Images from crime scenes often show partially concealed weapons due to obstructions such as hands and clothing, as well as surveillance camera limitations, which affect the efficacy of traditional detection methods. This work proposes an explainable forensic pipeline for occluded weapons detection, segmentation, and reconstruction. The proposed framework integrates RT-DETR-L, a transformer-based weapon detection model; MobileSAM for zero-shot segmentation of visible weapon regions; Stable Diffusion Inpainting for reconstruction of occluded regions; and a bilateral filter with Canny edge detection for forensic sketch generation. The detector was trained using synthetic occlusion augmentation on five weapon categories, such as firearm, grenade, knife, pistol, and rocket, and fire as an additional class for the environmental hazard indicator. The RT-DETR-L model achieves a mAP@50 of 0.86 and a mAP@50-95 of 0.65, averaged over the five weapon classes, on a dataset with synthetic occlusion augmentation. Reconstruction quality meets minimum quality thresholds (SSIM > 0.54, PSNR > 16 dB, Region IoU > 0.80) up to approximately 50% occlusion. An interactive Streamlite application demonstrates the pipeline's feasibility in 42-46 seconds as a controlled laboratory prototype. The proposed explainable forensic pipeline highlights the potential of combining transformer-based detection with generative AI to assist forensic weapon analysis under challenging occlusion scenarios. The generated reconstructions and sketches are intended as visual aids for expert review and must undergo independent forensic validation before any operational use.
Mortars enhance the lethality of Warfighters and protect them during combat. Accurate use of weapon systems is critical for mission success and to minimize health hazards, such as blast overpressure exposure. Although safety guidance exists and helps prevent accidents and injuries, military training is dynamic, and human factors such as fatigue and elevated core body temperature can increase the risk of error. In collaboration across the Defense Center for Public Health-Aberdeen and Walter Reed Army Institutes of Research, and MITRE, the team developed and evaluated the Augmented Reality Guidance System (ARGS) to support Department of War (DoW) decision making, serve as a force multiplier to enhance training, and support public health (e.g., monitor blast exposures). ARGS leverages emerging concepts in machine learning computer vision technology. It provides augmented reality, real-time, and after-action feedback to guide the actions of service members to mitigate unnecessary risks and support training and military operational medicine. ARGS uses the ZED stereo-camera, which is relatively low cost, waterproof, and intended for indoor and outdoor use, along with custom machine learning models for the DoW training use case. Through these models, ARGS evaluates the use of protective equipment by service members, the locations of individuals relative to weapon systems, and the use of the weapon systems. The team conducted 3 data collections at DoW mortar training events at 2 sites. The team implemented real-time facial blurring to preserve privacy and obtained feedback from instructors and unit leaders. The ARGS models successfully identified helmet use, individual's heads above the level of the mortar muzzle (which increases blast overpressure exposure), and individuals located downrange. The first real-world data collection enhanced the existing computer vision models (80:20 train-test split), and the updated models resulted in perfect detection of 134 mortar rounds fired during that session. At the second data collection, the updated ARGS computer vision models were evaluated in real time. Across all 3 training events the models accurately identified 99% of 539 rounds fired from the 60 mm, 81 mm, and 120 mm mortars. In the first training event, there were 13 false positives (e.g., because of false detection during mortar tube cleaning). After assessment the team developed a model to detect mortar cleaning and was able to detect all 32 cleaning evolutions recorded at the sites with one false positive. Across the training events, ARGS identified an average of 5.88 individuals around the weapon systems and a high instance of personnel within 20 ft of the weapon system with their head above the level of the mortar muzzle (>90% of rounds fired), which could be an opportunity for changes to training to reduce exposure. In addition to safety metrics, ARGS output includes rate of fire data, which is a common performance measure. ARGS shows promise for real-time support of range safety and after action review to enhance training effectiveness. ARGS identified and communicated safety information and deviations during training. This capability can help monitor and mitigate blast overpressure exposure and improve training to reduce injuries.
