Self-inflicted Wounds Research Articles

Guns on campus: Is that physics?

The report “Texas law sets off debate about guns at universities” (Physics Today, July 2016, page 26) seemed out of place in your magazine. The subject is not scientific, and the discussion was not handled in a scientific manner.I see the scientific process as basically an endless loop of five steps: Eliminate all emotions and preconceived notions related to the topic. Take as much data as possible, as randomly and nonjudgmentally as possible. Analyze the data for anomalies and patterns. Test to see if they correlate with any theories. Subject any findings to an open and intensive peer review. Cycle through the steps again based on responses and findings, and look for data in other new directions. For example, as a physicist, even if I am strongly religious, data showing the possibility of purely mechanical random creation should not be discarded or ignored simply because it threatens my beliefs.The only concrete data in the article were the laws themselves, the legal reactions to those laws, and two self-inflicted gunshot wounds. All other statements were either emotional conjectures about scary things that might happen or someone’s beliefs about possible events. No actual case histories were presented of concealed-carry-permit holders doing any of those scary things. To the contrary, according to the article, Utah and Idaho have seen no change in attitudes or behaviors on campus as a result of the new law.One possible source of data about the effect of concealed carry on campus is the seemingly infinite supply of statistical studies floating around. How many were truly scientific studies with useful data? What do they say?Another source might be a study of the individuals on campus to determine, for example, any influence their backgrounds and training might have on their current attitudes. Have they had gun training or endured gun-related trauma? Another source of data might be an examination of the requirements to obtain a concealed-carry permit. Would they inherently make someone a safer person with a gun? Another might be a study of police records to see if the good guy–bad guy issue is a real problem.I don’t claim to be on any side of the issue, except to want to believe the statements made about Utah and Idaho. Gun control is much more a political issue than a scientific one. But shouldn’t we as scientists conduct a proper, nonjudgmental data analysis?By the way, campuses have never been gun free. Many holders of concealed-carry permits ignore the signs and carry all the time, except when faced with metal detectors. Section:ChooseTop of page <<CITING ARTICLES© 2017 American Institute of Physics.

Penetrating Bihemispheric Traumatic Brain Injury: A Collective Review of Gunshot Wounds to the Head.

Head injuries that cross midline structures of the brain are bihemispheric. Other terms have been used to describe such injuries, but bihemispheric is the most accurate and should be standard nomenclature. Bihemispheric head injuries are associated with greater mortality and morbidity than other penetrating traumatic brain injuries (TBIs). Currently, there is a tendency to manage severe gunshot wounds (GSWs) to the head nonoperatively, despite reports of improved outcome in military patients treated aggressively. Thus, controversy exists in the management of civilian TBI. PubMed was searched for query terms, and PRISMA guidelines were used. Studies were selected by relevance and inclusion of data regarding etiology, diagnosis, and management of bihemispheric TBI. Case reports, studies not in English, and records lacking information on mechanism or bihemispheric injuries were excluded. Thirteen studies were included and most contained level IV evidence. The mean mortality rate of all head GSWs was 62% in adults and 32% in children. Bihemispheric GSWs had greater mortality rates of 82% in adults and 60% in children. There was a larger proportion of self-inflicted injury in studies with greater rates of bihemispheric injuries. Bihemispheric injuries have greater mortality rates than other penetrating TBI. Violation of midline brain structures such as the diencephalon and mesencephalon, increased rate of self-inflicted wounds, and lack of a standard management algorithm may increase the lethality of these injuries. Although bihemispheric injuries historically have been considered nonsalvageable, an aggressive surgical approach has been shown to improve outcomes, particularly in the military population.

A Legal and Economic Critique of President Trump's China Trade Policies

The administration of President Donald J. Trump has warned that it supports an aggressive across the board tariff of 45% on all imports from China to neutralize the effects of China’s currency manipulation. However, such a tariff cannot withstand an economic and legal analysis. Fundamental economic principles indicate that China’s alleged currency devaluation cannot create a real long-term trade advantage and that the effects of currency devaluation have no real effect on the U.S.-China trade balance. Not only is currency manipulation not a cause of the U.S. trade deficit with China but the proposed remedy of a draconian 45% tariff will only create a grievous self-inflicted wound on the U.S. and global economy. From a legal perspective, a 45% tariff cannot be justified under the legal regime of the World Trade Organization as such a tariff runs afoul of the tightly regulated regime of authorized trade sanctions. As the proposed tariff cannot be justified from a legal or economic perspective it is not an advisable or appropriate response to China’s trade practices.

