Sample records for general operating procedures

  1. 14 CFR 93.309 - General operating procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false General operating procedures. 93.309... Vicinity of Grand Canyon National Park, AZ § 93.309 General operating procedures. Except in an emergency... authorized in writing by the Flight Standards District Office: (1) Northbound. 11,500 or 13,500 feet MSL. (2...

  2. 14 CFR 93.309 - General operating procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false General operating procedures. 93.309... Vicinity of Grand Canyon National Park, AZ § 93.309 General operating procedures. Except in an emergency... authorized in writing by the Flight Standards District Office: (1) Northbound. 11,500 or 13,500 feet MSL. (2...

  3. 14 CFR 93.309 - General operating procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false General operating procedures. 93.309... Vicinity of Grand Canyon National Park, AZ § 93.309 General operating procedures. Except in an emergency... authorized in writing by the Flight Standards District Office: (1) Northbound. 11,500 or 13,500 feet MSL. (2...

  4. 14 CFR 93.309 - General operating procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false General operating procedures. 93.309... Vicinity of Grand Canyon National Park, AZ § 93.309 General operating procedures. Except in an emergency... authorized in writing by the Flight Standards District Office: (1) Northbound. 11,500 or 13,500 feet MSL. (2...

  5. 14 CFR 93.309 - General operating procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false General operating procedures. 93.309... Vicinity of Grand Canyon National Park, AZ § 93.309 General operating procedures. Except in an emergency... authorized in writing by the Flight Standards District Office: (1) Northbound. 11,500 or 13,500 feet MSL. (2...

  6. 47 CFR 36.391 - General.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PROCEDURES; STANDARD PROCEDURES FOR SEPARATING TELECOMMUNICATIONS PROPERTY COSTS, REVENUES, EXPENSES, TAXES AND RESERVES FOR TELECOMMUNICATIONS COMPANIES 1 Operating Expenses and Taxes Corporate Operations Expense § 36.391 General. Corporate Operations Expenses are included in the following account: General and...

  7. Specialization and the Current Practices of General Surgeons

    PubMed Central

    Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

    2014-01-01

    Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

  8. General surgery workloads and practice patterns in the United States, 2007 to 2009: a 10-year update from the American Board of Surgery.

    PubMed

    Valentine, R James; Jones, Andrew; Biester, Thomas W; Cogbill, Thomas H; Borman, Karen R; Rhodes, Robert S

    2011-09-01

    To assess changes in general surgery workloads and practice patterns in the past decade. Nearly 80% of graduating general surgery residents pursue additional training in a surgical subspecialty. This has resulted in a shortage of general surgeons, especially in rural areas. The purpose of this study is to characterize the workloads and practice patterns of general surgeons versus certified surgical subspecialists and to compare these data with those from a previous decade. The surgical operative logs of 4968 individuals recertifying in surgery 2007 to 2009 were reviewed. Data from 3362 (68%) certified only in Surgery (GS) were compared with 1606 (32%) with additional American Board of Medical Specialties certificates (GS+). Data from GS surgeons were also compared with data from GS surgeons recertifying 1995 to 1997. Independent variables were compared using factorial ANOVA. GS surgeons performed a mean of 533 ± 365 procedures annually. Women GS performed far more breast operations and fewer abdomen, alimentary tract and laparoscopic procedures compared to men GS (P < 0.001). GS surgeons recertifying at 10 years performed more abdominal, alimentary tract and laparoscopic procedures compared to those recertifying at 20 or 30 years (P < 0.001). Rural GS surgeons performed far more endoscopic procedures and fewer abdominal, alimentary tract, and laparoscopic procedures than urban counterparts (P < 0.001). The United States medical school graduates had similar workloads and distribution of operations to international medical graduates. Compared to 1995 to 1997, GS surgeons from 2007 to 2009 performed more procedures, especially endoscopic and laparoscopic. GS+ surgeons performed 15% to 33% of all general surgery procedures. GS practice patterns are heterogeneous; gender, age, and practice setting significantly affect operative caseloads. A substantial portion of general surgery procedures currently are performed by GS+ surgeons, whereas GS surgeons continue to perform considerable numbers of specialty operations. Reduced general surgery operative experience in GS+ residencies may negatively impact access to general surgical care. Similarly, narrowing GS residency operative experience may impair specialty operation access.

  9. 14 CFR 93.71 - General operating procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... of Niagara Falls, New York § 93.71 General operating procedures. (a) Flight restrictions are in effect below 3,500 feet MSL in the airspace above Niagara Falls, New York, west of a line from latitude..., aircraft operating on an ATC-approved IFR flight plan, aircraft operating the Scenic Falls Route pursuant...

  10. 14 CFR 93.71 - General operating procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... of Niagara Falls, New York § 93.71 General operating procedures. (a) Flight restrictions are in effect below 3,500 feet MSL in the airspace above Niagara Falls, New York, west of a line from latitude..., aircraft operating on an ATC-approved IFR flight plan, aircraft operating the Scenic Falls Route pursuant...

  11. 14 CFR 93.71 - General operating procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... of Niagara Falls, New York § 93.71 General operating procedures. (a) Flight restrictions are in effect below 3,500 feet MSL in the airspace above Niagara Falls, New York, west of a line from latitude..., aircraft operating on an ATC-approved IFR flight plan, aircraft operating the Scenic Falls Route pursuant...

  12. Operative experience of residents in US general surgery programs: a gap between expectation and experience.

    PubMed

    Bell, Richard H; Biester, Thomas W; Tabuenca, Arnold; Rhodes, Robert S; Cofer, Joseph B; Britt, L D; Lewis, Frank R

    2009-05-01

    The purpose of the study was to identify a group of operations which general surgery residency program directors believed residents should be competent to perform by the end of 5 years of training and then ascertain actual resident experience with these procedures during their training. There is concern about the adequacy of training of general surgeons in the United States. The American Board of Surgery and the Association of Program Directors in Surgery undertook a study to determine what operative procedures residency program directors consider to be essential to the practice of general surgery and then we measured the actual operative experience of graduating residents in those procedures, as reported to the Residency Review Committee for Surgery (RRC). An electronic survey was sent to residency program directors at the 254 general surgery programs in the US accredited by the RRC as of spring 2006. The program directors were presented with a list of 300 types of operations. Program directors graded the 300 procedures "A," "B," or "C" using the following criteria: A--graduating general surgery residents should be competent to perform the procedure independently; B--graduating residents should be familiar with the procedure, but not necessarily competent to perform it; and C--graduating residents neither need to be familiar with nor competent to perform the procedure. After ballots were tallied, the actual resident operative experience reported to the RRC by all residents finishing general surgery training in June 2005 was reviewed. One hundred twenty-one of the 300 operations were considered A level procedures by a majority of program directors (PDs). Graduating 2005 US residents (n = 1022) performed only 18 of the 121 A procedures, an average of more than 10 times during residency; 83 of 121 procedures were performed on an average less than 5 times and 31 procedures less than once. For 63 of the 121 procedures, the mode (most commonly reported) experience was 0. In addition, there was significant variation between residents in operative experience for specific procedures. In virtually all cases, the mean reported experience exceeded the mode, suggesting that the mean is a poor measure of typical experience. These data pose important problems for surgical educators. Methods will have to be developed to allow surgeons to reach a basic level of competence in procedures which they are likely to experience only rarely during residency. Even for more commonly performed procedures, the numbers of repetitions are not very robust, stressing the need to determine objectively whether residents are actually achieving basic competency in these operations. Finally, the large variations in experience between individuals in our residency system need to be explored, understood, and remedied.

  13. Specialization and the current practices of general surgeons.

    PubMed

    Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

    2014-01-01

    The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons' operative practices to inform surgical education and workforce planning. We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project for 3 US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and percentage of practice that made up their most common operation were calculated. Correlation was measured between general surgeons' case volume and the number of other specialists in a health service area. There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure constituted no more than 30% of total practice. The most common operations, ranked by the frequency they appeared as general surgeons' top procedure, included cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice composed of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (rho = -0.50; p = 0.005). Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. 14 CFR 93.71 - General operating procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... of Niagara Falls, New York § 93.71 General operating procedures. (a) Flight restrictions are in effect below 3,500 feet MSL in the airspace above Niagara Falls, New York, west of a line from latitude...

  15. Cost analysis of injection laryngoplasty performed under local anaesthesia versus general anaesthesia: an Australian perspective.

    PubMed

    Chandran, D; Woods, C M; Schar, M; Ma, N; Ooi, E H; Athanasiadis, T

    2018-02-01

    To conduct a cost analysis of injection laryngoplasty performed in the operating theatre under local anaesthesia and general anaesthesia. The retrospective study included patients who had undergone injection laryngoplasty as day cases between July 2013 and March 2016. Cost data were obtained, along with patient demographics, anaesthetic details, type of injectant, American Society of Anesthesiologists score, length of stay, total operating theatre time and surgeon procedure time. A total of 20 cases (general anaesthesia = 6, local anaesthesia = 14) were included in the cost analysis. The mean total cost under general anaesthesia (AU$2865.96 ± 756.29) was significantly higher than that under local anaesthesia (AU$1731.61 ± 290.29) (p < 0.001). The mean operating theatre time, surgeon procedure time and length of stay were all significantly lower under local anaesthesia compared to general anaesthesia. Time variables such as operating theatre time and length of stay were the most significant predictors of the total costs. Procedures performed under local anaesthesia in the operating theatre are associated with shorter operating theatre time and length of stay in the hospital, and provide significant cost savings. Further savings could be achieved if local anaesthesia procedures were performed in the office setting.

  16. Operator priming and generalization of practice in adults' simple arithmetic.

    PubMed

    Chen, Yalin; Campbell, Jamie I D

    2016-04-01

    There is a renewed debate about whether educated adults solve simple addition problems (e.g., 2 + 3) by direct fact retrieval or by fast, automatic counting-based procedures. Recent research testing adults' simple addition and multiplication showed that a 150-ms preview of the operator (+ or ×) facilitated addition, but not multiplication, suggesting that a general addition procedure was primed by the + sign. In Experiment 1 (n = 36), we applied this operator-priming paradigm to rule-based problems (0 + N = N, 1 × N = N, 0 × N = 0) and 1 + N problems with N ranging from 0 to 9. For the rule-based problems, we found both operator-preview facilitation and generalization of practice (e.g., practicing 0 + 3 sped up unpracticed 0 + 8), the latter being a signature of procedure use; however, we also found operator-preview facilitation for 1 + N in the absence of generalization, which implies the 1 + N problems were solved by fact retrieval but nonetheless were facilitated by an operator preview. Thus, the operator preview effect does not discriminate procedure use from fact retrieval. Experiment 2 (n = 36) investigated whether a population with advanced mathematical training-engineering and computer science students-would show generalization of practice for nonrule-based simple addition problems (e.g., 1 + 4, 4 + 7). The 0 + N problems again presented generalization, whereas no nonzero problem type did; but all nonzero problems sped up when the identical problems were retested, as predicted by item-specific fact retrieval. The results pose a strong challenge to the generality of the proposal that skilled adults' simple addition is based on fast procedural algorithms, and instead support a fact-retrieval model of fast addition performance. (c) 2016 APA, all rights reserved).

  17. Comparable operative times with and without surgery resident participation.

    PubMed

    Uecker, John; Luftman, Kevin; Ali, Sadia; Brown, Carlos

    2013-01-01

    Both physicians and patients may perceive that having surgical residents participate in operative procedures may prolong operations and worsen outcomes. We hypothesized that resident participation would prolong operative times and potentially adversely affect postoperative outcomes. To evaluate the effect of general surgery resident participation in surgical procedures on operative times and postoperative patient outcomes. Retrospective study of general surgery procedures performed during two 1-year time periods, 2007 without residents and 2011 with residents. Procedures included laparoscopic appendectomy and cholecystectomy, thyroidectomy, breast procedure, hernia repair, lower extremity amputation, tunneled venous catheter, and percutaneous endoscopic gastrostomy. The primary outcome was operative time and secondary outcomes included length of stay (LOS) and mortality. Academic general surgery residency program. There were 2280 operative procedures performed during the 2 periods: 1150 with resident involvement (RES group) and 1130 without residents (NORES group). The RES and NORES groups were similar for patient age (42 vs 41, p = 0.14) and male gender (46% vs 45%, p = 0.68), and there was no difference in overall operative time (68min vs 66min, p = 0.58). More specifically there was no difference in operative time (minutes) for specific procedures including laparoscopic appendectomy (67 vs 71, p = 0.8), thyroidectomy (125 vs 109, p = 0.16), breast procedure (38 vs 26, p = 0.79), hernia repair (61 vs 60, p = 0.74), lower extremity amputation (65 vs 77, p = 0.16), tunneled venous catheter (49 vs 47, p = 0.75), and percutaneous endoscopic gastrostomy (49 vs 46, p = 0.76). However, laparoscopic cholecystectomy took slightly longer in the RES group (71 vs 66, p = 0.02). LOS was shorter during the year with resident involvement (2.6 days vs 3.7 days, p = 0.0004) and there was no difference in mortality (0.17% vs 0.35%, p = 0.45). There is no difference in operative time for common general surgery procedures with or without resident involvement. In addition, resident involvement is associated with a decrease in LOS. This information should be used to change physician and patient negative perceptions regarding resident involvement while performing surgical procedures. © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  18. Advanced laparoscopic bariatric surgery Is safe in general surgery training.

    PubMed

    Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

    2017-05-01

    Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

  19. A Guide for Developing Standard Operating Job Procedures for the Pump Station Process Wastewater Treatment Facility. SOJP No. 3.

    ERIC Educational Resources Information Center

    Perley, Gordon F.

    This is a guide for standard operating job procedures for the pump station process of wastewater treatment plants. Step-by-step instructions are given for pre-start up inspection, start-up procedures, continuous routine operation procedures, and shut-down procedures. A general description of the equipment used in the process is given. Two…

  20. 14 CFR 91.1109 - Aircraft maintenance: Inspection program.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... be in writing and include at least the following information: (1) Instructions and procedures for the... TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional.... The instructions and procedures must set forth in detail the parts and areas of the airframe, engines...

  1. 14 CFR 91.1109 - Aircraft maintenance: Inspection program.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... be in writing and include at least the following information: (1) Instructions and procedures for the... TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional.... The instructions and procedures must set forth in detail the parts and areas of the airframe, engines...

  2. 14 CFR 91.1017 - Amending program manager's management specifications.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... management specifications, the following procedure applies: (1) The Flight Standards District Office that... filed within 30 days, the procedures of paragraph (c) of this section apply. (e) If the Flight Standards... TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional...

  3. 14 CFR 91.1017 - Amending program manager's management specifications.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... management specifications, the following procedure applies: (1) The Flight Standards District Office that... filed within 30 days, the procedures of paragraph (c) of this section apply. (e) If the Flight Standards... TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional...

  4. 14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... consumption and cruise control; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The..., DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT... manager's flight locating procedures; (2) Principles and methods for determining weight and balance, and...

  5. 14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... consumption and cruise control; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The..., DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT... manager's flight locating procedures; (2) Principles and methods for determining weight and balance, and...

  6. 14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... consumption and cruise control; (9) Flight planning; (10) Each normal and emergency procedure; and (11) The..., DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT... manager's flight locating procedures; (2) Principles and methods for determining weight and balance, and...

  7. 42 CFR 35.15 - Consent to operative procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Consent to operative procedures. 35.15 Section 35.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.15 Consent to operative procedures. Except in...

  8. 42 CFR 35.15 - Consent to operative procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Consent to operative procedures. 35.15 Section 35.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.15 Consent to operative procedures. Except in...

  9. 42 CFR 35.15 - Consent to operative procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Consent to operative procedures. 35.15 Section 35.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.15 Consent to operative procedures. Except in...

  10. 42 CFR 35.15 - Consent to operative procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Consent to operative procedures. 35.15 Section 35.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.15 Consent to operative procedures. Except in...

  11. 42 CFR 35.15 - Consent to operative procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Consent to operative procedures. 35.15 Section 35.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAL CARE AND EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.15 Consent to operative procedures. Except in...

  12. NHEXAS PHASE I ARIZONA STUDY--STANDARD OPERATING PROCEDURE FOR CALIBRATION, MAINTENANCE AND OPERATION OF ELECTRONIC BALANCES (BCO-L-23.0)

    EPA Science Inventory

    The purpose of this SOP is to describe the general procedures to be followed for the operation, calibration and maintenance of electronic balances. This procedure was followed to ensure consistent data retrieval during the Arizona NHEXAS project and the "Border" study. Keywords: ...

  13. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR OPERATION AND INITIALIZATION OF THE MAGELLAN GPS SATELLITE NAVIGATOR (UA-F-22.1)

    EPA Science Inventory

    The purpose of this SOP is to describe the general procedures for the operation and initialization of the Magellan Global Positioning System (GPS) Satellite Navigator. This procedure was followed to ensure consistent data retrieval during the Arizona NHEXAS project and the Borde...

  14. NHEXAS PHASE I ARIZONA STUDY--STANDARD OPERATING PROCEDURE FOR OPERATION, CALIBRATION AND MAINTENANCE OF FIXED AND ADJUSTABLE VOLUME PIPETTE GUNS (BCO-L-9.0)

    EPA Science Inventory

    The purpose of this SOP is to describe the general procedures for the operation, calibration, and maintenance of fixed- and adjustable-volume pipette guns. This procedure was followed to ensure consistent data retrieval during the Arizona NHEXAS project and the "Border" study. Ke...

  15. NHEXAS PHASE I ARIZONA STUDY--STANDARD OPERATING PROCEDURE FOR OPERATION AND INITIALIZATION OF THE MAGELLAN GPS SATELLITE NAVIGATOR (UA-F-22.1)

    EPA Science Inventory

    The purpose of this SOP is to describe the general procedures for the operation and initialization of the Magellan Global Positioning System (GPS) Satellite Navigator. This procedure was followed to ensure consistent data retrieval during the Arizona NHEXAS project and the "Bord...

  16. Identifying gaps in the surgical training curriculum in Rwanda through evaluation of operative activity at a teaching hospital.

    PubMed

    Rickard, Jennifer L; Ntakiyiruta, Georges; Chu, Kathryn M

    2015-01-01

    To define the operations performed by surgical residents at a tertiary referral hospital in Rwanda to help guide development of the residency program. Cross-sectional study of all patients operated by surgical residents from October 2012 to September 2013. University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali [CHUK]), a public, tertiary referral hospital in Kigali, Rwanda. All patient data were entered into the operative database by surgical residents at CHUK. A total of 2833 cases were entered into the surgical database. Of them, 53 cases were excluded from further analysis because no surgical resident was listed as the primary or assistant surgeon, leaving 2780 cases for analysis. There were 2780 operations involving surgical residents. Of them, 51% of procedures were classified under general surgery, 38% orthopedics, 7% neurosurgery, and 4% urology. Emergency operations accounted for 64% of the procedures, with 56% of those being general surgery and 35% orthopedic. Further, 50% of all operations were trauma, with 71% of those orthopedic and 21% general surgery. Surgical faculty were involved in 45% of operations as either the primary or the assistant surgeons, while the remainder of operations did not involve surgical faculty. Residents were primary surgeons in 68% of procedures and assistant surgeons in 84% of procedures. The operative experience of surgery residents at CHUK primarily involves emergency and trauma procedures. Although this likely reflects the demographics of surgical care within Rwanda, more focus should be placed on elective procedures to ensure that surgical residents are broadly trained. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  17. 18 CFR 376.209 - Procedures during periods of emergency requiring activation of the Continuity of Operations Plan.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... periods of emergency requiring activation of the Continuity of Operations Plan. 376.209 Section 376.209... GENERAL RULES ORGANIZATION, MISSION, AND FUNCTIONS; OPERATIONS DURING EMERGENCY CONDITIONS Commission Operation During Emergency Conditions § 376.209 Procedures during periods of emergency requiring activation...

  18. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR OPERATION, CALIBRATION AND MAINTENANCE OF FIXED AND ADJUSTABLE VOLUME PIPETTE GUNS (BCO-L-9.0)

    EPA Science Inventory

    The purpose of this SOP is to describe the general procedures for the operation, calibration, and maintenance of fixed- and adjustable-volume pipette guns. This procedure was followed to ensure consistent data retrieval during the Arizona NHEXAS project and the Border study. Keyw...

  19. 27 CFR 24.136 - Procedure for alternating proprietors.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Procedure for alternating proprietors. (a) General. Wine premises, or parts thereof, may be operated... limited to parts of the wine premises, the application will describe areas, buildings, floors, or rooms... wine premises will be operated. Once the qualifying documents have been approved, and operations...

  20. 30 CFR 250.408 - May I use alternative procedures or equipment during drilling operations?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... during drilling operations? 250.408 Section 250.408 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations General Requirements § 250.408 May I use alternative procedures or equipment...

  1. 30 CFR 250.408 - May I use alternative procedures or equipment during drilling operations?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... during drilling operations? 250.408 Section 250.408 Mineral Resources BUREAU OF SAFETY AND ENVIRONMENTAL ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations General Requirements § 250.408 May I use alternative procedures or...

  2. 30 CFR 250.408 - May I use alternative procedures or equipment during drilling operations?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... during drilling operations? 250.408 Section 250.408 Mineral Resources BUREAU OF SAFETY AND ENVIRONMENTAL ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations General Requirements § 250.408 May I use alternative procedures or...

  3. 30 CFR 250.408 - May I use alternative procedures or equipment during drilling operations?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... during drilling operations? 250.408 Section 250.408 Mineral Resources BUREAU OF SAFETY AND ENVIRONMENTAL ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations General Requirements § 250.408 May I use alternative procedures or...

  4. Getting started with robotics in general surgery with cholecystectomy: the Canadian experience.

    PubMed

    Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M

    2009-10-01

    The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p < 0.001). The mean time to clear the operating room was significantly longer for robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it cannot be justified for routine use. Our experience, however, demonstrates that robotic cholecystectomy is one means by which general surgeons may gain confidence in performing advanced robotic procedures.

  5. 49 CFR 1180.8 - Operational data.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 8 2011-10-01 2011-10-01 false Operational data. 1180.8 Section 1180.8..., TRACKAGE RIGHTS, AND LEASE PROCEDURES General Acquisition Procedures § 1180.8 Operational data. (a... chart. Data shown in the density chart shall be for the latest available full calendar year preceding...

  6. 49 CFR 1180.8 - Operational data.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Operational data. 1180.8 Section 1180.8..., TRACKAGE RIGHTS, AND LEASE PROCEDURES General Acquisition Procedures § 1180.8 Operational data. (a... chart. Data shown in the density chart shall be for the latest available full calendar year preceding...

  7. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR OPERATION AND MAINTENANCE OF THE ECOCHEM REAL-TIME AMBIENT AIR PAH MONITOR (UA-F-24.0)

    EPA Science Inventory

    The purpose of this SOP is to describe the general procedures to be followed for the operation and maintenance of the EcoChem real-time ambient air PAH monitor. This procedure was followed to ensure consistent data retrieval of PAH measurements during the Arizona NHEXAS project ...

  8. 40 CFR 75.30 - General provisions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.30 General provisions. (a) Except as... continuous emission monitoring system according to the missing data procedures in this subpart whenever the... missing data procedures in this subpart if the owner or operator uses SO2, CO2, NOX, or O2 concentration...

  9. 40 CFR 75.30 - General provisions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.30 General provisions. (a) Except as... continuous emission monitoring system according to the missing data procedures in this subpart whenever the... missing data procedures in this subpart if the owner or operator uses SO2, CO2, NOX, or O2 concentration...

  10. 40 CFR 75.30 - General provisions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.30 General provisions. (a) Except as... continuous emission monitoring system according to the missing data procedures in this subpart whenever the... missing data procedures in this subpart if the owner or operator uses SO2, CO2, NOX, or O2 concentration...

  11. 40 CFR 75.30 - General provisions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.30 General provisions. (a) Except as... continuous emission monitoring system according to the missing data procedures in this subpart whenever the... missing data procedures in this subpart if the owner or operator uses SO2, CO2, NOX, or O2 concentration...

  12. 40 CFR 75.30 - General provisions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) CONTINUOUS EMISSION MONITORING Missing Data Substitution Procedures § 75.30 General provisions. (a) Except as... continuous emission monitoring system according to the missing data procedures in this subpart whenever the... missing data procedures in this subpart if the owner or operator uses SO2, CO2, NOX, or O2 concentration...

  13. Changing trends in abdominal surgical complications following cardiac surgery in an era of advanced procedures. A retrospective cohort study.

    PubMed

    Ashfaq, Awais; Johnson, Daniel J; Chapital, Alyssa B; Lanza, Louis A; DeValeria, Patrick A; Arabia, Francisco A

    2015-03-01

    Abdominal complications following cardiopulmonary bypass (CPB) procedures may have mortality rates as high as 25%. Advanced procedures such as ventricular assist devices, artificial hearts and cardiac transplantation are being increasingly employed, changing the complexity of interventions. This study was undertaken to examine the changing trends in complications and the impact of cardiac surgery on emergency general surgery (EGS) coverage. A retrospective review was conducted of all CPB procedures admitted to our ICU between Jan. 2007 and Mar. 2010. The procedures included coronary bypass (CABG), valve, combination (including adult congenital) and advanced heart failure (AHF) procedures. The records were reviewed to obtain demographics, need for EGS consult/procedure and outcomes. Mean age of the patients was 66 ± 8.5 years, 71% were male. There were 945 CPB procedures performed on 914 patients during this study period. Over 39 months, 23 EGS consults were obtained, resulting in 10 operations and one hospital death (10% operative mortality). CABG and valve procedures had minimal impact on EGS workload while complex cardiac and AHF procedures accounted for significantly more EGS consultations (p < 0.005) and operations (p < 0.005). The majority of consultations were for small bowel obstruction/ileus (n = 4, 17%), cholecystitis (n = 3, 13%) and to rule out ischemia (n = 2, 9%) In the era of modern critical care and cardiac surgery, advanced technology has increased the volume of complex CPB procedures increasing the EGS workload. Emergency general surgeons working in institutions that perform advanced procedures should be aware of the potential for general surgical complications perioperatively and the resultant nuances that are associated with operative management in this patient population. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  14. 14 CFR 93.352 - Hudson River Exclusion specific operating procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Hudson River Exclusion specific operating procedures. 93.352 Section 93.352 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES SPECIAL AIR TRAFFIC RULES New York Class B...

  15. 14 CFR 93.353 - East River Exclusion specific operating procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false East River Exclusion specific operating procedures. 93.353 Section 93.353 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES SPECIAL AIR TRAFFIC RULES New York Class B...

  16. Reduction Mammoplasty: A Comparison Between Operations Performed by Plastic Surgery and General Surgery.

    PubMed

    Kordahi, Anthony M; Hoppe, Ian C; Lee, Edward S

    2015-01-01

    Reduction mammoplasty is an often-performed procedure by plastic surgeons and increasingly by general surgeons. The question has been posed in both general surgical literature and plastic surgical literature as to whether this procedure should remain the domain of surgical specialists. Some general surgeons are trained in breast reductions, whereas all plastic surgeons receive training in this procedure. The National Surgical Quality Improvement Project provides a unique opportunity to compare the 2 surgical specialties in an unbiased manner in terms of preoperative comorbidities and 30-day postoperative complications. The National Surgical Quality Improvement Project database was queried for the years 2005-2012. Patients were identified as having undergone a reduction mammoplasty by Current Procedural Terminology codes. RESULTS were refined to include only females with an International Classification of Diseases, Ninth Revision, code of 611.1 (hypertrophy of breasts). Information was collected regarding age, surgical specialty performing procedure, body mass index, and other preoperative variables. The outcomes utilized were presence of superficial surgical site infection, presence of deep surgical site infection, presence of wound dehiscence, postoperative respiratory compromise, pulmonary embolism, deep vein thrombosis, perioperative transfusion, operative time, reintubation, reoperation, and length of hospital stay. During this time period, there were 6239 reduction mammaplasties performed within the National Surgical Quality Improvement Project database: 339 by general surgery and 5900 by plastic surgery. No statistical differences were detected between the 2 groups with regard to superficial wound infections, deep wound infections, organ space infections, or wound dehiscence. There were no significant differences noted between within groups with regard to systemic postoperative complications. Patients undergoing a procedure by general surgery were more likely to experience a failure of skin flaps, necessitating a return to the operative room (P < .05). Operative time was longer in procedures performed by general surgery (P < .05). Several important differences appear to exist between reduction mammaplasties performed by general surgery and plastic surgery. A focused training in reduction mammoplasty appears to be beneficial to the patient. The limitations of this study include a lack of long-term follow-up with regard to aesthetic outcome, nipple malposition, nipple sensation, and late wound sequelae.

  17. A national review of the frequency of minimally invasive surgery among general surgery residents: assessment of ACGME case logs during 2 decades of general surgery resident training.

    PubMed

    Richards, Morgan K; McAteer, Jarod P; Drake, F Thurston; Goldin, Adam B; Khandelwal, Saurabh; Gow, Kenneth W

    2015-02-01

    Minimally invasive surgery (MIS) has created a shift in how many surgical diseases are treated. Examining the effect on resident operative experience provides valuable insight into trends that may be useful for restructuring the requirements of resident training. To evaluate changes in general surgery resident operative experience regarding MIS. Retrospective review of the frequency of MIS relative to open operations among general surgery residents using the Accreditation Council for Graduate Medical Education case logs for academic years 1993-1994 through 2011-2012. General surgery residency training among accredited programs in the United States. We analyzed the difference in the mean number of MIS techniques and corresponding open procedures across training periods using 2-tailed t tests with statistical significance set at P < .05. Of 6,467,708 operations with the option of MIS, 2,393,030 (37.0%) were performed with the MIS approach. Of all MIS operations performed, the 5 most common were cholecystectomy (48.5%), appendectomy (16.2%), groin hernia repair (10.0%), abdominal exploration (nontrauma) (4.4%), and antireflux procedures (3.6%). During the study period, there was a transition from a predominantly open to MIS approach for appendectomy, antireflux procedures, thoracic wedge resection, and partial gastric resection. Cholecystectomy is the only procedure for which MIS was more common than the open technique throughout the study period (P < .001). The open approach is more common for all other procedures, including splenectomy (0.7% MIS), common bile duct exploration (24.9% MIS), gastrostomy (25.9% MIS), abdominal exploration (33.1% MIS), hernia (20.3% MIS), lung resection (22.3% MIS), partial or total colectomy (39.1%), enterolysis (19.0% MIS), ileostomy (9.0% MIS), enterectomy (5.2% MIS), vagotomy (1.8% MIS), and pediatric antireflux procedures (35.9% MIS); P < .001. Minimally invasive surgery has an increasingly prominent role in contemporary surgical therapy for many common diseases. The open approach, however, still predominates in all but 5 procedures. Residents today must become efficient at performing multiple techniques for a single procedure, which demands a broader skill set than in the past.

  18. 40 CFR 240.210 - General operations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 24 2010-07-01 2010-07-01 false General operations. 240.210 Section 240.210 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.210 General...

  19. 23 CFR 627.5 - General principles and procedures.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS VALUE ENGINEERING § 627.5 General principles and procedures. (a) State VE programs. State transportation... studies. (2) Studies. Value engineering studies shall follow the widely recognized systematic problem...

  20. 23 CFR 627.5 - General principles and procedures.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS VALUE ENGINEERING § 627.5 General principles and procedures. (a) State VE programs. State transportation... studies. (2) Studies. Value engineering studies shall follow the widely recognized systematic problem...

  1. 23 CFR 627.5 - General principles and procedures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS VALUE ENGINEERING § 627.5 General principles and procedures. (a) State VE programs. State transportation... studies. (2) Studies. Value engineering studies shall follow the widely recognized systematic problem...

  2. 14 CFR 91.1025 - Program operating manual contents.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... flight; (f) Procedures to be followed by the pilot in command for determining that mechanical irregularities or defects reported for previous flights have been corrected or that correction of certain...

  3. 14 CFR 91.1025 - Program operating manual contents.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... flight; (f) Procedures to be followed by the pilot in command for determining that mechanical irregularities or defects reported for previous flights have been corrected or that correction of certain...

  4. 14 CFR 91.1025 - Program operating manual contents.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... flight; (f) Procedures to be followed by the pilot in command for determining that mechanical irregularities or defects reported for previous flights have been corrected or that correction of certain...

  5. 14 CFR 91.1025 - Program operating manual contents.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... flight; (f) Procedures to be followed by the pilot in command for determining that mechanical irregularities or defects reported for previous flights have been corrected or that correction of certain...

  6. 14 CFR 91.1025 - Program operating manual contents.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... flight; (f) Procedures to be followed by the pilot in command for determining that mechanical irregularities or defects reported for previous flights have been corrected or that correction of certain...

  7. What is the safety of nonemergent operative procedures performed at night? A study of 10,426 operations at an academic tertiary care hospital using the American College of Surgeons national surgical quality program improvement database.

    PubMed

    Turrentine, Florence E; Wang, Hongkun; Young, Jeffrey S; Calland, James Forrest

    2010-08-01

    Ever-increasing numbers of in-house acute care surgeons and competition for operating room time during normal daytime business hours have led to an increased frequency of nonemergent general and vascular surgery procedures occurring at night when there are fewer residents, consultants, nurses, and support staff available for assistance. This investigation tests the hypothesis that patients undergoing such procedures after hours are at increased risk for postoperative morbidity and mortality. Clinical data for 10,426 operative procedures performed over a 5-year period at a single academic tertiary care hospital were obtained from the American College of Surgeons National Surgical Quality Improvement Program Database. The prevalence of preoperative comorbid conditions, postoperative length of stay, morbidity, and mortality was compared between two cohorts of patients: one who underwent nonemergent operative procedures at night and other who underwent similar procedures during the day. Subsequent statistical comparisons utilized chi tests for comparisons of categorical variables and F-tests for continuous variables. Patients undergoing procedures at night had a greater prevalence of serious preoperative comorbid conditions. Procedure complexity as measured by relative value unit did not differ between groups, but length of stay was longer after night procedures (7.8 days vs. 4.3 days, p < 0.0001). Patients undergoing nonemergent general and vascular surgery procedures at night in an academic medical center do not seem to be at increased risk for postoperative morbidity or mortality. Performing nonemergent procedures at night seems to be a safe solution for daytime overcrowding of operating rooms.

  8. Meta-analysis of operative experiences of general surgery trainees during training.

    PubMed

    Elsey, E J; Griffiths, G; Humes, D J; West, J

    2017-01-01

    General surgical training curricula around the world set defined operative numbers to be achieved before completion of training. However, there are few studies reporting total operative experience in training. This systematic review aimed to quantify the published global operative experience at completion of training in general surgery. Electronic databases were searched systematically for articles in any language relating to operative experience in trainees completing postgraduate general surgical training. Two reviewers independently assessed citations for inclusion using agreed criteria. Studies were assessed for quantitative data in addition to study design and purpose. A meta-analysis was performed using a random-effects model of studies with appropriate data. The search resulted in 1979 titles for review. Of these, 24 studies were eligible for inclusion in the review and data from five studies were used in the meta-analysis. Studies with published data of operative experience at completion of surgical training originated from the USA (19), UK (2), the Netherlands (1), Spain (1) and Thailand (1). Mean total operative experience in training varied from 783 procedures in Thailand to 1915 in the UK. Meta-analysis produced a mean pooled estimate of 1366 (95 per cent c.i. 1026 to 1707) procedures per trainee at completion of training. There was marked heterogeneity between studies (I 2  = 99·6 per cent). There is a lack of robust data describing the operative experiences of general surgical trainees outside the USA. The number of surgical procedures performed by general surgeons in training varies considerably across the world. © 2016 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

  9. 14 CFR 91.1039 - IFR takeoff, approach and landing minimums.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) For flight planning purposes, if the destination airport does not have a weather reporting facility... TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional... on a program aircraft operating a program flight may begin an instrument approach procedure to an...

  10. 14 CFR 91.1039 - IFR takeoff, approach and landing minimums.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...) For flight planning purposes, if the destination airport does not have a weather reporting facility... TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional... on a program aircraft operating a program flight may begin an instrument approach procedure to an...

  11. 14 CFR 91.1039 - IFR takeoff, approach and landing minimums.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...) For flight planning purposes, if the destination airport does not have a weather reporting facility... TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional... on a program aircraft operating a program flight may begin an instrument approach procedure to an...

  12. 14 CFR 91.1039 - IFR takeoff, approach and landing minimums.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...) For flight planning purposes, if the destination airport does not have a weather reporting facility... TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional... on a program aircraft operating a program flight may begin an instrument approach procedure to an...

  13. 14 CFR 91.1039 - IFR takeoff, approach and landing minimums.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...) For flight planning purposes, if the destination airport does not have a weather reporting facility... TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional... on a program aircraft operating a program flight may begin an instrument approach procedure to an...

  14. 47 CFR 13.209 - Examination procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL RADIO OPERATORS Examination System § 13.209 Examination procedures. (a) Each examination for a commercial radio operator license must be administered at a... examinee to comply with its instructions. (b) Each examinee, when taking an examination for a commercial...

  15. 40 CFR 61.14 - Monitoring requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... determination of whether acceptable operating and maintenance procedures are being used will be based on information which may include, but not be limited to, review of operating and maintenance procedures...) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS General Provisions § 61.14 Monitoring requirements...

  16. 40 CFR 61.14 - Monitoring requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... determination of whether acceptable operating and maintenance procedures are being used will be based on information which may include, but not be limited to, review of operating and maintenance procedures...) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS General Provisions § 61.14 Monitoring requirements...

  17. 40 CFR 61.14 - Monitoring requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... determination of whether acceptable operating and maintenance procedures are being used will be based on information which may include, but not be limited to, review of operating and maintenance procedures...) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS General Provisions § 61.14 Monitoring requirements...

  18. 40 CFR 61.14 - Monitoring requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... determination of whether acceptable operating and maintenance procedures are being used will be based on information which may include, but not be limited to, review of operating and maintenance procedures...) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS General Provisions § 61.14 Monitoring requirements...

  19. 40 CFR 61.14 - Monitoring requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... determination of whether acceptable operating and maintenance procedures are being used will be based on information which may include, but not be limited to, review of operating and maintenance procedures...) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS General Provisions § 61.14 Monitoring requirements...

  20. NHEXAS PHASE I ARIZONA STUDY--LIST OF STANDARD OPERATING PROCEDURES

    EPA Science Inventory

    This document lists available protocols and SOPs for the NHEXAS Phase I Arizona study. It identifies protocols and SOPs for the following study components: (1) Sample collection and field operations, (2) Sample analysis, (3) General laboratory procedures, (4) Quality Assurance, (...

  1. Perioperative hypoxemia is common with horizontal positioning during general anesthesia and is associated with major adverse outcomes: a retrospective study of consecutive patients

    PubMed Central

    2014-01-01

    Background Reported perioperative pulmonary aspiration (POPA) rates have substantial variation. Perioperative hypoxemia (POH), a manifestation of POPA, has been infrequently studied beyond the PACU, for patients undergoing a diverse array of surgical procedures. Methods Consecutive adult patients with ASA I-IV and pre-operative pulmonary stability who underwent a surgical procedure requiring general anesthesia were investigated. Using pulse oximetry, POH was documented in the operating room and during the 48 hours following PACU discharge. POPA was the presence of an acute pulmonary infiltrate with POH. Results The 500 consecutive, eligible patients had operative body-positions of prone 13%, decubitus 8%, sitting 1%, and supine/lithotomy 78%, with standard practice of horizontal recumbency. POH was found in 150 (30%) patients. Post-operative stay with POH was 3.7 ± 4.7 days and without POH was 1.7 ± 2.3 days (p < 0.0001). POH rate varied from 14% to 58% among 11 of 12 operative procedure-categories. Conditions independently associated with POH (p < 0.05) were acute trauma, BMI, ASA level, glycopyrrolate administration, and duration of surgery. POPA occurred in 24 (4.8%) patients with higher mortality (8.3%), when compared to no POPA (0.2%; p = 0.0065). Post-operative stay was greater with POPA (7.7 ± 5.7 days), when compared to no POPA (2.0 ± 2.9 days; p = 0.0001). Conditions independently associated with POPA (p < 0.05) were cranial procedure, ASA level, and duration of surgery. POPA, acute trauma, duration of surgery, and inability to extubate in the OR were independently associated with post-operative stay (p < 0.05). POH, gastric dysmotility, acute trauma, cranial procedure, emergency procedure, and duration of surgery had independent correlations with post-operative length of stay (p < 0.05). Conclusions Adult surgical patients undergoing general anesthesia with horizontal recumbency have substantial POH and POPA rates. Hospital mortality was greater with POPA and post-operative stay was increased for POH and POPA. POH rates were noteworthy for virtually all categories of operative procedures and POH and POPA were independent predictors of post-operative length of stay. A study is needed to determine if modest reverse-Trendelenburg positioning during general anesthesia has a relationship with reduced POH and POPA rates. PMID:24940115

  2. Getting started with robotics in general surgery with cholecystectomy: the Canadian experience

    PubMed Central

    Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M.

