Pro-environmental behaviour is undermined by disgust sensitivity: The case of excessive laundering.

The amount of laundry washed by European consumers has grown excessively for reasons that cannot be explained by demographics alone. Initiatives trying to curb this trend have repeatedly failed. Previous studies have largely overlooked the psychological dimensions of laundering behaviour. In three separate studies we investigate how disgust, shame, cleanliness norms and environmental identity, mediated through a set of preceding behaviours, affect washing frequency. Our results highlight how conflicting psychological goals between disgust sensitivity and pro-environmental identity can undermine willingness to change laundry behaviour. Policy recommendations are suggested, and future research challenges are discussed.

Patient-related Factors Associated with Potentially Unnecessary Transfers for Pediatric Patients with Asthma: A Retrospective Cohort Study.

Background/Objective: Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma. Methods: We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2-17 years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was <24 hours and no advanced services were used, such as respiratory therapy or critical care. Patient-related characteristics were extracted, including age, gender, race/ethnicity, primary language, insurance status, and clinical characteristics. First, we used descriptive statistics to compare necessary vs unnecessary transfers. Second, we used generalized estimating equations accounting for clustering by ED to estimate odds ratios (OR) and identify factors associated with potentially unnecessary transfers. Results: A total of 4,233 pediatric ED patients were transferred with a diagnosis of asthma, including 461 (11%) transfers that met criteria as potentially unnecessary. Median age was 12 years (interquartile range 7-15), and 46% were female. Factors associated with increased odds of potentially unnecessary transfer while controlling for key factors included younger age (eg, 2-5 years, OR 2.0, 95% confidence interval [CI] 1.4-2.9), male gender (OR 1.4, 95% CI 1.1-1.7), and Hispanic ethnicity (OR 1.6, 95% CI 1.2-2.1), while multiple hospitalizations for asthma per year was associated with decreased odds (OR 0.2, 95% CI 0.1-0.4). Conclusion: Several patient-related factors were associated with increased or decreased odds of potentially unnecessary transfers among pediatric patients presenting to the ED with asthma. These factors can be considered in future work to better understand, predict, and reduce unnecessary transfers and their negative consequences.

Freshwater ecotoxicity characterization factors for PMT/vPvM substances.

This study addresses the gap in freshwater ecotoxicological characterization factors (CFs) for Persistent, Mobile, and Toxic (PMT) and Very Persistent and Very Mobile (vPvM) substances. These CFs are vital for integrating the ecotoxicity impacts of these chemicals into life cycle assessments. Our goals are twofold: first, to calculate experimental freshwater CFs for PMT/vPvM substances listed by the German Environment Agency (UBA); second, to compare these CFs with those from the USEtox database. The expanded UBA list includes 343 PMT/vPvM substances, each representing a unique chemical structure, and linked to 474 REACH-registered substances. This study successfully computed CFs for 244 substances, with 107 overlapping the USEtox database and 137 being new. However, ecotoxicity data limitations prevented CF determination for 97 substances. This research enhances our understanding of freshwater CFs for PMT/vPvM substances, covering 72% of UBA's 343 PMT/vPvM substances. Data scarcity remains a significant challenge, which invariably impedes CF calculations. Notably, the disparities observed between CF values in the USEtox database and those derived in this research largely stem from variations in ecotoxicity data. Consequently, this research underscores the dynamic nature of CFs for substances, emphasizing the need for regular updates to ensure their accuracy and relevance.

Eco-toxicological and climate change effects of sludge thermal treatments: Pathways towards zero pollution and negative emissions.

