Construction of a high-tech operating room for image-guided surgery using VR.

PubMed

Suzuki, Naoki; Hattori, Asaki; Suzuki, Shigeyuki; Otake, Yoshito; Hayashibe, Mitsuhiro; Kobayashi, Susumu; Nezu, Takehiko; Sakai, Haruo; Umezawa, Yuji

2005-01-01

This project aimed to construct an operating room to implement high dimensional (3D, 4D) medical imaging and medical virtual reality techniques that would enable clinical tests for new surgical procedures. We designed and constructed such an operating room at Dai-san Hospital, the Jikei Univ. School of Medicine, Tokyo, Japan. The room was equipped with various facilities for image-guided, robot and tele- surgery. In this report, we describe an outline of our "high-tech operating room" and future plans.

[Interface interconnection and data integration in implementing of digital operating room].

PubMed

Feng, Jingyi; Chen, Hua; Liu, Jiquan

2011-10-01

The digital operating-room, with highly integrated clinical information, is very important for rescuing lives of patients and improving quality of operations. Since equipments in domestic operating-rooms have diversified interface and nonstandard communication protocols, designing and implementing an integrated data sharing program for different kinds of diagnosing, monitoring, and treatment equipments become a key point in construction of digital operating room. This paper addresses interface interconnection and data integration for commonly used clinical equipments from aspects of hardware interface, interface connection and communication protocol, and offers a solution for interconnection and integration of clinical equipments in heterogeneous environment. Based on the solution, a case of an optimal digital operating-room is presented in this paper. Comparing with the international solution for digital operating-room, the solution proposed in this paper is more economical and effective. And finally, this paper provides a proposal for the platform construction of digital perating-room as well as a viewpoint for standardization of domestic clinical equipments.

Operating room scheduling using hybrid clustering priority rule and genetic algorithm

NASA Astrophysics Data System (ADS)

Santoso, Linda Wahyuni; Sinawan, Aisyah Ashrinawati; Wijaya, Andi Rahadiyan; Sudiarso, Andi; Masruroh, Nur Aini; Herliansyah, Muhammad Kusumawan

2017-11-01

Operating room is a bottleneck resource in most hospitals so that operating room scheduling system will influence the whole performance of the hospitals. This research develops a mathematical model of operating room scheduling for elective patients which considers patient priority with limit number of surgeons, operating rooms, and nurse team. Clustering analysis was conducted to the data of surgery durations using hierarchical and non-hierarchical methods. The priority rule of each resulting cluster was determined using Shortest Processing Time method. Genetic Algorithm was used to generate daily operating room schedule which resulted in the lowest values of patient waiting time and nurse overtime. The computational results show that this proposed model reduced patient waiting time by approximately 32.22% and nurse overtime by approximately 32.74% when compared to actual schedule.

9 CFR 590.508 - Candling and transfer-room operations.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., Processing, and Facility Requirements § 590.508 Candling and transfer-room operations. (a) Candling and transfer rooms and equipment shall be kept clean, free from cobwebs, dust, objectionable odors, and excess... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Candling and transfer-room operations...

9 CFR 590.508 - Candling and transfer-room operations.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., Processing, and Facility Requirements § 590.508 Candling and transfer-room operations. (a) Candling and transfer rooms and equipment shall be kept clean, free from cobwebs, dust, objectionable odors, and excess... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Candling and transfer-room operations...

9 CFR 590.508 - Candling and transfer-room operations.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., Processing, and Facility Requirements § 590.508 Candling and transfer-room operations. (a) Candling and transfer rooms and equipment shall be kept clean, free from cobwebs, dust, objectionable odors, and excess... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Candling and transfer-room operations...

9 CFR 590.508 - Candling and transfer-room operations.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., Processing, and Facility Requirements § 590.508 Candling and transfer-room operations. (a) Candling and transfer rooms and equipment shall be kept clean, free from cobwebs, dust, objectionable odors, and excess... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Candling and transfer-room operations...

9 CFR 590.508 - Candling and transfer-room operations.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., Processing, and Facility Requirements § 590.508 Candling and transfer-room operations. (a) Candling and transfer rooms and equipment shall be kept clean, free from cobwebs, dust, objectionable odors, and excess... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Candling and transfer-room operations...

Allocation of surgical procedures to operating rooms.

PubMed

Ozkarahan, I

1995-08-01

Reduction of health care costs is of paramount importance in our time. This paper is a part of the research which proposes an expert hospital decision support system for resource scheduling. The proposed system combines mathematical programming, knowledge base, and database technologies, and what is more, its friendly interface is suitable for any novice user. Operating rooms in hospitals represent big investments and must be utilized efficiently. In this paper, first a mathematical model similar to job shop scheduling models is developed. The model loads surgical cases to operating rooms by maximizing room utilization and minimizing overtime in a multiple operating room setting. Then a prototype expert system which replaces the expertise of the operations research analyst for the model, drives the modelbase, database, and manages the user dialog is developed. Finally, an overview of the sequencing procedures for operations within an operating room is also presented.

[Operating Room Nurses' Experiences of Securing for Patient Safety].

PubMed

Park, Kwang Ok; Kim, Jong Kyung; Kim, Myoung Sook

2015-10-01

This study was done to evaluate the experience of securing patient safety in hospital operating rooms. Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

An assessment of the quality indicators of operative and non-operative times in a public university hospital

PubMed Central

Costa, Altair da Silva; Leão, Luiz Eduardo Villaça; de Novais, Maykon Anderson Pires; Zucchi, Paola

2015-01-01

ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency. PMID:26761557

Air quality monitoring of the post-operative recovery room and locations surrounding operating theaters in a medical center in Taiwan.

PubMed

Tang, Chin-Sheng; Wan, Gwo-Hwa

2013-01-01

To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.

The operating room as a clinical learning environment: An exploratory study.

PubMed

Meyer, Rhoda; Van Schalkwyk, Susan C; Prakaschandra, Rosaley

2016-05-01

Students undertake their clinical placement in various clinical settings for the exposure to and acquisition of skills related to that particular context. The operating room is a context that offers the opportunity to develop critical skills related to the perioperative care of the patient. Despite numerous studies that have been undertaken in this field, few have investigated the operating room as a clinical learning environment in the South African private healthcare context. The aim of this study was to determine nursing students' perceptions of the operating room as a clinical learning environment. An exploratory, interpretive and descriptive design generating qualitative data was utilized. Eight nursing students completed an open-ended questionnaire, and twelve nursing students participated in the focus group discussion. Four themes emerged, namely, 'interpersonal factors', 'educational factors', 'private operating room context', and 'recommendations'. The opinion that the operating room offers an opportunity to gain skills unique to this context was expressed. However, despite the potential learning opportunities, the key findings of this study reveal negative perceptions of nursing students regarding learning experiences in the operating room. Exploration into the preparatory needs of students specific to learning outcomes before operating room placement should be considered. It will also be necessary to improve collaboration between lecturers, mentors and theatre managers. Copyright © 2016 Elsevier Ltd. All rights reserved.

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, FACING NORTH - Cape Canaveral Air Force Station, Launch Complex 39, Launch Control Center, LCC Road, East of Kennedy Parkway North, Cape Canaveral, Brevard County, FL

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, FACING SOUTHEAST - Cape Canaveral Air Force Station, Launch Complex 39, Launch Control Center, LCC Road, East of Kennedy Parkway North, Cape Canaveral, Brevard County, FL

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 3, FACING EAST - Cape Canaveral Air Force Station, Launch Complex 39, Launch Control Center, LCC Road, East of Kennedy Parkway North, Cape Canaveral, Brevard County, FL

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 4, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

DETAIL VIEW OF OPERATIONS MANAGEMENT ROOM, FIRING ROOM NO. 4, FACING WEST - Cape Canaveral Air Force Station, Launch Complex 39, Launch Control Center, LCC Road, East of Kennedy Parkway North, Cape Canaveral, Brevard County, FL

Air Quality Monitoring of the Post-Operative Recovery Room and Locations Surrounding Operating Theaters in a Medical Center in Taiwan

PubMed Central

Tang, Chin-Sheng; Wan, Gwo-Hwa

2013-01-01

To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers. PMID:23573296

Governing time in operating rooms.

PubMed

Riley, Robin; Manias, Elizabeth

2006-05-01

This paper examines how time is controlled and governed in operating rooms through interpersonal communication between nurses and doctors. Time is a valuable commodity in organizations with improvements often directed towards maximizing efficiencies. As a consequence, time can be a source of tension and interpersonal conflict as individuals compete for control of its use. The data in this paper emanate from an ethnographic study that explored a range of communication practices in operating room nursing. Participants comprised 11 operating room nurses. Data were collected over two years in three different institutional settings and involved participant observation, interviews and the keeping of a personal diary. A deconstructive analysis of the data was undertaken. Results are discussed in terms of the practices, in which clinicians are engaged in, to govern and control their use of time. The four practices presented in this paper include; questioning judgment and timing, controlling speed, estimating surgeons' use of time and coping with different perceptions of time. Time and speed were hotly contested by nurses. They used their personal knowledge of individual surgeon's habits of time to govern and control practice. Nurses thought about surgeons in terms of time and developed commonly accepted understandings about the length of surgical procedures. They used this knowledge to manage the scheduling of operations in the departments and to control the workflow in individual operating rooms. Knowledge of individual surgeons was a source of power for operating room nurses. Nurses have more power in the operating room than might be imagined but they exercise this power in subtle ways. If operating rooms are to work effectively, the operating room team must understand each others' work better.

Future of operating rooms.

PubMed

Reijnen, Michel M P J; Zeebregts, Clark J; Meijerink, Wilhelmus J H J

2005-01-01

Operating-room design has not changed significantly since the modern era of surgery began. Minimal invasive, endoscopic, procedures, and evolution of technology will affect operating-room design in the near future. Poor ergonomics has always been one of the major drawbacks of endoscopic surgery. Use of retractable arms and monitors will improve ergonomics of the operating team. Developments in telecommunication will allow surgeons to communicate with colleagues and experts during the procedure in virtually any location around the world, which increases teaching possibilities and procedural safety. Introduction and further development of intraoperative imaging, including real-time, three-dimensional (3-D) reconstructions of patient, and computer-aided surgery offer surgeons the opportunity to train the planned surgical procedure. Moreover, they will improve control and supervision of the procedure in learning situations. The last decade's robotics have made their introduction into the operating rooms. They improve control over the operating-room environment and will facilitate the performance of more complex procedures. However, high costs and lack of force feedback remain its major drawbacks. Improvements of robotic techniques and its implementation into the operating rooms will further guide their design into highly specialized operating units.

Nickel release from surgical instruments and operating room equipment.

PubMed

Boyd, Anne H; Hylwa, Sara A

2018-04-15

Background There has been no systematic study assessing nickel release from surgical instruments and equipment used within the operating suite. This equipment represents important potential sources of exposure for nickel-sensitive patients and hospital staff. To investigate nickel release from commonly used surgical instruments and operating room equipment. Using the dimethylglyoxime nickel spot test, a variety of surgical instruments and operating room equipment were tested for nickel release at our institution. Of the 128 surgical instruments tested, only 1 was positive for nickel release. Of the 43 operating room items tested, 19 were positive for nickel release, 7 of which have the potential for direct contact with patients and/or hospital staff. Hospital systems should be aware of surgical instruments and operating room equipment as potential sources of nickel exposure.

Nursing in a technological environment: nursing care in the operating room.

PubMed

Bull, Rosalind; FitzGerald, Mary

2006-02-01

Operating room nurses continue to draw criticism regarding the appropriateness of a nursing presence in the operating room. The technological focus of the theatre and the ways in which nurses in the theatre have shaped and reshaped their practice in response to technological change have caused people within and outside the nursing profession to question whether operating room nursing is a technological rather than nursing undertaking. This paper reports findings from an ethnographic study that was conducted in an Australian operating department. The study examined the contribution of nurses to the work of the operating room through intensive observation and ethnographic interviews. This paper uses selected findings from the study to explore the ways in which nurses in theatre interpret their role in terms of caring in a technological environment.

Assessment of operative times of multiple surgical specialties in a public university hospital

PubMed Central

Costa, Altair da Silva

2017-01-01

ABSTRACT Objective To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. Methods It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. Results The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. Conclusion This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays. PMID:28767919

The risk for syncope and presyncope during surgery in surgeons and nurses.

PubMed

Rudnicki, Jerzy; Zyśko, Dorota; Gajek, Jacek; Kuliczkowski, Wiktor; Rosińczuk-Tonderys, Joanna; Zielińska, Dominika; Terpiłowski, Łukasz; Agrawal, Anil Kumar

2011-11-01

Surgeons and nurses are exposed to orthostatic stress. To assess the lifetime incidence of syncopal and presyncopal events during surgery in operation room staff and reveal the predicting factors. The study included 317 subjects (161 F, 156 M) aged 43.9 ± 9.6; 216 surgeons and 101 instrumenters. The study included filling of an anonymous questionnaire on the syncope and presyncope history. At least one syncopal event during operation was reported by 4.7% and presyncope by 14.8% of the studied population. All but one subject reported prodromal symptoms before syncope. In the medical history, syncope outside the operating room was reported by 11% of the studied group. Syncope and presyncope during operation was related to syncope in the medical history outside the operation room, respectively: odds ratio (OR) 20.2 95% confidence interval (CI): 2.0-70.5 and OR 10.8; CI: 5.0-23.4 and to presyncope in the medical history, respectively: OR 23.5; CI: 7.4-74.4 OR 8.9; CI: 3.6-11.2 (P < 0.001). (1) Syncope and presyncope may occur during surgery in the staff of the operating room. (2) Syncope in the operating room is usually preceded by prodromal symptoms and has vasovagal origin. (3) Both lower then expected occurrence of syncope in the operating room staff and absence of any difference between genders in this regard indicate preselection in the process of choosing profession and specialization. (4) Syncope and presyncope outside the operating room in medical history increases the risk of syncope and presyncope inside the operation room.

[Operating room during natural disaster: lessons from the 2011 Tohoku earthquake].

PubMed

Fukuda, Ikuo; Hashimoto, Hiroshi; Suzuki, Yasuyuki; Satomi, Susumu; Unno, Michiaki; Ohuchi, Noriaki; Nakaji, Shigeyuki

2012-03-01

Objective of this study is to clarify damages in operating rooms after the 2011 Tohoku Earthquake. To survey structural and non-structural damage in operating theaters, we sent questionnaires to 155 acute care hospitals in Tohoku area. Questionnaires were sent back from 105 hospitals (70.3%). Total of 280 patients were undergoing any kinds of operations during the earthquake and severe seismic tremor greater than JMA Seismic Intensity 6 hit 49 hospitals. Operating room staffs experienced life-threatening tremor in 41 hospitals. Blackout occurred but emergency electronic supply unit worked immediately in 81 out of 90 hospitals. However, emergency power plant did not work in 9 hospitals. During earthquake some materials fell from shelves in 44 hospitals and medical instruments fell down in 14 hospitals. In 5 hospitals, they experienced collapse of operating room wall or ceiling causing inability to maintain sterile operative field. Damage in electric power and water supply plus damage in logistics made many operating rooms difficult to perform routine surgery for several days. The 2011 Tohoku earthquake affected medical supply in wide area of Tohoku district and induced dysfunction of operating room. Supply-chain management of medical goods should be reconsidered to prepare severe natural disaster.

TeamSTEPPS Improves Operating Room Efficiency and Patient Safety.

PubMed

Weld, Lancaster R; Stringer, Matthew T; Ebertowski, James S; Baumgartner, Timothy S; Kasprenski, Matthew C; Kelley, Jeremy C; Cho, Doug S; Tieva, Erwin A; Novak, Thomas E

2016-09-01

The objective was to evaluate the effect of TeamSTEPPS on operating room efficiency and patient safety. TeamSTEPPS consisted of briefings attended by all health care personnel assigned to the specific operating room to discuss issues unique to each case scheduled for that day. The operative times, on-time start rates, and turnover times of all cases performed by the urology service during the initial year with TeamSTEPPS were compared to the prior year. Patient safety issues identified during postoperative briefings were analyzed. The mean case time was 12.7 minutes less with TeamSTEPPS (P < .001). The on-time first-start rate improved by 21% with TeamSTEPPS (P < .001). The mean room turnover time did not change. Patient safety issues declined from an initial rate of 16% to 6% at midyear and remained stable (P < 0.001). TeamSTEPPS was associated with improved operating room efficiency and diminished patient safety issues in the operating room. © The Author(s) 2015.

Perceptions of Recent Graduates of the Adequacy of Anesthesia Training Programs.

ERIC Educational Resources Information Center

Spielman, Fred J.; Bowe, Edwin A.

1983-01-01

A survey examined physician attitudes toward operating room, nonoperating room, and nonpatient care responsibilities in their residencies. Training for operating room responsibilities was deemed adequate by most, and nonoperating room training inadequate. Recommendations include: hospital cooperation, more effective sessions, and supplementary…

Human Factors Guidance for Control Room and Digital Human-System Interface Design and Modification, Guidelines for Planning, Specification, Design, Licensing, Implementation, Training, Operation and Maintenance

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

R. Fink, D. Hill, J. O'Hara

2004-11-30

Nuclear plant operators face a significant challenge designing and modifying control rooms. This report provides guidance on planning, designing, implementing and operating modernized control rooms and digital human-system interfaces.

Operating Room Technology. Post Secondary Curriculum Guide.

ERIC Educational Resources Information Center

Simpson, Bruce; And Others

This curriculum guide was designed for use in postsecondary operating room technology education programs in Georgia. Its purpose is to provide for development of entry level skills in operating room technology in the areas of knowledge, theoretical structure, tool usage, diagnostic ability, related supportive skills, and occupational survival…

[Fire in the operating room].

PubMed

Koljonen, Virve; Mäkisalo, Heikki

2013-01-01

This article reviews the recent literature on operating room fires. Most of the reported cases have occurred from a spark from an ignition source in an oxygen-enriched atmosphere. Fire requires the presence of three components which all are ample in the operating room: heat, flammable materials or flammable gases.

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%).

Alcohol based surgical prep solution and the risk of fire in the operating room: a case report

PubMed Central

Batra, Sumit; Gupta, Rajiv

2008-01-01

A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room. PMID:18439304

Wearing long sleeves while prepping a patient in the operating room decreases airborne contaminants.

PubMed

Markel, Troy A; Gormley, Thomas; Greeley, Damon; Ostojic, John; Wagner, Jennifer

2018-04-01

The use of long sleeves by nonscrubbed personnel in the operating room has been called into question. We hypothesized that wearing long sleeves and gloves, compared with having bare arms without gloves, while applying the skin preparation solution would decrease particulate and microbial contamination. A mock patient skin prep was performed in 3 different operating rooms. A long-sleeved gown and gloves, or bare arms, were used to perform the procedure. Particle counters were used to assess airborne particulate contamination, and active and passive microbial assessment was achieved through air samplers and settle plate analysis. Data were compared with Student's t-test or Mann-Whitney U, and P < .05 was considered to be significant. Operating room B demonstrated decreased 5.0- µm particle sizes with the use of sleeves, while operating rooms A and C showed decreased total microbes only with the use of sleeves. Despite there being no difference in the average number of total microbes for all operating rooms assessed, the use of sleeves specifically appeared to decrease the shed of Micrococcus. The use of long sleeves and gloves while applying the skin preparation solution decreased particulate and microbial shedding in several of the operating rooms tested. Although long sleeves may not be necessary for all operating room personnel, they may decrease airborne contamination while the skin prep is applied, which may lead to decreased surgical site infections. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Operator's Manual, Boiler Room Operations and Maintenance. Supplement A, Air Pollution Training Institute Self-Instructional Course SI-466.

ERIC Educational Resources Information Center

Environmental Protection Agency, Research Triangle Park, NC. Air Pollution Training Inst.

This Operator's Manual is a supplement to a self-instructional course prepared for the United States Environmental Protection Agency. This publication is the Boiler Room Handbook for operating and maintaining the boiler and the boiler room. As the student completes this handbook, he is putting together a manual for running his own boiler. The…

Prospective Evaluation of Operating Room Inefficiency.

PubMed

Madni, Tarik D; Imran, Jonathan B; Clark, Audra T; Cunningham, Holly B; Taveras, Luis; Arnoldo, Brett D; Phelan, Herb A; Wolf, Steven E

2018-04-06

Previously, we identified that 60% of our facility's total operative time is nonoperative. We performed a review of our operating room to determine where inefficiencies exist in nonoperative time. Live video of operations performed in a burn operating room from 6/23/17 to 8/16/17 were prospectively reviewed. Preparation (end of induction to procedure start) and turnover (patient out of room to next patient in room) were divided into the following activities: 1) Preparation: remove dressing, position patient, clean patient, drape patient, and 2) Turnover: clean operating room, scrub tray set-up, anesthesia set-up. Ideal preparation time was calculated as the sum of time needed to perform preparation activities consecutively. Ideal turnover time was calculated as the sum of time needed to clean the operating room and to set up either the scrub tray or anesthesia (the larger of the two times as these can be done in parallel). We reviewed 101 consecutive operations. An average of 2.4±0.8 cases/day were performed. Ideal preparation and turnover time were 16.6 and 30.1 minutes, a 38.3% and 32.5% reduction compared to actual times. Attending surgeon presence in the operating room within 10 minutes of a patient's arrival was found to significantly decrease time to incision by 33% (52.7±14.3 minutes down to 35.7±20.4, p<0.0001). A reduction in preparation and turnover time could save $1.02 million and generate $1.76 million in additional revenue annually. Reducing preparation and turnover to ideal times could increase caseload to 4/day, leading to millions of dollars of savings annually.

Student Registered Nurse Anesthetists' Atittudes toward and Perceptions of Teamwork in the Operating Room

ERIC Educational Resources Information Center

Heiner, Jeremy S.

2013-01-01

Student registered nurse anesthetists are an important part of an operating room team, yet little research has investigated how they perceive teamwork or approach team related issues specific to the operating room. This mixed methods study evaluated junior and senior student registered nurse anesthetists' attitudes toward and perceptions of…

21 CFR 878.5070 - Air-handling apparatus for a surgical operating room.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Air-handling apparatus for a surgical operating room. 878.5070 Section 878.5070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND....5070 Air-handling apparatus for a surgical operating room. (a) Identification. Air-handling apparatus...

21 CFR 878.5070 - Air-handling apparatus for a surgical operating room.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Air-handling apparatus for a surgical operating room. 878.5070 Section 878.5070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND....5070 Air-handling apparatus for a surgical operating room. (a) Identification. Air-handling apparatus...

Foundations for teaching surgeons to address the contributions of systems to operating room team conflict.

PubMed

Rogers, David A; Lingard, Lorelei; Boehler, Margaret L; Espin, Sherry; Schindler, Nancy; Klingensmith, Mary; Mellinger, John D

2013-09-01

Prior research has shown that surgeons who effectively manage operating room conflict engage in a problem-solving stage devoted to modifying systems that contribute to team conflict. The purpose of this study was to clarify how systems contributed to operating room team conflict and clarify what surgeons do to modify them. Focus groups of circulating nurses and surgeons were conducted at 5 academic medical centers. Narratives describing the contributions of systems to operating room conflict and behaviors used by surgeons to address those systems were analyzed using the constant comparative approach associated with a constructivist grounded theory approach. Operating room team conflict was affected by 4 systems-related factors: team features, procedural-specific staff training, equipment management systems, and the administrative leadership itself. Effective systems problem solving included advocating for change based on patient safety concerns. The results of this study provide clarity about how systems contribute to operating room conflict and what surgeons can do to effectively modify these systems. This information is foundational material for a conflict management educational program for surgeons. Copyright © 2013 Elsevier Inc. All rights reserved.

Room temperature single-photon detectors for high bit rate quantum key distribution

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

Comandar, L. C.; Patel, K. A.; Engineering Department, Cambridge University, 9 J J Thomson Ave., Cambridge CB3 0FA

We report room temperature operation of telecom wavelength single-photon detectors for high bit rate quantum key distribution (QKD). Room temperature operation is achieved using InGaAs avalanche photodiodes integrated with electronics based on the self-differencing technique that increases avalanche discrimination sensitivity. Despite using room temperature detectors, we demonstrate QKD with record secure bit rates over a range of fiber lengths (e.g., 1.26 Mbit/s over 50 km). Furthermore, our results indicate that operating the detectors at room temperature increases the secure bit rate for short distances.

Operating room metrics score card-creating a prototype for individualized feedback.

PubMed

Gabriel, Rodney A; Gimlich, Robert; Ehrenfeld, Jesse M; Urman, Richard D

2014-11-01

The balance between reducing costs and inefficiencies with that of patient safety is a challenging problem faced in the operating room suite. An ongoing challenge is the creation of effective strategies that reduce these inefficiencies and provide real-time personalized metrics and electronic feedback to anesthesia practitioners. We created a sample report card structure, utilizing existing informatics systems. This system allows to gather and analyze operating room metrics for each anesthesia provider and offer personalized feedback. To accomplish this task, we identified key metrics that represented time and quality parameters. We collected these data for individual anesthesiologists and compared performance to the overall group average. Data were presented as an electronic score card and made available to individual clinicians on a real-time basis in an effort to provide effective feedback. These metrics included number of cancelled cases, average turnover time, average time to operating room ready and patient in room, number of delayed first case starts, average induction time, average extubation time, average time to recovery room arrival to discharge, performance feedback from other providers, compliance to various protocols, and total anesthetic costs. The concept we propose can easily be generalized to a variety of operating room settings, types of facilities and OR health care professionals. Such a scorecard can be created using content that is important for operating room efficiency, research, and practice improvement for anesthesia providers.

Noise in the operating rooms of Greek hospitals.

PubMed

Tsiou, Chrisoula; Efthymiatos, Gerasimos; Katostaras, Theophanis

2008-02-01

This study is an evaluation of the problem of noise pollution in operating rooms. The high sound pressure level of noise in the operating theatre has a negative impact on communication between operating room personnel. The research took place at nine Greek public hospitals with more than 400 beds. The objective evaluation consisted of sound pressure level measurements in terms of L(eq), as well as peak sound pressure levels in recordings during 43 surgeries in order to identify sources of noise. The subjective evaluation consisted of a questionnaire answered by 684 operating room personnel. The views of operating room personnel were studied using Pearson's X(2) Test and Fisher's Exact Test (SPSS Version 10.00), a t-test comparison was made of mean sound pressure levels, and the relationship of measurement duration and sound pressure level was examined using linear regression analysis (SPSS Version 13.00). The sound pressure levels of noise per operation and the sources of noise varied. The maximum measured level of noise during the main procedure of an operation was measured at L(eq)=71.9 dB(A), L(1)=84.7 dB(A), L(10)=76.2 dB(A), and L(99)=56.7 dB(A). The hospital building, machinery, tools, and people in the operating room were the main noise factors. In order to eliminate excess noise in the operating room it may be necessary to adopt a multidisciplinary approach. An improvement in environment (background noise levels), the implementation of effective standards, and the focusing of the surgical team on noise matters are considered necessary changes.

10 CFR 36.67 - Entering and leaving the radiation room.

Code of Federal Regulations, 2011 CFR

2011-01-01

... radiation room of a panoramic irradiator after an irradiation, the irradiator operator shall use a survey... irradiation, the irradiator operator shall: (1) Visually inspect the entire radiation room to verify that no...

10 CFR 36.67 - Entering and leaving the radiation room.

Code of Federal Regulations, 2010 CFR

2010-01-01

... radiation room of a panoramic irradiator after an irradiation, the irradiator operator shall use a survey... irradiation, the irradiator operator shall: (1) Visually inspect the entire radiation room to verify that no...

10 CFR 36.67 - Entering and leaving the radiation room.

Code of Federal Regulations, 2014 CFR

2014-01-01

... radiation room of a panoramic irradiator after an irradiation, the irradiator operator shall use a survey... irradiation, the irradiator operator shall: (1) Visually inspect the entire radiation room to verify that no...

10 CFR 36.67 - Entering and leaving the radiation room.

Code of Federal Regulations, 2012 CFR

2012-01-01

... radiation room of a panoramic irradiator after an irradiation, the irradiator operator shall use a survey... irradiation, the irradiator operator shall: (1) Visually inspect the entire radiation room to verify that no...

10 CFR 36.67 - Entering and leaving the radiation room.

Code of Federal Regulations, 2013 CFR

2013-01-01

... radiation room of a panoramic irradiator after an irradiation, the irradiator operator shall use a survey... irradiation, the irradiator operator shall: (1) Visually inspect the entire radiation room to verify that no...

Radiation protection measures: Implications on the design of neurosurgery operating rooms.

PubMed

Delgado-López, Pedro David; Sánchez-Jiménez, Javier; Herrero-Gutiérrez, Ana Isabel; Inclán-Cuesta, María Teresa; Corrales-García, Eva María; Martín-Alonso, Javier; Galacho-Harriero, Ana María; Rodríguez-Salazar, Antonio

To describe pros and cons of some radiation protection measures and the implications on the design of a neurosurgery operating room. Concurring with the acquisition and use of an O-arm device, a structural remodeling of our neurosurgery operating room was carried out. The theater was enlarged, the shielding was reinforced and a foldable leaded screen was installed inside the operating room. Radiation doses were measured in front of and behind the screen. The screen provides whole-body radiation protection for all the personnel inside the theater (effective dose <5μSv at 2,5 m from the gantry per O-arm exploration; 0,0μSv received behind the screen per O-arm exploration; and undetectable cumulative annual radiation dose behind the screen), obviates the need for leaded aprons and personal dosimeters, and minimizes the circulation of personnel. Enlarging the size of the operating room allows storing the equipment inside and minimizes the risk of collision and contamination. Rectangular rooms provide greater distance from the source of radiation. Floor, ceiling and walls shielding, a rectangular-shaped and large enough theater, the presence of a foldable leaded screen, and the security systems precluding an unexpected irruption into the operating room during irradiation are relevant issues to consider when designing a neurosurgery operating theater. Copyright © 2018 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

KSC-2009-5248

NASA Image and Video Library

2009-09-25

CAPE CANAVERAL, Fla. – This ribbon cutting officially turns over NASA Kennedy Space Center's Launch Control Center Firing Room 1 from the Space Shuttle Program to the Constellation Program. Participating are (from left) Pepper Phillips, director of the Constellation Project Office at Kennedy; Bob Cabana, Kennedy's director; Robert Crippen, former astronaut; Jeff Hanley, manager of the Constellation Program at NASA's Johnson Space Center; and Nancy Bray, deputy director of Center Operations at Kennedy. The room has undergone demolition and construction and been outfitted with consoles for the upcoming Ares I-X rocket flight test targeted for launch on Oct. 27. As the center of launch operations at Kennedy since the Apollo Program, the Launch Control Center, or LCC, has played a central role in NASA's human spaceflight programs. Firing Room 1 was the first operational firing room constructed. From this room, controllers launched the first Saturn V, the first crewed flight of Saturn V, the first crewed mission to the moon and the first space shuttle. Firing Room 1 will continue this tradition of firsts when controllers launch the Constellation Program's first flight test. Also, this firing room will be the center of operations for the upcoming Ares I and Orion operations. Photo credit: NASA/Kim Shiflett

Auto identification technology and its impact on patient safety in the Operating Room of the Future.

PubMed

Egan, Marie T; Sandberg, Warren S

2007-03-01

Automatic identification technologies, such as bar coding and radio frequency identification, are ubiquitous in everyday life but virtually nonexistent in the operating room. User expectations, based on everyday experience with automatic identification technologies, have generated much anticipation that these systems will improve readiness, workflow, and safety in the operating room, with minimal training requirements. We report, in narrative form, a multi-year experience with various automatic identification technologies in the Operating Room of the Future Project at Massachusetts General Hospital. In each case, the additional human labor required to make these ;labor-saving' technologies function in the medical environment has proved to be their undoing. We conclude that while automatic identification technologies show promise, significant barriers to realizing their potential still exist. Nevertheless, overcoming these obstacles is necessary if the vision of an operating room of the future in which all processes are monitored, controlled, and optimized is to be achieved.

Game theory: applications for surgeons and the operating room environment.

PubMed

McFadden, David W; Tsai, Mitchell; Kadry, Bassam; Souba, Wiley W

2012-11-01

Game theory is an economic system of strategic behavior, often referred to as the "theory of social situations." Very little has been written in the medical literature about game theory or its applications, yet the practice of surgery and the operating room environment clearly involves multiple social situations with both cooperative and non-cooperative behaviors. A comprehensive review was performed of the medical literature on game theory and its medical applications. Definitive resources on the subject were also examined and applied to surgery and the operating room whenever possible. Applications of game theory and its proposed dilemmas abound in the practicing surgeon's world, especially in the operating room environment. The surgeon with a basic understanding of game theory principles is better prepared for understanding and navigating the complex Operating Room system and optimizing cooperative behaviors for the benefit all stakeholders. Copyright © 2012 Mosby, Inc. All rights reserved.

[Comprehensive system integration and networking in operating rooms].

PubMed

Feußner, H; Ostler, D; Kohn, N; Vogel, T; Wilhelm, D; Koller, S; Kranzfelder, M

2016-12-01

A comprehensive surveillance and control system integrating all devices and functions is a precondition for realization of the operating room of the future. Multiple proprietary integrated operation room systems are currently available with a central user interface; however, they only cover a relatively small part of all functionalities. Internationally, there are at least three different initiatives to promote a comprehensive systems integration and networking in the operating room: the Japanese smart cyber operating theater (SCOT), the American medical device plug-and-play interoperability program (MDPnP) and the German secure and dynamic networking in operating room and hospital (OR.NET) project supported by the Federal Ministry of Education and Research. Within the framework of the internationally advanced OR.NET project, prototype solution approaches were realized, which make short-term and mid-term comprehensive data retrieval systems probable. An active and even autonomous control of the medical devices by the surveillance and control system (closed loop) is expected only in the long run due to strict regulatory barriers.

[Working conditions in the operating room: surgeons surveyed during the annual meeting of the German society of surgery 2004].

PubMed

Matern, U; Koneczny, S

2006-10-01

For the evaluation of working place conditions in the operating room a survey was conducted among the surgeons working in German hospitals. Questions regarded the personal profile, the architectural situation, the devices and instruments as well as the working posture. The answers to the 60 questions display a high potential for improvement within all fields. Every single group working in the operating room, as well as their professional organizations are asked to work on the optimization of the working place conditions in the operating room in terms of improvement of quality and efficiency.

Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection.

PubMed

Basques, Bryce A; Golinvaux, Nicholas S; Bohl, Daniel D; Yacob, Alem; Toy, Jason O; Varthi, Arya G; Grauer, Jonathan N

2014-10-15

Retrospective database review. To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. The American College of Surgeons National Surgical Quality Improvement Program database, which includes data from more than 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without the use of an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. A total of 23,670 elective spine procedures were identified, of which 2226 (9.4%) used an operating microscope. The average patient age was 55.1±14.4 years. The average operative time (incision to closure) was 125.7±82.0 minutes.Microscope use was associated with minor increases in preoperative room time (+2.9 min, P=0.013), operative time (+13.2 min, P<0.001), and total room time (+18.6 min, P<0.001) on multivariate analysis.A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and nonmicroscope groups for occurrence of any infection, superficial surgical site infection, deep surgical site infection, organ space infection, or sepsis/septic shock, regardless of surgery type. We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. 3.

Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection

PubMed Central

Basques, Bryce A.; Golinvaux, Nicholas S.; Bohl, Daniel D.; Yacob, Alem; Toy, Jason O.; Varthi, Arya G.; Grauer, Jonathan N.

2014-01-01

Study Design Retrospective database review. Objective To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Summary of Background Data Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, which includes data from over 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. Results A total of 23,670 elective spine procedures were identified, of which 2,226 (9.4%) used an operating microscope. The average patient age was 55.1 ± 14.4 years. The average operative time (incision to closure) was 125.7 ± 82.0 minutes. Microscope use was associated with minor increases in preoperative room time (+2.9 minutes, p=0.013), operative time (+13.2 minutes, p<0.001), and total room time (+18.6 minutes, p<0.001) on multivariate analysis. A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and non-microscope groups for occurrence of any infection, superficial surgical site infection (SSI), deep SSI, organ space infection, or sepsis/septic shock, regardless of surgery type. Conclusions We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. PMID:25188600

Information Foraging in Nuclear Power Plant Control Rooms

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

R.L. Boring

2011-09-01

nformation foraging theory articulates the role of the human as an 'informavore' that seeks information and follows optimal foraging strategies (i.e., the 'information scent') to find meaningful information. This paper briefly reviews the findings from information foraging theory outside the nuclear domain and then discusses the types of information foraging strategies operators employ for normal and off-normal operations in the control room. For example, operators may employ a predatory 'wolf' strategy of hunting for information in the face of a plant upset. However, during routine operations, the operators may employ a trapping 'spider' strategy of waiting for relevant indicators tomore » appear. This delineation corresponds to information pull and push strategies, respectively. No studies have been conducted to determine explicitly the characteristics of a control room interface that is optimized for both push and pull information foraging strategies, nor has there been empirical work to validate operator performance when transitioning between push and pull strategies. This paper explores examples of control room operators as wolves vs. spiders and con- cludes by proposing a set of research questions to investigate information foraging in control room settings.« less

Flow analysis of airborne particles in a hospital operating room

NASA Astrophysics Data System (ADS)

Faeghi, Shiva; Lennerts, Kunibert

2016-06-01

Preventing airborne infections during a surgery has been always an important issue to deliver effective and high quality medical care to the patient. One of the important sources of infection is particles that are distributed through airborne routes. Factors influencing infection rates caused by airborne particles, among others, are efficient ventilation and the arrangement of surgical facilities inside the operating room. The paper studies the ventilation airflow pattern in an operating room in a hospital located in Tehran, Iran, and seeks to find the efficient configurations with respect to the ventilation system and layout of facilities. This study uses computational fluid dynamics (CFD) and investigates the effects of different inflow velocities for inlets, two pressurization scenarios (equal and excess pressure) and two arrangements of surgical facilities in room while the door is completely open. The results show that system does not perform adequately when the door is open in the operating room under the current conditions, and excess pressure adjustments should be employed to achieve efficient results. The findings of this research can be discussed in the context of design and controlling of the ventilation facilities of operating rooms.

A simulator-based nuclear reactor emergency response training exercise.

PubMed

Waller, Edward; Bereznai, George; Shaw, John; Chaput, Joseph; Lafortune, Jean-Francois

Training offsite emergency response personnel basic awareness of onsite control room operations during nuclear power plant emergency conditions was the primary objective of a week-long workshop conducted on a CANDU® virtual nuclear reactor simulator available at the University of Ontario Institute of Technology, Oshawa, Canada. The workshop was designed to examine both normal and abnormal reactor operating conditions, and to observe the conditions in the control room that may have impact on the subsequent offsite emergency response. The workshop was attended by participants from a number of countries encompassing diverse job functions related to nuclear emergency response. Objectives of the workshop were to provide opportunities for participants to act in the roles of control room personnel under different reactor operating scenarios, providing a unique experience for participants to interact with the simulator in real-time, and providing increased awareness of control room operations during accident conditions. The ability to "pause" the simulator during exercises allowed the instructors to evaluate and critique the performance of participants, and to provide context with respect to potential offsite emergency actions. Feedback from the participants highlighted (i) advantages of observing and participating "hands-on" with operational exercises, (ii) their general unfamiliarity with control room operational procedures and arrangements prior to the workshop, (iii) awareness of the vast quantity of detailed control room procedures for both normal and transient conditions, and (iv) appreciation of the increased workload for the operators in the control room during a transient from normal operations. Based upon participant feedback, it was determined that the objectives of the training had been met, and that future workshops should be conducted.

Impact of the reduction of anaesthesia turnover time on operating room efficiency.

PubMed

Sokolovic, E; Biro, P; Wyss, P; Werthemann, C; Haller, U; Spahn, D; Szucs, T

2002-08-01

We investigated whether an increase in anaesthesia staffing to permit induction of anaesthesia before the previous case had ended ('overlapping') would increase overall efficiency in the operating room. Hitherto, the average duration of operating sessions was too long, thus impeding the timely commencement of physicians' ward duties. The investigation was designed as a prospective, non-randomized, interrupted time-series analysis divided into three phases: (a) a baseline of 3.5 months, (b) a 2.5 month intervention phase, in which anaesthesia staffing was increased by one attending physician and one nurse, and (c) a further 2 months under baseline conditions. Data focussed on process management were collected from operating room staff, anaesthesia personnel and surgeons using a structured questionnaire collected daily during the entire study. Turnover time between consecutive operations decreased from 65 to 52 min per operation (95% CI: 9; 17; P = 0.0001). Operating room occupancy increased from 4:28 to 5:27 h day-1 (95% CI: 50; 68; P = 0.005). The surgeons began their work on the ward 35 min (95% CI: 30; 40) later than before the intervention and their overtime increased from 22:36 to 139:50 h. The time between surgical operations decreased significantly. Increased operating room efficiency owing to overlapping induction of anaesthesia allows more intense scheduling of operations. Thus, physicians and nurses can be released to spend more time with their patients in the ward. Improving the efficiency of the operating room alone is insufficient to improve human resource management at all levels of a surgical clinic.

[Handling modern imaging procedures in a high-tech operating room].

PubMed

Hüfner, T; Citak, M; Imrecke, J; Krettek, C; Stübig, T

2012-03-01

Operating rooms are the central unit in the hospital network in trauma centers. In this area, high costs but also high revenues are generated. Modern operating theater concepts as an integrated model have been offered by different companies since the early 2000s. Our hypothesis is that integrative concepts for operating rooms, in addition to improved operating room ergonomics, have the potential for measurable time and cost savings. In our clinic, an integrated operating room concept (I-Suite, Stryker, Duisburg) was implemented after analysis of the problems. In addition to the ceiling-mounted arrangement, the system includes an endoscopy unit, a navigation system, and a voice control system. In the first 6 months (9/2005 to 2/2006), 112 procedures were performed in the integrated operating room: 34 total knee arthroplasties, 12 endoscopic spine surgeries, and 66 inpatient arthroscopic procedures (28 shoulder and 38 knee reconstructions). The analysis showed a daily saving of 22-45 min, corresponding to 15-30% of the daily changeover times, calculated to account for potential savings in the internal cost allocation of 225-450 EUR. A commercial operating room concept was evaluated in a pilot phase in terms of hard data, including time and cost factors. Besides the described effects further savings might be achieved through the effective use of voice control and the benefit of the sterile handle on the navigation camera, since waiting times for an additional nurse are minimized. The time of the procedure of intraoperative imaging is also reduced due to the ceiling-mounted concept, as the C-arm can be moved freely in the operating theater without hindering cables. By these measures and ensuing improved efficiency, the initial high costs for the implementation of the system may be cushioned over time.

Operating room myths: what is the evidence for common practices.

PubMed

Pada, Surinder; Perl, Trish M

2015-08-01

In order to ensure patient safety and prevent surgical site infections (SSIs), operating theaters/rooms have evolved into complex, highly technical environments. Prevention of healthcare-associated infections, and strategies to limit patient harm, have gained momentum over the last decade. This article aims to examine and dispute some commonly held beliefs with specific reference to: laminar airflow, noise and operating theater door openings and how these impact SSI. Laminar airflow may not be necessary for prosthetic implant surgery. Some recent data suggest that there may be patient harm. With the development of better surgical techniques and perioperative care, such costly systems may not be needed. Operating rooms with a high number of door openings have also been shown to experience higher SSI rates, as have operating rooms with high noise levels. These may serve as surrogate markers for operating room discipline. Initiatives which target these areas may be worth considering when devising strategies to reduce SSIs. Improved surveillance systems for SSIs are needed and should include operating theater airflow type. This will allow further analysis of the effect of laminar air flow on SSIs and provide evidence for a decisive recommendation. Cultivating a culture of good operating theater discipline may also reduce SSIs.

Cognitive Task Analysis of the HALIFAX-Class Operations Room Officer

DTIC Science & Technology

1999-03-10

Image Cover Sheet CLASSIFICATION SYSTEM NUMBER 510918 UNCLASSIFIED llllllllllllllllllllllllllllllllllllllll TITLE COGNITIVE TASK ANALYSIS OF THE...DATES COVERED 00-00-1999 to 00-00-1999 4. TITLE AND SUBTITLE Cognitive Task Analysis of the HALIFAX-Class Operations Room Officer 5a. CONTRACT...Ontario . ~ -- . ’ c ... - Incorporated Cognitive Task Analysis of the HALIFAX-Class Operations Room Officer: PWGSC Contract No. W7711-7-7404/001/SV

[Cleanliness in the operating room].

PubMed

Suzuki, Toshiyasu

2010-05-01

With regard to recent findings in the cleanliness of the operating room, concerning handwashing and performing operations, the traditional method of excessive scrubbing using a brush is not effective, and handwashing using only an alcohol-containing antiseptic hand rub (rubbing method) has become common practice. Use of a brush has already been abolished in some medical institutions. In addition, sterilized water used for handwashing when performing operations has no scientific basis and use of tap water is considered sufficient. Furthermore, the concept of operating room zoning has also undergone a dramatic change. It was discovered that a layout focusing on work efficiency is more desirable than the one that follows an excessively rigid zoning pattern. One-footwear System not requiring change of shoes also has various advantages in improving the efficiency of the operation room, and this is thought to become commonplace in the future.

Operator Support System Design forthe Operation of RSG-GAS Research Reactor

NASA Astrophysics Data System (ADS)

Santoso, S.; Situmorang, J.; Bakhri, S.; Subekti, M.; Sunaryo, G. R.

2018-02-01

The components of RSG-GAS main control room are facing the problem of material ageing and technology obsolescence as well, and therefore the need for modernization and refurbishment are essential. The modernization in control room can be applied on the operator support system which bears the function in providing information for assisting the operator in conducting diagnosis and actions. The research purpose is to design an operator support system for RSG-GAS control room. The design was developed based on the operator requirement in conducting task operation scenarios and the reactor operation characteristics. These scenarios include power operation, low power operation and shutdown/scram reactor. The operator support system design is presented in a single computer display which contains structure and support system elements e.g. operation procedure, status of safety related components and operational requirements, operation limit condition of parameters, alarm information, and prognosis function. The prototype was developed using LabView software and consisted of components structure and features of the operator support system. Information of each component in the operator support system need to be completed before it can be applied and integrated in the RSG-GAS main control room.

Study of a dry room in a battery manufacturing plant using a process model

NASA Astrophysics Data System (ADS)

Ahmed, Shabbir; Nelson, Paul A.; Dees, Dennis W.

2016-09-01

The manufacture of lithium ion batteries requires some processing steps to be carried out in a dry room, where the moisture content should remain below 100 parts per million. The design and operation of such a dry room adds to the cost of the battery. This paper studied the humidity management of the air to and from the dry room to understand the impact of design and operating parameters on the energy demand and the cost contribution towards the battery manufacturing cost. The study was conducted with the help of a process model for a dry room with a volume of 16,000 cubic meters. For a defined base case scenario it was found that the dry room operation has an energy demand of approximately 400 kW. The paper explores some tradeoffs in design and operating parameters by looking at the humidity reduction by quenching the make-up air vs. at the desiccant wheel, and the impact of the heat recovery from the desiccant regeneration cycle.

The Operating Room of the Future Versus the Future of the Operating Room.

PubMed

Kassam, Amin B; Rovin, Richard A; Walia, Sarika; Chakravarthi, Srikant; Celix, Juanita; Jennings, Jonathan; Khalili, Sammy; Gonen, Lior; Monroy-Sosa, Alejandro; Fukui, Melanie B

2017-06-01

Technological advancement in the operating room is evolving into a dynamic system mirroring that of the aeronautics industry. Through data visualization, information is continuously being captured, collected, and stored on a scalable informatics platform for rapid, intuitive, iterative learning. The authors believe this philosophy (paradigm) will feed into an intelligent informatics domain fully accessible to all and geared toward precision, cell-based therapy in which tissue can be targeted and interrogated in situ. In the future, the operating room will be a venue that facilitates this real-time tissue interrogation, which will guide in situ therapeutics to restore the state of health. Copyright © 2017 Elsevier Inc. All rights reserved.

40 CFR 62.15105 - Who must complete the operator training course? By when?

Code of Federal Regulations, 2011 CFR

2011-07-01

... supervisors, and control room operators who have obtained full certification from the American Society of... supervisors, and control room operators who have obtained provisional certification from the American Society...

40 CFR 62.15105 - Who must complete the operator training course? By when?

Code of Federal Regulations, 2010 CFR

2010-07-01

... supervisors, and control room operators who have obtained full certification from the American Society of... supervisors, and control room operators who have obtained provisional certification from the American Society...

Indoor air bacterial load and antibiotic susceptibility pattern of isolates in operating rooms and surgical wards at jimma university specialized hospital, southwest ethiopia.

PubMed

Genet, Chalachew; Kibru, Gebre; Tsegaye, Wondewosen

2011-03-01

Surgical site infection is the second most common health care associated infection. One of the risk factors for such infection is bacterial contamination of operating rooms' and surgical wards' indoor air. In view of that, the microbiological quality of air can be considered as a mirror of the hygienic condition of these rooms. Thus, the objective of this study was to determine the bacterial load and antibiotic susceptibility pattern of isolates in operating rooms' and surgical wards' indoor air of Jimma University Specialized Hospital. A cross sectional study was conducted to measure indoor air microbial quality of operating rooms and surgical wards from October to January 2009/2010 on 108 indoor air samples collected in twelve rounds using purposive sampling technique by Settle Plate Method (Passive Air Sampling following 1/1/1 Schedule). Sample processing and antimicrobial susceptibility testing were done following standard bacteriological techniques. The data was analyzed using SPSS version 16 and interpreted according to scientifically determined baseline values initially suggested by Fisher. The mean aerobic colony counts obtained in OR-1(46cfu/hr) and OR-2(28cfu/hr) was far beyond the set 5-8cfu/hr acceptable standards for passive room. Similarly the highest mean aerobic colony counts of 465cfu/hr and 461cfu/hr were observed in Female room-1 and room-2 respectively when compared to the acceptable range of 250-450cfu/hr. In this study only 3 isolates of S. pyogenes and 48 isolates of S. aureus were identified. Over 66% of S. aureus was identified in Critical Zone of Operating rooms. All isolates of S. aureus showed 100% and 82.8% resistance to methicillin and ampicillin respectively. Higher degree of aerobic bacterial load was measured from operating rooms' and surgical wards' indoor air. Reducing foot trafficking, improving the ventilation system and routine cleaning has to be made to maintain the aerobic bacteria load with in optimal level.

Prevention of 3 "never events" in the operating room: fires, gossypiboma, and wrong-site surgery.

PubMed

Zahiri, Hamid R; Stromberg, Jeffrey; Skupsky, Hadas; Knepp, Erin K; Folstein, Matthew; Silverman, Ronald; Singh, Devinder

2011-03-01

This study sought to identify and provide preventative recommendations for potentially devastating safety violations in the operating room. A Medline database search from 1950 to current using the terms patient safety and operating room was conducted. All topics identified were reviewed. Three patient safety violations with potential for immediate and devastating outcomes were selected for discussion using evidence-based literature. The search identified 2851 articles, 807 of which were directly related to patient safety in the operating room. Topics addressed by these 807 included infectious complications (26%), fires (11%), communication/teamwork (6%), retained foreign objects (3%), safety checklists (1%), and wrong-site surgery (1%). Fires, gossypiboma, and wrong-site surgery were selected for discussion. Although fire, gossypiboma, and wrong-site surgery should be "never events" in the operating room, they continue to persist as 3 common patient safety violations. This study provides the epidemiology, common etiologies, and evidence-based preventative recommendations for each.

Simulating environmental and psychological acoustic factors of the operating room.

PubMed

Bennett, Christopher L; Dudaryk, Roman; Ayers, Andrew L; McNeer, Richard R

2015-12-01

In this study, an operating room simulation environment was adapted to include quadraphonic speakers, which were used to recreate a composed clinical soundscape. To assess validity of the composed soundscape, several acoustic parameters of this simulated environment were acquired in the presence of alarms only, background noise only, or both. These parameters were also measured for comparison from size-matched operating rooms at Jackson Memorial Hospital. The parameters examined included sound level, reverberation time, and predictive metrics of speech intelligibility in quiet and noise. It was found that the sound levels and acoustic parameters were comparable between the simulated environment and the actual operating rooms. The impact of the background noise on the perception of medical alarms was then examined, and was found to have little impact on the audibility of the alarms. This study is a first in kind report of a comparison between the environmental and psychological acoustical parameters of a hospital simulation environment and actual operating rooms.

Retrospective Chart Review of Skin-to-Skin Contact in the Operating Room and Administration of Analgesic and Anxiolytic Medication to Women After Cesarean Birth.

