40 CFR 243.202-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Operations. 243.202-3 Section 243.202-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... receive periodic vehicle safety checks, including, but not limited to, inspection of brakes, windshield...

40 CFR 243.202-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Operations. 243.202-3 Section 243.202-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... receive periodic vehicle safety checks, including, but not limited to, inspection of brakes, windshield...

40 CFR 243.201-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... should meet the applicable provisions of the Occupational Safety and Health Administration Standards for... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Operations. 243.201-2 Section 243.201-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID...

40 CFR 240.209-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Occupational Respiratory Disease, National Institute for Occupational Safety and Health, Morgantown, W. Va. (c... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Operations. 240.209-3 Section 240.209-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID...

40 CFR 243.203-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... minimum collection frequency consistent with public health and safety should be adopted to minimize... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Operations. 243.203-2 Section 243.203-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID...

RECOMMENDED OPERATING PROCEDURE NO. 2.3: SAMPLING AND ANALYSIS OF TOTAL HYDROCARBONS FROM SOURCES BY CONTINUOUS EMISSION MONITOR

EPA Science Inventory

The report is a recommended operating procedure (ROP) prepared for use in research activities conducted by EPA's Air and Energy Engineering Research Laboratory (AEERL). he described method is applicable to the continuous measurement of total hydrocarbons (THCs), also known as tot...

RECOMMENDED OPERATING PROCEDURE NO. 51: GLASS SOURCE ASSESSMENT SAMPLING SYSTEM (GLASS SASS)

EPA Science Inventory

The report is a recommended operating procedure (ROP), prepared for use in research activities conducted by EPA's Air and Energy Engineering Research Laboratory (AEERL). he method described is applicable to the stack sampling of flue gas from a rotary kiln and to associated equip...

Candidate CDTI procedures study

NASA Technical Reports Server (NTRS)

Ace, R. E.

1981-01-01

A concept with potential for increasing airspace capacity by involving the pilot in the separation control loop is discussed. Some candidate options are presented. Both enroute and terminal area procedures are considered and, in many cases, a technologically advanced Air Traffic Control structure is assumed. Minimum display characteristics recommended for each of the described procedures are presented. Recommended sequencing of the operational testing of each of the candidate procedures is presented.

Chapter 8. Medical procedures. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Zimmerman, Janice L; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza pandemic or mass disaster with a specific focus on ensuring that adequate resources are available and appropriate protocols are developed to safely perform procedures in patients with and without influenza illness. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including performing medical procedures. Key recommendations include: (1) specify high-risk procedures (aerosol generating-procedures); (2) determine if certain procedures will not be performed during a pandemic; (3) develop protocols for safe performance of high-risk procedures that include appropriateness, qualifications of personnel, site, personal protection equipment, safe technique and equipment needs; (4) ensure adequate training of personnel in high-risk procedures; (5) procedures should be performed at the bedside whenever possible; (6) ensure safe respiratory therapy practices to avoid aerosols; (7) provide safe respiratory equipment; and (8) determine criteria for cancelling and/or altering elective procedures. Judicious planning and adoption of protocols for safe performance of medical procedures are necessary to optimize outcomes during a pandemic.

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

Barr, J.H.; Silha, R.E.; Richards, A.G.

A report of the Radiation Protection Committee of the American Academy of Oral Roentgenology on recommendation for reducing exposure to patient and dentist during oral radiographic procedures is reviewed. The following aspects of the problem of exposure reduction are considered: max permissible exposures to operators and patients, sources of radiation in dental offices, recommended building materials to be used for wall construction (with their lead equivalents), and detailed statements of procedures for protecting operators and patients. (TCO)

40 CFR 63.543 - What are my standards for process vents?

Code of Federal Regulations, 2013 CFR

2013-07-01

... available. You must develop and follow standard operating procedures designed to minimize emissions of total... the manufacturer's recommended procedures, if available, and the standard operating procedures... 40 Protection of Environment 10 2013-07-01 2013-07-01 false What are my standards for process...

40 CFR 63.543 - What are my standards for process vents?

Code of Federal Regulations, 2012 CFR

2012-07-01

... available. You must develop and follow standard operating procedures designed to minimize emissions of total... the manufacturer's recommended procedures, if available, and the standard operating procedures... 40 Protection of Environment 10 2012-07-01 2012-07-01 false What are my standards for process...

40 CFR 63.543 - What are my standards for process vents?

Code of Federal Regulations, 2014 CFR

2014-07-01

... develop and follow standard operating procedures designed to minimize emissions of total hydrocarbon for... manufacturer's recommended procedures, if available, and the standard operating procedures designed to minimize... 40 Protection of Environment 10 2014-07-01 2014-07-01 false What are my standards for process...

Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer

PubMed Central

Bleu, Géraldine; Merlot, Benjamin; Boulanger, Loïc; Vinatier, Denis; Kerdraon, Olivier; Collinet, Pierre

2015-01-01

Objective Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery. Methods This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied. Results Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications. Conclusion Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity. PMID:25872893

Surveillance of Environmental and Procedural Measures of Infection Control in the Operating Theatre Setting

PubMed Central

Raggi, Alessandra; Sanna, Tiziana; Mazzetti, Magda; Orsi, Alessandra; Zanni, Angela; Farruggia, Patrizia

2017-01-01

The microbiological contamination of operating theatres and the lack of adherence to best practices by surgical staff represent some of the factors affecting Surgical Site Infections (SSIs). The aim of the present study was to assess the microbiological quality of operating settings and the staff compliance to the SSI evidence-based control measures. Ten operating rooms were examined for microbiological contamination of air and surfaces, after cleaning procedures, in “at rest” conditions. Furthermore, 10 surgical operations were monitored to assess staff compliance to the recommended practices. None of the air samples exceeded microbiological reference standards and only six of the 200 surface samples (3.0%) were slightly above recommended levels. Potentially pathogenic bacteria and moulds were never detected. Staff compliance to best practices varied depending on the type of behaviour investigated and the role of the operator. The major not compliant behaviours were: pre-operative skin antisepsis, crowding of the operating room and hand hygiene of the anaesthetist. The good environmental microbiological quality observed is indicative of the efficacy of the cleaning-sanitization procedures adopted. The major critical point was staff compliance to recommended practices. Awareness campaigns are therefore necessary, aimed at improving the organisation of work so as to facilitate compliance to operative protocols. PMID:29283367

Recommended procedures for measuring aircraft noise and associated parameters

NASA Technical Reports Server (NTRS)

Marsh, A. H.

1977-01-01

Procedures are recommended for obtaining experimental values of aircraft flyover noise levels (and associated parameters). Specific recommendations are made for test criteria, instrumentation performance requirements, data-acquisition procedures, and test operations. The recommendations are based on state-of-the-art measurement capabilities available in 1976 and are consistent with the measurement objectives of the NASA Aircraft Noise Prediction Program. The recommendations are applicable to measurements of the noise produced by an airplane flying subsonically over (or past) microphones located near the surface of the ground. Aircraft types covered by the recommendations are fixed-wing airplanes powered by turbojet or turbofan engines and using conventional aerodynamic means for takeoff and landing. Various assumptions with respect to subsequent data processing and analysis were made (and are described) and the recommended measurement procedures are compatible with the assumptions. Some areas where additional research is needed relative to aircraft flyover noise measurement techniques are also discussed.

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

NASA Technical Reports Server (NTRS)

1976-01-01

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

Standard operating procedures for female orgasmic disorder: consensus of the International Society for Sexual Medicine.

PubMed

Laan, Ellen; Rellini, Alessandra H; Barnes, Tricia

2013-01-01

As the field of sexual medicine evolves, it is important to continually improve patient care by developing contemporary "standard operating procedures" (SOPs), reflecting the consensus view of experts in sexual medicine. Few, if any, consensus SOPs have been developed for the diagnosis and treatment of Female Orgasmic Disorder (FOD). The objective is to provide standard operating procedures for FOD. The SOP Committee was composed of a chair, selected by the International Society for the Study of Sexual Medicine, and two additional experts. To inform its key recommendations, the Committee used systematic reviews of available evidence and discussions during a group meeting, conference calls and e-mail communications. The Committee received no corporate funding or remuneration. A total of 12 recommendations for the assessment and treatment of FOD were generated, including suggestions for further research. Evidence-based, practice recommendations for the treatment of FOD are provided that will hopefully inform clinical decision making for those treating this common condition. © 2012 International Society for Sexual Medicine.

Development of a standard operating procedure for analysis of ammonia concentrations in coal fly ash.

DOT National Transportation Integrated Search

2015-04-01

Research was performed to support the development and recommendation of a standard operating : procedure (SOP) for analyzing the ammonia content in fly ash intended for use in concrete. A review : of existing ash producers found that several differen...

Pre-operative skin preparation practices: results of the 2007 French national assessment.

PubMed

Borgey, F; Thibon, P; Ertzscheid, M-A; Bernet, C; Gautier, C; Mourens, C; Bettinger, A; Aggoune, M; Galy, E; Lejeune, B; Kadi, Z

2012-05-01

Pre-operative skin preparation, aimed at reducing the endogenous microbial flora, is one of the main preventive measures employed to decrease the likelihood of surgical site infection. National recommendations on pre-operative management of infection risks were issued in France in 2004. To assess compliance with the French national guidelines for pre-operative skin preparation in 2007. A prospective audit was undertaken in French hospitals through interviews with patients and staff, and observation of professional practice. Compliance with five major criteria selected from the guidelines was studied: patient information, pre-operative showering, pre-operative hair removal, surgical site disinfection and documentation of these procedures. Data for 41,188 patients from all specialties at 609 facilities were analysed. Patients were issued with information about pre-operative showering in 88.2% of cases [95% confidence interval (CI) 87.9-88.5]. The recommended procedure for pre-operative showering, including hairwashing, with an antiseptic skin wash solution was followed by 70.3% of patients (95% CI 69.9-70.8); this percentage was higher when patients had received appropriate information (P < 0.001). Compliance with hair removal procedures was observed in 91.5% of cases (95% CI 91.2-91.8), and compliance with surgical site disinfection recommendations was observed in 25,529 cases (62.0%, 95% CI 61.5-62.5). The following documentary evidence was found: information given to patient, 35.6% of cases; pre-operative surgical hygiene, 82.3% of cases; and pre-operative site disinfection, 71.7% of cases. The essential content of the French guidelines seems to be understood, but reminders need to be issued. Some recommendations may need to be adapted for certain specialties. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

40 CFR 240.205-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended... excessive emissions, appropriate adjustments should be made to lower the emission to acceptable levels. ...

Recommended operating procedure No. 51: Glass source assessment sampling system (glass SASS). Final report, Jul 90-Jan 91

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

Grote, R.A.

1991-05-01

The report is a recommended operating procedure (ROP), prepared for use in research activities conducted by EPA's Air and Energy Engineering Research Laboratory (AEERL). The method described is applicable to the stack sampling of flue gas from a rotary kiln and to associated equipment of AEERL's Combustion Research Branch. It has been the standard method of sampling kiln flue gas due to the transient nature of the puff development and its capability to sample the maximum volume over the shortest time period. ROPs describe non-routine or experimental research operations where some judgment in application may be warranted. ROPs may notmore » be applicable to activities conducted by other research groups, and should not be used in place of standard operating procedures. Use of ROPs must be accompanied by an understanding of the purpose and scope. Questions should be directed to the author.« less

Recommended Procedures for the Internal Financial Auditing of University Libraries.

ERIC Educational Resources Information Center

Kurth, William H.; Zubatsky, David S.

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

40 CFR 240.204-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended... acceptable levels. (b) In the event of an accidental spill, the local regulatory agency should be notified...

40 CFR 240.201-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended... precautions to be taken if unacceptable wastes are delivered to the facility or are improperly left there...

40 CFR 240.201-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended... precautions to be taken if unacceptable wastes are delivered to the facility or are improperly left there...

40 CFR 240.207-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended... appearance. (b) Solid wastes that cannot be processed by the facility should be removed from the facility at...

Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States.

PubMed

Fanaroff, Alexander C; Zakroysky, Pearl; Dai, David; Wojdyla, Daniel; Sherwood, Matthew W; Roe, Matthew T; Wang, Tracy Y; Peterson, Eric D; Gurm, Hitinder S; Cohen, Mauricio G; Messenger, John C; Rao, Sunil V

2017-06-20

Professional guidelines have reduced the recommended minimum number to an average of 50 percutaneous coronary intervention (PCI) procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown. The authors describe herein PCI operator procedure volumes; characteristics of low-, intermediate-, and high-volume operators; and the relationship between operator volume and clinical outcomes in a large, contemporary, nationwide sample. Using data from the National Cardiovascular Data Registry collected between July 1, 2009, and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (<50 PCIs per year), intermediate- (50 to 100 PCIs per year), and high- (>100 PCIs per year) volume groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality. The median annual number of procedures performed per operator was 59; 44% of operators performed <50 PCI procedures per year. Low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes. Unadjusted in-hospital mortality was 1.86% for low-volume operators, 1.73% for intermediate-volume operators, and 1.48% for high-volume operators. The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted odds ratio: 1.16 for low versus high; adjusted odds ratio: 1.05 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was observed for post-PCI bleeding. Many PCI operators in the United States are performing fewer than the recommended number of PCI procedures annually. Although absolute risk differences are small and may be partially explained by unmeasured differences in case mix between operators, there remains an inverse relationship between PCI operator volume and in-hospital mortality that persisted in risk-adjusted analyses. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Operating Policies and Procedures of Computer Data-Base Systems.

ERIC Educational Resources Information Center

Anderson, David O.

Speaking on the operating policies and procedures of computer data bases containing information on students, the author divides his remarks into three parts: content decisions, data base security, and user access. He offers nine recommended practices that should increase the data base's usefulness to the user community: (1) the cost of developing…

[Efficacy and limits of the bariatric surgery].

PubMed

Nicolai, Albano; Taus, Marina; Busni, Debora; Petrelli, Massimiliano

2005-01-01

Morbid obesity is associated with and increased risk of serious comorbidities, including type 2 diabetes, sleep apnoea, cardiovascular diseases, and orthopedic disabilities. Not operative treatments for superobese patients have not been shown to produce reliable long-term benefits, therefore surgical therapy has became the treatment of choice. The number of surgical procedures increased in the last year confirm these data. However, before recommended a specific surgical procedures to a superobese patients it is necessary to consider some variables, such as: patient, health structure, and multidisciplinary equipe. Since there are not recommended or condemned surgical procedures, in this paper the Authors tried to evaluate the effectiveness and limits of the most performed surgical procedures for the treatment of pathologic obesity: gastric by-pass, biliopancreatic diversion (duodenal switch), vertical gastroplasty, banding gastric. The Authors used some pointer of outcome to measure effectiveness and limits: five year post-operative percentage excess weight loss >/< 50, peri-operative >/< 1%, early and late complications >/< 15%, reoperation >/< 3%, improvement of quality of life. Thanks to new surgical technique, restrictive options are losing ground, while malabsorbitive bariatric procedures are collecting successful.

Evaluation of standardized sample collection, packaging, and ...

EPA Pesticide Factsheets

Journal Sample collection procedures and primary receptacle (sample container and bag) decontamination methods should prevent contaminant transfer between contaminated and non-contaminated surfaces and areas during bio-incident operations. Cross-contamination of personnel, equipment, or sample containers may result in the exfiltration of biological agent from the exclusion (hot) zone and have unintended negative consequences on response resources, activities and outcomes. The current study was designed to: (1) evaluate currently recommended sample collection and packaging procedures to identify procedural steps that may increase the likelihood of spore exfiltration or contaminant transfer; (2) evaluate the efficacy of currently recommended primary receptacle decontamination procedures; and (3) evaluate the efficacy of outer packaging decontamination methods. Wet- and dry-deposited fluorescent tracer powder was used in contaminant transfer tests to qualitatively evaluate the currently-recommended sample collection procedures. Bacillus atrophaeus spores, a surrogate for Bacillus anthracis, were used to evaluate the efficacy of spray- and wipe-based decontamination procedures.

Standardization of carbon-phenolic composite test methodology

NASA Technical Reports Server (NTRS)

Hall, W. B.

1986-01-01

The objective of this study was to evaluate the residual volatiles, filler content, and resin flow test procedures for carbon-phenolic prepreg materials. The residual volatile test procedure was rewritten with tighter procedure control which was then evaluated by round robin testing by four laboratories on the same rolls of prepreg. Results indicated that the residual volatiles test was too operator and equipment dependent to be reliable, and it was recommended that the test be discontinued. The resin flow test procedures were rewritten with tighter procedure control, and it is now considered to be an acceptable test. It was recommended that the filler content determination be made prior to prepregging.

Current Level of Mission Control Automation at NASA/Goddard Space Flight Center

NASA Technical Reports Server (NTRS)

Maks, Lori; Breed, Julie; Rackley, Michael; Powers, Edward I. (Technical Monitor)

2001-01-01

NASA is particularly concerned with reducing mission operations costs through increased automation. This paper examines the operations procedures within NASA Mission Control Centers in order to uncover the level of automation that currently exists within them. Based on an assessment of mission operations procedures within three representative control centers, this paper recommends specific areas where there is potential for mission cost reduction through increased automation.

Launch COLA Operations: An Examination of Data Products, Procedures, and Thresholds

NASA Technical Reports Server (NTRS)

Hejduk, M. D.; Plakalovic, D.; Hametz, M. E.; Newman, L. K.; Ollivierre, J. C.; Beaver, B. A.; Thompson, R. C.

2015-01-01

NASA GSFC and KSC, acting in response to headquarters NASA direction, performed a year-long study of launch collision avoidance (LCOLA) operations in order to determine and recommend best risk assessment and mitigation practices. The following condenses the findings and recommendations of the study into one short summary, a more expanded version of which appears as Section 10.

40 CFR 240.209-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... operation during such emergency situations as power failure, air or water supply failure, equipment... devices such as hard hats, gloves, safety glasses, and footwear should be provided for facility employees...

Meteorological support for space operations: Review and recommendations

NASA Technical Reports Server (NTRS)

1988-01-01

The current meteorological support provided to NASA by NOAA, Air Weather Service, and other contractors is reviewed and suggestions are offered for its improvement. These recommendations include improvement in NASA's internal management organizational structure that would accommodate continued improvement in operational weather support, installation of new observing systems, improvement in analysis and forecasting procedures, and the establishment of an Applied Research and Forecasting Facility.

Estimating Commercial Truck VMT of Interstate Motor Carriers: Data Evaluation

DOT National Transportation Integrated Search

1989-11-01

The objectives of this study were to document and evaluate existing data sources and procedures that estimate the VMT (vehicle miles traveled) of commercial vehicles operating in interstate commerce; to recommend and develop the best procedures that ...

Improved Quick Disconnect (QD) Interface Through Fail Safe Parts Identification

NASA Technical Reports Server (NTRS)

Blanch-Payne, Evelyn

2001-01-01

An extensive review of existing Quick Disconnects (QDs) mating and demating operations was performed to determine which shuttle part interface identifications and procedures contribute to human factor errors. The research methods used consisted of interviews with engineers and technicians, examination of incident reports, critiques of video and audio tapes of QD operations, and attendance of a Hyper QD operational course. The data strongly suggests that there are inherit human factor errors involved in QD operations. To promote fail-safe operations, QD interface problem areas and recommendations were outlined and reviewed. It is suggested that dialogue, investigations and recommendations continue.

Evaluation of Winter Operational Runway Friction Measurement Equipment, Procedures, and Research

NASA Technical Reports Server (NTRS)

1995-01-01

This document produced by the FAA/Industry Winter Runway Friction Measurement and Reporting Working Group, is designed to provide an overview of current information on the present guidance, practices, and procedures for reporting runway pavement surface conditions during winter operations at airports. It contains recommendations on the desirability of providing the best procedural consistency and standardization and discusses the available means to implement the guidance that will result in improved aviation safety at airports during hazardous winter conditions.

40 CFR 243.201-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... waste handling techniques, and in the proper operation of collection equipment, such as those presented in Operation Responsible: Safe Refuse Collection. (b) Personal protective equipment such as gloves... Standards for Subpart I—Personal Protective Equipment (29 CFR 1910.132 through 1910.137). (c) Scavenging...

40 CFR 243.201-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... waste handling techniques, and in the proper operation of collection equipment, such as those presented in Operation Responsible: Safe Refuse Collection. (b) Personal protective equipment such as gloves... Standards for Subpart I—Personal Protective Equipment (29 CFR 1910.132 through 1910.137). (c) Scavenging...

Naval Training Equipment Center Index of Technical Reports,

DTIC Science & Technology

1982-09-01

741 RECOMMENDED PROCEDURES AND TRAINING NAVAL TRAINING AIDS. tAMPHIBIOUS OPERATIONS PROCEDURES AND RESEARCH PLANNING AD- 642 590 TRAINING DEVICES FOR...PROCEDURES AND RESEARCH PLANNING OBSERVATION AND FIRE CONTROL WITH FOR ANTI-AIR WARFARE TRAINING SPECIFIC REFERENCE TO THE TRAINING *AMPUTEES PROGRAM...619 AD- 707 757 NAVAL PERSONNEL *COMMUNICATION SATELLITES PROCEDURES AND RESEARCH PLANNING *COMBUSTION PRODUCTS Computer Managed Instruction by FOR

40 CFR Appendix E to Part 403 - Sampling Procedures

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 29 2011-07-01 2009-07-01 true Sampling Procedures E Appendix E to... Appendix E to Part 403—Sampling Procedures I. Composite Method A. It is recommended that influent and effluent operational data be obtained through 24-hour flow proportional composite samples. Sampling may be...

49 CFR Appendix E to Part 240 - Recommended Procedures for Conducting Skill Performance Tests

Code of Federal Regulations, 2010 CFR

2010-10-01

... tailor their testing procedures to the specific operational realities. This appendix contains FRA's..., headlight? —Couple to cars at a safe speed? —Properly control in train slack and buff forces? —Properly use...

Advanced superposition methods for high speed turbopump vibration analysis

NASA Technical Reports Server (NTRS)

Nielson, C. E.; Campany, A. D.

1981-01-01

The small, high pressure Mark 48 liquid hydrogen turbopump was analyzed and dynamically tested to determine the cause of high speed vibration at an operating speed of 92,400 rpm. This approaches the design point operating speed of 95,000 rpm. The initial dynamic analysis in the design stage and subsequent further analysis of the rotor only dynamics failed to predict the vibration characteristics found during testing. An advanced procedure for dynamics analysis was used in this investigation. The procedure involves developing accurate dynamic models of the rotor assembly and casing assembly by finite element analysis. The dynamically instrumented assemblies are independently rap tested to verify the analytical models. The verified models are then combined by modal superposition techniques to develop a completed turbopump model where dynamic characteristics are determined. The results of the dynamic testing and analysis obtained are presented and methods of moving the high speed vibration characteristics to speeds above the operating range are recommended. Recommendations for use of these advanced dynamic analysis procedures during initial design phases are given.

78 FR 26110 - Kicking Cars and Going Between Rolling Equipment During Flat Switching Operations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... Cars and Going Between Rolling Equipment During Flat Switching Operations AGENCY: Federal Railroad... occurred during a railroad switching operation that involved a railroad employee kicking cars and... make recommendations to railroads regarding the adoption of car-handling procedures during flat...

