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The emergency department (ED) is at the forefront of the chemical, biological, radiological, and nuclear (CBRN) response. This study adopted a multilevel systems approach using the human factors/ergonomics (HFE) method of hierarchical task analysis (HTA) with document analyses of CBRN plans to represent work‐as‐Imagined. Work‐as‐imagined was compared with data from semistructured interviews using prompt cards for CBRN scenarios (n = 57) representing work‐as‐done. The aim was to provide methodological evidence for the use of HTA with an empirical synthesis of the ED in response to CBRN events. HTA was the preferred systems mapping tool because it aligns with a systems thinking approach, allows multiple‐level comparisons, highlights variability, and has an established usability track record. This study demonstrates the usability of HTA in the context of the ED responding to a CBRN event. The findings for core CBRN concepts included (1) liaise and communicate, (2) isolate and contain, and (3) personal protective equipment. [ABSTRACT FROM AUTHOR]

To investigate differences in the safety behaviours of distracted and non-distracted pedestrians crossing roads, an unobtrusive observational study was conducted in Leicestershire, UK. Video recordings were taken of 1409 pedestrians crossing roads at controlled and uncontrolled crossing sites, both on a university campus and in urbanised town centre locations. On average, 42% of pedestrians were visibly distracted while crossing, and distracted pedestrians demonstrated significantly fewer safety behaviours than non-distracted pedestrians. They generally took longer to cross the road and made fewer looks towards the traffic environment, particularly at controlled crossings. Of all distraction activities, talking to another pedestrian had the most negative impact on safety behaviours. The findings highlight areas requiring further investigation, including distraction behaviours such as engaging with other pedestrians and supervising children. The results also identify that controlled crossings may benefit from targeted interventions to improve pedestrian safety. [ABSTRACT FROM AUTHOR]

Background: Peripheral hearing impairment has been proposed as a risk factor for dementia. However, the relationship between hearing ability, neurodegeneration and cognitive decline, and the extent to which pathological processes associated with increased risk of specific causes of dementia, such as β‐amyloid and small vessel disease, influence these relationships, is unclear. Method: Data were analysed from 287 cognitively normal adults born in the same week of 1946 who underwent pure tone audiometry testing at baseline (mean age = 70.6 years), with cognitive assessment and brain imaging at baseline and at follow‐up on average 2.4 years later. Peripheral hearing impairment was defined as a pure tone average of greater than 25 decibels in the best hearing ear. Rates of change for whole brain, hippocampal and ventricle volume were estimated from structural MRI using the Boundary Shift Integral. Cognition was assessed using the Pre‐clinical Alzheimer's Cognitive Composite. Regression models were performed to evaluate how baseline hearing impairment associated with subsequent brain atrophy and cognitive decline after adjustment for a range of variables including baseline β‐amyloid deposition (assessed using florbetapir‐PET) and baseline small vessel disease burden (estimated using white matter hyperintensity volume). Results: 111 out of 287 participants were defined as having peripheral hearing impairment. Hearing impaired individuals demonstrated faster rates of whole brain atrophy (p = 0.031 – figure/table 1) compared with those with normal hearing. Peripheral hearing impairment did not predict change in PACC performance, but there was evidence of an interaction between hearing impairment and whole brain atrophy rates in terms of effect on change in PACC performance. Specifically, faster rates of whole brain atrophy predicted greater cognitive decline in participants with hearing impairment (p = 0.004), whilst there was no evidence of an association between cognitive change and atrophy in participants with preserved hearing (figure/table 2). There was no evidence that β‐amyloid deposition or white matter hyperintensity volume modified these relationships. Conclusion: We present evidence of associations between peripheral hearing ability at age 70, brain atrophy and cognitive decline independent of β‐amyloid and small vessel disease, suggesting hearing may associate with brain health via mechanisms distinct from those typically implicated in pre‐clinical Alzheimer's disease and vascular cognitive impairment. [ABSTRACT FROM AUTHOR]

Bus travel is relatively safe: however there remains a lack of understanding of passenger injury incidents onboard buses. The objective of this study was to understand more about onboard passenger incidents to help inform injury mitigation. The UK national STATS19 data and Transport for London bus incident data (IRIS) were used to determine the size of the problem in Greater London. Other data including onboard incident reports from two bus operators and CCTV footage of 70 incidents were used to understand passenger injury in more depth and identify common themes and challenges. The STATS19 and IRIS analysis showed that there was a difference between nationally reported bus incidents compared to locally reported bus incidents. Non-collision incidents are prevalent in the data suggesting there is a large problem to tackle. The CCTV and bus incident data identified braking to be the single largest problem in onboard bus passenger injury incidents. Inconsistent reporting of passenger incidents and injury descriptions make it difficult to identify injury patterns and trends. Areas on the bus appear to contribute to higher injury incidents namely those seats facing and closest to the wheelchair area. Other challenges relating to expected passenger and driver behaviors were noted where blame for the incident and outcome can be attributed to both parties. This combined analysis of incident reports and CCTV footage has enabled a better understanding of the events leading to on-board passenger injury incidents. Preventing harsh braking would appear to be the most effective way of reducing passenger injuries. Additionally improved data collection would assist both transport authorities and bus operators to identify and monitor the effect of bus safety improvements. [ABSTRACT FROM AUTHOR]