PubMed

Wagner, Debra L; Lawrence, Stephen; Xu, Jing; Melsom, Janice

2018-04-01

Transporting a newborn out of the operating room after cesarean birth can contribute to maternal awareness of discomfort, anxiety, and the need for administration of analgesics and anxiolytics for relief. This retrospective study analyzed the association between skin-to-skin contact in the operating room and administration of analgesics and anxiolytics to women in the operating and recovery rooms after cesarean birth. Our results indicated a trend toward decreased medication administration for women who experienced skin-to-skin contact and add to evidence supporting the incorporation of skin-to-skin contact in the operating room as the standard of care for cesarean birth. This practice has the potential to enhance the birth experience, promote breastfeeding, and provide greater safety with less exposure to opioids and benzodiazepines for women and their newborns. © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

Software Support during a Control Room Upgrade

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

Michele Joyce; Michael Spata; Thomas Oren

2005-09-21

In 2004, after 14 years of accelerator operations and commissioning, Jefferson Lab renovated its main control room. Changes in technology and lessons learned during those 14 years drove the control room redesign in a new direction, one that optimizes workflow and makes critical information and controls available to everyone in the control room. Fundamental changes in a variety of software applications were required to facilitate the new operating paradigm. A critical component of the new control room design is a large-format video wall that is used to make a variety of operating information available to everyone in the room. Analogmore » devices such as oscilloscopes and function generators are now displayed on the video wall through two crosspoint switchers: one for analog signals and another for video signals. A new software GUI replaces manual configuration of the oscilloscopes and function generators and helps automate setup. Monitoring screens, customized for the video wall, now make important operating information visible to everyone, not just a single operator. New alarm handler software gives any operator, on any workstation, access to all alarm handler functionality, and multiple users can now contribute to a single electronic logbook entry. To further support the shift to distributed access and control, many applications have been redesigned to run on servers instead of on individual workstations.« less

Performance analysis of air conditioning system and airflow simulation in an operating theater

NASA Astrophysics Data System (ADS)

Alhamid, Muhammad Idrus; Budihardjo, Rahmat

2018-02-01

The importance of maintaining performance of a hospital operating theater is to establish an adequate circulation of clean air within the room. The parameter of air distribution in a space should be based on Air Changes per Hour (ACH) to maintain a positive room pressure. The dispersion of airborne particles in the operating theater was governed by regulating the air distribution so that the operating theater meets clean room standards ie ISO 14664 and ASHRAE 170. Here, we introduced several input parameters in a simulation environment to observe the pressure distribution in the room. Input parameters were air temperature, air velocity and volumetric flow rate entering and leaving room for existing and designed condition. In the existing operating theatre, several observations were found. It was found that the outlet air velocity at the HEPA filter above the operating table was too high thus causing a turbulent airflow pattern. Moreover, the setting temperature at 19°C was found to be too low. The supply of air into the room was observed at lower than 20 ACH which is under the standard requirement. Our simulation using FloVent 8.2™ program showed that not only airflow turbulence could be reduced but also the amount of particle contamination could also be minimized.

Implementation and evaluation of an interprofessional simulation-based education program for undergraduate nursing students in operating room nursing education: a randomized controlled trial.

PubMed

Wang, Rongmei; Shi, Nianke; Bai, Jinbing; Zheng, Yaguang; Zhao, Yue

2015-07-09

The present study was designed to implement an interprofessional simulation-based education program for nursing students and evaluate the influence of this program on nursing students' attitudes toward interprofessional education and knowledge about operating room nursing. Nursing students were randomly assigned to either the interprofessional simulation-based education or traditional course group. A before-and-after study of nursing students' attitudes toward the program was conducted using the Readiness for Interprofessional Learning Scale. Responses to an open-ended question were categorized using thematic content analysis. Nursing students' knowledge about operating room nursing was measured. Nursing students from the interprofessional simulation-based education group showed statistically different responses to four of the nineteen questions in the Readiness for Interprofessional Learning Scale, reflecting a more positive attitude toward interprofessional learning. This was also supported by thematic content analysis of the open-ended responses. Furthermore, nursing students in the simulation-based education group had a significant improvement in knowledge about operating room nursing. The integrated course with interprofessional education and simulation provided a positive impact on undergraduate nursing students' perceptions toward interprofessional learning and knowledge about operating room nursing. Our study demonstrated that this course may be a valuable elective option for undergraduate nursing students in operating room nursing education.

In-office vs. operating room procedures for recurrent respiratory papillomatosis.

PubMed

Miller, Anya J; Gardner, Glendon M

2017-01-01

We conducted a study to analyze hospital and patient costs, outcomes, and patient satisfaction among adults undergoing in-office and operating room procedures for the treatment of recurrent respiratory papillomatosis. Our final study population was made up of 17 patients-1 man and 16 women, aged 30 to 86 years (mean: 62). The mean number of in-office laser procedures per patient was 4.2, and the mean interval between procedures was 5.4 months (although 10 patients underwent only 1 office procedure); the mean number of operating room procedures was 13.5, and the mean interval between procedures was 14.3 months. An equal number of patients reported complications or adverse events with the two types of procedures-5 each. The difference in cost between the office procedure (mean: $3,413.00) and the operating room procedure (mean: $12,382.59) was almost $9,000, but these savings were offset by the fact that the office procedures needed to be performed three times as often. Patients reported slightly more anxiety and discomfort during the office procedures and, overall, they appeared to prefer the operating room procedure. We conclude that office procedures are significantly more cost-effective than operating room procedures, but their use may be limited by patient tolerance and the increased frequency of the procedure.

Buoyancy driven acceleration in a hospital operating room indoor environment

NASA Astrophysics Data System (ADS)

McNeill, James; Hertzberg, Jean; Zhai, John

2011-11-01

In hospital operating rooms, centrally located non-isothermal ceiling jets provide sterile air for protecting the surgical site from infectious particles in the room air as well as room cooling. Modern operating rooms are requiring larger temperature differences to accommodate increasing cooling loads for heat gains from medical equipment. This trend may lead to significant changes in the room air distribution patterns that may sacrifice the sterile air field across the surgical table. Quantitative flow visualization experiments using laser sheet illumination and RANS modeling of the indoor environment were conducted to demonstrate the impact of the indoor environment thermal conditions on the room air distribution. The angle of the jet shear layer was studied as function of the area of the vena contracta of the jet, which is in turn dependent upon the Archimedes number of the jet. Increases in the buoyancy forces cause greater air velocities in the vicinity of the surgical site increasing the likelihood of deposition of contaminants in the flow field. The outcome of this study shows the Archimedes number should be used as the design parameter for hospital operating room air distribution in order to maintain a proper supply air jet for covering the sterile region. This work is supported by ASHRAE.

The Attitudes and Behaviors of Anaesthesiology and Reanimation Specialists in Anaesthesia Care Applications Outside the Operating Room in Turkey: A Survey Study

PubMed Central

Yıldız, Mehmet; İyilikçi, Leyla; Duru, Seden; Hancı, Volkan

2014-01-01

Objective We aimed to investigate the attitudes and behaviors of anaesthesiologists in “non-operating room anaesthesia” applications, which can be described as anaesthesia applications performed outside the operating room, and their reflection on practice all over Turkey. Methods Our study was conducted between November 5, 2012 and January 7, 2013 with the approval of the Research Ethics Board. Survey data were obtained through distributing printed questionnaires to be completed either by hand or via the web. The questionnaire consisted of 38 questions. The data obtained were analyzed with the Statistical Package for Social Sciences (SPSS) program. Results A total of 500 anaesthesiologists replied to our survey; 93% of anaesthesia specialists reported that there was a request that the anaesthesia and anaesthesia outside the operating room was given in their institution. Among anaesthesiologists, 56% reported that there were other sections that can provide sedation other than the anaesthesiology department in their institutions. Anaesthesia care team members; equipment; anaesthetic techniques; monitoring methods; and hypnotic, analgesic, and antagonist agents had statistically significant differences according to the participants’ institutions. Equipment used in the anaesthesia practice outside the operating room, anaesthesia, and monitoring methods had statistically significant differences according to geographical distribution (p<0.05). Conclusion Outside the operating room, anaesthesia practices and security measures are compliant with the standards set by the guidelines, the key to the prevention of complications. In our study, the current status of anaesthetic procedures outside the operating room in our country have been analyzed. PMID:27366420

9 CFR 355.15 - Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly...

Code of Federal Regulations, 2012 CFR

2012-01-01

... storage rooms; outer premises, docks, driveways, etc.; fly-breeding material; nuisances. 355.15 Section....15 Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly... departments where certified products are prepared, handled, or stored. Docks and areas where cars and vehicles...

9 CFR 355.15 - Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly...

Code of Federal Regulations, 2014 CFR

2014-01-01

... storage rooms; outer premises, docks, driveways, etc.; fly-breeding material; nuisances. 355.15 Section....15 Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly... departments where certified products are prepared, handled, or stored. Docks and areas where cars and vehicles...

9 CFR 355.15 - Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly...

Code of Federal Regulations, 2013 CFR

2013-01-01

... storage rooms; outer premises, docks, driveways, etc.; fly-breeding material; nuisances. 355.15 Section....15 Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly... departments where certified products are prepared, handled, or stored. Docks and areas where cars and vehicles...

The Doctrinal Basis for Medical Stability Operations

DTIC Science & Technology

2010-01-01

lead actor, preferably a HN agency, but sometimes the military must take the lead in medical stability operations when overwhelming violence prevents...34 Assessment Tasks Administration of hospital Communications Obstetrics , Pediatrics, Emergency room. Operating room Nursing procedures Medical supply

Estimation of Blood Loss: Comparing the Accuracy of Operating Room Personnel

DTIC Science & Technology

1991-02-01

Operating Room Services to reserve an unutilized room for the day of the experiment . The experimental period was on June 14, 1990, from 8:30 AM to 12:00...moderate loss he may experience a decrease in pulse pressure, tachycardia, tachypnea, and postural hypotension. A major blood loss may constitute...during the procedure. In discussing his experience with 3,000 transfusions, Blain (1929) emphasized that the amount of blood lost during operations

Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System.

PubMed

Althausen, Peter L; Shannon, Steven; Owens, Brianne; Coll, Daniel; Cvitash, Michael; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J

2016-12-01

The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospitalbased PAs on orthopaedic trauma care at a level II community hospital. Retrospective case series. Level II trauma center. One thousand one hundred four trauma patients with orthopaedic injuries. PA involvement. Emergency room data such as triage time, time until seen by the orthopedic service, and total emergency room time was recorded. Operating room data such as time to surgery, set-up time, total operating time, and out of room time was entered as well. Charts were reviewed to determine if patients were given postoperative antibiotics and Deep Venous Thrombosis (DVT) prophylaxis. Intraoperative and postoperative complications were noted, and lengths of stay were calculated for all patients. At our institution, PA collections from patient care cover only 50% of their costs for salary and benefits. However, with PA involvement, trauma patients with orthopedic injuries were seen 205 minutes faster (P = 0.006), total Emergency Room (ER) time decreased 175 minutes (P = 0.0001), and time to surgery improved 360 minutes (P . 0.03). Operating room parameters were minimally improved, but postoperative DVT prophylaxis increased by a mean of 6.73% (P = 0.0084), postoperative antibiotic administration increased by 2.88% (P = 0.0302), and there was a 4.67% decrease in postoperative complications (P = 0.0034). Average length of stay decreased by 0.61 days (P = 0.27). Although the PA's collections do not cover their costs, the indirect economic and patient care impacts are clear. By increasing emergency room pull through and decreasing times to Operating Room (OR), operative times, lengths of stay, and complications, their existence is clearly beneficial to hospitals, physicians, and patients as well. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

9 CFR 355.15 - Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly...

Code of Federal Regulations, 2010 CFR

2010-01-01

...-breeding material; nuisances. All operating and storage rooms and departments of inspected plants used for... storage rooms; outer premises, docks, driveways, etc.; fly-breeding material; nuisances. 355.15 Section... premises of every inspected plant shall be kept in clean and orderly condition. All catchbasins on the...

9 CFR 355.15 - Inedible material operating and storage rooms; outer premises, docks, driveways, etc.; fly...

Code of Federal Regulations, 2011 CFR

2011-01-01

...-breeding material; nuisances. All operating and storage rooms and departments of inspected plants used for... storage rooms; outer premises, docks, driveways, etc.; fly-breeding material; nuisances. 355.15 Section... premises of every inspected plant shall be kept in clean and orderly condition. All catchbasins on the...

Study of a dry room in a battery manufacturing plant using a process model

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

Ahmed, Shabbir; Nelson, Paul A.; Dees, Dennis W.

The manufacture of lithium ion batteries requires some processing steps to be carried out in a dry room, where the moisture content should remain below 100 parts per million. The design and operation of such a dry room adds to the cost of the battery. This paper studies the humidity management of the air to and from the dry room to understand the impact of design and operating parameters on the energy demand and the cost contribution towards the battery manufacturing cost. The study is conducted with the help of a process model for a dry room with a volumemore » of 16000 cubic meters. For a defined base case scenario it is found that the dry room operation has an energy demand of approximately 400 kW. The paper explores some tradeoffs in design and operating parameters by looking at the humidity reduction by quenching the make-up air vs. at the desiccant wheel, and the impact of the heat recovery from the desiccant regeneration cycle.« less

Lean management in academic surgery.

PubMed

Collar, Ryan M; Shuman, Andrew G; Feiner, Sandra; McGonegal, Amy K; Heidel, Natalie; Duck, Mary; McLean, Scott A; Billi, John E; Healy, David W; Bradford, Carol R

2012-06-01

Lean is a management system designed to enhance productivity by eliminating waste. Surgical practice offers many opportunities for improving efficiency. Our objective was to determine whether systematic implementation of lean thinking in an academic otolaryngology operating room improves efficiency and profitability and preserves team morale and educational opportunities. In an 18-month prospective quasi-experimental study, a multidisciplinary task force systematically implemented lean thinking within an otolaryngology operating room of an academic health system. Operating room turnover time and turnaround time were measured during a baseline period; an observer-effect period in which workers were made aware that their efficiency was being measured but before implementing lean changes; and an intervention period after redesign principles had been used. The impact on teamwork, morale, and surgical resident education were measured during the baseline and intervention periods through validated surveys. A profit model was applied to estimate the financial implications of the study. There was no difference between the baseline and observer-effect periods of the study for turnover time (p = 0.98) or turnaround time (p = 0.20). During the intervention period, the mean turnover time and turnaround time were significantly shorter than during the baseline period (29 vs 38 minutes; p < 0.001 and 69 vs 89 minutes; p < 0.001, respectively). The composite morale score suggested improved morale after implementation (p = 0.011). Educational metrics were unchanged before and after implementation. The annual opportunity revenue for the involved operating room is $330,000; when extrapolated throughout the operating rooms, lean thinking could create 6,500 hours of capacity annually. Application of lean management techniques to a single operating room and surgical service improved operating room efficiency and morale, sustained resident education, and can provide considerable financial gains when scaled to an entire academic surgical suite. Copyright © 2012. Published by Elsevier Inc.

Evaluation of the disruptive behaviors among treatment teams and its reflection on the therapy process of patients in the operating room: The impact of personal conflicts

PubMed Central

Maddineshat, Maryam; Hashemi, Mitra; Tabatabaeichehr, Mahbubeh

2017-01-01

INTRODUCTION: Understanding the development and distribution of disruptive behaviour among members of a health-care team is critical to the safety and quality of patient care in high-risk environments such as operating rooms. The present study identified disruptive behaviour and its effect on the treatment of patients in the operating room environment. SUBJECTS AND METHODS: This cross-sectional study used the convenience sampling method to select 144 operating room physicians and nurses (91 women and 53 men). The study was conducted in the operating rooms of four academic hospitals with different specialties in North Khorasan province in Iran from December 2013 to September 2014. The data were collected using a translated, modified, and validated questionnaire to investigate the prevalence and consequences of disruptive behaviour, the response of the health care system to the behaviour, factors affecting the creation of conflict and the spread of disruptive behaviour. Statistical analysis of the data was performed using SPSS 18. RESULTS: Disruptive behaviour was reported by 82.95% physicians and nurses. On average, 39% of physicians and 21% of operating room nurses exhibited disruptive behaviour. Disruptive behaviour is associated with psychological and clinical consequences. Factors such as fear of retaliation (8%), lack of change (43.8%), lack of security (18.1%) and attitude of the organization (14.6%) are significant reasons for the failure to report these behaviours. CONCLUSIONS: The findings suggest that disruptive behaviour occurs and affects treatment and workflow of treatment teams in the operating room. Interpersonal conflict contributes to the growth of such behaviour; thus, more research should focus on this subject in the future. PMID:28852659

Evaluation of the disruptive behaviors among treatment teams and its reflection on the therapy process of patients in the operating room: The impact of personal conflicts.

PubMed

Maddineshat, Maryam; Hashemi, Mitra; Tabatabaeichehr, Mahbubeh

2017-01-01

Understanding the development and distribution of disruptive behaviour among members of a health-care team is critical to the safety and quality of patient care in high-risk environments such as operating rooms. The present study identified disruptive behaviour and its effect on the treatment of patients in the operating room environment. This cross-sectional study used the convenience sampling method to select 144 operating room physicians and nurses (91 women and 53 men). The study was conducted in the operating rooms of four academic hospitals with different specialties in North Khorasan province in Iran from December 2013 to September 2014. The data were collected using a translated, modified, and validated questionnaire to investigate the prevalence and consequences of disruptive behaviour, the response of the health care system to the behaviour, factors affecting the creation of conflict and the spread of disruptive behaviour. Statistical analysis of the data was performed using SPSS 18. Disruptive behaviour was reported by 82.95% physicians and nurses. On average, 39% of physicians and 21% of operating room nurses exhibited disruptive behaviour. Disruptive behaviour is associated with psychological and clinical consequences. Factors such as fear of retaliation (8%), lack of change (43.8%), lack of security (18.1%) and attitude of the organization (14.6%) are significant reasons for the failure to report these behaviours. The findings suggest that disruptive behaviour occurs and affects treatment and workflow of treatment teams in the operating room. Interpersonal conflict contributes to the growth of such behaviour; thus, more research should focus on this subject in the future.

Operating Room Environment Control. Part A: a Valve Cannister System for Anesthetic Gas Adsorption. Part B: a State-of-the-art Survey of Laminar Flow Operating Rooms. Part C: Three Laminar Flow Experiments

NASA Technical Reports Server (NTRS)

Meyer, J. S.; Kosovich, J.

1973-01-01

An anesthetic gas flow pop-off valve canister is described that is airtight and permits the patient to breath freely. Once its release mechanism is activated, the exhaust gases are collected at a hose adapter and passed through activated coal for adsorption. A survey of laminar air flow clean rooms is presented and the installation of laminar cross flow air systems in operating rooms is recommended. Laminar flow ventilation experiments determine drying period evaporation rates for chicken intestines, sponges, and sections of pig stomach.

Cost-benefit analysis of different air change rates in an operating room environment.

PubMed

Gormley, Thomas; Markel, Troy A; Jones, Howard; Greeley, Damon; Ostojic, John; Clarke, James H; Abkowitz, Mark; Wagner, Jennifer

2017-12-01

Hospitals face growing pressure to meet the dual but often competing goals of providing a safe environment while controlling operating costs. Evidence-based data are needed to provide insight for facility management practices to support these goals. The quality of the air in 3 operating rooms was measured at different ventilation rates. The energy cost to provide the heating, ventilation, and air conditioning to the rooms was estimated to provide a cost-benefit comparison of the effectiveness of different ventilation rates currently used in the health care industry. Simply increasing air change rates in the operating rooms tested did not necessarily provide an overall cleaner environment, but did substantially increase energy consumption and costs. Additionally, and unexpectedly, significant differences in microbial load and air velocity were detected between the sterile fields and back instrument tables. Increasing the ventilation rates in operating rooms in an effort to improve clinical outcomes and potentially reduce surgical site infections does not necessarily provide cleaner air, but does typically increase operating costs. Efficient distribution or management of the air can improve quality indicators and potentially reduce the number of air changes required. Measurable environmental quality indicators could be used in lieu of or in addition to air change rate requirements to optimize cost and quality for an operating room and other critical environments. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The Effects of Scavenging on Waste Methoxyflurane Concentrations in Veterinary Operating Room Air

DTIC Science & Technology

1981-01-01

Afl-AO5 572 AIR FORCE OCCUPATIONAL AND ENVIRONMENTAL H4EALTH LAS -ETC F/S 6120 TIE EFFECTS OF SCAVENGING ON WASTE METHOXYFLURANE CONCENTRATIOH-ETC...REPRINT The Effects of Scavenging on Waste Methoxyflurane Concentrations in Veterinary Operating Room Air Approved for public release; distribution...Waste Methoxyflurane Fnal y t Concentrations ir Veterinary Operating Room Air, 6.PROMN _6._PERFORMIN oIG. REPORT NUMBER 7. AUTOR~s)B. CONTRACT OR GRANT

Factors related to teamwork performance and stress of operating room nurses.

PubMed

Sonoda, Yukio; Onozuka, Daisuke; Hagihara, Akihito

2018-01-01

To evaluate operating room nurses' perception of teamwork performance and their level of mental stress and to identify related factors. Little is known about the factors affecting teamwork and the mental stress of surgical nurses, although the performance of the surgical team is essential for patient safety. The questionnaire survey for operation room nurses consisted of simple questions about teamwork performance and mental stress. Multivariate analyses were used to identify factors causing a sense of teamwork performance or mental stress. A large number of surgical nurses had a sense of teamwork performance, but 30-40% of operation room nurses were mentally stressed during surgery. Neither the patient nor the operation factors were related to the sense of teamwork performance in both types of nurses. Among scrub nurses, endoscopic and abdominal surgery, body mass index, blood loss and the American Society of Anesthesiologists physical status class were related to their mental stress. Conversely, circulating nurses were stressed about teamwork performance. The factors related to teamwork performance and mental stress during surgery differed between scrub and circulating nurses. Increased support for operation room nurses is necessary. The increased support leads to safer surgical procedures and better patient outcomes. © 2017 John Wiley & Sons Ltd.

Are we fully utilizing the functionalities of modern operating room ventilators?

PubMed

Liu, Shujie; Kacmarek, Robert M; Oto, Jun

2017-12-01

The modern operating room ventilators have become very sophisticated and many of their features are comparable with those of an ICU ventilator. To fully utilize the functionality of modern operating room ventilators, it is important for clinicians to understand in depth the working principle of these ventilators and their functionalities. Piston ventilators have the advantages of delivering accurate tidal volume and certain flow compensation functions. Turbine ventilators have great ability of flow compensation. Ventilation modes are mainly volume-based or pressure-based. Pressure-based ventilation modes provide better leak compensation than volume-based. The integration of advanced flow generation systems and ventilation modes of the modern operating room ventilators enables clinicians to provide both invasive and noninvasive ventilation in perioperative settings. Ventilator waveforms can be used for intraoperative neuromonitoring during cervical spine surgery. The increase in number of new features of modern operating room ventilators clearly creates the opportunity for clinicians to optimize ventilatory care. However, improving the quality of ventilator care relies on a complete understanding and correct use of these new features. VIDEO ABSTRACT: http://links.lww.com/COAN/A47.

Integrating medical devices in the operating room using service-oriented architectures.

PubMed

Ibach, Bastian; Benzko, Julia; Schlichting, Stefan; Zimolong, Andreas; Radermacher, Klaus

2012-08-01

Abstract With the increasing documentation requirements and communication capabilities of medical devices in the operating room, the integration and modular networking of these devices have become more and more important. Commercial integrated operating room systems are mainly proprietary developments using usually proprietary communication standards and interfaces, which reduce the possibility of integrating devices from different vendors. To overcome these limitations, there is a need for an open standardized architecture that is based on standard protocols and interfaces enabling the integration of devices from different vendors based on heterogeneous software and hardware components. Starting with an analysis of the requirements for device integration in the operating room and the techniques used for integrating devices in other industrial domains, a new concept for an integration architecture for the operating room based on the paradigm of a service-oriented architecture is developed. Standardized communication protocols and interface descriptions are used. As risk management is an important factor in the field of medical engineering, a risk analysis of the developed concept has been carried out and the first prototypes have been implemented.

Exposure of hospital operating room personnel to potentially harmful environmental agents

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

Sass-Kortsak, A.M.; Purdham, J.T.; Bozek, P.R.

1992-03-01

Epidemiologic studies of risk to reproductive health arising from the operating room environment have been inconclusive and lack quantitative exposure information. This study was undertaken to quantify exposure of operating room (OR) personnel to anesthetic agents, x-radiation, methyl methacrylate, and ethylene oxide and to determine how exposure varies with different operating room factors. Exposures of anesthetists and nurses to these agents were determined in selected operating rooms over three consecutive days. Each subject was asked to wear an x-radiation dosimeter for 1 month. Exposure to anesthetic agents was found to be influenced by the age of the OR facility, typemore » of surgical service, number of procedures carried out during the day, type of anesthetic circuitry, and method of anesthesia delivery. Anesthetists were found to have significantly greater exposures than OR nurses. Exposure of OR personnel to ethylene oxide, methyl methacrylate, and x-radiation were well within existing standards. Exposure of anesthetists and nurses to anesthetic agents, at times, was in excess of Ontario exposure guidelines, despite improvements in the control of anesthetic pollution.« less

Overutilization and underutilization of operating rooms - insights from behavioral health care operations management.

PubMed

Fügener, Andreas; Schiffels, Sebastian; Kolisch, Rainer

2017-03-01

The planning of surgery durations is crucial for efficient usage of operating theaters. Both planning too long and too short durations for surgeries lead to undesirable consequences, e.g. idle time, overtime, or rescheduling of surgeries. We define these consequences as operating room inefficiency. The overall objective of planning surgery durations is to minimize expected operating room inefficiency, since surgery durations are stochastic. While most health care studies assume economically rational behavior of decision makers, experimental studies have shown that decision makers often do not act according to economic incentives. Based on insights from health care operations management, medical decision making, behavioral operations management, as well as empirical observations, we derive hypotheses that surgeons' behavior deviates from economically rational behavior. To investigate this, we undertake an experimental study where experienced surgeons are asked to plan surgeries with uncertain durations. We discover systematic deviations from optimal decision making and offer behavioral explanations for the observed biases. Our research provides new insights to tackle a major problem in hospitals, i.e. low operating room utilization going along with staff overtime.

[Working conditions in operating rooms].

PubMed

Kułagowska, Ewa

2007-01-01

The aim of this study was to get acquainted with the opinions of the nursing staff on working conditions at their workplace. The study was carried out in a group of 398 nurses working in various kinds of operating rooms at 11 public hospitals. A questionnaire was used as a major tool of this study. The questionnaires were filled in by 259 operating room nurses (circulating nurses) and 139 nurse-anesthetists. The collected data show that working conditions in operating rooms do not ensure safety of the nursing staff at work. The main sources of problems are: work organization, technical factors, work equipment, work space, knowledge of hazards and strenuous factors among nurses, ways of preventing and/or limiting them. These elements are serious occupational risk factors influencing the work process and health status of nurses.

[Design and Implementation of a Mobile Operating Room Information Management System Based on Electronic Medical Record].

PubMed

Liu, Baozhen; Liu, Zhiguo; Wang, Xianwen

2015-06-01

A mobile operating room information management system with electronic medical record (EMR) is designed to improve work efficiency and to enhance the patient information sharing. In the operating room, this system acquires the information from various medical devices through the Client/Server (C/S) pattern, and automatically generates XML-based EMR. Outside the operating room, this system provides information access service by using the Browser/Server (B/S) pattern. Software test shows that this system can correctly collect medical information from equipment and clearly display the real-time waveform. By achieving surgery records with higher quality and sharing the information among mobile medical units, this system can effectively reduce doctors' workload and promote the information construction of the field hospital.

A procedure for rapid issue of red cells for emergency use.

PubMed

Weiskopf, Richard B; Webb, Mary; Stangle, Deena; Klinbergs, Gunter; Toy, Pearl

2005-04-01

A College of American Pathologists Q-Probe revealed that the median turnaround times for emergency requests for red blood cells from the operating room were 30 minutes to release of cells from the blood bank and 34 minutes to delivery to the operating room. These times may not be adequate to permit the red cells to provide sufficiently rapid delivery of oxygen in massively bleeding patients. To improve the time from emergency request for red cells to delivery to the operating room. A new emergency issue program was implemented for only the operating rooms; emergency issue to all other hospital locations remained unchanged. Six units of group O Rh-negative red blood cells (RBCs) are maintained in the blood bank in a separate basket with transfusion forms containing the unit numbers and expiration dates and a bag with one blood tubing segment from each unit. The times to issue and to delivery to the operating room suite were compared with time to issue of 2 group O Rh-negative RBCs for other hospital locations using the older system during the same time period and with the time to issue of 2 units to all other hospital locations during the preceding 2 years. A university hospital. Time between emergency request for red cells and delivery to the operating room. The time between blood bank notification and arrival in the operating room of the 6 units of RBCs was significantly shorter than the time required to just issue (not including delivery time) 2 units of RBCs to other hospital locations. With the new procedure, 82% of units issued reached the operating room within 2 minutes of request, 91% arrived within 3 minutes, and 100% arrived within 4 minutes. These percentages are significantly higher than those for only issue of blood (without delivery) using the older issuing procedure for all hospital locations during the previous 2 years (37%, 49%, and 66%, respectively; P = .007, .009, and .02, respectively) and for other locations during the same 7-month period (29%, 46%, and 73%, respectively; P = .004, .01, and .09, respectively). Time (mean [95% confidence interval]) from blood bank notification to delivery of RBCs to the operating room suite (2.1 [1.6-2.6] minutes, of which approximately 50-60 seconds is attributable to delivery time) was less than issue times (not including delivery times) using the older issuing procedure for other hospital locations during the same period (4.1 [3.1-5.0] minutes; P = .007). An emergency issue procedure can be used to issue several units of RBCs within 1 minute and have them delivered to the operating room within 2 minutes while maintaining sufficient controls and providing required information to satisfy patient and blood bank requirements.

[The endoscopic operating room OR 1].

PubMed

Dubuisson, J B; Chapron, C

2003-04-01

During the last few years, the development of surgical laparoscopy has been the major turning point, and the most important progress in the field of surgery. The specific installation requirements of surgical laparoscopy, as well as the technological progress proper to this surgical technique, justify the need of a new organization of the operating theatre. The new operating room OR 1 is especially designed to fit and satisfy the requirements of a modern operating theatre, where surgical laparoscopy plays a major role. The organization and the design of this new operating room (OR 1) rely on 2 main concepts: architectural, and computerized, through 2 PC systems SCB and AIDA. The main objectives of this new concept are: allowing the surgeon to control and command all the functions and the instruments, as well as the lighting of the room and the operating field; managing the surgical data and images required for medical files; establishing a communication network either from the inside or outside the sterile zone.

8. VIEW OF SLC3W CONTROL ROOM (ROOM 105) FROM ITS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. VIEW OF SLC-3W CONTROL ROOM (ROOM 105) FROM ITS NORTHEAST CORNER. TELEMETRY ROOM VISIBLE THROUGH WINDOWS IN SOUTH WALL. - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

7. VIEW OF SLC3W CONTROL ROOM (ROOM 105) FROM ITS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

7. VIEW OF SLC-3W CONTROL ROOM (ROOM 105) FROM ITS SOUTHWEST CORNER. NOTE RAISED FLATFORM IN CENTER OF ROOM. - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

Impact of surface disinfection and sterile draping of furniture on room air quality in a cardiac procedure room with a ventilation and air-conditioning system (extrusion airflow, cleanroom class 1b (DIN 1946-4)).

PubMed

Below, Harald; Ryll, Sylvia; Empen, Klaus; Dornquast, Tina; Felix, Stefan; Rosenau, Heike; Kramer, Sebastian; Kramer, Axel

2010-09-21

In a cardiac procedure room, ventilated by a ventilation and air-conditioning system with turbulent mixed airflow, a protection zone in the operating area could be defined through visualization of airflows. Within this protection zone, no turbulence was detectable in the room air.Under the given conditions, disinfection of all surfaces including all furniture and equipment after the last operation and subsequent draping of furniture and all equipment that could not be removed from the room with sterile surgical drapes improved the indoor room air quality from cleanroom class C to cleanroom class B. This also allows procedures with elevated requirements to be performed in room class 1b.

31. Fourth floor attic, operating room with skylight, view to ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

31. Fourth floor attic, operating room with skylight, view to south - Portsmouth Naval Hospital, Hospital Building, Rixey Place, bounded by Williamson Drive, Holcomb Road, & The Circle, Portsmouth, Portsmouth, VA

6. VIEW OF SLC3W CONTROL ROOM (ROOM 105) FROM ITS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. VIEW OF SLC-3W CONTROL ROOM (ROOM 105) FROM ITS SOUTHEAST CORNER - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

How do strategic decisions and operative practices affect operating room productivity?

PubMed

Peltokorpi, Antti

2011-12-01

Surgical operating rooms are cost-intensive parts of health service production. Managing operating units efficiently is essential when hospitals and healthcare systems aim to maximize health outcomes with limited resources. Previous research about operating room management has focused on studying the effect of management practices and decisions on efficiency by utilizing mainly modeling approach or before-after analysis in single hospital case. The purpose of this research is to analyze the synergic effect of strategic decisions and operative management practices on operating room productivity and to use a multiple case study method enabling statistical hypothesis testing with empirical data. 11 hypotheses that propose connections between the use of strategic and operative practices and productivity were tested in a multi-hospital study that included 26 units. The results indicate that operative practices, such as personnel management, case scheduling and performance measurement, affect productivity more remarkably than do strategic decisions that relate to, e.g., units' size, scope or academic status. Units with different strategic positions should apply different operative practices: Focused hospital units benefit most from sophisticated case scheduling and parallel processing whereas central and ambulatory units should apply flexible working hours, incentives and multi-skilled personnel. Operating units should be more active in applying management practices which are adequate for their strategic orientation.

Early Extubation in the Operating Room after Congenital Open-Heart Surgery.

PubMed

Fukunishi, Takuma; Oka, Norihiko; Yoshii, Takeshi; Kobayashi, Kensuke; Inoue, Nobuyuki; Horai, Tetsuya; Kitamura, Tadashi; Okamoto, Hirotsugu; Miyaji, Kagami

2018-01-27

Early extubation in the operating room after congenital open-heart surgery is feasible, but extubation in the intensive care unit after the operation remains common practice at many institutions. The purpose of this study was to evaluate retrospectively the adequacy of our early-extubation strategy and exclusion criteria through analysis based on the Risk Adjustment in Congenital Heart Surgery method (RACHS-1).This retrospective analysis included 359 cases requiring cardiopulmonary bypass (male, 195; female, 164; weight > 3.0 kg; aged 1 month to 18 years). Neonates and preoperatively intubated patients were excluded. Other exclusion criteria included severe preoperative pulmonary hypertension, high-dose catecholamine requirement after cardiopulmonary bypass, delayed sternal closure, laryngomalacia, serious bleeding, and delayed awakening. The early-extubation rates were compared between age groups and RACHS-1 classes.Overall, 83% of cases (298/359) were extubated in the operating room, classified by RACHS-1 categories as follows: 1, 59/59 (100%); 2, 164/200 (84%); 3, 61/78 (78%); and 4-6, 10/22 (45%). The early extubation rate in categories 1-3 (86%, 288/337) was significantly higher than for categories 4-6 (45.5%, 10/22) (P < 0.001). Because they met one of the exclusion criteria, 61 patients (17%) were not extubated in the operating room. Eight patients (2.7%) required re-intubation after early extubation in the operating room, and longer operation time was significantly associated with re-intubation (P < 0.001).Extubation in the operating room after congenital open-heart surgery was feasible based on our criteria, especially for patients in the low RACHS-1 categories, and involves a very low rate of re-intubation.

Maintaining reduced noise levels in a resource-constrained neonatal intensive care unit by operant conditioning.

PubMed

Ramesh, A; Denzil, S B; Linda, R; Josephine, P K; Nagapoornima, M; Suman Rao, P N; Swarna Rekha, A

2013-03-01

To evaluate the efficacy of operant conditioning in sustaining reduced noise levels in the neonatal intensive care unit (NICU). Quasi-experimental study on quality of care. Level III NICU of a teaching hospital in south India. 26 staff employed in the NICU. (7 Doctors, 13 Nursing staff and 6 Nursing assistants). Operant conditioning of staff activity for 6 months. This method involves positive and negative reinforcement to condition the staff to modify noise generating activities. Comparing noise levels in decibel: A weighted [dB (A)] before conditioning with levels at 18 and 24 months after conditioning. Decibel: A weighted accounts for noise that is audible to human ears. Operant conditioning for 6 months sustains the reduced noise levels to within 62 dB in ventilator room 95% CI: 60.4 - 62.2 and isolation room (95% CI: 55.8 - 61.5). In the preterm room, noise can be maintained within 52 dB (95% CI: 50.8 - 52.6). This effect is statistically significant in all the rooms at 18 months (P = 0.001). At 24 months post conditioning there is a significant rebound of noise levels by 8.6, 6.7 and 9.9 dB in the ventilator, isolation and preterm room, respectively (P =0.001). Operant conditioning for 6 months was effective in sustaining reduced noise levels. At 18 months post conditioning, the noise levels were maintained within 62 dB (A), 60 dB (A) and 52 dB (A) in the ventilator, isolation and pre-term room, respectively. Conditioning needs to be repeated at 12 months in the ventilator room and at 18 months in the other rooms.

Greening of orthopedic surgery.

PubMed

Lee, Rushyuan J; Mears, Simon C

2012-06-01

Every year, 4 billion pounds of waste are produced by health care facilities, and the amount continues to increase annually. In response, a movement toward greening health care has been building, with a particular focus on the operating room. Between 20% and 70% of health care waste originates from a hospital's operating room, and up to 90% of operating room waste is improperly sorted and sent for costly and unneeded hazardous waste processing. Recent successful changes include segregation of hospital waste, substitution of the ubiquitous polypropylene plastic wrap used for the sterilization and handling of surgical equipment with metal cases, and the reintroduction of reusable surgical gowns. Orthopedic-related changes include the successful reprocessing and reuse of external fixators, shavers, blades, burs, and tourniquets. These changes have been shown to be environmentally and economically beneficial. Early review indicates that these changes are feasible, but a need exists for further evaluation of the effect on the operating room and flow of the surgical procedure and of the risks to the surgeons and operating room staff. Other key considerations are the effects of reprocessed and reused equipment on patient care and outcome and the role of surgeons in helping patients make informed decisions regarding surgical care. The goals of this study were to summarize the amount and types of waste produced in hospitals and operating rooms, highlight the methods of disposal used, review disposal methods that have been developed to reduce waste and improve recycling, and explore future developments in greening health care. Copyright 2012, SLACK Incorporated.

EPRR

Science.gov Websites

Electronic Public Reading Room Operational Reading Room & Environmental Cleanup through April 2018 Los Alamos Legacy Cleanup Electronic Public Reading Room Environmental Cleanup from May 2018

12. INTERIOR VIEW OF GATE OPERATOR ROOM, SHOWING SLIDES GATE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

12. INTERIOR VIEW OF GATE OPERATOR ROOM, SHOWING SLIDES GATE OPERATORS, LOOKING NORTHWEST. - Sacramento River Water Treatment Plant Intake Pier & Access Bridge, Spanning Sacramento River approximately 175 feet west of eastern levee on river; roughly .5 mile downstream from confluence of Sacramento & American Rivers, Sacramento, Sacramento County, CA

Impact of surface disinfection and sterile draping of furniture on room air quality in a cardiac procedure room with a ventilation and air-conditioning system (extrusion airflow, cleanroom class 1b (DIN 1946-4))

PubMed Central

Below, Harald; Ryll, Sylvia; Empen, Klaus; Dornquast, Tina; Felix, Stefan; Rosenau, Heike; Kramer, Sebastian; Kramer, Axel

2010-01-01

In a cardiac procedure room, ventilated by a ventilation and air-conditioning system with turbulent mixed airflow, a protection zone in the operating area could be defined through visualization of airflows. Within this protection zone, no turbulence was detectable in the room air. Under the given conditions, disinfection of all surfaces including all furniture and equipment after the last operation and subsequent draping of furniture and all equipment that could not be removed from the room with sterile surgical drapes improved the indoor room air quality from cleanroom class C to cleanroom class B. This also allows procedures with elevated requirements to be performed in room class 1b. PMID:20941336

Evaluation of noise pollution level in the operating rooms of hospitals: A study in Iran.

PubMed

Giv, Masoumeh Dorri; Sani, Karim Ghazikhanlou; Alizadeh, Majid; Valinejadi, Ali; Majdabadi, Hesamedin Askari

2017-06-01

Noise pollution in the operating rooms is one of the remaining challenges. Both patients and physicians are exposed to different sound levels during the operative cases, many of which can last for hours. This study aims to evaluate the noise pollution in the operating rooms during different surgical procedures. In this cross-sectional study, sound level in the operating rooms of Hamadan University-affiliated hospitals (totally 10) in Iran during different surgical procedures was measured using B&K sound meter. The gathered data were compared with national and international standards. Statistical analysis was performed using descriptive statistics and one-way ANOVA, t -test, and Pearson's correlation test. Noise pollution level at majority of surgical procedures is higher than national and international documented standards. The highest level of noise pollution is related to orthopedic procedures, and the lowest one related to laparoscopic and heart surgery procedures. The highest and lowest registered sound level during the operation was 93 and 55 dB, respectively. Sound level generated by equipments (69 ± 4.1 dB), trolley movement (66 ± 2.3 dB), and personnel conversations (64 ± 3.9 dB) are the main sources of noise. The noise pollution of operating rooms are higher than available standards. The procedure needs to be corrected for achieving the proper conditions.

Delays in the operating room: signs of an imperfect system.

PubMed

Wong, Janice; Khu, Kathleen Joy; Kaderali, Zul; Bernstein, Mark

2010-06-01

Delays in the operating room have a negative effect on its efficiency and the working environment. In this prospective study, we analyzed data on perioperative system delays. One neurosurgeon prospectively recorded all errors, including perioperative delays, for consecutive patients undergoing elective procedures from May 2000 to February 2009. We analyzed the prevalence, causes and impact of perioperative system delays that occurred in one neurosurgeon's practice. A total of 1531 elective surgical cases were performed during the study period. Delays were the most common type of error (33.6%), and more than half (51.4%) of all cases had at least 1 delay. The most common cause of delay was equipment failure. The first cases of the day and cranial cases had more delays than subsequent cases and spinal cases, respectively. A delay in starting the first case was associated with subsequent delays. Delays frequently occur in the operating room and have a major effect on patient flow and resource utilization. Thorough documentation of perioperative delays provides a basis for the development of solutions for improving operating room efficiency and illustrates the principles underlying the causes of operating room delays across surgical disciplines.

[Present status of critical hemorrhage and its management in the operating room].

PubMed

Irita, Kazuo

2014-12-01

Hemorrhage is a major cause of cardiac arrest in the operating room. Many human factors, including surgical procedures, transfusion practices, blood supply, and anesthetic management, are involved in the process that leads to hemorrhage developing into a critical situation. It is desirable for hospital transfusion committees to prepare hospital-based regulations on 'actions to be taken to manage critical hemorrhage', and practice the implementation of these regulations with simulated drills. If intraoperative hemorrhage may become critical, a state of emergency should immediately be declared to the operating room staff, the blood transfusion service staff, and blood bank staff in order to organize a systematic approach to the ongoing problem and keep all responsible staff working outside the operating room informed of events developing in the room. To rapidly deal with critical hemorrhage, not only cooperation between anesthesiologists and surgeons but also linkage of operating rooms with blood transfusion services and a blood bank are important. When time is short, cross-matching tests are omitted, and ABO-identical red blood cells are used. When supplies of ABO-identical red blood cells are not available, ABO-compatible, non-identical red blood cells are used. Because a systematic, not individual, approach is required to prevent and manage critical hemorrhage, whether or not a hospital can establish a procedure to deal with it depends on the overall capability of critical and crisis management of the hospital. (Review).

Front view of bldg 30 which houses mission control

NASA Image and Video Library

1984-08-30

41D-3072 (30 Aug 1984) --- A 41-D shift change is taking place in the Johnson Space Center's Building 30. In its twenty years of operation, the mission control center has been the scene of many such changes. The windowless wing at left houses three floors, including rooms supporting flight control rooms 1 & 2 (formerly called mission operations control rooms 1 & 2).

Crew Field Notes: A New Tool for Planetary Surface Exploration

NASA Technical Reports Server (NTRS)

Horz, Friedrich; Evans, Cynthia; Eppler, Dean; Gernhardt, Michael; Bluethmann, William; Graf, Jodi; Bleisath, Scott

2011-01-01

The Desert Research and Technology Studies (DRATS) field tests of 2010 focused on the simultaneous operation of two rovers, a historical first. The complexity and data volume of two rovers operating simultaneously presented significant operational challenges for the on-site Mission Control Center, including the real time science support function. The latter was split into two "tactical" back rooms, one for each rover, that supported the real time traverse activities; in addition, a "strategic" science team convened overnight to synthesize the day's findings, and to conduct the strategic forward planning of the next day or days as detailed in [1, 2]. Current DRATS simulations and operations differ dramatically from those of Apollo, including the most evolved Apollo 15-17 missions, due to the advent of digital technologies. Modern digital still and video cameras, combined with the capability for real time transmission of large volumes of data, including multiple video streams, offer the prospect for the ground based science support room(s) in Mission Control to witness all crew activities in unprecedented detail and in real time. It was not uncommon during DRATS 2010 that each tactical science back room simultaneously received some 4-6 video streams from cameras mounted on the rover or the crews' backpacks. Some of the rover cameras are controllable PZT (pan, zoom, tilt) devices that can be operated by the crews (during extensive drives) or remotely by the back room (during EVAs). Typically, a dedicated "expert" and professional geologist in the tactical back room(s) controls, monitors and analyses a single video stream and provides the findings to the team, commonly supported by screen-saved images. It seems obvious, that the real time comprehension and synthesis of the verbal descriptions, extensive imagery, and other information (e.g. navigation data; time lines etc) flowing into the science support room(s) constitute a fundamental challenge to future mission operations: how can one analyze, comprehend and synthesize -in real time- the enormous data volume coming to the ground? Real time understanding of all data is needed for constructive interaction with the surface crews, and it becomes critical for the strategic forward planning process.

[Computerized monitoring system in the operating center with UNIX and X-window].

PubMed

Tanaka, Y; Hashimoto, S; Chihara, E; Kinoshita, T; Hirose, M; Nakagawa, M; Murakami, T

1992-01-01

We previously reported the fully automated data logging system in the operating center. Presently, we revised the system using a highly integrated operating system, UNIX instead of OS/9. With this multi-task and multi-window (X-window) system, we could monitor all 12 rooms in the operating center at a time. The system in the operating center consists of 2 computers, SONY NEWS1450 (UNIX workstation) and Sord M223 (CP/M, data logger). On the bitmapped display of the workstation, using X-window, the data of all the operating rooms can be visualized. Furthermore, 2 other minicomputers (Fujitsu A50 in the conference room, and A60 in the ICU) and a workstation (Sun3-80 in the ICU) were connected with ethernet. With the remote login function (NFS), we could easily obtain the data during the operation from outside the operating center. This system works automatically and needs no routine maintenance.

Operating room-to-incision interval and neonatal outcome in emergency caesarean section: a retrospective 5-year cohort study.

PubMed

Palmer, E; Ciechanowicz, S; Reeve, A; Harris, S; Wong, D J N; Sultan, P

2018-07-01

We conducted a 5-year retrospective cohort study on women undergoing caesarean section to investigate factors influencing the operating room-to-incision interval. Time-to-event analysis was performed for category-1 caesarean section using a Cox proportional hazards regression model. Covariates included: anaesthetic technique; body mass index; age; parity; time of delivery; and gestational age. Binary logistic regression was performed for 5-min Apgar score ≥ 7. There were 677 women who underwent category-1 caesarean section and who met the entry criteria. Unadjusted median (IQR [range]) operating room-to-incision intervals were: epidural top-up 11 (7-17 [0-87]) min; general anaesthesia 6 (4-11 [0-69]) min; spinal 13 (10-20 [0-83]) min; and combined spinal-epidural 24 (13-35 [0-75]) min. Cox regression showed general anaesthesia to be the most rapid method with a hazard ratio (95%CI) of 1.97 (1.60-2.44; p < 0.0001), followed by epidural top-up (reference group), spinal anaesthesia 0.79 (0.65-0.96; p = 0.02) and combined spinal-epidural 0.48 (0.35-0.67; p < 0.0001). Underweight and overweight body mass indexes were associated with longer operating room-to-incision intervals. General anaesthesia was associated with fewer 5-min Apgar scores ≥ 7 with an odds ratio (95%CI) of 0.28 (0.11-0.68; p < 0.01). There was no difference in neonatal outcomes between the first and fifth quintiles for operating room-to-incision intervals. General anaesthesia is associated with the most rapid operating room-to-incision interval for category-1 caesarean section, but is also associated with worse short term neonatal outcomes. Longer operating room-to-incision intervals were not associated with worse neonatal outcomes. © 2018 The Association of Anaesthetists of Great Britain and Ireland.

21 CFR 20.120 - Records available in Food and Drug Administration Public Reading Rooms.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Public Reading Rooms. 20.120 Section 20.120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF....120 Records available in Food and Drug Administration Public Reading Rooms. (a) The Food and Drug Administration operates two public reading rooms. The Freedom of Information Staff's Public Reading Room is...

21 CFR 20.120 - Records available in Food and Drug Administration Public Reading Rooms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Public Reading Rooms. 20.120 Section 20.120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF....120 Records available in Food and Drug Administration Public Reading Rooms. (a) The Food and Drug Administration operates two public reading rooms. The Freedom of Information Staff's Public Reading Room is...

Low-temperature operation of a Buck DC/DC converter

NASA Technical Reports Server (NTRS)

Ray, Biswajit; Gerber, Scott S.; Patterson, Richard L.; Myers, Ira T.

1995-01-01

Low-temperature (77 K) operation of a 42/28 V, 175 W, 50 kHz PWM Buck DC/DC converter designed with commercially available components is reported. Overall, the converter losses decreased at 77 K compared to room temperature operation. A full-load efficiency of 97 percent was recorded at liquid-nitrogen temperature, compared to 95.8 percent at room temperature. Power MOSFET operation improved significantly where as the output rectifier operation deteriorated at low-temperature. The performance of the output filter inductor and capacitor did not change significantly at 77 K compared to room temperature performance. It is possible to achieve high-density and high efficiency power conversion at low-temperatures due to improved electronic, electrical and thermal properties of materials.

13. INTERIOR VIEW OF GATE OPERATOR ROOM, SHOWING UNFINISHED CONCRETE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

13. INTERIOR VIEW OF GATE OPERATOR ROOM, SHOWING UNFINISHED CONCRETE WALLS AND SLIDE GATE OPERATORS, LOOKING NORTH. - Sacramento River Water Treatment Plant Intake Pier & Access Bridge, Spanning Sacramento River approximately 175 feet west of eastern levee on river; roughly .5 mile downstream from confluence of Sacramento & American Rivers, Sacramento, Sacramento County, CA

OR2020: The Operating Room of the Future

DTIC Science & Technology

2004-05-01

25 3.3 Technical Requirements: Standards and Tools for Improved Operating R oom Process Integration...Image processing and visualization tools must be made available to the operating room. 5. Communications issues must be addressed and aim toward...protocols for effectively performing advanced surgeries and using telecommunications-ready tools as needed. The following recommendations were made

76 FR 53714 - Notice of Request for the Approval of a New Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-29

... Transportation, 1200 New Jersey Avenue, SE., Docket Operations, M-30, West Building, Ground Floor, Room W12- 140...., Docket Operations, M-30, West Building, Ground Floor, Room W12-140, Washington, DC 20590-0001 between 9 a... New Jersey Avenue, SE., Docket Operations, M-30, West Building, [[Page 53715

Application of an Online Reference for Reviewing Basic Statistical Principles of Operating Room Management

ERIC Educational Resources Information Center

Dexter, Franklin; Masursky, Danielle; Wachtel, Ruth E.; Nussmeier, Nancy A.

