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OBJECTIVE:: The objectives of this study were 1) to identify quality and process of care indicators available in administrative workers' compensation data and to document their association with work disability outcomes, and 2) to use these indicators to assess whether nurse practitioners (NPs), recently authorized to serve as attending providers for injured workers in Washington State, performed differently than did primary care physicians (PCPs). METHODS:: Quality and process of care indicators for NP and PCP back injury claims from Washington State were compared using direct standardization and logistic regression. RESULTS:: This study found little evidence of differences between NP and PCP claims in case mix or quality of care. CONCLUSIONS:: The process of care indicators that we identified were highly associated with the duration of work disability and have potential for further development to assess and promote quality improvement. [ABSTRACT FROM AUTHOR]

PURPOSE/OBJECTIVES: To present models for the payment of research subjects, pros and cons of each, and the application of ethical principles in the current environment. DATA SOURCES: Federal regulations and guidelines, current and historical research, and opinions expressed in the nursing, medical, bioethics, pharmacology, and clinical trial literature. DATA SYNTHESIS: Relevant regulations are sparse. A variety of payment models exist, but all are somewhat problematic. Balancing the principles of respect for people and justice in our current society will not be entirely possible. Practice decisions must be made for individual situations. Special care must be taken with patients because they are subject to therapeutic misconception. CONCLUSIONS: No model fits all situations, but research nurses can use their skills to evaluate particular applications. As a society, nurses must promote participation in research as a socially responsible activity and prevent unethical payment models from predominating. IMPLICATIONS FOR NURSING PRACTICE: Oncology research nurses may be involved with the consent process, the development of protocols, and staff education. A thorough understanding of an issue that may impair the consent process or impinge upon subjects' rights is critical to effective and ethical practice. [ABSTRACT FROM AUTHOR]

Background: Few studies have assessed long-term opioid prescribing after a work-related injury. There is limited information about opioid prescriptions before an injury and how receipt of opioids before a work injury is associated with long-term opioid prescribing. We present patterns of long-term opioid prescription among workers after an injury, overall, and by pre-injury opioid use., Methods: We used linked workers' compensation and prescription drug monitoring program (PDMP) data to identify workers injured between July 2019 and June 2020 with an opioid prescription dispensed within 6 weeks after injury. Opioid prescribing was assessed for the 3 months before injury and for 1 year after injury or claim closure, whichever came first., Results: Among injured workers with an opioid in the first 6 weeks, 23% had opioids 6-12 weeks after injury, 19% had opioids 3-6 months, 14% had opioids 6-9 months, and 12% had opioids 9-12 months after injury; 19% had opioids in the 3 months before injury. For workers with opioid prescription prior to injury, the percentage with opioids 9-12 months after injury was 34%, versus 7% among workers with no opioids in the 3 months before injury (p < 0.001). Receipt of chronic opioids (for at least 60 days) 9-12 months after injury was substantially higher among those with prior opioid prescription (20%) than in those with no prior opioids (0.4%) (p < 0.001)., Conclusions: We found a strong relationship between opioid prescription in the 3 months before a work injury and opioid prescribing after an injury. Healthcare providers should be vigilant to the important relationship between prior opioid use and longer-term opioid use after work-related injuries., (© 2024 Wiley Periodicals LLC.)

Background: There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data., Methods: We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors., Results: Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors., Conclusion: We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system., (© 2024 Wiley Periodicals LLC.)

Background: Registered nurses (RNs) represent the largest segment of the health care workforce and have unique job demands and occupational health considerations. The purpose of this study was to describe the incidence, cost, and causes of occupational injuries among RNs in Washington State and to quantify the cumulative cost and burden of each type of injury, relative to all injuries among RNs., Methods: Annual injury claims data covered under Washington State workers' compensation (WC) fund were analyzed over a 13-year period (2007-2019). Annual mean incidence and cost of injuries were calculated and stratified by nature, source, and event/exposure. Negative binomial regression models were used to examine trends in injury incidence over time, for injury incidence overall, and by the most common injury classifications., Results: Between 2007 and 2019, 10,839 WC claims were filed and accepted for Washington State RNs (annual M = 834), totaling more than US$65 million. No significant trend in overall injury incidence was observed (incidence rate ratio [IRR]: 0.99, 95% confidence interval [CI] = [0.94, 1.05]). The most common injury exposures were bodily reaction and exertion, contact with objects and equipment, falls, and assaults and violent acts., Discussion: To our knowledge, this is the first broad study of the incidence and costs of occupational injuries among RNs across all workplace settings. We identified high-cost, high-frequency incidence rates of musculoskeletal, sharp, and violence-related occupational injury claims, highlighting intervention targets. Implications for Occupational Health Practice : Policy makers, health systems, and occupational health nurse leaders can use this information to identify priority areas where evidence-based occupational health and prevention programs are most needed., Competing Interests: Conflict of InterestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes., Methods: WC data were linked to a prospective survey in Ohio (N = 512) and Washington (N = 2,839). Workers were interviewed 6 weeks and 6 months after work-related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6-month work-related outcomes., Results: The WC-based FCI had high specificity but low sensitivity and was weakly associated with work-related outcomes. The survey-based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC-based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey-based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC-based FCI moved the estimate away from null (8.95% change)., Conclusions: The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution-including state-specific analyses with a reliable reference standard-before using a WC-based FCI in studies involving multiple states., (© 2023 Wiley Periodicals LLC.)

Background: Traumatic injury is a leading cause of death and disability among US workers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state-based occupational health indicator (OHI #22) was initiated in 2012 to track work-related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work-related hospitalizations., Methods: Seventeen states used hospital discharge data to calculate estimates for calendar years 2012-2019. State-panel fixed-effects regression was used to model linear trends in annual work-related hospitalization rates, OHI #22 rates, and the proportion of work-related hospitalizations resulting from severe injuries. Models included calendar year and pre- to post-ICD-10-CM transition., Results: Work-related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD-10-CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near-monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work-related hospitalizations before the ICD-10-CM transition, versus 9.1% post-transition., Conclusions: Although hospital discharge data suggest decreasing work-related hospitalizations over time, work-related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD-10-CM transition-associated structural break in 2015., (© 2023 Wiley Periodicals LLC.)

Work is an important social determinant of health; unfortunately, work-related injuries remain prevalent, can have devastating impact on worker health, and can impose heavy economic burdens on workers and society. Occupational health services research (OHSR) underpins occupational health services policy and practice, focusing on health determinants, health services, healthcare delivery, and health systems affecting workers. The field of OHSR has undergone tremendous expansion in both definition and scope over the past 25 years. In this commentary, focusing on the US, we document the historical development and evolution of OHSR as a research field, describe current doctoral-level OHSR training, and discuss challenges and opportunities for the OHSR field. We also propose an updated definition for the OHSR field: Research and evaluation related to the determinants of worker health and well-being; to occupational injury and illness prevention and surveillance; to healthcare, health programs, and health policy affecting workers; and to the organization, access, quality, outcomes, and costs of occupational health services and related health systems. Researchers trained in OHSR are essential contributors to improvements in healthcare, health systems, and policy and programs to improve worker health and productivity, as well as equity and justice in job and employment conditions. We look forward to the continued growth of OHSR as a field and to the expansion of OHSR academic training opportunities., (© 2023 Wiley Periodicals LLC.)

Background: Full practice authority (FPA) improves clinical autonomy for nurse practitioners (NPs). Autonomy may reduce burnout., Purpose: Estimate the effect of changing from reduced or restricted practice authority to FPA on NP burnout., Methods: In this quasi-experimental study, we compared NP burnout before (2016) and after (2018) a Veterans Health Administration (VHA) regulation authorized NP FPA. Burnout proportions were estimated for VHA facilities by aggregating responses to the VHA's All Employee Survey from 1,352 primary care NPs., Discussion: Seventy-seven percent of facilities changed to FPA postregulation. Burnout was six points lower among NPs in facilities that changed to FPA compared to facilities that had FPA prior to the regulation; however, this association was not statistically significant., Conclusion: NPs are increasingly working under independent practice. While changing to FPA did not reduce NP burnout, this association may vary by health care setting or when burnout is measured for individuals or teams., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to report., (Published by Elsevier Inc.)