The high moisture content and the potential presence of hazardous organic compounds (HOCs) and metals (HMs) in sewage sludge (SS) pose technical and regulatory challenges for its circular economy valorisation. Thermal treatments are expected to reduce the volume of SS while producing energy and eliminating HOCs. In this study, we integrate quantitative analysis of SS concentration of 12 HMs and 61 HOCs, including organophosphate flame retardants (OPFRs) and per- and poly-fluoroalkyl substances (PFAS), with life-cycle assessment to estimate removal efficiency of pollutants, climate change mitigation benefits and toxicological effects of existing and alternative SS treatments (involving pyrolysis, incineration, and/or anaerobic digestion). Conventional SS treatment leaves between 24 % and 40 % of OPFRs unabated, while almost no degradation occurs for PFAS. Thermal treatments can degrade more than 93% of target OPFRs and 95 % of target PFAS (with the rest released to effluents). The different treatments affect how HMs are emitted across environmental compartments. Conventional treatments also show higher climate change impacts than thermal treatments. Overall, thermal treatments can effectively reduce the HOCs emitted to the environment while delivering negative emissions (from about -56 to -111 kg CO2-eq per tonne of sludge, when pyrolysis is involved) and producing renewable energy from heat integration and valorization.

Association between EMS Workforce Density and Population Health Outcomes in the U.S.

BACKGROUND: The prehospital care provided by emergency medical services (EMS) personnel is a critical component of the public health, public safety, and health care systems in the U.S.; however, the population-level value of EMS care is often overlooked. No studies have examined how the density of EMS personnel relates to population-level health outcomes. Our objectives were to examine the geographic distribution and density of EMS personnel in the U.S.; and quantify the association between EMS personnel density and population-level health outcomes. METHODS: We conducted a cross-sectional evaluation of county-level EMS personnel density using estimates from the National Registry of Emergency Medical Technicians in nine states that require continuous national certification (Alabama, Louisiana, Massachusetts, Minnesota, New Hampshire, North Dakota, South Carolina, Vermont, and Washington, D.C.). Outcomes of interest included life expectancy, all-cause mortality, and cardiac arrest mortality. We used quantile regression models to examine the association between a 10-person increase in EMS personnel density and each outcome at the 10th, 50th (median), and 90th percentiles, controlling for population characteristics and area health resources. RESULTS: There were 356 counties included, with a mean EMS density of 223 EMS personnel per 100,000 population. Density was higher in rural compared to urban counties (247 versus 186 per 100,000 population; p = 0.001). In unadjusted models, there was a significant association between increase in EMS personnel density and an increase in life expectancy at each examined percentile (e.g., 50th percentile, increase of 52.9 days; 95% CI 40.2, 65.5; p < 0.001), decrease in all-cause mortality at each examined percentile, and decrease in cardiac arrest mortality at the 50th and 90th percentiles. These associations were not statistically significant in the adjusted models. CONCLUSIONS: EMS personnel density differs between urban and rural areas, with higher density per population in rural areas. There were no statistically significant associations between EMS density and population-level health outcomes after controlling for population characteristics and other health resources. The best approach to quantifying the community-level value that EMS care may or may not provide remains unclear.

Emergency Medical Services Management of Bronchospasm in the United States: A Cross-Sectional Analysis and Nationwide Quality Assessment.