2010-01-01

Operating room (OR) management differs from clinical anesthesia in that statistical literacy is needed daily to make good decisions. Two of the authors teach a course in operations research for surgical services to anesthesiologists, anesthesia residents, OR nursing directors, hospital administration students, and analysts to provide them with the…

Quantitative Investigation of Room-Temperature Breakdown Effects in Pixelated TlBr Detectors

NASA Astrophysics Data System (ADS)

Koehler, Will; He, Zhong; Thrall, Crystal; O'Neal, Sean; Kim, Hadong; Cirignano, Leonard; Shah, Kanai

2014-10-01

Due to favorable material properties such as high atomic number (Tl: 81, Br: 35), high density ( 7.56 g/cm3), and a wide band gap (2.68 eV), thallium-bromide (TlBr) is currently under investigation for use as an alternative room-temperature semiconductor gamma-ray spectrometer. TlBr detectors can achieve less than 1% FWHM energy resolution at 662 keV, but these results are limited to stable operation at - 20°C. After days to months of room-temperature operation, ionic conduction causes these devices to fail. This work correlates the varying leakage current with alpha-particle and gamma-ray spectroscopic performances at various operating temperatures. Depth-dependent photopeak centroids exhibit time-dependent transient behavior, which indicates trapping sites form near the anode surface during room-temperature operation. After refabrication, similar performance and functionality of failed detectors returned.

Evaluation of exposures of hospital employees to anesthetic gases

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

Lambeth, J.D.

1988-01-01

Hospital employees who work in hospital operating and recovery rooms are often exposed to a number of anesthetic gases. There is evidence to support the belief that such exposures have led to higher rates of miscarriages and spontaneous abortions of pregnancies among women directly exposed to these gases than among women not exposed. Most of the studies assessing exposure levels were conducted prior to the widespread use of scavenging systems. Air sampling was conducted in hospital operatories and recovery rooms of three large hospitals to assess the current exposure levels in these areas and determine the effectiveness of these systemsmore » in reducing exposures to fluoride-containing anesthetic gases. It was determined that recovery-room personnel are exposed to levels of anesthesia gases that often approach and exceed the recommended Threshold Limit Value-Time Weighted Average (TLV-TWA) of 2.0 ppm. Recovery-room personnel do not have the protection from exposure provided by scavenging systems in operating rooms. Operating-room personnel were exposed to anesthesia gas levels above the TLV-TWA only when patients were masked, or connected and disconnected from the scavenging systems. Recovery-room personnel also need to be protected from exposure to anesthesia gases by a scavenging system.« less

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

Comparison of three distinct surgical clothing systems for protection from air-borne bacteria: A prospective observational study

PubMed Central

2012-01-01

Background To prevent surgical site infection it is desirable to keep bacterial counts low in the operating room air during orthopaedic surgery, especially prosthetic surgery. As the air-borne bacteria are mainly derived from the skin flora of the personnel present in the operating room a reduction could be achieved by using a clothing system for staff made from a material fulfilling the requirements in the standard EN 13795. The aim of this study was to compare the protective capacity between three clothing systems made of different materials – one mixed cotton/polyester and two polyesters - which all had passed the tests according to EN 13795. Methods Measuring of CFU/m3 air was performed during 21 orthopaedic procedures performed in four operating rooms with turbulent, mixing ventilation with air flows of 755 – 1,050 L/s. All staff in the operating room wore clothes made from the same material during each surgical procedure. Results The source strength (mean value of CFU emitted from one person per second) calculated for the three garments were 4.1, 2.4 and 0.6 respectively. In an operating room with an air flow of 755 L/s both clothing systems made of polyester reduced the amount of CFU/m3 significantly compared to the clothing system made from mixed material. In an operating room with air intake of 1,050 L/s a significant reduction was only achieved with the polyester that had the lowest source strength. Conclusions Polyester has a better protective capacity than cotton/polyester. There is need for more discriminating tests of the protective efficacy of textile materials intended to use for operating garment. PMID:23068884

Psychomotor performance measured in a virtual environment correlates with technical skills in the operating room.

PubMed

Kundhal, Pavi S; Grantcharov, Teodor P

2009-03-01

This study was conducted to validate the role of virtual reality computer simulation as an objective method for assessing laparoscopic technical skills. The authors aimed to investigate whether performance in the operating room, assessed using a modified Objective Structured Assessment of Technical Skill (OSATS), correlated with the performance parameters registered by a virtual reality laparoscopic trainer (LapSim). The study enrolled 10 surgical residents (3 females) with a median of 5.5 years (range, 2-6 years) since graduation who had similar limited experience in laparoscopic surgery (median, 5; range, 1-16 laparoscopic cholecystectomies). All the participants performed three repetitions of seven basic skills tasks on the LapSim laparoscopic trainer and one laparoscopic cholecystectomy in the operating room. The operating room procedure was video recorded and blindly assessed by two independent observers using a modified OSATS rating scale. Assessment in the operating room was based on three parameters: time used, error score, and economy of motion score. During the tasks on the LapSim, time, error (tissue damage and millimeters of tissue damage [tasks 2-6], error score [incomplete target areas, badly placed clips, and dropped clips [task 7]), and economy of movement parameters (path length and angular path) were registered. The correlation between time, economy, and error parameters during the simulated tasks and the operating room procedure was statistically assessed using Spearman's test. Significant correlations were demonstrated between the time used to complete the operating room procedure and time used for task 7 (r (s) = 0.74; p = 0.015). The error score demonstrated during the laparoscopic cholecystectomy correlated well with the tissue damage in three of the seven tasks (p < 0.05), the millimeters of tissue damage during two of the tasks, and the error score in task 7 (r (s) = 0.67; p = 0.034). Furthermore, statistically significant correlations were observed between the economy of motion score from the operative procedure and LapSim's economy parameters (path length and angular path in six of the tasks) (p < 0.05). The current study demonstrated significant correlations between operative performance in the operating room (assessed using a well-validated rating scale) and psychomotor performance in virtual environment assessed by a computer simulator. This provides strong evidence for the validity of the simulator system as an objective tool for assessing laparoscopic skills. Virtual reality simulation can be used in practice to assess technical skills relevant for minimally invasive surgery.

Practices and impacts post-exposure to blood and body fluid in operating room nurses: A cross-sectional study.

PubMed

Kasatpibal, Nongyao; Whitney, JoAnne D; Katechanok, Sadubporn; Ngamsakulrat, Sukanya; Malairungsakul, Benjawan; Sirikulsathean, Pinyo; Nuntawinit, Chutatip; Muangnart, Thanisara

2016-05-01

Improper or inadequate actions taken after blood and body fluid exposures place individuals at risk for infection with bloodborne pathogens. This has potential, significant impact for health and well-being. To evaluate the practices and the personal impact experienced following blood and body fluid exposures among operating room nurses. A cross-sectional, multi-center study. Government and private hospitals from all parts of Thailand. Operating room nurses from 247 hospitals. A questionnaire eliciting responses on characteristics, post-exposure practices, and impacts was sent to 2500 operating room nurses. Usable questionnaires were returned by 2031 operating room nurses (81.2%). Of these 1270 had experience with blood and body fluid exposures (62.5%). Most operating room nurses did not report blood and body fluid exposures (60.9%). The major reasons of underreporting were low risk source (40.2%) and belief that they were not important to report (16.3%). Improper post-exposure practices were identified, 9.8% did not clean exposure area immediately, 18.0% squeezed out the wound, and 71.1% used antiseptic solution for cleansing a puncture wound. Post-exposure, 58.5% of them sought counseling, 16.3% took antiretroviral prophylaxis, 23.8% had serologic testing for hepatitis B and 43.1% for hepatitis C. The main personal impacts were anxiety (57.7%), stress (24.2%), and insomnia (10.2%). High underreporting, inappropriate post-exposure practices and impacts of exposure were identified from this study. Comprehensive education and effective training of post-exposure management may be keys to resolving these important problems. Copyright © 2016 Elsevier Ltd. All rights reserved.

Situation-Dependent Medical Device Risk Estimation: Design and Evaluation of an Equipment Management Center For Vendor-Independent Integrated Operating Rooms.

PubMed

Maktabi, Marianne; Neumuth, Thomas

2017-12-22

The complexity of surgical interventions and the number of technologies involved are constantly rising. Hospital staff has to learn how to handle new medical devices efficiently. However, if medical device-related incidents occur, the patient treatment is delayed. Patient safety could therefore be supported by an optimized assistance system that helps improve the management of technical equipment by nonmedical hospital staff. We developed a system for the optimal monitoring of networked medical device activity and maintenance requirements, which works in conjunction with a vendor-independent integrated operating room and an accurate surgical intervention Time And Resource Management System. An integrated situation-dependent risk assessment system gives the medical engineers optimal awareness of the medical devices in the operating room. A qualitative and quantitative survey among ten medical engineers from three different hospitals was performed to evaluate the approach. A series of 25 questions was used to evaluate various aspects of our system as well as the system currently used. Moreover, the respondents were asked to perform five tasks related to system supervision and incident handling. Our system received a very positive feedback. The evaluation studies showed that the integration of information, the structured presentation of information, and the assistance modules provide valuable support to medical engineers. An automated operating room monitoring system with an integrated risk assessment and Time And Resource Management System module is a new way to assist the staff being outside of a vendor-independent integrated operating room, who are nevertheless involved in processes in the operating room.

Scheduling elective surgeries: the tradeoff among bed capacity, waiting patients and operating room utilization using goal programming.

PubMed

Li, Xiangyong; Rafaliya, N; Baki, M Fazle; Chaouch, Ben A

2017-03-01

Scheduling of surgeries in the operating rooms under limited competing resources such as surgical and nursing staff, anesthesiologist, medical equipment, and recovery beds in surgical wards is a complicated process. A well-designed schedule should be concerned with the welfare of the entire system by allocating the available resources in an efficient and effective manner. In this paper, we develop an integer linear programming model in a manner useful for multiple goals for optimally scheduling elective surgeries based on the availability of surgeons and operating rooms over a time horizon. In particular, the model is concerned with the minimization of the following important goals: (1) the anticipated number of patients waiting for service; (2) the underutilization of operating room time; (3) the maximum expected number of patients in the recovery unit; and (4) the expected range (the difference between maximum and minimum expected number) of patients in the recovery unit. We develop two goal programming (GP) models: lexicographic GP model and weighted GP model. The lexicographic GP model schedules operating rooms when various preemptive priority levels are given to these four goals. A numerical study is conducted to illustrate the optimal master-surgery schedule obtained from the models. The numerical results demonstrate that when the available number of surgeons and operating rooms is known without error over the planning horizon, the proposed models can produce good schedules and priority levels and preference weights of four goals affect the resulting schedules. The results quantify the tradeoffs that must take place as the preemptive-weights of the four goals are changed.

12. VIEW OF OPERATING ROOMRCA COMMUNICATION REC STATION (THIS ROOM ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

12. VIEW OF OPERATING ROOM-RCA COMMUNICATION REC STATION (THIS ROOM WAS ORIGINALLY A MOTOR GENERATOR FACILITY AND SUPPLIED DC POWER TO AN EARLIER GENERATION OF POINT-TO-POINT RECEIVERS ON SECOND FLOOR). VIEW SHOWS TRANSMITTER CONTROL STATION AND AUDIO CONTROL STATION (LEFT, WATKINS-JOHNSON WJ-8718-23. HP RECEIVERS AND KENWOOD R-5000 COMMUNICATIONS RECEIVERS (220 DEGREES). - Marconi Radio Sites, Receiving, Point Reyes Station, Marin County, CA

[The use of an opect optic system in neurosurgical practice].

PubMed

Kalinovskiy, A V; Rzaev, D A; Yoshimitsu, K

2018-01-01

Modern neurosurgical practice is impossible without access to various information sources. The use of MRI and MSCT data during surgery is an integral part of the neurosurgeon's daily practice. Devices capable of managing an image viewer system without direct contact with equipment simplify working in the operating room. To test operation of a non-contact MRI and MSCT image viewer system in the operating room and to evaluate the system effectiveness. An Opect non-contact image management system developed at the Tokyo Women's Medical University was installed in one of the operating rooms of the Novosibirsk Federal Center of Neurosurgery in 2014. In 2015, the Opect system was used by operating surgeons in 73 surgeries performed in the same operating room. The system effectiveness was analyzed based on a survey of surgeons. The non-contact image viewer system occurred to be easy-to-learn for the personnel to operate this system, easy-to-manage it, and easy-to-present visual information during surgery. Application of the Opect system simplifies work with neuroimaging data during surgery. The surgeon can independently view series of relevant MRI and MSCT scans without any assistance.

Methodology for analyzing environmental quality indicators in a dynamic operating room environment.

PubMed

Gormley, Thomas; Markel, Troy A; Jones, Howard W; Wagner, Jennifer; Greeley, Damon; Clarke, James H; Abkowitz, Mark; Ostojic, John

2017-04-01

Sufficient quantities of quality air and controlled, unidirectional flow are important elements in providing a safe building environment for operating rooms. To make dynamic assessments of an operating room environment, a validated method of testing the multiple factors influencing the air quality in health care settings needed to be constructed. These include the following: temperature, humidity, particle load, number of microbial contaminants, pressurization, air velocity, and air distribution. The team developed the name environmental quality indicators (EQIs) to describe the overall air quality based on the actual measurements of these properties taken during the mock surgical procedures. These indicators were measured at 3 different hospitals during mock surgical procedures to simulate actual operating room conditions. EQIs included microbial assessments at the operating table and the back instrument table and real-time analysis of particle counts at 9 different defined locations in the operating suites. Air velocities were measured at the face of the supply diffusers, at the sterile field, at the back table, and at a return grille. The testing protocol provided consistent and comparable measurements of air quality indicators between institutions. At 20 air changes per hour (ACH), and an average temperature of 66.3°F, the median of the microbial contaminants for the 3 operating room sites ranged from 3-22 colony forming units (CFU)/m 3 at the sterile field and 5-27 CFU/m 3 at the back table. At 20 ACH, the median levels of the 0.5-µm particles at the 3 sites were 85,079, 85,325, and 912,232 in particles per cubic meter, with a predictable increase in particle load in the non-high-efficiency particulate air-filtered operating room site. Using a comparison with cleanroom standards, the microbial and particle counts in all 3 operating rooms were equivalent to International Organization for Standardization classifications 7 and 8 during the mock surgical procedures. The EQI protocol was measurable and repeatable and therefore can be safely used to evaluate air quality within the health care environment to provide guidance for operational practices and regulatory requirements. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Red-light-emitting laser diodes operating CW at room temperature

NASA Technical Reports Server (NTRS)

Kressel, H.; Hawrylo, F. Z.

1976-01-01

Heterojunction laser diodes of AlGaAs have been prepared with threshold current densities substantially below those previously achieved at room temperature in the 7200-8000-A spectral range. These devices operate continuously with simple oxide-isolated stripe contacts to 7400 A, which extends CW operation into the visible (red) portion of the spectrum.

A Protocol for a Prospective Study of Pregnancy Outcomes of Operating Room Nurses and Nurse Anesthetists Occupationally Exposed to Waste Anesthetic Gases as Compared to Psychiatric Nurses in the United States Air Force.

DTIC Science & Technology

1980-06-01

PROSPECTIVE STUDY OF PREGNANCY’ OUTCOMES OF OPERATING ROOM NURSES AND NURSE ANESTHETISTS OCCUPATIONALLY EXPOSED TO WASTE ANESTHETIC GASES AS COMPARED O TO...tionally Exposed to Waste Anesthetic Gases 6 Pt NFONMING 0 i REP"ORT NUMBER as Cor - p4~~ oP ciar~_Njssi Ruth L. Nancarrow 9 PERFONMtNG OI-GANIZATION...human factors involved in the control of waste anesthetic gases in the operating room; Lt. Colonel Phyllis Goins, Chief, Educa- tional Methodology

Applications for a hybrid operating room in thoracic surgery: from multidisciplinary procedures to ­­image-guided video-assisted thoracoscopic surgery

PubMed Central

Terra, Ricardo Mingarini; Andrade, Juliano Ribeiro; Mariani, Alessandro Wasum; Garcia, Rodrigo Gobbo; Succi, Jose Ernesto; Soares, Andrey; Zimmer, Paulo Marcelo

2016-01-01

ABSTRACT The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases. PMID:27812640

Optimizing Anesthesia-Related Waste Disposal in the Operating Room: A Brief Report.

PubMed

Hubbard, Richard M; Hayanga, Jeremiah A; Quinlan, Joseph J; Soltez, Anita K; Hayanga, Heather K

2017-10-01

Misappropriation of noncontaminated waste into regulated medical waste (RMW) containers is a source of added expense to health care facilities. The operating room is a significant contributor to RMW waste production. This study sought to determine whether disposing of anesthesia-related waste in standard waste receptacles before patient entry into the operating room would produce a reduction in RMW. A median of 0.35 kg of waste was collected from 51 cases sampled, with a potential annual reduction of 13,800 kg of RMW to the host institution, and a cost savings of $2200.

Determining high touch areas in the operating room with levels of contamination.

PubMed

Link, Terri; Kleiner, Catherine; Mancuso, Mary P; Dziadkowiec, Oliwier; Halverson-Carpenter, Katherine

2016-11-01

The Centers for Disease Control and Prevention put forth the recommendation to clean areas considered high touch more frequently than minimal touch surfaces. The operating room was not included in these recommendations. The purpose of this study was to determine the most frequently touched surfaces in the operating room and their level of contamination. Phase 1 was a descriptive study to identify high touch areas in the operating room. In phase 2, high touch areas determined in phase 1 were cultured to determine if high touch areas observed were also highly contaminated and if they were more contaminated than a low touch surface. The 5 primary high touch surfaces in order were the anesthesia computer mouse, OR bed, nurse computer mouse, OR door, and anesthesia medical cart. Using the OR light as a control, this study demonstrated that a low touch area was less contaminated than the high touch areas with the exception of the OR bed. Based on information and data collected in this study, it is recommended that an enhanced cleaning protocol be established based on the most frequently touched surfaces in the operating room. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Concentrations of methoxyflurane and nitrous oxide in veterinary operating rooms

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

Ward, G.S.; Byland, R.R.

1982-02-01

The surgical rooms of 14 private veterinary practices were monitored to determined methoxyflurane (MOF) concentrations during surgical procedure under routine working conditions. The average room volume for these 14 rooms was 29 m3. The average MOF value for all rooms was 2.3 ppm, with a range of 0.7 to 7.4 ppm. Four of the 14 rooms exceeded the maximum recommended concentration of 2 ppm. Six rooms which had 6 or more air changes/hr averaged 1.1 ppm, whereas 8 rooms with less than 6 measurable air changes/hr averaged 3.2 ppm. Operating rooms that had oxygen flows of more than 1,000 cm3/minmore » averaged 4.4 ppm, whereas those with flows of less than 1,000 cm3/min averaged 1.5 ppm. The average time spent during a surgical procedure using MOF, for all 14 facilities, was 2 hours. Nitrous oxide (N/sub 2/O) concentrations were determined in 4 veterinary surgical rooms. The average N/sub 2/O concentration for 3 rooms without waste anesthetic gas scavenging was 138 ppm. Concentration of N/sub 2/O in the waste anesthetic gas-scavenged surgical room was 14 ppm, which was below the maximum recommended concentration of 25 ppm.« less

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.

49 CFR 195.446 - Control room management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... written control room management procedures that implement the requirements of this section. The procedures... define the roles and responsibilities of a controller during normal, abnormal, and emergency operating... operator must define each of the following: (1) A controller's authority and responsibility to make...

[Environmental hygiene of the surgery suites for the control of surgical wound infection: Italian legislation and international guidelines].

PubMed

Charrier, L; Castella, A; Di Legami, V; Pastorino, F; Farina, E C; Argentero, P A; Zotti, C M

2006-01-01

Aim of the study is to describe the application of surgical site infection (SSI) control procedures in general surgery operating rooms of Piedmont region hospitals. A specific data collection form was designed to record information. 54 questionnaires were compiled. Piedmont legislation related to operating rooms' equipment is obeyed in more than 90% of hospitals. Nevertheless, there are some critical aspects than could be risk factors for SSI or that are not useful in order to prevent them: use of UV radiation (11.3%), use of tacky mats at the entrance of the operating room (5.7%), special cleaning of operating rooms after contaminated or dirty operations (73.6%) and routine environmental sampling (10%) that is strongly recommended by ISPESL guideline in disagreement with international recommendations. Steam autoclave is used for surgical instruments sterilization by 100% of hospitals, but only 50% of them performs an annual validation of both autoclave performance and sterilization procedures. The study gave useful information in order to promote some structural modifications and personnel education for efficacious SSI prevention and control.

The Association Between Operating Room Personnel and Turnover With Surgical Site Infection in More Than 12 000 Neurosurgical Cases.

PubMed

Wathen, Connor; Kshettry, Varun R; Krishnaney, Ajit; Gordon, Steven M; Fraser, Thomas; Benzel, Edward C; Modic, Michael T; Butler, Sam; Machado, Andre G

2016-12-01

Surgical site infection (SSI) contributes significantly to postoperative morbidity and mortality and greatly increases the cost of care. To identify the impact of workflow and personnel-related risk factors contributing to the incidence of SSIs in a large sample of neurological surgeries. Data were obtained using an enterprisewide electronic health record system, operating room, and anesthesia records for neurological procedures conducted between January 1, 2009, and November 30, 2012. SSI data were obtained from prospective surveillance by infection preventionists using Centers for Disease Control and Prevention definitions. A multivariate model was constructed and refined using backward elimination logistic regression methods. The analysis included 12 528 procedures. Most cases were elective (94.5%), and the average procedure length was 4.8 hours. The average number of people present in the operating room at any time during the procedure was 10.0. The overall infection rate was 2.3%. Patient body mass index (odds ratio, 1.03; 95% confidence interval [CI], 1.01-1.04) and sex (odds ratio, 1.36; 95% CI, 1.07-1.72) as well as procedure length (odds ratio, 1.19 per additional hour; 95% CI, 1.15-1.23) and nursing staff turnovers (odds ratio, 1.095 per additional turnover; 95% CI, 1.02-1.21) were significantly correlated with the risk of SSI. This study found that patient body mass index and male sex were associated with an increased risk of SSI. Operating room personnel turnover, a modifiable, work flow-related factor, was an independent variable positively correlated with SSI. This study suggests that efforts to reduce operating room turnover may be effective in preventing SSI. OR, operating roomSSI, surgical site infection.

Engine Research Building’s Central Control Room

NASA Image and Video Library

1948-07-21

Operators in the Engine Research Building’s Central Control Room at the National Advisory Committee for Aeronautics (NACA) Lewis Flight Propulsion Laboratory. The massive 4.25-acre Engine Research Building contains dozens of test cells, test stands, and altitude chambers. A powerful collection of compressors and exhausters located in the central portion of the basement provided process air and exhaust for these test areas. This system is connected to similar process air systems in the laboratory’s other large test facilities. The Central Control Room coordinates this activity and communicates with the local utilities. This photograph was taken just after a major upgrade to the control room in 1948. The panels on the wall contain rudimentary floor plans of the different Engine Research Building sections with indicator lights and instrumentation for each test cell. The process air equipment included 12 exhausters, four compressors, a refrigeration system, cooling water, and an exhaust system. The operators in the control room kept in contact with engineers running the process air system and those conducting the tests in the test cells. The operators also coordinated with the local power companies to make sure enough electricity was available to operate the powerful compressors and exhausters.

Conceptual Inquiry of the Space Shuttle and International Space Station GNC Flight Controllers

NASA Technical Reports Server (NTRS)

Kranzusch, Kara

2007-01-01

The concept of Mission Control was envisioned by Christopher Columbus Kraft in the 1960's. Instructed to figure out how to operate human space flight safely, Kraft envisioned a room of sub-system experts troubleshooting problems and supporting nominal flight activities under the guidance of one Flight Director who is responsible for the success of the mission. To facilitate clear communication, MCC communicates with the crew through a Capsule Communicator (CAPCOM) who is an astronaut themselves. Gemini 4 was the first mission to be supported by such a MCC and successfully completed the first American EVA. The MCC seen on television is called the Flight Control Room (FCR, pronounced ficker) or otherwise known as the front room. While this room is the most visible aspect, it is a very small component of the entire control center. The Shuttle FCR is known as the White FCR (WFCR) and Station's as FCR-1. (FCR-1 was actually the first FCR built at JSC which was used through the Gemini, Apollo and Shuttle programs until the WFCR was completed in 1992. Afterwards FCR-1 was refurbished first for the Life Sciences Center and then for the ISS in 2006.) Along with supporting the Flight Director, each FCR operator is also the supervisor for usually two or three support personnel in a back room called the Multi-Purpose Support Room (MPSR, pronounced mipser). MPSR operators are more deeply focused on their specific subsystems and have the responsible to analyze patterns, and diagnose and assess consequences of faults. The White MPSR (WMPSR) operators are always present for Shuttle operations; however, ISS FCR controllers only have support from their Blue MPSR (BMPSR) while the Shuttle is docked and during critical operations. Since ISS operates 24-7, the FCR team reduces to a much smaller Gemini team of 4-5 operators for night and weekend shifts when the crew is off-duty. The FCR is also supported by the Mission Evaluation Room (MER) which is a collection of contractor engineers who provide analysis and long-term troubleshooting support. Each MER operator is an expert in a very small portion of a sub-system and each FCR console usually interfaces with several MER positions.

Use of a Hybrid Operating Room to Improve Reduction of Syndesmotic Injuries in Ankle Fractures: A Case Report.

PubMed

Cancienne, Jourdan M; Crosen, Matelin P; Yarboro, Seth R

2016-01-01

Ankle fractures are one of the most common orthopedic injuries requiring operative treatment, and approximately 1 in 4 ankle fractures will have an associated distal tibiofibular syndesmosis disruption. Syndesmotic reduction is crucial to restoring ankle function and preventing the development of arthritis. The hybrid operating room provides 3-dimensional intraoperative imaging capabilities that can enable the surgeon to ensure the syndesmosis is appropriately reduced, particularly by comparing it with the contralateral ankle. By confirming the syndesmosis reduction intraoperatively, the risk of a return to the operating room for revision surgery is decreased. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Housing and testing in mixed-sex rooms increases motivation and accuracy during operant testing in both male and female mice.

PubMed

Lloyd, Kelsey R; Yaghoubi, Sarah K; Makinson, Ryan A; McKee, Sarah E; Reyes, Teresa M

2018-04-01

Operant behavior tasks are widely used in neuroscience research, but little is known about how variables such as housing and testing conditions affect rodent operant performance. We have previously observed differences in operant performance in male and female mice depending on whether mice were housed and tested in rooms containing only one sex versus rooms containing both sexes. Here, male and female mice in either single-sex or mixed sex housing rooms were trained on fixed ratio 1 (FR1) and progressive ratio (PR) tasks. For both sexes, animals in the mixed sex room had more accurate performance in FR1 and were more motivated in the PR task. We then moved the single sex housed animals to the mixed sex room and vice versa. Animals that started in mixed sex housing had no change to PR, but both sexes who started in single sex housing were more motivated after the switch. Additionally, the females that moved into single-sex housing performed less accurately in FR1. We conclude that housing and testing conditions can affect performance on FR1 and PR tasks. As these tasks are commonly used as training steps to more complex tasks, housing and testing conditions should be carefully considered during experiment design and reported in publications. Copyright © 2018 Elsevier Inc. All rights reserved.

Time-motion analysis of clinical nursing documentation during implementation of an electronic operating room management system for ophthalmic surgery.

PubMed

Read-Brown, Sarah; Sanders, David S; Brown, Anna S; Yackel, Thomas R; Choi, Dongseok; Tu, Daniel C; Chiang, Michael F

2013-01-01

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design.

Time-Motion Analysis of Clinical Nursing Documentation During Implementation of an Electronic Operating Room Management System for Ophthalmic Surgery

PubMed Central

Read-Brown, Sarah; Sanders, David S.; Brown, Anna S.; Yackel, Thomas R.; Choi, Dongseok; Tu, Daniel C.; Chiang, Michael F.

2013-01-01

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design. PMID:24551402

A novel interactive educational system in the operating room--the IE system.

PubMed

Nakayama, Takayuki; Numao, Noboru; Yoshida, Soichiro; Ishioka, Junichiro; Matsuoka, Yoh; Saito, Kazutaka; Fujii, Yasuhisa; Kihara, Kazunori

2016-02-02

The shortage of surgeon is one of the serious problems in Japan. To solve the problem, various efforts have been undertaken to improve surgical education and training. However, appropriate teaching methods in the operating room have not been well established. The aim of this study is to assess the utility of a novel interactive educational (IE) system for surgical education on urologic surgeries in the operating room. A total of 20 Japanese medical students were educated on urologic surgery using the IE system in the operating room. The IE system consists of two parts. The first is three-dimensional (3D) magnified vision of the operative field using a 3D head-mounted display and a 3D endoscope. The second is interactive educative communication between medical students and surgeons using a small-sized wireless communication device. The satisfaction level with the IE system and the physical burden on medical students was examined via questionnaire. All students utilized the IE system in urologic surgery and responded to the survey. Most students were satisfied with the IE system. They also felt more welcomed by the surgeon when using the IE system than when not using it. No major unpleasant symptoms were observed but five students (25 %) experienced mild eye fatigue as a result of viewing the medical images. The IE system has the potential to motivate students to become interested in surgery and could be an efficient method of surgical education in the operating room.

9 CFR 354.241 - Cleaning of rooms and compartments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... skinning room shall be kept clean and free from offensive odors at all times. (g) The walls, floors, and all equipment and utensils used in the killing and skinning room shall be thoroughly washed and cleaned after each day's operation. (h) The floor in the killing and skinning rooms shall be cleaned...

9 CFR 354.241 - Cleaning of rooms and compartments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... skinning room shall be kept clean and free from offensive odors at all times. (g) The walls, floors, and all equipment and utensils used in the killing and skinning room shall be thoroughly washed and cleaned after each day's operation. (h) The floor in the killing and skinning rooms shall be cleaned...

Clean room technology in surgery suites

NASA Technical Reports Server (NTRS)

1971-01-01

The principles of clean room technology and the criteria for their application to surgery are discussed. The basic types of surgical clean rooms are presented along with their advantages and disadvantages. Topics discussed include: microbiology of surgery suites; principles of laminar airflow systems, and their use in surgery; and asepsis and the operating room.

Microbiological aspects of clean room technology as applied to surgery, with special reference to unidirectional airflow systems

NASA Technical Reports Server (NTRS)

Wardle, M. D.

1974-01-01

The microbiological aspects of clean room technology as applied to surgery were reviewed. The following pertinent subject areas were examined: (1) clean room technology per se and its utilization for surgery, (2) microbiological monitoring of the clean room surgical environment, (3) clean rooms and their impact on operating room environmental microbiology, and (4) the effect of the technology on surgical wound infection rates. Conclusions were drawn for each topic investigated.

Surgical team turnover and operative time: An evaluation of operating room efficiency during pulmonary resection.

PubMed

Azzi, Alain Joe; Shah, Karan; Seely, Andrew; Villeneuve, James Patrick; Sundaresan, Sudhir R; Shamji, Farid M; Maziak, Donna E; Gilbert, Sebastien

2016-05-01

Health care resources are costly and should be used judiciously and efficiently. Predicting the duration of surgical procedures is key to optimizing operating room resources. Our objective was to identify factors influencing operative time, particularly surgical team turnover. We performed a single-institution, retrospective review of lobectomy operations. Univariate and multivariate analyses were performed to evaluate the impact of different factors on surgical time (skin-to-skin) and total procedure time. Staff turnover within the nursing component of the surgical team was defined as the number of instances any nurse had to leave the operating room over the total number of nurses involved in the operation. A total of 235 lobectomies were performed by 5 surgeons, most commonly for lung cancer (95%). On multivariate analysis, percent forced expiratory volume in 1 second, surgical approach, and lesion size had a significant effect on surgical time. Nursing turnover was associated with a significant increase in surgical time (53.7 minutes; 95% confidence interval, 6.4-101; P = .026) and total procedure time (83.2 minutes; 95% confidence interval, 30.1-136.2; P = .002). Active management of surgical team turnover may be an opportunity to improve operating room efficiency when the surgical team is engaged in a major pulmonary resection. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

A patient who was burned in the operative field: a case report.

PubMed

Chung, Soo Ho; Lee, Hae Hyeog; Kim, Tae Hee; Kim, Jeong Sig

2012-05-01

Operating room fires occur very rarely. Nevertheless, a disaster can complicate almost any kind of surgery. The majority of operating room fires result from the use of alcohol- based surgical preparation solutions, electro-surgical equipment, or flammable drapes in an oxygen-rich environment. We report a patient with an ovarian cyst and uterine myomas who suffered a flame burn while undergoing gynecological surgery.

Looking east along the operating deck above the intake toward ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Looking east along the operating deck above the intake toward the Main Control Room. An evaporative-cooling system is to the left of the Control Room, and a motor-operated, geared trolly hoist and rake for removing debris from the trash rack is in the foreground - Wellton-Mohawk Irrigation System, Pumping Plant No. 1, Bounded by Gila River & Union Pacific Railroad, Wellton, Yuma County, AZ

Determinants, associations, and psychometric properties of resident assessments of anesthesiologist operating room supervision.

PubMed

Hindman, Bradley J; Dexter, Franklin; Kreiter, Clarence D; Wachtel, Ruth E

2013-06-01

A study by de Oliveira Filho et al. reported a validated set of 9 questions by which Brazilian anesthesia residents assessed faculty supervision in the operating room. The aim of this study was to use this question set to determine whether faculty operating room supervision scores were associated with residents' year of clinical anesthesia training and/or number of specific resident-faculty interactions. We also characterized associations between faculty operating room supervision scores and resident assessments of: (1) faculty supervision in settings other than operating rooms, (2) faculty clinical ability (family choice), and (3) faculty teaching effectiveness. Finally, we characterized the psychometric properties of the de Oliveira Filho etal. question set in an United States anesthesia residency program. All 39 residents in the Department of Anesthesia of the University of Iowa in their first (n = 14), second (n = 13), or third (n = 12) year of clinical anesthesia training evaluated the supervision provided by all anesthesia faculty who staffed in at least 1 of 3 clinical settings (operating room [n = 49], surgical intensive care unit [n = 10], pain clinic [n = 6]). For all resident-faculty pairs, departmental billing data were used to quantitate the number of resident-faculty interactions and the interval between the last interaction and the assessment. A generalizability study was performed to determine the minimum number of resident evaluations needed for high reliability and dependability. There were no significant associations between faculty mean operating room supervision scores and: (1) resident-faculty patient encounters (Kendall τb = 0.01; 95% confidence interval [CI], -0.02 to +0.04; P = 0.71), (2) resident-faculty days of interaction (τb = -0.01; 95% CI, -0.05 to +0.02; P = 0.46), and (3) days since last resident-faculty interaction (τb = 0.01; 95% CI, -0.02 to 0.05; P = 0.49). Supervision scores for the operating room and surgical intensive care unit were highly correlated (τb = 0.71; 95% CI, 0.63 to 0.78; P < 0.0001). Supervision scores for the operating room also were highly correlated with family choice scores (τb = 0.77; 95% CI, 0.70 to 0.84; P < 0.0001) and teaching scores (τb = 0.87; 95% CI, 0.82 to 0.92; P < 0.0001). High reliability and dependability (both G- and ϕ-coefficients > 0.80) occurred when individual faculty anesthesiologists received assessments from 15 or more different residents. Supervision scores provided by all residents can be given equal weight when calculating an individual faculty anesthesiologist's mean supervision score. Assessments of supervision, teaching, and quality of clinical care are highly correlated. When the de Oliveira Filho et al. question set is used in a United States anesthesia residency program, supervision scores are highly reliable and dependable when at least 15 residents assess each faculty.

Imaging System for Vaginal Surgery.

PubMed

Taylor, G Bernard; Myers, Erinn M

2015-12-01

The vaginal surgeon is challenged with performing complex procedures within a surgical field of limited light and exposure. The video telescopic operating microscope is an illumination and imaging system that provides visualization during open surgical procedures with a limited field of view. The imaging system is positioned within the surgical field and then secured to the operating room table with a maneuverable holding arm. A high-definition camera and Xenon light source allow transmission of the magnified image to a high-definition monitor in the operating room. The monitor screen is positioned above the patient for the surgeon and assistants to view real time throughout the operation. The video telescopic operating microscope system was used to provide surgical illumination and magnification during total vaginal hysterectomy and salpingectomy, midurethral sling, and release of vaginal scar procedures. All procedures were completed without complications. The video telescopic operating microscope provided illumination of the vaginal operative field and display of the magnified image onto high-definition monitors in the operating room for the surgeon and staff to simultaneously view the procedures. The video telescopic operating microscope provides high-definition display, magnification, and illumination during vaginal surgery.

78 FR 73744 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-09

.... Mail: U.S. Department of Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12... Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue SE... information identified in this proposed AD, contact Boeing Commercial Airplanes, Attention: Data & Services...

62. (Credit CBF) Operating floor of filter room, c1912. The ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

62. (Credit CBF) Operating floor of filter room, c1912. The remodeled New York horizontal pressure filters (now gravity filters) are in the foreground; the remodelled Hyatt tub filters are in the background. - McNeil Street Pumping Station, McNeil Street & Cross Bayou, Shreveport, Caddo Parish, LA

46 CFR 69.121 - Engine room deduction.

Code of Federal Regulations, 2011 CFR

2011-10-01

... necessary for the safe operation and maintenance of the propelling machinery, the entire space, or, if... machinery space is not bulkheaded off or is larger than necessary for the safe operation and maintenance of... room deduction is either a percentage of the vessel's total propelling machinery spaces or a percentage...

Room-temperature operation of a Co:MgF2 laser

NASA Technical Reports Server (NTRS)

Welford, D.; Moulton, P. F.

1988-01-01

A normal-mode, pulsed Co:MgF2 laser has been operated at room temperature for the first time. Continuous tuning from 1750 to 2500 nm with pulse energies up to 70 mJ and 46-percent slope efficiency was obtained with a 1338-nm Nd:YAG pump laser.

A Foot Operated Timeout Room Door Latch.

ERIC Educational Resources Information Center

Foxx, R. M.; And Others

1982-01-01

This report describes the design and implementation of a foot operated timeout room door latch that permits staff members to maintain a misbehaving retarded individual in timeout without locking the door. Use of the latch also frees the staff member involved to record behavioral observations or reinforce appropriate behavior. (Author)

Do surgeons and surgical facilities disturb the clean air distribution close to a surgical patient in an orthopedic operating room with laminar airflow?

PubMed

Cao, Guangyu; Storås, Madeleine C A; Aganovic, Amar; Stenstad, Liv-Inger; Skogås, Jan Gunnar

2018-05-04

Airflow distribution in the operating room plays an important role in ensuring a clean operating microenvironment and preventing surgical site infections (SSIs) caused by airborne contaminations. The objective of this study was to characterize the airflow distribution in proximity to a patient in an orthopedic operating room. Experimental measurements were conducted in a real operating room at St. Olav's Hospital, Norway, with a laminar airflow system. Omnidirectional anemometers were used to investigate the air distribution in the operating zone, and 4 different cases were examined with a real person and a thermal manikin. This study showed that the downward airflow from the laminar airflow system varies in each case with different surgical arrangement, such as the position of the operating lamp. The results indicate that the interaction of thermal plumes from a patient and the downward laminar airflow may dominate the operating microenvironment. The airflow distribution in proximity to a patient is influenced by both the surgical facility and the presence of medical staff. A thermal manikin may be an economical and practical way to study the interaction of thermal plumes and downward laminar airflow. The provision of higher clean airflow rate in the operating microenvironment may be an effective way to prevent the development of SSIs caused by indoor airborne contamination. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

16. DINING ROOM INTERIOR SHOWING DOUBLE DOOR ARCHWAY INTO LIVING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

16. DINING ROOM INTERIOR SHOWING DOUBLE DOOR ARCHWAY INTO LIVING ROOM AND DOUBLE FRENCH DOORS INTO SOUTH END SCREENED PORCH. VIEW TO SOUTHWEST. - Big Creek Hydroelectric System, Powerhouse 8, Operator Cottage, Big Creek, Big Creek, Fresno County, CA

Impact of environmental factors on efficacy of upper-room air ultraviolet germicidal irradiation for inactivating airborne mycobacteria.

PubMed

Xu, Peng; Kujundzic, Elmira; Peccia, Jordan; Schafer, Millie P; Moss, Gene; Hernandez, Mark; Miller, Shelly L

2005-12-15

This study evaluated the efficacy of an upper-room air ultraviolet germicidal irradiation (UVGI) system for inactivating airborne bacteria, which irradiates the upper part of a room while minimizing radiation exposure to persons in the lower part of the room. A full-scale test room (87 m3), fitted with a UVGI system consisting of 9 louvered wall and ceiling fixtures (504 W all lamps operating) was operated at 24 and 34 degrees C, between 25 and 90% relative humidity, and at three ventilation rates. Mycobacterium parafortuitum cells were aerosolized into the room such that their numbers and physiologic state were comparable both with and without the UVGI system operating. Airborne bacteria were collected in duplicate using liquid impingers and quantified with direct epifluorescent microscopy and standard culturing assay. Performance of the UVGI system degraded significantly when the relative humidity was increased from 50% to 75-90% RH, the horizontal UV fluence rate distribution was skewed to one side compared to being evenly dispersed, and the room air temperature was stratified from hot at the ceiling to cold at the floor. The inactivation rate increased linearly with effective UV fluence rate up to 5 microW cm(-2); an increase in the fluence rate above this level did not yield a proportional increase in inactivation rate.

61. (Credit CBF) Operating floor of filter room, c1912. A ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

61. (Credit CBF) Operating floor of filter room, c1912. A remodeled Hyatt pressure filter, now operating as a tub, gravity, rapid sand filter, is in the foreground (the remodeling took place c1908-1909). The remodeled New York horizontal pressure filters (installed 01900, remodeled c1908-1909) are in the background. - McNeil Street Pumping Station, McNeil Street & Cross Bayou, Shreveport, Caddo Parish, LA

Virtual environment for training in microsurgery

NASA Astrophysics Data System (ADS)

Montgomery, Kevin N.; Stephanides, Michael; Brown, Joel; Latombe, Jean-Claude; Schendel, Stephen A.

1999-05-01

Microsurgery is a well-established medical field, and involves repair of approximately 1mm vessels and nerves under an operating microscope in order to reattach severed fingers or transfer tissue for reconstruction. Initial skill sin microvascular surgery are usually developed in the animal lab and subsequently in the operating room. Development of these skills typically requires about 6 months of animal based training before additional learning takes place in the operating room.

Ergonomic assessment of neck posture in the minimally invasive surgery suite during laparoscopic cholecystectomy.

PubMed

van Det, M J; Meijerink, W J H J; Hoff, C; van Veelen, M A; Pierie, J P E N

2008-11-01

With the expanding implementation of minimally invasive surgery, the operating team is confronted with challenges in the field of ergonomics. Visual feedback is derived from a monitor placed outside the operating field. This crossover trial was conducted to evaluate and compare neck posture in relation to monitor position in a dedicated minimally invasive surgery (MIS) suite and a conventional operating room. Assessment of the neck was conducted for 16 surgeons, assisting surgeons, and scrub nurses performing a laparoscopic cholecystectomy in both types of operating room. Flexion and rotation of the cervical spine were measured intraoperatively using a video analysis system. A two-question visual analog scale (VAS) questionnaire was used to evaluate posture in relation to the monitor position. Neck rotation was significantly reduced in the MIS suite for the surgeon (p = 0.018) and the assisting surgeon (p < 0.001). Neck flexion was significantly improved in the MIS suite for the surgeon (p < 0.001) and the scrub nurse (p = 0.018). On the questionnaire, the operating room team scored their posture significantly higher in the MIS suite and also indicated fewer musculoskeletal complaints. The ergonomic quality of the neck posture is significantly improved in the MIS suite for the entire operating room team.

Operating room environment and surgical site infections in arthroplasty procedures.

PubMed

Cristina, M L; Sartini, M; Schinca, E; Ottria, G; Spagnolo, A M

2016-09-01

The rate of surgical site infections (SSI) is strongly influenced by operating room quality, which is determined by the structural features of the facility and its systems and by the management and behavior of healthcare workers. The aim of the present study was to assess microbial contamination in the operating room during hip- and knee-replacement procedures, the behavior of operating room staff and the incidence of SSI through postdischarge surveillance. Microbial contamination was evaluated by active and passive sampling at rest and in operating conditions. Organizational and behavioral characteristics were collected through observational assessment. The incidence of SSI was evaluated in 255 patients, and follow-up examinations were carried out 30 and 365 days after the procedure. The mean values of the airborne and sedimenting microbial loads were 12.90 CFU/m 3 and 0.02 CFU/cm2/h, respectively. With regard to outcome, the infection rate proved to be 0.89% and was associated with knee-replacement procedures. The microorganism responsible for this superficial infection was Staphylococcus aureus. Clinical outcomes proved to be satisfactory, owing to the limited microbial load (in both at-rest and operating conditions), the appropriate behavior of the staff, compliance with the guidelines on preoperative antibiotic prophylaxis, and efficient management of the ventilation system.

Mortality in patients with end-stage renal disease and the risk of returning to the operating room after common General Surgery procedures.

PubMed

Brakoniecki, Katrina; Tam, Sophia; Chung, Paul; Smith, Michael; Alfonso, Antonio; Sugiyama, Gainosuke

2017-02-01

The prevalence of end-stage renal disease (ESRD) has increased, and there is limited data on the risks faced by this patient population undergoing surgery. Using American College of Surgeons National Surgical Quality Improvement Program, we identified common surgical procedures undergone by patients with ESRD. These patients were compared with a matched-control group. A subanalysis was performed to determine the risk factors for returning to the operating room in patients with ESRD. Of the 195,585 patients identified, 1,163 had ESRD. ESRD was associated with increased mortality (odds ratio [OR] 9.05, confidence interval [CI] 4.09 to 20.00) and rates of return to the operating room (OR 2.97, CI 1.99 to 4.46). Returning to the OR was associated with increased operation times (98.9 vs 130.2 minutes, P < .05), mortality (OR 4.35, CI 2.11 to 8.99), and morbidity (OR 7.6, CI 4.68 to 12.41). Patients with ESRD face greater risks when entering the operating room, and further study is needed to elucidate preventable risk factors. Copyright © 2016 Elsevier Inc. All rights reserved.

Light Water Reactor Sustainability Program A Reference Plan for Control Room Modernization: Planning and Analysis Phase

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

Jacques Hugo; Ronald Boring; Lew Hanes

2013-09-01

The U.S. Department of Energy’s Light Water Reactor Sustainability (LWRS) program is collaborating with a U.S. nuclear utility to bring about a systematic fleet-wide control room modernization. To facilitate this upgrade, a new distributed control system (DCS) is being introduced into the control rooms of these plants. The DCS will upgrade the legacy plant process computer and emergency response facility information system. In addition, the DCS will replace an existing analog turbine control system with a display-based system. With technology upgrades comes the opportunity to improve the overall human-system interaction between the operators and the control room. To optimize operatormore » performance, the LWRS Control Room Modernization research team followed a human-centered approach published by the U.S. Nuclear Regulatory Commission. NUREG-0711, Rev. 3, Human Factors Engineering Program Review Model (O’Hara et al., 2012), prescribes four phases for human factors engineering. This report provides examples of the first phase, Planning and Analysis. The three elements of Planning and Analysis in NUREG-0711 that are most crucial to initiating control room upgrades are: • Operating Experience Review: Identifies opportunities for improvement in the existing system and provides lessons learned from implemented systems. • Function Analysis and Allocation: Identifies which functions at the plant may be optimally handled by the DCS vs. the operators. • Task Analysis: Identifies how tasks might be optimized for the operators. Each of these elements is covered in a separate chapter. Examples are drawn from workshops with reactor operators that were conducted at the LWRS Human System Simulation Laboratory HSSL and at the respective plants. The findings in this report represent generalized accounts of more detailed proprietary reports produced for the utility for each plant. The goal of this LWRS report is to disseminate the technique and provide examples sufficient to serve as a template for other utilities’ projects for control room modernization.« less

The operating room charge nurse: coordinator and communicator.

PubMed Central

Moss, J.; Xiao, Y.; Zubaidah, S.

2001-01-01

To achieve the potential inherent in the use of computer applications in distributed environments, we need to understand the information needs of users. The purpose of this descriptive study was to document the communication of an operating room charge nurse to inform the design of technological communication applications for operating room coordination. A data collection tool was developed to record: 1) the purpose of the communication, 2) mode of communication, 3) the target individual, and 4) the length of time taken for each occurrence. The chosen data collection categories provided a functional structure for data collection and analysis involving communication. Study findings are discussed within the context of application design. PMID:11825234

Fire Safety for the Oral and Maxillofacial Surgeon and Surgical Staff.

PubMed

Di Pasquale, LisaMarie; Ferneini, Elie M

2017-05-01

Fire in the operating room is a life-threatening emergency that demands quick, efficient intervention. Because the circumstances surrounding fires are generally well-understood, virtually every operating room fire is preventable. Before every operating room case, thorough preprocedure "time outs" should address each team members' awareness of specific fire risks and agreement regarding fire concerns and emergency actions. Fire prevention centers on 3 constituent parts of the fire triad necessary for fire formation. Regular fire drills should guide policies and procedures to prevent surgical fires. Delivering optimal patient care in emergent situations requires surgical team training, practicing emergency roles, and specific actions. Copyright © 2016 Elsevier Inc. All rights reserved.

A Web-Based Operating Room Management Educational Tool.

PubMed

Tsai, Mitchell H; Haddad, Daniel J; Friend, Alexander F; Bender, S Patrick; Davidson, Melissa L

2016-08-01

In 2010, our department instituted a nonclinical, administrative rotation in operating room management for anesthesiology residents. Subsequently, we mandated the rotation for all senior anesthesiology residents in 2013. In 2014, under the auspices of the American Society of Anesthesiologists, we developed a web-based module covering the basics of finance, accounting, and operating room management. A multiple-choice test was given to residents at the beginning and end of the rotation, and we compared the mean scores between residents who took the traditional course and residents who took the web-based module. We found no significant difference between the groups of residents, suggesting that the web-based module is as effective as traditional didactics.

Microbial flora on cell-phones in an orthopedic surgery room before and after decontamination.

PubMed

Murgier, J; Coste, J-F; Cavaignac, E; Bayle-Iniguez, X; Chiron, P; Bonnevialle, P; Laffosse, J-M

2016-12-01

Cell-phones are the typical kind of object brought into the operating room from outside by hospital staff. A great effort is made to reduce the level of potentially contaminating bacteria in the operating room, and introducing these devices may run counter to good practice. The study hypothesis was that cell-phones are colonized by several strains of bacteria and may constitute a source of nosocomial contamination. The main study objective was to screen for bacterial colonies on the surfaces of cell-phones introduced in an orthopedic surgery room. The secondary objective was to assess the efficacy of decontamination. Samples were taken from the cell-phones of hospital staff (surgeons, anaesthetists, nurses, radiology operators, and external medical representatives) entering the operating room of the university hospital center orthopedic surgery department, Toulouse (France). Sampling used Count Tact ® contact gel, without wiping the phone down in advance. Both sides of the phone were sampled, before and after decontamination with a pad imbibed with 0.25% Surfanios ® Premium disinfectant. A nasal sample was also taken to investigate the correlation between Staphylococcus aureus in the nasal cavities and on the cell-phone. Fifty-two cell-phones were sampled. Before decontamination, the mean number of colony-forming units (CFU) was 258 per phone (range, 0-1,664). After decontamination, it was 127 (range, 0-800) (P=0.0001). Forty-nine cell-phones bore CFUs before decontamination (94%), and 39 after (75%) (P=0.02). Cell-phones are CFU carriers and may thus lead to contamination. Guidelines should be drawn up to encourage cleaning phones regularly and to reduce levels of use within the operating room. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The RoboConsultant: telementoring and remote presence in the operating room during minimally invasive urologic surgeries using a novel mobile robotic interface.

PubMed

Agarwal, Rahul; Levinson, Adam W; Allaf, Mohamad; Makarov, Danil; Nason, Alex; Su, Li-Ming

2007-11-01

Remote presence is the ability of an individual to project himself from one location to another to see, hear, roam, talk, and interact just as if that individual were actually there. The objective of this study was to evaluate the efficacy and functionality of a novel mobile robotic telementoring system controlled by a portable laptop control station linked via broadband Internet connection. RoboConsultant (RemotePresence-7; InTouch Health, Sunnyvale, CA) was employed for the purpose of intraoperative telementoring and consultation during five laparoscopic and endoscopic urologic procedures. Robot functionality including navigation, zoom capability, examination of external and internal endoscopic camera views, and telestration were evaluated. The robot was controlled by a senior surgeon from various locations ranging from an adjacent operating room to an affiliated hospital 5 miles away. The RoboConsultant performed without connection failure or interruption in each case, allowing the consulting surgeon to immerse himself and navigate within the operating room environment and provide effective communication, mentoring, telestration, and consultation. RoboConsultant provided clear, real-time, and effective telementoring and telestration and allowed the operator to experience remote presence in the operating room environment as a surgical consultant. The portable laptop control station and wireless connectivity allowed the consultant to be mobile and interact with the operating room team from virtually any location. In the future, the remote presence provided by the RoboConsultant may provide useful and effective intraoperative consultation by expert surgeons located in remote sites.