Directed energy weapons (DEWs) are emerging technologies that are transforming the modern battlespace. Despite their increasing presence, the associated injury patterns and health outcomes remain poorly understood. This review aims to consolidate existing knowledge on DEW-related injuries to assist military medical professionals in improving clinical care. A scoping review was conducted in accordance with PRISMA-ScR guidelines and included peer-reviewed and grey literature from 1980 to Nov. 30, 2024. Databases searched included PubMed, MEDLINE, AccessMedicine (textbooks), the Cochrane Library, EMBASE, Google Scholar, and Military Legal Resources (U.S. Army JAG School). Studies that focused on chemical, acoustic, and electrical/electromagnetic weapons were excluded because of differing pathophysiology. Two independent reviewers performed screening and data extraction. Results were synthesized narratively. Out of 200 identified studies, 33 met inclusion criteria. Most documented injuries involved thermal damage to skin, internal organs, and eyes. Notably, data were sparse on reproductive effects and the management of DEW injuries in polytrauma. Evidence suggests that DEWs may inflict central nervous system or deep tissue damage without external signs, potentially delaying diagnosis and treatment. Injury severity varied by energy type, anatomical target, and exposure duration. DEWs introduce novel clinical challenges for military health care providers, with injury profiles that may not align with traditional trauma paradigms. Standard physical assessments may fail to detect certain injuries. Long-term health outcomes following DEW exposure are largely unknown. There is an urgent need to develop and validate clinical guidelines and treatment protocols as DEWs become increasingly integrated into military operations. Directed energy weapons (DEWs), such as high-energy lasers and microwaves are increasingly used in modern warfare, but their health impacts are not well understood. This review explores the limited available research to understand how DEWs can injure the human body. Most known effects involve burns, eye damage, and internal injuries without visible signs. Unlike traditional weapons, DEWs may cause delayed symptoms or damage organs without leaving a mark on the skin. This study also highlights how little clinical guidance exists for treating these injuries, especially in combat settings. Medical personnel may need new diagnostic and treatment approaches to manage such cases. The article emphasizes the need for better awareness, protective equipment, and research to keep pace with the growing use of DEWs on the battlefield. Les armes à énergie dirigée (AÉD) sont des technologies émergentes qui transforment les champs de bataille modernes. Malgré leur utilisation croissante, les profils des blessures et les résultats cliniques qui s’y rattachent demeurent mal compris. Cette analyse vise à consolider les connaissances sur les blessures liées aux AÉD pour aider les professionnel.le.s en médecine militaire à améliorer les soins cliniques. Une analyse exploratoire, qui a été réalisée conformément aux directives PRISMA-ScR, incluait les publications révisées par un comité de lecture et la documentation parallèle parues entre 1980 et le 30 novembre 2024. Les recherches ont été effectuées dans les bases de données PubMed, MEDLINE, AccessMedicine (manuels), la Bibliothèque Cochrane, EMBASE, Google Scholar et Military Legal Resources (École JAC de l’armée américaine). Les études qui portaient sur des armes chimiques, acoustiques et électriques ou électromagnétiques ont été exclues en raison de physiopathologies différentes. Deux analystes indépendant.e.s ont procédé à la sélection et à l’extraction des données. Les résultats ont été synthétisés dans un cadre narratif. Des 200 études sélectionnées, 33 respectaient les critères d’inclusion. La plupart des blessures confirmées comportaient une atteinte thermique de la peau, des organes internes et des yeux. Notamment, les données relatives aux effets des AÉD sur la reproduction et la prise en charge des blessures polytraumatiques étaient rares. D’après les données probantes, les AÉD peuvent infliger des dommages au système nerveux central ou aux tissus profonds sans être liées à des signes extérieurs, ce qui peut retarder le diagnostic et le traitement. La gravité des blessures variait selon le type d’énergie, la cible anatomique et la durée de l’exposition. Les AÉD entraînent de nouveaux problèmes cliniques pour les professionnel.le.s de la médecine militaire, et les profils des blessures pourraient différer des paradigmes habituels relatifs aux traumatismes. Il se peut que les évaluations physiques standards ne détectent pas certaines blessures. Les résultats cliniques à long terme après une exposition aux AÉD sont largement inconnus. Il est urgent de rédiger et de valider les directives cliniques et les protocoles thérapeutiques, puisque les AÉD font de plus en plus partie des opérations militaires. Les armes à énergie dirigée (AÉD), telles que les lasers et les dispositifs hyperfréquences haute énergie, sont de plus en plus utilisées dans les champs de bataille modernes, mais leurs répercussions sur la santé sont mal comprises. Cette analyse explore les recherches disponibles limitées pour comprendre les blessures que les AÉD peuvent causer au corps humain. La plupart des effets connus incluent des brûlures, des atteintes oculaires et des blessures internes sans signes visibles. Contrairement aux armes traditionnelles, les AÉD peuvent provoquer des symptômes à retardement ou endommager des organes sans laisser de marque sur la peau. Cette étude fait également ressortir le peu d’orientations cliniques portant sur le traitement de ces blessures, particulièrement en contexte de combat. Le personnel médical peut avoir besoin de nouvelles approches diagnostiques et thérapeutiques pour prendre en charge ces cas. L’article fait valoir la nécessité de mieux connaître les effets de ces armes, de porter de l’équipement protecteur et de s’assurer que la recherche suit le rythme de l’utilisation croissante d’AÉD sur les champs de bataille.
