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Smith DJ. Occupational Health and Safety in the Era of Gun Violence. Workplace Health Saf 2024; 72:208-209. [PMID: 38477223 DOI: 10.1177/21650799241235411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Affiliation(s)
- Daniel J Smith
- M. Louise Fitzpatrick College of Nursing, Villanova University
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2
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Ballas SJ, Mufti A, Adames Ramos K, Cabral-Hernandez A, Rudolph-Math T, Thenor-Louis I, Wentlent Z, Izadyar S, Wallenstein K, Hagen K, Guzman-Curtis R, Northhardt T, Brenner J. Recommendations for the Clinician Role in Reducing Gun Violence. Psychol Rep 2024:332941241253592. [PMID: 38743484 DOI: 10.1177/00332941241253592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
There is a growing need for clear and definitive guidelines to prevent firearm violence in communities across the United States. Recommendations explore the utility and feasibility of universal screenings and recommend utilizing universal screening due to a lack of a clear risk to it. Providers should also work to create risk reduction plans with patients as well. Furthermore, recommendations for mental health care, counseling, and bystander training are made for institutions and their providers.
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Affiliation(s)
- Samantha J Ballas
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alina Mufti
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kenneth Adames Ramos
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Timothy Rudolph-Math
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Isabelle Thenor-Louis
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Zachariah Wentlent
- Medical Student, College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Shahram Izadyar
- Department of Neurology, Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kim Wallenstein
- Department of Surgery, Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kathryn Hagen
- Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Trina Northhardt
- Patient Safety Emergency Medicine Department, Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jay Brenner
- Medicine, Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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3
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Tischler EH, Nian PP, Mastrokostas P, Wolfert AJ, Tsai SHL, Ibrahim I, Gross JM, Malik AN, Suneja N. Shots fired: evaluation of vascular injury, compartment syndrome, and transfusion rates among civilian ballistic orthopaedic fracture patients presenting to two Level I trauma centres. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03955-1. [PMID: 38693348 DOI: 10.1007/s00590-024-03955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/08/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE This study investigates baseline patient demographics and predictors of vascular injury, blood transfusion, and compartment syndrome in patients with orthopaedic fractures secondary to GSWs at two high-volume Level I trauma centres. METHODS A retrospective chart review of all GSW-related trauma patients at two Level I trauma centres between July 2019 and September 2021 was conducted. Chi-squared and two-tailed independent t tests were used for data analysis, and logistic regression with odds ratios (OR) determined predictors of primary outcomes. RESULTS Among 478 GSW patients, 94 (19.7%) sustained 130 orthopaedic fractures, most commonly at the lower extremity (77.7%). Orthopaedic fracture patients showed significantly higher rates of vascular injury (29.8 vs. 4.7%, p < 0.001), transfusion (27.7 vs. 12.8%, p = 0.006), and compartment syndrome (3.2 vs. 0.3%, p = 0.011) compared to non-orthopaedic injury patients. Univariable analysis identified ankle (OR = 47.50, p < 0.001) and hip/femur fractures (OR = 5.31, p < 0.001) as predictors of vascular injury. Multivariable logistic regression revealed lower extremity vascular injury (OR = 54.69, p = 0.006) and anatomic fracture sites of the humerus (OR = 15.17, p = 0.008), clavicle/scapula (OR = 11.30, p = 0.009), and acetabulum/pelvis (OR = 7.17, p = 0.025) as predictors of blood transfusion. Univariable analysis showed lower extremity vascular injury (OR = 30.14, p = 0.007) as a predictor of compartment syndrome. CONCLUSION These findings underscore the importance of diagnosing and managing vascular injuries and compartment syndrome in GSW-related orthopaedic fractures, emphasizing the necessity for targeted transfusion strategies in such cases.
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Affiliation(s)
- Eric H Tischler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Patrick P Nian
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Paul Mastrokostas
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Adam J Wolfert
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sung Huang Laurent Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center and Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Ishaq Ibrahim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jonathan M Gross
- Department of Orthopaedic Surgery, Northwell Health-Staten Island University Hospital, New York City, NY, USA
| | - Aden N Malik
- Department of Orthopaedic Surgery, Lincoln Hospital, Bronx, NY, USA
| | - Nishant Suneja
- Department of Orthopaedic Surgery, Lincoln Hospital, Bronx, NY, USA.