Background/Objective: Bronchospasm, caused by asthma and other related conditions, is a significant cause of morbidity and mortality commonly managed by emergency medical services (EMS). We aimed to evaluate the quality of prehospital management of bronchospasm by EMS in the US.Methods: The National EMS Information System Public Release Research dataset, a nationwide convenience sample of prehospital patient care report data from 2018 to 2019, was used to capture 9-1-1 activations where patients aged ≥2 years were treated and transported by EMS for suspected bronchospasm. First, we described the extent to which EMS care met eight quality measures identified from available statewide EMS protocols, existing quality measures, and national guidelines. Second, we quantified the extent of risk-standardized agency-level variation in administration of inhaled beta agonists and systemic corticosteroids using logistic regression models, accounting for patient characteristics, severity, and clustering by agencies. Third, we compared rates of completed prehospital interventions between pediatric (age <18 years) versus adult patients using two-sample t-tests.Results: A total of 1,336,988 EMS encounters for suspected bronchospasm met inclusion criteria. Median age of patients was 66 years, with only 4% pediatric; 55% were female. Advanced life support (ALS) units managed 94% of suspected bronchospasm. Respiratory rate (98%) and pulse oximetry (96%) were documented in nearly all cases. Supplemental oxygen was administered to hypoxic patients by 65% of basic life support (BLS) and 73% of ALS units. BLS administered inhaled beta-agonist therapy less than half the time (48%), compared to 77% by ALS. ALS administered inhaled anticholinergic therapy in 38% of cases, and systemic corticosteroids in 19% of cases. Pediatric patients were significantly less likely to receive supplemental oxygen when hypoxic, inhaled beta-agonists, inhaled anticholinergics, or systemic corticosteroids.Conclusions: We found important gaps in recent EMS practice for prehospital care of suspected bronchospasm. We highlight three targets for improvement: inhaled beta-agonist administration by BLS, systemic corticosteroid administration by ALS, and increased interventions for pediatric patients. These findings indicate important areas for research, protocol modification, and quality improvement efforts to improve EMS management of bronchospasm.

Patients who use emergency medical services have greater severity of illness or injury compared to those who present to the emergency department via other means: A retrospective cohort study.

Objective: We aimed to evaluate the differences in characteristics and illness/injury severity among patients who present to the emergency department (ED) via emergency medical services (EMS) compared to patients who present via other means. Methods: We analyzed a nationwide sample of ED visits from the 2015-2019 National Hospital Ambulatory Medical Care Survey. We excluded patients <18 or >92 years old, who eloped or left against medical advice, or who arrived via interfacility transport. Mode of presentation was dichotomized to those presenting to the ED via EMS versus any other mode of transportation. Using the appropriate survey sampling weights, we described patient characteristics and compared measures of illness/injury severity between groups using a multivariable logistic regression model. Results: An unweighted total of 73,397 ED visits, representing a weighted estimate of 528,083,416 ED visits in the United States during 2015-2019, included 18% arriving via EMS and 82% via other means. EMS patients were older, more often male, more often had multiple chronic medical conditions, and less often had private insurance. EMS patients had higher priority triage scores, consumed more resources in the ED, and had longer lengths of stay. Arrival by EMS was associated with higher odds of hospital admission (odds ratio [OR] 2.7, 95% confidence interval [CI] 2.4-2.9) and in-hospital mortality (OR 11.1, 95% CI 7.3-17.2). Conclusions: Patients presenting via EMS had significantly different characteristics and outcomes than those presenting via other means. These important differences should be considered when comparing studies of all ED patients versus those who present via EMS.

Twenty Years After the EMS Research Agenda: Trends in Emergency Medical Services Publications and Research Funding.

STUDY OBJECTIVE: Since its publication in 2001, the National EMS Research Agenda has brought attention to a relative paucity of emergency medical services (EMS)-specific research and has called for an increase in funding and infrastructure to support EMS research. We investigated the trends in EMS-specific publications and National Institutes of Health (NIH)-funded research grants in the 20 years since this landmark publication. METHODS: We performed a structured PubMed search of English-language citations from 2001 to 2020 to identify publications with populations, settings, or topics related to EMS care, education, or operations. Publications in trade journals and studies not involving humans were excluded. We also queried NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) using a similar structured search. Titles, keywords, and abstracts were reviewed. Descriptive statistics were calculated, and nonlinear trends were described using segmented regression models. RESULTS: A total of 183,307 references met the search criteria in PubMed, and 4,281 grants were identified in NIH RePORTER. After removing duplicates, 152,408 titles were screened, with 17,314 (11.5%) included. EMS-related publications increased from 419 in 2001 to 1,788 in 2020, a 327% increase, compared with a 197% increase in total PubMed publications. There was a statistically significant nonlinear (J-shaped) increase in EMS publications after 2007. There were 1,166 funded EMS-related NIH grants, with a 469% increase from 2001 to 2020 compared with an 18% increase in overall NIH awards. CONCLUSION: Although total publications have doubled in the United States over the past 20 years, EMS-specific research has more than tripled and the number of funded EMS research grants has increased nearly 5-fold. Future evaluation should examine the quality of this research and its application to clinical practice.