Conducted Electrical Weapons (CEWs) are widely used worldwide by law enforcement as an intermediate less-lethal force option. While CEW direct electrical effects are generally transient, and direct significant injuries are rare but sometimes severe, secondary effects from associated falls related to neuromuscular effects while rare, may also be severe. To characterize the frequency, severity, and injury patterns of permanent paralysis associated with CEW deployments, with emphasis on fall-related and law-enforcement force related trauma. We analyzed a curated case series of 17 incidents (2004-2024) in which individuals sustained paraplegia or tetraplegia associated with CEW use by law enforcement. We judged 13 of these falls to have been caused by the CEW while 4 may have been only temporally related. Demographics, circumstances, injury mechanisms, and neurological outcomes were summarized descriptively. Of the 17 cases we found, 15 were in the USA and 2 were in the UK. Permanent tetraplegia occurred in 8 cases and paraplegia in 8 cases; there was a single recovery. The mean age was 37 years (range 17-65). All cases involved subjects actively resisting or attempting to flee law enforcement interaction. Elevated falls with head-first impacts, generating thoracic or cervical spine trauma, predominated as causes. Subject paralysis following CEW deployment is a rare but severe complication of attempted electrical weapon control by neuromuscular effects.
Suicides disguised as homicides present a persistent challenge in forensic case analysis, particularly when the weapon is deliberately removed after discharge. This study investigates the evolution of weapon concealment techniques-specifically the "load-and-rope" and "helium balloon-tied gun" methods-across documented casework, forensic literature, and detective fiction. Through comparative textual analysis and a review of suicides staged as homicides from 1893 to the present, we identify a recurring forensic staging pattern that links narrative transmission to real-world behavior and vice versa. The "load-and-rope" trick, first described in 1893 by Hans Gross, re-emerged in detective fiction beginning in 1922 before resurfacing in real forensic cases. The "helium balloon" method, introduced in a 2003 episode of CSI: Crime Scene Investigation, was subsequently replicated in two confirmed suicides. Based on these findings, we propose an interpretation rooted in the copycat phenomenon, whereby fictional forensic staging techniques-diffused through literature and media-are adopted and adapted in actual suicides. Recognizing this narrative transmission is essential for forensic professionals tasked with distinguishing suicides from homicides. This study underscores the need for interdisciplinary awareness in forensic staging, where cultural narratives may shape criminal behavior as much as technical means.
The TASER™ T10® (T10) is a new generation of conducted electrical weapon (CEW) introduced in 2023. T10 has significant new technology enhancements related to the deployed darts. These darts are thin-diameter, low-profile projectiles launched by primer-ignited black-powder instead of compressed nitrogen used in previous model launch platforms. They are also launched at higher muzzle velocity (62.5±9.1m/s or 205±30 feet/s) than previous CEW darts, to assist with enhanced target adherence. We retrospectively examined digital images of human tissue that had 40 T10 darts fired into it at measured velocities between 186 feet per second and 273 feet per second (56.7- 83.2m/s). Target sites included bare skin on the lower abdomen, mid-thigh, and buttocks. The T10 darts were fired via an adjustable velocity, compressed air cannon through a ballistic chronograph to record accurate projectile velocities. The images were evaluated for evidence of over-penetration. Even at the fastest velocities, no over-penetration of human tissue was noted. We conclude that the new CEW darts operate with a significant margin of safety in terms of muzzle velocity and risk of human tissue penetration when fired as intended into recommended target areas.