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Ziminski D. A social problem analysis of the 1993 Brady Act and the 2022 Bipartisan Safer Communities Act. Front Public Health 2024; 12:1338722. [PMID: 38601502 PMCID: PMC11004240 DOI: 10.3389/fpubh.2024.1338722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
In June 2022, the U.S. federal government passed its first major firearm policy since the Brady Handgun Violence Prevention Act of 1993, the Bipartisan Safer Communities Act (BSCA). Summative content analysis was used to explore how the social problem of firearm violence was outlined in both policies, with the goal of extracting the social issue's definition from the policies' approaches to solving it. Both policies do not outline the various types of firearm violence, nor the disproportionate effect of firearm violence on certain populations. This work informs the role of federal policy in defining and monitoring firearm violence as a public health issue, identifying both individual and structural risk and protective factors from an asset-based lens, and allocating preventative efforts in communities that are most affected.
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Affiliation(s)
- Devon Ziminski
- School of Social Work, Rutgers University, New Brunswick, NJ, United States
- New Jersey Gun Violence Research Center, School of Public Health, Rutgers University, Piscataway, NJ, United States
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Reyes G, Gadot R, Ouellette L, Nouri SH, Gopinath SP, Patel AJ. Firearm-Related Traumatic Brain Injuries in Adults: A Scoping Review. Neurosurgery 2024; 94:229-239. [PMID: 37878414 DOI: 10.1227/neu.0000000000002734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Firearm-related traumatic brain injury (TBI) has emerged as a significant public health issue in the United States, coinciding with a rapid increase in gun-related deaths. This scoping review aims to update our understanding of firearm-related TBI in adult populations. METHODS A comprehensive search of 6 online databases yielded 22 studies that met the inclusion criteria. The reviewed studies predominantly focused on young adult men who were victims of assault, although other vulnerable populations were also affected. RESULTS Key factors in evaluating patients with firearm-related TBI included low Glasgow Coma Scale scores, central nervous system involvement, hypotension, and coagulopathies at presentation. Poor outcomes in firearm-related TBIs were influenced by various factors, including the location and trajectory of the gunshot wound, hypercoagulability, hemodynamic instability, insurance status, and specific clinical findings at hospital admission. CONCLUSION Proposed interventions aimed to reduce the incidence and mortality of penetrating TBIs, including medical interventions such as coagulopathy reversal and changes to prehospital stabilization procedures. However, further research is needed to demonstrate the effectiveness of these interventions. The findings of this scoping review hope to inform future policy research, advocacy efforts, and the training of neurosurgeons and other treating clinicians in the management of firearm-related TBI.
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Affiliation(s)
- Gabriel Reyes
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Texas Medical Center Library, Houston , Texas , USA
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Texas Medical Center Library, Houston , Texas , USA
| | | | - Shervin H Nouri
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston , Texas , USA
- Texas Medical Center Library, Houston , Texas , USA
| | - Shankar P Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Texas Medical Center Library, Houston , Texas , USA
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston , Texas , USA
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston , Texas , USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston , Texas , USA
- Texas Medical Center Library, Houston , Texas , USA
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Dao KD, Gisselman AS, Siegel MB, Hegedus EJ, Wooten LC. Firearm Violence as a Public Health Crisis: A Call to Action for Physical Therapists. Phys Ther 2024; 104:pzad143. [PMID: 37839055 DOI: 10.1093/ptj/pzad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Kim D Dao
- Department of Rehabilitation Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Michael B Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Eric J Hegedus
- Department of Rehabilitation Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Liana C Wooten
- Department of Rehabilitation Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
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Siu M, Perez Coulter A, Knee A, Tirabassi MV. Association Between Social Vulnerability Index and Hospital Readmission Following Gunshot Injuries. J Surg Res 2024; 293:50-56. [PMID: 37716100 DOI: 10.1016/j.jss.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION No association regarding classification of social vulnerability and outcomes of patients with gunshot injury have been described. Our goal was to assess whether the socioeconomic vulnerability index (SVI), is associated with an increased risk of hospital readmission following gunshot wounds. METHODS We conducted an exploratory retrospective cohort study on Massachusetts patients with trauma following gunshot wounds from January 1, 2012 to December 31, 2020 using the institutional trauma registry. We estimated the association between high social vulnerability (defined by the Centers for Disease Control and Prevention as ≥90th percentile) and incidence of all-cause readmission at 30, 60, and 90 d (overall and stratified over sex, race, and age groups). Estimates from unadjusted log-binomial regression were reported using relative risks (RRs) and 95% confidence intervals. Time-to-event (readmission) was assessed using Kaplan-Meier plots. RESULTS A total of 386 patients were included for analysis: 211 (55%) with SVI <0.90 and 175 (45%) with SVI ≥0.90. The mean (standard deviation) age was 29 (13) y, with majority being male (89%). There was no strong risk of readmission associated with SVI ≥0.90; the interval with the greatest risk was at 60 d (RR = 1.34; 95% confidence interval [0.73, 2.45]). Among stratified analyses, the strongest associations were observed when restricting to young adults (aged 18-35) with RRs of 2.49, 2.62, and 2.45 for 30, 60, and 90 d readmission, respectively. CONCLUSIONS Overall, high SVI was not associated with all-cause readmission; however, subanalyses suggest an association among young adults. Future research should explore SVI as a tool for identifying patients with trauma at risk for readmission.