Evaluation of standardized sample collection, packaging, and decontamination procedures to assess cross-contamination potential during Bacillus anthracis incident response operations

PubMed Central

Calfee, M. Worth; Tufts, Jenia; Meyer, Kathryn; McConkey, Katrina; Mickelsen, Leroy; Rose, Laura; Dowell, Chad; Delaney, Lisa; Weber, Angela; Morse, Stephen; Chaitram, Jasmine; Gray, Marshall

2016-01-01

Sample collection procedures and primary receptacle (sample container and bag) decontamination methods should prevent contaminant transfer between contaminated and non-contaminated surfaces and areas during bio-incident operations. Cross-contamination of personnel, equipment, or sample containers may result in the exfiltration of biological agent from the exclusion (hot) zone and have unintended negative consequences on response resources, activities and outcomes. The current study was designed to: (1) evaluate currently recommended sample collection and packaging procedures to identify procedural steps that may increase the likelihood of spore exfiltration or contaminant transfer; (2) evaluate the efficacy of currently recommended primary receptacle decontamination procedures; and (3) evaluate the efficacy of outer packaging decontamination methods. Wet- and dry-deposited fluorescent tracer powder was used in contaminant transfer tests to qualitatively evaluate the currently-recommended sample collection procedures. Bacillus atrophaeus spores, a surrogate for Bacillus anthracis, were used to evaluate the efficacy of spray- and wipe-based decontamination procedures. Both decontamination procedures were quantitatively evaluated on three types of sample packaging materials (corrugated fiberboard, polystyrene foam, and polyethylene plastic), and two contamination mechanisms (wet or dry inoculums). Contaminant transfer results suggested that size-appropriate gloves should be worn by personnel, templates should not be taped to or removed from surfaces, and primary receptacles should be selected carefully. The decontamination tests indicated that wipe-based decontamination procedures may be more effective than spray-based procedures; efficacy was not influenced by material type but was affected by the inoculation method. Incomplete surface decontamination was observed in all tests with dry inoculums. This study provides a foundation for optimizing current B. anthracis response procedures to minimize contaminant exfiltration. PMID:27362274

Evaluation of standardized sample collection, packaging, and decontamination procedures to assess cross-contamination potential during Bacillus anthracis incident response operations.

PubMed

Calfee, M Worth; Tufts, Jenia; Meyer, Kathryn; McConkey, Katrina; Mickelsen, Leroy; Rose, Laura; Dowell, Chad; Delaney, Lisa; Weber, Angela; Morse, Stephen; Chaitram, Jasmine; Gray, Marshall

2016-12-01

Sample collection procedures and primary receptacle (sample container and bag) decontamination methods should prevent contaminant transfer between contaminated and non-contaminated surfaces and areas during bio-incident operations. Cross-contamination of personnel, equipment, or sample containers may result in the exfiltration of biological agent from the exclusion (hot) zone and have unintended negative consequences on response resources, activities and outcomes. The current study was designed to: (1) evaluate currently recommended sample collection and packaging procedures to identify procedural steps that may increase the likelihood of spore exfiltration or contaminant transfer; (2) evaluate the efficacy of currently recommended primary receptacle decontamination procedures; and (3) evaluate the efficacy of outer packaging decontamination methods. Wet- and dry-deposited fluorescent tracer powder was used in contaminant transfer tests to qualitatively evaluate the currently-recommended sample collection procedures. Bacillus atrophaeus spores, a surrogate for Bacillus anthracis, were used to evaluate the efficacy of spray- and wipe-based decontamination procedures. Both decontamination procedures were quantitatively evaluated on three types of sample packaging materials (corrugated fiberboard, polystyrene foam, and polyethylene plastic), and two contamination mechanisms (wet or dry inoculums). Contaminant transfer results suggested that size-appropriate gloves should be worn by personnel, templates should not be taped to or removed from surfaces, and primary receptacles should be selected carefully. The decontamination tests indicated that wipe-based decontamination procedures may be more effective than spray-based procedures; efficacy was not influenced by material type but was affected by the inoculation method. Incomplete surface decontamination was observed in all tests with dry inoculums. This study provides a foundation for optimizing current B. anthracis response procedures to minimize contaminant exfiltration.

40 CFR 240.206-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended... spillages occur, emptying the solid waste storage area at least weekly, and routinely cleaning the remainder of the facility. (b) Solid waste and residue should not be allowed to accumulate at the facility for...

Modal Analysis for Grid Operation

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

MANGO software is to provide a solution for improving small signal stability of power systems through adjusting operator-controllable variables using PMU measurement. System oscillation problems are one of the major threats to the grid stability and reliability in California and the Western Interconnection. These problems result in power fluctuations, lower grid operation efficiency, and may even lead to large-scale grid breakup and outages. This MANGO software aims to solve this problem by automatically generating recommended operation procedures termed Modal Analysis for Grid Operation (MANGO) to improve damping of inter-area oscillation modes. The MANGO procedure includes three steps: recognizing small signalmore » stability problems, implementing operating point adjustment using modal sensitivity, and evaluating the effectiveness of the adjustment. The MANGO software package is designed to help implement the MANGO procedure.« less

[Features of the maintenance of automated developing machines].

PubMed

Koveshnikov, A I

1999-01-01

Based on his long-term own experience the author gives recommendations on the assembly, adjustment, operation, and preventive maintenance of automatic developing machines. Procedures are presented for evaluating the quality of X-ray films and controlling the activity of operating qualities of a developer while machining photographic materials. Troubles and malfunction of equipment and procedures for their elimination are shown to affect the quality of development of films.

76 FR 10420 - Delegation of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-24

... Standard Operating Procedure 00 01 2, Chapter 3, paragraph 2, or is unable to perform the functions and... to the Administrator for approval applications for licenses to operate as a small business investment... authorities granted by the Administrator to recommend and approve applications for a license to operate as a...

Life Cycle Costs in Education: Operations & Maintenance Considered.

ERIC Educational Resources Information Center

Moussatche, Helena; Languell-Urquhart, Jennifer; Woodson, Carol

2000-01-01

Discusses life cycle cost analysis when deciding on flooring finishes and examines operations and maintenance cost effectiveness relative to hard, resilient, and soft flooring. A chart of evaluated flooring materials' characteristics, appropriate maintenance procedures, and recommended frequency is included. (GR)

EDRN Standard Operating Procedures (SOP) — EDRN Public Portal

Cancer.gov

The NCI’s Early Detection Research Network is developing a number of standard operating procedures for assays, methods, and protocols for collection and processing of biological samples, and other reference materials to assist investigators to conduct experiments in a consistent, reliable manner. These SOPs are established by the investigators of the Early Detection Research Network to maintain constancy throughout the Network. These SOPs represent neither a consensus, nor are the recommendations of NCI.

40 CFR 240.210 - General operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

Energy Program Updates Existing Schools

ERIC Educational Resources Information Center

American School and University, 1976

1976-01-01

Herricks Public School District has adopted an energy conservation program that establishes an energy consumption baseline and makes recommendations to modify systems and operational procedures. (Author/MLF)

[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.

Recommendations for numerical solution of reinforced-panel and fuselage-ring problems

NASA Technical Reports Server (NTRS)

Hoff, N J; Libby, Paul A

1949-01-01

Procedures are recommended for solving the equations of equilibrium of reinforced panels and isolated fuselage rings as represented by the external loads and the operations table established according to Southwell's method. From the solution of these equations the stress distribution can be easily determined. The method of systematic relaxations, the matrix-calculus method, and several other methods applicable in special cases are discussed. Definite recommendations are made for obtaining the solution of reinforced-panel problems which are generally designated as shear lag problems. The procedures recommended are demonstrated in the analysis of a number of panels. In the case of fuselage rings it is not possible to make definite recommendations for the solution of the equilibrium equations for all rings and loadings. However, suggestions based on the latest experience are made and demonstrated on several rings.

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

DTIC Science & Technology

1981-09-01

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

76 FR 62894 - Following Procedures When Going Between Rolling Equipment

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-11

... Operations Fatality Analysis (SOFA) Working Group. In October 1999, the Working Group issued a report titled ``Findings and Recommendations of the SOFA Working Group.'' The report can be found on FRA's Web site at http... recommendation reads as follows: \\1\\ More recently, in March 2011, the SOFA Working Group issued a report titled...

Information Flow Analysis of Level 4 Payload Processing Operations

NASA Technical Reports Server (NTRS)

Danz, Mary E.

1991-01-01

The Level 4 Mission Sequence Test (MST) was studied to develop strategies and recommendations to facilitate information flow. Recommendations developed as a result of this study include revised format of the Test and Assembly Procedure (TAP) document and a conceptualized software based system to assist in the management of information flow during the MST.

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

[Recommendations for the peri-operative management of bariatric surgery patients: results of a national survey].

PubMed

Ortega, Joaquin; Cassinello, Norberto; Baltasar, Aniceto; Torres, Antonio J

2012-01-01

To standardise possible peri-operative bariatric surgery protocols, a survey was prepared to be filled in by members of the Spanish Society for Obesity (Sociedad Española de Cirugía de la Obesidad) (SECO), and to approve it at the XII National Congress. A total of 47 members of SECO from 14 autonomous communities responded, and it unanimously approved by the Congress. As highly recommended peri-operative procedures, were proposed: full laboratory analysis (98%) with an endocrine study (90%), ECG (96%), chest x-ray (98%), an oesophageal-gastric imaging test (endoscopy or gastro-duodenal transit study (98%), antibiotic prophylaxis (92%) and use of low molecular weight heparins pre-operatively (96%), and for 2 weeks (83%). Pre-surgical, abdominal ultrasound (86%), spirometry (80%), diet (88%) and psychological study (76%), and during surgery, use of elastic stockings (76%), leak tests (92%) and drainages (90%), were established as advisable procedures. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

Aircraft noise effects on cultural resources: Recommendation and rationale for further research

NASA Astrophysics Data System (ADS)

Hanson, Carl E.; King, Kenneth W.; Eagan, Mary Ellen; Horonjeff, Richard D.

1993-05-01

The results are ultimately used to estimate the potential for damage to a wide variety of cultural resources from operations of commercial helicopters. Comparison of measured vibration levels with criteria for damage based on structural velocities will provide a family of restrictions on aircraft operations in the vicinity of sensitive structures. Such restrictions could take the form of minimum separation distances and prohibited maneuvers for helicopters. The results of the study would be presented in a report as a set of recommended procedures for helicopter operations to avoid damage to prehistoric, historic, sensitive, and conventional structures.

Recommendations for reducing ambiguity in written procedures.

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

Matzen, Laura E.

Previous studies in the nuclear weapons complex have shown that ambiguous work instructions (WIs) and operating procedures (OPs) can lead to human error, which is a major cause for concern. This report outlines some of the sources of ambiguity in written English and describes three recommendations for reducing ambiguity in WIs and OPs. The recommendations are based on commonly used research techniques in the fields of linguistics and cognitive psychology. The first recommendation is to gather empirical data that can be used to improve the recommended word lists that are provided to technical writers. The second recommendation is to havemore » a review in which new WIs and OPs and checked for ambiguities and clarity. The third recommendation is to use self-paced reading time studies to identify any remaining ambiguities before the new WIs and OPs are put into use. If these three steps are followed for new WIs and OPs, the likelihood of human errors related to ambiguity could be greatly reduced.« less

The Joanna Briggs Institute Best Practice Information Sheet: music as an intervention in hospitals.

PubMed

2011-03-01

This Best Practice Information Sheet aims to synthesize the best-available evidence on music as a therapeutic intervention for the management of anxiety or pain related to procedural or operative interventions. The information that is contained in this sheet has been derived from studies that were included in a systematic review that was conducted by The Joanna Briggs Institute. The original references can be sourced from the systematic review. Music as a therapeutic intervention is a development largely of the mid-20th century; however, it has existed in various forms in most cultures for many centuries. The Best Practice Information Sheet includes music-listening before a procedure or operation, during a procedure or operation, and after a procedure or operation. It excludes other forms of music therapy. Several recommendations for practice are made. © 2011 Blackwell Publishing Asia Pty Ltd.

Pressure Safety: Advanced Live 11459

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

Glass, George

Many Los Alamos National Laboratory (LANL) operations use pressure equipment and systems. Failure to follow proper procedures when designing or operating pressure systems can result in injuries to personnel and damage to equipment and/or the environment. This manual presents an overview of the requirements and recommendations that address the safe design and operation of pressure systems at LANL.

40 CFR 240.210-1 - Requirement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Requirement. 240.210-1 Section 240.210... THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.210-1 Requirement... the design requirements. An operations manual describing the various tasks to be performed, operating...

40 CFR 240.210-1 - Requirement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Requirement. 240.210-1 Section 240.210... THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.210-1 Requirement... the design requirements. An operations manual describing the various tasks to be performed, operating...

40 CFR 240.210-1 - Requirement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Requirement. 240.210-1 Section 240.210... THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.210-1 Requirement... the design requirements. An operations manual describing the various tasks to be performed, operating...

[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.

Study report recommendations for the next generation Range Safety System (RSS) Integrated Receiver/Decoder (IRD)

NASA Technical Reports Server (NTRS)

Crosby, Robert H.

1992-01-01

The Integrated Receiver/Decoder (IRD) currently used on the Space Shuttle was designed in the 1980 and prior time frame. Over the past 12 years, several parts have become obsolete or difficult to obtain. As directed by the Marshall Space Flight Center, a primary objective is to investigate updating the IRD design using the latest technology subsystems. To take advantage of experience with the current designs, an analysis of failures and a review of discrepancy reports, material review board actions, scrap, etc. are given. A recommended new design designated as the Advanced Receiver/Decoder (ARD) is presented. This design uses the latest technology components to simplify circuits, improve performance, reduce size and cost, and improve reliability. A self-test command is recommended that can improve and simplify operational procedures. Here, the new design is contrasted with the old. Possible simplification of the total Range Safety System is discussed, as is a single-step crypto technique that can improve and simplify operational procedures.

Media Center: Operations Handbook.

ERIC Educational Resources Information Center

Dependents Schools (DOD), Washington, DC.

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

The environmental analysis of helicopter operations by Federal agencies: Current procedures and research needs

NASA Technical Reports Server (NTRS)

Smith, C. C.; Warner, D. B.; Dajani, J. S.

1977-01-01

The technical, economic, and environmental problems restricting commercial helicopter passenger operations are reviewed. The key considerations for effective assessment procedures are outlined and a preliminary model for the environmental analysis of helicopters is developed. It is recommended that this model, or some similar approach, be used as a common base for the development of comprehensive environmental assessment methods for each of the federal agencies concerned with helicopters. A description of the critical environmental research issues applicable to helicopters is also presented.

Restoration Advisory Board (RAB) Implementation Guidelines

EPA Pesticide Factsheets

This document provides recommended procedures for establishing and operating Restoration Advisory Boards (RABs). It is intended as a resource for installation, EPA, and State personnel and citizens who participate in RABs.

Imperatives for Change; A Management Improvement Analysis of the Seattle Public Library. A Report to the Board of Trustees.

ERIC Educational Resources Information Center

Public Affairs Counseling, San Francisco, CA.

To develop organizational recommendations, propose new management procedures, and assist in budget preparation, a management improvement analysis was undertaken at the Seattle Public Library. Discussions were held with library board and supervising staff on all aspects of organization, operations, and services; a trial budget procedure was…

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

Code of Federal Regulations, 2011 CFR

2011-07-01

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

Positive Exchange of Flight Controls Program

DOT National Transportation Integrated Search

1995-03-10

This advisory circular provides guidance for all pilots, especially student pilots, flight instructors, and pilot examiners, on the recommended procedure to use for the positive exchange of flight controls between pilots when operating an aircraft.

40 CFR 68.56 - Maintenance.

Code of Federal Regulations, 2011 CFR

2011-07-01

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

40 CFR 68.56 - Maintenance.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

40 CFR 68.56 - Maintenance.

Code of Federal Regulations, 2012 CFR

2012-07-01

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

40 CFR 68.56 - Maintenance.

Code of Federal Regulations, 2014 CFR

2014-07-01

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

40 CFR 68.56 - Maintenance.

Code of Federal Regulations, 2013 CFR

2013-07-01

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

Medical Operations Console Procedure Evaluation: BME Response to Crew Call Down for an Emergency

NASA Technical Reports Server (NTRS)

Johnson-Troop; Pettys, Marianne; Hurst, Victor, IV; Smaka, Todd; Paul, Bonnie; Rosenquist, Kevin; Gast, Karin; Gillis, David; McCulley, Phyllis

2006-01-01

International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task completion and/or navigation, in particular the execution of the Surgeon call sequence. Debrief comments were used to analyze unclear procedural steps and to discern any discrepancies between the procedure and generally accepted BME actions. The sequence followed by BME participants differed considerably from the sequence intended by the procedure. Common deviations included the call sequence used to contact Surgeon, the content of BME and crew interaction and the gathering of pertinent console resources. Differing perceptions of task priority and imprecise language seem to have caused multiple deviations from the procedure s intended sequence. The study generated 40 recommendations for the procedure, of which 34 are being implemented. These recommendations address improving the clarity of the instructions, identifying training considerations, expediting Surgeon contact, improving cues for anticipated flight control team communication and identifying missing console tools.

Raising the quality of rheumatology management recommendations: lessons from the EULAR process 10 years after provision of standard operating procedures.

PubMed

Colebatch-Bourn, Alexandra N; Conaghan, Philip G; Arden, Nigel K; Cooper, Cyrus; Dougados, Maxime; Edwards, Christopher J

2015-08-01

To increase understanding of how to raise the quality of rheumatology guidelines by reviewing European League Against Rheumatism (EULAR) management recommendations, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, 10 years after publication of the EULAR standardized operating procedures (SOP) for the production of recommendations. It was hoped that this work could help inform improvements in guideline development by other societies and organizations. The SOP were published in 2004 to ensure the quality of EULAR-endorsed recommendations. We reviewed 27 published EULAR recommendations for management using the AGREE II tool. This provides a framework to assess the quality of guidelines across six broad domains using 23 specific questions. Overall the EULAR recommendations reviewed have been performed to a high standard. There are particular strengths in the methodology and presentation of the guidelines; however, the results indicate areas for development in future recommendations: in particular, stakeholder involvement and applicability of the recommendations. Improvements in quality were evident in recent years, with patient representation in 9 of 15 (60.0%) recommendations published 2010-14 compared with 4 of 12 (33.3%) published 2000-09. In the last 10 years the overall quality of recommendations was good, with standards improving over the decade following publication of the SOP. However, this review process has identified potential areas for improvement, especially in patient representation and provision of implementation tools. The lessons from this work can be applied to the development of rheumatology guidelines by other societies and organizations. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Abstract Model of the SATS Concept of Operations: Initial Results and Recommendations

NASA Technical Reports Server (NTRS)

Dowek, Gilles; Munoz, Cesar; Carreno, Victor A.

2004-01-01

An abstract mathematical model of the concept of operations for the Small Aircraft Transportation System (SATS) is presented. The Concept of Operations consist of several procedures that describe nominal operations for SATS, Several safety properties of the system are proven using formal techniques. The final goal of the verification effort is to show that under nominal operations, aircraft are safely separated. The abstract model was written and formally verified in the Prototype Verification System (PVS).

Testing Procedures for Open Circuit Air Diving H ELMETS AND Semi-Closed Circuit Mixed Gas Diving Helmets

DTIC Science & Technology

1973-12-18

abosrbent canister under all of the conditions in which the helmet will be expected to operate. These tests are very similar to those of Section III. B. 4... abosrbent canister will be operating but on air). Since the CO2 absorbent canister is not operating, it need not be instrumented. b. Recommended Tests -W 1

40 CFR 240.211-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... every 60 minutes and as changes are made. (5) Weights of bottom ash, grate siftings, and fly ash.... (10) Gross calorific value of daily representative samples of bottom ash, grate siftings, and fly ash...

Chapter 6. Protection of patients and staff during a pandemic. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Taylor, Bruce L; Montgomery, Hugh E; Rhodes, Andrew; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on protection of patients and staff. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including protection of patients and staff. Key recommendations include: (1) prepare infection control and occupational health policies for clinical risks relating to potential disease transmission; (2) decrease clinical risks and provide adequate facilities through advanced planning to maximise capacity by increasing essential equipment, drugs, supplies and encouraging staff availability; (3) create robust systems to maintain staff confidence and safety by minimising non-clinical risks and maintaining or escalating essential services; (4) prepare formal reassurance plans for legal protection; (5) provide assistance to staff working outside their normal domains. Judicious planning and adoption of protocols for protection of patients and staff are necessary to optimise outcomes during a pandemic.

On the design of flight-deck procedures

NASA Technical Reports Server (NTRS)

Degani, Asaf; Wiener, Earl L.

1994-01-01

In complex human-machine systems, operations, training, and standardization depend on a elaborate set of procedures which are specified and mandated by the operational management of the organization. The intent is to provide guidance to the pilots, to ensure a logical, efficient, safe, and predictable means of carrying out the mission objectives. In this report the authors examine the issue of procedure use and design from a broad viewpoint. The authors recommend a process which we call 'The Four P's:' philosophy, policies, procedures, and practices. We believe that if an organization commits to this process, it can create a set of procedures that are more internally consistent, less confusing, better respected by the flight crews, and that will lead to greater conformity. The 'Four-P' model, and the guidelines for procedural development in appendix 1, resulted from cockpit observations, extensive interviews with airline management and pilots, interviews and discussion at one major airframe manufacturer, and an examination of accident and incident reports. Although this report is based on airline operations, we believe that the principles may be applicable to other complex, high-risk systems, such as nuclear power production, manufacturing process control, space flight, and military operations.

Assessing the safety and efficacy of drugs used in preparing the nose for diagnostic and therapeutic procedures: a systematic review.

PubMed

Saif, A M; Farboud, A; Delfosse, E; Pope, L; Adke, M

2016-10-01

Local anaesthetics and vasoconstrictors are essential for pain control and to aid intra-operative haemostasis in nasal procedures. They also improve access, and reduce discomfort when performing nasal endoscopy. There are no clear guidelines on preparing the nose despite evermore diagnostic and therapeutic procedures utilising the nose as a point of access. This review aims to identify nasal preparations used in diagnostic and therapeutic nasal procedures and to examine their safety and efficacy. Systematic review. A search was carried out using PubMed, MEDLINE, Ovid EMBASE, the Cochrane library and references from the included articles. The inclusion criteria included: full-text English language articles with regard to nasal preparation for surgery. Case reports, systematic reviews, meta-analysis, double-blind placebo controlled randomised trials (RCTs) and case series were included. A total of 53 articles were retrieved: 13 articles on nasal preparation for operative procedures, six on functional endoscopic sinus surgery and 22 on nasendoscopy as well as six case reports. Cocaine was the most widely used topical preparation for operative procedures but was associated with more side-effects; thus, topical tetracaine and levobupivacaine infiltration are alternatives with equivalent efficacy but reduced adverse effects. All articles reviewed for functional endoscopic sinus surgery used a mixture containing lidocaine, adrenaline or both. Flexible nasendoscopy causes minimal patient discomfort and preparation is only recommended in selected patients, in contrast to rigid nasendoscopy which requires preparation. For operative procedures, such as septorhinoplasty, a single agent tetracaine or levobupivicaine provides an improved surgical field. In functional endoscopic sinus surgery, lidocaine-adrenaline preparations have resulted in significantly better surgical and patient outcomes. There is little evidence to support the routine use of pre-procedural nasal preparation for flexible nasendoscopy. Those undergoing rigid endoscopy conversely always require the use of a vasoconstrictor and local anaesthetic. Pre-procedure assessment of patients is recommended, with agents being reserved for those with low pain thresholds, high anxiety and small nasal apertures presenting resistance to the insertion of the endoscope. © 2015 John Wiley & Sons Ltd.

Long term pavement performance program protocol for calibrating traffic data collection equipment

DOT National Transportation Integrated Search

1998-05-10

This document describes the procedures that the Long Term Pavement Performance (LTPP) program recommends for ensuring that traffic data collection equipment used for LTPP traffic monitoring efforts operates correctly and collects valid data.

Applicability of NASA contract quality management and failure mode effect analysis procedures to the USGS Outer Continental Shelf oil and gas lease management program

NASA Technical Reports Server (NTRS)

Dyer, M. K.; Little, D. G.; Hoard, E. G.; Taylor, A. C.; Campbell, R.

1972-01-01

An approach that might be used for determining the applicability of NASA management techniques to benefit almost any type of down-to-earth enterprise is presented. A study was made to determine the following: (1) the practicality of adopting NASA contractual quality management techniques to the U.S. Geological Survey Outer Continental Shelf lease management function; (2) the applicability of failure mode effects analysis to the drilling, production, and delivery systems in use offshore; (3) the impact on industrial offshore operations and onshore management operations required to apply recommended NASA techniques; and (4) the probable changes required in laws or regulations in order to implement recommendations. Several management activities that have been applied to space programs are identified, and their institution for improved management of offshore and onshore oil and gas operations is recommended.