The positive impact of structured teaching in the operating room.

PubMed

Leung, Yee; Salfinger, Stuart; Mercer, Annette

2015-12-01

A survey of obstetric and gynaecology trainees in Australia found the trainee's opinion of the consultants' teaching ability for laparoscopic procedures and procedures dealing with complications as 'poor' in 21.2% and 23.4% of responses, respectively (Aust NZ J Obstet Gynaecol 2009; 49: 84). Surgical caseload per trainee is falling for a variety of reasons. Strategies need to be adopted to enhance the surgical learning experience of trainees in the operating room. We describe the use of a structured encounter template to facilitate the teaching of surgery in the operating room and report the response of the trainees to this intervention. Trainees attached to a gynaecologic surgery unit all underwent surgical training using a set format based on the surgical encounter template, including briefing, goal setting and intra-operative teaching aims as well as debriefing. Data on the trainees' experience and perception of their learning experience were then collected and analysed as quantitative and qualitative data sets. The trainees reported satisfaction with the use of a structured encounter template to facilitate the surgical teaching in the operating room. Some trainees had not received such clarity of feedback or the opportunity to complete a procedure independently prior to using the structured encounter template. A structured surgical encounter template based on andragogy principles to focus consultant teaching in the operating room is highly acceptable to obstetric and gynaecology trainees in Australia. Allowing the trainee the opportunity to set objectives and receive feedback empowers the trainee and enhances their educational experience. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Physics and function of operating room suction.

PubMed

Meagher, A P; Hugh, T B; Li, B; Montano, S R

1991-09-01

A study was done to evaluate the performance of suction apparatus in the operating room. The investigation was prompted by perceived poor suction performance in a suite of new operating rooms built in accordance with Standards Australia (SA) specifications. SA performance tests were conducted on each of four suction outlets in nine operating rooms. All 36 outlets complied with SA standards for flow-rate (minimum 40 L/min) and occluded negative pressure (ONP; minimum -60 kPa). However, 24 collection units failed to comply with standards (ONP) of -40 kPa achieved in less than 4 s when a 4 L disposable suction apparatus was connected (mean time to ONP: 6.1 s, 95% confidence interval: 4.9, 7.3). When smaller capacity suction jars were substituted, more units met SA standards. The standards therefore need revision to include specification of the capacity of the collecting apparatus. Other factors that were found to degrade suction performance significantly were air leakage and defective shut-off valves. The physical principles involved in operating room suction are described. Surgeons and anaesthetists should understand these principles, and it is recommended that a simple pre-operative check of the suction apparatus should be carried out, as follows: (1) Turn the wall control knob fully on, and disconnect the suction apparatus. The gauge should register zero. (2) Connect the suction jars. If the indicated gauge pressure is in excess of -15 kPa, investigate the equipment for excessive resistance, particularly in the shut-off valve, which should be replaced with a new unit if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Full Scale Evaluation of How Task-Based Overview Displays Impact Operator Workload and Situation Awareness When in Emergency Procedure Space

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

Spielman, Zachary; Hill, Racheal; LeBlanc, Katya

Control room modernization is critical to extending the life of the 99 operating commercial nuclear power plants (NPP) within the United States. However, due to the lack of evidence demonstrating the efficiency and effectiveness of recent candidate technologies, current NPP control rooms operate without the benefit of various newer technologies now available. As nuclear power plants begin to extend their licenses to continue operating for another 20 years, there is increased interest in modernizing the control room and supplementing the existing control boards with advanced technologies. As part of a series of studies investigating the benefits of advanced control roommore » technologies, the researchers conducted an experimental study to observe the effect of Task-Based Overview Displays (TODs) on operator workload and situation awareness (SA) while completing typical operating scenarios. Researchers employed the Situation Awareness Rating Technique (SART) and the NASA Task Load Index (TLX) as construct measures.« less

21 CFR 113.87 - Operations in the thermal processing room.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Operations in the thermal processing room. 113.87 Section 113.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION THERMALLY PROCESSED LOW-ACID FOODS PACKAGED IN HERMETICALLY SEALED...

AuPd/polyaniline as the anode in an ethylene glycol microfluidic fuel cell operated at room temperature.

PubMed

Arjona, N; Palacios, A; Moreno-Zuria, A; Guerra-Balcázar, M; Ledesma-García, J; Arriaga, L G

2014-08-04

AuPd/polyaniline was used for the first time, for ethylene glycol (EG) electrooxidation in a novel microfluidic fuel cell (MFC) operated at room temperature. The device exhibits high electrocatalytic performance and stability for the conversion of cheap and fully available EG as fuel.

Practice Brief: Accommodating Deaf and Hard of Hearing Students in Operating Room Environments--A Case Study

ERIC Educational Resources Information Center

Meeks, Lisa M.; Laird-Metke, Elisa; Rollins, Mark; Gandhi, Seema; Stechert, Martin; Jain, Neera R.

2015-01-01

Increasing numbers of deaf students in the health professions require accommodations in the clinical setting to ensure effective learning and accurate communication. Although classroom learning barriers have long been identified and addressed, barriers to clinical education have been far less analyzed. Operating room clerkships, which include many…

42. View of CSMR room equipment status board and operators ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

42. View of CSMR room equipment status board and operators console with two phone links to MWOC in transmitter building no. 102. - Clear Air Force Station, Ballistic Missile Early Warning System Site II, One mile west of mile marker 293.5 on Parks Highway, 5 miles southwest of Anderson, Anderson, Denali Borough, AK

Continuous-wave operation of InAsSb/InP quantum - dot lasers near 2 (mu)m at room temperature

NASA Technical Reports Server (NTRS)

Qiu, Yueming; Uhl, David; Keo, Sam

2004-01-01

InAsSb quantum-dot lasers near 2 pm were demonstrated in cw operation at room temperature with a threshold current density of below 1 kA/cm, output power of 3 mW/facet and a differential quantum efficiency of 13%.

21 CFR 878.5070 - Air-handling apparatus for a surgical operating room.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Air-handling apparatus for a surgical operating room. 878.5070 Section 878.5070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Therapeutic Devices § 878...

21 CFR 878.5070 - Air-handling apparatus for a surgical operating room.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Air-handling apparatus for a surgical operating room. 878.5070 Section 878.5070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Therapeutic Devices § 878...

21 CFR 878.5070 - Air-handling apparatus for a surgical operating room.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Air-handling apparatus for a surgical operating room. 878.5070 Section 878.5070 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Therapeutic Devices § 878...

Central Control Room in the Engine Research Building

NASA Image and Video Library

1968-11-21

Operators in the Engine Research Building’s Central Control Room at the National Aeronautics and Space Administration (NASA) Lewis Research Center. The massive 4.25-acre Engine Research Building contains dozens of test cells, test stands, and altitude chambers. A powerful a collection of compressors and exhausters located in the central portion of the basement provides process air and exhaust for these test areas. This system is connected to similar process air systems in the laboratory’s other large test facilities. The Central Control Room coordinates this activity and communicates with the local utilities. The panels on the wall contain schematics with indicator lights and instrumentation for the atmospheric exhaust, altitude exhaust, refrigerated air, and process air systems. The process air equipment included twelve exhausters, four compressors, refrigeration system, cooling water, and an exhaust system. The operators in the control room kept in contact with engineers running the process air system and those conducting the tests in the test cells. The operators also coordinated with the local power companies to make sure enough electricity was available to operate the powerful compressors and exhausters.

Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy.

PubMed

Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M

2015-04-01

(1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Interior of display area (room 101), looking south towards TV ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Interior of display area (room 101), looking south towards TV control panel room (room 139) at far left corner. The stairway leads to the commander's quarters and the senior battle viewing bridge at top right. Control and communication consoles at the right - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

Mass Analyzers Facilitate Research on Addiction

NASA Technical Reports Server (NTRS)

2012-01-01

The famous go/no go command for Space Shuttle launches comes from a place called the Firing Room. Located at Kennedy Space Center in the Launch Control Center (LCC), there are actually four Firing Rooms that take up most of the third floor of the LCC. These rooms comprise the nerve center for Space Shuttle launch and processing. Test engineers in the Firing Rooms operate the Launch Processing System (LPS), which is a highly automated, computer-controlled system for assembly, checkout, and launch of the Space Shuttle. LPS monitors thousands of measurements on the Space Shuttle and its ground support equipment, compares them to predefined tolerance levels, and then displays values that are out of tolerance. Firing Room operators view the data and send commands about everything from propellant levels inside the external tank to temperatures inside the crew compartment. In many cases, LPS will automatically react to abnormal conditions and perform related functions without test engineer intervention; however, firing room engineers continue to look at each and every happening to ensure a safe launch. Some of the systems monitored during launch operations include electrical, cooling, communications, and computers. One of the thousands of measurements derived from these systems is the amount of hydrogen and oxygen inside the shuttle during launch.

Altitude Wind Tunnel Control Room at the Aircraft Engine Research Laboratory

NASA Image and Video Library

1944-07-21

Operators in the control room for the Altitude Wind Tunnel at the National Advisory Committee for Aeronautics (NACA) Aircraft Engine Research Laboratory remotely operate a Wright R–3350 engine in the tunnel’s test section. Four of the engines were used to power the B–29 Superfortress, a critical weapon in the Pacific theater during World War II. The wind tunnel, which had been in operation for approximately six months, was the nation’s only wind tunnel capable of testing full-scale engines in simulated altitude conditions. The soundproof control room was used to operate the wind tunnel and control the engine being run in the test section. The operators worked with assistants in the adjacent Exhauster Building and Refrigeration Building to manage the large altitude simulation systems. The operator at the center console controlled the tunnel’s drive fan and operated the engine in the test section. Two sets of pneumatic levers near his right forearm controlled engine fuel flow, speed, and cooling. Panels on the opposite wall, out of view to the left, were used to manage the combustion air, refrigeration, and exhauster systems. The control panel also displayed the master air speed, altitude, and temperature gauges, as well as a plethora of pressure, temperature, and airflow readings from different locations on the engine. The operator to the right monitored the manometer tubes to determine the pressure levels. Despite just being a few feet away from the roaring engine, the control room remained quiet during the tests.

Laparoscopic assistance by operating room nurses: Results of a virtual-reality study.

PubMed

Paschold, M; Huber, T; Maedge, S; Zeissig, S R; Lang, H; Kneist, W

2017-04-01

Laparoscopic assistance is often entrusted to a less experienced resident, medical student, or operating room nurse. Data regarding laparoscopic training for operating room nurses are not available. The aim of the study was to analyse the initial performance level and learning curves of operating room nurses in basic laparoscopic surgery compared with medical students and surgical residents to determine their ability to assist with this type of procedure. The study was designed to compare the initial virtual reality performance level and learning curves of user groups to analyse competence in laparoscopic assistance. The study subjects were operating room nurses, medical students, and first year residents. Participants performed three validated tasks (camera navigation, peg transfer, fine dissection) on a virtual reality laparoscopic simulator three times in 3 consecutive days. Laparoscopic experts were enrolled as a control group. Participants filled out questionnaires before and after the course. Nurses and students were comparable in their initial performance (p>0.05). Residents performed better in camera navigation than students and nurses and reached the expert level for this task. Residents, students, and nurses had comparable bimanual skills throughout the study; while, experts performed significantly better in bimanual manoeuvres at all times (p<0.05). The included user groups had comparable skills for bimanual tasks. Residents with limited experience reached the expert level in camera navigation. With training, nurses, students, and first year residents are equally capable of assisting in basic laparoscopic procedures. Copyright © 2017 Elsevier Ltd. All rights reserved.

Emotional intelligence in the operating room: analysis from the Boston Marathon bombing.

PubMed

Chang, Beverly P; Vacanti, Joshua C; Michaud, Yvonne; Flanagan, Hugh; Urman, Richard D

2014-01-01

The Boston Marathon terrorist bombing that occurred on April 15, 2013 illustrates the importance of a cohesive, efficient management for the operating room and perioperative services. Conceptually, emotional intelligence (EI) is a form of social intelligence used by individuals in leadership positions to monitor the feelings and emotions of their team while implementing a strategic plan. To describe the experience of caring for victims of the bombing at a large tertiary care center and provide examples demonstrating the importance of EI and its role in the management of patient flow and overall care. A retrospective review of trauma data was performed. Data regarding patient flow, treatment types, treatment times, and outcomes were gathered from the hospital's electronic tracking system and subsequently analyzed. Analyses were performed to aggregate the data, identify trends, and describe the medical care. Immediately following the bombing, a total of 35 patients were brought to the emergency department (ED) with injuries requiring immediate medical attention. 10 of these patients went directly to the operating room on arrival to the hospital. The first victim was in an operating room within 21 minutes after arrival to the ED. The application of EI in managerial decisions helped to ensure smooth transitions for victims throughout all stages of their perioperative care. EI provided the fundamental groundwork that allowed the operating room manager and nurse leaders to establish the calm and coordinated leadership that facilitated patient care and teamwork.

Making meaning from sensory cues: a qualitative investigation of postgraduate learning in the operating room.

PubMed

Cope, Alexandra C; Mavroveli, Stella; Bezemer, Jeff; Hanna, George B; Kneebone, Roger

2015-08-01

The authors aimed to map and explicate what surgeons perceive they learn in the operating room. The researchers used a grounded theory method in which data were iteratively collected through semistructured one-to-one interviews in 2010 and 2011 at four participating hospital sites. A four-person data analysis team from differing academic backgrounds qualitatively analyzed the content of the transcripts employing an immersion/crystallization approach. Participants were 22 UK surgeons, some of whom were in training at the time of the study and some of whom were attending surgeons. Major themes of learning in the operating room were perceived to be factual knowledge, motor skills, sensory semiosis, adaptive strategies, team working and management, and attitudes and behaviors. The analysis team classified 277 data points (short paragraphs or groups of sentences conveying meaning) under these major themes and subthemes. A key component of learning in the operating room that emerged from these data was sensory semiosis, defined as learning to make sense of visual and haptic cues. Although the authors found that learning in the operating room occurred across a wide range of domains, sensory semiosis was found to be an important theme that has not previously been fully acknowledged or discussed in the surgical literature. The discussion draws on the wider literature from the social sciences and cognitive psychology literature to examine how professionals learn to make meaning from "signs" making parallels with other medical specialties.

86. VIEW OF AUTOPILOT ROOM LOOKING WEST FROM CENTER OF ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

86. VIEW OF AUTOPILOT ROOM LOOKING WEST FROM CENTER OF ROOM. IBM PERSONAL COMPUTER FOR SLC-3W AUTOPILOT FUNCTIONS IN SOUTHWEST CORNER (LEFT). - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

Energy Efficiency in Small Server Rooms: Field Surveys and Findings

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

Cheung, Iris; Greenberg, Steve; Mahdavi, Roozbeh

Fifty-seven percent of US servers are housed in server closets, server rooms, and localized data centers, in what are commonly referred to as small server rooms, which comprise 99percent of all server spaces in the US. While many mid-tier and enterprise-class data centers are owned by large corporations that consider energy efficiency a goal to minimize business operating costs, small server rooms typically are not similarly motivated. They are characterized by decentralized ownership and management and come in many configurations, which creates a unique set of efficiency challenges. To develop energy efficiency strategies for these spaces, we surveyed 30 smallmore » server rooms across eight institutions, and selected four of them for detailed assessments. The four rooms had Power Usage Effectiveness (PUE) values ranging from 1.5 to 2.1. Energy saving opportunities ranged from no- to low-cost measures such as raising cooling set points and better airflow management, to more involved but cost-effective measures including server consolidation and virtualization, and dedicated cooling with economizers. We found that inefficiencies mainly resulted from organizational rather than technical issues. Because of the inherent space and resource limitations, the most effective measure is to operate servers through energy-efficient cloud-based services or well-managed larger data centers, rather than server rooms. Backup power requirement, and IT and cooling efficiency should be evaluated to minimize energy waste in the server space. Utility programs are instrumental in raising awareness and spreading technical knowledge on server operation, and the implementation of energy efficiency measures in small server rooms.« less

AIRBORNE MICROORGANISMS IN BROILER PROCESSING PLANTS.

PubMed

KOTULA, A W; KINNER, J A

1964-05-01

Concentrations of total aerobic bacteria, molds, yeasts, coliforms, enterococci, and psychrophiles were determined in the air of two poultry processing plants with Andersen samplers and a mobile power supply. Total aerobic bacterial counts were highest in the dressing room, with diminishing numbers in the shackling, eviscerating, and holding rooms, when sampling was carried out during plant operation. The average counts per ft(3) of air in these four rooms were 2,200; 560; 230; and 62, respectively. (Each value is the average of 36 observations.) The number of organisms increased in the shackling and dressing rooms once processing was begun. Average total aerobic bacterial counts increased from 70 to 870 to 3,000 in the shackling room and from 310 to 4,900 to 7,000 in the dressing room when sampling was carried out at 5:00 am (before plant operations), 9:00 am, and 2:00 pm, respectively. (Each value is the mean of 12 observations.) Airborne molds might originate from a source other than the poultry being processed.

Airborne Microorganisms in Broiler Processing Plants

PubMed Central

Kotula, Anthony W.; Kinner, Jack A.

1964-01-01

Concentrations of total aerobic bacteria, molds, yeasts, coliforms, enterococci, and psychrophiles were determined in the air of two poultry processing plants with Andersen samplers and a mobile power supply. Total aerobic bacterial counts were highest in the dressing room, with diminishing numbers in the shackling, eviscerating, and holding rooms, when sampling was carried out during plant operation. The average counts per ft3 of air in these four rooms were 2,200; 560; 230; and 62, respectively. (Each value is the average of 36 observations.) The number of organisms increased in the shackling and dressing rooms once processing was begun. Average total aerobic bacterial counts increased from 70 to 870 to 3,000 in the shackling room and from 310 to 4,900 to 7,000 in the dressing room when sampling was carried out at 5:00 am (before plant operations), 9:00 am, and 2:00 pm, respectively. (Each value is the mean of 12 observations.) Airborne molds might originate from a source other than the poultry being processed. Images FIG. 3 PMID:14170951

Spatial and temporal variations in indoor environmental conditions, human occupancy, and operational characteristics in a new hospital building

DOE PAGES

Ramos, Tiffanie; Dedesko, Sandra; Siegel, Jeffrey A.; ...

2015-03-02

The dynamics of indoor environmental conditions, human occupancy, and operational characteristics of buildings influence human comfort and indoor environmental quality, including the survival and progression of microbial communities. A suite of continuous, long-term environmental and operational parameters were measured in ten patient rooms and two nurse stations in a new hospital building in Chicago, IL to characterize the indoor environment in which microbial samples were taken for the Hospital Microbiome Project. Measurements included environmental conditions (indoor dry-bulb temperature, relative humidity, humidity ratio, and illuminance) in the patient rooms and nurse stations; differential pressure between the patient rooms and hallways; surrogatemore » measures for human occupancy and activity in the patient rooms using both indoor air CO₂ concentrations and infrared doorway beam-break counters; and outdoor air fractions in the heating, ventilating, and air-conditioning systems serving the sampled spaces. Measurements were made at 5-minute intervals over consecutive days for nearly one year, providing a total of ~8×10⁶ data points. Indoor temperature, illuminance, and human occupancy/activity were all weakly correlated between rooms, while relative humidity, humidity ratio, and outdoor air fractions showed strong temporal (seasonal) patterns and strong spatial correlations between rooms. Differential pressure measurements confirmed that all patient rooms were operated at neutral pressure. The patient rooms averaged about 100 combined entrances and exits per day, which suggests they were relatively lightly occupied compared to higher traffic environments (e.g., retail buildings) and more similar to lower traffic office environments. There were also clear differences in several environmental parameters before and after the hospital was occupied with patients and staff. Characterizing and understanding factors that influence these building dynamics is vital for hospital environments, where they can impact patient health and the survival and spread of healthcare associated infections.« less

Spatial and Temporal Variations in Indoor Environmental Conditions, Human Occupancy, and Operational Characteristics in a New Hospital Building

PubMed Central

Ramos, Tiffanie; Dedesko, Sandra; Siegel, Jeffrey A.; Gilbert, Jack A.; Stephens, Brent

2015-01-01

The dynamics of indoor environmental conditions, human occupancy, and operational characteristics of buildings influence human comfort and indoor environmental quality, including the survival and progression of microbial communities. A suite of continuous, long-term environmental and operational parameters were measured in ten patient rooms and two nurse stations in a new hospital building in Chicago, IL to characterize the indoor environment in which microbial samples were taken for the Hospital Microbiome Project. Measurements included environmental conditions (indoor dry-bulb temperature, relative humidity, humidity ratio, and illuminance) in the patient rooms and nurse stations; differential pressure between the patient rooms and hallways; surrogate measures for human occupancy and activity in the patient rooms using both indoor air CO2 concentrations and infrared doorway beam-break counters; and outdoor air fractions in the heating, ventilating, and air-conditioning systems serving the sampled spaces. Measurements were made at 5-minute intervals over consecutive days for nearly one year, providing a total of ∼8×106 data points. Indoor temperature, illuminance, and human occupancy/activity were all weakly correlated between rooms, while relative humidity, humidity ratio, and outdoor air fractions showed strong temporal (seasonal) patterns and strong spatial correlations between rooms. Differential pressure measurements confirmed that all patient rooms were operated at neutral pressure. The patient rooms averaged about 100 combined entrances and exits per day, which suggests they were relatively lightly occupied compared to higher traffic environments (e.g., retail buildings) and more similar to lower traffic office environments. There were also clear differences in several environmental parameters before and after the hospital was occupied with patients and staff. Characterizing and understanding factors that influence these building dynamics is vital for hospital environments, where they can impact patient health and the survival and spread of healthcare associated infections. PMID:25729898

Process simulation during the design process makes the difference: process simulations applied to a traditional design.

PubMed

Traversari, Roberto; Goedhart, Rien; Schraagen, Jan Maarten

2013-01-01

The objective is evaluation of a traditionally designed operating room using simulation of various surgical workflows. A literature search showed that there is no evidence for an optimal operating room layout regarding the position and size of an ultraclean ventilation (UCV) canopy with a separate preparation room for laying out instruments and in which patients are induced in the operating room itself. Neither was literature found reporting on process simulation being used for this application. Many technical guidelines and designs have mainly evolved over time, and there is no evidence on whether the proposed measures are also effective for the optimization of the layout for workflows. The study was conducted by applying observational techniques to simulated typical surgical procedures. Process simulations which included complete surgical teams and equipment required for the intervention were carried out for four typical interventions. Four observers used a form to record conflicts with the clean area boundaries and the height of the supply bridge. Preferences for particular layouts were discussed with the surgical team after each simulated procedure. We established that a clean area measuring 3 × 3 m and a supply bridge height of 2.05 m was satisfactory for most situations, provided a movable operation table is used. The only cases in which conflicts with the supply bridge were observed were during the use of a surgical robot (Da Vinci) and a surgical microscope. During multiple trauma interventions, bottlenecks regarding the dimensions of the clean area will probably arise. The process simulation of four typical interventions has led to significantly different operating room layouts than were arrived at through the traditional design process. Evidence-based design, human factors, work environment, operating room, traditional design, process simulation, surgical workflowsPreferred Citation: Traversari, R., Goedhart, R., & Schraagen, J. M. (2013). Process simulation during the design process makes the difference: Process simulations applied to a traditional design. Health Environments Research & Design Journal 6(2), pp 58-76.

Clinical Efficacy of Simulated Vitreoretinal Surgery to Prepare Surgeons for the Upcoming Intervention in the Operating Room

PubMed Central

Deuchler, Svenja; Wagner, Clemens; Singh, Pankaj; Müller, Michael; Al-Dwairi, Rami; Benjilali, Rachid; Schill, Markus; Ackermann, Hanns; Bon, Dimitra; Kohnen, Thomas; Schoene, Benjamin; Koss, Michael; Koch, Frank

2016-01-01

Purpose To evaluate the efficacy of the virtual reality training simulator Eyesi to prepare surgeons for performing pars plana vitrectomies and its potential to predict the surgeons’ performance. Methods In a preparation phase, four participating vitreoretinal surgeons performed repeated simulator training with predefined tasks. If a surgeon was assigned to perform a vitrectomy for the management of complex retinal detachment after a surgical break of at least 60 hours it was randomly decided whether a warmup training on the simulator was required (n = 9) or not (n = 12). Performance at the simulator was measured using the built-in scoring metrics. The surgical performance was determined by two blinded observers who analyzed the video-recorded interventions. One of them repeated the analysis to check for intra-observer consistency. The surgical performance of the interventions with and without simulator training was compared. In addition, for the surgeries with simulator training, the simulator performance was compared to the performance in the operating room. Results Comparing each surgeon’s performance with and without warmup trainingshowed a significant effect of warmup training onto the final outcome in the operating room. For the surgeries that were preceeded by the warmup procedure, the performance at the simulator was compared with the operating room performance. We found that there is a significant relation. The governing factor of low scores in the simulator were iatrogenic retinal holes, bleedings and lens damage. Surgeons who caused minor damage in the simulation also performed well in the operating room. Conclusions Despite the large variation of conditions, the effect of a warmup training as well as a relation between the performance at the simulator and in the operating room was found with statistical significance. Simulator training is able to serve as a warmup to increase the average performance. PMID:26964040

Development concepts of a Smart Cyber Operating Theater (SCOT) using ORiN technology.

PubMed

Okamoto, Jun; Masamune, Ken; Iseki, Hiroshi; Muragaki, Yoshihiro

2018-02-23

Currently, networking has not progressed in the treatment room. Almost every medical device in the treatment room operates as a stand-alone device. In this project, we aim to develop a networked operating room called "Smart Cyber Operating Theater (SCOT)". Medical devices are connected using Open Resource interface for the Network (ORiN) technology. In this paper, we describe the concept of the SCOT project. SCOT is integrated using the communication interface ORiN, which was originally developed for industry. One feature of ORiN is that the system can be constructed flexibly. ORiN creates abstracts of the same type of devices and increases the robustness of the system for device exchange. By using ORiN technology, we are developing new applications, such as decision-making navigation or a precision guided treatment system.

Phasor Simulator for Operator Training Project

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

Dyer, Jim

2016-09-14

Synchrophasor systems are being deployed in power systems throughout the North American Power Grid and there are plans to integrate this technology and its associated tools into Independent System Operator (ISO)/utility control room operations. A pre-requisite to using synchrophasor technologies in control rooms is for operators to obtain training and understand how to use this technology in real-time situations. The Phasor Simulator for Operator Training (PSOT) project objective was to develop, deploy and demonstrate a pre-commercial training simulator for operators on the use of this technology and to promote acceptance of the technology in utility and ISO/Regional Transmission Owner (RTO)more » control centers.« less

A Pilot Study Investigating the Effects of Advanced Nuclear Power Plant Control Room Technologies: Methods and Qualitative Results

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

BLanc, Katya Le; Powers, David; Joe, Jeffrey

2015-08-01

Control room modernization is an important part of life extension for the existing light water reactor fleet. None of the 99 currently operating commercial nuclear power plants in the U.S. has completed a full-scale control room modernization to date. Nuclear power plant main control rooms for the existing commercial reactor fleet remain significantly analog, with only limited digital modernizations. Upgrades in the U.S. do not achieve the full potential of newer technologies that might otherwise enhance plant and operator performance. The goal of the control room upgrade benefits research is to identify previously overlooked benefits of modernization, identify candidate technologiesmore » that may facilitate such benefits, and demonstrate these technologies through human factors research. This report describes a pilot study to test upgrades to the Human Systems Simulation Laboratory at INL.« less

West wall, display area (room 101), view 1 of 4: ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

West wall, display area (room 101), view 1 of 4: southwest corner, showing stairs to commander's quarters and viewing bridge, windows to controller's room (room 102), south end of control consoles, and holes in pedestal floor for computer equipment cables (tape drive I/O?) - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

Managing rumor and gossip in operating room settings.

PubMed

Blakeley, J A; Ribeiro, V; Hughes, A

1996-07-01

The unique features of the operating room (OR) make it an ideal setting for the proliferation of gossip and rumor. Although not always negative, these "grapevine" communications can reduce productivity and work satisfaction. Hence, OR managers need to understand these forms of communication and prevent or control their negative consequences. The authors offer suggestions for undertaking this challenge.

Health Occupations--Operating Room Technician. Kit No. 63. Instructor's Manual [and] Student Learning Activity Guide.

ERIC Educational Resources Information Center

Jackson, Janette

An instructor's manual and student activity guide on the operating room technician are provided in this set of prevocational education materials which focuses on the vocational area of health occupations. (This set of materials is one of ninety-two prevocational education sets arranged around a cluster of seven vocational offerings: agriculture,…

The critically ill injured patient.

PubMed

Cereda, Maurizio; Weiss, Yoram G; Deutschman, Clifford S

2007-03-01

Patients admitted to the ICU after severe trauma require frequent procedures in the operating room, particularly in cases where a damage control strategy is used. The ventilatory management of these patients in the operating room can be particularly challenging. These patients often have severely impaired respiratory mechanics because of acute lung injury and abdominal compartment syndrome. Consequently, the pressure and flow generation capabilities of standard anesthesia ventilators may be inadequate to support ventilation and gas exchange. This article presents the problems that may be encountered in patients who have severe abdominal and lung injuries, and the current management concepts used in caring for these patients in the critical care setting, to provide guidelines for the anesthetist faced with these patients in the operating room.

Risk management for surgical energy-driven devices used in the operating room.

PubMed

Borie, F; Mathonnet, M; Deleuze, A; Millat, B; Gravié, J-F; Johanet, H; Lesage, J-P; Gugenheim, J

2017-12-27

Complications related to energy sources in the operating room are not well-recognized or published, despite occasionally dramatic consequences for the patient and the responsible surgeon. The goal of this study was to evaluate the risks and consequences related to use of energy sources in the operating room. Between 2009 and 2015, 876 adverse events related to health care (AERHC) linked to energy sources in the operating room were declared in the French experience feedback data base "REX". We performed a descriptive analysis of these AERHC and analyzed the root causes of these events and of the indications for non-elective repeat operations, for each energy source. Five different energy sources were used, producing 876 declared AERHC: monopolar electrocoagulation: 614 (70%) AERHC, advanced bipolar coagulation (thermofusion): 137 (16%) AERHC, ultrasonic devices: 69 (8%) AERHC, traditional bipolar electrocoagulation: 32 AERHC, and cold light: 24 AERHC. The adverse events reported were skin burns (27.5% of AERHC), insulation defects (16% of AERHC), visceral burns or perforation (30% of AERHC), fires (11% of AERHC), bleeding (7.5% of AERHC) and misuse or miscellaneous causes (8% of AERHC). For the five energy sources, the root causes were essentially misuse, imperfect training and/or cost-related reasons regarding equipment purchase or maintenance. One hundred and forty-six non-elective procedures (17% of AERHC) were performed for complications related to the use of energy sources in the operating room. This study illustrates the risks related to the use of energy sources on the OR and their consequences. Most cases were related to persistent misunderstanding of appropriate usage within the medical and paramedical teams, but complications are also related to administrative decisions concerning the purchase and maintenance of these devices. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Modeled Effectiveness of Ventilation with Contaminant Control Devices on Indoor Air Quality in a Swine Farrowing Facility

PubMed Central

Anthony, T. Renée; Altmaier, Ralph; Park, Jae Hong; Peters, Thomas M.

2016-01-01

Because adverse health effects experienced by swine farm workers in concentrated animal feeding operations (CAFOs) have been associated with exposure to dust and gases, efforts to reduce exposures are warranted, particularly in winter seasons when exposures increase due to decreased ventilation. Simulation of air quality and operating costs for ventilating swine CAFO, including treating and recirculating air through a farrowing room, was performed using mass and energy balance equations over a 90-day winter season. System operation required controlling heater operation to achieve room temperatures optimal to ensure animal health (20 to 22.5°C). Five air pollution control devices, four room ventilation rates, and five recirculation patterns were examined. Inhalable dust concentrations were easily reduced using standard industrial air pollution control devices, including a cyclone, filtration, and electrostatic precipitator. Operating ventilation systems at 0.94 m3 s−1 (2000 cfm) with 75 to 100% recirculation of treated air from cyclone, electrostatic precipitator, and shaker dust filtration system achieves adequate particle control with operating costs under $1.00 per pig produced ($0.22 to 0.54), although carbon dioxide (CO2) concentrations approach 2000 ppm using in-room ventilated gas fired heaters. In no simulation were CO2 concentrations below industry recommended concentrations (1540 ppm), but alternative heating devices could reduce CO2 to acceptable concentrations. While this investigation does not represent all production swine farrowing barns, which differ in characteristics including room dimensions and swine occupancy, the simulation model and ventilation optimization methods can be applied to other production sites. This work shows that ventilation may be a cost-effective control option in the swine industry to reduce exposures. PMID:24433305

Modeled effectiveness of ventilation with contaminant control devices on indoor air quality in a swine farrowing facility.

PubMed

Anthony, T Renée; Altmaier, Ralph; Park, Jae Hong; Peters, Thomas M

2014-01-01

Because adverse health effects experienced by swine farm workers in concentrated animal feeding operations (CAFOs) have been associated with exposure to dust and gases, efforts to reduce exposures are warranted, particularly in winter seasons when exposures increase due to decreased ventilation. Simulation of air quality and operating costs for ventilating swine CAFO, including treating and recirculating air through a farrowing room, was performed using mass and energy balance equations over a 90-day winter season. System operation required controlling heater operation to achieve room temperatures optimal to ensure animal health (20 to 22.5 °C). Five air pollution control devices, four room ventilation rates, and five recirculation patterns were examined. Inhalable dust concentrations were easily reduced using standard industrial air pollution control devices, including a cyclone, filtration, and electrostatic precipitator. Operating ventilation systems at 0.94 m3 s(-1) (2000 cfm) with 75 to 100% recirculation of treated air from cyclone, electrostatic precipitator, and shaker dust filtration system achieves adequate particle control with operating costs under $1.00 per pig produced ($0.22 to 0.54), although carbon dioxide (CO2) concentrations approach 2000 ppm using in-room ventilated gas fired heaters. In no simulation were CO2 concentrations below industry recommended concentrations (1540 ppm), but alternative heating devices could reduce CO2 to acceptable concentrations. While this investigation does not represent all production swine farrowing barns, which differ in characteristics including room dimensions and swine occupancy, the simulation model and ventilation optimization methods can be applied to other production sites. This work shows that ventilation may be a cost-effective control option in the swine industry to reduce exposures.

10. LIVING ROOM INTERIOR SHOWING 1 OVER 1 LIGHT, DOUBLEHUNG, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

10. LIVING ROOM INTERIOR SHOWING 1 OVER 1 LIGHT, DOUBLEHUNG, WOOD-FRAME WINDOWS FLANKING FRONT ENTRANCE DOOR AND SOUTH END DOOR TO ENCLOSED SLEEPING PORCH/STAIR ACCESS TO ATTIC. CEILING AND WALLS IN THIS ROOM AND THROUGHOUT THE HOUSE ARE COVERED WITH ORIGINAL FIBERBOARD. THE FLOOR IN THIS ROOM AND ALL OTHERS EXCEPT THE BATHROOM, KITCHEN AND DINING ROOM ARE HARDWOOD. VIEW TO SOUTHEAST. - Big Creek Hydroelectric System, Big Creek Town, Operator House, Orchard Avenue south of Huntington Lake Road, Big Creek, Fresno County, CA

Effects of operational decisions on the diffusion of epidemic disease: A system dynamics modeling of the MERS-CoV outbreak in South Korea.

PubMed

Shin, Nina; Kwag, Taewoo; Park, Sangwook; Kim, Yon Hui

2017-05-21

We evaluated the nosocomial outbreak of Middle East Respiratory Syndrome (MERS) Coronavirus (CoV) in the Republic of Korea, 2015, from a healthcare operations management perspective. Establishment of healthcare policy in South Korea provides patients' freedom to select and visit multiple hospitals. Current policy enforces hospitals preference for multi-patient rooms to single-patient rooms, to lower financial burden. Existing healthcare systems tragically contributed to 186 MERS outbreak cases, starting from single "index patient" into three generations of secondary infections. By developing a macro-level health system dynamics model, we provide empirical knowledge to examining the case from both operational and financial perspectives. In our simulation, under base infectivity scenario, high emergency room occupancy circumstance contributed to an estimated average of 101 (917%) more infected patients, compared to when in low occupancy circumstance. Economic patient room design showed an estimated 702% increase in the number of infected patients, despite the overall 98% savings in total expected costs compared to optimal room design. This study provides first time, system dynamics model, performance measurements from an operational perspective. Importantly, the intent of this study was to provide evidence to motivate public, private, and government healthcare administrators' recognition of current shortcomings, to optimize performance as a whole system, rather than mere individual aspects. Copyright © 2017 Elsevier Ltd. All rights reserved.

Control of the Environment in the Operating Room.

PubMed

Katz, Jonathan D

2017-10-01

There is a direct relationship between the quality of the environment of a workplace and the productivity and efficiency of the work accomplished. Components such as temperature, humidity, ventilation, drafts, lighting, and noise each contribute to the quality of the overall environment and the sense of well-being of those who work there.The modern operating room is a unique workplace with specific, and frequently conflicting, environmental requirements for each of the inhabitants. Even minor disturbances in the internal environment of the operating room can have serious ramifications on the comfort, effectiveness, and safety of each of the inhabitants. A cool, well-ventilated, and dry climate is optimal for many members of the surgical team. Any significant deviation from these objectives raises the risk of decreased efficiency and productivity and adverse surgical outcomes. A warmer, more humid, and quieter environment is necessary for the patient. If these requirements are not met, the risk of surgical morbidity and mortality is increased. An important task for the surgical team is to find the correct balance between these 2 opposed requirements. Several of the components of the operating room environment, especially room temperature and airflow patterns, are easily manipulated by the members of the surgical team. In the following discussion, we will examine these elements to better understand the clinical ramifications of adjustments and accommodations that are frequently made to meet the requirements of both the surgical staff and the patient.

An Estimation for Availability of Battery less LF Band RFID Tag to Identify Patients in Operation Room from Viewpoint of Engineering

NASA Astrophysics Data System (ADS)

Hosaka, Ryosuke

Nowadays, medical accidents increase in Japanese patient environment. Especially, misidentification of the patients occurred in operation room of higher level hospitals. It is considered that the great deals of accidents are due to mistakes by nurse. However, the accidents are prevented by management of patients. If a suitable patient identification system is developed, the accidents are prevented. In this study, new patient identification system using battery less LF band RFID(Radio Frequency Identification) is proposed. In the method, battery less RFID tag is attached to patient. In operation room, patient is identified before operation using the proposed system. However, identification distance of RFID is small. It is important that extension of the distance. In this study, antennas of RFID tag and sensor are designed. Two types of tag are proposed. One of them is set on wristband. An antenna for the tag is designed as a circular shape with 30mm in diameter. The other one is shaped like a necklace. The antenna is also designed 220mm, 240mm and 260mm in diameter. Using necklace type new antenna, sufficient identification distance for detection of the tag in the operation room is realized. The patient identification is realized using the proposed system

Can efficient supply management in the operating room save millions?

PubMed

Park, Kyung W; Dickerson, Cheryl

2009-04-01

Supply expenses occupy an ever-increasing portion of the expense budget in today's increasingly technologically complex operating rooms. Yet, little has been studied and published in the anesthesia literature. This review attempts to bring the topic of supply management to anesthesiologists, who play a significant role in operating room management. Little investigative work has been performed on supply management. Anecdotal reports suggest the benefits of a perpetual inventory system over a periodic inventory system. A perpetual inventory system uses utilization data to update inventory on hand continually and this information is linked to purchasing and restocking, whereas a periodic inventory system counts inventory at some regular intervals (such as annually) and uses average utilization to set par levels. On the basis of application of operational management concepts, ways of taking advantage of a perpetual inventory system to achieve savings in supply expenses are outlined. These include linking the operating room scheduling and supply order system, distributor-driven just-in-time delivery of case carts, continual updating of preference lists based on utilization patterns, increasing inventory turnovers, standardizing surgical practices, and vendor consignment of high unit-cost items such as implants. In addition, Lean principles of visual management and elimination of eight wastes may be applicable to supply management.

Peritonectomy and hyperthermic intraperitoneal chemotherapy: cost analysis and sustainability.

PubMed

Bagnoli, Pietro F; Cananzi, F C M; Brocchi, A; Ardito, A; Strada, D; Cozzaglio, L; Mussi, C; Brusa, S; Carlino, C; Borrelli, B; Alemanno, F; Quagliuolo, V

2015-03-01

Malignancies of the peritoneum remain a challenge in any hospital that accepts to manage them, due not only to difficulties associated with the complexity of the procedures involved but also the costs, which - in Italy and other countries that use a diagnosis-related group (DRG) system - are not adequately reimbursed. We analyzed data relative to 24 patients operated on between September 2010 and May 2013 with special regard to operating room expenditure, ICU stay, duration of hospitalization, and DRG reimbursement. The total costs per patient included clinical, operating room, procedure, pathology, imaging, ward care, allied healthcare, pharmaceutical, and ICU costs. Postoperative hospital stay, drugs and materials, and operating room occupancy were the main factors affecting the expenditure for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. We had a median hospitalization of 14 days, median ICU stay of 2.4 days, and median operating room occupancy of 585 min. The median expenditure for each case was € 21,744; the median reimbursement by the national health system € 8,375. In a DRG reimbursement system, the economic effort in the management of patients undergoing peritonectomy procedures may not be counterbalanced by adequate reimbursement. Joint efforts between medical and administration parties are mandatory to develop appropriate treatment protocols and keep down the costs. Copyright © 2014 Elsevier Ltd. All rights reserved.

OR.NET: multi-perspective qualitative evaluation of an integrated operating room based on IEEE 11073 SDC.

PubMed

Rockstroh, M; Franke, S; Hofer, M; Will, A; Kasparick, M; Andersen, B; Neumuth, T

2017-08-01

Clinical working environments have become very complex imposing many different tasks in diagnosis, medical treatment, and care procedures. During the German flagship project OR.NET, more than 50 partners developed technologies for an open integration of medical devices and IT systems in the operating room. The aim of the present work was to evaluate a large set of the proposed concepts from the perspectives of various stakeholders. The demonstration OR is focused on interventions from the head and neck surgery and was developed in close cooperation with surgeons and numerous colleagues of the project partners. The demonstration OR was qualitatively evaluated including technical as well as clinical aspects. In the evaluation, a questionnaire was used to obtain feedback from hospital operators. The clinical implications were covered by structured interviews with surgeons, anesthesiologists and OR staff. In the present work, we qualitatively evaluate a subset of the proposed concepts from the perspectives of various stakeholders. The feedback of the clinicians indicates that there is a need for a flexible data and control integration. The hospital operators stress the need for tools to simplify risk management in openly integrated operating rooms. The implementation of openly integrated operating rooms will positively affect the surgeons, the anesthesiologists, the surgical nursing staff, as well as the technical personnel and the hospital operators. The evaluation demonstrated the need for OR integration technologies and identified the missing tools to support risk management and approval as the main barriers for future installments.

Light Water Reactor Sustainability Program Operator Performance Metrics for Control Room Modernization: A Practical Guide for Early Design Evaluation

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

Ronald Boring; Roger Lew; Thomas Ulrich

2014-03-01

As control rooms are modernized with new digital systems at nuclear power plants, it is necessary to evaluate the operator performance using these systems as part of a verification and validation process. There are no standard, predefined metrics available for assessing what is satisfactory operator interaction with new systems, especially during the early design stages of a new system. This report identifies the process and metrics for evaluating human system interfaces as part of control room modernization. The report includes background information on design and evaluation, a thorough discussion of human performance measures, and a practical example of how themore » process and metrics have been used as part of a turbine control system upgrade during the formative stages of design. The process and metrics are geared toward generalizability to other applications and serve as a template for utilities undertaking their own control room modernization activities.« less

Workflows and individual differences during visually guided routine tasks in a road traffic management control room.

PubMed

Starke, Sandra D; Baber, Chris; Cooke, Neil J; Howes, Andrew

2017-05-01

Road traffic control rooms rely on human operators to monitor and interact with information presented on multiple displays. Past studies have found inconsistent use of available visual information sources in such settings across different domains. In this study, we aimed to broaden the understanding of observer behaviour in control rooms by analysing a case study in road traffic control. We conducted a field study in a live road traffic control room where five operators responded to incidents while wearing a mobile eye tracker. Using qualitative and quantitative approaches, we investigated the operators' workflow using ergonomics methods and quantified visual information sampling. We found that individuals showed differing preferences for viewing modalities and weighting of task components, with a strong coupling between eye and head movement. For the quantitative analysis of the eye tracking data, we propose a number of metrics which may prove useful to compare visual sampling behaviour across domains in future. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Radiation safety for anaesthesia providers in the orthopaedic operating room.

PubMed

Rhea, E B; Rogers, T H; Riehl, J T

2016-04-01

In many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is needed. We conducted a systematic review to identify studies that measured the amount of radiation that anaesthetists were exposed to in the orthopaedic operating room. Multiple studies have shown that at 1.5 m from the source of radiation, anaesthetists received no radiation, or amounts so small that a person would have to be present in an unreasonable number of operations to receive cumulative doses of any significance. Radiation doses at this distance were often at the limits of the sensitivity of the measuring dosimeter. We question the need to wear lead protection for anaesthesia providers who are routinely at 1.5 m or a greater distance from standard fluoroscopy units. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

Crew resource management: using aviation techniques to improve operating room safety.

PubMed

Ricci, Michael A; Brumsted, John R

2012-04-01

Since the publication of the Institute of Medicine report estimating nearly 100,000 deaths per year from medical errors, hospitals and physicians have a renewed focus upon error reduction. We implemented a surgical crew resource management (CRM) program for all operating room (OR) personnel. In our academic medical center, 19,000 procedures per year are performed in 27 operating rooms. Mandatory CRM training was implemented for all peri-operative personnel. Aviation techniques introduced included a pre-operative checklist and brief, post-operative debrief, read and initial files, and various other aviation-based techniques. Compliance with conduct of the brief/debrief was monitored as well as wrong-site surgeries and retained foreign body events. The malpractice insurance database for claims was also queried for the period prior to and after training. Initial training was accomplished for 517 people, including all anesthesiologists, surgeons, nurses, technicians, and OR assistants. Pre-operative briefing increased from 6.7 to 99% within 4 mo. Wrong site surgeries and retained foreign bodies decreased from a high of seven in 2007 to none in 2008, but, after 14 mo without additional training, these rose to five in 2009. Malpractice expenses (payouts and legal fees) totaled $793,000 (2003-2007), but have been zero since 2008. CRM training and implementation had an impact on reducing the incidence of wrong site surgery and retained foreign bodies in our operating rooms. However, constant reinforcement and refresher training is necessary for sustained results. Though no one technique can prevent all errors, CRM can effect culture change, producing a safer environment.

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

Ramos, Tiffanie; Dedesko, Sandra; Siegel, Jeffrey A.

The dynamics of indoor environmental conditions, human occupancy, and operational characteristics of buildings influence human comfort and indoor environmental quality, including the survival and progression of microbial communities. A suite of continuous, long-term environmental and operational parameters were measured in ten patient rooms and two nurse stations in a new hospital building in Chicago, IL to characterize the indoor environment in which microbial samples were taken for the Hospital Microbiome Project. Measurements included environmental conditions (indoor dry-bulb temperature, relative humidity, humidity ratio, and illuminance) in the patient rooms and nurse stations; differential pressure between the patient rooms and hallways; surrogatemore » measures for human occupancy and activity in the patient rooms using both indoor air CO₂ concentrations and infrared doorway beam-break counters; and outdoor air fractions in the heating, ventilating, and air-conditioning systems serving the sampled spaces. Measurements were made at 5-minute intervals over consecutive days for nearly one year, providing a total of ~8×10⁶ data points. Indoor temperature, illuminance, and human occupancy/activity were all weakly correlated between rooms, while relative humidity, humidity ratio, and outdoor air fractions showed strong temporal (seasonal) patterns and strong spatial correlations between rooms. Differential pressure measurements confirmed that all patient rooms were operated at neutral pressure. The patient rooms averaged about 100 combined entrances and exits per day, which suggests they were relatively lightly occupied compared to higher traffic environments (e.g., retail buildings) and more similar to lower traffic office environments. There were also clear differences in several environmental parameters before and after the hospital was occupied with patients and staff. Characterizing and understanding factors that influence these building dynamics is vital for hospital environments, where they can impact patient health and the survival and spread of healthcare associated infections.« less

Touchless interaction with software in interventional radiology and surgery: a systematic literature review.

PubMed

Mewes, André; Hensen, Bennet; Wacker, Frank; Hansen, Christian

2017-02-01

In this article, we systematically examine the current state of research of systems that focus on touchless human-computer interaction in operating rooms and interventional radiology suites. We further discuss the drawbacks of current solutions and underline promising technologies for future development. A systematic literature search of scientific papers that deal with touchless control of medical software in the immediate environment of the operation room and interventional radiology suite was performed. This includes methods for touchless gesture interaction, voice control and eye tracking. Fifty-five research papers were identified and analyzed in detail including 33 journal publications. Most of the identified literature (62 %) deals with the control of medical image viewers. The others present interaction techniques for laparoscopic assistance (13 %), telerobotic assistance and operating room control (9 % each) as well as for robotic operating room assistance and intraoperative registration (3.5 % each). Only 8 systems (14.5 %) were tested in a real clinical environment, and 7 (12.7 %) were not evaluated at all. In the last 10 years, many advancements have led to robust touchless interaction approaches. However, only a few have been systematically evaluated in real operating room settings. Further research is required to cope with current limitations of touchless software interfaces in clinical environments. The main challenges for future research are the improvement and evaluation of usability and intuitiveness of touchless human-computer interaction and the full integration into productive systems as well as the reduction of necessary interaction steps and further development of hands-free interaction.

Comparison between mixed and laminar airflow systems in operating rooms and the influence of human factors: experiences from a Swedish orthopedic center.

PubMed

Erichsen Andersson, Annette; Petzold, Max; Bergh, Ingrid; Karlsson, Jón; Eriksson, Bengt I; Nilsson, Kerstin

2014-06-01

The importance of laminar airflow systems in operating rooms as protection from surgical site infections has been questioned. The aim of our study was to explore the differences in air contamination rates between displacement ventilation and laminar airflow systems during planned and acute orthopedic implant surgery. A second aim was to compare the influence of the number of people present, the reasons for traffic flow, and the door-opening rates between the 2 systems. Active air sampling and observations were made during 63 orthopedic implant operations. The laminar airflow system resulted in a reduction of 89% in colony forming units in comparison with the displacement system (P < .001). The air samples taken in the preparation rooms showed high levels of bacterial growth (≈ 40 CFU/m(3)). Our study shows that laminar airflow-ventilated operating rooms offer high-quality air during surgery, with very low levels of colony forming units close to the surgical wound. The continuous maintenance of laminar air flow and other technical systems are crucial, because minor failures in complex systems like those in operating rooms can result in a detrimental effect on air quality and jeopardize the safety of patients. The technical ventilation solutions are important, but they do not guarantee clean air, because many other factors, such as the organization of the work and staff behavior, influence air cleanliness. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

A comprehensive operating room information system using the Kinect sensors and RFID.

PubMed

Nouei, Mahyar Taghizadeh; Kamyad, Ali Vahidian; Soroush, Ahmad Reza; Ghazalbash, Somayeh

2015-04-01

Occasionally, surgeons do need various types of information to be available rapidly, efficiently and safely during surgical procedures. Meanwhile, they need to free up hands throughout the surgery to necessarily access the mouse to control any application in the sterility mode. In addition, they are required to record audio as well as video files, and enter and save some data. This is an attempt to develop a comprehensive operating room information system called "Medinav" to tackle all mentioned issues. An integrated and comprehensive operating room information system is introduced to be compatible with Health Level 7 (HL7) and digital imaging and communications in medicine (DICOM). DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. Besides, a natural user interface (NUI) is designed specifically for operating rooms where touch-less interactions with finger and hand tracking are in use. Further, the system could both record procedural data automatically, and view acquired information from multiple perspectives graphically. A prototype system is tested in a live operating room environment at an Iranian teaching hospital. There are also contextual interviews and usability satisfaction questionnaires conducted with the "MediNav" system to investigate how useful the proposed system could be. The results reveal that integration of these systems into a complete solution is the key to not only stream up data and workflow but maximize surgical team usefulness as well. It is now possible to comprehensively collect and visualize medical information, and access a management tool with a touch-less NUI in a rather quick, practical, and harmless manner.

The effect of mentoring on clinical perioperative competence in operating room nursing students.

