Recycling manure as cow bedding: Potential benefits and risks for UK dairy farms

Material obtained from physical separation of slurry (recycled manure solids; RMS) has been used as bedding for dairy cows in dry climates in the US since the 1970s. Relatively recently, the technical ability to produce drier material has led to adoption of the practice in Europe under different climatic conditions. This review collates the evidence available on benefits and risks of using RMS bedding on dairy farms, with a European context in mind. There was less evidence than expected for anecdotal claims of improved cow comfort. Among animal health risks, only udder health has received appreciable attention. There are some circumstantial reports of difficulties of maintaining udder health on RMS, but no large scale or long term studies of effects on clinical and subclinical mastitis have been published. Existing reports do not give consistent evidence of inevitable problems, nor is there any information on clinical implications for other diseases. The scientific basis for guidelines on management of RMS bedding is limited. Decisions on optimum treatment and management may present conflicts between controls of different groups of organisms. There is no information on the influence that such 'recycling' of manure may have on pathogen virulence. The possibility of influence on genetic material conveying antimicrobial resistance is a concern, but little understood. Should UK or other non-US farmers adopt RMS, they are advised to do so with caution, apply the required strategies for risk mitigation, maintain strict hygiene of bed management and milking practices and closely monitor the effects on herd health.

The challenges to performance and sustaining mutual health organisations/health institutions: an exploratory study in Ghana

PURPOSE

The purpose of this paper is to explore challenges to the performance and sustainability of mutual health organisations (MHOs) and health institutions towards enhancing access to quality health care (HC) in Ghana.

DESIGN/METHODOLOGY/APPROACH

Data were gathered through interviews and documentary review.

FINDINGS

Problems with late release of reimbursement funds for discharging with claims by the central government has impacted heavily on the financial and strategic management and decision-making processes of the MHOs and health institutions.

RESEARCH LIMITATIONS/IMPLICATIONS

The lack of in-depth analysis of the financial viability of the MHOs; and the limited number of schemes selected.

PRACTICAL IMPLICATIONS

Recommends the need to ensure prompt release of reimbursement funds by government to enable the MHOs to reimburse claims to health institutions.

SOCIAL IMPLICATIONS

There is a perceived tension between the MHOs and HC institutions due to late release of reimbursement funds by the government.

ORIGINALITY/VALUE

Contributes to understanding of how the NHI Act influences the operations of MHOs and health institutions towards increasing access to quality HC and financing.

Data-driven risk identification in phase III clinical trials using central statistical monitoring

Our interest lies in quality control for clinical trials, in the context of risk-based monitoring (RBM). We specifically study the use of central statistical monitoring (CSM) to support RBM. Under an RBM paradigm, we claim that CSM has a key role to play in identifying the "risks to the most critical data elements and processes" that will drive targeted oversight. In order to support this claim, we first see how to characterize the risks that may affect clinical trials. We then discuss how CSM can be understood as a tool for providing a set of data-driven key risk indicators (KRIs), which help to organize adaptive targeted monitoring. Several case studies are provided where issues in a clinical trial have been identified thanks to targeted investigation after the identification of a risk using CSM. Using CSM to build data-driven KRIs helps to identify different kinds of issues in clinical trials. This ability is directly linked with the exhaustiveness of the CSM approach and its flexibility in the definition of the risks that are searched for when identifying the KRIs. In practice, a CSM assessment of the clinical database seems essential to ensure data quality. The atypical data patterns found in some centers and variables are seen as KRIs under a RBM approach. Targeted monitoring or data management queries can be used to confirm whether the KRIs point to an actual issue or not.

The effect of electronic reminders on risk management among diabetic patients in low resourced settings

BACKGROUND

Information technology has potential to improve health care delivery particularly among individuals with chronic diseases such as diabetes in low and middle-income countries (LMIC). Research on the usefulness of information technology to manage persons living with chronic diseases is scarce in LMIC. We sought to evaluate the effect of an electronic reminder system on cardiovascular risk factors (blood pressure, heart rate, and fasting plasma glucose) and adherence to clinical appointments among persons living with diabetes.

