Bexar County Medical Examiner's Office

Team science is essential for publishing in peer-reviewed journals and advancing health behavior research. As such, it is important to demystify considerations for authorship and co-authorship in terms of inclusion, order, expectations, and transparent communication. Authorship disagreements are a common source of conflict within writing teams and, if not addressed appropriately, can threaten trust and future collaborations. This commentary introduces a four-step framework for navigating authorship decisions with forethought, transparency, and fairness. The framework aims to reduce misunderstandings, strengthen teamwork, and foster the development of early-career researchers. Developing competence in authorship negotiation is an essential skill for all researchers. For trainees, this framework offers guidance for approaching authorship within collaborative projects, while for mentors, it serves as a practical tool for modeling and teaching best practices.

Abstract This article details how connection to the late Dr. Stafford Hood, Culturally Responsive Evaluation (CRE) and Culturally Responsive Evaluation and Assessment (CREA) provided conceptual, methodological, and affirming foundations of our collective work as Latina evaluators, knowledge co‐creators, and mobilizers. The introduction of CRE & CREA with strategic sponsorship provided by Dr. Hood are key historic moments in the legitimization and advancement of Latine evaluators within and across the American Evaluation Association (AEA) and CREA. The co‐authors, who are multiethnic and multicultural Latinas, consider LatCrit theory, collective agency, and legitimacy in relation to key moments in the evolution of Latine evaluation discourse over the last decade.

BACKGROUND Latinx populations are severely underrepresented among organ donors compared with the non-Hispanic White population. The <i>Promotoras de Donación</i> e-learning module was developed to train Latinx lay health educators (ie, promotoras) to discuss deceased organ donation and promote donor designation within their communities. OBJECTIVE This paper described the results of 2 studies designed to assess the direct and indirect effects of the module on promotoras’ and mature Latinas’ organ donation and donor designation knowledge, attitudes, and behaviors. METHODS In partnership with 4 community-based promotoras organizations, we designed 2 nonrandomized, quasiexperimental pragmatic studies to evaluate the <i>Promotoras de Donación</i> e-learning module, with participating promotoras and mature Latinas serving as their own controls. Brief surveys were administered to participating promotoras before and after module completion to assess changes in organ donation knowledge and support and communication confidence (study 1). Promotoras participating in the first study were asked to hold at least 2 group conversations about organ donation and donor designation with mature Latinas (study 2); paper-pencil surveys were completed by all participants before and after the group conversations. Descriptive statistics, means and SDs, and counts and percentages were used as appropriate to categorize the samples. Paired sample 2-tailed <i>t</i> test was used to assess changes in knowledge of and support for organ donation and confidence in discussing donation and promoting donor designation from pre- to posttest. RESULTS Overall, 40 promotoras completed this module (study 1). Increases in organ donation knowledge (mean 6.0, SD 1.9 to mean 6.2, SD 2.9) and support (mean 3.4, SD 0.9 to mean 3.6, SD 0.9) were observed from pre- to posttest; however, these changes did not reach statistical significance. A statistically significant increase in communication confidence was found (mean 692.1, SD 232.4 to mean 852.3, SD 139.7; <i>P</i>=.01). The module was well received, with most participants deeming it well organized, presenting new information, and providing realistic and helpful portrayals of donation conversations. A total of 52 group discussions with 375 attendees were led by 25 promotoras (study 2). The trained promotora-led group discussions about organ donation resulted in increased support for organ donation in promotoras and mature Latinas from pre- to posttest. Knowledge of the steps to become an organ donor and belief that the process is easy to perform increased in mature Latinas from pre- to posttest by 30.7% and 15.2%, respectively. In total, 5.6% (21/375) of attendees submitted completed organ donation registration forms. CONCLUSIONS This evaluation provides preliminary support for the module’s direct and indirect effects on organ donation knowledge, attitudes, and behaviors. The need for additional modifications to and future evaluations of the module are discussed.