    2009-01-01

    Background The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Methods Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. Results There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p < 0.001). The mean time to clear the operating room was significantly longer for robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Conclusion Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it cannot be justified for routine use. Our experience, however, demonstrates that robotic cholecystectomy is one means by which general surgeons may gain confidence in performing advanced robotic procedures. PMID:19865571

  3. Paediatric minor oral surgical procedures under inhalation sedation and general anaesthetic: a comparison of variety and duration of treatment.

    PubMed

    Foley, J

    2008-03-01

    To develop baseline data in relation to paediatric minor oral surgical procedures undertaken with both general anaesthesia and nitrous oxide inhalation sedation within a Hospital Dental Service. Data were collected prospectively over a three-year period from May 2003 to June 2006 for patients attending the Departments of Paediatric Dentistry, Dundee Dental Hospital and Ninewells Hospital, NHS Tayside, Great Britain, for all surgical procedures undertaken with either inhalation sedation or general anaesthetic. Both operator status and the procedure being undertaken were noted. In addition, the operating time was recorded. Data for 166 patients (F: 102; M: 64) with a median age of 12.50 (inter-quartile range 10.00, 14.20) years showed that 195 surgical procedures were undertaken. Of these 160 and 35 were with general anaesthetic and sedation respectively. The surgical removal of impacted, carious and supernumerary unit(s) accounted for 53.8% of all procedures, whilst the exposure of impacted teeth and soft tissue surgery represented 34.9% and 11.3% of procedures respectively. The median surgical time for techniques undertaken with sedation was 30.00 (inter-quartile range 25.00, 43.50) minutes whilst that for general anaesthetic was similar at 30.00 (inter-quartile range 15.25, 40.00) minutes (not statistically significant, (Mann Whitney U, W = 3081.5, P = 0.331). The majority of paediatric minor oral surgical procedures entail surgical exposure or removal of impacted teeth. The median treatment time for most procedures undertaken with either general anaesthetic or nitrous oxide sedation was 30 minutes.

  4. A cadaveric procedural anatomy course enhances operative competence.

    PubMed

    Sharma, Gaurav; Aycart, Mario A; Najjar, Peter A; van Houten, Trudy; Smink, Douglas S; Askari, Reza; Gates, Jonathan D

    2016-03-01

    Inadequate anatomy training has been cited as a major contributor to declines in surgical resident operative competence and confidence. We report the impact of a procedurally oriented general surgery cadaveric dissection course on trainee-operative confidence and competence. After obtaining institutional review board approval, postgraduate year 2 and 3 general surgery residents were prospectively enrolled into two cohorts: (1) an intervention group (n = 7) participating in an 8-wk procedurally oriented cadaver course and (2) controls (n = 7) given access to course materials without participation in cadaver dissection. At both the beginning and end of the study, we used two evaluation instruments: (1) an oral examination using standardized templates and (2) a questionnaire assessing operative confidence. There were no intergroup differences in baseline characteristics, including number of operative procedures performed to date. Residents who took the anatomy course had significantly higher improvements in examination scores on common bile duct exploration (mean ± standard error, 33 ± 8% versus 10 ± 7%, P = 0.04), femoral endarterectomy (43 ± 5% versus 11 ± 7%, P = 0.003), fasciotomies (55 ± 10% versus 22 ± 9%, P = 0.04), inguinal hernia repair (20 ± 9% versus -14 ± 5%, P = 0.005), superior mesenteric artery embolectomy (38 ± 10% versus 2 ± 11%, P = 0.04), and in overall examination scores (31 ± 4% versus 8% ± 3%, P = 0.0006). In addition, they reported higher operative confidence on common bile duct exploration (P = 0.008) and superior mesenteric artery embolectomy (P = 0.02), and a trend toward higher overall operative confidence (P = 0.06). In this study, we demonstrate that a procedurally oriented cadaver course covering a wide range of essential general surgery procedures resulted in significant improvements in self-reported operative confidence and competence as assessed by oral examination. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. The Operative Burden of General Surgical Disease and Non-Battle Injury in a Deployed Military Treatment Facility in Afghanistan.

    PubMed

    Hollingsworth, Andrew C; Bowley, Douglas M; Lundy, Jonathan B

    2016-09-01

    Contemporary medical operations support a mobile, nonconventional force involved in nation building, counterinsurgency, and humanitarian operations. Prior reports have described surgical care for disease and nonbattle injuries (DNBI). The purpose of this report is to describe the prevalence and scope of DNBI managed by general surgeons in a contemporary, deployed medical facility. A 2-year retrospective review of the operative logbook from the U.K. Role 3 Multinational Hospital, Camp Bastion, Afghanistan, was performed to determine the prevalence and makeup of procedures performed for DNBI by general surgeons. Nontrauma general surgical procedures accounted for 7.7% (n = 279 of 3,607 cases) of cases; appendectomy (n = 146) was the most common, followed by drainage of soft tissue (n = 55) and oral abscesses (n = 5), scrotal exploration (n = 12), and hernia repair (n = 7). A total of 7.2% (n = 20 of 279) of cases fell outside the standard scope of practice of an urban, civilian general surgeon. Although the prevalence of operative procedures for DNBI was low, the spectrum of cases included those not typically managed in the civilian setting of the United Kingdom. With an evolving decline in case volume performed in multiple anatomic locations due to subspecialization during surgical training, this gap in expertise is likely to increase. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  6. Standard operating procedures, water immersion facility, revision B

    NASA Technical Reports Server (NTRS)

    1979-01-01

    General guideline procedures to identify those factors that are common to all spacecraft design laboratory support group emergency procedures and to establish the basic rescue plan are presented. This eliminates needless repetition of the fundamentals from the other, more specific procedures.

  7. 37 CFR 254.1 - General.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Patents, Trademarks, and Copyrights COPYRIGHT OFFICE, LIBRARY OF CONGRESS COPYRIGHT ARBITRATION ROYALTY PANEL RULES AND PROCEDURES ADJUSTMENT OF ROYALTY RATE FOR COIN-OPERATED PHONORECORD PLAYERS § 254.1 General. This part 254 establishes the compulsory license fees for coin-operated phonorecord players...

  8. The use of theatre time for paediatric dentistry under general anaesthesia.

    PubMed

    Foley, Jennifer; Soldani, Francesca

    2007-01-01

    The aim of this paper was to determine the use of theatre time for all procedures performed under general anaesthetic on a paediatric dental list. A prospective study of paediatric dental general anaesthetic procedures was undertaken at Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK. Data were collected prospectively for 71 operating lists over a 3-year period from April 2003 to March 2006. Both operator status and the procedure being undertaken were recorded. In addition, pre-anaesthetic, anaesthetic, operating and disconnection times were recorded. Of the 71 lists examined, 61 either finished early or on time, with a median unused time of 32.50 min (interquartile range = 19.50, 50.00 min), whilst 10 lists finished late with a median overrun time of 30.50 min (interquartile range = 9.25, 45.50 min). Comparing lists which finished late with those which were completed within time, the median pre-anaesthetic time was significantly longer (Mann-Whitney U-test, W = 20.05, P = 0.048). Overall, the theatre was in use for 78.22% of time combining pre-anaesthetic, anaesthetic, operating and disconnection times; hence, there was poor time utilization of theatre for 21.78% of the total theatre time. Overall, 85.9% of theatre sessions for dental procedures under general anaesthetic in children finished early or on time. Where lists finished late, the duration of the pre-anaesthetic time appeared to be the significant factor.

  9. [Examination of diagnosis procedure combination survey data that influence function evaluation coefficient II].

    PubMed

    Nakajima, Hisato; Yano, Kouya; Nagasawa, Kaoko; Kobayashi, Eiji; Yokota, Kuninobu

    2015-01-01

    On the basis of Diagnosis Procedure Combination (DPC) survey data, the factors that increase the value of function evaluation coefficient II were considered. A total of 1,505 hospitals were divided into groups I, II, and III, and the following items were considered. 1. Significant differences in function evaluation coefficient II and DPC survey data. 2. Examination of using the Mahalanobis-Taguchi (MT) method. 3. Correlation between function evaluation coefficient II and each DPC survey data item. 1. Function evaluation coefficient II was highest in group II. Group I hospitals showed the highest bed capacity, and numbers of hospitalization days, operations, chemotherapies, radiotherapies and general anesthesia procedures. 2. Using the MT method, we found that the number of ambulance conveyances was effective factor in group I hospitals, the number of general anesthesia procedures was effective factor in group II hospitals, and the bed capacity was effective factor in group III hospitals. 3. In group I hospitals, function evaluation coefficient II significantly correlated to the numbers of ambulance conveyances and chemotherapies. In group II hospitals, function evaluation coefficient II significantly correlated to bed capacity, the numbers of ambulance conveyances, hospitalization days, operations, general anesthesia procedures, and mean hospitalization days. In group III hospitals, function evaluation coefficient II significantly correlated to all items. The factors that improve the value of function evaluation coefficient II were the increases in the numbers of ambulance conveyances, chemotherapies and radiotherapies in group I hospitals, increases in the numbers of hospitalization days, operations, ambulance conveyances and general anesthesia procedures in group II hospitals, and increases in the numbers of hospitalization days, operations and ambulance conveyances. These results indicate that the profit of a hospital will increase, which will lead to medical services of good quality.

  10. 46 CFR 272.42 - Audit requirements and procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... procedures. (a) Required audit. In connection with the audit of the Operator's subsidizable expenses, the... of audit results. Upon completion of the audit by the Office of Inspector General, the MARAD Office of Financial Approvals shall notify the Operator of the audit results, including any items disallowed...

  11. 47 CFR 80.96 - Maintenance tests.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 5 2014-10-01 2014-10-01 false Maintenance tests. 80.96 Section 80.96 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES STATIONS IN THE MARITIME SERVICES Operating Requirements and Procedures Operating Procedures-General § 80.96 Maintenance tests. Stations are authorized to...

  12. 47 CFR 80.91 - Order of priority of communications.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SERVICES STATIONS IN THE MARITIME SERVICES Operating Requirements and Procedures Operating Procedures-General § 80.91 Order of priority of communications. (a) All stations in the maritime mobile service and the maritime mobile-satellite service shall be capable of offering four levels of priority in the...

  13. 47 CFR 80.91 - Order of priority of communications.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES STATIONS IN THE MARITIME SERVICES Operating Requirements and Procedures Operating Procedures-General § 80.91 Order of priority of communications. (a) All stations in the maritime mobile service and the maritime mobile-satellite service shall be capable of offering four levels of priority in the...

  14. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--LIST OF STANDARD OPERATING PROCEDURES

    EPA Science Inventory

    This document lists available protocols and SOPs for the U.S.-Mexico Border Program study. It identifies protocols and SOPs for the following study components: (1) Sample collection and field operations, (2) Sample analysis, (3) General laboratory procedures, (4) Quality Assuranc...

  15. 47 CFR 15.523 - Measurement procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Measurement procedures. 15.523 Section 15.523 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL RADIO FREQUENCY DEVICES Ultra-Wideband Operation § 15.523 Measurement procedures. Measurements shall be made in accordance with the procedures specified by...

  16. 47 CFR 36.2 - Fundamental principles underlying procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Fundamental principles underlying procedures... Fundamental principles underlying procedures. (a) The following general principles underlie the procedures... operating forces on a unit basis (e.g., conversation-minute-kilometers per message, weighted standard work...

  17. NHEXAS PHASE I MARYLAND STUDY--STANDARD OPERATING PROCEDURE FOR FIELD SAMPLING--GENERAL INFORMATION (F01)

    EPA Science Inventory

    The purpose of this SOP is to provide an overview of field sampling procedures. This SOP details the samples taken, the responsibilities of the field staff, an approximate schedule for field operations, persons responsible for analyses, equipment used for sampling, and contents ...

  18. 21 CFR 120.6 - Sanitation standard operating procedures.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Sanitation standard operating procedures. 120.6 Section 120.6 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) SYSTEMS General...

  19. 21 CFR 120.6 - Sanitation standard operating procedures.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Sanitation standard operating procedures. 120.6 Section 120.6 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) SYSTEMS General...

  20. Recommended Procedures for the Internal Financial Auditing of University Libraries.

    ERIC Educational Resources Information Center

    Kurth, William H.; Zubatsky, David S.

    This study develops a generalized procedure for the internal financial auditing of university libraries. It identifies critical internal control points in library operations, and develops questions to measure and evaluate fiscal operations effectiveness. Auditing data and advice were gathered from a survey of 87 members of the Association of…

  1. 49 CFR 218.97 - Good faith challenge procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the railroad's operating rules implementing the requirements of this subpart. (b) General procedures... requirements of this subpart. (1) Each railroad or employer shall adopt and implement written procedures which... fulfill the requirements of this subpart. Each railroad or employer's written procedures shall provide for...

  2. 40 CFR 1065.10 - Other procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... meet all applicable emission standards. (b) Our testing. These procedures generally apply for testing... importance of pursuing changes to the procedures: (i) Whether supplemental emission standards or other... procedures. For example, this may apply if your engine cannot operate on the specified duty cycle. In this...

  3. 49 CFR 218.97 - Good faith challenge procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the railroad's operating rules implementing the requirements of this subpart. (b) General procedures... requirements of this subpart. (1) Each railroad or employer shall adopt and implement written procedures which... fulfill the requirements of this subpart. Each railroad or employer's written procedures shall provide for...

  4. 40 CFR 1065.10 - Other procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... meet all applicable emission standards. (b) Our testing. These procedures generally apply for testing... importance of pursuing changes to the procedures: (i) Whether supplemental emission standards or other... procedures. For example, this may apply if your engine cannot operate on the specified duty cycle. In this...

  5. 49 CFR 218.97 - Good faith challenge procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the railroad's operating rules implementing the requirements of this subpart. (b) General procedures... requirements of this subpart. (1) Each railroad or employer shall adopt and implement written procedures which... fulfill the requirements of this subpart. Each railroad or employer's written procedures shall provide for...

  6. 40 CFR 1065.10 - Other procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... meet all applicable emission standards. (b) Our testing. These procedures generally apply for testing... importance of pursuing changes to the procedures: (i) Whether supplemental emission standards or other... procedures. For example, this may apply if your engine cannot operate on the specified duty cycle. In this...

  7. 40 CFR 1065.10 - Other procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... meet all applicable emission standards. (b) Our testing. These procedures generally apply for testing... importance of pursuing changes to the procedures: (i) Whether supplemental emission standards or other... procedures. For example, this may apply if your engine cannot operate on the specified duty cycle. In this...

  8. 40 CFR 1065.10 - Other procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... meet all applicable emission standards. (b) Our testing. These procedures generally apply for testing... importance of pursuing changes to the procedures: (i) Whether supplemental emission standards or other... procedures. For example, this may apply if your engine cannot operate on the specified duty cycle. In this...

  9. 49 CFR 218.97 - Good faith challenge procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the railroad's operating rules implementing the requirements of this subpart. (b) General procedures... requirements of this subpart. (1) Each railroad or employer shall adopt and implement written procedures which... fulfill the requirements of this subpart. Each railroad or employer's written procedures shall provide for...

  10. 49 CFR 218.97 - Good faith challenge procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the railroad's operating rules implementing the requirements of this subpart. (b) General procedures... requirements of this subpart. (1) Each railroad or employer shall adopt and implement written procedures which... fulfill the requirements of this subpart. Each railroad or employer's written procedures shall provide for...

  11. Utility of an airframe referenced spatial auditory display for general aviation operations

    NASA Astrophysics Data System (ADS)

    Naqvi, M. Hassan; Wigdahl, Alan J.; Ranaudo, Richard J.

    2009-05-01

    The University of Tennessee Space Institute (UTSI) completed flight testing with an airframe-referenced localized audio cueing display. The purpose was to assess its affect on pilot performance, workload, and situational awareness in two scenarios simulating single-pilot general aviation operations under instrument meteorological conditions. Each scenario consisted of 12 test procedures conducted under simulated instrument meteorological conditions, half with the cue off, and half with the cue on. Simulated aircraft malfunctions were strategically inserted at critical times during each test procedure. Ten pilots participated in the study; half flew a moderate workload scenario consisting of point to point navigation and holding pattern operations and half flew a high workload scenario consisting of non precision approaches and missed approach procedures. Flight data consisted of aircraft and navigation state parameters, NASA Task Load Index (TLX) assessments, and post-flight questionnaires. With localized cues there was slightly better pilot technical performance, a reduction in workload, and a perceived improvement in situational awareness. Results indicate that an airframe-referenced auditory display has utility and pilot acceptance in general aviation operations.

  12. Soil Sampling Operating Procedure

    EPA Pesticide Factsheets

    EPA Region 4 Science and Ecosystem Support Division (SESD) document that describes general and specific procedures, methods, and considerations when collecting soil samples for field screening or laboratory analysis.

  13. Sediment Sampling Operating Procedure

    EPA Pesticide Factsheets

    EPA Region 4 Science and Ecosystem Support Division (SESD) document that describes general and specific procedures, methods, and considerations when collecting sediment samples for field screening or laboratory analysis.

  14. 7 CFR 58.930 - Official test methods.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., GENERAL SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Operations and Operating Procedures § 58.930 Official test methods. (a) Chemical. Chemical analysis, except where otherwise prescribed...

  15. 7 CFR 58.930 - Official test methods.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., GENERAL SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Operations and Operating Procedures § 58.930 Official test methods. (a) Chemical. Chemical analysis, except where otherwise prescribed...

  16. 7 CFR 58.930 - Official test methods.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., GENERAL SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Operations and Operating Procedures § 58.930 Official test methods. (a) Chemical. Chemical analysis, except where otherwise prescribed...

  17. 7 CFR 58.930 - Official test methods.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., GENERAL SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Operations and Operating Procedures § 58.930 Official test methods. (a) Chemical. Chemical analysis, except where otherwise prescribed...

  18. 7 CFR 58.930 - Official test methods.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., GENERAL SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Operations and Operating Procedures § 58.930 Official test methods. (a) Chemical. Chemical analysis, except where otherwise prescribed...

  19. Does operative experience during residency correlate with reported competency of recent general surgery graduates?

    PubMed Central

    Safavi, Arash; Lai, Sarah; Butterworth, Sonia; Hameed, Morad; Schiller, Dan; Skarsgard, Erik

    2012-01-01

    Background Identification of attributes of residency training that predict competency would improve surgical education. We hypothesized that case experience during residency would correlate with self-reported competency of recent graduates. Methods Aggregate case log data of residents enrolled in 2 general surgery programs were collected over a 12-month period and stratified into Surgical Council on Resident Education (SCORE) categories. We surveyed recent (< 5 yr) residency graduates on procedural competency. Resident case volumes were correlated with survey responses by SCORE category. Results In all, 75 residents performed 11 715 operations, which were distributed by SCORE category as follows: essential-common (EC) 9935 (84.8%), essential-uncommon (EU) 889 (7.6%) and complex 891 (7.6%). Alimentary tract procedures were the most commonly performed EC (2386, 24%) and EU (504, 56.7%) procedures. The least common EC procedure was plastic surgery (4, 0.04%), and the least common EU procedure was abdomen–spleen (1, 0.1%). The questionnaire response rate was 45%. For EC procedures, self-reported competency was highest in skin and soft tissue, thoracic and head and neck (each 100%) and lowest in vascular–venous (54%), whereas for EU procedures it was highest in abdomen–general (100%) and lowest in vascular–arterial (62%). The correlation between case volume and self-reported competency was poor (R = 0.2 for EC procedures). Conclusion Self-reported competency correlates poorly with operative case experience during residency. Other curriculum factors, including specific rotations and timing, balance between inpatient and outpatient surgical experience and competition for cases, may contribute to procedural competency acquisition during residency. PMID:22854144

  20. Field Operations and Enforcement Manual for Air Pollution Control. Volume II: Control Technology and General Source Inspection.

    ERIC Educational Resources Information Center

    Weisburd, Melvin I.

    The Field Operations and Enforcement Manual for Air Pollution Control, Volume II, explains in detail the following: technology of source control, modification of operations, particulate control equipment, sulfur dioxide removal systems for power plants, and control equipment for gases and vapors; inspection procedures for general sources, fuel…

  1. Soil Gas Sampling Operating Procedure

    EPA Pesticide Factsheets

    EPA Region 4 Science and Ecosystem Support Division (SESD) document that describes general and specific procedures, methods, and considerations when collecting soil gas samples for field screening or laboratory analysis.

  2. 14 CFR 93.71 - General operating procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...) AIR TRAFFIC AND GENERAL OPERATING RULES SPECIAL AIR TRAFFIC RULES Flight Restrictions in the Vicinity... International Control Dam) to the United States/Canadian Border and thence along the border to the point of... to approval of Transport Canada, aircraft carrying law enforcement officials, or aircraft carrying...

  3. Impact of the European Working Time Directive (EWTD) on the operative experience of surgery residents.

    PubMed

    Hopmans, Cornelis J; den Hoed, Pieter T; van der Laan, Lijckle; van der Harst, Erwin; van der Elst, Maarten; Mannaerts, Guido H H; Dawson, Imro; Timman, Reinier; Wijnhoven, Bas P L; IJzermans, Jan N M

    2015-04-01

    In Europe and the United States, work hour restrictions are considered to be particularly burdensome for residents in surgery specialties. The aim of this study was to examine whether reduction of the work week to 48 hours resulting from the implementation of the European Working Time Directive has affected the operative experience of surgery residents. This study was conducted in a general surgery training region in the Netherlands, consisting of 1 university hospital and 6 district training hospitals. Operating records summarizing the surgical procedures performed as "primary surgeon" in the operating theater for different grades of surgeons were retrospectively analyzed for the period 2005-2012 by the use of linear regression models. Operative procedures performed by residents were considered the main outcome measure. In total, 235,357 operative procedures were performed, including 47,458 (20.2%) in the university hospital and 187,899 (79.8%) in the district training hospitals (n = 5). For residents in the university hospital, the mean number of operative procedures performed per 1.0 full-time equivalent increased from 128 operations in 2005 to 204 operations in 2012 (P = .001), whereas for residents in district training hospitals, no substantial differences were found over time. The mean (±SD) operative caseload of 64 residents who completed the 6-year training program between 2005 and 2012 was 1,391 ± 226 (range, 768-1856). A comparison of the operative caseload according to year of board-certification showed no difference. Implementation of the European Working Time Directive has not affected adversely the number of surgical procedures performed by residents within a general surgical training region in the Netherlands. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. 27 CFR 19.26 - Alternate methods or procedures.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Alternate methods or... Provisions Alternate Methods Or Procedures and Experimental Operations § 19.26 Alternate methods or procedures. (a) General. The appropriate TTB officer may approve the use of an alternate method or procedure...

  5. Use of National Burden to Define Operative Emergency General Surgery.

    PubMed

    Scott, John W; Olufajo, Olubode A; Brat, Gabriel A; Rose, John A; Zogg, Cheryl K; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2016-06-15

    Emergency general surgery (EGS) represents 11% of surgical admissions and 50% of surgical mortality in the United States. However, there is currently no established definition of the EGS procedures. To define a set of procedures accounting for at least 80% of the national burden of operative EGS. A retrospective review was conducted using data from the 2008-2011 National Inpatient Sample. Adults (age, ≥18 years) with primary EGS diagnoses consistent with the American Association for the Surgery of Trauma definition, admitted urgently or emergently, who underwent an operative procedure within 2 days of admission were included in the analyses. Procedures were ranked to account for national mortality and complication burden. Among ranked procedures, contributions to total EGS frequency, mortality, and hospital costs were assessed. The data query and analysis were performed between November 15, 2015, and February 16, 2016. Overall procedure frequency, in-hospital mortality, major complications, and inpatient costs calculated per 3-digit International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. The study identified 421 476 patient encounters associated with operative EGS, weighted to represent 2.1 million nationally over the 4-year study period. The overall mortality rate was 1.23% (95% CI, 1.18%-1.28%), the complication rate was 15.0% (95% CI, 14.6%-15.3%), and mean cost per admission was $13 241 (95% CI, $12 957-$13 525). After ranking the 35 procedure groups by contribution to EGS mortality and morbidity burden, a final set of 7 operative EGS procedures were identified, which collectively accounted for 80.0% of procedures, 80.3% of deaths, 78.9% of complications, and 80.2% of inpatient costs nationwide. These 7 procedures included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy. Only 7 procedures account for most admissions, deaths, complications, and inpatient costs attributable to the 512 079 EGS procedures performed in the United States each year. National quality benchmarks and cost reduction efforts should focus on these common, complicated, and costly EGS procedures.

  6. 29 CFR 1926.1081 - Pre-dive procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION Diving General Operations Procedures § 1926.1081 Pre-dive procedures. Note: The requirements applicable to construction work under this section are...

  7. 29 CFR 1926.1083 - Post-dive procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION Diving General Operations Procedures § 1926.1083 Post-dive procedures. Note: The requirements applicable to construction work under this section are...

  8. 29 CFR 1926.1082 - Procedures during dive.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION Diving General Operations Procedures § 1926.1082 Procedures during dive. Note: The requirements applicable to construction work under this section are...

  9. Resident operative experience in general surgery, plastic surgery, and urology 5 years after implementation of the ACGME duty hour policy.

    PubMed

    Simien, Christopher; Holt, Kathleen D; Richter, Thomas H; Whalen, Thomas V; Coburn, Michael; Havlik, Robert J; Miller, Rebecca S

    2010-08-01

    Resident duty hour restrictions were implemented in 2002-2003. This study examines changes in resident surgical experience since these restrictions were put into place. Operative log data for 3 specialties were examined: general surgery, urology, and plastic surgery. The academic year immediately preceding the duty hour restrictions, 2002-2003, was used as a baseline for comparison to subsequent academic years. Operative log data for graduating residents through 2007-2008 were the primary focus of the analysis. Examination of associated variables that may moderate the relationship between fewer duty hours and surgical volume was also included. Plastic surgery showed no changes in operative volume following duty hour restrictions. Operative volume increased in urology programs. General surgery showed a decrease in volume in some operative categories but an increase in others. Specifically the procedures in vascular, plastic, and thoracic areas showed a consistent decrease. There was no increase in the percentage of programs' graduates falling below minimum requirements. Procedures in pancreas, endocrine, and laparoscopic areas demonstrated an increase in volume. Graduates in larger surgical programs performed fewer procedures than graduates in smaller programs; this was not the case for urology or plastic surgery programs. The reduction of duty hours has not resulted in an across the board decrease in operative volume. Factors other than duty hour reforms may be responsible for some of the observed findings.

  10. [Robotics in general surgery: personal experience, critical analysis and prospectives].

    PubMed

    Fracastoro, Gerolamo; Borzellino, Giuseppe; Castelli, Annalisa; Fiorini, Paolo

    2005-01-01

    Today mini invasive surgery has the chance to be enhanced with sophisticated informative systems (Computer Assisted Surgery, CAS) like robotics, tele-mentoring and tele-presence. ZEUS and da Vinci, present in more than 120 Centres in the world, have been used in many fields of surgery and have been tested in some general surgical procedures. Since the end of 2003, we have performed 70 experimental procedures and 24 operations of general surgery with ZEUS robotic system, after having properly trained 3 surgeons and the operating room staff. Apart from the robot set-up, the mean operative time of the robotic operations was similar to the laparoscopic ones; no complications due to robotic technique occurred. The Authors report benefits and disadvantages related to robots' utilization, problems still to be solved and the possibility to make use of them with tele-surgery, training and virtual surgery.

  11. 46 CFR 197.206 - Substitutes for required equipment, materials, apparatus, arrangements, procedures, or tests.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Substitutes for required equipment, materials, apparatus, arrangements, procedures, or tests. 197.206 Section 197.206 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE OCCUPATIONAL SAFETY AND HEALTH STANDARDS GENERAL PROVISIONS Commercial Diving Operations General § 197.206...

  12. Generalized peritonitis due to perforated diverticulitis: Hartmann's procedure or primary anastomosis?

    PubMed

    Trenti, Loris; Biondo, Sebastiano; Golda, Thomas; Monica, Millan; Kreisler, Esther; Fraccalvieri, Domenico; Frago, Ricardo; Jaurrieta, Eduardo

    2011-03-01

    Hartmann's procedure (HP) still remains the most frequently performed procedure for diffuse peritonitis due to perforated diverticulitis. The aims of this study were to assess the feasibility and safety of resection with primary anastomosis (RPA) in patients with purulent or fecal diverticular peritonitis and review morbidity and mortality after single stage procedure and Hartmann in our experience. From January 1995 through December 2008, patients operated for generalized diverticular peritonitis were studied. Patients were classified into two main groups: RPA and HP. A total of 87 patients underwent emergency surgery for diverticulitis complicated with purulent or diffuse fecal peritonitis. Sixty (69%) had undergone HP while RPA was performed in 27 patients (31%). At the multivariate analysis, RPA was associated with less post-operative complications (P < 0.05). Three out of the 27 patients with RPA (11.1%) developed a clinical anastomotic leakage and needed re-operation. RPA can be safely performed without adding morbidity and mortality in cases of diffuse diverticular peritonitis. HP should be reserved only for hemodynamically unstable or high-risk patients. Specialization in colorectal surgery improves mortality and raises the percentage of one-stage procedures.

  13. Early tracking would improve the operative experience of general surgery residents.

    PubMed

    Stain, Steven C; Biester, Thomas W; Hanks, John B; Ashley, Stanley W; Valentine, R James; Bass, Barbara L; Buyske, Jo

    2010-09-01

    High surgical complexity and individual career goals has led most general surgery (GS) residents to pursue fellowship training, resulting in a shortage of surgeons who practice broad-based general surgery. We hypothesize that early tracking of residents would improve operative experience of residents planning to be general surgeons, and could foster greater interest and confidence in this career path. Surgical Operative Log data from GS and fellowship bound residents (FB) applying for the 2008 American Board of Surgery Qualifying Examination (QE) were used to construct a hypothetical training model with 6 months of early specialization (ESP) for FB residents in 4 specialties (cardiac, vascular, colorectal, pediatric); and presumed these cases would be available to GS residents within the same program. A total of 142 training programs had both FB residents (n = 237) and GS residents (n = 402), and represented 70% of all 2008 QE applicants. The mean numbers of operations by FB and GS residents were 1131 and 1091, respectively. There were a mean of 252 cases by FB residents in the chief year, theoretically making 126 cases available for each GS resident. In 9 defined categories, the hypothetical model would result in an increase in the 5-year operative experience of GS residents (mastectomy 6.5%; colectomy 22.8%; gastrectomy 23.4%; antireflux procedures 23.4%; pancreatic resection 37.4%; liver resection 29.3%; endocrine procedures 19.6%; trauma operations 13.3%; GI endoscopy 6.5%). The ESP model improves operative experience of GS residents, particularly for complex gastrointestinal procedures. The expansion of subspecialty ESP should be considered.

  14. So you want to start a small railroad : Surface Transportation Board small railroad application procedures

    DOT National Transportation Integrated Search

    1997-03-01

    This information bulletin provides general information on Surface Transportation Board (STB) procedures for obtaining approval to operate a railroad. It focuses primarily on those procedures that are most useful in helping potential and established s...

  15. Reagan National Airport : limited opportunities to improve airlines' compliance with noise abatement procedures

    DOT National Transportation Integrated Search

    2000-06-01

    Local airport procedures and federal laws contain a number of provisions designed in part to limit aircraft noise at Reagan National. First, a nighttime noise procedure imposed by the airport authority generally permits flight operations between 10 p...

  16. Toward an explicit analysis of generalization: A stimulus control interpretation

    PubMed Central

    Kirby, Kimberly C.; Bickel, Warren K.

    1988-01-01

    Producing generality of treatment effects to new settings has been a critical concern for applied behavior analysts, but a systematic and reliable means of producing generality has yet to be provided. We argue that the principles of stimulus control and reinforcement underlie the production of most generalized effects; therefore, we suggest interpreting generalization programming in terms of stimulus control. The generalization programming procedures identified by Stokes and Baer (1977) are discussed in terms of both the stimulus control tactics explicitly identified and those that may be operating but are not explicitly identified. Our interpretation clarifies the critical components of Stokes and Baer's procedures and places greater emphasis on planning for generalization as a part of training procedures. PMID:22478006

  17. 9 CFR 416.11 - General rules.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... General rules. Each official establishment shall develop, implement, and maintain written standard operating procedures for sanitation (Sanitation SOP's) in accordance with the requirements of this part. ...

  18. 9 CFR 416.11 - General rules.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... General rules. Each official establishment shall develop, implement, and maintain written standard operating procedures for sanitation (Sanitation SOP's) in accordance with the requirements of this part. ...

  19. 9 CFR 416.11 - General rules.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... General rules. Each official establishment shall develop, implement, and maintain written standard operating procedures for sanitation (Sanitation SOP's) in accordance with the requirements of this part. ...

  20. 9 CFR 416.11 - General rules.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... General rules. Each official establishment shall develop, implement, and maintain written standard operating procedures for sanitation (Sanitation SOP's) in accordance with the requirements of this part. ...

  1. 9 CFR 416.11 - General rules.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... General rules. Each official establishment shall develop, implement, and maintain written standard operating procedures for sanitation (Sanitation SOP's) in accordance with the requirements of this part. ...

  2. Operating manual for the Bulk Shielding Reactor

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Not Available

    1983-04-01

    The BSR is a pool-type reactor. It has the capabilities of continuous operation at a power level of 2 MW or at any desired lower power level. This manual presents descriptive and operational information. The reactor and its auxillary facilities are described from physical and operational viewpoints. Detailed operating procedures are included which are applicable from source-level startup to full-power operation. Also included are procedures relative to the safety of personnel and equipment in the areas of experiments, radiation and contamination control, emergency actions, and general safety. This manual supercedes all previous operating manuals for the BSR.

  3. Operating manual for the Bulk Shielding Reactor

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Not Available

    1987-03-01

    The BSR is a pool-type reactor. It has the capabilities of continuous operation at a power level of 2 MW or at any desired lower power level. This manual presents descriptive and operational information. The reactor and its auxiliary facilities are described from physical and operational viewpoints. Detailed operating procedures are included which are applicable from source-level startup to full-power operation. Also included are procedures relative to the safety of personnel and equipment in the areas of experiments, radiation and contamination control, emergency actions, and general safety. This manual supersedes all previous operating manuals for the BSR.

  4. Towards Verification of Operational Procedures Using Auto-Generated Diagnostic Trees

    NASA Technical Reports Server (NTRS)

    Kurtoglu, Tolga; Lutz, Robyn; Patterson-Hine, Ann

    2009-01-01

    The design, development, and operation of complex space, lunar and planetary exploration systems require the development of general procedures that describe a detailed set of instructions capturing how mission tasks are performed. For both crewed and uncrewed NASA systems, mission safety and the accomplishment of the scientific mission objectives are highly dependent on the correctness of procedures. In this paper, we describe how to use the auto-generated diagnostic trees from existing diagnostic models to improve the verification of standard operating procedures. Specifically, we introduce a systematic method, namely the Diagnostic Tree for Verification (DTV), developed with the goal of leveraging the information contained within auto-generated diagnostic trees in order to check the correctness of procedures, to streamline the procedures in terms of reducing the number of steps or use of resources in them, and to propose alternative procedural steps adaptive to changing operational conditions. The application of the DTV method to a spacecraft electrical power system shows the feasibility of the approach and its range of capabilities

  5. 14 CFR 34.5 - Special test procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... EXHAUST EMISSION REQUIREMENTS FOR TURBINE ENGINE POWERED AIRPLANES General Provisions § 34.5 Special test... or operator of aircraft or aircraft engines, approve test procedures for any aircraft or aircraft engine that is not susceptible to satisfactory testing by the procedures set forth herein. Prior to...

  6. Fundamental procedures of geographic information analysis

    NASA Technical Reports Server (NTRS)

    Berry, J. K.; Tomlin, C. D.

    1981-01-01

    Analytical procedures common to most computer-oriented geographic information systems are composed of fundamental map processing operations. A conceptual framework for such procedures is developed and basic operations common to a broad range of applications are described. Among the major classes of primitive operations identified are those associated with: reclassifying map categories as a function of the initial classification, the shape, the position, or the size of the spatial configuration associated with each category; overlaying maps on a point-by-point, a category-wide, or a map-wide basis; measuring distance; establishing visual or optimal path connectivity; and characterizing cartographic neighborhoods based on the thematic or spatial attributes of the data values within each neighborhood. By organizing such operations in a coherent manner, the basis for a generalized cartographic modeling structure can be developed which accommodates a variety of needs in a common, flexible and intuitive manner. The use of each is limited only by the general thematic and spatial nature of the data to which it is applied.

  7. 12 CFR 7.2000 - Corporate governance procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... amended 1994, and as amended thereafter), or the Model Business Corporation Act (1984, as amended 1994... OPERATIONS Corporate Practices § 7.2000 Corporate governance procedures. (a) General. A national bank... soundness, a national bank may elect to follow the corporate governance procedures of the law of the state...

  8. 12 CFR 7.2000 - Corporate governance procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... amended 1994, and as amended thereafter), or the Model Business Corporation Act (1984, as amended 1994... OPERATIONS Corporate Practices § 7.2000 Corporate governance procedures. (a) General. A national bank... soundness, a national bank may elect to follow the corporate governance procedures of the law of the state...

  9. Locality-preserving logical operators in topological stabilizer codes

    NASA Astrophysics Data System (ADS)

    Webster, Paul; Bartlett, Stephen D.

    2018-01-01

    Locality-preserving logical operators in topological codes are naturally fault tolerant, since they preserve the correctability of local errors. Using a correspondence between such operators and gapped domain walls, we describe a procedure for finding all locality-preserving logical operators admitted by a large and important class of topological stabilizer codes. In particular, we focus on those equivalent to a stack of a finite number of surface codes of any spatial dimension, where our procedure fully specifies the group of locality-preserving logical operators. We also present examples of how our procedure applies to codes with different boundary conditions, including color codes and toric codes, as well as more general codes such as Abelian quantum double models and codes with fermionic excitations in more than two dimensions.

  10. Operant Variability: Procedures and Processes

    ERIC Educational Resources Information Center

    Machado, Armando; Tonneau, Francois

    2012-01-01

    Barba's (2012) article deftly weaves three main themes in one argument about operant variability. From general theoretical considerations on operant behavior (Catania, 1973), Barba derives methodological guidelines about response differentiation and applies them to the study of operant variability. In the process, he uncovers unnoticed features of…

  11. 14 CFR 294.1 - Applicability and purpose.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PROCEEDINGS) ECONOMIC REGULATIONS CANADIAN CHARTER AIR TAXI OPERATORS General § 294.1 Applicability and... taxi operators,” and establishes registration procedures for these carriers operating or seeking to... air taxi operators from certain provisions of the Subtitle VII of Title 49 of the United States Code...

  12. 14 CFR 294.1 - Applicability and purpose.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PROCEEDINGS) ECONOMIC REGULATIONS CANADIAN CHARTER AIR TAXI OPERATORS General § 294.1 Applicability and... taxi operators,” and establishes registration procedures for these carriers operating or seeking to... air taxi operators from certain provisions of the Subtitle VII of Title 49 of the United States Code...

  13. First 101 Robotic General Surgery Cases in a Community Hospital

    PubMed Central

    Robertson, Jarrod C.; Alrajhi, Sharifah

    2016-01-01

    Background and Objectives: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Methods: Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Results: Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. Conclusion: A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy. PMID:27667913

  14. First 101 Robotic General Surgery Cases in a Community Hospital.

    PubMed

    Oviedo, Rodolfo J; Robertson, Jarrod C; Alrajhi, Sharifah

    2016-01-01

    The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy.

