·75 ng mL-1 ) or drug reaction with eosinophilia and systemic symptoms (4·73 ± 3·00 ng mL-1 ) vs. tolerant controls (2·97 ± 3·00 ng mL-1 ). HMGB1 was significantly elevated in Taiwanese patients with SJS/TEN, highest during the acute phase (32·6 ± 26·6 ng mL-1 ) vs. the maximal (19·7 ± 23·2 ng mL-1 ; P = 0·007) and recovery (24·6 ± 25·3 ng mL-1 ; P = 0·027) phases. In blister fluid from Spanish patients with SJS/TEN, HMGB1 (486·8 ± 687·9 ng mL-1 ) was significantly higher than in serum (8·8 ± 7·6 ng mL-1 ; P <0·001). Preblistered SJS/TEN skin showed decreased epidermal nuclear HMGB1 expression in upper epidermis vs. healthy or MPE skin but retained basal/suprabasal expression. CONCLUSIONS: Epidermal HMGB1 expression was decreased in SJS/TEN skin. Retained basal/suprabasal epidermal HMGB1 expression may exacerbate localized injury in SJS/TEN.

Edged weapons awareness.

Edged weapons (sometimes referred to as sharp weapons or blades) are an increasing threat to military personnel, the blue light community (police, ambulance, firefighters, other first responders) and the general public worldwide. The use of edged weapons in criminal and terrorist incidents internationally means the forensic community needs an awareness of the technology of edged weapons, how they are used, the damage (clothing and wounding) that might be caused and any other forensic implications. In this paper, the magnitude of the problem is presented, prior research summarised and implications for forensic investigations discussed.

Preliminary development of a bleeding layer to assess the effect of a ballistic impact on textile damage.

When a person is shot, they are generally wearing clothing which will be damaged by the perforation of the bullet. There are relatively few reports of such textile damage in the literature and the effect of blood on the textile damage observed is not reported. The appearance of textile damage caused by bullet impacts is further compounded by the diverse nature of (i) fabrics used in apparel and (ii) ammunition types. In this work, the effect of blood on textile damage due to ballistic impact was investigated by the development of a specimen that incorporated blood. The specimens were impacted with two types of pistol ammunition that are commonly available (i) 9mm Luger HP (8.03g; Federal Premium® Law Enforcement; jacketed hollow-point) and (ii) .357 Magnum (10.24g; Express® Pistol and Revolver; Remington, R357M3, flat-nose soft-point). The resulting textile damage was compared to that in specimens without a bleeding layer. The interaction of blood with textile damage caused by a bullet-impact affected the appearance of the textile damage and resulted in the dispersion of the bullet wipe. These results are important in the content of evidence examined by a textile damage assessor compared to what might be seen in a typical re-creation event in a laboratory. The use of a bleeding layer in textile damage investigations due to ballistic impact resulted in a more realistic scenario.

Preliminary study into the skeletal injuries sustained to the spine from posterior non-perforating ballistic impacts into body armour.

INTRODUCTION: The aim of this paper was to examine any injuries from posterior behind armour blunt trauma ballistic impacts directly over the spine onto typical hard body armours. Due to the spine being close to the surface of the skin and a lack of any previous specific research into this topic, this study was designed to gain preliminary insight into the mechanisms involved and injuries caused. Pigs were chosen as the closest representative of human spine, tissue and skin, although their spines are deeper under the surface than humans. Baseline spine and ribs shots were conducted to ensure that the study was effective. METHOD: This study used a 65 kg cadaveric pig eviscerated torso and 7.62 NATO ammunition (7.62×51; L2A2; mean velocity=838 m/s, SD=4 m/s) impacting hard body armour plates over the spine. Injuries were inspected, and sections were removed for X-ray and micro-CT assessment. RESULTS: There was no visible soft tissue damage under the impact point on the armour over the spine, and no bony injuries were reported. Baseline rib shots resulted in multiple rib fractures; some showed minimal displacement of the bone. Baseline spine shot resulted in damage across the spine involving spinal cord and bone. CONCLUSION: No injuries were noted from the spinal impacts, and the rib shots resulted in injuries consistent with those previously reported. The anatomical differences between pigs and humans does not preclude that bony injuries could occur in a human from these types of spinal ballistic impacts.