Chapter 9. Educational process. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Richards, Guy A; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with focus on education of all stakeholders, specifically the emergency executive control groups, ICU staff and staff co-opted to assist with patient management. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics, including staff education. Key recommendations include: (1) define functional roles and responsibilities of the internal personnel and interface agencies or sectors; (2) determine logistic support and requirements necessary for the effective implementation of the SOPs; (3) determine what is required to maintain the SOPs; (4) recommended training and activities include: (a) personal protection techniques; (b) environmental contamination; (c) medical management; (d) laboratory specimens; (e) alert lists; (f) training of recruited staff; (g) ethical issues; (h) psychosocial issues; (i) dealing with the deceased; (j) policies for restricting visitors; (k) mechanisms for enforcing policies; (5) Training should begin as soon as possible with daily demonstrations followed by supervised practice; (6) identify the staff to participate in training programs, verify that they have participated and evaluate their knowledge subsequently. Judicious planning and adoption of protocols for staff education are necessary to optimize outcomes during a pandemic.

[Cardiovascular assessment and management before non-cardiac surgery].

PubMed

Schwarz, Stefanie; Bernheim, Alain M

2015-05-06

The preoperative cardiovascular risk management accounts for patient-related risk factors, the circumstances leading to the surgical procedure, and the risk of the operation. While urgent operations should not be delayed for cardiac testing, an elective surgical intervention should be postponed in unstable cardiac conditions. In stable cardiac situations, prophylactic coronary interventions to reduce the risk of perioperative complications are rarely indicated. Therefore, in most cases, the planned operation can be performed without previous cardiac stress testing or coronary angiography. Preoperative imaging stress testing is recommended for patients with poor functional capacities that are at high cardiovascular risk prior to a high-risk operation. According to the literature, preoperative prophylactic administration of betablockers and aspirin is controversial. Preoperative discontinuation of dual anti-platelet therapy within six months following drug-eluting stent implantation is not recommended.

Nonsurgical Medical Penile Girth Augmentation: Experience-Based Recommendations.

PubMed

Oates, Jayson; Sharp, Gemma

2017-10-01

Penile augmentation is increasingly sought by men who are dissatisfied with the size and/or appearance of their penis. However, augmentation procedures are still considered to be highly controversial with no standardized recommendations reported in the medical literature and limited outcome data. Nevertheless, these procedures continue to be performed in increasing numbers in private settings. Therefore, there is a need for safe, effective, and minimally invasive procedures to be developed, evaluated, and reported in the research literature. In this article, we focus particularly on girth enhancement procedures rather than lengthening procedures as penile girth appears to be particularly important for sexual satisfaction. We discuss the advantages and disadvantages of the common techniques to date, with a focus on the minimally invasive injectable girth augmentation techniques. Based on considerable operative experience, we offer our own suggestions for patient screening, technique selection, and perioperative care. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

40 CFR 240.200-1 - Requirement.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-1 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.200-1 Requirement. In consultation with the responsible agencies, the owner/operator shall determine what wastes shall...

40 CFR 240.200-1 - Requirement.

Code of Federal Regulations, 2011 CFR

2011-07-01

...-1 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.200-1 Requirement. In consultation with the responsible agencies, the owner/operator shall determine what wastes shall...

Maintaining standards for surgery for female urinary incontinence.

PubMed

Riss, P; Hinterholzer, S

2010-01-01

MAINTAINING STANDARDS IN SURGERY FOR FEMALE URINARY INCONTINENCE: Operations for female stress urinary incontinence (SUI) are among the most common operations performed. In particular, recent advances in surgical technique and materials available for this type of surgery have made these operations more accessible, but even if an operation is characterized as "minimally invasive" surgeons must aim to maintain the highest possible standards in the interest of their patients. STANDARDS IN PATIENT SELECTION: Great care has to be taken to do a thorough workup of a patient about to undergo surgery. A detailed history and a good clinical evaluation including a clinical stress test is a prerequisite. It is highly recommended to do an urodynamic investigation prior to any surgery which affects bladder storage and micturition in order to confirm the presumptive diagnosis and to exclude patients who should not undergo surgery (e.g. with voiding disorders). STANDARDS IN SURGERY: Before taking a patient to theatre the surgeon must be clear in him or her mind about which operation to do. In other words preoperative selection of the appropriate type of operation is of the greatest importance. For this reason every surgeon has to be familiar with a certain range of incontinence procedures from which she can choose in a particular instance. There is no doubt that tension-free mid-urethral slings have become the procedures of choice in most cases of stress urinary incontinence. However, there will be cases where other procedures are called for such as traditional colposuspension or fascial slings. It is the responsibility of every surgeon not to use procedures which are outdated or not recommended. To maintain standards in incontinence surgery every surgeon has to familiarize him or herself with the procedure, to learn the procedure, to practice the procedure with the help of experienced peers, and finally to achieve the highest level of competence him or herself. So-called Industry sponsored "training centres" can be helpful but there are no shortcut to use all possible resources to learn and practice new surgery. Guidelines have become very important in evaluating new procedures and in categorizing the available evidence. They focus on specific recommendations which we can and should use in our daily practice. Again we still have the responsibility to follow the medical literature closely and to adapt our practice as new evidence becomes available-even before it is incorporated into guidelines. STANDARDS IN FOLLOW-UP: Last but not least we have to follow standards when following up on our patients. As far as possible in the context of the health care system where we practice we should aim to see the patient we have operated on at least once 6-12 weeks after surgery. We must also make sure that the patient has access to care in case a problem develops later. And we ourselves must be familiar with the complications and consequences of surgery for stress urinary incontinence and must be able to manage a patient who is not completely satisfied after surgery.

EVA safety: Space suit system interoperability

NASA Technical Reports Server (NTRS)

Skoog, A. I.; McBarron, J. W.; Abramov, L. P.; Zvezda, A. O.

1995-01-01

The results and the recommendations of the International Academy of Astronautics extravehicular activities (IAA EVA) Committee work are presented. The IAA EVA protocols and operation were analyzed for harmonization procedures and for the standardization of safety critical and operationally important interfaces. The key role of EVA and how to improve the situation based on the identified EVA space suit system interoperability deficiencies were considered.

Logistics Management Systems in Desert Shield/Desert Storm - How Well Did They Do?

DTIC Science & Technology

1992-04-07

were grovped into five major categories: Containerization and Packaging; Distribution Management ; Automation/Communications; Peace versus War Operations...incorporated into normal operating procedures. Distribution ManaQement. Distribution management was plagued with confusion throughout DS\\DS. This...to carrier terminals, depots and vendors. TDS recommendations to address the distribution management issue focused on: 1. Authorization of direct

CNC Turning Center Operations and Prove Out. Computer Numerical Control Operator/Programmer. 444-334.

ERIC Educational Resources Information Center

Skowronski, Steven D.

This student guide provides materials for a course designed to instruct the student in the recommended procedures used when setting up tooling and verifying part programs for a two-axis computer numerical control (CNC) turning center. The course consists of seven units. Unit 1 discusses course content and reviews and demonstrates set-up procedures…

Continuation of advanced crew procedures development techniques

NASA Technical Reports Server (NTRS)

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

1976-01-01

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

Lear jet telescope system

NASA Technical Reports Server (NTRS)

Erickson, E. F.; Goorvitch, D.; Dix, M. G.; Hitchman, M. J.

1974-01-01

The telescope system was designed as a multi-user facility for observations of celestial objects at infrared wavelengths, where ground-based observations are difficult or impossible due to the effects of telluric atmospheric absorption. The telescope is mounted in a Lear jet model 24B which typically permits 70 min. of observing per flight at altitudes in excess of 45,000 ft (13 km). Telescope system installation is discussed, along with appropriate setup and adjustment procedures. Operation of the guidance system is also explained, and checklists are provided which pertain to the recommended safe operating and in-flight trouble-shooting procedures for the equipment.

Standard operating procedures for neurophysiologic assessment of male sexual dysfunction.

PubMed

Giuliano, Francois; Rowland, David L

2013-05-01

Can neurophysiological testing in male patients with sexual dysfunction benefit the decision-making process? The answer remains unclear. To provide standard operating procedures for the neurophysiologic assessment of male sexual dysfunction. Medical literature was reviewed and combined with expert opinion of the authors. Bulbocavernosus reflex latency time, pudendal somatosensory evoked potentials, and sympathetic skin responses have been considered as potential candidates for the diagnosis and assessment of erectile dysfunction (ED). Currently, there is no consensus on a standardized methodology for these neurophysiological investigations in the overall assessment of ED. These procedures are unable to assess the integrity of the efferent parasympathetic proerectile penile innervation; accordingly, none of these assessment procedures is recommended for ED patients. Corpus cavernosum electromyography (CC-EMG) can detect abnormalities in cavernous smooth muscle although these alterations can be attributed both to damage to autonomic penile innervation and to degenerative processes of the cavernous smooth muscle. CC-EMG is still considered experimental. Evidence does not support that men with premature ejaculation (PE) are consistently characterized by penile hypersensitivity; accordingly, penile threshold determination is not recommended to in the diagnosis of PE. Neurophysiological investigation of other components of the penile sensory pathways in PE patients has not provided any definitive contribution to the diagnosis. No neurophysiological assessment procedures yield additional information that consistently aids in the assessment of PE and ED. © 2013 International Society for Sexual Medicine.

Early clinical outcomes following laparoscopic inguinal hernia repair.

PubMed

Tolver, Mette Astrup

2013-07-01

Laparoscopic inguinal hernia repair (TAPP) has gained increasing popularity because of less post-operative pain and a shorter duration of convalescence compared with open hernia repair technique (Lichtenstein). However, investigation of duration of convalescence with non-restrictive recommendations, and a procedure-specific characterization of the early clinical outcomes after TAPP was lacking. Furthermore, optimization of the post-operative period with fibrin sealant versus tacks for fixation of mesh, and the glucocorticoid dexamethasone versus placebo needed to be investigated in randomized clinical trials. The objective of this PhD thesis was to characterize the early clinical outcomes after TAPP and optimize the post-operative period. The four studies included in this thesis have investigated duration of convalescence and procedure-specific post-operative pain and other early clinical outcomes after TAPP. Furthermore, it has been shown that fibrin sealant can improve the early post-operative period compared with tacks, while dexamethasone showed no advantages apart from reduced use of antiemetics compared with placebo. Based on these findings, and the existing knowledge, 3-5 days of convalescence should be expected when 1 day of convalescence is recommended and future studies should focus on reducing intraabdominal pain after TAPP. Fibrin sealant can optimize the early clinical outcomes but the risk of hernia recurrence and chronic pain needs to be evaluated. Dexamethasone should be investigated in higher doses.

Trends in procedures for infertility and caesarean sections: was NICE disinvestment guidance implemented? NICE recommendation reminders.

PubMed

Chamberlain, Charlotte A; Martin, Richard M; Busby, John; Gilbert, Rebecca; Cahill, David J; Hollingworth, William

2013-02-06

National Institute for Health and Clinical Excellence (NICE) clinical guidelines and subsequent NICE issued 'recommendation reminders' advocate discontinuing two fertility procedures and caesarean sections in women with hepatitis. We assess whether NICE guidance in 2004 and recommendation reminders were associated with a change in the rate of clinical procedures performed. Routine inpatient Hospital Episode Statistics (HES) data were extracted from the HES database for 1st April 1998 to 31st March 2010 using OPCS procedure codes for varicocele operations in infertile men, endometrial biopsies in infertile women and caesarean sections in women with hepatitis B or C. We used Joinpoint regression to identify points in time when the trend in procedure rates changed markedly, to identify any influence of the release of NICE guidance. Between 1998-2010, planned caesarean sections in women with and without hepatitis B or C increased yearly (annual percentage change (APC) 4.9%, 95% CI 2.1% to 7.7%) in women with hepatitis, compared with women without (APC 4.0% [95% CI 2.7% to 5.3%] up to 2001, APC -0.6% [95% CI -2.8% to 1.8%] up to 2004 and 1.3% [95% CI 0.8% to 1.8%] up to 2010). In infertile women under 40 years of age, endometrial biopsies for investigation of infertility increased, APC 6.0% (95% CI 3.6% to 8.4%) up to 2003, APC 1.5% (95% CI -4.3% to 7.7%) to 2007 followed by APC 12.8% (95% CI 1.0% to 26.0%) to 2010. Varicocele procedures remained relatively static between 1998 and 2010 (APC -0.5%, 95% CI -2.3% to 1.3%). There was no decline in use of the three studied procedures, contrary to NICE guidance, and no change in uptake associated with the timing of NICE guidance or recommendation reminders. 'Do not do' recommendation reminders may be ineffective at improving clinical practice or achieving disinvestment.

Surgical treatment of malrotation after infancy: a population-based study.

PubMed

Malek, Marcus M; Burd, Randall S

2005-01-01

Because malrotation most commonly presents in infants, treatment recommendations for older children (>1 year) have been based on data obtained from small case series. The purpose of this study was to use a large national database to determine the clinical significance of older children presenting with malrotation to develop treatment recommendations for this group. Records of children undergoing a Ladd's procedure were identified in the Kids' Inpatient Database, an administrative database that contains all pediatric discharges from 27 states during 2000. Patient characteristics, associated diagnoses, operations performed, and mortality were evaluated. Discharge weighting was used to obtain a national estimate of the number of children older than 1 year treated for malrotation. Two hundred nineteen older children (>1 and <18 years) undergoing a Ladd's procedure were identified in the database. One hundred sixty-four (75%) of these patients were admitted for treatment of malrotation, whereas most of the remaining 55 patients (25%) were admitted for another diagnosis and underwent a Ladd's procedure incidental to another abdominal operation. Seventy-five patients underwent a Ladd's procedure during an emergency admission. Thirty-one patients had volvulus or intestinal ischemia, 7 underwent intestinal resection, and 1 patient died. Based on case weightings, it was estimated that 362 older children underwent a Ladd's procedure for symptoms related to malrotation in 2000 in the United States (5.3 cases per million population). These findings provide support for performing a Ladd's procedure in older children with incidentally found malrotation to prevent the rare but potentially devastating complications of this anomaly.

Challenges to decision-making processes in the national HTA agency in Brazil: operational procedures, evidence use and recommendations.

PubMed

Yuba, Tania Yuka; Novaes, Hillegonda Maria Dutilh; de Soárez, Patrícia Coelho

2018-05-11

The quality of the evidence used in health technology assessment (HTA) agency reports has been considered essential for decision-making processes and their legitimacy. In Brazil, CONITEC is the agency responsible for defining data mandatory for the submission of proposals for the incorporation of new technologies. The objective of this study was to analyse CONITEC recommendation reports, the type of scientific evidence used in them and their compliance with operational procedures. This is a descriptive study based on CONITEC official reports from July 2012 through December 2016. Data were collected with a specific extraction form and analysed using descriptive statistics. We evaluated 199 CONITEC recommendation reports. The annual number of reports increased during the study period. The absolute annual number of new technologies incorporated in 2013 (n = 24) was similar to that observed for 2014 (n = 24) and 2015 (n = 22), decreasing in 2016 (n = 13). The type of technology most frequently evaluated was 'drugs' (68.3%), followed by 'procedures' (20.1%). Overall, 117 (58.8%) reports were internal demands, 75 (37.7%) were external demands and 7 (3.5%) were mixed demands. There were differences between internal and external demands in terms of the evidence used in the reports and the decision regarding the recommendation to incorporate the technologies. Among the internal demands, the recommendation to incorporate the new technology was made for 70.9% of the reports, only 9.6% of which included full HTAs. Among the external demands, the incorporation of the new technology was recommended for 17.3% of the reports, 76.9% of which included full HTAs. Of the 101 reports in which incorporation of the new technology was recommended, 88 (87.1%) did not include a full health economic evaluation and ICER calculation. There are compliance difficulties with the recommendations in the CONITEC internal regulations regarding the type and quality of evidence considered in the analysis of recommendation reports. The characteristics of the evidence used in recommendation reports and those considered to be mandatory were very different, indicating problems in decision-making processes. There is a need to study, with a broader perspective, the factors that influence the type of evidence used in decision-making processes in order to contribute to the development of better practices and policies.

Implementing AORN recommended practices for care of patients undergoing pneumatic tourniquet-assisted procedures.

PubMed

Hicks, Rodney W; Denholm, Bonnie

2013-10-01

Perioperative nurses are likely to encounter the use of pneumatic tourniquets in a variety of operative and invasive extremity procedures. Use of a pneumatic tourniquet offers an opportunity to obtain a near-bloodless surgical field; however, the use of tourniquets is not without risk. Unfavorable outcomes include pain, thrombotic events, nerve compression injuries, and disruption of skin integrity. Perioperative nurses should be familiar with the indications, contraindications, and changes in physiology associated with pneumatic tourniquet use. The revised AORN "Recommended practices for care of patients undergoing pneumatic tourniquet-assisted procedures" is focused on the perioperative nurse's role in patient care and provides guidance for developing, implementing, and evaluating practices that promote patient safety and improve the likelihood of positive outcomes. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Determination of the performance of the Kaplan hydraulic turbines through simplified procedure

NASA Astrophysics Data System (ADS)

Pădureanu, I.; Jurcu, M.; Campian, C. V.; Haţiegan, C.

2018-01-01

A simplified procedure has been developed, compared to the complex one recommended by IEC 60041 (i.e. index samples), for measurement of the performance of the hydraulic turbines. The simplified procedure determines the minimum and maximum powers, the efficiency at maximum power, the evolution of powers by head and flow and to determine the correct relationship between runner/impeller blade angle and guide vane opening for most efficient operation of double-regulated machines. The simplified procedure can be used for a rapid and partial estimation of the performance of hydraulic turbines for repair and maintenance work.

Radiation exposure to the operator performing cardiac angiography with U-arm systems

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

Balter, S.; Sones, F.M. Jr.; Brancato, R.

The radiation exposure received by a group of operators performing 700 coronary angiograms was measured using the brachial artery approach and the Philips Cardio Diagnost. Nineteen sites were monitored on each operator, using lithium fluoride thermoluminescent dosimeters. Four hundred examinations were performed with a table-mounted protective shield in place. Three hundred were performed without the shield. The average exposures (in mR per study) with and without the shield were 1.9/6 for the eyes and 1.4/8.3 for the thyroid. The resulting operator exposure with the shield in place is low enough so that an operator performing 25 procedures per week onmore » a continuous basis will not exceed the recommendations of the National Commission on Radiological Protection and Units. We therefore strongly recommend the use of properly designed and appropriately positioned shield with all U-arm systems.« less

Radiation exposure to the operator performing cardiac angiography with U-arm systems

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

Balter, S.; Sones, F.M. Jr.; Brancato, R.

We measured the radiation exposure received by a group of operators performing 700 coronary angiograms. All studies were performed using the brachial artery approach and the Philips Cardio Diagnost. Nineteen sites were monitored on each operator, using lithium fluoride thermoluminescent dosimeters. Four hundred examinations were performed with a table-mounted protective shield in place. Three hundred were performed without the shield. The averge exposures (in mR per study) with and without the shield were 1.9/6 for the eyes and 1.4/8.3 for the thyroid. The resulting operator exposure with the shield in place is low enough so that an operator performing 25more » procedures per week on a continuous basis will not exceed the recommendations of the National Commission on Radiological Protection and Units. We therefore strongly recommend the use of properly designed and appropriately positioned shield with all U-arm systems.« less

16 CFR 1702.2 - Procedural requirements and recommendations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Procedural requirements and recommendations...; PETITION PROCEDURES AND REQUIREMENTS § 1702.2 Procedural requirements and recommendations. (a) Requirements... recommendations. The following are procedural recommendations to help the Commission in its consideration of...

16 CFR 1702.2 - Procedural requirements and recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Procedural requirements and recommendations...; PETITION PROCEDURES AND REQUIREMENTS § 1702.2 Procedural requirements and recommendations. (a) Requirements... recommendations. The following are procedural recommendations to help the Commission in its consideration of...

43 CFR 417.2 - Consultation with contractors.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION MEASURES... Regional Director of annual recommendations relating to water conservation measures and operating practices in the diversion, delivery, distribution and use of Colorado River water, and to the making by the...

43 CFR 417.2 - Consultation with contractors.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION MEASURES... Regional Director of annual recommendations relating to water conservation measures and operating practices in the diversion, delivery, distribution and use of Colorado River water, and to the making by the...

43 CFR 417.2 - Consultation with contractors.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION MEASURES... Regional Director of annual recommendations relating to water conservation measures and operating practices in the diversion, delivery, distribution and use of Colorado River water, and to the making by the...

43 CFR 417.2 - Consultation with contractors.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION MEASURES... Regional Director of annual recommendations relating to water conservation measures and operating practices in the diversion, delivery, distribution and use of Colorado River water, and to the making by the...

43 CFR 417.2 - Consultation with contractors.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION MEASURES... Regional Director of annual recommendations relating to water conservation measures and operating practices in the diversion, delivery, distribution and use of Colorado River water, and to the making by the...

77 FR 53841 - Amador County Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-04

... Self-Determination Act (Pub. L. 112-141) (the Act) and operates in compliance with the Federal Advisory...'s processes and procedures, review applications, and make recommendations for projects to be.... Written comments may be submitted as described under SUPPLEMENTARY INFORMATION. All comments, including...

NaK loop testing of thermoelectric converter modules (SNAP program)

NASA Technical Reports Server (NTRS)

Johnson, J. L.

1973-01-01

The history of testing of compact tubular modules in flowing NaK loops is summarized. Test procedures, data handling, and instrument calibration are discussed. Also included is descriptive information of the test facilities, operational problems encountered, and some recommendations for testing.

Spectrophotometric Titration of a Mixture of Calcium and Magnesium.

ERIC Educational Resources Information Center

Fulton, Robert; And Others

1986-01-01

Describes a spectrophotometric titration experiment which uses a manual titration spectrophotometer and manually operated buret, rather than special instrumentation. Identifies the equipment, materials, and procedures needed for the completion of the experiment. Recommends the use of this experiment in introductory quantitative analysis…

40 CFR 243.204-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... collection system. These records should be used for scheduling maintenance and replacement, for budgeting, and for system evaluation and comparison. (b) The collection system should be reviewed on a regular...) SOLID WASTES GUIDELINES FOR THE STORAGE AND COLLECTION OF RESIDENTIAL, COMMERCIAL, AND INSTITUTIONAL...

43 CFR 417.3 - Notice of recommendations and determinations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... RECLAMATION, DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION... raised, cropping practices, the type of irrigation system in use, the condition of water carriage and distribution facilities, record of water orders, and rejections of ordered water, general operating practices...

43 CFR 417.3 - Notice of recommendations and determinations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... RECLAMATION, DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION... raised, cropping practices, the type of irrigation system in use, the condition of water carriage and distribution facilities, record of water orders, and rejections of ordered water, general operating practices...

43 CFR 417.3 - Notice of recommendations and determinations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RECLAMATION, DEPARTMENT OF THE INTERIOR PROCEDURAL METHODS FOR IMPLEMENTING COLORADO RIVER WATER CONSERVATION... raised, cropping practices, the type of irrigation system in use, the condition of water carriage and distribution facilities, record of water orders, and rejections of ordered water, general operating practices...

IMPORTANCE OF CONTEXTUAL DATA IN PRODUCING HEALTH TECHNOLOGY ASSESSMENT RECOMMENDATIONS: A CASE STUDY.

PubMed

Poder, Thomas G; Bellemare, Christian A

2018-01-01

Contextual data and local expertise are important sources of data that cannot be ignored in hospital-based health technology assessment (HTA) processes. Despite a lack of or unconvincing evidence in the scientific literature, technology can be recommended in a given context. We illustrate this using a case study regarding biplane angiography for vascular neurointervention. A systematic literature review was conducted, along with an analysis of the context in our setting. The outcomes of interest were radiation doses, clinical complications, procedure times, purchase cost, impact on teaching program, the confidence of clinicians in the technology, quality of care, accessibility, and the volume of activity. A committee comprising managers, clinical experts, physicians, physicists and HTA experts was created to produce a recommendation regarding biplane technology acquisition to replace a monoplane device. The systematic literature review yielded nine eligible articles for analysis. Despite a very low level of evidence in the literature, the biplane system appears to reduce ionizing radiation and medical complications, as well as shorten procedure time. Contextual data indicated that the biplane system could improve operator confidence, which could translate into reduced risk, particularly for complex procedures. In addition, the biplane system can support our institution in its advanced procedures teaching program. Given the advantages provided by the biplane technology in our setting, the committee has recommended its acquisition. Contextual data were of utmost importance in this recommendation. Moreover, this technology should be implemented alongside a responsibility to collect outcome data to optimize clinical protocol in the doses of ionizing delivered.

