Bomb Blast Research Articles

Impact of injury mechanism on early wound closure in patients with acute conflict-related extremity wounds: A prospective cohort analysis from two civilian hospitals in Iraq and Jordan.

Gunshots and bomb blasts are important causes of extremity injuries in conflict zones, yet little research exists on the characteristics and outcomes of these injuries in civilian populations. We performed a prospective cohort analysis utilizing data from a randomized trial conducted at two civilian hospitals in Jordan and Iraq in 2015-2019. Adults who presented ≤72h of sustaining an extremity injury were included. We used mechanism of injury (gunshot/bomb blast) as the exposure and wound closure by day 5 as the primary outcome measure. The population predominantly comprised young men (n=163, 94% male, and median age 29years) injured by gunshots (61%) or bomb blasts (39%). Compared with the gunshot group, more participants in the bomb blast group had concomitant injuries (32/63 [51%] vs. 11/100 [11%], p<0.001) and vascular injuries (9/63 [14%] vs. 4/100 [4%], p=0.02). The wounds were larger in the bomb blast group compared with the gunshot group (median area 86cm2 [IQR 24-161] vs. 21cm2 [IQR 7-57], p<0.001). Compared with the bomb blast group, significantly more participants in the gunshot group achieved wound closure by day 5 (74/100 [74%] vs. 16/63 [25%], p<0.001). This difference remained after controlling for confounding factors (odds ratio 4.7, 95% confidence interval 1.6-13.7). In civilians with conflict-related extremity injuries, bomb blast wounds had a lower likelihood of achieving closure within 5days than gunshot wounds, independent of other factors, such as wound size and vascular injuries. ClinicalTrials.gov, NCT02444598. Registered 14-05-2015, https://classic. gov/ct2/show/NCT02444598.

A Qualitative Narrative Study of Rescue and Recovery Workers Responding to the Terrorist Bombing of Oklahoma City's Murrah Building.

Much of disaster mental health research uses quantitative methods, focusing on numerical prevalence, services, and outcomes. Qualitative methods can provide more detailed, rich, and spontaneous insights into personal disaster experiences, yielding important insights beyond deductive methods. This large-scale qualitative narrative study examined experiences of 181 Oklahoma City bombing rescue/recovery workers. Thematic narrative content of the bombing experience arose from personal accounts of the bomb blast by rescue/recovery workers proceeding chronologically from initial awareness and deployment to harrowing onsite search and rescue/recovery missions to the aftermath with reflections on the bombing. Beyond disaster recovery/rescue worker stories published in popular media, little other substantive published knowledge on this topic is available, and therefore this research study provides a wealth of new in-depth information that can provide guidance for policy and practice for disaster response.

Profile of bomb blast injuries

Bomb blast injuries in India have unfortunately been a recurring and tragic reality, stemming from acts of terrorism and insurgency that have targeted various regions of the country. These incidents have resulted in significant loss of life, severe injuries, and lasting trauma for those affected. The impact of bomb blast injuries in India is not only physical but also psychological, affecting individuals, families, and communities at large.The injuries sustained in bomb blasts can vary in severity and type, depending on factors such as the type of explosive device used, the location of the blast, and the proximity of individuals to the explosion. Common injuries include shrapnel wounds, burns, fractures, traumatic amputations, and head injuries. The force of the blast can cause extensive damage to internal organs, leading to conditions such as blast lung injury, abdominal trauma, and hearing loss. The pattern of injuries due to bomb blast on the victims. Identification of the dead body of the deceased victims. To ascertain the distance of the victim from the blast from nature of injuries. Eardrum injuries sustained and mental trauma to live victims. To ascertain the presence of foreign bodies, primary and secondary missiles and there by assisting in investigations. The present study “The Profile of Bomb Blast Injuries’’ has been carried out in the one of the Major Medical College and Hospital in Maharashtra State. The present study has been carried out during the period of January 2003 to July 2004, During this study total cases studied were sixty nine (69), they are grouped as A &amp; B. A : - 32 cases died due to bomb blast has been meticulously studied. B: - 37 injured persons ( clinical cases) due to bomb blast has been studied in the different wardsof hospital. In the present work total 69 cases were studied by group A &amp; B i.e group A: 32 cases brought dead in the hospital, while group B:37 cases admitted in the hospital and following conclusion are derived :-1. Maximum affected persons from group A: deaths as well as from group B : clinical cases injured in bomb blast, were in the age group of 11 to 40 years. 2. Maximum cases from group A (brought dead to the hospital) as well as clinical cases from group B admitted in the hospital are much higher in males as compared to females. 3. The persons died, group A and injured cases (clinical) group B, during bomb blast in present study was mainly belong to Hindu religion as compared to other religions. 4. It was found in the present study that the persons died in bomb blast were mostly the residents of Mumbai city in comparison with those who are residing outside of Mumbai.

