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A systematic review of studies providing evidence of the linkage between human factors (HF) in the design and management of operations to production quality performance was conducted. 71 peer reviewed research papers were found to provide evidence of the HF-Quality relationship. These studies identified 178 design factors relating to quality. These included 1) Product Design (54), 2) Production Process Design (75), and 3) Workstation Design aspects (49). In addition 26 Individual quality risk factors were identified. Of the studies identified, about half studied the effects on the human finding associations with the operator workload and fatigue indicators and quality performance. These intermediary variables may provide insight into the mechanism by which HF flaws in the design of production lead to quality deficits in running manufacturing. These results provide useful information for operations managers and production system design teams to secure higher quality performance in their systems by applying human factors.

BackgroundMycofiltration is an environment friendly technology which involves the treatment of contaminated water by passing it through a network of fungal mycelium. This technology has gained momentum over the years, and the systematic review chartered in this protocol will compile and synthesise literature on mycofiltration studies, paying special attention to the types and levels of contaminants removed. The systematic review should provide insight into the removal efficiency of mycofiltration by synthesising the mycofiltration knowledge base. Moreover, the proposed contribution will inform further research and provide comprehensive information to relevant stakeholders, such as municipalities, which might be in need of interventions for alleviating wastewater-related pollution in surrounding water bodies.MethodsThis systematic review protocol is based on the question, “What is the effectiveness of mycofiltration for removal of contaminants from water?” A thorough search of peer reviewed journal articles and grey literature sources will be conducted on academic journal databases, websites, specialist sources such as environmental organisations as well social and networking sources. A supplemental search will also be performed by forward and backward citation tracing. A two-stage screening process at title, abstract and full text level, will be conducted, against predefined inclusion criteria. Studies that meet inclusion criteria will be subjected to quality assessment. Data will be extracted and compiled into a narrative synthesis and summarised into tables and figures. Meta-analysis will be performed where sufficient evidence-base allows.

In this article we go beyond epidemiological models to make a case for a more holistic approach to the use of face masks as a risk mitigation factor in the context of the Covid-19 pandemic. We argue that while masking offers a measure of protection from infection, its moral, political, and affective implications produce two main collateral risks. These are: (1) the heightening of social boundaries, which thus increase the potential of conflict between different social groups; and (2) the impairment of normative interaction rituals followed by a dynamic of distancing, insulation, and social alienation. While we stop short from constructing a hierarchy of risks, we do argue that policy makers should consider these collateral risks as part of any large-scale Covid-19 risk mitigation and communication strategy. We thus provide some principled guidance on how that might be done.

It would be useful for researchers, practitioners, and decision-makers to anticipate the hazards that workers will face in the future. The focus of this study is a systematic review of published information to identify and characterize scenarios and hazards in the future of work. Eleven bibliographic databases were systematically searched for papers and reports published from 1999 to 2019 that described future of work scenarios or identified future work-related hazards. To compile a comprehensive collection of views of the future, supplemental and ad hoc searches were also performed. After screening all search records against a set of predetermined criteria, the review yielded 36 references (17 peer-reviewed, 4 gray, and 15 supplemental) containing scenarios. In these, the future of work was described along multiple conceptual axes (e.g. labor market changes, societal values, and manual versus cognitive work). Technology was identified as the primary driver of the future of work in most scenarios, and there were divergent views in the literature as to whether technology will create more or fewer jobs than it displaces. Workforce demographics, globalization, climate change, economic conditions, and urbanization were also mentioned as influential factors. Other important themes included human enhancement, social isolation, loneliness, worker monitoring, advanced manufacturing, hazardous exposures, sustainability, biotechnology, and synthetic biology. Pandemics have not been widely considered in the future of work literature, but the recent COVID-19 pandemic illustrates that was short-sighted. Pandemics may accelerate future of work trends and merit critical consideration in scenario development. Many scenarios described ‘new’ or ‘exacerbated’ psychosocial hazards of work, whereas comparatively fewer discussed physical, chemical, or biological hazards. Various preventive recommendations were identified. In particular, reducing stress associated with precarious work and its requirements of continual skill preparation and training was acknowledged as critical for protecting and promoting the health and well-being of the future workforce. In conclusion, the future of work will be comprised of diverse complex scenarios and a mosaic of old and new hazards. These findings may serve as the basis for considering how to shape the future of work.

