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Introduction: Bacterial wound infections are a danger to both military and civilian populations. The nature of injury and infection associated with combat related wounds are important in guiding antibiotic prophylaxis and empiric treatment guidelines.Materials and Methods: The isolates were screened for drug-resistance by the MicroScan Walkaway Plus System using either the Negative Breakpoint Combo Panel (NBCP) 30 or 34 or Positive Breakpoint Combo Panel (PBPC) 20 or 23. Isolates with a minimum inhibitory concentration (MIC) of ≥8 μg/mL to imipenem and/or meropenem were tested for both carbapenemase production using the CarbaNP test and real-time PCR to determine molecular resistance mechanisms. Plasmid conjugation analysis was performed to define potential for horizontal gene transfer.Results: We characterized 634 bacterial wound isolates collected from September 2013 to December 2017 from patients seen at a Philippine military tertiary hospital presenting with combat or non-combat injuries [354 (military) and 280 (civilians)]. Staphylococcus aureus was the most predominant bacterial species isolated from wounds in both populations (104/634, 16%). A variety of Gram-negative bacterial species comprised 442/634 (70%) of the isolates identified, with the most prevalent shown to be Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp. Carbapenemase production was detected in 34/442 (8%) Gram-negative isolates. Testing for molecular resistance mechanisms showed 32/34 (17 military, 15 civilian) wound isolates were blaNDM positive and 2 were blaVIM positive, with the two blaVIM isolates found in the civilian population. Plasmid conjugation of 14 blaNDM and 2 blaVIM positive wound isolates representatives showed 2/16 (13%) produced E. coli J53 transconjugants (E. coli from a civilian; E. cloacae from a military).Conclusion: We describe in this study the wound bacterial and antibiotic resistance profile in the military (combat vs non-combat associated) and civilian population. We observed that, with the exception of Acinetobacter sp., resistance of prevalent Gram-negative bacterial species to imipenem or meropenem were not significantly different between the military and civilian populations. We also presented data on the prevalent bacterial species isolated from both combat and non-combat wounds in a military tertiary care hospital setting as well as the carbapenemase-encoding gene primarily responsible for carbapenem resistance as well as evidence of horizontal transfer via mobile genetic elements. Clinicians may use this information to guide empiric antibiotic coverage for the predominant organisms if wound culture results are not readily available.A prospective, longitudinal evaluation of the wound bacterial profile documenting the changing bacterial flora using higher resolution molecular strategies can provide a more comprehensive understanding of the diversity, composition, and abundance of bacterial composition of the wound microbial community from the time of injury, during the course of evacuation from the field to higher level of care facilities, and up to wound resolution. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Skin rejuvenation procedures have become common with sophisticated technologies with reduced downtime and related risks. Recently, microneedling has been paired with radiofrequency to create Fractional Radiofrequency Microneedling (FRFM) to induce neocollagenesis. Frequently, topical products are applied immediately after the needling. This procedure is known as percutaneous collagen induction therapy (PCIT). Postoperative topical wound care is critical for prompt rapid and safe healing, with moist wound healing deemed of primary importance for fast and correct scarring process. An ideal dressing enables a moist environment while reducing postprocedural inflammatory responses in the first stages of wound healing. Objective: To evaluate whether an innovative silicone‐based wound dressing is superior than standard of care therapy in decreasing severity and duration of treatment‐site acute inflammatory reactions post PCIT. Materials and Methods: Endymed PRO Intensif Handpiece (Endymed, Israel) was used for the full‐face FRFM procedure. Subjects (n = 20) applied treatment (Stratacel®—Stratpharma SG, Switzerland) and control (Aquaphor®—Beiersdorf Inc, USA) immediately after the procedure and daily; they were evaluated immediately postprocedure (baseline assessment), at 2, 3 and 7 days postprocedure. Digital and 3D pictures (Antera 3D Camera for Skin Analysis—Miravex, Ireland) were taken at each assessment. Results: All patients healed properly without reporting adverse reactions to any of the studied products. Erythema at each study visit was significantly reduced with the use of the novel wound dressing (P < 0.001). A statistically significant difference in favor of the innovative wound dressing also emerged with respect to the patient‐rated product properties (P = 0.008), such as feel on skin, drying time and stickiness. Conclusions: The novel wound dressing reduced signs of acute inflammation following PCIT when compared to standard of care, without reporting adverse events and resulting in a more favorable outcome from a patient perspective. [ABSTRACT FROM AUTHOR]

