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BACKGROUND Cognitive fatigue (CF) is a human response to stimulation and stress and is a common comorbidity in many medical conditions that can result in serious consequences; however, studying CF under controlled conditions is difficult. Immersive virtual reality provides an experimental environment that enables the precise measurement of the response of an individual to complex stimuli in a controlled environment. OBJECTIVE We aim to examine the development of an immersive virtual shopping experience to measure subjective and objective indicators of CF induced by instrumental activities of daily living. METHODS We will recruit 84 healthy participants (aged 18-75 years) for a 2-phase study. Phase 1 is a user experience study for testing the software functionality, user interface, and realism of the virtual shopping environment. Phase 2 uses a 3-arm randomized controlled trial to determine the effect that the immersive environment has on fatigue. Participants will be randomized into 1 of 3 conditions exploring fatigue response during a typical human activity (grocery shopping). The level of cognitive and emotional challenges will change during each activity. The primary outcome of phase 1 is the experience of user interface difficulties. The primary outcome of phase 2 is self-reported CF. The core secondary phase 2 outcomes include subjective cognitive load, change in task performance behavior, and eye tracking. Phase 2 uses within-subject repeated measures analysis of variance to compare pre- and postfatigue measures under 3 conditions (control, cognitive challenge, and emotional challenge). RESULTS This study was approved by the scientific review committee of the National Institute of Nursing Research and was identified as an exempt study by the institutional review board of the National Institutes of Health. Data collection will begin in spring 2021. CONCLUSIONS Immersive virtual reality may be a useful research platform for simulating the induction of CF associated with the cognitive and emotional challenges of instrumental activities of daily living. CLINICALTRIAL ClinicalTrials.gov NCT04883359; http://clinicaltrials.gov/ct2/show/NCT04883359 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/28073

Introduction Poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. Racial/ethnic minoritized groups in the United States experience worse sleep than non-Hispanic Whites (nHW), likely due to downstream effects of systemic and structural discrimination. Nonetheless, the extent of sleep disparities in the perinatal period remains understudied. In this analysis we estimated the prevalence of subjective measures of sleep in a multi-racial/ethnic pregnant population from the Environmental influences on Child Health Outcomes (ECHO) program. Methods Participants self-reported their race and ethnicity and were grouped into four categories: 1)nHW, 2)non-Hispanic Black/African American (nHB/AA), 3)Hispanic, 4)non-Hispanic Asian (nHA). Our analysis examined trimester-specific nocturnal sleep duration, sleep quality, and sleep disturbances (derived from the Pittsburgh Sleep Quality Index and the ECHO maternal sleep health questionnaire) by race/ethnicity. A total of 1119,2409 and 1284 participants in the first (T1), second (T2) and third trimesters (T3) reported on sleep duration. 1107,1742 and 783 participants in T1,T2 and T3 reported on sleep quality. 1112,1758, and 787 participants in T1,T2 and T3 reported on sleep disturbances Linear or multinomial regression were used to estimate associations between race/ethnicity and each sleep domain by trimester, controlling for body mass index (BMI) and age. We repeated analyses within education strata (high school degree, GED/equivalent; some college and above) Results nHB/AA participants reported shorter sleep duration (T2: β=-0.55 [-0.80,-0.31]: T3: β=-0.65 [-0.99,-0.31]), and more sleep disturbances (T2:β=1.92 [1.09,2.75]; T3:β=1.41 [0.09,2.74]) compared to nHW. Hispanic participants reported longer duration compared to nHW (T1: β=0.22 [0.00004, 0.44];T2: β=0.61 [0.47,0.76];T3: β=0.46 [0.22,0.70]), better sleep quality (Compare to Very good quality OR for Fairly good T1: OR=0.48 [0.32,0.73], T2: OR=0.36 [0.26,0.48], T3: OR=0.31 [0.18,0.52]; Fairly bad T1:OR=0.27 [0.16,0.44], T2:OR=0.46 [0.31,0.67], T3: OR=0.31[0.17,0.55]), and fewer sleep disturbances (T2 β=-0.5 [-1.0,-0.12]; T3 β=-1.21 [-2.07,-0.35]). Differences persisted within the subsample of high SES women. Conclusion These findings highlight racial/ethnic disparities across multiple domains of sleep health during pregnancy. Given the stark racial/ethnic disparities in perinatal outcomes and their associations with sleep health, further research is warranted to investigate the determinants of these disparities, such as downstream effects of systemic and structural discrimination Support (If Any)