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Affiliation(s)
- Margaret Siu
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts.
| | - Aixa Perez Coulter
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Alexander Knee
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts; Baystate Medical Center, Epidemology/Biostatistics Research Core, Office of Research, Springfield, Massachusetts
| | - Michael V Tirabassi
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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Henry OS, Batchu S, Lachant J, Armento I, Hunter K, Staffa SJ, Porter J, Egodage T. Disadvantaged Neighborhoods Continue to Bear the Burden of Gun Violence. J Surg Res 2024; 293:396-402. [PMID: 37806227 DOI: 10.1016/j.jss.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/11/2023] [Accepted: 09/03/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Gun violence is a pervasive and dynamic public health crisis causing substantial burden on communities and healthcare systems in the United States. Risk factor and outcome analyses are crucial to develop effective interventions. The aim of this study was to assess firearm injury in a diverse community setting as it relates to neighborhood socioeconomic disadvantage and changes over time following large-scale local interventions. METHODS All county residents with firearm injury presenting to a Level 1 Trauma Center from January 2012 to December 2021 were retrospectively reviewed. Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage based on a nine-digit zip code at patients' home address. Injuries were also stratified by 5-year time periods, 2012-2016 and 2017-2021. Demographics and clinical data were analyzed including injury severity, hospital course, and discharge location. Data were compared by ADI quintile and between time periods using chi-squared, one-way analysis of variance, and Cochran-Armitage test. RESULTS A total of 1044 injuries were evaluated. Patients were 93% male with mean age of 29 y (standard deviation 10.2) and were concentrated in the most disadvantaged neighborhoods (74% ADI Q5). Black or African American race was greater in the most disadvantaged ADI groups (76% versus 47%-66%; P <0.001). Percentage of total injuries in the most disadvantaged ADI group rose from 71% to 78% over time (P = 0.006). Mortality occurred in 154 (15%) patients overall, while most (71%) were discharged to home. Mortality declined from 18% to 11% over time (P <0.001). Medicaid utilization rose from 42% to 77% alongside a decrease in self-pay status from 44% to 4% (P <0.001). There were no clinically significant group differences in injury severity or clinical characteristics. CONCLUSIONS Firearm injury remains concentrated in the most socioeconomically disadvantaged neighborhoods, and this disparity is increasing over time. Medicaid utilization rose and mortality decreased in this population over time. This research presents a method to inform and monitor local gun violence interventions using ADI to address public health equity.
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Affiliation(s)
- Owen S Henry
- Cooper Medical School of Rowan University, Camden, New Jersey; Division of Trauma, Cooper University Hospital, Camden, New Jersey.
