A comparison of the efficacy and safety of olanzapine versus haloperidol during transition from intramuscular to oral therapy

Background: Acutely agitated patients with schizophrenia who receive intramuscular (IM) medications typically are switched to oral (PO) antipsychotic maintenance therapy Objective: The goal of this study was to assess the efficacy and safety of olanzapine versus those of haloperidol during transition from IM to PO therapy We used additional data from a previously reported trial to test the hypothesis that the reduction in agitation achieved by IM olanzapine 10 mg or IM haloperidol 7.5 mg would be maintained following transition to 4 days of PO olanzapine or PO haloperidol (5-20 mg/d for both). We also hypothesized that olanzapine would maintain its more favorable extrapyramidal symptom (EPS) safety profile. Methods: This was a multinational (hospitals in 13 countries), double-blind, randomized, controlled trial. Acutely agitated inpatients with schizophrenia were treated with 1 to 3 IM injections of olanzapine 10 mg or haloperidol 7.5 mg over 24 hours and were entered into a 4-day PO treatment period with the same medication (5-20 mg/d for both). The primary efficacy measurement was reduction in agitation, as measured by the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) score. Adverse events and scores on EPS rating scales were assessed. Results: A total of 311 patients (204 men, 107 women; mean [SD] age, 38.2 [11.6] years) were enrolled (131, 126, and 54 patients in the olanzapine, haloperidol, and placebo groups, respectively). In all, 93.1% (122/131) of olanzapine-treated patients and 92.1% (116/126) of haloperidol-treated patients completed the IM period and entered the PO period; 85.5% (112/131) of olanzapine-treated patients and 84.1% (106/126) of haloperidol-treated patients completed the PO period. IM olanzapine and IM haloperidol effectively reduced agitation over 24 hours (mean [SD] PANSS-EC change, -7.1 [4.8] vs -6.7 [4.3], respectively). Reductions in agitation were sustained throughout the PO period with both study drugs (mean [SD] change from PO period baseline, -0.6 [4.8] vs -1.3 [4.4], respectively). During PO treatment, haloperidol-treated patients spontaneously reported significantly more acute dystonia than olanzapine-treated patients (4.3% [5/116] vs 0% [0/122], respectively; P = 0.026) and akathisia (5.2% [6/116] vs 0% [0/122], respectively; P = 0.013). Significantly more haloperidol-treated patients than olanzapine-treated patients met categorical criteria for treatment-emergent akathisia (18.5% [17/92] vs 6.5% [7/107], respectively; P = 0.015). Conclusions: In the acutely agitated patients with schizophrenia in this study, both IM olanzapine 10 mg and IM haloperidol 7.5 mg effectively reduced agitation over 24 hours. This alleviation of agitation was sustained following transition from IM therapy to 4 days of PO treatment (5-20 mg/d for both). During the 4 days of PO treatment, olanzapine-treated patients did not spontaneously report any incidences of acute dystonia, and olanzapine had a superior EPS safety profile to that of haloperidol. The combination of IM and PO olanzapine may help improve the treatment of acutely agitated patients with schizophrenia. Copyright (C) 2003 Excerpta Medica, Inc.

Safety issues in functional capacity evaluation: Findings from a trial of a new approach for evaluating clients with chronic back pain

Although safety is recognized as a critical issue in functional capacity evaluations (FCEs), it has rarely been investigated. This paper reports on the findings of a study which examined safety aspects of a new approach to FCE. Fourteen rehabilitation clients with chronic back pain participated in the study. Aspects examined included the pre-FCE screening procedures, the monitoring of performance and safety during the FCE, and the end of FCE measures and follow-up procedures. Support was found for the screening procedures of the approach, particularly blood pressure measurement, and for the combined approach to monitoring of the persons performance from biomechanical, physiological and psychophysical perspectives. Issues for FCE safety in general are identified and discussed, including the importance of screening procedures to determine readiness for FCEs and the issue of load handling in FCEs, especially in relation to clients with chronic back pain.

