A New Social Contract for Governing Industrial Risk in the Community

Despite extensive regulation of hazardous industrial activities, residents of many communities that host these activities fear risks to their health and safety and suffer impacts that degrade the local environment. The concept of a New Social Contract (NSC) is presented as a supplement to regulation. It would involve company-community negotiation of an agreement, either enforceable or trust based, that provides company commitments to address the local risks and impacts. The concept is then examined with reference to experience with the negotiation of good neighbor agreements and the corporate social responsibility movement, and followed by discussion of the negotiation process for securing company commitments and implementation issues. Recommendations based on best practices and lessons learned from relevant experience are then presented for optimal use of the NSC concept

The Social Control of Science and Technology

Science and technology increasingly work changes in the complex matrix of society. These changes pervade our ecological systems and our physical and psychic health. Less perceptibly, they pervade our culture, our values, and our value based institutions such as the law. In turn, our values and institutions shape the progress and utilization of science and technology. As we know, science and technology have provided society with enormous material benefits and a higher standard of living and health. But we now realize that this process has been accompanied by alarming rates of resource consumption and many new hazards to ecological systems and health. Social response to these unexpected problems has been of a remedial nature - e.g., how to diminish pollution through regulation and technology. But it must be repeated that our values and institutions shape the progress and use of science and technology, and therefore the fundamental social response must be of a preventative or a priori nature to the extent that this is possible. This important task can be described as the need to formulate coherent and humane social controls on science and technology

Prone position: Does it help with acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO)?

Introduction: Lung protective ventilation therapy with low tidal volume-high PEEP is the standard treatment for the patients with acute respiratory distress syndrome (ARDS). Oscillators are occasionally used for salvage ventilation in cases where poor compliance restricts the use of traditional ventilation with ARDS. In addition to ventilator therapy, prone positioning has been used to improve oxygenation. We presented a challenging case of ARDS, which failed medical management extracorporeal membrane oxygenation (ECMO) support and oscillatory ventilation. Prone positioning was initiated which improved oxygenation, respiratory compliance and posterior atelectasis. Case presentation: A 41-year-old morbid obese female developed ARDS due to influenza pneumonia. The patient remained hypoxic despite optimum medical and ventilator management and required veno-venous extracorporeal membrane oxygenation (VV ECMO). CT scan of the chest showed ARDS with posterior consolidation. Despite ARDSnet ventilation support, antiviral therapy and ECMO support, there was no clinical improvement. High frequency oscillatory ventilation was initiated on ECMO day #13, which resulted in no respiratory improvement over the next 5 days. On ECMO day #18, the patient was placed on a Rotaprone? bed Therapy, utilizing a proning strategy of 16 hours a day. The clinical improvements observed were resolving of the consolidation on CXR, improvements in ventilatory parameters and decreased oxygen requirements. The patient was successfully weaned off ECMO on POD#25 (8 days post prone bed). Conclusions: Prone position improved oxygen saturation and pulmonary compliance in severe ARDS requiring ECMO and it might facilitate early weaning

Systemic inflammatory response syndrome (SIRS) after extracorporeal membrane oxygenation (ECMO): Incidence, risks and survivals.

INTRODUCTION: Systemic inflammatory response syndrome (SIRS) is frequently observed after extracorporeal membrane oxygenation (ECMO) decannulation; however, these issues have not been investigated well in the past. METHODS: Retrospective chart review was performed to identify post-ECMO SIRS phenomenon, defined by exhibiting 2/3 of the following criteria: fever, leukocytosis, and escalation of vasopressors. The patients were divided into 2 groups: patients with documented infections (Group I) and patients with true SIRS (Group TS) without any evidence of infection. Survival and pre-, intra- and post-ECMO risk factors were analyzed. RESULTS: Among 62 ECMO survivors, 37 (60%) patients developed the post-ECMO SIRS phenomenon, including Group I (n = 22) and Group TS (n = 15). The 30-day survival rate of Group I and TS was 77% and 100%, respectively (p = 0.047), although risk factors were identical. CONCLUSIONS: SIRS phenomenon after ECMO decannulation commonly occurs. Differentiating between the similar clinical presentations of SIRS and infection is important and will impact clinical outcomes

