The corporate quest for zero accidents: A case study into the response to safety transgressions in the industrial sector

Since the 1990s, the idea that accidents should be reduced to zero is gaining growing acclaim in the fields of road safety and occupational safety and health. As most of the literature on this so-called Zero Accident Vision (ZAV) deals exclusively with its application to road safety, which is a public sector responsibility, there is a need to learn more about the way it is implemented by private companies. This paper reports on a case study into the zero accident approach followed by steel company Tata Steel IJmuiden (the Netherlands). The study suggests that private sector advocates of the ZAV, unlike their public sector counterparts, tend to view safety aspirations and economic considerations as mutually reinforcing. However, it is shown that this harmony model does not entirely hold in practice. The findings also highlight another discrepancy. Characteristic of the ZAV is a systems-theoretic focus on identifying root causes of unsafe situations rather than on individual error and blame. Yet employee behavior appears to be a major target for Tata’s safety policy and several managers insist on punishing unsafe behavior. Paradoxically, this punitive tendency seems partly stimulated by and at the same time could hinder the very ambition of eradicating all accidents

Serum Neurofilament Light Association With Progression in Natalizumab-Treated Patients With Relapsing-Remitting Multiple Sclerosis

OBJECTIVE: The objective of this study was to investigate the potential of serum neurofilament light (NfL) to reflect or predict progression mostly independent of acute inflammatory disease activity in patients with relapsing remitting multiple sclerosis (RRMS) treated with natalizumab. METHODS: Patients were selected from a prospective observational cohort study initiated in 2006 at the VU University Medical Center Amsterdam, The Netherlands, including patients with RRMS treated with natalizumab. Selection criteria included an age of 18 years or older and a minimum follow-up of 3 years from natalizumab initiation. Clinical and MRI assessments were performedon a yearly basis, and serum NfL was measured at 5 time-points during the follow-up, including on the day of natalizumab initiation (baseline), 3 months, 1 year and 2 years after natalizumab initiation, and on last follow-up visit. Using general linear regression models, we compared the longitudinal dynamics of NfL between patients with and without confirmed EDSS progression between year 1 visit and last follow-up, and between individuals with and without EDSS+ progression, a composite endpoint including the EDSS, 9 hole peg test and timed 25 foot-walk. RESULTS: Eighty-nine natalizumab-treated patients with RRMS were included. Median follow-up time was 5.2 years (IQR 4.3-6.7, range 3.0-11.0) after natalizumab initiation, mean age at time of natalizumab initiation was 36.9 (SD: 8.5), and median disease duration was 7.4 years (IQR 3.8-12.1). Between year 1 and the last follow-up, 28/89 (31.5%) individuals showed confirmed EDSS progression. Data for the EDSS+ endpoint was available for 73 out of the 89 patients and 35/73 (47.9%) showed confirmed EDSS+ progression.We observed a significant reduction in NfL levels 3 months after natalizumab initiation, which reached its nadir of close to 50% of baseline levels 1 year after treatment initiation. We found no difference in the longitudinal dynamics of NfL in progressors versus non-progressors. NfL levels at baseline and 1 year after natalizumab initiation did not predict progression at last follow-up. DISCUSSION: In our cohort of natalizumab-treated patients with RRMS, NfL fails to capture or predict progression that occurs largely independently of clinical or radiological signs of acute focal inflammatory disease activity. Additional biomarkers may thus be needed to monitor progression in these patients. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that serum NfL levels are not associated with disease progression in natalizumab-treated patients with RRMS

Kappa free light chains is a valid tool in the diagnostics of MS: A large multicenter study

