Type 2 diabetes:assessing the relative risks and benefits of glucose-lowering medications

The selection of appropriate pharmacologic therapy for any disease requires a careful assessment of benefit and risk. In the case of type 2 diabetes, this decision typically balances the benefits accrued from improved glycemic control with the risks inherent in glucose-lowering medications. This review is intended to assist therapeutic decision-making by carefully assessing the potential benefit from improved metabolic control relative to the potential risks of a wide array of currently prescribed glucose-lowering agents. Wherever possible, risks and benefits have been expressed in terms of absolute rates (events per 1000 patient-years) to facilitate cross-study comparisons. The review incorporates data from new studies (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation, Action to Control Cardiovascular Risk in Diabetes, and the Veterans Affairs Diabetes Trial), as well as safety issues associated with newer glucose-lowering medications. © 2010 Elsevier Inc. All rights reserved.

Workers' understanding of chemical risks: electroplating case study

BACKGROUND: There is limited research concerning how small companies in particular, respond to health and safety messages. AIMS: To understand individuals' knowledge and beliefs about chemical risks and to compare these with those of experts. METHODS: The use of chromic acid in particular, and also other chemicals associated with chrome plating were studied. All chromium plating firms were based in the West Midlands. The methodology involved initial face to face interviews (n = 21) with chromium platers, structured questionnaires (n = 84) to test the prevalence of beliefs identified in the interviews, an expert questionnaire, and a workshop to discuss findings. The responses of platers were compared with those of occupational health and safety experts. RESULTS: Although chromium platers appeared to understand the short term adverse effects of the chemicals to which they are exposed, their understanding of long term, or chronic effects appeared to be incomplete. They had good knowledge of acute effects based primarily on experience. Platers were aware of the hazardous nature of the chemicals with which they work, but did not draw distinction between the terms "hazards" and "risks". They had difficulties articulating the effects of the chemicals and how exposure might occur; although it is inappropriate to equate this with lack of knowledge. A significant minority of platers displayed deficiencies in understanding key technical terms used in Safety Data Sheets. CONCLUSIONS: This study provides a method which can be used to gain some understanding of workers' knowledge and beliefs about risks that they are exposed to in the workplace. The study also identifies gaps between the platers' knowledge and beliefs and those of experts. New risk information needs to be designed which addresses the information needs of platers using language that they understand.

Social and scientific issues in the acceptibility of radiation risks

Ionising radiation hazards are perhaps the most documented and regulated occupational and environmental hazard. In the radiological protection field a single expert advisory organisation has had an unusually large influence on the international standard setting process. This is the International Commission on Radiological Protection (ICRP). Two common, and opposing views, exist over the formulation of protection recommendations by the ICRP. The first, and most widely accepted, is that its recommendations are scientifically determined. The second view, is that its recommendations are politically or socially determined. Neither of these analyses adequately accounts for the complex process in which protection recommendations are formulated. A third view, provided by studies of the origins of scientific controversy, suggests that both science and social factors are important in the assessment and limitation of risk. The aim of this thesis is not simply to examine the origin of controversy. Issues of equal, if not more, importance are the resolution of controversy, the formation of consensus and the maintenance of expert authority and influence. These issues form the central focus of this thesis. The aim is to assess the process through which the ICRP formulates its radiological protection recommendations and comment on the extent that these are influenced by the affiliations of its members. This thesis concludes that the ICRP's recommendations have been shaped by a complex relationship of scientific and social considerations, in which a socio-technical commitment to nuclear energy has played a key role. The Commission has responded to new scientific data by making complex changes to its philosophy and methods of describing risk. Where reductions in numerical limits have been applied they have been accompanied by practical measures designed to limit the impact of the change and provide continuity with the old limits and flexibility in the application of the new recommendations.