Optimal preventive maintenance of leased equipment with corrective minimal repairs

For leased equipment, the lessor carries out the maintenance of the equipment. Usually, the contract of lease specifies the penalty for equipment failures and for repairs not being carried out within specified time limits. This implies that optimal preventive maintenance policies must take these penalty costs into account and properly traded against the cost of preventive maintenance actions. The costs associated with failures are high as unplanned corrective maintenance actions are costly and the resulting penalties due to lease contract terms being violated. The paper develops a model to determine the optimal parameters of a preventive maintenance policy that takes into account all these costs to minimize the total expected cost to the lessor for new item lease. The parameters of the policy are (i) the number of preventive maintenance actions to be carried out over the lease period, (ii) the time instants for such actions, and (iii) the level of action. (c) 2005 Elsevier B.V. All rights reserved.

IT support for managing aircraft spares in a closed-loop supply chain

This paper reports on the development of elements of an e-supply chain management system for managing maintenance, repair and overhaul (MRO) relationships in the aerospace industry. A standard systems development methodology has been followed to produce a process model (i.e. the AMSCR model); an information model (i.e. business rules) and a computerised information management capability (i.e. automated optimisation). The proof of concept for this web-based MRO supply chain system has been established through the collaboration with a sample of the different types of supply chain members. The proven benefit is a reduction in the stock-holding costs for the whole supply chain whilst also minimising non-flying time of the aircraft that the supply chain supports. This type of system is now vital in an industry that has continuously decreasing profit margins, which in turn means pressure to reduce servicing times and increase the interval between maintenance actions.

Designing a support system for aerospace maintenance supply chains

Purpose - To develop a systems strategy for supply chain management in aerospace maintenance, repair and overhaul (MRO). Design/methodology/approach - A standard systems development methodology has been followed to produce a process model (i.e. the AMSCR model); an information model (i.e. business rules) and a computerised information management capability (i.e. automated optimisation). Findings - The proof of concept for this web-based MRO supply chain system has been established through collaboration with a sample of the different types of supply chain members. The proven benefits comprise new potential to minimise the stock holding costs of the whole supply chain whilst also minimising non-flying time of the aircraft that the supply chain supports. Research limitations/implications - The scale of change needed to successfully model and automate the supply chain is vast. This research is a limited-scale experiment intended to show the power of process analysis and automation, coupled with strategic use of management science techniques, to derive tangible business benefit. Practical implications - This type of system is now vital in an industry that has continuously decreasing profit margins; which in turn means pressure to reduce servicing times and increase the mean time between them. Originality/value - Original work has been conducted at several levels: process, information and automation. The proof-of-concept system has been applied to an aircraft MRO supply chain. This is an area of research that has been neglected, and as a result is not well served by current systems solutions. © Emerald Group Publishing Limited.

Maintenance strategies affecting equipment performance

Proper maintenance of plant items is crucial for the safe and profitable operation of process plants, The relevant maintenance policies fall into the following four categories: (i) preventivejopportunistic/breakdown replacement policies, (ii) inspection/inspection-repair-replacernent policies, (iii) restorative maintenance policies, and (iv) condition based maintenance policies, For correlating failure times of component equipnent and complete systems, the Weibull failure distribution has been used, A new powerful method, SEQLIM, has been proposed for the estimation of the Weibull parameters; particularly, when maintenance records contain very few failures and many successful operation times. When a system consists of a number of replaceable, ageing components, an opporturistic replacernent policy has been found to be cost-effective, A simple opportunistic rrodel has been developed. Inspection models with various objective functions have been investigated, It was found that, on the assumption of a negative exponential failure distribution, all models converge to the same optimal inspection interval; provided the safety components are very reliable and the demand rate is low, When deterioration becomes a contributory factor to same failures, periodic inspections, calculated from above models, are too frequent, A case of safety trip systems has been studied, A highly effective restorative maintenance policy can be developed if the performance of the equipment under this category can be related to some predictive modelling. A novel fouling model has been proposed to determine cleaning strategies of condensers, Condition-based maintenance policies have been investigated. A simple gauge has been designed for condition monitoring of relief valve springs. A typical case of an exothermic inert gas generation plant has been studied, to demonstrate how various policies can be applied to devise overall maintenance actions.