Role of Forensic Odontology in Identification of Persons: A Review Article.

Forensic dentistry plays a pivotal role in identifying deceased individuals when visual or other means of identification are not possible, particularly in the aftermath of mass disasters or criminal activities. Accurate and timely identification of the deceased and injured becomes crucial following events like earthquakes, fires, transport accidents, gunshot incidents, floods, tsunamis, bomb blasts, and terrorist attacks. The process of creating a person's identity is a formidable task, often relying on prevalent methods such as dental, DNA, and fingerprint analyses. Forensic odontology, a specialized field within dentistry, assumes a significant role in identifying individuals in accidents, civil unrest, natural and mass disasters, and crimes related to genocide. In cases where natural teeth are absent, the marking or labeling of dentures becomes essential for personal identification. Teeth's resilience to destruction and decomposition makes dental identification feasible even under extreme conditions. The fundamental principle of forensic dentistry rests on the uniqueness of each individual's oral structure, emphasizing that no two mouths are identical, not even in the case of twins. The purpose of this review is to explore the role of forensic dentistry in identifying individuals through various methods such as denture labeling, cheiloscopy, radiographs, bite mark analysis, rugoscopy, salivary signature, age and sex estimation, dental DNA identification, individual characteristics, and denture marking. Based on detailed ante-mortem records from dental specialists, which are compared to postmortem data during investigations, forensic dentistry is a trustworthy technique for identifying deceased individuals and criminals.

Pattern and Management of Missile Injury to the Oral and Maxillofacial Region: A 12-Year Experience During Boko Haram Insurgency in Maiduguri, North-Eastern Nigeria.

Missile injury is a global public health problem, which occurs in both military and civilian settings. Boko Haram insurgency in North-Eastern Nigeria is one of the major violence the country experienced that resulted in many civilian casualties. This study was aimed at exploring the various patterns of the missile injuries to the maxillofacial region during Boko Haram insurgency. In this retrospective cross-sectional study, relevant information was retrieved from patient records including sociodemographic, causes of missile injuries, site of injuries, pattern of presentation, treatment, and the complications, and analysed using SPSS version 23. A total of 526 patients with various maxillofacial injuries were seen during this 12-year study period, with age ranging from 4 to 65 years, the peak incidence in the age group 31-40 years, 89.5% were males, 92.9% of the injuries were allegedly inflicted by insurgents and comprised of 61.0% gunshot injuries, 24.5% bomb blast, and machete cuts 7.4%. Most of the injuries occurred in the lower third of the face, 39.8%, and mandible was the commonest fractured facial bone. Facial injuries commonly are associated with devastating consequences to survivors and, hence, may require long time monitoring and psychosocial rehabilitations.

