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Background Heat related illness (HRI) places a significant burden on the health and safety of working populations and its impacts will likely increase with climate change. The aim of this study was to characterize the demographic and occupational characteristics of Washington workers who suffered from HRI from 2006 to 2017 using workers' compensation claims data. Methods We used Washington workers' compensation data linked to weather station data to identify cases of work‐related HRI. We utilized Occupational Injury and Illness Classification System codes, International Classification of Diseases 9/10 codes, and medical review to identify accepted and rejected Washington State (WA) workers' compensation claims for HRI from 2006 to 2017. We estimated rates of HRI by industry and evaluated patterns by ambient temperature. Results We detected 918 confirmed Washington workers' compensation HRI claims from 2006 to 2017, 654 were accepted and 264 were rejected. Public Administration had the highest third quarter rate (131.3 per 100 000 full time employees [FTE]), followed by Agriculture, Forestry, Fishing, and Hunting (102.6 per 100 000 FTE). The median maximum daytime temperature was below the Washington heat rule threshold for 45% of the accepted HRI claims. Latinos were estimated to be overrepresented in HRI cases. Conclusion The WA heat rule threshold may not be adequately protecting workers and racial disparities are present in occupational HRI. Employers should take additional precautions to prevent HRI depending on the intensity of heat exposure. States without heat rules and with large industry sectors disproportionately affected by HRI should consider regulations to protect outdoor workers in the face of more frequent and extreme heat waves.

A new patient safety curriculum was successfully introduced into a family medicine residency. The curriculum integrates patient safety into residents' daily activities and incorporates input from the disciplines of nursing and pharmacy so as to help build more effective clinical teams and inculcate a culture of safety.

Practice facilitators (PFs) are health care professionals, who assist primary care practices in research and quality improvement activities. Their work goes beyond data collection and feedback and includes practice enhancement methods to facilitate system-level changes. PFs provide a framework for translating research into practice by building relationships, improving communication, facilitating change, and sharing resources in practice-based research networks (PBRNs). Scope/Range of ActivitiesWithin PBRNs, PFs participate most often in externally funded research projects initiated by an academic organization. Although network clinicians may have an active role in the planning and the completion of these projects, the activity of PFs is driven mostly by the study protocols. In these projects, PFs act as research assistants. However, the PF model underscores the importance of relationship building. Relationships developed between the PFs and a group of practices is essential to implement and sustain interventions in primary care. PFs also assist clinicians in local research and QI projects initiated by the practices. Clinicians may develop project ideas on their own, or PFs can help the practices initiate projects based on an assessment of the practice's needs and potential to implement interventions. Project ideas and solutions are often shared with other providers within a PBRN via the PFs (cross-pollination). 4,5 Relationships with PracticesBecause translational research projects often require the re-engineering of the practice, it is espe-

Intranasal administration of naloxone appears to be effective in treatment of opioid overdose when i.v. administration is impossible or undesirable.

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Death from large burn wounds has pushed the development of life-saving techniques to cover and heal these wounds as rapidly as possible, resulting in a variety of tissue engineered skin substitutes available on the market. There remains a paucity of good quality RCTs evaluating the efficacy of skin substitutes, and even fewer studies comparing products to each other. While some products have been used successfully for dermatologic applications and published in the literature, a vast majority of data that we do have on skin substitutes relates to chronic wound management and care of burn patients. Though not specific to our specialty, the use of skin substitutes for these indications can be extrapolated to dermatology. Understanding the composition, advantages/disadvantages, and risk/benefit of each product, as well as the indications for each product's use, facilitates the selection of the appropriate substitute. This review will hopefully provide the information that makes the use of these products feasible for the appropriate defect.