Internet-Delivered Psychological Treatments (IDPT) are based on evidence-based psychological treatment models adjusted for interaction through the Internet. The use of Internet technologies has the potential to increase the availability of evidence-based mental health services for a far-reaching population with the use of fewer resources. Despite evidence that Internet Interventions can be effective means in mental health morbidities, most current IDPT systems are tunnel-based, inflexible, and non-interoperable. Hence it becomes essential to understand which elements of an Internet intervention contribute to effectiveness and treatment outcomes. By analogy, adaptation is a central aspect of successful face-to-face mental health therapy. Adaptability to patient needs can be regarded as an essential outcome factor in online systems for mental health interventions as well. While some aspects of rule-based and machine-learning-based adaptation have attracted attention in recent IDPT development, systematic reporting of core components, dimensions of adaptiveness, information architecture, and strategies for adaptation in the IDPT system are still lacking. To bridge this gap, we propose a model that shows how adaptive systems are represented in classical control theory and discuss how the model can be used to specify adaptive IDPT systems. Concerning the reference model, we outline the core components of adaptive IDPT systems, the main adaptive elements, dimensions of adaptiveness, information architecture applied to adaptive systems, and strategies used in the adaptation process. We also provide comprehensive guidelines on how to develop an adaptive IDPT system based on the Person-Based Approach. publishedVersion

Communication networks are subject to many challenges leading to single or multiple failures of its elements. Example failure scenarios include unintentional failures due to scheduled maintenance activities or massive failures caused by disaster-induced events. Therefore, it is crucial to enhance the networks with redundancy and resilience mechanisms able to maintain the availability of network services after a failure. As these problems are often inherently hard to solve to optimality, the role of time-efficient approximation schemes is essential. In this paper, we highlight the selected problems of communication networks resilience addressed in this issue of Networks. Locked until 27.03.2021 due to copyright restrictions. This is the peer reviewed version of an article, which has been published in final form at [DOI: 10.1002/net.21940 ]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

Risks related with healthcare are always dynamic, and they are affected by situations of patients, human errors in treatment and even the states of medical devices. This paper proposes a dynamic medical risk assessment model, for capturing the impacts of factors on the occurrence of adverse events. In this model, a static fault tree is established to show risk scenarios. Dynamic Bayesian network and Bayesian inference are introduced to analyze the operations of medical devices, in consideration of their failures, repairs, and human errors over time. Hemodialysis infection is taken as the case to verify that the proposed method is helpful to demonstrate the changes of medical risks with time, and to identify the critical events contributing to the occurrence of the adverse event at different moments. These findings can act as the basis to assign and adjust safety measures.

Although peer review is considered one of the main pillars of modern science, experimental methods and protocols seem to be not a rigorous subject of this process in many papers. Commercial equipment, test kits, labeling kits, previously published concepts, and standard protocols are often considered to be not worth a detailed description or validation. Even more disturbing is the extremely biased citation behavior in this context, which sometimes leads to surrogate citations to avoid low-impact journals, preprints, or to indicate traditional practices. This article describes some of these surprising habits and suggests some measures to avoid the most unpleasant effects, which in the long term may undermine the credibility of science as a whole.