DNA quality and quantity in adipose tissue: a comparison of the effects of bomb explosion

BACKGROUND Adipose tissue is often overlooked in DNA testing due to misconceptions about its DNA content. However, its shock-absorbing qualities may be useful for high-pressure scenarios like bomb blasts. This study aimed to evaluate DNA quality and quantity in adipose tissue affected by blasts compared to that in unaffected tissue.&#x0D; METHODS 10 adipose tissue samples were taken from regions near and far from the blast, representing the blast-exposed and non-blast-exposed groups. The adipose tissue was stored at a low temperature for 5 days, after which an organic extraction method was applied. The purity of the DNA extract was assessed using a NanoDrop spectrophotometer, and its integrity was evaluated using 0.8% concentration gel electrophoresis at 60 V for 90 min. DNA typing was conducted using the GlobalFiler™ kit, and DNA quantity was determined with the Quantifiler™ Trio DNA Quantification kit.&#x0D; RESULTS Of 20 DNA extracts from adipose tissue, all samples demonstrated purity, integrity, and complete typing results. Adequate integrity was found in 90% of samples in both groups. A 50% incidence of allele shifting was observed at the D7S820 locus within the blast-exposed group.&#x0D; CONCLUSIONS DNA from blast-exposed adipose tissue exhibited no significant quality or quantity differences from non-blast-exposed tissue. This suggested adipose tissue’s potential as an alternative DNA source in a bomb explosion.

Prospective Study on Estimation of Stature of Adult from Length of Clavicle in a Tertiary Care Hospital in Tamilnadu

Forensic anthropology can play an important role in the identification process. Besides determination of race, sex and age of the unknown individual, estimation of stature enhances the reliability of identification. It is easier to get those data when the whole body or the entire skeleton isavailable to the forensic anthropologist. However incases of deliberate mutilation and disposal in parts, interference by wild animal and bomb blast by terrorist attack, recovery of the whole body or complete skeleton may not be possible. In those cases, in the forensic anthropologists have to give this opinion based upon the available supplied skeleton remains. Although approximate stature of the individual can be estimated from most of the long bones using either multiplication factors or regressionformulae, studies on estimation of stature from clavicle are limited. In the past, Terry, Oliver and Thieeme have tried to estimate the stature of the individual from clavicle. So the present study is planned to determine the stature from clavicle.

Evaluation of emergency department admissions of mass casualty patients using the revised trauma score, injury severity score, and trauma and injury severity score.

There is a need for studies evaluating prognostic scoring systems in mass trauma patients in conflict regions to predict patient prognosis for emergency surgical prioritization. In this study, we aimed to evaluate scoring systems such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in trauma patients admitted due to mass trauma in Northern Syria. This study was a retrospective evaluation of patients admitted due to mass trauma to the emergency departments of hospitals in Northern Syria. The diagnostic efficiency of RTS, ISS, and TRISS scoring systems was evaluated in these admissions in the first half of 2021. The most common causes of mass trauma were bomb blast (67.3%), gunshot (28.8%), and 14 (3.9%) patients admitted with other causes. When the odds ratio (OR) was analyzed, a one-unit increase in the RTS score increased the odds of survival by a factor of 6.133, and a one-unit increase in the TRISS score increased the odds of survival by a factor of 1.057. Differently, it was found that each 1-unit increase in ISS decreased the patient's probability of survival by 0.856 units. When RTS, TRISS, and ISS scores were analyzed, the area under the ROC curve was statistically significant for all of them (p<0.001) and all of them had a diagnostic value for mortality with sensitivities of 99.0%, 94.8%, and 91.9%; specificities of 87.8%, 90.5%, and 88.6; AUC of 0.958, 0.975, and 0.958, respectively. The use of trauma scoring systems, especially TRISS, may be useful for prioritizing patients in mass casualty settings in the presence of overcapacity.