Background: Patient enrollment levels at Veterans Health Administration (VHA) facilities change based on Veteran demand for care, potentially affecting demands on staff. Effects on burnout in the primary care workforce associated with increases or decreases in enrollment are unknown., Objective: Estimate associations between patient enrollment and burnout., Design: In this serial cross-sectional study, VHA patient enrollment and workforce data from 2014 to 2018 were linked to burnout estimates for 138 VHA facilities. The VHA's annual All Employee Survey provided burnout estimates., Participants: A total of 82,421 responses to the 2014-2018 All Employee Surveys by primary care providers (PCPs), including physicians, nurse practitioners, and physician assistants; nurses; clinical associates; and administrative clerks were included. Respondents identified as patient-aligned care team members., Main Measures: Independent variables were (1) the ratio of enrollment to PCPs at VHA facilities and (2) the year-over-year change in enrollment per PCP. Burnout was measured as the annual proportion of staff at VHA facilities who reported emotional exhaustion and/or depersonalization. Each primary care role was analyzed independently., Key Results: Overall enrollment decreased from 1553 enrollees per PCP in 2014 to 1442 enrollees per PCP in 2018 across VHA facilities. Forty-three facilities experienced increased enrollment (mean of 1524 enrollees/PCP in 2014 to 1668 in 2018) and 95 facilities experienced decreased enrollment (mean of 1566 enrollees/PCP in 2014 to 1339 in 2018). Burnout decreased for all primary care roles. PCP burnout was highest, decreasing from a facility-level mean of 51.7% in 2014 to 43.8% in 2018. Enrollment was not significantly associated with burnout for any role except nurses, for whom a 1% year-over-year increase in enrollment was associated with a 0.2 percentage point increase in burnout (95% CI: 0.1 to 0.3)., Conclusions: Studies assessing changes in organizational-level predictors are rare in burnout research. Patient enrollment predicted burnout only among nurses in primary care., (© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.)

This article describes the development and evaluation of an online workplace stress reduction toolkit for use by managers of 9-1-1 emergency communication centers (ECCs). A three-step process for development and testing of digital learning resources was used: (1) establishing need and focus through ECC manager stakeholder engagement, (2) pretesting of the toolkit with the target ECC manager audience, and (3) toolkit utilization and evaluation. The toolkit was developed in close partnership with stakeholders throughout the entire process. Toolkit usage was documented via registration data. The evaluation utilized an online survey that included closed and open-ended questions, which were analyzed using descriptive statistics and qualitative thematic analysis. Over a 20-month period, 274 people registered for the toolkit and, of those, 184 (67%) accessed the content. Respondents to the evaluation survey ( N = 156) scored the toolkit highly on satisfaction, self-efficacy, and perceived utility measures. Survey respondents reported intent to apply toolkit content through the following: providing organizational resources to help workers take better care of themselves (41%); creating a lower stress worksite environment (35%) and sharing resources with staff to (1) reduce stress (19%), (2) support conflict resolution (21%), and (3) prevent and/or stop bullying (17%). In delivering actionable content to ECC managers, the toolkit shows promise in addressing and mitigating occupational stress in ECCs. Further research needs to determine the relationship of this strategy for reducing ECC stress.

Objectives: Electronic health record (EHR) inbox notifications can be burdensome for primary care providers (PCPs), potentially contributing to burnout. We estimated the association between changes in the quantities of EHR inbox notifications and PCP burnout., Study Design: In this observational study, we tested the association between the percent change in daily inbox notification volumes and PCP burnout after an initiative to reduce low-value notifications at the Veterans Health Administration (VHA)., Methods: The VHA initiative resulted in increases and decreases in notification volumes for PCPs. For each facility, the proportion of PCPs reporting burnout was estimated using VHA All Employee Survey responses before and after the initiative in 2016 and 2018, respectively. Survey responses were aggregated for 6459 PCPs (physicians, nurse practitioners, and physician assistants) at 138 VHA facilities. Fixed effects regression models estimated the association of small and large increases and small and large decreases in notifications on burnout., Results: Daily inbox notifications per PCP decreased by a mean (SD) of 5.9% (30.1%) across study facilities, from a mean (SD) of 128 (52) notifications to 114 (44) notifications after the initiative. Fifty-one percent of facilities experienced reductions in notifications, 30% experienced no change, and 20% experienced increased notifications. PCP burnout was not significantly associated with any level of increase or decrease in notifications., Conclusions: Changes in notification volumes alone did not predict PCP burnout. Future research to reduce burnout might still address EHR notification volumes, but as part of a broader set of strategies that consider the other stressors that PCPs experience.

Background: Associations between the intensity of physical therapy (PT) treatments and health outcomes among individuals with back pain have been examined in the general population; however, few studies have explored these associations in injured workers. Our study objective was to examine whether intensity of PT treatments is positively associated with work and health outcomes in injured workers with back pain., Methods: We conducted a secondary analysis of prospective data collected from the Washington State Workers' Compensation (WC) Disability Risk Identification Study Cohort (D-RISC). D-RISC combined survey results with WC data from the Washington State Department of Labor and Industries. Workers with a State Fund WC claim for back injuries between June 2002 and April 2004 and who received PT services within the first year of injury were eligible. Intensity of PT treatment was measured as the type and amount of PT services within 28 days from the first PT visit. Outcome measures included work disability and self-reported measures for working for pay, pain intensity, and functional status at 1-year follow-up. We conducted linear and logistic regression models to test associations., Results: We identified 662 eligible workers. In adjusted models, although the intensity of PT treatment was not significantly associated with work disability at 1-year follow-up, it was associated with lower odds of working for pay, decreased pain intensity, and improved functional status., Conclusions: Our findings suggest that there may be small benefits from receiving active PT, manual therapy, and frequent PT treatments within 28 days of initiating PT care., (© 2022 Wiley Periodicals LLC.)

Background: Persons released from prison are at an increased risk of mortality compared to the non-incarcerated population, particularly from drug- and opioid-related overdose. Contributors to overdose mortality vary with changing patterns of substance use and updating overdose and mortality statistics may help focus resources for persons released from prison., Methods: In this retrospective cohort study, records for 33,811 people released from Washington State Department of Corrections prisons between 2014 and 2018 were linked to Washington State death records from 2014 to 2019. We calculated post-release mortality rates by cause of death, including overdose and substance-related mortality. Hazard ratios for risk factors for all-cause, non-overdose, and overdose mortality were estimated using Cox proportional hazards regression., Results: 862 deaths were identified among persons released from prison. The all-cause mortality rate was 747 per 100,000 person-years (95 % CI: 699-800), and drug overdose was the leading cause of death (216 per 100,000 person-years; 95 % CI: 190-244). Psychostimulant-related mortality (152 per 100,000 person-years; 95 % CI: 131-177) and opioid-related mortality (138 per 100,000 person-years; 95 % CI: 118-161) were the most prevalent among substance-related causes of death, with the greatest mortality risk occurring within two weeks after release. Older age at most recent release, previous incarceration, and drug-related convictions were significant risk factors for all-cause and overdose mortality within six years after release., Conclusions: Psychostimulants were the greatest contributors to substance-related mortality for persons released from Washington State prisons. Greater efforts to prevent psychostimulant- and opioid-related overdose are needed., Competing Interests: Conflict of Interest The authors have no declarations of competing interest to report., (Published by Elsevier B.V.)