  15. Graduating general surgery resident operative confidence: perspective from a national survey.

    PubMed

    Fonseca, Annabelle L; Reddy, Vikram; Longo, Walter E; Gusberg, Richard J

    2014-08-01

    General surgical training has changed significantly over the last decade with work hour restrictions, increasing subspecialization, the expanding use of minimally invasive techniques, and nonoperative management for solid organ trauma. Given these changes, this study was undertaken to assess the confidence of graduating general surgery residents in performing open surgical operations and to determine factors associated with increased confidence. A survey was developed and sent to general surgery residents nationally. We queried them regarding demographics and program characteristics, asked them to rate their confidence (rated 1-5 on a Likert scale) in performing open surgical procedures and compared those who indicated confidence with those who did not. We received 653 responses from the fifth year (postgraduate year 5) surgical residents: 69% male, 68% from university programs, and 51% from programs affiliated with a Veterans Affairs hospital; 22% from small programs, 34% from medium programs, and 44% from large programs. Anticipated postresidency operative confidence was 72%. More than 25% of residents reported a lack of confidence in performing eight of the 13 operations they were queried about. Training at a university program, a large program, dedicated research years, future fellowship plans, and training at a program that performed a large percentage of operations laparoscopically was associated with decreased confidence in performing a number of open surgical procedures. Increased surgical volume was associated with increased operative confidence. Confidence in performing open surgery also varied regionally. Graduating surgical residents indicated a significant lack of confidence in performing a variety of open surgical procedures. This decreased confidence was associated with age, operative volume as well as type, and location of training program. Analyzing and addressing this confidence deficit merits further study. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Parametric estimates for the receiver operating characteristic curve generalization for non-monotone relationships.

    PubMed

    Martínez-Camblor, Pablo; Pardo-Fernández, Juan C

    2017-01-01

    Diagnostic procedures are based on establishing certain conditions and then checking if those conditions are satisfied by a given individual. When the diagnostic procedure is based on a continuous marker, this is equivalent to fix a region or classification subset and then check if the observed value of the marker belongs to that region. Receiver operating characteristic curve is a valuable and popular tool to study and compare the diagnostic ability of a given marker. Besides, the area under the receiver operating characteristic curve is frequently used as an index of the global discrimination ability. This paper revises and widens the scope of the receiver operating characteristic curve definition by setting the classification subsets in which the final decision is based in the spotlight of the analysis. We revise the definition of the receiver operating characteristic curve in terms of particular classes of classification subsets and then focus on a receiver operating characteristic curve generalization for situations in which both low and high values of the marker are associated with more probability of having the studied characteristic. Parametric and non-parametric estimators of the receiver operating characteristic curve generalization are investigated. Monte Carlo studies and real data examples illustrate their practical performance.

  17. Evolution of the Whipple procedure at the Massachusetts General Hospital.

    PubMed

    Fernández-del Castillo, Carlos; Morales-Oyarvide, Vicente; McGrath, Deborah; Wargo, Jennifer A; Ferrone, Cristina R; Thayer, Sarah P; Lillemoe, Keith D; Warshaw, Andrew L

    2012-09-01

    Since Allen O. Whipple published his seminal paper in 1935, the procedure that bears his name has been performed widely throughout the world and is now a common operation in major medical centers. The goal of this study was to investigate the evolution of pancreatoduodenectomy at the Massachusetts General Hospital (MGH). We sought to identify all pancreatoduodenectomies performed at the MGH since 1935. Cases were obtained from a computerized database, hospital medical records, and the MGH historical archive. Demographics, diagnosis, intraoperative variables and short-term surgical outcomes were recorded. The first pancreatoduodenectomy at the MGH was carried out in 1941; since then, 2,050 Whipple procedures have been performed. Pancreatic ductal adenocarcinoma was the most frequent indication (36%). Pylorus preservation has been the most important variation in technique, accounting for 45% of Whipple procedures in the 1980s; observation of frequent delayed gastric emptying after this procedure led to decline in its use. Pancreatic fistula was the most frequent complication (13%). Operative blood replacement and reoperation rates have decreased markedly over time; the most frequent indication for reoperation was intra-abdominal bleeding. Mortality has decreased from 45% to 0.8%, with sepsis and hypovolemic shock being the most frequent causes of death. Mean duration of hospital stay has decreased from >30 to 9.5 days, along with an increasing readmission rate (currently 19%). The Whipple procedure in the 21st century is a well-established operation. Improvements in operative technique and perioperative care have contributed in making it a safe operation that continues evolving. Copyright © 2012 Mosby, Inc. All rights reserved.

  18. Knowing the operative game plan: a novel tool for the assessment of surgical procedural knowledge.

    PubMed

    Balayla, Jacques; Bergman, Simon; Ghitulescu, Gabriela; Feldman, Liane S; Fraser, Shannon A

    2012-08-01

    What is the source of inadequate performance in the operating room? Is it a lack of technical skills, poor judgment or a lack of procedural knowledge? We created a surgical procedural knowledge (SPK) assessment tool and evaluated its use. We interviewed medical students, residents and training program staff on SPK assessment tools developed for 3 different common general surgery procedures: inguinal hernia repair with mesh in men, laparoscopic cholecystectomy and right hemicolectomy. The tools were developed as a step-wise assessment of specific surgical procedures based on techniques described in a current surgical text. We compared novice (medical student to postgraduate year [PGY]-2) and expert group (PGY-3 to program staff) scores using the Mann-Whitney U test. We calculated the total SPK score and defined a cut-off score using receiver operating characteristic analysis. In all, 5 participants in 7 different training groups (n = 35) underwent an interview. Median scores for each procedure and overall SPK scores increased with experience. The median SPK for novices was 54.9 (95% confidence interval [CI] 21.6-58.8) compared with 98.05 (95% CP 94.1-100.0) for experts (p = 0.012). The SPK cut-off score of 93.1 discriminates between novice and expert surgeons. Surgical procedural knowledge can reliably be assessed using our SPK assessment tool. It can discriminate between novice and expert surgeons for common general surgical procedures. Future studies are planned to evaluate its use for more complex procedures.

  19. 47 CFR 1.10003 - When can I start operating?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false When can I start operating? 1.10003 Section 1.10003 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE International Bureau Filing System § 1.10003 When can I start operating? You can begin operating your facility or...

  20. Crew operations

    NASA Technical Reports Server (NTRS)

    1971-01-01

    The requirements for the activities involved, and the procedures used by the crew in the operations of the modular space station are presented. All crew-related characteristics of the station and its operations are indicated. The interior configuration and arrangement of each of the space station modules, the facilities and equipment in the module and their operation are described as related to crew habitability. The crew activities and procedures involved in the operation of the station in the accomplishment of its primary mission are defined. The operations involved in initial station buildup, and the on-orbit operation and maintenance of the station and its subsystems to support the experimental program are included. A general description of experiment operations is also given.

  1. Ear, nose and throat day-case surgery at a district general hospital.

    PubMed

    Pézier, T; Stimpson, P; Kanegaonkar, R G; Bowdler, D A

    2009-03-01

    In 2000, The NHS Plan in the UK set a target of 75% for all surgical activity to be performed as day-cases. We aim to assess day-case turnover for ENT procedures and, in particular, day-case rates for adult and paediatric otological procedures together with re-admissions within 72 h as a proxy measure of safety. Retrospective collection of data (procedure and length of stay) from the computerised theatre system (Galaxy) and Patient Information Management System (PIMS) of all elective patients operated over one calendar year. The setting was a district general hospital ENT department in South East England. All ENT operations are performed with the exception of oncological head and neck procedures and complex skull-base surgery. Overall, 2538 elective operations were performed during the study period. A total of 1535 elective adult procedures were performed with 74% (1137 of 1535) performed as day-cases. Of 1003 paediatric operations, 73% (730 of 1003) were day-cases. Concerning otological procedures, 93.4% (311 of 333) of paediatric procedures were day-cases. For adults, we divided the procedures into major and minor, achieving day-case rates of 88% (93 of 101) and 91% (85 of 93), respectively. The overall day-case rate for otological procedures was 91% (528 of 580). Re-admission rates overall were 0.7% (11 of 1535) for adults and 0.9% (9 of 1003) for paediatric procedures. The most common procedure for re-admission was tonsillectomy accounting for 56% of all adult re-admissions and 78% of paediatric re-admissions. The were no deaths following day-case procedures. ENT surgery is well-suited to a day-case approach. UK Government targets are attainable when considering routine ENT surgery. Day-case rates for otology in excess of targets are possible even when considering major ear surgery.

  2. Time Management in the Operating Room: An Analysis of the Dedicated Minimally Invasive Surgery Suite

    PubMed Central

    Hsiao, Kenneth C.; Machaidze, Zurab

    2004-01-01

    Background: Dedicated minimally invasive surgery suites are available that contain specialized equipment to facilitate endoscopic surgery. Laparoscopy performed in a general operating room is hampered by the multitude of additional equipment that must be transported into the room. The objective of this study was to compare the preparation times between procedures performed in traditional operating rooms versus dedicated minimally invasive surgery suites to see whether operating room efficiency is improved in the specialized room. Methods: The records of 50 patients who underwent laparoscopic procedures between September 2000 and April 2002 were retrospectively reviewed. Twenty-three patients underwent surgery in a general operating room and 18 patients in an minimally invasive surgery suite. Nine patients were excluded because of cystoscopic procedures undergone prior to laparoscopy. Various time points were recorded from which various time intervals were derived, such as preanesthesia time, anesthesia induction time, and total preparation time. A 2-tailed, unpaired Student t test was used for statistical analysis. Results: The mean preanesthesia time was significantly faster in the minimally invasive surgery suite (12.2 minutes) compared with that in the traditional operating room (17.8 minutes) (P=0.013). Mean anesthesia induction time in the minimally invasive surgery suite (47.5 minutes) was similar to time in the traditional operating room (45.7 minutes) (P=0.734). The average total preparation time for the minimally invasive surgery suite (59.6 minutes) was not significantly faster than that in the general operating room (63.5 minutes) (P=0.481). Conclusion: The amount of time that elapses between the patient entering the room and anesthesia induction is statically shorter in a dedicated minimally invasive surgery suite. Laparoscopic surgery is performed more efficiently in a dedicated minimally invasive surgery suite versus a traditional operating room. PMID:15554269

  3. 23 CFR 710.401 - General.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... acquired property along the Interstate, the STD shall secure an approval from the FHWA for such change or use. The STD shall specify in the State's ROW operations manual, procedures for the rental, leasing... procedures if approved for use by the STD. ...

  4. 23 CFR 710.401 - General.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... acquired property along the Interstate, the STD shall secure an approval from the FHWA for such change or use. The STD shall specify in the State's ROW operations manual, procedures for the rental, leasing... procedures if approved for use by the STD. ...

  5. 40 CFR 148.4 - Procedures for case-by-case extensions to an effective date.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... (CONTINUED) WATER PROGRAMS (CONTINUED) HAZARDOUS WASTE INJECTION RESTRICTIONS General § 148.4 Procedures for case-by-case extensions to an effective date. The owner or operator of a Class I hazardous waste...

  6. 21 CFR 10.200 - Scope.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...'s policy on the presence and operation of electronic recording equipment at such proceedings and to... AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATIVE PRACTICES AND PROCEDURES Electronic Media Coverage of Public Administrative Proceedings; Guideline on Policy and Procedures...

  7. 48 CFR 232.070 - Responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... DoD contract financing, including DoD contract financing policies and important related procedures... operations. Refer specific cases involving financing policy or important procedural issues to OUSD(AT&L)DPAP... OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING 232.070 Responsibilities. (a) The...

  8. Impact of Residency Training Level on the Surgical Quality Following General Surgery Procedures.

    PubMed

    Loiero, Dominik; Slankamenac, Maja; Clavien, Pierre-Alain; Slankamenac, Ksenija

    2017-11-01

    To investigate the safety of surgical performance by residents of different training level performing common general surgical procedures. Data were consecutively collected from all patients undergoing general surgical procedures such as laparoscopic cholecystectomy, laparoscopic appendectomy, inguinal, femoral and umbilical hernia repair from 2005 to 2011 at the Department of Surgery of the University Hospital of Zurich, Switzerland. The operating surgeons were grouped into junior residents, senior residents and consultants. The comprehensive complication index (CCI) representing the overall number and severity of all postoperative complications served as primary safety endpoint. A multivariable linear regression analysis was used to analyze differences between groups. Additionally, we focused on the impact of senior residents assisting junior residents on postoperative outcome comparing to consultants. During the observed time, 2715 patients underwent a general surgical procedure. In 1114 times, a senior resident operated and in 669 procedures junior residents performed the surgery. The overall postoperative morbidity quantified by the CCI was for consultants 5.0 (SD 10.7), for senior residents 3.5 (8.2) and for junior residents 3.6 (8.3). After adjusting for possible confounders, no difference between groups concerning the postoperative complications was detected. There is also no difference in postoperative complications detectable if junior residents were assisted by consultants then if assisted by senior residents. Patient safety is ensured in general surgery when performed by surgical junior residents. Senior residents are able to adopt the role of the teaching surgeon in charge without compromising patients' safety.

  9. School Business. A Manual for School Officials. Revised Edition.

    ERIC Educational Resources Information Center

    Smith, Richard N.

    An outline is presented of business procedures related to the many facets of educational program operations. Statutes, regulations, practices, attorney general's opinions and reports, and court decisions relative to school business in Iowa are cited. While the report is a review of the procedures for the state of Iowa, a number of procedures are…

  10. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR SOIL CHARACTERIZATION (UA-L-11.1)

    EPA Science Inventory

    The purpose of this SOP is to describe the procedures to be followed in splitting and determining the grain size characteristics, electrical conductivity, and pH of the "Composite Soil" and "Foundation Soil" samples. This procedure applies to the general characterization of sedi...

  11. 32 CFR Appendix C to Part 246 - Personnel Policies and Procedures

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 2 2010-07-01 2010-07-01 false Personnel Policies and Procedures C Appendix C... (CONTINUED) MISCELLANEOUS STARS AND STRIPES (S&S) NEWSPAPER AND BUSINESS OPERATIONS Pt. 246, App. C Appendix C to Part 246—Personnel Policies and Procedures A. General Nonappropriated Fund (NAF) Employment...

  12. Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures.

    PubMed

    Hill, Maureen V; McMahon, Michelle L; Stucke, Ryland S; Barth, Richard J

    2017-04-01

    To examine opioid prescribing patterns after general surgery procedures and to estimate an ideal number of pills to prescribe. Diversion of prescription opioids is a major contributor to the rising mortality from opioid overdoses. Data to inform surgeons on the optimal dose of opioids to prescribe after common general surgical procedures is lacking. We evaluated 642 patients undergoing 5 outpatient procedures: partial mastectomy (PM), partial mastectomy with sentinel lymph node biopsy (PM SLNB), laparoscopic cholecystectomy (LC), laparoscopic inguinal hernia repair (LIH), and open inguinal hernia repair (IH). Postoperative opioid prescriptions and refill data were tabulated. A phone survey was conducted to determine the number of opioid pills taken. There was a wide variation in the number of opioid pills prescribed to patients undergoing the same operation. The median number (and range) prescribed were: PM 20 (0-50), PM SLNB 20 (0-60), LC 30 (0-100), LIH 30 (15-70), and IH 30 (15-120). Only 28% of the prescribed pills were taken. This percentage varied by operation: PM 15%, PM SLNB 25%, LC 33%, LIH 15%, and IH 31%. Less than 2% of patients obtained refills.We identified the number of pills that would fully supply the opioid needs of 80% of patients undergoing each operation: PM 5, PM SLNB 10, LC 15, LIH 15, and IH 15. If this number were prescribed, the number of opioid initially prescribed would be 43% of the actual number prescribed. There is wide variability in opioid prescriptions for common general surgery procedures. In many cases excess pills are prescribed. Using our ideal number, surgeons can adequately treat postoperative pain and markedly decrease the number of opioids prescribed.

  13. A leading edge heating array and a flat surface heating array - operation, maintenance and repair manual

    NASA Technical Reports Server (NTRS)

    1975-01-01

    A general description of the leading edge/flat surface heating array is presented along with its components, assembly instructions, installation instructions, operation procedures, maintenance instructions, repair procedures, schematics, spare parts lists, engineering drawings of the array, and functional acceptance test log sheets. The proper replacement of components, correct torque values, step-by-step maintenance instructions, and pretest checkouts are described.

  14. General Anesthesia Time for Pediatric Dental Cases

    PubMed Central

    Forsyth, Anna R.; Seminario, Ana Lucia; Scott, JoAnna; Berg, Joel; Ivanova, Iskra; Lee, Helen

    2012-01-01

    Purpose The purpose of this study was to describe the use of operating room (OR) time for pediatric dental procedures performed under general anesthesia (GA) at a regional children’s hospital over a 2-year period. Methods A cross-sectional review of a pediatric dental GA records was performed at Seattle Children’s Hospital. Data were collected for 709 0- to 21-year-old patients from January 2008 to December 2009. Demographic data, dental and anesthesia operator types, and procedures were recorded. Utilization of OR time was analyzed. Results The mean age of patients was 7.1 years (±4.2 SD), and 58% were male. Distribution by American Society of Anesthesiology (ASA) classifications were: ASA I 226 (32%); ASA II 316 (45%); ASA III 167 (24%). Cases finished earlier than the scheduled time by an average of 14 minutes (±28). Overrun time was significantly associated with: patient age (P=.01); ASA classification (P=.006); treatment type (P<.001); number of teeth treated (P<.001); and dentist operator type (P=.005). Conclusions Overall, 73% of dental procedures under GA finished early or on time. Significant variables included patient age, medical status, treatment type and extent, and dentist operator type. Assessing factors that impact the time needed in GA may enhance efficiency for pediatric dental procedures. PMID:23211897

  15. 30 CFR 250.408 - May I use alternative procedures or equipment during drilling operations?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... during drilling operations? 250.408 Section 250.408 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, REGULATION, AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations General Requirements § 250.408 May I use...

  16. Declining operative experience for junior level residents: Is this an unintended consequence of minimally invasive surgery?

    PubMed Central

    Mullen, Matthew G.; Salerno, Elise P.; Michaels, Alex D.; Hedrick, Traci L.; Sohn, Min-Woong; Smith, Philip W.; Schirmer, Bruce D.; Friel, Charles M.

    2016-01-01

    Introduction Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. Methods A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The ACS NSQIP Participant Use Files were queried for these procedures between 2005–2012. Cases were stratified by participating resident post-graduate year (PGY) with ‘junior resident’ defined as PGY1–3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. Results 185,335 cases were included in the study. For three of the operations we considered, the prevalence of laparoscopic surgery increased from 2005–2012 (all p<0.001). Cholecystectomy was an exception, which showed an unchanged proportion of cases performed laparoscopically across the study period (p=0.119). Junior resident participation decreased by 4.5%/year (p<0.001) for laparoscopic procedures and by 6.2%/year (p<0.001) for open procedures. The proportion of laparoscopic surgeries performed by junior level residents decreased for appendectomy by 2.6%/year (p<0.001) and cholecystectomy by 6.1%/year (p<0.001), whereas it was unchanged for inguinal herniorrhaphy (p=0.75) and increased for partial colectomy by 3.9%/year (p=0.003). A decline in junior resident participation was seen for all open surgeries, with appendectomy decreasing by 9.4%/year (p<0.001), cholecystectomy by 4.1%/year (p<0.002), inguinal herniorrhaphy by 10%/year (p<0.001) and partial colectomy by 2.9%/year (p<0.004). Conclusions Along with the proliferation of laparoscopy for common general surgical procedures there has been a concomitant reduction in the participation of junior level residents. As previously thought, familiarity with laparoscopy has not translated to redistribution of basic operations from senior to junior residents. This trend has significant implications for general surgery resident education. PMID:27066854

  17. Safety validation test equipment operation

    NASA Astrophysics Data System (ADS)

    Kurosaki, Tadaaki; Watanabe, Takashi

    1992-08-01

    An overview of the activities conducted on safety validation test equipment operation for materials used for NASA manned missions is presented. Safety validation tests, such as flammability, odor, offgassing, and so forth were conducted in accordance with NASA-NHB-8060.1C using test subjects common with those used by NASA, and the equipment used were qualified for their functions and performances in accordance with NASDA-CR-99124 'Safety Validation Test Qualification Procedures.' Test procedure systems were established by preparing 'Common Procedures for Safety Validation Test' as well as test procedures for flammability, offgassing, and odor tests. The test operation organization chaired by the General Manager of the Parts and Material Laboratory of NASDA (National Space Development Agency of Japan) was established, and the test leaders and operators in the organization were qualified in accordance with the specified procedures. One-hundred-one tests had been conducted so far by the Parts and Material Laboratory according to the request submitted by the manufacturers through the Space Station Group and the Safety and Product Assurance for Manned Systems Office.

  18. RVUs poorly correlate with measures of surgical effort and complexity

    PubMed Central

    Shah, Dhruvil R.; Bold, Richard J.; Yang, Anthony D.; Khatri, Vijay P.; Martinez, Steve R.; Canter, Robert J.

    2014-01-01

    Background The relationship between procedural relative value units (RVUs) for surgical procedures and other measures of surgeon effort are poorly characterized. We hypothesized that RVUs would poorly correlate with quantifiable metrics of surgeon effort. Methods Using the 2010 ACS-NSQIP database, we selected 11 primary CPT codes associated with high volume surgical procedures. We then identified all patients with a single reported procedural RVU who underwent non-emergent, inpatient general surgical operations. We used linear regression to correlate length of stay, operative time, overall morbidity, frequency of serious adverse events (SAEs), and mortality with RVUs. We used multivariable logistic regression using all pre-operative NSQIP variables to determine other significant predictors of our outcome measures. Results Among 14,481 patients, RVUs poorly correlated with individual length of stay (R2=0.05), operative time (R2=0.10), and mortality (R2=0.35). There was a moderate correlation between RVUs and SAEs (R2 =0.79), and RVUs and overall morbidity (R2=0.75). However, among low to mid-level RVU procedures (11 to 35) there was a poor correlation between SAEs (R2=0.15), overall morbidity (R2=0.05), and RVUs. On multivariable analysis, RVUs were significant predictors of operative time, length of stay, and SAEs (OR 1.06, 95%CI: 1.05–1.07), but RVUs were not a significant predictor of mortality (OR 1.02, 95%CI: 0.99–1.05) Conclusion For common, index general surgery procedures, the current RVU assignments poorly correlate with certain metrics of surgeon work, while moderately correlating with others. Given the increasing emphasis on measuring and tracking surgeon productivity, more objective measures of surgeon work and productivity should be developed. PMID:24953983

  19. Does speed matter? The impact of operative time on outcome in laparoscopic surgery

    PubMed Central

    Jackson, Timothy D.; Wannares, Jeffrey J.; Lancaster, R. Todd; Rattner, David W.

    2012-01-01

    Introduction Controversy exists concerning the importance of operative time on patient outcomes. It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling. The objective of the present study was to determine the effect of operative time on 30-day outcomes in laparoscopic surgery. Methods Patients who underwent laparoscopic general surgery procedures (colectomy, cholecystectomy, Nissen fundoplication, inguinal hernia, and gastric bypass) from the ACS-NSQIP 2005–2008 participant use file were identified. Exclusion criteria were defined a priori to identify same-day admission, elective procedures. Operative time was divided into deciles and summary statistics were analyzed. Univariate analyses using a Cochran-Armitage test for trend were completed. The effect of operative time on 30-day morbidity was further analyzed for each procedure type using multivariate regression controlling for case complexity and additional patient factors. Patients within the highest deciles were excluded to reduce outlier effect. Results A total of 76,748 elective general surgical patients who underwent laparoscopic procedures were analyzed. Univariate analyses of deciles of operative time demonstrated a statistically significant trend (p \\ 0.0001) toward increasing odds of complications with increasing operative time for laparoscopic colectomy (n = 10,135), cholecystectomy (n = 37,407), Nissen fundoplication (n = 4,934), and gastric bypass (n = 17,842). The trend was not found to be significant for laparoscopic inguinal hernia repair (n = 6,430; p = 0.14). Multivariate modeling revealed the effect of operative time to remain significant after controlling for additional patient factors. Conclusion Increasing operative time was associated with increased odds of complications and, therefore, it appears that speed may matter in laparoscopic surgery. These analyses are limited in their inability to adjust for all patient factors, potential confounders, and case complexities. Additional hierarchical multivariate analyses at the surgeon level would be important to examine this relationship further. PMID:21298533

  20. Does speed matter? The impact of operative time on outcome in laparoscopic surgery.

    PubMed

    Jackson, Timothy D; Wannares, Jeffrey J; Lancaster, R Todd; Rattner, David W; Hutter, Matthew M

    2011-07-01

    Controversy exists concerning the importance of operative time on patient outcomes. It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling. The objective of the present study was to determine the effect of operative time on 30-day outcomes in laparoscopic surgery. Patients who underwent laparoscopic general surgery procedures (colectomy, cholecystectomy, Nissen fundoplication, inguinal hernia, and gastric bypass) from the ACS-NSQIP 2005-2008 participant use file were identified. Exclusion criteria were defined a priori to identify same-day admission, elective procedures. Operative time was divided into deciles and summary statistics were analyzed. Univariate analyses using a Cochran-Armitage test for trend were completed. The effect of operative time on 30-day morbidity was further analyzed for each procedure type using multivariate regression controlling for case complexity and additional patient factors. Patients within the highest deciles were excluded to reduce outlier effect. A total of 76,748 elective general surgical patients who underwent laparoscopic procedures were analyzed. Univariate analyses of deciles of operative time demonstrated a statistically significant trend (p<0.0001) toward increasing odds of complications with increasing operative time for laparoscopic colectomy (n=10,135), cholecystectomy (n=37,407), Nissen fundoplication (n=4,934), and gastric bypass (n=17,842). The trend was not found to be significant for laparoscopic inguinal hernia repair (n=6,430; p=0.14). Multivariate modeling revealed the effect of operative time to remain significant after controlling for additional patient factors. Increasing operative time was associated with increased odds of complications and, therefore, it appears that speed may matter in laparoscopic surgery. These analyses are limited in their inability to adjust for all patient factors, potential confounders, and case complexities. Additional hierarchical multivariate analyses at the surgeon level would be important to examine this relationship further.

  1. Effect of minimally invasive surgery fellowship on residents' operative experience.

    PubMed

    Altieri, Maria S; Frenkel, Catherine; Scriven, Richard; Thornton, Deborah; Halbert, Caitlin; Talamini, Mark; Telem, Dana A; Pryor, Aurora D

    2017-01-01

    There is an increased need for surgical trainees to acquire advanced laparoscopic skills as laparoscopy becomes the standard of care in many areas of general surgery. Since the introduction of minimally invasive surgery (MIS) fellowships, there has been a continuing debate as to whether these fellowships adversely affect general surgery resident exposure to laparoscopic cases. The aim of our study was to examine whether the introduction of an MIS fellowship negatively impacts general surgery residents' experience at a single academic center. We describe the changes following establishment of MIS fellowship at an academic center. Resident case log system from the Accreditation Council for Graduate Medical Education was queried to obtain all PGY 1-5 resident operative case logs. Two-year time period preceding and following the institution of an MIS fellowship at our institution in 2012 was compared. P values less than 0.05 were considered statistically significant. Following initiation of the MIS fellowship, an MIS service was established. The service comprised of a fellow, midlevel resident, and intern. Operative experience was examined. From 2010-2012 to 2012-2014, residents logged a total of 272 and 585 complex laparoscopic cases, respectively. There were 43 residents from 2010 to 2013 and 44 residents from 2013 to 2014. When the two time periods were compared, a trend of increased numbers for all procedures was noted, except laparoscopic GYN/genito-urinary procedures. Average percent increase in complex general surgery procedures was 249 ± 179.8 %. Following establishment of a MIS fellowship, reported cases by residents were higher or similar to those reported nationally for laparoscopic procedures. Institution of an MIS fellowship had a favorable effect on general surgery resident operative education at a single academic training center. Residents may benefit from the presence of a fellowship at an academic center because they are able to participate in an increased number of complex laparoscopic cases.

  2. 7 CFR 1717.600 - General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... any other agreement with RUS, or if RUS determines that loan security and/or repayment is threatened... POST-LOAN POLICIES AND PROCEDURES COMMON TO INSURED AND GUARANTEED ELECTRIC LOANS Operational Controls § 1717.600 General. (a) General. The loan contract and mortgage between the Rural Utilities Service (RUS...

  3. 50 CFR 218.234 - Mitigation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Frequency Active (SURTASS LFA) Sonar § 218.234 Mitigation. When conducting operations identified in § 218... monitoring. (b) General Operating Procedures: (1) Prior to SURTASS LFA sonar operations, the Navy will... SURTASS LFA sonar signal at a frequency greater than 500 Hertz (Hz). (c) LFA Sonar Mitigation Zone and 1...

  4. 50 CFR 218.234 - Mitigation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Frequency Active (SURTASS LFA) Sonar § 218.234 Mitigation. When conducting operations identified in § 218... monitoring. (b) General Operating Procedures: (1) Prior to SURTASS LFA sonar operations, the Navy will... SURTASS LFA sonar signal at a frequency greater than 500 Hertz (Hz). (c) LFA Sonar Mitigation Zone and 1...

  5. 50 CFR 218.234 - Mitigation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Frequency Active (SURTASS LFA) Sonar § 218.234 Mitigation. When conducting operations identified in § 218... monitoring. (b) General Operating Procedures: (1) Prior to SURTASS LFA sonar operations, the Navy will... SURTASS LFA sonar signal at a frequency greater than 500 Hertz (Hz). (c) LFA Sonar Mitigation Zone and 1...

  6. Shuttle user analysis (study 2.2). Volume 3: Business risk and value of operations in space (BRAVO). Part 2: User's manual

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The purpose of the BRAVO User's Manual is to describe the BRAVO methodology in terms of step-by-step procedures. The BRAVO methodology then becomes a tool which a team of analysts can utilize to perform cost effectiveness analyses on potential future space applications with a relatively general set of input information and a relatively small expenditure of resources. An overview of the BRAVO procedure is given by describing the complete procedure in a general form.

  7. 19 CFR 148.105 - Procedure for excluding articles from flat rate of duty.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Procedure for excluding articles from flat rate of... Importations of Limited Value § 148.105 Procedure for excluding articles from flat rate of duty. (a) Generally... communicate the information in writing to the Commissioner of Customs, Attention: Office of Field Operations...

  8. NHEXAS PHASE I ARIZONA STUDY--STANDARD OPERATING PROCEDURE FOR CLEANING GLASSWARE TO BE USED FOR INORGANIC METALS ANALYSIS (BCO-L-10.0)

    EPA Science Inventory

    The purpose of this SOP is to describe the general procedures to be followed for cleaning glassware used in preparing and analyzing soil, house dust, air filter, surface wipe, or dermal wash samples for inorganic metals. This procedure was followed to ensure consistent data retr...

  9. Consensus-based training and assessment model for general surgery.

    PubMed

    Szasz, P; Louridas, M; de Montbrun, S; Harris, K A; Grantcharov, T P

    2016-05-01

    Surgical education is becoming competency-based with the implementation of in-training milestones. Training guidelines should reflect these changes and determine the specific procedures for such milestone assessments. This study aimed to develop a consensus view regarding operative procedures and tasks considered appropriate for junior and senior trainees, and the procedures that can be used as technical milestone assessments for trainee progression in general surgery. A Delphi process was followed where questionnaires were distributed to all 17 Canadian general surgery programme directors. Items were ranked on a 5-point Likert scale, with consensus defined as Cronbach's α of at least 0·70. Items rated 4 or above on the 5-point Likert scale by 80 per cent of the programme directors were included in the models. Two Delphi rounds were completed, with 14 programme directors taking part in round one and 11 in round two. The overall consensus was high (Cronbach's α = 0·98). The training model included 101 unique procedures and tasks, 24 specific to junior trainees, 68 specific to senior trainees, and nine appropriate to all. The assessment model included four procedures. A system of operative procedures and tasks for junior- and senior-level trainees has been developed along with an assessment model for trainee progression. These can be used as milestones in competency-based assessments. © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

  10. Variability in Resident Operative Hand Experience by Specialty.

    PubMed

    Silvestre, Jason; Lin, Ines C; Levin, L Scott; Chang, Benjamin

    2018-01-01

    Recent attention has sought to standardize hand surgery training in the United States. This study analyzes the variability in operative hand experience for orthopedic and general surgery residents. Case logs for orthopedic and general surgery residency graduates were obtained from the American Council of Graduate Medical Education (2006-2007 to 2014-2015). Plastic surgery case logs were not available for comparison. Hand surgery case volumes were compared between specialties with parametric tests. Intraspecialty variation in orthopedic surgery was assessed between the bottom and top 10th percentiles in procedure categories. Case logs for 9605 general surgery residents and 5911 orthopedic surgery residents were analyzed. Orthopedic surgery residents performed a greater number of hand surgery cases than general surgery residents ( P < .001). Mean total hand experience ranged from 2.5 ± 4 to 2.8 ± 5 procedures for general surgery residents with no reported cases of soft tissue repairs, vascular repairs, and replants. Significant intraspecialty variation existed in orthopedic surgery for all hand procedure categories (range, 3.3-15.0). As the model for hand surgery training evolves, general surgeons may represent an underutilized talent pool to meet the critical demand for hand surgeon specialists. Future research is needed to determine acceptable levels of training variability in hand surgery.

  11. 24 CFR 983.51 - Owner proposal selection procedures.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... operated to provide broad public notice of the opportunity to offer PBV proposals for consideration by the... general circulation and other means designed and actually operated to provide broad public notice. The... operated to provide broad public notice. (e) PHA-owned units. A PHA-owned unit may be assisted under the...

  12. National Program for Inspection of Non-Federal Dams. Farm Brook Site 2A Dam (CT 01546), Connecticut Coastal Basin, Hamden, Connecticut. Phase I Inspection Report.

    DTIC Science & Technology

    1981-09-01

    01546 NAME OF DAM: Farm Brook Site 2A Darn TO4N: Hamden COUNTY AND STATE: New Haven County, Connecticut STREAM: Wilmot Brook *DATE OF INSPECTION...few lives. Therefore, an emergency operation plan, including a downstream warning system should be prepared and implemented. It is recommended that...3.2 Evaluation 3-4 4. OPERATIONAL & MAINTENANCE PROCEDURES - 4.1 Operational Procedures 4-1 a. General b. Description of any Warning System in Effect

  13. Technical approaches for measurement of human errors

    NASA Technical Reports Server (NTRS)

    Clement, W. F.; Heffley, R. K.; Jewell, W. F.; Mcruer, D. T.

    1980-01-01

    Human error is a significant contributing factor in a very high proportion of civil transport, general aviation, and rotorcraft accidents. The technical details of a variety of proven approaches for the measurement of human errors in the context of the national airspace system are presented. Unobtrusive measurements suitable for cockpit operations and procedures in part of full mission simulation are emphasized. Procedure, system performance, and human operator centered measurements are discussed as they apply to the manual control, communication, supervisory, and monitoring tasks which are relevant to aviation operations.

  14. Laser safety programs in general surgery.

    PubMed

    Lanzafame, R J

    1994-06-01

    General surgery represents a speciality where, while any procedure can be performed with lasers, there are no procedures for which the laser is the sine quo non. The general surgeon may perform a variety of procedures with a multitude of laser wavelengths and technologies. Laser safety in general surgery requires a multidisciplinary approach. Effective laser safety requires the oversight of the hospital's "laser usage committee" and "laser safety officer" while providing a workable framework for daily laser use in a variety of clinical scenarios simultaneously. This framework must be user-friendly rather than oppressive. This presentation will describe laser safety at the Rochester General Hospital, a tertiary care, community-based teaching hospital. The safety program incorporates the following components: input to physician credentialing and training, education and in-servicing of nursing and technical personnel, equipment purchase and maintenance, quality assurance, and safety monitoring. The University of Rochester general surgery residency training program mandates laser training during the PGY-2 year. This program stresses the safe use of lasers and provides the basis for graded hands-on experience during the surgical residency. The greatest challenge for laser safety in general surgery centers on the burgeoning field of minimally invasive surgery. Safety assurance must be balanced so as to maintain a safe operating-room environment while ensuring patient safety and the ability to permit the surgery to proceed efficiently. Safety measures for laparoscopic procedures must be sensitive to the needs of the surgical team while not providing confusing signals for the "gallery" observers. This task is critical for the safe operation of lasers in general surgery. Effective laser safety in general surgery requires constant vigilance tempered with sensitivity to the needs of the surgeon and the patient as laser technology and its applications continue to evolve.

  15. NASA TLA workload analysis support. Volume 1: Detailed task scenarios for general aviation and metering and spacing studies

    NASA Technical Reports Server (NTRS)

    Sundstrom, J. L.

    1980-01-01

    The techniques required to produce and validate six detailed task timeline scenarios for crew workload studies are described. Specific emphasis is given to: general aviation single pilot instrument flight rules operations in a high density traffic area; fixed path metering and spacing operations; and comparative workload operation between the forward and aft-flight decks of the NASA terminal control vehicle. The validation efforts also provide a cursory examination of the resultant demand workload based on the operating procedures depicted in the detailed task scenarios.

  16. A Preliminary Procedure for Teaching Children with Autism to Mand for Social Information.

    PubMed

    Shillingsburg, M Alice; Frampton, Sarah E; Wymer, Sarah C; Bartlett, Brittany

    2018-03-01

    We used procedures established within the mands for information literature to teach two children with autism to mand for social information. Establishing operation trials were alternated with abolishing operation trials to verify the function of the responses as mands. Use of the acquired information was evaluated by examining responding to questions about their social partner. Both participants acquired mands for social information and showed generalization to novel social partners.

  17. [Fistulography. Results of 126 examinations (author's transl)].

    PubMed

    Metges, P J; Silici, R; Kleitz, C; Delahaye, R P; Mine, J; Pailler, J L

    1980-01-01

    The authors describe the results obtained in a series of 126 patients examined by fistulography. This investigation should be conducted systematically after operative treatment of any type of fistula. The procedure involves perfusion of a water-soluble iodized contrast medium at low pressure, using a balloon sound to ensure that there are no leaks. The results supply the general or orthopedic surgeon with the information necessary for deciding the operative procedure to be used.

  18. 40 CFR Appendix B to Part 434 - Baseline Determination and Compliance Monitoring for Pre-existing Discharges at Remining Operations

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    .... Rather than assign one a rank of 2 and the other a rank of 3, the average of 2 and 3 (i.e., 2.5) is given... baseline and monitoring (i.e., n = 12 and m = 12), the critical value C is 99. (f) Compare C to Sn. If Sn... Discharges at Remining Operations I. General Procedure Requirements a. This appendix presents the procedures...

  19. 40 CFR Appendix B to Part 434 - Baseline Determination and Compliance Monitoring for Pre-existing Discharges at Remining Operations

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    .... Rather than assign one a rank of 2 and the other a rank of 3, the average of 2 and 3 (i.e., 2.5) is given... baseline and monitoring (i.e., n = 12 and m = 12), the critical value C is 99. (f) Compare C to Sn. If Sn... Discharges at Remining Operations I. General Procedure Requirements a. This appendix presents the procedures...

  20. Higher surgical training opportunities in the general hospital setting; getting the balance right.

    PubMed

    Robertson, I; Traynor, O; Khan, W; Waldron, R; Barry, K

    2013-12-01

    The general hospital can play an important role in training of higher surgical trainees (HSTs) in Ireland and abroad. Training opportunities in such a setting have not been closely analysed to date. The aim of this study was to quantify operative exposure for HSTs over a 5-year period in a single institution. Analysis of electronic training logbooks (over a 5-year period, 2007-2012) was performed for general surgery trainees on the higher surgical training programme in Ireland. The most commonly performed adult and paediatric procedures per trainee, per year were analysed. Standard general surgery operations such as herniae (average 58, range 32-86) and cholecystectomy (average 60, range 49-72) ranked highly in each logbook. The most frequently performed emergency operations were appendicectomy (average 45, range 33-53) and laparotomy for acute abdomen (average 48, range 10-79). Paediatric surgical experience included appendicectomy, circumcision, orchidopexy and hernia/hydrocoele repair. Overall, the procedure most commonly performed in the adult setting was endoscopy, with each trainee recording an average of 116 (range 98-132) oesophagogastroduodenoscopies and 284 (range 227-354) colonoscopies. General hospitals continue to play a major role in the training of higher surgical trainees. Analysis of the electronic logbooks over a 5-year period reveals the high volume of procedures available to trainees in a non-specialist centre. Such training opportunities are invaluable in the context of changing work practices and limited resources.