To validate kappa free light chain (KFLC) and lambda free light chain (LFLC) indices as a diagnostic biomarker in multiple sclerosis (MS).We performed a multicenter study including 745 patients from 18 centers (219 controls and 526 clinically isolated syndrome (CIS)/MS patients) with a known oligoclonal IgG band (OCB) status. KFLC and LFLC were measured in paired cerebrospinal fluid (CSF) and serum samples. Gaussian mixture modeling was used to define a cut-off for KFLC and LFLC indexes.The cut-off for the KFLC index was 6.6 (95% confidence interval (CI) = 5.2-138.1). The cut-off for the LFLC index was 6.9 (95% CI = 4.5-22.2). For CIS/MS patients, sensitivity of the KFLC index (0.88; 95% CI = 0.85-0.90) was higher than OCB (0.82; 95%CI = 0.79-0.85; p < 0.001), but specificity (0.83; 95% CI = 0.78-0.88) was lower (OCB = 0.92; 95% CI = 0.89-0.96; p < 0.001). Both sensitivity and specificity for the LFLC index were lower than OCB.Compared with OCB, the KFLC index is more sensitive but less specific for diagnosing CIS/MS. Lacking an elevated KFLC index is more powerful for excluding MS compared with OCB but the latter is more important for ruling in a diagnosis of CIS/MS

Evaluating strategic environmental assessment in the Netherlands: Content, process and procedure as indissoluble criteria for effectiveness

To assess the effectiveness of strategic environmental assessment (SEA) we distinguish between its contribution to the quality of the ultimate policy choice (usefulness, applicability), the procedural quality of the planning process (transparency, timeliness) and the quality of stakeholder participation in the planning process (openness, equity, dialogue). In the context of two case studies involving Dutch planning practice, we argue that when and how an SEA is applied is crucial to understanding its e

Selected Adnexal Cystic Masses in Postmenopausal Women Can be Safely Managed by Laparoscopy

The aim of this study was to assess the efficacy and safety of laparoscopic treatment for adnexal cystic masses that were predicted to be benign in postmenopausal women. Postmenopausal women found to have an adnexal cystic mass were retrospectively evaluated with transvaginal ultrasonography, and serum CA-125 levels. The selection criteria were adnexal cystic masses greater than 3 cm but less than 10 cm, the masses were in the benign range (4-8) of Sassone's scoring system for transvaginal ultrasonography, and the patients had serum CA-125 levels less than 65 IU/mL. Two hundred nineteen women fulfilled the criteria and underwent operative laparoscopy. Almost all the masses (99.5%) were accurately predicted to be benign except for one borderline ovarian tumor. Two hundreds thirteen (97.3%) women were successfully managed by operative laparoscopy and six (2.7%) required laparotomy. For the patients managed by laparoscopy, the mean operative time was 51.3 min; the mean hospital stay was 2.5 days. There was no significant morbidity and surgery-related mortality. The combination of the Sassone's scoring system for transvaginal ultrasonography and serum CA-125 level can accurately predict benign cystic masses, and operative laparoscopy is technically feasible and safe for the management of adnexal mass in postmenopausal women

Kappa free light chains is a valid tool in the diagnostics of MS: A large multicenter study

Objective: To validate kappa free light chain (KFLC) and lambda free light chain (LFLC) indices as a diagnostic biomarker in multiple sclerosis (MS). Methods: We performed a multicenter study including 745 patients from 18 centers (219 controls and 526 clinically isolated syndrome (CIS)/MS patients) with a known oligoclonal IgG band (OCB) status. KFLC and LFLC were measured in paired cerebrospinal fluid (CSF) and serum samples. Gaussian mix- ture modeling was used to define a cut-off for KFLC and LFLC indexes. Results: The cut-off for the KFLC index was 6.6 (95% confidence interval (CI) = 5.2-138.1). The cut-off for the LFLC index was 6.9 (95% CI=4.5-22.2). For CIS/MS patients, sensitivity of the KFLC index (0.88; 95% CI = 0.85-0.90) was higher than OCB (0.82; 95%CI = 0.79-0.85; p < 0.001), but specificity (0.83; 95% CI = 0.78-0.88) was lower (OCB = 0.92; 95% CI = 0.89-0.96; p < 0.001). Both sensitivity and specificity for the LFLC index were lower than OCB. Conclusion: Compared with OCB, the KFLC index is more sensitive but less specific for diagnosing CIS/MS. Lacking an elevated KFLC index is more powerful for excluding MS compared with OCB but the latter is more important for ruling in a diagnosis of CIS/MS