Binospec is a high throughput, 370 to 1000 nm, imaging spectrograph that addresses two adjacent 8' by 15' fields of view. Binospec was commissioned in late 2017 at the f/5 focus of the 6.5m MMT and is now available to all MMT observers. Aperture masks cut from stainless steel with a laser cutter are used to define the entrance apertures that range from 15' long slits to hundreds of 2" slitlets. System throughputs, including the MMT's mirrors and the f/5 wide-field corrector peak at ~30%. Three reflection gratings, duplicated for the two beams, provide resolutions ($\lambda$/$\Delta \lambda$) between 1300 and $>$5000 with a 1" wide slit. Two through-the-mask guiders are used for target acquisition, mask alignment, guiding, and precision offsets. A full-time Shack-Hartmann wave front sensor allows continuous adjustment of primary mirror support forces, telescope collimation and focus. Active flexure control maintains spectrograph alignment and focus under varying gravity and thermal conditions., Comment: PASP in press; 45 pages, 59 figures

Based upon an awareness of the need to increase its policy footprint, the American Association of Colleges of Nursing's (AACN) Board of Directors convened a think tank of nurse experts in the field of policy curriculum to advise the Board. The goal of the think tank was to review the current landscape, analyze trends, and create a set of recommendations for AACN's Board to consider. The Faculty Policy Think Tank (FPTT) met between 2016 and 2017 to review and reflect on methods to increase expertise of nursing faculty and students in health policy and make recommendations to the AACN Board to advance the agenda of the organization, member schools, and the profession. This article describes the methods and processes the Think Tank employed to develop a set of recommendations for the AACN Board of Directors.

Independent participation in academic settings is decreased for children who have limited speech and are diagnosed with autism spectrum disorder (ASD). The use of technology with children with ASD changes behavior, assists with making choices, and increases communication; however, no studies evaluated its impact on performance or required support in classroom activities. The objective of this study was to determine whether an iPad with Proloquo2Go would increase independent activity/task performance and reduce required support for children with ASD, during classroom activities compared with no and other forms of technology (i.e., picture exchange communication system [PECS], SMARTBoard). The study compared the use of Proloquo2Go on the iPad to alternative technologies for performance in classroom activities in four children diagnosed with ASD. Using Proloquo2Go to respond to academic opportunities, children required less support than when using no technology, and equal support to when using a PECS or SMARTBoard. Proloquo2Go on the iPad can enhance academic occupational performance in adding voice output and a variety of response choices.

El proposito de este documento es evaluar la evolucion y el desempeno de las politicas de transporte publico urbano y su implementacion en un grupo representativo de ciudades latinoamericanas: Buenos Aires, Curitiba, Bogota, Guatemala, Lima, Montevideo, Pereira, San Salvador y Tegucigalpa.

Review question/objective The objectives are to evaluate whether the use of dexmedetomidine in obstructive sleep apnea patients decreases: a)respiratory adverse events, b)overall use of narcotics, c)and pain levels Inclusion criteria Types of participants This review will consider studies that include adult surgical patients (ages 18 years and older) who are diagnosed with obstructive sleep apnea or who are at risk for obstructive sleep apnea as determined utilizing the STOP BANG questionnaire and who had surgery in the past 48 hours. Types of intervention(s)/phenomena of interest This review will evaluate the effectiveness of dexmedetomidine on pain levels, amount of narcotic pain medication use and adverse respiratory events on adult patients with obstructive sleep apnea for up to 48 hours following surgery. Studies that compare perioperative (pre-, intra- or postoperative) administration of dexmedetomidine to narcotics, other analgesics, and placebo will be considered. All modes of dexmedetomidine administration and all variations of dosage, frequency and duration will be included as well as interventions combining dexmedetomidine with another treatment if that same treatment, without dexmedetomidine, is also given to the control group. Types of outcomes This review will consider studies that include the following outcome measures: amount of narcotic pain medication use, adverse respiratory events which include rates of oxygen desaturations and episodes of respiratory depression, and patient level of pain. For the purposes of this review, respiratory depression is defined as a respiratory rate of less than 8 breaths per minute and oxygen desaturation is defined as oxygen saturation levels of less than 90%.