Mathematical modelling of patient risks in a hospital environment, using multiple regression analysis

The aim of this research work was primarily to examine the relevance of patient parameters, ward structures, procedures and practices, in respect of the potential hazards of wound cross-infection and nasal colonisation with multiple resistant strains of Staphylococcus aureus, which it is thought might provide a useful indication of a patient's general susceptibility to wound infection. Information from a large cross-sectional survey involving 12,000 patients from some 41 hospitals and 375 wards was collected over a five-year period from 1967-72, and its validity checked before any subsequent analysis was carried out. Many environmental factors and procedures which had previously been thought (but never conclusively proved) to have an influence on wound infection or nasal colonisation rates, were assessed, and subsequently dismissed as not being significant, provided that the standard of the current range of practices and procedures is maintained and not allowed to deteriorate. Retrospective analysis revealed that the probability of wound infection was influenced by the patient's age, duration of pre-operative hospitalisation, sex, type of wound, presence and type of drain, number of patients in ward, and other special risk factors, whilst nasal colonisation was found to be influenced by the patient's age, total duration of hospitalisation, sex, antibiotics, proportion of occupied beds in the ward, average distance between bed centres and special risk factors. A multi-variate regression analysis technique was used to develop statistical models, consisting of variable patient and environmental factors which were found to have a significant influence on the risks pertaining to wound infection and nasal colonisation. A relationship between wound infection and nasal colonisation was then established and this led to the development of a more advanced model for predicting wound infections, taking advantage of the additional knowledge of the patient's state of nasal colonisation prior to operation.

Accountability, organisational learning and risks to patient safety in England: conflict or compromise?

This article examines the current risk regulation regime, within the English National Health Service (NHS), by investigating the two, sometimes conflicting, approaches to risk embodied within the field of policies towards patient safety. The first approach focuses on promoting accountability and is built on legal principles surrounding negligence and competence. The second approach focuses on promoting learning from previous mistakes and near-misses, and is built on the development of a ‘safety culture’. Previous work has drawn attention to problems associated with risk-based regulation when faced with the dual imperatives of accountability and organisational learning. The article develops this by considering whether the NHS patient safety regime demonstrates the coexistence of two different risk regulation regimes, or merely one regime with contradictory elements. It uses the heuristic device of ‘institutional logics’ to examine the coexistence of and interrelationship between ‘organisational learning’ and ‘accountability’ logics driving risk regulation in health care.

Evolution of competing strategies in a threshold model for task allocation

A nature inspired decentralised multi-agent algorithm is proposed to solve a problem of distributed task allocation in which cities produce and store batches of different mail types. Agents must collect and process the mail batches, without global knowledge of their environment or communication between agents. The problem is constrained so that agents are penalised for switching mail types. When an agent process a mail batch of different type to the previous one, it must undergo a change-over, with repeated change-overs rendering the agent inactive. The efficiency (average amount of mail retrieved), and the flexibility (ability of the agents to react to changes in the environment) are investigated both in static and dynamic environments and with respect to sudden changes. New rules for mail selection and specialisation are proposed and are shown to exhibit improved efficiency and flexibility compared to existing ones. We employ a evolutionary algorithm which allows the various rules to evolve and compete. Apart from obtaining optimised parameters for the various rules for any environment, we also observe extinction and speciation.

Competing for knowledge:creating, connecting and growing

With the buzzwords of knowledge-based economy and knowledge-driven economy, policy-makers, as well as journalists and management consultants, are pushing forward a vision of change that transforms the way advanced economies work. Yet little is understood about how the knowledge-based economy differs from the old, traditional economy. It is generally agreed that the phenomenon has grown out of the branch of economic thought known as new growth theory. Digesting up-to-date thinking in economics, management, innovation studies and economic geography, this significant volume provides an account of these developments and how they have transformed advanced economies.

Testing competing HRM-performance linkage models:evidence from the Greek manufacturing sector

This paper proposes an integrative framework for the conduct of a more thorough and robust analysis regarding the linkage between Human Resource Management (HRM) and business performance. In order to provide the required basis for the proposed framework, initially, the core aspects of the main HRM models predicting business performance are analysed. The framework proposes both the principle of mediation (i.e. HRM outcomes mediate the relationship between organisational strategies and business performance) and the perspective of simultaneity of decision-making by firms with regard to the consideration of business strategies and HRM policies. In order to empirically test this framework the methodological approach of 'structural equation models' is employed. The empirical research is based on a sample of 178 organisations operating in the Greek manufacturing sector. The paper concludes that both the mediation principle and the simultaneity perspective are supported, emphasising further the positive role of HRM outcomes towards organisational performance.