Kappa free light chains is a valid tool in the diagnostics of MS : A large multicenter study

To validate kappa free light chain (KFLC) and lambda free light chain (LFLC) indices as a diagnostic biomarker in multiple sclerosis (MS). We performed a multicenter study including 745 patients from 18 centers (219 controls and 526 clinically isolated syndrome (CIS)/MS patients) with a known oligoclonal IgG band (OCB) status. KFLC and LFLC were measured in paired cerebrospinal fluid (CSF) and serum samples. Gaussian mixture modeling was used to define a cut-off for KFLC and LFLC indexes. The cut-off for the KFLC index was 6.6 (95% confidence interval (CI) = 5.2-138.1). The cut-off for the LFLC index was 6.9 (95% CI = 4.5-22.2). For CIS/MS patients, sensitivity of the KFLC index (0.88; 95% CI = 0.85-0.90) was higher than OCB (0.82; 95%CI = 0.79-0.85; p < 0.001), but specificity (0.83; 95% CI = 0.78-0.88) was lower (OCB = 0.92; 95% CI = 0.89-0.96; p < 0.001). Both sensitivity and specificity for the LFLC index were lower than OCB. Compared with OCB, the KFLC index is more sensitive but less specific for diagnosing CIS/MS. Lacking an elevated KFLC index is more powerful for excluding MS compared with OCB but the latter is more important for ruling in a diagnosis of CIS/MS

The Cultural Preservation of the Navajo Nation. A multicultural and assimilation policy analysis on the Navajo Nation and cultural preservation

In this thesis the cultural preservation of the Navajo Nation is analyzed through a multicultural and assimilation framework. The Navajo Nation is a case study in this research. A policy analysis is used in this thesis and analyses policies in three proxy categories of culture: education, land ownership, and self-governance. The main policies analyzed in this thesis are the current (federal) policies regarding education, land ownership, and self-governance. Current means the policies that are in place and in effect today. This thesis also analyses past policies in order to create a foundation. It further analyzes these policies to examine the outcomes and implications of the policies on the cultural preservation of the Navajo Nation. Gerd Baumann’s theories on culture, Kymlicka’s liberal multiculturalism, Margalit and Halbertal’s communitarian multiculturalism, and assimilation are used as the theoretical framework of this thesis. The findings cannot be generalized. Some policies have the outcome that was intended whereas other policies have the opposite outcomes of what was intended in the policy. Thus, multicultural policies do not necessarily have a multicultural outcome, sometimes the outcomes of the policy can have an opposite outcome of what the nature of the policy is

The Cultural Preservation of the Navajo Nation. A multicultural and assimilation policy analysis on the Navajo Nation and cultural preservation

In this thesis the cultural preservation of the Navajo Nation is analyzed through a multicultural and assimilation framework. The Navajo Nation is a case study in this research. A policy analysis is used in this thesis and analyses policies in three proxy categories of culture: education, land ownership, and self-governance. The main policies analyzed in this thesis are the current (federal) policies regarding education, land ownership, and self-governance. Current means the policies that are in place and in effect today. This thesis also analyses past policies in order to create a foundation. It further analyzes these policies to examine the outcomes and implications of the policies on the cultural preservation of the Navajo Nation. Gerd Baumann’s theories on culture, Kymlicka’s liberal multiculturalism, Margalit and Halbertal’s communitarian multiculturalism, and assimilation are used as the theoretical framework of this thesis. The findings cannot be generalized. Some policies have the outcome that was intended whereas other policies have the opposite outcomes of what was intended in the policy. Thus, multicultural policies do not necessarily have a multicultural outcome, sometimes the outcomes of the policy can have an opposite outcome of what the nature of the policy is