Weapon carrying and brandishing among youth remains a serious public health issue. In a previous commentary, I expressed concerns about gaps in recent literature on the subject, particularly among manuscripts that engaged General Strain Theory as a sole theoretical framework. I argued that these manuscripts overemphasized individual-level analyses and neglected root causes and systemic injustice. This essay responds to a critique of that original commentary, coauthored by Timothy Brezina and Robert Agnew.
Exposure to traumatic experiences during military service can result in different psychological and social consequences for individuals and their close social networks. This study aims to contribute to a psychosocial understanding of these phenomena by examining whether the relationship between perceived socio-economic status and the health of Veterans is moderated by participation in Veterans' associations, as well as whether this moderation effect is moderated by the level of identification with the military group. A total of 480 male Portuguese Veterans (Mage = 73.24; SD = 3.74) completed validated measures of perceived socio-economic status, physical and mental health, identification with the military, and participation in Veterans' associations. The results show that Veterans facing greater economic vulnerability report poorer health outcomes. However, those who are members of Veterans' associations, particularly those with a strong identification with the military, report better health despite their socio-economic vulnerability. Overall, this study highlights the importance of Veterans' associations as identity-based support networks that can promote the health and well-being of military Veterans. Exposure to traumatic experiences during military service can lead to various psychological and social effects for Veterans and their close social networks. This study aims to better understand how Veterans’ health is related to their economic situation and whether participating in Veterans’ associations can make a difference for their health status. We also examine whether the benefits of these associations are stronger for those with a strong identification with the military. The results show that male Portuguese Colonial War Veterans facing greater economic vulnerability tended to report poorer health outcomes. However, members of Veterans’ associations, particularly those with a strong identification with the military, tended to report better health despite their socio-economic vulnerability. Overall, the findings highlight the important role of Veterans’ associations as supportive communities that can help improve the health and well-being of military Veterans. L’exposition à des expériences traumatiques pendant le service militaire peut avoir des conséquences psychologiques et sociales différentes selon les diverses personnes et leurs réseaux sociaux proches. Cette étude vise à mieux comprendre ces phénomènes sur le plan psychologique par l’examen des relations entre la perception de la situation socioéconomique et la santé des vétéran·e·s, qui est modérée par la fréquentation des associations de vétéran·e·s. Elle évalue aussi si cet effet de modération est relativisé par le degré d’identification au groupe militaire. Au total, 480 vétérans portugais. (Mâge = 73,24; ÉT = 3,74) ont fourni des mesures validées de la perception de leur situation socioéconomique, de leur santé physique et mentale, de leur identification aux Forces armées et de leur fréquentation des associations de vétéran·e·s. Les résultats révèlent que les vétérans plus vulnérables sur le plan économique déclarent de moins bons résultats cliniques. Cependant, ceux qui sont membres d’associations de vétéran·e·s, notamment lorsqu’ils s’identifient fortement aux Forces armées, déclarent être en meilleure santé malgré leur vulnérabilité socioéconomique. Dans l’ensemble, cette étude fait ressortir l’importance des associations de vétéran·e·s pour renforcer l’identité et promouvoir la santé et le bien-être des militaires vétéran·e·s. L’exposition à des expériences traumatiques pendant le service militaire peut avoir divers effets psychologiques et sociaux sur les vétéran·e·s et leurs réseaux sociaux rapprochés. Cette étude vise à mieux comprendre la relation entre la santé des vétéran·e·s et leur situation économique et à déterminer si la participation à des associations de vétéran·e·s peut faire une différence pour leur état de santé. On examine également si les bienfaits de ces associations sont plus marqués pour les personnes qui ressentent un plus fort sentiment d’appartenance envers les Forces armées. Les résultats démontrent que les vétérans des guerres coloniales portugaises dans une grande vulnérabilité économique avaient tendance à signaler une moins bonne santé physique. Cependant, les membres d’associations de vétéran·e·s, notamment s’ils et elles ressentaient un fort sentiment d’appartenance envers les Forces armées, avaient tendance à se déclarer en meilleure santé malgré leur vulnérabilité socioéconomique. Dans l’ensemble, les résultats démontrent le rôle important des associations de vétéran·e·s pour former des communautés solidaires qui peuvent contribuer à améliorer la santé et le bien-être des vétéran·e·s.