The burden of gunshot wounding of UK military personnel in Iraq and Afghanistan from 2003-14.

INTRODUCTION: Gunshot wounding (GSW) is the second most common mechanism of injury in warfare after explosive injury. The aim of this study was to define the clinical burden of GSW placed on UK forces throughout the recent Iraq and Afghanistan conflicts. METHODS: This study was a retrospective review of data from the UK Military Joint Theatre Trauma Registry (JTTR). A JTTR search identified records within the 12 year period of conflict between 19 Mar 2003 and 27 Oct 2014 of all UK military GSW casualties sustained during the complete timelines of both conflicts. Included cases had their clinical timelines and treatment further examined from time of injury up until discharge from hospital or death. RESULTS: There were 723 casualties identified (177 fatalities, 546 survivors). Median age at the time of injury was 24 years (range 18-46 years), with 99.6% of casualties being male. Most common anatomical locations for injury were the extremities, with 52% of all casualties sustaining extremity GSW, followed by 16% GSW to the head, 15% to the thorax, and 7% to the abdomen. In survivors, the rate of extremity injury was higher at 69%, with head, thorax and abdomen injuries relatively lower at 5%, 11% and 6% respectively. All GSW casualties had a total of 2827 separate injuries catalogued. A total of 545 casualties (523 survivors, 22 fatalities) underwent 2357 recorded surgical procedures, which were carried out over 1455 surgical episodes between admission to a deployed medical facility and subsequent transfer to the Royal Centre for Defence Medicine (RCDM) in the UK. This gave a median of 3 (IQR 2-5) surgical procedures within a median of 2 (IQR 2-3) surgical episodes per casualty. Casualties had a combined length of stay (LoS) of 25 years within a medical facility, with a mean LoS in a deployed facility of 1.9 days and 14 days in RCDM. CONCLUSION: These findings define the massive burden of injury associated with battlefield GSW and underscore the need for further research to both reduce wound incidence and severity of these complex injuries.

The use of gelatine in wound ballistics research.

Blocks of gelatine are used in both lethality and survivability studies for broadly the same reason, i.e. comparison of ammunition effects using a material that it is assumed represents (some part of) the human body. The gelatine is used to visualise the temporary and permanent wound profiles; elements of which are recognised as providing a reasonable approximation to wounding in humans. One set of researchers aim to improve the lethality of the projectile, and the other to understand the effects of the projectile on the body to improve survivability. Research areas that use gelatine blocks are diverse and include ammunition designers, the medical and forensics communities and designers of ballistic protective equipment (including body armour). This paper aims to provide an overarching review of the use of gelatine for wound ballistics studies; it is not intended to provide an extensive review of wound ballistics as that already exists, e.g. Legal Med 23:21-29, 2016. Key messages are that test variables, projectile type (bullet, fragmentation), impact site on the body and intermediate layers (e.g. clothing, personal protective equipment (PPE)) can affect the resulting wound profiles.

Effects of chair vibration on indoor annoyance ratings of sonic booms.

The effects of perceptible whole-body vibrations on annoyance ratings of sonic booms and other impulsive environmental sounds experienced indoors were studied. Fifteen pairs of test subjects made annoyance ratings while seated in a living room environment. There were two chairs, one isolated from floor vibrations and the other not isolated, and every test subject rated all signals in both chairs. Halfway through each test session, subjects changed seats. Subjects who sat in the isolated chair first gave lower mean annoyance ratings in both halves of the test than subjects who sat in the non-isolated chair first. Annoyance predictions from models using both sound and vibration measures were closer to average annoyance ratings than predictions from a model using sound measures alone. Reformulation of the annoyance model revealed that the presence of perceptible vibration is equivalent to increasing acoustic metric Perceived Level by 4.8 dB when calculated on exterior signals and by 5.6 dB when calculated on interior signals.

Fibroblast growth factor-2 drives and maintains progressive corneal neovascularization following HSV-1 infection.