Emerging evidence suggests that harmful exposures during military service, such as traumatic brain injury (TBI), may contribute to mental health, chronic disease, and mortality risks. To assess the mortality rates and estimate the number of all-cause and cause-specific excess deaths among veterans serving after the September 11, 2001, terrorist attacks (9/11) with and without exposure to TBI. This cohort study analyzed administrative and mortality data from January 1, 2002, through December 31, 2018, for a cohort of US military veterans who served during the Global War on Terrorism after the 9/11 terrorist attacks. Veterans who served active duty after 9/11 with 3 or more years of care in the Military Health System or had 3 or more years of care in the Military Health System and 2 or more years of care in the Veterans Health Administration were included for analysis. The study used data from the Veterans Affairs/Department of Defense Identity Repository database, matching health records data from the Military Health Service Management Analysis and Reporting tool, the Veterans Health Administration Veterans Informatics and Computing Infrastructure, and the National Death Index. For comparison with the total US population, the study used the Centers for Disease Control and Prevention WONDER database. Data analysis was performed from June 16 to September 8, 2021. Traumatic brain injury. Multivariable, negative binomial regression models were used to estimate adjusted all-cause and cause-specific mortality rates for the post-9/11 military veteran cohort, stratified by TBI severity level, and the total US population. Differences in mortality rates between post-9/11 military veterans and the total US population were used to estimate excess deaths from each cause of death. Among 2 516 189 post-9/11 military veterans (2 167 736 [86.2%] male; and 45 324 [1.8%] American Indian/Alaska Native, 160 178 [6.4%], Asian/Pacific Islander, 259 737 [10.3%] Hispanic, 387 926 [15.4%] non-Hispanic Black, 1 619 834 [64.4%] non-Hispanic White, and 43 190 [1.7%] unknown), 17.5% had mild TBI and 3.0% had moderate to severe TBI; there were 30 564 deaths. Adjusted, age-specific mortality rates were higher for post-9/11 military veterans than for the total US population and increased with TBI severity. There were an estimated 3858 (95% CI, 1225-6490) excess deaths among all post-9/11 military veterans. Of these, an estimated 275 (95% CI, -1435 to 1985) were not exposed to TBI, 2285 (95% CI, 1637 to 2933) had mild TBI, and 1298 (95% CI, 1023 to 1572) had moderate to severe TBI. Estimated excess deaths were predominantly from suicides (4218; 95% CI, 3621 to 4816) and accidents (2631; 95% CI, 1929 to 3333). Veterans with moderate to severe TBI accounted for 33.6% of total excess deaths, 11-fold higher than would otherwise be expected. This military veteran cohort experienced more excess mortality compared with the total US population than all combat deaths from 9/11/01 through 9/11/21, concentrated among individuals exposed to TBI. These results suggest that a focus on what puts veterans at risk for accelerated aging and increased mortality is warranted.

Although retrospective analyses have found that combat-injured service members are at high risk for mental and physical health outcomes following injury, relatively little is known about the long-term health of injured service members. To better understand long-term health outcomes after combat injury, a large, prospective observational cohort collecting both subjective and objective health data is needed. Given that a study of this nature would be costly and face many logistical challenges, we first conducted a pilot to assess the feasibility of a larger, definitive study. We ran a prospective, observational pilot study of 119 combat-injured service members and veterans who completed (1) at least one set of laboratory measurements (blood and urine sample collection and vitals measurements) at Clinical Laboratory Improvement Amendment of 1988 compliant laboratory locations and (2) at least one online assessment for the Wounded Warrior Recovery Project (WWRP), a 15-year examination of patient-reported outcomes among service members injured on combat deployment. We recruited the pilot study cohort from WWRP participants who met eligibility criteria and indicated interest in additional research opportunities. We collected laboratory values and patient-reported outcomes at baseline and again 1 year later, and obtained demographic, injury, and military service data from the Expeditionary Medical Encounter Database. The David Grant USAF Medical Center Institution Review Board (IRB) and the Naval Health Research Center IRB reviewed and approved the study protocols. During recruitment for the pilot study, 624 study candidates were identified from WWRP. Of the 397 candidates we contacted about the pilot study, 179 (45.1%) enrolled and 119 (66.4%) of those who enrolled completed the first year of participation. The second study year was suspended due to the coronavirus disease-2019 pandemic. At the time of suspension, 72 (60.5%) participants completed follow-up laboratory appointments, and 111 (93.3%) completed second-year WWRP assessments. Participants in the pilot study were predominately male (95.0%) and non-Hispanic White (55.5%), with a median (interquartile range) age of 38.3 (34.1-45.4) years. Collection of patient-reported outcomes and laboratory samples in a geographically dispersed cohort of combat-injured service members is possible. While significant challenges exist, our pilot study results indicate that a larger, longitudinal, cohort study is feasible.

A growing body of literature on military personnel and veterans’ health suggests that prior military service may be associated with exposures that increase the risk of cardiovascular disease (CVD), which may differ by race/ethnicity. This study examined the hypothesis that differential telomere shortening, a measure of cellular aging, by race/ethnicity may explain prior findings of differential CVD risk in racial/ethnic groups with military service. Data from the first two continuous waves of the National Health and Nutrition Examination Survey (NHANES), administered from 1999–2002 were analyzed. Mean telomere length in base pairs was analyzed with multivariable adjusted linear regression with complex sample design, stratified by sex. The unadjusted mean telomere length was 225.8 base shorter for individuals with prior military service. The mean telomere length for men was 47.2 (95% CI: −92.9, −1.5; p < 0.05) base pairs shorter for men with military service after adjustment for demographic, socioeconomic, and behavioral variables, but did not differ significantly in women with and without prior military service. The interaction between military service and race/ethnicity was not significant for men or women. The results suggest that military service may contribute to accelerated aging as a result of health damaging exposures, such as combat, injury, and environmental contaminants, though other unmeasured confounders could also potentially explain the results.