Emergency management of traumatic spinal cord injury: a systematic review

Globally, trauma is a prominent factor contributing to mortality and impairment. Hemorrhage accounts for up to 40% of fatalities resulting from traumatic injuries. Current approaches to improve mortality rates have prioritized the implementation of effective techniques for the early management of bleeding and the treatment of coagulation disorders. This is an updated systematic review of studies that examined the emergency care of traumatic spinal cord injury (SCI) from 2017 to 2023. A literature search was conducted using Google Scholar, Web of Science, Cochrane, and PubMed databases to find relevant research on our issue. The search terms used were &amp;quot;SCI, Spine trauma, Emergency, management, Traumatic cervical SCI&amp;quot; and were employed in different combinations. Furthermore, an assessment was conducted on original research that examines the emergency care of severe SCI. The inclusion criteria were based on full-text publications. Out of the 85 research that were collected, only nine satisfied the inclusion requirements. Out of the total number of studies, seven were conducted retrospectively, one was a case report, and another was a cross-sectional research. The research population consisted of around 159,982 individuals diagnosed with SCI. Respiratory ssues, septicemia, and cardiovascular complications were the leading causes of in-hospital mortality in those with complete acute SCI. Elderly people, physical injuries, paralysis of all four limbs, and reliance on mechanical breathing were all associated with greater death rates. The American Spinal Injury Association grade upon admission was the greatest predictor of morbidity and death. Road traffic accidents were the major cause of CI among Saudi men. Bomb blasts quickly followed falls, gaining second place. Road traffic accidents are the second most common cause of SCI among females, behind falls. Younger people who suffer spinal cord injuries frequently were found to have a better prognosis for recovery than older people.

Impact of Point-of-Care Ultrasound on Secondary Triage: A Pilot Study

Abstract Objectives In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of-care ultrasound (POCUS) on the accuracy of secondary triage conducted at an advanced medical post (AMP) to enhance the detection of patients who, despite their apparent clinically stable condition, could benefit from immediate life-saving interventions or priority earlier transport to definitive care. Methods A mass casualty simulated event consisting of a bomb blast in a remote area was conducted with 10 simulated casualties classified as YELLOW at the primary triage scene; patients were evaluated by 4 physicians at an AMP. Three patients had, respectively, hemoperitoneum, pneumothorax, and hemothorax. Two of the four physicians were provided the use of POCUS. Results All 4 physicians were able to suspect hemoperitoneum, but only physicians utilizing POCUS detected pneumothorax and hemothorax. Conclusion This study suggests that POCUS-enhanced secondary MCI triage at an AMP may represent an effective methodology to accurately detect nonapparent injuries that require time-dependent priority transport or life-saving interventions. Further studies with larger samples conducted in varied MCI scenarios are warranted.

Bilateral anterolateral thigh free flap in a flow-through chimeric pattern for a extensively large defect reconstruction: a case of an elderly patient under spinal-epidural anesthesia

An 83-year-old male patient presented with a Marjolin’s ulcer on his lower leg, which developed 60 years after a bomb blast injury. The lesion was a 24×12-cm2 chronic ulcer located circumferentially around the mid-third lower leg. Considering the patient’s age, vessel status, and the extent of the defect after wide excision, which included a section of the tibia, reconstruction utilizing bilateral anterolateral thigh free flaps in a flow-through pattern under spinal-epidural anesthesia was planned. The operative time was 9 hours, and the patient fully recovered without any complications. The patient was able to walk without any orthosis, and no evidence of recurrence was found during a 3-year postoperative follow-up period.

SCMD suspicious cryptographic message detection

The proposed framework aims to prevent global crimes, specifically terrorist attacks, bomb blasts, and drone attacks, by using the Suspicious Cryptographic Message Detection (SCMD) system to detect and decrypt suspicious messages. Terrorists often use encrypted messages to communicate with their teammates in different parts of the world, making it difficult for authorities to monitor their activities. The framework addresses this issue by detecting with gradient boosting algorithm and cryptanalyzing by using Simple Substitution Cipher techniques to decrypt suspicious messages and predict potential criminal activity. The framework utilizes various emerging trends in information technology, including machine learning techniques, pre-defined decision rules, wordnet, and semantic web ontology, to predict the type of crime, the criminal's name and location, and other criminal details. It comprises multiple components, including Semantic web Ontology, Suspicious Database, and machine learning techniques, to facilitate the detection and reporting of criminal activity. When the server receives a suspicious encrypted message, the framework detect and decrypts it and predicts the type of crime based on microblogs before it can be executed by the criminals. The details of the criminals are then alerted to the cybercrime department, reducing the burden on security departments and enhancing public safety. In summary, the framework provides a comprehensive solution to the challenges posed by encrypted messages in criminal activities. It uses advanced technologies to identify and predict potential criminal activities, enabling law enforcement agencies to take preemptive actions to prevent major and minor attacks, including terrorist attacks.