  1. 7 CFR 58.437 - Salt.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Quality Specifications for Raw Material § 58... requirements of the Food Chemical Codex. Operations and Operating Procedures ...

  2. 7 CFR 58.437 - Salt.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Quality Specifications for Raw Material § 58... requirements of the Food Chemical Codex. Operations and Operating Procedures ...

  3. 7 CFR 58.437 - Salt.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Quality Specifications for Raw Material § 58... requirements of the Food Chemical Codex. Operations and Operating Procedures ...

  4. 7 CFR 58.437 - Salt.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Quality Specifications for Raw Material § 58... requirements of the Food Chemical Codex. Operations and Operating Procedures ...

  5. The University of Michigan--Flint. Faculty Policies and Procedures.

    ERIC Educational Resources Information Center

    Michigan Univ., Flint.

    The 1975 edition of the faculty handbook is a collection of information of general interest to faculty and staff. It outlines many aspects of university operations including university governance; appointments; promotion; tenure; termination; appeal procedures; salaries and other compensations; scholarships, fellowships, research grants; staff…

  6. Ventriculoperitoneal shunt

    MedlinePlus

    ... cavities (ventricles) of the brain ( hydrocephalus ). Description This procedure is done in the operating room under general anesthesia. It takes about 1 1/2 hours. A tube (catheter) is passed from the cavities of the head to the ... is drained. The procedure is done as follows: An area of hair ...

  7. Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry.

    PubMed

    Samuel, Isaac; Mason, Edward E; Renquist, Kathleen E; Huang, Yu-Hui; Zimmerman, M Bridget; Jamal, Mohammad

    2006-11-01

    The epidemic of morbid obesity has increased bariatric procedures performed. Trend analyses provide important information that may impact individual practices. Patient data from 137 surgeons were examined from 1987 to 2004 (41,860 patients) using Cochran-Armitage Trend test and Generalized Linear Model. Over an 18-year period, surgeon preference for combined restrictive-malabsorptive procedures increased from 33% to 94%, while simple gastric restriction decreased correspondingly (P < .0001). Surgeons per worksite doubled and cases per surgeon increased 71%. Laparoscopic procedures increased to 24%. The percentage of males, mean operative age, and initial body mass index (BMI) increased significantly (P < .0001). Postoperative hospital stay decreased from 5.0 to 3.9 days (P < .0001). The most common procedure in 2004 was Roux-en-Y gastric bypass (RYGB) (59%). Bariatric surgery patients are now older and heavier, length of stay is shorter, and the laparoscopic approach is more frequent. From 1987 to 2004, the general trend shows a clear preference for combined restrictive-malabsorptive operations.

  8. [Ambulatory Essure implant placement sterilization procedure for women: prospective study comparing general anesthesia versus hypnosis combined with sedation].

    PubMed

    Musellec, H; Bernard, F; Houssel, P; Guillou, N; Hugot, P; Martin, L; Hamelin, H; Lanchou, J; Gentili, M-E; Devins, C; Virot, C

    2010-12-01

    implant placement Essure, sterilization procedure for women, were performed under hypnosedation (HYP) and compared to the operative anxiety and analgesia of 12 patients operated-on under general anesthesia (GA). prospective and comparative group study. two groups of twelve patients were matched and compared based on the choice of anesthetic technique: hypnotics (HYP) with possible additional sedation by propofol and remifentanil or GA involving propofol, sevoflurane and remifentanil. The assessment of anxiety and pain based on a visual analogy scale (0-10) and use of analgesics were studied in the recovery room and at discharge of hospital. The statistical analysis relies on nonparametric tests for paired data (Wilcoxon test). all patients were operated. The two groups are statistically comparable. The preoperative anxiety before premedication is lower in the HYP group (p<0.05). No conversion to general anaesthesia is necessary in the HYP group, but five patients were using sedatives drugs but doses are very low compared to general anaesthesia. The analgesic consumption was equivalent in both groups. we conclude that hypnosedation is a valuable alternative to traditional anesthetic techniques for ambulatory Essure implant. The use of hypnotic tool is an interesting alternative for the management of patients during invasive medical procedures or surgical, providing psychological benefits to the patient. 2010. Published by Elsevier SAS.

  9. Comparison of treatment costs of laparoscopic and open surgery.

    PubMed

    Śmigielski, Jacek A; Piskorz, Łukasz; Koptas, Włodzimierz

    2015-09-01

    Laparoscopy has been a standard procedure in most medical centres providing surgical services for many years. Both the range and number of laparoscopic procedures performed are constantly increasing. Over the last decade, laparoscopic procedures have been successfully applied both in emergency and oncological surgery. However, treatment costs have become a more important factor in choosing between open or laparoscopic procedures. To present the total real costs of open and laparoscopic cholecystectomy, appendectomy and sigmoidectomy. Between 1 May 2010 and 30 March 2015 in the Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, and in the Department of General Surgery of the Saint John of God Hospital, Lodz, doctors performed 1404 cholecystectomies, 392 appendectomies and 88 sigmoidectomies. A total of 97% of the cholecystectomy procedures were laparoscopic and 3% were open. Similarly, 22% of total appendectomies were laparoscopic and 78% were open, while 9% of sigmoidectomies were laparoscopic and 91% open. The requirement for single-use equipment in laparoscopic procedures increases the expense. However, after adding up all other costs, surprisingly, differences between the costs of laparoscopic and open procedures ranged from 451 PLN/€ 114 for laparoscopic operations to 611 PLN/€ 153 for open operations. Laparoscopic cholecystectomy, considered the standard surgery for treating gallbladder diseases, is cheaper than open cholecystectomy. Laparoscopic appendectomy and sigmoidectomy are safe methods of minimally invasive surgery, slightly more expensive than open operations. Of all the analyzed procedures, one-day laparoscopic cholecystectomy is the most profitable. The costs of both laparoscopic and open sigmoidectomy are greatly underestimated in Poland.

  10. Redefining the Surgical Council of Resident Education (SCORE) Curriculum: A Comparison with the Operative Experiences of Graduated General Surgical Residents.

    PubMed

    Strosberg, David S; Quinn, Kristen M; Abdel-Misih, Sherif R; Harzman, Alan E

    2018-04-01

    Our objective was to investigate the number and classify surgical operations performed by general surgery residents and compare these with the updated Surgical Council on Resident Education (SCORE) curriculum. We performed a retrospective review of logged surgical cases from general surgical residents who completed training at a single center from 2011 to 2015. The logged cases were correlated with the operations extracted from the SCORE curriculum. Hundred and fifty-one procedures were examined; there were 98 "core" and 53 "advanced" cases as determined by the SCORE. Twenty-eight residents graduated with an average of 1017 major cases. Each resident completed 66 (67%) core cases and 17 (32%) advanced cases an average of one or more times with 39 (40%) core cases and 6 (11%) advanced cases completed five or more times. Core procedures that are infrequently or not performed by residents should be identified in each program to focus on resident education.

  11. 30 CFR 71.201 - Sampling; general requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Sampling; general requirements. 71.201 Section... MINES Sampling Procedures § 71.201 Sampling; general requirements. (a) Each operator shall take... required by this part with a sampling device approved by the Secretary and the Secretary of Health and...

  12. 30 CFR 90.201 - Sampling; general requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Sampling; general requirements. 90.201 Section... PNEUMOCONIOSIS Sampling Procedures § 90.201 Sampling; general requirements. (a) Each operator shall take... required by this part with a sampling device approved by the Secretary and the Secretary of Health and...

  13. 30 CFR 71.201 - Sampling; general requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Sampling; general requirements. 71.201 Section... MINES Sampling Procedures § 71.201 Sampling; general requirements. (a) Each operator shall take... required by this part with a sampling device approved by the Secretary and the Secretary of Health and...

  14. 30 CFR 90.201 - Sampling; general requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Sampling; general requirements. 90.201 Section... PNEUMOCONIOSIS Sampling Procedures § 90.201 Sampling; general requirements. (a) Each operator shall take... required by this part with a sampling device approved by the Secretary and the Secretary of Health and...

  15. 21 CFR 7.59 - General industry guidance.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 1 2012-04-01 2012-04-01 false General industry guidance. 7.59 Section 7.59 Food... POLICY Recalls (Including Product Corrections)-Guidance on Policy, Procedures, and Industry Responsibilities § 7.59 General industry guidance. A recall can be disruptive of a firm's operation and business...

  16. 21 CFR 7.59 - General industry guidance.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 1 2014-04-01 2014-04-01 false General industry guidance. 7.59 Section 7.59 Food... POLICY Recalls (Including Product Corrections)-Guidance on Policy, Procedures, and Industry Responsibilities § 7.59 General industry guidance. A recall can be disruptive of a firm's operation and business...

  17. 21 CFR 7.59 - General industry guidance.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 1 2013-04-01 2013-04-01 false General industry guidance. 7.59 Section 7.59 Food... POLICY Recalls (Including Product Corrections)-Guidance on Policy, Procedures, and Industry Responsibilities § 7.59 General industry guidance. A recall can be disruptive of a firm's operation and business...

  18. 21 CFR 7.59 - General industry guidance.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 1 2011-04-01 2011-04-01 false General industry guidance. 7.59 Section 7.59 Food... POLICY Recalls (Including Product Corrections)-Guidance on Policy, Procedures, and Industry Responsibilities § 7.59 General industry guidance. A recall can be disruptive of a firm's operation and business...

  19. Do patients fear undergoing general anesthesia for oral surgery?

    PubMed

    Elmore, Jasmine R; Priest, James H; Laskin, Daniel M

    2014-01-01

    Many patients undergoing major surgery have more fear of the general anesthesia than the procedure. This appears to be reversed with oral surgery. Therefore, patients need to be as well informed about this aspect as the surgical operation.

  20. Retrospective Review of the Anaesthetic Management of Maxillectomies and Mandibulectomies for Benign Tumours in Sub-Saharan Africa.

    PubMed

    White, Michelle C; Horner, Katherine C; Lai, Peggy S

    2016-01-01

    Safe anaesthesia is a crucial component of safe surgical care, yet anaesthetic complications are common in resource-limited settings. We describe differences in anaesthetic needs for Mandibulectomy vs. Maxillectomy in three sub-Saharan African countries. Retrospective review of patients undergoing minor Mandibulectomy, major Mandibulectomy, or Maxillectomy in Togo, Guinea and Republic of the Congo. Surgeries were performed on the Africa Mercy, an international non-governmental hospital ship. Primary outcomes were need for advanced airway management and intra-operative blood loss. Secondary outcomes were time under general anaesthesia and hospital length of stay. Multivariate regression determined the association between operation type and each outcome measure. 105 patients were included (25 minor Mandibulectomy, 58 major Mandibulectomy, 22 Maxillectomy procedures). In-hospital mortality was 0%. 44/105 (41.9%) required an advanced airway management technique to achieve intubation, although in all cases this was anticipated prior to the procedure; no differences were noted between surgical procedure (p = 0.72). Operative procedure was a significant risk factor for intra-operative blood loss. Patients undergoing Maxillectomy lost on average 851.5 (413.3, 1289.8, p = 0.0003) mL more blood than patients undergoing minor Mandibulectomy, and 507.3 (150.3, 864.3, p = 0.007) mL more blood than patients undergoing major Mandibulectomy. Patients undergoing Maxillectomy had a significantly higher time under general anaesthesia than those undergoing minor Mandibulectomy. There was no significant difference in hospital length of stay between operation type. Anaesthetic considerations for minor Mandibulectomy, major Mandibulectomy, and Maxillectomy differ with respect to intra-operative blood loss and time under general anaesthesia, but not need for advanced airway management or length of stay. Although advanced airway management was required in 41.9% of patients, there were no unanticipated difficult airways. With appropriate training and resources, safe anaesthesia can be delivered to patients from low-income countries requiring major head and neck surgery.

  1. Retrospective Review of the Anaesthetic Management of Maxillectomies and Mandibulectomies for Benign Tumours in Sub-Saharan Africa

    PubMed Central

    White, Michelle C.; Horner, Katherine C.; Lai, Peggy S.

    2016-01-01

    Background Safe anaesthesia is a crucial component of safe surgical care, yet anaesthetic complications are common in resource-limited settings. We describe differences in anaesthetic needs for Mandibulectomy vs. Maxillectomy in three sub-Saharan African countries. Materials and Methods Retrospective review of patients undergoing minor Mandibulectomy, major Mandibulectomy, or Maxillectomy in Togo, Guinea and Republic of the Congo. Surgeries were performed on the Africa Mercy, an international non-governmental hospital ship. Primary outcomes were need for advanced airway management and intra-operative blood loss. Secondary outcomes were time under general anaesthesia and hospital length of stay. Multivariate regression determined the association between operation type and each outcome measure. Results 105 patients were included (25 minor Mandibulectomy, 58 major Mandibulectomy, 22 Maxillectomy procedures). In-hospital mortality was 0%. 44/105 (41.9%) required an advanced airway management technique to achieve intubation, although in all cases this was anticipated prior to the procedure; no differences were noted between surgical procedure (p = 0.72). Operative procedure was a significant risk factor for intra-operative blood loss. Patients undergoing Maxillectomy lost on average 851.5 (413.3, 1289.8, p = 0.0003) mL more blood than patients undergoing minor Mandibulectomy, and 507.3 (150.3, 864.3, p = 0.007) mL more blood than patients undergoing major Mandibulectomy. Patients undergoing Maxillectomy had a significantly higher time under general anaesthesia than those undergoing minor Mandibulectomy. There was no significant difference in hospital length of stay between operation type. Conclusion Anaesthetic considerations for minor Mandibulectomy, major Mandibulectomy, and Maxillectomy differ with respect to intra-operative blood loss and time under general anaesthesia, but not need for advanced airway management or length of stay. Although advanced airway management was required in 41.9% of patients, there were no unanticipated difficult airways. With appropriate training and resources, safe anaesthesia can be delivered to patients from low-income countries requiring major head and neck surgery. PMID:27788172

  2. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR CLEANING GLASSWARE TO BE USED FOR INORGANIC METALS ANALYSIS (BCO-L-10.0)

    EPA Science Inventory

    The purpose of this SOP is to describe the general procedures to be followed for cleaning glassware used in preparing and analyzing soil, house dust, air filter, surface wipe, or dermal wash samples for inorganic metals. This procedure was followed to ensure consistent data retr...

  3. Early experiences of endoscopic procedures in general surgery assisted by a computer-enhanced surgical system.

    PubMed

    Hashizume, M; Shimada, M; Tomikawa, M; Ikeda, Y; Takahashi, I; Abe, R; Koga, F; Gotoh, N; Konishi, K; Maehara, S; Sugimachi, K

    2002-08-01

    We performed a variety of complete total endoscopic general surgical procedures, including colon resection, distal gastrectomy, and splenectomy, successfully with the assistance of the da Vinci computer-enhanced surgical system. The robotic system allowed us to manipulate the endoscopic instruments as effectively as during open surgery. It enhanced visualization of both the operative field and precision of the necessary techniques, as well as being less stressful for the endoscopic operating team. This technological innovation can therefore help surgeons overcome many of the difficulties associated with the endoscopic approach and thus has the potential to enable more precise, safer, and more minimally invasive surgery in the future.

  4. 7 CFR 58.633 - Color.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Quality Specifications for Raw Material § 58... and Drug Administration as safe for human consumption. Operations and Operating Procedures ...

  5. V/STOL tilt rotor research aircraft. Volume 1: General information, revision C

    NASA Technical Reports Server (NTRS)

    Kimbell, M.; Whitener, A.

    1980-01-01

    The configuration, operation and maintenance requirements for the contractor-furnished portion of the XV-15 research instrumentation and data acquisition system are defined. Descriptions of systems operation, maintenance and checkout procedures, and cable designations are given.

  6. 29 CFR 1910.420 - Safe practices manual.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Commercial Diving Operations General Operations Procedures § 1910.420..., equipment failure, adverse environmental conditions, and medical illness and injury. [42 FR 37668, July 22...

  7. 30 CFR 250.800 - General requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Mineral Resources BUREAU OF SAFETY AND ENVIRONMENTAL ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Production Safety Systems... environments. Production safety systems operated in subfreezing climates shall utilize equipment and procedures...

  8. 30 CFR 250.800 - General requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Mineral Resources BUREAU OF SAFETY AND ENVIRONMENTAL ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Production Safety Systems... environments. Production safety systems operated in subfreezing climates shall utilize equipment and procedures...

  9. 30 CFR 250.800 - General requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Mineral Resources BUREAU OF SAFETY AND ENVIRONMENTAL ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Production Safety Systems... environments. Production safety systems operated in subfreezing climates shall utilize equipment and procedures...

  10. Spokane Community College Library Serials Operation Handbook.

    ERIC Educational Resources Information Center

    Waesche, Betty; Cargill, Katie

    Listed are general policies for handling periodicals and specific policies for their acquisition, renewal, and processing, as well as procedures for checking in and claiming periodicals and handling duplicate copies. Flowcharts accompany procedural statements for claiming and checking-in periodicals and for dealing with duplicates. Specific duties…

  11. [Outpatient breast surgery].

    PubMed

    Cappel, J; Lüders, K

    1980-01-24

    Indication, standard operative procedure and technique of ambulant diagnostic mammary surgery is shown in detail from 15 years of experience. In respect of reducing costs intraoperative quick-frozen sections and in case of malignancy radical mastectomy immediately after biopsy during continuous general anesthesia is important. By retrospective analysis we could prove that operative results in treatment of benign breast tumors by out-patient surgery or otherwise for in-patients do not differ. According to an inquiry patients preferred by 60% out-patient procedure.

  12. Flight Test Guide (Part 61 Revised); Private Pilot Airplane.

    ERIC Educational Resources Information Center

    Federal Aviation Administration (DOT), Washington, DC. Flight Standards Service.

    This guide provides an outline of the skills required to pass the flight test for a Private Pilot Certificate with Airplane Rating under part 61 (revised) of Federal Aviation Regulations. General procedures for flight tests are described and the following pilot operations outlined: preflight operations, airport and traffic pattern operations,…

  13. Cost Analysis of Spinal Versus General Anesthesia for Lumbar Diskectomy and Laminectomy Spine Surgery.

    PubMed

    Agarwal, Prateek; Pierce, John; Welch, William C

    2016-05-01

    Lumbar spine surgery can be performed using various anesthetic modalities, most notably general or spinal anesthesia. Because data comparing the cost of these anesthetic modalities in spine surgery are scarce, this study asks whether spinal anesthesia is less costly than general anesthesia. A total of 542 patients who underwent elective lumbar diskectomy or laminectomy spine surgery between 2007 and 2011 were retrospectively identified, with 364 having received spinal anesthesia and 178 having received general anesthesia. Mean direct operating cost, indirect cost (general support staff, insurance, taxes, floor space, facility, and administrative costs), and total cost were compared among patients who received general and spinal anesthesia. Linear multiple regression analysis was used to identify the effect of anesthesia type on cost and determine the factors underlying this effect, while controlling for patient and procedure characteristics. When controlling for patient and procedure characteristics, use of spinal anesthesia was associated with a 41.1% lower direct operating cost (-$3629 ± $343, P < 0.001), 36.6% lower indirect cost (-$1603 ± $168, P < 0.001), and 39.6% lower total cost (-$5232 ± $482, P < 0.001) compared with general anesthesia. Shorter hospital stay, shorter duration of anesthesia, shorter duration of operation, and lower estimated blood loss contributed to lower costs for spinal anesthesia, but other factors beyond these were also responsible for lower direct operating and total costs. When comparing the benefits of spinal and general anesthesia, spinal anesthesia is less costly when used in patients undergoing lumbar diskectomy and laminectomy spine surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Generalization of cross-modal stimulus equivalence classes: operant processes as components in human category formation.

    PubMed Central

    Lane, S D; Clow, J K; Innis, A; Critchfield, T S

    1998-01-01

    This study employed a stimulus-class rating procedure to explore whether stimulus equivalence and stimulus generalization can combine to promote the formation of open-ended categories incorporating cross-modal stimuli. A pretest of simple auditory discrimination indicated that subjects (college students) could discriminate among a range of tones used in the main study. Before beginning the main study, 10 subjects learned to use a rating procedure for categorizing sets of stimuli as class consistent or class inconsistent. After completing conditional discrimination training with new stimuli (shapes and tones), the subjects demonstrated the formation of cross-modal equivalence classes. Subsequently, the class-inclusion rating procedure was reinstituted, this time with cross-modal sets of stimuli drawn from the equivalence classes. On some occasions, the tones of the equivalence classes were replaced by novel tones. The probability that these novel sets would be rated as class consistent was generally a function of the auditory distance between the novel tone and the tone that was explicitly included in the equivalence class. These data extend prior work on generalization of equivalence classes, and support the role of operant processes in human category formation. PMID:9821680

  15. Clopidogrel and bleeding after general surgery procedures.

    PubMed

    Ozao-Choy, Junko; Tammaro, Yolanda; Fradis, Martin; Weber, Kaare; Divino, Celia M

    2008-08-01

    Although many studies in the cardiothoracic literature exist about the relationship between clopidogrel and postoperative bleeding, there is scarce data in the general surgery literature. We assessed whether there are increased bleeding complications, morbidity, mortality, and resource utilization in patients who are on clopidogrel (Plavix) within 1 week before undergoing a general surgery procedure. Fifty consecutive patient charts were retrospectively reviewed after identifying patients who had pharmacy orders for clopidogrel and who underwent a general surgery procedure between 2003 and 2007. Patients who took clopidogrel within 6 days before surgery (group I, n = 28) were compared with patients who stopped clopidogrel for 7 days or more (group II, n = 22). A larger percentage of patients who took their last dose of clopidogrel within 1 week of surgery (21.4% vs 9.5%) had significant bleeding after surgery requiring blood transfusion. However, there were no significant differences between the groups in operative or postoperative blood transfusions (P = 0.12, 0.53), decreases in hematocrit (P = 0.21), hospital stay (P = 0.09), intensive care unit stay (P = 0.41), late complications (P = 0.45), or mortality (P = 0.42). Although our cohort is limited in size, these results suggest that in the case of a nonelective general surgery procedure where outcomes depend on timely surgery, clopidogrel taken within 6 days before surgery should not be a reason to delay surgery. However, careful attention must be paid to meticulous hemostasis, and platelets must be readily available for transfusion in the operating room.

  16. Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre.

    PubMed

    Schroeder, R P J; Chrzan, R J; Klijn, A J; Kuijper, C F; Dik, P; de Jong, T P V M

    2015-10-01

    Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collaborating with other specialities, modular training and training outside the operating theatre. Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential. Copyright © 2015. Published by Elsevier Ltd.

  17. Resource utilization and charges of patients with and without diagnosed venous thromboembolism during primary hospitalization and after elective inpatient surgery: a retrospective study.

    PubMed

    Sepassi, Aryana; Chingcuanco, Francine; Gordon, Ronald; Meier, Angela; Divino, Victoria; DeKoven, Mitch; Ben-Joseph, Rami

    2018-06-01

    To assess incremental charges of patients experiencing venous thromboembolisms (VTE) across various types of elective inpatient surgical procedures with administration of general anesthesia in the US. The authors performed a retrospective study utilizing data from a nationwide hospital operational records database from July 2014 through June 2015 to compare a group of inpatients experiencing a VTE event post-operatively to a propensity score matched group of inpatients who did not experience a VTE. Patients included in the analysis had a hospital admission for an elective inpatient surgical procedure with the use of general anesthesia. Procedures of the heart, brain, lungs, and obstetrical procedures were excluded, as these procedures often require a scheduled ICU stay post-operatively. Outcomes examined included VTE events during hospitalization, length of stay, unscheduled ICU transfers, number of days spent in the ICU if transferred, 3- and 30-day re-admissions, and total hospital charges incurred. The study included 17,727 patients undergoing elective inpatient surgical procedures. Of these, 36 patients who experienced a VTE event were matched to 108 patients who did not. VTE events occurred in 0.2% of the study population, with most events occurring for patients undergoing total knee replacement. VTE patients had a mean total hospital charge of $60,814 vs $48,325 for non-VTE patients, resulting in a mean incremental charge of $11,979 (p < .05). Compared to non-VTE patients, VTE patients had longer length of stay (5.9 days vs 3.7 days, p < .001), experienced a higher rate of 3-day re-admissions (3 vs 0 patients) and 30-day re-admissions (7 vs 2 patients). Patients undergoing elective inpatient surgical procedures with general anesthesia who had a VTE event during their primary hospitalization had a significantly longer length of stay and significantly higher total hospital charges than comparable patients without a VTE event.

  18. General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital.

    PubMed

    Kwok, C-S; Gordon, A C

    2016-09-01

    Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals.

  19. MSUSTAT.

    ERIC Educational Resources Information Center

    Mauriello, David

    1984-01-01

    Reviews an interactive statistical analysis package (designed to run on 8- and 16-bit machines that utilize CP/M 80 and MS-DOS operating systems), considering its features and uses, documentation, operation, and performance. The package consists of 40 general purpose statistical procedures derived from the classic textbook "Statistical…

  20. 47 CFR 1.903 - Authorization required.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Wireless Radio Services... the Wireless Radio Services must be used and operated only in accordance with the rules applicable to... operate mobile or fixed stations in the Wireless Radio Services, except for certain stations in the Rural...

  1. 30 CFR 250.1633 - Production measurement.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Production measurement. 250.1633 Section 250... SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Sulphur Operations § 250.1633 Production measurement. (a) General. Measurement equipment and security procedures shall be designed, installed, used, maintained, and...

  2. We still need to operate at night!

    PubMed Central

    Faiz, Omar; Banerjee, Saswata; Tekkis, Paris; Papagrigoriadis, Savvas; Rennie, John; Leather, Andrew

    2007-01-01

    Introduction In the past the National Confidential Enquiry into Peri-operative deaths (NCEPOD) have advocated a reduction in non-essential night-time operating in NHS hospitals. In this study a retrospective analysis of the emergency general surgical operative workload at a London Teaching centre was performed. Methods All general surgical and vascular emergency operations recorded prospectively on the theatre database between 1997 and 2004 were included in the study. Operations were categorised according to whether they commenced during the daytime(08:01–18:00 hours), evening(18:01–00:00 hours) or night-time(00:01–08:00 hours). The procedure type and grade of the participating surgical personnel were also recorded. Bivariate correlation was used to analyse changing trends in the emergency workload. Results In total 5,316 emergency operations were performed over the study period. The numbers of daytime, evening and night-time emergency procedures performed were 2,963(55.7%), 1,832(34.5%), and 521(9.8%) respectively. Laparotomies and complex vascular procedures collectively accounted for half of all cases performed after midnight whereas they represented only 30% of the combined daytime and evening emergency workload. Thirty-two percent (n = 166) of all night-time operations were supervised or performed by a consultant surgeon. The annual volume of emergency cases performed increased significantly throughout the study period. Enhanced daytime (r = 0.741, p < 0.01) and evening (r = 0.548, p < 0.01) operating absorbed this increase in workload. There was no significant change in the absolute number of cases performed at night but the proportion of the emergency workload that took place after midnight decreased significantly throughout the study (r = -0.742, p < 0.01). Conclusion A small but consistent volume of complex cases require emergency surgery after midnight. Provision of an emergency general surgical service must incorporate this need. PMID:17973987

  3. The impact of intra-operative interruptions on surgeons' perceived workload: an observational study in elective general and orthopedic surgery.

    PubMed

    Weigl, Matthias; Antoniadis, Sophia; Chiapponi, Costanza; Bruns, Christiane; Sevdalis, Nick

    2015-01-01

    Surgeons' intra-operative workload is critical for effective and safe surgical performance. Detrimental conditions in the operating room (OR) environment may add to perceived workload and jeopardize surgical performance and outcomes. This study aims to evaluate the impact of different intra-operative workflow interruptions on surgeons' capacity to manage their workload safely and efficiently. This was an observational study of intra-operative interruptions and self-rated workload in two surgical specialties (general, orthopedic/trauma surgery). Intra-operative interruptions were assessed via expert observation using a well-validated observation tool. Surgeons, nurses, and anesthesiologists assessed their intra-operative workload directly after case completion based on three items of the validated Surgery Task Load Index (mental demand, situational stress, distraction). A total of 56 elective cases (35 open, 21 laparoscopic) with 94 workload ratings were included. Mean intra-operative duration was 1 h 37 min. Intra-operative interruptions were on average observed 9.78 times per hour. People who entered/exited the OR (30.6 %) as well as telephone-/beeper-related disruptions (23.6 %) occurred most often. Equipment and OR environment-related interruptions were associated with highest interference with team functioning particularly in laparoscopic procedures. After identifying task and procedural influences, partial correlational analyses revealed that case-irrelevant communications were negatively associated with surgeons' mental fatigue and situational stress, whereas surgeons' reported distraction was increased by case-irrelevant communication and procedural disruptions. OR nurses' and anesthesiologists' perceived workload was also related to intra-operative interruption events. Our study documents the unique contribution of different interruptions on surgeons' workload; whereas case-irrelevant communications may be beneficial for mental fatigue and stress in routine cases, procedural interruptions and case-irrelevant communication may contribute to surgeons' mental focus deteriorating. Well-designed OR environments, surgical leadership, and awareness can help to control unnecessary interruptions for effective and safe surgical care.

  4. 28 CFR 65.84 - Procedures for the Attorney General when seeking State or local assistance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.84 Procedures for... operational direction to State or local law enforcement officers assisting in a Federal response pursuant to... local law enforcement officers to exercise Federal immigration enforcement authority under the...

  5. 28 CFR 65.84 - Procedures for the Attorney General when seeking State or local assistance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.84 Procedures for... operational direction to State or local law enforcement officers assisting in a Federal response pursuant to... local law enforcement officers to exercise Federal immigration enforcement authority under the...

  6. 28 CFR 65.84 - Procedures for the Attorney General when seeking State or local assistance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.84 Procedures for... operational direction to State or local law enforcement officers assisting in a Federal response pursuant to... local law enforcement officers to exercise Federal immigration enforcement authority under the...

  7. 28 CFR 65.84 - Procedures for the Attorney General when seeking State or local assistance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (CONTINUED) EMERGENCY FEDERAL LAW ENFORCEMENT ASSISTANCE Immigration Emergency Fund § 65.84 Procedures for... operational direction to State or local law enforcement officers assisting in a Federal response pursuant to... local law enforcement officers to exercise Federal immigration enforcement authority under the...

  8. 77 FR 25188 - Extension of Agency Information Collection Activity Under OMB Review: Enhanced Security...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-27

    ... general aviation (GA) aircraft operators who wish to fly into and/or out of Ronald Reagan Washington.... Information Collection Requirement Title: Enhanced Security Procedures at Ronald Reagan Washington National...] Extension of Agency Information Collection Activity Under OMB Review: Enhanced Security Procedures at Ronald...

  9. 46 CFR 197.206 - Substitutes for required equipment, materials, apparatus, arrangements, procedures, or tests.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Substitutes for required equipment, materials, apparatus... Operations General § 197.206 Substitutes for required equipment, materials, apparatus, arrangements, procedures, or tests. (a) The Coast Guard may accept substitutes for equipment, materials, apparatus...

  10. 46 CFR 197.206 - Substitutes for required equipment, materials, apparatus, arrangements, procedures, or tests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Substitutes for required equipment, materials, apparatus... Operations General § 197.206 Substitutes for required equipment, materials, apparatus, arrangements, procedures, or tests. (a) The Coast Guard may accept substitutes for equipment, materials, apparatus...

  11. Automatic computer procedure for generating exact and analytical kinetic energy operators based on the polyspherical approach: General formulation and removal of singularities

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ndong, Mamadou; Lauvergnat, David; Nauts, André

    2013-11-28

    We present new techniques for an automatic computation of the kinetic energy operator in analytical form. These techniques are based on the use of the polyspherical approach and are extended to take into account Cartesian coordinates as well. An automatic procedure is developed where analytical expressions are obtained by symbolic calculations. This procedure is a full generalization of the one presented in Ndong et al., [J. Chem. Phys. 136, 034107 (2012)]. The correctness of the new implementation is analyzed by comparison with results obtained from the TNUM program. We give several illustrations that could be useful for users of themore » code. In particular, we discuss some cyclic compounds which are important in photochemistry. Among others, we show that choosing a well-adapted parameterization and decomposition into subsystems can allow one to avoid singularities in the kinetic energy operator. We also discuss a relation between polyspherical and Z-matrix coordinates: this comparison could be helpful for building an interface between the new code and a quantum chemistry package.« less

  12. Flight Experiment Investigation of General Aviation Self-Separation and Sequencing Tasks

    NASA Technical Reports Server (NTRS)

    Murdoch, Jennifer L.; Ramiscal, Ermin R.; McNabb, Jennifer L.; Bussink, Frank J. L.

    2005-01-01

    A new flight operations concept called Small Aircraft Transportation System (SATS) Higher Volume Operations (HVO) was developed to increase capacity during Instrument Meteorological Conditions (IMC) at non-towered, non-radar airports by enabling concurrent operations of multiple aircraft. One aspect of this concept involves having pilots safely self-separate from other aircraft during approaches into these airports using appropriate SATS HVO procedures. A flight experiment was conducted to determine if instrument-rated general aviation (GA) pilots could self-separate and sequence their ownship aircraft, while following a simulated aircraft, into a non-towered, non-radar airport during simulated IMC. Six GA pilots' workload levels and abilities to perform self-separation and sequencing procedures while flying a global positioning system (GPS) instrument approach procedure were examined. The results showed that the evaluation pilots maintained at least the minimum specified separation between their ownship aircraft and simulated traffic and maintained their assigned landing sequence 100-percent of the time. Neither flight path deviations nor subjective workload assessments were negatively impacted by the additional tasks of self-separating and sequencing during these instrument approaches.

  13. Photographic consulting services to the Earth Resources program. [using aerial photography as a tool for scientific measurement

    NASA Technical Reports Server (NTRS)

    1976-01-01

    The recommendations, procedures, and techniques are summarized which provided by the Kodak Apparatus Division to the Ames Research Center to support the Earth Resources Aircraft Program at that facility. Recommendations, procedures, and calibration data are included for sensitometry, densitometry, laboratory cleanliness, and determination of camera exposure. Additional comments are made regarding process control procedures and general laboratory operations.

  14. 14 CFR 61.43 - Practical tests: General procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) AIRMEN CERTIFICATION: PILOTS, FLIGHT INSTRUCTORS, AND GROUND INSTRUCTORS General § 61.43... consists of— (1) Performing the tasks specified in the areas of operation for the airman certificate or... performing each task successfully; (3) Demonstrating proficiency and competency within the approved standards...

  15. Declining Operative Experience for Junior-Level Residents: Is This an Unintended Consequence of Minimally Invasive Surgery?

    PubMed

    Mullen, Matthew G; Salerno, Elise P; Michaels, Alex D; Hedrick, Traci L; Sohn, Min-Woong; Smith, Philip W; Schirmer, Bruce D; Friel, Charles M

    2016-01-01

    Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried for these procedures between 2005 and 2012. Cases were stratified by participating resident post-graduate year with "junior resident" defined as post-graduate year1-3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. A total of 185,335 cases were included in the study. For 3 of the operations we considered, the prevalence of laparoscopic surgery increased from 2005-2012 (all p < 0.001). Cholecystectomy was an exception, which showed an unchanged proportion of cases performed laparoscopically across the study period (p = 0.119). Junior resident participation decreased by 4.5%/y (p < 0.001) for laparoscopic procedures and by 6.2%/y (p < 0.001) for open procedures. The proportion of laparoscopic surgeries performed by junior-level residents decreased for appendectomy by 2.6%/y (p < 0.001) and cholecystectomy by 6.1%/y (p < 0.001), whereas it was unchanged for inguinal herniorrhaphy (p = 0.75) and increased for partial colectomy by 3.9%/y (p = 0.003). A decline in junior resident participation was seen for all open surgeries, with appendectomy decreasing by 9.4%/y (p < 0.001), cholecystectomy by 4.1%/y (p < 0.002), inguinal herniorrhaphy by 10%/y (p < 0.001) and partial colectomy by 2.9%/y (p < 0.004). Along with the proliferation of laparoscopy for common general surgical procedures there has been a concomitant reduction in the participation of junior-level residents. As previously thought, familiarity with laparoscopy has not translated to redistribution of basic operations from senior to junior residents. This trend has significant implications for general surgery resident education. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  16. The costs and quality of operative training for residents in tympanoplasty type I.

    PubMed

    Wang, Mao-Che; Yu, Eric Chen-Hua; Shiao, An-Suey; Liao, Wen-Huei; Liu, Chia-Yu

    2009-05-01

    A teaching hospital would incur more operation room costs on training surgical residents. To evaluate the increased operation time and the increased operation room costs of operations performed by surgical residents. As a model we used a very common surgical otology procedure -- tympanoplasty type I. From January 1, 2004 to December 31, 2004, we included in this study 100 patients who received tympanoplasty type I in Taipei Veterans General Hospital. Fifty-six procedures were performed by a single board-certified surgeon and 44 procedures were performed by residents. We analyzed the operation time and surgical outcomes in these two groups of patients. The operation room cost per minute was obtained by dividing the total operation room expenses by total operation time in the year 2004. The average operation time of residents was 116.47 min, which was significantly longer (p<0.0001) than that of the board-certified surgeon (average 81.07 min). It cost USD $40.36 more for each operation performed by residents in terms of operation room costs. The surgical success rate of residents was 81.82%, which was significantly lower (p=0.016) than that of the board-certified surgeon (96.43%).

  17. 21 CFR 211.130 - Packaging and labeling operations.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Packaging and Labeling Control § 211.130 Packaging and labeling operations. There shall be written procedures designed to... manufacture and control of the batch. (d) Examination of packaging and labeling materials for suitability and...

  18. 49 CFR 450.16 - Withdrawal of delegation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450.16 Withdrawal of delegation. (a) The Chief, Office of Operating and Environmental Standards (CG-OES... of Operating and Environmental Standards (CG-OES), U.S. Coast Guard gives to the Approval Authority...

  19. 49 CFR 450.16 - Withdrawal of delegation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450.16 Withdrawal of delegation. (a) The Chief, Office of Operating and Environmental Standards (CG-OES... of Operating and Environmental Standards (CG-OES), U.S. Coast Guard gives to the Approval Authority...

  20. 49 CFR 450.16 - Withdrawal of delegation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450.16 Withdrawal of delegation. (a) The Chief, Office of Operating and Environmental Standards (CG-522... of Operating and Environmental Standards (CG-522), U.S. Coast Guard gives to the Approval Authority...

  1. 49 CFR 450.16 - Withdrawal of delegation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450.16 Withdrawal of delegation. (a) The Chief, Office of Operating and Environmental Standards (CG-OES... of Operating and Environmental Standards (CG-OES), U.S. Coast Guard gives to the Approval Authority...

  2. 49 CFR 450.16 - Withdrawal of delegation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450.16 Withdrawal of delegation. (a) The Chief, Office of Operating and Environmental Standards (CG-522... of Operating and Environmental Standards (CG-522), U.S. Coast Guard gives to the Approval Authority...

  3. 47 CFR 90.403 - General operating requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... service providers pursuant to part 20 of this chapter, each licensee must restrict all transmissions to the minimum practical transmission time and must employ an efficient operating procedure designed to... such deviation is corrected. For transmissions concerning the imminent safety-of-life or property, the...

  4. 47 CFR 90.403 - General operating requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... service providers pursuant to part 20 of this chapter, each licensee must restrict all transmissions to the minimum practical transmission time and must employ an efficient operating procedure designed to... such deviation is corrected. For transmissions concerning the imminent safety-of-life or property, the...

  5. 47 CFR 90.403 - General operating requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... service providers pursuant to part 20 of this chapter, each licensee must restrict all transmissions to the minimum practical transmission time and must employ an efficient operating procedure designed to... such deviation is corrected. For transmissions concerning the imminent safety-of-life or property, the...

  6. 47 CFR 90.403 - General operating requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... service providers pursuant to part 20 of this chapter, each licensee must restrict all transmissions to the minimum practical transmission time and must employ an efficient operating procedure designed to... such deviation is corrected. For transmissions concerning the imminent safety-of-life or property, the...