Skin penetration operators' knowledge and attitudes towards infection control.

PubMed

Oberdorfer, Aurmporn; Wiggers, John H; Considine, Robyn J; Bowman, Jenny; Cockburn, Jill

2003-01-01

To assess the knowledge and attitudes of owners/managers of commercial skin-penetration premises regarding infection control. A telephone survey was conducted with a randomly selected sample of 874 owners/managers. Participants appeared to lack knowledge of essential infection-control practices. Less than 39% correctly identified recommended disinfection procedures, and between 12% to 67% were not aware of inappropriate sterlization procedures. Almost all participants accepted the need for guidelines. Half acknowledged a need to improve their infection-control compliance, and most accepted having their premises regularly checked by the councils. There is a considerable opportunity to increase infection-control compliance among skin-penetration operators.

Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Hick, John L; Christian, Michael D; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for a mass disaster or influenza epidemic with a specific focus on surge capacity and infrastructure considerations. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including surge capacity and infrastructure considerations. Key recommendations include: (1) hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas; (2) hospitals should have appropriate beds and monitors for these expansion areas; hospitals should develop contingency plans at the facility and government (local, state, provincial, national) levels to provide additional ventilators; (3) hospitals should develop a phased staffing plan (nursing and physician) for ICUs that provides sufficient patient care supervision during contingency and crisis situations; (4) hospitals should provide expert input to the emergency management personnel at the hospital both during planning for surge capacity as well as during response; (5) hospitals should assure that adequate infrastructure support is present to support critical care activities; (6) hospitals should prioritize locations for expansion by expanding existing ICUs, using postanesthesia care units and emergency departments to capacity, then step-down units, large procedure suites, telemetry units and finally hospital wards. Judicious planning and adoption of protocols for surge capacity and infrastructure considerations are necessary to optimize outcomes during a pandemic.

Calibration and evaluation of a dispersant application system

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

Shum, J.S.

1987-05-01

The report presents recommended methods for calibrating and operating boat-mounted dispersant application systems. Calibration of one commercially-available system and several unusual problems encountered in calibration are described. Charts and procedures for selecting pump rates and other operating parameters in order to achieve a desired dosage are provided. The calibration was performed at the EPA's Oil and Hazardous Materials Simulated Environmental Test Tank (OHMSETT) facility in Leonardo, New Jersey.

40 CFR 240.211-3 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... measurements and laboratory analyses required by the responsible agency. (12) Complete records of monitoring... waste received and processed, summarized on a monthly basis. (2) A summary of the laboratory analyses including at least monthly averages. (3) Number and qualifications of personnel in each job category; total...

40 CFR 57.404 - Measurements, records, and reports.

Code of Federal Regulations, 2010 CFR

2010-07-01

... and record at least one measurement of sulfur dioxide concentration and stack gas flow rate from the... manufacturer's recommended zero adjustment and calibration procedures at least once per 24-hour operating... which clearly show instrument readings before and after zero adjustment and calibration. (5) The results...

Criteria for Centralized Warehousing Procedures in Public School Districts. Summary Report.

ERIC Educational Resources Information Center

Forsythe, Ralph A.; Thomson, Leland A.

This survey of opinions of architects, certified public accountants, and educators (who have written concerning, shown leadership in, or have specialized knowledge about warehousing) covers the planning, organizing, material handling, and paper processing of presently operated school district central warehouses. All recommendations concerning…

77 FR 49779 - Meeting of the Amador County Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-17

... Community Self-Determination Act (Pub. L. 112-141) (the Act) and operates in compliance with the Federal... committee's processes and procedures, review applications, and make recommendations for projects to be.... Written comments may be submitted as described under Supplementary Information. All comments, including...

Legacy of Operational Space Medicine During the Space Shuttle Program

NASA Technical Reports Server (NTRS)

Stepaniakm, P.; Gilmore, S.; Johnston, S.; Chandler, M.; Beven, G.

2011-01-01

The Johnson Space Center s Medical Science Division branches were involved in preparing astronauts for space flight during the 30 year period of the Space Shuttle Program. These branches included the Flight Medicine Clinic, Medical Operations and the Behavioral Health Program. The components of each facet of these support services were: the Flight Medicine Clinic s medical selection process and medical care; the Medical Operations equipment, training, procedures and emergency medical services; and the Behavioral Health and Performance operations. Each presenter will discuss the evolution of its operations, implementations, lessons learned and recommendations for future vehicles and short duration space missions.

75 FR 62639 - Air Ambulance and Commercial Helicopter Operations, Part 91 Helicopter Operations, and Part 135...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-12

...This proposed rule addresses air ambulance and commercial helicopter operations, part 91 helicopter operations, and load manifest requirements for all part 135 aircraft. From 2002 to 2008, there has been an increase in fatal helicopter air ambulance accidents. To address these safety concerns, the FAA is proposing to implement operational procedures and require additional equipment on board helicopter air ambulances. Many of these proposed requirements currently are found in agency guidance publications and would address National Transportation Safety Board (NTSB) safety recommendations. Some of these safety concerns are not unique to the helicopter air ambulance industry and affect all commercial helicopter operations. Accordingly, the FAA also is proposing to amend regulations pertaining to all commercial helicopter operations conducted under part 135 to include equipment requirements, pilot training, and alternate airport weather minima. The changes are intended to provide certificate holders and pilots with additional tools and procedures that will aid in preventing accidents.

The economics and timing of preoperative antibiotics for orthopaedic procedures.

PubMed

Norman, B A; Bartsch, S M; Duggan, A P; Rodrigues, M B; Stuckey, D R; Chen, A F; Lee, B Y

2013-12-01

The efficacy of antibiotics in preventing surgical site infections (SSIs) depends on the timing of administration relative to the start of surgery. However, currently, both the timing of and recommendations for administration vary substantially. To determine how the economic value from the hospital perspective of preoperative antibiotics varies with the timing of administration for orthopaedic procedures. Computational decision and operational models were developed from the hospital perspective. Baseline analyses looked at current timing of administration, while additional analyses varied the timing of administration, compliance with recommended guidelines, and the goal time-interval. Beginning antibiotic administration within 0-30 min prior to surgery resulted in the lowest costs and SSIs. Operationally, linking to a pre-surgical activity, administering antibiotics prior to incision but after anaesthesia-ready time was optimal, as 92.1% of the time, antibiotics were administered in the optimal time-interval (0-30 min prior to incision). Improving administration compliance from 80% to 90% for this pre-surgical activity results in cost savings of $447 per year for a hospital performing 100 orthopaedic operations a year. This study quantifies the potential cost-savings when antibiotic administration timing is improved, which in turn can guide the amount hospitals should invest to address this issue.

Evidence-Based Management of Pain After Excisional Haemorrhoidectomy Surgery: A PROSPECT Review Update.

PubMed

Sammour, Tarik; Barazanchi, Ahmed W H; Hill, Andrew G

2017-02-01

The aim of this systematic review was to update previous PROSPECT ( http://www.postoppain.org ) review recommendations for the management of pain after excisional haemorrhoidectomy. Randomized studies and reviews published in the English language from July 2006 (end date of last review) to March 2016, assessing analgesic, anaesthetic, and operative interventions pertaining to excisional haemorrhoidectomy in adults, and reporting pain scores, were retrieved from the EMBASE and MEDLINE databases. An additional 464 studies were identified of which 74 met the inclusion criteria. There were 48 randomized controlled trials and 26 reviews. Quantitative analyses were not performed, as there were limited numbers of trials with a sufficiently homogeneous design. Pudendal nerve block, with or without general anaesthesia, is recommended for all patients undergoing haemorrhoidal surgery. Either closed haemorrhoidectomy, or open haemorrhoidectomy with electrocoagulation of the pedicle is recommended as the primary procedure. Combinations of analgesics (paracetamol, non-steroidal anti-inflammatory drugs, and opioids), topical lignocaine and glyceryl trinitrate, laxatives, and oral metronidazole are recommended post-operatively. The recommendations are largely based on single intervention, not multimodal intervention, studies.

Factors associated with use of pre-operative chemoradiation therapy for rectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium

PubMed Central

Charlton, Mary E.; Lin, Chi; Jiang, Dingfeng; Stitzenberg, Karyn B.; Halfdanarson, Thorvardur R.; Pendergast, Jane F.; Chrischilles, Elizabeth A.; Wallace, Robert B.

2012-01-01

Purpose Pre-operative (pre-op) chemoradiation therapy (CRT) improves local control and reduces toxicity more than post-operative (post-op) CRT for the treatment of stages II/III rectal cancer, but studies suggest many patients still receive post-op CRT. We examined patient beliefs, and clinical and provider characteristics associated with receipt of recommended therapy. Methods We identified stage II/III rectal cancer patients who had primary site resection and CRT among subjects in the Cancer Care Outcomes Research and Surveillance Consortium, a population- and health system-based prospective cohort of newly diagnosed colorectal cancer patients from 2003 to 2005. Patient surveys and abstracted medical records were used to construct variables and determine sequence of CRT and surgery. Logistic regression was used to model the association between predictors and receipt of pre-op CRT. Results Of the 201 patients, 66% received pre-op and 34% received post-op CRT. Those visiting a medical oncologist and/or radiation oncologist prior to a surgeon had a 96% (95% CI, 92% to 100%) predicted probability of receiving pre-op CRT, compared to 48% (95% CI, 41% to 55%) for those visiting a surgeon first. Among those visiting a surgeon first, documentation of recommended staging procedures was associated with receiving pre-op CRT. Conclusion Sequence of provider visits and documentation of recommended staging procedures were important predictors of receiving pre-op CRT. Initial multidisciplinary evaluation led to better adherence to CRT guidelines. Further evaluation of provider characteristics, referral patterns and related health system processes should be undertaken to inform targeted interventions to reduce variation from recommended care. PMID:22992624

Cultural Myopia: The Need for a Corrective Lens

ERIC Educational Resources Information Center

Gerry, Martin H.

1973-01-01

To recognize the differing linguistic characteristics and cultural identity of minority children in the planning and operation of education programs, this task group recommended the development of additional policies to notify school districts of the types of discriminatory practices that might be occurring and to set forth model procedures which…

40 CFR 246.201-3 - Recommended procedures: Glass, can, and mixed paper separation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Glass, can... and Recommended Procedures § 246.201-3 Recommended procedures: Glass, can, and mixed paper separation. In areas where markets are available, it is recommended that glass, cans, and mixed paper be...

40 CFR 246.201-3 - Recommended procedures: Glass, can, and mixed paper separation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Glass, can... and Recommended Procedures § 246.201-3 Recommended procedures: Glass, can, and mixed paper separation. In areas where markets are available, it is recommended that glass, cans, and mixed paper be...

Implementation of a near-zero fluoroscopy approach in interventional electrophysiology: impact of operator experience.

PubMed

Wannagat, Severin; Loehr, Lena; Lask, Sebastian; Völk, Katharina; Karaköse, Tamer; Özcelik, Cemil; Mügge, Andreas; Wutzler, Alexander

2018-04-01

Catheter ablation is performed under fluoroscopic guidance. Reduction of radiation dose for patients and staff is emphasized by current recommendations. Previous studies have shown that lower operator experience leads to increased radiation dose. On the other hand, less experienced operators may depend even more on fluoroscopic guidance. Our study aimed to evaluate feasibility and efficacy of a non-fluoroscopic approach in different training levels. From January 2017, a near-zero fluoroscopy approach was established in two centers. Four operators (beginner, 1st year fellow, 2nd year fellow, expert) were instructed to perform the complete procedure with the use of a 3-D mapping system without fluoroscopy. A historical cohort that underwent procedures with fluoroscopy use served as control group. Dose area product (DPA), procedure duration, acute procedural success, and complications were compared between the groups and for each operator. Procedures were performed in 157 patients. The first 100 patients underwent procedures with fluoroscopic guidance, the following 57 procedures were performed with the near-zero fluoroscopy approach. The results show a significant reduction in DPA for all operators immediately after implementation of the near-zero fluoroscopy protocol (control 637 ± 611 μGy/m 2 ; beginner 44.1 ± 79.5 μGy/m 2 , p = 0.002; 1st year fellow 24.3 ± 46.4.5 μGy/m 2 , p = 0.001; 2nd year fellow 130.3 ± 233.3 μGy/m 2 , p = 0.003; expert 9.3 ± 37.4 μGy/m 2 , P < 0.001). Procedure duration, acute success, and complications were not significantly different between the groups. Our results show a 90% reduction of DPA shortly after implementation of a near-zero fluoroscopy approach in interventional electrophysiology even in operators in training.

Trends in procedures for infertility and caesarean sections: was NICE disinvestment guidance implemented? NICE recommendation reminders

PubMed Central

2013-01-01

Background National Institute for Health and Clinical Excellence (NICE) clinical guidelines and subsequent NICE issued ‘recommendation reminders’ advocate discontinuing two fertility procedures and caesarean sections in women with hepatitis. We assess whether NICE guidance in 2004 and recommendation reminders were associated with a change in the rate of clinical procedures performed. Methods Routine inpatient Hospital Episode Statistics (HES) data were extracted from the HES database for 1st April 1998 to 31st March 2010 using OPCS procedure codes for varicocele operations in infertile men, endometrial biopsies in infertile women and caesarean sections in women with hepatitis B or C. We used Joinpoint regression to identify points in time when the trend in procedure rates changed markedly, to identify any influence of the release of NICE guidance. Results Between 1998-2010, planned caesarean sections in women with and without hepatitis B or C increased yearly (annual percentage change (APC) 4.9%, 95% CI 2.1% to 7.7%) in women with hepatitis, compared with women without (APC 4.0% [95% CI 2.7% to 5.3%] up to 2001, APC -0.6% [95% CI -2.8% to 1.8%] up to 2004 and 1.3% [95% CI 0.8% to 1.8%] up to 2010). In infertile women under 40 years of age, endometrial biopsies for investigation of infertility increased, APC 6.0% (95% CI 3.6% to 8.4%) up to 2003, APC 1.5% (95% CI -4.3% to 7.7%) to 2007 followed by APC 12.8% (95% CI 1.0% to 26.0%) to 2010. Varicocele procedures remained relatively static between 1998 and 2010 (APC -0.5%, 95% CI -2.3% to 1.3%). Conclusions There was no decline in use of the three studied procedures, contrary to NICE guidance, and no change in uptake associated with the timing of NICE guidance or recommendation reminders. ‘Do not do’ recommendation reminders may be ineffective at improving clinical practice or achieving disinvestment. PMID:23388377

Abnormal/Emergency Situations. Impact of Unmanned Aircraft Systems Emergency and Abnormal Events on the National Airspace System

NASA Technical Reports Server (NTRS)

2006-01-01

Access 5 analyzed the differences between UAS and manned aircraft operations under five categories of abnormal or emergency situations: Link Failure, Lost Communications, Onboard System Failures, Control Station Failures and Abnormal Weather. These analyses were made from the vantage point of the impact that these operations have on the US air traffic control system, with recommendations for new policies and procedures included where appropriate.

Status report on the land processes aircraft science management operations working group

NASA Technical Reports Server (NTRS)

Lawless, James G.; Mann, Lisa J.

1991-01-01

Since its inception three years ago, the Land Processes Aircraft Science Management Operations Working Group (MOWG) provided recommendations on the optimal use of the Agency's aircraft in support of the Land Processes Science Program. Recommendations covered topics such as aircraft and sensor usage, development of long-range plans, Multisensor Airborne Campaigns (MAC), program balance, aircraft sensor databases, new technology and sensor development, and increased University scientist participation in the program. Impacts of these recommendations improved the efficiency of various procedures including the flight request process, tracking of flight hours, and aircraft usage. The group also created a bibliography focused on publications produced by Land Processes scientists from the use of the aircraft program, surveyed NASA funded PI's on their participation in the aircraft program, and developed a planning template for multi-sensor airborne campaigns. Benefits from these activities are summarized.

Implementation of Recommendations from the One System Comparative Evaluation of the Hanford Tank Farms and Waste Treatment Plant Safety Bases

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

Garrett, Richard L.; Niemi, Belinda J.; Paik, Ingle K.

2013-11-07

A Comparative Evaluation was conducted for One System Integrated Project Team to compare the safety bases for the Hanford Waste Treatment and Immobilization Plant Project (WTP) and Tank Operations Contract (TOC) (i.e., Tank Farms) by an Expert Review Team. The evaluation had an overarching purpose to facilitate effective integration between WTP and TOC safety bases. It was to provide One System management with an objective evaluation of identified differences in safety basis process requirements, guidance, direction, procedures, and products (including safety controls, key safety basis inputs and assumptions, and consequence calculation methodologies) between WTP and TOC. The evaluation identified 25more » recommendations (Opportunities for Integration). The resolution of these recommendations resulted in 16 implementation plans. The completion of these implementation plans will help ensure consistent safety bases for WTP and TOC along with consistent safety basis processes. procedures, and analyses. and should increase the likelihood of a successful startup of the WTP. This early integration will result in long-term cost savings and significant operational improvements. In addition, the implementation plans lead to the development of eight new safety analysis methodologies that can be used at other U.S. Department of Energy (US DOE) complex sites where URS Corporation is involved.« less

Operations & Maintenance Best Practices - A Guide to Achieving Operational Efficiency (Release 3)

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

Sullivan, Greg; Pugh, Ray; Melendez, Aldo P.

This guide highlights operations and maintenance programs targeting energy and water efficiency that are estimated to save 5% to 20% on energy bills without a significant capital investment. The purpose of this guide is to provide you, the Operations and Maintenance (O&M)/Energy manager and practitioner, with useful information about O&M management, technologies, energy and water efficiency, and cost-reduction approaches. To make this guide useful and to reflect your needs and concerns, the authors met with O&M and Energy managers via Federal Energy Management Program (FEMP) workshops. In addition, the authors conducted extensive literature searches and contacted numerous vendors and industrymore » experts. The information and case studies that appear in this guide resulted from these activities. It needs to be stated at the outset that this guide is designed to provide information on effective O&M as it applies to systems and equipment typically found at Federal facilities. This guide is not designed to provide the reader with step-by-step procedures for performing O&M on any specific piece of equipment. Rather, this guide first directs the user to the manufacturer's specifications and recommendations. In no way should the recommendations in this guide be used in place of manufacturer's recommendations. The recommendations in this guide are designed to supplement those of the manufacturer, or, as is all too often the case, provide guidance for systems and equipment for which all technical documentation has been lost. As a rule, this guide will first defer to the manufacturer's recommendations on equipment operation and maintenance.« less

Experience reveals ways to minimize failures in rod-pumped wells

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

Patterson, J.C.; Bucaram, S.M.; Curfew, J.V.

From the experience gained over the past 25 years, ARCO Oil and Gas Co. has developed recommendations to reduce equipment failure in sucker-rod pumping installations. These recommendations include equipment selection and design, operating procedures, and chemical treatment. Equipment failure and its attendant costs are extremely important in today's petroleum industry. Because rod pumping is the predominant means of artificial lift, minimizing equipment failure in rod pumped wells can have a significant impact on profitability. This compilation of recommendations comes from field locations throughout the US and other countries. The goal is to address and solve problems on a well-by-well basis.

Aesthetic Surgery of the Buttocks Using Implants: Practice-Based Recommendations.

PubMed

Senderoff, Douglas M

2016-05-01

The demand for gluteal enhancement has increased rapidly in the past few years. In this Continuing Medical Education (CME) article, the evaluation, surgical planning, operative technique, and management of potential complications of gluteal augmentation using solid silicone implants are discussed. Practice-based recommendations are presented along with a review of the scientific literature. The intramuscular and subfascial technique is described along with a discussion of the advantages and disadvantages of each approach. Guidelines for implant selection, placement, and revisional procedures are presented along with recommendations for maximizing successful outcomes. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Human Factors Process Task Analysis Liquid Oxygen Pump Acceptance Test Procedure for the Advanced Technology Development Center

NASA Technical Reports Server (NTRS)

Diorio, Kimberly A.

2002-01-01

A process task analysis effort was undertaken by Dynacs Inc. commencing in June 2002 under contract from NASA YA-D6. Funding was provided through NASA's Ames Research Center (ARC), Code M/HQ, and Industrial Engineering and Safety (IES). The John F. Kennedy Space Center (KSC) Engineering Development Contract (EDC) Task Order was 5SMA768. The scope of the effort was to conduct a Human Factors Process Failure Modes and Effects Analysis (HF PFMEA) of a hazardous activity and provide recommendations to eliminate or reduce the effects of errors caused by human factors. The Liquid Oxygen (LOX) Pump Acceptance Test Procedure (ATP) was selected for this analysis. The HF PFMEA table (see appendix A) provides an analysis of six major categories evaluated for this study. These categories include Personnel Certification, Test Procedure Format, Test Procedure Safety Controls, Test Article Data, Instrumentation, and Voice Communication. For each specific requirement listed in appendix A, the following topics were addressed: Requirement, Potential Human Error, Performance-Shaping Factors, Potential Effects of the Error, Barriers and Controls, Risk Priority Numbers, and Recommended Actions. This report summarizes findings and gives recommendations as determined by the data contained in appendix A. It also includes a discussion of technology barriers and challenges to performing task analyses, as well as lessons learned. The HF PFMEA table in appendix A recommends the use of accepted and required safety criteria in order to reduce the risk of human error. The items with the highest risk priority numbers should receive the greatest amount of consideration. Implementation of the recommendations will result in a safer operation for all personnel.

The risk of eye splash in burn surgery.

PubMed

Tehrani, H; Juma, A; Lambe, G; James, M I

2009-06-01

Although the incidence of eye splash injury has been assessed for a number of surgical specialities, such risks posed to the burn surgeon have not been previously quantified. During 100 consecutive procedures the operating burns team wore a clean set of goggles, counting the number of blood splashes on the goggles after each procedure. During this study there were 47 cases of potential eye splash injury, although the individual was only aware of 2 of these intra-operatively. Seven of the splashes involved more than 6 blood droplets on the goggles. The consultant burn surgeon was the most likely to be splashed, sustaining a potential injury in over half cases operated upon. Procedures greater than 45 min in length were more likely to result in a splash than those shorter than 45 min. We recommend that eye protection should be used either in the form of goggles or a visor and should encompass all burn theatre cases as a matter of policy.

Standard formatted data units-control authority procedures

NASA Technical Reports Server (NTRS)

1991-01-01

The purpose of this document is to establish a set of minimum and optional requirements for the implementation of Control Authority (CA) organizations within and among the Agencies participating in the Consultative Committee for Space Data Systems (CCSDS). By satisfying these requirements, the resultant cooperating set of CA organizations will produce a global CA service supporting information transfer with digital data under the Standard Formatted Data Unit (SFDU) concept. This service is primarily accomplished through the registration, permanent archiving, and dissemination of metadata in the form of Metadata Objects (MDO) that assist in the interpretation of data objects received in SFDU form. This Recommendation addresses the responsibilities, services, and interface protocols for a hierarchy of CA organizations. The top level, consisting of the CCSDS Secretariat and its operational agent, is unique and primarily provides a global coordination function. The lower levels are Agency CA organizations that have primary responsibility for the registration, archiving, and dissemination of MDOs. As experience is gained and technology evolves, the CA Procedures will be extended to include enhanced services and their supporting protocols. In particular, it is anticipated that eventually CA organizations will be linked via networks on a global basis, and will provide requestors with online automated access to CA services. While this Recommendation does not preclude such operations, it also does not recommend the specific protocols to be used to ensure global compatibility of these services. These recommendations will be generated as experience is gained.

[Rectal carcinoma in a 24-year-old man with Hirschsprung's disease].