RESEARCH DESIGN AND METHODS

A randomized controlled design was used to recruit 200 diabetic patients (intervention n=100, control n=100) from the National Diabetes Management Research Centre, Accra. All patients received usual diabetes care. The intervention group was given electronic reminders for their clinical appointments and their physicians were prompted with abnormal laboratory results for six months.

RESULTS

Baseline characteristics were largely similar for both groups. At six months follow up, the mean reductions of all the cardiovascular risk factors in the intervention group were significantly greater than in the control group: -1.7 kg/m(2) versus -1.1 kg/m(2)(p=0.002) for BMI; -4.7 mmHg versus -2.8 mmHg (p=0.002) for SBP; -5.3 mmH versus -3.1 mmHg (p=0.001) for DBP; -1.7 bpm versus -0.1 bpm (p=0.001) for heart rate and -2.3 mmol/L versus -1.6 mmol/L (p=0.001) for fasting plasma glucose, respectively. Adherence to appointment schedules was also significantly higher in the intervention group compared with the control group (97.8% versus 89.4%, p=0.010).

CONCLUSIONS

Locally developed electronic initiatives such as this resulted in improved cardiovascular risk factors and effective compliance to clinical practices and improved quality of care for persons living with diabetes.

Knowledge of Emergency Department Triage nurses in management of patients with mental health needs: comparisons with the Triage Model of Lazio (TLM)

OBJECTIVES

To refer the current competences of Triage Nurses (TRNs) assessing the person with metal health problems in Emergency Departments (ED), and the impact of the Triage Lazio Model (TLM) upon it.

MATERIALS AND METHODS

An anonymous questionnaire was administered to ED TRNs of the Lazio Region. Standardized Cronbach's alpha was used for reliability estimation.

RESULTS

The Cronbach's alpha was 0.4. Two hundred ninety-nine TRNs were interviewed: 66% women, 47% aged 31-40 years, 60% followed TLM. The consideration of the patient as 'one who comes out of the normal', 'a person with altered functions of mind or mental function' and as 'hostile, aggressive and unpredictable' was reported more by females in comparison to the males (OR=1.76; OR=3.50; OR=1.79); TRNs who have not followed the course on TLM had higher probability to consider 'hostile, aggressive and unpredictable' the psychiatric patients (OR=1.87) in comparison with other Triage courses; those who have taken a course on Triage but at least 3 years ago, had a lower probability to consider as 'one who comes out of the normal' (OR=0.55).

CONCLUSIONS

having followed the course TLM, having participated in a recent triage course, male gender, and the seniority in this job appear to be contributing factors for a proper management of psychiatric patients. Continuous improvement of specific knowledge and skills for the management of patients with mental health needs are mandatory.

[Entomological factors of arboviruses emergences]

Arboviruses - viruses transmitted by haematophagous arthropods - are responsible for febrile syndromes, which sometimes include haemorrhagic or neurological symptoms. Human activities have facilitated the emergence of these originally zoonotic viruses and the domestication and spread throughout the world of their major vectors. The last decade has seen significant changes in the epidemiology of arboviruses transmitted by mosquitoes of the genus Aedes, particularly in relation to the intercontinental spread of Aedes albopictus. Here, we address the epidemiological consequences of the invasion by this species into Central Africa and Europe in a context of viral globalization. The risk of transmission in these areas is influenced by virus-vector adaptation phenomena as well as environmental phenomena including climate. Faced with these new risks, it is essential to develop competences in entomological and virological surveillance, risk assessment and forecasting of epidemic risk in order to develop strategies for the prevention and control of epidemics.

[Global risk management]

Risk management is a fundamental component of any successful company, whether it is in economic, societal or environmental aspect. Risk management is an especially important activity for companies that optimal security challenge of products and services is great. This is the case especially for the health sector institutions. Risk management is therefore a decision support tool and a means to ensure the sustainability of an organization. In this context, what methods and approaches implemented to manage the risks? Through this state of the art, we are interested in the concept of risk and risk management processes. Then we focus on the different methods of risk management and the criteria for choosing among these methods. Finally we highlight the need to supplement these methods by a systemic and global approach including through risk assessment by the audits.

