Effects of input energy and impactor shape on cranial fracture patterns.

This study documents relationships between input energy, impactor shape, and the formation of fractures in human crania. Parietal impact experiments (n = 12) were performed at 67% higher input energy compared to previously reported experiments. Fracture origins, characteristics, and locations were compared at two input energy levels with three impactor shapes (focal "hammer", flat "brick", and curved "bat").

Rapid, sensitive, and specific lateral-flow immunochromatographic point-of-care device for detection of varicella-zoster virus immunoglobulin G antibodies in fingerstick blood.

Varicella zoster virus (VZV) causes childhood chickenpox, becomes latent in sensory ganglia and reactivates years later to cause shingles (Zoster) and postherpetic neuralgia in the elderly and immunosuppressed individuals. Serologic IgG tests can be used to determine if a person has antibodies to VZV from past varicella infection or had received varicella or zoster (shingles) vaccination. Commercial enzyme-linked immunosorbent assays (ELISAs) are currently used for the detection of VZV IgG antibodies in patient serum samples.

Investigating reverse butterfly fractures: An experimental approach and application of fractography.

Butterfly fractures are expected to form with the transverse portion on the tension side and the wedge portion on the compression side of a bent bone, however wedges have also been observed in the reverse orientation and are reported to be frequent in concentrated 4-point bending. To investigate how these fractures form, concentrated 4-point bending experiments were performed on nine human femora and documented using high-speed video. Videos showed the wedge portion formed as fracture initiated in tension, branched obliquely, then curved to terminate on the tension face.

Effects of age and rate of twist on torsional fracture patterns in infant porcine femora.

Objective: Long bone fractures are a common injury in the pediatric population. Differentiation between abusive, or non-accidental trauma, and accidental trauma in children remains challenging for forensic practitioners. A recent clinical-based study was able to separate pediatric abusive from accidental trauma based on femoral fracture pattern using the ratio of fracture length over bone diameter (fracture ratio), as determined from radiographic analysis of this fractured bone.

Experimental investigation of cranial fracture initiation in blunt human head impacts.

The relationship between the point of blunt impact and the location of cranial fracture initiation continues to be poorly understood. The current study used high-speed video to capture cranial fracture initiation and propagation in impact experiments on twelve unembalmed, intact human cadaver heads. Video footage provided direct evidence that blunt cranial impacts can produce linear fractures initiating peripheral to the impact site.

The Inverse Equity Hypothesis: Analyses of Institutional Deliveries in 286 National Surveys.

Objectives: To test the inverse equity hypothesis, which postulates that new health interventions are initially adopted by the wealthy and thus increase inequalities-as population coverage increases, only the poorest will lag behind all other groups.

Methods: We analyzed the proportion of births occurring in a health facility by wealth quintile in 286 surveys from 89 low- and middle-income countries (1993-2015) and developed an inequality pattern index. Positive values indicate that inequality is driven by early adoption by the wealthy (top inequality), whereas negative values signal bottom inequality.

The Role of Interface Shape on the Impact Characteristics and Cranial Fracture Patterns Using the Immature Porcine Head Model,

The forensic literature suggests that when adolescents fall onto edged and pointed surfaces, depressed fractures can occur at low energy levels. This study documents impact biomechanics and fracture characteristics of infant porcine skulls dropped onto flat, curved, edged, and focal surfaces. Results showed that the energy needed for fracture initiation was nearly four times higher against a flat surface than against the other surfaces.

A method of determining bending properties of poultry long bones using beam analysis and micro-CT data.

While conventional mechanical testing has been regarded as a gold standard for the evaluation of bone heath in numerous studies, with recent advances in medical imaging, virtual methods of biomechanics are rapidly evolving in the human literature. The objective of the current study was to evaluate the feasibility of determining the elastic and failure properties of poultry long bones using established methods of analysis from the human literature. In order to incorporate a large range of bone sizes and densities, a small number of specimens were utilized from an ongoing study of Regmi et al.

Budgeting based on need: a model to determine sub-national allocation of resources for health services in Indonesia.

Background: Allocating national resources to regions based on need is a key policy issue in most health systems. Many systems utilise proxy measures of need as the basis for allocation formulae. Increasingly these are underpinned by complex statistical methods to separate need from supplier induced utilisation.

The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in 1982, 1993, and 2004.

Background: Middle-income countries will need to drastically reduce neonatal deaths to achieve the Millennium Development Goal for child survival. The evolution of antenatal and perinatal care indicators in the Brazilian city of Pelotas from 1982 to 2004 provides a useful case study of potential challenges.

Methods: We prospectively studied three birth cohorts representing all urban births in 1982, 1993, and from January to July, 2004.

Achieving universal coverage with health interventions.

Cost-effective public health interventions are not reaching developing country populations who need them. Programmes to deliver these interventions are too often patchy, low quality, inequitable, and short-lived. We review the challenges of going to scale, building on known, effective interventions to achieve universal coverage.

The multi-country evaluation of the integrated management of childhood illness strategy: lessons for the evaluation of public health interventions.

The Multi-Country Evaluation of the Integrated Management of Childhood Illness (IMCI) includes studies of the effectiveness, cost, and impact of the IMCI strategy in Bangladesh, Brazil, Peru, Tanzania, and Uganda. Seven questions were addressed when the evaluation was designed: who would be in charge, through what mechanisms IMCI could affect child health, whether the focus would be efficacy or effectiveness, what indicators would be measured, what types of inference would be made, how costs would be incorporated, and what elements would constitute the plan of analysis. We describe how these questions were answered, the challenges encountered in implementing the evaluation, and the 5 study designs.

The Pelotas birth cohort study, Rio Grande do Sul, Brazil, 1982-2001.

Given the growing recognition of the importance of the life course approach for the determination of chronic diseases, birth cohort studies are becoming increasingly important. This paper describes the methods used in the 1982 Pelotas (Brazil) birth cohort study, one of the largest and longest studies of this type in developing countries. All 5,914 hospital births occurring in Pelotas in 1982 (over 99% of all deliveries) were studied prospectively.

Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial.

Objective: To evaluate the effect on morbidity and mortality of providing daily zinc for 14 days to children with diarrhoea.

Design: Cluster randomised comparison.

Setting: Matlab field site of International Center for Diarrhoeal Disease Research, Bangladesh.

Cost-effectiveness of community health workers in tuberculosis control in Bangladesh.

Objective: To compare the cost-effectiveness of the tuberculosis (TB) programme run by the Bangladesh Rural Advancement Committee (BRAC), which uses community health workers (CHWs), with that of the government TB programme which does not use CHWs.

Methods: TB control statistics and cost data for July 1996 - June 1997 were collected from both government and BRAC thanas (subdistricts) in rural Bangladesh. To measure the cost per patient cured, total costs were divided by the total number of patients cured.