RESUMEN
PURPOSE: Rates of trauma patients presenting with history of prior trauma range from 25 to 44%. Outcomes involving recidivists in the setting of intentional trauma, especially penetrating trauma, are conflicting. We hypothesized that if violence does escalate with successive incidence, then injuries due to successive violence should escalate or become increasingly severe with successive admissions. METHODS: The trauma registry from an urban level I adult and pediatric trauma center was queried for injuries due to blunt assault, stabbing, and firearm injury. Primary outcome measures were mortality, injury mechanism, and injury severity for each successive trauma admission. RESULTS: Victims of blunt assault and stabbing were more likely to become recidivists than victims of gun violence (OR 1.53, p < 0.001 and OR 1.57, p < 0.001). Violent re-injury became increasingly severe only in victims of repeated gun violence. Patients with gunshot as the mechanism at every admission are at highest risk for mortality (OR 13.48, p < 0.001). All but one mortality (95.8%) in the recidivist population occurred within 180 days of discharge from a prior injury. CONCLUSION: Recidivism for interpersonal violence results in a significant number of admissions to trauma centers. In our patient cohort, injury associated with successive blunt assaults did not worsen with subsequent admissions. Recidivism for gunshot wounds tends to be more severe and have a worse prognosis with each successive admission compared to outcomes associated with repeated stab wounds. Focused efforts should include rehabilitation efforts early in the post-injury period, especially in patients with a history of gunshot wounds.
Asunto(s)
Reincidencia , Centros Traumatológicos/estadística & datos numéricos , Violencia , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Niño , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Sistema de Registros , Heridas y Lesiones/etiología , Heridas no Penetrantes/epidemiología , Heridas no Penetrantes/etiología , Heridas Penetrantes/epidemiología , Heridas Penetrantes/etiología , Adulto JovenRESUMEN
Fabrication of ultrasharp probes is of interest for many applications, including scanning probe microscopy and electron-stimulated patterning of surfaces. These techniques require reproducible ultrasharp metallic tips, yet the efficient and reproducible fabrication of these consumable items has remained an elusive goal. Here we describe a novel biased-probe field-directed sputter sharpening technique applicable to conductive materials, which produces nanometer and sub-nanometer sharp W, Pt-Ir and W-HfB(2) tips able to perform atomic-scale lithography on Si. Compared with traditional probes fabricated by etching or conventional sputter erosion, field-directed sputter sharpened probes have smaller radii and produce lithographic patterns 18-26% sharper with atomic-scale lithographic fidelity.