Background: Nearly half of U.S. workers have access to workplace wellness programs (WWPs), 58% of workers with access participate. The aim of this study was to assess interest in WWP participation and identify reasons for lack of interest among workers with work-related permanent impairments-a population at elevated risk of adverse health outcomes., Methods: Workers who returned to work after a work-related permanent impairment were interviewed 11 to 15 months after workers' compensation claim closure. Qualitative content analysis methods were used to code open-ended responses., Findings: Of 560 respondents, 51.4% expressed interest in WWP participation. Numerous adverse health and economic characteristics were associated with WWP interest, for example, interest was expressed by 63.3% of workers reporting fair/poor health status versus 47.1% reporting good/excellent; 56.9% of workers reporting moderate/severe pain versus 41.4% reporting mild/no pain; 64.7% of workers without health insurance versus 50.1% with health insurance; 69.0% of workers reporting depression versus 47.2% without depression; 70.4% of workers reporting obesity versus 48.0% without obesity; and 63.2% of workers often worried about expenses versus 46.9% reporting sometimes/never worried. Specific participation barriers were described by 34.2% of the 272 workers who were not interested., Conclusions/applications to Practice: A majority of workers with work-related permanent impairments-particularly those with adverse health and economic characteristics-were interested in WWPs. Many workers who reported no interest cited participation barriers. Further research is needed to determine whether addressing such barriers would enhance equitable access. Those undertaking WWP planning, implementation, and outreach should ensure that WWPs are inclusive and serve workers with disabilities.

Background: Older workers are increasingly represented in the U.S. workforce, but frequently work part-timeor intermittently, hindering accurate injury rate estimates. To reduce the impact of reporting barriers on rate comparisons, we focused on reinjury (both injury recurrence and new injury) among workers with a workers' compensation claim, assessing: (1) reinjury risk for workers age 65+ versus <65; (2) importance of work-time at-risk measurement for rate estimates and comparisons; and (3) age distribution of potential risk factors., Methods: Washington State workers' compensation claims for a retrospective cohort of workers with work-related permanent impairments were linked to state wage files. Reinjury rates were calculated for the cohort (N = 11,184) and a survey sample (N = 582), using both calendar time and full-time equivalent (FTE)-adjusted time. Risk differentials were assessed using rate ratios and adjusted survival models., Results: The rate ratio for workers age 65+ (vs. <65) was 0.45 (p < 0.001) using calendar time, but 0.70 (p = 0.07) using FTE-adjusted time. Survey-based rates were 35.7 per 100 worker-years for workers age 65+, versus 14.8 for <65. Workers age 65+ (vs. <65) were more likely to work <100% FTE, but were similar regarding job strain, their ability to handle physical job demands, and their comfort reporting unsafe conditions or injuries., Conclusions: Accounting for work-time at risk substantially improves age-based reinjury comparisons. Although the marked elevation in self-reported reinjury risk for older workers might be a small-sample artifact (n = 34), workers age 65+ are likely at higher risk than previously appreciated. Ongoing workforce trends demand increased attention to injury surveillance and prevention for older workers., (© 2022 Wiley Periodicals LLC.)

Background: Opioid use disorder (OUD) is a serious health condition that is effectively treated with buprenorphine. However, only a minority of people with OUD are able to access buprenorphine. Many access points for buprenorphine have high barriers for initiation and retention. Health care and drug treatment systems have not been able to provide services to all-let alone the majority-who need it, and many with OUD report extreme challenges starting and staying on buprenorphine in those care settings. We describe the design and protocol for a study of a rapid access buprenorphine program model in six Washington State communities at existing sites serving people who are unhoused and/or using syringe services programs. This study aimed to test the effectiveness of a Community-Based Medication-First Program model., Methods: We are conducting a hybrid effectiveness-implementation study of a rapid access buprenorphine model of care staffed by prescribers, nurse care managers, and care navigators. The Community-Based Medication-First model of care was designed as a 6-month, induction-stabilization-transition model to be delivered between 2019 and 2022. Effectiveness outcomes will be tested by comparing the intervention group with a comparison group derived from state records of people who had OUD. Construction of the comparison group will align characteristics such as geography, demographics, historical rates of arrests, OUD medication, and health care utilization, using restriction and propensity score techniques. Outcomes will include arrests, emergency and inpatient health care utilization, and mortality rates. Descriptive statistics for buprenorphine utilization patterns during the intervention period will be documented with the prescription drug monitoring program., Discussion: Results of this study will help determine the effectiveness of the intervention. Given the serious population-level and individual-level impacts of OUD, it is essential that services be readily available to all people with OUD, including those who cannot readily access care due to their circumstances, capacity, preferences, and related systems barriers., (© 2022. The Author(s).)

Objective: To describe telehealth trends within a population-based workers' compensation system during the COVID-19 pandemic, and to assess telehealth utilization by sociodemographic characteristics., Methods: This cross-sectional study used Washington State workers' compensation claims and medical billing data from January 2019 to October 2020., Results: Telehealth use averaged 1.2% of medical bills pre-pandemic, peaked in April 2020 at 8.8%, and leveled off to around 3.6% from July to October 2020. Telehealth utilization differed significantly by age, sex, number of dependents, injury, industry, and receipt of interpreter services. Workers residing in counties with higher population, lower poverty rates, and greater Internet access had higher telehealth usage., Conclusions: There were dramatic shifts in telehealth; usage differed by sociodemographic characteristics. Further studies evaluating disparities in tele-health access among injured workers are needed., Competing Interests: Dawn M. Ehde is paid an honorarium to be a journal editor by the American Psychological Association and receives funding from NIH, NIDILRR, PCORI, and the National MS Society. Morgan Young is the Associate Medical Director for Chiropractic at the Department of Labor and Industries, which provided contract to partially fund this work; he was on the contract team to ensure contract execution and assisted in developing the research agenda for the contract. All other authors have no conflicts of interest to disclose., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Background: Safety climate (SC) is a robust leading indicator of occupational safety outcomes. There is, however, limited research on SC among workers who have returned to work with a work-related permanent impairment., Objective: This study examined three propositions: (1) a two-level model of SC (group-level and organization-level SC) will provide the best fit to the data; (2) antecedent factors such as safety training, job demands, supervisor support, coworker support, and decision latitude will predict SC; and (3) previously reported associations between SC and outcomes such as reinjury, work-family conflict, job performance, and job security will be observed., Method: A representative cross-sectional survey gathered information about experiences during the first year of work reintegration. About one year after claim closure, 599 interviews with workers were conducted (53.8% response rate). Confirmatory factor analyses were conducted to test the factor structure of the SC construct. Further, researchers used correlation analyses to examine the criterion-related validity., Results: Consistent with general worker populations, our findings suggest the following: (1) the two-factor structure of SC outperformed the single-factor structure in our population of workers with a permanent impairment; (2) correlations demonstrate that workplace safety training, decision latitude, supervisor support, coworker support, and job demands could predict SC; and (3) SC may positively impact reinjury risk, work-family conflict, and may increase job performance and job security., Conclusions: Our study validated a two-factor SC scale among workers with a history of disabling workplace injury or permanent impairment who have returned to work. Practical applications of this scale will equip organizations with the necessary data to improve working conditions for this population.

Background: Following a work-related permanent impairment, injured workers commonly face barriers to safe and successful return to work (RTW). Examining workers' experiences with the workers' compensation (WC) system could highlight opportunities to improve RTW outcomes. Objectives included summarizing workers': (1) appraisal of several WC-based RTW programs, and (2) suggestions for vocational rehabilitation and WC system improvements to promote safe and sustained RTW., Methods: In telephone interviews, 582 Washington State workers with work-related permanent impairments were asked whether participation in specified WC-based RTW programs helped them RTW and/or stay at work. Suggestions for program and system improvements were solicited using open-ended questions; qualitative content analysis methods were used to inductively code responses., Results: Most respondents reported positive impacts from RTW program participation; for example, 62.5% of vocational rehabilitation participants reported it helped them RTW, and 51.7% reported it helped them stay at work. Among 582 respondents, 28.0% reported that no change was needed to the WC system, while 57.6% provided suggestions or critiques. Reduce delays/simplify process/improve efficiency was the most frequent WC system theme-mentioned by 34.9%. Among 120 vocational rehabilitation participants, 35.8% reported that no change was needed to vocational rehabilitation, while 46.7% (N = 56) provided suggestions or critiques. More worker choice/input into the vocational retraining plan was the most frequent vocational rehabilitation theme-mentioned by 33.9%., Conclusions: This study's findings suggest that there is substantial room for improvement in workers' experience with the WC system. In addition, injured workers' feedback may reflect opportunities to reduce administrative burden and to improve worker health and RTW outcomes., (© 2021 Wiley Periodicals LLC.)

