The capillary microextraction of volatiles (CMV) device was equipped with a novel Peltier cooler to investigate cryofocused extraction of organic gunshot residue (OGSR) for the first time. Prior research demonstrated the CMV’s capabilities for detecting nitroglycerin, 2,4-dinitrotoluene, diphenylamine, and ethyl centralite on shooters’ hands via gas chromatography-mass spectrometry. Further method development increased the recoveries of these four target compounds with an optimal 20-minute equilibrium time at 80˚C followed by extracting 3 L at a 1 L/min flow rate. The Cryo-CMV was evaluated for detection of semi-volatile OGSR compounds. The unique challenges presented with sampling of semi-volatiles were overcome by sample heating, applying high (>1 L/min) sampling flow rates and heating the transfer line between the container and cooled CMV. Cryofocusing at -10˚C provided increased recoveries for smokeless powders and OGSR compounds and therefore demonstrates excellent potential for other forensic applications with analysis of VOCs from fire debris and illicit drugs.

Traumatic arteriovenous fistulas of the neck are a relatively uncommon injury, whose ramifications can include immediate or delayed neurological insults, massive bleeding, or death. Angiography and embolization have been increasingly used to manage this complex injury pattern. In this particular case, the patient underwent management of bilateral communicating arteriovenous fistulae using a commercially available plug occlusion device. Epidemiology, with an emphasis on patient management and outcomes, is discussed.

Background: Cerebrovascular injury (CVI) is a potentially devastating complication of gunshot wounds to the head (GSWH), with yet unclear incidence and prognostic implications. Few studies have also attempted to define CVI risk factors and their role in patient outcomes. We aimed to describe 10 years of CVI from GSWH and characterize these injury patterns. Methods: Single-institution data from 2009 to 2019 were queried to identify patients presenting with dural-penetrating GSWH. Patient records were reviewed for GSWH characteristics, CVI patterns, management, and follow-up. Results: Overall, 63 of 297 patients with GSWH underwent computed tomography angiography (CTA) with 44.4% showing CVI. The middle cerebral artery (22.2%), dural venous sinuses (15.9%), and internal carotid artery (14.3%) were most frequently injured. Arterial occlusion was the most prominent injury type (22.2%) followed by sinus thrombosis (15.9%). One fifth of patients underwent delayed repeat CTA, with 20.1% showing new/previously unrecognized CVI. Bihemispheric bullet tracts were associated with CVI occurrence (P = 0.001) and mortality (P = 0.034). Dissection injuries (P = 0.013), injuries to the vertebrobasilar system (P = 0.036), or the presence of ≥2 concurrent CVIs (P = 0.024) were associated with increased risk of mortality. Of patients with CVI on initial CTA, 30% died within the first 24 hours. Conclusions: CVI was found in 44.4% of patients who underwent CTA. Dissection and vertebrobasilar injuries are associated with the highest mortality. CTA should be considered in any potentially survivable GSWH. Longitudinal study with consistent CTA use is necessary to determine the true prevalence of CVI and optimize the use of imaging modalities.

Background: Cerebrovascular injury (CVI) is a potentially devastating complication of gunshot wounds to the head (GSWH), with yet unclear incidence and prognostic implications. Few studies have also attempted to define CVI risk factors and their role in patient outcomes. We aimed to describe 10 years of CVI from GSWH and characterize these injury patterns. Methods: Single-institution data from 2009 to 2019 were queried to identify patients presenting with dural-penetrating GSWH. Patient records were reviewed for GSWH characteristics, CVI patterns, management, and follow-up. Results: Overall, 63 of 297 patients with GSWH underwent computed tomography angiography (CTA) with 44.4% showing CVI. The middle cerebral artery (22.2%), dural venous sinuses (15.9%), and internal carotid artery (14.3%) were most frequently injured. Arterial occlusion was the most prominent injury type (22.2%) followed by sinus thrombosis (15.9%). One fifth of patients underwent delayed repeat CTA, with 20.1% showing new/previously unrecognized CVI. Bihemispheric bullet tracts were associated with CVI occurrence (P = 0.001) and mortality (P = 0.034). Dissection injuries (P = 0.013), injuries to the vertebrobasilar system (P = 0.036), or the presence of ≥2 concurrent CVIs (P = 0.024) were associated with increased risk of mortality. Of patients with CVI on initial CTA, 30% died within the first 24 hours. Conclusions: CVI was found in 44.4% of patients who underwent CTA. Dissection and vertebrobasilar injuries are associated with the highest mortality. CTA should be considered in any potentially survivable GSWH. Longitudinal study with consistent CTA use is necessary to determine the true prevalence of CVI and optimize the use of imaging modalities.