Risk management in radiology departments

Medical imaging and interventional radiology sustained prompt changes in the last few years, mainly as a result of technology breakthroughs, rise in workload, deficit in workforce and globalization. Risk is considered to be the chance or possibility of incurring loss or of a negative event happening that may cause injury to patients or medical practitioners. There are various causes of risks leading to harm and injury in radiology departments, and it is one of the objectives of this paper to scrutinize some of the causes. This will drive to consideration of some of the approaches that are used in managing risks in radiology. This paper aims at investigating risk management in radiology, and this will be achieved through a thorough assessment of the risk control measures that are used in the radiology department. It has been observed that the major focus of risk management in such medical setting is to reduce and eliminate harm and injury to patients through integration of various medical precautions. The field of Radiology is rapidly evolving due to technology advances and the globalization of healthcare. This ongoing development will have a great impact on the level of quality of care and service delivery. Thus, risk management in radiology is essential in protecting the patients, radiologists, and the medical organization in terms of capital and widening of the reputation of the medical organization with the patients.

Unplanned return to theater: A quality of care and risk management index?

INTRODUCTION

Surgical quality and risk management is a major public health issue. The consequences of unplanned return to theater are social, occupational, financial and even legal. Unscheduled revision surgery is a major adverse event, resulting from serious complications - some of which are thought to be avoidable. The present study sought to assess and analyze the incidence of unplanned return to theater in an orthopedic surgery department. The study hypothesis was that some of the complications involved could be avoided.

PATIENTS AND METHOD

A mixed retrospective-prospective study examined a consecutive series of 10,158 patients operated on in an orthopedic and traumatologic surgery department between January 2011 and December 2013. Patients undergoing revision surgery for reasons directly related to the primary procedure were analyzed. Patients were distributed among the following subgroups: infection, implant dislocation; hemorrhagic complication, mechanical complication, problem of primary technique, stiffness, wound healing disorder. Specific indicators of dysfunction liable to have contributed to onset of the complication were applied in each subgroup, to determine the avoidable or unavoidable nature of the event.

RESULTS

Two hundred and twenty-four patients (2.2%) underwent revision surgery for reasons directly related to the primary procedure. One hundred and eight cases (48.2%) were considered to have been avoidable: 48 infections (21.4%), 27 implant dislocations (12%), 15 hemorrhagic complications (6.7%), 66 mechanical complications (29.5%), 35 technical problems at primary surgery (15.6%), 21 cases of stiffness (9.3%), and 12 cases of delayed wound healing (5.3%). Mean time to revision surgery was 2.7 ± 2.6 months. Extending the time-window to 1 year recruited extra cases: in 31.7% of cases, onset was after the 90th postoperative day, which is the usual deadline. The rate of unplanned return to theater was higher after unscheduled (traumatic: 3.2%) than scheduled surgery (1.7%, P < 0.001).

CONCLUSION

Return to surgery in orthopedic and traumatologic surgery is underestimated. Annual incidence was 2.2%, and twice as high (3.2%) following traumatologic compared to scheduled surgery (1.7%). Analysis found that almost half the cases were avoidable. They represent a relevant and easily assessed indicator of treatment quality and associated risk management. A national or even international database in the form of an anonymous registry of revision surgeries would be useful.

[Security of the medicinal therapy: Cartography of risks a priori within service of orthopaedic surgery]

INTRODUCTION

Security and quality of the Medicinal Therapy are one of the most important objectives of the April 6th, 2011 order. The objective is to realize this study of the risks incurred by patients related to management and security of medicinal therapy in order to establish a plan to reduce the risks of drug's dispensation.

MATERIALS AND METHOD

The method of the Preliminary Risk Analysis (PRA) has been implemented by a multidisciplinary group in a hospital service of orthopaedic surgery. The study focused on the dispensation phase of medicinal circuit.