Cancer is one of the most complex genomic diseases that can gain abilities to resist different therapies. These capabilities, known as the hallmark of cancer, allow specific and personalised therapies such as immunotherapy. This review paper discusses how different immunotherapies, such as immune checkpoint blockade, chimeric antigen receptor (CAR) T-cell, and Oncolytic viral therapy, which are currently being used and researched to overcome cancer cell capabilities by using the patient's immune system. Immune checkpoint blockade therapy is used to block immune inhibitory pathways using anti-PD-1 receptor and anti-CTLA-4 receptor antibodies, which make lymphocytes more responsive towards cancer cells. Then, it is discussed how CAR T-cells are designed to make cancer antigens more easily identified by T-cells for a more specific immune response. Furthermore, it is shown that oncolytic viruses directly destroy cancer cells and, indirectly, make them more vulnerable to the immune system. It is proposed that oncolytic viral therapy is a bridge between Immune checkpoint and CAR T-cell therapies for a more effective and more specific immune response towards cancer.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Nuclear receptors (NRs) of the NR1J1 group have been described in aquatic invertebrates and proposed as the evolutionary counterparts of vertebrate NR1I receptors, known for their role in xenobiotic-sensing and detoxification. In bivalves, previous studies have shown that NR1J1 activity and gene expression are modulated by pharmaceuticals, toxins, natural compounds, and algal extracts. However, their functional properties and diversification remain poorly understood. Here, we investigated the function and evolution of NR1J1 receptors in the bivalves Mytilus galloprovincialis and Ruditapes decussatus. We first identified four nr1j1 paralogs in R. decussatus and then integrated phylogenetic analysis, domain identity comparisons, tissue distribution profiling, and luciferase-based transactivation assays to characterize NR1J1 paralogs from both species. The receptors displayed distinct but partially overlapping transactivation profiles in response to confirmed ligands of NR1I and NR1H receptors, natural compounds, plant extracts, and fish bile, indicating paralog- and species-specific differences in ligand responsiveness. Allocholic acid emerged as the most consistent agonist across paralogs, whereas curcumin, carnosic acid, and Ptychopetalum olacoides extract showed more selective response patterns. Tissue profiling revealed broad but non-uniform expression of nr1j1 paralogs across bivalve tissues. Together, these findings underscore that bivalve NR1J1 receptors constitute a functionally diversified chemical-sensing system and provide a framework for future studies addressing ligand-dependent regulation and detoxification pathways.
The omics sciences represent a revolution for clinical studies, offering integrative approaches to analyzing biological data with unprecedented depth. From the discovery of the double-helix structure of DNA to the CRISPR-Cas9 gene editing tool, passing through the evolution of sequencing platforms and the exponential advance of computing power and in silico tools, omics has progressed in its role of leading innovative solutions for old challenges in health sciences. In this review, we describe different omics, the history of their techniques and technologies, data analysis and up-to-date visualization tools used for clinical data in research and health systems. We also discuss how omics are currently being applied in diagnosis, precision and personalized medicine. For the future, omics vow to underpin the majority of decisions made by health professionals, allowing individualized treatments based on Big Data and personal biological information.
暂无摘要（点击查看详情）
In a recent commentary that appeared in this journal, Levine criticizes the dominance of general strain theory (GST) in the weapon carrying and use literature, as the theory is said to offer a narrow micro-level approach that "overemphasizes immediate causes." According to Levine, the growing influence of GST has contributed to the neglect of larger structural and cultural forces that provide the context for high rates of youth violence and victimization. While we agree that such larger forces are too often neglected in the research literature, we believe Levine has misdiagnosed the cause of this neglect based on a gross mischaracterization of GST. In fact, GST is not to blame, as the theory explicitly recognizes and encourages research on the role of socioeconomic, community- and societal-level factors. After providing an accurate summary of GST, we discuss other factors that may be responsible for the emphasis on micro-level variables and explanations.