Background: Roughly 10% of occupational injuries result in permanent impairment. After initial return to work (RTW), many workers with permanent impairments face RTW interruption due to reinjury, unstable health, disability, and layoff. This study used open-ended survey data to: (1) explore workplace factors identified by workers as important levers for change, some of which may previously have been unrecognized; and (2) summarize workers' suggestions for workplace improvements to promote sustained RTW and prevent reinjury., Methods: This study included data from workers' compensation claims and telephone surveys of 582 Washington State workers who had RTW after a work-related injury involving permanent impairment. The survey was conducted in 2019, about a year after claim closure. We used qualitative content analysis methods to inductively code open-ended survey responses., Results: The most frequent themes were: safety precautions/safer workplace (18.1%), adequate staffing/appropriate task distribution (16.2%), and safety climate (14.1%). Other frequent themes included ergonomics, rest breaks, job strain, predictability and flexibility in work scheduling practices, employer response to injury, social support, communication, and respect. Many workers reported that they were not listened to, or that their input was not sought or valued. Workers often linked communication deficiencies to preventable deficiencies in safety practices, safety climate, and RTW practices, and also to lack of respect or distrust. In counterpoint, nearly one-third of respondents reported that no change was needed to their workplace., Conclusions: Policies and interventions targeting worker-suggested workplace improvements may promote safe and sustained RTW, which is essential for worker health and economic stability., (© 2021 Wiley Periodicals LLC.)

Background: Nonstandard employment arrangements are becoming increasingly common and could provide needed flexibility for workers living with disabilities. However, these arrangements may indicate precarious employment, that is, employment characterized by instability, powerlessness, and limited worker rights and benefits. Little is known about the role of nonstandard and precarious jobs in the well-being of disabled persons during workforce reintegration after permanent impairment from work-related injuries or illnesses., Methods: We used linked survey and administrative data for a sample of 442 Washington State workers who recently returned to work and received a workers' compensation permanent partial disability award after permanent impairment from a work-related injury. Multivariable logistic regression models were used to examine associations between nonstandard employment and outcomes related to worker well-being and sustained employment. We also examined associations between a multidimensional measure of precarious employment and these outcomes. Secondarily, qualitative content analysis methods were used to code worker suggestions on how workplaces could support sustained return to work (RTW)., Results: Workers in: (1) nonstandard jobs (compared with full-time, permanent jobs), and (2) precarious jobs (compared with less precarious jobs) had higher adjusted odds of low expectations for sustained RTW. Additionally, workers in precarious jobs had higher odds of reporting fair or poor health and unmet need for disability accommodation. Workers in nonstandard and precarious jobs frequently reported wanting safer and adequately staffed workplaces to ensure safety and maintain sustained employment., Conclusions: Ensuring safe, secure employment for disabled workers could play an important role in their well-being and sustained RTW., (© 2021 Wiley Periodicals LLC.)

Objectives: Roughly 10% of occupational injuries result in permanent impairment and a permanent partial disability (PPD) award. After initial return to work (RTW) following a work injury, many workers with permanent impairment face RTW interruption (breaks in ongoing employment due to reinjury, poor health, disability, lay-off, etc.). Most RTW and reinjury research has focused on worker-level risk factors, and less is known about contextual factors that may be amenable to workplace or workers' compensation (WC)-based interventions. The aim of this study was to identify modifiable organizational and psychosocial workplace factors associated with (i) RTW interruption and (ii) reinjury among workers with a permanent impairment., Methods: This retrospective cohort study included WC claims data and survey data for 567 injured workers who RTW at least briefly after a work-related injury that resulted in permanent impairment. Workers were interviewed once by phone, 11-15 months after WC claim closure with a PPD award. Logistic regression models were used to estimate associations between each workplace factor of interest and each outcome, controlling for whole body impairment percentage, gender, age, nativity, educational level, State Fund versus self-insured WC coverage, employer size, union membership, industry sector, and employment duration of current/most recent job., Results: Twelve percent of workers had been reinjured in their current or most recent job, 12% of workers were no longer working at the time of interview, and <1% of workers reported both outcomes. The most frequently reported reason for RTW interruption was impairment, disability, and/or pain from the previous work injury. Lower reported levels of safety climate, supervisor support, and ability to take time off work for personal/family matters were significantly associated with both RTW interruption and reinjury. Inadequate employer/health care provider communication, perceived stigmatization from supervisors and/or coworkers, and lower levels of coworker support were significantly associated with RTW interruption but not with reinjury. Discomfort with reporting an unsafe situation at work, absence of a health and safety committee, and higher job strain were significantly associated with reinjury, but not with RTW interruption. Inadequate safety training and lack of needed job accommodations were not significantly associated with either outcome. There were no notable or statistically significant interactions between workplace factors and degree of impairment, and no consistent direction of association., Conclusions: This study provides evidence that several potentially modifiable organizational and psychosocial factors are associated with safe and sustained RTW among injured workers with work-related permanent impairment. The lack of interaction between any of these workplace factors and degree of impairment suggests that these findings may be generalizable to all workers, and further suggests that workplace interventions based on these findings might be useful for both primary and secondary prevention. Though primary prevention is key, secondary prevention efforts to sustain RTW and prevent reinjury may reduce the considerable health, economic, and social burden of occupational injury and illness., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Background: Roughly 10% of injured workers experience work injuries that result in permanent impairment and a permanent partial disability (PPD) award. This study aimed to characterize and quantify long-term employment outcomes for injured workers, by the degree of whole body impairment (WBI) and by participation in several workers' compensation (WC)-based return-to-work (RTW) programs., Methods: A retrospective cohort of 43,968 Washington State workers were followed for up to 10 years after WC claim closure (2009-2017). Degree of impairment was classified as: (1) no PPD award, (2) PPD award with WBI < 10%, or (3) PPD award with WBI ≥ 10%. State wage files were used to construct employment outcomes for regression, modeling: (1) time to first RTW, (2) time to first RTW interruption, (3) RTW volatility, and (4) employment gaps., Results: Wage patterns and employment outcomes differed significantly by the degree of impairment. Compared to other workers, workers with WBI ≥ 10% had delayed RTW, shorter average times to first RTW interruption, and higher rates of both RTW interruptions and quarters without wages. Time to first RTW averaged over a year, increasing with the degree of impairment. About 9% overall-and 27% of workers with ≥10% WBI-had no observed wages after claim closure. In adjusted models, workers with WBI ≥ 10% had significantly poorer employment outcomes, compared to workers with no PPD award (p < 0.001)., Conclusions: State wage files provide an efficient approach to identifying RTW patterns. Workers with permanent impairment were at substantially higher risk of poor employment outcomes. WC-based RTW programs may promote better employment outcomes., (© 2021 Wiley Periodicals LLC.)