PubMed

Henriksen, Jeppe; Green, Charlotte; Ljungmann, Ken

2018-06-18

This case report presents an incident of rectal carcinoma in a 24-year-old man with Hirschsprung's disease, for which he was operated in his early childhood, with a Soave pull-through procedure. No direct association between Hirschsprung's disease and rectal cancer was found in our review of the literature. However, several case reports of rectal cancers following pull-through procedures exist. A low threshold for further clinical investigations is recommended, if these patients are presenting with gastrointestinal symptoms.

Rapid insulin sensitivity test (RIST).

PubMed

Lautt, W W; Wang, X; Sadri, P; Legare, D J; Macedo, M P

1998-12-01

A rapid insulin sensitivity test (RIST) was recently introduced to assess insulin action in vivo (H. Xie, L. Zhu, Y.L. Zhang, D.J. Legare, and W.W. Lautt. J. Pharmacol. Toxicol. Methods, 35: 77-82. 1996). This technical report describes the current recommended standard operating procedure for the use of the RIST in rats based upon additional experience with approximately 100 tests. We describe the manufacture and use of an arterial-venous shunt that allows rapid multiple arterial samples and intravenous administration of drugs. The RIST procedure involves determination of a stable arterial glucose baseline to define the ideal euglycemic level to be maintained following a 5-min infusion of insulin, with the RIST index being the amount of glucose required to be infused to maintain euglycemia over the test period. Insulin administration by a 5-min infusion is preferable to a 30-s bolus administration. No significant difference was determined between the use of Toronto pork-beef or human insulin. Four consecutive RISTs were carried out in the same animal over 4-5 h with no tendency for change with time. The RIST index is sufficiently sensitive and reproducible to permit establishment of insulin dose-response curves and interference of insulin action by elimination of hepatic parasympathetic nerves, using atropine. This technical report provides the current recommended standard operating procedure for the RIST.

Formalising multidisciplinary peer review: developing a haematological malignancy-specific electronic proforma and standard operating procedure to facilitate procedural efficiency and evidence-based clinical practice.

PubMed

Trotman, Judith; Trinh, Jimmy; Kwan, Yiu Lam; Estell, Jane A; Fletcher, Julie; Archer, Kate; Lee, Kenneth; Foo, Kerwin; Curnow, Jennifer; Bianchi, Alessandra; Wignall, Lynda; Verner, Emma; Gasiorowski, Robin; Siedlecka, Elizabeth; Cunningham, Ilona

2017-05-01

Multidisciplinary team (MDT) meetings aimed at facilitating peer review have become standard practice in oncology. However, there is scant literature on the optimal structure and conduct of such meetings. To develop a process for formal peer review of patients with haematological malignancies and to audit any resulting changes made to the management recommendations of the treating physician. A standard operating procedure (SOP) for MDT meetings was developed essentially to integrate clinical peer review with weekly pathology and radiology meetings. The centrepiece is the electronic submission of a patient-specific proforma (Microsoft InfoPath) prior to the meeting. It serves as the template for presentation, discussion and recording of recommendations and conclusions. The final verified document is stored in the electronic patient record, and a copy is sent to the general practitioner. The proposed management plans were compared to the consensus recommendations of the meeting for the first 4 years since inception. Both SOP and proforma underwent continual improvements. These provided the framework for the conduct of a robust weekly MDT meeting for peer review of the management of patients with haematological malignancies. On 20% of occasions, patient management plans were altered to optimise patient care as a direct consequence on peer review at the MDT. Our streamlined process, in its ultimate format, has provided a mature and efficient forum for formal peer review in a genuine multidisciplinary environment. Both initial data and informal feedback support its ongoing activity as an integral component of delivering quality patient care. © 2016 Royal Australasian College of Physicians.

(abstract) Mission Operations and Control Assurance: Flight Operations Quality Improvements

NASA Technical Reports Server (NTRS)

Welz, Linda L.; Bruno, Kristin J.; Kazz, Sheri L.; Witkowski, Mona M.

1993-01-01

Mission Operations and Command Assurance (MO&CA), a recent addition to flight operations teams at JPL. provides a system level function to instill quality in mission operations. MO&CA's primary goal at JPL is to help improve the operational reliability for projects during flight. MO&CA tasks include early detection and correction of process design and procedural deficiencies within projects. Early detection and correction are essential during development of operational procedures and training of operational teams. MO&CA's effort focuses directly on reducing the probability of radiating incorrect commands to a spacecraft. Over the last seven years at JPL, MO&CA has become a valuable asset to JPL flight projects. JPL flight projects have benefited significantly from MO&CA's efforts to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit directly from previous and ongoing experience. Since MO&CA, like Total Quality Management (TQM), focuses on continuous improvement of processes and elimination of rework, we recommend that this effort be continued on NASA flight projects.

Integrated Data Collection Analysis (IDCA) Program - Mixing Procedures and Materials Compatibility

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

Olinger, Becky D.; Sandstrom, Mary M.; Warner, Kirstin F.

Three mixing procedures have been standardized for the IDCA proficiency test—solid-solid, solid-liquid, and liquid-liquid. Due to the variety of precursors used in formulating the materials for the test, these three mixing methods have been designed to address all combinations of materials. Hand mixing is recommended for quantities less than 10 grams and Jar Mill mixing is recommended for quantities over 10 grams. Consideration must also be given to the type of container used for the mixing due to the wide range of chemical reactivity of the precursors and mixtures. Eight web site sources from container and chemical manufacturers have beenmore » consulted. Compatible materials have been compiled as a resource for selecting containers made of materials stable to the mixtures. In addition, container materials used in practice by the participating laboratories are discussed. Consulting chemical compatibility tables is highly recommended for each operation by each individual engaged in testing the materials in this proficiency test.« less

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines.

PubMed

Veitch, Andrew M; Vanbiervliet, Geoffroy; Gershlick, Anthony H; Boustiere, Christian; Baglin, Trevor P; Smith, Lesley-Ann; Radaelli, Franco; Knight, Evelyn; Gralnek, Ian M; Hassan, Cesare; Dumonceau, Jean-Marc

2016-04-01

The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage vs. thrombosis due to discontinuation of therapy. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor): For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation);For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation).For high-risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation). Warfarin: The advice for warfarin is fundamentally unchanged from BSG 2008 guidance. Direct Oral Anticoagulants (DOAC): For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation). For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥ 48 hours before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30 - 50 mL/min we recommend that the last dose of DOAC be taken 72 hours before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation). © Georg Thieme Verlag KG Stuttgart · New York.

Standard operating procedures for vascular surgery in erectile dysfunction: revascularization and venous procedures.

PubMed

Sohn, Michael; Hatzinger, Martin; Goldstein, Irwin; Krishnamurti, Sudhakar

2013-01-01

The impact of penile blood supply on erectile function was recognized some 500 years ago. At the turn of the 20th century first results of penile venous ligation were published and in 1973 the first surgical attempts to restore penile arterial inflow were undertaken. Numerous techniques were published in the meantime, but inclusion criteria, patient selection, and success evaluation differed extremely between study groups. To develop evidence-based standard operating procedures (SOPs) for vascular surgery in erectile dysfunction, based on recent state of the art consensus reports and recently published articles in peer-reviewed journals. Based on the recent publication of the consensus process during the 2009 International Consultation on Sexual Medicine in Paris, recommendations are derived for diagnosis and surgical treatment of vascular erectile dysfunction. In addition several recent publications in this field not mentioned in the consensus statements are included in the discussion. The Oxford system of evidence-based review was systematically applied. Due to the generally low level of evidence in this field expert opinions were accepted, if published after a well-defined consensus process in peer-reviewed journals. Referring to penile revascularization it may be concluded, that in the face of missing randomized trials, only recommendations grade D may be given: this kind of surgery may be offered to men less than 55 years, who are nonsmokers, nondiabetic, and demonstrate isolated arterial stenoses in the absence of generalized vascular disease. The evidence level for recommendations concerning penile venous ligations may be even lower. Too many unsolved controversies exist and universal diagnostic criteria for patient selection as well as operative technique selection have not been unequivocally established. This kind of surgery is still considered investigational but may be offered in special situations on an individualized basis in an investigational or research setting after obtaining written consent, using both pre- and postoperatively validated measuring instruments of success evaluation. SOPs for penile revascularization procedures can be developed, concerning a highly selected patient group with isolated arterial stenoses. Based on the available data it is not yet possible to define SOPs for surgical treatment of corporal veno-occlusive dysfunction. © 2012 International Society for Sexual Medicine.

Recommendations for the Development of a Dust Suppressant Test Operations Procedure (TOP) Performed at the U.S. Army Yuma Proving Ground

DTIC Science & Technology

2010-02-08

variety of bedrock types including: igneous ( basalt , granite, and rhyolite), metamorphic (schist and gneiss), and sedimentary rocks of Quaternary...TerraLOC® Standard formulation was applied. Chemical dust suppressant formulations vary widely, to include salts, oils, fiber mixtures and synthetic

Video. A Guide to the Use of Portable Video Equipment.

ERIC Educational Resources Information Center

Rowatt, Robert W.

This guide describes the portable equipment necessary for preparing a video production, and recommends ways of using that equipment to create a video program. Step by step instructions are provided for setting up the equipment for battery operation or with a mains electricity supply. Information is also given on procedures for recording, playing…

Rating Lift Cranes Operating on Platforms in the Ocean Environment SAE J-1366--Proposed SAE Recommended Practice (Version 4.0)

DTIC Science & Technology

1992-03-01

Hueneme, CA 93043-5003 9. SPONSORING/MiONITORING AGENCY NAME(S) AND ADDRESSE(S) 10 . SPONSORINGINMONITORING AGENZY REPORT NUMBER Naval Facilities...8 6. Calculation Procedure .. .. ....... ...... ...... 10 7. Marine Crane Rating Chart Format .. ..... ...... ... 15 8...Rating for List. .. .... ....... ....... .... 16 9. Pendulation .. .. ....... ...... ....... ... 17 10 . References

Online Paper Repositories and the Role of Scholarly Societies: An AERA Conference Report

ERIC Educational Resources Information Center

Educational Researcher, 2010

2010-01-01

This article examines issues faced by scholarly societies that are developing and sustaining online paper repositories. It is based on the AERA Conference on Online Paper Repositories, which focused on fundamental issues of policy and procedure important to the operations of online working paper repositories. The report and recommendations address…

75 FR 75 - Special Conditions: Boeing Model 787-8 Airplane; Overhead Crew Rest Compartment

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-04

..., explain the reason for any recommended change, and include supporting data. We ask that you send us two...-site operational evaluation. Any changes to the approved OCR compartment configuration that affect crewmember emergency egress or any other procedures affecting safety of the occupying crewmembers or related...

The European Stroke Organisation Guidelines: a standard operating procedure.

PubMed

Ntaios, George; Bornstein, Natan M; Caso, Valeria; Christensen, Hanne; De Keyser, Jacques; Diener, Hans-Christoph; Diez-Tejedor, Exuperio; Ferro, Jose M; Ford, Gary A; Grau, Armin; Keller, Emanuella; Leys, Didier; Russell, David; Toni, Danilo; Turc, Guillaume; Van der Worp, Bart; Wahlgren, Nils; Steiner, Thorsten

2015-10-01

In 2008, the recently founded European Stroke Organisation published its guidelines for the management of ischemic stroke and transient ischemic attack. This highly cited document was translated in several languages and was updated in 2009. Since then, the European Stroke Organisation has published guidelines for the management of intracranial aneurysms and subarachnoidal hemorrhage, for the establishment of stroke units and stroke centers, and recently for the management of intracerebral hemorrhage. In recent years, the methodology for the development of guidelines has evolved significantly. To keep pace with this progress and driven by the strong determination of the European Stroke Organisation to further promote stroke management, education, and research, the European Stroke Organisation decided to delineate a detailed standard operating procedure for its guidelines. There are two important cornerstones in this standard operating procedure: The first is the implementation of the Grading of Recommendations Assessment, Development, and Evaluation methodology for the development of its Guideline Documents. The second one is the decision of the European Stroke Organisation to move from the classical model of a single Guideline Document about a major topic (e.g. management of ischemic stroke) to focused modules (i.e. subdivisions of a major topic). This will enable the European Stroke Organisation to react faster when new developments in a specific stroke field occur and update its recommendations on the related module rather swiftly; with the previous approach of a single large Guideline Document, its entire revision had to be completed before an updated publication, delaying the production of up-to-date guidelines. After discussion within the European Stroke Organisation Guidelines Committee and significant input from European Stroke Organisation members as well as methodologists and analysts, this document presents the official standard operating procedure for the development of the Guideline Documents of the European Stroke Organisation. © 2015 World Stroke Organization.

Standardizing care and monitoring for anesthesia or procedural sedation delivered outside the operating room.

PubMed

Eichhorn, Volker; Henzler, Dietrich; Murphy, Michael F

2010-08-01

The purpose of this review is to summarize recommendations for the safe and efficient conductance of sedation and anesthesia at remote locations; and to define safety standards, monitoring techniques, quality of care and procedural eligibility. Anesthesia outside of the operating room is rapidly increasing in numbers, which has seen a growth of older and sicker patients. These circumstances have created a need for guidelines, for both specialist anesthesia providers and nonanesthesia-trained practitioners, that define patient selection, minimum monitoring (hemodynamics and respiration), facility design and equipment, policy framework, recovery facilities and policies. The patient's safety throughout all stages of sedation and/or anesthesia is the most pertinent goal. Recent data emphasize the importance of monitoring pulse oximetry and end-tidal carbon dioxide for any sedating or anesthetic procedure. Substandard monitoring combined with oversedation and subsequent respiratory depression are implicated as the main reasons for catastrophic sedation and anesthetic outcomes at remote locations. Patient selection, procedure appropriateness and location appropriateness are the key elements defining the provision of safe anesthesia care outside the operating room. Titratable, short-acting intravenous drugs are preferred such as propofol and remifentanil.

The Prevention of Positioning Injuries during Gynecologic Operations. Guideline of DGGG (S1-Level, AWMF Registry No. 015/077, February 2015)

PubMed Central

Fleisch, M. C.; Bremerich, D.; Schulte-Mattler, W.; Tannen, A.; Teichmann, A. T.; Bader, W.; Balzer, K.; Renner, S. P.; Römer, T.; Roth, S.; Schütz, F.; Thill, M.; Tinneberg, H.; Zarras, K.

2015-01-01

Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Positioning injuries after lengthy gynecological procedures are rare, but the associated complications can be potentially serious for patients. Moreover, such injuries often lead to claims of malpractice and negligence requiring detailed medical investigation. To date, there are no binding evidence-based recommendations for the prevention of such injuries. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. The recommendations cover: PMID:26365999

Are general surgeons able to accurately self-assess their level of technical skills?

PubMed

Rizan, C; Ansell, J; Tilston, T W; Warren, N; Torkington, J

2015-11-01

Self-assessment is a way of improving technical capabilities without the need for trainer feedback. It can identify areas for improvement and promote professional medical development. The aim of this review was to identify whether self-assessment is an accurate form of technical skills appraisal in general surgery. The PubMed, MEDLINE(®), Embase(™) and Cochrane databases were searched for studies assessing the reliability of self-assessment of technical skills in general surgery. For each study, we recorded the skills assessed and the evaluation methods used. Common endpoints between studies were compared to provide recommendations based on the levels of evidence. Twelve studies met the inclusion criteria from 22,292 initial papers. There was no level 1 evidence published. All papers compared the correlation between self-appraisal versus an expert score but differed in the technical skills assessment and the evaluation tools used. The accuracy of self-assessment improved with increasing experience (level 2 recommendation), age (level 3 recommendation) and the use of video playback (level 3 recommendation). Accuracy was reduced by stressful learning environments (level 2 recommendation), lack of familiarity with assessment tools (level 3 recommendation) and in advanced surgical procedures (level 3 recommendation). Evidence exists to support the reliability of self-assessment of technical skills in general surgery. Several variables have been shown to affect the accuracy of self-assessment of technical skills. Future work should focus on evaluating the reliability of self-assessment during live operating procedures.

Key Issues in the Analysis of Remote Sensing Data: A report on the workshop

NASA Technical Reports Server (NTRS)

Swain, P. H. (Principal Investigator)

1981-01-01

The procedures of a workshop assessing the state of the art of machine analysis of remotely sensed data are summarized. Areas discussed were: data bases, image registration, image preprocessing operations, map oriented considerations, advanced digital systems, artificial intelligence methods, image classification, and improved classifier training. Recommendations of areas for further research are presented.

Automated Chromium Plating Line for Gun Barrels

DTIC Science & Technology

1979-09-01

consistent pretreatments and bath dwell times. Some of the advantages of automated processing include increased productivity (average of 20^) due to...when automated processing procedures’ are used. The current method of applying chromium electrodeposits to gun tubes is a manual, batch operation...currently practiced with rotary swaged gun tubes would substantially reduce the difficulties in automated processing . RECOMMENDATIONS

78 FR 25487 - Final License Renewal Interim Staff Guidance LR-ISG-2012-01: Wall Thinning Due to Erosion Mechanisms

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

....'' This LR-ISG revises an NRC staff-recommended aging management program (AMP) in NUREG-1801, Revision 2, ``Generic Aging Lessons Learned (GALL) Report,'' and the NRC staff's aging management review procedure and... for piping and components within the scope of the Requirements for Renewal of Operating Licenses for...

Joint Implications for Contracted Logistics

DTIC Science & Technology

2007-03-30

authority with the host nation country and policy on using UCMJ for contracted personnel. As tailored theater policies are developed and contracting...responsibility, this paper recommends better joint training, leader development and joint enablers for contracting operations. JOINT...U.S. Joint Forces Command (JFCOM) are analyzing Congressional and DOD policy to develop procedures and force structure to support contractor

Bayesian networks for satellite payload testing

NASA Astrophysics Data System (ADS)

Przytula, Krzysztof W.; Hagen, Frank; Yung, Kar

1999-11-01

Satellite payloads are fast increasing in complexity, resulting in commensurate growth in cost of manufacturing and operation. A need exists for a software tool, which would assist engineers in production and operation of satellite systems. We have designed and implemented a software tool, which performs part of this task. The tool aids a test engineer in debugging satellite payloads during system testing. At this stage of satellite integration and testing both the tested payload and the testing equipment represent complicated systems consisting of a very large number of components and devices. When an error is detected during execution of a test procedure, the tool presents to the engineer a ranked list of potential sources of the error and a list of recommended further tests. The engineer decides this on this basis if to perform some of the recommended additional test or replace the suspect component. The tool has been installed in payload testing facility. The tool is based on Bayesian networks, a graphical method of representing uncertainty in terms of probabilistic influences. The Bayesian network was configured using detailed flow diagrams of testing procedures and block diagrams of the payload and testing hardware. The conditional and prior probability values were initially obtained from experts and refined in later stages of design. The Bayesian network provided a very informative model of the payload and testing equipment and inspired many new ideas regarding the future test procedures and testing equipment configurations. The tool is the first step in developing a family of tools for various phases of satellite integration and operation.

Radiation Exposure of Interventional Radiologists During Computed Tomography Fluoroscopy-Guided Renal Cryoablation and Lung Radiofrequency Ablation: Direct Measurement in a Clinical Setting.

PubMed

Matsui, Yusuke; Hiraki, Takao; Gobara, Hideo; Iguchi, Toshihiro; Fujiwara, Hiroyasu; Kawabata, Takahiro; Yamauchi, Takatsugu; Yamaguchi, Takuya; Kanazawa, Susumu

2016-06-01

Computed tomography (CT) fluoroscopy-guided renal cryoablation and lung radiofrequency ablation (RFA) have received increasing attention as promising cancer therapies. Although radiation exposure of interventional radiologists during these procedures is an important concern, data on operator exposure are lacking. Radiation dose to interventional radiologists during CT fluoroscopy-guided renal cryoablation (n = 20) and lung RFA (n = 20) was measured prospectively in a clinical setting. Effective dose to the operator was calculated from the 1-cm dose equivalent measured on the neck outside the lead apron, and on the left chest inside the lead apron, using electronic dosimeters. Equivalent dose to the operator's finger skin was measured using thermoluminescent dosimeter rings. The mean (median) effective dose to the operator per procedure was 6.05 (4.52) μSv during renal cryoablation and 0.74 (0.55) μSv during lung RFA. The mean (median) equivalent dose to the operator's finger skin per procedure was 2.1 (2.1) mSv during renal cryoablation, and 0.3 (0.3) mSv during lung RFA. Radiation dose to interventional radiologists during renal cryoablation and lung RFA were at an acceptable level, and in line with recommended dose limits for occupational radiation exposure.

40 CFR 246.201-6 - Recommended procedures: Transportation to market.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Transportation to market. 246.201-6 Section 246.201-6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Procedures § 246.201-6 Recommended procedures: Transportation to market. Transportation to market may be...

40 CFR 246.201-3 - Recommended procedures: Glass, can, and mixed paper separation.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., and mixed paper separation. 246.201-3 Section 246.201-3 Protection of Environment ENVIRONMENTAL... and Recommended Procedures § 246.201-3 Recommended procedures: Glass, can, and mixed paper separation. In areas where markets are available, it is recommended that glass, cans, and mixed paper be...

40 CFR 246.201-3 - Recommended procedures: Glass, can, and mixed paper separation.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., and mixed paper separation. 246.201-3 Section 246.201-3 Protection of Environment ENVIRONMENTAL... and Recommended Procedures § 246.201-3 Recommended procedures: Glass, can, and mixed paper separation. In areas where markets are available, it is recommended that glass, cans, and mixed paper be...

40 CFR 246.200-4 - Recommended procedures: Levels of separation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Levels of... § 246.200-4 Recommended procedures: Levels of separation. A two-level separation is recommended for most... separate category cost effective may choose to implement three levels of separation: (1) Computer papers...

[Surgical methods of abortion].

PubMed

Linet, T

2016-12-01

A state of the art of surgical method of abortion focusing on safety and practical aspects. A systematic review of French-speaking or English-speaking evidence-based literature about surgical methods of abortion was performed using Pubmed, Cochrane and international recommendations. Surgical abortion is efficient and safe regardless of gestational age, even before 7 weeks gestation (EL2). A systematic prophylactic antibiotics should be preferred to a targeted antibiotic prophylaxis (grade A). In women under 25 years, doxycycline is preferred (grade C) due to the high prevalence of Chlamydia trachomatis. Systematic cervical preparation is recommended for reducing the incidence of complications from vacuum aspiration (grade A). Misoprostol is a first-line agent (grade A). When misoprostol is used before a vacuum aspiration, a dose of 400 mcg is recommended. The choice of vaginal route or sublingual administration should be left to the woman: (i) the vaginal route 3 hours before the procedure has a good efficiency/safety ratio (grade A); (ii) the sublingual administration 1 to 3 hours before the procedure has a higher efficiency (EL1). The patient should be warned of more common gastrointestinal side effects. The addition of mifepristone 200mg 24 to 48hours before the procedure is interesting for pregnancies between 12 and 14 weeks gestations (EL2). The systematic use of nonsteroidal anti-inflammatory drugs is recommended for limiting the operative and postoperative pain (grade B). Routine vaginal application of an antiseptic prior to the procedure cannot be recommended (grade B). The type of anesthesia (general or local) should be left up to the woman after explanation of the benefit-risk ratio (grade B). Paracervical local anesthesia (PLA) is recommended before performing a vacuum aspiration under local anesthesia (grade A). The electric or manual vacuum methods are very effective, safe and acceptable to women (grade A). Before 9 weeks gestation, the manual vacuum aspiration could have a subjective interest (grade B). The electric vacuum aspiration is recommended after 9 weeks gestation (best practice agreement). For a pregnancy of unknown location, the success of the procedure can reasonably be determined if hCG drops more than 50 % on day 5 and 80 % on day 7 (NP3). After a surgical abortion, paracetamol or addition of paracetamol and codeine is not recommended (grade B). Copyright © 2016. Published by Elsevier Masson SAS.

Implementation of genetic conservation practices in a muskellunge propagation and stocking program

USGS Publications Warehouse

Jennings, Martin J.; Sloss, Brian L.; Hatzenbeler, Gene R.; Kampa, Jeffrey M.; Simonson, Timothy D.; Avelallemant, Steven P.; Lindenberger, Gary A.; Underwood, Bruce D.