A retrospective review of out of hospital cardiac arrest at Gillette Stadium: 10 years of experience at a large sports venue.

Introduction: Rates of out-of-hospital cardiac arrest (OHCA) at major sporting events are as high as 0.7 per 100,000 attendees. However, factors contributing to OHCA at mass gatherings have not been well-described. We describe our experience with ten years of medical oversight and OHCA care at a professional football stadium. Methods: We performed a retrospective review of OHCA events between August 2010 and January 2020 at a 65,878-seat football stadium, with a single transporting EMS agency and a single receiving hospital. We analyzed EMS incident reports and matched patients to hospital records for outcome data. Results: A total of 7,767,345 people attended 115 football games during the study period. There were 21 OHCAs (0.27 per 100,000 attendees). Ninety-five percent of OHCAs were witnessed and 71.4% had an initial shockable rhythm, with bystander AED use in 47.6%. Median EMS response time was 2 minutes (IQR 1-6). For 7 patients defibrillated by EMS, time to defibrillation was 4 minutes (IQR 4-11). Return of spontaneous circulation (ROSC) occurred in 71%, with 47% having good 30-day neurologic survival. All patients with an initial rhythm of asystole died. Conclusion: The ROSC rate at our stadium exceeded 70% with almost half surviving with good neurologic outcomes, substantially higher than that reported for the general public. We hope that our experience will provide valuable lessons to other similarly sized stadiums.

Out-of-Hospital Presentation and Management of Asthma and Chronic Obstructive Pulmonary Disease Exacerbations in the United States: A Nationwide Retrospective Cohort Study.

STUDY OBJECTIVE: To describe the demographic, clinical, and emergency medical service (EMS) response characteristics associated with EMS activations for asthma and chronic obstructive pulmonary disease (COPD) exacerbations in the US. METHODS: Using a nationwide set of out-of-hospital patient care report data from 2018 to 2019, we analyzed 9-1-1 EMS activations where asthma/COPD exacerbation was indicated by symptom, impression, or treatment provided. We excluded patients with ages less than 2 years or unknown, nonemergency transports, and encounters with any indication of anaphylaxis. Demographic, clinical, and EMS response characteristics were described for pediatric and adult patients with asthma/COPD exacerbations. RESULTS: A total of 1,336,988 asthma/COPD exacerbations were included, comprising 5% of qualifying 9-1-1 scene activations from 2018 to 2019. Most patients were adults (96%). Most adult patients were female (55%), whereas most pediatric patients were male (58%). Most activations occurred in urban settings (82%), particularly in pediatric patients (90%). Most asthma/COPD exacerbations were managed by advanced life support units (94%). Inhaled bronchodilators and systemic corticosteroid therapy were administered to 75% and 14% of all patients, respectively. Adults more often had oxygen saturation <92% (43% vs 20% of pediatric patients) and were more often treated with assisted ventilation (9% vs 1%). CONCLUSION: In this large nationwide sample of 9-1-1 activations treated and transported by EMS, 5% were for asthma/COPD exacerbation. Future work should focus on evidence-based standardization of EMS protocols and practice for asthma/COPD exacerbations to improve the quality of EMS care.

Differences in Out-of-Hospital Cardiac Arrest Management and Outcomes across Urban, Suburban, and Rural Settings.