Purpose The purpose of this study was to descriptively quantify experiences of injured workers with permanent impairment during their first year of work reintegration. Methods A representative survey was conducted to characterize health, disability, pain, employment, reinjury, and economic outcomes for 598 workers with permanent impairment who had returned to work during the year after workers' compensation claim closure. Survey responses were summarized by degree of whole body impairment (< 10% vs. ≥ 10%). Results Injured workers who had returned to work reported that permanent impairment made it difficult to get a job (47%) and to keep their job (58%). A year after claim closure, 66% reported moderate to very severe pain; 40% reported pain interference with work. About 13% reported new work injuries; over half thought permanent impairment increased their reinjury risk. Asked to compare current to pre-injury work status, workers with a higher degree of impairment more frequently reported working fewer hours (OR 1.60; 95% CI 1.06, 2.42), earning less (OR 1.56; 95% CI 1.04, 2.36), and being at higher risk of losing their current job due to their impairment (OR 1.66; 95% CI 1.01, 2.71). Conclusions Injured workers with permanent impairment face long-term challenges related to health limitations, chronic pain, work reintegration, and economic impacts. Workers with a higher degree of impairment more frequently reported several economic and job security challenges. Developing workplace and workers' compensation-based interventions that reduce return-to-work interruption and reinjury for workers with permanent impairment should be prioritized as an important public health and societal goal.

Objective: To test associations between several opioid prescribing policy interventions and changes in early (acute/subacute) high-risk opioid prescribing practices., Data Sources: Population-based workers' compensation pharmacy billing and claims data, Washington State Department of Labor and Industries (January 2008-June 2015)., Study Design: We used interrupted time series analysis to test associations between three policy intervention timepoints and monthly proportions of population-based measures of high-risk, low-risk, and any workers' compensation-related opioid prescribing. We also tested associations between the policy intervention timepoints and five high-risk opioid prescribing indicators among workers prescribed any opioids within 3 months after injury: (a) >7 cumulative (not necessarily consecutive) days' supply of opioids during the acute phase, (b) high-dose opioids, (c) concurrent sedatives, (d) chronic opioids, and (e) a composite high-risk opioid prescribing indicator., Principal Findings: Within 3 months after injury, 9 percent of workers were exposed to high-risk and 12 percent to low-risk workers' compensation-related opioid prescribing; 79 percent filled no workers' compensation-related opioid prescription. Among workers prescribed any early (acute/subacute) opioids, the indicator for >7 days' supply of opioids during the acute phase was present for 30 percent, high-dose opioids for 18 percent, concurrent sedatives for 3 percent, and chronic opioids for 2 percent. Beyond a general shift toward more infrequent and lower-risk workers' compensation-related opioid prescribing, each policy intervention timepoint was significantly associated with reductions in specific acute/subacute high-risk opioid prescribing indicators; each of the four specific high-risk opioid prescribing indicators had significant reductions associated with at least one policy., Conclusions: Several state-level opioid prescribing policies were significantly associated with safer workers' compensation-related opioid prescribing practices during the first 3 months after injury (acute/subacute phase), which should in turn reduce transition to chronic opioids and associated negative health outcomes., (© 2020 Health Research and Educational Trust.)

Background: Many injured workers are reinjured, but reinjury risk is challenging to quantify. Because many injured workers face delayed return-to-work, or return to part-time or intermittent jobs, a calendar timescale may overestimate actual work-time at risk, yielding underestimated reinjury rates. Objectives included determining: (1) reinjury risk by degree of permanent impairment and other factors, and (2) how choice of timescale affects reinjury estimates., Methods: This retrospective cohort study included Washington State workers' compensation (WC) claims for 43,114 injured workers, linked to state wage files (2003-2018). Three timescales were used to define at-risk denominators: (1) calendar quarters; (2) quarters with any wages; and (3) full-time equivalent (FTE) quarters, defined as cumulative work hours ÷ 520. Associations between reinjury outcomes and worker, injury, job, and WC vocational rehabilitation program participation characteristics were assessed using Cox proportional hazards regression., Results: Overall reinjury rates were 5.9 per 100 worker-years using a calendar timescale (95% confidence interval [CI]: 5.8-6.0), 10.0 using any-wage quarters (95% CI: 9.9-10.2), and 12.5 using FTE quarters (95% CI: 12.3-12.7). Reinjury rates were highest in the first two quarters after initial injury, remaining elevated for about 4 years. Using FTE quarters, workers with ≥10% whole body impairment had a 34% higher risk of reinjury relative to workers with no permanent partial disability award (95% CI: 1.25-1.44); no difference was detected using calendar time., Conclusions: Timescale substantially affects reinjury estimates and comparisons between groups with differential return-to-work patterns. Linking wage data to WC claims facilitates measurement of long-term employment, yielding more accurate reinjury estimates., (© 2020 Wiley Periodicals LLC.)

Background: The Functional Comorbidity Index (FCI) was developed for community-based adult populations, with function as the outcome. The original FCI was a survey tool, but several International Classification of Diseases (ICD) code lists-for calculating the FCI using administrative data-have been published. However, compatible International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM versions have not been available., Objective: We developed ICD-9-CM and ICD-10-CM diagnosis code lists to optimize FCI concordance across ICD lexicons., Research Design: We assessed concordance and frequency distributions across ICD lexicons for the FCI and individual comorbidities. We used length of stay and discharge disposition to assess continuity of FCI criterion validity across lexicons., Subjects: State Inpatient Databases from Arizona, Colorado, Michigan, New Jersey, New York, Utah, and Washington State (calendar year 2015) were obtained from the Healthcare Cost and Utilization Project. State Inpatient Databases contained ICD-9-CM diagnoses for the first 3 calendar quarters of 2015 and ICD-10-CM diagnoses for the fourth quarter of 2015. Inpatients under 18 years old were excluded., Measures: Length of stay and discharge disposition outcomes were assessed in separate regression models. Covariates included age, sex, state, ICD lexicon, and FCI/lexicon interaction., Results: The FCI demonstrated stability across lexicons, despite small discrepancies in prevalence for individual comorbidities. Under ICD-9-CM, each additional comorbidity was associated with an 8.9% increase in mean length of stay and an 18.5% decrease in the odds of a routine discharge, compared with an 8.4% increase and 17.4% decrease, respectively, under ICD-10-CM., Conclusion: This study provides compatible ICD-9-CM and ICD-10-CM diagnosis code lists for the FCI.

Objective: To estimate associations between early high-risk opioid prescribing practices and long-term work-related disability., Methods: Washington State Fund injured workers with at least one opioid prescription filled within 6 weeks after injury (2002 to 2013) were included (N = 83,150). Associations between early high-risk opioid prescribing (longer duration, higher dosage, concurrent sedatives), and time lost from work, total permanent disability, and a surrogate measure for Social Security disability benefits were tested. Measures of early hospitalization, body part, and nature of injury were included to address confounding by indication concerns, along with sensitivity analyses controlling for injury severity., Results: In adjusted logistic models, early high-risk opioid prescribing was associated with roughly three times the odds of each outcome., Conclusion: Exposure to high-risk opioid prescribing within 90 days of injury was significantly and substantially associated with long-term temporary and permanent disability.