  7. Observation of behavioural markers of non-technical skills in the operating room and their relationship to intra-operative incidents.

    PubMed

    Siu, Joey; Maran, Nikki; Paterson-Brown, Simon

    2016-06-01

    The importance of non-technical skills in improving surgical safety and performance is now well recognised. Better understanding is needed of the impact that non-technical skills of the multi-disciplinary theatre team have on intra-operative incidents in the operating room (OR) using structured theatre-based assessment. The interaction of non-technical skills that influence surgical safety of the OR team will be explored and made more transparent. Between May-August 2013, a range of procedures in general and vascular surgery in the Royal Infirmary of Edinburgh were performed. Non-technical skills behavioural markers and associated intra-operative incidents were recorded using established behavioural marking systems (NOTSS, ANTS and SPLINTS). Adherence to the surgical safety checklist was also observed. A total of 51 procedures were observed, with 90 recorded incidents - 57 of which were considered avoidable. Poor situational awareness was a common area for surgeons and anaesthetists leading to most intra-operative incidents. Poor communication and teamwork across the whole OR team had a generally large impact on intra-operative incidents. Leadership was shown to be an essential set of skills for the surgeons as demonstrated by the high correlation of poor leadership with intra-operative incidents. Team-working and management skills appeared to be especially important for anaesthetists in the recovery from an intra-operative incident. A significant number of avoidable incidents occur during operative procedures. These can all be linked to failures in non-technical skills. Better training of both individual and team in non-technical skills is needed in order to improve patient safety in the operating room. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  8. Recovery process and determinants of adverse event occurrence in bronchoscopic procedures performed under general anaesthesia.

    PubMed

    Özden Omaygenç, Derya; Ünal, Nermin; Edipoğlu, Saadet İpek; Barca Şeker, Tuğçe; Özgül, Mehmet Akif; Turan, Demet; Özdemir, Cengiz; Karaca, İbrahim Oğuz; Çetinkaya, Erdoğan

    2018-04-16

    Regarding the fact that rigid bronchoscopy is generally performed under general anaesthesia and this patient subgroup is remarkably morbid, encountering procedure and/or anaesthesia related complications are highly likely. Here, we aimed to assess factors influencing recovery and detect possible determinants of adverse event occurrence during these operations performed in a tertiary referral centre. Eighty-one consecutive ASA I-IV patients were recruited for this investigation. In the operating theatre after induction of anaesthesia and advancement of the device, maintenance was provided with total intravenous anaesthesia. Neuromuscular blockage was invariably administered, and patients were ventilated manually. In addition to preoperative demographic and procedural characteristics, perioperative hemodynamic variables, recovery times and observed adverse events were noted. Basic demographic properties, ASA and Mallampati scores, and procedure specific variables as lesion localization, lesion and procedure type were comparable among groups assembled with reference to event occurrence. Patients who had experienced adverse event had higher heart rates. Recovery times were comparable between Event (-) and Event (+) groups. Relationship of recovery process were individually tested with all variables and only lesion type was detected to have an effect on respiration and extubation times. Among all parameters only procedural time seemed to be associated with adverse event occurrence (mins, 22.9 ± 11.9 vs 41.6 ± 28.8, P < .001). Recovery times related with return of spontaneous respiration were significantly lower in procedures performed for treatment of tumoral diseases in this study and procedure length was determined to be the ultimate factor which had an impact on adverse event occurrence. © 2018 John Wiley & Sons Ltd.

  9. Computer-aided placement of deep brain stimulators: from planning to intraoperative guidance

    NASA Astrophysics Data System (ADS)

    D'Haese, Pierre-Francois; Pallavaram, Srivatsan; Kao, Chris; Konrad, Peter E.; Dawant, Benoit M.

    2005-04-01

    The long term objective of our research is to develop a system that will automate as much as possible DBS implantation procedures. It is estimated that about 180,000 patients/year would benefit from DBS implantation. Yet, only 3000 procedures are performed annually. This is so because the combined expertise required to perform the procedure successfully is only available at a limited number of sites. Our goal is to transform this procedure into a procedure that can be performed by a general neurosurgeon at a community hospital. In this work we report on our current progress toward developing a system for the computer-assisted pre-operative selection of target points and for the intra-operative adjustment of these points. The system consists of a deformable atlas of optimal target points that can be used to select automatically the pre-operative target, of an electrophysiological atlas, and of an intra-operative interface. The atlas is deformed using a rigid then a non-rigid registration algorithm developed at our institution. Results we have obtained show that automatic prediction of target points is an achievable goal. Our results also indicate that electrophysiological information can be used to resolve structures not visible in anatomic images, thus improving both pre-operative and intra-operative guidance. Our intra-operative system has reached the stage of a working prototype that is clinically used at our institution.

  10. ENRAF Series 854 Advanced Technology Gauge (ATG) with SPU ll Card for Leak Detector Use Acceptance Test Procedure

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    SMITH, S.G.

    1999-08-13

    This procedure checks the Enraf gauge received at Hanford is completely functional and has received no shipping damage. This procedure does not certify the gauge operation. The manufacturer certifies gauge operation. This procedure provides acceptance testing for Enraf Series 854 level gauges used to detect leaks in Hanford Waste Storage Tank annuli. The test will verify that the gauge functions according to the manufacturer's instructions and specifications and is properly setup prior to being delivered to the tank farm area. This ATP does not set up the gauge for any specific tank, but is generalized to permit testing the gaugemore » prior to installation package preparation.« less

  11. The causal perturbation expansion revisited: Rescaling the interacting Dirac sea

    NASA Astrophysics Data System (ADS)

    Finster, Felix; Grotz, Andreas

    2010-07-01

    The causal perturbation expansion defines the Dirac sea in the presence of a time-dependent external field. It yields an operator whose image generalizes the vacuum solutions of negative energy and thus gives a canonical splitting of the solution space into two subspaces. After giving a self-contained introduction to the ideas and techniques, we show that this operator is, in general, not idempotent. We modify the standard construction by a rescaling procedure giving a projector on the generalized negative-energy subspace. The resulting rescaled causal perturbation expansion uniquely defines the fermionic projector in terms of a series of distributional solutions of the Dirac equation. The technical core of the paper is to work out the combinatorics of the expansion in detail. It is also shown that the fermionic projector with interaction can be obtained from the free projector by a unitary transformation. We finally analyze the consequences of the rescaling procedure on the light-cone expansion.

  12. ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES.

    PubMed

    Onakpoya, O H; Asudo, F D; Adeoye, A O

    2014-03-01

    Ophthalmic surgical procedures are performed under anaesthesia to enhance comfort and cooperation of patient. To review factors influencing the choice of anaesthesia for ophthalmic surgical procedures. Restrospective descriptive study. Eye unit of a tertiary hospital. All patients who had ophthalmic surgeries in the operating theatre from January 2002 to December 2009. Two hundred and ninety ophthalmic surgeries were carried out during the study period. Age range was 1-95 years and mean of 61.0 ± 1.9; most (55%) were elderly while 4.8% were children. One hundred and fourty seven (50.7%) were males, 143(49.3%) females; male:female of 1.03:1. Local anaesthesia was the more commonly (92.1%) employed while general anaesthesia was used in 23(7.9%) patients. General anaesthesia was used more frequently (71.4%) in children compared to other age groups; the mean age and standard error of means for patients who had general anaesthesia (27.2 /5.4 years) is smaller compared to 63.9/0.93 years for patients who had local anaesthesia (p < 0.0001). Regional anaesthesia was the most frequently used for all types of procedures except for eye wall repairs in which general anaesthesia was used for 71.4% of patients (p < 0.0001). General anaesthesia was indicated in seven (41.2%) of emergency ophthalmic surgical procedures as compared to 16 (5.9%) of elective ophthalmic procedures P < 0.0001. General anaesthesia was more commonly employed in children, eye wall repairs and emergency ophthalmic surgical procedures.

  13. 14 CFR 23.45 - General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...: The effect on these distances of operation on other types of surfaces (for example, grass, gravel... accordance with § 23.1583(p). (h) For commuter category airplanes, the following also apply: (1) Unless... the extent that they are compatible with the operating procedures required by paragraph (h)(3) of this...

  14. 14 CFR 23.45 - General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...: The effect on these distances of operation on other types of surfaces (for example, grass, gravel... accordance with § 23.1583(p). (h) For commuter category airplanes, the following also apply: (1) Unless... the extent that they are compatible with the operating procedures required by paragraph (h)(3) of this...

  15. Robot-assisted laparoscopic (RAL) procedures in general surgery.

    PubMed

    Alimoglu, Orhan; Sagiroglu, Julide; Atak, Ibrahim; Kilic, Ali; Eren, Tunc; Caliskan, Mujgan; Bas, Gurhan

    2016-09-01

    Robotics was introduced in clinical practice more than two decades ago, and it has gained remarkable popularity for a wide variety of laparoscopic procedures. We report our results of robot-assisted laparoscopic surgery (RALS) in the most commonly applied general surgical procedures. Ninety seven patients underwent RALS from 2009 to 2012. Indications for RALS were cholelithiasis, gastric carcinoma, splenic tumors, colorectal carcinoma, benign colorectal diseases, non-toxic nodular goiter and incisional hernia. Records of patients were analyzed for demographic features, intraoperative and postoperative complications and conversion to open surgery. Forty six female and 51 male patients were operated and mean age was 58,4 (range: 25-88). Ninety three out of 97 procedures (96%) were completed robotically, 4 were converted to open surgery and there were 15 postoperative complications. There was no mortality. Wide variety of procedures of general surgery can be managed safely and effectively by RALS. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  16. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR ADMINISTERING FIELD QUESTIONNAIRES--GENERAL (UA-T-2.0)

    EPA Science Inventory

    The purpose of this SOP is to outline the objectives of and instructions for questionnaire administration in order to ensure consistency among the instructions given to respondents in the field. This procedure was followed to ensure consistent data retrieval during the Arizona N...

  17. Detailed Test Plan Redundant Sensor Strapdown IMU Evaluation Program

    NASA Technical Reports Server (NTRS)

    Hartwell, T.; Miyatake, Y.; Wedekind, D. E.

    1971-01-01

    The test plan for a redundant sensor strapdown inertial measuring unit evaluation program is presented. The subjects discussed are: (1) test philosophy and limitations, (2) test sequence, (3) equipment specifications, (4) general operating procedures, (5) calibration procedures, (6) alignment test phase, and (7) navigation test phase. The data and analysis requirements are analyzed.

  18. 29 CFR 1926.1404 - Assembly/Disassembly-general requirements (applies to all assembly and disassembly operations).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...'s procedures must be followed. When lifting loads without using outriggers or stabilizers, the manufacturer's procedures must be met regarding truck wedges or screws. (r) Rigging. In addition to following...(o)(3) before assembly/disassembly begins. (5) Boom and jib pick points. The point(s) of attachment...

  19. 29 CFR 1926.1404 - Assembly/Disassembly-general requirements (applies to all assembly and disassembly operations).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...'s procedures must be followed. When lifting loads without using outriggers or stabilizers, the manufacturer's procedures must be met regarding truck wedges or screws. (r) Rigging. In addition to following...(o)(3) before assembly/disassembly begins. (5) Boom and jib pick points. The point(s) of attachment...

  20. 29 CFR 1926.1404 - Assembly/Disassembly-general requirements (applies to all assembly and disassembly operations).

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...'s procedures must be followed. When lifting loads without using outriggers or stabilizers, the manufacturer's procedures must be met regarding truck wedges or screws. (r) Rigging. In addition to following...(o)(3) before assembly/disassembly begins. (5) Boom and jib pick points. The point(s) of attachment...

  1. 29 CFR 1926.1404 - Assembly/Disassembly-general requirements (applies to all assembly and disassembly operations).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...'s procedures must be followed. When lifting loads without using outriggers or stabilizers, the manufacturer's procedures must be met regarding truck wedges or screws. (r) Rigging. In addition to following...(o)(3) before assembly/disassembly begins. (5) Boom and jib pick points. The point(s) of attachment...

  2. NHEXAS PHASE I ARIZONA STUDY--STANDARD OPERATING PROCEDURE FOR ADMINISTERING FIELD QX--GENERAL (UA-T-2.0)

    EPA Science Inventory

    The purpose of this SOP is to outline the objectives of and instructions for questionnaire administration in order to ensure consistency among the instructions given to respondents in the field. This procedure was followed to ensure consistent data retrieval during the Arizona N...

  3. NHEXAS PHASE I ARIZONA STUDY--STANDARD OPERATING PROCEDURE FOR FIELD PERSONNEL TRAINING--GENERAL (UA-T-3.0)

    EPA Science Inventory

    The purpose of this SOP is to describe basic pre- and post-field visit activities and standards which are expected of every Field Team member. This procedure was followed to ensure consistent data retrieval during the Arizona NHEXAS project and the "Border" study. Keywords: tra...

  4. NHEXAS PHASE I ARIZONA STUDY--STANDARD OPERATING PROCEDURE FOR GENERAL LABORATORY TRAINING PLAN--BATTELLE (BCO-T-1.0)

    EPA Science Inventory

    This SOP describes the training sequence followed by each member of the technical staff at Battelle who participates in the NHEXAS project. The procedure is designed to provide them with an overview of the project in terms of project goals, structure, and laboratory requirements...

  5. NHEXAS PHASE I ARIZONA STUDY--STANDARD OPERATING PROCEDURE FOR LABORATORY ASSISTANT TRAINING PLAN--GENERAL (UA-T-6.0)

    EPA Science Inventory

    The purpose of this SOP is to describe the training sequence of incoming student laboratory assistants. The procedure is designed to provide them with an overview of the project in terms of project goals, structure, and laboratory needs. This overview familiarizes the student l...

  6. Extended System Operations Studies for Automated Guideway Transit Systems : Procedure for the Analysis of Representative AGT Deployments

    DOT National Transportation Integrated Search

    1981-12-01

    The purpose of this report is to present a general procedure for using the SOS software to analyze AGT systems. Data to aid the analyst in specifying input information, required as input to the software, are summarized in the appendices. The data are...

  7. 40 CFR 72.66 - Public comments.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... REGULATION Federal Acid Rain Permit Issuance Procedures § 72.66 Public comments. (a) General. During the..., if any, to owners and operators of any unit covered by the Acid Rain permit application. (c) Contents...) The environmental effects of acid rain, acid deposition, sulfur dioxide, or nitrogen oxides generally...

  8. 40 CFR 72.66 - Public comments.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... REGULATION Federal Acid Rain Permit Issuance Procedures § 72.66 Public comments. (a) General. During the..., if any, to owners and operators of any unit covered by the Acid Rain permit application. (c) Contents...) The environmental effects of acid rain, acid deposition, sulfur dioxide, or nitrogen oxides generally...

  9. 40 CFR 72.66 - Public comments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... REGULATION Federal Acid Rain Permit Issuance Procedures § 72.66 Public comments. (a) General. During the..., if any, to owners and operators of any unit covered by the Acid Rain permit application. (c) Contents...) The environmental effects of acid rain, acid deposition, sulfur dioxide, or nitrogen oxides generally...

  10. 40 CFR 72.66 - Public comments.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... REGULATION Federal Acid Rain Permit Issuance Procedures § 72.66 Public comments. (a) General. During the..., if any, to owners and operators of any unit covered by the Acid Rain permit application. (c) Contents...) The environmental effects of acid rain, acid deposition, sulfur dioxide, or nitrogen oxides generally...

  11. 40 CFR 72.66 - Public comments.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... REGULATION Federal Acid Rain Permit Issuance Procedures § 72.66 Public comments. (a) General. During the..., if any, to owners and operators of any unit covered by the Acid Rain permit application. (c) Contents...) The environmental effects of acid rain, acid deposition, sulfur dioxide, or nitrogen oxides generally...

  12. The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy.

    PubMed

    Wojcik, Brandon M; Fong, Zhi Ven; Patel, Madhukar S; Chang, David C; Petrusa, Emil; Mullen, John T; Phitayakorn, Roy

    General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program. Single institution case-control pilot study of a resident-run minor surgery clinic from 9/2014 to 6/2015. Rotating third-year residents staffed the clinic once weekly. Residents performed operations independently in their own procedure room. A supervising attending surgeon staffed each case prior to residents performing the procedure and viewed the surgical site before wound closure. Postprocedure patient complications and admissions to the hospital because of a complication were analyzed and compared with an attending control cohort. Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. Ten third-year general surgery residents. Overall, 341 patients underwent a total of 399 procedures (110 in the resident clinic vs. 289 in the attending clinic). Minor surgeries included soft tissue mass excision (n = 275), abscess incision and drainage (n = 66), skin lesion excision (n = 37), skin tag removal (n = 15), and lymph node excision (n = 6). There was no significant difference in the overall rate of patients developing a postprocedure complication within 30 days (3.6% resident vs. 2.8% attending; p = 0.65); which persisted on multivariate analysis. Similar findings were observed for the rate of hospital admission resulting from a complication. Resident evaluations overwhelmingly supported the rotation, citing increased operative autonomy as the greatest strength. Implementation of a resident-run minor surgery clinic is a safe and effective method to increase trainee operative autonomy. The rotation is well suited for mid-level residents, as it provides an opportunity for realistic self-evaluation and focused learning that may enhance their operative experience during senior level rotations. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  13. Ergonomic task analysis of ultrasound-guided femoral nerve block: a pilot study.

    PubMed

    Ajmal, Muhammad; Power, Susan; Smith, Tim; Shorten, George D

    2011-02-01

    To apply ergonomic task analysis to the performance of ultrasound-guided (US-guided) femoral nerve block (FNB) in an acute hospital setting. Pilot prospective observational study. Orthopedic operating room of a regional trauma hospital. 15 anesthesiologists of various levels of experience in US-guided FNB (estimated minimum experience < 10 procedures; maximum about 50 procedures, and from basic trainees to consultants); and 15 patients (5 men and 10 women), aged 77 ± 15 (mean ± SD yrs) years. MEASUREMENTS/OBSERVATIONS: A data capture "tool", which was modified from one previously developed for ergonomic study of spinal anesthesia, was studied. Patient, operator, and heterogeneous environmental factors related to ergonomic performance of US-guided FNB were identified. The observation period started immediately before commencement of positioning the patient and ended on completion of perineural injection. Data were acquired using direct observations, photography, and application of a questionnaire. The quality of ergonomic performance was generally suboptimal and varied greatly among operators. Eight (experience < 10 procedures) of 15 operators excessively rotated their head, neck, and/or back to visualize the image on the ultrasound machine. Eight operators (experience < 10 procedures) performed the procedure with excessive thoracolumbar flexion. Performance of US-guided FNB presents ergonomic challenges and was suboptimal during most of the procedures observed. Formal training in US-guided peripheral nerve blockade should include reference to ergonomic factors. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. 19 CFR 146.21 - General requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... English language copy of its written inventory control and recordkeeping systems procedures manual in... zone activation approval the operator remains liable for complying with all inventory control and...

  15. 19 CFR 146.21 - General requirements.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... English language copy of its written inventory control and recordkeeping systems procedures manual in... zone activation approval the operator remains liable for complying with all inventory control and...

  16. The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision.

    PubMed

    Andersen, Morten Jon; Gromov, Kiril; Brix, Michael; Troelsen, Anders

    2014-06-01

    The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Müller), and whether they were performed during or outside regular hours. Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries by interns were performed under supervision, whereas 32% of operations by junior residents were unsupervised. Supervision was absent in 14-16% and 22-33% of the three most frequent primary procedures and reoperations when performed by interns and junior residents, respectively. The proportion of unsupervised procedures by junior residents grew from 30% during to 40% (p < 0.001) outside regular hours. Interns and junior residents together performed almost half of all fracture-related surgery. The extent of supervision was generally high; however, a third of the primary procedures performed by junior residents were unsupervised. The extent of unsupervised surgery performed by junior residents was significantly higher outside regular hours. not relevant. The Danish Fracture Database ("Dansk Frakturdatabase") was approved by the Danish Data Protection Agency ID: 01321.

  17. Ladder operators for the Klein-Gordon equation with a scalar curvature term

    NASA Astrophysics Data System (ADS)

    Mück, Wolfgang

    2018-01-01

    Recently, Cardoso, Houri and Kimura constructed generalized ladder operators for massive Klein-Gordon scalar fields in space-times with conformal symmetry. Their construction requires a closed conformal Killing vector, which is also an eigenvector of the Ricci tensor. Here, a similar procedure is used to construct generalized ladder operators for the Klein-Gordon equation with a scalar curvature term. It is proven that a ladder operator requires the existence of a conformal Killing vector, which must satisfy an additional property. This property is necessary and sufficient for the construction of a ladder operator. For maximally symmetric space-times, the results are equivalent to those of Cardoso, Houri and Kimura.

  18. Increased anaesthesia duration increases venous thromboembolism risk in plastic surgery: A 6-year analysis of over 19,000 cases using the NSQIP dataset.

    PubMed

    Mlodinow, Alexei S; Khavanin, Nima; Ver Halen, Jon P; Rambachan, Aksharananda; Gutowski, Karol A; Kim, John Y S

    2015-01-01

    Venous thromboembolism (VTE) is a significant cause of morbidity and mortality, particularly in the postoperative setting. Various risk stratification schema exist in the plastic surgery literature, but do not take into account variations in procedure length. The putative risk of VTE conferred by increased length of time under anaesthesia has never been rigorously explored. The goal of this study is to assess this relationship and to benchmark VTE rates in plastic surgery. A large, multi-institutional quality-improvement database was queried for plastic and reconstructive surgery procedures performed under general anaesthesia between 2005-2011. In total, 19,276 cases were abstracted from the database. Z-scores were calculated based on procedure-specific mean surgical durations, to assess each case's length in comparison to the mean for that procedure. A total of 70 patients (0.36%) experienced a post-operative VTE. Patients with and without post-operative VTE were compared with respect to a variety of demographics, comorbidities, and intraoperative characteristics. Potential confounders for VTE were included in a regression model, along with the Z-scores. VTE occurred in both cosmetic and reconstructive procedures. Longer surgery time, relative to procedural means, was associated with increased VTE rates. Further, regression analysis showed increase in Z-score to be an independent risk factor for post-operative VTE (Odds Ratio of 1.772 per unit, p-value < 0.001). Subgroup analyses corroborated these findings. This study validates the long-held view that increased surgical duration confers risk of VTE, as well as benchmarks VTE rates in plastic surgery procedures. While this in itself does not suggest an intervention, surgical time under general anaesthesia would be a useful addition to existing risk models in plastic surgery.

  19. 49 CFR 192.711 - Transmission lines: General requirements for repair procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... system according to the following: (1) Non integrity management repairs: The operator must make permanent repairs as soon as feasible. (2) Integrity management repairs: When an operator discovers a condition on a...) PIPELINE SAFETY TRANSPORTATION OF NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS...

  20. 30 CFR 736.11 - General procedural requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... expects coal exploration or surface coal mining and reclamation operations to exist on non-Federal and non... program for regulation of coal exploration and surface coal mining and reclamation operations on non... revise a Federal program for a State, if necessary to further the purposes of the Act and the regulations...

  1. 30 CFR 736.11 - General procedural requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... expects coal exploration or surface coal mining and reclamation operations to exist on non-Federal and non... program for regulation of coal exploration and surface coal mining and reclamation operations on non... revise a Federal program for a State, if necessary to further the purposes of the Act and the regulations...

  2. 30 CFR 736.11 - General procedural requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... expects coal exploration or surface coal mining and reclamation operations to exist on non-Federal and non... program for regulation of coal exploration and surface coal mining and reclamation operations on non... revise a Federal program for a State, if necessary to further the purposes of the Act and the regulations...

  3. 30 CFR 736.11 - General procedural requirements.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... expects coal exploration or surface coal mining and reclamation operations to exist on non-Federal and non... program for regulation of coal exploration and surface coal mining and reclamation operations on non... revise a Federal program for a State, if necessary to further the purposes of the Act and the regulations...

  4. 30 CFR 736.11 - General procedural requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... expects coal exploration or surface coal mining and reclamation operations to exist on non-Federal and non... program for regulation of coal exploration and surface coal mining and reclamation operations on non... revise a Federal program for a State, if necessary to further the purposes of the Act and the regulations...

  5. Media Center: Operations Handbook.

    ERIC Educational Resources Information Center

    Dependents Schools (DOD), Washington, DC.

    This guide to basic technical procedures recommended in the operation of within-school media centers is intended for all Department of Defense Dependent Schools (DoDDS) media specialists, clerks, aides, and technicians. The first four sections refer to the general media program functions identified in the related manual, "A is for Apple:…

  6. 29 CFR 1910.426 - Mixed-gas diving.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 5 2010-07-01 2010-07-01 false Mixed-gas diving. 1910.426 Section 1910.426 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Commercial Diving Operations Specific Operations Procedures § 1910.426 Mixed-gas diving. (a) General. Employers engaged in mixed-gas diving shall comply with the following...

  7. 47 CFR 25.272 - General inter-system coordination procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... network control center which will have the responsibility to monitor space-to-Earth transmissions in its system. This would indirectly monitor uplink earth station transmissions in its system and to coordinate.... (c) The transmitting earth station licensee shall provide the operator(s) of the satellites, on which...

  8. 47 CFR 25.272 - General inter-system coordination procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... network control center which will have the responsibility to monitor space-to-Earth transmissions in its system. This would indirectly monitor uplink earth station transmissions in its system and to coordinate.... (c) The transmitting earth station licensee shall provide the operator(s) of the satellites, on which...

  9. 47 CFR 25.272 - General inter-system coordination procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... network control center which will have the responsibility to do the following: (1) Monitor space-to-Earth transmissions in its system (thus indirectly monitoring uplink earth station transmissions in its system) and (2... issues. (c) The transmitting earth station licensee shall provide the operator(s) of the satellites, on...

  10. 14 CFR 23.45 - General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... accordance with § 23.1583(p). (h) For multiengine jets weighing over 6,000 pounds in the normal, utility, and...: The effect on these distances of operation on other types of surfaces (for example, grass, gravel... that they are compatible with the operating procedures required by paragraph (h)(3) of this section. (3...

  11. 14 CFR 23.45 - General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... these surfaces listed in the Airplane Flight Manual in accordance with § 23.1583(p). (h) For commuter... run of § 23.59; and (4) Landing distance of § 23.75. Note: The effect on these distances of operation... operating procedures required by paragraph (h)(3) of this section. (3) Unless otherwise prescribed, in...

  12. 49 CFR 176.700 - General stowage requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... materials requiring supplemental operational procedures, the shipper must furnish the master or person in charge of the vessel a copy of the necessary operational instructions. (d) A person may not remain... of Management and Budget under control numbers 2137-0534, 2137-0535 and 2137-0536) [Amdt. 176-15, 48...

  13. Instruction manual model 600F, data transmission test set

    NASA Technical Reports Server (NTRS)

    1972-01-01

    Information necessary for the operation and maintenance of the Model 600F Data Transmission Test Set is presented. A description is contained of the physical and functional characteristics; pertinent installation data; instructions for operating the equipment; general and detailed principles of operation; preventive and corrective maintenance procedures; and block, logic, and component layout diagrams of the equipment and its major component assemblies.

  14. Single-Port Surgery: Laboratory Experience with the daVinci Single-Site Platform

    PubMed Central

    Haber, Georges-Pascal; Kaouk, Jihad; Kroh, Matthew; Chalikonda, Sricharan; Falcone, Tommaso

    2011-01-01

    Background and Objectives: The purpose of this study was to evaluate the feasibility and validity of a dedicated da Vinci single-port platform in the porcine model in the performance of gynecologic surgery. Methods: This pilot study was conducted in 4 female pigs. All pigs had a general anesthetic and were placed in the supine and flank position. A 2-cm umbilical incision was made, through which a robotic single-port device was placed and pneumoperitoneum obtained. A data set was collected for each procedure and included port placement time, docking time, operative time, blood loss, and complications. Operative times were compared between cases and procedures by use of the Student t test. Results: A total of 28 surgical procedures (8 oophorectomies, 4 hysterectomies, 8 pelvic lymph node dissections, 4 aorto-caval nodal dissections, 2 bladder repairs, 1 uterine horn anastomosis, and 1 radical cystectomy) were performed. There was no statistically significant difference in operating times for symmetrical procedures among animals (P=0.3215). Conclusions: This animal study demonstrates that single-port robotic surgery using a dedicated single-site platform allows performing technically challenging procedures within acceptable operative times and without complications or insertion of additional trocars. PMID:21902962

  15. Continuation of advanced crew procedures development techniques

    NASA Technical Reports Server (NTRS)

    Arbet, J. D.; Benbow, R. L.; Evans, M. E.; Mangiaracina, A. A.; Mcgavern, J. L.; Spangler, M. C.; Tatum, I. C.

    1976-01-01

    An operational computer program, the Procedures and Performance Program (PPP) which operates in conjunction with the Phase I Shuttle Procedures Simulator to provide a procedures recording and crew/vehicle performance monitoring capability was developed. A technical synopsis of each task resulting in the development of the Procedures and Performance Program is provided. Conclusions and recommendations for action leading to the improvements in production of crew procedures development and crew training support are included. The PPP provides real-time CRT displays and post-run hardcopy output of procedures, difference procedures, performance data, parametric analysis data, and training script/training status data. During post-run, the program is designed to support evaluation through the reconstruction of displays to any point in time. A permanent record of the simulation exercise can be obtained via hardcopy output of the display data and via transfer to the Generalized Documentation Processor (GDP). Reference procedures data may be transferred from the GDP to the PPP. Interface is provided with the all digital trajectory program, the Space Vehicle Dynamics Simulator (SVDS) to support initial procedures timeline development.

  16. Malpractice risk and cost are significantly reduced after tort reform.

    PubMed

    Stewart, Ronald M; Geoghegan, Kathy; Myers, John G; Sirinek, Kenneth R; Corneille, Michael G; Mueller, Deborah; Dent, Daniel L; Wolf, Steven E; Pruitt, Basil A

    2011-04-01

    Rising medical malpractice premiums have reached a crisis point in many areas of the United States. In 2003 the Texas legislature passed a comprehensive package of tort reform laws that included a cap at $250,000 on noneconomic damages in most medical malpractice cases. We hypothesized that tort reform laws significantly reduce the risk of malpractice lawsuit in an academic medical center. We compared malpractice prevalence, incidence, and liability costs before and after comprehensive state tort reform measures were implemented. Two prospectively maintained institutional databases were used to calculate and characterize malpractice risk: a surgical operation database and a risk management and malpractice database. Risk groups were divided into pretort reform (1992 to 2004) and post-tort reform groups (2004 to the present). Operative procedures were included for elective, urgent, and emergency general surgery procedures. During the study period, 98,513 general surgical procedures were performed. A total of 28 lawsuits (25 pre-reform, 3 postreform) were filed, naming general surgery faculty or residents. The prevalence of lawsuits filed/100,000 procedures performed is as follows: before reform, 40 lawsuits/100,000 procedures, and after reform, 8 lawsuits/100,000 procedures (p < 0.01, relative risk 0.21 [95% CI 0.063 to 0.62]). Virtually all of the liability and defense cost was in the pretort reform period: $595,000/year versus $515/year in the postreform group (p < 0.01). Implementation of comprehensive tort reform in Texas was associated with a significant decrease in the prevalence and cost of surgical malpractice lawsuits at one academic medical center. Copyright © 2011. Published by Elsevier Inc.

  17. Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience☆,☆☆,★,★★

    PubMed Central

    Flynn-O’Brien, Katherine T.; Trelles, Miguel; Dominguez, Lynette; Hassani, Ghulam Hiadar; Akemani, Clemence; Naseer, Aamer; Ntawukiruwabo, Innocent Bagura; Kushner, Adam L.; Rothstein, David H.; Stewart, Barclay T.

    2018-01-01

    Purpose Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams. Methods Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death. Results Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age <1 year, use of general anesthesia with a definitive airway, and operation during conflict. Conclusion Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions. PMID:26454469

  18. Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience.

    PubMed

    Flynn-O'Brien, Katherine T; Trelles, Miguel; Dominguez, Lynette; Hassani, Ghulam Hiadar; Akemani, Clemence; Naseer, Aamer; Ntawukiruwabo, Innocent Bagura; Kushner, Adam L; Rothstein, David H; Stewart, Barclay T

    2016-04-01

    Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams. Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death. Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age <1year, use of general anesthesia with a definitive airway, and operation during conflict. Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Overnight Science.

    ERIC Educational Resources Information Center

    Smith, Nancy N.; Stahl, Robert J.

    1981-01-01

    Outlines objectives for an elementary science camping program and summarizes general operational procedures. Campsite activities related to such topics as microorganisms, eye and sight, nature trails, bees, carpentry, and astronomy are described. (DS)

  20. Impact of spinal anesthesia for open pyloromyotomy on operating room time.

    PubMed

    Kachko, Ludmyla; Simhi, Eliahu; Freud, Enrique; Dlugy, Elena; Katz, Jacob

    2009-10-01

    When pyloromyotomy for hypertrophic pyloric stenosis (HPS) is performed under general anesthesia, metabolic abnormalities and fluid deficits coupled with residual anesthetics may increase the risk of postoperative apnea, thereby, prolonging operating room time and delaying extubation. Spinal anesthesia has been found to reduce the rate of postoperative apnea in high-risk infants. The aim of the study was to evaluate the effect of spinal vs general anesthesia on operating room time in infants undergoing open pyloromyotomy. Data for 60 infants who underwent pyloromyotomy under spinal (n = 24) or general (n = 36) anesthesia at a tertiary pediatric medical center were derived from the computerized database. Primary outcome measures were total operating room time, procedure duration, anesthesia release time, wake-up time, and anesthesia control time (anesthesia release plus wake-up). Nonparametric Mann-Whitney test was used for statistical analysis, and Levene's test was used to assess the equality of variances in samples; P

  1. Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients.

    PubMed

    Blok, J L; Boersma, M; Terra, J B; Spoo, J R; Leeman, F W J; van den Heuvel, E R; Huizinga, J; Jonkman, M F; Horváth, B

    2015-08-01

    Treatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure. To investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia. A clinical records-based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires. A total of 482 operations (363 primary operations and 119 re-operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient's and doctor's delay) was 6.5 years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied). The diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery. © 2015 European Academy of Dermatology and Venereology.

  2. General Employee Training Live, Course 15503

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Gabel, Daniel Glen; Hughes, Heather

    This training at Los Alamos National Laboratory contains the following sections: Introduction to the Laboratory, Institutional Quality Assurance, Facilities, Policies, Procedures, and Other Requirements, Safety Expectations, Worker Protection: Occupational Safety and Health, Industrial Hygiene and Safety, Lockout/Tagout, General Employee Radiological Training, Fire Protection, Security, Emergency Operations, Occupational Health, and Environment.

  3. 40 CFR 63.11115 - What are my general duties to minimize emissions?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Dispensing Facilities Emission Limitations and Management Practices § 63.11115 What are my general duties to... consistent with safety and good air pollution control practices for minimizing emissions. Determination of... and maintenance procedures, review of operation and maintenance records, and inspection of the source...

  4. 40 CFR 63.11115 - What are my general duties to minimize emissions?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Dispensing Facilities Emission Limitations and Management Practices § 63.11115 What are my general duties to... consistent with safety and good air pollution control practices for minimizing emissions. Determination of... and maintenance procedures, review of operation and maintenance records, and inspection of the source...

  5. 40 CFR 63.11115 - What are my general duties to minimize emissions?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Dispensing Facilities Emission Limitations and Management Practices § 63.11115 What are my general duties to... consistent with safety and good air pollution control practices for minimizing emissions. Determination of... and maintenance procedures, review of operation and maintenance records, and inspection of the source...

  6. 42 CFR 81.22 - General guidelines for use of NIOSH-IREP.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SAFETY AND HEALTH RESEARCH AND RELATED ACTIVITIES GUIDELINES FOR DETERMINING PROBABILITY OF CAUSATION... Probability of Causation § 81.22 General guidelines for use of NIOSH-IREP. DOL will use procedures specified in the NIOSH-IREP Operating Guide to calculate probability of causation estimates under EEOICPA. The...

  7. 46 CFR 340.3 - General provisions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... procedures shall be applicable: (1) In connection with deployment of the Armed Forces of the United States... SECURITY AND NATIONAL DEFENSE RELATED OPERATIONS § 340.3 General provisions. (a) The provisions of this rule apply pursuant to authority granted to the President by title I, Defense Production Act of 1950...

  8. 46 CFR 340.3 - General provisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... procedures shall be applicable: (1) In connection with deployment of the Armed Forces of the United States... SECURITY AND NATIONAL DEFENSE RELATED OPERATIONS § 340.3 General provisions. (a) The provisions of this rule apply pursuant to authority granted to the President by title I, Defense Production Act of 1950...

  9. 25 CFR 700.81 - Monthly housing cost.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Monthly housing cost. 700.81 Section 700.81 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Policies and Instructions Definitions § 700.81 Monthly housing cost. (a) General. The term monthly housing...

  10. National practice patterns and outcomes of pediatric nephrectomy: comparison between urology and general surgery.

    PubMed

    Suson, Kristina D; Wolfe-Christensen, Cortney; Elder, Jack S; Lakshmanan, Yegappan

    2015-05-01

    In adults nephrectomy is under the purview of urologists, but pediatric urologists and pediatric general surgeons perform extirpative renal surgery in children. We compared the contemporary performance and outcome of all-cause nephrectomy at pediatric hospitals as performed by pediatric urologists and pediatric general surgeons. We queried the Pediatric Health Information System to identify patients 0 to 18 years old who were treated with nephrectomy between 2004 and 2013 by pediatric urologists and pediatric general surgeons. Data points included age, gender, severity level, mortality risk, complications and length of stay. Patients were compared by APR DRG codes 442 (kidney and urinary tract procedures for malignancy) and 443 (kidney and urinary tract procedures for nonmalignancy). Pediatric urologists performed more all-cause nephrectomies. While pediatric urologists were more likely to operate on patients with benign renal disease, pediatric general surgeons were more likely to operate on children with malignancy. Patients on whom pediatric general surgeons operated had a higher average severity level and were at greater risk for mortality. After controlling for differences patients without malignancy operated on by pediatric urologists had a shorter length of stay, and fewer medical and surgical complications. There was no difference in length of stay, or medical or surgical complications in patients with malignancy. Overall compared to pediatric general surgeons more nephrectomies are performed by pediatric urologists. Short-term outcomes, including length of stay and complication rates, appear better in this data set in patients without malignancy who undergo nephrectomy by pediatric urologists but there is no difference in outcomes when nephrectomy is performed for malignancy. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. 33 CFR 240.2 - Applicability.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... GENERAL CREDIT FOR FLOOD CONTROL § 240.2 Applicability. Policies and procedures contained herein apply to all HQUSACE elements and field operating agencies of the Corps of Engineers having Civil Works...

  12. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR FIELD PERSONNEL TRAINING--GENERAL (UA-T-3.0)

    EPA Science Inventory

    The purpose of this SOP is to describe basic pre- and post-field visit activities and standards which are expected of every field team member. This procedure was followed to ensure consistent data retrieval during the Arizona NHEXAS project and the Border study. Keywords: traini...

  13. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR GENERAL LABORATORY TRAINING PLAN (BCO-T-1.0)

    EPA Science Inventory

    This SOP describes the training sequence followed by each member of the technical staff at Battelle who participates in the project. The procedure is designed to provide them with an overview of the project in terms of project goals, structure, and laboratory requirements. This...

  14. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR LABORATORY ASSISTANT TRAINING PLAN--GENERAL (UA-T-6.0)

    EPA Science Inventory

    The purpose of this SOP is to describe the training sequence of incoming student laboratory assistants. The procedure is designed to provide them with an overview of the project in terms of project goals, structure, and laboratory needs. This overview familiarizes the student l...

  15. U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--STANDARD OPERATING PROCEDURE FOR GENERAL TRAINING OF STUDENT DATA ASSISTANTS (UA-T-5.0)

    EPA Science Inventory

    The purpose of this SOP is to describe the training sequence for incoming student data assistants (students). The procedure is designed to provide them with an overview of the study in terms of study goals, structure and project data needs. This overview familiarizes the studen...

  16. Sampling. Operational Control Tests for Wastewater Treatment Facilities. Instructor's Manual [and] Student Workbook.

    ERIC Educational Resources Information Center

    Carnegie, John W.