Concern has grown over the potential neurological effects following repetitive exposure to blast waves generated by explosives and weapons during training and operations. Military personnel may be repeatedly exposed to low-level blast although using explosives to gain entry and during routine heavy weapons training. Repeated blast exposure, even within allowable limits, has been associated with cognitive deficits. The Blast Overpressure (BOP) Tool was developed to support BOP exposure mitigation guidance by informing training cadre, unit commanders, and range managers of predicted exposures to facilitate mitigation of BOP risk during training. Section 734 of the National Defense Authorization Act for Fiscal Year 2018 (Public Law 115-91) required the Secretary of Defense to conduct a longitudinal medical study of blast pressure exposure of members of the armed forces. The BOP Tool was developed as a part of this initiative to improve awareness and mitigation of BOP in training environments. The team received feedback from the operational community. The BOP Tool predicts BOP exposures based on weapon type, ammunition, individual posture, and proximity to the weapon system. Three versions of the tool address specific end-user requirements. A mobile application offers real-time feedback and increased feasibility for field use. A desktop version includes a Site Module for planning weapon placement and personnel positions to minimize exposure, and a Scene Module for three-dimensional visualization of blast effects on the human body, allowing users to test mitigation strategies and assess cumulative exposure to different body regions. Additionally, an ArcGIS-integrated version supports range safety management by providing enhanced BOP risk assessment capabilities. Preliminary end user feedback suggests that the tool is already informing best practices to protect Service Members from BOP in the garrison environment by simulating comparatively more protective postures and positioning around weapon systems during live fire training. The BOP Tool advances understanding of blast exposure and supports the development of safer training protocols for military personnel. By enabling real-time prediction and visualization of BOP effects, the tool augments leader risk assessment and decision-making, ultimately contributing to optimized health and safety of Service Members during heavy weapon training.
To examine age related performance in wheelchair fencing Para athletes across five Paralympic Games editions, considering sex, sport class, competitive achievement, Paralympic cycle, and weapon type. This retrospective study analyzed official results from Sydney 2000, Athens 2004, Beijing 2008, Tokyo 2020, and Paris 2024, including 878 athletes (356 females, 522 males). Age related performance was compared across sexes, sport classes (A and B), competitive achievement (medalists vs. non-medalists), Paralympic editions, and weapon types (épée, foil, sabre). Mann-Whitney U tests were applied for pairwise comparisons and Kruskal-Wallis tests for differences across editions and weapons (α=0.05). No significant age difference was found between males (35 y) and females (33 y). class B athletes older than class A (male: P=0.038; female: P=0.002). Non-medalists were older than medalists (P<0.001). Age did not differ across Paralympic editions or weapon types (P>0.05). Most athletes were over 30 years old, particularly females (χ²=38.10; P<0.001). Age related performance was similar between male and female wheelchair fencing Para athletes and remained stable across Paralympic cycles. However, sport class and competitive achievement were associated with age differences, highlighting the relevance of classification and competitive level for understanding the longevity of elite wheelchair fencing athletes.
AI is being rapidly integrated across nearly all sectors, including within healthcare and health systems. The prevailing dominant narrative frames AI's impact on health as overwhelmingly positive and destined to improve further. However, this benefit-focused discourse overlooks a growing set of serious risks to human health arising from AI systems already in use or clearly on a path to deployment-termed as near-term AI risks to health. The most prominent near-term AI risks to health are outlined, including algorithmic bias, erroneous clinical diagnoses and recommendations, AI-enabled health disinformation, harms to mental health, AI-driven mass unemployment, lethal autonomous weapons systems, AI-enabled chemical and biological weapons and AI as both a vulnerability and an enabler of cyberattacks on health systems. Each risk is already causing harm, or could plausibly do so soon, to the health of substantial proportions of populations, thereby collectively satisfying the criteria for a public health problem. Recognising near-term AI risks to health as a public health problem rebalances the benefit-centric narrative. The article addresses counterarguments and briefly outlines potential risk management responses: mandatory AI health impact assessments for high-risk systems, public health-oriented surveillance of AI-related harms and systematic embedding of public health expertise within AI governance structures.