Background Type 1 diabetes is a common childhood pediatric disease characterized by autoimmune destruction of insulin producing βeta-cells in the pancreas.1 Effective measurement and control of blood glucose levels is critical for the health and wellbeing of adolescents with type 1 diabetes. Adolescents using continuous subcutaneous insulin pumps are able to perform continuous glucose monitoring. However, evidence is unclear if this improves effectiveness when compared to self-glucose monitoring alone. This review aims to establish the optimal care of an adolescent with type 1 diabetes mellitus to maintain glycemic control and to avoid hypoglycemia. Objectives The review question is: are metabolic outcomes improved in outpatient adolescents with type 1 diabetes on a continuous subcutaneous insulin infusion pump when continuous glucose monitoring is used, compared to self-glucose monitoring alone? Inclusion criteria Types of participants This review included studies of adolescent patients, aged 12 to 18 years, in the outpatient setting with type 1 diabetes mellitus utilizing a continuous subcutaneous insulin infusion pump. Type of intervention This review included studies which evaluated continuous glucose monitoring, as compared to self-glucose monitoring alone, in adolescents utilizing a continuous subcutaneous insulin infusion pump. Types of outcomes This review included studies examining the following outcome measures: number of hypoglycemic episodes (glucose < 70mg/dL) and hemoglobin A1C level. Types of studies This review included randomized controlled trials, quasi-experimental studies were considered only in the absence of randomized controlled trials. Search strategy The search strategy included studies published between 2002 and 2012 in, or translated into, English. Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity utilizing standardized critical appraisal instrument from the Joanna Briggs Institute. Data extraction Data was extracted from papers included in the review using the standardized data extraction tool from Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data synthesis Quantitative papers were pooled by statistical meta-analysis using JBI-MAStARI. A fixed effect model for continuous data was utilized to express weighted mean differences and 95% confidence intervals were calculated. Heterogeneity was assessed statistically using the standard Chi-square. Results There is no statistical or clinically significant difference in levels of hemoglobin A1C in adolescents on continuous subcutaneous insulin infusion pumps utilizing continuous glucose monitoring devices as compared to those utilizing self-glucose monitoring alone. Conclusions From the findings of this review, the utilization of a continuous glucose-monitoring device in conjunction with an insulin pump does not improve hemoglobin A1C levels when compared with self-glucose monitoring in adolescent patients with type 1 diabetes.