Objective: High-risk opioid prescribing practices in workers' compensation (WC) settings are associated with excess opioid-related morbidity, longer work disability and higher costs. This study characterises the burden of prescription opioid-related hospitalisations among injured workers., Methods: Hospital discharge data for eight states (Arizona, Colorado, Michigan, New Jersey, New York, South Carolina, Utah and Washington) were obtained from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We calculated 5-year (2010-2014) average annual rates of prescription opioid overdose/adverse effect (AE) hospitalisations. Injured workers were identified using payer (WC) and external cause codes., Results: State-level average annual prescription opioid overdose/AE hospitalisation rates ranged from 0.3 to 1.2 per 100 000 employed workers. Rates for workers aged ≥65 years old were two to six times the overall rates. Among those hospitalised with prescription opioid overdose/AEs, injured workers were more likely than other inpatients to have a low back disorder diagnosis, and less likely to have an opioid dependence/abuse or cancer diagnosis, or a fatal outcome. Averaged across states, WC was the primary expected payer for <1% of prescription opioid overdose/AE hospitalisations vs 6% of injury hospitalisations., Conclusions: Population-based estimates of prescription opioid morbidity are almost nonexistent for injured workers; this study begins to fill that gap. Rates for injured workers increased markedly with age but were low relative to inpatients overall. Research is needed to assess whether WC as payer adequately identifies work-related opioid morbidity for surveillance purposes, and to further quantify the burden of prescription opioid-related morbidity., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

The heavy economic burden of work-related injury/illness falls not only on employers and workers' compensation systems, but increasingly on health care systems, health and disability insurance, social safety net programs, and workers and their families. We present a flow diagram illustrating mechanisms responsible for the financial burden of occupational injury/illness borne by social safety net programs and by workers and their families, due to cost-shifting and gaps in workers' compensation coverage. This flow diagram depicts various pathways leading to coverage gaps that may shift the burden of occupational injury/illness-related health care and disability costs ultimately to workers, particularly the most socioeconomically vulnerable. We describe existing research and important research gaps linked to specific pathways in the flow diagram. This flow diagram was developed to facilitate more detailed and comprehensive research into the financial burden imposed by work-related injury/illness, in order to focus policy efforts where improvement is most needed.

Context: Analyses of prescribing trends using prescription drug monitoring programs (PDMP) are impacted by changes in reporting requirements and in the scheduling of medications by the Drug Enforcement Administration. In 2014, the Drug Enforcement Administration changed the status of tramadol from an unscheduled to a scheduled medication. The addition of tramadol to the PDMP may affect the prevalence of opioid-prescribing metrics and the interpretation of prescribing trends., Objective: The objectives were to (1) examine trends in opioid prescribing in Washington State between 2012 and 2017, (2) assess the potential impact of adding tramadol to PDMP on these trends, and (3) describe challenges in defining and implementing opioid-prescribing metrics., Design: Analysis of quarterly summary statistics of opioid prescribing., Setting: Washington State., Participants: Washington State residents., Main Outcome Measures: The metrics include measures of opioid prescribing overall and by age group, chronic opioid prescribing, high-dose prescribing among those on chronic opioid therapy, prescribing of concurrent opioids and sedatives, days' supply of new opioid prescriptions, and transition from short-term to long-term use of opioids., Results: In Washington, the prevalence of any opioid prescribing, chronic opioid prescribing, high-dose opioid prescribing, and prescribing of concurrent opioids and sedatives declined between 2012 and 2017. The prevalence of opioid prescribing was higher in older than in younger age groups. The addition of tramadol to the Washington PDMP in 2014 affected the observed prevalence of all opioid metrics and of all opioid-prescribing trends. Conclusions about trends in opioid prescribing differ substantially depending on whether tramadol is included or not, particularly in 2014 and 2015., Conclusions: The development of opioid-prescribing metrics is relatively new. There is likely much benefit of standard definitions of opioid metrics at the state and national levels to track important trends and compare progress from state to state.

Purpose: High-risk opioid prescribing is a critical driver of prescription opioid-related morbidity and mortality. This study explored opioid prescribing patterns across urban-rural and economic distress classifications. Secondarily, this study explored the urban-rural distribution of relevant health services, economic factors, and population characteristics., Methods: County-level opioid prescribing metrics were based on quarterly Washington State Prescription Monitoring Program data (2012-2017). Counties were classified using the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties, and Washington State unemployment-based distressed areas. County-level measures from Area Health Resources Files were used to describe the urban-rural continuum., Findings: Persistent economic distress was associated with higher-risk opioid prescribing. The large central metropolitan category had lower-risk opioid prescribing metrics than the other 5 urban-rural categories, which were similar to each other and not ordered by degree of rurality. High-risk prescribing declined over time, without notable trend divergence by either urban-rural or economic distress classifications., Conclusions: The most striking urban-rural differences in opioid prescribing metrics were between large central metropolitan and all other categories; thus, we recommend caution when collapsing urban-rural categories for analysis. Further research is needed regarding geographic and economic patterning of opioid prescribing practices, as well as the dissemination of guidelines and best practices across the urban-rural continuum. Finally, the multiple intertwined burdens faced by rural communities-higher-risk prescribing practices, higher opioid morbidity and mortality rates, and fewer resources for primary care, mental health care, alternative pain treatment, and opioid use disorder treatment-must be addressed as an urgent public health priority., (© 2019 National Rural Health Association.)

Introduction: Opioid use disorder (OUD) is common among people in jail and is effectively treated with medications for OUD (MOUD). People with OUD may have an incomplete or inaccurate understanding of OUD and MOUD, and of how to access care. We evaluated an OUD treatment decision making (TDM) intervention to determine whether the intervention increased MOUD initiation post-release., Methods: We conducted an observational retrospective cohort study of the TDM intervention on initiation of MOUD, individuals with records data indicating confirmed or suspected OUD incarcerated in four eligible jails were eligible to receive the intervention. Time-to-event analyses of the TDM intervention were conducted using Cox proportional hazard modeling with MOUD as the outcome., Results: Cox proportional hazard modeling, with the intervention modeled as having a time-varying effect due to violation of the proportionality assumption, indicated that those receiving the TDM intervention (n = 568) were significantly more likely to initiate MOUD during the first month after release from jail (adjusted hazard ratio 6.27, 95 % C.I. 4.20-9.37), but not in subsequent months (AHR 1.33 95 % C.I. 0.94-1.89), adjusting for demographics, prior MOUD, or felony or gross misdemeanor arrest in the prior year compared to those not receiving the intervention (n = 3174)., Conclusion: The TDM intervention was associated with a significantly higher relative hazard of starting MOUD, specifically during the first month after incarceration. However, a minority of all eligible people received any MOUD. Future research should examine ways to increase initiation on MOUD immediately after (or ideally during) incarceration., (Copyright © 2019 Elsevier B.V. All rights reserved.)

A series of titanium alkoxides ([Ti(OR) 4 ] (OR = OCH(CH 3 ) 2 (OPr i ), OC(CH 3 ) 3 (OBu t ), and OCH 2 C(CH 3 ) 3 (ONep)) were modified with a set of substituted hydroxyl-benzaldehydes [HO-BzA-L x : x = 1, 2-hydroxybenzaldehyde (L = H), 2-hydroxy-3-methoxybenzaldehyde (OMe-3), 5-bromo-2-hydroxybenzaldehyde (Br-5), 2-hydroxy-5-nitrobenzaldehyde (NO 2 -5); x = 2, 3,5-di- tert -butyl-2-hydroxybenzaldehyde (Bu t -3,5), 2-hydroxy-3,5-diiodobenzaldehyde (I-3,5)] in pyridine (py). Instead of the expected simple substitution, each of the HO-BzA-L x modifiers were reduced to their respective diol [(py)(OR) 2 Ti(κ 2 (O,μ-O')(OC 6 H 4 - x (CH 2 O)-2)(L) x ] (OR = OPr i , x = 1, L = H ( 1a ), OMe-3 ( 2a ), Br-5 ( 3a ·py), NO 2 -5 ( 4a ·4py); x = 2, Bu t -3,5 ( 5a ), I-3,5 ( 6a ), ONep; x = 1, L = H ( 1b ), OMe-3 ( 2b ), Br-5 ( 3b ·py), NO 2 -5 ( 4b ); x = 2, Bu t -3,5 ( 5b ), I-3,5 ( 6b ·py)), as identified by single crystal X-ray studies. The 1 H NMR spectral data were complex at room temperature but simplified at high temperatures (70 °C). Diffusion ordered spectroscopy (DOSY) NMR experiments indicated that 2a maintained the dinuclear structure in a solution independent of the temperature, whereas 2b appears to be monomeric over the same temperature range. On the basis of additional NMR studies, the mechanism of the reduction of the HO-BzA-L x to the dioxide ligand was thought to occur by a Meerwein-Pondorf-Verley (MPV) mechanism. The structures of 1a - 6b appear to be the intermediate dioxide products of the MPV reduction, which became "trapped" by the Lewis basic solvate.

