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Introduction: Gallbladder cancer (GBC) incidence is rising, yet prognosis remains poor. Oncological resection of stage T1b or higher improves survival, yet many patients do not receive appropriate resection. This study aims to evaluate factors that may attribute to this discrepancy using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database., Materials and Methods: SEER Medicare (2008-2015) patients with GBC stage T1b or higher were classified as receiving cholecystectomy alone (CCY) or cholecystectomy and liver/biliary resection (oncologic resection). Outcomes and overall survival were compared, before and after propensity score matching on baseline characteristics, using Chi-square and Wilcoxon rank-sum tests for categorical and continuous variables, respectively., Results: We identified 1129 patients of which 830 underwent CCY (58.3% early stage/41.7% late stage) while 299 had complete resection (54.2% early stage/45.8% late stage). CCY patients were more often female (73.4% versus 65.6%; P = 0.0104), ≥80 y old (48.2% versus 22.4%; P < 0.0001), frail (44.5% versus 27.1%; P < 0.0001), treated by general surgeons (98.1% versus 84.9%; P < 0.0001) versus surgical oncologists, not undergoing chemotherapy (72.3% versus 54.5%; P < 0.0001), managed at nonacademic hospitals (51.2% versus 28.4%; P < 0.0001). After matching, oncologic resection demonstrated improved overall survival compared to CCY at 1-y (69.2% versus 47.2%; P < 0.0001), 3-y (42.8% versus 21.1%; P < 0.0001), and 5-y (37.5% versus 17.4%; P < 0.0001)., Conclusions: Most GBC patients may not be receiving appropriate oncological resection, especially patients who are female, older, frail, operated on by a general surgeon, not undergoing chemotherapy, or managed at nonacademic hospitals. Even when adjusting for patient factors, complete resection is associated with overall survival outcomes at multiple endpoints. Limiting sex, age, and frail status as factors and involving surgical oncologists or receiving management at academic centers may increase oncologic resection rates and thus improve survival for GBC patients., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Few states established assault weapon bans (AWBs) after the federal AWB expired. The effectiveness of state AWBs as well as neighboring state legislation, in reducing the local prevalence of assault weapons (AWs) or in reducing overall shooting lethality is unknown., Methods: We queried the Gun Violence Archive (2014-2021) to identify US firearm injuries and fatalities. Shooting case fatality rates were compared among states with and without AWBs, as reported in the State Firearm Laws Database. Data on recovered firearms was obtained from the ATF Firearms Trace Database and used to estimate weapon prevalence. Recovered firearms were classified as AWs based on caliber (7.62 mm, 5.56 mm, 0.223 cal). We performed spatially weighted linear regression models, with fixed effects for state and year to assess the association between geographically clustered state legislation and firearm outcomes., Results: From 2014 to 2021, the US shooting victim case fatality rate was 8.06% and did not differ among states with and without AWBs. The proportion of AWs to total firearms was 5.0% in states without an AWB and 6.0% in states with an AWB (mean difference [95% CI] = -0.8% [-1.6% to -0.2%], P = 0.03). Most recovered firearms in AWB states originated from non-AWB states. On adjusted models, there was no association between state-level AWB and firearm case fatality; however, adjacency to states with an AWB was associated with lower case fatality (P < 0.001). Clustered AWB states with shared borders had lower AW prevalence and fatality rates than the rest of the US., Conclusions: Isolated state AWBs are not inversely associated with shooting case fatality rates nor the prevalence of AWs, but AWBs among multiple neighboring states may be associated with both outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Diversity in medicine has a positive effect on outcomes, especially for Asian patients. We sought to evaluate representation of Asians across entry and leadership levels in surgical training., Methods: Publicly accessible population data from 2018 to 2023 were collected from the US Census Bureau, the Association of American Medical Colleges, and the American Board of Surgery (ABS). Frequencies based on self-identified Asian status were identified, and proportions were calculated., Results: The US census showed Asians constituted 4.9% of the US population in 2018 versus 6% in 2023. The proportion of Asian medical students rose from 21.6% to 24.8%; however, Asian surgical residency applicants remained constant at 20%. ABS certifications of Asians have increased from 13.7% to 18.5%. ABS examiners increased from 15.7% to 17.1%., Conclusions: In 5 years, Asians have made numeric gains in medical school and surgical training. However, Asian representation lags at Board examiner levels compared to the medical student population. The ABS has made recent efforts at transparency around examiner and examinee characteristics. A pillar of ensuring a well-trained surgical workforce to serve the public is to mandate that all surgical trainees and graduates undergo fair examinations, and are fairly assessed on their qualifications. Observed progress should further invigorate all surgical applicants, residents and leadership to take an even more active role in making surgery more diverse and welcoming to all, by including careful analyses of diversity at all levels., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The COVID-19 pandemic heralded a surge in firearm homicides (FH) in many, but not all, urban centers. We aimed to determine the relationship of firearm restrictive legislation, stay-at-home orders (SaHOs), and FH during the height of the COVID-19 pandemic in US cities., Methods: Demographics and socioeconomic data were captured from the 2020 US Census for large (population ≥250,000) cities. FH data were captured from the Gun Violence Archive. We retrieved firearm recovery estimates from the Bureau of Alcohol, Tobacco, and Firearms Firearms Trace Database. Firearm restrictive legislation was gathered from the State Firearm Laws Database. SaHO durations were found from press releases and government sources. Variables with P ≤ 0.200 in univariate linear regression were entered into a final multivariable model., Results: A median of 7.5 FH per 100,000 people occurred in the 85 included US cities across 32 states in 2020 (range, 0.35-69.80 per 100,000). In multivariable regression, longer SaHOs (β: 0.033, 95% confidence interval [CI]: 0.014-0.053, P = 0.001) and higher poverty (β: 0.471, 95% CI: 0.280-0.670, P < 0.001) were associated with increases in FH. Handgun-specific laws (β: -0.793, 95% CI: -1.430 to -0.160, P = 0.015) were associated with lower FH., Conclusions: We found that poverty and longer SaHOs were associated with increased FH in large US cities during the height of the pandemic, while handgun-specific laws were associated with a decrease. Reducing poverty, mitigating the negative effects of SaHOs, and expanding handgun-specific legislation may protect from surges in FH during future crises., (Copyright © 2023 Elsevier Inc. All rights reserved.)