BACKGROUND: Rural prehospital care settings are underrepresented in the out-of-hospital cardiac arrest (OHCA) literature. This study aimed to describe treatment patterns and the odds of a favorable patient outcome (e.g., return of spontaneous circulation (ROSC) or being presumptively alive at the end of the incident) among rural OHCA patients in the U.S. METHODS: Using the 2018 National Emergency Medical Services Informational System (NEMSIS) dataset, we analyzed OHCA incidents where an emergency medical services (EMS) unit provided cardiopulmonary resuscitation (CPR) and either terminated the resuscitation or completed transport. We excluded traumatic injuries, pediatric patients, and incidents with response time >60 minutes. The primary outcome was ROSC at any time during the EMS incident. The secondary outcome was a binary end-of-event indicator previously described for use in NEMSIS to estimate longer-term outcomes. Multivariable logistic regression was performed for each outcome measure comparing rural, suburban, and urban settings while controlling for key factors. RESULTS: A total of 64,489 OHCA incidents were included, with 5,601 (8.9%) in rural settings. Among the full sample of OHCA incidents, ROSC was achieved in 20,578 (33.6%) cases, including 29.2% in rural settings and 34.1% in urban or suburban settings (p < 0.001). Advanced life support units responded to 95.3% of all calls, and a greater proportion of rural OHCA incidents were managed by basic life support units (7.4% vs. 4.2%, p < 0.001). Rural OHCA incidents had longer response times (7.5 vs. 5.9 minutes, p < 0.001), and rural patients were less likely to receive epinephrine (69.3% vs. 73.3%, p < 0.001). Further, EMS clinicians in rural areas were more likely to use mechanical CPR (29.5% vs. 27.6%, p < 0.01) and were less likely to perform advanced airway management (48.5% vs. 54.2%, p < 0.001). Rural patients had lower odds of achieving ROSC than urban patients after controlling for other factors (OR 0.81, 95% CI: 0.75-0.87). Rural patients also had lower odds of having a positive end-of-event outcome (i.e., presumptively alive) after controlling for other factors (OR 0.86, 95% CI: 0.79-0.93). CONCLUSION: In this national sample of EMS-treated OHCAs, rural patients had lower odds of a favorable outcome (e.g., ROSC or presumptively alive) compared to those in urban settings.

Prehospital care for traumatic cardiac arrest in the US: A cross-sectional analysis and call for a national guideline.

AIM: We describe emergency medical services (EMS) protocols and prehospital practice patterns related to traumatic cardiac arrest (TCA) management in the U.S. METHODS: We examined EMS management of TCA by 1) assessing variability in recommended treatments in state EMS protocols for TCA and 2) analyzing EMS care using a nationwide sample of EMS activations. We included EMS activations involving TCA in adult (≥18 years) patients where resuscitation was attempted by EMS. Descriptive statistics for recommended and actual treatments were calculated and compared between blunt and penetrating trauma using χ2 and independent 2-group Mann-Whitney U tests. RESULTS: There were 35 state EMS protocols publicly available for review, of which 16 (45.7%) had a specific TCA protocol and 17 (48.5%) had a specific termination of resuscitation protocol for TCA. Recommended treatments varied. We then analyzed 9,565 EMS activations involving TCA (79.1% blunt, 20.9% penetrating). Most activations (93%) were managed by advanced life support. Return of spontaneous circulation was achieved in 25.5% of activations, and resuscitation was terminated by EMS in 26.4% of activations. Median prehospital scene time was 16.4 minutes; scene time was shorter for penetrating mechanisms than blunt (12.0 vs 17.0 min, p < 0.001). Endotracheal intubation was performed in 32.0% of activations, vascular access obtained in 66.6%, crystalloid fluids administered in 28.8%, and adrenaline administered in 60.1%. CONCLUSION: Actual and recommended approaches to EMS treatment of TCA vary nationally. These variations in protocols and treatments highlight the need for a standardized approach to prehospital management of TCA in the U.S.

Prior Knowledge for Predictive Modeling: The Case of Acute Aquatic Toxicity.