ST-Elevation Myocardial Infarction after Penetrating Thoracic Trauma

BackgroundST-segment elevation myocardial infarction (STEMI) may complicate penetrating thoracic trauma. Case ReportThis report describes a 42-year-old man who sustained a self-inflicted gunshot wound to the left chest. Electrocardiogram showed ST elevation in the inferior leads. Emergent catheterization was not recommended and conservative management was initiated. Cardiac catheterization 4 days later showed no perturbation of the coronary arteries, neither atherosclerotic nor traumatic. Why Should an Emergency Physician Be Aware of This?This case is unusual because it demonstrates a STEMI with no detectable plaque rupture or gunshot pellets on coronary catheterization. The decision to aggressively manage these patients with early coronary angiography depends on the hemodynamic status of the patient, their cardiac risk factors, and their ability to tolerate ischemic insult. In asymptomatic hemodynamically stable patients, conservative medical management should be considered. Myocardial infarction is a complication after penetrating thoracic trauma and should be considered in initial evaluation.

The Hidden Story of Innovation: Charity Hospital, Angola Prison, and the Challenging of Surgical Dogma

The late 1960s was a period of significant upheaval of social, cultural, and scientific norms. The generally accepted notion of mandatory laparotomy for all penetrating abdominal injuries was among those norms being called into question across the country and many advocated expectant management of selected patients presenting with this type of injury. Leaders of the surgical community published opinions on either side of the argument. The house staff at Charity Hospital during this period was among the busiest in the nation in treating these injuries, many of them inmates of the Louisiana State Penitentiary who used self-inflicted stab wounds to the abdomen as a means of temporary respite from the inhumane conditions in the prison. Inspired, in part, by the overabundance of negative laparotomies among this group, F. Carter Nance went on to systematically challenge the standard of care. This effort constitutes one of the major forces for change of the surgical dogma of mandatory laparotomy for all abdominal stab wounds. It is the first major study to show conclusively that delayed laparotomy for perforated viscous was not significantly detrimental and posed less of a risk than unnecessary laparotomy. The circumstances surrounding this initiative constitute a powerful and heretofore unknown chapter in the history of surgical innovation.

Firestorm over supposed gag order on USDA scientists was self-inflicted wound, agency says

Firestorm over supposed gag order on USDA scientists was self-inflicted wound, agency says

It’s the Occupation, Stupid!

It’s the Occupation, Stupid!

Management of a Complex Excoriation Disorder-induced Wound with a Viable Cryopreserved Placental Membrane.

Summary:Excoriation disorder (ED), also known as dermatotillomania, is a condition characterized by repeated “skin picking” that leads to the formation of skin lesions. Because of the similarity of its symptoms to obsessive compulsive disorder, ED is classified as a subcategory of obsessive compulsive disorder by Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Although the majority of the self-inflicted wounds are not clinically significant, many wounds lead to social and occupational dysfunction by becoming infected, chronic, and life threatening. This report describes the successful use of a viable intact cryopreserved human amniotic membrane in conjunction with selective serotonin re-uptake inhibitors in treating an ED patient who presented with a large calvarial wound of 3-year duration that had failed previous extensive medical and surgical interventions.

2579: Face transplantation and the reconstructive management of the self-inflicted gunshot wound: An aesthetic, functional, and psychosocial report of 6 clinical cases

2579: Face transplantation and the reconstructive management of the self-inflicted gunshot wound: An aesthetic, functional, and psychosocial report of 6 clinical cases

Oculocardiac Reflex as a Result of Intraorbital Trauma

BackgroundThe oculocardiac reflex is a decrease in heart rate caused by ocular compression or traction upon the extraocular musculature. Multiple instances of this phenomenon have been described in anesthesia, trauma, craniofacial, and ophthalmology literature, but there is a sparsity of documentation in the emergency medicine literature. Case ReportWe describe the observation and management of the oculocardiac reflex in a 26-year-old man with retrobulbar hematoma and intraocular trauma caused by a self-inflicted gunshot wound. Why Should an Emergency Physician Be Aware of This?Prompt recognition of the oculocardiac reflex is important for the emergency physician given the common occurrence of craniofacial trauma and the potentially devastating consequences if not recognized and addressed.