Testing for SARS-CoV-2 infection is key in managing the current pandemic. More than 1700 preprints and peer reviewed journal articles evaluating tests for SARS-CoV-2 infection have been published as of January 2021. However, evaluations of these studies have identified many methodological issues, leading to a high risk of bias and difficulties applying the results in practice. Better guidance is urgently needed on the conduct and interpretation of these studies. This article outlines the principles for defining the intended purpose of the test; study population selection; reference standard, test timing; and other critical considerations for the design, reporting, and interpretation of diagnostic accuracy studies. The implementation and accuracy of SARS-CoV-2 tests have major implications for individuals and communities, balancing the potential consequences of continued infection against the need for public health measures, such as the restriction of movements and social activities. Decision making in the current pandemic requires a clear understanding of the clinical performance and limitations of testing. This article provides guidance to assist researchers design robust diagnostic accuracy studies, assist publishers and peer reviewers to assess such studies, and support clinicians and policy makers in their evaluation of the evidence on SARS-CoV-2 testing for clinical and public health decisions. The guidance aims to ensure that studies evaluating the diagnostic accuracy of SARS-CoV-2 tests are conducted as rigorously as possible, in an efficient and timely way.

This paper reflects on how risk science, with its concepts, principles, approaches, methods and models, can support the actual assessments, communication and handling of the vulnerabilities and risks related to the Coronavirus (Covid-19) pandemic. We highlight the importance of acknowledging uncertainty as a main component of risk, in order to properly characterize and communicate risk, as well as to understand the difference between professional risk judgements and risk perception. We challenge the use of the commonly referred to phrase that the policies adopted are science-based, in a situation like this characterized by fundamental uncertainties about the underlying phenomena and the effects of possible interventions. Arguments are provided for a ‘balanced’ use of precaution, combined with adaptive management and learning.

Funder: Arcadia Fund; funder-id: http://dx.doi.org/10.13039/100012088, Funder: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula (PenCLAHRC), Background: Understanding how the conservation of nature can lead to improvement in human conditions is a research area with significant growth and attention. Progress towards effective conservation requires understanding mechanisms for achieving impact within complex social-ecological systems. Causal models are useful tools for defining plausible pathways from conservation actions to impacts on nature and people. Evaluating the potential of different strategies for delivering co-benefits for nature and people will require the use and testing of clear causal models that explicitly define the logic and assumptions behind cause and effect relationships. Objectives and methods: In this study, we outline criteria for credible causal models and systematically evaluated their use in a broad base of literature (~1,000 peer-reviewed and grey literature articles from a published systematic evidence map) on links between nature-based conservation actions and human well-being impacts. Results: Out of 1,027 publications identified, only ~20% of articles used any type of causal models to guide their work, and only 14 total articles fulfilled all criteria for credibility. Articles rarely tested the validity of models with empirical data. Implications: Not using causal models risks poorly defined strategies, misunderstanding of potential mechanisms for affecting change, inefficient use of resources, and focusing on implausible efforts for achieving sustainability.

Should the use of performance-enhancing drugs (PED) be banned in sport? A proper response to this question depends upon ideas of the meaning and value of sport. To a certain extent, sport is associated with ideal values such as equality of opportunity, fair play, performance and progress. PED use is considered contrary to these values. On the other hand, critics see sport as an expression of non-sustainable and competitive individualism that threatens human welfare and development. PED use is considered a logical consequence of these values. I challenge both views as simplistic and inadequate. I develop what I refer to as the normative structure of sport consisting of self-imposed constraints at three levels: in the formal rules, in norms for fair play, and in the interpretation of athletic excellence as a morally relevant instantiation of human excellence. I argue that the question of a ban on PED should be discussed at the third level and depends upon interpretations of athletic excellence as a form of human excellence. I conclude that, in the current situation of elite sport, proponents of a ban on PED seem to have the strongest arguments.

Numerous methods for information security risk assessment (ISRA) are available, yet there is little guidance on how to choose one. Through a comprehensive risk identification, estimation, and evaluation framework, the author evaluates the practical application of three ISRA methods in terms of tasks required, user experience, and results. © 2017 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.