| | - Sai Batchu
- Cooper Medical School of Rowan University, Camden, New Jersey; Division of Trauma, Cooper University Hospital, Camden, New Jersey
| | - Joseph Lachant
- Division of Trauma, Cooper University Hospital, Camden, New Jersey
| | - Isabella Armento
- Division of Trauma, Cooper University Hospital, Camden, New Jersey
| | - Krystal Hunter
- Division of Trauma, Cooper University Hospital, Camden, New Jersey
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - John Porter
- Division of Trauma, Cooper University Hospital, Camden, New Jersey
| | - Tanya Egodage
- Division of Trauma, Cooper University Hospital, Camden, New Jersey
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Rice BM. Using nursing science to advance policy and practice in the context of social and structural determinants of health. Nurs Outlook 2023; 71:102060. [PMID: 37852871 PMCID: PMC10843015 DOI: 10.1016/j.outlook.2023.102060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/17/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Social and structural determinants of health play a large role in health inequities. PURPOSE To highlight how nursing science can be used to advance policy and practice in the context of social and structural determinants of health. METHODS This paper reports on the author's keynote presentation from the 2022 State of The Science Conference on Social and Structural Determinants of Health presented by the Council for the Advancement of Nursing Science. Key concepts are overviewed and defined, followed by examples of two community-engaged research projects with findings that inform practice and policy. The author concludes with individual-, social- and structural-level recommendations as a clarion call for nurses to use research to eliminate health inequities and promote justice for all. CONCLUSION What we know is, in part, only as good as what we do with that knowledge. When lives are at stake, gone are the days of knowing something and failing to act on that knowledge.
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Affiliation(s)
- Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA.
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Leslie C, DiMagno K. Identification of Performance Improvement Objectives After Management of a Mass Shooting Incident: A Retrospective Study. Cureus 2023; 15:e47529. [PMID: 38022271 PMCID: PMC10664770 DOI: 10.7759/cureus.47529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Mass shootings are firearm incidents involving four or more victims at one or more locations close to one another. Although some American College of Surgeons designated trauma centers have the experience and resources to adequately treat mass shooting victims who arrive simultaneously or in close proximity to each other, many others do not. Therefore, the objective of this retrospective case series was to evaluate the effectiveness of the treatment of five consecutive gunshot wound victims who presented to a Level II trauma center within 36 minutes of each other. Lessons learned from that experience were used to identify the most effective pre-hospital and hospital management interventions. Opportunities for performance improvement were analyzed with respect to the current literature and the American College of Surgeons 2022 consensus recommendations for mass shootings.
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Affiliation(s)
- Cynthia Leslie
- Division of Trauma and Critical Care, Good Samaritan University Hospital, West Islip, USA
| | - Kevin DiMagno
- Medical School, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
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Jaffee SR, Hasford S, Fein JA. Differential exposure to gun or knife violence over two decades is associated with sibling differences in depression. Dev Psychopathol 2023; 35:2096-2102. [PMID: 35983801 DOI: 10.1017/s0954579422000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We tested whether exposure to gun or knife violence over two decades is a cause of depression in young adulthood using data from a nationally representative sample in the United States. The National Longitudinal Study of Adolescent to Adult Health is a sample of 20,745 adolescents, assessed in 1994-95 with follow-ups in 1995-1996 (n = 14,738), 2001-2002 (n = 15,197) and 2007-2008 (n = 15,701; 24 to 32 years old). At each wave, respondents reported exposure to gun or knife violence and symptoms of depression. Regression and sibling fixed effects analyses were conducted to test whether cumulative exposure to gun or knife violence was associated with depression. In fully adjusted models, greater cumulative exposure to gun or knife violence was associated with more symptoms of depression (b = 0.12, 95% C. I. = 0.05; 0.19, p < 0.01) and higher risk for clinically significant depression in young adulthood (OR = 1.07, 95% C. I. = 1.02; 1.13, p < 0.01). Results replicated in sibling fixed effects models (b = 0.21, 95% C. I. = 0.01; 0.42, p < 0.05). These quasi-experimental data suggest that exposure to gun or knife violence is a cause of depression in young adulthood.
