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Speed limits were increased in Utah and other States after repeal of the national maximum speed limit law (NMSL) in 1995. This study analyzed effects of the increased speed limit on Utah highways on crash rates, fatality crash rates, and injury crash rates. Annual (1992–1999) rates of crashes, fatality crashes, and injury crashes for the following highway categories were calculated: urban Interstate segments (current speed limit 60–65 miles per hour (mph)); rural Interstate segments (current speed limit 70–75 mph); 55 mph rural non-Interstate highway segments; and high-speed non-Interstate highways (current speed limit 60–65 mph). Data were analyzed using autoregressive integrative moving average intervention time series analysis techniques. There were significant increases in total crash rates on urban (60–65 mph) Interstate segments (confounded by extensive ongoing highway construction on these highways), and in fatal crash rates on high-speed (60–65 mph) rural non-Interstate segments. The following variables were unaffected: total, fatality, and injury crash rates on rural Interstate segments; fatality and injury crash rates on urban Interstate segments; total and injury crash rates on high-speed non-Interstate segments. These results show an adverse effect on crash occurrence for subsets of crash types and highways, but do not show a major overall effect of NMSL repeal and increased speed limit on crash occurrence on Utah highways. [Copyright &y& Elsevier]

Background: Quality of cardiopulmonary resuscitation (CPR) is associated with survival, but recommended guidelines are often not met, and less than half the children with an in-hospital arrest will survive to discharge. A single-center before-and-after study demonstrated that outcomes may be improved with a novel training program in which all pediatric intensive care unit staff are encouraged to participate in frequent CPR refresher training and regular, structured resuscitation debriefings focused on patient-centric physiology., Methods/design: This ongoing trial will assess whether a program of structured debriefings and point-of-care bedside practice that emphasizes physiologic resuscitation targets improves the rate of survival to hospital discharge with favorable neurologic outcome in children receiving CPR in the intensive care unit. This study is designed as a hybrid stepped-wedge trial in which two of ten participating hospitals are randomly assigned to enroll in the intervention group and two are assigned to enroll in the control group for the duration of the trial. The remaining six hospitals enroll initially in the control group but will transition to enrolling in the intervention group at randomly assigned staggered times during the enrollment period., Discussion: To our knowledge, this is the first implementation of a hybrid stepped-wedge design. It was chosen over a traditional stepped-wedge design because the resulting improvement in statistical power reduces the required enrollment by 9 months (14%). However, this design comes with additional challenges, including logistics of implementing an intervention prior to the start of enrollment. Nevertheless, if results from the single-center pilot are confirmed in this trial, it will have a profound effect on CPR training and quality improvement initiatives., Trial Registration: ClinicalTrials.gov, NCT02837497 . Registered on July 19, 2016.