Introduction The continued advancement in blood pressure monitoring techniques for hypertension raises the economic concerns. This signifies the value and importance of high quality economic evaluations as a guide for an efficient allocation of scarce resources and making reimbursement decisions. Aim To assess different methods for the economic evaluation of blood pressure monitoring techniques in hypertension with their strengths and limitations and to suggest potential ways to improve the quality of economic evaluation in this field. Methods A critical literature review of methods used in economic evaluation in blood pressure monitoring techniques was done. A literature search was conducted in selected databases to identify the full economic evaluations, cost-analysis and cost-consequence analyses, earliest from 1990s to date. The quality assessment of the methods used was done based on the standard Drummond’s guidelines and Philip’s checklists. Results Eighteen unique peer reviewed economic evaluations were identified in blood pressure monitoring techniques. The most frequent type of economic evaluation was cost-effectiveness analysis from healthcare perspective and Markov cohort modelling. The quality of the methods used needs improvement in different areas, mainly the study design, valuation of cost and outcome and uncertainty analysis. Overall, results of economic evaluations are to be applied with caution to other settings. Conclusions There is a constant need to improve the magnitude and quality of economic evaluations in this health technology, especially for children, that should follow standard quality criteria. More and more economic evaluations need to focus on subgroups with increased risk for target organ damage to heart, kidney and brain, subsequent to hypertension. The care providers and policy makers need to give due consideration to the quality of these health economic evaluations in making evidence-based decisions for patients and society as a whole.

A paradigm shift is presently underway in the shipping industry promising safer, greener and more efficient ship traffic. In this article, we will look at some of the accidents from conventional shipping and see if they could have been avoided with autonomous ship technology. A hypothesis of increased safety is often brought forward, and we know from various studies that the number of maritime accidents that involves what is called “human error” ranges from some 60-90 percent. If we replace the human with automation, can we then reduce the number of accidents? On the other hand, is there a possibility for new types of accidents to appear? What about the accidents that are today averted by the crew? This paper will present a method to assess these different aspects of the risk scenarios in light of the specific capabilities and constraints of autonomous ships. Under the terms of the Creative Commons Attribution License (CC BY-NC)

This paper discusses state of the art of unmanned aircraft systems (UAS), drones (unmanned aerial vehicle -UAV's)and control infrastructure. The focus has been to explore risks, vulnerabilities and safe use of UAS in industrial operations. The use of UAS has been in rapid expansion in governmental areas (monitoring, military applications) and in the public domain (leisure, photography, transportation, monitoring). Several vulnerabilities have been identified. Few empirical analyses of operations, incidents and successful recoveries are available due to limited reporting. However, safety information from military drone operations are available. The three research questions in this paper are to describe planned use of UAS, major risks and benefits of UAS, and needed research, requirements and rules to improve safety and resilience of operations. We have explored the status of research in Norway, we have performed a literature review of autonomy in aviation, and we have explored relevant cases of industrial transport systems. Our findings indicate that rules and regulations are lagging development of technology and that there is poor focus on major risks related to human factors in engineering, design and operations. To ensure that safety and resilience is in focus from design, there is a need to define scope (i.e. control system as part of UAS) establish functional guidelines (such as human factors guidelines) and improve regulatory frameworks.

Earthquakes around the world are unnecessarily lethal and destructive, adversely affecting the health and well-being of affected populations. Most immediate deaths and injuries are caused by building collapse, making search and rescue (SAR) an early priority. In this review, we assess the SAR response to earthquake disasters. First, we review the evidence for the majority of individuals being rescued locally, often by relatives and neighbours. We then summarise evidence for successful live rescues by international SAR (ISAR) teams, along with the costs, ethics and other considerations of deployment. Finally, we propose an alternative approach to postdisaster ISAR, with the goal of reducing overall morbidity and mortality.

The current, and welcome, focus on standardization of techniques and transparency of reporting in the biomedical, peer-reviewed literature is commendable. However, that focus has been intermittent as well as lacklustre and so failed to tackle the alarming lack of reliability and reproducibly of biomedical research. Authors have access to numerous recommendations, ranging from simple standards dealing with technical issues to those regulating clinical trials, suggesting that improved reporting guidelines are not the solution. The elemental solution is for editors to require meticulous implementation of their journals’ instructions for authors and reviewers and stipulate that no paper is published without a transparent, complete and accurate materials and methods section.