PubMed

Mirbagher Ajorpaz, Neda; Zagheri Tafreshi, Mansoureh; Mohtashami, Jamileh; Zayeri, Farid; Rahemi, Zahra

2016-05-01

The aim of this study was to investigate the effects of mentoring on the clinical perioperative competence of nursing operating room students in Iran. Mentoring is an essential part of clinical education, which has been studied in different populations of students. However, there is a need to assess its effectiveness in operating room students' competence. A randomised controlled trial was performed. Sixty nursing operating room students were randomly assigned to experimental and control groups. Both the control and experimental groups had routine training in the form of faculty supervision. The experimental group had an additional mentoring program. Using the Persian Perceived Perioperative Competence Scale-Revised, clinical competence was compared between the two groups, before and after the intervention. Using SPSS 19, descriptive and inferential statistics, including chi-square and t-tests, were conducted. In the experimental group, the difference between the mean scores of clinical competence before (19·43 ± 2·80) and after (27·86 ± 1·87) the intervention was significant (p ≤ 0·001). After intervention, the difference between the mean scores of the control (3·9 ± 0·15) and experimental (8·61 ± 0·68) groups was significant (p ≤ 0·003). Findings affirmed the positive effect of mentorship programmes on clinical competence in nursing operating room students. Mentoring is an effective method for preparing nursing students in practice. Health care systems may improve as a result of staff-student relationships that ultimately increase the quality care for patients. © 2016 John Wiley & Sons Ltd.

Cost and morbidity analysis of chest port insertion in adults: Outpatient clinic versus operating room placement.

PubMed

Feo, Claudio F; Ginesu, Giorgio C; Bellini, Alessandro; Cherchi, Giuseppe; Scanu, Antonio M; Cossu, Maria Laura; Fancellu, Alessandro; Porcu, Alberto

2017-09-01

Totally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate. Data on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room. Between 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (<30 days, p = 0.54) and late complications (30-120 days, p = 0.53). The average charge for placement of a chest port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic. Our results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.

DSS 13 phase 2 pedestal room microwave layout

NASA Technical Reports Server (NTRS)

Cwik, T.; Chen, J. C.

1991-01-01

The design and predicted performance is described of the microwave layout for three band operation of the beam waveguide antenna Deep Space Station 13. Three pedestal room microwave candidate layout designs were produced for simultaneous X/S and X/Ka band operation. One of the three designs was chosen based on given constraints, and for this design the microwave performance was estimated.

APOLLO XIII CREW - MISSION OPERATIONS CONTROL ROOM (MOCR) - APOLLO XII - LUNAR EXTRAVEHICULAR ACTIVITY (EVA) - MSC

NASA Image and Video Library

1969-11-21

S69-59525 (19 Nov. 1969) --- Overall view of activity in the Mission Operations Control Room (MOCR) in the Mission Control Center (MCC), Building 30, during the Apollo 12 lunar landing mission. When this picture was made the first Apollo 12 extravehicular activity (EVA) was being televised from the surface of the moon. Photo credit: NASA

Mission Operations Control Room (MOCR) activities during STS-6 mission

NASA Image and Video Library

1983-04-05

Astronauts Roy D. Bridges (left) and RIchard O. Covey serve as spacecraft communicators (CAPCOM) for STS-6. They are seated at the CAPCOM console in the mission operations control room (MOCR) of JSC's mission control center (30119); Flight Director Jay H. Greene communicates with a nearby flight controller in the MOCR just after launch of the Challenger (30120).

Using Goal Setting, Task Clarification, and Feedback to Increase the Use of the Hands-Free Technique by Hospital Operating Room Staff

ERIC Educational Resources Information Center

Cunningham, Thomas R.; Austin, John

2007-01-01

We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from…

Effectiveness of in-room air filtration and dilution ventilation for tuberculosis infection control.

PubMed

Miller-Leiden, S; Lobascio, C; Nazaroff, W W; Macher, J M

1996-09-01

Tuberculosis (TB) is a public health problem that may pose substantial risks to health care workers and others. TB infection occurs by inhalation of airborne bacteria emitted by persons with active disease. We experimentally evaluated the effectiveness of in-room air filtration systems, specifically portable air filters (PAFs) and ceiling-mounted air filters (CMAFs), in conjunction with dilution ventilation, for controlling TB exposure in high-risk settings. For each experiment, a test aerosol was continuously generated and released into a full-sized room. With the in-room air filter and room ventilation system operating, time-averaged airborne particle concentrations were measured at several points. The effectiveness of in-room air filtration plus ventilation was determined by comparing particle concentrations with and without device operation. The four PAFs and three CMAFs we evaluated reduced room-average particle concentrations, typically by 30% to 90%, relative to a baseline scenario with two air-changes per hour of ventilation (outside air) only. Increasing the rate of air flow recirculating through the filter and/or air flow from the ventilation did not always increase effectiveness. Concentrations were generally higher near the emission source than elsewhere in the room. Both the air flow configuration of the filter and its placement within the room were important, influencing room air flow patterns and the spatial distribution of concentrations. Air filters containing efficient, but non-high efficiency particulate air (HEPA) filter media were as effective as air filters containing HEPA filter media.

Effectiveness of In-Room Air Filtration and Dilution Ventilation for Tuberculosis Infection Control.

PubMed

Miller-Leiden, S; Lohascio, C; Nazaroff, W W; Macher, J M

1996-09-01

Tuberculosis (TB) is a public health problem that may pose substantial risks to health care workers and others. TB infection occurs by inhalation of airborne bacteria emitted by persons with active disease. We experimentally evaluated the effectiveness of in-room air filtration systems, specifically portable air filters (PAFs) and ceiling-mounted air filters (CMAFs), in conjunction with dilution ventilation, for controlling TB exposure in high-risk settings. For each experiment, a test aerosol was continuously generated and released into a full-sized room. With the in-room air filter and room ventilation system operating, time-averaged airborne particle concentrations were measured at several points. The effectiveness of in-room air filtration plus ventilation was determined by comparing particle concentrations with and without device operation. The four PAFs and three CMAFs we evaluated reduced room-average particle concentrations, typically by 30% to 90%, relative to a baseline scenario with two air-changes per hour of ventilation (outside air) only. Increasing the rate of air flow recirculating through the filter and/or air flow from the ventilation did not always increase effectiveness. Concentrations were generally higher near the emission source than elsewhere in the room. Both the air flow configuration of the filter and its placement within the room were important, influencing room air flow patterns and the spatial distribution of concentrations. Air filters containing efficient, but non-high efficiency particulate air (HEPA) filter media were as effective as air filters containing HEPA filter media.

Clean Room in the Zero Gravity Research Facility

NASA Image and Video Library

1968-07-21

A technician prepares a test sample in the Zero Gravity Research Facility clean room at the National Aeronautics and Space Administration (NASA) Lewis Research Center. The Zero Gravity Research Facility contained a drop tower which provided five seconds of microgravity during freefall in its 450-foot deep vacuum chamber. The facility has been used for a variety of studies relating to the behavior of fluids and flames in microgravity. During normal operations, a cylindrical 3-foot diameter and 11-foot long vehicle was used to house the experiments, instrumentation, and high speed cameras. The 4.5-foot long and 1.5-foot wide rectangular vehicle, seen in this photograph, was used less frequently. A 3-foot diameter orb was used for the special ten-second drops in which the package was pneumatically shot to the top of the tower then dropped. The facility also contained a control room, shop offices, tool and equipment rooms, and this clean room. The 242.5-foot long and 19.5-foot wide clean room was equipped with specialized cleaning equipment. In the 1960s the room was rated as a class 10,000 clean room, but I was capable of meeting the class 100 requirements. The room included a fume hood, ultrasonic cleaner, and a laminar flow station which operated as a class 100 environment. The environment in the clean room was maintained at 71° F and a relative humidity of 45- percent.

[Education in postgraduate surgical schools: the role of the surgical tutor as supervisor in the operating room].

PubMed

Alloni, Rossana; Binetti, Paola; Coppola, Roberto; Arullani, Augusto

2005-01-01

The Postgraduate Surgical education is in an era of transition, in order to create physicians with skills and attitudes needed by modern health care. Many studies have examined the impact of surgical tutoring in surgical residency programs in USA Medical Schools, while few experiences are reported from European Universities. The new Italian guidelines for post-graduate education require a structured clinical learning with the supervision of a tutor ("attending surgeon" for surgical residency); it is a challenge to describe the role of this teacher and educator, and to implement an effective evaluation of operating room teachers. Confidential survey was administered to 14 surgical residents of the Authors' University. Questions were related to their surgical activity and their perception of educational role of tutors in operating room and tutors' teaching behaviors. Residents pointed out five behaviors they perceive as signs of tutor excellence in clinical and operating room setting. According with studies from other Universities, residents need a tutor with competency but also with good teaching skills and a mature self-perception as educator. Faculty would provide training programs for surgeons in order to improve their teaching skills and behaviors.

Cost comparison and safety of emergency department conscious sedation for the removal of ear foreign bodies.

PubMed

Olson, Michael D; Saw, Jessica; Visscher, Sue L; Balakrishnan, Karthik

2018-07-01

The purpose of this study is to investigate the relative cost and safety of ear foreign body (FB) removal via conscious sedation in the emergency department. A retrospective review of patients presenting from 2000 to 2015 to the emergency department at Mayo Clinic, Rochester, Minnesota was performed. 63 patients requiring sedation for ear foreign body removal were identified. Descriptive data, safety data, and costs were obtained for the study. There were no appreciable differences in patient safety outcomes and otologic outcomes in patients who received sedation in the emergency department or anesthesia in the operating room for FB removal. Cost analysis demonstrated increased cost associated with operating room utilization verses conscious sedation in the emergency department, with the greatest cost increase being in patients evaluated first in the emergency department and then sent to the operating room. Ear foreign body removal in the emergency department is shows a similar safety profile to removal in the operating room, but at a markedly lower cost. Emergency department conscious sedation should be considered a viable option in appropriately selected patients with this common problem given these results. Copyright © 2018. Published by Elsevier B.V.

14. NBS REMOTE MANIPULATOR SIMULATOR (RMS) CONTROL ROOM. THE RMS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

14. NBS REMOTE MANIPULATOR SIMULATOR (RMS) CONTROL ROOM. THE RMS CONTROL PANEL IS IDENTICAL TO THE SHUTTLE ORBITER AFT FLIGHT DECK WITH ALL RMS SWITCHES AND CONTROL KNOBS FOR INVOKING ANY POSSIBLE FLIGHT OPERATIONAL MODE. THIS INCLUDES ALL COMPUTER AIDED OPERATIONAL MODES, AS WELL AS FULL MANUAL MODE. THE MONITORS IN THE AFT FLIGHT DECK WINDOWS AND THE GLASSES THE OPERATOR WEARS PROVIDE A 3-D VIDEO PICTURE TO AID THE OPERATOR WITH DEPTH PERCEPTION WHILE OPERATING THE ARM. THIS IS REQUIRED BECAUSE THE RMS OPERATOR CANNOT VIEW RMS MOVEMENTS IN THE WATER WHILE AT THE CONTROL PANEL. - Marshall Space Flight Center, Neutral Buoyancy Simulator Facility, Rideout Road, Huntsville, Madison County, AL

The Challenge of New and Emerging Information Operations

DTIC Science & Technology

1999-06-01

Information Dominance Center (IDC) are addressing the operational and technological needs. The IDC serves as a model for the DoD and a proposed virtual hearing room for Congress. As the IDC and its supporting technologies mature, individuals will be able to freely enter, navigate, plan, and execute operations within Perceptual and Knowledge Landscapes. This capability begins the transition from Information Dominance to Knowledge Dominance. The IDC is instantiating such entities as smart rooms, avatars, square pixel displays, polymorphic views, and

3D Perception Technologies for Surgical Operating Theatres.

PubMed

Beyl, T; Schreiter, L; Nicolai, P; Raczkowsky, J; Wörn, H

2016-01-01

3D Perception technologies have been explored in various fields. This paper explores the application of such technologies for surgical operating theatres. Clinical applications can be found in workflow detection, tracking and analysis, collision avoidance with medical robots, perception of interaction between participants of the operation, training of the operation room crew, patient calibration and many more. In this paper a complete perception solution for the operating room is shown. The system is based on the ToF technology integrated to the Microsoft Kinect One implements a multi camera approach. Special emphasize is put on the tracking of the personnel and the evaluation of the system performance and accuracy.

51. VIEW OF LORAL ADS 100A COMPUTERS LOCATED CENTRALLY ON ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

51. VIEW OF LORAL ADS 100A COMPUTERS LOCATED CENTRALLY ON NORTH WALL OF TELEMETRY ROOM (ROOM 106). SLC-3W CONTROL ROOM IS VISIBLE IN BACKGROUND THROUGH WINDOW IN NORTH WALL. - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

KSC-2014-1973

NASA Image and Video Library

2014-04-03

CAPE CANAVERAL, Fla. – The Mobile Launcher is visible through a window inside Firing Room 4 in the Launch Control Center at NASA's Kennedy Space Center in Florida. The Ground Systems Development and Operations Program is overseeing efforts to create a new multi-user firing room in Firing Room 4. The main floor consoles, cabling and wires below the floor and ceiling tiles above have been removed. Sub-flooring has been installed and the room is marked off to create four separate rooms on the main floor. The design of Firing Room 4 will incorporate five control room areas that are flexible to meet current and future NASA and commercial user requirements. The equipment and most of the consoles from Firing Room 4 were moved to Firing Room 2 for possible future reuse. Photo credit: NASA/Ben Smegelsky

KSC-2013-3235

NASA Image and Video Library

2013-08-09

CAPE CANAVERAL, Fla. – As seen on Google Maps, Firing Room 4 inside the Launch Control Center at NASA's Kennedy Space Center was one of the four control rooms used by NASA and contractor launch teams to oversee a space shuttle countdown. This firing room was the most advanced of the control rooms used for shuttle missions and was the primary firing room for the shuttle's final series of launches before retirement. It is furnished in a more contemporary style with wood cabinets and other features, although it retains many of the computer systems the shuttle counted on to operate safely. Specialized operators worked at consoles tailored to keep track of the status of shuttle systems while the spacecraft was processed in the Orbiter Processing Facility, being stacked inside the Vehicle Assembly Building and standing at the launch pad before liftoff. The firing rooms, including 3, were also used during NASA's Apollo Program. Google precisely mapped the space center and some of its historical facilities for the company's map page. The work allows Internet users to see inside buildings at Kennedy as they were used during the space shuttle era. Photo credit: Google/Wendy Wang

High-density magnetoresistive random access memory operating at ultralow voltage at room temperature.

PubMed

Hu, Jia-Mian; Li, Zheng; Chen, Long-Qing; Nan, Ce-Wen

2011-11-22

The main bottlenecks limiting the practical applications of current magnetoresistive random access memory (MRAM) technology are its low storage density and high writing energy consumption. Although a number of proposals have been reported for voltage-controlled memory device in recent years, none of them simultaneously satisfy the important device attributes: high storage capacity, low power consumption and room temperature operation. Here we present, using phase-field simulations, a simple and new pathway towards high-performance MRAMs that display significant improvements over existing MRAM technologies or proposed concepts. The proposed nanoscale MRAM device simultaneously exhibits ultrahigh storage capacity of up to 88 Gb inch(-2), ultralow power dissipation as low as 0.16 fJ per bit and room temperature high-speed operation below 10 ns.

High-density magnetoresistive random access memory operating at ultralow voltage at room temperature

PubMed Central

Hu, Jia-Mian; Li, Zheng; Chen, Long-Qing; Nan, Ce-Wen

2011-01-01

The main bottlenecks limiting the practical applications of current magnetoresistive random access memory (MRAM) technology are its low storage density and high writing energy consumption. Although a number of proposals have been reported for voltage-controlled memory device in recent years, none of them simultaneously satisfy the important device attributes: high storage capacity, low power consumption and room temperature operation. Here we present, using phase-field simulations, a simple and new pathway towards high-performance MRAMs that display significant improvements over existing MRAM technologies or proposed concepts. The proposed nanoscale MRAM device simultaneously exhibits ultrahigh storage capacity of up to 88 Gb inch−2, ultralow power dissipation as low as 0.16 fJ per bit and room temperature high-speed operation below 10 ns. PMID:22109527

Single-use surgical clothing system for reduction of airborne bacteria in the operating room.

PubMed

Tammelin, A; Ljungqvist, B; Reinmüller, B

2013-07-01

It is desirable to maintain a low bacterial count in the operating room air to prevent surgical site infection. This can be achieved by ventilation or by all staff in the operating room wearing clothes made from low-permeable material (i.e. clean air suits). We investigated whether there was a difference in protective efficacy between a single-use clothing system made of polypropylene and a reusable clothing system made of a mixed material (cotton/polyester) by testing both in a dispersal chamber and during surgical procedures. Counts of colony-forming units (cfu)/m(3) air were significantly lower when using the single-use clothing system in both settings. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

KSC-2014-1972

NASA Image and Video Library

2014-04-03

CAPE CANAVERAL, Fla. – The Ground Systems Development and Operations Program is overseeing efforts to create a new multi-user firing room in Firing Room 4 in the Launch Control Center at NASA's Kennedy Space Center in Florida. The main floor consoles, cabling and wires below the floor and ceiling tiles have been removed. Sub-flooring has been installed and the room is marked off to create four separate rooms on the main floor. The design of Firing Room 4 will incorporate five control room areas that are flexible to meet current and future NASA and commercial user requirements. The equipment and most of the consoles from Firing Room 4 were moved to Firing Room 2 for possible future reuse. Photo credit: NASA/Ben Smegelsky

Operating Room Traffic as a Modifiable Risk Factor for Surgical Site Infection.

PubMed

Wanta, Brendan T; Glasgow, Amy E; Habermann, Elizabeth B; Kor, Daryl J; Cima, Robert R; Berbari, Elie F; Curry, Timothy B; Brown, Michael J; Hyder, Joseph A

2016-12-01

Surgical site infections (SSI) contribute to surgical patients' morbidity and costs. Operating room traffic may be a modifiable risk factor for SSI. We investigated the impact of additional operating room personnel on the risk of superficial SSI (sSSI). In this matched case-control study, cases included patients in whom sSSI developed in clean surgical incisions after elective, daytime operations. Control subjects were matched by age, gender, and procedure. Operating room personnel were classified as (1) surgical scrubbed, (2) surgical non-scrubbed, or (3) anesthesia. We used conditional logistic regression to test the extent to which additional personnel overall and from each work group were associated with infection. In total, 474 patients and 803 control subjects were identified. Each additional person among total personnel and personnel from each work group was significantly associated with greater odds of infection (all personnel, odds ratio [OR] = 1.082, 95% confidence interval [CI] 1.031-1.134, p = 0.0013; surgical scrubbed OR = 1.132, 95% CI 1.029-1.245, p = 0.0105; surgical non-scrubbed OR = 1.123, 95% CI 1.008-1.251, p = 0.0357; anesthesia OR = 1.153, 95% CI 1.031-1.290, p = 0.0127). After adjusting for operative duration, body mass index, diabetes mellitus, and vascular disease, additional personnel and sSSI were no longer associated overall or for any work groups (total personnel OR = 1.033, 95% CI 0.974-1.095, p = 0.2746; surgical scrubbed OR = 1.060, 95% CI 0.952-1.179, p = 0.2893; surgical non-scrubbed OR = 1.023 95% CI 0.907-1.154, p = 0.7129; anesthesia OR = 1.051, 95% CI 0.926-1.193, p = 0.4442). The presence of additional operating room personnel was not independently associated with increased odds of sSSI. Efforts dedicated to sSSI reduction should focus on other modifiable risk factors.

Room-temperature nine-µm-wavelength photodetectors and GHz-frequency heterodyne receivers.

PubMed

Palaferri, Daniele; Todorov, Yanko; Bigioli, Azzurra; Mottaghizadeh, Alireza; Gacemi, Djamal; Calabrese, Allegra; Vasanelli, Angela; Li, Lianhe; Davies, A Giles; Linfield, Edmund H; Kapsalidis, Filippos; Beck, Mattias; Faist, Jérôme; Sirtori, Carlo

2018-04-05

Room-temperature operation is essential for any optoelectronics technology that aims to provide low-cost, compact systems for widespread applications. A recent technological advance in this direction is bolometric detection for thermal imaging, which has achieved relatively high sensitivity and video rates (about 60 hertz) at room temperature. However, owing to thermally induced dark current, room-temperature operation is still a great challenge for semiconductor photodetectors targeting the wavelength band between 8 and 12 micrometres, and all relevant applications, such as imaging, environmental remote sensing and laser-based free-space communication, have been realized at low temperatures. For these devices, high sensitivity and high speed have never been compatible with high-temperature operation. Here we show that a long-wavelength (nine micrometres) infrared quantum-well photodetector fabricated from a metamaterial made of sub-wavelength metallic resonators exhibits strongly enhanced performance with respect to the state of the art up to room temperature. This occurs because the photonic collection area of each resonator is much larger than its electrical area, thus substantially reducing the dark current of the device. Furthermore, we show that our photonic architecture overcomes intrinsic limitations of the material, such as the drop of the electronic drift velocity with temperature, which constrains conventional geometries at cryogenic operation. Finally, the reduced physical area of the device and its increased responsivity allow us to take advantage of the intrinsic high-frequency response of the quantum detector at room temperature. By mixing the frequencies of two quantum-cascade lasers on the detector, which acts as a heterodyne receiver, we have measured a high-frequency signal, above four gigahertz (GHz). Therefore, these wide-band uncooled detectors could benefit technologies such as high-speed (gigabits per second) multichannel coherent data transfer and high-precision molecular spectroscopy.

Room-temperature nine-µm-wavelength photodetectors and GHz-frequency heterodyne receivers

NASA Astrophysics Data System (ADS)

Palaferri, Daniele; Todorov, Yanko; Bigioli, Azzurra; Mottaghizadeh, Alireza; Gacemi, Djamal; Calabrese, Allegra; Vasanelli, Angela; Li, Lianhe; Davies, A. Giles; Linfield, Edmund H.; Kapsalidis, Filippos; Beck, Mattias; Faist, Jérôme; Sirtori, Carlo

2018-04-01

Room-temperature operation is essential for any optoelectronics technology that aims to provide low-cost, compact systems for widespread applications. A recent technological advance in this direction is bolometric detection for thermal imaging, which has achieved relatively high sensitivity and video rates (about 60 hertz) at room temperature. However, owing to thermally induced dark current, room-temperature operation is still a great challenge for semiconductor photodetectors targeting the wavelength band between 8 and 12 micrometres, and all relevant applications, such as imaging, environmental remote sensing and laser-based free-space communication, have been realized at low temperatures. For these devices, high sensitivity and high speed have never been compatible with high-temperature operation. Here we show that a long-wavelength (nine micrometres) infrared quantum-well photodetector fabricated from a metamaterial made of sub-wavelength metallic resonators exhibits strongly enhanced performance with respect to the state of the art up to room temperature. This occurs because the photonic collection area of each resonator is much larger than its electrical area, thus substantially reducing the dark current of the device. Furthermore, we show that our photonic architecture overcomes intrinsic limitations of the material, such as the drop of the electronic drift velocity with temperature, which constrains conventional geometries at cryogenic operation. Finally, the reduced physical area of the device and its increased responsivity allow us to take advantage of the intrinsic high-frequency response of the quantum detector at room temperature. By mixing the frequencies of two quantum-cascade lasers on the detector, which acts as a heterodyne receiver, we have measured a high-frequency signal, above four gigahertz (GHz). Therefore, these wide-band uncooled detectors could benefit technologies such as high-speed (gigabits per second) multichannel coherent data transfer and high-precision molecular spectroscopy.

Temperature-controlled airflow ventilation in operating rooms compared with laminar airflow and turbulent mixed airflow.

PubMed

Alsved, M; Civilis, A; Ekolind, P; Tammelin, A; Andersson, A Erichsen; Jakobsson, J; Svensson, T; Ramstorp, M; Sadrizadeh, S; Larsson, P-A; Bohgard, M; Šantl-Temkiv, T; Löndahl, J

2018-02-01

To evaluate three types of ventilation systems for operating rooms with respect to air cleanliness [in colony-forming units (cfu/m 3 )], energy consumption and comfort of working environment (noise and draught) as reported by surgical team members. Two commonly used ventilation systems, vertical laminar airflow (LAF) and turbulent mixed airflow (TMA), were compared with a newly developed ventilation technique, temperature-controlled airflow (T c AF). The cfu concentrations were measured at three locations in an operating room during 45 orthopaedic procedures: close to the wound (<40cm), at the instrument table and peripherally in the room. The operating team evaluated the comfort of the working environment by answering a questionnaire. LAF and T c AF, but not TMA, resulted in less than 10cfu/m 3 at all measurement locations in the room during surgery. Median values of cfu/m 3 close to the wound (250 samples) were 0 for LAF, 1 for T c AF and 10 for TMA. Peripherally in the room, the cfu concentrations were lowest for T c AF. The cfu concentrations did not scale proportionally with airflow rates. Compared with LAF, the power consumption of T c AF was 28% lower and there was significantly less disturbance from noise and draught. T c AF and LAF remove bacteria more efficiently from the air than TMA, especially close to the wound and at the instrument table. Like LAF, the new T c AF ventilation system maintained very low levels of cfu in the air, but T c AF used substantially less energy and provided a more comfortable working environment than LAF. This enables energy savings with preserved air quality. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

The 'Room within a Room' Concept for Monitored Warhead Dismantlement

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

Tanner, Jennifer E.; Benz, Jacob M.; White, Helen

2014-12-01

Over the past 10 years, US and UK experts have engaged in a technical collaboration with the aim of improving scientific and technological abilities in support of potential future nuclear arms control and non-proliferation agreements. In 2011 a monitored dismantlement exercise provided an opportunity to develop and test potential monitoring technologies and approaches. The exercise followed a simulated nuclear object through a dismantlement process and looked to explore, with a level of realism, issues surrounding device and material monitoring, chain of custody, authentication and certification of equipment, data management and managed access. This paper focuses on the development and deploymentmore » of the ‘room-within-a-room’ system, which was designed to maintain chain of custody during disassembly operations. A key challenge for any verification regime operating within a nuclear weapon complex is to provide the monitoring party with the opportunity to gather sufficient evidence, whilst protecting sensitive or proliferative information held by the host. The requirement to address both monitoring and host party concerns led to a dual function design which: • Created a controlled boundary around the disassembly process area which could provide evidence of unauthorised diversion activities. • Shielded sensitive disassembly operations from monitoring party observation. The deployed room-within-a-room was an integrated system which combined a number of chain of custody technologies (i.e. cameras, tamper indicating panels and enclosures, seals, unique identifiers and radiation portals) and supporting deployment procedures. This paper discusses the bounding aims and constraints identified by the monitoring and host parties with respect to the disassembly phase, the design of the room-within-a-room system, lessons learned during deployment, conclusions and potential areas of future work. Overall it was agreed that the room-within-a-room approach was effective but the individual technologies used to create the system deployed during this exercise required further development.« less

How clean is your clean room?

PubMed

Govier, J

2006-01-01

After investment in a clean room, cleanliness, sanitisation or sterility is essential to ensuring it operates at the highest standard. This article advises on the products and maintenance procedures to achieve this.

Job satisfaction or production? How staff and leadership understand operating room efficiency: a qualitative study.

PubMed

Arakelian, E; Gunningberg, L; Larsson, J

2008-11-01

How to increase efficiency in operating departments has been widely studied. However, there is no overall definition of efficiency. Supervisors urging staff to work efficiently may meet strong reactions due to staff believing that demands for efficiency means just stress at work. Differences in how efficiency is understood may constitute an obstacle to supervisors' efforts to promote it. This study aimed to explore how staff and leadership understand operating room efficiency. Twenty-one members of staff and supervisors in an operating department in a Swedish county hospital were interviewed. The analysis was performed with a phenomenographic approach that aims to discover the variations in how a phenomenon is understood by a group of people. Six categories were found in the understanding of operation room efficiency: (A) having the right qualifications; (B) enjoying work; (C) planning and having good control and overview; (D) each professional performing the correct tasks; (E) completing a work assignment; and (F) producing as much as possible per time unit. The most significant finding was that most of the nurses and assistant nurses understood efficiency as individual knowledge and experience emphasizing the importance of the work process, whereas the supervisors and physicians understood efficiency in terms of production per time unit or completing an assignment. The concept 'operating room efficiency' is understood in different ways by leadership and staff members. Supervisors who are aware of this variation will have better prerequisites for defining the concept and for creating a common platform towards becoming efficient.

The effect of procedure room temperature and humidity on LASIK outcomes

PubMed Central

Seider, Michael I.; McLeod, Stephen D.; Porco, Travis C.; Schallhorn, Steven C.

2013-01-01

Objective To determine if procedure room temperature and humidity during LASIK affects refractive outcomes in a very large patient sample. Design Retrospective cohort study. Participants 202,394 eyes of 105,712 patients aged 18 to 75 years old who underwent LASIK at an Optical Express, Inc. location in their United Kingdom and Ireland centers from January 1, 2008 to June 30, 2011 who met inclusion criteria. Methods Patient age, gender, pre- and one month post-LASIK manifest refraction and flap creation technique were recorded as well as the ambient temperature and humidity during LASIK. Effect size determination, in addition to univariate and multivariate analysis was performed to characterize the relationships between LASIK procedure room temperature and humidity and post-operative refractive outcome. Main Outcome Measures One month post-LASIK manifest refraction. Results No clinically significant effect of procedure room temperature or humidity was found on LASIK refractive outcomes. When considering all eyes in our population, an increase of one degree Celsius during LASIK was associated with a 0.003 diopter more hyperopic refraction one month post-operatively and an increase in one percent humidity was associated with a 0.0004 more myopic refraction. These effect sizes were the same or similar when considering only myopic eyes, only hyperopic eyes and subgroups of eyes stratified by age and pre-operative refractive error. Conclusions Procedure room temperature or humidity during LASIK was found to have no clinically significant relationship with post-operative manifest refraction in our population. PMID:23769199

Direct surgeon control of the computer in the operating room.

PubMed

Onceanu, Dumitru; Stewart, A James

2011-01-01

This paper describes the design and evaluation of a joystick-like device that allows direct surgeon control of the computer in the operating room. The device contains no electronic parts, is easy to use, is unobtrusive, has no physical connection to the computer, and makes use of an existing surgical tool. The device was tested in comparison to a mouse and to verbal dictation.

American ASTP crewmen briefed on operation of consoles in main control room

NASA Image and Video Library

1975-04-25

S75-25619 (25 April 1975) --- A group of American ASTP crewmen is briefed on the operation of the consoles in the main control room at the ASTP flight control center at the Cosmonaut Training Center (Star City) near Moscow. The astronauts were in the Soviet Union for ASTP joint crew training with the Soviet ASTP crewmen. PHOTO COURTESY: USSR ACADEMY OF SCIENCES

26. VIEW OF SOUTHERN PORTION OF EAST BOILER ROOM LOOKING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

26. VIEW OF SOUTHERN PORTION OF EAST BOILER ROOM LOOKING EAST AT BOILER 904. BOILER 904 WAS MANUFACTURED BY RILEY STOKER AND INSTALLED IN 1944. ORIGINALLY FUELED BY PULVERIZED COAL, IT WAS CONVERTED TO GAS/OIL OPERATION IN 1978 AND OPERATED UNTIL THE PLANT CLOSED. - New York, New Haven & Hartford Railroad, Cos Cob Power Plant, Sound Shore Drive, Greenwich, Fairfield County, CT

27. VIEW OF SOUTHERN PORTION OF EAST BOILER ROOM LOOKING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

27. VIEW OF SOUTHERN PORTION OF EAST BOILER ROOM LOOKING EAST AT UPPER PORTION BOILER 904. BOILER 904 WAS MANUFACTURED BY RILEY STOKER AND INSTALLED IN 1944. ORIGINALLY FUELED BY PULVERIZED COAL, IT WAS CONVERTED TO GAS/OIL OPERATION IN 1978 AND OPERATED UNTIL THE PLANT CLOSED. - New York, New Haven & Hartford Railroad, Cos Cob Power Plant, Sound Shore Drive, Greenwich, Fairfield County, CT

Priority coding for control room alarms

DOEpatents

Scarola, Kenneth; Jamison, David S.; Manazir, Richard M.; Rescorl, Robert L.; Harmon, Daryl L.

1994-01-01

Indicating the priority of a spatially fixed, activated alarm tile on an alarm tile array by a shape coding at the tile, and preferably using the same shape coding wherever the same alarm condition is indicated elsewhere in the control room. The status of an alarm tile can change automatically or by operator acknowledgement, but tones and/or flashing cues continue to provide status information to the operator.

Improving operating room first start efficiency - value of both checklist and a pre-operative facilitator.

PubMed

Panni, M K; Shah, S J; Chavarro, C; Rawl, M; Wojnarwsky, P K; Panni, J K

2013-10-01

There are multiple components leading to improved operating room efficiency. We undertook a project focusing on first case starts; accounting for each delay component on a global basis. Our hypothesis was there would be a reduction in first start delays after we implemented strategies to address the issues identified through this accounting process. An orange sheet checklist was implemented, with specific items that needed to be clear prior to roll back to the operating room (OR), and an OR facilitator was employed to intervene whenever there were any missing items needed for a specific patient. We present the data from this quality improvement project over an 18-month period. Initially, 10.07 (± 0.73) delayed first starts occurred per day but declined steadily over time to a low of 4.95 (± 0.38) per day after 6 months (-49.2 %, P < 0.001). By the end of the project, the most common reasons for delay still included late surgical attending (19%), schedule changes (14%) as well as 'other reasons' (13%), but with an overall reduction per day of each. Total anaesthesia delay initially totalled 11% of the first start delays, but was negligible (< 1%) at the project's completion. While we have a challenging operating room environment based on our patient population, multiple trainees in both the surgery and anaesthesiology teams: an orange sheet - pre-operative checklist in addition to a dedicated pre-operative facilitator; allowed us to make a substantial improvement in our first start on time starts. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Data mining of space heating system performance in affordable housing

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

Ren, Xiaoxin; Yan, Da; Hong, Tianzhen

The space heating in residential buildings accounts for a considerable amount of the primary energy use. Therefore, understanding the operation and performance of space heating systems becomes crucial in improving occupant comfort while reducing energy use. This study investigated the behavior of occupants adjusting their thermostat settings and heating system operations in a 62-unit affordable housing complex in Revere, Massachusetts, USA. The data mining methods, including clustering approach and decision trees, were used to ascertain occupant behavior patterns. Data tabulating ON/OFF space heating states was assessed, to provide a better understanding of the intermittent operation of space heating systems inmore » terms of system cycling frequency and the duration of each operation. The decision tree was used to verify the link between room temperature settings, house and heating system characteristics and the heating energy use. The results suggest that the majority of apartments show fairly constant room temperature profiles with limited variations during a day or between weekday and weekend. Data clustering results revealed six typical patterns of room temperature profiles during the heating season. Space heating systems cycled more frequently than anticipated due to a tight range of room thermostat settings and potentially oversized heating capacities. In conclusion, from this study affirm data mining techniques are an effective method to analyze large datasets and extract hidden patterns to inform design and improve operations.« less

Data mining of space heating system performance in affordable housing

DOE PAGES

Ren, Xiaoxin; Yan, Da; Hong, Tianzhen

2015-02-16

The space heating in residential buildings accounts for a considerable amount of the primary energy use. Therefore, understanding the operation and performance of space heating systems becomes crucial in improving occupant comfort while reducing energy use. This study investigated the behavior of occupants adjusting their thermostat settings and heating system operations in a 62-unit affordable housing complex in Revere, Massachusetts, USA. The data mining methods, including clustering approach and decision trees, were used to ascertain occupant behavior patterns. Data tabulating ON/OFF space heating states was assessed, to provide a better understanding of the intermittent operation of space heating systems inmore » terms of system cycling frequency and the duration of each operation. The decision tree was used to verify the link between room temperature settings, house and heating system characteristics and the heating energy use. The results suggest that the majority of apartments show fairly constant room temperature profiles with limited variations during a day or between weekday and weekend. Data clustering results revealed six typical patterns of room temperature profiles during the heating season. Space heating systems cycled more frequently than anticipated due to a tight range of room thermostat settings and potentially oversized heating capacities. In conclusion, from this study affirm data mining techniques are an effective method to analyze large datasets and extract hidden patterns to inform design and improve operations.« less

Operating Room Delays: Meaningful Use in Electronic Health Record.

PubMed

Van Winkle, Rachelle A; Champagne, Mary T; Gilman-Mays, Meri; Aucoin, Julia

2016-06-01

Perioperative areas are the most costly to operate and account for more than 40% of expenses. The high costs prompted one organization to analyze surgical delays through a retrospective review of their new electronic health record. Electronic health records have made it easier to access and aggregate clinical data; 2123 operating room cases were analyzed. Implementing a new electronic health record system is complex; inaccurate data and poor implementation can introduce new problems. Validating the electronic health record development processes determines the ease of use and the user interface, specifically related to user compliance with the intent of the electronic health record development. The revalidation process after implementation determines if the intent of the design was fulfilled and data can be meaningfully used. In this organization, the data fields completed through automation provided quantifiable, meaningful data. However, data fields completed by staff that required subjective decision making resulted in incomplete data nearly 24% of the time. The ease of use was further complicated by 490 permutations (combinations of delay types and reasons) that were built into the electronic health record. Operating room delay themes emerged notwithstanding the significant complexity of the electronic health record build; however, improved accuracy could improve meaningful data collection and a more accurate root cause analysis of operating room delays. Accurate and meaningful use of data affords a more reliable approach in quality, safety, and cost-effective initiatives.

KSC-2014-2302

NASA Image and Video Library

2014-04-25

CAPE CANAVERAL, Fla. – Construction workers have installed the framing and some of the inner walls inside Firing Room 4 in the Launch Control Center at NASA's Kennedy Space Center in Florida. Three rows of upper level management consoles remain. The Ground Systems Development and Operations Program is overseeing efforts to create a new firing room based on a multi-user concept. The design of Firing Room 4 will incorporate five control room areas that are flexible to meet current and future NASA and commercial user requirements. The equipment and most of the consoles from Firing Room 4 were moved to Firing Room 2 for possible future reuse. Photo credit: NASA/Dimitri Gerondidakis

KSC-2014-2304

NASA Image and Video Library

2014-04-25

CAPE CANAVERAL, Fla. – Construction workers have installed the framing and some of the inner walls inside Firing Room 4 in the Launch Control Center at NASA's Kennedy Space Center in Florida. Three rows of upper level management consoles remain. The Ground Systems Development and Operations Program is overseeing efforts to create a new firing room based on a multi-user concept. The design of Firing Room 4 will incorporate five control room areas that are flexible to meet current and future NASA and commercial user requirements. The equipment and most of the consoles from Firing Room 4 were moved to Firing Room 2 for possible future reuse. Photo credit: NASA/Dimitri Gerondidakis

KSC-2014-2303

NASA Image and Video Library

2014-04-25

CAPE CANAVERAL, Fla. – Construction workers have installed the framing and some of the inner walls inside Firing Room 4 in the Launch Control Center at NASA's Kennedy Space Center in Florida. Three rows of upper level management consoles remain. The Ground Systems Development and Operations Program is overseeing efforts to create a new firing room based on a multi-user concept. The design of Firing Room 4 will incorporate five control room areas that are flexible to meet current and future NASA and commercial user requirements. The equipment and most of the consoles from Firing Room 4 were moved to Firing Room 2 for possible future reuse. Photo credit: NASA/Dimitri Gerondidakis

West wall, display area (room 101), view 4 of 4: ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

West wall, display area (room 101), view 4 of 4: northwest corner, with D.M. logistics office below (room 137), and D.O./D.D.O. offices above. Lower stairs lead to entry shown in view 13 - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

11. Historic view of Building 100 control room, showing personnel ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

11. Historic view of Building 100 control room, showing personnel operating rocket engine test controls and observer watching activity from observation room. May 27, 1957. On file at NASA Plumbrook Research Center, Sandusky, Ohio. NASA photo number C-45020. - Rocket Engine Testing Facility, GRC Building No. 100, NASA Glenn Research Center, Cleveland, Cuyahoga County, OH

KSC-2014-1971

NASA Image and Video Library

2014-04-03

CAPE CANAVERAL, Fla. – The Ground Systems Development and Operations Program is overseeing efforts to create a new multi-user firing room in Firing Room 4 in the Launch Control Center at NASA's Kennedy Space Center in Florida. The main floor consoles, cabling and wires below the floor and ceiling tiles above have been removed. Sub-flooring has been installed and the room is marked off to create four separate rooms on the main floor. In view along the soffit are space shuttle launch plaques for 21 missions launched from Firing Room 4. The design of Firing Room 4 will incorporate five control room areas that are flexible to meet current and future NASA and commercial user requirements. The equipment and most of the consoles from Firing Room 4 were moved to Firing Room 2 for possible future reuse. Photo credit: NASA/Ben Smegelsky

Integrated intelligent systems in advanced reactor control rooms

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

Beckmeyer, R.R.

1989-01-01

An intelligent, reactor control room, information system is designed to be an integral part of an advanced control room and will assist the reactor operator's decision making process by continuously monitoring the current plant state and providing recommended operator actions to improve that state. This intelligent system is an integral part of, as well as an extension to, the plant protection and control systems. This paper describes the interaction of several functional components (intelligent information data display, technical specifications monitoring, and dynamic procedures) of the overall system and the artificial intelligence laboratory environment assembled for testing the prototype. 10 refs.,more » 5 figs.« less

Effect of mobile laminar airflow units on airborne bacterial contamination during neurosurgical procedures.

PubMed

von Vogelsang, A-C; Förander, P; Arvidsson, M; Löwenhielm, P

2018-03-24

Surgical site infections (SSIs) after neurosurgery are potentially life-threatening and entail great costs. SSIs may occur from airborne bacteria in the operating room, and ultraclean air is desired during infection-prone cleaning procedures. Door openings and the number of persons present in the operating room affect the air quality. Mobile laminar airflow (MLAF) units, with horizontal laminar airflow, have previously been shown to reduce airborne bacterial contamination. To assess the effect of MLAF units on airborne bacterial contamination during neurosurgical procedures. In a quasi-experimental design, bacteria-carrying particles (colony-forming units: cfu) during neurosurgical procedures were measured with active air-sampling in operating rooms with conventional turbulent ventilation, and with additional MLAF units. The MLAF units were shifted between operating rooms monthly. Colony-forming unit count and bacterial species detection were conducted after incubation. Data was collected for a period of 18 months. A total of 233 samples were collected during 45 neurosurgical procedures. The use of MLAF units significantly reduced the numbers of cfu in the surgical site area (P < 0.001) and above the instrument table (P < 0.001). Logistic regression showed that the only significant predictor affecting cfu count was the use of MLAF units (odds ratio: 41.6; 95% confidence interval: 11.3-152.8; P < 0.001). The most frequently detected bacteria were coagulase-negative staphylococci. MLAF successfully reduces cfu during neurosurgery to ultraclean air levels. MLAF units are valuable when the main operating room ventilation system is unable to produce ultraclean air in infection-prone clean neurosurgery. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Device- and system-independent personal touchless user interface for operating rooms : One personal UI to control all displays in an operating room.

PubMed

Ma, Meng; Fallavollita, Pascal; Habert, Séverine; Weidert, Simon; Navab, Nassir

2016-06-01

In the modern day operating room, the surgeon performs surgeries with the support of different medical systems that showcase patient information, physiological data, and medical images. It is generally accepted that numerous interactions must be performed by the surgical team to control the corresponding medical system to retrieve the desired information. Joysticks and physical keys are still present in the operating room due to the disadvantages of mouses, and surgeons often communicate instructions to the surgical team when requiring information from a specific medical system. In this paper, a novel user interface is developed that allows the surgeon to personally perform touchless interaction with the various medical systems, switch effortlessly among them, all of this without modifying the systems' software and hardware. To achieve this, a wearable RGB-D sensor is mounted on the surgeon's head for inside-out tracking of his/her finger with any of the medical systems' displays. Android devices with a special application are connected to the computers on which the medical systems are running, simulating a normal USB mouse and keyboard. When the surgeon performs interaction using pointing gestures, the desired cursor position in the targeted medical system display, and gestures, are transformed into general events and then sent to the corresponding Android device. Finally, the application running on the Android devices generates the corresponding mouse or keyboard events according to the targeted medical system. To simulate an operating room setting, our unique user interface was tested by seven medical participants who performed several interactions with the visualization of CT, MRI, and fluoroscopy images at varying distances from them. Results from the system usability scale and NASA-TLX workload index indicated a strong acceptance of our proposed user interface.

Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study.

PubMed

Erestam, Sofia; Haglind, Eva; Bock, David; Andersson, Annette Erichsen; Angenete, Eva

2017-01-01

Inter-professional teamwork in the operating room is important for patient safety. The World Health Organization (WHO) checklist was introduced to improve intraoperative teamwork. The aim of this study was to evaluate the safety climate in a Swedish operating room setting before and after an intervention, using a revised version of the WHO checklist to improve teamwork. This study is a single center prospective interventional study. Participants were personnel working in operating room teams including surgeons, anesthesiologists, scrub nurses, nurse anaesthetists and nurse assistants. The study started with pre-interventional observations of the WHO checklist use followed by education on safety climate, the WHO checklist, and non-technical skills in the operating room. Thereafter a revised version of the WHO checklist was introduced. Post-interventional observations regarding the performance of the WHO checklist were carried out. The Safety Attitude Questionnaire was used to assess safety climate at baseline and post-intervention. At baseline we discovered a need for improved teamwork and communication. The participants considered teamwork to be important for patient safety, but had different perceptions of good teamwork between professions. The intervention, a revised version of the WHO checklist, did not affect teamwork climate. Adherence to the revision of the checklist was insufficient, dominated by a lack of structure. There was no significant change in teamwork climate by use of the revised WHO checklist, which may be due to insufficient implementation, as a lack of adherence to the WHO checklist was detected. We found deficiencies in teamwork and communication. Further studies exploring how to improve safety climate are needed. NCT02329691.

[Economic impact of strategies using ephedrine prefilled syringes].

PubMed

Crégut-Corbaton, J; Malbranche, C; Guignard, M-H; Fagnoni, P

2013-11-01

Ephedrine is an emergency drug available in ampules and syringes need to be prepared in advance according to one of two strategies in our establishment: strategy 1 (S1: 1 ampule per patient) and strategy 2 (S2: 1 ampule per operating room). There are also prefilled syringes. Because of their high cost and conflicting results in the literature, we assessed the economic interest of using prefilled syringes compared with strategies S1 and S2. This was a prospective observational study. The consumption of ephedrine was recorded over two periods of 14 days: P1 with syringes prepared in advance according to S1 or S2 and P2 with the on-demand use of prefilled syringes. The cost of a syringe of ephedrine prepared in advance (nurse time preparation included) was evaluated at €1.65 vs. €3.57 for a prefilled syringe. In operating rooms using S1, the use of prefilled syringes reduced overall the cost per patient about €1.22 and global annual costs by 72% (€2830), while the decrease was about €0.32 for the cost per patient and about 47% (€2760) for global annual costs for operating rooms using S2. The interest of our study is that we investigated different supply strategies for ephedrine within a large number of operating rooms. In our establishment, it was decided to use prefilled syringes in operating rooms that used S1. As well as the economic interest, prefilled syringes contributed to improved safety and saved nursing time. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Mobile zoned/exponential LAF screen: a new concept in ultra-clean air technology for additional operating room ventilation.

PubMed

Friberg, B; Lindgren, M; Karlsson, C; Bergström, A; Friberg, S

2002-04-01

A mobile screen (0.5 x 0.4 m) producing ultra-clean exponential LAF (air-flow central zone 0.6 m/s and peripheral zone 0.4 m/s) was investigated as an addition to conventional turbulent/mixing operating room ventilation. The evaluation was performed during strictly standardized sham operations reflecting conditions during major surgery. The study consisted of a pilot experiment designed to give high counts of sedimenting aerobic colony forming units (cfu). In a second main study, recording dust particles, air-borne and sedimenting aerobic cfu, the screen was associated with optimal operating room clothing. In the pilot experiment the use of the screen resulted in a substantial reduction of sedimenting bacteria from 3835-4940 to 0-390 cfu/m(2)/h. In the main study, the use of the additional LAF reduced the surface contamination from 416-329 to 7-78 cfu/m(2)/h up to 1.6 m from the screen (P=0.001-0.0001). Measured in the wound area the screen reduced the air counts of bacteria from 9-14 to 0.2-0.4 cfu/m(3) (P=0.008-0.0001) and a marked reduction of air-borne dust particles was recorded (P=0.007-0.009). In conclusion, the additional mobile LAF screen reduced the counts of aerobic air-borne and sedimenting bacteria-carrying particles as well as dust particles to the levels gained with complete ultra-clean LAF room ventilation. Thus, the screen might prove a valuable addition to operating room ventilation as well as in other areas where asepsis is essential. Copyright 2002 The Hospital Infection Society.

Benefits of Advanced Control Room Technologies: Phase One Upgrades to the HSSL, Research Plan, and Performance Measures

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

Le Blanc, Katya; Joe, Jeffrey; Rice, Brandon

Control Room modernization is an important part of life extension for the existing light water reactor fleet. None of the 99 currently operating commercial nuclear power plants in the U.S. has completed a full-scale control room modernization to date. A full-scale modernization might, for example, entail replacement of all analog panels with digital workstations. Such modernizations have been undertaken successfully in upgrades in Europe and Asia, but the U.S. has yet to undertake a control room upgrade of this magnitude. Instead, nuclear power plant main control rooms for the existing commercial reactor fleet remain significantly analog, with only limited digitalmore » modernizations. Previous research under the U.S. Department of Energy’s Light Water Reactor Sustainability Program has helped establish a systematic process for control room upgrades that support the transition to a hybrid control room. While the guidance developed to date helps streamline the process of modernization and reduce costs and uncertainty associated with introducing digital control technologies into an existing control room, these upgrades do not achieve the full potential of newer technologies that might otherwise enhance plant and operator performance. The aim of the control room benefits research is to identify previously overlooked benefits of modernization, identify candidate technologies that may facilitate such benefits, and demonstrate these technologies through human factors research. This report describes the initial upgrades to the HSSL and outlines the methodology for a pilot test of the HSSL configuration.« less

A Research Framework for Demonstrating Benefits of Advanced Control Room Technologies

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

Le Blanc, Katya; Boring, Ronald; Joe, Jeffrey

Control Room modernization is an important part of life extension for the existing light water reactor fleet. None of the 99 currently operating commercial nuclear power plants in the U.S. has completed a full-scale control room modernization to date. A full-scale modernization might, for example, entail replacement of all analog panels with digital workstations. Such modernizations have been undertaken successfully in upgrades in Europe and Asia, but the U.S. has yet to undertake a control room upgrade of this magnitude. Instead, nuclear power plant main control rooms for the existing commercial reactor fleet remain significantly analog, with only limited digitalmore » modernizations. Previous research under the U.S. Department of Energy’s Light Water Reactor Sustainability Program has helped establish a systematic process for control room upgrades that support the transition to a hybrid control. While the guidance developed to date helps streamline the process of modernization and reduce costs and uncertainty associated with introducing digital control technologies into an existing control room, these upgrades do not achieve the full potential of newer technologies that might otherwise enhance plant and operator performance. The aim of the control room benefits research presented here is to identify previously overlooked benefits of modernization, identify candidate technologies that may facilitate such benefits, and demonstrate these technologies through human factors research. This report serves as an outline for planned research on the benefits of greater modernization in the main control rooms of nuclear power plants.« less

Undergraduate surgical nursing preparation and guided operating room experience: A quantitative analysis.

PubMed

Foran, Paula

2016-01-01

The aim of this research was to determine if guided operating theatre experience in the undergraduate nursing curricula enhanced surgical knowledge and understanding of nursing care provided outside this specialist area in the pre- and post-operative surgical wards. Using quantitative analyses, undergraduate nurses were knowledge tested on areas of pre- and post-operative surgical nursing in their final semester of study. As much learning occurs in nurses' first year of practice, participants were re-tested again after their Graduate Nurse Program/Preceptorship year. Participants' results were compared to the model of operating room education they had participated in to determine if there was a relationship between the type of theatre education they experienced (if any) and their knowledge of surgical ward nursing. Findings revealed undergraduates nurses receiving guided operating theatre experience had a 76% pass rate compared to 56% with non-guided or no experience (p < 0.001). Graduates with guided operating theatre experience as undergraduates or graduate nurses achieved a 100% pass rate compared to 53% with non-guided or no experience (p < 0.001). The research informs us that undergraduate nurses achieve greater learning about surgical ward nursing via guided operating room experience as opposed to surgical ward nursing experience alone. Copyright © 2015 Elsevier Ltd. All rights reserved.

