This paper presents an alternative way to use records from safety investigations as a means to support the evaluation of safety management (SM) aspects. Datasets from safety investigation reports and progress records of an aviation organization were analyzed with the scope of assessing safety management’s role, speed of safety communication, timeliness of safety investigation processes and realization of safety recommendations, and the extent of convergence among SM and investigation teams. The results suggested an interfering role of the safety department, severe delays in safety investigations, timely implementation of recommendations, quick dissemination of investigation reports to the end-users, and a low ratio of investigation team recommendations included in the final safety investigation reports. The results were attributed to non-scalable safety investigation procedures, ineffective resource management, lack of consistent bidirectional communication, lack of investigators’ awareness about the overall organizational context, and a weak commitment of other departments to the realization of safety recommendations. The set of metrics and the combination of quantitative and qualitative methods presented in this paper can support organizations to the transition towards a performance-based evaluation of safety management.
The construction and transport sectors both have a substantial impact on the environment. The construction, maintaining and renovating of roads involves both these sectors and the environmental impact of this work can be reduced. The basic principle of a circular economy is to close material loops and so retain the highest utility, quality and value of products, components and materials as possible. An important question in this respect is how to qualify and quantify material flows. Material and project passports seem to be part of the solution to improve insights and sharing information on quantities and qualities of materials used in construction projects. This paper has used a literature study on material passports and has taken into account current project management software used by a municipality, in order to share a framework for organising and collecting road construction data. Furthermore, various scanning equipment and procedures were employed onsite in an experiment in collecting actual road data. This resulted in a large amount of different data files that have been interpreted and incorporated into the existing database structure of the municipality. The insights gained may help other researchers, principals and contractors in the road construction industry in collecting and storing reliable data necessary to renovate roads circularly.
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Background: Many international clinical guidelines recommend therapeutic exercise as a core treatment for knee and hip osteoarthritis. We aimed to identify individual patient-level moderators of the effect of therapeutic exercise for reducing pain and improving physical function in people with knee osteoarthritis, hip osteoarthritis, or both. Methods: We did a systematic review and individual participant data (IPD) meta-analysis of randomised controlled trials comparing therapeutic exercise with non-exercise controls in people with knee osteoathritis, hip osteoarthritis, or both. We searched ten databases from March 1, 2012, to Feb 25, 2019, for randomised controlled trials comparing the effects of exercise with non-exercise or other exercise controls on pain and physical function outcomes among people with knee osteoarthritis, hip osteoarthritis, or both. IPD were requested from leads of all eligible randomised controlled trials. 12 potential moderators of interest were explored to ascertain whether they were associated with short-term (12 weeks), medium-term (6 months), and long-term (12 months) effects of exercise on self-reported pain and physical function, in comparison with non-exercise controls. Overall intervention effects were also summarised. This study is prospectively registered on PROSPERO (CRD42017054049). Findings: Of 91 eligible randomised controlled trials that compared exercise with non-exercise controls, IPD from 31 randomised controlled trials (n=4241 participants) were included in the meta-analysis. Randomised controlled trials included participants with knee osteoarthritis (18 [58%] of 31 trials), hip osteoarthritis (six [19%]), or both (seven [23%]) and tested heterogeneous exercise interventions versus heterogeneous non-exercise controls, with variable risk of bias. Summary meta-analysis results showed that, on average, compared with non-exercise controls, therapeutic exercise reduced pain on a standardised 0–100 scale (with 100 corresponding to worst pain), with a difference of –6·36 points (95% CI –8·45 to –4·27, borrowing of strength [BoS] 10·3%, between-study variance [τ2] 21·6) in the short term, –3·77 points (–5·97 to –1·57, BoS 30·0%, τ2 14·4) in the medium term, and –3·43 points (–5·18 to –1·69, BoS 31·7%, τ2 4·5) in the long term. Therapeutic exercise also improved physical function on a standardised 0–100 scale (with 100 corresponding to worst physical function), with a difference of –4·46 points in the short term (95% CI –5·95 to –2·98, BoS 10·5%, τ2 10·1), –2·71 points in the medium term (–4·63 to –0·78, BoS 33·6%, τ2 11·9), and –3·39 points in the long term (–4·97 to –1·81, BoS 34·1%, τ2 6·4). Baseline pain and physical function moderated the effect of exercise on pain and physical function outcomes. Those with higher self-reported pain and physical function scores at baseline (ie, poorer physical function) generally benefited more than those with lower self-reported pain and physical function scores at baseline, with the evidence most certain in the short term (12 weeks). Interpretation: There was evidence of a small, positive overall effect of therapeutic exercise on pain and physical function compared with non-exercise controls. However, this effect is of questionable clinical importance, particularly in the medium and long term. As individuals with higher pain severity and poorer physical function at baseline benefited more than those with lower pain severity and better physical function at baseline, targeting individuals with higher levels of osteoarthritis-related pain and disability for therapeutic exercise might be of merit. Funding: Chartered Society of Physiotherapy Charitable Trust and the National Institute for Health and Care Research.
