A failure of voluntarism: the case of joint health and safety committees in Britain

This paper sets out the history of the attempt to establish voluntary health and safety committees in Britain, their failure and the attempt to legislate for their development. The impact of this legislation is analysed and the paper concludes by presenting a framework, which it is argued, would be developed for analysing the impact of legislation in Britain and in other countries such as New Zealand

Quality of Surface Waters of the United States 1955

This report contains daily minimum and maximum temperature data for Waller Creek at 23rd Street between the months of March and September 1955.The quality-of-water Investigations of the United States Geological Survey are concerned with chemical and physical characteristics of the surface and groundwater supplies of the Nation. Most of the investigations carried on in cooperation with States and other Federal agencies deal with the amounts of matter in solution and in suspension in streams. The records of chemical analysis, suspended sediment, and temperature for surface waters given in this volume serve as a basis for determining the suitability of the waters examined for industrial, agricultural, and domestic uses insofar as such use is affected by the dissolved or suspended mineral matter in the waters. The discharge of a stream and, to a lesser extent, the chemical quality are related to variations in rainfall and other forms of precipitation. In general, lower concentrations of dissolved solids may be expected during the periods of high flow than during periods of low flow. The concentration in some streams may change materially with relatively small variations in flow, whereas for other streams the quality may remain relatively uniform throughout large ranges in discharge. The quantities of suspended sediment carried by streams are also related to discharge, and during flood periods the sediment concentrations in many streams vary over wide ranges. The regular yearly publication of records of chemical analyses, suspended sediment, and water temperature was begun by the Geological Survey in 1941. The annual records prior to 1948 were published in a single volume for the entire country. Beginning in 1948, the records were published in two volumes, and beginning in 1950, in four volumes, covering the drainage basins shown in figure 1. The samples for which data are given were collected from October 1, 1954, to September 30, 1955. Descriptive statements are given for each sampling station for which regular series of chemical analyses, temperature observations, or sediment determinations have been made. These statements include the location of the stream-sampling station, drainage area, length of time for which records are available, extremes of dissolved solids, hardness, sediment loads, water temperature, and other pertinent data. Records of water discharge of the streams at, or near, the sampling point for the sampling period are included in most tables of analyses. The records are arranged by drainage basins, according to Geological Survey practice in reporting records of streamflow. During the year ended September 30, 1955, 160 regular sampling stations on 100 streams for the study of the chemical character of surface waters were maintained by the Geological Survey in the area covered by this volume. Samples were collected less frequently during the year at many other points. Water temperatures were measured daily at 123 of the regular sampling stations. Not all analyses of samples of surface water collected during the year have been included. Single analyses of an incomplete nature generally have been omitted. Also, determinations made on the daily samples before compositing have not been reported. Specific conductance was usually determined on each daily sample, and as noted in the table headings this information is available for reference at the district offices listed under Division of Work, on page 22. Quantities of suspended sediment are reported for 26 stations during the year ending September 30, 1955. The sediment samples were collected one or more times daily at most stations, depending on the rate of flow and changes in stage of the stream. Sediment samples were collected less frequently during the year at many other points. In connection with measurements of sediment discharge, sizes of sediment particles were determined at 25 of the stations. Material which is transported almost in continuous contact with the stream bed and the material that bounces along the bed in short skips or leaps is termed " bedload" and is not considered in this report. All other undissolved fragmental material in transport is termed "suspended sediment" and generally constitutes the major part of the total sediment load. At the present time no reliable routine method has been developed for determining bedload.Waller Creek Working Grou

A failure of voluntarism: the case of joint health and safety committees in Britain

This paper sets out the history of the attempt to establish voluntary health and safety committees in Britain, their failure and the attempt to legislate for their development. The impact of this legislation is analysed and the paper concludes by presenting a framework, which it is argued, would be developed for analysing the impact of legislation in Britain and in other countries such as New Zealand

International comparison of fisheries management with respect to nature conservation

In dit rapport worden enkele voorbeelden besproken van visserijen die zodanig zijn gereguleerd dat geen significante schade wordt aangericht aan het ecosysteem. De leidende vraag is in feite of dergelijke visserijen wel bestaan. Het rapport bespreekt beleidsopties voor een zodanig beheer van visserijen dat de negatieve gevolgen voor het ecosysteem worden beperkt, en beschrijft de rol en de huidige status van systemen voor eco-keurmerken voor visserij, zoals die van de Marine Stewardship Council. Tevens wordt de algemene vraag besproken of er voorbeelden zijn aan te wijzen waarin zelfregulatie door visserijbedrijven heeft bijgedragen aan de bescherming van mariene ecosystemen. Voor de Noordzee worden de mogelijke implicaties van EU-richtlijnen zoals de Vogel- en Habitat-richtlijn en van internationale visserijverdragen besproken. Trefwoorden: duurzame visserij, visserijbeheer, co-management, natuurbehoud, eco-keurmerken, Marine Stewardship Council, EU Habitatrichtlijn, EU Vogelrichtlij