Risks and benefits of selective (re)presentation of interviewees' talk:some insights from discourse analysis

Purpose: The purpose of this paper is to examine the quality of evidence collected during interview. Current UK national guidance on the interviewing of victims and witnesses recommends a phased approach, allowing the interviewee to deliver their free report before any questioning takes place, and stipulating that during this free report the interviewee should not be interrupted. Interviewers, therefore, often find it necessary during questioning to reactivate parts of the interviewee's free report for further elaboration. Design/methodology/approach: The first section of this paper draws on a collection of police interviews with women reporting rape, and discusses one method by which this is achieved - the indirect quotation of the interviewee by the interviewer - exploring the potential implications for the quality of evidence collected during this type of interview. The second section of the paper draws on the same data set and concerns itself with a particular method by which information provided by an interviewee has its meaning "fixed" by the interviewer. Findings: It is found that "formulating" is a recurrent practice arising from the need to clarify elements of the account for the benefit of what is termed the "overhearing audience" - in this context, the police scribe, CPS, and potentially the Court. Since the means by which this "fixing" is achieved necessarily involves the foregrounding of elements of the account deemed to be particularly salient at the expense of other elements which may be entirely deleted, formulations are rarely entirely neutral. Their production, therefore, has the potential to exert undue interviewer influence over the negotiated "final version" of interviewees' accounts. Originality/value: The paper highlights the fact that accurate re-presentations of interviewees' accounts are a crucial tool in ensuring smooth progression of interviews and that re-stated speech and formulation often have implications for the quality of evidence collected during significant witness interviews. © Emerald Group Publishing Limited.

Perceived risks in cross-border transactions in agri-food chains

Nowadays, agri-food chains are more global than ever and are characterized by increased imports and exports and global sourcing of products, resulting in increased cross-border transaction risks. The objective of this paper is to identify the typical risks regarding agri-food supply chains involved in cross-border transactions and to assess their importance as perceived by agri-food managers. The analysis takes into consideration four different agrifood value chains (meat, grain, olive oil, fresh vegetables and fruits). Following an explorative approach and a qualitative technique, a series of face to face in-depth interviews was conducted. Results indicate that risk perception may be quite different across countries, value chains, tiers of the supply chain, as well as across respondents. The prevalence of Market dynamics risks was pointed out in most of the interviews, yielding the impression that many operators identify the market as the most difficult environment. Differences in risk perception between fresh produce (fruit/vegetables and meat) and processed food chains (grain and olive oil) are probably interrelated to the different degree of integration within these supply chains, the different level of standardization achieved and the different causes of risks that are inherent to the nature of the product.

Innovation and policy networks:the social shaping of BSE-related technologies and the inadequate assessmant of related risks

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The core executive's approach to regulation:from 'better regulation' to 'risk-tolerant deregulation'

This article examines changes in the New Labour core executive’s approach to regulation and its relationship with risk, through analysing documentary, legislative and press sources concerning approaches to regulatory decision-making. It claims that an initial commitment to ‘better regulation’ has gradually been replaced by explicit support for deregulation. A reduction in the scope of regulation was also promoted by the Thatcher and Major governments. The New Labour core executive shares previous (Conservative) administrations’ concern to include business in deregulatory decision-making. However, the article claims that there is one significant difference in the New Labour deregulatory approach: a new toleration of risk. Deregulation is, now, described as a corrective to regulators’ over-reactions to perceived risks, which, it is claimed, are holding back economic and technological progress. However, this new approach excludes competing views concerning how risk should be regulated. In particular, it does not engage with widespread popular views that governments should continue to protect against risk.

Supply chain innovation for competing in highly competitive markets:challenges and solutions

Rapid changes in technological development are forcing businesses to continuously innovate to improve their competitiveness, which is particularly evident in logistics and supply chain management (SCM), where innovation impacts both the strategic and operational levels. Supply Chain Innovation for Competing in Highly Dynamic Markets: Challenges and Solutions investigates the role of innovation in the management of supply chains of today. This book focuses on supply chain integration from both strategic and operational perspectives and the impact of information technology-related innovation in supply chain and logistics service industries. It also analyzes how environmental innovation affects logistical decisions throughout the supply chain and the strategies employed in managing logistics-related environmental impacts. Finally, the book explores theoretical and practical implications of innovation in the management of supply systems.