2010-01-01

Conservation of genetic resources is a challenging issue for agencies managing popular sport fishes. To address the ongoing potential for genetic risks, we developed a comprehensive set of recommendations to conserve genetic diversity of muskellunge (Esox masquinongy) in Wisconsin, and evaluated the extent to which the recommendations can be implemented. Although some details are specific to Wisconsin's muskellunge propagation program, many of the practical issues affecting implementation are applicable to other species and production systems. We developed guidelines to restrict future broodstock collection operations to lakes with natural reproduction and to develop a set of brood lakes to use on a rotational basis within regional stock boundaries, but implementation will require considering lakes with variable stocking histories. Maintaining an effective population size sufficient to minimize the risk of losing alleles requires limiting broodstock collection to large lakes. Recommendations to better approximate the temporal distribution of spawning in hatchery operations and randomize selection of brood fish are feasible. Guidelines to modify rearing and distribution procedures face some logistic constraints. An evaluation of genetic diversity of hatchery-produced fish during 2008 demonstrated variable success representing genetic variation of the source population. Continued evaluation of hatchery operations will optimize operational efficiency while moving toward genetic conservation goals.

Implementation of genetic conservation practices in a muskellunge propagation and stocking program

USGS Publications Warehouse

Jennings, Martin J.; Sloss, Brian L.; Hatzenbeler, Gene R.; Kampa, Jeffrey M.; Simonson, Timothy D.; Avelallemant, Steven P.; Lindenberger, Gary A.; Underwood, Bruce D.

2010-01-01

Conservation of genetic resources is a challenging issue for agencies managing popular sport fishes. To address the ongoing potential for genetic risks, we developed a comprehensive set of recommendations to conserve genetic diversity of muskellunge (Esox masquinongy) in Wisconsin, and evaluated the extent to which the recommendations can be implemented. Although some details are specific to Wisconsin's muskellunge propagation program, many of the practical issues affecting implementation are applicable to other species and production systems. We developed guidelines to restrict future brood stock collection operations to lakes with natural reproduction and to develop a set of brood lakes to use on a rotational basis within regional stock boundaries, but implementation will require considering lakes with variable stocking histories. Maintaining an effective population size sufficient to minimize the risk of losing alleles requires limiting brood stock collection to large lakes. Recommendations to better approximate the temporal distribution of spawning in hatchery operations and randomize selection of brood fish are feasible. Guidelines to modify rearing and distribution procedures face some logistic constraints. An evaluation of genetic diversity of hatchery-produced fish during 2008 demonstrated variable success representing genetic variation of the source population. Continued evaluation of hatchery operations will optimize operational efficiency while moving toward genetic conservation goals.

[Hybrid operating rooms: only for advanced endovascular procedures?].

PubMed

Verhoeven, E; Katsargyris, A; Töpel, I; Steinbauer, M

2013-10-01

The evolution of endovascular techniques has led to the concept of the "hybrid operating room" (hybrid OR). A hybrid OR combines the sterility of an OR in an operating theatre environment with a high-quality fixed imaging system. On the basis of these advantages it would be desirable that an angio-hybrid OR becomes a standard requirement for endovascular surgery. In Great Britain guidelines have already been published that require a hybrid OR even for normal endovascular management of the infrarenal aorta. However, in Germany there are no guidelines from professional societies or formal rules from the federal joint committee, thus in this article a classification of endovascular procedures according to their complexity and the necessary infrastructures are proposed in order to define particular procedures that should only be performed in an angio-hybrid OR. According to our experience, endovascular procedures can be classified into four categories based on their complexity and the requirements regarding fluoroscopy: level 1: standard EVAR, TEVAR, iliac and popliteal artery procedures; level 2: iliac branched (IBD) and standard (2 fenestrations for the renal arteries and a scallop for the superior mesenteric artery) fenestrated stent-grafting; level 3: more complex fenestrated procedures (three or four fenestrations); and level 4: branched stent-grafting for TAAA. At this moment it is still acceptable to perform level 1 and level 2 procedures outside of a hybrid OR. In our opinion, it is not recommended to perform level 3 and level 4 endovascular procedures without a hybrid OR. Georg Thieme Verlag KG Stuttgart · New York.

40 CFR 246.201-3 - Recommended procedures: Glass, can, and mixed paper separation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... mixed paper separation. 246.201-3 Section 246.201-3 Protection of Environment ENVIRONMENTAL PROTECTION... Recommended Procedures § 246.201-3 Recommended procedures: Glass, can, and mixed paper separation. In areas where markets are available, it is recommended that glass, cans, and mixed paper be separated at the...

Estimating the risks of cancer mortality and genetic defects resulting from exposures to low levels of ionizing radiation

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

Buhl, T.E.; Hansen, W.R.

1984-05-01

Estimators for calculating the risk of cancer and genetic disorders induced by exposure to ionizing radiation have been recommended by the US National Academy of Sciences Committee on the Biological Effects of Ionizing Radiations, the UN Scientific Committee on the Effects of Atomic Radiation, and the International Committee on Radiological Protection. These groups have also considered the risks of somatic effects other than cancer. The US National Council on Radiation Protection and Measurements has discussed risk estimate procedures for radiation-induced health effects. The recommendations of these national and international advisory committees are summarized and compared in this report. Based onmore » this review, two procedures for risk estimation are presented for use in radiological assessments performed by the US Department of Energy under the National Environmental Policy Act of 1969 (NEPA). In the first procedure, age- and sex-averaged risk estimators calculated with US average demographic statistics would be used with estimates of radiation dose to calculate the projected risk of cancer and genetic disorders that would result from the operation being reviewed under NEPA. If more site-specific risk estimators are needed, and the demographic information is available, a second procedure is described that would involve direct calculation of the risk estimators using recommended risk-rate factors. The computer program REPCAL has been written to perform this calculation and is described in this report. 25 references, 16 tables.« less

[Limb lengthening in dwarfism].

PubMed

Correll, J; Held, P

2000-09-01

Limb lengthening in dwarfism has become a standardised procedure with a good prognosis. In most cases external fixation is used. Gain of leg length up to 15 cm and more is possible in the lower leg and the femur and 8.5 cm in the humerus. Limb lengthening is useful in many cases of dwarfism due to skeletal dysplasia. There are a number of risks and possible complications involved and the procedure also requires considerable time. We report the results of 48 patients with dwarfism operated on in the Orthopädische Kinderklinik Aschau (Orthopaedic Hospital for Children). It must not be recommended as a normal tool in handling the problems of dwarfism, but it makes sense in some cases of dwarfism. We describe and discuss the prerequisites for the operative treatment.

Pre-College Science Curriculum Activities of the National Science Foundation. Report of Science Curriculum Review Team, Volume II-Appendix.

ERIC Educational Resources Information Center

National Science Foundation, Washington, DC.

Presented is a detailed study of National Science Foundation (NSF) programs in pre-college science education. The development of policies and operational procedures are traced over the past quarter century and their impact on management practice analyzed. The report is presented in two parts: Volume 1, the findings and recommendations, and Volume…

Determination of the moisture content in the fluoride oxide fluxes of electroslag remelting

NASA Astrophysics Data System (ADS)

Vdovin, K. N.; Feoktistov, N. A.; Pivovarova, K. G.; Deryabin, D. A.

2016-12-01

ANF-32 flux has been studied with regard to the moisture content both after storage and upon operation. A simple and reliable procedure for the determination of the moisture content in ESR fluxes is proposed, and recommendations are given on monitoring the moisture content in calcined fluxes. The main sources of crystallization water of hydration are hydrogen sources.

Operational Exercise Integration Recommendations for DoD Cyber Ranges

DTIC Science & Technology

2015-08-05

be the precision and recall of a security information and event management (SIEM) system ’s notifications of unauthorized access to that directory...network traffic, port scanning Deplete Resources TCP flooding, memory leak exploitation Injection Cross-site scripting attacks, SQL injection Deceptive...requirements for personnel development; tactics, techniques, and procedures (TTPs) devel- opment; and mission rehearsals . While unique in their own

The impact of new business approaches derived from the Manned Transportation System Study

NASA Technical Reports Server (NTRS)

Mccandless, B., II; Baillif, F. F.; Lance, N.; Clark, B. C.; Geyer, M. S.; Gaunce, M.; Anson, H. W.; Bienhof, D. G.; Carey, D. A.; Emmet, B. R.

1992-01-01

The results are reported of a survey conducted among senior managers within the government and participating companies to identify the items that could improve industry's way of doing business with NASA. New and recommended practices in management, operations, organization, procurement, and procedures are discussed. The development of multitiered requirement systems for NASA programs is addressed.

Standard operating procedures for Peyronie's disease.

PubMed

Levine, Laurence A; Burnett, Arthur L

2013-01-01

Peyronie's disease (PD) refers to a penile deformity that is associated with sexual dysfunction. To provide recommendations and Standard Operating Procedures (SOPs) based on best evidence for diagnosis and treatment of PD. Medical literature was reviewed and combined with expert opinion of the authors. Recommendations and SOPs based on grading of evidence-based medical literature. PD is a fibrotic wound-healing disorder involving the tunica albuginea of the corpora cavernosa. The resulting scar is responsible for a variety of deformities, including curvature, shortening, narrowing with hinge effect, and is frequently associated in the early phase with pain. Patients frequently experience diminished quality erections. All of these conditions can compromise sexual function for the affected male. The etiopathophysiology of PD has yet to be clarified and as a result, effective, reliable, mechanistic directed non-surgical therapy is lacking. The management of PD consists of proper diagnosis and treatment, ranging from non-surgical to surgical interventions. The main state of treatment for PD rests at this time on surgical correction that should be based on clear indications, involve surgical consent, and follow a surgical algorithm that includes tunica plication, plaque incision/partial excision and grafting, and penile prosthesis implantation. © 2012 International Society for Sexual Medicine.

Guidelines for testing and release procedures

NASA Technical Reports Server (NTRS)

Molari, R.; Conway, M.

1984-01-01

Guidelines and procedures are recommended for the testing and release of the types of computer software efforts commonly performed at NASA/Ames Research Center. All recommendations are based on the premise that testing and release activities must be specifically selected for the environment, size, and purpose of each individual software project. Guidelines are presented for building a Test Plan and using formal Test Plan and Test Care Inspections on it. Frequent references are made to NASA/Ames Guidelines for Software Inspections. Guidelines are presented for selecting an Overall Test Approach and for each of the four main phases of testing: (1) Unit Testing of Components, (2) Integration Testing of Components, (3) System Integration Testing, and (4) Acceptance Testing. Tools used for testing are listed, including those available from operating systems used at Ames, specialized tools which can be developed, unit test drivers, stub module generators, and the use of format test reporting schemes.

The feasibility, safety and outcomes of laparoscopic re-operation for achalasia.

PubMed

James, David R C; Purkayastha, Sanjay; Aziz, Omer; Amygdalos, Iakovos; Darzi, Ara W; Hanna, George B; Zacharakis, Emmanouil

2012-05-01

Heller myotomy for achalasia is associated with a recurrence rate of around 10%, thus reoperative surgery is often necessitated. This paper aims to review the available literature on laparoscopic reoperation for achalasia in order to assess its feasibility and effectiveness. A Medline, Embase, Ovid, Cochrane database and Google(TM) Scholar search was performed with the following Mesh terms: "laparoscopic", "redo", "reoperative", "Heller's", "esophagomyotomy" and "achalasia". Outcomes of interest included patient demographics and details of primary procedure, operative details, intra- and post operative complications and symptom scores. Seven studies reported outcomes from 54 cases. Conversion occurred in 7% (4/54) of cases. Thirteen percent (7/54) of patients sustained intra-operative gastric or oesophageal perforation; however these were all noted and repaired intra-operatively leading to no subsequent morbidity. No deaths were reported. Pre- and post operative symptom scores were heterogeneous, however did appear to improve after the procedure. This review demonstrates that laparoscopic reoperation for achalasia is feasible and safe with complication rates comparable to the primary laparoscopic operation. It is recommended that laparoscopic reoperative Heller's myotomy should only be performed by surgeons with special interest in oesophagogastric surgery and adequate experience in laparoscopic surgery for achalasia.

BWR Servicing and Refueling Improvement Program: Phase I summary report

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

Perry, D.R.

1978-09-01

Under the U.S. Department of Energy sponsorship, General Electric Co. (GE) undertook a study of boiling water reactor (BWR) refueling outages for the purpose of recommending the development and demonstration of critical path time savings improvements. The Tennessee Valley Authority (TVA) joined the study as a subcontractor, providing monitoring assistance and making the Browns Ferry Site available for improvement demonstrations. Agreement was also reached with Georgia Power Co., Power Authority of the State of New York, and Commonwealth Edison Co. for monitoring and data collection at Hatch 1, FitzPatrick, and Quad Cities 1 nuclear plants, respectively. The objective was tomore » identify, develop, and demonstrate improved refueling, maintenance, and inspection procedures and equipment. The improvements recommended in this study are applicable to BWR nuclear plants currently in operation as well as those in the design and construction phases. The recommendations and outage information can be used as a basis to plan and conduct the first outages of new plants and to improve the planning and facilities of currently operating plants. Many of the recommendations can readily be incorporated in plants currently in the design and construction phases as well as in the design of future plants. Many of these recommended improvements can be implemented immediately by utilities without further technical development.« less

Architecture and data processing alternatives for the tse computer. Volume 4: Image rotation using tse operations

NASA Technical Reports Server (NTRS)

Kao, M. H.; Bodenheimer, R. E.

1976-01-01

The tse computer's capability of achieving image congruence between temporal and multiple images with misregistration due to rotational differences is reported. The coordinate transformations are obtained and a general algorithms is devised to perform image rotation using tse operations very efficiently. The details of this algorithm as well as its theoretical implications are presented. Step by step procedures of image registration are described in detail. Numerous examples are also employed to demonstrate the correctness and the effectiveness of the algorithms and conclusions and recommendations are made.

[Governance of innovative cardiovascular devices: when evidence is not enough].

PubMed

Addis, Antonio; Davoli, Marina

2016-01-01

Aortic stenosis is the most common valve disease and transcatheter aortic valve implantation (TAVI) is considered as an alternative to surgical valve replacement or to medical treatment in inoperable or high-risk patients. Although physicians have learned how to care for critically ill old patients and enable many to survive, major surgical procedures, operating on patients at very high risk, are often not suitable. Studies showed that selected cohorts of patients undergoing TAVI might have better outcomes in terms of survival and quality of life. However, mortality and safety data associated with the less invasive intervention do not always justify such new technologies for all patients with severe aortic stenosis, taking into account also the high cost associated. A systematic review of the available scientific literature has been performed. In this context, a DECIDE framework has been used providing a systematic and transparent approach for going from evidence to healthcare decisions. Before suggesting final recommendations, historical data of interventions done at regional level and regulatory decisions adopted in other countries following health technology assessment analysis, have been analyzed. All final recommendations based on this document have been discussed and reviewed with a working group done by the health operators directly involved in this technology within the regional health service context. Recommendations for the identification of patients suitable for TAVI are given together with a list of characteristics that should be required to all centers eligible for the performance of TAVI and with a procedure able to allow better quality assurance and prospective monitoring process of all new cases enrolled for such intervention. Impact of these recommendations will be measured using a regional registry collecting data on new patients undergoing TAVI.

Chapter 5. Essential equipment, pharmaceuticals and supplies. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Sprung, Charles L; Kesecioglu, Jozef

2010-04-01

To provide recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza pandemic or mass disaster with a specific focus on essential equipment, pharmaceuticals and supplies. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including essential equipment, pharmaceuticals and supplies. Key recommendations include: (1) ensure that adequate essential medical equipment, pharmaceuticals and important supplies are available during a disaster; (2) develop a communication and coordination system between health care facilities and local/regional/state/country governmental authorities for the provision of additional support; (3) determine the required resources, order and stockpile adequate resources, and judiciously distribute them; (4) acquire additional mechanical ventilators that are portable, provide adequate gas exchange for a range of clinical conditions, function with low-flow oxygen and without high pressure, and are safe for patients and staff; (5) provide advanced ventilatory support and rescue therapies including high levels of inspired oxygen and positive end-expiratory pressure, volume and pressure control ventilation, inhaled nitric oxide, high-frequency ventilation, prone positioning ventilation and extracorporeal membrane oxygenation; (6) triage scarce resources including equipment, pharmaceuticals and supplies based on those who are likely to benefit most or on a 'first come, first served' basis. Judicious planning and adoption of protocols for providing adequate equipment, pharmaceuticals and supplies are necessary to optimize outcomes during a pandemic.

Chapter 4. Manpower. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Sandrock, Christian

2010-04-01

To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on manpower. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including manpower. Key recommendations include: (1) plan to access, coordinate and increase labor resources for continued and expanded ICU care including increasing critical care specialists and expanded practice for non-critical care personnel; (2) develop an education, awareness, preparation and communication program to ensure a well-protected and prepared workforce with coordinated rapid manpower expansion; (3) maintain a central inventory of all clinical and non-clinical staff with their current roles along with possible emergency re-training possibilities; (4) coordinate all clinical and non-clinical staffing requirements and determine the hospital's daily needs including a sick and no-show list together with ICU requirements; (5) provide clinical care to patients only with clinical staff and not with non-clinical staff; (6) delegate duties not within the scope of workers' practice under crisis conditions with proper supervision and support from experienced clinicians to ensure patient safety; (7) intensivists should supervise nonintensivist physicians to expand the workforce if patient surge exceeds the number of available ICU-trained specialists. Judicious planning and adoption of protocols for providing adequate manpower are necessary to optimize outcomes during a pandemic.

40 CFR 240.209-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240.209-2 Section 240.209-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.202-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240.202-2 Section 240.202-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.210-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240.210-2 Section 240.210-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.206-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240.206-2 Section 240.206-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.202-2 - Recommended procedures: Design.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Design. 240.202-2 Section 240.202-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.211-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240.211-2 Section 240.211-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures...

40 CFR 240.200-2 - Recommended procedures: Design.

Code of Federal Regulations, 2011 CFR

2011-07-01

....200-2 Section 240.200-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.200-2 Recommended procedures: Design. (a) In addition to the residential and commercial wastes...

40 CFR 240.200-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

....200-2 Section 240.200-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.200-2 Recommended procedures: Design. (a) In addition to the residential and commercial wastes...

40 CFR 240.200-2 - Recommended procedures: Design.

Code of Federal Regulations, 2013 CFR

2013-07-01

... processing. These include: Certain bulky wastes (e.g., combustible demolition and construction debris, tree... WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures § 240.200-2 Recommended procedures: Design. (a) In addition to the residential and commercial wastes...

Solar industrial process heat systems: An assessment of standards for materials and components

NASA Astrophysics Data System (ADS)

Rossiter, W. J.; Shipp, W. E.

1981-09-01

A study was conducted to obtain information on the performance of materials and components in operational solar industrial process heat (PH) systems, and to provide recommendations for the development of standards including evaluative test procedures for materials and components. An assessment of the needs for standards for evaluating the long-term performance of materials and components of IPH systems was made. The assessment was based on the availability of existing standards, and information obtained from a field survey of operational systems, the literature, and discussions with individuals in the industry. Field inspections of 10 operational IPH systems were performed.

Reconstruction for chronic Achilles tendinopathy: comparison of flexor hallucis longus (FHL) transfer versus V-Y advancement.

PubMed

Staggers, Jackson R; Smith, Kenneth; de C Netto, Cesar; Naranje, Sameer; Prasad, Krishna; Shah, Ashish

2018-04-01

Several operative techniques exist for Achilles tendinopathy. The purpose of our study was to compare the clinical and functional outcomes of flexor hallucis longus (FHL) transfer and V-Y advancement for the treatment of chronic insertional Achilles tendinopathy. Retrospective chart review from 2010 to 2016 of patients that underwent FHL transfer or V-Y advancement for chronic insertional Achilles tendinopathy. Outcome measures were compared for these two procedures. In total, 46 patients (49 ankles) with a mean age of 55.0 (range 33-73) years. Mean follow-up time 44.7 +/- 25.5 months. FHL group had 21 patients (21 ankles) with 89% satisfaction, 14% complication rate, final VAS of 0.4, final VISA-A of 89.1, subjective strength improvement following surgery of 78%, and 94% would recommend the procedure. V-Y group had 25 patients (28 ankles) with 74% subjective satisfaction, 21% complication rate, final VAS of 1.4, final VISA-A of 78.4, subjective strength improvement following surgery of 67%, and 84% would recommend the procedure. There was no significant difference in any of the results rates between the two groups (p > .05). V-Y advancement is comparable to FHL transfer for the operative management of insertional Achilles tendinopathy. Though our results trend towards less satisfactory results following V-Y advancement, we found high satisfaction rates with similar functional outcomes and complication rates in both operative groups. We suggest considering V-Y advancement as a viable option for the primary treatment of chronic insertional Achilles tendinopathy in patients who may not be an ideal candidate for FHL transfer.

An expert system that performs a satellite station keepimg maneuver

NASA Technical Reports Server (NTRS)

Linesbrowning, M. Kate; Stone, John L., Jr.

1987-01-01

The development and characteristics of a prototype expert system, Expert System for Satellite Orbit Control (ESSOC), capable of providing real-time spacecraft system analysis and command generation for a geostationary satellite are described. The ESSOC recommends appropriate commands that reflect both the changing spacecraft condition and previous procedural action. An internal knowledge base stores satellite status information and is updated with processed spacecraft telemetry. Procedural structure data are encoded in production rules. Structural methods of knowledge acquisition and the design and performance-enhancing techniques that enable ESSOC to operate in real time are also considered.

Structural Tailoring of Advanced Turboprops (STAT)

NASA Technical Reports Server (NTRS)

Brown, Kenneth W.

1988-01-01

This interim report describes the progress achieved in the structural Tailoring of Advanced Turboprops (STAT) program which was developed to perform numerical optimizations on highly swept propfan blades. The optimization procedure seeks to minimize an objective function, defined as either direct operating cost or aeroelastic differences between a blade and its scaled model, by tuning internal and external geometry variables that must satisfy realistic blade design constraints. This report provides a detailed description of the input, optimization procedures, approximate analyses and refined analyses, as well as validation test cases for the STAT program. In addition, conclusions and recommendations are summarized.

Sensitivity of fish density estimates to standard analytical procedures applied to Great Lakes hydroacoustic data

USGS Publications Warehouse

Kocovsky, Patrick M.; Rudstam, Lars G.; Yule, Daniel L.; Warner, David M.; Schaner, Ted; Pientka, Bernie; Deller, John W.; Waterfield, Holly A.; Witzel, Larry D.; Sullivan, Patrick J.

2013-01-01

Standardized methods of data collection and analysis ensure quality and facilitate comparisons among systems. We evaluated the importance of three recommendations from the Standard Operating Procedure for hydroacoustics in the Laurentian Great Lakes (GLSOP) on density estimates of target species: noise subtraction; setting volume backscattering strength (Sv) thresholds from user-defined minimum target strength (TS) of interest (TS-based Sv threshold); and calculations of an index for multiple targets (Nv index) to identify and remove biased TS values. Eliminating noise had the predictable effect of decreasing density estimates in most lakes. Using the TS-based Sv threshold decreased fish densities in the middle and lower layers in the deepest lakes with abundant invertebrates (e.g., Mysis diluviana). Correcting for biased in situ TS increased measured density up to 86% in the shallower lakes, which had the highest fish densities. The current recommendations by the GLSOP significantly influence acoustic density estimates, but the degree of importance is lake dependent. Applying GLSOP recommendations, whether in the Laurentian Great Lakes or elsewhere, will improve our ability to compare results among lakes. We recommend further development of standards, including minimum TS and analytical cell size, for reducing the effect of biased in situ TS on density estimates.

USEPA MANUAL OF METHODS FOR VIROLOGY | Science ...