Small firearms can create sound levels exceeding the safe threshold of human hearing with even one shot. Understanding how the sound propagates will lead to better range and military drill design. This thesis describes errors associated with different predictive interpolation models for the M16A4. Before directly discussing potential sources of error, the thesis first seeks to validate the data acquired. This is done through waveform inspection with a focus on shot-to-shot consistency. Finding the standard deviation in level between a 10-shot volley provides a good baseline with which other sources of error can be compared to. For both peak and 8-hour A-weighted equivalent levels, the deviation tended to be 1-1.2 dB. With this constraint in mind, the thesis then discussions potential error of measurements along the radial arc. By comparing nearest neighbor microphones with measured values, it was determined that a finer resolution behind the shooter is most relevant. Second, radial propagation was plotted to justify potential decay rates for further plotting. A model of spherical spreading is reasonable, but overestimates the level at farther distances e.g. 50 m. Lastly the thesis focuses on interpolation mapping to predict levels around the range. The baseline model was created using a Cartesian interpolation scheme that uses ghost points to help limit potential artifacts. Leave-one-out analysis highlighted a necessity of microphone placement behind the shooter and other less important microphones. Use of symmetry across the firing direction provides excellent results, generally below the 1 dB standard deviation. In the end, a best-practices guideline is given, which reduces number of required microphones by half. Through these analyses, future measurements will be more effective in microphone placement. With these level maps, one will also be able to better determine potential hearing risks associated with small firearm use and even avoid them through better drill.

OBJECTIVE: Gunshot wounds to the head (GSWH) are devastating injuries with a grim prognosis. Several prognostic scores have been created to estimate mortality and functional outcome, including the so-called Baylor score, an uncomplicated scoring method based on bullet trajectory, patient age, and neurological status on admission. This study aimed to validate the Baylor score within a temporally, institutionally, and geographically distinct patient population. METHODS: Data were obtained from the trauma registry at a level I trauma center in the southeastern US. Patients with a GSWH in which dural penetration occurred were identified from data collected between January 1, 2009, and June 30, 2019. Patient demographics, medical history, bullet trajectory, intent of GSWH (e.g., suicide), admission vital signs, Glasgow Coma Scale score, pupillary response, laboratory studies, and imaging reports were collected. The Baylor score was calculated directly by using its clinical components. The ability of the Baylor score to predict mortality and good functional outcome (Glasgow Outcome Scale score 4 or 5) was assessed using the receiver operating characteristic curve and the area under the curve (AUC) as a measure of performance. RESULTS: A total of 297 patients met inclusion criteria (mean age 38.0 [SD 15.7] years, 73.4% White, 85.2% male). A total of 205 (69.0%) patients died, whereas 69 (23.2%) patients had good functional outcome. Overall, the Baylor score showed excellent discrimination of mortality (AUC = 0.88) and good functional outcome (AUC = 0.90). Baylor scores of 3-5 underestimated mortality. Baylor scores of 0, 1, and 2 underestimated good functional outcome. CONCLUSIONS: The Baylor score is an accurate and easy-to-use prognostic scoring tool that demonstrated relatively stable performance in a distinct cohort between 2009 and 2019. In the current era of trauma management, providers may continue to use the score at the point of admission to guide family counseling and to direct investment of healthcare resources.