High-Impact Low-Probability (HILP) events in power systems historically involve a multitude of aspects, including diverse and disparate threats, failures and sequences of events. Each of these aspects are associated with different types of uncertainties. In practice, the analyst has to make trade-offs between computational efficiency and accuracy in the different aspects that are included in the analysis. Without a clear understanding of the specific problem to be solved and which aspects that are important to capture, elaborate quantitative analysis may be of limited value. This paper presents the development of a qualitative framework for analysing HILP events in power systems. By mapping aspects of power system HILP events to a bow-tie model, it provides a framework for defining, decomposing and delimitating decision problems related to such events. The framework may guide the analyst in the development and application of methods for quantitative analysis and for considering different types of uncertainties. Development of a qualitative framework for analysing high-impact low-probability events in power systems

This paper presents an approach to conduct risk assessments of complex incentive systems, using a case study of the normative Peer Review Process (PRP). This research centers on appliances and adaptations of the Conflicting Incentives Risk Analysis (CIRA). First as an approach to Root Cause Analysis of a known incident, and then for a full assessment of the incentives in the PRP together with possible risk treatments. CIRA uses an alternative notion of risk, where risk modeling is in terms of conflicting incentives between the risk owner and the stakeholders concerning the execution of actions. Compared to traditional risk assessment approaches, CIRA provides an insight into the underlying incentives behind a risk, and not just the technical vulnerability, likelihood and consequence. The main contributions of this work are an approach to obtain insight into incentives as root causes, and an approach to detecting and analyzing risks from incentives in the normative PRP. This paper also discusses risk treatments in terms of incentives to make the PRP more robust, together with a discussion of how to approach risk analysis of incentives. © 2015 by the author; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/4.0/).

The article considers how the past and present tendency to focus on selecting the best projects based on the sole criterion of meritorious science may result in a sub-optimal portfolio. The authors argue that scientists need to proactively engage in the discussion over the need to improve the efficiency and effectiveness of societal investments to ensure that the next generation of the management and decision-making process for our science, technology and innovation system is rooted in sound principles.The classic peer review process tends to provide unintended overlap and allows for an ill fit between some of the pieces and unwanted gaps to occur. Areas of high risk and high return can be missed due to their controversial nature and split decisions typically resulting in negative funding decisions. In general, high risk and a high frequency of split decisions tend to be replaced with lower risk initiatives. The authors propose herein supplementing peer review with research portfolio evaluation approaches and decision-making tools that can better assess research uncertainties and other special features of the transformation of the resulting knowledge into improved social well-being. A coupling of research quality review by peers with more systematic portfolio meta-analysis of recommended projects is both possible and essential.

The purpose of this paper is to systematically analyse a typical planning process in the offshore industry from the perspective of causes of major accidents, with the ultimate aim of identifying factors that affect the risk for major accidents occurring. We first study and describe a typical planning process for offshore oil and gas operations in Norway. Then we analyse a number of theories of major accidents, to see how the different theories and their explanations of causes and contributing factors can be of relevance for future plans and planning processes. Finally, we review accident investigations to search for evidence of how weaknesses in planning processes can contribute to major accidents through the above identified factors. Also, we try to identify any additional factors that have not been recognised through the theoretical review. This provides empirical support for the theoretical basis. Thirteen factors which directly or indirectly can influence the planning process causing a major accident potential are identified. These are exemplified through a review of investigation reports. The paper suggests that planning process should focus more on increasing quality in the plans at an early phase, with examples from incidents, and illustrate the relation between planning quality and potential for major accidents.

The Black-Scholes model and the peer-review process are combined to offer more insight into the apparent value of research projects. In doing so high-risk/high-return research is found to be more attractive and financially rational than under the traditional peer review approach. In other words projects with the highest disagreement amongst panel members should sometimes be selected even though the average panel score may not be the highest under consideration. This finding is important as it improves the existing peer review process by utilizing not only the mean value of peer reviews, but also their standard deviation. This note also opens the consideration of the potential of Real Options approaches for decision support for project selection and management of research.