The review question is: Are metabolic outcomes improved in outpatient adolescents (aged 13 to 19 years) with type 1 diabetes on a Continuous Subcutaneous Insulin Infusion (CSII) when continuous glucose monitoring is used, compared to self-glucose monitoring alone?Type 1 diabetes is the most common childhood paediatric disease, characterised by impairment of insulin producing βeta-cells in the pancreas. Internationally, there is variation in the incidence of type 1 diabetes in paediatric patients. According to the Center for Disease Control and Prevention (CDC) and the SEARCH for Diabetes in Youth Study Group, the overall incidence rate of this autoimmune disease is 24.3/100,000 in those 19 years of age . Annually, more than 15,000 children and adolescents are diagnosed in the United States (US) . From 1990 to 1999, the World Health Organization (WHO) launched the Multinational Project for Childhood Diabetes (DIAMOND), which was tasked with assessing type 1 diabetes in those 14 years or younger worldwide . Finland was discovered to have the highest age-adjusted incidence at 40.9 cases per 100,000/year. The lowest age-adjusted incidence is in China and Venezuela at 0.1 cases per 100,000/year. Globally, the largest increase in incidence is in those aged 10 to 14 years . This systematic review will focus on adolescent patients with type 1 diabetes, aged 13 to 19 years who manage their diabetes with an insulin pump.Patients with type 1 diabetes mellitus typically present with a history of polydipsia, polyuria, polyphagia, and weight loss . Initial findings include hyperglycemia, glycosuria, and ketones in the blood or urine . In 2009, the International Expert Committee deemed a haemoglobin A1C (glycosylated haemoglobin) of 6.5% or higher to be the standard for diagnosis . The American Diabetes Association (ADA) as well as the International Diabetes Federation and the European Association Study of Diabetes (EASD) accept this measure as the diagnostic tool for diabetes. Haemoglobin A1C is the most commonly used measurement for patients with type 1 diabetes . It refers to the measurement of the amount of glucose bound to haemoglobin. It is an average of blood glucose levels for the last 120 days, which is consistent with the average life span of a red blood cell (RBC).Compensation for the lack of insulin-secreting βeta-cells is accomplished through administration of insulin. For adolescents, insulin dosing is based on pubescent status, age, weight, activity level, and amount of carbohydrates consumed . Insulin administration, carbohydrate counting, and correction of hyperglycemia are necessary for maintaining glycemic control. Insulin can be administered through multiple daily injections (MDI) of rapid, intermediate and long-acting insulin .Another form of insulin delivery is the Continuous Subcutaneous Insulin Infusion (CSII), also known as an insulin pump, which is designed to meet physiological requirements through programmable basal rates and bolus doses . CSII's utilise rapid-acting insulin and establish a basal rate, which replaces the need for long-acting insulin. Bolus dosing is accomplished through adjusting the pump and is utilised to account for nutritional intake as well as hyperglycemia correction. Adjustments are also made for physical activity and exercise, as this can affect glucose levels . All patients considered in this systematic review will be utilising insulin pumps.In 2006, the United States had more than 35,000 patients, under the age of 21 years, receiving insulin therapy through an insulin pump . In Europe, the percentage of people with type 1 diabetes utilising a CSII is lower, potentially due to variation in health care coverage . There are various forms of insulin pumps, all with similar capabilities including a dose calculator for high blood glucose correction and carbohydrate ratios, programming software, and several other features . Software and programming is specific to each manufacturer. Basal rate abilities vary in each model from 0.05 units/hour to 30 units/hour . Information from the pump can be uploaded to online registries allowing providers to review trends and usage. It is imperative the information is reviewed concurrently with glucose monitoring results in order to ensure appropriate dosing and treatment .The intervention considered in this systematic review is the use of continuous glucose monitoring (CGM) in conjunction with a CSII. CGM utilises a sensor placed in the interstitial subcutaneous tissue, which then measures glucose levels. This is accomplished with "electrochemical sensors that use glucose oxidase and measure an electric current generated when glucose reacts with oxygen. The sensors are coated with a specialised membrane to make them biocompatible" . The CGM has programmable high and low levels to alert the user when the limit is being reached. Information regarding continuous glucose levels can then be downloaded and reviewed. Based on the report, providers, patients, and caregivers may assess trends and consider changing basal rates or bolus doses .CGM sensors currently do not offer a closed-loop solution. The user must enter insulin dosing information into the pump, taking into account the present glucose level and duration of action of the insulin. Currently, CGMs are regarded as a supplemental method for assessing the effectiveness of glucose control. Existing studies are underway to improve accuracy and communication between the sensor and insulin pump with the goal to develop an artificial pancreas . Currently, CGM sensors must be calibrated with a glucometer, as specified by the manufacturer .The comparison for this review is the standard of care, self-glucose monitoring (SGM), in patients with insulin pumps . SGM is accomplished with a glucometer and blood sample typically obtained from a finger prick. The Diabetes Control and Complications Trial (DCCT) demonstrated frequency of monitoring improves glycemic control and decreases the risk of comorbidity . Data from this significant study continues to contribute to current diabetes management. According to the ADA, children and adolescents should monitor their blood glucose at least three or more times per day. Blood glucose data is utilised to calculate appropriate insulin doses. Similar to the CGM, information from the glucometers can be downloaded for assessment of results and trends. However, the result is dependent on the action of the patient to obtain the sample and only represents a specific moment in time whereas the CGM sensor continuously tracks the blood glucose level. Depending on the model, CGM can provide glucose levels every one to ten minutes. The sensor may last for up to 72 hours and results are available in real time .This systematic review will address two metabolic outcomes: a decrease in the number of hypoglycemic episodes and a haemoglobin A1C level7.5%. These outcomes were chosen due to their significance as indicators in the management of type 1 diabetes. Glucose levels should be between 90 mg/dL and 130 mg/dL (5.0mmol/l and 7.2mmol/l) before meals and between 90 mg/dL and 150 mg/dL at night (5.0mmmol/l and 8.3mmol/l) . Optimal care of an adolescent with type 1 diabetes mellitus is to safely maintain glycemic control and avoid hypoglycemia.Haemoglobin A1C is an indicator of how well the disease is being managed and should be evaluated every three months. McCulloch recommends the haemoglobin A1C level should be compared to approximately 50 recent blood glucose readings to ensure the accuracy of patient SGM . The reliability and validity of this test is based on the evidence discovered by the DCCT demonstrating those with lower haemoglobin A1C levels have fewer complications . The target A1C for adolescents, aged 13 to 19 years of age, is7.5% . This is consistent with the National Institute of Clinical Excellence (NICE) and diabetes management guidelines of the Australasian Paediatric Endocrine Group for the Department of Health and Ageing .An initial search for a systematic review regarding insulin pumps in adolescents with type 1 diabetes mellitus and concurrent use of CGM was conducted in the Joanna Briggs Institute Library of Systematic Reviews, Cochrane Database of Systematic Reviews, and PubMed. No systematic reviews were found.