The role of face transplantation in the self-inflicted gunshot wound

Facial self-inflicted gunshot wounds (SIGSWs) cause a devastating midfacial defect and pose a challenging problem to the reconstructive surgeon. Face transplantation (FT) has the potential for near-normal restoration in otherwise non-reconstructible defects. Two out of 7 FT recipients at Brigham and Women's Hospital (BWH) sustained SIGSWs. In this study, we illustrate the role of FT in the management of SIGSWs through an aesthetic, functional, and psychosocial examination of outcomes. We performed a retrospective analysis of individuals with SIGSWs who were screened at BWH between 2008 and 2015. We then collected data of the injuries, modes of conventional reconstruction (CR), and deficits. For the FT recipients, we critically reviewed the psychosocial screening process and post-transplantation aesthetic, functional, and psychosocial outcomes. A total of six individuals post-SIGSWs were screened for FT. All of them had undergone CR, with five receiving loco-regional flaps and free tissue transfers, and one undergoing serial debridement and primary soft-tissue repair. Following CR, all suffered from residual functional and aesthetic deficits. Two underwent partial FT and one is currently undergoing FT screening. We describe the pre-transplant psychosocial screening process and the aesthetic, functional, and psychosocial outcomes of the SIGSW FT recipients. We examined the facial SIGSW injury, outcomes of CR, and the mechanism of FT to offer a potential solution to the shortcomings of CR. More importantly, we highlight the critical nature of the psychosocial component of the multidisciplinary evaluation given the history of mental illness and suicidal behavior in this subset of patients.

Poetics of Memory: Aesthetics and Experience of Holocaust Remembrance in Museums

This essay offers a comparative analysis of Holocaust commemoration in three museums: The Jewish Museum Berlin; Yad Vashem: The Holocaust Martyrs’ and Heroes’ Remembrance Authority in Jerusalem and the United States Holocaust Memorial Museum in Washington, DC. In particular, the essay examines exhibition techniques, architecture and the visceral, physical experience of the visitor in each museum. My argument focuses on the way that museums draw on aesthetic technique, design and the manipulation of visitor experience to create Holocaust narratives that resonate with and reflect each country’s dominant Holocaust discourse. In Yad Vashem, this narrative is a distinctly Zionist one that relies on the symbolism of autochthony and redemption in contrast to Jewish suffering in exile. The United States Holocaust Memorial Museum’s Holocaust narrative, in contrast, is rooted in the idea of American exceptionalism and democracy as the antidote to Fascism and anti-Semitism, while the Holocaust narrative of the Jewish Museum Berlin, as developed in its architecture, memorial spaces and select exhibits, draws on the symbolism of the void to emphasize the loss of Germany’s Jewish communities as irreparable rupture and self-inflicted wound.

The Working Poor: Two Perspectives on Reality—A Communication to the Editor Inviting a Discussion

The Working Poor: Two Perspectives on Reality—A Communication to the Editor Inviting a Discussion

The self—harmed, visualized, and reblogged: Remaking of self-injury narratives on Tumblr

Images featuring self-injury (SI) have been proliferating on social media. This article reports the findings of a visual narrative analysis of 294 photo-based posts on Tumblr, exploring how SI is narrated through the interplay between image content, photographic composition, associated texts and tags, and reblogging. Findings reveal a shift in the iconography of SI from direct depictions of self-injured bodies to re-appropriations of popular media content that figuratively represent emotional struggles. Images of self-inflicted wounds received 10 times less reblogs than images without wounds, and media memes conveying hopeless moods were the most widely distributed. These memes represent SI as a form of life struggle virtually anyone can face while complicating conventional readings of SI as an individual pathologic experience. We discuss these findings in the context of an emergent online curation culture and how Tumblr’s unique affordances may both offer and limit possibilities for narrating SI.

Treatment of hesitation marks on the forearm by the pinhole method.

Scars from self-inflicted wounds, referred to as "hesitation marks," are usually linear, flat, poorly oriented, white in color, and often located on the forearm. Many patients do not undergo treatment for these due to limited available modalities. The aim of this study was to evaluate the efficacy and safety of the pinhole method using a 10,600nm carbon dioxide (CO2) laser for treating hesitation marks on the forearm. We conducted a retrospective chart review of patients with hesitation marks treated by the pinhole method from March 2010 to April 2014. Eleven patients with hesitation marks (mean age 37.8years; range, 23-67years) were treated with the pinhole method over the 4-year study period. Subjects were treated via the pinhole method in one to six treatment sessions at 4- to 8-week intervals. Two blinded observers evaluated photographs taken at baseline and 3months after the final treatment and assessed improvement using a quartile grading scale. Compared with baseline, there was mild to moderate improvement in all patients (mean score 3.0). The patient satisfaction survey revealed a mean improvement score of 2.82. The pinhole method using a CO2 laser may be an effective treatment option in patients with hesitation marks on the forearm.

A Comparison of Self-Inflicted Stab Wounds Versus Assault-Induced Stab Wounds.