    A brief overview of the basic concepts and philosophies for sampling water and waste water systems is presented in this module. The module is not intended to specify sampling procedures, frequencies, or locations for specific treatment facilities but rather to outline those general procedures which should be followed when sampling under most…

  17. Audit Oversight: Quality Control System at U.S. Special Operations Command Inspector General Audit Division

    DTIC Science & Technology

    2002-08-21

    The Audit Division provides the Commander, U.S. Special Operations Command (USSOCOM) with professional auditing services to safeguard, account for...and ensure the proper use of special operations forces assets in accomplishing the USSOCOM mission. The Audit Division reports to the USSOCOM Inspector...U.S. Army Special Operations Command, Naval Special Warfare Command, and the Joint Special Operations Command. Appendix A contains a summary of the Audit Division policy and procedures.

  18. Analysis of verbal communication during teaching in the operating room and the potentials for surgical training.

    PubMed

    Blom, E M; Verdaasdonk, E G G; Stassen, L P S; Stassen, H G; Wieringa, P A; Dankelman, J

    2007-09-01

    Verbal communication in the operating room during surgical procedures affects team performance, reflects individual skills, and is related to the complexity of the operation process. During the procedural training of surgeons (residents), feedback and guidance is given through verbal communication. A classification method based on structural analysis of the contents was developed to analyze verbal communication. This study aimed to evaluate whether a classification method for the contents of verbal communication in the operating room could provide insight into the teaching processes. Eight laparoscopic cholecystectomies were videotaped. Two entire cholecystectomies and the dissection phase of six additional procedures were analyzed by categorization of the communication in terms of type (4 categories: commanding, explaining, questioning, and miscellaneous) and content (9 categories: operation method, location, direction, instrument handling, visualization, anatomy and pathology, general, private, undefinable). The operation was divided into six phases: start, dissection, clipping, separating, control, closing. Classification of the communication during two entire procedures showed that each phase of the operation was dominated by different kinds of communication. A high percentage of explaining anatomy and pathology was found throughout the whole procedure except for the control and closing phases. In the dissection phases, 60% of verbal communication concerned explaining. These explaining communication events were divided as follows: 27% operation method, 19% anatomy and pathology, 25% location (positioning of the instrument-tissue interaction), 15% direction (direction of tissue manipulation), 11% instrument handling, and 3% other nonclassified instructions. The proposed classification method is feasible for analyzing verbal communication during surgical procedures. Communication content objectively reflects the interaction between surgeon and resident. This information can potentially be used to specify training needs, and may contribute to the evaluation of different training methods.

  19. [Hydrotherapy equipment].

    PubMed

    Tsibikov, V B; Ragozin, S I; Mikheeva, L V

    1985-01-01

    A flow-chart is developed demonstrating the relation between medical and prophylactic institutions within the organizational structure of the rehabilitation system and main types of rehabilitation procedures. In order to ascertain the priority in equipping rehabilitation services with adequate hardware the special priority criterion is introduced. The highest priority is assigned to balneotherapeutic and fangotherapeutic services. Based on the operation-by-operation analysis of clinical processes related to service and performance of balneologic procedures the preliminary set of clinical devices designed for baths, basins and showers in hospitals and rehabilitation departments is defined in a generalized form.

  20. Surgical resident involvement is safe for common elective general surgery procedures.

    PubMed

    Tseng, Warren H; Jin, Leah; Canter, Robert J; Martinez, Steve R; Khatri, Vijay P; Gauvin, Jeffrey; Bold, Richard J; Wisner, David; Taylor, Sandra; Chen, Steven L

    2011-07-01

    Outcomes of surgical resident training are under scrutiny with the changing milieu of surgical education. Few have investigated the effect of surgical resident involvement (SRI) on operative parameters. Examining 7 common general surgery procedures, we evaluated the effect of SRI on perioperative morbidity and mortality and operative time (OpT). The American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2007) was used to identify 7 cases of nonemergent operations. Cases with simultaneous procedures were excluded. Logistic regression was performed across all procedures and within each procedure incorporating SRI, OpT, and risk-stratifying American College of Surgery National Surgical Quality Improvement Program morbidity and mortality probability scores, which incorporate multiple prognostic individual patient factors. Procedure-specific, SRI-stratified OpTs were compared using Wilcoxon rank-sum tests. A total of 71.3% of the 37,907 cases had SRI. Absolute 30-day morbidity for all cases with SRI and without SRI were 3.0% and 1.0%, respectively (p < 0.001); absolute 30-day mortality for all cases with SRI and without SRI were 0.1% and 0.08%, respectively (p < 0.001). After multivariate analysis by specific procedure, SRI was not associated with increased morbidity but was associated with decreased mortality during open right colectomy (odds ratio 0.32; p = 0.01). Across all procedures, SRI was associated with increased morbidity (odds ratio 1.14; p = 0.048) but decreased mortality (odds ratio 0.42; p < 0.001). Mean OpT for all procedures was consistently lower for cases without SRI. SRI has a measurable impact on both 30-day morbidity and mortality and OpT. These data have implications to the impact associated with surgical graduate medical education. Further studies to identify causes of patient morbidity and prevention strategies in surgical teaching environments are warranted. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  1. A Simulation Study of Instrument Meteorological Condition Approaches to Dual Parallel Runways Spaced 3400 and 2500 Feet Apart Using Flight-Deck-Centered Technology

    NASA Technical Reports Server (NTRS)

    Waller, Marvin C.; Scanlon, Charles H.

    1999-01-01

    A number of our nations airports depend on closely spaced parallel runway operations to handle their normal traffic throughput when weather conditions are favorable. For safety these operations are curtailed in Instrument Meteorological Conditions (IMC) when the ceiling or visibility deteriorates and operations in many cases are limited to the equivalent of a single runway. Where parallel runway spacing is less than 2500 feet, capacity loss in IMC is on the order of 50 percent for these runways. Clearly, these capacity losses result in landing delays, inconveniences to the public, increased operational cost to the airlines, and general interruption of commerce. This document presents a description and the results of a fixed-base simulation study to evaluate an initial concept that includes a set of procedures for conducting safe flight in closely spaced parallel runway operations in IMC. Consideration of flight-deck information technology and displays to support the procedures is also included in the discussions. The procedures and supporting technology rely heavily on airborne capabilities operating in conjunction with the air traffic control system.

  2. Evaluating Coding Accuracy in General Surgery Residents' Accreditation Council for Graduate Medical Education Procedural Case Logs.

    PubMed

    Balla, Fadi; Garwe, Tabitha; Motghare, Prasenjeet; Stamile, Tessa; Kim, Jennifer; Mahnken, Heidi; Lees, Jason

    The Accreditation Council for Graduate Medical Education (ACGME) case log captures resident operative experience based on Current Procedural Terminology (CPT) codes and is used to track operative experience during residency. With increasing emphasis on resident operative experiences, coding is more important than ever. It has been shown in other surgical specialties at similar institutions that the residents' ACGME case log may not accurately reflect their operative experience. What barriers may influence this remains unclear. As the only objective measure of resident operative experience, an accurate case log is paramount in representing one's operative experience. This study aims to determine the accuracy of procedural coding by general surgical residents at a single institution. Data were collected from 2 consecutive graduating classes of surgical residents' ACGME case logs from 2008 to 2014. A total of 5799 entries from 7 residents were collected. The CPT codes entered by residents were compared to departmental billing records submitted by the attending surgeon for each procedure. Assigned CPT codes by institutional American Academy of Professional Coders certified abstract coders were considered the "gold standard." A total of 4356 (75.12%) of 5799 entries were identified in billing records. Excel 2010 and SAS 9.3 were used for analysis. In the event of multiple codes for the same patient, any match between resident codes and billing record codes was considered a "correct" entry. A 4-question survey was distributed to all current general surgical residents at our institution for feedback on coding habits, limitations to accurate coding, and opinions on ACGME case log representation of their operative experience. All 7 residents had a low percentage of correctly entered CPT codes. The overall accuracy proportion for all residents was 52.82% (range: 43.32%-60.07%). Only 1 resident showed significant improvement in accuracy during his/her training (p = 0.0043). The survey response rate was 100%. Survey results indicated that inability to find the precise code within the ACGME search interface and unfamiliarity with available CPT codes were by far the most common perceived barriers to accuracy. Survey results also indicated that most residents (74%) believe that they code accurately most of the time and agree that their case log would accurately represent their operative experience (66.6%). This is the first study to evaluate correctness of residents' ACGME case logs in general surgery. The degree of inaccuracy found here necessitates further investigation into the etiology of these discrepancies. Instruction on coding practices should also benefit the residents after graduation. Optimizing communication among attendings and residents, improving ACGME coding search interface, and implementing consistent coding practices could improve accuracy giving a more realistic view of residents' operative experience. Published by Elsevier Inc.

  3. Model of a training program in robotic surgery and its initial results.

    PubMed

    Madureira, Fernando Athayde Veloso; Varela, José Luís Souza; Madureira, Delta; D'Almeida, Luis Alfredo Vieira; Madureira, Fábio Athayde Veloso; Duarte, Alexandre Miranda; Vaz, Otávio Pires; Ramos, José Reinan

    2017-01-01

    to describe the implementation of a training program in robotic surgery and to point the General Surgery procedures that can be performed with advantages using the robotic platform. we conducted a retrospective analysis of data collected prospectively from the robotic surgery group in General and Colo-Retal Surgery at the Samaritan Hospital (Rio de Janeiro, Brazil), from October 2012 to December 2015. We describe the training stages and particularities. two hundred and ninety three robotic operations were performed in general surgery: 108 procedures for morbid obesity, 59 colorectal surgeries, 55 procedures in the esophago-gastric transition area, 16 cholecystectomies, 27 abdominal wall hernioplasties, 13 inguinal hernioplasties, two gastrectomies with D2 lymphadenectomy, one vagotomy, two diaphragmatic hernioplasties, four liver surgeries, two adrenalectomies, two splenectomies, one pancreatectomy and one bilio-digestive anastomosis. The complication rate was 2.4%, with no major complications. the robotic surgery program of the Samaritan Hospital was safely implemented and with initial results better than the ones described in the current literature. There seems to be benefits in using the robotic platform in super-obese patients, re-operations of obesity surgery and hiatus hernias, giant and paraesophageal hiatus hernias, ventral hernias with multiple defects and rectal resections.

  4. Effect of intraoperative analgesia on children's pain perception during recovery after painful dental procedures performed under general anaesthesia.

    PubMed

    El Batawi, H Y

    2015-02-01

    To investigate the possible effect of intraoperative analgesia, namely diclofenac sodium compared to acetaminophen on post-recovery pain perception in children undergoing painful dental procedures under general anaesthesia. A double-blind randomised clinical trial. A sample of 180 consecutive cases of children undergoing full dental rehabilitation under general anaesthesia in a private hospital in Saudi Arabia during 2013 was divided into three groups (60 children each) according to the analgesic used prior to extubation. Group A, children had diclofenac sodium suppository. Group B, children received acetaminophen suppository and Group C, the control group. Using an authenticated Arabic version of the Wong and Baker faces Pain assessment Scale, patients were asked to choose the face that suits best the pain he/she is suffering. Data were collected and recorded for statistical analysis. Student's t test was used for comparison of sample means. A preliminary F test to compare sample variances was carried out to determine the appropriate t test variant to be used. A "p" value less than 0.05 was considered significant. More than 93% of children had post-operative pain in varying degrees. High statistical significance was observed between children in groups A and B compared to control group C with the later scoring high pain perception. Diclofenac showed higher potency in multiple painful procedures, while the statistical difference was not significant in children with three or less painful dental procedures. Diclophenac sodium is more potent than acetaminophen, especially for multiple pain-provoking or traumatic procedures. A timely use of NSAID analgesia just before extubation helps provide adequate coverage during recovery. Peri-operative analgesia is to be recommended as an essential treatment adjunct for child dental rehabilitation under general anaesthesia.

  5. Examination of Factors that Influence the Operation Income and Expenditure Balance Difference Rate of 20 Educational Foundation Universities.

    PubMed

    Nakajima, Hisato; Yano, Kouya; Nagasawa, Kaoko; Katou, Satoka; Yokota, Kuninobu

    2017-01-01

    The objective of this study is to examine the factors that influence the operation income and expenditure balance ratio of school corporations running university hospitals by multiple regression analysis. 1. We conducted cluster analysis of the financial ratio and classified the school corporations into those running colleges and universities.2. We conducted multiple regression analysis using the operation income and expenditure balance ratio of the colleges as the variables and the Diagnosis Procedure Combination data as the explaining variables.3. The predictive expression was used for multiple regression analysis. 1. The school corporations were divided into those running universities (7), colleges (20) and others. The medical income ratio and the debt ratio were high and the student payment ratio was low in the colleges.2. The numbers of emergency care hospitalizations, operations, radiation therapies, and ambulance conveyances, and the complexity index had a positive influence on the operation income and expenditure balance ratio. On the other hand, the number of general anesthesia procedures, the cover rate index, and the emergency care index had a negative influence.3. The predictive expression was as follows.Operation income and expenditure balance ratio = 0.027 × number of emergency care hospitalizations + 0.005 × number of operations + 0.019 × number of radiation therapies + 0.007 × number of ambulance conveyances - 0.003 × number of general anesthesia procedures + 648.344 × complexity index - 5877.210 × cover rate index - 2746.415 × emergency care index - 38.647Conclusion: In colleges, the number of emergency care hospitalizations, the number of operations, the number of radiation therapies, and the number of ambulance conveyances and the complexity index were factors for gaining ordinary profit.

  6. Systematic review of general thoracic surgery articles to identify predictors of operating room case durations.

    PubMed

    Dexter, Franklin; Dexter, Elisabeth U; Masursky, Danielle; Nussmeier, Nancy A

    2008-04-01

    Previous studies of operating room (OR) information systems data over the past two decades have shown how to predict case durations using the combination of scheduled procedure(s), individual surgeon and assistant(s), and type of anesthetic(s). We hypothesized that the accuracy of case duration prediction could be improved by the use of other electronic medical record data (e.g., patient weight or surgeon notes using standardized vocabularies). General thoracic surgery was used as a model specialty because much of its workload is elective (scheduled) and many of its cases are long. PubMed was searched for thoracic surgery papers reporting operative time, surgical time, etc. The systematic literature review identified 48 papers reporting statistically significant differences in perioperative times. There were multiple reports of differences in OR times based on the procedure(s), perioperative team including primary surgeon, and type of anesthetic, in that sequence of importance. All such detail may not be known when the case is originally scheduled and thus may require an updated duration the day before surgery. Although the use of these categorical data from OR systems can result in few historical data for estimating each case's duration, bias and imprecision of case duration estimates are unlikely to be affected. There was a report of a difference in case duration based on additional information. However, the incidence of the procedure for the diagnosis was so uncommon as to be unlikely to affect OR management. Matching findings of prior studies using OR information system data, multiple case series show that it is important to rely on the precise procedure(s), surgical team, and type of anesthetic when estimating case durations. OR information systems need to incorporate the statistical methods designed for small numbers of prior surgical cases. Future research should focus on the most effective methods to update the prediction of each case's duration as these data become available. The case series did not reveal additional data which could be cost-effectively integrated with OR information systems data to improve the accuracy of predicted durations for general thoracic surgery cases.

  7. Application of robotics in general surgery: initial experience.

    PubMed

    Nguyen, Ninh T; Hinojosa, Marcelo W; Finley, David; Stevens, Melinda; Paya, Mahbod

    2004-10-01

    Robotic surgery was recently approved for clinical use in general abdominal surgery. The aim of this study was to review our experience with the da Vinci surgical system during laparoscopic general surgical procedures. Eighteen patients underwent robotically assisted laparoscopic abdominal surgery between June 2002 and March 2003. Main outcome measures were operative time, room setup time, robotic arm-positioning and surgical time, blood loss, conversion to laparoscopy, length of stay, and morbidity. The types of robotically assisted laparoscopic procedures were excision of gastric leiomyoma (n = 1), Heller myotomy (n = 1), cholecystectomy (n = 2), gastric banding (n = 2), Nissen fundoplication (n = 4), and gastric bypass (n = 8). The mean room setup time was 63 +/- 14 minutes, and the mean robotic arm-positioning time was 16 +/- 7 minutes. Conversion to laparoscopy occurred in two (11%) of 18 cases because of equipment difficulty (n = 1) and technical difficulty (n = 1). Estimated blood loss was 91 +/- 71 mL. The mean operative time was 156 +/- 42 minutes, and the robotic operative time was 27% of the total operative time. The mean length of hospital stay was 2.2 +/- 1.5 days. There was one postoperative wound infection and one anastomotic stricture. Robotically assisted laparoscopic abdominal surgery is feasible and safe; however, the theoretical advantages of the da Vinci surgical system were not clinically apparent.

  8. Are paediatric operations evidence based? A prospective analysis of general surgery practice in a teaching paediatric hospital.

    PubMed

    Zani-Ruttenstock, Elke; Zani, Augusto; Bullman, Emma; Lapidus-Krol, Eveline; Pierro, Agostino

    2015-01-01

    Paediatric surgical practice should be based upon solid scientific evidence. A study in 1998 (Baraldini et al., Pediatr Surg Int) indicated that only a quarter of paediatric operations were supported by the then gold standard of evidence based medicine (EBM) which was defined by randomized controlled trials (RCTs). The aim of the current study was to re-evaluate paediatric surgical practice 16 years after the previous study in a larger cohort of patients. A prospective observational study was performed in a tertiary level teaching hospital for children. The study was approved by the local research ethics board. All diagnostic and therapeutic procedures requiring a general anaesthetic carried out over a 4-week period (24 Feb 2014-22 Mar 2014) under the general surgery service or involving a general paediatric surgeon were included in the study. Pubmed and EMBASE were used to search in the literature for the highest level of evidence supporting the recorded procedures. Evidence was classified according to the Oxford Centre for Evidence Based Medicine (OCEBM) 2009 system as well as according to the classification used by Baraldini et al. Results was compared using Χ (2) test. P < 0.05 was considered statistically significant. During the study period, 126 operations (36 different types) were performed on 118 patients. According to the OCEBM classification, 62 procedures (49 %) were supported by systematic reviews of multiple homogeneous RCTs (level 1a), 13 (10 %) by individual RCTs (level 1b), 5 (4 %) by systematic reviews of cohort studies (level 2a), 11 (9 %) by individual cohort studies, 1 (1 %) by systematic review of case-control studies (level 3a), 14 (11 %) by case-control studies (level 3b), 9 (7 %) by case series (type 4) and 11 procedures (9 %) were based on expert opinion or deemed self-evident interventions (type 5). High level of evidence (OCEBM level 1a or 1b or level I according to Baraldini et al. PSI 1998) supported 75 (60 %) operations in the current study compared to 18 (26 %) in the study of 1998 (P < 0.0001). The present study shows that nowadays a remarkable number of paediatric surgical procedures are supported by high level of evidence. Despite this improvement in evidence-based paediatric surgical practice, more than a third of the procedures still lack sufficient evidence-based literature support. More RCTs are warranted to support and direct paediatric surgery practice according to the principals of EBM.

  9. 42 CFR 488.9 - Onsite observation of accreditation organization operations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Onsite observation of accreditation organization operations. 488.9 Section 488.9 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES General Provisions § 488.9 Onsite...

  10. 14 CFR 91.189 - Category II and III operations: General operating rules.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... references for the intended runway is distinctly visible and identifiable to the pilot: (i) The approach... execute an appropriate missed approach whenever, prior to touchdown, the requirements of paragraph (d) of... familiarity with, the aircraft and the procedures to be used; and (3) The instrument panel in front of the...

  11. 14 CFR 91.189 - Category II and III operations: General operating rules.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... references for the intended runway is distinctly visible and identifiable to the pilot: (i) The approach... execute an appropriate missed approach whenever, prior to touchdown, the requirements of paragraph (d) of... familiarity with, the aircraft and the procedures to be used; and (3) The instrument panel in front of the...

  12. A Methodical Approach to the Creation, Operation, and Enhancement of a General-use Microcomputer Laboratory.

    ERIC Educational Resources Information Center

    Seilheimer, Steven D.

    1988-01-01

    Outlines procedures for developing a microcomputer laboratory for use by students in an academic organization, based on experiences at Niagara University. The four phases described include: (1) needs assessment; (2) establishment, including software and hardware selection and physical facilities; (3) operation, including staffing, maintenance,…

  13. Operator Priming and Generalization of Practice in Adults' Simple Arithmetic

    ERIC Educational Resources Information Center

    Chen, Yalin; Campbell, Jamie I. D.

    2016-01-01

    There is a renewed debate about whether educated adults solve simple addition problems (e.g., 2 + 3) by direct fact retrieval or by fast, automatic counting-based procedures. Recent research testing adults' simple addition and multiplication showed that a 150-ms preview of the operator (+ or ×) facilitated addition, but not multiplication,…

  14. 46 CFR Sec. 6 - General provisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... provisions. (a) In case of repatriation of any seaman as a passenger aboard a vessel operated for account of... repatriated as a passenger aboard a vessel operated for the account of the National Shipping Authority, shall... charged with the cost of the repatriation. (c) It is recognized that the procedure set forth in this order...

  15. National trends in minimally invasive and open operative experience of graduating general surgery residents: implications for surgical skills curricula development?

    PubMed

    Carson, Jeffrey S; Smith, Lynette; Are, Madhuri; Edney, James; Azarow, Kenneth; Mercer, David W; Thompson, Jon S; Are, Chandrakanth

    2011-12-01

    The aim of this study was to analyze national trends in minimally invasive and open cases of all graduating residents in general surgery. A retrospective analysis was performed on data obtained from Accreditation Council for Graduate Medical Education logs (1999-2008) of graduating residents from all US general surgery residency programs. Data were analyzed using Mantel-Haenszel χ(2) tests and the Bonferroni adjustment to detect trends in the number of minimally invasive and open cases. Minimally invasive procedures accounted for an increasing proportion of cases performed (3.7% to 11.1%, P < .0001), with a proportional decrease in open cases. An increase in minimally invasive procedures with a proportional decrease in open procedures was noted in subcategories such as alimentary tract, abdominal, vascular, thoracic, and pediatric surgery (P < .0001). The results of this study demonstrate that general surgery residents in the United States are performing a greater number of minimally invasive and fewer open procedures for common surgical conditions. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Advanced crew procedures development techniques

    NASA Technical Reports Server (NTRS)

    Arbet, J. D.; Benbow, R. L.; Mangiaracina, A. A.; Mcgavern, J. L.; Spangler, M. C.; Tatum, I. C.

    1975-01-01

    The development of an operational computer program, the Procedures and Performance Program (PPP), is reported which provides a procedures recording and crew/vehicle performance monitoring capability. The PPP provides real time CRT displays and postrun hardcopy of procedures, difference procedures, performance, performance evaluation, and training script/training status data. During post-run, the program is designed to support evaluation through the reconstruction of displays to any point in time. A permanent record of the simulation exercise can be obtained via hardcopy output of the display data, and via magnetic tape transfer to the Generalized Documentation Processor (GDP). Reference procedures data may be transferred from the GDP to the PPP.

  17. On-Line Library Housekeeping Systems. A Survey

    ERIC Educational Resources Information Center

    McAllister, Caryl

    1971-01-01

    A general discussion of on-line procedures, batch and real-time updating, types of files and indexes, terminals, and the use of a general-purpose data management system as a vehicle for on-line operation is followed by an Appendix giving detailed information on each on the known systems. (14 references) (Author/NH)

  18. The M68HC11 gripper controller electronics

    NASA Technical Reports Server (NTRS)

    Kelley, Robert B.; Bethel, Jeffrey

    1991-01-01

    This document describes the instrumentation, operational theory, circuit implementation, calibration procedures, and general notes for the CIRSSE general purpose pneumatic hand. The mechanical design and the control software are discussed. The circuit design, PCB layout, hand instrumentation, and controller construction described in detail in this document are the result of a senior project.

  19. Optimum electric utility spot price determinations for small power producing facilities operating under PURPA provisions

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ghoudjehbaklou, H.; Puttgen, H.B.

    This paper outlines an optimum spot price determination procedure in the general context of the Public Utility Regulatory Policies Act, PURPA, provisions. PURPA stipulates that local utilities must offer to purchase all available excess electric energy from Qualifying Facilities, QF, at fair market prices. As a direct consequence of these PURPA regulations, a growing number of owners are installing power producing facilities and optimize their operational schedules to minimize their utility related costs or, in some cases, actually maximize their revenues from energy sales to the local utility. In turn, the utility strives to use spot prices which maximize itsmore » revenues from any given Small Power Producing Facility, SPPF, a schedule while respecting the general regulatory and contractual framework. the proposed optimum spot price determination procedure fully models the SPPF operation, it enforces the contractual and regulatory restrictions, and it ensures the uniqueness of the optimum SPPF schedule.« less

  20. Optimum electric utility spot price determinations for small power producing facilities operating under PURPA provisions

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ghoudjehbaklou, H.; Puttgen, H.B.

    The present paper outlines an optimum spot price determination procedure in the general context of the Public Utility Regulatory Policies Act, PURPA, provisions. PURPA stipulates that local utilities must offer to purchase all available excess electric energy from Qualifying Facilities, QF, at fair market prices. As a direct consequence of these PURPA regulations, a growing number of owners are installing power producing facilities and optimize their operational schedules to minimize their utility related costs or, in some cases, actually maximize their revenues from energy sales to the local utility. In turn, the utility will strive to use spot prices whichmore » maximize its revenues from any given Small Power Producing Facility, SPPF, schedule while respecting the general regulatory and contractual framework. The proposed optimum spot price determination procedure fully models the SPPF operation, it enforces the contractual and regulatory restrictions, and it ensures the uniqueness of the optimum SPPF schedule.« less

  1. 49 CFR 450.15 - Termination of delegation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... giving written notice of its intent to the Chief, Office of Operating and Environmental Standards (CG-OES... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450...

  2. 49 CFR 450.15 - Termination of delegation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... giving written notice of its intent to the Chief, Office of Operating and Environmental Standards (CG-OES... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450...

  3. 49 CFR 450.15 - Termination of delegation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... giving written notice of its intent to the Chief, Office of Operating and Environmental Standards (CG-522... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450...

  4. 49 CFR 450.15 - Termination of delegation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... giving written notice of its intent to the Chief, Office of Operating and Environmental Standards (CG-OES... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450...

  5. 49 CFR 450.15 - Termination of delegation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... giving written notice of its intent to the Chief, Office of Operating and Environmental Standards (CG-522... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450...

  6. 49 CFR 390.3 - General applicability.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... enterprise; (4) The transportation of human corpses or sick and injured persons; (5) The operation of fire...) Subpart F, Intermodal Equipment Providers, of Part 385, Safety Fitness Procedures. (2) Part 386, Rules of...

  7. Small Aircraft Transportation System, Higher Volume Operations Concept: Off-Nominal Operations

    NASA Technical Reports Server (NTRS)

    Abbott, Terence S.; Consiglio, Maria C.; Baxley, Brian T.; Williams, Daniel M.; Conway, Sheila R.

    2005-01-01

    This document expands the Small Aircraft Transportation System, (SATS) Higher Volume Operations (HVO) concept to include off-nominal conditions. The general philosophy underlying the HVO concept is the establishment of a newly defined area of flight operations called a Self-Controlled Area (SCA). During periods of poor weather, a block of airspace would be established around designated non-towered, non-radar airports. Aircraft flying enroute to a SATS airport would be on a standard instrument flight rules flight clearance with Air Traffic Control providing separation services. Within the SCA, pilots would take responsibility for separation assurance between their aircraft and other similarly equipped aircraft. Previous work developed the procedures for normal HVO operations. This document provides details for off-nominal and emergency procedures for situations that could be expected to occur in a future SCA.

  8. 14 CFR 330.3 - What do the terms used in this part mean?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (AVIATION PROCEEDINGS) PROCEDURAL REGULATIONS PROCEDURES FOR COMPENSATION OF AIR CARRIERS General Provisions § 330.3 What do the terms used in this part mean? The following terms apply to this part: Air carrier means any U.S. air carrier, as defined in 49 U.S.C. 40102. Air taxi operator means an air carrier, other...

  9. Flying SATS Higher Volume Operations: Training, Lessons Learned, and Pilots' Experiences

    NASA Technical Reports Server (NTRS)

    Conway, Sheila; Williams, Dan; Adams, Catherine; Consiglio, Maria; Murdoch, Jennifer

    2005-01-01

    Developments in aviation, including new surveillance technologies and quicker, more economical small aircraft, have been identified as driving factors in a potential expansion of the use of non-towered, non-radar airports. The Small Aircraft Transportation System (SATS) project has developed the Higher Volume Operations (HVO) concept that enables pilots to safely arrive and depart these airports in instrument conditions at an increased rate as compared to today's procedures. This is achieved by transferring some traffic management tasks to centralized, ground-based automation, while assigning others to participating pilots aided by on-board tools. This paper describes strategies and lessons learned while training pilots to fly these innovative operations. Pilot approaches to using the experimental displays and dynamic altering systems during training are discussed. Potential operational benefits as well as pit-falls and frustrations expressed by subjects while learning to fly these new procedures are presented. Generally, pilots were comfortable with the procedures and the training process, and expressed interest in its near-term implementation.

  10. On the classical and quantum integrability of systems of resonant oscillators

    NASA Astrophysics Data System (ADS)

    Marino, Massimo

    2017-01-01

    We study in this paper systems of harmonic oscillators with resonant frequencies. For these systems we present general procedures for the construction of sets of functionally independent constants of motion, which can be used for the definition of generalized actionangle variables, in accordance with the general description of degenerate integrable systems which was presented by Nekhoroshev in a seminal paper in 1972. We then apply to these classical integrable systems the procedure of quantization which has been proposed to the author by Nekhoroshev during his last years of activity at Milan University. This procedure is based on the construction of linear operators by means of the symmetrization of the classical constants of motion mentioned above. For 3 oscillators with resonance 1: 1: 2, by using a computer program we have discovered an exceptional integrable system, which cannot be obtained with the standard methods based on the obvious symmetries of the Hamiltonian function. In this exceptional case, quantum integrability can be realized only by means of a modification of the symmetrization procedure.

  11. Generalized Weyl-Wigner map and Vey quantum mechanics

    NASA Astrophysics Data System (ADS)

    Dias, Nuno Costa; Prata, João Nuno

    2001-12-01

    The Weyl-Wigner map yields the entire structure of Moyal quantum mechanics directly from the standard operator formulation. The covariant generalization of Moyal theory, also known as Vey quantum mechanics, was presented in the literature many years ago. However, a derivation of the formalism directly from standard operator quantum mechanics, clarifying the relation between the two formulations, is still missing. In this article we present a covariant generalization of the Weyl order prescription and of the Weyl-Wigner map and use them to derive Vey quantum mechanics directly from the standard operator formulation. The procedure displays some interesting features: it yields all the key ingredients and provides a more straightforward interpretation of the Vey theory including a direct implementation of unitary operator transformations as phase space coordinate transformations in the Vey idiom. These features are illustrated through a simple example.

  12. Developing a preservation policy and procedure statement for a health sciences library.

    PubMed Central

    Paulson, B A

    1989-01-01

    The preconditions for creating a preservation policy document in a health sciences library are an existing preservation policy for the institution of which it is a part and administrative support for preservation. The assumption underlying preservation activity, from the formulation of general guidelines to the detail of operating procedure, is that collection development and preservation are complementary functions. Documentation of operational procedures in some detail should be a part of the statement. Since preservation activity cuts across functional library structures, all management staff should be involved in the planning process and be made aware of their responsibilities. The creation of a preservation policy statement will highlight unaddressed issues, procedural inadequacies, and differences in staff perceptions of priorities, but a written statement provides a framework for setting priorities and making decisions. PMID:2758183

  13. POSSUM and P-POSSUM for risk assessment in general surgery in the elderly.

    PubMed

    Igari, Kimihiro; Ochiai, Takanori; Yamazaki, Shigeru

    2013-09-01

    The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) use preoperative and intraoperative factors to evaluate risk. We examined our surgical results to investigate predictive factors for morbidity and mortality, and evaluate the accuracy of the POSSUM and P-POSSUM. Patients (n = 593) aged ≥80 years, undergoing general surgical procedures were enrolled. Logistic regression analysis was used to determine the independent predictors. The predicted outcomes using POSSUM and P-POSSUM were also compared with actual outcomes. Physiological score (PS) and operative severity score (OS) were independent predictors of morbidity and mortality. Using POSSUM, the observed/expected (O/E) morbidity ratio was 1.44 and O/E mortality ratio was 0.98. Using P-POSSUM, the O/E mortality ratio was 1.0. Even though POSSUM tended to underestimate the morbidity rate, POSSUM and P-POSSUM accurately predicted the mortality rate after general surgical procedures.

  14. Terminal Area Procedures for Paired Runways

    NASA Technical Reports Server (NTRS)

    Lozito, Sandra; Verma, Savita Arora

    2011-01-01

    Parallel runway operations have been found to increase capacity within the National Airspace but poor visibility conditions reduce the use of these operations. The NextGen and SESAR Programs have identified the capacity benefits from increased use of closely-space parallel runway. Previous research examined the concepts and procedures related to parallel runways however, there has been no investigation of the procedures associated with the strategic and tactical pairing of aircraft for these operations. This simulation study developed and examined the pilot and controller procedures and information requirements for creating aircraft pairs for parallel runway operations. The goal was to achieve aircraft pairing with a temporal separation of 15s (+/- 10s error) at a coupling point that was about 12 nmi from the runway threshold. Two variables were explored for the pilot participants: two levels of flight deck automation (current-day flight deck automation and auto speed control future automation) as well as two flight deck displays that assisted in pilot conformance monitoring. The controllers were also provided with automation to help create and maintain aircraft pairs. Results show the operations in this study were acceptable and safe. Subjective workload, when using the pairing procedures and tools, was generally low for both controllers and pilots, and situation awareness was typically moderate to high. Pilot workload was influenced by display type and automation condition. Further research on pairing and off-nominal conditions is required however, this investigation identified promising findings about the feasibility of closely-spaced parallel runway operations.

  15. [Robots in general surgery: present and future].

    PubMed

    Galvani, Carlos; Horgan, Santiago

    2005-09-01

    Robotic surgery is an emerging technology. We began to use this technique in 2000, after it was approved by the Food and Drug Administration. Our preliminary experience was satisfactory. We report 4 years' experience of using this technique in our institution. Between August 2000 and December 2004, 399 patients underwent robotic surgery using the Da Vinci system. We performed 110 gastric bypass procedures, 30 Lap band, 59 Heller myotomies, 12 Nissen fundoplications, 6 epiphrenic diverticula, 18 total esophagectomies, 3 esophageal leiomyoma resections, 1 pyloroplasty, 2 gastrojejunostomies, 2 transduodenal sphincteroplasties, 10 adrenalectomies and 145 living-related donor nephrectomies. Operating times for fundoplications and Lap band were longer. After the learning curve, the operating times and morbidity of the remaining procedures were considerably reduced. Robot-assisted surgery allows advanced laparoscopic procedures to be performed with enhanced results given that it reduces the learning curve as measured by operating time and morbidity.

  16. The feasibility of introducing advanced minimally invasive surgery into surgical practice

    PubMed Central

    Birch, Daniel W.; Misra, Monali; Farrokhyar, Forough

    2007-01-01

    Background This study investigates the feasibility of performing advanced minimally invasive surgery (MIS) in a nonspecialized practice environment. Methods We conducted a cross-sectional survey of all community general surgeons currently practising in Ontario. Results Few community surgeons perform a high volume (> 10 procedures per yr) of advanced MIS. Most (70%) believe it is important to acquire additional skills in advanced MIS. The most appropriate methods for learning advanced MIS are believed to be expert mentoring (79.7%), courses (77.2%) and a colleague mentor (63.9%). A total of 57.6% of respondents have attended a course in MIS while in practice, and most have access to a reasonable variety of instrumentation. Respondents believe that 57.6% of assistants, 54.8% of nurses and 43.4% of anaesthetists are relatively inexperienced with advanced MIS. Barriers to establishing advanced MIS include limited operating room access (50%), resources or equipment (45.2%) and limited expert mentoring (43.6%). Surgeons with less than 10 years of practice found lack of trained nursing staff (7.9% v. 4.2%, p = 0.01) and experienced assistants (12% v. 6.2%, p = 0.008) to be more important barriers than did those with over 10 years of practice, respectively. Conclusion Most general surgeons working in Ontario are self-taught with respect to MIS skills, and few perform a high volume of advanced MIS. Only one-half of all respondents have access to skilled MIS operating room nurses, surgical assistants or anesthesiology. Despite this, general surgeons perceive the greatest barriers to introducing advanced MIS procedures to be limited access to operating rooms, resources or equipment and limited mentoring. This study has shown that the role of the surgical team in advanced MIS may be underestimated by many general surgeons. These data have important implications in training general surgeons and in incorporating additional advanced MIS procedures into the armamentarium of general surgeons. PMID:17897513

  17. Safety and efficacy of transurethral pneumatic lithotripsy for bladder calculi in children.

    PubMed

    Khosa, Ali Sher; Hussain, Muhammad; Hussain, Manzoor

    2012-12-01

    To determine the safety and efficacy of transurethral pneumatic lithotripsy for bladder calculi in children. The study included 100 children up to 15 years of age undergoing pneumatic cystolithoclast for bladder stones. The descriptive study was conducted from September 2006 to February 2007 at the Sindh Institute of Urology and Transplantation, Karachi. The inclusion criteria was children up to 15 years of age with a bladder stone of up to 3cm, pre-operative negative urine culture, no coagulopathy and fit for general anaesthesia. An X-ray and ultrasound of Kidney and Urinary Bladder (KUB) was mandatory. The procedure was done under general anaesthesia with a single dose of pre-operative antibiotic. A mini-scope of 4FR or a semi-rigid ureteroscope of 7/8.5 FR with pneumatic wolf lithoclast was used for the fragmentation of stones. Duration of procedure, any per-operative and post-operative complications and the duration of hospital stay were recorded. Post-operatively, the patient underwent ultrasound Kidney and Urinary Bladder at the first follow-up to assess stone clearance after one week. Mean patients age was 4.95 +/- 3.3 years. The male-to-female ratio was 11.5: 1 The mean hospital stay was 9.2 +/- 2.5 hours. The mean operating time was 25 (10 -65) minutes. Ten (10%) patients developed minor complications out of which 5 (5%) developed haematuria and 4 (4%) developed difficulty in passing urine. One (1%) of the patients developed post-operative retention of urine. All the patients were stone-free after the procedure. The transurethral pneumatic lithoclast is very effective and safe in children with bladder stones up to 3cm.

  18. 32 CFR 2004.20 - National Industrial Security Program Operating Manual (NISPOM) [201(a)].

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... phases of the contracting process. (b) As a general rule, procedures for safeguarding classified information by contractors and recommendations for changes shall be addressed through the NISPOM coordination...

  19. 9 CFR 381.65 - Operations and procedures, generally.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... with visible fecal material shall be prevented from entering the chilling tank. (f) Detached ova may be... only to be moved to an official egg product processing plant for processing. Ova from condemned...

  20. 9 CFR 381.65 - Operations and procedures, generally.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... with visible fecal material shall be prevented from entering the chilling tank. (f) Detached ova may be... only to be moved to an official egg product processing plant for processing. Ova from condemned...

  1. 9 CFR 381.65 - Operations and procedures, generally.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... with visible fecal material shall be prevented from entering the chilling tank. (f) Detached ova may be... only to be moved to an official egg product processing plant for processing. Ova from condemned...

  2. 9 CFR 381.65 - Operations and procedures, generally.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... with visible fecal material shall be prevented from entering the chilling tank. (f) Detached ova may be... only to be moved to an official egg product processing plant for processing. Ova from condemned...

  3. 9 CFR 381.65 - Operations and procedures, generally.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... with visible fecal material shall be prevented from entering the chilling tank. (f) Detached ova may be... only to be moved to an official egg product processing plant for processing. Ova from condemned...

  4. General RMP Guidance - Chapter 6: Prevention Program (Program 2)

    EPA Pesticide Factsheets

    Sound prevention practices are founded on safety information, hazard review, operating procedures, training, maintenance, compliance audits, and accident investigation. These must be integrated into a risk management system that you implement consistently.

  5. 40 CFR 68.56 - Maintenance.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... testing procedures shall follow recognized and generally accepted good engineering practices. The...' recommendations, industry standards or codes, good engineering practices, and prior operating experience. ...