Reliability:its implications in production systems design

Research on production systems design has in recent years tended to concentrate on ‘software’ factors such as organisational aspects, work design, and the planning of the production operations. In contrast, relatively little attention has been paid to maximising the contributions made by fixed assets, particularly machines and equipment. However, as the cost of unproductive machine time has increased, reliability, particularly of machine tools, has become ever more important. Reliability theory and research has traditionally been based in the main on electrical and electronic equipment whereas mechanical devices, especially machine tools, have not received sufficiently objective treatment. A recently completed research project has considered the reliability of machine tools by taking sample surveys of purchasers, maintainers and manufacturers. Breakdown data were also collected from a number of engineering companies and analysed using both manual and computer techniques. Results obtained have provided an indication of those factors most likely to influence reliability and which in turn could lead to improved design and selection of machine tool systems. Statistical analysis of long-term field data has revealed patterns of trends of failure which could help in the design of more meaningful maintenance schemes.

Developing a model for consumer product safety evaluation

Safety enforcement practitioners within Europe and marketers, designers or manufacturers of consumer products need to determine compliance with the legal test of "reasonable safety" for consumer goods, to reduce the "risks" of injury to the minimum. To enable freedom of movement of products, a method for safety appraisal is required for use as an "expert" system of hazard analysis by non-experts in safety testing of consumer goods for implementation consistently throughout Europe. Safety testing approaches and the concept of risk assessment and hazard analysis are reviewed in developing a model for appraising consumer product safety which seeks to integrate the human factors contribution of risk assessment, hazard perception, and information processing. The model develops a system of hazard identification, hazard analysis and risk assessment which can be applied to a wide range of consumer products through use of a series of systematic checklists and matrices and applies alternative numerical and graphical methods for calculating a final product safety risk assessment score. It is then applied in its pilot form by selected "volunteer" Trading Standards Departments to a sample of consumer products. A series of questionnaires is used to select participating Trading Standards Departments, to explore the contribution of potential subjective influences, to establish views regarding the usability and reliability of the model and any preferences for the risk assessment scoring system used. The outcome of the two stage hazard analysis and risk assessment process is considered to determine consistency in results of hazard analysis, final decisions regarding the safety of the sample product and to determine any correlation in the decisions made using the model and alternative scoring methods of risk assessment. The research also identifies a number of opportunities for future work, and indicates a number of areas where further work has already begun.

The value of proprietary health and safety software to proactive health and safety management

There has been little research in health and safety management concernmg the application of information technology to the field. This thesis attempts to stimulate interest in this area by analysing the value of proprietary health and safety software to proactive health and safety management. The thesis is based upon the detailed software evaluation of seven pieces of proprietary health and safety software. It features a discussion concerning the development of information technology and health and safety management, a review of the key issues identified during the software evaluations, an analysis of the commercial market for this type of software, and a consideration of the broader issues which surround the use of this software. It also includes practical guidance for the evaluation, selection, implementation and maintenance of all health and safety management software. This includes a comprehensive software evaluation chart. The implications of the research are considered for proprietary health and safety software, the application of information technology to health and safety management, and for future research.