Early assessment of the potential impact of chemicals on health and the environment requires toxicological properties of the molecules. Predictive modeling is often used to estimate the property values in silico from pre-existing experimental data, which is often scarce and uncertain. One of the ways to advance the predictive modeling procedure might be the use of knowledge existing in the field. Scientific publications contain a vast amount of knowledge. However, the amount of manual work required to process the enormous volumes of information gathered in scientific articles might hinder its utilization. This work explores the opportunity of semiautomated knowledge extraction from scientific papers and investigates a few potential ways of its use for predictive modeling. The knowledge extraction and predictive modeling are applied to the field of acute aquatic toxicity. Acute aquatic toxicity is an important parameter of the safety assessment of chemicals. The extensive amount of diverse information existing in the field makes acute aquatic toxicity an attractive area for investigation of knowledge use for predictive modeling. The work demonstrates that the knowledge collection and classification procedure could be useful in hybrid modeling studies concerning the model and predictor selection, addressing data gaps, and evaluation of models' performance.

Trends in demographic and employment characteristics of US emergency medical technicians and paramedics, 2011-2019.

Background: Describing the US emergency medical services workforce is important to understand gaps in recruitment and retention and inform efforts to improve diversity. Our objective was to describe the characteristics and temporal trends of emergency medical technicians (EMTs) and paramedics in the United States. Methods: We performed a repeated cross-sectional evaluation of US Census Bureau's American Community Survey 1-year Public Use Microdata Sample data sets from 2011-2019. We included respondents working as an EMT or paramedic. Survey-weighted descriptive statistics of demographic and employment characteristics were calculated. Trend analysis was conducted using joinpoint regression to estimate slope and annual percent change (APC). Results: The total estimated number of EMTs and paramedics in the United States increased from 216,310 (95%CI 204,957-227,663) in 2011 to 289,830 (95%CI 276,918-302,743) in 2019 (APC 3.0%; 95%CI 1.4%, 4.7%). There was a slight increase in the proportion of females (2011, 31%; 2019, 35%). There was a significant decrease in proportion of non-Hispanic whites (2011, 80%; 2019, 72%; APC -1.5%; 95%CI -2.0%, -0.9%) with concurrent increases in other racial/ethnic groups (e.g., Hispanics, 2011, 10%; 2019, 13%). About half worked >40 hours per week, with little change over time. Between 15% and 18% lived and worked in different states, and about 40% traveled ≥30 minutes to their workplace. Conclusions: The number of EMTs and paramedics actively working in EMS as their primary paid occupation has increased over time. However, there have been only modest changes in their demographic diversity.

Prospective environmental risk screening of seven advanced materials based on production volumes and aquatic ecotoxicity.

The number and volume of advanced materials being manufactured is increasing. In order to mitigate future impacts from such materials, assessment methods that can provide early indications of potential environmental risk are required. This paper presents a further development and testing of an environmental risk screening method based on two proxy measures: aquatic ecotoxicity and global annual production volumes. In addition to considering current production volumes, this further developed method considers potential future production volumes, thereby enabling prospective environmental risk screening. The proxy measures are applied to seven advanced materials: graphene, graphene oxide, nanocellulose, nanodiamond, quantum dots, nano-sized molybdenum disulfide, and MXenes. Only MXenes show high aquatic ecotoxicity, though the number of test results is still very limited. While current production volumes are relatively modest for most materials, several of the materials (graphene, graphene oxide, nanocellulose, nano-sized molybdenum disulfide, and MXenes) have the potential to become high-volume materials in the future. For MXenes, with both high aquatic ecotoxicity and high potential future production volumes, more detailed environmental risk assessments should be considered. For the other materials with high potential future production volumes, the recommendation is to continuously monitor their aquatic ecotoxicity data. Based on the application of the proxy measures combined with future scenarios for production volumes, we recommend this environmental risk screening method be used in the early development of advanced materials to prioritize which advanced materials should be subject to more detailed environmental assessments.

An Outdoor Aging Study to Investigate the Release of Per- And Polyfluoroalkyl Substances (PFAS) from Functional Textiles.