Telephone equipment room, showing channel terminal bank with vacuum tubes. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Telephone equipment room, showing channel terminal bank with vacuum tubes. View to east - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

Altitude Wind Tunnel Control Room

NASA Image and Video Library

1945-05-21

Researchers at the National Advisory Committee for Aeronautics (NACA) Aircraft Engine Research Laboratory monitor a ramjet's performance in the Altitude Wind Tunnel from the control room. The soundproof control room was just a few feet from the tunnel’s 20-foot-diameter test section. In the control room, the operators could control all aspects of the tunnel’s operation, including the air density, temperature, and speed. They also operated the engine or test article in the test section by controlling the angle-of-attack, speed, power, and other parameters. The men in this photograph are monitoring the engine’s thrust and lift. A NACA-designed 20-inch-diameter ramjet was installed in the tunnel in May 1945. Thrust figures from these runs were compared with drag data from tests of scale models in small supersonic tunnels to verify the ramjet’s feasibility. The tunnel was used to analyze the ramjet’s overall performance up to altitudes of 47,000 feet and speeds to Mach 1.84. The researchers found that an increase in altitude caused a reduction in the engine’s horsepower and identified optimal flameholder configurations.

Ultrasensitive Room-Temperature Operable Gas Sensors Using p-Type Na:ZnO Nanoflowers for Diabetes Detection.

PubMed

Jaisutti, Rawat; Lee, Minkyung; Kim, Jaeyoung; Choi, Seungbeom; Ha, Tae-Jun; Kim, Jaekyun; Kim, Hyoungsub; Park, Sung Kyu; Kim, Yong-Hoon

2017-03-15

Ultrasensitive room-temperature operable gas sensors utilizing the photocatalytic activity of Na-doped p-type ZnO (Na:ZnO) nanoflowers (NFs) are demonstrated as a promising candidate for diabetes detection. The flowerlike Na:ZnO nanoparticles possessing ultrathin hierarchical nanosheets were synthesized by a facile solution route at a low processing temperature of 40 °C. It was found that the Na element acting as a p-type dopant was successfully incorporated in the ZnO lattice. On the basis of the synthesized p-type Na:ZnO NFs, room-temperature operable chemiresistive-type gas sensors were realized, activated by ultraviolet (UV) illumination. The Na:ZnO NF gas sensors exhibited high gas response (S of 3.35) and fast response time (∼18 s) and recovery time (∼63 s) to acetone gas (100 ppm, UV intensity of 5 mW cm -2 ), and furthermore, subppm level (0.2 ppm) detection was achieved at room temperature, which enables the diagnosis of various diseases including diabetes from exhaled breath.

Assessment of operative times of multiple surgical specialties in a public university hospital.

PubMed

Costa, Altair da Silva

2017-01-01

To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays. Avaliar os indicadores de tempo da anestesia, da operação e da permanência do paciente em sala de diversas especialidades do centro cirúrgico de um hospital universitário. Foi realizado em estudo descritivo transversal a partir da base de dados do centro cirúrgico e mensuradas as seguintes etapas: duração de anestesia, tempo do procedimento e tempo de permanência do paciente em sala das diversas especialidades. Foram incluídas as operações realizadas em sequência na mesma sala, das 7h às 17h, eletivas ou de urgências. Realizamos o calculo do percentil 80 da duração das etapas, onde 80% dos procedimentos ficaram abaixo deste valor obtido. O estudo incluiu 8.337 operações realizadas no período de 1 ano de 12 especialidades cirúrgicas. A média geral da duração da anestesia de todas as especialidades foi de 178,12±110,46 minutos, e o percentil 80 foi de 252 minutos. A média do tempo operatório foi 130,45±97,23 minutos, e o percentil 80 foi de 195 minutos. A média do tempo total do paciente em sala operatória foi de 197,30±113,71 minutos, e o percentil 80 foi de 285 minutos. A variação da média geral em relação ao percentil 80 foi de 41% na anestesia, 49% nas operações e 44% no tempo de sala. Na média geral, a anestesia ocupou 88% do tempo de sala e a operação, 61%. Este estudo identificou padrões nas durações das etapas das operações. A informação das médias históricas das especialidades pode auxiliar no planejamento do centro cirúrgico e diminuir os atrasos.

[Design of an anesthesia and micro-environment information management system in mobile operating room].

PubMed

Wang, Xianwen; Liu, Zhiguo; Zhang, Wenchang; Wu, Qingfu; Tan, Shulin

2013-08-01

We have designed a mobile operating room information management system. The system is composed of a client and a server. A client, consisting of a PC, medical equipments, PLC and sensors, provides the acquisition and processing of anesthesia and micro-environment data. A server is a powerful computer that stores the data of the system. The client gathers the medical device data by using the C/S mode, and analyzes the obtained HL7 messages through the class library call. The client collects the micro-environment information with PLC, and finishes the data reading with the OPC technology. Experiment results showed that the designed system could manage the patient anesthesia and micro-environment information well, and improve the efficiency of the doctors' works and the digital level of the mobile operating room.

Operating room integration and telehealth.

PubMed

Bucholz, Richard D; Laycock, Keith A; McDurmont, Leslie

2011-01-01

The increasing use of advanced automated and computer-controlled systems and devices in surgical procedures has resulted in problems arising from the crowding of the operating room with equipment and the incompatible control and communication standards associated with each system. This lack of compatibility between systems and centralized control means that the surgeon is frequently required to interact with multiple computer interfaces in order to obtain updates and exert control over the various devices at his disposal. To reduce this complexity and provide the surgeon with more complete and precise control of the operating room systems, a unified interface and communication network has been developed. In addition to improving efficiency, this network also allows the surgeon to grant remote access to consultants and observers at other institutions, enabling experts to participate in the procedure without having to travel to the site.

Room temperature solid-state quantum emitters in the telecom range.

PubMed

Zhou, Yu; Wang, Ziyu; Rasmita, Abdullah; Kim, Sejeong; Berhane, Amanuel; Bodrog, Zoltán; Adamo, Giorgio; Gali, Adam; Aharonovich, Igor; Gao, Wei-Bo

2018-03-01

On-demand, single-photon emitters (SPEs) play a key role across a broad range of quantum technologies. In quantum networks and quantum key distribution protocols, where photons are used as flying qubits, telecom wavelength operation is preferred because of the reduced fiber loss. However, despite the tremendous efforts to develop various triggered SPE platforms, a robust source of triggered SPEs operating at room temperature and the telecom wavelength is still missing. We report a triggered, optically stable, room temperature solid-state SPE operating at telecom wavelengths. The emitters exhibit high photon purity (~5% multiphoton events) and a record-high brightness of ~1.5 MHz. The emission is attributed to localized defects in a gallium nitride (GaN) crystal. The high-performance SPEs embedded in a technologically mature semiconductor are promising for on-chip quantum simulators and practical quantum communication technologies.

[Educational intervention on malignant hyperthermia with nursing professionals of the operating room].

PubMed

Sousa, Cristina Silva; Bispo, Daniela Magalhaes; Cunha, Ana Lucia Mirancos da; Siqueira, Ivana Lucia Correa Pimentel de

2015-04-01

To evaluate the effectiveness of an educational intervention on malignant hyperthermia with operating room nurses. A quasi-experimental study, aimed at an educational intervention of short duration with the nursing staff in the operating room of the institution hosting the research in the city of São Paulo, with the participation of 96 professionals. Pre-intervention tests and post-intervention tests were applied, which consisted of a lecture followed by simulation. Considering the overall results of the intervention, there was a statistically significant difference (p<0.00). After the educational intervention, there was an increase of the minimum and maximum scores, and average growth of 2.64 points in the knowledge of professionals when compared to the previous step. The educational intervention strategy favors the concept of the content developed by everyone involved and qualifies professionals to work safely.

Does a surgical simulator improve resident operative performance of laparoscopic tubal ligation?

PubMed

Banks, Erika H; Chudnoff, Scott; Karmin, Ira; Wang, Cuiling; Pardanani, Setul

2007-11-01

The purpose of this study was to assess whether a surgical skills simulator laboratory improves resident knowledge and operative performance of laparoscopic tubal ligation. Twenty postgraduate year 1 residents were assigned randomly to either a surgical simulator laboratory on laparoscopic tubal ligation together with apprenticeship teaching in the operating room or to apprenticeship teaching alone. Tests that were given before and after the training assessed basic knowledge. Attending physicians who were blinded to resident randomization status evaluated postgraduate year 1 performance on a laparoscopic tubal ligation in the operating room with 3 validated tools: a task-specific checklist, global rating scale, and pass/fail grade. Postgraduate year 1 residents who were assigned randomly to the surgical simulator laboratory performed significantly better than control subjects on all 3 surgical assessment tools (the checklist, the global score, and the pass/fail analysis) and scored significantly better on the knowledge posttest (all P < .0005). Compared with apprenticeship teaching alone, a surgical simulator laboratory on laparoscopic tubal ligation improved resident knowledge and performance in the operating room.

Metal oxide gas sensors on the nanoscale

NASA Astrophysics Data System (ADS)

Plecenik, A.; Haidry, A. A.; Plecenik, T.; Durina, P.; Truchly, M.; Mosko, M.; Grancic, B.; Gregor, M.; Roch, T.; Satrapinskyy, L.; Moskova, A.; Mikula, M.; Kus, P.

2014-06-01

Low cost, low power and highly sensitive gas sensors operating at room temperature are very important devices for controlled hydrogen gas production and storage. One of the disadvantages of chemosensors is their high operating temperature (usually 200 - 400 °C), which excludes such type of sensors from usage in explosive environment. In this report, a new concept of gas chemosensors operating at room temperature based on TiO2 thin films is discussed. Integration of such sensor is fully compatible with sub-100 nm semiconductor technology and could be transferred directly from labor to commercial sphere.

FRAMEWORK AND APPLICATION FOR MODELING CONTROL ROOM CREW PERFORMANCE AT NUCLEAR POWER PLANTS

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

Ronald L Boring; David I Gertman; Tuan Q Tran

2008-09-01

This paper summarizes an emerging project regarding the utilization of high-fidelity MIDAS simulations for visualizing and modeling control room crew performance at nuclear power plants. The key envisioned uses for MIDAS-based control room simulations are: (i) the estimation of human error associated with advanced control room equipment and configurations, (ii) the investigative determination of contributory cognitive factors for risk significant scenarios involving control room operating crews, and (iii) the certification of reduced staffing levels in advanced control rooms. It is proposed that MIDAS serves as a key component for the effective modeling of cognition, elements of situation awareness, and riskmore » associated with human performance in next generation control rooms.« less

The use of pH adjusted lignocaine in controlling operative pain in the day surgery unit: a prospective, randomised trial.

PubMed

Fitton, A R; Ragbir, M; Milling, M A

1996-09-01

We report the results of a randomised, case matched, controlled, double blind study on 40 patients undergoing correction of their prominent ears, comparing efficacy of pH adjusted lignocaine to lignocaine alone in controlling operative pain. Each patient received commercial lignocaine in one ear and the same preparation reconstituted with 1 ml of 8.4% sodium bicarbonate in the other ear according to our randomisation protocol. 30 patients were studied to compare the difference between the buffered and commercial preparation infiltrated at room temperature. A further 10 patients were studied to assess the benefit the buffered preparation at room temperature had over commercial lignocaine warmed to body temperature. Linear analogue pain scores for discomfort at infiltration and during the operation itself were analysed. Buffered lignocaine imparts a significant reduction in pain on infiltration, compared to the commercial preparation at both room and body temperature. Both preparations were equally effective in obliterating pain during the operation itself.

Shaping the operating room and perioperative systems of the future: innovating for improved competitiveness.

PubMed

Seim, Andreas R; Sandberg, Warren S

2010-12-01

To review the current state of anesthesiology for operative and invasive procedures, with an eye toward possible future states. Anesthesiology is at once a mature specialty and in a crisis--requiring breakthrough to move forward. The cost of care now approaches reimbursement, and outcomes as commonly measured approach perfection. Thus, the cost of further improvements seems ready to topple the field, just as the specialty is realizing that seemingly innocuous anesthetic choices have long-term consequences, and better practice is required. Anesthesiologists must create more headroom between costs and revenues in order to sustain the academic vigor and creativity required to create better clinical practice. We outline three areas in which technological and organizational innovation in anesthesiology can improve competitiveness and become a driving force in collaborative efforts to develop the operating rooms and perioperative systems of the future: increasing the profitability of operating rooms; increasing the efficiency of anesthesia; and technological and organizational innovation to foster improved patient flow, communication, coordination, and organizational learning.

Operating Room of the Future: Advanced Technologies in Safe and Efficient Operating Rooms

DTIC Science & Technology

2008-10-01

fit” or compatibility with different tasks. Ideally, the optimal match between tasks and well-designed display alternatives will be self -apparent...hierarchical display environment. The FARO robot arm is used as an accurate and reliable tracker to control a virtual camera. The virtual camera pose is...in learning outcomes due to self -feedback, improvements in learning outcomes due to instructor feedback and synchronous versus asynchronous

76 FR 15870 - Airworthiness Directives; Airbus Model A310 Series Airplanes, and Airbus Model A300 B4-600, B4...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-22

..., Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE... Building Ground Floor, Room W12-40, 1200 New Jersey Avenue, SE., Washington, DC, between 9 a.m. and 5 p.m... than estimated here. Based on these figures, we estimate the cost of the proposed AD on U.S. operators...

ETR CONTROL BUILDING, TRA647, INTERIOR. CONTROL ROOM, CONTEXTUAL VIEW. INSTRUMENT ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

ETR CONTROL BUILDING, TRA-647, INTERIOR. CONTROL ROOM, CONTEXTUAL VIEW. INSTRUMENT PANELS AT REAR OF OPERATOR'S CONSOLE GAVE OPERATOR STATUS OF REACTOR PERFORMANCE, COOLANT-WATER CHARACTERISTICS AND OTHER INDICATORS. WINDOWS AT RIGHT LOOKED INTO ETR BUILDING FIRST FLOOR. CAMERA FACING EAST. INL NEGATIVE NO. HD42-6. Mike Crane, Photographer, 3/2004 - Idaho National Engineering Laboratory, Test Reactor Area, Materials & Engineering Test Reactors, Scoville, Butte County, ID

Gesture-Controlled Interface for Contactless Control of Various Computer Programs with a Hooking-Based Keyboard and Mouse-Mapping Technique in the Operating Room

PubMed Central

Park, Ben Joonyeon; Jang, Taekjin; Choi, Jong Woo; Kim, Namkug

2016-01-01

We developed a contactless interface that exploits hand gestures to effectively control medical images in the operating room. We developed an in-house program called GestureHook that exploits message hooking techniques to convert gestures into specific functions. For quantitative evaluation of this program, we used gestures to control images of a dynamic biliary CT study and compared the results with those of a mouse (8.54 ± 1.77 s to 5.29 ± 1.00 s; p < 0.001) and measured the recognition rates of specific gestures and the success rates of tasks based on clinical scenarios. For clinical applications, this program was set up in the operating room to browse images for plastic surgery. A surgeon browsed images from three different programs: CT images from a PACS program, volume-rendered images from a 3D PACS program, and surgical planning photographs from a basic image viewing program. All programs could be seamlessly controlled by gestures and motions. This approach can control all operating room programs without source code modification and provide surgeons with a new way to safely browse through images and easily switch applications during surgical procedures. PMID:26981146

Gesture-Controlled Interface for Contactless Control of Various Computer Programs with a Hooking-Based Keyboard and Mouse-Mapping Technique in the Operating Room.

PubMed

Park, Ben Joonyeon; Jang, Taekjin; Choi, Jong Woo; Kim, Namkug

2016-01-01

We developed a contactless interface that exploits hand gestures to effectively control medical images in the operating room. We developed an in-house program called GestureHook that exploits message hooking techniques to convert gestures into specific functions. For quantitative evaluation of this program, we used gestures to control images of a dynamic biliary CT study and compared the results with those of a mouse (8.54 ± 1.77 s to 5.29 ± 1.00 s; p < 0.001) and measured the recognition rates of specific gestures and the success rates of tasks based on clinical scenarios. For clinical applications, this program was set up in the operating room to browse images for plastic surgery. A surgeon browsed images from three different programs: CT images from a PACS program, volume-rendered images from a 3D PACS program, and surgical planning photographs from a basic image viewing program. All programs could be seamlessly controlled by gestures and motions. This approach can control all operating room programs without source code modification and provide surgeons with a new way to safely browse through images and easily switch applications during surgical procedures.

Use of hands-free technique among operating room nurses in the Republic of Korea.

PubMed

Jeong, Ihn Sook; Park, Sunmi

2009-03-01

The recently introduced concept of hands-free technique (HFT) currently has no recommendations or formal educational program for use in the Republic of Korea. This study evaluated the level of HFT use and investigated factors related to HFT use among Korean operating room nurses. Data were obtained through a self-administered questionnaire from 158 operating room nurses in 7 general hospitals in Busan, Republic of Korea, in April and May 2006. The questionnaire elicited information on demographics, exposure to education on HFT, attitude toward the need for HFT, concerns about exposure to bloodborne pathogens, and experience with HTF use. Multilevel multiple logistic regression analysis with generalized estimating equations was used, and adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. We found that 56% of the participants had used HFT, and 50% had received education on HFT. The use of HFT had a significant association with both education on HFT (OR = 12.02; 95% CI = 7.50 to 19.25) and attitude toward the need for HFT (OR = 4.22; 95% CI = 2.43 to 7.35). Increasing education about HFT could be the most important approach to increasing the use of HFT among Korean operating room nurses. Thus, routine teaching about HFT should be provided to these nurses.

Feasibility of touch-less control of operating room lights.

PubMed

Hartmann, Florian; Schlaefer, Alexander

2013-03-01

Today's highly technical operating rooms lead to fairly complex surgical workflows where the surgeon has to interact with a number of devices, including the operating room light. Hence, ideally, the surgeon could direct the light without major disruption of his work. We studied whether a gesture tracking-based control of an automated operating room light is feasible. So far, there has been little research on control approaches for operating lights. We have implemented an exemplary setup to mimic an automated light controlled by a gesture tracking system. The setup includes a articulated arm to position the light source and an off-the-shelf RGBD camera to detect the user interaction. We assessed the tracking performance using a robot-mounted hand phantom and ran a number of tests with 18 volunteers to evaluate the potential of touch-less light control. All test persons were comfortable with using the gesture-based system and quickly learned how to move a light spot on flat surface. The hand tracking error is direction-dependent and in the range of several centimeters, with a standard deviation of less than 1 mm and up to 3.5 mm orthogonal and parallel to the finger orientation, respectively. However, the subjects had no problems following even more complex paths with a width of less than 10 cm. The average speed was 0.15 m/s, and even initially slow subjects improved over time. Gestures to initiate control can be performed in approximately 2 s. Two-thirds of the subjects considered gesture control to be simple, and a majority considered it to be rather efficient. Implementation of an automated operating room light and touch-less control using an RGBD camera for gesture tracking is feasible. The remaining tracking error does not affect smooth control, and the use of the system is intuitive even for inexperienced users.

40 CFR Table 1 to Subpart IIIii of... - Work Practice Standards-Design, Operation, and Maintenance Requirements

Code of Federal Regulations, 2010 CFR

2010-07-01

... Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali Plants Pt. 63, Subpt. IIIII, Table 1 Table 1 to... . . . 1. Cell rooms a. For new or modified cell rooms, construct each cell room interior using materials... mercury spills or accumulations, and are easy to clean. b. Limit access around and beneath mercury cells...

Human factor engineering based design and modernization of control rooms with new I and C systems

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

Larraz, J.; Rejas, L.; Ortega, F.

2012-07-01

Instrumentation and Control (I and C) systems of the latest nuclear power plants are based on the use of digital technology, distributed control systems and the integration of information in data networks (Distributed Control and Instrumentation Systems). This has a repercussion on Control Rooms (CRs), where the operations and monitoring interfaces correspond to these systems. These technologies are also used in modernizing I and C systems in currently operative nuclear power plants. The new interfaces provide additional capabilities for operation and supervision, as well as a high degree of flexibility, versatility and reliability. An example of this is the implementationmore » of solutions such as compact stations, high level supervision screens, overview displays, computerized procedures, new operational support systems or intelligent alarms processing systems in the modernized Man-Machine Interface (MMI). These changes in the MMI are accompanied by newly added Software (SW) controls and new solutions in automation. Tecnatom has been leading various projects in this area for several years, both in Asian countries and in the United States, using in all cases international standards from which Tecnatom own methodologies have been developed and optimized. The experience acquired in applying this methodology to the design of new control rooms is to a large extent applicable also to the modernization of current control rooms. An adequate design of the interface between the operator and the systems will facilitate safe operation, contribute to the prompt identification of problems and help in the distribution of tasks and communications between the different members of the operating shift. Based on Tecnatom experience in the field, this article presents the methodological approach used as well as the most relevant aspects of this kind of project. (authors)« less

Pre-use anesthesia machine check; certified anesthesia technician based quality improvement audit.

PubMed

Al Suhaibani, Mazen; Al Malki, Assaf; Al Dosary, Saad; Al Barmawi, Hanan; Pogoku, Mahdhav

2014-01-01

Quality assurance of providing a work ready machine in multiple theatre operating rooms in a tertiary modern medical center in Riyadh. The aim of the following study is to keep high quality environment for workers and patients in surgical operating rooms. Technicians based audit by using key performance indicators to assure inspection, passing test of machine worthiness for use daily and in between cases and in case of unexpected failure to provide quick replacement by ready to use another anesthetic machine. The anesthetic machines in all operating rooms are daily and continuously inspected and passed as ready by technicians and verified by anesthesiologist consultant or assistant consultant. The daily records of each machines were collected then inspected for data analysis by quality improvement committee department for descriptive analysis and report the degree of staff compliance to daily inspection as "met" items. Replaced machine during use and overall compliance. Distractive statistic using Microsoft Excel 2003 tables and graphs of sums and percentages of item studied in this audit. Audit obtained highest compliance percentage and low rate of replacement of machine which indicate unexpected machine state of use and quick machine switch. The authors are able to conclude that following regular inspection and running self-check recommended by the manufacturers can contribute to abort any possibility of hazard of anesthesia machine failure during operation. Furthermore in case of unexpected reason to replace the anesthesia machine in quick maneuver contributes to high assured operative utilization of man machine inter-phase in modern surgical operating rooms.

Isolated transient loss of consciousness is an indicator of significant injury.

PubMed

Owings, J T; Wisner, D H; Battistella, F D; Perlstein, J; Walby, W F; Tharratt, R S

1998-09-01

To determine if isolated transient loss of consciousness is an indicator of significant injury. University-based level I trauma center. Phase 1 retrospective case series of all patients with trauma admitted directly from the emergency department to the operating room or an intensive care unit who had transient loss of consciousness as their only trauma triage criterion. Phase 2 prospective case series of all trauma patients transported by emergency medical system personnel with transient loss of consciousness as their only trauma triage criterion. Emergency operation and intensive care unit admission. Phase 1: From January 1, 1992, to March 31, 1995, we admitted 10255 patients with trauma. Three hundred seven (3%) met the enrollment criteria and were admitted to the operating room (n = 168) or intensive care unit (n = 139). Of these, 58 (18.9%) were taken to the operating room emergently to manage life-threatening injuries: 11 (4%) had craniotomies and 47 (15%) had non-neurosurgical operations. Phase 2: From July 1 to December 31, 1996, 2770 trauma patients were transported to our facility; 135 (4.9%) met the enrollment criteria. Forty-one (30.4%) of these required admission, and 6 (4.4%) were taken emergently to the operating room from the emergency department (1 [1%] for a craniotomy, 3 [2.2%] for intra-abdominal bleeding, and 2 [1.5%] for other procedures). Two (1.5%) of the 135 patients died. Patients with isolated transient loss of consciousness are at significant risk of critical surgical and neurosurgical injuries. These patients should be triaged to trauma centers or hospitals with adequate imaging, surgical, and neurosurgical resources.

Operating Room Fires and Surgical Skin Preparation.

PubMed

Jones, Edward L; Overbey, Douglas M; Chapman, Brandon C; Jones, Teresa S; Hilton, Sarah A; Moore, John T; Robinson, Thomas N

2017-07-01

Operating room fires are "never events" that remain an under-reported source of devastating complications. One common set-up that promotes fires is the use of surgical skin preparations combined with electrosurgery and oxygen. Limited data exist examining the incidence of fires and surgical skin preparations. A standardized, ex vivo model was created with a 15 × 15 cm section of clipped porcine skin. An electrosurgical "Bovie" pencil was activated for 2 seconds on 30 Watts coagulation mode in 21% oxygen (room air), both immediately and 3 minutes after skin preparation application. Skin preparations with and without alcohol were tested, and were applied with and without pooling. Alcohol-based skin preparations included 70% isopropyl alcohol (IPA) with 2% chlorhexidine gluconate, 74% IPA with 0.7% iodine povacrylex, and plain 70% IPA. No fires occurred with nonalcohol-based preparations (p < 0.001 vs alcohol-based preparations). Alcohol-based preparations caused flash flames at 0 minutes in 22% (13 of 60) and at 3 minutes in 10% (6 of 60) of tests. When examining pooling of alcohol-based preparations, fires occurred in 38% (23 of 60) at 0 minutes and 27% (16 of 60) at 3 minutes. Alcohol-based skin preparations fuel operating room fires in common clinical scenarios. Following manufacturer guidelines and allowing 3 minutes for drying, surgical fires were still created in 1 in 10 cases without pooling and more than one-quarter of cases with pooling. Surgeons can decrease the risk of an operating room fire by using nonalcohol-based skin preparations or avoiding pooling of the preparation solution. Published by Elsevier Inc.

Delivering images to the operating room: a web-based solution.

PubMed

Bennett, W F; Tunstall, K M; Skinner, P W; Spigos, D G

2002-01-01

As radiology departments become filmless, they are discovering that some areas are particularly difficult to deliver images. Many departments have found that the operating room is one such area. There are space constraints and difficulty in manipulating the images by a sterile surgeon. This report describes one method to overcome this obstacle. The author's institution has been using picture archiving and communication system (PACS) for approximately 3 years, and it has been a filmless department for 1 year. The PACS transfers images to a webserver for distribution throughout the hospital. It is accessed by Internet Explorer without any additional software. The authors recently started a pilot program in which they installed dual panel flat screen monitors in 6 operating rooms. The computers are connected to the hospital backbone by ethernet. Graphic cards installed in the computers allow the use of dual monitors. Because the surgeons were experienced in viewing cases on the enterprise web system, they had little difficulty in adapting to the operating room (OR) system. Initial reception of the system is positive. The use of the web system was found to be superior by the surgeons because of the flexibility and manipulation of the images compared with film. Images can be magnified to facilitate viewing from across the room. The ultimate goal of electronic radiology is to replace hardcopy film in all aspects. One area that PACS has difficulty in accomplishing this goal is in the operating room. Most institutions have continued to print film for the OR. The authors have initiated a project that may allow web viewing in the OR. Because of limited space in the OR, an additional computer was undesirable. The CPU tower, keyboard, and mouse were mounted on a frame on the wall. The images were displayed on 2 flat screen monitors, which simulated the viewboxes traditionally used by the surgeons. Interviews with the surgeons have found both positive and negative aspects of the system. Overall impression is good, but the timeliness of the intraoperative films needs to be improved. The author's pilot project of installing a web-based display system in the operating room still is being evaluated. Their initial results have been positive, and if there are no major problems that arise the project will be expanded. These results show that it is possible to provide image delivery to the OR over the intranet that is acceptable to the surgeons.

[Risk management in the operating room in cardiovascular and thoracic surgery; from the nursing point of view].

PubMed

Nakano, Yaemi

2008-08-01

The primary risk management, on the side of a nurse, in the operating room includes prevention of misidentificatin of both the patient and the site of operation. Leaving of a foreign body in the patient, falling of the patient from the operating table, incidence of deep venous thrombosis and mismatch of blood transfusion should also be prevented with utmost care. The long operating time in cardiovascular surgery and the lateral position of the patient on the operating table in chest or esophageal surgery require additional risk management. Risks of pressure sore as well as nervous injury can be prevented by fixing the patient securely with soft pads to maintain comfortable posture. Above all, careful watching of the patient's condition is most important.

83. DETAIL OF HONEYWELL AIRCONDITIONING CONTROLS IN SLC3E CONTROL ROOM ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

83. DETAIL OF HONEYWELL AIR-CONDITIONING CONTROLS IN SLC-3E CONTROL ROOM - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

101. STARBOARD AIRPLANE ELEVATOR MACHINERY ROOM AFT LOOKING FORWARD ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

101. STARBOARD AIRPLANE ELEVATOR MACHINERY ROOM - AFT LOOKING FORWARD PORT TO STARBOARD SHOWING ELEVATOR ENGINE, LIFTING WIRES, HYDRAULIC PIPING WITH REMOTE OPERATOR. - U.S.S. HORNET, Puget Sound Naval Shipyard, Sinclair Inlet, Bremerton, Kitsap County, WA

6. INTERIOR OF THE MAIN EQUIPMENT ROOM, AN/FPS66 ALPHA, BUILDING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. INTERIOR OF THE MAIN EQUIPMENT ROOM, AN/FPS66 ALPHA, BUILDING 408, LOOKING WEST. - Mill Valley Air Force Station, Operations Building & Annex, East Ridgecrest Boulevard, Mount Tamalpais, Mill Valley, Marin County, CA

14. LIVING ROOM INTERIOR SHOWING WEST SIDE AND SOUTH END ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

14. LIVING ROOM INTERIOR SHOWING WEST SIDE AND SOUTH END DOUBLE FRENCH DOORS, AND FIBERBOARD WALLS. VIEW TO SOUTHWEST. - Big Creek Hydroelectric System, Powerhouse 8, Operator Cottage, Big Creek, Big Creek, Fresno County, CA

Acoustic facilities for human factors research at NASA Langley Research Center: Description and operational capabilities

NASA Astrophysics Data System (ADS)

Hubbard, H. H.; Powell, C. A.

1981-06-01

A number of facilities were developed which provide a unique test capability for psychoacoustics and related human factors research. The design philosophy, physical layouts, dimensions, construction features, operating capabilities, and example applications for these facilities are described. In the exterior effects room, human subjects are exposed to the types of noises that are experienced outdoors, and in the interior effects room, subjects are exposed to the types of noises and noise-induced vibrations that are experience indoors. Subjects are also exposed to noises in an echo-free environment in the anechoic listening room. An aircraft noise synthesis system, which simulates aircraft flyover noise at an observer position on the ground, is used in conjunction with these three rooms. The passenger ride quality apparatus, a device for studying passenger response to noise and vibration in aircraft, or in other vehicles, is described.

Master Console System Monitoring and Control Development

NASA Technical Reports Server (NTRS)

Brooks, Russell A.

2013-01-01

The Master Console internship during the spring of 2013 involved the development of firing room displays at the John F. Kennedy Space Center (KSC). This position was with the Master Console Product Group (MCPG) on the Launch Control System (LCS) project. This project is responsible for the System Monitoring and Control (SMC) and Record and Retrieval (R&R) of launch operations data. The Master Console is responsible for: loading the correct software into each of the remaining consoles in the firing room, connecting the proper data paths to and from the launch vehicle and all ground support equipment, and initializing the entire firing room system to begin processing. During my internship, I developed a system health and status display for use by Master Console Operators (MCO) to monitor and verify the integrity of the servers, gateways, network switches, and firewalls used in the firing room.

Acoustic facilities for human factors research at NASA Langley Research Center: Description and operational capabilities

NASA Technical Reports Server (NTRS)

Hubbard, H. H.; Powell, C. A.

1981-01-01

A number of facilities were developed which provide a unique test capability for psychoacoustics and related human factors research. The design philosophy, physical layouts, dimensions, construction features, operating capabilities, and example applications for these facilities are described. In the exterior effects room, human subjects are exposed to the types of noises that are experienced outdoors, and in the interior effects room, subjects are exposed to the types of noises and noise-induced vibrations that are experience indoors. Subjects are also exposed to noises in an echo-free environment in the anechoic listening room. An aircraft noise synthesis system, which simulates aircraft flyover noise at an observer position on the ground, is used in conjunction with these three rooms. The passenger ride quality apparatus, a device for studying passenger response to noise and vibration in aircraft, or in other vehicles, is described.

Broad-gain (Δλ/λ0

PubMed

Fujita, Kazuue; Furuta, Shinichi; Dougakiuchi, Tatsuo; Sugiyama, Atsushi; Edamura, Tadataka; Yamanishi, Masamichi

2011-01-31

Broad-gain operation of λ~8.7 μm quantum cascade lasers based on dual-upper-state to multiple-lower-state transition design is reported. The devices exhibit surprisingly wide (~500 cm(-1)) electroluminescence spectra which are very insensitive to voltage and temperature changes above room temperature. With recourse to the temperature-insensitivity of electroluminescence spectra, the lasers demonstrate an extremely-weak temperature-dependence of laser performances: T0-value of 510 K, associated with a room temperature threshold current density of 2.6 kA/cm2. In addition, despite such wide gain spectra, room temperature, continuous wave operation of the laser with buried hetero structure is achieved.

77 FR 66082 - NASA Advisory Council; Human Exploration and Operations Committee; Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-01

... Exploration and Operations Committee; Meeting AGENCY: National Aeronautics and Space Administration. ACTION... Integration --International Space Station Status --Outreach --Human Exploration and Operations Status... Advisory Council Human Exploration and Operations Committee session in the Space Operations Center, Room...

Management of a fire in the operating room.

PubMed

Kaye, Alan David; Kolinsky, Daniel; Urman, Richard D

2014-04-01

Operating room (OR) fires remain a significant source of liability for anesthesia providers and injury for patients, despite existing practice guidelines and other improvements in operating room safety. Factors contributing to OR fires are well understood and these occurrences are generally preventable. OR personnel must be familiar with the fire triad which consists of a fuel supply, an oxidizing agent, and an ignition source. Existing evidence shows that OR-related fires can result in significant patient complications and malpractice claims. Steps to reduce fires include taking appropriate safety measures before a patient is brought to the OR, taking proper preventive measures during surgery, and effectively managing fire and patient complications when they occur. Decreasing the incidence of fires should be a team effort involving the entire OR personnel, including surgeons, anesthesia providers, nurses, scrub technologists, and administrators. Communication and coordination among members of the OR team is essential to creating a culture of safety.

The modern brain tumor operating room: from standard essentials to current state-of-the-art.

PubMed

Barnett, Gene H; Nathoo, Narendra

2004-01-01

It is just over a century since successful brain tumor resection. Since then the diagnosis, imaging, and management of brain tumors have improved, in large part due to technological advances. Similarly, the operating room (OR) for brain tumor surgery has increased in complexity and specificity with multiple forms of equipment now considered necessary as technical adjuncts. It is evident that the theme of minimalism in combination with advanced image-guidance techniques and a cohort of sophisticated technologies (e.g., robotics and nanotechnology) will drive changes in the current OR environment for the foreseeable future. In this report we describe what may be regarded today as standard essentials in an operating room for the surgical management of brain tumors and what we believe to be the current 'state-of-the-art' brain tumor OR. Also, we speculate on the additional capabilities of the brain tumor OR of the near future.

Orientation based on nursing diagnoses. Old concepts in today's practice.

PubMed

Anderson, L K; Vincent, N

1991-10-01

Although many operating room orientation programs contain content necessary to meet accrediting guidelines, very few tie the nursing process to the content. Our orientation is structured within a nursing framework (ie, Dr Gordon's "Eleven Functional Health Patterns") and emphasizes nursing diagnoses, theory, and clinical competencies. Although the new orientation program has been in effect for only two years, we feel the following list reflects the positive outcomes so far: decreased staff turnover (ie, one nurse out of 26 full-time equivalents in 18 months), increased success in recruiting nurses into the operating room (ie, multiple applicants as positions open), new nurses demonstrate comfort with basic perioperative nursing practice with-in six months, and nurses who did not complete new orientation program are requesting all or portions of the content. By using this plan, essential aspects of perioperative practice are consistent with hospital-wide nursing practice, practice standards for the operating room, and accrediting standards.

Traffic in the operating room: a review of factors influencing air flow and surgical wound contamination.

PubMed

Pokrywka, Marian; Byers, Karin

2013-06-01

Surgical wound contamination leading to surgical site infection can result from disruption of the intended airflow in the operating room (OR). When personnel enter and exit the OR, or create unnecessary movement and traffic during the procedure, the intended airflow in the vicinity of the open wound becomes disrupted and does not adequately remove airborne contaminants from the sterile field. An increase in the bacterial counts of airborne microorganisms is noted during increased activity levels within the OR. Researchers have studied OR traffic and door openings as a determinant of air contamination. During a surgical procedure the door to the operating room may be open as long as 20 minutes out of each surgical hour during critical procedures involving implants. Interventions into limiting excessive movement and traffic in the OR may lead to reductions in surgical site infections in select populations.

Learning gestures for customizable human-computer interaction in the operating room.

PubMed

Schwarz, Loren Arthur; Bigdelou, Ali; Navab, Nassir

2011-01-01

Interaction with computer-based medical devices in the operating room is often challenging for surgeons due to sterility requirements and the complexity of interventional procedures. Typical solutions, such as delegating the interaction task to an assistant, can be inefficient. We propose a method for gesture-based interaction in the operating room that surgeons can customize to personal requirements and interventional workflow. Given training examples for each desired gesture, our system learns low-dimensional manifold models that enable recognizing gestures and tracking particular poses for fine-grained control. By capturing the surgeon's movements with a few wireless body-worn inertial sensors, we avoid issues of camera-based systems, such as sensitivity to illumination and occlusions. Using a component-based framework implementation, our method can easily be connected to different medical devices. Our experiments show that the approach is able to robustly recognize learned gestures and to distinguish these from other movements.

Room temperature solid-state quantum emitters in the telecom range

PubMed Central

Bodrog, Zoltán; Adamo, Giorgio; Gali, Adam

2018-01-01

On-demand, single-photon emitters (SPEs) play a key role across a broad range of quantum technologies. In quantum networks and quantum key distribution protocols, where photons are used as flying qubits, telecom wavelength operation is preferred because of the reduced fiber loss. However, despite the tremendous efforts to develop various triggered SPE platforms, a robust source of triggered SPEs operating at room temperature and the telecom wavelength is still missing. We report a triggered, optically stable, room temperature solid-state SPE operating at telecom wavelengths. The emitters exhibit high photon purity (~5% multiphoton events) and a record-high brightness of ~1.5 MHz. The emission is attributed to localized defects in a gallium nitride (GaN) crystal. The high-performance SPEs embedded in a technologically mature semiconductor are promising for on-chip quantum simulators and practical quantum communication technologies. PMID:29670945

Effect of deep cryogenic temperature on silicon-on-insulator CMOS mismatch: A circuit designer’s perspective

NASA Astrophysics Data System (ADS)

Das, Kushal; Lehmann, Torsten

2014-07-01

The effect of ultra low operating temperature on mismatch among identically designed Silicon-on-Sapphire CMOS devices is investigated in detail from a circuit design view point. The evolution of transistor matching properties for different operating conditions at both room and 4.2 K temperature are presented. The statistical analysis reveals that mismatch at low temperature is effectively unrelated to that at room temperature, which disagrees with previously published literature. The measurement data was used to extract key transistor parameters and the consequence of temperature lowering on their respective variance is estimated. We find that standard deviation of the threshold-voltage mismatch deteriorates by a factor ∼2 at 4.2 K temperature. Similar to room temperature operation, mismatch at 4.2 K is bias point dependent and the degradation of matching at very low temperature depends to some extent on how the bias point shifts upon cooling.

Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care.

PubMed

Harris, Lisa H; Dalton, Vanessa K; Johnson, Timothy R B

2007-05-01

Early pregnancy failure and induced abortion are often managed differently, even though safe uterine evacuation is the goal in both. Early pregnancy failure is commonly treated by curettage in operating room settings in anesthetized patients. Induced abortion is most commonly managed by office vacuum aspiration in awake or sedated patients. Medical evidence does not support routine operating room management of early pregnancy failure. This commentary reviews historical origins of these different care standards, explores political factors responsible for their perpetuation, and uses experience at University of Michigan to dramatize the ways in which history, politics, and biomedicine intersect to produce patient care. The University of Michigan initiated office uterine evacuations for early pregnancy failure treatment. Patients previously went to the operating room. These changes required faculty, staff, and resident education. Our efforts blurred the lines between spontaneous and induced abortion management, improved patient care and better utilized hospital resources.

Use of face masks by non-scrubbed operating room staff: a randomized controlled trial.

PubMed

Webster, Joan; Croger, Sarah; Lister, Carolyn; Doidge, Michelle; Terry, Michael J; Jones, Ian

2010-03-01

Ambiguity remains about the effectiveness of wearing surgical face masks. The purpose of this study was to assess the impact on surgical site infections (SSIs) when non-scrubbed operating room staff did not wear surgical face masks. Eight hundred twenty-seven participants undergoing elective or emergency obstetric, gynecological, general, orthopaedic, breast or urological surgery in an Australian tertiary hospital were enrolled. Complete follow-up data were available for 811 patients (98.1%). Operating room lists were randomly allocated to a 'Mask group' (all non-scrubbed staff wore a mask) or 'No Mask group' (none of the non-scrubbed staff wore masks). The primary end point, SSI was identified using in-patient surveillance; post discharge follow-up and chart reviews. The patient was followed for up to six weeks. Overall, 83 (10.2%) surgical site infections were recorded; 46/401 (11.5%) in the Masked group and 37/410 (9.0%) in the No Mask group; odds ratio (OR) 0.77 (95% confidence interval (CI) 0.49 to 1.21), p = 0.151. Independent risk factors for surgical site infection included: any pre-operative stay (adjusted odds ratio [aOR], 0.43 (95% CI, 0.20; 0.95), high BMI aOR, 0.38 (95% CI, 0.17; 0.87), and any previous surgical site infection aOR, 0.40 (95% CI, 0.17; 0.89). Surgical site infection rates did not increase when non-scrubbed operating room personnel did not wear a face mask.

Developing a model of competence in the operating theatre: psychometric validation of the perceived perioperative competence scale-revised.

PubMed

Gillespie, Brigid M; Polit, Denise F; Hamlin, Lois; Chaboyer, Wendy

2012-01-01

This paper describes the development and validation of the Revised Perioperative Competence Scale (PPCS-R). There is a lack of a psychometrically tested sound self-assessment tools to measure nurses' perceived competence in the operating room. Content validity was established by a panel of international experts and the original 98-item scale was pilot tested with 345 nurses in Queensland, Australia. Following the removal of several items, a national sample that included all 3209 nurses who were members of the Australian College of Operating Room Nurses was surveyed using the 94-item version. Psychometric testing assessed content validity using exploratory factor analysis, internal consistency using Cronbach's alpha, and construct validity using the "known groups" technique. During item reduction, several preliminary factor analyses were performed on two random halves of the sample (n=550). Usable data for psychometric assessment were obtained from 1122 nurses. The original 94-item scale was reduced to 40 items. The final factor analysis using the entire sample resulted in a 40 item six-factor solution. Cronbach's alpha for the 40-item scale was .96. Construct validation demonstrated significant differences (p<.0001) in perceived competence scores relative to years of operating room experience and receipt of specialty education. On the basis of these results, the psychometric properties of the PPCS-R were considered encouraging. Further testing of the tool in different samples of operating room nurses is necessary to enable cross-cultural comparisons. Copyright © 2011 Elsevier Ltd. All rights reserved.

Document handover of ISS Flight Control room to new Flight Control Room in old MCC

NASA Image and Video Library

2006-10-06

JSC2006-E-43863 (6 Oct. 2006)--- International Space Station flight controllers have this area as their new home with increased technical capabilities, more workspace and a long, distinguished history. The newly updated facility is just down the hall from its predecessor at NASA's Johnson Space Center, Houston. This view is toward the rear of the "new" room. Known as Flight Control Room 1, it was first used to control a space flight 38 years ago, the mission of Apollo 7 launched Oct. 11, 1968. It was one of two control rooms for NASA's manned missions. The room it replaces in its new ISS role, designated the Blue Flight Control Room, had been in operation since the first station component was launched in 1998.

Large-eddy simulation of human-induced contaminant transport in room compartments.

PubMed

Choi, J-I; Edwards, J R

2012-02-01

A large-eddy simulation is used to investigate contaminant transport owing to complex human and door motions and vent-system activity in room compartments where a contaminated and clean room are connected by a vestibule. Human and door motions are simulated with an immersed boundary procedure. We demonstrate the details of contaminant transport owing to human- and door-motion-induced wake development during a short-duration event involving the movement of a person (or persons) from a contaminated room, through a vestibule, into a clean room. Parametric studies that capture the effects of human walking pattern, door operation, over-pressure level, and vestibule size are systematically conducted. A faster walking speed results in less mass transport from the contaminated room into the clean room. The net effect of increasing the volume of the vestibule is to reduce the contaminant transport. The results show that swinging-door motion is the dominant transport mechanism and that human-induced wake motion enhances compartment-to-compartment transport. The effect of human activity on contaminant transport may be important in design and operation of clean or isolation rooms in chemical or pharmaceutical industries and intensive care units for airborne infectious disease control in a hospital. The present simulations demonstrate details of contaminant transport in such indoor environments during human motion events and show that simulation-based sensitivity analysis can be utilized for the diagnosis of contaminant infiltration and for better environmental protection. © 2011 John Wiley & Sons A/S.

Utilizing Diffusion Theory to predict carbon dioxide concentration in an indoor environment

NASA Astrophysics Data System (ADS)

Kramer, Andrew R.

This research details a new method of relating sources of carbon dioxide to carbon dioxide concentration in a room operating in a reduced ventilation mode by utilizing Diffusion Theory. The theoretical basis of this research involved solving Fick's Second Law of Diffusion in spherical coordinates for a source of carbon dioxide flowing at a constant rate and located in the center of an impermeable spherical boundary. The solution was developed using a Laplace Transformation. A spherical diffusion test chamber was constructed and used to validate and benchmark the developed theory. The method was benchmarked by using Dispersion Coefficients for large carbon dioxide flow rates due to diffusion induced convection. The theoretical model was adapted to model a room operating with restricted ventilation in the presence of a known, constant source of carbon dioxide. The room was modeled as a sphere of volume equal to the room and utilized a Dispersion Coefficient that is consistent with published values. The developed Diffusion Model successfully predicted the spatial concentration of carbon dioxide in a room operating in a reduced ventilation mode in the presence of a source of carbon dioxide. The flow rates of carbon dioxide that were used in the room are comparable to the average flow rate of carbon dioxide from a person during quiet breathing, also known as the Tidal Breathing. This indicates the Diffusion Model developed from this research has the potential to correlate carbon dioxide concentration with static occupancy levels which can lead to energy savings through a reduction in air exchange rates when low occupancy is detected.

Fully Stretchable and Humidity-Resistant Quantum Dot Gas Sensors.

PubMed

Song, Zhilong; Huang, Zhao; Liu, Jingyao; Hu, Zhixiang; Zhang, Jianbing; Zhang, Guangzu; Yi, Fei; Jiang, Shenglin; Lian, Jiabiao; Yan, Jia; Zang, Jianfeng; Liu, Huan

2018-05-25

Stretchable gas sensors that accommodate the shape and motion characteristics of human body are indispensable to a wearable or attachable smart sensing system. However, these gas sensors usually have poor response and recovery kinetics when operated at room temperature, and especially suffer from humidity interference and mechanical robustness issues. Here, we demonstrate the first fully stretchable gas sensors which are operated at room temperature with enhanced stability against humidity. We created a crumpled quantum dot (QD) sensing layer on elastomeric substrate with flexible graphene as electrodes. Through the control over the prestrain of the flexible substrate, we achieved a 5.8 times improvement in NO 2 response at room temperature with desirable stretchability even under 1000 stretch/relax cycles mechanism deformation. The uniformly wavy structural configuration of the crumpled QD gas-sensing layer enabled an improvement in the antihumidity interference. The sensor response shows a minor vibration of 15.9% at room temperature from relative humidity of 0 to 86.7% compared to that of the flat-film sensors with vibration of 84.2%. The successful assembly of QD solids into a crumpled gas-sensing layer enabled a body-attachable, mechanically robust, and humidity-resistant gas sensor, opening up a new pathway to room-temperature operable gas sensors which may be implemented in future smart sensing systems such as stretchable electronic nose and multipurpose electronic skin.

Telementoring: use of augmented reality in orthopaedic education: AAOS exhibit selection.

PubMed

Ponce, Brent A; Jennings, Jonathan K; Clay, Terry B; May, Mathew B; Huisingh, Carrie; Sheppard, Evan D

2014-05-21

Virtual interactive presence (VIP) is a new technology that allows an individual to deliver real-time virtual assistance to another geographically remote individual via a standard Internet connection. The objectives of this pilot study were to evaluate the efficiency and performance of a VIP system implemented in an operating room setting, determine the potential utility of the system for guidance of surgical procedures, and assess the safety of the system. Following institutional review board approval, fifteen patients underwent arthroscopic shoulder procedures. Two VIP stations were used, one in the operating room and the other in an adjoining dictation room. The attending surgeon proctored operating resident surgeons from the dictation room until his physical presence was required in the operating room. Following each procedure, the attending surgeon, resident surgeons, and three surgical staff members completed a Likert-scale questionnaire regarding the educational utility, efficiency of use, and safety of the system. The operative time was also compared with historical data. Both attending and resident surgeons assigned a favorable rating to the utility of the VIP to highlight anatomy and provide feedback to the resident (p > 0.05 for the difference). Both groups agreed that the system was easy to use and that safety was not compromised (p > 0.05). The majority of resident and attending surgeon responses indicated no perceptible lag between motions (95% and 100%, respectively; p > 0.99) and no interference of the VIP system with the surgical procedure (85% and 100%, respectively; p = 0.24). The mean operative times with and without VIP use did not differ significantly for rotator cuff repair (p = 0.90) or for treatment of instability (p = 0.57). This pilot study revealed that the VIP technology was efficient, safe, and effective as a teaching tool. The attending and resident surgeons agreed that training was enhanced, and this occurred without increasing operative times. Furthermore, the attending surgeon believed that this technology improved teaching effectiveness. These results are promising, and further objective quantification is warranted.

8. VIEW OF THE SWITCHGEAR AND ELECTRICAL SUPPLY ROOM IN ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. VIEW OF THE SWITCHGEAR AND ELECTRICAL SUPPLY ROOM IN BETWEEN SIDES A AND B OF BUILDING 883. EQUIPMENT WITHIN THE BUILDING REQUIRED AN EXTENSIVE AMOUNT OF POWER. THE ELECTRICAL SUPPLY ROOM IS ESSENTIALLY AN ELECTRICAL SUBSTATION. (1/23/57) - Rocky Flats Plant, Uranium Rolling & Forming Operations, Southeast section of plant, southeast quadrant of intersection of Central Avenue & Eighth Street, Golden, Jefferson County, CO

75 FR 69862 - Airworthiness Directives; MD Helicopters, Inc. Model MD900 Helicopters

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-16

... Transportation, Docket Operations, M-30, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE... Building Ground Floor, Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590, between 9 a.m. and... (telephone (800) 647-5527) is located in Room W12-140 on the ground floor of the West Building at the street...

KSC-06pd0396

NASA Image and Video Library

2006-03-01

KENNEDY SPACE CENTER, FLA. - The Operations Support Building II at NASA's Kennedy Space Center is seen here, newly built and landscaped. The building replaced modular housing and trailers in the Launch Complex 39 area. The five-story, 189,000-square-foot building consists of approximately 860 office spaces, training rooms, computer rooms, multimedia conference rooms, technical libraries, and a 352-person mission conference center with observation deck. Photo credit: Cory Huston

Method of underground mining by pillar extraction

DOEpatents

Bowen, Ray J.; Bowen, William R.

1980-08-12

A method of sublevel caving and pillar and top coal extraction for mining thick coal seams includes the advance mining of rooms and crosscuts along the bottom of a seam to a height of about eight feet, and the retreat mining of the top coal from the rooms, crosscuts and portions of the pillars remaining from formation of the rooms and cross-cuts. In the retreat mining, a pocket is formed in a pillar, the top coal above the pocket is drilled, charged and shot, and then the fallen coal is loaded by a continuous miner so that the operator remains under a roof which has not been shot. The top coal from that portion of the room adjacent the pocket is then mined, and another pocket is formed in the pillar. The top coal above the second pocket is mined followed by the mining of the top coal of that portion of the room adjacent the second pocket, all by use of a continuous miner which allows the operator to remain under a roof portion which has not been shot.