A series of prominent mass shootings in the United States (US) has prompted renewed interest in revising gun policy. One proposal that has gained political traction is raising the minimum age for purchase and possession of guns to 21. While some commentators have suggested that the public mood may be shifting on gun policy, proposals to raise the minimum age have nevertheless provoked controversy. In this manuscript, we examine the ethical acceptability of raising the minimum age of purchase and possession of guns to 21. First, we examine the nature of the rights claim at issue. Second, we examine liberty-based objections to minimum age laws, and offer counter-arguments to these claims. Then, we examine the nature of the harm to be prevented via minimum age laws. We conclude that gun ownership is an important right, but one that nevertheless is ethical to regulate. We argue that liberty-based objections to minimum age laws are not as strong as critics of these laws claim. While we acknowledge the data limitations on assessing their likely success in reducing gun-related harms, we argue that minimum age laws are an ethically permissible policy strategy. We conclude with several recommendations for further research and policy responses to addressing the toll of gun-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background Firearm injuries related to legal intervention have come under scrutiny because of recent events. Methods The Kids' Inpatient Database (1997-2012) was searched for firearm injuries due to legal interventions ( International Classification of Diseases, ninth revision, Clinical Modification E970) requiring inpatient admission in children aged <20 y. Cases were weighted to provide national estimates. The Brady Campaign criteria were used to identify lenient versus strict gun law states. Results Overall, 275 cases were identified, with a 7.5% mortality rate. Incidence peaked at 1.0 per 100,000 admissions in 2006, significantly increased from a low 0.2 per 100,000 admissions in 1997, P < 0.001. Patients were predominantly male (97%). African Americans (44%) represented the largest racial group, followed by Hispanics (30%) and Caucasians (20%). Mean age was 17.5 ± 2.08 y. Patients were insured by Medicaid (33%) or a private payer (24%); the remainder (43%) was uninsured. Admissions most frequently occurred at urban teaching hospitals (81%). Cases occurred most frequently in the Southern United States (44%), followed by the Western United States (35%). Most patients presented to non–children's hospitals (97%). Mean hospital admission cost was 27,507 ± 40,197 USD, whereas mean charges amounted to 75,905 ± 116,622 USD. Cases mostly occurred in lenient (56%) gun law states, whereas the remainder occurred in strict (41%) and neutral (3%) states. When analyzed by race, Caucasians (16%) had a significantly higher mortality rate when compared with African Americans (5%), P = 0.03. Conclusions An analysis of this very specific injury mechanism demonstrates important findings, which are difficult to collect from conventional data sources. Future research will contribute to the objective analysis of this politically charged subject. [ABSTRACT FROM AUTHOR]

The nonprofit organization Project Healing Waters Fly Fishing, established in 2005, is committed to helping American war veterans deal with the physical and emotional wounds incurred in combat. Volunteers teach veterans how to fly fish, tie flies, and build rods, and they accompany the vets to streams, rivers, and lakes for angling. Although the Project Healing Waters website makes no mention of Ernest Hemingway or his story "Big Two-Hearted River," the organization's mission suggests that contemporary veterans, like Hemingway's Nick Adams, can find peace and become healthy while fishing on a body of water. [ABSTRACT FROM AUTHOR]

Abstract: Background context: The United States is presently engaged in the largest scale armed conflict since Vietnam. Despite recent investigations into the scope of injuries sustained by soldiers in Iraq and Afghanistan, little information is available regarding the incidence and epidemiology of spine trauma in this population. Purpose: Characterize the incidence and epidemiology of spinal injuries sustained during combat by soldiers of a US Army Brigade Combat Team (BCT) that participated in Operation Iraqi Freedom. Study design: Descriptive epidemiologic study. Patient sample: A total of 4,122 soldiers who served in Iraq with an Army BCT during “The Surge” operation. Outcome measures: Spine injury epidemiology was calculated for the BCT, including the spine combat casualty rate, and percent medically evacuated (MEDEVAC). Methods: Unit rosters were obtained, and a comprehensive database identifying all combat-related spine injuries was created by querying each soldiers'' electronic medical record and the unit''s casualty rosters. Demographic information was recorded including age, sex, rank, injury mechanism, presence of polytrauma, and injury outcome. Injury outcomes were classified as killed in action, died of wounds, MEDEVAC, or returned to duty. The incidence of spine injuries was determined, and epidemiology was characterized using calculations of the spine combat casualty rate and percent MEDEVAC. Comparisons were made to published reports from previous conflicts. Results: A total of 29 soldiers sustained 31 combat-related spine injuries. These accounted for 7.4% (29 out of 390) of all casualties sustained during combat. Blunt trauma to the spine, often resulting from an explosive mechanism, was encountered in 65% of cases. Closed fractures of the spine occurred in 21% of casualties and open injuries occurred in 7%. The spine combat casualty rate was 5.6 out of 1,000 soldier combat-years, and the percent MEDEVAC was 19%. Conclusions: This investigation is the first of its kind, documenting the nature of spine trauma in a major American conflict. The incidence of spine injuries in this study is the highest ever documented and is indicative of the tactics used by the enemy in the current war. Given this fact, it is likely that the prevalence of combat-related spine trauma will increase in the future. Larger, more extensive, studies of this kind must be conducted in the future. [Copyright &y& Elsevier]

Much of the literature about the assassination of John F. Kennedy focuses on and fetishizes the physical body of the president. This article examines how the president's wounded body-as represented in the Zapruder film and the autopsy photos especially- has become the subject of an enduring pornography of violence. In particular, the essay considers how his body has aroused in some white men feelings of not only horror and anxiety but also of exhilaration and guilty pleasure. By studying these contradictory impulses at work, we can draw closer to understanding why the damaged white male body has become, since the 1960s, an object of fantasy for many thousands of Americans. [ABSTRACT FROM AUTHOR]

The article discusses a study which estimates the life expectancy loss attributed to the premature death of individuals who have survived gun-related traumatic brain injury (TBI) and spinal cord injury (SCI) in the U.S. The study uses interpersonal TBI data taken from a surveillance system and self-inflicted TBI data acquired from the Web-based Injury Statistics and Reporting System. Results showed that life expectancy declined by 3.1 days due to the shorter lifespan of gunshot survivors. Black and white males lose 9.5 and 4.6 days respectively while black females lose 1.5 days and the white ones lose 1.0 days.

Penetrating extremity trauma is a potentially devastating injury that must be identified and managed expeditiously. Early hemorrhage control may be life-saving. This two-part article comprehensively addresses the approach and management of penetrating extremity trauma, highlighting controversies and advances. [ABSTRACT FROM AUTHOR]