EPA Pesticide Factsheets

This chapter describes procedures for the detection of coliphases in water matrices. These procedures are based on those presented in the Supplement to the 20th Edition of Standard Methods for the Examination of Water and Eastewater and EPA Methods 1601 and 1602. Two quantitative procedures and one qualitative, presence-absence procedures are presented. The procedures can be used, without supplementary methods, to assay small volumes of water (10 mL to 1L). For larger volumes (>100L), large-scale concentration methods such as described in Chapter 14 may be incorporated into the assay scheme. However, as some concentration procedures may result in appreciable loss or inactivation of coliphage, it is recommended that the suitability of any large volume concentration method be evaluated in measured recovery trials before implementation. Develop sensitive techniques to detect and identify emerging human waterborne pathogenic viruses and viruses on the CCL.Determine effectiveness of viral indicators to measure microbial quality in water matrices.Support activities: (a) culture and distribution of mammalian cells for Agency and scientific community research needs, (b) provide operator expertise for research requiring confocal and electron microscopy, (c) glassware cleaning, sterilization and biological waste disposal for the Cincinnati EPA facility, (d) operation of infectious pathogenic suite, (e) maintenance of walk-in constant temperature rooms and (f) provid

40 CFR 246.202-5 - Recommended procedures: Transportation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Transportation. 246.202-5 Section 246.202-5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-5 Recommended procedures: Transportation. Transportation to market may be supplied by either...

40 CFR 246.202-5 - Recommended procedures: Transportation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Transportation. 246.202-5 Section 246.202-5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-5 Recommended procedures: Transportation. Transportation to market may be supplied by either...

40 CFR 246.202-5 - Recommended procedures: Transportation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended procedures: Transportation. 246.202-5 Section 246.202-5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-5 Recommended procedures: Transportation. Transportation to market may be supplied by either...

40 CFR 246.200-7 - Recommended procedures: Transportation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended procedures: Transportation. 246.200-7 Section 246.200-7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-7 Recommended procedures: Transportation. Transportation to market may be supplied by the...

40 CFR 246.202-5 - Recommended procedures: Transportation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommended procedures: Transportation. 246.202-5 Section 246.202-5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-5 Recommended procedures: Transportation. Transportation to market may be supplied by either...

40 CFR 246.200-7 - Recommended procedures: Transportation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Transportation. 246.200-7 Section 246.200-7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-7 Recommended procedures: Transportation. Transportation to market may be supplied by the...

40 CFR 246.200-7 - Recommended procedures: Transportation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Transportation. 246.200-7 Section 246.200-7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-7 Recommended procedures: Transportation. Transportation to market may be supplied by the...

40 CFR 246.200-7 - Recommended procedures: Transportation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommended procedures: Transportation. 246.200-7 Section 246.200-7 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-7 Recommended procedures: Transportation. Transportation to market may be supplied by the...

Applicability of NASA (ARC) two-segment approach procedures to Boeing Aircraft

NASA Technical Reports Server (NTRS)

Allison, R. L.

1974-01-01

An engineering study to determine the feasibility of applying the NASA (ARC) two-segment approach procedures and avionics to the Boeing fleet of commercial jet transports is presented. This feasibility study is concerned with the speed/path control and systems compability aspects of the procedures. Path performance data are provided for representative Boeing 707/727/737/747 passenger models. Thrust margin requirements for speed/path control are analyzed for still air and shearing tailwind conditions. Certification of the two-segment equipment and possible effects on existing airplane certification are discussed. Operational restrictions on use of the procedures with current autothrottles and in icing or reported tailwind conditions are recommended. Using the NASA/UAL 727 procedures as a baseline, maximum upper glide slopes for representative 707/727/737/747 models are defined as a starting point for further study and/or flight evaluation programs.

Uniform Food Service Management System.

DTIC Science & Technology

The study report contains an analysis of the management of food service within the Office of the Secretary of Defense and the military departments...Procedures and organizations which inhibit an optimum food service management system are discussed. Recommendations are made for the establishment of...a uniform food service management system in the Department of Defense which will be responsive to present day requirements in food service operations

Remote sensing training for Corps of Engineering personnel: The university training module concept

NASA Technical Reports Server (NTRS)

1982-01-01

A concept to permit Corps of Engineers personnel to obtain and maintain an appropriate level of individual proficiency in the application of remote sensing to water resource management is described. Recommendations are made for specific training courses and include structure and staffing requirements, syllabi and methods of operation, supporting materials, and procedures for integrating information systems management into the University Training Modules.

40 CFR 246.200-6 - Recommended procedures: Storage.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Storage. 246....200-6 Recommended procedures: Storage. Among the alternatives for paper storage are on-site bailing, the use of stationary compactors, or storage in corrugated boxes or normal waste containers. Stored...

40 CFR 246.200-6 - Recommended procedures: Storage.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommended procedures: Storage. 246....200-6 Recommended procedures: Storage. Among the alternatives for paper storage are on-site bailing, the use of stationary compactors, or storage in corrugated boxes or normal waste containers. Stored...

40 CFR 246.200-6 - Recommended procedures: Storage.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended procedures: Storage. 246....200-6 Recommended procedures: Storage. Among the alternatives for paper storage are on-site bailing, the use of stationary compactors, or storage in corrugated boxes or normal waste containers. Stored...

40 CFR 246.200-6 - Recommended procedures: Storage.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Storage. 246....200-6 Recommended procedures: Storage. Among the alternatives for paper storage are on-site bailing, the use of stationary compactors, or storage in corrugated boxes or normal waste containers. Stored...

40 CFR 246.200-6 - Recommended procedures: Storage.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Storage. 246....200-6 Recommended procedures: Storage. Among the alternatives for paper storage are on-site bailing, the use of stationary compactors, or storage in corrugated boxes or normal waste containers. Stored...

12 CFR 19.38 - Recommended decision and filing of record.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PRACTICE AND PROCEDURE Uniform Rules of Practice and Procedure § 19.38 Recommended decision and filing of... allowed for filing reply briefs under § 19.37(b), the administrative law judge shall file with and certify... administrative law judge's recommended decision, recommended findings of fact, recommended conclusions of law...

40 CFR 240.203-2 - Recommended procedures: Design.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommended procedures: Design. 240... § 240.203-2 Recommended procedures: Design. (a) The types, amounts (by weight and volume), and characteristics of all solid wastes expected to be processed should be determined by survey and analysis. The...

40 CFR 240.203-2 - Recommended procedures: Design.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommended procedures: Design. 240... § 240.203-2 Recommended procedures: Design. (a) The types, amounts (by weight and volume), and characteristics of all solid wastes expected to be processed should be determined by survey and analysis. The...

40 CFR 240.203-2 - Recommended procedures: Design.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Design. 240... § 240.203-2 Recommended procedures: Design. (a) The types, amounts (by weight and volume), and characteristics of all solid wastes expected to be processed should be determined by survey and analysis. The...

40 CFR 240.203-2 - Recommended procedures: Design.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommended procedures: Design. 240.203... § 240.203-2 Recommended procedures: Design. (a) The types, amounts (by weight and volume), and characteristics of all solid wastes expected to be processed should be determined by survey and analysis. The...

40 CFR 240.203-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Design. 240... § 240.203-2 Recommended procedures: Design. (a) The types, amounts (by weight and volume), and characteristics of all solid wastes expected to be processed should be determined by survey and analysis. The...

40 CFR 246.202-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Market study. 246.202-3 Section 246.202-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-3 Recommended procedures: Market study. An investigation of markets should be made by the...

40 CFR 246.201-4 - Recommended procedures: Market study.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Market study. 246.201-4 Section 246.201-4 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.201-4 Recommended procedures: Market study. An investigation of markets should be made for each...

40 CFR 246.201-4 - Recommended procedures: Market study.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Market study. 246.201-4 Section 246.201-4 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.201-4 Recommended procedures: Market study. An investigation of markets should be made for each...

40 CFR 246.202-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Market study. 246.202-3 Section 246.202-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.202-3 Recommended procedures: Market study. An investigation of markets should be made by the...

40 CFR 246.200-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommended procedures: Market study. 246.200-3 Section 246.200-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-3 Recommended procedures: Market study. An investigation of markets should be made by the...

40 CFR 246.200-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Market study. 246.200-3 Section 246.200-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 246.200-3 Recommended procedures: Market study. An investigation of markets should be made by the...

40 CFR 246.201-7 - Recommended procedures: Cost analysis.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Cost analysis... § 246.201-7 Recommended procedures: Cost analysis. After potential markets have been located (but prior... residual solid waste have been established, an analysis should be conducted which compares the costs of the...

40 CFR 246.202-6 - Recommended procedures: Cost analysis.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Cost analysis... § 246.202-6 Recommended procedures: Cost analysis. After potential markets have been identified (but... residual solid waste have been established, an analysis should be conducted which compares the costs of the...

40 CFR 246.200-8 - Recommended procedures: Cost analysis.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommended procedures: Cost analysis... § 246.200-8 Recommended procedures: Cost analysis. After potential markets have been located (but prior... paper and residual solid waste have been established, an analysis should be conducted which compares the...

Guidewire retention following central venous catheterisation: a human factors and safe design investigation.

PubMed

Horberry, Tim; Teng, Yi-Chun; Ward, James; Patil, Vishal; Clarkson, P John

2014-01-01

Central Venous Catheterisation (CVC) has occasionally been associated with cases of retained guidewires in patients after surgery. In theory, this is a completely avoidable complication; however, as with any human procedure, operator error leading to guidewires being occasionally retained cannot be fully eliminated. The work described here investigated the issue in an attempt to better understand it both from an operator and a systems perspective, and to ultimately recommend appropriate safe design solutions that reduce guidewire retention errors. Nine distinct methods were used: observations of the procedure, a literature review, interviewing CVC end-users, task analysis construction, CVC procedural audits, two human reliability assessments, usability heuristics and a comprehensive solution survey with CVC end-users. The three solutions that operators rated most highly, in terms of both practicality and effectiveness, were: making trainees better aware of the potential guidewire complications and strongly emphasising guidewire removal in CVC training, actively checking that the guidewire is present in the waste tray for disposal, and standardising purchase of central line sets so that differences that may affect chances of guidewire loss is minimised. Further work to eliminate/engineer out the possibility of guidewires being retained is proposed.

Chapter 1. Introduction. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Sprung, Charles L; Cohen, Robert; Adini, Bruria

2010-04-01

In December 2007, the European Society of Intensive Care Medicine established a Task Force to develop standard operating procedures (SOPs) for operating intensive care units (ICU) during an influenza epidemic or mass disaster. To provide direction for health care professionals in the preparation and management of emergency ICU situations during an influenza epidemic or mass disaster, standardize activities, and promote coordination and communication among the medical teams. Based on a literature review and contributions of content experts, a list of essential categories for managing emergency situations in the ICU were identified. Based on three cycles of a modified Delphi process, consensus was achieved regarding the categories. A primary author along with an expert group drafted SOPs for each category. Based on the Delphi cycles, the following key topics were found to be important for emergency preparedness: triage, infrastructure, essential equipment, manpower, protection of staff and patients, medical procedures, hospital policy, coordination and collaboration with interface units, registration and reporting, administrative policies and education. The draft SOPs serve as benchmarks for emergency preparedness and response of ICUs to emergencies or outbreak of pandemics.

Mental imagery and learning: a qualitative study in orthopaedic trauma surgery.

PubMed

Ibrahim, Edward F; Richardson, Martin D; Nestel, Debra

2015-09-01

Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery. This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training. Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis. Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure. Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure. © 2015 John Wiley & Sons Ltd.

Stapled haemorrhoidopexy: a consensus position paper by an international working party - indications, contra-indications and technique.

PubMed

Corman, M L; Gravié, J-F; Hager, T; Loudon, M A; Mascagni, D; Nyström, P-O; Seow-Choen, F; Abcarian, H; Marcello, P; Weiss, E; Longo, A

2003-07-01

An international working party with experience in the performance of an alternative haemorrhoid operation through the use of the circular stapler was convened for the purpose of developing a consensus as to the criteria for undertaking this procedure. The agenda consisted of first, naming the operation; second, the indications and contra-indications for its performance; and third, the preferred surgical technique. Among the recommendations for individuals who plan to embark on this surgery are that experience with anorectal surgery and an understanding of anorectal anatomy are requisites; experience with circular stapling devices is essential; and the surgeon must attend a formal course which should include lectures, videos, the application of the instrument in models, and observation of the operation as performed by a surgeon recognized by his or her peers-leading ultimately to undertaking the procedure while being observed by an experienced surgeon. Following satisfactory completion of the above, independent responsibility should be determined by an individual's department of surgery.

Bladder injuries during laparoscopic orchiopexy: incidence and lessons learned.

PubMed

Hsieh, Michael H; Bayne, Aaron; Cisek, Lars J; Jones, Eric A; Roth, David R

2009-07-01

Laparoscopic orchiopexy is a safe operation. However, the bladder can be injured during creation of the transperitoneal tunnel for the cryptorchid testis. We reviewed our experience with this complication. We searched the operative notes of patients who had undergone laparoscopic orchiopexy between August 15, 2002 and October 1, 2008, and identified bladder injuries and their treatment. A total of 93 patients underwent laparoscopic orchiopexies for 101 undescended testes during the study interval, with 3 procedures resulting in bladder injuries. The 3 operations varied with regard to whether the injury was recognized intraoperatively or postoperatively, and repaired in an open or laparoscopic fashion. Bladder injury during laparoscopic orchiopexy is a rare but serious complication that can be managed by an open or laparoscopic approach. We recommend placement of a urethral catheter and syringe assisted drainage of all urine from the bladder at the beginning of the operation, careful perivesical dissection particularly in children with prior inguinal surgery, filling and emptying of the bladder during the procedure, and maintaining a high index of suspicion especially when hematuria is observed.

STS-61 mission director's post-mission report

NASA Technical Reports Server (NTRS)

Newman, Ronald L.

1995-01-01

To ensure the success of the complex Hubble Space Telescope servicing mission, STS-61, NASA established a number of independent review groups to assess management, design, planning, and preparation for the mission. One of the resulting recommendations for mission success was that an overall Mission Director be appointed to coordinate management activities of the Space Shuttle and Hubble programs and to consolidate results of the team reviews and expedite responses to recommendations. This report presents pre-mission events important to the experience base of mission management, with related Mission Director's recommendations following the event(s) to which they apply. All Mission Director's recommendations are presented collectively in an appendix. Other appendixes contain recommendations from the various review groups, including Payload Officers, the JSC Extravehicular Activity (EVA) Section, JSC EVA Management Office, JSC Crew and Thermal Systems Division, and the STS-61 crew itself. This report also lists mission events in chronological order and includes as an appendix a post-mission summary by the lead Payload Deployment and Retrieval System Officer. Recommendations range from those pertaining to specific component use or operating techniques to those for improved management, review, planning, and safety procedures.

National Trends in Prostate Biopsy and Radical Prostatectomy Volumes Following the US Preventive Services Task Force Guidelines Against Prostate-Specific Antigen Screening.

PubMed

Halpern, Joshua A; Shoag, Jonathan E; Artis, Amanda S; Ballman, Karla V; Sedrakyan, Art; Hershman, Dawn L; Wright, Jason D; Shih, Ya Chen Tina; Hu, Jim C

2017-02-01

Studies demonstrate that use of prostate-specific antigen screening decreased significantly following the US Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen screening in 2012. To determine downstream effects on practice patterns in prostate cancer diagnosis and treatment following the 2012 USPSTF recommendation. Procedural volumes of certifying and recertifying urologists from 2009 through 2016 were evaluated for variation in prostate biopsy and radical prostatectomy (RP) volume. Trends were confirmed using the New York Statewide Planning and Research Cooperative System and Nationwide Inpatient Sample. The study included a representative sample of urologists across practice settings and nationally representative sample of all RP discharges. We obtained operative case logs from the American Board of Urology and identified urologists performing at least 1 prostate biopsy (n = 5173) or RP (n = 3748), respectively. The 2012 USPSTF recommendation against routine population-wide prostate-specific antigen screening. Change in median biopsy and RP volume per urologist and national procedural volume. Following the USPSTF recommendation, median biopsy volume per urologist decreased from 29 to 21 (interquartile range [IQR}, 12-34; P < .001). After adjusting for physician and practice characteristics, biopsy volume decreased by 28.7% following 2012 (parameter estimate, -0.25; SE, 0.03; P < .001). Similarly, following the USPSTF recommendation, median RP volume per urologist decreased from 7 (IQR, 3-15) to 6 (IQR, 2-12) (P < .001), and in adjusted analyses, RP volume decreased 16.2% (parameter estimate, -0.15; SE, 0.05; P = .003). Following the 2012 USPSTF recommendation, prostate biopsy and RP volumes decreased significantly. A panoramic vantage point is needed to evaluate the long-term consequences of the 2012 USPSTF recommendation.

Item Unique Identification Capability Expansion: Established Process Analysis, Cost Benefit Analysis, and Optimal Marking Procedures

DTIC Science & Technology

2014-12-01

chemical etching EDM electrical discharge machine EID enterprise identifier EOSS Engineering Operational Sequencing System F Fahrenheit...Center in Corona , California, released a DoN IUID Marking Guide, which made recommendations on how to mark legacy items. It provides technical...uploaded into the IUID registry managed by the Naval Surface Warfare Center (NSWC) in Corona , California. There is no set amount of information

[Arthroscopic therapy of the unstable shoulder joint--acceptance and critical considerations].

PubMed

Jerosch, J

1997-01-01

The purpose of this study was to document and to present the acceptance of arthroscopically performed stabilising procedures of the glenohumeral joint. In a nationwide survey of instructors of the association of arthroscopy, members of the arthroscopy group of the german orthopedic society, and orthopedic and trauma surgeons with special interest in joint surgery we evaluated the current treatment modalities for patients with unstable shoulder joints. After an average of 2.09 +/- 1.0 shoulder redislocations surgery is recommended. The Bankart-operation (63.4%) is the favourite procedure for open surgery. In a descended order the Weber rotation-osteotomie, the Putti-Platt operation, the Max-Lange procedure, and in a minimal amount of the cases the Bristow-procedure are performed. Looking at the arthroscopic procedures, the distribution is much more equal. The Caspari technique is used by 27.6% and the Morgan technique by 25.1%. Bone anchors are used by 20.4% and the Suretac is used by 18.9% of the surgeons. The anchor knot technique (8%) is only rarely performed. In case of an elongated capsule the majority of the surgeons would not perform arthroscopic surgery. 42.4% of the surgeons judge the arthroscopic technique less secure. However, 38.9% do not see any difference to open procedures. Taking the available information, arthroscopic stabilising procedures seems to have slightly inferior results compared to standard open surgery. The Bankart procedure with or without a capsular shift is still the golden standard.

Standard operating procedures for female genital sexual pain.

PubMed

Fugl-Meyer, Kerstin S; Bohm-Starke, Nina; Damsted Petersen, Christina; Fugl-Meyer, Axel; Parish, Sharon; Giraldi, Annamaria

2013-01-01

Female genital sexual pain (GSP) is a common, distressing complaint in women of all ages that is underrecognized and undertreated. Definitions and terminology for female GSP are currently being debated. While some authors have suggested that GSP is not per se a sexual dysfunction, but rather a localized genial pain syndrome, others adhere to using clearly sexually related terms such as dyspareunia and vaginismus. The aims of this brief review are to present definitions of the different types of female GSP. Their etiology, incidence, prevalence, and comorbidity with somatic and psychological disorders are highlighted, and different somatic and psychological assessment and treatment modalities are discussed. The Standard Operating Procedures (SOP) committee was composed of a chair and five additional experts. No corporate funding or remuneration was received. The authors agreed to survey relevant databases, journal articles and utilize their own clinical experience. Consensus was guided by systematic discussions by e-mail communications. MAIN OUTCOME/RESULTS: There is a clear lack of epidemiological data defining female GSP disorders and a lack of evidence supporting therapeutic interventions. However, this international expert group will recommend guidelines for management of female GSP. GSP disorders are complex. It is recommended that their evaluation and treatment are performed through comprehensive somato-psychological multidisciplinary approach. © 2012 International Society for Sexual Medicine.

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

Establishment and operation of the National Accident Sampling System (NASS) team within the cities of Ft. Lauderdale/Hollywood, Florida

NASA Astrophysics Data System (ADS)

Beddow, B.; Roberts, C.; Rankin, J.; Bloch, A.; Peizer, J.

1981-01-01

The National Accident Sampling System (NASS) is described. The study area discussed is one of the original ten sites selected for NASS implementation. In addition to collecting data from the field, the original ten sites address questions of feasibility of the plan, projected results of the data collection effort, and specific operational topics, e.g., team size, sampling requirements, training approaches, quality control procedures, and field techniques. Activities and results of the first three years of the project, for both major tasks (establishment and operation) are addressed. Topics include: study area documentation; team description, function and activities; problems and solutions; and recommendations.

Operator Performance Evaluation of Fault Management Interfaces for Next-Generation Spacecraft

NASA Technical Reports Server (NTRS)

Hayashi, Miwa; Ravinder, Ujwala; Beutter, Brent; McCann, Robert S.; Spirkovska, Lilly; Renema, Fritz

2008-01-01

In the cockpit of the NASA's next generation of spacecraft, most of vehicle commanding will be carried out via electronic interfaces instead of hard cockpit switches. Checklists will be also displayed and completed on electronic procedure viewers rather than from paper. Transitioning to electronic cockpit interfaces opens up opportunities for more automated assistance, including automated root-cause diagnosis capability. The paper reports an empirical study evaluating two potential concepts for fault management interfaces incorporating two different levels of automation. The operator performance benefits produced by automation were assessed. Also, some design recommendations for spacecraft fault management interfaces are discussed.

[Determination of blood alcohol among aviation personnel: proposed operative protocol].

PubMed

Lopez, A; Cardoni, F; Bova, M; Simonazzi, S; Romolo, F S; Ricciardi Tenore, G

2003-01-01

The problems of the use/abuse of alcohol need a special attention by the Public Authorities, based on the scientific evidences related to the subject. We would like to define in the present paper the procedures for alcohol testing (and drug testing) in the sailors, following the international aviation authorities (ICAO, JAR-OPS-1, FAA) recommendations. A Working Group was established to study both the scientific and the legal aspects of the problems related to alcohol testing in Italy. Experts from the Università "La Sapienza" and from Alitalia studied the alcohol testing issues abroad to set out criteria, guidelines and procedures for random testing in Italy.

Results of the first provisional technical secretariat interlaboratory comparison test

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

Stuff, J.R.; Hoffland, L.

1995-06-01

The principal task of this laboratory in the first Provisional Technical Secretariat (PTS) Interlaboratory Comparison Test was to verify and test the extraction and preparation procedures outlined in the Recommended Operating Procedures for Sampling and Analysis in the Verification of Chemical Disarmament in addition to our laboratory extraction methods and our laboratory analysis methods. Sample preparation began on 16 May 1994 and analysis was completed on 12 June 1994. The analytical methods used included NMR ({sup 1}H and {sup 31}P) GC/AED, GC/MS (EI and methane CI), GC/IRD, HPLC/IC, HPLC/TSP/MS, MS/MS(Electrospray), and CZE.

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

Fedorov, M. P.; Elistratov, V. V.; Maslikov, V. I.

Studies of greenhouse-gas emissions from the surfaces of the world’s reservoirs, which has demonstrated ambiguity of assessments of the effect of reservoirs on greenhouse-gas emissions to the atmosphere, is analyzed. It is recommended that greenhouse- gas emissions from various reservoirs be assessed by the procedure “GHG Measurement Guidelines for Fresh Water Reservoirs” (2010) for the purpose of creating a data base with results of standardized measurements. Aprogram for research into greenhouse-gas emissions is being developed at the St. Petersburg Polytechnic University in conformity with the IHA procedure at the reservoirs impounded by the Sayano-Shushenskaya and Mainskaya HPP operated by themore » RusHydro Co.« less

20 CFR 702.272 - Informal recommendation by district director.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Informal recommendation by district director... PROCEDURE Claims Procedures Discrimination § 702.272 Informal recommendation by district director. (a) If... employer and employee accept the district director's recommendation, it will be incorporated in an order...

Hydrogen Fire in a Storage Vessel

NASA Technical Reports Server (NTRS)

Hester, Zena M.