Rough-terrain groundspeed measurement:a radar-based commercial solution

Off-highway motive plant equipment is costly in capital outlay and maintenance. To reduce these overheads and increase site safety and workrate, a technique of assessing and limiting the velocity of such equipment is required. Due to the extreme environmental conditions met on such sites, conventional velocity measurement techniques are inappropriate. Ogden Electronics Limited were formed specifically to manufacture a motive plant safety system incorporating a speed sensor and sanction unit; to date, the only such commercial unit available. However, problems plague the reliability, accuracy and mass production of this unit. This project assesses the company's exisiting product, and in conjunction with an appreciation of the company history and structure, concludes that this unit is unsuited to its intended application. Means of improving the measurement accuracy and longevity of this unit, commensurate with the company's limited resources and experience, are proposed, both for immediate retrofit and for longer term use. This information is presented in the form of a number of internal reports for the company. The off-highway environment is examined; and in conjunction with an evaluation of means of obtaining a returned signal, comparisons of processing techniques, and on-site gathering of previously unavailable data, preliminary designs for an alternative product are drafted. Theoretical aspects are covered by a literature review of ground-pointing radar, vehicular radar, and velocity measuring systems. This review establishes and collates the body of knowledge in areas previously considered unrelated. Based upon this work, a new design is proposed which is suitable for incorporation into the existing company product range. Following production engineering of the design, five units were constructed, tested and evaluated on-site. After extended field trials, this design has shown itself to possess greater accuracy, reliability and versatility than the existing sensor, at a lower unit cost.

Two-phases control of DSRC Vehicle networks for road intersection coexisting safety applications

In this paper we propose a two phases control method for DSRC vehicle networks at road intersection, where multiple road safety applications may coexist. We consider two safety applications, emergency safety application with high priority and routine safety applications with low priority. The control method is designed to provide high availability and low latency for emergency safety applications while leave as much as possible bandwidth for routine applications. It is expected to be capable of adapting to changing network conditions. In the first phase of the method we use a simulation based offline approach to find out the best configurations for message rate and MAC layer parameters for given numbers of vehicles. In the second phase we use the configurations identified by simulations at roadside access point (AP) for system operation. A utilization function is proposed to balance the QoS performances provided to multiple safety applications. It is demonstrated that the proposed method can largely improve the system performance when compared to fixed control method.

Adaptive congestion control of DSRC vehicle networks for collaborative road safety applications

Congestion control is critical for the provisioning of quality of services (QoS) over dedicated short range communications (DSRC) vehicle networks for road safety applications. In this paper we propose a congestion control method for DSRC vehicle networks at road intersection, with the aims of providing high availability and low latency channels for high priority emergency safety applications while maximizing channel utilization for low priority routine safety applications. In this method a offline simulation based approach is used to find out the best possible configurations of message rate and MAC layer backoff exponent (BE) for a given number of vehicles equipped with DSRC radios. The identified best configurations are then used online by an roadside access point (AP) for system operation. Simulation results demonstrated that this adaptive method significantly outperforms the fixed control method under varying number of vehicles. The impact of estimation error on the number of vehicles in the network on system level performance is also investigated.

QoS guarantee with adaptive transmit power and message rate control for DSRC vehicle network based road safety applications

Quality of services (QoS) support is critical for dedicated short range communications (DSRC) vehicle networks based collaborative road safety applications. In this paper we propose an adaptive power and message rate control method for DSRC vehicle networks at road intersections. The design objective is to provide high availability and low latency channels for high priority emergency safety applications while maximizing channel utilization for low priority routine safety applications. In this method an offline simulation based approach is used to find out the best possible configurations of transmit power and message rate for given numbers of vehicles in the network. The identified best configurations are then used online by roadside access points (AP) according to estimated number of vehicles. Simulation results show that this adaptive method significantly outperforms a fixed control method. © 2011 Springer-Verlag.

A new inventory model for aircraft spares

A special inventory problem is presented: aircraft spares that are repaired and returned to spares, called rotable inventory. Rotable inventory is not consumed so does not change in the medium term, but is rotated through operational, maintenance and stock phases. The objective for inventory performance is fleet Service Level (SL), which effects aircraft dispatch performance. A model is proposed where the fleet SL drives combined stock levels such that cost is optimized. By holding greater numbers of lower-cost items and holding lower levels of more expensive items, it is possible to achieve substantial cost savings while maintaining performance. This approach is shown to be an advance over the current literature and is tested with case data, with conclusive results.