Ontwikkeling van een geïntegreerde kosten-baten analyse methode van multifunctioneel ruimtegebruik in de Noordzee en kustzone

De Noordzee is zowel een ecologisch als sociaal-economisch belangrijk gebied waarbij deze aspecten niet langer als aparte onderdelen kunnen worden beschouwd. Bij de inrichting en gebruik van de Noordzee en kustzone moet rekening worden gehouden met de verschillende belangen en factoren van de gebruikers en is een geïntegreerde aanpak nodig. Om beleidsbeslissingen met betrekking tot het ruimtelijk gebruik van de Noordzee te vereenvoudigen is het ministerie LNV in 2003 gestart met project “Noordzee en kust” (P418). In dit kader werken de leerstoelgroep Milieusysteemanalyse (MSA) van Wageningen Universiteit en Research Centre, Alterra Texel en het LEI samen. In 2003 is een geïntegreerde Kosten-Baten Analyse methode met betrekking tot multifunctioneel ruimtegebruik in het Nederlandse gedeelte van de Noordzee ontwikkeld. Deze methode zal worden verfijnd en getoetst in de resterende tijd van dit onderzoek (2004 tot en met 2006). Het raamwerk dat is ontwikkeld voor dit onderzoek bestaat uit vier onderdelen: i) de definiëring van functies, goederen, diensten en waarden, ii) belangenafweging en conflictanalyse iii) besluitvorming en iv) planning en uitvoeringsfase.In deze eerste fase is het systeem “de Noordzee” beschreven op basis van gebiedskenmerken en ecotopen. Verschillende gebieden in de Noordzee zijn onderzocht waarbij blijkt dat er nog leemtes in kennis zijn die kunnen worden aangevuld, zoals voor bijvoorbeeld de Zeeuwse banken en diepere gaten in de zuidelijke Noordzee. De systeembeschrijving dient als basis voor de eerste stap van het ontwikkelde raamwerk; de functie analyse. In deze eerste fase is ook alvast een eerste inventarisatie gemaakt van de ecologische en sociaal-economische functies van de Noordzee en kustzone. Sommige ecosysteem functies hebben vooral een economisch belang, zoals de visserij, olie-, gas-, en zandwinning, terwijl andere functies meer gerelateerd zijn aan een ecologisch belang zoals de regulatie (nutriënten huishouding) en habitat functies (kraamkamer) of het sociaal-culturele belang (kunst, esthetisch, geschiedenis etc.). Wanneer alle functies en belangen zo goed mogelijk in kaart gebracht zijn kan aan de hand daarvan een maatschappelijke discussie worden gestart om complexe problemen in de Noordzee en kustgebied aan te pakken, waarbij beleidsbeslissingen kunnen worden vereenvoudigd door een meer evenwichtige afweging van de kosten en baten die gepaard gaan met diverse scenario’s.Voor een goed beleid en beheer van de Noordzee en kustgebieden is een maatschappelijk gerichte aanpak nodig waarbij integratie op meerdere niveaus plaatsvindt, namelijk: i) integratie van ecologische, economische en sociale aspecten, ii) integratie tussen wetenschappers, beleidsmaker en burgers, iii) institutionele integratie (zowel verticale beleidsintegratie als horizontale beleidsintegratie (tussen verschillende sectoren)) en iv) een integratie over tijd en ruimte. Communicatie op alle niveaus is daarbij belangrijk om de wederzijdse afhankelijkheid tussen stakeholders zichtbaar te maken. Relevante stakeholders met een belang in de Noordzee zullen worden geïdentificeerd in de volgende fase (2004) van dit onderzoek. Deze groepen zullen worden geïnterviewd om hun ideeën, missies, doelstellingen en belangen te onderzoeken. Op die manier kunnen tegenstrijdige belangen/ conflicten en daarnaast mogelijkheden voor meervoudig ruimtegebruik worden geanalyseerd. Workshops zullen worden gebruikt om een idee te vormen hoe de “consensus building proces” zou moeten worden ontworpen om het beleid en beheer van de Noordzee te faciliteren. Dit project wordt afgerond met een case studie waarmee het ontwikkelde raamwerk zal worden getoetst