The GMT-Consortium Large Earth Finder (G-CLEF) will be a cross-dispersed, optical band echelle spectrograph to be delivered as the first light scientific instrument for the Giant Magellan Telescope (GMT) in 2022. G-CLEF is vacuum enclosed and fiber-fed to enable precision radial velocity (PRV) measurements, especially for the detection and characterization of low-mass exoplanets orbiting solar-type stars. The passband of G-CLEF is broad, extending from 3500A to 9500A. This passband provides good sensitivity at blue wavelengths for stellar abundance studies and deep red response for observations of high-redshift phenomena. The design of G-CLEF incorporates several novel technical innovations. We give an overview of the innovative features of the current design. G-CLEF will be the first PRV spectrograph to have a composite optical bench so as to exploit that material’s extremely low coefficient of thermal expansion, high in-plane thermal conductivity and high stiffness-to-mass ratio. The spectrograph camera subsystem is divided into a red and a blue channel, split by a dichroic, so there are two independent refractive spectrograph cameras. The control system software is being developed in model-driven software context that has been adopted globally by the GMT. G-CLEF has been conceived and designed within a strict systems engineering framework. As a part of this process, we have developed a analytical toolset to assess the predicted performance of G-CLEF as it has evolved through design phases.

The GMT-Consortium Large Earth Finder (G-CLEF) is an echelle spectrograph with precision radial velocity (PRV) capability that will be a first light instrument for the Giant Magellan Telescope (GMT). G-CLEF has a PRV precision goal of 40 cm/sec (10 cm/s for multiple measurements) to enable detection of Earth-like exoplanets in the habitable zones of sun-like stars1. This precision is a primary driver of G-CLEF’s structural design. Extreme stability is necessary to minimize image motions at the CCD detectors. Minute changes in temperature, pressure, and acceleration environments cause structural deformations, inducing image motions which degrade PRV precision. The instrument’s structural design will ensure that the PRV goal is achieved under the environments G-CLEF will be subjected to as installed on the GMT azimuth platform, including: Millikelvin (0.001 °K) thermal soaks and gradients 10 millibar changes in ambient pressure Changes in acceleration due to instrument tip/tilt and telescope slewing Carbon fiber/cyanate composite was selected for the optical bench structure in order to meet performance goals. Low coefficient of thermal expansion (CTE) and high stiffness-to-weight are key features of the composite optical bench design. Manufacturability and serviceability of the instrument are also drivers of the design. In this paper, we discuss analyses leading to technical choices made to minimize G-CLEF’s sensitivity to changing environments. Finite element analysis (FEA) and image motion sensitivity studies were conducted to determine PRV performance under operational environments. We discuss the design of the optical bench structure to optimize stiffness-to-weight and minimize deformations due to inertial and pressure effects. We also discuss quasi-kinematic mounting of optical elements and assemblies, and optimization of these to ensure minimal image motion under thermal, pressure, and inertial loads expected during PRV observations.

