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Metrics are commonly used in engineering as measures of the performance of a system for a given attribute. Two metrics that could be used in the assessment of safety-critical systems, the steady-state safety, and the Mean Time To Unsafe Failure (MTTUF) are developed.

The occupational stress inherent in firefighting poses both physiological and psychological risks to firefighters that have been found to possess a reciprocal nature. That is, the nature of these relationships in terms of indicator and impact are elusive, especially as it relates to sleep health (e.g., quality, quantity, hygiene, etc.) as a specific physiological risk and burnout as a specific psychological risk. A series of mediation models were assessed to examine the reciprocal relationships between occupational stress, burnout, and sleep health in a sample of 161 career firefighters. The mediation models confirmed reciprocity among the variables in so much that relationships were best described by the underlying mechanism at work. Comprehensive assessments of both subjective and objective markers of sleep health should be incorporated into firefighter research to supplement behavioral health assessments and interventions, especially related to burnout and occupational stress. [ABSTRACT FROM AUTHOR]

Background: We aim to describe the outcomes of Geriatric Emergency Room Innovations for Veterans (GERI‐VET), the first comprehensive Veterans Affairs Geriatric ED program. Methods: In this prospective observational cohort study at an urban Veterans Affairs Medical Center ED, participants included Veterans aged 65 years and older treated in the ED from January 7, 2017 to February 29, 2020. Veterans with an Identification of Seniors At Risk (ISAR) score >2 were considered eligible for GERI‐VET, receiving geriatric screens and care coordination in addition to standard ED treatment. The control group included GERI‐VET eligible Veterans who did not receive GERI‐VET care. Propensity score matching was used to compare outcomes in the GERI‐VET group (N = 725) and a matched control group (n = 725). Key measures included ED resource utilization, outpatient referrals, ED admission, and 30‐day admission. Results: In the ED, the GERI‐VET group received more consults to pharmacy (315 [43.4%] vs. 195 [26.9%], p < 0.001) and social work (399 [55.0%] vs. 132 [18.2%], p < 0.001). The GERI‐VET group had higher referral rates to Geriatrics (64 [17.7%] vs. 18 [5.8%], p < 0.001) and Home Based Primary Care (110 [30.4%] vs. 24 [7.8%], p < 0.001). Key outcome measures included lower rates of ED admission (363 [50.1%] vs. 417 [n = 57.5%], p = 0.003) and 30‐day hospital admission (412 [56.8%] vs. 464 [64.0%], p = 0.004) without increasing ED length of stay (5.4 ± 2.2 vs. 5.4 ± 2.6 h, p = 0.85) or 72‐h ED revisits (23 [3.2%] vs. 16 [2.2%], p = 0.25) in the GERI‐VET group. Conclusions: A program designed to screen for geriatric syndromes and coordinate care among at‐risk older Veterans was associated with increased multidisciplinary resource utilization and reduced ED and 30‐day admissions without increasing ED length of stay or re‐visitation. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have found disparities in emergency medical service (EMS) transports for rural residents including double the average response time and lower patient survival rates when compared with their urban counterparts. Since 2012, the rate of rural hospitals closures has risen alarmingly from previous years. Previous studies have linked the closure of rural hospitals to increased EMS transport and total activation time. However, data and methods used in previous studies have not included facility-level characteristics, which limits the ability to tease out the nuances of each closure. Thus, the purpose of this study is to examine the impact of rural hospital closures on EMS travel time, as well as the characteristics of the closed hospitals. Sample: Data sources for the study came from a state-level EMS database, the CMS Provider of Service files, and state-level hospital data reports. Methods: Geographic information system software was used to geocode hospital locations and generate service areas based on drive times. We identified rural hospitals that closed in Alabama between 2010-2018 and then identified the 911 call data from the state's EMS database that occurred within close proximity of each of the hospitals of interest, resulting in a sample of 120,802 EMS calls. Findings: We identified five hospital closures within our time period. For one of the five closures, EMS transport time to the emergency department increased by thirteen minutes post-closure. In two of the five closures, transport time increased by five minutes or less. In two instances, however, transport time decreased. Conclusions: Our findings suggest that not all rural hospital closures result in increased EMS transport times as rural patients may have already been routinely transported to alternate hospitals. Additionally, specific characteristics of a hospital pre-closure may be related to changes in EMS travel times that occur post-closure. [ABSTRACT FROM AUTHOR]

There do not seem to be any harmful side effects of nicotine patches for teenage smokers. Twenty-two teenage smokers who smoked more than 20 cigarettes per day and were trying to quit smoking wore nicotine patches for 8 weeks. During this time period they also participated in a support group and received individual counseling. The participants reported only minor side effects including skin reactions, vomiting, headaches, and dizziness. Three participants had quit smoking at the end of the 8-week period and one was not smoking 6 months after the study period., ABSTRACT. Objective. To evaluate the safety, tolerance, and efficacy of 24-hour nicotine patch therapy in adolescent smokers who were trying to stop smoking. Design. Nonrandomized, open-label, 6-month clinical trial. Setting. Five public high schools in the Rochester, MN, area. Subjects. Twenty-two adolescent smokers, aged 13 through 17 years, with current smoking rate of 20 or more cigarettes per day (cpd). Intervention. Daily nicotine patch therapy for 8 weeks (22 mg/d for 6 weeks followed by 11 mg/d for 2 weeks). Weekly individual behavioral counseling and group support continued for 8 weeks with follow up visits at 3 and 6 months and a mailed survey at 1 year. Main Outcome Measures. Self-reported smoking abstinence verified by expired air carbon monoxide of 8 ppm or less, nicotine withdrawal symptoms, adverse experiences, and blood cotinine levels. Results. Subjects had a mean [+ or -] SD smoking rate of 23.3 [+ or -] 5.0 (range, 20 to 35) cpd at study entry and 2.6 [+ or -] 1.6 years of smoking the mean age was 15.9 [+ or -] 1.2 (range 13 through 17) years, and 68% were girls. Of the 22 participants, 19 (86%) completed patch therapy, 3 (14%) had biochemically validated smoking cessation at week 8, and 1 continued to be smoke free at 3 and 6 months after patch initiation. There was a significant decrease from baseline in the mean nicotine withdrawal scores for days 4 and 7 of week 1 and the mean for weeks 2 through 8. Skin reactions were the most common adverse event. As the worst skin reactions, 55% had erythema only, 5% had erythema and edema, and 9% had erythema and vesicles, whereas 32% had no skin reactions. Other reported adverse events were headaches (41%), nausea and vomiting (41%), tiredness (41%), dizziness (27%), and arm pain (23%). None of these were considered serious, life threatening, or led to the discontinuation of patch therapy. In adults with comparable smoking rates, we found that the adolescents had lower blood cotinine levels. Those smoking 20 to 25 cpd had cotinine levels of 146 [+ or -] 84 (adolescents) vs 260 [+ or -] 98 (adults) ng/ml, and those smoking 26 to 35 cpd had levels of 169 [+ or -] 73 vs 276 [+ or -] 110 ng/ml, respectively. Conclusion. Nicotine patch therapy seems safe in adolescent smokers. Placebo-controlled trials are needed to establish the efficacy of nicotine patch therapy in adolescents. Pediatrics 1996;98:659-667; nicotine patch therapy, adolescent smokers., Tobacco use is the single most preventable cause of death in the United States.[1] In 1992 tobacco killed more people in the United States than alcohol, cocaine, crack, heroin, homicide, [...]