Retreatment of hepatitis C non-responsive to Interferon. A placebo controlled randomized trial of Ribavirin monotherapy versus combination therapy with Ribavirin and Interferon in 121 patients in the Benelux [ISRCTN53821378]

BACKGROUND: Evidence based medicine depends on unbiased selection of completed randomized controlled trials. For completeness it is important to publish all trials. This report describes the first large randomised controlled trial where combination therapy was compared to placebo therapy and to ribavirin monotherapy, which has not been published untill now. METHODS: One hundred and twenty one patients with chronic hepatitis C and elevated transaminases who did not respond to previous treatment with standard interferon monotherapy, were included from 16 centers in Belgium, the Netherlands and Luxembourg between 1992 and 1996. Patient poor-response characteristics were: genotype 1 (69%), HCV RNA above 2 × 10(6 )copies/ml (55%) and cirrhosis (38%). Patients were randomized to 6 months combination therapy with interferon alpha-2b (3 MU tiw) and ribavirin (1000–1200 mg / day), 6 months ribavirin monotherapy (1000–1200 mg / day) or 6 months ribavirin placebo. The study was double blinded for the ribavirin / placebo component. One patient did not fit the entry criteria, and 3 did not start. All 117 patients who received at least one dose of treatment were included in the intention to treat analysis. RESULTS: At the end of treatment, HCV RNA was undetectable in 35% of patients on combination therapy and in none of the patients treated with ribavirin monotherapy or placebo. The sustained virological response rate at 6 months after therapy was 15% for patients treated with interferon and ribavirin. During the 6 months treatment period 13% of patients on interferon ribavirin combination therapy, 13% of patients on ribavirin monotherapy and 11% of patients on placebo withdrew due to side effects or noncompliance. At 24 weeks of treatment the mean Hb level was 85% of the baseline value, which means a mean decrease from 9.1 mmol/l to 7.8 mmol/l. The Hb levels at the end of treatment were not significantly different from patients treated with ribavirin monotherapy (p = 0.76). End of treatment WBC was significantly lower in patients treated with combination therapy, compared to ribavirin (p < 0.01) as well as for patients treated with ribavirin monotherapy compared to placebo (p < 0.01). DISCUSSION: This belated report on the only placebo controlled study of interferon ribavirin combination therapy in non responders to standard doses of interferon monotherapy documents the effectiveness, be it limited, of this approach as well as the dynamics of the effects on blood counts

Adverse drug events caused by three high-risk drug–drug interactions in patients admitted to intensive care units:A multicentre retrospective observational study

Aims: Knowledge about adverse drug events caused by drug–drug interactions (DDI-ADEs) is limited. We aimed to provide detailed insights about DDI-ADEs related to three frequent, high-risk potential DDIs (pDDIs) in the critical care setting: pDDIs with international normalized ratio increase (INR+) potential, pDDIs with acute kidney injury (AKI) potential, and pDDIs with QTc prolongation potential. Methods: We extracted routinely collected retrospective data from electronic health records of intensive care units (ICUs) patients (≥18 years), admitted to ten hospitals in the Netherlands between January 2010 and September 2019. We used computerized triggers (e-triggers) to preselect patients with potential DDI-ADEs. Between September 2020 and October 2021, clinical experts conducted a retrospective manual patient chart review on a subset of preselected patients, and assessed causality, severity, preventability, and contribution to ICU length of stay of DDI-ADEs using internationally prevailing standards. Results: In total 85 422 patients with ≥1 pDDI were included. Of these patients, 32 820 (38.4%) have been exposed to one of the three pDDIs. In the exposed group, 1141 (3.5%) patients were preselected using e-triggers. Of 237 patients (21%) assessed, 155 (65.4%) experienced an actual DDI-ADE; 52.9% had severity level of serious or higher, 75.5% were preventable, and 19.3% contributed to a longer ICU length of stay. The positive predictive value was the highest for DDI-INR+ e-trigger (0.76), followed by DDI-AKI e-trigger (0.57). Conclusion: The highly preventable nature and severity of DDI-ADEs, calls for action to optimize ICU patient safety. Use of e-triggers proved to be a promising preselection strategy.</p

Adverse drug events caused by three high-risk drug–drug interactions in patients admitted to intensive care units:A multicentre retrospective observational study