11. CENTRAL ATLAS CONTROL CONSOLE IN SLC3W CONTROL ROOM. COMMUNICATIONS ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

11. CENTRAL ATLAS CONTROL CONSOLE IN SLC-3W CONTROL ROOM. COMMUNICATIONS HEADSETS IN FOREGROUND. - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

Interior view to the southwest of Computer Room 157 ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Interior view to the southwest of Computer Room 157 - Over-the-Horizon Backscatter Radar Network, Mountain Home Air Force Operations Building, On Desert Street at 9th Avenue Mountain Home Air Force Base, Mountain Home, Elmore County, ID

Human factors aspects of control room design: Guidelines and annotated bibliography

NASA Technical Reports Server (NTRS)

Mitchell, C. M.; Stewart, L. J.; Bocast, A. K.; Murphy, E. D.

1982-01-01

A human factors analysis of the workstation design for the Earth Radiation Budget Satellite mission operation room is discussed. The relevance of anthropometry, design rules, environmental design goals, and the social-psychological environment are discussed.

Hydrogen-atmosphere induction furnace has increased temperature range

NASA Technical Reports Server (NTRS)

Caves, R. M.; Gresslin, C. H.

1966-01-01

Improved hydrogen-atmosphere induction furnace operates at temperatures up to 5,350 deg F. The furnace heats up from room temperature to 4,750 deg F in 30 seconds and cools down to room temperature in 2 minutes.

17. DINING ROOM INTERIOR SHOWING GROUP OF THREE 1 LIGHT ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

17. DINING ROOM INTERIOR SHOWING GROUP OF THREE 1 LIGHT OVER 1 LIGHT WINDOWS, AND DOORWAY INTO KITCHEN. VIEW TO EAST. - Big Creek Hydroelectric System, Powerhouse 8, Operator Cottage, Big Creek, Big Creek, Fresno County, CA

Cartoon distraction alleviates anxiety in children during induction of anesthesia.

PubMed

Lee, Jeongwoo; Lee, Jihye; Lim, Hyungsun; Son, Ji-Seon; Lee, Jun-Rae; Kim, Dong-Chan; Ko, Seonghoon

2012-11-01

We performed this study to determine the beneficial effects of viewing an animated cartoon and playing with a favorite toy on preoperative anxiety in children aged 3 to 7 years in the operating room before anesthesia induction. One hundred thirty children aged 3 to 7 years with ASA physical status I or II were enrolled. Subjects were randomly assigned to 1 of 3 groups: group 1 (control), group 2 (toy), and group 3 (animated cartoon). The children in group 2 were asked to bring their favorite toy and were allowed to play with it until anesthesia induction. The children in group 3 watched their selected animated cartoon until anesthesia induction. Children's preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) and parent-recorded anxiety Visual Analog Scale (VAS) the night before surgery, in the preanesthetic holding room, and just before anesthesia induction. In the preanesthetic holding room, the group 2 mYPAS and parent-recorded anxiety VAS scores were significantly lower than those of groups 1 and 3 (mYPAS: P = 0.007; parent-recorded anxiety VAS: P = 0.02). In the operating room, the children in group 3 had the lowest mYPAS and parent-recorded anxiety VAS scores among the 3 groups (mYPAS: P < 0.001; parent-recorded anxiety VAS: P < 0.001). In group 3, the mYPAS and parent-recorded anxiety VAS scores of only 3 and 5 children were increased in the operating room compared with their scores in the preanesthetic holding room, whereas the anxiety scores of 32 and 34 children in group 1 and 25 and 32 children in group 2 had increased (P < 0.001). The number of children whose scores indicated no anxiety (mYPAS score <30) in the operating room was 3 (7%), 9 (23%), and 18 (43%) in groups 1, 2, and 3, respectively (P < 0.001). Allowing the viewing of animated cartoons by pediatric surgical patients is a very effective method to alleviate preoperative anxiety. Our study suggests that this intervention is an inexpensive, easy to administer, and comprehensive method for anxiety reduction in the pediatric surgical population.

Protecting your eyes in the laser operating room.

PubMed

Sallavanti, R A

1995-01-01

1. Laser protective eyewear is nearly as important to the OR nurse as the surgical mask in an operating room where laser surgery is performed. 2. Most hospitals require OR personnel to wear protective eyewear during laser procedures in voluntary compliance with American National Standards Institute (ANSI) Z136.3 for the safe use of lasers in health care facilities. 3. The basic steps to protecting your eyes are as follows: Select the appropriate eyewear (plastic or glass); make sure the eyewear fits properly; wear the protective lenses during laser testing and operation; and heed your laser safety officer.

Auditing Operating Room Recycling: A Management Case Report.

PubMed

McGain, Forbes; Jarosz, Katherine Maria; Nguyen, Martin Ngoc Hoai Huong; Bates, Samantha; O'Shea, Catherine Jane

2015-08-01

Much waste arises from operating rooms (ORs). We estimated the practical and financial feasibility of an OR recycling program, weighing all waste from 6 ORs in Melbourne, Australia. Over 1 week, 237 operations produced 1265 kg in total: general waste 570 kg (45%), infectious waste 410 kg (32%), and recyclables 285 kg (23%). The achieved recycling had no infectious contamination. The achieved recycling/potential recycling rate was 285 kg/517 kg (55%). The average waste disposal costs were similar for general waste and recycling. OR recycling rates of 20%-25% total waste were achievable without compromising infection control or financial constraints.

Human Factors Principles in Information Dashboard Design

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

Hugo, Jacques V.; St. Germain, Shawn

When planning for control room upgrades, nuclear power plants have to deal with a multitude of engineering and operational impacts. This will inevitably include several human factors considerations, including physical ergonomics of workstations, viewing angles, lighting, seating, new communication requirements, and new concepts of operation. In helping nuclear power utilities to deal with these challenges, the Idaho National Laboratory (INL) has developed effective methods to manage the various phases of the upgrade life cycle. These methods focus on integrating human factors engineering processes with the plant’s systems engineering process, a large part of which is the development of end-state conceptsmore » for control room modernization. Such an end-state concept is a description of a set of required conditions that define the achievement of the plant’s objectives for the upgrade. Typically, the end-state concept describes the transition of a conventional control room, over time, to a facility that employs advanced digital automation technologies in a way that significantly improves system reliability, reduces human and control room-related hazards, reduces system and component obsolescence, and significantly improves operator performance. To make the various upgrade phases as concrete and as visible as possible, an end-state concept would include a set of visual representations of the control room before and after various upgrade phases to provide the context and a framework within which to consider the various options in the upgrade. This includes the various control systems, human-system interfaces to be replaced, and possible changes to operator workstations. This paper describes how this framework helps to ensure an integrated and cohesive outcome that is consistent with human factors engineering principles and also provide substantial improvement in operator performance. The paper further describes the application of this integrated approach in the strategic modernization program at a nuclear power plant where legacy systems are upgraded to advanced digital technologies through a systematic process that links human factors principles to the systems engineering process. This approach will help to create an integrated control room architecture beyond what is possible for individual subsystem upgrades alone. In addition, several human factors design and evaluation methods were used to develop the end-state concept, including interactive sessions with operators in INL’s Human System Simulation Laboratory, three-dimensional modeling to visualize control board changes.« less

KSC-2009-3687

NASA Image and Video Library

2009-06-10

CAPE CANAVERAL, Fla. – Workers at NASA's Kennedy Space Center in Florida secure a new window on the Firing Room in the Launch Control Center. New, hurricane-rated window systems for the four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers. The old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Jack Pfaller

The effect of an ion generator on indoor air quality in a residential room.

PubMed

Waring, M S; Siegel, J A

2011-08-01

Ion generators charge particles with a corona prior to their removal on collector plates or indoor surfaces and also emit ozone, which can react with terpenes to yield secondary organic aerosol, carbonyls, carboxylic acids, and free radicals. This study characterized the indoor air quality implications of operating an ion generator in a 27 m(3) residential room, with four different test room configurations. Two room configurations had carpet overlaying the original flooring of stained/sealed concrete, and for one configuration with and without carpet, a plug-in air freshener was used as a terpene source. Measurements included airborne sampling of particulate matter (0.015-20 μm), terpenes and C(1) -C(4) and C(6) -C(10) aldehydes, ozone concentrations, and air exchange rates. When the heating, ventilating, and air-conditioning system was not operating (room air exchange rate = ∼0.5/h), the use of the ion generator in the presence of the air freshener led to a net increase in ultrafine particles (<0.1 μm). Also, increased concentrations of ozone were observed regardless of air freshener presence, as well as increases in formaldehyde and nonanal, albeit within measurement uncertainty in some cases. Thus, it may be prudent to limit ion generator use indoors until evidence of safety can be ascertained. Portable ion generators are intended to clean the air of particles, but they may emit ozone as a byproduct of their operation, which has the potential to degrade indoor air quality. This study showed that under certain conditions in a residential room, the use of a portable ion generator can increase concentrations of ozone and, to a lesser degree, potentially aldehydes. Also, if operated in the presence of a plug-in air freshener that emits terpenes, its use can increase concentrations of secondary organic aerosol in the ultrafine size range. © 2010 John Wiley & Sons A/S.

21 CFR 58.81 - Standard operating procedures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Testing Facilities Operation § 58.81 Standard operating procedures. (a) A testing facility shall have standard operating procedures in writing setting... following: (1) Animal room preparation. (2) Animal care. (3) Receipt, identification, storage, handling...

21 CFR 58.81 - Standard operating procedures.

Code of Federal Regulations, 2013 CFR

2013-04-01

... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Testing Facilities Operation § 58.81 Standard operating procedures. (a) A testing facility shall have standard operating procedures in writing setting... following: (1) Animal room preparation. (2) Animal care. (3) Receipt, identification, storage, handling...

21 CFR 58.81 - Standard operating procedures.

Code of Federal Regulations, 2012 CFR

2012-04-01

... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Testing Facilities Operation § 58.81 Standard operating procedures. (a) A testing facility shall have standard operating procedures in writing setting... following: (1) Animal room preparation. (2) Animal care. (3) Receipt, identification, storage, handling...

21 CFR 58.81 - Standard operating procedures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... LABORATORY PRACTICE FOR NONCLINICAL LABORATORY STUDIES Testing Facilities Operation § 58.81 Standard operating procedures. (a) A testing facility shall have standard operating procedures in writing setting... following: (1) Animal room preparation. (2) Animal care. (3) Receipt, identification, storage, handling...

Document handover of ISS Flight Control room to new Flight Control Room in old MCC

NASA Image and Video Library

2006-10-06

JSC2006-E-43860 (6 Oct. 2006)--- International Space Station flight controllers have this area as their new home with increased technical capabilities, more workspace and a long, distinguished history. The newly updated facility is just down the hall from its predecessor at NASA's Johnson Space Center, Houston. Known as Flight Control Room 1, it was first used to control a space flight 38 years ago, the mission of Apollo 7 launched Oct. 11, 1968. It was one of two control rooms for NASA's manned missions. The room it replaces in its new ISS role, designated the Blue Flight Control Room, had been in operation since the first station component was launched in 1998.

KSC-2014-1969

NASA Image and Video Library

2014-04-03

CAPE CANAVERAL, Fla. – Three rows of upper level management consoles are all that remain in Firing Room 4 in the Launch Control Center at NASA’s Kennedy Space Center in Florida. The main floor consoles, cabling and wires below the floor and ceiling tiles above have been removed. The Ground Systems Development and Operations Program is overseeing efforts to create a new firing room based on a multi-user concept that will support NASA and commercial launch needs. The design of Firing Room 4 will incorporate five control room areas that are flexible to meet current and future NASA and commercial user requirements. The equipment and most of the consoles from Firing Room 4 were moved to Firing Room 2 for possible future reuse. Photo credit: NASA/Ben Smegelsky

KSC-2014-1970

NASA Image and Video Library

2014-04-03

CAPE CANAVERAL, Fla. – Three rows of upper level management consoles are all that remain in Firing Room 4 in the Launch Control Center at NASA’s Kennedy Space Center in Florida. The main floor consoles, cabling and wires below the floor and ceiling tiles above have been removed. The Ground Systems Development and Operations Program is overseeing efforts to create a new firing room based on a multi-user concept that will support NASA and commercial launch needs. The design of Firing Room 4 will incorporate five control room areas that are flexible to meet current and future NASA and commercial user requirements. The equipment and most of the consoles from Firing Room 4 were moved to Firing Room 2 for possible future reuse. Photo credit: NASA/Ben Smegelsky

[Simulation-based training and OR apprenticeship for medical students : A prospective, randomized, single-blind study of clinical skills].

PubMed

Ott, T; Schmidtmann, I; Limbach, T; Gottschling, P F; Buggenhagen, H; Kurz, S; Pestel, G

2016-11-01

Simulation-based training (SBT) has developed into an established method of medical training. Studies focusing on the education of medical students have used simulation as an evaluation tool for defined skills. A small number of studies provide evidence that SBT improves medical students' skills in the clinical setting. Moreover, they were strictly limited to a few areas, such as the diagnosis of heart murmurs or the correct application of cricoid pressure. Other studies could not prove adequate transferability from the skills gained in SBT to the patient site. Whether SBT has an effect on medical students' skills in anesthesiology in the clinical setting is controversial. To explore this issue, we designed a prospective, randomized, single-blind trial that was integrated into the undergraduate anesthesiology curriculum of our department during the second year of the clinical phase of medical school. This study intended to explore the effect of SBT on medical students within the mandatory undergraduate anesthesiology curriculum of our department in the operating room with respect to basic skills in anesthesiology. After obtaining ethical approval, the participating students of the third clinical semester were randomized into two groups: the SIM-OR group was trained by a 225 min long SBT in basic skills in anesthesiology before attending the operating room (OR) apprenticeship. The OR-SIM group was trained after the operating room apprenticeship by SBT. During SBT the students were trained in five clinical skills detailed below. Further, two clinical scenarios were simulated using a full-scale simulator. The students had to prepare the patient and perform induction of anesthesia, including bag-mask ventilation after induction in scenario 1 and rapid sequence induction in scenario 2. Using the five-point Likert scale, five defined skills were evaluated at defined time points during the study period. 1) application of the safety checklist, 2) application of basic patient monitoring, 3) establishment of intravenous access, 4) bag-and-mask ventilation, and 5) adjustment of ventilatory parameters after the patients' airways were secured. A cumulative score of 5 points was defined as the best and a cumulative score of 25 as the worst rating for a defined time point. The primary endpoint was the cumulative score after day 1 in the operating room apprenticeship and the difference in cumulative scores from days 1 to 4. Our hypothesis was that the SIM-OR group would achieve a better score after day 1 in the operating room apprenticeship and would gain a larger increase in score from day 1 to day 4 than the OR-SIM group. 73 students were allocated to the OR-SIM group and 70 students to the SIM-OR group. There was no significant difference between the two groups after day 1 of the operating room apprenticeship and no difference in increase of the cumulative score from day 1 to day 4 (median of cumulative score on day 1: 'SIM-OR' 11.2 points vs. 'OR-SIM' 14.6 points; p = 0.067; median of difference from day 1 to day 4: 'SIM-OR' -3.7 vs. 'OR-SIM' -6.4; p = 0.110). With the methods applied, this study could not prove that 225 min of SBT before the operating room apprenticeship increased the medical students' clinical skills as evaluated in the operating room. Secondary endpoints indicate that medical students have better clinical skills at the end of the entire curriculum when they have been trained through SBT before the operating room apprenticeship. However, the authors believe that simulator training has a positive impact on students' acquisition of procedural and patient safety skills, even if the methods applied in this study may not mirror this aspect sufficiently.

Exodus - Distributed artificial intelligence for Shuttle firing rooms

NASA Technical Reports Server (NTRS)

Heard, Astrid E.

1990-01-01

This paper describes the Expert System for Operations Distributed Users (EXODUS), a knowledge-based artificial intelligence system developed for the four Firing Rooms at the Kennedy Space Center. EXODUS is used by the Shuttle engineers and test conductors to monitor and control the sequence of tasks required for processing and launching Shuttle vehicles. In this paper, attention is given to the goals and the design of EXODUS, the operational requirements, and the extensibility of the technology.

The Surgeons' Leadership Inventory (SLI): a taxonomy and rating system for surgeons' intraoperative leadership skills.

PubMed

Henrickson Parker, Sarah; Flin, Rhona; McKinley, Aileen; Yule, Steven

2013-06-01

Surgeons must demonstrate leadership to optimize performance and maximize patient safety in the operating room, but no behavior rating tool is available to measure leadership. Ten focus groups with members of the operating room team discussed surgeons' intraoperative leadership. Surgeons' leadership behaviors were extracted and used to finalize the Surgeons' Leadership Inventory (SLI), which was checked by surgeons (n = 6) for accuracy and face validity. The SLI was used to code video recordings (n = 5) of operations to test reliability. Eight elements of surgeons' leadership were included in the SLI: (1) maintaining standards, (2) managing resources, (3) making decisions, (4) directing, (5) training, (6) supporting others, (7) communicating, and (8) coping with pressure. Interrater reliability to code videos of surgeons' behaviors while operating using this tool was acceptable (κ = .70). The SLI is empirically grounded in focus group data and both the leadership and surgical literature. The interrater reliability of the system was acceptable. The inventory could be used for rating surgeons' leadership in the operating room for research or as a basis for postoperative feedback on performance. Copyright © 2013 Elsevier Inc. All rights reserved.

Closing emergency operating rooms improves efficiency.

PubMed

Wullink, Gerhard; Van Houdenhoven, Mark; Hans, Erwin W; van Oostrum, Jeroen M; van der Lans, Marieke; Kazemier, Geert

2007-12-01

Long waiting times for emergency operations increase a patient's risk of postoperative complications and morbidity. Reserving Operating Room (OR) capacity is a common technique to maximize the responsiveness of an OR in case of arrival of an emergency patient. This study determines the best way to reserve OR time for emergency surgery. In this study two approaches of reserving capacity were compared: (1) concentrating all reserved OR capacity in dedicated emergency ORs, and (2) evenly reserving capacity in all elective ORs. By using a discrete event simulation model the real situation was modelled. Main outcome measures were: (1) waiting time, (2) staff overtime, and (3) OR utilisation were evaluated for the two approaches. Results indicated that the policy of reserving capacity for emergency surgery in all elective ORs led to an improvement in waiting times for emergency surgery from 74 (+/-4.4) minutes to 8 (+/-0.5) min. Working in overtime was reduced by 20%, and overall OR utilisation can increase by around 3%. Emergency patients are operated upon more efficiently on elective Operating Rooms instead of a dedicated Emergency OR. The results of this study led to closing of the Emergency OR in the Erasmus MC (Rotterdam, The Netherlands).

Development of an Operation Control System for Photovoltaics and Electric Storage Heaters for Houses Based on Information in Weather Forecasts

NASA Astrophysics Data System (ADS)

Obara, Shin'ya

An all-electric home using an electric storage heater with safety and cleaning is expanded. However, the general electric storage heater leads to an unpleasant room temperature and energy loss by the overs and shorts of the amount of heat radiation when the climate condition changes greatly. Consequently, the operation of the electric storage heater introduced into an all-electric home, a storage type electric water heater, and photovoltaics was planned using weather forecast information distributed by a communication line. The comfortable evaluation (the difference between a room-temperature target and a room-temperature result) when the proposed system was employed based on the operation planning, purchase electric energy, and capacity of photovoltaics was investigated. As a result, comfortable heating operation was realized by using weather forecast data; furthermore, it is expected that the purchase cost of the commercial power in daytime can be reduced by introducing photovoltaics. Moreover, when the capacity of the photovoltaics was increased, the surplus power was stored in the electric storage heater, but an extremely unpleasant room temperature was not shown in the investigation ranges of this paper. By obtaining weather information from the forecast of the day from an external service using a communication line, the heating system of the all-electric home with low energy loss and comfort temperature is realizable.

The effectiveness of the error reporting promoting program on the nursing error incidence rate in Korean operating rooms.

PubMed

Kim, Myoung-Soo; Kim, Jung-Soon; Jung, In Sook; Kim, Young Hae; Kim, Ho Jung

2007-03-01

The purpose of this study was to develop and evaluate an error reporting promoting program(ERPP) to systematically reduce the incidence rate of nursing errors in operating room. A non-equivalent control group non-synchronized design was used. Twenty-six operating room nurses who were in one university hospital in Busan participated in this study. They were stratified into four groups according to their operating room experience and were allocated to the experimental and control groups using a matching method. Mann-Whitney U Test was used to analyze the differences pre and post incidence rates of nursing errors between the two groups. The incidence rate of nursing errors decreased significantly in the experimental group compared to the pre-test score from 28.4% to 15.7%. The incidence rate by domains, it decreased significantly in the 3 domains-"compliance of aseptic technique", "management of document", "environmental management" in the experimental group while it decreased in the control group which was applied ordinary error-reporting method. Error-reporting system can make possible to hold the errors in common and to learn from them. ERPP was effective to reduce the errors of recognition-related nursing activities. For the wake of more effective error-prevention, we will be better to apply effort of risk management along the whole health care system with this program.

Physician communication in the operating room: expanding application of face-negotiation theory to the health communication context.

PubMed

Kirschbaum, Kristin

2012-01-01

Communication variables that are associated with face-negotiation theory were examined in a sample of operating-room physicians. A survey was administered to anesthesiologists and surgeons at a teaching hospital in the southwestern United States to measure three variables commonly associated with face-negotiation theory: conflict-management style, face concern, and self-construal. The survey instrument that was administered to physicians includes items that measured these three variables in previous face-negotiation research with slight modification of item wording for relevance in the medical setting. The physician data were analyzed using confirmatory factor analysis, Pearson's correlations, and t-tests. Results of this initial investigation showed that variables associated with face-negotiation theory were evident in the sample physician population. In addition, the correlations were similar among variables in the medical sample as those found in previous face-negotiation research. Finally, t-tests suggest variance between anesthesiologists and surgeons on specific communication variables. These findings suggest three implications that warrant further investigation with expanded sample size: (1) An intercultural communication theory and instrument can be utilized for health communication research; (2) as applied in a medical context, face-negotiation theory can be expanded beyond traditional intercultural communication boundaries; and (3) theoretically based communication structures applied in a medical context could help explain physician miscommunication in the operating room to assist future design of communication training programs for operating-room physicians.

[Operating rooms during the second half of the 20th century and its change with surgical advances].

PubMed

Steimle, Raoul H

2011-01-01

With the rise of new specialities after the World War, the number of OP rooms increases. They became gathered on the basement of buildings near the central sterilisation. To enter the OP room, everyone passes through the dressing "sas". "Slippers", uniforms, gloves and many supplies are now for single-use. Electrified operating tables with their own accessories became very useful. Air conditioning is appreciated too in our countries. The operating microscope for ORL, ophthalmology and neurosurgery is used by every one. In cardiology the coronary revascularisation being common stuff, cardiac transplantation (1967) and open-heart surgery received special attention. Vascular surgeons are dedicated to arteritiden, implants, and aortic aneurysms. Urology is focused on renal transplants (since 1959), and more recently on lithotrity and coelioscopic prostatectomy. The coeliosurgery conquered the abdominal pathology and the endoscopic techniques became current. In neurosurgery, stereotaxy to treat parkinson's disease is not used so often since Levodopa exists. But it is still useful to implant brain-stimulating electrodes for refractory parkinson's cases, some other dyskinesias, mental troubles or epilepsies. The neuronavigation brought new possibilities. At century's end, ambulatory surgery reduces surgical costs. Bigger and multidisciplinary theatres are now preferred. The open-heart surgery assisted by computer and robotics is evolving. Finally, we recall OP room accidents, which are not directly dealing with the operation.

Auditory display as feedback for a novel eye-tracking system for sterile operating room interaction.

PubMed

Black, David; Unger, Michael; Fischer, Nele; Kikinis, Ron; Hahn, Horst; Neumuth, Thomas; Glaser, Bernhard

2018-01-01

The growing number of technical systems in the operating room has increased attention on developing touchless interaction methods for sterile conditions. However, touchless interaction paradigms lack the tactile feedback found in common input devices such as mice and keyboards. We propose a novel touchless eye-tracking interaction system with auditory display as a feedback method for completing typical operating room tasks. Auditory display provides feedback concerning the selected input into the eye-tracking system as well as a confirmation of the system response. An eye-tracking system with a novel auditory display using both earcons and parameter-mapping sonification was developed to allow touchless interaction for six typical scrub nurse tasks. An evaluation with novice participants compared auditory display with visual display with respect to reaction time and a series of subjective measures. When using auditory display to substitute for the lost tactile feedback during eye-tracking interaction, participants exhibit reduced reaction time compared to using visual-only display. In addition, the auditory feedback led to lower subjective workload and higher usefulness and system acceptance ratings. Due to the absence of tactile feedback for eye-tracking and other touchless interaction methods, auditory display is shown to be a useful and necessary addition to new interaction concepts for the sterile operating room, reducing reaction times while improving subjective measures, including usefulness, user satisfaction, and cognitive workload.

Use of computer-assisted drug therapy outside the operating room.

PubMed

Singh, Preet Mohinder; Borle, Anuradha; Goudra, Basavana G

2016-08-01

The number of procedures performed in the out-of-operating room setting under sedation has increased many fold in recent years. Sedation techniques aim to achieve rapid patient turnover through the use of short-acting drugs with minimal residual side-effects (mainly propofol and opioids). Even for common procedures, the practice of sedation delivery varies widely among providers. Computer-based sedation models have the potential to assist sedation providers and offer a more consistent and safer sedation experience for patients. Target-controlled infusions using propofol and other short-acting opioids for sedation have shown promising results in terms of increasing patient safety and allowing for more rapid wake-up times. Target-controlled infusion systems with real-time patient monitoring can titrate drug doses automatically to maintain optimal depth of sedation. The best recent example of this is the propofol-based Sedasys sedation system. Sedasys redefined individualized sedation by the addition of an automated clinical parameter that monitors depth of sedation. However, because of poor adoption and cost issues, it has been recently withdrawn by the manufacturer. Present automated drug delivery systems can assist in the provision of sedation for out-of-operating room procedures but cannot substitute for anesthesia providers. Use of the available technology has the potential to improve patient outcomes, decrease provider workload, and have a long-term economic impact on anesthesia care delivery outside of the operating room.

Perceptions of perioperative nursing competence: a cross-country comparison.

PubMed

Gillespie, Brigid M; Harbeck, Emma B; Falk-Brynhildsen, Karin; Nilsson, Ulrica; Jaensson, Maria

2018-01-01

Throughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses' perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room. We conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses' reported perceived perioperative competence. Regardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses' number of years of experience in the operating room. Nurses from Sweden with 6-10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with > 10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland. Researchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence.

Patient doses and occupational exposure in a hybrid operating room.

PubMed

Andrés, C; Pérez-García, H; Agulla, M; Torres, R; Miguel, D; Del Castillo, A; Flota, C M; Alonso, D; de Frutos, J; Vaquero, C

2017-05-01

This study aimed to characterize the radiation exposure to patients and workers in a new vascular hybrid operating room during X-ray-guided procedures. During one year, data from 260 interventions performed in a hybrid operating room equipped with a Siemens Artis Zeego angiography system were monitored. The patient doses were analysed using the following parameters: radiation time, kerma-area product, patient entrance reference point dose and peak skin dose. Staff radiation exposure and ambient dose equivalent were also measured using direct reading dosimeters and thermoluminescent dosimeters. The radiation time, kerma-area product, patient entrance reference point dose and peak skin dose were, on average, 19:15min, 67Gy·cm 2 , 0.41Gy and 0.23Gy, respectively. Although the contribution of the acquisition mode was smaller than 5% in terms of the radiation time, this mode accounted for more than 60% of the effective dose per patient. All of the worker dose measurements remained below the limits established by law. The working conditions in the hybrid operating room HOR are safe in terms of patient and staff radiation protection. Nevertheless, doses are highly dependent on the workload; thus, further research is necessary to evaluate any possible radiological deviation of the daily working conditions in the HOR. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Transformer room fire tests

NASA Astrophysics Data System (ADS)

Fustich, C. D.

1980-03-01

A series of transformer room fire tests are reported to demonstate the shock hazard present when automatic sprinklers operate over energized electrical equipment. Fire protection was provided by standard 0.5 inch pendent automatic sprinklers temperature rated at 135 F and installed to give approximately 150 sq ft per head coverage. A 480 v dry transformer was used in the room to provide a three phase, four wire distribution system. It is shown that the induced currents in the test room during the various tests are relatively small and pose no appreciable personnel shock hazard.

What factors influence attending surgeon decisions about resident autonomy in the operating room?

PubMed

Williams, Reed G; George, Brian C; Meyerson, Shari L; Bohnen, Jordan D; Dunnington, Gary L; Schuller, Mary C; Torbeck, Laura; Mullen, John T; Auyang, Edward; Chipman, Jeffrey G; Choi, Jennifer; Choti, Michael; Endean, Eric; Foley, Eugene F; Mandell, Samuel; Meier, Andreas; Smink, Douglas S; Terhune, Kyla P; Wise, Paul; DaRosa, Debra; Soper, Nathaniel; Zwischenberger, Joseph B; Lillemoe, Keith D; Fryer, Jonathan P

2017-12-01

Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors. Copyright © 2017 Elsevier Inc. All rights reserved.

Procedure and information displays in advanced nuclear control rooms: experimental evaluation of an integrated design.

PubMed

Chen, Yue; Gao, Qin; Song, Fei; Li, Zhizhong; Wang, Yufan

2017-08-01

In the main control rooms of nuclear power plants, operators frequently have to switch between procedure displays and system information displays. In this study, we proposed an operation-unit-based integrated design, which combines the two displays to facilitate the synthesis of information. We grouped actions that complete a single goal into operation units and showed these operation units on the displays of system states. In addition, we used different levels of visual salience to highlight the current unit and provided a list of execution history records. A laboratory experiment, with 42 students performing a simulated procedure to deal with unexpected high pressuriser level, was conducted to compare this design against an action-based integrated design and the existing separated-displays design. The results indicate that our operation-unit-based integrated design yields the best performance in terms of time and completion rate and helped more participants to detect unexpected system failures. Practitioner Summary: In current nuclear control rooms, operators frequently have to switch between procedure and system information displays. We developed an integrated design that incorporates procedure information into system displays. A laboratory study showed that the proposed design significantly improved participants' performance and increased the probability of detecting unexpected system failures.

Single-use instruments, cutting blocks, and trials increase efficiency in the operating room during total knee arthroplasty: a prospective comparison of navigated and non-navigated cases.

PubMed

Mont, Michael A; McElroy, Mark J; Johnson, Aaron J; Pivec, Robert

2013-08-01

The purpose of this prospective controlled trial was to determine if efficiency increases could be achieved in non-navigated and navigated total knee arthroplasties by replacing traditional saws, cutting blocks, and trials with specialized saws and single-use cutting blocks and trials. Various timing metrics during total knee arthroplasty, including operating room preparation times and specific intra-operative times, were measured in 400 procedures performed by eight different surgeons at 6 institutions. Efficiency increases were the result of statistically significant reductions in combined instrument setup and cleanup times as well as in adjusted surgical episode times in navigated total knee arthroplasties. Single-use instruments show promising benefits, but adequate patient follow-up is needed to confirm safety and efficacy before they can be widely adopted. Nevertheless, the authors believe that the use of single-use instruments, cutting guides, and trial implants for total knee arthroplasty will play an increasing role in improving operating room efficiency. Copyright © 2013 Elsevier Inc. All rights reserved.

Virtual operating room for team training in surgery.

PubMed

Abelson, Jonathan S; Silverman, Elliott; Banfelder, Jason; Naides, Alexandra; Costa, Ricardo; Dakin, Gregory

2015-09-01

We proposed to develop a novel virtual reality (VR) team training system. The objective of this study was to determine the feasibility of creating a VR operating room to simulate a surgical crisis scenario and evaluate the simulator for construct and face validity. We modified ICE STORM (Integrated Clinical Environment; Systems, Training, Operations, Research, Methods), a VR-based system capable of modeling a variety of health care personnel and environments. ICE STORM was used to simulate a standardized surgical crisis scenario, whereby participants needed to correct 4 elements responsible for loss of laparoscopic visualization. The construct and face validity of the environment were measured. Thirty-three participants completed the VR simulation. Attendings completed the simulation in less time than trainees (271 vs 201 seconds, P = .032). Participants felt the training environment was realistic and had a favorable impression of the simulation. All participants felt the workload of the simulation was low. Creation of a VR-based operating room for team training in surgery is feasible and can afford a realistic team training environment. Copyright © 2015 Elsevier Inc. All rights reserved.

Promotion of family-centered birth with gentle cesarean delivery.

PubMed

Magee, Susanna R; Battle, Cynthia; Morton, John; Nothnagle, Melissa

2014-01-01

In this commentary we describe our experience developing a "gentle cesarean" program at a community hospital housing a family medicine residency program. The gentle cesarean technique has been popularized in recent obstetrics literature as a viable option to enhance the experience and outcomes of women and families undergoing cesarean delivery. Skin-to-skin placement of the infant in the operating room with no separation of mother and infant, reduction of extraneous noise, and initiation of breastfeeding in the operating room distinguish this technique from traditional cesarean delivery. Collaboration among family physicians, obstetricians, midwives, pediatricians, neonatologists, anesthesiologists, nurses, and operating room personnel facilitated the provision of gentle cesarean delivery to families requiring an operative birth. Among 144 gentle cesarean births performed from 2009 to 2012, complication rates were similar to or lower than those for traditional cesarean births. Gentle cesarean delivery is now standard of care at our institution. By sharing our experience, we hope to help other hospitals develop gentle cesarean programs. Family physicians should play an integral role in this process. © Copyright 2014 by the American Board of Family Medicine.

Applying science and strategy to operating room workforce management.

PubMed

Butler, Victoria; Clinton, Christopher; Sagi, Harsha K; Kenney, Robert; Barsoum, Wael K

2012-01-01

The traditional means of planning nurse staffing for operating rooms are either poorly translated to the setting or do not provide decision makers with a platform to defend their needs, especially in an era of health care reform. The surgical operations department of the Cleveland Clinic initiated a quality improvement project aimed at applying a scientific method to operating room staffing. One goal was to provide a defensible plan for allocating direct caregiver positions. A second goal was to provide a quick and easy way for nurse managers and directors to track positions and graphically depict the effect of vacancies and orientation on their staffing budgets. Using an objective, scientific method allows position requests to be approved quickly and allows managers to feel much more comfortable functioning in a "lean" mode because they know needed positions will be approved quickly. Managers and directors also have found that graphically depicting numbers of vacant positions, as well as staff in orientation, could quickly relate a story visually rather than getting "bogged down" in narrative (often losing finance administrators along the way).

Time-of-flight-assisted Kinect camera-based people detection for intuitive human robot cooperation in the surgical operating room.

PubMed

Beyl, Tim; Nicolai, Philip; Comparetti, Mirko D; Raczkowsky, Jörg; De Momi, Elena; Wörn, Heinz

2016-07-01

Scene supervision is a major tool to make medical robots safer and more intuitive. The paper shows an approach to efficiently use 3D cameras within the surgical operating room to enable for safe human robot interaction and action perception. Additionally the presented approach aims to make 3D camera-based scene supervision more reliable and accurate. A camera system composed of multiple Kinect and time-of-flight cameras has been designed, implemented and calibrated. Calibration and object detection as well as people tracking methods have been designed and evaluated. The camera system shows a good registration accuracy of 0.05 m. The tracking of humans is reliable and accurate and has been evaluated in an experimental setup using operating clothing. The robot detection shows an error of around 0.04 m. The robustness and accuracy of the approach allow for an integration into modern operating room. The data output can be used directly for situation and workflow detection as well as collision avoidance.

Hybrid simulation: bringing motivation to the art of teamwork training in the operating room.

PubMed

Kjellin, A; Hedman, L; Escher, C; Felländer-Tsai, L

2014-12-01

Crew resource management-based operating room team training will be an evident part of future surgical training. Hybrid simulation in the operating room enables the opportunity for trainees to perform higher fidelity training of technical and non-technical skills in a realistic context. We focus on situational motivation and self-efficacy, two important factors for optimal learning in light of a prototype course for teams of residents in surgery and anesthesiology and nurses. Authentic operating room teams consisting of residents in anesthesia (n = 2), anesthesia nurses (n = 3), residents in surgery (n = 2), and scrub nurses (n = 6) were, during a one-day course, exposed to four different scenarios. Their situational motivation was self-assessed (ranging from 1 = does not correspond at all to 7 = corresponds exactly) immediately after training, and their self-efficacy (graded from 1 to 7) before and after training. Training was performed in a mock-up operating theater equipped with a hybrid patient simulator (SimMan 3G; Laerdal) and a laparoscopic simulator (Lap Mentor Express; Simbionix). The functionality of the systematic hybrid procedure simulation scenario was evaluated by an exit questionnaire (graded from 1 = disagree entirely to 5 = agree completely). The trainees were mostly intrinsically motivated, engaged for their own sake, and had a rather great degree of self-determination toward the training situation. Self-efficacy among the team members improved significantly from 4 to 6 (median). Overall evaluation showed very good result with a median grading of 5. We conclude that hybrid simulation is feasible and has the possibility to train an authentic operating team in order to improve individual motivation and confidence. © The Finnish Surgical Society 2014.

Metal nanoparticle film-based room temperature Coulomb transistor.

PubMed

Willing, Svenja; Lehmann, Hauke; Volkmann, Mirjam; Klinke, Christian

2017-07-01

Single-electron transistors would represent an approach to developing less power-consuming microelectronic devices if room temperature operation and industry-compatible fabrication were possible. We present a concept based on stripes of small, self-assembled, colloidal, metal nanoparticles on a back-gate device architecture, which leads to well-defined and well-controllable transistor characteristics. This Coulomb transistor has three main advantages. By using the scalable Langmuir-Blodgett method, we combine high-quality chemically synthesized metal nanoparticles with standard lithography techniques. The resulting transistors show on/off ratios above 90%, reliable and sinusoidal Coulomb oscillations, and room temperature operation. Furthermore, this concept allows for versatile tuning of the device properties such as Coulomb energy gap and threshold voltage, as well as period, position, and strength of the oscillations.

Hand-assisted laparoscopic versus robot-assisted laparoscopic partial nephrectomy: comparison of short-term outcomes and cost.

PubMed

Elsamra, Sammy E; Leone, Andrew R; Lasser, Michael S; Thavaseelan, Simone; Golijanin, Dragan; Haleblian, George E; Pareek, Gyan

2013-02-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) and laparoscopic partial nephrectomy (LPN) have become standard for the surgical management of small renal masses (SRMs). However, no studies have evaluated the short-term outcomes or cost of RALPN as compared with hand-assisted laparoscopic partial nephrectomy (HALPN) in a standardized fashion. A retrospective review of all patients who underwent HALPN or RALPN from 2006 to 2010 were assessed for patient age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, radiographic tumor size, nephrometry (radius, endo/exophytic, nearness to collecting system, anterior/posterior, lines of polarity [RENAL]) scores, operative and room times, hospital length of stay (LOS), estimated blood loss (EBL), requirement of hilar vessel clamping, warm ischemia time (WIT), pre- and postprocedural creatinine and hemoglobin levels, and complications. Total costs of the procedures were estimated based on operating room component (operative staff time, anesthesia, and supply) and hospital stay cost (room and board, pharmacy). A robotic premium cost, estimated based on the yearly overall cost of the da Vinci S surgical system divided by the annual number of cases, was included in the RALPN cost. Cost figures were obtained from hospital administration and applied to the mean HALPN and RALPN patient. Forty-seven patients underwent HALPN since 2006 and 21 patients underwent RALPN since 2008. ASA, BMI, EBL, tumor size, nephrometry score, positive margin rate, change in creatinine, change in hemoglobin, morphine equivalents used, and complication rate were all similar in both groups (p>0.05). Room time and operative time were significantly shorter for the HALPN cohort (p=0.001) whereas LOS was significantly shorter in the RALPN cohort (p=0.019). Despite the shorter LOS, RALPN was associated with a $1165 increased cost, mainly due to increased operating room time and premium cost of the robot. While early in our experience, RALPN offered no significant advantage in short-term outcomes over HALPN and was associated with an increased cost of over $1150.

78 FR 7465 - Agency Information Collection Activities: Submission for the Office of Management and Budget (OMB...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-01

..., and applicants for facility (i.e., nuclear power and non-power research and test reactor) operating... the final supporting statement, at the NRC's Public Document Room, Room O-1F21, One White Flint North...

Wiring repair area, southwest corner of room 227, looking east. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Wiring repair area, southwest corner of room 227, looking east. Repair area includes soldering equipment and wire dispensing reels hanging from the ceiling - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

Comprehensive Surgical Coaching Enhances Surgical Skill in the Operating Room: A Randomized Controlled Trial.

PubMed

Bonrath, Esther M; Dedy, Nicolas J; Gordon, Lauren E; Grantcharov, Teodor P

2015-08-01

The aim of the study was to determine whether individualized coaching improved surgical technical skill in the operating room to a higher degree than current residency training. Clinical training in the operating room is a valuable opportunity for surgeons to acquire skill and knowledge; however, it often remains underutilized. Coaching has been successfully used in various industries to enhance performance, but its role in surgery has been insufficiently investigated. This randomized controlled trial was conducted at one surgical training program. Trainees undergoing a minimally invasive surgery rotation were randomized to either conventional training (CT) or comprehensive surgical coaching (CSC). CT included ward and operating room duties, and regular departmental teaching sessions. CSC comprised performance analysis, debriefing, feedback, and behavior modeling. Primary outcome measures were technical performance as measured on global and procedure-specific rating scales, and surgical safety parameters, measured by error count. Operative performance was assessed by blinded video analysis of the first and last cases recorded by the participants during their rotation. Twenty residents were randomized and 18 completed the study. At posttraining the CSC group (n = 9) scored significantly higher on a procedure-specific skill scale compared with the CT group (n = 9) [median, 3.90 (interquartile range, 3.68-4.30) vs 3.60 (2.98-3.70), P = 0.017], and made fewer technical errors [10 (7-13) vs 18 (13-21), P = 0.003]. Significant within-group improvements for all skill metrics were only noted in the CSC group. Comprehensive surgical coaching enhances surgical training and results in skill acquisition superior to conventional training.

Progressive Entrustment to Achieve Resident Autonomy in the Operating Room: A National Qualitative Study With General Surgery Faculty and Residents.

PubMed

Sandhu, Gurjit; Magas, Christopher P; Robinson, Adina B; Scally, Christopher P; Minter, Rebecca M

2017-06-01

The purpose of this study was to identify behaviors that faculty and residents exhibit during intraoperative interactions, which support or inhibit progressive entrustment leading to operative autonomy. In the operating room, a critical balance is sought between direct faculty supervision and appropriate increase in resident autonomy with indirect faculty supervision. Little is known regarding perspectives of faculty and residents about how attendings increasingly step back and safely delegate autonomy to trainees. Understanding the context in which these decisions are made is critical to achieving a safe strategy for imparting progressive responsibility. A qualitative study was undertaken from January 2014 to February 2015. Semistructured interviews were conducted with 37 faculty and 59 residents from 14 and 41 institutions, respectively. Participants were selected using stratified random sampling from general surgery residency programs across the United States to represent a range of university, university-affiliated, and community programs, and geographic regions. Audio recordings of interviews were transcribed, iteratively analyzed, and emergent themes identified. Six themes were identified as influencing progressive entrustment in the operating room: optimizing faculty intraoperative feedback; policies and regulations affecting role of resident in the operating room; flexible faculty teaching strategies; context-specific variables; leadership opportunities for resident in the case; and safe struggle for resident when appropriate. Perspectives of faculty and residents while overlapping were different in emphasis. Better understanding faculty-resident interactions, individual behaviors, contextual influences, and national regulations that influence intraoperative education have the potential to significantly affect progressive entrustment in training paradigms.

Evaluation of optimum room entry times for radiation therapists after high energy whole pelvic photon treatments.

PubMed

Ho, Lavine; White, Peter; Chan, Edward; Chan, Kim; Ng, Janet; Tam, Timothy

2012-01-01

Linear accelerators operating at or above 10 MV produce neutrons by photonuclear reactions and induce activation in machine components, which are a source of potential exposure for radiation therapists. This study estimated gamma dose contributions to radiation therapists during high energy, whole pelvic, photon beam treatments and determined the optimum room entry times, in terms of safety of radiation therapists. Two types of technique (anterior-posterior opposing and 3-field technique) were studied. An Elekta Precise treatment system, operating up to 18 MV, was investigated. Measurements with an area monitoring device (a Mini 900R radiation monitor) were performed, to calculate gamma dose rates around the radiotherapy facility. Measurements inside the treatment room were performed when the linear accelerator was in use. The doses received by radiation therapists were estimated, and optimum room entry times were determined. The highest gamma dose rates were approximately 7 μSv/h inside the treatment room, while the doses in the control room were close to background (~0 μSv/h) for all techniques. The highest personal dose received by radiation therapists was estimated at 5 mSv/yr. To optimize protection, radiation therapists should wait for up to11 min after beam-off prior to room entry. The potential risks to radiation therapists with standard safety procedures were well below internationally recommended values, but risks could be further decreased by delaying room entry times. Dependent on the technique used, optimum entry times ranged between 7 to 11 min. A balance between moderate treatment times versus reduction in measured equivalent doses should be considered.

[OR management - Checklists for OR-design for OR-managers - results of a workshop].

PubMed

Bock, Matthias; Steinmeyer-Bauer, Klaus; Schüpfer, Guido

2014-10-01

The construction of an operating room (OR) suite represents an important intermediate- and long term investment. The planning process starts with the quantitative estimation of the procedures to be carried out which defines the operative capacity for the life time of the facility. This permits the calculation of the number of ORs and the definition of the resources for the recovery room, the intermediate care and intensive care unit.The projectors should integrate the new facility into workflow, workload and logistics of the entire hospital. The simulation flow of patients and accompanying persons and of the routes of the personnel is helpful for this purpose. Separating structures for outpatients from those for inpatients and avoiding de-centralized rooms helps designing an efficient and safe OR suite.The design of the single ORs should be flexible to permit changes or technical innovations during their use period. Mobile equipment is preferable to permanently installed devices. We consider an expanse of at least 45 m(2) for any location adequate for general ORs. The space requirements are elevated for hybrid ORs and rooms dedicated for robotic surgery.The design of the suite should separate the flow of personnel, patients and logistics. Surgical instruments and their logistics should be standardized. Dedicated locations for a simultaneous preparation of the instrumentation tables permit parallel processing. Thus an adequate capacity of preparation rooms and storage rooms is necessary. Dressing rooms, rest rooms, showers and lounges are important for the working conditions and should be planned in an adequate size and number. © Georg Thieme Verlag Stuttgart · New York.

A National Coordinating Center for Prehospital Trauma Research Funding Transfusion Using Stored Fresh Whole Blood

DTIC Science & Technology

2016-09-01

bank data base 28-30 5% Analyze blood bank data base 28-33 0% Other Major Tasks: Identification of communities in the UCLA catchment area 1-3 N/A...coagulopathy in real-time is underway. The Blood Bank is working to identify a pool of whole blood donors and incorporating the new product (FWB) in...Blood Bank , emergency Room, Trauma, Operating Room, Intensive Care Unit, etc) to coordinate and streamline standard operating procedures for the

A System Approach to Navy Medical Education and Training. Appendix 36. Competency Curriculum for Operating Room Assistant and Operating Room Technician.

DTIC Science & Technology

1974-08-31

These methods and curriculum materials constituted a third (instructional) sub-system. Thus, as originally proposed, a system capability has been...NODAL and its associated indexing techniques, it is possible to assemble modified or completely different inventories than those used in this research...covering all hair as a source of infection Method by which synthetic material causes static electricity Danger of static electricity in O.R. suite I

Marine Corps Operational Medicine: An Analysis of Medical Supply Requirements for the Surgical Company Operating Room

DTIC Science & Technology

2004-06-18

354 Minor room clean-up Yes Yes 358 Tracheostomy Yes Yes 359 Induce local anesthesia No Yes 403 Decompression Craniotomy Yes Yes 455 Amputation... Drainage Auto Transfusion Bag 6s 1.2 EA 6515014993126 Pleurevac Drainage Unit W/Blood Retreival 6s 1.2 EA 6510011603261 Sponge Laparotomy...2.5’ Ster 24s 4 EA 6515011535730 Suture Nonabsorb Surg Cardio 3-0 Dbl Armed Poly Monofilament Ster 36s 2 EA 6515008669073 Tube Drainage

Reliability of constricted double-heterojunction AlGaAs diode lasers

NASA Technical Reports Server (NTRS)

Botez, D.; Connolly, J. C.; Ettenberg, M.; Gilbert, D. B.; Hughes, J. J.

1983-01-01

Constricted double-heterojunction diode lasers have been life tested at 70 C heatsink temperature and 3-4 mW/facet in CW operation. A median life of 7800 h is obtained at 70 C, which extrapolates to 400,000 h median life at room temperature. The extrapolated mean time to failure at room temperature is in excess of 1,000,000 h. Single-longitudinal-mode CW operation is maintained after 10,000 h of accelerated aging at 70 C.

Cross-industry benchmarking: is it applicable to the operating room?

PubMed

Marco, A P; Hart, S

2001-01-01

The use of benchmarking has been growing in nonmedical industries. This concept is being increasingly applied to medicine as the industry strives to improve quality and improve financial performance. Benchmarks can be either internal (set by the institution) or external (use other's performance as a goal). In some industries, benchmarking has crossed industry lines to identify breakthroughs in thinking. In this article, we examine whether the airline industry can be used as a source of external process benchmarking for the operating room.

Operating Room of the Future: Advanced Technologies in Safe and Efficient Operating Rooms

DTIC Science & Technology

2010-10-01

research, and treatment purposes. A laser optical mouse and a graphics tablet were used by radiologists to segment 12 simulated reference lesions per...radiologists seg- mented a total of 132 simulated lesions. Overall error in contour segmentation was less with the graphics tablet than with the mouse...PG0.0001). Error in area of segmentation was not significantly different between the tablet and the mouse (P=0.62). Time for segmen- tation was less with

Engineers and technicians in the control room at the Dryden Flight Research Center must constantly monitor critical operations and checks during research projects like NASA's hypersonic X-43A

NASA Image and Video Library

2004-01-24

Engineers and technicians in the control room at the Dryden Flight Research Center must constantly monitor critical operations and checks during research projects like NASA's hypersonic X-43A. Visible in the photo, taken two days before the X-43's captive carry flight in January 2004, are [foreground to background]; Tony Kawano (Range Safety Officer), Brad Neal (Mission Controller), and Griffin Corpening (Test Conductor).

The Effects of Scavenging on Waste Nitrous Oxide Concentrations in Veterinary Operating Room Air

DTIC Science & Technology

1981-06-01

nitrous oxide with vitamin B (1, 8, 15, 34). The first report of nitrous oxide concentrations in human operating rooms appeared in 1969 and...study. Anesthesiology 29:565-569. 5. Cohen, E.N., J.W. Belvill and B.W. Brown, Jr. 1971. Anesthesia, pregnancy, and miscarriage : A study of...Chanarin. 1978. Editorial: nitrous oxide and vitamin B . Br. J. Anaesth. 50:1089-1090. 17 35. Ruby, D.L., R.M. Buchan and B.J. Gunter. 1980. Waste

Role of Ultraviolet Disinfection in the Prevention of Surgical Site Infections.

PubMed

Simmons, Sarah; Dale, Charles; Holt, James; Velasquez, Katie; Stibich, Mark

2017-01-01

The role of the environment in surgical site infections is surprisingly understudied. UV disinfection holds promise for reducing the level of contamination in operating rooms and thereby lowering the risk of infection for patients. Issues such as the frequency, amount and locations for UV disinfection to have an impact on the risk of surgical site infection are recently emerging in the literature. As technologies and knowledge improve, UV disinfection will have a role to play in operating rooms in the future.

Advanced Technologies in Safe and Efficient Operating Rooms

DTIC Science & Technology

2006-02-01

in this report are those of the author( s ) and should not be construed as an official Department of the Army position, policy or decision unless so...information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE 01-02...and Efficient Operating Rooms 5b. GRANT NUMBER DAMD17-03-2-0001 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR( S ) 5d. PROJECT NUMBER Adrian E. Park

Room-temperature lasing operation of a quantum-dot vertical-cavity surface-emitting laser

NASA Astrophysics Data System (ADS)

Saito, Hideaki; Nishi, Kenichi; Ogura, Ichiro; Sugou, Shigeo; Sugimoto, Yoshimasa

1996-11-01

Self-assembled growth of quantum dots by molecular-beam epitaxy is used to form the active region of a vertical-cavity surface-emitting laser (VCSEL). Ten layers of InGaAs quantum dots are stacked in order to increase the gain. This quantum-dot VCSEL has a continuous-wave operating current of 32 mA at room temperature. Emission spectra at various current injections demonstrate that the lasing action is associated with a higher-order transition in the quantum dots.