Achieving equity in assessment remains a persistent challenge in medical education. While research has focused predominantly on psychometric approaches to fairness, exploration has been limited into how racial equity is embedded at foundational stages of assessment development. In particular, the influence of test developers' racial composition on assessment design has been largely overlooked. This study investigated how the racial makeup of test development teams impacts the incorporation of justice-oriented principles into assessment design. Guided by critical theory and a justice-oriented assessment framework, we employed Foucauldian Critical Discourse Analysis to examine the design processes of three groups of assessment developers (N = 16) purposefully sampled from the US academic medical education community. We grouped participants by racial identity: Group A (white-identifying, n = 5), Group B (non-majority-identifying, n = 5), and Group C (mixed racial composition, n = 6). Following an interactive session on equitable assessment principles, groups collaboratively designed a mock OSCE station assessing communication skills. The data collected included transcribed group discussions, the OSCE station, and participant group reflections on their experiences. Our findings reveal a pervasive gap between equity awareness and equity action. Despite demonstrating clear conceptual understanding of equity principles, participant groups struggled to operationalize these principles in practice. We identified four themes from the discourse analysis: an absence of explicit equity discussions despite the study's stated focus; the sanitization of assessment and weaponization of "culture" as a dividing practice; the treatment of learners as erased, ghostlike figures-homogenous and without agency-while patients were centered as diverse and significant; and the framing of equity as a weapon or curveball rather than a foundational design element. Participant groups frequently defaulted to traditional standardized approaches, expressing discomfort about incorporating equity without introducing stereotypes. Power dynamics and professional norms emerged as significant barriers, with participants deferring to clinical expertise and avoiding confrontation on equity-related issues. Notably, racial diversity among test developers alone did not substantially advance equity in the designed assessment. This study underscores that the test developer's equity awareness and racially diverse representation, while necessary, are insufficient for achieving justice-oriented assessment design. Without intentional structural changes and cultural shifts in how assessment is conceptualized, equity will remain peripheral rather than foundational. These findings offer actionable insights for national licensing bodies, medical schools, and residency programs seeking to embed equity more meaningfully into high-stakes assessment practices, suggesting that frameworks such as Design Justice may provide pathways for inclusive, community-centered approaches to assessment development.
Cluster munitions remain a significant source of blast and fragmentation injuries in modern armed conflicts owing to their wide-area effects, high fragment density, and the persistence of unexploded submunitions. These weapons generate complex injury patterns involving blast overpressure, high-velocity fragment penetration, thermal effects, and multi-system trauma, posing substantial clinical, forensic, and humanitarian challenges. This narrative review synthesizes current evidence on injury mechanisms associated with cluster munitions, with particular emphasis on fragment-induced penetrating trauma, wound morphology, injury biomechanics, and forensic interpretation. Relevant literature was identified through searches of major scientific databases and supplemented by forensic and conflict-related reports. The reviewed evidence indicates that secondary blast injuries caused by high-velocity fragments represent the predominant mechanism of injury associated with cluster munitions, frequently affecting the extremities, head, neck, thorax, and abdomen. Fragment characteristics, including velocity, mass, geometry, and impact angle, strongly influence penetration behaviour, tissue disruption, and wound patterns. Recent advances in ballistic gelatin testing, tissue simulants, post-mortem investigations, medical imaging, and computational modeling have improved understanding of fragment-tissue interactions and injury prediction. From a forensic perspective, irregular wound morphology, retained metallic fragments, complex injury trajectories, and multisystem trauma present significant challenges for injury reconstruction, weapon attribution, and cause-of-death determination. In addition to immediate casualties, unexploded ordnance (UXO) associated with cluster munitions continues to cause injuries and fatalities long after hostilities have ceased. Despite advances in injury biomechanics and forensic investigation, significant gaps remain in the quantitative characterization of fragment injuries and standardization of medico-legal assessment protocols. Improved integration of forensic pathology, biomechanics, trauma medicine, and computational modeling is essential for advancing injury reconstruction, forensic investigation, protective strategies, and civilian protection in conflict-affected environments.