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Affiliation(s)
- Sara R Jaffee
- University of Pennsylvania, Department of Psychology, Philadelphia, PA, USA
| | - Stephanie Hasford
- University of Pennsylvania, Department of Psychology, Philadelphia, PA, USA
| | - Joel A Fein
- Center for Violence Prevention, Children's Hospital of Philadelphia, Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, PA, USA
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Ross KM, Walsh CS, O'Connor KE, Sullivan TN. Ecological promotive and protective factors deterring gun carriage for young adults living in communities with high rates of community violence. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1164-1180. [PMID: 36710523 DOI: 10.1002/jcop.23008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/23/2022] [Accepted: 01/14/2023] [Indexed: 06/18/2023]
Abstract
This study identified promotive and protective factors that lessened the likelihood of handgun carriage in a sample of 141 predominantly Black (97%) young adults (ages 18-22) living in high burden communities experiencing elevated rates of violence. Participants completed surveys assessing overall risk and protective factors for violence across ecological contexts (e.g., individual/peer, family, school, and community). A series of regression and moderation analyses were conducted to ascertain direct (promotive) and indirect (protective) relations between factors across the ecological model and likelihood of gun carriage. Results indicated that (1) consistent with previous studies, both witnessing violence and violence victimization were significant risk factors for handgun carriage, (2) ethnic identity was a significant promotive factor related to a lower likelihood of handgun carriage, and (3) lack of family conflict, student status, and community assets were significant protective factors where higher levels of these factors attenuated the relation between exposure to community violence and likelihood of gun carriage. This is one of the first strengths-based studies examining factors that may mitigate the likelihood of gun carriage for young adults in high risk contexts. Our findings suggest that gun violence prevention efforts for high burden communities should support young adults by strengthening factors across the ecological model (e.g., individual, family, school, and community).
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Affiliation(s)
| | - Colleen S Walsh
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kelly E O'Connor
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Terri N Sullivan
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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13
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Lee LK, Fleegler EW, Goyal MK, Doh KF, Laraque-Arena D, Hoffman BD, Injury Violence And Poison Prevention CO. Firearm-Related Injuries and Deaths in Children and Youth. Pediatrics 2022; 150:189687. [PMID: 36207778 DOI: 10.1542/peds.2022-060071] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kiesha Fraser Doh
- Division of Pediatrics and Emergency Medicine, Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, Mailman School of Public Health at Columbia University, Departments of Epidemiology and Pediatrics, New York, NY
| | - Benjamin D Hoffman
- Division of General Pediatrics, Oregon Health and Science University, Portland, OR
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Mitchell RA, Aronson JD. Violence and the Carceral State: A Public Health Continuum. JAMA 2022; 328:1183-1184. [PMID: 36166009 DOI: 10.1001/jama.2022.17144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This Viewpoint reports the disproportionate rate of firearm-related deaths in US Black communities; emphasizes the urgency of addressing this issue; and details the causes of these deaths in the context of community, law enforcement, and in custody.
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Affiliation(s)
- Roger A Mitchell
- Department of Pathology, Howard University College of Medicine, Washington, DC
| | - Jay D Aronson
- Department of History, Dietrich College of Humanities and Social Sciences, and Center for Human Rights Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
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15
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Chien LC, Holloway A, Gakh M, Coughenour C. A novel gun law strength index and influential state gun laws for firearm homicide in the United States, 1999–2018. Public Health 2022; 210:91-98. [DOI: 10.1016/j.puhe.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/01/2022] [Accepted: 06/13/2022] [Indexed: 10/16/2022]
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Newsome K, Sen-Crowe B, Autrey C, Alfaro S, Levy M, Bilski T, Ibrahim J, Elkbuli A. A Closer Look at the Rising Epidemic of Mass Shootings in the United States and Its Association With Gun Legislation, Laws, and Sales. J Surg Res 2022; 280:103-113. [PMID: 35969931 DOI: 10.1016/j.jss.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/13/2022] [Accepted: 07/12/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Mass shootings pose a considerable threat to public safety and significantly cost the United States in terms of lives and expenses. The following are the specific aims of this study: (1) to assess US mass shootings, firearm-related sales, laws, and regional differences from 2015 to 2021 and (2) to investigate changes in mass shootings and firearm sales before and during the Coronavirus Disease 2019 pandemic. METHODS A retrospective review was conducted of mass shootings, gun sales, and laws regarding the minimum age required to purchase a firearm within the United States from 2015 to 2021. The 10 states/regions with the greatest mean mass shootings/capita from 2015 to 2021 were selected for further analysis. RESULTS Mass shootings correlated significantly with firearm sales from 2015 to 2021 nationwide (P < 0.02 for all). The growth in mass shootings, the number killed/injured, and gun sales were greater in 2020 and 2021 compared to the years prior. The 10 states with the highest mean mass shooting/capita over the study period were Alabama, Arkansas, the District of Columbia, Illinois, Louisiana, Maryland, Mississippi, Missouri, South Carolina, and Tennessee. No significant correlation was found between the number of mass shootings/capita and the minimum age to purchase a firearm. CONCLUSIONS Firearm sales correlated significantly with mass shootings from 2015 to 2021. Mass shootings and gun sales increased at greater rates during the Coronavirus Disease 2019 pandemic compared to the years before the pandemic. Mass shootings exhibited inconsistent trends with state gun laws regarding the minimum age to purchase a firearm. Future studies may consider investigating the methods by which firearms used in mass shootings are obtained to further identify targets for prevention.