BackgroundA better understanding of the long-term health effects of combat injury is important for the management of veterans’ health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian trauma patients.ObjectiveTo determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors.DesignRetrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems.ParticipantsCombat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured.Main MeasuresTraumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes.Key ResultsAfter adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18–3.55), DM (HR 4.45, 95% CI 2.15–9.18), and CAD (HR 4.87, 95% CI 2.11–11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05–1.24) and CAD (HR 1.62, 95% CI 1.11–2.37).ConclusionsSevere traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian trauma patients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies.

Raba Kistner, Inc. (RKI) was contracted by K-Friese + Associates (CLIENT), on behalf of San Antonio Water Systems (SAWS) to conduct archaeological monitoring for emergency repairs to a collapsed sewer lateral within West Houston Street in downtown San Antonio, Bexar County, Texas. The project involved the excavation of the area around the collapsed portion of the sewer lateral and the replacement of the damaged line. The project is located within the boundaries of a Catholic Cemetery and is between Milam Square (41BX991), which is a historic cemetery, and an area of the Children’s Hospital of San Antonio where the first City Cemeteries have been documented. As such, the City of San Antonio Office of Historic Preservation (COSA OHP) required the monitoring of the excavation activities. The proposed project is located on lands controlled by the City of San Antonio and work was conducted by SAWS, both entities of the State of Texas. As such, the project falls under the Antiquities Code of Texas (ACT) (Texas Natural Resource Code, Title 9, Chapter 191). Furthermore, the project was also subject to review under Chapter 35 of the City of San Antonio’s Unified Development Code (UDC) (Article VI, Historic Preservation and Urban Design). All work was conducted in accordance with the Archeological Survey Standards for Texas as set forth by the Council of Texas Archeologists (CTA) and the THC under Texas Antiquities Committee Permit Number 9209. A desktop review was conducted to determine if any previously conducted archaeological investigations or any cultural resources had been documented within the APE. Review of the Texas Archeological Sites Atlas (Atlas), revealed that no previous archaeological surveys have been conducted within the APE and that no previously recorded archaeological sites have been documented within the APE. Cultural resources monitoring investigations for the project were conducted on December 21 and 22, 2019, and January 14, 2020. Antonio Padilla served as Project Manager and Principal Investigator, and all field work was conducted by Lindy Martinez and Susan Sincerbox. The undertaking involved the excavation of an approximately 34-foot-long (10 meter [m]-) north-south, 2.5–to–9-foot-wide east-west (0.5–to–2.74 m-) trench that extended from the sewer main located near the center of West Houston Street to the clean out located under the sidewalk north of West Houston Street. For archaeological purposes the Area of Potential Effects (APE) consisted of approximately 800 square feet or 0.018 acres. The depths of impacts reached a depth of 6 feet (1.8 m) below surface. During the investigations, it was discovered that the entire APE has been heavily impacted by previous construction events and the installation of utilities. Throughout the excavations, construction gravels reaching a depth of 6 feet (1.8 m) below surface were observed within the entire APE, and several utilities were encountered. No intact soils were present within the trench. It appears that previous construction events and installation of utilities have removed all intact soils to the depth reached by the trench. Due to the absence of intact soils, no soils were screened. Additionally, no cultural materials or cultural features were observed during the monitoring of the excavations. RKI has made a reasonable and good faith effort identifying cultural resources within the APE. No significant deposits or features were identified during cultural resource monitoring. As a result, RKI does not recommend further archaeological investigations within the APE. However, should changes be made to the APE, further work may be required. No diagnostic artifacts were collected during the course of the investigations, thus, no artifacts will be curated at the completion of the project. All field records generated during this project will be permanently curated at the Center for Archaeological Research at the University of Texas at San Antonio.

Many studies have been published examining various features of fatal gunshot wounds such as type of firearm, range of fire, number of shots, and wound location as a way of determining between homicidal and suicidal deaths. Pathologists frequently have to give evidence in court, and may have their opinion about probable manner of death challenged or be questioned about how sure they can be. In the literature, the features are always discussed in isolation, but in practice, the pathologist has to consider such details in combination. Using pooled data from a systematic review to obtain large data sets, this study shows how Bayesian analysis can be applied to consideration of combined features and can thus provide a quantified degree of confidence to support the pathologist's opinion through the use of likelihood ratios. Case examples are provided to illustrate the impact of different features.