Objectives: High-risk opioid-prescribing practices contribute to a national epidemic of opioid-related morbidity and mortality. The objective of this study was to determine whether the adoption of state-level opioid-prescribing guidelines that specify a high-dose threshold is associated with trends in rates of opioid overdose hospitalizations, for prescription opioids, for heroin, and for all opioids., Methods: We identified 3 guideline states (Colorado, Utah, Washington) and 5 comparator states (Arizona, California, Michigan, New Jersey, South Carolina). We used state-level opioid overdose hospitalization data from 2001-2014 for these 8 states. Data were based on the State Inpatient Databases and provided by the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, via HCUPnet. We used negative binomial panel regression to model trends in annual rates of opioid overdose hospitalizations. We used a multiple-baseline difference-in-differences study design to compare postguideline trends with concurrent trends for comparator states., Results: For each guideline state, postguideline trends in rates of prescription opioid and all opioid overdose hospitalizations decreased compared with trends in the comparator states. The mean annual relative percentage decrease ranged from 3.2%-7.5% for trends in rates of prescription opioid overdose hospitalizations and from 5.4%-8.5% for trends in rates of all opioid overdose hospitalizations., Conclusions: These findings provide preliminary evidence that opioid-dosing guidelines may be an effective strategy for combating this public health crisis. Further research is needed to identify the individual effects of opioid-related interventions that occurred during the study period.

Background: Opioid overdose is a major and increasing cause of injury and death. There is an urgent need for interventions to reduce overdose events among high-risk persons., Methods: Adults at elevated risk for opioid overdose involving heroin or pharmaceutical opioids who had been cared for in an emergency department (ED) were randomised to overdose education combined with a brief behavioural intervention and take-home naloxone or usual care. Outcomes included: (1) time to first opioid overdose-related event resulting in medical attention or death using competing risks survival analysis; and (2) ED visit and hospitalisation rates, using negative binomial regression and adjusting for time at risk., Results: During the follow-up period, 24% of the 241 participants had at least one overdose event, 85% had one or more ED visits and 55% had at least one hospitalisation, with no significant differences between intervention and comparison groups. The instantaneous risk of an overdose event was not significantly lower for the intervention group (sub-HR: 0.83; 95% CI 0.49 to 1.40)., Discussion: These null findings may be due in part to the severity of the population in terms of housing insecurity (70% impermanently housed), drug use, unemployment and acute healthcare issues. Given the high overdose and healthcare utilisation rates, more intensive interventions, such as direct referral and provision of housing and opioid agonist treatment medications, may be necessary to have a substantial impact on opioid overdoses for this high-acuity population in acute care settings., Trial Registration Number: NCT0178830; Results., Competing Interests: Competing interests: POC has previously directed National Institutes of Health-funded trials that have received donated study medications from Alkermes (2014–2015) and Gilead (2015–2017)., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Evidence has associated opioid use initiated early in a workers' compensation claim with subsequent disability. In 2013, the Washington State Department of Labor and Industries (DLI) implemented procedures based on new regulations that require improvement in pain and function to approve opioids beyond the acute pain period., Methods: We measured opioid prescriptions between 6 and 12 weeks following injury, an indicator of persistent opioid use. Actuarial data for the association of any opioid use versus no opioid use with development of lost time payments are reported., Results: Prior authorization with hard stops led to a sustained drop in persistent opioid use, from nearly 5% in 2013 to less than 1% in 2017. This reduction was also associated with reversal of the increased lost work time patterns seen from 1999 to 2010., Conclusions: Prior authorization targeted at preventing transition to chronic opioid use can prevent and reverse adverse time loss development that has occurred on a population basis concomitant with the opioid epidemic., (© 2018 Wiley Periodicals, Inc.)

The impact on the morphology nanoceramic materials generated from group 4 metal alkoxides ([M(OR) 4 ]) and the same precursors modified by 6,6'-(((2-hydroxyethyl)azanediyl)bis(methylene))bis(2,4-di- tert-butylphenol) (referred to as H 3 -AM-DBP 2 (1)) was explored. The products isolated from the 1:1 stoichiometric reaction of a series of [M(OR) 4 ] where M = Ti, Zr, or Hf; OR = OCH(CH 3 ) 2 (OPr i ); OC(CH 3 ) 3 (OBu t ); OCH 2 C(CH 3 ) 3 (ONep) with H 3 -AM-DBP 2 proved, by single crystal X-ray diffraction, to be [(ONep)Ti( k 4 ( O,O',O'',N)-AM-DBP 2 )] (2), [(OR)M(μ( O)- k 3 ( O',O'',N)-AM-DBP 2 )] 2 [M = Zr: OR = OPr i , 3·tol; OBu t , 4·tol; ONep, 5·tol; M = Hf: OR = OBu t , 6·tol; ONep, 7·tol]. The product from each system led to a tetradentate AM-DBP 2 ligand and retention of a parent alkoxide ligand. For the monomeric Ti derivative (2), the metal was solved in a trigonal bipyramidal geometry, whereas for the Zr (3-5) and Hf (6, 7) derivatives a symmetric dinuclear complex was formed where the ethoxide moiety of the AM-DBP 2 ligand bridges to the other metal center, generating an octahedral geometry. High quality density functional theory level gas-phase electronic structure calculations on compounds 2-7 using Gaussian 09 were used for meaningful time dependent density functional theory calculations in the interpretation of the UV-vis absorbance spectral data on 2-7. Nanoparticles generated from the solvothermal treatment of the ONep/AM-DBP 2 modified compounds (2, 5, 7) in comparison to their parent [M(ONep) 4 ] were larger and had improved regularity and dispersion of the final ceramic nanomaterials.

In an effort to generate single-source precursors for the production of metal-siloxide (MSiO x ) materials, the tris(trimethylsilyl)silanol (H-SST or H-OSi(SiMe 3 ) 3 (1) ligand was reacted with a series of group 4 and 5 metal alkoxides. The group 4 products were crystallographically characterized as [Ti(SST) 2 (OR) 2 ] (OR = OPr i (2), OBu t (3), ONep (4)); [Ti(SST) 3 (OBu n )] (5); [Zr(SST) 2 (OBu t ) 2 (py)] (6); [Zr(SST) 3 (OR)] (OR = OBu t (7), ONep, (8)); [Hf(SST) 2 (OBu t ) 2 ] (9); and [Hf(SST) 2 (ONep) 2 (py) n ] ( n = 1 (10), n = 2 (10a)) where OPr i = OCH(CH 3 ) 2 , OBu t = OC(CH 3 ) 3 , OBu n = O(CH 2 ) 3 CH 3 , ONep = OCH 2 C(CH 3 ) 3 , py = pyridine. The crystal structures revealed varied SST substitutions for: monomeric Ti species that adopted a tetrahedral ( T-4) geometry; monomeric Zr compounds with coordination that varied from T-4 to trigonal bipyramidal ( TBPY-5); and monomeric Hf complexes isolated in a TBPY-5 geometry. For the group 5 species, the following derivatives were structurally identified as [V(SST) 3 (py) 2 ] (11), [Nb(SST) 3 (OEt) 2 ] (12), [Nb(O)(SST) 3 (py)] (13), 2[H][(Nb(μ-O) 2 (SST)) 6 (μ 6 -O)] (14), [Nb 8 O 10 (OEt) 18 (SST) 2 ·1/5Na 2 O] (15), [Ta(SST)(μ-OEt)(OEt) 3 ] 2 (16), and [Ta(SST) 3 (OEt) 2 ] (17) where OEt = OCH 2 CH 3 . The group 5 monomeric complexes were solved in a TBPY-5 arrangement, whereas the Ta of the dinculear 16 was solved in an octahedral coordination environment. Thermal analyses of these precursors revealed a stepwise loss of ligand, which indicated their potential utility for generating the MSiO x materials. The complexes were thermally processed (350-1100 °C, 4 h, ambient atmosphere), but instead of the desired MSiO x , transmission electron microscopy analyses revealed that fractions of the group 4 and group 5 precursors had formed unusual metal oxide silica architectures.