The OECD’s Global Forum is set to publish the terms of reference for peer reviews on automatic exchange of information pursuant to the OECD’s Common Reporting Standard (CRS) in the near future. This paper anticipates those terms and proposes concrete elements that future peer review should contain for them to be effective in protecting the integrity of the CRS. Chief among these elements are specific statistics to ensure compliance, identify avoidance schemes and allow evaluation by independent and excluded parties (e.g. developing countries and civil society). We have written several reports identifying fundamental loopholes, gaps and biases in the CRS, and proposed fixes to them. However, we understand that neither the Global Forum nor the upcoming Terms of Reference for peer reviews can change or fix the CRS. For this reason, this report focuses only on recommendations for what peer reviews can do to ensure that the CRS, as it is, will be effectively implemented.

In this study we assess the applicability of a set of reliability criteria proposed by Agerstrand et al. This was done by evaluating the reliability of 12 non-standard peer-reviewed ecotoxicity and toxicity studies for Bisphenol A. There was an overall agreement between the evaluator and the authors of the papers regarding the result of the evaluations. This suggests that the criteria offer enough guidance to be a useful and consistent evaluation tool. It provides a transparent and structured approach, and ensures that a minimum and similar set of criteria is used. The evaluation of the peer-reviewed ecotoxicity and toxicity studies concludes that important information is sometimes missing, and therefore the studies do not always meet common regulatory requirements regarding reporting. Whether this is due to insufficient reporting or due to poorly performed studies is not known. To improve the reporting, and thereby promote reliability and reproducibility, researchers, reviewers, and editors are r...

This paper discusses experiences, risks and mitigation in autonomous transport systems, to improve learning and risk-based governance. This is based on literature reviews, experiences of autonomous transport systems and involvement in the regulatory process. The maturity varies between rail, road, aviation and shipping. Issues that may be transferred and adapted between modes are selected. The three research questions are: to describe major risks introduced by autonomous transport systems; how to mitigate the main risks through design and regulation; and suggest a way forward. The risk is dependent on operational domain, surrounding infrastructure, meaningful human control (including control centrals with human based interfaces), sensor ability, reliable propulsion and technology that are secure. Meaningful human control and system certification is a challenge. There is a need to gather data from incidents. In Norway autonomous shipping and road transportation are prioritized. Autonomy in rail and aviation, has not been prioritized in the same manner.

Total force fitness is an emerging concept defined as a state in which the individual, family, and organization can sustain optimal well-being and performance under all conditions. Medical and environmental fitness are two of the component domains in the total force fitness framework. These domains have purposely been combined as they are inextricably intertwined: a warfighter must be able to function, free of any anticipated medical condition that could compromise either individual or unit effectiveness, while potentially confronting multiple environmental challenges. Medical fitness, best described as a state of general mental and physical well-being, is determined by medical metrics. Environmental fitness is defined as the ability to perform mission-specific duties in any environment and withstand the multiple stressors of deployment and war. This article defines the domains of medical and environmental fitness, describes the benefits of a medically and environmentally fit force, and identifies...

In regulatory toxicology, quality assessment of in vivo studies is a critical step for assessing chemical risks. It is crucial for preserving public health studies that are considered suitable for regulating chemicals are robust. Current procedures for conducting quality assessments in safety agencies are not structured, clear or consistent. This leaves room for criticism about lack of transparency, subjective influence and the potential for insufficient protection provided by resulting safety standards. We propose a tool called "Qualichem in vivo" that is designed to systematically and transparently assess the quality of in vivo studies used in chemical health risk assessment. We demonstrate its use here with 12 experts, using two controversial studies on Bisphenol A (BPA) that played an important role in BPA regulation in Europe. The results obtained with Qualichem contradict the quality assessments conducted by expert committees in safety agencies for both of these studies. Furthermore, they show that reliance on standardized guidelines to ensure scientific quality is only partially justified. Qualichem allows experts with different disciplinary backgrounds and professional experiences to express their individual and sometimes divergent views - an improvement over the current way of dealing with minority opinions. It provides a transparent framework for expressing an aggregated, multi-expert level of confidence in a study, and allows a simple graphical representation of how well the study integrates the best available scientific knowledge. Qualichem can be used to compare assessments of the same study by different health agencies, increasing transparency and trust in the work of expert committees. In addition, it may be used in systematic evaluation of in vivo studies submitted by industry in the dossiers that are required for compliance with the REACH Regulation. Qualichem provides a balanced, common framework for assessing the quality of studies that may or may not be following standardized guidelines. © 2014 Maxim, van der Sluijs.