RESULTS

This analysis revealed 148 scenarii, 35 were criticality unacceptable. Fifty-four initial risk control actions were proposed and their stress levels to put them in place were evaluated.

DISCUSSION

The main measures of risk management are: training, information, communication, computerization, automation, dual control, updating the documentation system, drug reconciliation and respect for Best Practices Hospitallers (BPH).

CONCLUSIONS

Risk management requires a significant human and financial investment as well as, material resources and multidisciplinary expertise in order to offer the best solutions.

Development of a consensus-base list of criteria for prescribing medication in a pediatric population

BACKGROUND

Although many people are involved in the optimal use of a medication within this process, the use of medications carries risks of adverse events, which are greater in the pediatric population because of many factors.

OBJECTIVE

In this context, our aim was to develop a consensus-based list of criteria for the safety of the pediatric medication-use process or circuit (referred to from now on as the CIRCUS tool: CIRcuit-of-Child-drug-USe).

SETTING

Multicenter with a trio of experts from eight university hospitals.

METHODS

A literature search (1998-2013) was conducted in order to identify the different safety practice domains for the pediatric medication use process. Twenty-six safety practice domains were identified and 48 compliance criteria were formulated. In order to reach a consensus on the most relevant compliance criteria for safety practices, an international 24 French-speaking multidisciplinary panelists (8 doctors, 8 pharmacists and 8 nurses) selected to represent a broad range of experience levels and specialties took part in a two round Delphi survey which was conducted between March and July 2013. Each panelist was asked to rate each proposed criterion on a 1-9 Likert scale in order to show their level of agreement (i.e. 1 reflects strong disagreement and 9 reflects strong agreement).

MAIN OUTCOME MEASURE

Development of a consensus-base list for safety practices in pediatrics.

RESULTS

Twenty-two of the 24 professionals invited to take part in this survey (92% participation rate) completed the two Delphi rounds. At the end of the two Delphi rounds, a total of 38/48 (79%) safety practice compliance criteria achieved consensus by the panelists. The criteria were grouped into 23 domains.

CONCLUSION

This study presents the development of a self-assessment tool for safety practices in the pediatric drug-use process using a Delphi method. This tool may be used in order to record and compare the prevalence of best safety practices in the pediatric drug-use process.

Developing and Implementing a Culture of Safety in the Dentoalveolar Surgical Practice

The health care industry and delivery systems are placing greater emphasis on making their organizations safe. They do this by cultivating a culture of safety to help anticipate and prevent injuries and documenting and investigating injuries to develop prevention protocols. Many of the strategies used in the hospital industry can be applied to the dentoalveolar surgery practice of oral-maxillofacial surgeons and other dentists. This article discusses the development of a culture of safety in the dentoalveolar practice and gives ideas of how threats of injuries to patients, guests, and the surgical care team can be reduced or eliminated.

Casualties of war: the infection control assessment of civilians transferred from conflict zones to specialist units overseas for treatment

The casualties of global conflict attract media attention and sympathy in public, governmental, and non-governmental circles. Hospitals in developed countries offering specialist reconstructive or tertiary services are not infrequently asked to accept civilian patients from overseas conflict for complex surgical procedures or rehabilitation. Concern about the infection prevention and control risks posed by these patients, and the lack of a good evidence base on which to base measured precautions, means that the precautionary principle of accepting zero risk is usually followed. The aim of this article is to highlight infection control considerations that may be required when treating casualties from overseas conflict, based partly on our own experience. Currently there is a lack of published evidence and national consensus on how to manage these patients. The precautionary principle requires that there is an ongoing search for evidence and knowledge that can be used to move towards more traditional risk management. We propose that only by gathering the experiences of the many individual hospitals that have each cared for small numbers of such patients can such evidence and knowledge be assimilated.