Objectives: To examine automobile crash risk associated with cognition in older drivers without dementia., Design: Retrospective secondary analysis of longitudinal cohort study., Setting: Our study used data from the Adult Changes in Thought (ACT) Study merged with Washington State crash reports and licensure records. Data were available from 2002 to 2015., Participants: Group Health enrollees from Washington State aged 65 and older with active driver's licenses (N=2,615)., Measurements: Cognitive function was assessed using the Cognitive Abilities Screening Instrument scored using item response theory (CASI-IRT). The study outcome was police-reported motor vehicle crash. We used a negative binomial mixed-effects model with robust standard errors clustered on the individual and considered associations between crash risk, level of cognition, and amount of decline since the previous study visit. Covariates included age, sex, education, alcohol, depression, medical comorbidities, eyesight, hearing, and physical function. Individuals were censored at dementia diagnosis, death, or failure to renew their license., Results: Over an average of 7 years of follow-up, 350 (13%) people had at least one crash. A 1-unit lower CASI-IRT score was associated with a higher adjusted incidence rate ratio of crash of 1.26 (95% confidence interval=1.08-1.51). Beyond level of cognition, amount of cognitive decline between study visits was not associated with crash risk., Conclusion: This study suggests that, in older drivers, poorer performance on the CASI-IRT may be a risk factor for motor vehicle crashes, even in individuals without diagnosed dementia. Further research is needed to understand driving behavior and inform driving decisions for older adults with poor cognitive function., (© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.)

We disclose a [(PhO) 3 P]/NiBr 2 -catalyzed regioselective β,δ-diarylation of unactivated olefins in ketimines with aryl halides and arylzinc reagents. This diarylation proceeds at remote locations to the carbonyl group to afford, after simple H + workup, diversely substituted β,δ-diarylketones that are otherwise difficult to access readily with existing methods. Deuterium-labeling and crossover experiments indicate that diarylation proceeds by ligand-enabled contraction of transient nickellacycles.

Older adults are an active and growing segment of drivers in the United States. We compared the risk of motor vehicle crash among older licensed drivers diagnosed with dementia to crash risk among older licensed drivers without diagnosis of dementia. This retrospective cohort study used data from Group Health (GH), a Washington State health maintenance organization. Research participants were members of GH, aged 65-79 during the study who lived in Washington State from 1999-2009. Participant health records were linked with police-reported crash and licensure records. We estimated the risk of crash for older drivers diagnosed with dementia compared to older drivers without diagnosis of dementia using a Cox proportional hazards model with robust standard errors, accounting for recurrent events (crashes). Multivariable models were adjusted for age, sex, history of alcohol abuse or depression, comorbidities, and medications. There were 29,730 eligible individuals with an active driving license. Approximately 6% were diagnosed with dementia before or during the study. The police-reported crash rate was 14.7 per 1000 driver-years. The adjusted hazard ratio of crash among older drivers with diagnosed dementia was 0.56 (95% CI 0.33, 0.95) compared to those without diagnosed dementia. On-road and simulator-based research showed older adults with dementia demonstrated impaired driving skill and capabilities. The observed lower crash risk in our study may result from protective steps to limit driving among older adults diagnosed with dementia. Future research should examine driving risk reduction strategies at the time of dementia diagnosis and their impact on reducing crash risk., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

A pair of thallium salen derivatives was synthesized and characterized for potential use as monitors (or taggants) or as models for Group 13 complexes for subterranean fluid flows. These precursors were isolated from the reaction of thallium ethoxide with N,N'-bis(3,5-di-tert-butylsalicylidene)-ethylenediamine (H 2 -salo-Bu t ), or N,N'-bis(3,5-di-tert-butylsalicylidene)-1,2-phenylenediamine (H 2 -saloPh-Bu t ). The products were identified by single crystal X-ray diffraction as: [((μ-O) 2 ,κ 1 -(N)(N')salo-Bu t )Tl 2 ] (1) and {[((μ-O) 2 saloPh-Bu t )Tl 2 ][((μ-O) 2 ,κ 1 -(N)(N')saloPh-Bu t )Tl 2 ]} (2). Both structures are similar, wherein each O atom of the salo moiety bridges the two Tl atoms, leading to a TlTl interaction, which is further stabilized by an intramolecular π-bond with neighboring phenyl rings. For 1, an additional TlN interaction was solved for each metal center; whereas, for 2, one of the two molecules in the matrix has a weak TlN interaction but no bonding noted in the other molecule. Both Density Functional Theory (DFT) calculations and variable temperature solution 205 Tl NMR studies of 1 and 2 further confirmed the TlTl interaction. The UV-vis absorbance spectra of these compounds had an absorbance peak at 392 nm for 1 and a broad absorbance peak centered at 469 nm for 2, which were found to be in good agreement with the DFT calculated spectra that were dominated by the singlet state. Fluorescence emission and excitation studies reveal absorptions at 360 and 380 nm for 1 and 2, respectively, which are attributed to the TlTl metal centers. To demonstrate practicality, fluorescence spectra of 1 and 2 were obtained using a handheld 405 nm cw laser pointer and portable spectrometer where compound 1 was found to glow 15 times brighter than compound 2. Only compound 1 was found to survive the simulated deep-well conditions explored, which was attributed to the TlN interaction noted for 1 but not for 2.

A family of magnesium and calcium salen-derivatives was synthesized and characterized for use as subterranean fluid flow monitors. For the Mg complexes, di- n-butyl magnesium ([Mg(Bu n ) 2 ]) was reacted with N, N'-ethylene bis(salicylideneimine) (H 2 -salen), N, N'-bis(salicylidene)-1,2-phenylenediamine (H 2 -saloPh), N, N'-bis(3,5-di- t-butylsalicylidene)-ethylenediamine (H 2 -salo-Bu t ), or N, N'-bis(3,5-di- t-butylsalicylidene)-1,2-phenylenediamine (H 2 -saloPh-Bu t ), and the products were identified by single-crystal X-ray diffraction as [(κ 3 -(O,N,N'),μ-(O')saloPh)(μ-(O),(κ 2 -(N,N'),μ-(O')saloPh) 2 (μ-(O),κ 3 -(N,N',O')saloPh')Mg 4 ]·2tol (1·2tol; saloPh' = an alkyl-modified saloPh derivative generated in situ), [(κ 4 -(O,N,N',O')saloPh)Mg(py) 2 ]·py (2·py), [(κ 4 -(O,N,N',O')salo-Bu t )Mg(py) 2 ] (3), [(κ 4 -(O,N,N',O')saloPh-Bu t )Mg(py) 2 ]·tol (4·tol), and [(κ 3 -(O,N,N'),μ-(O')saloPh-Bu t )Mg] 2 (5), where tol = toluene; py = pyridine. For the Ca species, a calcium amide was independently reacted with H 2 -salo-Bu t and H 2 -saloPh-Bu t to generate the crystallographcially characterized compounds: [(κ 4 -(O,N,N',O')salo-Bu t )Ca(py) 3 ] (6), [(κ 4 -(O,N,N',O')saloPh-Bu t )Ca(py) 3 ]·py (7·py). The bulk powders of these compounds were further characterized by a number of analytical tools, where 2-7 were found to be distinguishable by Fourier transform infrared and resonance Raman spectroscopies. Structural properties obtained from quantum calculations of gas-phase analogues are in good agreement with the single-crystal results. The potential utility of these compounds as taggants for monitoring subterranean fluid flows was demonstrated through a series of experiments to evaluate their stability to high temperature and pressure, interaction with mineral surfaces, and elution behavior from a loaded proppant pack.