Animals serve a vital role as models for important biomedical research to understand and discover treatments for a wide range of human and animal diseases. Animals also serve an important role in determining the efficacy and safety of vaccines, medicines, consumer products, and a wide range of other substances. However, the welfare of animals used in research and testing may be adversely impacted by the pain and distress resulting from the induction of disease or toxicity. Animal welfare laws and policies mandate that such pain and distress should be avoided, or if not avoidable, should be limited to only that which is necessary in order to attain study objectives. Best practice strategies for minimizing or avoiding pain and distress include the use of pain-relieving drugs, humane endpoints, supportive veterinary care and husbandry, acclimatization, and consideration of replacement and reduction alternatives. Consideration and appropriate use of these best practices can help assure optimal welfare for animals used in biomedical research and testing. Objective: To discuss adverse animal welfare impacts that may result from biomedical research and testing studies, and to discuss current best practices for minimizing or avoiding these adverse impacts based on published guidelines and peer reviewed literature. The main focus will be on refinement: to discuss common research and testing models that involve pain and distress, and to discuss ways to avoid or minimize this pain and distress. Where replacement and reduction alternatives are available and applicable that can reduce the number of animals that will experience pain and/or distress, these will also be briefly discussed.

Cost savings are not always enough to convince industry to adopt prevention actions.

Without carefully designed communication protocols, hospitals can fail to meet the query and reporting requirements imposed by the Joint Commission on Accreditation of Healthcare Organizations, the National Practitioner Data Bank, and state medical societies. This article tracks the history of the requirements, outlines current standards, and offers specific recommendations for operational procedures to avoid potential pitfalls.

The selection of reference compounds is crucial for a successful in vitro test development in order to proof the relevance of the test system. This publication describes the criteria and the selection strategy leading to a list of more than 130 chemicals suitable for test development within the ReProTect project. The presented chemical inventory aimed to support the development and optimization of in vitro tests that seek to fulfill ECVAM's criteria for entering into the prevalidation. In order to select appropriate substances, a primary database was established compiling information from existing databases. In a second step, predefined selection criteria have been applied to obtain a comprehensive list ready to undergo a peer review process from independent experts with industrial, academic and regulatory background. Finally, a peer reviewed chemical list containing 13 substances challenging endocrine disrupter tests, additional 50 substances serving as reference chemicals for various tests evaluating effects on male and female fertility, and finally 61 substances were identified as known to provoke effects on the early development of mammalian offspring. The final list aims to cover relevant and specific mode/site of actions as they are known to be relevant for various substance classes. However, the recommended list should not be interpreted as a list of reproductive toxicants, because such a description requires proven associations with adverse effects of mammalian reproduction, which are subject of regulatory decisions done by involved competent authorities.

The first two articles in this series reviewed the reasons for widespread acceptance of surveillence and control methods in hospital infection control programs, and discussed important factors contributing to the successes and failures in applying this approach to noninfectious nosocomial events. The quality assurance program ‘targets of surveillence” identified in these articles are referred to as “quality indicators” by other authors and have been defined as “a quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities.” This article highlights those attributes of quality indicators that should be critiqued prior to implementation in a patient care review environment and discusses methods of improving quality indicator performance with ongoing monitoring and evaluation.

Bibliometric measures such as publication impact factor and total number of citations have in many scientific fields become principal means of evaluating scientific merit. Thus it has become important to study how the system of publication in peer reviewed journals succeeds or fails in maintaining standards of quality control. One particularly interesting indicator of these standards is the response to mistakes in the control system.

