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Article ; Online: Exploring the complexity of firearm homicides in Harris County, Texas, from 2009 to 2021: Implications for theory and prevention.

Drake, Stacy A / Lemke, Michael K / Yang, Yijiong

Social science & medicine (1982)

2022 Volume 305, Page(s) 115048

Abstract: Firearm violence is a major health problem in the United States that clusters asymmetrically across geographic and demographic lines, and the persistence and unequal distribution of firearm violence suggests that novel causal explanations and theoretical ...

Abstract	Firearm violence is a major health problem in the United States that clusters asymmetrically across geographic and demographic lines, and the persistence and unequal distribution of firearm violence suggests that novel causal explanations and theoretical frameworks may be warranted to guide preventive strategies. Thus, this study explores the following three hypotheses that are grounded in complex systems theory: 1) trends in firearm homicides risks have shifted heterogeneously in Harris County across endemic degree of risk; 2) firearm homicides clusters have remained resilient in Harris County across the study time period; and 3), the associations between known contextual correlates of firearm homicides and the distribution of firearm homicides risks in Harris County have manifested as nonlinear. Using a retrospective study design (n = 4,397) from January 1, 2009-June 31, 2021, medicolegal death investigation data from the Harris County Institute of Forensic Sciences and estimates of community characteristics from the American Community Survey were analyzed using Joinpoint trend analysis, kernel density geospatial analysis, and proportion tests. Trend analyses revealed that firearm homicides risks shifted heterogeneously across endemic degree of risk, with geographical areas with lower initial firearm homicides risks experiencing more profound upward shifts across the time period of the study. Geospatial analyses identified the resiliency of firearm homicides clusters across the study period, particularly in central, southern, and south-western districts of the city. Finally, the relationships between known contextual correlates and the distribution of firearm homicides risks in Harris County appeared to be nonlinear, particularly regarding ethnicity. This study provides data-driven results that suggest the plausibility of complex systems theory in advancing the understanding of causality in firearm homicides. Further, these findings support the urgent need for complex systems-informed preventive efforts that account for spatiotemporal heterogeneity, key interactions that generate nonlinearity, and latent feedback loops that underlie resiliency in firearm homicides.
MeSH term(s)	Firearms ; Homicide ; Humans ; Retrospective Studies ; Suicide ; Texas/epidemiology ; United States ; Violence ; Wounds, Gunshot/epidemiology
Language	English
Publishing date	2022-05-19
Publishing country	England
Document type	Journal Article
ZDB-ID	4766-1
ISSN	1873-5347 ; 0037-7856 ; 0277-9536
ISSN (online)	1873-5347
ISSN	0037-7856 ; 0277-9536
DOI	10.1016/j.socscimed.2022.115048
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Article ; Online: Rural-urban, age, and gender disparities and trends in suicide and homicide: Multistate evidence across 12 years.

Lemke, Michael Kenneth / Akinlotan, Marvellous / Yang, Yijiong / Drake, Stacy A

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

2022 Volume 38, Issue 4, Page(s) 754–763

Abstract: Purpose: Few studies have simultaneously assessed age and gender trends in homicide and suicide across the rural-urban continuum. Herein, we examine geographic and demographic trends in suicide and homicide death rates by: (1) determining overall macro ... ...