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Affiliation(s)
- Kevin Newsome
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Brendon Sen-Crowe
- NSU NOVA Southeastern University, Dr Kiran.C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Cody Autrey
- NSU NOVA Southeastern University, Dr Kiran.C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Sophie Alfaro
- A.T. Still University School of Osteopathic Medicine, Arizona
| | - Marc Levy
- Arnold Palmer Children's Hospital at Orlando Health, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Tracy Bilski
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida; Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida
| | - Joseph Ibrahim
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida; Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida
| | - Adel Elkbuli
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida; Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida.
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Drake SA, Lemke MK, Yang Y. Exploring the complexity of firearm homicides in Harris County, Texas, from 2009 to 2021: Implications for theory and prevention. Soc Sci Med 2022; 305:115048. [PMID: 35617763 DOI: 10.1016/j.socscimed.2022.115048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/03/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
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.
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Affiliation(s)
- Stacy A Drake
- College of Nursing, Texas A&M University, 2121 W. Holcombe Blvd #1011A, Houston, TX, 77030, USA.
| | - Michael K Lemke
- Department of Social Sciences, University of Houston-Downtown, USA
| | - Yijiong Yang
- Department of Research, The University of Texas Health Science Center Cizak School of Nursing at Houston, USA
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18
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Logan TK, Cole J. Firearm-related threat exposure and associated factors among men and women entering a supportive housing substance use disorder recovery program. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:367-377. [PMID: 35157534 DOI: 10.1080/00952990.2021.2007259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Exposure to firearm victimization has often been overlooked as a sequela of substance use disorders (SUD).Objectives: The overall objective of this study was to explore firearm-related victimization and associated factors among men and women entering a supportive housing SUD recovery program.Methods: This study used program intake information from men (n = 1,758) and women (n = 1,066) clients entering a SUD recovery program.Results: Results found that almost half (49.3%) of the clients entering the program had ever been threatened with a firearm or held at gunpoint, and one-quarter of those clients had experienced firearm-related threats in the 6 months before entering the program. Economic vulnerability, mental health problems, polysubstance use, interpersonal victimization, and early use of drugs and alcohol were associated with firearm-related threat exposure. Many of the factors associated with firearm-related threat exposure were similar for men and women. Multivariate results found that polysubstance use (OR 1.16 men and 1.13 women), number of adverse childhood events (OR 1.13 men and 1.09 women), and interpersonal victimization (OR 3.41 men and 2.05 women) in the 6 months before program entry were significantly associated with ever being threatened with a firearm. Suicidality (OR 1.53 men and 1.80 women) and interpersonal victimization (OR 6.38 men and 6.08 women) were associated with being threatened with a firearm in the 6 months before program entry for both men and women.Conclusion: Results suggest there is a need for firearm-related risk reduction interventions for individuals in SUD recovery programs.
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Affiliation(s)
- T K Logan
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Jennifer Cole
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
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Lemke MK, Wolf DA, Drake SA. A Call for Complex Systems and Syndemic Theory in Firearm Violence Research. Am J Prev Med 2022; 62:459-465. [PMID: 34879969 DOI: 10.1016/j.amepre.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/27/2021] [Accepted: 08/18/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Michael K Lemke
- Department of Social Sciences, College of Humanities and Social Sciences, University of Houston-Downtown, Houston, Texas.