Cyanobacterial bloom management through integrated monitoring and forecasting in large shallow eutrophic Lake Taihu (China)

The large shallow eutrophic Lake Taihu in China has long suffered from eutrophication and toxic cyanobacterial blooms. Despite considerable efforts to divert effluents from the watershed, the cyanobacterial blooms still reoccur and persist throughout summer. To mitigate cyanobacterial bloom pollution risk, a large scale integrated monitoring and forecasting system was developed, and a series of emergency response measures were instigated based on early warning. This system has been in place for 2009-2012. With this integrated monitoring system, it was found that the detectable maximum and average cyanobacterial bloom area were similar to that before drinking water crisis, indicating that poor eutrophic status and cyanobacterial bloom had persisted without significant alleviation. It also revealed that cyanobacterial bloom would occur after the intense storm, which may be associated with the increase in buoyance of cyanobacterial colonies. Although the cyanobacterial blooms had persisted during the monitoring period, there had been a reduction in frequency and intensity of the cyanobacterial bloom induced black water agglomerates (a phenomenon of algal bloom death decay to release a large amount black dissolved organic matter), and there have been no further drinking water crises. This monitoring and response strategy can reduce the cyanobacterial bloom pollution risk, but cannot reduce eutrophication and cyanobacterial blooms, problems which will take decades to resolve.

The PRONE score: an algorithm for predicting doctors' risks of formal patient complaints using routinely collected administrative data

Background

Medicolegal agencies—such as malpractice insurers, medical boards and complaints bodies—are mostly passive regulators; they react to episodes of substandard care, rather than intervening to prevent them. At least part of the explanation for this reactive role lies in the widely recognised difficulty of making robust predictions about medicolegal risk at the individual clinician level. We aimed to develop a simple, reliable scoring system for predicting Australian doctors’ risks of becoming the subject of repeated patient complaints.

Methods

Using routinely collected administrative data, we constructed a national sample of 13 849 formal complaints against 8424 doctors. The complaints were lodged by patients with state health service commissions in Australia over a 12-year period. We used multivariate logistic regression analysis to identify predictors of subsequent complaints, defined as another complaint occurring within 2 years of an index complaint. Model estimates were then used to derive a simple predictive algorithm, designed for application at the doctor level.

Results

The PRONE (Predicted Risk Of New Event) score is a 22-point scoring system that indicates a doctor's future complaint risk based on four variables: a doctor's specialty and sex, the number of previous complaints and the time since the last complaint. The PRONE score performed well in predicting subsequent complaints, exhibiting strong validity and reliability and reasonable goodness of fit (c-statistic=0.70).

Conclusions

The PRONE score appears to be a valid method for assessing individual doctors’ risks of attracting recurrent complaints. Regulators could harness such information to target quality improvement interventions, and prevent substandard care and patient dissatisfaction. The approach we describe should be replicable in other agencies that handle large numbers of patient complaints or malpractice claims.

[Responsibility due to medication errors in France: a study based on SHAM insurance data]

PURPOSE

The safe medication practices at the hospital constitute a major public health problem. Drug supply chain is a complex process, potentially source of errors and damages for the patient. SHAM insurances are the biggest French provider of medical liability insurances and a relevant source of data on the health care complications.

METHODS

The main objective of the study was to analyze the type and cause of medication errors declared to SHAM and having led to a conviction by a court. We did a retrospective study on insurance claims provided by SHAM insurances with a medication error and leading to a condemnation over a 6-year period (between 2005 and 2010).

RESULTS

Thirty-one cases were analysed, 21 for scheduled activity and 10 for emergency activity. Consequences of claims were mostly serious (12 deaths, 14 serious complications, 5 simple complications). The types of medication errors were a drug monitoring error (11 cases), an administration error (5 cases), an overdose (6 cases), an allergy (4 cases), a contraindication (3 cases) and an omission (2 cases). Intravenous route of administration was involved in 19 of 31 cases (61%). The causes identified by the court expert were an error related to service organization (11), an error related to medical practice (11) or nursing practice (13). Only one claim was due to the hospital pharmacy.

CONCLUSION

The claim related to drug supply chain is infrequent but potentially serious. These data should help strengthen quality approach in risk management.