Abstract	Purpose: Few studies have simultaneously assessed age and gender trends in homicide and suicide across the rural-urban continuum. Herein, we examine geographic and demographic trends in suicide and homicide death rates by: (1) determining overall macro and disaggregated trends; (2) examining differences in trends based on rural-urban county classification; and (3) identifying differences in stratified trends among age and gender classifications. Methods: A retrospective study design used suicide and homicide data (n = 199,456) from years 2005to 2017 across 16 US states. Suicide and homicide deaths were grouped by age, gender, and rural-urban classification for descriptive analyses, and trends were analyzed using Joinpoint trend analysis software. Findings: Violence resulted in 142,470 suicide and 56,986 homicide deaths between 2005 and 2017. Among both males and females, overall macro trends of suicide and homicide rates generally increased with greater rurality, and trends in rural rates differed from those in nonrural areas. Joinpoint trend analysis revealed significant increases in male suicide rates in large metropolitan (1.66%), micropolitan (1.78%), and rural areas (1.77%); female suicide rates in large metropolitan (2.17%), small metropolitan (3.25%), and micropolitan areas (3.26%); male homicide rates in large metropolitan areas (10.19%); and female homicide rates in rural areas (8.29%). Finally, when stratified by age, several significant trends were found, including increases in suicide rates among females aged 64 and older in rural areas (11.71%). Conclusions: Heterogeneous trends were found in suicide and homicide rates within specific rural-urban, age, and gender subgroups. Prevention efforts should proactively target those subgroups identified herein as most at-risk of violence.
MeSH term(s)	Female ; Homicide ; Humans ; Male ; Retrospective Studies ; Rural Population ; Suicide ; United States/epidemiology ; Urban Population
Language	English
Publishing date	2022-05-03
Publishing country	England
Document type	Journal Article
ZDB-ID	639160-6
ISSN	1748-0361 ; 0890-765X
ISSN (online)	1748-0361
ISSN	0890-765X
DOI	10.1111/jrh.12670
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Article: Rural‐urban, age, and gender disparities and trends in suicide and homicide: Multistate evidence across 12 years

Lemke, Michael Kenneth / Akinlotan, Marvellous / Yang, Yijiong / Drake, Stacy A.

Journal of rural health. 2022 Sept., v. 38, no. 4

2022

Abstract: PURPOSE: Few studies have simultaneously assessed age and gender trends in homicide and suicide across the rural‐urban continuum. Herein, we examine geographic and demographic trends in suicide and homicide death rates by: (1) determining overall macro ... ...

Abstract	PURPOSE: Few studies have simultaneously assessed age and gender trends in homicide and suicide across the rural‐urban continuum. Herein, we examine geographic and demographic trends in suicide and homicide death rates by: (1) determining overall macro and disaggregated trends; (2) examining differences in trends based on rural‐urban county classification; and (3) identifying differences in stratified trends among age and gender classifications. METHODS: A retrospective study design used suicide and homicide data (n = 199,456) from years 2005to 2017 across 16 US states. Suicide and homicide deaths were grouped by age, gender, and rural‐urban classification for descriptive analyses, and trends were analyzed using Joinpoint trend analysis software. FINDINGS: Violence resulted in 142,470 suicide and 56,986 homicide deaths between 2005 and 2017. Among both males and females, overall macro trends of suicide and homicide rates generally increased with greater rurality, and trends in rural rates differed from those in nonrural areas. Joinpoint trend analysis revealed significant increases in male suicide rates in large metropolitan (1.66%), micropolitan (1.78%), and rural areas (1.77%); female suicide rates in large metropolitan (2.17%), small metropolitan (3.25%), and micropolitan areas (3.26%); male homicide rates in large metropolitan areas (10.19%); and female homicide rates in rural areas (8.29%). Finally, when stratified by age, several significant trends were found, including increases in suicide rates among females aged 64 and older in rural areas (11.71%). CONCLUSIONS: Heterogeneous trends were found in suicide and homicide rates within specific rural‐urban, age, and gender subgroups. Prevention efforts should proactively target those subgroups identified herein as most at‐risk of violence.
Keywords	computer software ; death ; experimental design ; females ; males ; retrospective studies ; rural health ; suicide ; violence
Language	English
Dates of publication	2022-09
Size	p. 754-763.
Publishing place	John Wiley & Sons, Ltd
Document type	Article
Note	JOURNAL ARTICLE
ZDB-ID	639160-6
ISSN	0890-765X
ISSN	0890-765X
DOI	10.1111/jrh.12670
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Article ; Online: Evaluating the robustness of the CMS Hospital Value-Based Purchasing measurement system.