  6. 40 CFR 68.56 - Maintenance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... testing procedures shall follow recognized and generally accepted good engineering practices. The...' recommendations, industry standards or codes, good engineering practices, and prior operating experience. ...

  7. 40 CFR 68.56 - Maintenance.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... testing procedures shall follow recognized and generally accepted good engineering practices. The...' recommendations, industry standards or codes, good engineering practices, and prior operating experience. ...

  8. 40 CFR 68.56 - Maintenance.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... testing procedures shall follow recognized and generally accepted good engineering practices. The...' recommendations, industry standards or codes, good engineering practices, and prior operating experience. ...

  9. 40 CFR 68.56 - Maintenance.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... testing procedures shall follow recognized and generally accepted good engineering practices. The...' recommendations, industry standards or codes, good engineering practices, and prior operating experience. ...

  10. Abdominal wall surgery

    MedlinePlus

    ... Description Your surgery will be done in an operating room in a hospital. You will receive general anesthesia . This will keep you asleep and pain-free during the procedure. The surgery takes 2 to 6 hours. You ...

  11. Levels of Stress among General Practitioners, Students and Specialists In Pediatric Dentistry during Dental Treatment.

    PubMed

    Davidovich, E; Pessov, Y; Baniel, A; Ram, D

    2015-01-01

    To assess self-reported stress during the performance of different procedures in pediatric dentistry, according to the professional experience of the dentists. During the years 2010 to 2011, an anonymous survey was administered by means of an internet link, and by distribution at professional meetings of dentists . No statistically significant differences in stress were reported for maxilla and mandibular procedures. Placement of a rubber dam was rated as the most stressful procedure among dental students. For general practitioners and specialists, injection of local anesthesia to an anxious child was the most stressful procedure, regardless of age, sex, or years of professional experience. A negative correlation was found between years of experience and level of stress for all the procedures surveyed, but not for the use of nitrous oxide. No differences were found between male and female dentists in stress scores for any of the procedures. Higher rates of stress during operative procedures were reported among dental students than among experienced dentists. Anxiety of the pediatric patients, but not the location of the procedure: maxillary or mandibular, affected the dentists' reported level of stress.

  12. Timeliner: Automating Procedures on the ISS

    NASA Technical Reports Server (NTRS)

    Brown, Robert; Braunstein, E.; Brunet, Rick; Grace, R.; Vu, T.; Zimpfer, Doug; Dwyer, William K.; Robinson, Emily

    2002-01-01

    Timeliner has been developed as a tool to automate procedural tasks. These tasks may be sequential tasks that would typically be performed by a human operator, or precisely ordered sequencing tasks that allow autonomous execution of a control process. The Timeliner system includes elements for compiling and executing sequences that are defined in the Timeliner language. The Timeliner language was specifically designed to allow easy definition of scripts that provide sequencing and control of complex systems. The execution environment provides real-time monitoring and control based on the commands and conditions defined in the Timeliner language. The Timeliner sequence control may be preprogrammed, compiled from Timeliner "scripts," or it may consist of real-time, interactive inputs from system operators. In general, the Timeliner system lowers the workload for mission or process control operations. In a mission environment, scripts can be used to automate spacecraft operations including autonomous or interactive vehicle control, performance of preflight and post-flight subsystem checkouts, or handling of failure detection and recovery. Timeliner may also be used for mission payload operations, such as stepping through pre-defined procedures of a scientific experiment.

  13. Space shuttle/payload interface analysis. Volume 4: Business Risk and Value of Operations in Space (BRAVO). Part 1: Summary

    NASA Technical Reports Server (NTRS)

    1974-01-01

    Background information is provided which emphasizes the philosophy behind analytical techniques used in the business risk and value of operations in space (BRAVO) study. The focus of the summary is on the general approach, operation of the procedures, and the status of the study. For Vol. 1, see N74-12493; for Vol. 2, see N74-14530.

  14. Outcomes of surgery in patients aged ≥90 years in the general surgical setting.

    PubMed

    Sudlow, A; Tuffaha, H; Stearns, A T; Shaikh, I A

    2018-03-01

    Introduction An increasing proportion of the population is living into their nineties and beyond. These high risk patients are now presenting more frequently to both elective and emergency surgical services. There is limited research looking at outcomes of general surgical procedures in nonagenarians and centenarians to guide surgeons assessing these cases. Methods A retrospective analysis was conducted of all patients aged ≥90 years undergoing elective and emergency general surgical procedures at a tertiary care facility between 2009 and 2015. Vascular, breast and endocrine procedures were excluded. Patient demographics and characteristics were collated. Primary outcomes were 30-day and 90-day mortality rates. The impact of ASA (American Society of Anesthesiologists) grade, operation severity and emergency presentation was assessed using multivariate analysis. Results Overall, 161 patients (58 elective, 103 emergency) were identified for inclusion in the study. The mean patient age was 92.8 years (range: 90-106 years). The 90-day mortality rates were 5.2% and 19.4% for elective and emergency procedures respectively (p=0.013). The median survival was 29 and 19 months respectively (p=0.001). Emergency and major gastrointestinal operations were associated with a significant increase in mortality. Patients undergoing emergency major colonic or upper gastrointestinal surgery had a 90-day mortality rate of 53.8%. Conclusions The risk for patients aged over 90 years having an elective procedure differs significantly in the short term from those having emergency surgery. In selected cases, elective surgery carries an acceptable mortality risk. Emergency surgery is associated with a significantly increased risk of death, particularly after major gastrointestinal resections.

  15. Evaluating the heat pump alternative for heating enclosed wastewater treatment facilities in cold regions

    NASA Astrophysics Data System (ADS)

    Martel, C. J.; Phetteplace, G. E.

    1982-05-01

    This report presents a five-step procedure for evaluating the technical and economic feasibility of using heat pumps to recover heat from treatment plant effluent. The procedure is meant to be used at the facility planning level by engineers who are unfamiliar with this technology. An example of the use of the procedure and general design information are provided. Also, the report reviews the operational experience with heat pumps at wastewater plants located in Fairbanks, Alaska, Madison, Wisconsin, and Wilton, Maine.

  16. Operation plan for the data 100/LARS terminal system

    NASA Technical Reports Server (NTRS)

    Bowen, A. J., Jr.

    1980-01-01

    The Data 100/LARS terminal system provides an interface for processing on the IBM 3031 computer system at Purdue University's Laboratory for Applications of Remote Sensing. The environment in which the system is operated and supported is discussed. The general support responsibilities, procedural mechanisms, and training established for the benefit of the system users are defined.

  17. THE EDUCATIONAL INSTITUTION AS A SYSTEM--A PROPOSED GENERALIZED PROCEDURE FOR ANALYSIS.

    ERIC Educational Resources Information Center

    REISMAN, ARNOLD; TAFT, MARTIN I.

    A UNIFIED APPROACH TO THE ANALYSIS AND SYNTHESIS OF THE FUNCTIONS AND OPERATIONS IN EDUCATIONAL INSTITUTIONS IS PRESENTED. SYSTEMS ANALYSIS TECHNIQUES USED IN OTHER AREAS SUCH AS CRAFT, PERT, CERBS, AND OPERATIONS RESEARCH ARE SUGGESTED AS POTENTIALLY ADAPTABLE FOR USE IN HIGHER EDUCATION. THE MAJOR OBJECTIVE OF A SCHOOL IS TO ALLOCATE AVAILABLE…

  18. 76 FR 14362 - Policies To Promote Rural Radio Service and To Streamline Allotment and Assignment Procedures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-16

    ... set forth in the First R&O, the Priority is premised on the unique ability of Tribes and Tribal... services the Tribal Priority generally operates as a dispositive preference in the application process... Tribal Priority operates as a dispositive preference in the AM commercial and FM NCE application contexts...

  19. Behavioral mechanisms of context fear generalization in mice

    PubMed Central

    Huckleberry, Kylie A.; Ferguson, Laura B.

    2016-01-01

    There is growing interest in generalization of learned contextual fear, driven in part by the hypothesis that mood and anxiety disorders stem from impaired hippocampal mechanisms of fear generalization and discrimination. However, there has been relatively little investigation of the behavioral and procedural mechanisms that might control generalization of contextual fear. We assessed the relative contribution of different contextual features to context fear generalization and characterized how two common conditioning protocols—foreground (uncued) and background (cued) contextual fear conditioning—affected context fear generalization. In one experiment, mice were fear conditioned in context A, and then tested for contextual fear both in A and in an alternate context created by changing a subset of A's elements. The results suggest that floor configuration and odor are more salient features than chamber shape. A second experiment compared context fear generalization in background and foreground context conditioning. Although foreground conditioning produced more context fear than background conditioning, the two procedures produced equal amounts of generalized fear. Finally, results indicated that the order of context tests (original first versus alternate first) significantly modulates context fear generalization, perhaps because the original and alternate contexts are differentially sensitive to extinction. Overall, results demonstrate that context fear generalization is sensitive to procedural variations and likely reflects the operation of multiple interacting psychological and neural mechanisms. PMID:27918275

  20. Some Direct and Generalized Effects of Replacing an Autistic Man's Echolalia with Correct Responses to Questions.

    ERIC Educational Resources Information Center

    McMorrow, Martin J.; Foxx, R. M.

    1986-01-01

    The use of operant procedures was extended to decrease immediate echolalia and increase appropriate responding to questions of a 21-year-old autistic man. Multiple baseline designs demonstrated that echolalia was rapidly replaced with correct stimulus-specific responses. A variety of generalized improvements were observed in verbal responses to…

  1. 40 CFR Table 1 to Subpart Aaaa of... - Applicability of NESHAP General Provisions to Subpart AAAA

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reconstructed sources 63.6(e) Operation and maintenance requirements, startup, shutdown and malfunction plan...(b)(2)(i)-(b)(2)(v) General recordkeeping requirements 63.10(d)(5) If actions taken during a startup, shutdown and malfunction plan are consistent with the procedures in the startup, shutdown and malfunction...

  2. 40 CFR Table 1 to Subpart Aaaa of... - Applicability of NESHAP General Provisions to Subpart AAAA

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reconstructed sources 63.6(e) Operation and maintenance requirements, startup, shutdown and malfunction plan...(b)(2)(i)-(b)(2)(v) General recordkeeping requirements 63.10(d)(5) If actions taken during a startup, shutdown and malfunction plan are consistent with the procedures in the startup, shutdown and malfunction...

  3. Integrated corridor management analysis, modeling and simulation (AMS) methodology.

    DOT National Transportation Integrated Search

    2008-03-01

    This AMS Methodologies Document provides a discussion of potential ICM analytical approaches for the assessment of generic corridor operations. The AMS framework described in this report identifies strategies and procedures for tailoring AMS general ...

  4. 39 CFR 776.3 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... UNITED STATES POSTAL SERVICE ENVIRONMENTAL REGULATIONS FLOODPLAIN AND WETLAND PROCEDURES General... buildings, structures and improvements. Contending site means a site or existing building for a proposed... operations organization. Facility means any building, appurtenant structures, or associated infrastructure...

  5. A guide to safe field operations

    USGS Publications Warehouse

    Yobbi, D.K.; Yorke, T.H.; Mycyk, R.T.

    1996-01-01

    Most functions of the U.S. Geological Survey (USGS), Water Resources Division (WRD) require employees to participate in numerous field activities ranging from routine meetings with cooperators, other federal and public officials, and private citizens to potentially hazardous assignments, such as making flood measurements and scuba diving to service underwater instruments. It is paramount that each employee be aware of safety procedures and operational policies of the WRD to ensure that (1) their activities avoid or minimize personal injury to the employee, coworkers, or anyone in the vicinity of the field activity, and (2) their conduct does not infringe on the personal or property rights of any individual or organization. The purpose of the guide is to familiarize employees with the operational and safety procedures expected to be followed by each employee as a representative of the WRD. It is also intended as a training tool for all new employees and a document to be reviewed by each employee before undertaking a field assignment. It includes general procedures that are standard and applicable to all field operations, such as communication, vehicle operation, and adequate preparation for anticipated weather conditions. It also includes a discussion of specific procedures and safety considerations for most of the routine field assignments undertaken by hydrologists and hydrologic technicians of the WRD. The guide is not intended to be a technical handbook outlining step-by-step procedures for performing specific tasks or a comprehensive discussion of every possible activity that may be undertaken by a USGS employee. Employees are referred to the Techniques for Water-Resources Investigations (TWRI) series for specific technical procedures and to the U.S. Geological Survey Safety and Environmental Health Handbook 445-1-H (USGS, August 1989), USGS Occupational Hazards and Safety Procedures Handbook 445-2-H (December 1993), the WRD notebook on Safety Policy and Guidance Memoranda, and other references for procedures and safety issues related to nonroutine activities, such as operations on large vessels and aircraft.

  6. Anaesthesia for bronchoscopy

    PubMed Central

    Chadha, Meenu; Kulshrestha, Mayank; Biyani, Alok

    2015-01-01

    Bronchoscopy as an investigation or therapeutic procedure demands anaesthesiologist to act accordingly. The present review will take the reader from rigid to fibreoptic flexible bronchoscopy. These procedures are now done as day care procedures in the operation theatre or in critical care units. Advantages and limitations of both rigid and flexible bronchoscopy are analysed. Recently, conscious sedation has come up as the commonly used anaesthetic technique for simple bronchoscopic procedures. However, general anaesthesia still remains a standard technique for more complex procedures. New advances in the field of anaesthesiology such as use of short acting opioids, use of newer drugs such as dexmedetomidine, supraglottic airways and mechanical jet ventilators have facilitated and eased the conduct of the procedure. PMID:26556915

  7. The association between pediatric general emergency department visits and post operative adenotonsillectomy hospital return.

    PubMed

    Bangiyev, John N; Thottam, Prasad J; Christenson, Jennifer R; Metz, Christopher M; Haupert, Michael S

    2015-02-01

    To define the association between pre-operative general emergency department visits, gender, and pre-operative diagnosis with post-operative emergency department return following adenotonsillectomy. Retrospective chart review of 1468 pediatric patients who underwent adenotonsillectomy at a tertiary pediatric hospital between 2011 and 2013. There was a significant relationship between patients who visited the ED pre-operatively, 25% (N=96) returned to the ED post-procedure, compared to 10% who did not have a pre-operative ED visit. There was an overall significant relation between having a pre-operative visit (χ(2)=53.6, df=1, p<0.001), female gender (female=56.9%; male=43.1%; χ(2)=4.2, df=1, p=0.04), and having a preoperative diagnosis of recurrent strep tonsillitis (OSA and RST=18%; RST=17.5%; OSA=11.8%; χ(2)=12.8, p=0.002) and having a post-operative ED visit. Generalized pre-operative visits along with gender and diagnosis of recurrent streptococcal tonsillitis were found to be positively associated with post-operative ED visits for common post-operative complaints. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. A Battalion/Division Fiscal Control System for Training Resource Management.

    DTIC Science & Technology

    1981-12-01

    of each command using it. With many Army fiscal procedures consuming large volumes of time and resources to support operations with questionable...Document (FAD)) spe- cifying the appropriation and budget programs for which the funds may be used . The FAD is the installation’s approved financial...operating budgets. Although a proper term would be operating targets, budget is used for ease of understanding. These funds are principally for general

  9. Takotsubo cardiomyopathy precipitated by maxillofacial surgery and general anesthesia: a case report and review of literature.

    PubMed

    Bruckman, Karl C; Taub, Daniel I; McNulty, Stephen E

    2013-12-01

    Takotsubo cardiomyopathy (TCM) is a syndrome characterized by a transient episode of heart failure. The specific etiology of this condition is widely speculated. The purpose of this case report and literature review was to investigate the incidence of TCM with regard to general anesthesia, especially those cases involving operative procedures within the realm of oral and maxillofacial surgery. It is intended that the present case serve as a guide for fellow surgeons to identify and manage this syndrome. The present case was explained and a review of the literature was performed. PubMed was used to search for articles involving surgical procedures under general anesthesia, including oral and maxillofacial surgery. It was determined that TCM rarely occurs in conjunction with surgical procedures under general anesthesia, especially those of the head and neck region. TCM is an uncommon medical condition with significant morbidity and mortality when managed incorrectly. The occurrence of this syndrome in relation to oral and maxillofacial procedures is also rare, although it is imperative that surgeons be able to recognize and treat this condition appropriately. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases.

    PubMed

    Lambertz, A; Schälte, G; Winter, J; Röth, A; Busch, D; Ulmer, T F; Steinau, G; Neumann, U P; Klink, C D

    2014-10-01

    Inguinal hernia repair is the most frequently performed surgical procedure in infants and children. Especially in premature infants, prevalence reaches up to 30% in coincidence with high rates of incarceration during the first year of life. These infants carry an increased risk of complications due to general anesthesia. Thus, spinal anesthesia is a topic of growing interest for this group of patients. We hypothesized that spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants even at high risk and cases of incarceration. Between 2003 and 2013, we operated 100 infants younger than 6 months with inguinal hernia. Clinical data were collected prospectively and retrospectively analyzed. Patients were divided into two groups depending on anesthesia procedure (spinal anesthesia, Group 1 vs. general anesthesia, Group 2). Spinal anesthesia was performed in 69 infants, and 31 infants were operated in general anesthesia, respectively. In 7 of these 31 infants, general anesthesia was chosen because of lumbar puncture failure. Infants operated in spinal anesthesia were significantly smaller (54 ± 4 vs. 57 ± 4 cm; p = 0.001), had a lower body weight (4,047 ± 1,002 vs. 5,327 ± 1,376 g; p < 0.001) and higher rate of prematurity (26 vs. 4%; p = 0.017) compared to those operated in general anesthesia. No complications related to surgery or to anesthesia were found in both groups. The number of relevant preexisting diseases was higher in Group 1 (11 vs. 3%; p = 0.54). Seven of eight emergent incarcerated hernia repairs were performed in spinal anesthesia (p = 0.429). Spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants, especially in high-risk premature infants and in cases of hernia incarceration.

  11. Low-speed longitudinal orbiter qualities

    NASA Technical Reports Server (NTRS)

    Powers, B. G.

    1985-01-01

    The shuttle program took on the challenge of providing a manual landing capability for an operational vehicle returning from orbit. Some complex challenges were encountered in developing the longitudinal flying qualities required to land the orbiter manually in an operational environment. Approach and landing test flights indicated a tendency for pilot-induced oscillation near landing. Changes in the operational procedures reduced the difficulty of the landing task, and an adaptive stick filter was incorporated to reduce the severity of any pilot-induced oscillatory motions. Fixed-base, movingbase, and in-flight simulations were used for the evaluations, and in general, flight simulation was the only reliable means of assessing the low-speed longitudinal flying qualities problems. Overall, the orbiter control system and operational procedures have produced a good capability to routinely perform precise landings with a large, unpowered vehicle with a low lift-to-drag ratio.

  12. Polymer impregnated bridge slabs : interim report.

    DOT National Transportation Integrated Search

    1979-01-01

    The procedure used for producing precast slabs of polymer impregnated concrete (PIC) and described in this report was generally satisfactory from an operational standpoint. A strength loss of 14%, attributable to the drying step, was observed in PIC ...

  13. 76 FR 19913 - Compliance Testing Procedures: Correction Factor for Room Air Conditioners

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-11

    ... covered under ASHRAE Standard 37, generally do not have this feature and operate primarily with dry... performance. It is the air mass flow rate that transfers heat between cooler coils or condensers and...

  14. 75 FR 5234 - Procedures for Reimbursement of General Aviation Operators and Service Providers in the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-02

    ... reimburse the eligible parties, to be available until expended, and identified the five airports as Ronald Reagan Washington National Airport; College Park Airport in College Park, Maryland; Potomac Airfield in...

  15. Increased risk environment for emergency general surgery in the context of regionalization and specialization.

    PubMed

    Beecher, S; O'Leary, D P; McLaughlin, R

    2015-09-01

    The pressures on tertiary hospitals with increased volume and complexity related to regionalization and specialization has impacted upon availability of operating theatres with consequent displacement of emergencies to high risk out of hours settings. A retrospective review of an electronic emergency theatre list prospectively maintained database was performed over a two year period. Data gathered included type of operation performed, Time to Theatre (TTT), operation start time and length of stay (LOS). Of 7041 emergency operations 25% were performed out of hours. 2949 patient had general surgical emergency procedures with 910 (30%) performed out of hours. 53% of all emergency laparotomies and 54% of appendicectomies were out of hours. 57% of cases operated on out of hours had been awaiting surgery during the day. Mean TTT was shorter for those admitted at the weekend compared to those admitted during the week (15.6 vs 24.9 h) (p < 0.0001). The majority of major emergency surgery is performed out of hours in a way unfavorable to good clinical outcomes. It is of concern that more than half of the most life threating procedures involving laparotomy, take place out of hours. Regionalization needs to be accompanied by infrastructure planning to accommodate emergency surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  16. Surgical Burn Care by Médecins Sans Frontières-Operations Center Brussels: 2008 to 2014.

    PubMed

    Stewart, Barclay T; Trelles, Miguel; Dominguez, Lynette; Wong, Evan; Fiozounam, Hervé Tribunal; Hassani, Ghulam Hiadar; Akemani, Clemence; Naseer, Aemer; Ntawukiruwabo, Innocent Bagura; Kushner, Adam L

    Humanitarian organizations care for burns during crisis and while supporting healthcare facilities in low-income and middle-income countries. This study aimed to define the epidemiology of burn-related procedures to aid humanitarian response. In addition, operational data collected from humanitarian organizations are useful for describing surgical need otherwise unmet by national health systems. Procedures performed in operating theatres run by Médecins Sans Frontières-Operations Centre Brussels (MSF-OCB) from July 2008 through June 2014 were reviewed. Surgical specialist missions were excluded. Burn procedures were quantified, related to demographics and reason for humanitarian response, and described. A total of 96,239 operations were performed at 27 MSF-OCB projects in 15 countries between 2008 and 2014. Of the 33,947 general surgical operations, 4,280 (11%) were for burns. This proportion steadily increased from 3% in 2008 to 24% in 2014. People receiving surgical care from conflict relief missions had nearly twice the odds of having a burn operation compared with people requiring surgery in communities affected by natural disaster (adjusted odds ratio, 1.94; 95% confidence interval, 1.46-2.58). Nearly 70% of burn procedures were planned serial visits to the theatre. A diverse skill set was required. Unmet humanitarian assistance needs increased US$400 million dollars in 2013 in the face of an increasing number of individuals affected by crisis and a growing surgical burden. Given the high volume of burn procedures performed at MSF-OCB projects and the resource intensive nature of burn management, requisite planning and reliable funding are necessary to ensure quality for burn care in humanitarian settings.

  17. A unified framework for weighted parametric multiple test procedures.

    PubMed

    Xi, Dong; Glimm, Ekkehard; Maurer, Willi; Bretz, Frank

    2017-09-01

    We describe a general framework for weighted parametric multiple test procedures based on the closure principle. We utilize general weighting strategies that can reflect complex study objectives and include many procedures in the literature as special cases. The proposed weighted parametric tests bridge the gap between rejection rules using either adjusted significance levels or adjusted p-values. This connection is made by allowing intersection hypotheses of the underlying closed test procedure to be tested at level smaller than α. This may be also necessary to take certain study situations into account. For such cases we introduce a subclass of exact α-level parametric tests that satisfy the consonance property. When the correlation is known only for certain subsets of the test statistics, a new procedure is proposed to fully utilize this knowledge within each subset. We illustrate the proposed weighted parametric tests using a clinical trial example and conduct a simulation study to investigate its operating characteristics. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  18. User's manual for RAD/EQUIL/1973: A general purpose radiation transport program

    NASA Technical Reports Server (NTRS)

    Nicolet, W. E.

    1973-01-01

    A procedure is described for implementing the RAD/EQUIL/1973 program, and instructions are given which allow the program input to be prepared, the output to be interpreted, the operating procedures identified which must be followed, and the meaning of the error messages to be understood. The structure of the program is described through a verbal description, a FORTRAN variables list, and a listing of the program.

  19. Terminal Area Procedures for Paired Runways

    NASA Technical Reports Server (NTRS)

    Lozito, Sandy

    2011-01-01

    Parallel Runway operations have been found to increase capacity within the National Airspace (NAS) however, poor visibility conditions reduce this capacity [1]. Much research has been conducted to examine the concepts and procedures related to parallel runways however, there has been no investigation of the procedures associated with the strategic and tactical pairing of aircraft for these operations. This study developed and examined the pilot and controller procedures and information requirements for creating aircraft pairs for parallel runway operations. The goal was to achieve aircraft pairing with a temporal separation of 15s(+/- 10s error) at a coupling point that is about 12 nmi from the runway threshold. Two variables were explored for the pilot participants: Two levels of flight deck automation (current-day flight deck automation, and a prototype future automation) as well as two flight deck displays that assisted in pilot conformance monitoring. The controllers were also provided with automation to help create and maintain aircraft pairs. Data showed that the operations in this study were found to be acceptable and safe. Workload when using the pairing procedures and tools was generally low for both controllers and pilots, and situation awareness (SA) was typically moderate to high. There were some differences based upon the display and automation conditions for the pilots. Future research should consider the refinement of the concepts and tools for pilot and controller displays and automation for parallel runway concepts.

  20. Surgical procedures in liver transplant patients: A monocentric retrospective cohort study.

    PubMed

    Sommacale, Daniele; Nagarajan, Ganesh; Lhuaire, Martin; Dondero, Federica; Pessaux, Patrick; Piardi, Tullio; Sauvanet, Alain; Kianmanesh, Reza; Belghiti, Jacques

    2017-05-01

    Pre-existing chronic liver diseases and the complexity of the transplant surgery procedures lead to a greater risk of further surgery in transplanted patients compared to the general population. The aim of this monocentric retrospective cohort study was to assess the epidemiology of surgical complications in liver transplanted patients who require further surgical procedures and to characterize their post-operative risk of complications to enhance their medical care. From January 1997 to December 2011, 1211 patients underwent orthotropic liver transplantation in our center. A retrospective analysis of prospectively collected data was performed considering patients who underwent surgical procedures more than three months after transplantation. We recorded liver transplantation technique, type of surgery, post-operative complications, time since the liver transplant and immunosuppressive regimens. Among these, 161 patients (15%) underwent a further 183 surgical procedures for conditions both related and unrelated to the transplant. The most common surgical procedure was for an incisional hernia repair (n = 101), followed by bilioenteric anastomosis (n = 44), intestinal surgery (n = 23), liver surgery (n = 8) and other surgical procedures (n = 7). Emergency surgery was required in 19 procedures (10%), while 162 procedures (90%) were performed electively. Post-operative mortality and morbidity were 1% and 30%, respectively. According to the Dindo-Clavien classification, the most common grade of morbidity was grade III (46%), followed by grade II (40%). Surgical procedures on liver transplanted patients are associated with a significantly high risk of complications, irrespective of the time elapsed since transplantation. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  1. Achilles tenotomy as an office procedure and current practising trends among New Zealand orthopaedic surgeons.

    PubMed

    Agius, Lewis; Wickham, Angus; Walker, Cameron; Knudsen, Joshua

    2018-05-18

    Percutaneous Achilles tenotomy (PAT) is performed during the final phase of casting with Ponseti method. Several settings have been proposed as venues for this procedure, however it is increasingly being performed in theatre under a general anaesthetic (GA). General anaesthesia, however, is expensive and not without risks. The purpose of the present study was to compare results of outpatient releases to theatre releases, and assess current practising trends among orthopaedic surgeons. Retrospective comparison of patients with idiopathic clubfoot managed by Ponseti method who had Achilles tenotomy performed in outpatient clinic and in theatre. Surveys were sent to all POSNZ members to determine current practising trends in New Zealand. Parental satisfaction surveys were performed. Comparative cost analysis was performed using hospital billing information. The current study includes 64 idiopathic congenital clubfeet (19 bilateral cases). PAT was performed on 26 clubfeet under local anaesthetic in an outpatient setting, and 33 clubfeet under GA in a theatre setting. There was no significant difference for post-operative complications, or recurrence (p=0.67). Those in theatre group were exposed to a greater number of general anaesthetics before the age of four. Among practising New Zealand paediatric orthopaedic surgeons, 77.78% perform this in theatre under general anaesthesia, while only 22.22% perform PAT in outpatient clinic. The main barriers included concerns regarding pain control, concerns regarding incomplete release, concerns regarding distress to family and concerns regarding sterility. Parental satisfaction surveys found pain management to be excellent. Financial data was analysed and indicative costs were $6,061 NZD per procedure in theatre, compared to $378 NZD per procedure in clinic. PAT performed in a clinic setting is both safe and efficacious with results comparative to that performed in theatre. There was no difference in post-operative complications or recurrence. Parental satisfaction to this procedure is excellent. There are significant financial advantages. Based on this data, our institution now performs all releases in an outpatient setting.

  2. Student Government.

    ERIC Educational Resources Information Center

    Morrow, Joyce

    Materials for running a student government program at the junior high school level are provided in three general sections. Section 1 is a description of student government operations. Topics covered include student government responsibilities and activities, student council meeting procedures, parliamentary rules, responsibilities of the…

  3. TREATMENT PLANT EVALUATION FOR PARTICULATE CONTAMINANT REMOVAL

    EPA Science Inventory

    A general procedure is suggested for evaluating performance of water filtration plants. Plant operating records should be reviewed. Plant hydraulics should be evaluated. Chemical feed pumps, measuring, and additional points, plus control of chemical doses, are discussed. Rapid mi...

  4. Optimized autonomous operations of a 20 K space hydrogen sorption cryocooler

    NASA Astrophysics Data System (ADS)

    Borders, J.; Morgante, G.; Prina, M.; Pearson, D.; Bhandari, P.

    2004-06-01

    A fully redundant hydrogen sorption cryocooler is being developed for the European Space Agency Planck mission, dedicated to the measurement of the temperature anisotropies of the cosmic microwave background radiation with unprecedented sensitivity and resolution [Advances in Cryogenic Engineering 45A (2000) 499]. In order to achieve this ambitious scientific task, this cooler is required to provide a stable temperature reference (˜20 K) and appropriate cooling (˜1 W) to the two instruments on-board, with a flight operational lifetime of 18 months. During mission operations, communication with the spacecraft will be possible in a restricted time-window, not longer than 2 h/day. This implies the need for an operations control structure with the required robustness to safely perform autonomous procedures. The cooler performance depends on many operating parameters (such as the temperatures of the pre-cooling stages and the warm radiator), therefore the operation control system needs the capability to adapt to variations of these boundary conditions, while maintaining safe operating procedures. An engineering bread board (EBB) cooler was assembled and tested to evaluate the behavior of the system under conditions simulating flight operations and the test data were used to refine and improve the operation control software. In order to minimize scientific data loss, the cooler is required to detect all possible failure modes and to autonomously react to them by taking the appropriate action in a rapid fashion. Various procedures and schemes both general and specific in nature were developed, tested and implemented to achieve these goals. In general, the robustness to malfunctions was increased by implementing an automatic classification of anomalies in different levels relative to the seriousness of the error. The response is therefore proportional to the failure level. Specifically, the start-up sequence duration was significantly reduced, allowing a much faster activation of the system, particularly useful in case of restarts after inadvertent shutdowns arising from malfunctions in the spacecraft. The capacity of the system to detect J-T plugs was increased to the point that the cooler is able to autonomously identify actual contaminants clogging from gas flow reductions due to off-nominal operating conditions. Once a plug is confirmed, the software autonomously energizes, and subsequently turns off, a J-T defrost heater until the clog is removed, bringing the system back to normal operating conditions. In this paper, all the cooler Operational Modes are presented, together with the description of the logic structure of the procedures and the advantages they produce for the operations.

  5. Identifying areas of weakness in thoracic surgery residency training: a comparison of the perceptions of residents and program directors.

    PubMed

    Edwards, Janet P; Schofield, Adam; Paolucci, Elizabeth Oddone; Schieman, Colin; Kelly, Elizabeth; Servatyari, Ramin; Dixon, Elijah; Ball, Chad G; Grondin, Sean C

    2014-01-01

    To identify core thoracic surgery procedures that require increased emphasis during thoracic surgery residency for residents to achieve operative independence and to compare the perspectives of residents and program directors in this regard. A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents (12) and program directors (8) addressing the residents' ability to perform 19 core thoracic surgery procedures independently after the completion of residency. Residents were also questioned about the adequacy of their operative exposure to these 19 procedures during their residency training. A descriptive summary including calculations of frequencies and proportions was conducted. The perceptions of the 2 groups were then compared using the Fisher exact test employing a Bonferroni correction. The relationship between residents' operative exposure and their perceived operative ability was explored in the same fashion. The response rate was 100% for residents and program directors. No statistical differences were found between residents' and program directors' perceptions of residents' ability to perform the 19 core procedures independently. Both groups identified lung transplantation, first rib resection, and extrapleural pneumonectomy as procedures for which residents were not adequately prepared to perform independently. Residents' subjective ratings of operative exposure were in good agreement with their reported operative ability for 13 of 19 procedures. This study provides new insight into the perceptions of thoracic surgery residents and their program directors regarding operative ability. This study points to good agreement between residents and program directors regarding residents' surgical capabilities. This study provides information regarding potential weaknesses in thoracic surgery training, which may warrant an examination of the curricula of existing programs as well as a reconsideration of what the scope of practice of a general thoracic surgeon should entail. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

  6. Designing a process for executing projects under an international agreement

    NASA Technical Reports Server (NTRS)

    Mohan, S. N.

    2003-01-01

    Projects executed under an international agreement require special arrangements in order to operate within confines of regulations issued by the State Department and the Commerce Department. In order to communicate enterprise-level guidance and procedural information uniformly to projects based on interpretations that carry the weight of institutional authority, a process was developed. This paper provides a script for designing processes in general, using this particular process for context. While the context is incidental, the method described is applicable to any process in general. The paper will expound on novel features utilized for dissemination of the procedural details over the Internet following such process design.

  7. [General surgery in a rural hospital in the State of Quintana Roo, Mexico].

    PubMed

    Padrón-Arredondo, Guillermo

    2006-01-01

    The general surgeon maintains extraordinary validity worldwide, especially in countries like the United States, Canada, India, and continents such as Australia and Africa. In addition to their role as a general surgeon, they assist with surgical pathologies in rural areas where there is generally a lack of technology to carry out complicated procedures. Therefore, we undertook this study to determine the number and type of surgical procedures carried out in a rural hospital with three general surgeons, as well as to determine morbidity and respective mortality. The study was retrospective and longitudinal, using descriptive statistics during a 5.5-year period. During the period of June 1999 to December 2004, a total of 651 (100%) surgical procedures were carried out. There were 351 males (53%) and 300 females (47%) with average age of 28.5 +/- 16.0 years. There were 408 (63%) minor surgical procedures accomplished in the operating room: 150 (45%) for females with average age of 25.8 +/- 13.8 years old and 258 (55%) for males with average age of 27.7 +/- 15.5 years old. There were 243 major surgical procedures (37%): for females there were 150 (60%) with average age of 28.4 +/- 11.8 years old and for males there were 93 (40%) with average age of 29.5 +/- 16.6 years old [morbidity, six cases (0.9%) and mortality, two cases (0.3%)]. The demand for surgery in rural areas is not different from the surgery carried out in large cities, although there are limitations. It is important in this regard to adequately prepare the general surgeon in Mexico.

  8. Robot-assisted general surgery.

    PubMed

    Hazey, Jeffrey W; Melvin, W Scott

    2004-06-01

    With the initiation of laparoscopic techniques in general surgery, we have seen a significant expansion of minimally invasive techniques in the last 16 years. More recently, robotic-assisted laparoscopy has moved into the general surgeon's armamentarium to address some of the shortcomings of laparoscopic surgery. AESOP (Computer Motion, Goleta, CA) addressed the issue of visualization as a robotic camera holder. With the introduction of the ZEUS robotic surgical system (Computer Motion), the ability to remotely operate laparoscopic instruments became a reality. US Food and Drug Administration approval in July 2000 of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) further defined the ability of a robotic-assist device to address limitations in laparoscopy. This includes a significant improvement in instrument dexterity, dampening of natural hand tremors, three-dimensional visualization, ergonomics, and camera stability. As experience with robotic technology increased and its applications to advanced laparoscopic procedures have become more understood, more procedures have been performed with robotic assistance. Numerous studies have shown equivalent or improved patient outcomes when robotic-assist devices are used. Initially, robotic-assisted laparoscopic cholecystectomy was deemed safe, and now robotics has been shown to be safe in foregut procedures, including Nissen fundoplication, Heller myotomy, gastric banding procedures, and Roux-en-Y gastric bypass. These techniques have been extrapolated to solid-organ procedures (splenectomy, adrenalectomy, and pancreatic surgery) as well as robotic-assisted laparoscopic colectomy. In this chapter, we review the evolution of robotic technology and its applications in general surgical procedures.

  9. Behavioral Variability, Learning Processes, and Creativity

    DTIC Science & Technology

    1990-09-01

    Nursery Schools . ~ 9-10 y.o. subjects, at the concrete operative stage and coming from Primary Schools . - 14-15 y.o. subjects, at the formal thought...stage and coming from General Secondary Schools (no Technical School subject has been considered). - Adults, students at the University. Cognitive...classifications combine in a single situation, the operations of seiation and of classification, as approached in the classical Piaget’s procedures

  10. 0 + 5 Vascular Surgery Residents' Operative Experience in General Surgery: An Analysis of Operative Logs from 12 Integrated Programs.

    PubMed

    Smith, Brigitte K; Kang, P Chulhi; McAninch, Chris; Leverson, Glen; Sullivan, Sarah; Mitchell, Erica L

    2016-01-01

    Integrated (0 + 5) vascular surgery (VS) residency programs must include 24 months of training in core general surgery. The Accreditation Council for Graduate Medical Education currently does not require specific case numbers in general surgery for 0 + 5 trainees; however, program directors have structured this time to optimize operative experience. The aim of this study is to determine the case volume and type of cases that VS residents are exposed to during their core surgery training. Accreditation council for graduate medical education operative logs for current 0 + 5 VS residents were obtained and retrospectively reviewed to determine general surgery case volume and distribution between open and laparoscopic cases performed. Standard statistical methods were applied. A total of 12 integrated VS residency programs provided operative case logs for current residents. A total of 41 integrated VS residents in clinical years 2 through 5. During the postgraduate year-1 training year, residents participated in significantly more open than laparoscopic general surgery cases (p < 0.0001). This difference was consistent over the first 3 years of training. The most frequently logged open general surgery cases are hernia repair (20%), skin and soft tissue (7.4%), and breast (6.3%). Residents in programs with core surgery over 3 years participated in significantly more general surgery operations compared with residents in programs with core surgery spread out over 4 years (p = 0.035). 0 + 5 VS residents perform significantly more open operations than laparoscopic operations during their core surgery training. The majority of these operations are minor, nonabdominal procedures. The 0 + 5 VS residency program general surgery operative training requirements should be reevaluated and case minimums defined. The general surgery training component of 0 + 5 VS residencies may need to be restructured to meet the needs of current and future trainees. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  11. The effect of nasal midazolam premedication on parents-child separation and recovery time in dental procedures under general anaesthesia.

    PubMed

    Eskandarian, T; Arabzade Moghadam, S; Reza Ghaemi, S; Bayani, M

    2015-06-01

    For many children medical and dental procedures, unfamiliar dental staff and treatment places are disturbing and stressful. Stress in children often makes them uncooperative. General anaesthesia is indicated for anxious uncooperative children or those who are disabled, immature or too young to undergo dental treatment by other means. Moreover parents' separation while entering the operative room is a traumatic experience for children. Thus premedication such as midazolam is recommended to decrease child's stress. In these situations the increased recovery time was considered as one of the midazolam side effects. There is no study that evaluated the effect of midazolam both in parents-child separation and recovery time in long dental procedure. The purpose of this study was to evaluate the effect of nasal midazolam premedication with placebo on parents-child separation and recovery times in uncooperative paediatric patients undergoing long-lasting general anaesthesia for dental procedures. This randomised, double-blind study was done on 60 uncooperative patients (ASA physical status I or II) aged 2-4 years who were scheduled for general anaesthesia for dental treatment. Group A received 0.2 mg/kg intranasal midazolam as premedication, and group B received the same volume of intranasal placebo 20 minutes before entering the operating room for general anaesthesia. General anaesthesia was done with the same method for all patients, then parent-child separation and recovery times were compared between the two groups. Statical significance was set at P≤0.05. Statically analysis was performed using SPSS version17.Chi-squared and student t-tests were applied to analyse the data. We found significant differences in parents- child separation assessment between two groups. Nasal midazolam premedication had a positive effect on parents-child separation; but there was no significant difference between the two groups in terms of recovery time. Premedication of nasal midazolam before induction of general anaesthesia did not prolong recovery time but made the separation of children from their parents easier by showing a better behaviour.