A retrospective observational study of medical incident command and decision-making in the 2011 Oslo bombing

Background

A core task for commanders in charge of an emergency response operation is to make decisions. The purposes of the study were to describe what critical decisions the ambulance commander and the medical commander make in a mass casualty incident response and to explore what the underlying conditions affecting decision-making are. The study was conducted in the context of the 2011 government district terrorist bombing in Norway.

Methods

The study was a retrospective, descriptive observational study collecting data through participating observation, semi-structured interviews, and recordings of emergency medical services’ radio communications. Analysis was conducted using systematic text condensation. The ambulance commander was interviewed using the critical decision method.

Results

The medical emergency response lasted 6.5 h, with little clinical activity after 2 h. Most critical decisions were made within the first 30 min, with the ambulance commander making the bulk of decisions. Situation assessment and underlying uncertainties strongly affected decision-making, but there was a mutual interaction between these three factors that developed throughout the different stages of the operation. Knowledge and experience were major determinants of how easily commanders picked up sensory cues and translated them into situation assessments. The number and magnitude of uncertainties were largest in the development stage, after most of the critical decisions had been made.

Conclusions

In the studied mass casualty incident, the commanders made most critical decisions in the early stages of the emergency response when resources did not meet demand. Decisions were made under significant uncertainty and time pressure. Ambulance and medical commanders should be prepared to make situation assessments and decisions early and be ready to adjust as uncertainties are reduced.

Electronic supplementary material

The online version of this article (doi:10.1186/s12245-015-0052-9) contains supplementary material, which is available to authorized users.

Microbial Contamination of Drinking Water and Human Health from Community Water Systems

A relatively short list of reference viral, bacterial and protozoan pathogens appears adequate to assess microbial risks and inform a system-based management of drinking waters. Nonetheless, there are data gaps, e.g. human enteric viruses resulting in endemic infection levels if poorly performing disinfection and/or distribution systems are used, and the risks from fungi. Where disinfection is the only treatment and/or filtration is poor, cryptosporidiosis is the most likely enteric disease to be identified during waterborne outbreaks, but generally non-human-infectious genotypes are present in the absence of human or calf fecal contamination. Enteric bacteria may dominate risks during major fecal contamination events that are ineffectively managed. Reliance on culture-based methods exaggerates treatment efficacy and reduces our ability to identify pathogens/indicators; however, next-generation sequencing and polymerase chain reaction approaches are on the cusp of changing that. Overall, water-based Legionella and non-tuberculous mycobacteria probably dominate health burden at exposure points following the various societal uses of drinking water.

Predictive validity of the START for unauthorised leave and substance abuse in a secure mental health setting: a pseudo-prospective cohort study

BACKGROUND

Risk assessment and management is central to the nursing role in forensic mental health settings. The Short Term Assessment of Risk and Treatability (START) aims to support assessment through identification of risk and protective factors. It has demonstrated predictive validity for aggression; it also aims to aid risk assessment for unauthorised leave and substance abuse where its performance is relatively untested.

OBJECTIVES

To test the predictive validity of the START for unauthorised leave and substance abuse.

DESIGN

A naturalistic, pseudo-prospective cohort study.

SETTINGS

Four centres of a large UK provider of secure inpatient mental health services.

PARTICIPANTS

Inpatients resident between May 2011 and October 2013 who remained in the service for 3-months following assessment with the START by their clinical team. Exclusion criteria were missing assessment data in excess of prorating guidelines. Of 900 eligible patients 73 were excluded leaving a final sample size of n=827 (response rate 91.9%). Mean age was 38.5 years (SD=16.7); most participants (72.2%) were male; common diagnoses were schizophrenia-type disorders, personality disorders, organic disorders, developmental disorders and intellectual disability.

METHODS

Routinely conducted START assessments were gathered. Subsequent incidents of substance abuse and unauthorised leave were coded independently. Positive and negative predictive values of low and elevated risk were calculated. Receiver Operating Characteristic analysis was conducted to ascertain the predictive accuracy of the assessments based on their sensitivity and specificity.