Characteristics and Outcomes Among Patients with Acute Extremity Wounds Due to Gunshots Versus Bomb Blasts – A Prospective Cohort Analysis from Two Civilian Hospitals in Iraq and Jordan

Introduction:Gunshots and bomb blasts are important causes of injury within conflict zones and extremities are frequently affected. There is a paucity of research on the characteristics and outcomes among civilians with conflict-related extremity injuries.Method:We performed a prospective cohort analysis utilizing data collected during a randomized trial at two civilian hospitals in Jordan and Iraq between 2015 and 2019. Adult patients who presented within 72 hours of sustaining an extremity injury requiring surgical care were included. We used mechanism of injury (gunshot versus bomb blast) as the exposure and wound closure by day five as the primary outcome measure.Results:The population was predominantly young men (n=163, 94% male, median age 29 years), injured by gunshots (61%) or bomb blasts (39%). Compared to the gunshot group, participants in the bomb blast group had more concomitant injuries (32/63 [51%] vs 11/100 [11%]; p&lt;0.001), larger wounds (median area 100 cm2 [IQR 50–145] vs 53 cm2 [IQR 25–78]; p&lt;0.001) and more frequent infections (16/63 [25%] vs 13/100 [13%]; p=0.04). Wound closure by day five was achieved in 25% (n=16/63) of the bomb blast group and 74% (n=74/100) of the gunshot group (p&lt;0.001). This difference remained after controlling for confounding factors (OR 4.7; 95% CI 1.6–13.7).Conclusion:In this first prospective cohort analysis of civilians with acute conflict-associated injuries, those with extremity wounds caused by bomb blasts had worse outcomes than those with gunshot wounds. Our findings may prove useful to inform treatment protocols for civilians in armed conflict settings.

Indo-Pak Newspapers Coverage of the Pulwama Incident

In the political and military tensions between India and Pakistan, print media play an important role in stabilizing the issues or portraying the narrative of the state to the world. Both the countries spend more on defense in comparison to other sectors. The main reason for spending billions of USD on the military is the Kashmir issue. Though both countries have a long-lasted history of rivalry when it comes to the Kashmir issue after the Pulwama attack, the tensions between the two neighboring countries were the worst in the last thirty years. In such a horrible situation, media from both sides were busy defending their stances.This study aims to the comparison of Pulwama attack coverage in English newspapers from both sides (Daily Dawn from Pakistan &amp; the Hindu from India) that how these most circulated newspapers covered the whole conflict, what were their contributions to peace, and how they portrayed the stance of their governments. As the incident started on 14 February 2019 after the bomb blast, therefore we have covered editorials of both newspapers from 14 February to 5 March 2019. Both sides exaggerated the whole issue however; we noticed that Indian media and Political leadership used harsh words and false statements.

Echoes Of Terror And Oppression In "Noha E Be’Naam"

Terrorism is often Construrd as a well-thought out extreme from of violence to perceived injustices the after effects of terrorism are usually reported without understanding the underlying psychological and social determinations of terrorism act since 9/11 pakistan has been at the epicentre of both terrorism and war against it , especially balochistan and khaybe Pakhtunkhwa began to present the scene of a battlefield , so its indelible fears on the lives and minds of the residents of this region were erased . These incidents of terrorism also schocked the writers and poets their pens started writing the stories of these bloody incidents and bomb blasts in their own words . Muhammad Jameel kachu khol has made his place in Urdu Fiction writers and the agony and fear that prompted him to write the stories is cutting human existance like a gnat. This paper helpsto explains the psychological and social perspective of terrorism in KPK represented by Jameel kachokhel in his short stories.