Herpes simplex virus type 1 (HSV-1) infection of the cornea induces vascular endothelial growth factor A (VEGF-A)-dependent lymphangiogenesis that continues to develop well beyond the resolution of infection. Inflammatory leukocytes infiltrate the cornea and have been implicated to be essential for corneal neovascularization, an important clinically relevant manifestation of stromal keratitis. Here we report that cornea infiltrating leukocytes including neutrophils and T cells do not have a significant role in corneal neovascularization past virus clearance. Antibody-mediated depletion of these cells did not impact lymphatic or blood vessel genesis. Multiple pro-angiogenic factors including IL-6, angiopoietin-2, hepatocyte growth factor, fibroblast growth factor-2 (FGF-2), VEGF-A, and matrix metalloproteinase-9 were expressed within the cornea following virus clearance. A single bolus of dexamethasone at day 10 post infection (pi) resulted in suppression of blood vessel genesis and regression of lymphatic vessels at day 21 pi compared to control-treated mice. Whereas IL-6 neutralization had a modest impact on hemangiogenesis (days 14-21 pi) and lymphangiogenesis (day 21 pi) in a time-dependent fashion, neutralization of FGF-2 had a more pronounced effect on the suppression of neovascularization (blood and lymphatic vessels) in a time-dependent, leukocyte-independent manner. Furthermore, FGF-2 neutralization suppressed the expression of all pro-angiogenic factors measured and preserved visual acuity.

Do air-gaps behind soft body armour affect protection?

INTRODUCTION: Body armour typically comprises a fabric garment covering the torso combined with hard armour (ceramic/composite). Some users wear only soft armour which provides protection from sharp weapons and pistol ammunition. It is usually recommended that body armour is worn against the body with no air-gaps being present between the wearer and the armour. However, air-gaps can occur in certain situations such as females around the breasts, in badly fitting armour and where manufacturers have incorporated an air-gap claiming improvements in thermophysiological burden. The effect of an air-gap on the ballistic protection and the back face signature (BFS) as a result of a non-perforating ballistic impact was determined. METHODS: Armour panels representative of typical police armour (400x400 mm) were mounted on calibrated Roma Plastilina No 1 and impacted with 9 mm Luger FMJ (9×19 mm; full metal jacket; Dynamit Nobel DM11A1B2) ammunition at 365±10 m/s with a range of air-gaps (0-15 mm). Whether or not the ammunition perforated the armour was noted, the BFS was measured and the incidence of pencilling (a severe, deep and narrow BFS) was identified. RESULTS: For 0° impacts, a critical air-gap size of 10 mm is detrimental to armour performance for the armour/ammunition combination assessed in this work. Specifically, the incidences of pencilling were more common with a 10 mm air-gap and resulted in BFS depth:volume ratios ≥1.0. For impacts at 30° the armour was susceptible to perforation irrespective of air-gap. CONCLUSIONS: This work suggested that an air-gap behind police body armour might result in an increased likelihood of injury. It is recommended that body armour is worn with no air-gap underneath.

The molecular genetics of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis.

Chemotherapy-induced peripheral neuropathy (CIPN) can adversely affect completion of systemic anti-cancer treatment and cause long-term morbidity. Increasingly pharmacogenetic studies have been performed to explore susceptibility to this important adverse effect. A systematic review was conducted to identify pharmacogenetic studies, assess their quality and findings and undertake meta-analysis where possible. 93 studies were included. Notable methodological issues included lack of standardisation and detail in phenotype definition and acknowledgement of potential confounding factors. Insufficient data was presented in many studies meaning only a minority could be included in meta-analysis showing mainly non-significant effects. Nonetheless, SNPs in CYP2C8, CYP3A4, ARHGEF10, EPHA and TUBB2A genes (taxanes), FARS2, ACYP2 and TAC1 (oxaliplatin), and CEP75 and CYP3A5 (vincristine) are of potential interest. These require exploration in large cohort studies with robust methodology and well-defined phenotypes. Seeking standardisation of phenotype, collaboration and subsequently, individual-patient-data meta-analysis may facilitate identifying contributory SNPs which could be combined in a polygenic risk score to predict those most at risk of CIPN.