Radiation from Nuclear Power Plants: The Need for Congressional Directives

Congress often responds to a complex problem by empowering an independent regulatory agency to enforce its legislative will. Acknowledging its own lack of knowledge and time, Congress gives the agency a measure of freedom to modify the legal requirements to fit a variety of circumstances that the legislature could not foresee. Ordinarily Congress restrains this autonomy by prescribing general criteria that the agency must consider and objectives that must be met.\u27 These provisions enable Congress to measure the agency\u27s progress and make necessary changes in the law. In addition, competition from other bureaus forces the agency to act vigorously or face a loss of prestige. But Congress did not follow its normal practice in enacting the provisions governing radioactive emissions from nuclear power plants. Instead, it permitted the Atomic Energy Commission (AEC) to add protective conditions to power plant licenses whenever the agency felt that they would be appropriate. 2 Criteria and goals for public exposure to power plant radiation were left to the agency\u27s planners. Moreover, Congress granted other agencies authority that logically extends to radioactive discharges, but neither explicitly sanctioned competitive efforts nor provided for interagency cooperation with the AEC. Congress may have been reluctant to clarify its desires while the federal government continued to promote nuclear power in an effort to recoup some of its capital investment in atomic weapons research and gaseous diffusion plants. Yet the end of official optimism implicit in the division of the AEC into research and regulatory branches 3 has not eliminated the uncertainty. This article explores the consequences of uncontrolled congressional delegation of authority to the AEC\u27s successor, the Nuclear Regulatory Commission (NRC), and recommends ways of curbing agency discretion that could better guard the public health from the risks imposed by ionizing radiation. Section I discusses the potential role of the Environmental Protection Agency and state agencies in the regulation of radioactive discharges. It criticizes the congressional indecision that led to the restrictive judicial doctrines of federal and administrative preemption, but suggests that the EPA and the states still retain sufficient authority to adopt standards that complement the NRC\u27s requirements. Section II questions the usefulness of the NRC\u27s cost-benefit balancing test that must justify emission standards before they are imposed. It shows the practical failings of such analyses and advises Congress to reclaim its power to set standards according to a representative assessment of acceptable risk. Once Congress makes these social choices, the NRC can apply cost-effectiveness to select the best method of meeting the congressional standards

Environmental Decision-Making and Facilities Siting

Facility siting is today a highly complex process involving developers, interest groups and numerous authorities at all levels of government. Measured in terms of costs and time, the process is inefficient. Measured in terms of environmental quality indicators, the process is largely ineffective in ensuring the appropriate siting and design decisions. Each of the numerous Federal, state and local authorities involved in the process in turn applies its narrowly drawn criteria to its permit and other review procedures—to accomplish its limited objectives

LMO\u27s: Treasure Chest or Pandora\u27s Box

Biotechnology is beginning to trans- A form agriculture across the globe. After thousands of years of traditional plant and animal breeding, and centuries of mechanization and chemical application, genetic research has opened a Pandora\u27s box of living modified organisms (LMOs) designed to improve the productivity and efficiency of commercial agriculture. A multitude of transgenic crops and animals is now being introduced into commerce by biotechnology companies, and b nations are puzzling out how to appropriate the benefits and manage the risks. American biotechnology companies and agencies are the leading proponents of using LMOs. They claim that two decades of costly and careful research and several years of field testing in the United States prove that the LMOs being offered are a safe and effective means of improving productivity, reducing dependency on toxic chemicals, preventing environmental and health hazards, enhancing nutrition, achieving a reliable food supply for burgeoning populations in poorer countries, and promoting sustainable growth

Genetic Testing for Susceptability to Disease from Exposure to Toxic Chemicals: Implications for Public and Worker Health Policies

The Environmental Genome Program intends to identify susceptibility genes that would indicate if a person is more vulnerable to cancer or other disease as a result of exposure to certain chemicals in the workplace, the environment, foods, or other products. Research findings and the capability to test persons for such genes are likely to impugn and challenge health policies and regulatory programs that do not take genetic susceptibility into account when conferring health benefits and restricting chemical exposures. This article focuses on the Occupational Safety and Health Administration (OSHA) and discusses four options available to this agency for protecting genetically susceptible workers and the issues involved in designing and implementing each option. The options involve amending each workplace chemical standard to incorporate genetic testing in a medically supervised program akin to OSHA\u27s Lead Standard, generic revision of all standards so they are sufficiently stringent to protect susceptible workers, requiring information dissemination to prompt management and workforce initiatives, and incorporating genetic susceptibility in holding employers accountable to OSHA\u27s general duty clause