Revere, Lee / Langland-Orban, Barbara / Large, John / Yang, Yijiong

Health services research

2021 Volume 56, Issue 3, Page(s) 464–473

Abstract: Background: The Hospital Value-Based Purchasing Program (HVBP) is a pay for performance system that impacts traditional Medicare fee-for-service payments to hospitals through rewards and penalties.: Objectives: To explore variation in overall and ... ...

Abstract	Background: The Hospital Value-Based Purchasing Program (HVBP) is a pay for performance system that impacts traditional Medicare fee-for-service payments to hospitals through rewards and penalties. Objectives: To explore variation in overall and individual-hospital total performance score (TPS) and embedded domains for hospitals during 2014-2018. Data source: Hospital data were retrieved from the publicly available HOSArchive dataset. Study design: Distribution of annual TPS and HVBP domain scores for 2014-2018 was evaluated using descriptive statistics. Transitional probabilities were analyzed to evaluate annual movement in the TPS ranking for outlier hospitals in the Top and Bottom 5%. Principal findings: TPS scores are positively skewed while the distribution of domain scores vary with patient experience, (clinical) outcome, and efficiency domains having a large number of (positive) outliers. Mean TPS score decreased from 40.54 in 2014 to 38.04 by 2018. Improvement was shown in mean domain scores for clinical process of care and clinical outcome using 95% confidence intervals, with hospitals gaining 10 points over the study period in clinical outcome. Changes in the mean scores for other domains did not show consistent increases or decreases. Chi-square analyses of hospital ranking categories showed some evidence that, as a group, hospitals initially ranked in the Bottom 5% are making consistent annual movements to higher categories. In contrast, over half of the hospitals ranking in the initial Top 5% remained in the top category across all study years. Conclusions: It may be time for CMS to redesign the HVBP incentive program to assure the measures accurately demonstrate sustained improvement, the domain weights appropriately reflect the level of importance, and the TPS comparative ranking methodology does not discourage lower-performing hospitals from actively improving the care they deliver and achieving top ranks.
MeSH term(s)	Centers for Medicare and Medicaid Services, U.S. ; Economics, Hospital/statistics & numerical data ; Humans ; United States ; Value-Based Purchasing/organization & administration ; Value-Based Purchasing/standards ; Value-Based Purchasing/statistics & numerical data
Language	English
Publishing date	2021-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	410435-3
ISSN	1475-6773 ; 0017-9124
ISSN (online)	1475-6773
ISSN	0017-9124
DOI	10.1111/1475-6773.13608
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Article ; Online: Comparing survival rates and mortality in operative versus nonoperative treatment for femoral neck fractures among Alzheimer's disease patients: A retrospective cohort study.

Yang, Yijiong / Drake, Stacy A / Wang, Jing / Shen, Gordon C / Miao, Hongyu / Morgan, Robert O / Du, Xianglin L / Lairson, David R

Aging medicine (Milton (N.S.W))

2023 Volume 7, Issue 1, Page(s) 52–59

Abstract: Introduction: Addressing femoral neck fractures resulting from ground-level falls in older adults with Alzheimer's disease (AD) involves a personalized treatment plan. There is considerable ongoing debate concerning the relative advantages and ... ...