Which is better?? e-Fast or contrast enhanced computed tomography in blunt abdominal trauma: An observational study in tertiary care center

Background: Blunt Abdominal trauma is one of the most common causes among injuries caused mainly due to road traffic accidents and assaults. The rapid increase in number of motor vehicles and its aftermath has caused rapid increase in number of victims to blunt abdominal trauma. Motor vehicle accidents account for 75 to 80% of blunt abdominal trauma. Blunt injury of abdomen is also a result of fall from height, assault with blunt objects, industrial mishaps, sport injuries, bomb blast and fall from riding bicycle. Due to the delay in diagnosis and inadequate treatment of the abdominal injuries, most of the cases are fatal. The knowledge in the management of blunt abdominal trauma has progressively increased. The reason for this could be due to the interval between trauma and hospitalization, inadequate and lack of appropriate surgical treatment, delay in diagnosis, post-operative complications and associated trauma especially to head, thorax and pelvis.Aims and Objectives: To study the sensitivity of eFAST in comparison with CECT in blunt injury abdomen patients.Material and Methods: All the patients brought to emergency department with the history of road traffic accident, fall from height, assault with blunt objects, industrial mishaps, sport injuries, bomb blast and fall from riding bicycle are included in the study. eFAST was done in the resuscitation area for all the patients. After admission all the patients with eFAST positive were on close observation for to proceed with CECT Abdomen and Pelvis or to operate the patient.Results: A total of 50 cases of blunt injury abdomen presenting in our trauma care setup were included in our study. Of these cases 44 cases (88%) were males and 06 cases (12%) were females. The age group spectrum studied was comprised of 16 years to 72 years and the mean age of the study group was 37.22 years. 40 patients were operated for haemoperitoneum and other 10 patients were managed conservatively.Conclusion: CECT is the gold standard technique for evaluating of blunt injury patients because it is highly sensitive and panoramic compared with eFAST. However eFAST can help us in assessing the severity of the trauma and helps in decision making for emergency laprotomy.

Prevalence of Psychiatric Morbidity Among Victims of Terrorist Attacks: Comparative Study

To evaluate the occurrence of psychiatric morbidity Posttraumatic Stress Disorder (PTSD); mood state; (state of depression, anxiety, stress) and its effect on general health among victims of terrorist attacks (mild injuries, severe injuries &amp; amputation) in Peshawar, Khyber Pakhtunkhwa. Current study was a cross-sectional correlational research applied on three groups of admitted patients; who were injured during attacks (with mild injuries, severe injuries &amp; severe injuries along with amputation), the data were collected after one week of attack during from the patients who had direct exposure to terrorist attacks and sought treatment from Combined Military Hospital, Peshawar, Pakistan, during the period of November 2021 to September 2022. Sample included all the survivors who sought medical assistance from the hospital. The instruments comprised upon Impact of Event Scale Revised (IES-R 22), General Health Questionnaire (GHQ-12), and Depression, Anxiety and Stress Scale (DASS-21). PTSD has positive association with Depression, Anxiety and Stress but negative association with General Health Questionnaire among terrorists’ attack victims. The terrorist attack victims had significantly higher psychiatric morbidity than non-exposed participants. Psychiatric morbidity was found highest in the victims of survivors of bomb blasts.