The emission of per- and polyfluoroalkyl substances (PFAS) from functional textiles was investigated via an outdoor weathering experiment in Sydney, Australia. Polyamide (PA) textile fabrics treated with different water-repellent, side-chain fluorinated polymers (SFPs) were exposed on a rooftop to multiple natural stressors, including direct sunlight, precipitation, wind, and heat for 6-months. After weathering, additional stress was applied to the fabrics through abrasion and washing. Textile characterization using a multiplatform analytical approach revealed loss of both PFAS-containing textile fragments (e.g., microfibers) as well as formation and loss of low molecular weight PFAS, both of which occurred throughout weathering. These changes were accompanied by a loss of color and water repellency of the textile. The potential formation of perfluoroalkyl acids (PFAAs) from mobile residuals was quantified by oxidative conversion of extracts from unweathered textiles. Each SFP-textile finish emitted a distinct PFAA pattern following weathering, and in some cases the concentrations exceeded regulatory limits for textiles. In addition to transformation of residual low molecular weight PFAA-precursors, release of polymeric PFAS from degradation and loss of textile fibers/particles contributed to overall PFAS emissions during weathering.

Disparity in prehospital scene time for geriatric trauma patients.

BACKGROUND: Geriatric patients face disparities in prehospital trauma care. We hypothesized that geriatric trauma patients are more likely to experience prolonged prehospital scene time than younger adults. METHODS: Retrospective analysis of the 2017 National Emergency Medical Services Information System. Patients who met anatomic or physiologic trauma criteria based on national triage guidelines were included (n = 16,356). Geriatric patients (age≥65, n = 3594) were compared to younger adults (age 18-64). The primary outcome was prolonged scene time (>10 min). Multivariable logistic regression was performed, controlling for patient demographics, on-scene treatments, and injury severity. RESULTS: Geriatric patients were more likely to experience prolonged scene time than younger adults after controlling for other factors (OR 1.78, 95% CI 1.57-2.04, p < 0.001). The likelihood of prolonged scene time reached OR 2.29 (95% CI 1.85-2.84) for patients age 70-79 and OR 2.66 (95% CI 2.07-3.42) for patients age 80-89, relative to age 18-29. CONCLUSIONS: Geriatric trauma patients are more likely than younger adults to have prolonged prehospital scene time. This disparity may be caused by delayed recognition of injury severity or age-related cognitive biases.

Gender differences in dermatologist practice locations in the United States: A cross-sectional analysis of current gender gaps.

BACKGROUND: The percentage of female dermatologists has increased from 6.9% in 1970 to 48.9% in 2017. Despite the changing gender composition of the dermatologist workforce, it is unknown whether there are gender-based differences in dermatology practice locations. OBJECTIVE: This study aimed to characterize gender-based differences in dermatology practice locations across the United States. METHODS: A cross-sectional study of all dermatologists in the 2020 Centers for Medicare and Medicaid Services Physician Compare Database was performed. The number of self-identified female dermatologists and total dermatologists in each county and state was tabulated, and Spearman's correlation coefficients between county-level demographic and socioeconomic characteristics and female practices were calculated. RESULTS: Among 11,911 dermatologists, 5945 (49.9%) self-identified as female and 5966 (50.1%) as male. Of the 1052 counties with a dermatologist, 291 (27.7%) had no female dermatologist and 149 (14.2%) had no male dermatologist. The percentage of female dermatologists in each state ranged from 18.4% to 62.2%. Female dermatologists practiced more in areas with a higher percentage of democratic voters (r = +0.22) and higher median household income (r = +0.18), and less in rural counties (r = -0.18) or counties with higher uninsured rates (r = -0.11). CONCLUSION: Female dermatologists remain significantly underrepresented in some regions in the United States, particularly in the Mountain states and rural counties. As women continue entering the dermatologist workforce, these results can inform workforce planning strategies to improve the distribution and accessibility of dermatologists across the United States.