Abstract	Introduction: Addressing femoral neck fractures resulting from ground-level falls in older adults with Alzheimer's disease (AD) involves a personalized treatment plan. There is considerable ongoing debate concerning the relative advantages and disadvantages of surgical treatment (internal fixation or arthroplasty) vs nonoperative treatment for femoral neck fractures in older persons with AD. Methods: This retrospective cohort study compared the mortality, hazard ratio, and survival rate between operative and nonoperative treatments, controlling for patients' demographic information and baseline health status. The study population consisted of Optum beneficiaries diagnosed with AD who experienced an initial femoral neck fracture claim between January 1, 2012, and December 31, 2017. Kaplan-Meier survival curves were applied to compare the treatment groups' post-fracture survival rates and mortality. Cox regression was used to examine the survival period by controlling the covariates. Results: Out of the 4157 patients with AD with femoral neck fractures, 59.8% were women (n = 2487). The median age was 81 years. The 1-year survival rate for nonoperative treatment (70.19%) was lower than that for internal fixation (75.27%) and arthroplasty treatment (82.32%). Compared with the nonoperative group, arthroplasty surgical treatment had significant lower hazard risk of death (arthroplasty hazard ratio: 0.850, 95% CI: 0.728-0.991, Discussion: The findings suggest that the operative treatment group experiences higher survival rates and lower mortality rates than the nonoperative group. This paper provides insights into treatment outcomes of older adults with AD receiving medical care for femoral neck fractures.
Language	English
Publishing date	2023-12-19
Publishing country	Australia
Document type	Journal Article
ISSN	2475-0360
ISSN (online)	2475-0360
DOI	10.1002/agm2.12279
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Article ; Online: The silent killer: Previously undetected pulmonary emboli that result in death after discharge.

Kalkwarf, Kyle J / Yang, Yijiong / Mora, Stephen / Wolf, Dwayne A / Robertson, Ronald D / Holcomb, John B / Drake, Stacy A

Injury

2023 Volume 54, Issue 11, Page(s) 111016

Abstract: Introduction: Pulmonary embolism (PE) is a recognized cause of death in hospitalized trauma patients, yet less is known about PE after discharge.: Patients & methods: All post-discharge, autopsy-demonstrated, fatal PE resulting from trauma within a ... ...

Abstract	Introduction: Pulmonary embolism (PE) is a recognized cause of death in hospitalized trauma patients, yet less is known about PE after discharge. Patients & methods: All post-discharge, autopsy-demonstrated, fatal PE resulting from trauma within a large US county over six years were analyzed. Counts, percentages, mean values, SD, and IQR were calculated for all variables. Results: 1848 trauma deaths were reviewed, of which 85% had an autopsy. Eighty-five patients died from PE after discharge from their initial injury. 53% were initially treated at non-trauma centers, and 9% did not seek medical assistance. 75% were injured by falling, and most injuries occurred in the lower extremities. 86% had an ISS <16, but 87% needed assistance or were bed-bound after injury, despite 75% having no mobility limitations before the injury. 53% died within one month of injury, and 91% within the first year. Before death, only 11% were prescribed chemical thromboprophylaxis or an antiplatelet agent, and only 8% were diagnosed with venous thromboembolism before death. Conclusions: Fatal PE after discharge typically occurred following activity-limiting lower extremity injuries with an ISS<16.
MeSH term(s)	Humans ; Anticoagulants/therapeutic use ; Venous Thromboembolism/prevention & control ; Patient Discharge ; Aftercare ; Pulmonary Embolism/prevention & control ; Risk Factors
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-09-06
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2023.111016
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Article ; Online: Identifying gaps and improving investigation of fatal elder abuse and/or neglect.

Drake, Stacy A / Akande, Anthony / Kelly, P Adam / Yang, Yijiong / Wolf, Dwayne A

Journal of forensic sciences

2021 Volume 66, Issue 6, Page(s) 2274–2282

Abstract: Death investigator and autopsy reports for decedents 65 years and older within a major metropolitan area over a five-year period were assessed for the possibility of elder abuse and/or neglect. The study consisted of two stages. A simple two-question ... ...