Ethnic conflicts in Sri Lanka: An analytical study based on Post-colonial Sri Lankan English literature

Sri Lanka is a multi-communal country that consists of four major ethnicities, namely: Sinhalese, Tamils and Muslims.The country has experienced several ethnical conflicts and riots since 1948. As a result, certain literary works in post-colonial Sri Lankan literature deals with war and ethnic conflicts in Sri Lanka. On this basis, this study was conducted to analyze the post-colonial Sri Lankan English literature in relation to ethnical conflicts in Sri Lanka. This study was an analytical research. In this study, the poem “Gajaga wannama” and the drama “Rasanayagam’s Last Riot” were analyzed to identify how the post-colonial Sri Lankan English literature describes nugatory ethnical violence against minorities in Sri Lanka. According to the review and analysis of the literary works such as the poem “Gajaga wannama” and the drama “Rasanayagam’s Last Riot”, several anti-minorities conflicts and riots have been recorded in the Sri Lankan history since 1948. Especially, the 1983 July riot was the massive anti-Tamil violence which was led by the fundamental thugs and mobs with the support of the United National Party government. Based on the analysis of the selected poem and drama, it is obvious that Tamil People lived Colombo, the Capital City of Sri Lanka were brutally killed and their assets and belongings were destroyed over a night following a bomb blast carried out by the Liberation of Tiger Tamil Ealam (LTTE) in the Northern part of Sri Lanka. This riot is primarily concerned with the nugatory anti-minority’s violence in Sri Lanka.

Effect of Vertical Setbacks of Space Frame Structure under Seismic and Blast Loads using Applied Element Method

Structures, when subjected to nonlinear dynamic loading, drastically affect the structure’s physical properties. The structural failure occurred at the critical points of weakness during the earthquake. These structural weaknesses observed in irregular structures are mainly due to the improper distribution of mass, geometry and stiffness. Architects usually prefer irregular buildings for the aesthetics point of view. These irregular structures are more vulnerable to dynamic loading. On the other hand, the devastating failure due to bomb blast is also the concern for the study as many vital structures collapsed because of the terrorist attack. Such failures need to be checked by studying the performance of building under the earthquake and blast loading. The objectives of this paper are to compare the peak responses at each storey level of mass irregular space frame structure to the dynamic effect. Firstly, Time History of the Northridge earthquake spectra with Peak Ground Acceleration (P.G.A.) =8.660 m/s2 = 0.883g at 9.82 seconds considered and analysed. Secondly, blast material [1] composed of two different charge weights [2] 1000 kg TNT and 2500 kg TNT at a distance of 10m was considered. For responses to the structure, the most advanced numerical tool viz., Applied Element Method (AEM) has been used. It is concluded that the amplitude of Northridge earthquake’s maximum x-displacement at the terrace level is closer to maximum x-displacement for the blast load of 2500kg TNT but the time of occurrence was changed abruptly, i.e., Northridge earthquake maximum displacement occurs at the duration of nearly 10 sec, but the maximum displacement of blast load of 2500kg TNT is occurring almost at 0.2 sec, i.e., 50 times quicker in occurrence.

Interdisciplinary inpatient rehabilitation of acquired brain injury - Part II - a proposed model of care for Pakistan.

Rehabilitation of acquired brain injury (ABI) is a complex and costly intervention in which the comprehensive rehabilitation services should be integrated with neurosciences units to provide best possible opportunities of recovery to the patients. Keeping in view the diversity and chronicity of impairments, the follow up needs to be well planned in terms of duration and patient convenience. These types of services need to be run by the government and funded by government, with parallel efforts to make national guidelines and registry to keep a track of patients suffering from ABI. In Pakistan, the burden of people with ABI is increasing. This can be attributed to the acts of terrorism and bomb blasts, rapid urbanization and increase in number of motor vehicles resulting in increased frequency of roadside accidents, lack of adequate medical and evacuation services and the absence of hyper acute neurosurgical units. We have proposed an ABI rehabilitation plan considering the local health care system, socio-cultural context and resources. The proposed ABI rehabilitation pathway will not only improve the clinical care and continued support delivered by health services to adults with ABI but will also facilitate community reintegration and support their families and care givers.