BackgroundAlthough self-inflicted and assault-induced knife injuries might have different mortality and morbidity rates, no studies have actually evaluated the importance of the cause of knife injuries in terms of patient outcomes and treatment strategies.ObjectivesThe aims of this study were to assess the difference between the outcomes of patients presenting with self-inflicted stab wounds (SISW) versus assault-induced stab wounds (AISW).Patients and MethodsA retrospective review of the relevant electronic medical records was performed for the period between January 2000 and December 2012 for patients who were referred to the department of surgery for stab wounds by the trauma team. The patients were divided into either SISW (n = 10) or AISW groups (n = 11), depending on the cause of the injury.ResultsA total of 19 patients had undergone exploratory laparotomy. Of the nine patients with SISW undergoing this procedure, no injury was found in seven of the patients. In the AISW group, eight of the ten laparotomies were therapeutic. Three patients in the AISW group died during hospital admission. The average number of stab wounds was 1.2 for the SISW group and 3.5 for the AISW group. Organ injuries were more frequent in the AISW group, affecting the lung (2), diaphragm (3), liver (5), small bowel (2), colon (2), and kidney (1).ConclusionsAlthough evaluations of the initial vital signs and physical examinations are still important, the history regarding the source of the stab wounds (AISW vs. SISW) may be helpful in determining the appropriate treatment methods and predicting patient outcomes.

Elbow Arthrodesis in a Bald Eagle (Haliaeetus leucocephalus)

An adult female bald eagle (Haliaeetus leucocephalus) of unknown age sustained a fractured right humerus and following surgical repair was deemed nonreleasable because of an inability to sustain flight accompanied by a severe wing droop. After relocation to a public aviary for display, the bird repeatedly caused self-inflicted wounds from standing on the malpositioned wing. Owing to the inability to hold the elbow in flexion, the bird would step on the distal aspect of the right wing with the talons causing deep penetrating wounds. Physical examination of the affected wing revealed no cause for the wing droop. Radiographic images revealed a healed fracture of the right humerus with significant remodeling of the bone around the injury. No other lesions were noted. Attempted arthrodesis of the elbow using cross pins and type I external fixators to immobilize the joint failed. The procedure was repeated with modifications of lag screws to fix the elbow and immobilization of the joint with intramedullary pins, which provided successful arthrodesis. The surgical intervention allowed the bird to avoid amputation, and after 5 years there has been no further incident of self-inflicted wing injury.

Self-inflicted wound with a nail in the heart: Case report

Abstract Introduction Adequate diagnosis and treatment of penetrating cardiac injury (PCI) represents a great challenge for the surgeon in the emergency department (ED) because of its high mortality. It is estimated that more than 90% of mortality happens before the patient reaches the hospital and only 15–50% of those will receive appropriate medical treatment. Case report A 42-year-old hemodynamically stable male is brought to the ED with a protruding nail in his thorax. He is taken to the operating room (OR) where a medial sternotomy is performed and an injury is found in the left ventricle. Cardiac muscle repair is performed with pericardial patch. Discussion PCI from a suicide attempt secondary to a nail hammered into the chest is very rare and no previous reports were found by the author. Conclusion The objects that penetrate cardiac structures must be removed in a proper OR with capable personnel and the resources available to perform procedures like an urgent thoracotomy or sternotomy.

Superior Mesenteric Artery-Duodenal Fistula Secondary to a Gunshot Wound

Arterioenteric fistulas are a rare cause of massive gastrointestinal hemorrhage. We present a patient who developed a fistula between a middle colic artery pseudoaneurysm, a proximal branch of the superior mesenteric artery (SMA), and the third part of the duodenum 2 weeks after a self-inflicted gunshot wound to the abdomen. The patient's presentation, evaluation, treatment, and prognosis are discussed. All prior published cases of SMA-duodenal fistulas are reviewed.

Delayed Tension Pneumocephalus following Gunshot Wound to the Head: A Case Report and Review of the Literature.

Tension pneumocephalus is a rare complication of head trauma and neurosurgical procedures, amongst other causes. It is defined by the combination of intracranial air, increased intracranial pressure, and mass effect. Although it often presents soon after surgery, it can also rarely present in a delayed fashion. We present a case of delayed tension pneumocephalus, occurring approximately 16 weeks after bifrontal craniectomy for a self-inflicted gunshot wound. Following a month of rhinorrhea, postnasal drip, and cough, the patient presented with a sensation of expansion in the area of the right forehead. As tension pneumocephalus is an emergency that can be fatal, this patient was treated expediently and avoided severe neurological deficits. The case recounted here is important as a demonstrative example that tension pneumocephalus does not always follow a defined course immediately after trauma or neurosurgery but rather can develop insidiously without obvious signs.