Abstract	Death investigator and autopsy reports for decedents 65 years and older within a major metropolitan area over a five-year period were assessed for the possibility of elder abuse and/or neglect. The study consisted of two stages. A simple two-question screening criteria was used to determine whether the decedent was (1) dependent on another for at least one activity of daily living and (2) had a presence of at least one indicator of abuse and/or neglect. Second, only cases with affirmative criteria responses were reviewed to identify inconsistent or deficient variables that precluded (or if present, allowed) determination of abuse and/or neglect. A multidisciplinary panel of local and national experts, including forensic pathologists, law enforcement, and geriatricians assessed these indicators as indicative of presence of abuse/neglect, and these indicators were subsequently developed as a supplemental data collection tool. Of a possible 2798 cases, 2324 (83%) were excluded using the screening criteria. This reduced the number of cases that warranted further investigation to 474 (17% of elderly deaths in this timeframe). All 474 decedents were dependent on another for at least one ADL and 322 (68%) had unexplained injuries. In 180 (38%) cases had recorded notation of a suspicion of abuse and/or neglect at the time of death. The results support the premise that a simple, two-criterion screening can effectively identify cases of potential abuse and/or neglect and, when followed by a supplemental data collection tool, cases can be efficiently evaluated.
MeSH term(s)	Aged ; Aged, 80 and over ; Disabled Persons/statistics & numerical data ; Elder Abuse/diagnosis ; Female ; Humans ; Male ; Mass Screening ; Residence Characteristics ; Retrospective Studies ; Risk Factors ; Wounds and Injuries/epidemiology
Language	English
Publishing date	2021-09-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	219216-0
ISSN	1556-4029 ; 0022-1198
ISSN (online)	1556-4029
ISSN	0022-1198
DOI	10.1111/1556-4029.14884
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Article ; Online: Geospatial Analysis of Prehospital Triage and Early Potential Preventable Traumatic Deaths.

Klutts, Garrett N / Kalkwarf, Kyle J / Yang, Yijiong / Gill, Joseph P / Wade, Charles E / Persse, David / Wolf, Dwayne A / Deloach, Joe P / Smedley, Weston A / Corbin, Seana L / Schulz, Kevin / Tabor, Jeff / Bhavaraju, Avi / Drake, Stacy

The American surgeon

2023 Volume 89, Issue 7, Page(s) 3322–3324

Abstract: Severely injured patients often depend on prompt prehospital triage for survival. This study aimed to examine the under-triage of preventable or potentially preventable traumatic deaths. A retrospective review of Harris County, TX, revealed 1848 deaths ... ...

Abstract	Severely injured patients often depend on prompt prehospital triage for survival. This study aimed to examine the under-triage of preventable or potentially preventable traumatic deaths. A retrospective review of Harris County, TX, revealed 1848 deaths within 24 hours of injury, with 186 being preventable or potentially preventable (P/PP). The analysis evaluated the geospatial relationship between each death and the receiving hospital. Out of the 186 P/PP deaths, these were more commonly male, minority, and penetrating mechanisms when compared with NP deaths. Of the 186 PP/P, 97 patients were transported to hospital care, 35 (36%) were transported to Level III, IV, or non-designated hospitals. Geospatial analysis revealed an association between the location of initial injury and proximity to receiving Level III, IV, and non-designated centers. Geospatial analysis supports proximity to the nearest hospital as one of the primary reasons for under-triage.
MeSH term(s)	Humans ; Male ; Triage ; Emergency Medical Services ; Trauma Centers ; Hospitals ; Retrospective Studies ; Wounds and Injuries/therapy
Language	English
Publishing date	2023-02-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348231157910
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Article ; Online: Efficacy of a Just-in-Time Adaptive Intervention to Promote HIV Risk Reduction Behaviors Among Young Adults Experiencing Homelessness: Pilot Randomized Controlled Trial.

Santa Maria, Diane / Padhye, Nikhil / Businelle, Michael / Yang, Yijiong / Jones, Jennifer / Sims, Alexis / Lightfoot, Marguerita

Journal of medical Internet research

2021 Volume 23, Issue 7, Page(s) e26704

Abstract: Background: People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with ... ...