RESULTS

Patient-based rates of unauthorised leave (2.4%) and substance abuse (1.6%) were low. The positive and negative predictive values for unauthorised leave were 5.9% and 98.4%; and for substance abuse 8.1% and 99.0%. The START specific risk estimate for unauthorised leave predicted its associated outcome (Area under the curve=.659, p<.05, 95% CI .531, .786); the substance abuse risk estimate predicted its outcome with a large effect size (Area under the curve=.723, p<.01, 95% CI .568, .879).

CONCLUSIONS

The study provides limited support for the START by demonstrating the predictive validity of its specific risk estimates for substance abuse and unauthorised leave. High negative predictive values suggest the tool may be of most utility in screening out low risk individuals from unnecessary restrictive interventions; very low positive predictive values suggest caution before implementing restrictive interventions in those rated at elevated risk. Researchers should investigate how multidisciplinary teams formulate risk assessments for these outcomes since they outperform the quantitative element of this tool.

Interactive computations: toward risk management in interactive intelligent systems

Understanding the nature of interactions is regarded as one of the biggest challenges in projects related to complex adaptive systems. We discuss foundations for interactive computations in interactive intelligent systems (IIS), developed in the Wistech program and used for modeling complex systems. We emphasize the key role of risk management in problem solving by IIS. The considerations are based on experience gained in real-life projects concerning, e.g., medical diagnosis and therapy support, control of an unmanned helicopter, fraud detection algorithmic trading or fire commander decision support.

A risk-mitigation approach to the management of induced seismicity

Earthquakes may be induced by a wide range of anthropogenic activities such as mining, fluid injection and extraction, and hydraulic fracturing. In recent years, the increased occurrence of induced seismicity and the impact of some of these earthquakes on the built environment have heightened both public concern and regulatory scrutiny, motivating the need for a framework for the management of induced seismicity. Efforts to develop systems to enable control of seismicity have not yet resulted in solutions that can be applied with confidence in most cases. The more rational approach proposed herein is based on applying the same risk quantification and mitigation measures that are applied to the hazard from natural seismicity. This framework allows informed decision-making regarding the conduct of anthropogenic activities that may cause earthquakes. The consequent risk, if related to non-structural damage (when re-location is not an option), can be addressed by appropriate financial compensation. If the risk poses a threat to life and limb, then it may be reduced through the application of strengthening measures in the built environment-the cost of which can be balanced against the economic benefits of the activity in question-rather than attempting to ensure that some threshold on earthquake magnitude or ground-shaking amplitude is not exceeded. However, because of the specific characteristics of induced earthquakes-which may occur in regions with little or no natural seismicity-the procedures used in standard earthquake engineering need adaptation and modification for application to induced seismicity.

Integrating ecosystem services into risk management decisions: case study with Spanish citrus and the insecticide chlorpyrifos

The European regulatory system for the approval of pesticides includes a thorough evaluation of risks to the environment and is designed to be protective of ecosystems. However, a decision to ban an agrochemical could also potentially have a negative impact on the value of ecosystem services, if resulting changes in crop management are damaging to ecosystems or result in negative socio-economic impacts. To support regulatory decision-making, consideration of ecosystem services to identify best environmental management options could be a way forward. There is generally a growing trend for the consideration of ecosystem services in decision making. Ecosystems provide the conditions for growing food, regulate water and provide wildlife habitats; these, amongst others, are known as ecosystem services. The objectives of this case study were to bring a holistic approach to decision making by valuing the environmental, social and economic benefits derived from the use of chlorpyrifos in Valencian citrus production. Spanish growers harvest between 5 and 6 milliont of citrus annually, worth an estimated €5 to 7 billion in food markets throughout Europe. The approach highlighted the potential for unintended negative consequences of regulatory decisions if the full context is not considered. In this study, rather than a regulatory restriction, the best option was the continued use of chlorpyrifos together with vegetated conservation patches as refuges for non-target insects. The conservation patches offset potential insecticidal impacts to insects whilst maintaining citrus production, farm income and the amenity value of the citrus landscape of Valencia. This was an initial proof-of-concept study and illustrates the importance of a wider perspective; other cases may have different outcomes depending on policies, the pesticide, crop scenarios, farm economics and the region.