O principal objetivo deste estudo foi testar a capacidade da tomografia computadorizada helicoidal com múltiplas fileiras de detectores (TCMD) na identificação/exclusão de lesões em vítimas de ferimento por arma de fogo (FAF) abdominal. Os achados de imagem foram comparados aos cirúrgicos em todos os pacientes da amostra. A TCMD demonstrou elevada acurácia na avaliação de órgãos sólidos, vísceras ocas, grandes vasos e diafragma. Quase a metade dos pacientes (45,2%) não exibiu lesões que necessitassem obrigatoriamente de correção cirúrgica. A TCMD mostrou-se excelente na avaliação dos pacientes da amostra, podendo contribuir com informações importantes ao manejo de vítimas de FAF abdominal. / The main objective of this study was to test the ability of multi-detector row computed tomography (MDCT) in the identification/exclusion of lesions in abdominal gunshot wound (GW) victims. The imaging findings were compared with the surgical ones in all of the studied patients. MDCT demonstrated elevated accuracy in the evaluation of solid organs, hollow viscus, great vessels, and diaphragm. Almost half of the patients (45.2%) did not show lesions requiring obligatory surgical interventions. MDCT showed to be excellent in the evaluation of the studied patients, and can contribute with important information for the management of abdominal GW victims.

Diariamente milhares de profissionais da área de segurança utilizam armas de fogo, quer em ações de combate a criminalidade; quer em treinamentos obrigatórios que a atividade exige. Apesar disso a quantidade de informação sobre os riscos à saúde desses profissionais devido da exposição aos resíduos de disparos, especialmente quando são usadas armas de grosso calibre, ainda é escassa. Este trabalho pretendeu trazer uma contribuição às discussões sobre o tema com uma proposta de normalização para ser observada no planejamento dos procedimentos de treinamento e atividades desses profissionais. Para tanto foram estudados dois grupos de profissionais: o primeiro, profissionais militares da Polícia Militar do Estado de São Paulo durante intensas jornadas de treinamento com esforço físico e grande numero de disparos com armas de fogo de grosso calibre O segundo grupo envolvendo peritos criminais do núcleo de balística do Instituto de Criminalística da Secretaria de Segurança do Estado de São Paulo. Foram utilizadas amostras de materiais biológicos (sangue, urina e saliva) e amostras do ar dos ambientes fechados onde estas rotinas de trabalho ocorrem. No caso dos profissionais militares, os níveis dos metais monitorados no ar variaram de acordo com o tipo de arma e munição utilizada, sendo ultrapassado o limite de tolerância estabelecido na NR-15 (100 μg/m3) após o uso de espingarda (216 μg/m3). A média e desvio padrão dos níveis de chumbo no sangue antes (3,3 μg/dL ± 0,7) e depois (18,2 μg/dL ± 5,1) do curso indicam que ouve um aumento importante num curto período de tempo, também houve aumento nos níveis de chumbo e antimônio na urina. No segundo caso de exposição ocupacional aos resíduos de disparo no núcleo dos peritos balísticos se verificou uma baixa quantidade de resíduos no ambiente de trabalho, se comparado com o Limite de Tolerância preconizado na norma NR-15, e uma baixa quantidade de chumbo no sangue (3,9 μg/dL ± 0,8) se comparado com o Índice Biológico Maximo Permitido IBMP (60 μg/dL) estabelecido na NR-7, sem embargo quando comparado o grupo de balísticos com o grupo controle (1,8 μg/dL ± 0,7) estabeleceu se uma diferença. O estudo dos cenários de exposição permitiu gerar uma proposta para trabalho seguro nestes ambientes e recomendações para o desenho e uso de estantes fechados de disparo. Os câmbios que se introduzam nos costumes e comportamentos dos profissionais levaram uma diminuição do risco associado ao uso de armas de fogo nestes estantes. As conclusões do presente trabalho contribuem para a adequação das medidas de proteção dos trabalhadores de segurança, e na adequação da legislação relativa aos limites de tolerância e índices bilógicos empregados no controle de saúde ocupacional. / Daily thousands of military officers from security forces use fire arms, sometimes in actions against crime or in mandatory training seasons. Despite of this, there is a few information about the risk associated with firing ranges, especially when heavy weapons are used in a hard training seasons with hard physical work and elevated number of rounds, the security forces might be under risk of intoxication. Other types of exposure with less frequency and intensity, but using a high lead containing ammunition and different types of weapons, like in the ballistics forensic cases are not yet sufficiently studied. Data from these types of occupational exposure in these environments are important in order to establish safety working procedures. The goal in this research is to study the occupational exposure in the police department and the ballistics laboratories in personal who are under the risk of this exposure in their routinely daily work and during the training courses in the Sao Paulo´s Military Police Department. In order to reach this, some biological materials were sampled (blood, urine and saliva) as well as air samples from the environment in the firing ranges during routinely daily work. In the two studied cases the monitored airborne lead varied in accordance with the type of weapon and ammunition used, and was ultra passed the limit of exposure established in the norm NR-15 (100 μg/m3) after the shot gun was used during the training season (216 μg/m3). The average and standard deviation of lead content in blood before (3,3 μg/dL ± 0,7) and after (18,2 μg/dL ± 5,1) de training season shows a significant rise of the lead levels in a very short period of time. An increment of the lead and antimony levels in urine was demonstrated. The other studied case, in the ballistics laboratory showed minor increments of lead in blood and airborne residues when compared with the limits established in the norm NR- 7 (60 μg/dL) but when compared in a cohort study the data lead to establish a significant difference between the exposed group from the ballistics and the control group. These results let us to design a proposal to safely work in these environments and to give the recommendations in the engineering design of the indoor ranges. The implemented changes will lead to minimize the risk associated with the use of weapons and lead containing ammunitions. The conclusions of the present work contribute to adequateness of the related legislation and the tolerance limits of exposure used in the occupational health practice.