Abstract	Background: People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use, or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors. Objective: This pilot study tested the initial efficacy of an innovative, smartphone-based, just-in-time adaptive intervention that assessed predictors of HIV risk behaviors in real time and automatically provided behavioral feedback and goal attainment information. Methods: A randomized attention control design was used among young adults experiencing homelessness, aged 18-25 years, recruited from shelters and drop-in centers in May 2019. Participants were randomized to either a control or an intervention group. The intervention (called MY-RID [Motivating Youth to Reduce Infection and Disconnection]) consisted of brief messages delivered via smartphone over 6 weeks in response to preidentified predictors that were assessed using ecological momentary assessments. Bayesian hierarchical regression models were used to assess intervention effects on sexual activity, drug use, alcohol use, and their corresponding urges. Results: Participants (N=97) were predominantly youth (mean age 21.2, SD 2.1 years) who identified as heterosexual (n=51, 52%), male (n=56, 57%), and African American (n=56, 57%). Reports of sexual activity, drug use, alcohol use, stress, and all urges (ie, sexual, drug, alcohol) reduced over time in both groups. Daily drug use reduced by a factor of 13.8 times over 6 weeks in the intervention group relative to the control group (Multimedia Appendix 4). Lower urges for sex were found in the intervention group relative to the control group over the duration of the study. Finally, there was a statistically significant reduction in reports of feeling stressed the day before between the intervention and control conditions (P=.03). Conclusions: Findings indicate promising intervention effects on drug use, stress, and urges for sex in a hard-to-reach, high-risk population. The MY-RID intervention should be further tested in a larger randomized controlled trial to further investigate its efficacy and impact on sexual risk behaviors. Trial registration: ClinicalTrials.gov NCT03911024; https://clinicaltrials.gov/ct2/show/NCT03911024.
MeSH term(s)	Adolescent ; Adult ; Bayes Theorem ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; Homeless Persons ; Humans ; Male ; Pilot Projects ; Risk Reduction Behavior ; Young Adult
Language	English
Publishing date	2021-07-06
Publishing country	Canada
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1439-4456
ISSN (online)	1438-8871
ISSN	1439-4456
DOI	10.2196/26704
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Article ; Online: Fatal and Nonfatal Injury Patterns of Stranded Motorists.

Drake, Stacy A / Yang, Yijiong / Gao, Si / Mora, Stephen / Garza, Robin / Moore, Laura / Todd, S Rob / Wilson, Chad / Wolf, Dwayne A

Journal of forensic nursing

2021 Volume 17, Issue 3, Page(s) 154–162

Abstract: Abstract: Because nonfatal and fatal incidents for stranded motorists are not separated from vehicular accidents, little data are available on incident characteristics. To close this gap, data fields were inserted into databases at a medical examiner's ... ...

Abstract	Abstract: Because nonfatal and fatal incidents for stranded motorists are not separated from vehicular accidents, little data are available on incident characteristics. To close this gap, data fields were inserted into databases at a medical examiner's office and two trauma centers to collect injury-related information. Forensic nurses and pathologists aided in forming a collaboration among the agencies involved and supported data collection efforts. Data collected over a 5-year period were examined for injury patterns to determine risk factors affecting these patterns. Of the total sample (N = 219), 24.7% had spinal injuries resulting in fatal injuries for 46 of 54 individuals. The odds were stranded motorists with spine-related injuries (C1-C7) had 9.13 times higher risk for a fatal outcome compared with those without spine-related injuries. Severe injuries (Abbreviated Injury Scale scores ≥ 4) noted for head/neck (29.7%) and chest (24.2%) were significantly associated with fatality. Of the 219 cases, 22.8% were inside of a stopped vehicle, and 77.2% were outside a vehicle at the time of injury. Outcomes illustrated the success of the interprofessional collaboration between trauma centers and a medicolegal death investigation agency that resulted in data useful for forensic nurses and pathologists documenting evidence, emergency and trauma responding personnel in patient priority stabilization, and injury prevention specialists for highway safety programs.
MeSH term(s)	Abbreviated Injury Scale ; Adult ; Automobile Driving ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Texas/epidemiology ; Wounds and Injuries/epidemiology
Language	English
Publishing date	2021-04-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2460839-7
ISSN	1939-3938 ; 1556-3693
ISSN (online)	1939-3938
ISSN	1556-3693
DOI	10.1097/JFN.0000000000000329
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