An examination of the potential added value of water safety plans to the United States national drinking water legislation

National and sub-national governments develop and enforce regulations to ensure the delivery of safe drinking water in the United States (US) and countries worldwide. However, periodic contamination events, waterborne endemic illness and outbreaks of waterborne disease still occur, illustrating that delivery of safe drinking water is not guaranteed. In this study, we examined the potential added value of a preventive risk management approach, specifically, water safety plans (WSPs), in the US in order to improve drinking water quality. We undertook a comparative analysis between US drinking water regulations and WSP steps to analyze the similarities and differences between them, and identify how WSPs might complement drinking water regulations in the US. Findings show that US drinking water regulations and WSP steps were aligned in the areas of describing the water supply system and defining monitoring and controls. However, gaps exist between US drinking water regulations and WSPs in the areas of team procedures and training, internal risk assessment and prioritization, and management procedures and plans. The study contributes to understanding both required and voluntary drinking water management practices in the US and how implementing water safety plans could benefit water systems to improve drinking water quality and human health.

Experience Feedback Committee: a management tool to improve patient safety in mental health

BACKGROUND

A management tool, called the Experience Feedback Committee, has been applied for patient safety and successfully used in medical departments. The purpose of this study was to analyse the functioning of an Experience Feedback Committee in a psychiatric department and to explore its contribution to the particular issues of patient safety in mental health.

METHODS

We conducted a descriptive study based on all the written documents produced by the Experience Feedback Committee between March 2010 and January 2013. The study was conducted in Grenoble University Hospital in France. We analysed all reported incidents, reports of meetings and event analysis reports. Adverse events were classified according to the Conceptual Framework for the International Classification for Patient Safety.

RESULTS

A total of 30 meetings were attended by 22 professionals including seven physicians and 12 paramedical practitioners. We identified 475 incidents reported to the Experience Feedback Committee. Most of them (92 %) had no medical consequence for the patient. Eleven incidents were investigated with an analysis method inspired by civil aviation security systems. Twenty-one corrective actions were set up, including eight responses to the specific problems of a mental health unit, such as training to respond to situations of violence or management of suicide attempts.

CONCLUSIONS

The Experience Feedback Committee makes it possible to involve mental healthcare professionals directly in safety management. This tool seems appropriate to manage specific patient safety issues in mental health.

Discussion on the boundary of risk assessment and risk management

The current question on the relation of “risk assessment” and “risk management” may exist at the level of who should be responsible for what. Here, the argument will be made upon “Risk Analysis”. The problem here is whether a same person can or should perform both risk assessment and risk management or not. The risk assessors and risk managers are to be sharing the task to perform the risk analysis under close cooperation. The practical endpoint of the risk analysis is the “round table meeting” where the risk assessors and risk managers become aware of their own accurate role and relation with the other stake holders inclding those who are managed or regulated.

Credentials needed for a toxicologist to be a risk assessor are not only an ability to qualify and analyze the data, but an ability to understand the ‘plausibility’ that can be extrapolated from them. Different from the “weight of evidence” approach, plausibility is to extrapolate the data by scientifically referring to the wider range of knowledge.

Even as a perfect risk assessor, a tragedy waits for those who unknowingly mixes up the position of risk assessor and risk manager. Potentially it happens when a personal belief was reflected to risk management and went wrong with the risk communication processes. In the round table, risk assessors and managers should talk to each other with plausibility in science and sharing the task towards the goal of the meeting.

A cascade of events initiated by the March 11, 2011 devastating earthquake has affected toxicology researchers in various ways. A generalized conclusion here is that the risk assessors and risk managers should discuss, before and during the round table meeting, “how far can we pollute our living space?” based on a realization that Toxicology is covering both “Hygiene” of public population and “Clinical aspects” of individuals who consult a doctor.