Baigiamajame magistro darbe teoriškai tiriami statybinio parakinio įrenginio vidinės balistikos hidrodinaminiai ir termodinaminiai procesai. Be to, modeliuojami garso slopintuvai ir teoriškai tiriamas jų efektyvumas. Darbe padarytos vidinės balistikos, kaip mokslo, statybinių viniašaudžių ir garso slopintuvų tipų apžvalgos. Atliktas skaitinis vidinės balistikos ir dujų plėtimosi procesų modeliavimas. Pateikti modeliavimo rezultatai ir jų analizė. / The topic of Master thesis is research of powder-actuated hydrodynamic ant thermodynamic processes in pyrotechnic tube. Also were made 3d models of suppressors and modeled their effectiveness. Internal ballistics, powder-actuated tools and suppressors reviews were made. Performed calculations of internal ballistics and gas extension processes. Presented results and analysis.

O principal objetivo deste estudo foi testar a capacidade da tomografia computadorizada helicoidal com múltiplas fileiras de detectores (TCMD) na identificação/exclusão de lesões em vítimas de ferimento por arma de fogo (FAF) abdominal. Os achados de imagem foram comparados aos cirúrgicos em todos os pacientes da amostra. A TCMD demonstrou elevada acurácia na avaliação de órgãos sólidos, vísceras ocas, grandes vasos e diafragma. Quase a metade dos pacientes (45,2%) não exibiu lesões que necessitassem obrigatoriamente de correção cirúrgica. A TCMD mostrou-se excelente na avaliação dos pacientes da amostra, podendo contribuir com informações importantes ao manejo de vítimas de FAF abdominal. / The main objective of this study was to test the ability of multi-detector row computed tomography (MDCT) in the identification/exclusion of lesions in abdominal gunshot wound (GW) victims. The imaging findings were compared with the surgical ones in all of the studied patients. MDCT demonstrated elevated accuracy in the evaluation of solid organs, hollow viscus, great vessels, and diaphragm. Almost half of the patients (45.2%) did not show lesions requiring obligatory surgical interventions. MDCT showed to be excellent in the evaluation of the studied patients, and can contribute with important information for the management of abdominal GW victims.