To examine the effects of repetition time (TR) on metabolite concentration measurements in the human brain inSpectra were acquired from the posterior cingulate of five healthy adults at repetition times of 1.5 s, 3.0 s, 4.0 s, 6.0 s, and 8.0 s on a 3T MRI system. Relaxation data were also acquired for the water signal in the voxel of interest to separate tissue water and cerebrospinal fluid signal contributions. All data were quantified relative to total creatine and relative to the tissue water signal.On average, the variance for absolute metabolite concentrations was smaller than that of ratio concentrations (P = 0.003). Metabolite ratio concentrations calculated from a short TR of 1.5 s significantly differed (P 0.05) from their "true" ratios, i.e., ratios corrected for TTo minimize potential TR-dependent concentration differences at 3T, a minimum TR of 2.5 s is suggested for ratio concentration measurements, and a 5-s TR for absolute concentrations. When possible, preference should be to perform absolute concentration measurements.2 J. Magn. Reson. Imaging 2017;45:710-721.

The current study examined the main and interactive effects of offender race/ethnicity and sex on sentence length decisions for drug offenders convicted in three federal courts located in Iowa, Minnesota, and Nebraska. The additive model showed that females received shorter prison sentences than similarly situated male offenders, but there were no differences between white offenders and minority offenders. However, when the data were partitioned by sex, black males were found to receive lengthier prison terms than white males. There were no differences between white males and Hispanic males, and white females were treated no differently than either black or Hispanic females. Moreover, when the data were partitioned by race/ethnicity, white females were treated no differently than white males. However, black females received shorter sentences than black males and Hispanic females received shorter sentences than Hispanic males. Further analyses showed that black and Hispanic males also received longer sentences than white females and that black males received longer sentences than all other offenders (with the exception of Hispanic male offenders). These findings mesh with those gleaned from other sentencing studies, although they are at odds with theoretical notions that leniency at the sentencing stage is reserved only for white women.

Mean soil respiration rates (carbon dioxide efflux from bare soils) among salt marshes in Narragansett Bay, RI ranged from 1.7–7.8 μmol m−2 s−1 inSpartina patens in high marsh zones and 1.7–6.0 μmol m−2 s−1 inS. alterniflora in low marsh zones. The soil respiration rates significantly increased along a gradient of increasing watershed nitrogen (N) loads (S. alterniflora, R2 = 0.95, P = 0.0008;S. patens, R2 = 0.70, P = 0.02). As the soil respiration increased, the percent carbon (C) and N in the soil surface layer decreased in theS. alterniflora, suggesting that in part, the increased soil respiration rates are contributing to the increased turnover of labile organic matter. In contrast, there were no apparent relationships between the soil respiration rates in the high marsh and the soil C and N contents of the surface layer. However, there was a broad-scale pattern and significant inverse relationship between the high marsh soil respiration rates and the landscape belowground biomass ofS. patens. As more and more salt marsh systems are subjected to increasing nutrient loads, decomposition rates of soil organic matter may increase in marsh soils leading to higher turnover rates of C and N.

MONEY 2000™ is a successful consumer education programme that was implemented by Cooperative Extension personnel in over two dozen states of the USA between 1996 and 2002. One of the unique features of this programme is that it was based on the Transtheoretical Model of Change (TTM), a framework that has been widely used to study health-related behaviour changes such as smoking cessation. This paper first describes how the MONEY 2000™ programme was developed around major constructs contained within the TTM. Findings are reported from a survey conducted with participants in the first two states that delivered the programme. The findings suggest that several change processes used by MONEY 2000™ participants are associated with specific stages of change. In addition, there may be differences in behavioural changes between participants who increased their savings and those who reduced their debts.

Analysis of NFIRS statistics of the numbers, proportions and ratios of injuries and fatalities for bedrooms, kitchens, lounge rooms and other rooms in apartment buildings identifies factors influencing the probability of injury and death in apartment fires. Injuries and fatalities are compared primarily using the injury/fatality ratio (I/F ratio). Factors affecting fire outcomes available in the database include the room of fire origin, the age and sex of the casualties, the time of alarm, the ignition factor and the casualty location at time of ignition, condition before injury, activity at time of injury and condition preventing escape. There are wide variations in the proportions of casualties in various categories between the various room types. These appear likely to represent differences in the behaviour and the types of people involved in fires as casualties in the different rooms. There are differences between injury and fatality outcomes that also relate to the characteristics of the occupants and the uses of the rooms.