Aims: Knowledge about adverse drug events caused by drug–drug interactions (DDI-ADEs) is limited. We aimed to provide detailed insights about DDI-ADEs related to three frequent, high-risk potential DDIs (pDDIs) in the critical care setting: pDDIs with international normalized ratio increase (INR+) potential, pDDIs with acute kidney injury (AKI) potential, and pDDIs with QTc prolongation potential. Methods: We extracted routinely collected retrospective data from electronic health records of intensive care units (ICUs) patients (≥18 years), admitted to ten hospitals in the Netherlands between January 2010 and September 2019. We used computerized triggers (e-triggers) to preselect patients with potential DDI-ADEs. Between September 2020 and October 2021, clinical experts conducted a retrospective manual patient chart review on a subset of preselected patients, and assessed causality, severity, preventability, and contribution to ICU length of stay of DDI-ADEs using internationally prevailing standards. Results: In total 85 422 patients with ≥1 pDDI were included. Of these patients, 32 820 (38.4%) have been exposed to one of the three pDDIs. In the exposed group, 1141 (3.5%) patients were preselected using e-triggers. Of 237 patients (21%) assessed, 155 (65.4%) experienced an actual DDI-ADE; 52.9% had severity level of serious or higher, 75.5% were preventable, and 19.3% contributed to a longer ICU length of stay. The positive predictive value was the highest for DDI-INR+ e-trigger (0.76), followed by DDI-AKI e-trigger (0.57). Conclusion: The highly preventable nature and severity of DDI-ADEs, calls for action to optimize ICU patient safety. Use of e-triggers proved to be a promising preselection strategy.</p

Adverse drug events caused by three high-risk drug–drug interactions in patients admitted to intensive care units:A multicentre retrospective observational study

Aims: Knowledge about adverse drug events caused by drug–drug interactions (DDI-ADEs) is limited. We aimed to provide detailed insights about DDI-ADEs related to three frequent, high-risk potential DDIs (pDDIs) in the critical care setting: pDDIs with international normalized ratio increase (INR+) potential, pDDIs with acute kidney injury (AKI) potential, and pDDIs with QTc prolongation potential. Methods: We extracted routinely collected retrospective data from electronic health records of intensive care units (ICUs) patients (≥18 years), admitted to ten hospitals in the Netherlands between January 2010 and September 2019. We used computerized triggers (e-triggers) to preselect patients with potential DDI-ADEs. Between September 2020 and October 2021, clinical experts conducted a retrospective manual patient chart review on a subset of preselected patients, and assessed causality, severity, preventability, and contribution to ICU length of stay of DDI-ADEs using internationally prevailing standards. Results: In total 85 422 patients with ≥1 pDDI were included. Of these patients, 32 820 (38.4%) have been exposed to one of the three pDDIs. In the exposed group, 1141 (3.5%) patients were preselected using e-triggers. Of 237 patients (21%) assessed, 155 (65.4%) experienced an actual DDI-ADE; 52.9% had severity level of serious or higher, 75.5% were preventable, and 19.3% contributed to a longer ICU length of stay. The positive predictive value was the highest for DDI-INR+ e-trigger (0.76), followed by DDI-AKI e-trigger (0.57). Conclusion: The highly preventable nature and severity of DDI-ADEs, calls for action to optimize ICU patient safety. Use of e-triggers proved to be a promising preselection strategy.</p

Adverse drug events caused by three high-risk drug–drug interactions in patients admitted to intensive care units:A multicentre retrospective observational study

Aims: Knowledge about adverse drug events caused by drug–drug interactions (DDI-ADEs) is limited. We aimed to provide detailed insights about DDI-ADEs related to three frequent, high-risk potential DDIs (pDDIs) in the critical care setting: pDDIs with international normalized ratio increase (INR+) potential, pDDIs with acute kidney injury (AKI) potential, and pDDIs with QTc prolongation potential. Methods: We extracted routinely collected retrospective data from electronic health records of intensive care units (ICUs) patients (≥18 years), admitted to ten hospitals in the Netherlands between January 2010 and September 2019. We used computerized triggers (e-triggers) to preselect patients with potential DDI-ADEs. Between September 2020 and October 2021, clinical experts conducted a retrospective manual patient chart review on a subset of preselected patients, and assessed causality, severity, preventability, and contribution to ICU length of stay of DDI-ADEs using internationally prevailing standards. Results: In total 85 422 patients with ≥1 pDDI were included. Of these patients, 32 820 (38.4%) have been exposed to one of the three pDDIs. In the exposed group, 1141 (3.5%) patients were preselected using e-triggers. Of 237 patients (21%) assessed, 155 (65.4%) experienced an actual DDI-ADE; 52.9% had severity level of serious or higher, 75.5% were preventable, and 19.3% contributed to a longer ICU length of stay. The positive predictive value was the highest for DDI-INR+ e-trigger (0.76), followed by DDI-AKI e-trigger (0.57). Conclusion: The highly preventable nature and severity of DDI-ADEs, calls for action to optimize ICU patient safety. Use of e-triggers proved to be a promising preselection strategy.</p