Phase 1 IWAR Test Results

DTIC Science & Technology

2010-01-01

Symantec Server Antivirus 1 1 1 1 2 7 8 8 Service Passwords 0 10 4 4 4 10 5 5 Banner Needs 0 0 0 0 0 0 0 0 Unauthorized Software 0 1 0 1 4 1 4 1... software needed to manage and operate systems in the testing rooms. Systems in the testing rooms were made to resemble shipboard Navy systems as closely...i.e., work- station and server software , routing and switching, operating systems, and so forth). This training was also designed to provide

Decreasing airborne contamination levels in high-risk hospital areas using a novel mobile air-treatment unit.

PubMed

Bergeron, V; Reboux, G; Poirot, J L; Laudinet, N

2007-10-01

To evaluate the performance of a new mobile air-treatment unit that uses nonthermal-plasma reactors for lowering the airborne bioburden in critical hospital environments and reducing the risk of nosocomial infection due to opportunistic airborne pathogens, such as Aspergillus fumigatus. Tests were conducted in 2 different high-risk hospital areas: an operating room under simulated conditions and rooms hosting patients in a pediatric hematology ward. Operating room testing provided performance evaluations of removal rates for airborne contamination (ie, particles larger than 0.5 microm) and overall lowering of the airborne bioburden (ie, colony-forming units of total mesophilic flora and fungal flora per cubic meter of air). In the hematology service, opportunistic and nonpathogenic airborne fungal levels in a patient's room equipped with an air-treatment unit were compared to those in a control room. In an operating room with a volume of 118 m(3), the time required to lower the concentration of airborne particles larger than 0.5 microm by 90% was decreased from 12 minutes with the existing high-efficiency particulate air filtration system to less than 2 minutes with the units tested, with a 2-log decrease in the steady-state levels of such particles (P<.01). Concurrently, total airborne mesophilic flora concentrations dropped by a factor of 2, and the concentrations of fungal species were reduced to undetectable levels (P<.01). The 12-day test period in the hematology ward revealed a significant reduction in airborne fungus levels (P<.01), with average reductions of 75% for opportunistic species and 82% for nonpathogenic species. Our data indicate that the mobile, nonthermal-plasma air treatment unit tested in this study can rapidly reduce the levels of airborne particles and significantly lower the airborne bioburden in high-risk hospital environments.

Effect of Resident Involvement on Operative Time and Operating Room Staffing Costs.

PubMed

Allen, Robert William; Pruitt, Mark; Taaffe, Kevin M

The operating room (OR) is a major driver of hospital costs; therefore, operative time is an expensive resource. The training of surgical residents must include time spent in the OR, but that experience comes with a cost to the surgeon and hospital. The objective of this article is to determine the effect of surgical resident involvement in the OR on operative time and subsequent hospital labor costs. The Kruskal-Wallis statistical test is used to determine whether or not there is a difference in operative times between 2 groups of cases (with residents and without residents). This difference leads to an increased cost in associated hospital labor costs for the group with the longer operative time. Cases were performed at Greenville Memorial Hospital. Greenville Memorial Hospital is part of the larger healthcare system, Greenville Health System, located in Greenville, SC and is a level 1 trauma center with up to 33 staffed ORs. A total of 84,997 cases were performed at the partnering hospital between January 1st, 2011 and July 31st, 2015. Cases were only chosen for analysis if there was only one CPT code associated with the case and there were more than 5 observations for each group being studied. This article presents a comprehensive retrospective analysis of 29,134 cases covering 246 procedures. The analysis shows that 45 procedures took significantly longer with a resident present in the room. The average increase in operative time was 4.8 minutes and the cost per minute of extra operative time was determined to be $9.57 per minute. OR labor costs at the partnering hospital was found to be $2,257,433, or $492,889 per year. Knowing the affect on operative time and OR costs allows managers to make smart decisions when considering alternative educational and training techniques. In addition, knowing the connection between residents in the room and surgical duration could help provide better estimates of surgical time in the future and increase the predictability of procedure duration. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

KSC-2009-3683

NASA Image and Video Library

2009-06-10

CAPE CANAVERAL, Fla. – A new window is lowered toward the existing Firing Room windows in the Launch Control Center at NASA's Kennedy Space Center in Florida. New, hurricane-rated window systems for the four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers. The old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Jack Pfaller

KSC-2009-3682

NASA Image and Video Library

2009-06-10

CAPE CANAVERAL, Fla. – A new window is lowered toward the existing Firing Room windows in the Launch Control Center at NASA's Kennedy Space Center in Florida. New, hurricane-rated window systems for the four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers. The old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Jack Pfaller

KSC-2009-3681

NASA Image and Video Library

2009-06-10

CAPE CANAVERAL, Fla. – Work continues on removing the louvers and replacing the windows on the Firing Room windows in the Launch Control Center at NASA's Kennedy Space Center in Florida. New, hurricane-rated window systems for the four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers. The old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Jack Pfaller

KSC-2009-3686

NASA Image and Video Library

2009-06-10

CAPE CANAVERAL, Fla. – Workers at NASA's Kennedy Space Center in Florida carefully place a new window on the Firing Room in the Launch Control Center. New, hurricane-rated window systems for the four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers. The old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Jack Pfaller

KSC-2009-3684

NASA Image and Video Library

2009-06-10

CAPE CANAVERAL, Fla. – Alongside the Launch Control Center at NASA's Kennedy Space Center in Florida, a new window is prepared to be lifted up to the existing Firing Room windows. New, hurricane-rated window systems for the four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers. The old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Jack Pfaller

KSC-2009-3685

NASA Image and Video Library

2009-06-10

CAPE CANAVERAL, Fla. – A new window is raised toward the existing Firing Room windows in the Launch Control Center at NASA's Kennedy Space Center in Florida. New, hurricane-rated window systems for the four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers. The old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Jack Pfaller

[A day in the busy obstetric unit from the anesthesiologist point of view, experience at the Cleveland clinic; Cleveland, Ohio].

PubMed

Ootaki, Chiyo; Barsoum, Sabri

2009-10-01

Cleveland Clinic Labor and Delivery Unit is a syntactical delivery facility and comprised of 16 delivery rooms, 3 operating rooms, 3 triage rooms, and 1 recovery room that has a capacity of 6 beds, 43 postpartum rooms, 2 nurseries, and 1 neonatal intensive care unit (NICU). Cleveland Clinic Labor and Delivery Unit (LDU) had 3,691 delivery cases in 2007. The ratio of neuraxial analgesia (NA) during labor is 84.2% (2,348/ 2,787), using epidural anesthesia or combined spinalepidural anesthesia (CSEA). This article introduces the obstetrical (OB) anesthesia practice at the Cleveland Clinic and our novel anesthetic regime as typical of one typical busy day.

Fires and Burns Occurring in an Electrocautery after Skin Preparation with Alcohol during a Neurosurgery

PubMed Central

Chae, Sang-Bae; Yoo, Chan-Jong; Park, Cheol-Wan

2014-01-01

While there are reports regarding burns occurring to patients during the surgery, there are little reports concerning the incidents of the burns related to neurosurgical operations. Moreover, in Korea, even surveys and statistics on the incidents of burns in operating rooms are not known. This report explores burns occurring to a patient in an electrocautery scenario after disinfecting the surgical site with alcohol during the preparation of a neurosurgical operation in an operating room where there is much exposure to oxygen. The authors show a case of a 33-year-old male patient who undergoing evacuation of hematoma on occipital lesion, suffered second degree burns as a result of surgical fires. PMID:25024831

KSC-06pd2797

NASA Image and Video Library

2006-12-13

KENNEDY SPACE CENTER, FLA. -- Firing Room 1 of the Launch Control Center has been stripped of its equipment in preparation for transforming it to support the launch operations for the Ares launch vehicles. The Shuttle Processing Transition Team has worked to decommission Firing Room 1, also known as FR1, for transfer to the Constellation Program. The transition includes removing all the computer systems currently in the room and installing new equipment and software. The room was recently renamed the Young/Crippen Firing Room to honor Commander John Young and Pilot Robert Crippen in tribute to the 25th anniversary of the first space shuttle flight on April 12, 1981. It was this firing room that launched the historic flight and the crew of STS-1, Young and Crippen. Photo credit: NASA/Jim Grossmann

KSC-06pd2796

NASA Image and Video Library

2006-12-13

KENNEDY SPACE CENTER, FLA. -- Firing Room 1 of the Launch Control Center has been stripped of its equipment in preparation for transforming it to support the launch operations for the Ares launch vehicles. The Shuttle Processing Transition Team has worked to decommission Firing Room 1, also known as FR1, for transfer to the Constellation Program. The transition includes removing all the computer systems currently in the room and installing new equipment and software. The room was recently renamed the Young/Crippen Firing Room to honor Commander John Young and Pilot Robert Crippen in tribute to the 25th anniversary of the first space shuttle flight on April 12, 1981. It was this firing room that launched the historic flight and the crew of STS-1, Young and Crippen. Photo credit: NASA/Jim Grossmann

KSC-06pd2795

NASA Image and Video Library

2006-12-13

KENNEDY SPACE CENTER, FLA. -- Firing Room 1 of the Launch Control Center has been stripped of its equipment in preparation for transforming it to support the launch operations for the Ares launch vehicles. The Shuttle Processing Transition Team has worked to decommission Firing Room 1, also known as FR1, for transfer to the Constellation Program. The transition includes removing all the computer systems currently in the room and installing new equipment and software. The room was recently renamed the Young/Crippen Firing Room to honor Commander John Young and Pilot Robert Crippen in tribute to the 25th anniversary of the first space shuttle flight on April 12, 1981. It was this firing room that launched the historic flight and the crew of STS-1, Young and Crippen. Photo credit: NASA/Jim Grossmann

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

This study tests the performance of a variable airflow small-diameter duct heating, ventilation, and air conditioning (HVAC) system in a new construction unoccupied low-load test house in Pittsburgh, Pennsylvania. The duct system was installed entirely in conditioned space and was operated from the winter through summer seasons. Measurements were collected on the in-room temperatures and energy consumed by the air handler and heat pump unit. Operation modes with three different volumes of airflow were compared to determine the ideal airflow scenario that maximizes room-to-room thermal uniformity while minimizing fan energy consumption. Black felt infrared imagery was used as a measuremore » of diffuser throw and in-room air mixing. Measured results indicate the small-diameter, high velocity airflow system can provide comfort under some conditions. Solar heat gains resulted in southern rooms drifting beyond acceptable temperature limits. Insufficient airflow to some bedrooms also resulted in periods of potential discomfort. Homebuilders or HVAC contractors can use these results to assess whether this space conditioning strategy is an attractive alternative to a traditional duct system. The team performed a cost analysis of two duct system configurations: (1) a conventional diameter and velocity duct system, and (2) the small-diameter duct system. This work applies to both new and retrofit homes that have achieved a low heating and cooling density either by energy conservation or by operation in a mild climate with few heating or cooling degree days. Guidance is provided on cost trade-offs between the conventional duct system and the small-diameter duct system.« less

A consideration of ketamine dreams.

PubMed

Hejja, P; Galloon, S

1975-01-01

This study was designed to see whether covering of the eyes during and after ketamine anaesthesia would reduce the incidence of dreams. One hundred and fifty patients, randomly divided into three groups, underwent therapeutic abortion with ketamine as the sole anaesthesia. One hundred patients had their eyes completely covered, 50 in the operating room only and 50 in the operating room and in the recovery room. The third 50 were controls, with their eyes uncovered. All patients were questioned post-operatively about dreams, nausea and vomiting, headache, dizziness and experiences, and also how frequently they dreamed at home. Although covering the eyes in the recovery room only reduced the incidence of dreams marginally, it became obvious that the patients who dreamed after ketamine (in all 3 groups) were those who normally dreamed at home. There were 82 patients who were recorded as not being home-dreamers, and only two of these dreamed after ketamine. In contrast, of the 68 home-dreamers, 50 dreamed after ketamine, and 17 of these had unpleasant dreams. In the home-dreamers, covering the eyes reduced the incidence of dreams from 86 per cent in Group 1 to 72 per cent in Group 2 and 64 per cent in Group 3. It is suggested that goggles may be advantageous when dealing with home-dreamers, and a question about the patient's tendency to dream should be included in the preoperative questioning. Alterations in premedication and the use of a quiet dark room during recovery may even further reduce unpleasant dreams in this group.

Leaky electronic states for photovoltaic photodetectors based on asymmetric superlattices

NASA Astrophysics Data System (ADS)

Penello, Germano Maioli; Pereira, Pedro Henrique; Pires, Mauricio Pamplona; Sivco, Deborah; Gmachl, Claire; Souza, Patricia Lustoza

2018-01-01

The concept of leaky electronic states in the continuum is used to achieve room temperature operation of photovoltaic superlattice infrared photodetectors. A structural asymmetric InGaAs/InAlAs potential profile is designed to create states in the continuum with the preferential direction for electron extraction and, consequently, to obtain photovoltaic operation at room temperature. Due to the photovoltaic operation and virtual increase in the bandoffset, the device presents both low dark current and low noise. The Johnson noise limited specific detectivity reaches values as high as 1.4 × 1011 Jones at 80 K. At 300 K, the detectivity obtained is 7.0 × 105 Jones.

[The hybrid operating room. Home of high-end intraoperative imaging].

PubMed

Gebhard, F; Riepl, C; Richter, P; Liebold, A; Gorki, H; Wirtz, R; König, R; Wilde, F; Schramm, A; Kraus, M

2012-02-01

A hybrid operating room must serve the medical needs of different highly specialized disciplines. It integrates interventional techniques for cardiovascular procedures and allows operations in the field of orthopaedic surgery, neurosurgery and maxillofacial surgery. The integration of all steps such as planning, documentation and the procedure itself saves time and precious resources. The best available imaging devices and user interfaces reduce the need for extensive personnel in the OR and facilitate new minimally invasive procedures. The immediate possibility of postoperative control images in CT-like quality enables the surgeon to react to problems during the same procedure without the need for later revision.

Conference room 211, adjacent to commander's quarters, with vault door ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Conference room 211, adjacent to commander's quarters, with vault door at right. Projection area at center is equipped with automatic security drapes. Projection room uses a 45 degree mirror to reflect the image onto the frosted glass screen. Door on far left leads to display area senior battle staff viewing bridge, and the commander's quarters - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

Interior, equipment room, weather support area (from July, 1968 drawing) ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Interior, equipment room, weather support area (from July, 1968 drawing) at north end of display area, looking west. Window looks south towards the main console - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

20. VIEW OF WASTE TREATMENT CONTROL ROOM IN BUILDING 374. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

20. VIEW OF WASTE TREATMENT CONTROL ROOM IN BUILDING 374. THE BUILDING 371/374 COMPLEX WAS DESIGNED TO EMPHASIZE AUTOMATICALLY CONTROLLED, REMOTELY OPERATED PROCESSES. (1/80) - Rocky Flats Plant, Plutonium Recovery Facility, Northwest portion of Rocky Flats Plant, Golden, Jefferson County, CO

Using an integrative mock-up simulation approach for evidence-based evaluation of operating room design prototypes.

PubMed

Bayramzadeh, Sara; Joseph, Anjali; Allison, David; Shultz, Jonas; Abernathy, James

2018-07-01

This paper describes the process and tools developed as part of a multidisciplinary collaborative simulation-based approach for iterative design and evaluation of operating room (OR) prototypes. Full-scale physical mock-ups of healthcare spaces offer an opportunity to actively communicate with and to engage multidisciplinary stakeholders in the design process. While mock-ups are increasingly being used in healthcare facility design projects, they are rarely evaluated in a manner to support active user feedback and engagement. Researchers and architecture students worked closely with clinicians and architects to develop OR design prototypes and engaged clinical end-users in simulated scenarios. An evaluation toolkit was developed to compare design prototypes. The mock-up evaluation helped the team make key decisions about room size, location of OR table, intra-room zoning, and doors location. Structured simulation based mock-up evaluations conducted in the design process can help stakeholders visualize their future workspace and provide active feedback. Copyright © 2018 Elsevier Ltd. All rights reserved.

Display Developer for Firing Room Applications

NASA Technical Reports Server (NTRS)

Bowman, Elizabeth A.

2013-01-01

The firing room at Kennedy Space Center (KSC) is responsible for all NASA human spaceflight launch operations, therefore it is vital that all displays within the firing room be properly tested, up-to-date, and user-friendly during a launch. The Ground Main Propulsion System (GMPS) requires a number of remote displays for Vehicle Integration and Launch (VIL) Operations at KSC. My project is to develop remote displays for the GMPS using the Display Services and Framework (DSF) editor. These remote displays will be based on model images provided by GMPS through PowerPoint. Using the DSF editor, the PowerPoint images can be recreated with active buttons associated with the correct Compact Unique Identifiers (CUIs). These displays will be documented in the Software Requirements and Design Specifications (SRDS) at the 90% GMPS Design Review. In the future, these remote displays will be available for other developers to improve, edit, or add on to so that the display may be incorporated into the firing room to be used for launches.

46 CFR 154.1840 - Protective clothing.

Code of Federal Regulations, 2011 CFR

2011-10-01

... FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Operations § 154.1840 Protective clothing... operation, except those assigned to gas-safe cargo control rooms, wears protective clothing. ...

46 CFR 154.1840 - Protective clothing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Operations § 154.1840 Protective clothing... operation, except those assigned to gas-safe cargo control rooms, wears protective clothing. ...

Game theoretic approaches to operating room management.

PubMed

Marco, Alan P

2002-05-01

All interactions between people can be considered games with rules and outcomes. However, modern business practices demand that the players in the game go beyond traditional game theory and look at new ways to improve the outcome of the game. Choosing the right strategy is important to a player's success. A new business strategy, "co-opetition," can be used to increase the value of the game ("create a bigger pie") through cooperative behavior, whereas competition is used to divided the "pie." By looking at how the players adopt simultaneous roles such as complementor and competitor the stakeholders in the operating room (managers, surgeons, anesthesiologists, and nursing staff) can apply the principles of co-opetition to improve the overall success of their facility. Such stakeholders can utilize knowledge of how populations act in games to enhance cooperative play. Adopting such a perspective may lead to increases in the satisfaction and morale of those involved with the operating rooms. Increased morale should increase productivity and staff retention and reduce recruiting needs.

Objective Assessment of Surgical Technical Skill and Competency in the Operating Room.

PubMed

Vedula, S Swaroop; Ishii, Masaru; Hager, Gregory D

2017-06-21

Training skillful and competent surgeons is critical to ensure high quality of care and to minimize disparities in access to effective care. Traditional models to train surgeons are being challenged by rapid advances in technology, an intensified patient-safety culture, and a need for value-driven health systems. Simultaneously, technological developments are enabling capture and analysis of large amounts of complex surgical data. These developments are motivating a "surgical data science" approach to objective computer-aided technical skill evaluation (OCASE-T) for scalable, accurate assessment; individualized feedback; and automated coaching. We define the problem space for OCASE-T and summarize 45 publications representing recent research in this domain. We find that most studies on OCASE-T are simulation based; very few are in the operating room. The algorithms and validation methodologies used for OCASE-T are highly varied; there is no uniform consensus. Future research should emphasize competency assessment in the operating room, validation against patient outcomes, and effectiveness for surgical training.

Lessons learned in command environment development

NASA Astrophysics Data System (ADS)

Wallace, Daniel F.; Collie, Brad E.

2000-11-01

As we consider the issues associated with the development of an Integrated Command Environment (ICE), we must obviously consider the rich history in the development of control rooms, operations centers, information centers, dispatch offices, and other command and control environments. This paper considers the historical perspective of control environments from the industrial revolution through the information revolution, and examines the historical influences and the implications that that has for us today. Environments to be considered are military command and control spaces, emergency response centers, medical response centers, nuclear reactor control rooms, and operations centers. Historical 'lessons learned' from the development and evolution of these environments will be examined to determine valuable models to use, and those to be avoided. What are the pitfalls? What are the assumptions that drive the environment design? Three case histories will be presented, examining (1) the control room of the Three Mile Island power plant, (2) the redesign of the US Naval Space Command operations center, and (3) a testbed for an ICE aboard a naval surface combatant.

High-resolution ionization detector and array of such detectors

DOEpatents

McGregor, Douglas S [Ypsilanti, MI; Rojeski, Ronald A [Pleasanton, CA

2001-01-16

A high-resolution ionization detector and an array of such detectors are described which utilize a reference pattern of conductive or semiconductive material to form interaction, pervious and measurement regions in an ionization substrate of, for example, CdZnTe material. The ionization detector is a room temperature semiconductor radiation detector. Various geometries of such a detector and an array of such detectors produce room temperature operated gamma ray spectrometers with relatively high resolution. For example, a 1 cm.sup.3 detector is capable of measuring .sup.137 Cs 662 keV gamma rays with room temperature energy resolution approaching 2% at FWHM. Two major types of such detectors include a parallel strip semiconductor Frisch grid detector and the geometrically weighted trapezoid prism semiconductor Frisch grid detector. The geometrically weighted detector records room temperature (24.degree. C.) energy resolutions of 2.68% FWHM for .sup.137 Cs 662 keV gamma rays and 2.45% FWHM for .sup.60 Co 1.332 MeV gamma rays. The detectors perform well without any electronic pulse rejection, correction or compensation techniques. The devices operate at room temperature with simple commercially available NIM bin electronics and do not require special preamplifiers or cooling stages for good spectroscopic results.

Measuring Human Performance in Simulated Nuclear Power Plant Control Rooms Using Eye Tracking

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

Kovesdi, Casey Robert; Rice, Brandon Charles; Bower, Gordon Ross

Control room modernization will be an important part of life extension for the existing light water reactor fleet. As part of modernization efforts, personnel will need to gain a full understanding of how control room technologies affect performance of human operators. Recent advances in technology enables the use of eye tracking technology to continuously measure an operator’s eye movement, which correlates with a variety of human performance constructs such as situation awareness and workload. This report describes eye tracking metrics in the context of how they will be used in nuclear power plant control room simulator studies.

KSC-2009-3553

NASA Image and Video Library

2009-06-05

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, new, hurricane-rated window systems for the Launch Control Center's four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts, the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers, and the old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Tim Jacobs

KSC-2009-3548

NASA Image and Video Library

2009-06-05

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, new, hurricane-rated window systems for the Launch Control Center's four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts, the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers, and the old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Tim Jacobs

KSC-2009-3550

NASA Image and Video Library

2009-06-05

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, new, hurricane-rated window systems for the Launch Control Center's four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts, the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers, and the old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Tim Jacobs

KSC-2009-3547

NASA Image and Video Library

2009-06-05

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, new, hurricane-rated window systems for the four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts, the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers, and the old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Tim Jacobs

KSC-2009-3551

NASA Image and Video Library

2009-06-05

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, new, hurricane-rated window systems for the Launch Control Center's four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts, the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers, and the old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Tim Jacobs

KSC-2009-3549

NASA Image and Video Library

2009-06-05

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, new, hurricane-rated window systems for the Launch Control Center's four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts, the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers, and the old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Tim Jacobs

KSC-2009-3552

NASA Image and Video Library

2009-06-05

CAPE CANAVERAL, Fla. – At NASA's Kennedy Space Center in Florida, new, hurricane-rated window systems for the Launch Control Center's four Firing Rooms and the vestibule areas between Firing Rooms 1 & 2 and Firing Rooms 3 & 4 are being installed. In order to avoid operational impacts, the new windows are being installed on the outside of the existing windows, enclosing the space formerly occupied by the louvers, and the old windows will remain in place until the new windows are completely installed and leak tested. This approach will continue to keep the firing rooms from being exposed to the elements. Photo credit: NASA/Tim Jacobs

Land Ahoy! Understanding Submarine Command and Control During the Completion of Inshore Operations.

PubMed

Roberts, Aaron P J; Stanton, Neville A; Fay, Daniel

2017-12-01

The aim of this study was to use multiple command teams to provide empirical evidence for understanding communication flow, information pertinence, and tasks undertaken in a submarine control room when completing higher- and lower-demand inshore operation (INSO) scenarios. The focus of submarine operations has changed, and submarines are increasingly required to operate in costal littoral zones. However, submarine command team performance during INSO is not well understood, particularly from a sociotechnical systems perspective. A submarine control-room simulator was built. The creation of networked workstations allowed a team of nine operators to perform tasks completed by submarine command teams during INSO. The Event Analysis of Systematic Teamwork method was used to model the social, task, and information networks and to describe command team performance. Ten teams were recruited for the study, affording statistical comparisons of how command-team roles and level of demand affected performance. Results indicated that the submarine command-team members are required to rapidly integrate sonar and visual data as the periscope is used, periodically, in a "duck-and-run" fashion, to maintain covertness. The fusion of such information is primarily completed by the operations officer (OPSO), with this operator experiencing significantly greater demand than any other operator. The OPSO was a bottleneck in the command team when completing INSO, experiencing similar load in both scenarios, suggesting that the command team may benefit from data synthesis tasks being more evenly distributed within the command team. The work can inform future control-room design and command-team ways of working by identifying bottlenecks in terms of information and task flow between operators.

Resident Autonomy in the Operating Room: Expectations Versus Reality.

PubMed

Meyerson, Shari L; Sternbach, Joel M; Zwischenberger, Joseph B; Bender, Edward M

2017-09-01

There is concern about graduating thoracic trainees' independent operative skills due to limited autonomy in training. This study compared faculty and trainee expected levels of autonomy with intraoperative measurements of autonomy for common cardiothoracic operations. Participants underwent frame-of-reference training on the 4-point Zwisch scale of operative autonomy (show and tell → active help → passive help → supervision only) and evaluated autonomy in actual cases using the Zwisch Me!! mobile application. A separate "expected autonomy" survey elicited faculty and resident perceptions of how much autonomy a resident should have for six common operations: decortication, wedge resection, thoracoscopic lobectomy, coronary artery bypass grafting, aortic valve replacement, and mitral valve repair. Thirty-three trainees from 7 institutions submitted evaluations of 596 cases over 18 months (March 2015 to September 2016). Thirty attendings subsequently provided their evaluation of 476 of those cases (79.9% response rate). Expected autonomy surveys were completed by 21 attendings and 19 trainees from 5 institutions. The six operations included in the survey constituted 47% (226 of 476) of the cases evaluated. Trainee and attending expectations did not differ significantly for senior trainees. Both groups expected significantly higher levels of autonomy than observed in the operating room for all six types of cases. Although faculty and trainees both expect similar levels of autonomy in the operating room, real-time measurements of autonomy show a gap between expectations and reality. Decreasing this gap will require a concerted effort by both faculty and residents to focus on the development of independent operative skills. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Economic analysis of linking operating room scheduling and hospital material management information systems for just-in-time inventory control.

PubMed

Epstein, R H; Dexter, F

2000-08-01

Operating room (OR) scheduling information systems can decrease perioperative labor costs. Material management information systems can decrease perioperative inventory costs. We used computer simulation to investigate whether using the OR schedule to trigger purchasing of perioperative supplies is likely to further decrease perioperative inventory costs, as compared with using sophisticated, stand-alone material management inventory control. Although we designed the simulations to favor financially linking the information systems, we found that this strategy would be expected to decrease inventory costs substantively only for items of high price ($1000 each) and volume (>1000 used each year). Because expensive items typically have different models and sizes, each of which is used by a hospital less often than this, for almost all items there will be no benefit to making daily adjustments to the order volume based on booked cases. We conclude that, in a hospital with a sophisticated material management information system, OR managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the OR information system with the hospital's material management information system to achieve just-in-time inventory control. In a hospital with a sophisticated material management information system, operating room managers will probably achieve greater cost reductions from focusing on negotiating less expensive purchase prices for items than on trying to link the operating room information system with the hospital's material management information system to achieve just-in-time inventory control.

Safety culture in the gynecology robotics operating room.

PubMed

Zullo, Melissa D; McCarroll, Michele L; Mendise, Thomas M; Ferris, Edward F; Roulette, G D; Zolton, Jessica; Andrews, Stephen J; von Gruenigen, Vivian E

2014-01-01

To measure the safety culture in the robotics surgery operating room before and after implementation of the Robotic Operating Room Computerized Checklist (RORCC). Prospective study. Gynecology surgical staff (n = 32). An urban community hospital. The Safety Attitudes Questionnaire domains examined were teamwork, safety, job satisfaction, stress recognition, perceptions of management, and working conditions. Questions and domains were described using percent agreement and the Cronbach alpha. Paired t-tests were used to describe differences before and after implementation of the checklist. Mean (SD) staff age was 46.7 (9.5) years, and most were women (78%) and worked full-time (97%). Twenty respondents (83% of nurses, 80% of surgeons, 66% of surgical technicians, and 33% of certified registered nurse anesthetists) completed the Safety Attitudes Questionnaire; 6 were excluded because of non-matching identifiers. Before RORCC implementation, the highest quality of communication and collaboration was reported by surgeons and surgical technicians (100%). Certified registered nurse anesthetists reported only adequate levels of communication and collaboration with other positions. Most staff reported positive responses for teamwork (48%; α = 0.81), safety (47%; α = 0.75), working conditions (37%; α = 0.55), stress recognition (26%; α = 0.71), and perceptions of management (32%; α = 0.52). No differences were observed after RORCC implementation. Quality of communication and collaboration in the gynecology robotics operating room is high between most positions; however, safety attitude responses are low overall. No differences after RORCC implementation and low response rates may highlight lack of staff support. Copyright © 2014. Published by Elsevier Inc.

Adult and pediatric anesthesia/sedation for gastrointestinal procedures outside of the operating room.

PubMed

Michel Foehn, Esther R

2015-08-01

This review presents current trends of safe and efficient anesthesia and sedation for adults and children for gastrointestinal procedures outside of the operating room with a special focus on total intravenous anesthesia (TIVA), target-controlled infusion (TCI), intravenous or topical lidocaine, and the use of the video laryngoscope. The concepts of a well tolerated and adequate anesthesia or sedation for gastrointestinal procedures outside of the operating room have to meet the needs of the adult and pediatric patients and the special requests of the gastroenterologists. Anesthesia and sedation of adults for gastrointestinal procedures with TIVA or TCI and spontaneous breathing is well established. Many institutions perform anesthesia for pediatric patients undergoing gastrointestinal procedures with an inhalational agent, especially in young children and for short procedures. Unlike adults, in young children the airways frequently must be secured with a tracheal tube or laryngeal mask. Respiration may be spontaneous, assisted, or controlled. TIVA and TCI are increasingly chosen for older children and longer procedures. A local anesthetic administered intravenously or topically to the upper airways and the use of the video laryngoscope can facilitate the insertion of the endoscope. Both anesthesiologists and nonanesthesiologists have to achieve a consensus and develop quality-improvement strategies to provide safe and efficient anesthesia and sedation for gastrointestinal procedures outside of the operating room for pediatric and adult patients. Techniques using TIVA, TCI, intravenous or topical application of lidocaine, and the video laryngoscope may improve and facilitate gastrointestinal procedures for the patients, the anesthesiologists, and the gastroenterologists.

Assessing Nurse Anaesthetists' Non-Technical Skills in the operating room.

PubMed

Lyk-Jensen, H T; Jepsen, R M H G; Spanager, L; Dieckmann, P; Østergaard, D

2014-08-01

Incident reporting and fieldwork in operating rooms have shown that some of the errors that arise in anaesthesia relate to inadequate use of non-technical skills. To provide a tool for training and feedback on nurse anaesthetists' non-technical skills, this study aimed to adapt the Anaesthetists' Non-Technical Skills (ANTS) as a behavioural marker system for the formative assessment of nurse anaesthetists' non-technical skills in the operating room. A qualitative approach with focus group interviews was used to identify the non-technical skills of nurse anaesthetists in the operating room. The interview data were transcribed verbatim. Directed content analysis was used to code and sort data deductively into the ANTS categories: task management, team working, situation awareness and decision making. The prototype named Nurse Anaesthetists' Non-Technical Skills (N-ANTS) was presented and discussed in a group of subject matter experts to ensure face validity. The N-ANTS system consists of the same four categories as ANTS and 15 underlying elements. Three to five good and poor behavioural markers for each element were identified. The headings and definitions of the categories and elements were adjusted to encompass the behavioural markers in N-ANTS. The differences that emerged mainly reflected statements regarding the establishment of role, competence, and task delegation. A behavioural marker system, N-ANTS, for nurse anaesthetists was adapted from a behavioural marker system, ANTS, for anaesthesiologists. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Anaesthesiologists' views on the need for point-of-care information system in the operating room: a survey of the European Society of Anaesthesiologists.

PubMed

Perel, A; Berkenstadt, H; Ziv, A; Katzenelson, R; Aitkenhead, A

2004-11-01

In this preliminary study we wanted to explore the attitudes of anaesthesiologists to a point-of-care information system in the operating room. The study was conducted as a preliminary step in the process of developing such a system by the European Society of Anaesthesiologists (ESA). A questionnaire was distributed to all 2240 attendees of the ESA's annual meeting in Gothenburg, Sweden, which took place in April 2001. Of the 329 responders (response rate of 14.6%), 79% were qualified specialists with more than 10 yr of experience (68%), mostly from Western Europe. Most responders admitted to regularly experiencing lack of medical knowledge relating to real-time patient care at least once a month (74%) or at least once a week (46%), and 39% admitted to having made errors during anaesthesia due to lack of medical information that can be otherwise found in a handbook. The choice ofa less optimal but more familiar approach to patient management due to lack of knowledge was reported by 37%. Eighty-eight percent of responders believe that having a point-of-care information system for the anaesthesiologists in the operating room is either important or very important. This preliminary survey demonstrates that lack of knowledge of anaesthesiologists may be a significant source of medical errors in the operating room, and suggests that a point-of-care information system for the anaesthesiologist may be of value.

Stuffed Animals in the Operating Room: A Reservoir of Bacteria With a Simple Solution.

PubMed

Held, Michael; Mignemi, Megan; O'Rear, Lynda; Wise, Michelle; Zane, Gabriella; Murphy Zane, M Siobhan; Schoenecker, Jonathan G

2015-12-01

Despite hand washing and other protocols surgical-site infections (SSIs) have not been eliminated. This implies that either current measures are not effective or there are alternative sources of bacterial exposure to the surgical wound. In this study we tested the hypothesis that stuffed animals or other items allowed to accompany pediatric patients to the operating room as a way to ease anxiety may represent a reservoir of bacteria. Stuffed animals brought into the operating room and stuffed animals that were washed and dried in a conventional washer/dryer and placed in clean sealable plastic bags were swabbed and bacterial colonies were quantified. Results were reported as no growth, light growth, moderate growth, and heavy growth. All stuffed animals showed bacterial growth. A total of 79% of stuffed animals were effectively "sterilized" by a single wash and dry cycle in a conventional home washer/dryer. Sterilized stuffed animals remained sterile after being packed in a sealed bag for 24 hours. These results indicate that items of comfort, such as stuffed animals, brought into the operating room with a benevolent purpose may represent a reservoir of bacteria that could lead to unwanted SSI. Washing an item of comfort 1 day before surgery effectively sterilizes that item of comfort. Future studies will be needed to determine a correlation between "culture positive" stuffed animals and SSI or if providing a child with a "sterile" stuffed animal reduces SSI.

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.

Metal nanoparticle film–based room temperature Coulomb transistor

PubMed Central

Willing, Svenja; Lehmann, Hauke; Volkmann, Mirjam; Klinke, Christian

2017-01-01

Single-electron transistors would represent an approach to developing less power–consuming microelectronic devices if room temperature operation and industry-compatible fabrication were possible. We present a concept based on stripes of small, self-assembled, colloidal, metal nanoparticles on a back-gate device architecture, which leads to well-defined and well-controllable transistor characteristics. This Coulomb transistor has three main advantages. By using the scalable Langmuir-Blodgett method, we combine high-quality chemically synthesized metal nanoparticles with standard lithography techniques. The resulting transistors show on/off ratios above 90%, reliable and sinusoidal Coulomb oscillations, and room temperature operation. Furthermore, this concept allows for versatile tuning of the device properties such as Coulomb energy gap and threshold voltage, as well as period, position, and strength of the oscillations. PMID:28740864

10 CFR 429.15 - Room air conditioners.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Room air conditioners. 429.15 Section 429.15 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION CERTIFICATION, COMPLIANCE, AND ENFORCEMENT FOR CONSUMER PRODUCTS AND... selected and tested to ensure that— (i) Any represented value of estimated annual operating cost, energy...

29. Perimeter acquisition radar building room #318, data processing system ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

29. Perimeter acquisition radar building room #318, data processing system area; data processor maintenance and operations center, showing data processing consoles - Stanley R. Mickelsen Safeguard Complex, Perimeter Acquisition Radar Building, Limited Access Area, between Limited Access Patrol Road & Service Road A, Nekoma, Cavalier County, ND

Pneumatic vacuum tube message center, basement room 23, looking southeast ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Pneumatic vacuum tube message center, basement room 23, looking southeast toward doorway and corridor. Note soundproof walls, pedestal flooring, and cable tray suspended from the ceiling - March Air Force Base, Strategic Air Command, Combat Operations Center, 5220 Riverside Drive, Moreno Valley, Riverside County, CA

75 FR 6214 - Notice of Meeting of the Advisory Committee on Commercial Operations of Customs and Border...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-08

... will be held at the Embassy Suites Hotel Miami Airport in the Coconut Grove/Havana Room, 3974 NW South... presentations. All visitors must check-in at the Embassy Suites Hotel at the Coconut Grove/Havana Room with CBP...

9 CFR 354.243 - Operations and procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

...) The floors in the eviscerating room shall be kept clean and reasonably dry during eviscerating... accord with clean and sanitary methods. (a) There shall be no handling or storing of materials which create an objectionable condition in rooms, compartments, or other places in the plant where any product...

9 CFR 354.243 - Operations and procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

...) The floors in the eviscerating room shall be kept clean and reasonably dry during eviscerating... accord with clean and sanitary methods. (a) There shall be no handling or storing of materials which create an objectionable condition in rooms, compartments, or other places in the plant where any product...

9 CFR 354.243 - Operations and procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

...) The floors in the eviscerating room shall be kept clean and reasonably dry during eviscerating... accord with clean and sanitary methods. (a) There shall be no handling or storing of materials which create an objectionable condition in rooms, compartments, or other places in the plant where any product...

Locker-Room Talk.

ERIC Educational Resources Information Center

Lowe, Jason; Noyes, Brad

1999-01-01

Explains how proper athletic facility locker-room design can save time and money. Design factors that address who will be using the facility are discussed as are user requirements, such as preparation areas, total storage area per user, grooming area, and security areas. Final comments address maintenance and operations issues. (GR)

[On-line data management system using a portable blood gas analyzer in the operating room].

PubMed

Shimosato, G; Ibuki, T; Hirata, M; Shigemi, K; Tanaka, Y

2000-03-01

It is very important to establish a clinical testing system which is not only prompt, simple and accurate but also safe for the patients and medical staff in the operating room, emergency room and intensive care unit. In our institution an i-STAT portable blood gas analyser has been widely used for point of care testing in all the operating rooms. This clinical testing system has been upgraded by adding an i-STAT communication protocol to our online data management system. The analysed data transmitted by the i-STAT as an infrared signal is transformed to an electronic signal through the IR link and sent to the central data station (CDS) via RS232C. The data received by the CDS is then sent to the upper grade computer system where the data is recorded on the hard disk. One advantage of this system is that it is connected to the hospital computer system. Not only does this new system meet the need for accurate, safe, effective and economical laboratory testing, but also retrospective and multifactorial analysis of intraoperative events can be easily carried out. In the future this system can be applied to telemedicine through the Internet and contribute to the treatment of critically ill patients.

Synthesis of AuPd alloyed nanoparticles via room-temperature electron reduction with argon glow discharge as electron source.

PubMed

Yang, Manman; Wang, Zongyuan; Wang, Wei; Liu, Chang-Jun

2014-01-01

Argon glow discharge has been employed as a cheap, environmentally friendly, and convenient electron source for simultaneous reduction of HAuCl4 and PdCl2 on the anodic aluminum oxide (AAO) substrate. The thermal imaging confirms that the synthesis is operated at room temperature. The reduction is conducted with a short time (30 min) under the pressure of approximately 100 Pa. This room-temperature electron reduction operates in a dry way and requires neither hydrogen nor extra heating nor chemical reducing agent. The analyses using X-ray photoelectron spectroscopy (XPS) confirm all the metallic ions have been reduced. The characterization with X-ray diffraction (XRD) and high-resolution transmission electron microscopy (HRTEM) shows that AuPd alloyed nanoparticles are formed. There also exist some highly dispersed Au and Pd monometallic particles that cannot be detected by XRD and transmission electron microscopy (TEM) because of their small particle sizes. The observed AuPd alloyed nanoparticles are spherical with an average size of 14 nm. No core-shell structure can be observed. The room-temperature electron reduction can be operated in a larger scale. It is an easy way for the synthesis of AuPd alloyed nanoparticles.

[Development and effects of an e-learning program in operating room nursing for nursing students].

PubMed

Park, Eun Hee; Hwang, Seon Young

2011-02-01

This study was conducted to develop an e-Learning program that assists nursing students' clinical practice in operating room nursing and to examine the learning effects. Based on content and need analysis, 9 learning modules were developed for nursing care in operating rooms and with operating equipment. To verify the effects of the program, a quasi-experimental pretest-posttest control group design was employed. The participants in this study were 74 third-year nursing students (34 in the experimental and 40 in the control group) from a junior college in G-city, Korea, who were engaged in a one week clinical practicum in an operating unit. Frequencies, χ(2)-test and t-test with the SPSS program 17.0 were used to analyze the data. Knowledge was significantly higher in the experimental group compared to the control group (p=.018). However, there was no significant difference between the two groups in self-directed learning. The experimental group had significantly higher motivation toward learning, which was examined posttest only (p=.027). These results indicate that the implementation of an e-Learning program needs to be continued as an effective educational tool, but more research on the best way to implement e-Learning in students' practicum is needed.

Sampling for Patient Exit Interviews: Assessment of Methods Using Mathematical Derivation and Computer Simulations.

PubMed

Geldsetzer, Pascal; Fink, Günther; Vaikath, Maria; Bärnighausen, Till

2018-02-01

(1) To evaluate the operational efficiency of various sampling methods for patient exit interviews; (2) to discuss under what circumstances each method yields an unbiased sample; and (3) to propose a new, operationally efficient, and unbiased sampling method. Literature review, mathematical derivation, and Monte Carlo simulations. Our simulations show that in patient exit interviews it is most operationally efficient if the interviewer, after completing an interview, selects the next patient exiting the clinical consultation. We demonstrate mathematically that this method yields a biased sample: patients who spend a longer time with the clinician are overrepresented. This bias can be removed by selecting the next patient who enters, rather than exits, the consultation room. We show that this sampling method is operationally more efficient than alternative methods (systematic and simple random sampling) in most primary health care settings. Under the assumption that the order in which patients enter the consultation room is unrelated to the length of time spent with the clinician and the interviewer, selecting the next patient entering the consultation room tends to be the operationally most efficient unbiased sampling method for patient exit interviews. © 2016 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

PubMed Central

CRISTINA, M.L.; SCHINCA, E.; OTTRIA, G.; SPAGNOLO, A.M.

2016-01-01

Summary Background. The rate of surgical site infections (SSI) is strongly influenced by operating room quality, which is determined by the structural features of the facility and its systems and by the management and behavior of healthcare workers. The aim of the present study was to assess microbial contamination in the operating room during hip- and knee-replacement procedures, the behavior of operating room staff and the incidence of SSI through postdischarge surveillance. Methods. Microbial contamination was evaluated by active and passive sampling at rest and in operating conditions. Organizational and behavioral characteristics were collected through observational assessment. The incidence of SSI was evaluated in 255 patients, and follow-up examinations were carried out 30 and 365 days after the procedure. Results. The mean values of the airborne and sedimenting microbial loads were 12.90 CFU/m3 and 0.02 CFU/cm2/h, respectively. With regard to outcome, the infection rate proved to be 0.89% and was associated with knee-replacement procedures. The microorganism responsible for this superficial infection was Staphylococcus aureus. Conclusions. Clinical outcomes proved to be satisfactory, owing to the limited microbial load (in both at-rest and operating conditions), the appropriate behavior of the staff, compliance with the guidelines on preoperative antibiotic prophylaxis, and efficient management of the ventilation system. PMID:27980378

Poster - 26: Electronic Waiting Room Management for a busy Cancer Centre

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

Kildea, John; Hijal, Tarek

We describe an electronic waiting room management system that we have developed and deployed in our cancer centre. Our system connects with our electronic medical records systems, gathers data for a machine learning algorithm to predict future patient waiting times, and is integrated with a mobile phone app. The system has been in operation for over nine months and has led to reduced lines, calmer waiting rooms and overwhelming patient and staff satisfaction.

[A project to improve the validity rate for nursing staff operating single door autoclave sterilizers].

PubMed

Chen, Chun-Hung; Li, Cheng-Chang; Chou, Chuan-Yu; Chen, Shu-Hwa

2009-08-01

This project was designed to improve the low validity rate for nurses responsible to operate single door autoclave sterilizers in the operating room. By investigating the current status, we found that the nursing staff validity rate of cognition on the autoclave sterilizer was 85%, and the practice operating check validity rate was only 80%. Such was due to a lack of in-service education. Problems with operation included: 1. Unsafe behaviors - not following standard procedure, lacking relevant operating knowledge and absence of a check form; 2. Unsafe environment - the conveying steam piping was typically not covered and lacked operation marks. Recommended improvement measures included: 1. holding in-service education; 2. generating an operation procedure flow chart; 3. implementing obstacle eliminating procedures; 4. covering piping to prevent fire and burns; 5. performing regular checks to ensure all procedures are followed. Following intervention, nursing staff cognition rose from 85% to 100%, while the operation validity rate rose from 80% to 100%. These changes ensure a safer operating room environment, and helps facilities move toward a zero accident rate in the healthcare environment.

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

Ryan, E. Ronan, E-mail: ronan@ronanryan.com; Thornton, Raymond; Sofocleous, Constantinos T.

PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0-0.13) mSv for the primary operator, 0.01 (range 0-0.05) mSv for the nurse anesthetist, and 0.02 (range 0-0.05) mSv for the radiology technologist. The median extremitymore » dose equivalent for the operator was 0.05 (range 0-0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient.« less

Factors affecting the energy consumption of two refrigerator-freezers

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

Kao, J.Y.; Kelley, G.E.

Two refrigerator-freezers, one with a top-mounted freezer and one with side-by-side doors, were tested in the laboratory to determine the sensitivity of their energy consumption to various operational factors. Room temperature, room humidity, door openings, and the setting of the anti-sweat heater switch were the factors examined. The results indicated that the room temperature and door openings had a significantly greater effect on energy consumption than the other two factors. More detailed tests were then performed under different room temperature and door-opening combinations. The relationship of door openings and the equivalent test room temperature was established. Finally, the effect onmore » energy of different temperature settings was studied. Test results are presented and discussed.« less

Optimization of fluorescent imaging in the operating room through pulsed acquisition and gating to ambient background cycling

PubMed Central

Sexton, Kristian J.; Zhao, Yan; Davis, Scott C.; Jiang, Shudong; Pogue, Brian W.

2017-01-01

The design of fluorescence imaging instruments for surgical guidance is rapidly evolving, and a key issue is to efficiently capture signals with high ambient room lighting. Here, we introduce a novel time-gated approach to fluorescence imaging synchronizing acquisition to the 120 Hz light of the room, with pulsed LED excitation and gated ICCD detection. It is shown that under bright ambient room light this technique allows for the detection of physiologically relevant nanomolar fluorophore concentrations, and in particular reduces the light fluctuations present from the room lights, making low concentration measurements more reliable. This is particularly relevant for the light bands near 700nm that are more dominated by ambient lights. PMID:28663895

5 CFR 2411.4 - Information policy.

Code of Federal Regulations, 2011 CFR

2011-01-01

... instructions to staff that affect a member of the public (except those establishing internal operating rules... the Internet/World Wide-Web site (http://www.flra.gov/foia/reading_room.html). The Web site containing... Reading Room should be submitted to the FLRA's Office of the Solicitor (mail: Office of the Solicitor...

21 CFR 113.87 - Operations in the thermal processing room.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Section 113.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION THERMALLY PROCESSED LOW-ACID FOODS PACKAGED IN HERMETICALLY SEALED... Food and Drug Administration. (b) A system for product traffic control in the retort room shall be...

21 CFR 113.87 - Operations in the thermal processing room.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Section 113.87 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION THERMALLY PROCESSED LOW-ACID FOODS PACKAGED IN HERMETICALLY SEALED... Administration. (b) A system for product traffic control in the retort room shall be estab-lished to prevent...

82. VIEW OF AIRCONDITIONING CONTROLS LOCATED IN NORTHEAST CORNER OF ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

82. VIEW OF AIR-CONDITIONING CONTROLS LOCATED IN NORTHEAST CORNER OF SLC-3E CONTROL ROOM. DIAL ON RIGHT (EAST) PERPENDICULAR WALL IS DIMMER FOR ROOM LIGHTING. - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

18. The west end of the dining room contains four ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

18. The west end of the dining room contains four windows that overlook Central Avenue. As other millwork in the restaurant, these windows were originally finished with stain and varnish. Transoms retain their original operators. Credit GADA/MRM. - Stroud Building, 31-33 North Central Avenue, Phoenix, Maricopa County, AZ

ENVIRONMENTAL TECHNOLOGY VERIFICATION REPORT REMOVAL OF MERCURY FROM DENTAL OFFICE WASTEWATER

EPA Science Inventory

Verification testing of the DRNA Mercury Recovery Unit (MRU) was conducted during a seven-week period, at a dental office in Michigan that had three operatory rooms and two hygiene rooms. The office operated four days per week and averaged approximately eight (8) mercury amalgam ...

Clifford Charlesworth seated at his console in Mission Control Room

NASA Image and Video Library

1968-12-21

S68-55742 (21 Dec. 1968) --- Clifford E. Charlesworth, Apollo 8 "Green Team" flight director, is seated at his console in the Mission Operations Control Room in the Mission Control Center, Building 30, during the launch of the Apollo 8 (Spacecraft 103/Saturn 503) manned lunar orbit space mission.

CONTROL ROOM WITH SPRINKLER SYSTEM CONTROLS, INCLUDING MANUAL CONTROL BOXES ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

CONTROL ROOM WITH SPRINKLER SYSTEM CONTROLS, INCLUDING MANUAL CONTROL BOXES FOR THE VENTILATION SYSTEM AND A PLC SWITCH FOR AUTOMATIC CO (CARBON MONOXIDE) SYSTEM. THE AIR TESTING SYSTEM IS FREE STANDING AND THE FANS ARE COMPUTER-OPERATED. - Alaskan Way Viaduct and Battery Street Tunnel, Seattle, King County, WA

VIEW OF HISTORIC SLATE SWITCHBOARD IN THE CONTROL ROOM OF ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

VIEW OF HISTORIC SLATE SWITCHBOARD IN THE CONTROL ROOM OF THE ELWHA POWERHOUSE, INCLUDING: METERS, PROTECTIVE RELAYS, AND SWITCHES. NOTE ADDITION OF PERSONAL COMPUTERS FOR POWER METERING AND OPERATIONS. PHOTO BY JET LOWE, HAER, 1995. - Elwha River Hydroelectric System, Elwha Hydroelectric Dam & Plant, Port Angeles, Clallam County, WA

Changes In Arterial Hemoglobin Oxygen Saturation During Transport From the Operating Room to the Postanesthesia Care Unit In Healthy Patients Breathing Room Air

DTIC Science & Technology

1998-12-16

motion artifact, electrical noise from the electrocautery, intravenous dyes such as methylene blue and indocyanine green, carboxyhemoglobin and... carboxyhemoglobin because the oximeter fails to distinguish between oxyhemoglobin and carboxyhemoglobin (Patel, Norden, & Hannallah, 1988) . Thus

46 CFR 153.981 - Leaving room in tank for cargo expansion.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 5 2012-10-01 2012-10-01 false Leaving room in tank for cargo expansion. 153.981 Section 153.981 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SHIPS CARRYING BULK LIQUID, LIQUEFIED GAS, OR COMPRESSED GAS HAZARDOUS MATERIALS Operations Cargo...

46 CFR 153.981 - Leaving room in tank for cargo expansion.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 5 2013-10-01 2013-10-01 false Leaving room in tank for cargo expansion. 153.981 Section 153.981 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SHIPS CARRYING BULK LIQUID, LIQUEFIED GAS, OR COMPRESSED GAS HAZARDOUS MATERIALS Operations Cargo...

46 CFR 153.981 - Leaving room in tank for cargo expansion.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 5 2010-10-01 2010-10-01 false Leaving room in tank for cargo expansion. 153.981 Section 153.981 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SHIPS CARRYING BULK LIQUID, LIQUEFIED GAS, OR COMPRESSED GAS HAZARDOUS MATERIALS Operations Cargo...