| | - Dwayne A Wolf
- Medical Examiner's Office, Harris County Institute of Forensic Sciences, Houston, Texas
| | - Stacy A Drake
- College of Nursing, Texas A&M University, Houston, Texas
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Hsu HT, Fulginiti A, Petering R, Barman-Adhikari A, Bedell K, Ferguson KM, Narendorf SC, Shelton J, Santa Maria D, Bender K, Rice E. Understanding the Correlates of Firearm Violence Involvement Among Young Adults Experiencing Homelessness: A 7-City Study. Am J Prev Med 2021; 61:585-590. [PMID: 33952410 PMCID: PMC8455409 DOI: 10.1016/j.amepre.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Young adults experiencing homelessness are vulnerable to firearm violence. This study aims to explore the correlates of firearm violence involvement among this vulnerable population, which may inform firearm violence reduction intervention development. METHODS Between 2016 and 2017, young adults experiencing homelessness aged 18-26 years (N=1,426) were recruited in 7 U.S. cities. Respondents completed a self-administered computer-assisted anonymous survey regarding their homeless experiences and violence involvement. Separate multivariate logistic regression models were conducted in 2020 to explore the correlates of direct firearm violence victimization, witness of firearm violence, and firearm violence perpetration. RESULTS A high proportion of young adults experiencing homelessness were involved in firearm violence (witnessing firearm violence: 40%; direct firearm violence victimization: 28%; perpetration: 18%). Stressful experiences, such as childhood trauma and street victimization, were associated with greater odds of firearm violence involvement. Black (OR=2.4, p<0.001) and Latinx (OR=2.0, p<0.05) young adults had greater odds of experiencing direct firearm violence victimization than White young adults. Black (OR=2.0, p<0.01) and Latinx (OR=2.4, p<0.001) young adults were also at greater risk of witnessing firearm violence. Young adults with mental illness had greater odds of being directly victimized by firearm violence (OR=1.7, p<0.01). CONCLUSIONS Given the inter-related nature of firearm violence involvement and given that risk factors for violence are often embedded in social and structural contexts, multipronged community-based approaches to prevent firearm violence among young adults experiencing homelessness are necessary. Targeted efforts may be indicated to attenuate the risk and promote resilience among subgroups of young adults experiencing homelessness who are disproportionately affected by firearm violence.
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Affiliation(s)
- Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, Missouri.
| | - Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, Colorado
| | | | | | - Kenneth Bedell
- School of Social Work, University of Missouri, Columbia, Missouri
| | | | - Sarah C Narendorf
- Graduate College of Social Work, University of Houston, Houston, Texas
| | - Jama Shelton
- Silberman School of Social Work, Hunter College, New York, New York
| | - Diane Santa Maria
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, Colorado
| | - Eric Rice
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
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21
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Elkbuli A, Rowe S, Raslan S, Ali A, Boserup B, McKenney M. An Analysis of Patients Dead on Arrival in the American College of Surgeons Trauma Quality Program Participant Use File Data Set. Am Surg 2021; 88:2374-2379. [PMID: 33877943 DOI: 10.1177/00031348211011099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Trauma patient care begins on-scene as field triage and mode of transportation are determinants of patient outcomes. This study evaluates the US national patterns of dead on arrival (DOA) among the trauma population. METHODS A cross-sectional review of the American College of Surgeons (ACS) Trauma Quality Program Participant Use File (TQP-PUF) data set (2013-2017) was performed. Trauma patients reported as DOA were stratified by ISS into low (<15), intermediate (15-24), or high (≥25) severity. Each group was then subdivided by patient demographics, mechanism, type of injury, and mode of transportation. RESULTS Of the 4 336 816 injury cases in the TQP-PUF data set, 33 199 were DOA (.77%). 77.1% (25 604/33 199) of DOAs were male. In the low-ISS group, .36% (13 272/3 639 811) were DOA; in the intermediate-ISS group, 1.2% (4868/421 994) were DOA; and in the high-ISS group, 5.5% (15 059/275 011) were DOA. Motor vehicle collisions (MVCs) (11 262) and firearms (8894) were the most common injury types, equating to 60.7% of DOAs. Falls accounted for 9.1% of all DOAs. The most common DOA age-group was 18-64 years, followed by ≥65 years. CONCLUSION DOA trauma patients are predominately adult men suffering fatal blunt force injuries most frequently via MVC. DOAs are caused by all ranges of injury severity. We recommend further development of prevention programs thereby reducing the prevalence of common traumatic injuries, notably MVC, falls, and firearms to improve survival. Future studies should also investigate the access to and distribution of trauma centers and the role of helicopter, ground, and police transport modalities and transport time on and reducing DOAs and improving trauma patient outcomes.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Scott Rowe
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Shahm Raslan
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Aleeza Ali
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Brad Boserup
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
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