BackgroundWe evaluated correlates of gunshot wound (GSW) injuries in Miami-Dade County, Florida. Firearm-related injury has previously been linked to socio- and geo-demographic indicators such as occupation, income, neighborhood and race in other metropolitan areas, but remains understudied in Miami.MethodsWe reviewed 4,547 cases from a Level I trauma center’s patient registry involving an intentional firearm-related injury occurring from 2002 to 2012. During this eleven-year study period, this trauma center was the only one in Miami-Dade County, and thus representative of countywide injuries.ResultsThe crude morbidity rate of GSW injury over the 11-year period was 15 per 100,000 persons with a crude mortality rate of 0.27 per 100,000 persons. The case fatality rate of injured patients was 15.4%. Both morbidity and mortality increased modestly over the 11-year study period. The total number of GSW patients rose annually during the study period and patients were disproportionately young, black males, though we observed higher severity of injury in white populations. Geo-demographic analysis revealed that both GSW incident locations and patient home addresses are spatially clustered in predominantly poor, black neighborhoods near downtown Miami, and that these patterns persisted throughout the study period. Using spatial regression, we observed that census tract-level GSW incidence rates (coded by home address) were associated with a census tract’s proportion of black residents (P < .001), single-parent households (P < .001), and median age (P < .001) (R 2 = .42).ConclusionsThese findings represent the first representative geo-demographic analysis of GSW injuries in Miami-Dade County, and offer evidence to support urgent, targeted community engagement and prevention strategies to reduce local firearm violence.

8%-20.7%), although the upper extremity was the most frequently fractured region overall (52.1%; 95% CI, 48.1%-56.1%); 28.7% of patients (95% CI, 23.7%-33.8%) required hospital admission. Discussion | To our knowledge, this study is the first to identify and characterize leash-dependent dog walking as an activity that imparts a significant and rising injury risk in older adults. The gravity of this burden is exemplified by the hip being most frequently fractured, because this injury is associated with long-term decreases in quality of life and functional capabilities, as well as mortality rates approaching 30%. 5 Combined with the sex disparity in injury burden, older women considering dog ownership must be made aware of this risk. Clinicians may play a role in identifying at-risk patients and minimizing fracture risk by advocating for preventive actions, such as obedience training to ensure dogs do not lunge while leashed, or suggesting smaller dog breeds for individuals contemplating ownership. 6 The study has limitations. Despite the validated nature of the source database, our findings likely underestimate the morbidity associated with elderly Americans walking leashed dogs: only emergency department cases are contained within the National Electronic Injury Surveillance System, and our analysis excluded less severe, nonfracture injuries. Moreover, the database does not include comparative dog sizes, cases requiring operative intervention, or disposition after discharge; future research may clarify the consequences of these variables. This study draws attention to an activity that can result in significant injury. For older adults-especially those living alone and with decreased bone mineral density-the risks associated with walking leashed dogs merit consideration. Even one such injury could result in a potentially lethal hip fracture, lifelong complications, or loss of independence.

Since 2011, the war in Syria has resulted in the displacement of 12.2 million people. Over 5.6 million have fled Syria to seek asylum in neighbouring countries, while 6.6 million have been internally displaced. Family separation, with significant psychological, social and economic implications, is a key concern for those who flee violence and cross international borders. This qualitative study sought to understand the causes of separation among Syrian families in Jordan and the obstacles to family reunification. Semi-structured, in-depth interviews were conducted with 85 Syrian refugee families identified as having separated family members. We present critical moments during migration when family separation occurs: (1) while fleeing Syria, (2) while residing in Jordan and (3) pre-existing separation due to work or travel that was exacerbated by the conflict. We also highlight the factors that perpetuate separation among families, preventing or delaying them from reuniting. These findings may help to inform more humane family-reunification practices as well as identify future research and learning needs.

Objectives and Background: The aim of this study was to characterize equity and inclusion in acute care surgery (ACS) with a survey to examine the demographics of ACS surgeons, the exclusionary or biased behaviors they witnessed and experienced, and where those behaviors happen. A major initiative of the Equity, Quality, and Inclusion in Trauma Surgery Practice Ad Hoc Task Force of the Eastern Association for the Surgery of Trauma was to characterize equity and inclusion in ACS. To do so, a survey was created with the above objectives. Methods: A cross-sectional, mixed-methods anonymous online survey was sent to all EAST members. Closed-ended questions are reported as percentages with a cutoff of α = 0.05 for significance. Quantitative results were analyzed focusing on mistreatment and bias. Results: Most respondents identified as white, non-Hispanic and male. In the past 12 months, 57.5% of females witnessed or experienced sexual harassment, whereas 48.6% of surgeons of color witnessed or experienced racial/ethnic discrimination. Sexual harassment, racial/ethnic prejudice, or discrimination based on sexual orientation/sex identity was more frequent in the workplace than at academic conferences or in ACS. Females were more likely than males to report unfair treatment due to age, appearance or sex in the workplace and ACS (P ≤ 0.002). Surgeons of color were more likely than white, non-Hispanics to report unfair treatment in the workplace and ACS due to race/ethnicity (P < 0.001). Conclusions: This is the first survey of ACS surgeons on equity and inclusion. Perceptions of bias are prevalent. Minorities reported more inequity than their white male counterparts. Behavior in the workplace was worse than at academic conferences or ACS. Ensuring equity and inclusion may help ACS attract and retain the best and brightest without fear of unfair treatment.