This commentary emphasizes the importance of Hernán's contention that the impact factor's strong dependence on nonquality factors makes it utterly flawed as a way to evaluate quality of journals or papers.

Many believe that medical expert systems have great potential to improve health care, but few of these systems have been rigorously evaluated, and even fewer are in routine use. We propose the evaluation of medical expert systems in two stages: laboratory and field testing. In the former, the perspectives of both prospective users and experts responsible for implementation are valuable. In the latter, the study must be designed to test, in an unbiased manner, whether the system is used in clinical practice, and if it is used, how it affects the structure, process and outcome of health care encounters. We conclude with proposals for encouraging the objective evaluation of these systems.

Peer review is the mechanism of the scientific community. It is the basis of most decisions, such as the recruitment of staff, the publication of scientific papers and, most important, the allocation of funds. In recent years, much has been published about the process, which is perceived as inadequate and in need of replacement by something more objective. There have even been experiments which demonstrate that the decision-making appears to be almost random. However, most of the perceived problems are due, I believe, to inappropriate boundary conditions.

Most assessments of the quality of restorations are entirely subjective and involve standard clinical diagnostic equipment. However in recent years there has been an increasing demand for more accurate and reliable methods. Attempts to achieve these have been directed mainly towards the standardization of clinical judgements by the provision of various systems of guidelines of criteria upon which to base them. While these have improved the usefulness of the assessments, they have remained largely subjective. Furthermore, the efficacy of using the particular criteria selected are themselves open to questioning. By the use of more complex methods of examination, often in the field of restorative materials research, assessments have been made of various features of restorations and a body of knowledge concerning factors that might influence or manifest their quality has been build up. However the true significance of much of this knowledge in terms of the clinical behaviour, and thus the finite quality of restorations in service, has yet to be established, for many of the studies have been undertaken in isolation from the dynamic conditions of function in the mouth. Notably, however, a few objective clinical studies have been carried out and objective measurements of some factors affecting the quality of restorations have been reported.

The authors propose that active physician participation in current review methodologies, including PSRO, can lessen the potential for such problems as the development of unrealistic standards, emphasis on review and record keeping as ends rather than means, and ineffectuality of the systems themselves. Potential advantages of PSRO are seen in areas of quality assessment and improvement, economy, and enhancement of the continuing learning processess of physicians. The authors suggest that physicians should resist pressures toward separation of reviewing authority from clinical competence.

The problem-oriented medical record has been extensively described and widely recommended by many. Its true value in patient care, teaching, and clinical research must now be proved. Potential shortcomings of the system include overemphasis on style and compartmentalization, uncritical acceptance of a data base, inefficiencies in the process of data retrieval, lack of criteria for problem formulation, and an expectation that problem orientation alone will permit effective record auditing.

The evaluation of the clinical practice of the flight nurse is difficult from a methodologic standpoint. Innovative approaches are required in order to get the true picture of the actual quality of the nurse's care. While the retrospective approach is certainly the most convenient, it is certainly not the best approach. A more varied and comprehensive approach to evaluating care, using an assortment of methodologies, is required to adequately quantify the quality of care provided by the flight nurse.

During recent years, the health care industry has been characterized by rapid increases in the volume of services delivered. This escalation is in part unjustified by medical need, and has produced a variety of efforts on the part of payers and providers to restrict overuse. In this article the authors consider the issues and problems involved in the control of medical utilization. Five categories of control are considered in detail: supply limitations, financial disincentives, authorization requirements, review mechanisms, and legal action. The article suggests that the success or failure of these various control mechanisms hinges upon four factors: whose use is being regulated, who performs the control activities, whether the attempted control involves a judgment as to the appropriateness of treatment, and whether the attempt to control occurs before, after, or during treatment. It is concluded that most current forms of utilization control suffer from ambiguity of purpose, organizational inefficiency, and undesirable side effects. The authors offer several proposals to correct these shortcomings, but conclude that the only long-range solution to overutilization lies in a more integrated approach to medical resource allocation and a consequent change in the structure of provider and user incentives.