  12. A checklist for endonasal transsphenoidal anterior skull base surgery.

    PubMed

    Laws, Edward R; Wong, Judith M; Smith, Timothy R; de Los Reyes, Kenneth; Aglio, Linda S; Thorne, Alison J; Cote, David J; Esposito, Felice; Cappabianca, Paolo; Gawande, Atul

    2016-06-01

    OBJECT Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%-17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors' institution has instituted a general preoperative "time-out" designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. METHODS An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. RESULTS The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management, monitoring, and other special considerations (e.g., Valsalva, jugular compression, lumbar drain, and so on). The Surgical Pause is composed of personnel introductions, planned procedural elements, estimation of duration of surgery, anticipated blood loss and fluid management, imaging, specimen collection, and questions of a surgical nature. The Equipment Pause assures proper function and availability of the microscope, endoscope, cameras and recorders, guidance systems, special instruments, ultrasonic microdoppler, microdebrider, drills, and other adjunctive supplies (e.g., Avitene, cotton balls, nasal packs, and so on). The Closure Pause is dedicated to issues of immediate postoperative patient disposition, orders, and management. CONCLUSIONS Surgical complications are a considerable cause of death and disability worldwide. Checklists have been shown to be an effective tool for reducing preventable errors surrounding surgery and decreasing associated complications. Although general checklists are already in place in most institutions, a specific checklist for endonasal transsphenoidal anterior skull base surgery was developed to help safeguard patients, improve outcomes, and enhance teambuilding.

  13. 47 CFR 1.1703 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Grants by Random Selection Cable... control of entities holding authorizations. (b) Authorization. A written instrument issued by the FCC conveying authority to operate, for a specified period, a station in the Cable Television Relay Service. In...

  14. 47 CFR 1.1703 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Grants by Random Selection Cable... control of entities holding authorizations. (b) Authorization. A written instrument issued by the FCC conveying authority to operate, for a specified period, a station in the Cable Television Relay Service. In...

  15. 47 CFR 1.1703 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Cable Operations and Licensing... requests to assign rights granted by the authorization or to transfer control of entities holding... specified period, a station in the Cable Television Relay Service. In addition, this term includes authority...

  16. 47 CFR 1.1703 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Grants by Random Selection Cable... control of entities holding authorizations. (b) Authorization. A written instrument issued by the FCC conveying authority to operate, for a specified period, a station in the Cable Television Relay Service. In...

  17. [Surgical manegement of breast cancer].

    PubMed

    Bussmann, J F; Trede, M

    1975-12-18

    A survey of common operative methods in carcinoma of the breast is given. The own procedure in localized and generalized stages of the disease is presented. Simple mastectomy plus axillary dissection has according to our experience proven to be the method of choice.

  18. 48 CFR 970.2770-1 - General.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... subpart prescribes policies and procedures for implementing the National Competitiveness Technology... technology transfer be established as a mission of each Government-owned laboratory operated under contract... purposes and are engaged in the production, maintenance, testing, or dismantlement of a nuclear weapon or...

  19. 48 CFR 970.2770-1 - General.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... subpart prescribes policies and procedures for implementing the National Competitiveness Technology... technology transfer be established as a mission of each Government-owned laboratory operated under contract... purposes and are engaged in the production, maintenance, testing, or dismantlement of a nuclear weapon or...

  20. 48 CFR 970.2770-1 - General.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... subpart prescribes policies and procedures for implementing the National Competitiveness Technology... technology transfer be established as a mission of each Government-owned laboratory operated under contract... purposes and are engaged in the production, maintenance, testing, or dismantlement of a nuclear weapon or...

  1. 48 CFR 970.2770-1 - General.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... subpart prescribes policies and procedures for implementing the National Competitiveness Technology... technology transfer be established as a mission of each Government-owned laboratory operated under contract... purposes and are engaged in the production, maintenance, testing, or dismantlement of a nuclear weapon or...

  2. 48 CFR 970.2770-1 - General.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... subpart prescribes policies and procedures for implementing the National Competitiveness Technology... technology transfer be established as a mission of each Government-owned laboratory operated under contract... purposes and are engaged in the production, maintenance, testing, or dismantlement of a nuclear weapon or...

  3. 29 CFR 1926.1080 - Safe practices manual.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION Diving General Operations Procedures § 1926.1080 Safe practices manual. Note: The requirements applicable to construction work under this section are...

  4. 12 CFR 614.4170 - General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... lender. Procedures shall require: (i) The procurement of periodic operating data essential for maintaining control, for the proper analysis of such data, and prompt action as needed; (ii) Inspections... insurance, margin requirements, warehousing, and the prompt exercise of legal options to preserve the lender...

  5. 12 CFR 614.4170 - General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... lender. Procedures shall require: (i) The procurement of periodic operating data essential for maintaining control, for the proper analysis of such data, and prompt action as needed; (ii) Inspections... insurance, margin requirements, warehousing, and the prompt exercise of legal options to preserve the lender...

  6. 12 CFR 614.4170 - General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... lender. Procedures shall require: (i) The procurement of periodic operating data essential for maintaining control, for the proper analysis of such data, and prompt action as needed; (ii) Inspections... insurance, margin requirements, warehousing, and the prompt exercise of legal options to preserve the lender...

  7. 12 CFR 614.4170 - General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... lender. Procedures shall require: (i) The procurement of periodic operating data essential for maintaining control, for the proper analysis of such data, and prompt action as needed; (ii) Inspections... insurance, margin requirements, warehousing, and the prompt exercise of legal options to preserve the lender...

  8. The effect on outcome of peribulbar anaesthesia in conjunction with general anesthesia for vitreoretinal surgery.

    PubMed

    Ghali, A M; El Btarny, A M

    2010-03-01

    The purpose of this study was to evaluate peri-operative outcome after vitreoretinal surgery when peribulbar anaesthesia is combined with general anaesthesia. Sixty adult patients undergoing elective primary retinal detachment surgery with scleral buckling or an encircling procedure received either peribulbar anaesthesia in conjunction with general anaesthesia or general anaesthesia alone. For peribulbar anaesthesia a single percutaneous injection of 5-7 ml of local anaesthetic solution (0.75% ropivacaine with hyaluronidase 15 iu.ml(-1)) was used. The incidence of intra-operative oculocardiac reflex and surgical bleeding interfering with the surgical field, postoperative pain and analgesia requirements, and postoperative nausea and vomiting were recorded. In the block group there was a lower incidence of oculocardiac reflex and surgical bleeding intra-operatively. Patients in the block group also had better postoperative analgesia and a lower incidence of postoperative nausea and vomiting compared with the group without a block. The use of peribulbar anaesthesia in conjunction with general anesthesia was superior to general anaesthesia alone for vitreoretinal surgery with scleral buckling.

  9. Data user's notes of the radio astronomy experiment aboard the OGO-V spacecraft

    NASA Technical Reports Server (NTRS)

    Haddock, F. T.; Breckenridge, S. L.

    1970-01-01

    General information concerning the low-frequency radiometer, instrument package launching and operation, and scientific objectives of the flight are provided. Calibration curves and correction factors, with general and detailed information on the preflight calibration procedure are included. The data acquisition methods and the format of the data reduction, both on 35 mm film and on incremental computer plots, are described.

  10. Robotic Surgical Training in an Academic Institution

    PubMed Central

    Chitwood, W. Randolph; Nifong, L. Wiley; Chapman, William H. H.; Felger, Jason E.; Bailey, B. Marcus; Ballint, Tara; Mendleson, Kim G.; Kim, Victor B.; Young, James A.; Albrecht, Robert A.

    2001-01-01

    Objective To detail robotic procedure development and clinical applications for mitral valve, biliary, and gastric reflux operations, and to implement a multispecialty robotic surgery training curriculum for both surgeons and surgical teams. Summary Background Data Remote, accurate telemanipulation of intracavitary instruments by general and cardiac surgeons is now possible. Complex technologic advancements in surgical robotics require well-designed training programs. Moreover, efficient robotic surgical procedures must be developed methodically and safely implemented clinically. Methods Advanced training on robotic systems provides surgeon confidence when operating in tiny intracavitary spaces. Three-dimensional vision and articulated instrument control are essential. The authors’ two da Vinci robotic systems have been dedicated to procedure development, clinical surgery, and training of surgical specialists. Their center has been the first United States site to train surgeons formally in clinical robotics. Results Established surgeons and residents have been trained using a defined robotic surgical educational curriculum. Also, 30 multispecialty teams have been trained in robotic mechanics and electronics. Initially, robotic procedures were developed experimentally and are described. In the past year the authors have performed 52 robotic-assisted clinical operations: 18 mitral valve repairs, 20 cholecystectomies, and 14 Nissen fundoplications. These respective operations required 108, 28, and 73 minutes of robotic telemanipulation to complete. Procedure times for the last half of the abdominal operations decreased significantly, as did the knot-tying time in mitral operations. There have been no deaths and few complications. One mitral patient had postoperative bleeding. Conclusion Robotic surgery can be performed safely with excellent results. The authors have developed an effective curriculum for training teams in robotic surgery. After training, surgeons have applied these methods effectively and safely. PMID:11573041

  11. Wilson loops on Riemann surfaces, Liouville theory and covariantization of the conformal group

    NASA Astrophysics Data System (ADS)

    Matone, Marco; Pasti, Paolo

    2015-06-01

    The covariantization procedure is usually referred to the translation operator, that is the derivative. Here we introduce a general method to covariantize arbitrary differential operators, such as the ones defining the fundamental group of a given manifold. We focus on the differential operators representing the sl2(ℝ) generators, which in turn, generate, by exponentiation, the two-dimensional conformal transformations. A key point of our construction is the recent result on the closed forms of the Baker-Campbell-Hausdorff formula. In particular, our covariantization receipt is quite general. This has a deep consequence since it means that the covariantization of the conformal group is always definite. Our covariantization receipt is quite general and apply in general situations, including AdS/CFT. Here we focus on the projective unitary representations of the fundamental group of a Riemann surface, which may include elliptic points and punctures, introduced in the framework of noncommutative Riemann surfaces. It turns out that the covariantized conformal operators are built in terms of Wilson loops around Poincaré geodesics, implying a deep relationship between gauge theories on Riemann surfaces and Liouville theory.

  12. [Seven Cases of Surgery for Breast Cancer under Tumescent Local Anesthesia].

    PubMed

    Hosoya, Tokuko; Nakagawa, Tsuyoshi; Oda, Goshi; Uetake, Hiroyuki

    2015-11-01

    Surgical procedures for breast cancer are usually performed under general anesthesia. However, general anesthesia needs to be avoided in some cases due to patient-related factors such as the presence of comorbid diseases. In these cases, we perform surgery under tumescent local anesthesia(TLA)in our department. Seven patients who were diagnosed with breast cancer underwent surgery under TLA instead of general anesthesia due to their comorbidities. The planned surgical procedures were successfully completed under TLA. A shift to general anesthesia could be avoided in all cases. The operative procedures for the breasts included modified radical mastectomy (Bt) in 3 cases and wide excision (Bp) in 4 cases. In addition, axillary lymph node dissection was performed in 2 cases; sampling, in 1 case; sentinel lymph node biopsy, in 2 cases; and no procedure for the axilla, in 2 cases. In terms of anesthesia, 2 cases were managed under TLA alone and 5 cases were managed under TLA combined with epidural anesthesia. Lidocaine was used for local anesthesia and did not reach the maximal permissive dose in all cases. No postoperative complication was observed. No local recurrence or new metastasis was observed during the observation period, which ranged from 1 to 67 months after the surgery. These findings demonstrate that surgery for breast cancer under TLA is safe and offers high curability for patients at high risk for complications of general anesthesia.

  13. Standard Operating Procedure for Using the NAFTA Guidance to Calculate Representative Half-life Values and Characterizing Pesticide Degradation

    EPA Pesticide Factsheets

    Results of the degradation kinetics project and describes a general approach for calculating and selecting representative half-life values from soil and aquatic transformation studies for risk assessment and exposure modeling purposes.

  14. 25 CFR 515.12 - Specific exemptions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...), (e)(1) and (f): Indian Gaming Individuals Records System (b) The exemptions under paragraph (a) of... NATIONAL INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GENERAL PROVISIONS PRIVACY ACT PROCEDURES... employment in an Indian gaming operation, the applicable exemption may be waived by the Commission. (c...

  15. 25 CFR 700.83 - Nonprofit organization.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Nonprofit organization. 700.83 Section 700.83 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Policies and Instructions Definitions § 700.83 Nonprofit organization. The term nonprofit organization...

  16. 48 CFR 7.104 - General procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., fiscal, legal, and technical personnel. If contract performance is to be in a designated operational area... shall review the plan and, if appropriate, revise it. (b) Requirements and logistics personnel should... planner should consult with requirements and logistics personnel who determine type, quality, quantity...

  17. 48 CFR 7.104 - General procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., fiscal, legal, and technical personnel. If contract performance is to be in a designated operational area... shall review the plan and, if appropriate, revise it. (b) Requirements and logistics personnel should... planner should consult with requirements and logistics personnel who determine type, quality, quantity...

  18. 48 CFR 7.104 - General procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., fiscal, legal, and technical personnel. If contract performance is to be in a designated operational area... shall review the plan and, if appropriate, revise it. (b) Requirements and logistics personnel should... planner should consult with requirements and logistics personnel who determine type, quality, quantity...

  19. 48 CFR 7.104 - General procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., fiscal, legal, and technical personnel. If contract performance is to be in a designated operational area... shall review the plan and, if appropriate, revise it. (b) Requirements and logistics personnel should... planner should consult with requirements and logistics personnel who determine type, quality, quantity...

  20. 48 CFR 7.104 - General procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., fiscal, legal, and technical personnel. If contract performance is to be in a designated operational area... shall review the plan and, if appropriate, revise it. (b) Requirements and logistics personnel should... planner should consult with requirements and logistics personnel who determine type, quality, quantity...

  1. 40 CFR 58.2 - Purpose.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... QUALITY SURVEILLANCE General Provisions § 58.2 Purpose. (a) This part contains requirements for measuring ambient air quality and for reporting ambient air quality data and related information. The monitoring criteria pertain to the following areas: (1) Quality assurance procedures for monitor operation and data...

  2. 40 CFR 58.2 - Purpose.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... QUALITY SURVEILLANCE General Provisions § 58.2 Purpose. (a) This part contains requirements for measuring ambient air quality and for reporting ambient air quality data and related information. The monitoring criteria pertain to the following areas: (1) Quality assurance procedures for monitor operation and data...

  3. 40 CFR 58.2 - Purpose.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... QUALITY SURVEILLANCE General Provisions § 58.2 Purpose. (a) This part contains requirements for measuring ambient air quality and for reporting ambient air quality data and related information. The monitoring criteria pertain to the following areas: (1) Quality assurance procedures for monitor operation and data...

  4. 40 CFR 58.2 - Purpose.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... QUALITY SURVEILLANCE General Provisions § 58.2 Purpose. (a) This part contains requirements for measuring ambient air quality and for reporting ambient air quality data and related information. The monitoring criteria pertain to the following areas: (1) Quality assurance procedures for monitor operation and data...

  5. 21 CFR 120.6 - Sanitation standard operating procedures.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Section 120.6 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) SYSTEMS General..., fuel, pesticides, cleaning compounds, sanitizing agents, condensate, and other chemical, physical, and...

  6. 21 CFR 120.6 - Sanitation standard operating procedures.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Section 120.6 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) SYSTEMS General..., fuel, pesticides, cleaning compounds, sanitizing agents, condensate, and other chemical, physical, and...

  7. 40 CFR 63.9005 - What are my general requirements for complying with this subpart?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., calibrated, maintained, and operated according to manufacturer's specifications or other written procedures... AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Hydrochloric Acid...

  8. 40 CFR 63.9005 - What are my general requirements for complying with this subpart?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., calibrated, maintained, and operated according to manufacturer's specifications or other written procedures... AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Hydrochloric Acid...

  9. 40 CFR 63.9005 - What are my general requirements for complying with this subpart?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., calibrated, maintained, and operated according to manufacturer's specifications or other written procedures... AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Hydrochloric Acid...

  10. 40 CFR 63.9005 - What are my general requirements for complying with this subpart?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., calibrated, maintained, and operated according to manufacturer's specifications or other written procedures... AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Hydrochloric Acid...

  11. 40 CFR 63.9005 - What are my general requirements for complying with this subpart?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., calibrated, maintained, and operated according to manufacturer's specifications or other written procedures... AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Hydrochloric Acid...

  12. 14 CFR 249.20 - Preservation of records by certificated air carriers.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... receivable or payable, detailed journals and ledgers or their equivalents, together with supporting papers Do. (b) General accounts receivable or payable, detailed journals and ledgers or their equivalents... internal audits and procedural studies; operational, management, accounting, financial, and legal service...

  13. 14 CFR 249.20 - Preservation of records by certificated air carriers.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... receivable or payable, detailed journals and ledgers or their equivalents, together with supporting papers Do. (b) General accounts receivable or payable, detailed journals and ledgers or their equivalents... internal audits and procedural studies; operational, management, accounting, financial, and legal service...

  14. 14 CFR 249.20 - Preservation of records by certificated air carriers.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... receivable or payable, detailed journals and ledgers or their equivalents, together with supporting papers Do. (b) General accounts receivable or payable, detailed journals and ledgers or their equivalents... internal audits and procedural studies; operational, management, accounting, financial, and legal service...

  15. 7 CFR 2610.2 - Headquarters organization.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... units. (b) Operational units. (1) The Assistant Inspector General for Policy Development and Resources Management (AIG/PD&RM) formulates OIG policies and procedures; develops, administers and directs... action. The immediate office of the AIG/PD&RM and two divisions carry out these functions. (2) The...

  16. 7 CFR 2610.2 - Headquarters organization.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... units. (b) Operational units. (1) The Assistant Inspector General for Policy Development and Resources Management (AIG/PD&RM) formulates OIG policies and procedures; develops, administers and directs... action. The immediate office of the AIG/PD&RM and two divisions carry out these functions. (2) The...

  17. 49 CFR 1562.21 - Scope, general requirements, and definitions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... WASHINGTON, DC, METROPOLITAN AREA Ronald Reagan Washington National Airport: Enhanced Security Procedures for... to aircraft operations into or out of Ronald Reagan Washington National Airport (DCA), fixed base... not include an armed security officer. DCA means Ronald Reagan Washington National Airport. DASSP...

  18. 49 CFR 1562.21 - Scope, general requirements, and definitions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... WASHINGTON, DC, METROPOLITAN AREA Ronald Reagan Washington National Airport: Enhanced Security Procedures for... to aircraft operations into or out of Ronald Reagan Washington National Airport (DCA), fixed base... not include an armed security officer. DCA means Ronald Reagan Washington National Airport. DASSP...

  19. Guidelines and Standards for Proprietary Schools.

    ERIC Educational Resources Information Center

    Georgia State Board of Education, Atlanta.

    This guide contains information pertaining to Georgia law, rules, regulations, and standards of practice for regulating proprietary schools in Georgia. Section 1 of the guide presents operation guidelines, including definitions, exemptions, general provisions, certificates of approval of schools, and appeals procedures. Section 2 presents minimum…

  20. 10 CFR 501.2 - Prepetition conference.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Prepetition conference. 501.2 Section 501.2 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS ADMINISTRATIVE PROCEDURES AND SANCTIONS General Provisions § 501.2 Prepetition conference. (a) Owners and operators of powerplants may request a prepetition...

  1. 49 CFR 1562.21 - Scope, general requirements, and definitions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... WASHINGTON, DC, METROPOLITAN AREA Ronald Reagan Washington National Airport: Enhanced Security Procedures for... operators located at DCA or gateway airports; individuals designated as a security coordinator by aircraft... not include an armed security officer. DCA means Ronald Reagan Washington National Airport. DASSP...

  2. 49 CFR 1562.21 - Scope, general requirements, and definitions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... WASHINGTON, DC, METROPOLITAN AREA Ronald Reagan Washington National Airport: Enhanced Security Procedures for... operators located at DCA or gateway airports; individuals designated as a security coordinator by aircraft... not include an armed security officer. DCA means Ronald Reagan Washington National Airport. DASSP...

  3. 49 CFR 1562.21 - Scope, general requirements, and definitions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... WASHINGTON, DC, METROPOLITAN AREA Ronald Reagan Washington National Airport: Enhanced Security Procedures for... operators located at DCA or gateway airports; individuals designated as a security coordinator by aircraft... not include an armed security officer. DCA means Ronald Reagan Washington National Airport. DASSP...

  4. A MATHEMATICAL MODEL OF ELECTROSTATIC PRECIPITATION. (REVISION 1): VOLUME I. MODELING AND PROGRAMMING

    EPA Science Inventory

    The report briefly describes the fundamental mechanisms and limiting factors involved in the electrostatic precipitation process. It discusses theories and procedures used in the computer model to describe the physical mechanisms, and generally describes the major operations perf...

  5. 22 CFR 1102.2 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... for examination and copying, or furnishing a copy of records. Duplication refers to the process of... organization, functions, policies, decisions, procedures, operations, or other activities of the Government or... make their products available for purchase or subscription by the general public. In the case of...

  6. Microbial Load in Septic and Aseptic Procedure Rooms.

    PubMed

    Harnoss, Julian-Camill; Assadian, Ojan; Diener, Markus Karl; Müller, Thomas; Baguhl, Romy; Dettenkofer, Markus; Scheerer, Lukas; Kohlmann, Thomas; Heidecke, Claus-Dieter; Gessner, Stephan; Büchler, Markus Wolfgang; Kramer, Axel

    2017-07-10

    Highly effective measures to prevent surgical wound infections have been established over the last two decades. We studied whether the strict separation of septic and aseptic procedure rooms is still necessary. In an exploratory, prospective observational study, the microbial concentration in an operating room without a room ventilating system (RVS) was analyzed during 16 septic and 14 aseptic operations with the aid of an air sampler (50 cm and 1 m from the operative field) and sedimentation plates (1 m from the operative field, and contact culture on the walls). The means and standard deviations of the microbial loads were compared with the aid of GEE models (generalized estimation equations). In the comparison of septic and aseptic operations, no relevant differences were found with respect to the overall microbial concentration in the room air (401.7 ± 176.3 versus 388.2 ± 178.3 CFU/m 3 ; p = 0.692 [CFU, colony-forming units]) or sedimentation 1 m from the operative field (45.3 ± 22.0 versus 48.7 ± 18.5 CFU/m 2 /min; p = 0.603) and on the walls (35.7 ± 43.7 versus 29.0 ± 49.4 CFU/m 2 /min; p = 0.685). The only relevant differences between the microbial spectra associated with the two types of procedure were a small amount of sedimentation of Escherichia coli and Enterococcus faecalis in septic operations, and of staphylococcus aureus and pseudomonas stutzeri in aseptic operations, up to 30 minutes after the end of the procedure. These data do not suggest that septic and aseptic procedure rooms need to be separated. In interpreting the findings, one should recall that the study was not planned as an equivalence or non-inferiority study. Wherever patient safety is concerned, high-level safety concepts should only be demoted to lower levels if new and convincing evidence becomes available.

  7. Starting a robotic program in general thoracic surgery: why, how, and lessons learned.

    PubMed

    Cerfolio, Robert J; Bryant, Ayesha S; Minnich, Douglas J

    2011-06-01

    We report our experience in starting a robotic program in thoracic surgery. We retrospectively reviewed our experience in starting a robotic program in general thoracic surgery on a consecutive series of patients. Between February 2009 and September 2010, 150 patients underwent robotic operations. Types of procedures were lobectomy in 62, thymectomy in 30, and benign esophageal procedures in 6. No thymectomy or esophageal procedures required conversion. One conversion was needed for suspected bleeding for a mediastinal mass. Twelve patients were converted for lobectomy (none for bleeding, 1 in the last 24). Median operative time for robotic thymectomy was 119 minutes, and median length of stay was 1 day. The median time for robotic lobectomy was 185 minutes, and median length of stay was 2 days. There were no operative deaths. Morbidity occurred in 23 patients (15%). All patients with cancer had R0 resections and resection of all visible mediastinal and hilar lymph nodes. Robotic surgery is safe and oncologically sound. It requires training of the entire operating room team. The learning curve is steep, involving port placement, availability of the proper instrumentation, use of the correct robotic arms, and proper patient positioning. The robot provides an ideal surgical approach for thymectomy and other mediastinal tumors. Its advantage over thoracoscopy for pulmonary resection is unproven; however, we believe complete thoracic lymph node dissection and teaching is easier. Importantly, defined credentialing for surgeons and cost analysis studies are needed. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Atrial fibrillation ablation using remote magnetic navigation and the risk of atrial-esophageal fistula: international multicenter experience.

    PubMed

    Danon, Asaf; Shurrab, Mohammed; Nair, Krishnakumar Mohanan; Latcu, Decebal Gabriel; Arruda, Mauricio S; Chen, Xu; Szili-Torok, Tamas; Rossvol, Ole; Wissner, Eric E; Lashevsky, Ilan; Crystal, Eugene

    2015-08-01

    Remote magnetic navigation (RMN) has been used in various electrophysiological procedures, including atrial fibrillation (AF) ablation. Atrial-esophageal fistula (AEF) is one of most disastrous complications of AF ablation. We aimed to evaluate the incidence of AEF during AF ablation using RMN in comparison to manual ablation. We conducted the first international survey among RMN operators for assessment of the prevalence of AEF and procedural parameters affecting the risk. Data from parallel survey of AEF among Canadian interventional electrophysiologists (CIE) using only manual catheters served as control. Fifteen RMN operators (who performed 3637 procedures) and 25 manual CIE operators (7016 procedures) responded to the survey. RMN operators were more experienced than CIE operators (16.3 ± 8.3 vs. 9.2 ± 5.4 practice years in electrophysiology, p = 0.007). The maximal energy output in the posterior wall was higher in the operator using RMN (33 ± 5 vs. 28.6 ± 4.9 W; p = 0.02). Other parameters including use of preprocedural images, irrigated catheter, pump flow rate, esophageal temperature monitoring, intracardiac echocardiography (ICE), and general anesthesia were similar. CIE operators administered proton-pump inhibitors postoperatively significantly more than RMN operators (76 vs. 35%, p = 0.01). AEF was reported in 5 of the 7016 patients in the control group (0.07%) but in none of the RMN group (p = 0.11). AEF is a rare complication and its evaluation necessitates large-scale studies. Although no AEF case with RMN was reported in this large study or previously on the literature, the rarity of this complication prevents firm conclusion about the risk.

  9. [Descriptive analysis of work and trends in anaesthesiology from 2005 to 2006: quantitative and qualitative aspects of effects and evaluation of anaesthesia].

    PubMed

    Majstorović, Branislava M; Simić, Snezana; Milaković, Branko D; Vucović, Dragan S; Aleksić, Valentina V

    2010-01-01

    In anaesthesiology, economic aspects have been insufficiently studied. The aim of this paper was the assessment of rational choice of the anaesthesiological services based on the analysis of the scope, distribution, trend and cost. The costs of anaesthesiological services were counted based on "unit" prices from the Republic Health Insurance Fund. Data were analysed by methods of descriptive statistics and statistical significance was tested by Student's t-test and chi2-test. The number of general anaesthesia was higher and average time of general anaesthesia was shorter, without statistical significance (t-test, p = 0.436) during 2006 compared to the previous year. Local anaesthesia was significantly higher (chi2-test, p = 0.001) in relation to planned operation in emergency surgery. The analysis of total anaesthesiological procedures revealed that a number of procedures significantly increased in ENT and MFH surgery, and ophthalmology, while some reduction was observed in general surgery, orthopaedics and trauma surgery and cardiovascular surgery (chi2-test, p = 0.000). The number of analgesia was higher than other procedures (chi2-test, p = 0.000). The structure of the cost was 24% in neurosurgery, 16% in digestive (general) surgery,14% in gynaecology and obstetrics, 13% in cardiovascular surgery and 9% in emergency room. Anaesthesiological services costs were the highest in neurosurgery, due to the length anaesthesia, and digestive surgery due to the total number of general anaesthesia performed. It is important to implement pharmacoeconomic studies in all departments, and to separate the anaesthesia services for emergency and planned operations. Disproportions between the number of anaesthesia, surgery interventions and the number of patients in surgical departments gives reason to design relation database.

  10. Medical Operations Console Procedure Evaluation: BME Response to Crew Call Down for an Emergency

    NASA Technical Reports Server (NTRS)

    Johnson-Troop; Pettys, Marianne; Hurst, Victor, IV; Smaka, Todd; Paul, Bonnie; Rosenquist, Kevin; Gast, Karin; Gillis, David; McCulley, Phyllis

    2006-01-01

    International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task completion and/or navigation, in particular the execution of the Surgeon call sequence. Debrief comments were used to analyze unclear procedural steps and to discern any discrepancies between the procedure and generally accepted BME actions. The sequence followed by BME participants differed considerably from the sequence intended by the procedure. Common deviations included the call sequence used to contact Surgeon, the content of BME and crew interaction and the gathering of pertinent console resources. Differing perceptions of task priority and imprecise language seem to have caused multiple deviations from the procedure s intended sequence. The study generated 40 recommendations for the procedure, of which 34 are being implemented. These recommendations address improving the clarity of the instructions, identifying training considerations, expediting Surgeon contact, improving cues for anticipated flight control team communication and identifying missing console tools.

  11. An Evaluation of the Effects of the Transobturator Tape Procedure on Sexual Satisfaction in Women with Stress Urinary Incontinence Using the Libido Scoring System

    PubMed Central

    Narin, Raziye; Nazik, Hakan; Narin, Mehmet Ali; Aytan, Hakan; Api, Murat

    2013-01-01

    Introduction and Hypothesis. Most women experience automatic urine leakage in their lifetimes. SUI is the most common type in women. Suburethral slings have become a standard surgical procedure for the treatment of stress urinary incontinence when conservative therapy failed. The treatment of stress urinary incontinence by suburethral sling may improve body image by reducing urinary leakage and may improve sexual satisfaction. Methods. A total of 59 sexually active patients were included in the study and underwent a TOT outside-in procedure. The LSS was applied in all patients by self-completion of questionnaires preoperatively and 6 months after the operation. General pleasure with the operation was measured by visual analogue score (VAS). Pre- and postoperative scores were recorded and analyzed using SPSS 11.5. Results. Two parameters of the LSS, orgasm and who starts the sexual activity, increased at a statistically significant rate. Conclusion. Sexual satisfaction and desire have partially improved after the TOT procedure. PMID:24288621

  12. Post-operative outcomes in older patients: a single-centre observational study.

    PubMed

    Tang, Benjamin; Green, Cameron; Yeoh, Aun Chian; Husain, Faisal; Subramaniam, Ashwin

    2018-05-01

    Improved life-expectancies have seen increased rates of older patients undergoing surgery worldwide. These patients are at increased risk of post-operative complications. Australian evidence is limited regarding the association between age and post-operative outcomes, especially rapid response calls (RRCs) as indicators of adverse outcomes. The aim was to compare the post-operative outcomes of older patients (≥80 years) to younger patients. Specifically, 30-day in-hospital mortality; unplanned intensive care unit (ICU) admission; and RRC activation within 72 h post-operatively. Single-centre retrospective observational study conducted over 12 months in a metropolitan Australian hospital. All adult patients (≥16 years) undergoing surgical procedures were included, excluding cardiac and obstetric/gynaecological surgeries. Patient co-morbidities were quantified using Charlson co-morbidity index (CCI) and American Society of Anesthesiologists physical status classification. Seven thousand four hundred and seventy-nine patients met inclusion criteria, 14.5% (n = 1086) aged ≥80 years. Most procedures (65%) were elective; and general surgical procedures were most common (24.2%). Compared to younger patients, older patients had significantly higher 30-day mortality (2.3% versus 0.2%; P < 0.001), increased post-operative RRC rates (7.3% versus 1.2%; P < 0.001), and unplanned ICU admissions (3.2% versus 1.6%; P < 0.001). Increasing age was associated with increased risk of post-operative RRC, unplanned ICU admission, and in-hospital mortality (all P < 0.01), with associations remaining significant after controlling for surgery type and CCI. Older patients are at increased risk of adverse post-operative outcomes, including post-operative RRC, unplanned ICU admission, and mortality, especially if they underwent emergency procedures. This has implications for preoperative risk stratification and post-operative management. Incidence of post-operative RRCs may be an important indicator of post-operative care. © 2018 Royal Australasian College of Surgeons.

  13. Liquid Scintillation Counting - Packard Triple-Label Calibration

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Torretto, P. A.

    2017-03-23

    The Radiological Measurements Laboratory (RML) maintains and operates nine Packard Liquid Scintillation Counters (LSCs). These counters were obtained through various sources and were generally purchased as 2500, 2700 or 3100 series counters. In 2004/2005 the software and firmware on the counters were upgraded. The counters are now designated as 3100 series counters running the Quantasmart software package. Thus, a single procedure can be used to calibrate and operate the Packard LSCs.

  14. Bi-orthogonal approach to non-Hermitian Hamiltonians with the oscillator spectrum: Generalized coherent states for nonlinear algebras

    NASA Astrophysics Data System (ADS)

    Rosas-Ortiz, Oscar; Zelaya, Kevin

    2018-01-01

    A set of Hamiltonians that are not self-adjoint but have the spectrum of the harmonic oscillator is studied. The eigenvectors of these operators and those of their Hermitian conjugates form a bi-orthogonal system that provides a mathematical procedure to satisfy the superposition principle. In this form the non-Hermitian oscillators can be studied in much the same way as in the Hermitian approaches. Two different nonlinear algebras generated by properly constructed ladder operators are found and the corresponding generalized coherent states are obtained. The non-Hermitian oscillators can be steered to the conventional one by the appropriate selection of parameters. In such limit, the generators of the nonlinear algebras converge to generalized ladder operators that would represent either intensity-dependent interactions or multi-photon processes if the oscillator is associated with single mode photon fields in nonlinear media.

  15. Perioperative mortality: Analysis of 3 years of operative data across 7 general surgical projects of Médecins Sans Frontières in Democratic Republic of Congo, Central African Republic, and South Sudan.

    PubMed

    Davies, Jessica F; Lenglet, Annick; van Wijhe, Marten; Ariti, Cono

    2016-05-01

    The African continent has the greatest burden of surgical disability-adjusted life years, yet the least is known about operative care here. This analysis describes the surgical patients admitted to 7 hospitals supported by the Médécins Sans Frontières (MSF) over 3 years in 3 conflict-affected countries-Eastern Democratic Republic of Congo, Central African Republic, and South Sudan. A standardized operative data collection tool was used for routine collection of operative inpatient data between 2011 and 2013 at 7 MSF surgical facilities. Surgical records of 14,482 patients were analyzed to describe surgical epidemiology, major procedures, and perioperative mortality. The perioperative mortality rate (POMR) was calculated within 2 days of admission (POMR2) and within 30 days from admission (POMR30). The POMR is used as a marker of quality of operative care. Caesarean delivery was the most common major procedure performed and had a POMR30 of 5.28 per 1,000 admissions. The overall inpatient mortality was 19.67 per 1,000 admissions. Children had greater POMR than adults for the same procedure types (47.97 vs 15.89 deaths per 1,000 admissions, P < .001); 85.1% of all major procedures were emergency procedures and between 3 and 30% of admissions were related to violence. After adjustment, perioperative death was associated with emergency surgery, violence, and age younger than 15 years. POMRs varied by age group and type of major procedure performed. Collecting surgical data is achievable and can inform future planning and support for national surgical programs. More information is needed on operative outcomes in adults and children in low-resource settings to improve quality and access to care. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Automated sizing of large structures by mixed optimization methods

    NASA Technical Reports Server (NTRS)

    Sobieszczanski, J.; Loendorf, D.

    1973-01-01

    A procedure for automating the sizing of wing-fuselage airframes was developed and implemented in the form of an operational program. The program combines fully stressed design to determine an overall material distribution with mass-strength and mathematical programming methods to design structural details accounting for realistic design constraints. The practicality and efficiency of the procedure is demonstrated for transport aircraft configurations. The methodology is sufficiently general to be applicable to other large and complex structures.

  17. A Comparison of Domain Sampling Procedures for Test Construction

    DTIC Science & Technology

    1992-10-01

    B AEROSPACE GROUND EQUIPNENT GENERAL MECHANIC AFSC 454X1 306 KNOWLEDGE TEST AFPT 80-423-205 103 AEROSPACE GOUND EQUIPNENT SPECIALTY (AFS 454Xl) JOB... 454X1 ). The information collected will be used for research purposes only and will have no effect on your career. Test results will be available for...exercise proper towing and positioning procedures, operate two-way radios and clean vehicles. 127 AEROSPACE GROUND EQUIPMENT AFSC 454X1 SELF-RATING FORNS

  18. A cross sectional study of surgical training among United Kingdom general practitioners with specialist interests in surgery.

    PubMed

    Ferguson, H J M; Fitzgerald, J E F; Reilly, J; Beamish, A J; Gokani, V J

    2015-04-08

    Increasing numbers of minor surgical procedures are being performed in the community. In the UK, general practitioners (family medicine physicians) with a specialist interest (GPwSI) in surgery frequently undertake them. This shift has caused decreases in available cases for junior surgeons to gain and consolidate operative skills. This study evaluated GPwSI's case-load, procedural training and perceptions of offering formalised operative training experience to surgical trainees. Prospective, questionnaire-based cross-sectional study. A novel, 13-item, self-administered questionnaire was distributed to members of the Association of Surgeons in Primary Care (ASPC). A total 113 of 120 ASPC members completed the questionnaire, representing a 94% response rate. Respondents were general practitioners practising or intending to practice surgery in the community. Respondents performed a mean of 38 (range 5-150) surgical procedures per month in primary care. 37% (42/113) of respondents had previously been awarded Membership or Fellowship of a Surgical Royal College; 22% (25/113) had completed a surgical certificate or diploma or undertaken a course of less than 1 year duration. 41% (46/113) had no formal British surgical qualifications. All respondents believed that surgical training in primary care could be valuable for surgical trainees, and the majority (71/113, 63%) felt that both general practice and surgical trainees could benefit equally from such training. There is a significant volume of surgical procedures being undertaken in the community by general practitioners, with the capacity and appetite for training of prospective surgeons in this setting, providing appropriate standards are achieved and maintained, commensurate with current standards in secondary care. Surgical experience and training of GPwSI's in surgery is highly varied, and does not yet benefit from the quality assurance secondary care surgical training in the UK undergoes. The Royal Colleges of Surgery and General Practice are well placed to invest in such infrastructure to provide long-term, high-quality service and training in the community. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Anesthetic management for carbon dioxide laser surgery of the larynx.

    PubMed

    Shaker, M H; Konchigeri, H N; Andrews, A H; Holinger, P H

    1976-06-01

    Fifty-one patients underwent 71 carbon dioxide laser procedures under general anesthesia for various intralaryngeal pathology. Anesthesia was induced with thiopental sodium, followed by succinylcholine to facilitate endotracheal intubation. For maintenance of anesthesia, 70% nitrous oxide was supplemented with halothane, enflurane or small doses of fentanyl. Succinylcholine, d-tubocurare or pancuronium were used to maintain muscular relaxation of jaw, pharyngeal and laryngeal muscles for a smooth lasing procedure. Small diameter (16-22 Fr.), red rubber, cuffed endotracheal tubes provided maximum working space, facilitated the controlled ventilation and reduced the explosion hazard of the anesthetic gases. Safely eyeglasses were used by all the personnel in the operating room against accidental injury to the cornea by the laser beam. Anesthetic management provided excellent operative conditions with maximum safety to the patient and the personnel in the operating room.

  20. Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training.

    PubMed

    Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M

    2011-11-01

    To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for surgical residency education, including advanced surgical critical care management. In addition, creation of an NTE service provides an optimal general surgery case mix, including major abdominal operations, that can augment declining trauma surgery caseloads, maintain acute care faculty surgical skills, and support general and acute care surgery residency training.

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