2010-01-01

On October 23, 2007, the operations team began a procedure to sample the Liquid Hydrogen (LH2) storage vessels ("tanks"), and associated transfer system. This procedure was being performed to determine the conditions within the system, and if necessary, to purge the system of any excess Gaseous Hydrogen (GH2) in preparation for reactivation of the system. The system had not been used since 2003. The LH2 storage system contains two (2) spherical pressure vessels of 225,000 gallons in volume, with a maximum working pressure (MAWP) of 50 psig. Eight inch transfer piping connects them to the usage point. Operations began with activation of the burnstack for the LH2 storage area. Pneumatic (GN2) systems in the storage area were then activated and checked. Pressurization of storage tank number 1 with gaseous nitrogen (GN2) was initiated, with a target pressure of 10 psig, at which point samples were planned to be taken. At 5 psig, a loud noise was heard in the upper area of tank number 2. Smoke was seen exiting the burnstack and from the insulation on vent lines for both tanks. At this time tank number 1 was vented and the pressurization system was secured. The mishap resulted in physical damage to both storage tanks, as well as to some of the piping for both tanks. Corrective action included repair of the damaged hardware by a qualified contractor. Preventive action included documented organizational policy and procedures for establishing standby and mothball conditions for facilities and equipment, including provisions as detailed in the investigation report recommendations: Recommendation 1: The using organization should define necessary activities in order to place hydrogen systems in long term periods of inactivity. The defined activities should address requirements for rendering inert, isolation (i.e., physical disconnect, double block and bleed, etc.) and periodic monitoring. Recommendation 2: The using organization should develop a process to periodically monitor hazardous systems for proper configuration (i.e., a daily/weekly/monthly check sheet to verify critical purges are active).

49 CFR Appendix E to Part 240 - Recommended Procedures for Conducting Skill Performance Tests

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Recommended Procedures for Conducting Skill... LOCOMOTIVE ENGINEERS Pt. 240, App. E Appendix E to Part 240—Recommended Procedures for Conducting Skill Performance Tests FRA requires (see § 240.127 and § 240.211) that locomotive engineers be given a skill...

Modifications in endoscopic practice for pediatric patients.

PubMed

Lightdale, Jenifer R; Acosta, Ruben; Shergill, Amandeep K; Chandrasekhara, Vinay; Chathadi, Krishnavel; Early, Dayna; Evans, John A; Fanelli, Robert D; Fisher, Deborah A; Fonkalsrud, Lisa; Hwang, Joo Ha; Kashab, Mouen; Muthusamy, V Raman; Pasha, Shabana; Saltzman, John R; Cash, Brooks D

2014-05-01

We recommend that endoscopy in children be performed by pediatric-trained endoscopists whenever possible. We recommend that adult-trained endoscopists coordinate their services with pediatricians and pediatric specialists when they are needed to perform endoscopic procedures in children. We recommend that endoscopy be performed within 24 hours in symptomatic pediatric patients with known or suspected ingestion of caustic substances. We recommend emergent foreign-body removal of esophageal button batteries, as well as 2 or more rare-earth neodymium magnets. We recommend that procedural and resuscitative equipment appropriate for pediatric use should be readily available during endoscopic procedures. We recommend that personnel trained specifically in pediatric life support and airway management be readily available during sedated procedures in children. We recommend the use of endoscopes smaller than 6 mm in diameter in infants and children weighing less than 10 kg. We recommend the use of standard adult duodenoscopes for performing ERCP in children who weigh at least 10 kg. We recommend the placement of 12F or 16F percutaneous endoscopic gastrostomy tubes in children who weigh less than 50 kg.

Chapter 7. Critical care triage. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Christian, Michael D; Joynt, Gavin M; Hick, John L; Colvin, John; Danis, Marion; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on critical care triage. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including critical care triage. Key recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resources; (2) developing fair and equitable policies may require restricting ICU services to patients most likely to benefit; (3) usual treatments and standards of practice may be impossible to deliver; (4) ICU care and treatments may have to be withheld from patients likely to die even with ICU care and withdrawn after a trial in patients who do not improve or deteriorate; (5) triage criteria should be objective, ethical, transparent, applied equitably and be publically disclosed; (6) trigger triage protocols for pandemic influenza only when critical care resources across a broad geographic area are or will be overwhelmed despite all reasonable efforts to extend resources or obtain additional resources; (7) triage of patients for ICU should be based on those who are likely to benefit most or a 'first come, first served' basis; (8) a triage officer should apply inclusion and exclusion criteria to determine patient qualification for ICU admission. Judicious planning and adoption of protocols for critical care triage are necessary to optimize outcomes during a pandemic.

Chapter 3. Coordination and collaboration with interface units. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Joynt, Gavin M; Loo, Shi; Taylor, Bruce L; Margalit, Gila; Christian, Michael D; Sandrock, Christian; Danis, Marion; Leoniv, Yuval; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on enhancing coordination and collaboration between the ICU and other key stakeholders. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including coordination and collaboration. Key recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resource use and communications; (2) develop a system of communication, coordination and collaboration between the ICU and key interface departments within the hospital; (3) identify key functions or processes requiring coordination and collaboration, the most important of these being manpower and resources utilization (surge capacity) and re-allocation of personnel, equipment and physical space; (4) develop processes to allow smooth inter-departmental patient transfers; (5) creating systems and guidelines is not sufficient, it is important to: (a) identify the roles and responsibilities of key individuals necessary for the implementation of the guidelines; (b) ensure that these individuals are adequately trained and prepared to perform their roles; (c) ensure adequate equipment to allow key coordination and collaboration activities; (d) ensure an adequate physical environment to allow staff to properly implement guidelines; (6) trigger events for determining a crisis should be defined. Judicious planning and adoption of protocols for coordination and collaboration with interface units are necessary to optimize outcomes during a pandemic.

Vertebral body clinico-morphological features following percutaneous vertebroplasty versus the conservatory approach.

PubMed

Constantin, Cristian; Albulescu, Dana Maria; Diţă, Daniel Răzvan; Georgescu, Claudia Valentina; Deaconu, Andrei Constantin

2018-01-01

Most percutaneous vertebroplasty procedures are being performed in order to relieve pain in patients with severe osteoporosis and associated stable fractures of one or more vertebral bodies. In addition, vertebroplasty is also recommended for patients suffering from post-traumatic symptoms associated with vertebral fractures, patients with large angiomas positioned inside the vertebral body, with an increased risk for collapse fracture and also patients presenting with pain associated with vertebral body metastatic disease. On another aspect, it is possible that in isolated cases, an orthopedic surgeon confronted with a vertebra plana presentation will recommend bone cement injection into the vertebral bodies adjacent to the fractured one, in order to have a better and more robust substrate for placement of screws or other fixation devices. The aim of our study is to compare results attained by the Department of Interventional Radiology, in performing this procedure, with results attained by following the classical orthopedic treatment procedure, involving non-operative treatment, using medication and bracing varying from simple extension orthoses in order to limit spinal flexion, light bracing for contiguous fractures, presenting either angulation or compression, and for severe cases standard thoracolumbosacral orthoses (TLSOs).

Preliminary acclimation strategies for successful startup in conventional biofilters.

PubMed

Elías, Ana; Barona, Astrid; Gallastegi, Gorka; Rojo, Naiara; Gurtubay, Luis; Ibarra-Berastegi, Gabriel

2010-08-01

The question of how to obtain the best inocula for conventional biofilters arises when an acclimation/adaptation procedure is to be applied. Bearing in mind that no standardized procedure for acclimating inocula exists, certain preliminary strategies for obtaining an active inoculum from wastewater treatment sludge are proposed in this work. Toluene was the contaminant to be degraded. Concerning the prior separation of sludge phases, no obvious advantage was found in separating the supernatant phase of the sludge before acclimation. As far as a continuous or discontinuous acclimation mode is concerned, the latter is recommended for rapidly obtaining acclimated sludge samples by operating the system for no longer than 1 month. The continuous mode rendered similar degradation rates, although it required longer operating time. Nevertheless, the great advantage of the continuous system lay in the absence of daily maintenance and the ready availability of the activated sample.

Contractor and government - Teamwork and commitment

NASA Technical Reports Server (NTRS)

Griffin, G. D.

1985-01-01

Procedures being implemented at NASA to improve cooperation with contractors and increase productivity are reviewed from the NASA point of view. The goals of the U.S. space program for the coming 25 years are listed, and the importance of the commercial utilization of space in these plans is stressed. Consideration is given to the ongoing American Productivity Center White-Collar Productivity-Improvement Project, the implementation of the recommendations of the 1984 NASA/Contractor Conferences in present and future contracts, and the use of incentive contracts to create situations in which both NASA and the contractor benefit from increased productivity. Future plans call for increased industry responsibility in managing and operating the STS; steamlining of Shuttle operations; advanced design-to-cost procedures, increased commonality, better NASA-contractor communications, and more use of CAD/CAM and robotics for the Space Station; and accommodation of greatly expanded private investment and exploitation of space.

[Individual learning curve for radical robot-assisted prostatectomy based on the example of three professionals working in one clinic].

PubMed

Rasner, P I; Pushkar', D Iu; Kolontarev, K B; Kotenkov, D V

2014-01-01

The appearance of new surgical technique always requires evaluation of its effectiveness and ease of acquisition. A comparative study of the results of the first three series of successive robot-assisted radical prostatectomy (RARP) performed on at time by three surgeons, was conducted. The series consisted of 40 procedures, and were divided into 4 groups of 10 operations for the analysis. When comparing data, statistically significant improvement of intra- and postoperative performance in each series was revealed, with increase in the number of operations performed, and in each subsequent series compared with the preceding one. We recommend to perform the planned conversion at the first operation. In our study, previous laparoscopic experience did not provide any significant advantages in the acquisition of robot-assisted technology. To characterize the individual learning curve, we recommend the use of the number of operations that the surgeon looked in the life-surgery regimen and/or in which he participated as an assistant before his own surgical activity, as well as the indicator "technical defect". In addition to the term "individual learning curve", we propose to introduce the terms "surgeon's individual training phase", and "clinic's learning curve".

High-Penetration Photovoltaic Planning Methodologies

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

Gao, David Wenzhong; Muljadi, Eduard; Tian, Tian

The main objective of this report is to provide an overview of select U.S. utility methodologies for performing high-penetration photovoltaic (HPPV) system planning and impact studies. This report covers the Federal Energy Regulatory Commission's orders related to photovoltaic (PV) power system interconnection, particularly the interconnection processes for the Large Generation Interconnection Procedures and Small Generation Interconnection Procedures. In addition, it includes U.S. state interconnection standards and procedures. The procedures used by these regulatory bodies consider the impacts of HPPV power plants on the networks. Technical interconnection requirements for HPPV voltage regulation include aspects of power monitoring, grounding, synchronization, connection tomore » the overall distribution system, back-feeds, disconnecting means, abnormal operating conditions, and power quality. This report provides a summary of mitigation strategies to minimize the impact of HPPV. Recommendations and revisions to the standards may take place as the penetration level of renewables on the grid increases and new technologies develop in future years.« less

Standard operating procedures for sows and piglets in farrowing and lactation in Japanese commercial herds.

PubMed

Ichikawa, Hiroki; Koketsu, Yuzo

2012-11-01

The objectives of the present study were to advance the development of standard operating procedures for sows and piglets during farrowing and lactation in Japanese herds by surveying management procedures and to examine the relationships between the procedures and herd reproductive performance. In 2009, 115 herds using the same recording system were asked to complete a questionnaire about their management procedures. Data from 96 (83.5%) returned questionnaires were coordinated with the respective herd reproductive performance. The participating herds were classified into two groups based on the upper 25th percentile of pigs weaned per mated female per year: high-performing (>23.8 pigs) or ordinary herds. ANOVA was used to compare the procedures between two herd groups. Modeling with backward elimination was performed to establish the most important procedures for herd performance. More high-performing herds practiced farrowing induction and high-performing herds also had a higher percentage of farrowing-induced sows than ordinary herds (P<0.05). Modeling showed that herds feeding lactating sows with dietary fiber had 1.4% lower preweaning mortality risk than those that did not (P<0.05). Herds practicing fostering techniques or using nurse sows had 0.2 kg heavier average pig weaning weight than those not using these procedures (P<0.05). There was no association between pigs born alive and any of the surveyed management procedures. Based on these results, we recommend improving performances in breeding herds by feeding lactating sows with dietary fiber, performing fostering techniques and using nurse sows.

[ISO 9001 certification of innovation and clinical research departments: Extending the scope of health assessment].

PubMed

Sambou, C; Guillemaut, S; Morelle, M; Achache, A; Le Corroller, A-G; Perol, D; Perrier, L

2017-04-01

The International organization for standardization (ISO) is the world leader in providing industrial and commercial standards and certifications. Beyond medical devices, four French clinical research and innovation departments have received an ISO 9001 certification (the standard for quality management). Simultaneously, medico-economic studies have become increasingly important in the public decision process. Using the clinical research and innovation department from the Léon-Bérard Cancer Center as an example, the purpose of this article is to show how the scope of the ISO 9001 certification has been extended to cover medico-economic studies. All of the processes, procedures, operating modes, documents, and indicators used by the clinical research and innovation department of the Léon-Bérard center were investigated. Literature searches were conducted using Medline keywords. The recommendations from the French national authority for health and other organizations, such as the International society for pharmacoeconomics and outcomes research (ISPOR), were also considered, as well as the recommendations of the General inspectorate of social affairs. In accordance with the national and international recommendations, two procedures were created and four procedures were revised at this center. Five indicators of quality and an evaluation chart were developed. By adopting the ISO 9001 certification into its medico-economic studies, the clinical research and innovation department of the Léon-Bérard center has used an innovative approach in the context of the growing importance of economic studies in decision-making. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Weather Requirements and Procedures for Step 1: High Altitude Long Endurance (HALE) Unmanned Aircraft System (UAS) Flight Operations in the National Air Space (NAS)

NASA Technical Reports Server (NTRS)

2007-01-01

This cover sheet is for version 2 of the weather requirements document along with Appendix A. The purpose of the requirements document was to identify and to list the weather functional requirements needed to achieve the Access 5 vision of "operating High Altitude, Long Endurance (HALE) Unmanned Aircraft Systems (UAS) routinely, safely, and reliably in the National Airspace System (NAS) for Step 1." A discussion of the Federal Aviation Administration (FAA) references and related policies, procedures, and standards is provided as basis for the recommendations supported within this document. Additional procedures and reference documentation related to weather functional requirements is also provided for background. The functional requirements and related information are to be proposed to the FAA and various standards organizations for consideration and approval. The appendix was designed to show that sources of flight weather information are readily available to UAS pilots conducting missions in the NAS. All weather information for this presentation was obtained from the public internet.

[Surgical treatment of colonic and rectal tumors].

PubMed

Verushkin, I I; Ratmanov, A M; Kotomin, S V; Sharnov, V A; Verushkina, N I

1996-01-01

The study included three groups of patients with rectal and colonic tumors operated on under emergency and routine conditions. The percentage of emergency operations proved rather high, surgery being performed under both hospital and field conditions. Causes for calls have been evaluated and extent of surgery versus operating conditions and immediate results in each group assessed. Operating under hospital conditions is recommended for carrying out procedures like that of Hartman involving obligatory removal of tumor and verification of diagnosis. Reconstructive surgery should be performed in specialized wards of a regional clinic. Higher expertise of rural surgeons as well as increased competence of general practitioners in oncopathology, timely inclusion of oncologists into on-call teams of doctors and hospitalization of patients into specialized wards contribute to higher effectiveness of treatment of bowel pathologies.

Antibiotic Prescribing Practices for Prevention of Surgical Site Infections in Australia: Increased Uptake of National Guidelines after Surveillance and Reporting and Impact on Infection Rates.

PubMed

Bull, Ann L; Worth, Leon J; Spelman, Tim; Richards, Michael J

2017-10-01

Antimicrobial prophylaxis is the single most effective intervention to reduce risk of surgical site infections (SSIs); however, prescribing practices should be aligned with accepted and recommended surgical antibiotic prophylaxis (SAP) regimens to be effective. As part of a comprehensive surveillance network, SAP data are collated and analyzed for compliance with recommendations. Results are reported to hospitals for quality improvement purposes. In this study, statewide results were analyzed to ascertain changes over time and whether improved compliance was associated with a reduction in risk for SSI. A standardized tool for monitoring SAP and SSIs was used in Victorian healthcare facilities. For the current study, data submitted for the period 2003-2015 were analyzed. Compliance with national recommendations (Australian Therapeutic Guidelines-Antibiotic) was used as the reference standard for antibiotic selection, timing, and duration Results: A total of 144,075 surgical procedures were surveyed during the study period. During this period, the proportion of patients receiving antibiotic agents according to national guidelines increased. Across all surgical groups, the odds ratio (OR) for appropriate SAP choice increased by 13%/year. Greatest improvement was seen for colorectal procedures (19%/year), with the smallest change observed for cholecystectomy and cardiac operations (9%/year). The OR for receiving an antibiotic agent at the recommended time increased by 12%/year and the odds of the antibiotic agent being discontinued within 24 hours by 27%/year. Non-compliance with a recommended SAP agent and timing was associated with an increased risk of SSI across all procedure groups (OR 1.33, 95% confidence interval 1.24-1.43). Sustained improvements in prescribing practices for SAP have been demonstrated through a comprehensive surveillance and reporting system. Non-compliance with SAP guidelines is associated with an increased risk for SSI. Quality improvement programs must focus on uptake and implementation of evidence-based guidelines.

Influence of operator experience and PCI volume on transfemoral access techniques: A collaboration of international cardiovascular societies.

PubMed

Nelson, Daniel W; Damluji, Abdulla A; Patel, Nish; Valgimigli, Marco; Windecker, Stephan; Byrne, Robert; Nolan, James; Patel, Tejas; Brilakis, Emmanouil; Banerjee, Subhash; Mayol, Jorge; Cantor, Warren J; Alfonso, Carlos E; Rao, Sunil V; Moscucci, Mauro; Cohen, Mauricio G

2018-03-01

Transfemoral access (TFA) is widely used for coronary angiography and percutaneous coronary intervention (PCI). The influence of operator age, gender, experience, and procedural volume on performance of femoral arterial access has not been studied. A survey instrument was developed and distributed via e-mail from professional societies to interventional cardiologists worldwide from March to December 2016. A total of 988 physicians from 88 countries responded to the survey. TFA is the preferred approach for patients with cardiogenic shock, left main or bifurcation PCI, and procedures with mechanical circulatory support. Older (<50years: 56.4%; ≥50years: 66.8%, p<0.0039) and high PCI volume operators (<100 PCI: 57.3%; 100-299 PCI: 58.7%; ≥300 PCI: 64.3%, p<0.134) preferred palpation only without imaging (fluoroscopy or ultrasound (US)) for TFA. Most respondents preferred not to use micropuncture needle to puncture the femoral artery. Older (≥50years: 64.4%; <50years: 71.5%, p<0.04) and high PCI volume operators (≥300 PCI: 64.1%; 100-299 PCI: 72.6%; <100 PCI: 67.9%, p<0.072) tended not to perform femoral angiography (FA). Of those performing FA, the majority opted to do it at the end of the procedure. Despite best practice guideline recommendations, older and high PCI volume interventional cardiologists prefer not to use imaging for femoral access or perform femoral angiography during TF procedures. These data highlight opportunities to further reduce TFA complications. Copyright © 2017 Elsevier Inc. All rights reserved.

Bypass Ratio: The US Air Force and Light-Attack Aviation

DTIC Science & Technology

2013-06-01

for making recommendations which optimize base activity and its impact on the environment. Local and state politics can keep a base open even if it is...for the region, and this conduct can affect global commerce. Such disruption and destabilization in turn can have large impacts on the US diplomatic... IFR ) operations, emergency procedures, low-level flight and two-ship formation flight by this stage. Once track selection occurs, the light-attack

Silicone rubber band treatment of rectal prolapse.

PubMed

Jackaman, F R; Francis, J N; Hopkinson, B R

1980-09-01

Fifty-two patients with rectal prolapse have been treated by the silicone rubber band perianal suture technique and satisfactory results have been obtained in 46 (89%). Eleven patients required reoperation to achieve this result. The procedure is a minor one, with little morbidity and no mortality. Provided that faecal impaction can be avoided in patients having this operation a successful outcome, can be expected. It is recommended especially for the frail and elderly with rectal prolapse.

Sea wind parameters retrieval using Y-configured Doppler navigation system data. Performance and accuracy

NASA Astrophysics Data System (ADS)

Khachaturian, A. B.; Nekrasov, A. V.; Bogachev, M. I.

2018-05-01

The authors report the results of the computer simulations of the performance and accuracy of the sea wind speed and direction retrieval. The analyzed measurements over the sea surface are made by the airborne microwave Doppler navigation system (DNS) with three Y-configured beams operated as a scatterometer enhancing its functionality. Single- and double-stage wind measurement procedures are proposed and recommendations for their implementation are described.

Enhanced Preliminary Assessment Report: Kapalama Military Reservation, Honolulu, Hawaii

DTIC Science & Technology

1990-02-01

Environmentally Significant Operations - Transformers 3-4 5-1 Recommended Sampling Methods 5-6 vii 1073M2-4 LIST OF TABLES Tabf lN. Title ES-1 ESOs...Phase III. ES-I 1073M2-4 ESOs identified on the property include: Buildings 913/914 - Mortuary - chemicals used in the embalming process. The chemicals...The chemicals stored here are associated with the examination and embalming procedures performed at the mortuary and include arterial fluids

Assay optimisation and technology transfer for multi-site immuno-monitoring in vaccine trials

PubMed Central

Harris, Stephanie A.; Satti, Iman; Bryan, Donna; Walker, K. Barry; Dockrell, Hazel M.; McShane, Helen; Ho, Mei Mei

2017-01-01

Cellular immunological assays are important tools for the monitoring of responses to T-cell-inducing vaccine candidates. As these bioassays are often technically complex and require considerable experience, careful technology transfer between laboratories is critical if high quality, reproducible data that allows comparison between sites, is to be generated. The aim of this study, funded by the European Union Framework Program 7-funded TRANSVAC project, was to optimise Standard Operating Procedures and the technology transfer process to maximise the reproducibility of three bioassays for interferon-gamma responses: enzyme-linked immunosorbent assay (ELISA), ex-vivo enzyme-linked immunospot and intracellular cytokine staining. We found that the initial variability in results generated across three different laboratories reduced following a combination of Standard Operating Procedure harmonisation and the undertaking of side-by-side training sessions in which assay operators performed each assay in the presence of an assay ‘lead’ operator. Mean inter-site coefficients of variance reduced following this training session when compared with the pre-training values, most notably for the ELISA assay. There was a trend for increased inter-site variability at lower response magnitudes for the ELISA and intracellular cytokine staining assays. In conclusion, we recommend that on-site operator training is an essential component of the assay technology transfer process and combined with harmonised Standard Operating Procedures will improve the quality, reproducibility and comparability of data produced across different laboratories. These data may be helpful in ongoing discussions of the potential risk/benefit of centralised immunological assay strategies for large clinical trials versus decentralised units. PMID:29020010

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

Matsui, Yusuke, E-mail: wckyh140@yahoo.co.jp; Hiraki, Takao, E-mail: takaoh@tc4.so-net.ne.jp; Gobara, Hideo, E-mail: gobara@cc.okayama-u.ac.jp

IntroductionComputed tomography (CT) fluoroscopy-guided renal cryoablation and lung radiofrequency ablation (RFA) have received increasing attention as promising cancer therapies. Although radiation exposure of interventional radiologists during these procedures is an important concern, data on operator exposure are lacking.Materials and MethodsRadiation dose to interventional radiologists during CT fluoroscopy-guided renal cryoablation (n = 20) and lung RFA (n = 20) was measured prospectively in a clinical setting. Effective dose to the operator was calculated from the 1-cm dose equivalent measured on the neck outside the lead apron, and on the left chest inside the lead apron, using electronic dosimeters. Equivalent dose to the operator’s finger skinmore » was measured using thermoluminescent dosimeter rings.ResultsThe mean (median) effective dose to the operator per procedure was 6.05 (4.52) μSv during renal cryoablation and 0.74 (0.55) μSv during lung RFA. The mean (median) equivalent dose to the operator’s finger skin per procedure was 2.1 (2.1) mSv during renal cryoablation, and 0.3 (0.3) mSv during lung RFA.ConclusionRadiation dose to interventional radiologists during renal cryoablation and lung RFA were at an acceptable level, and in line with recommended dose limits for occupational radiation exposure.« less

Content Analysis of Vomit and Diarrhea Cleanup Procedures To Prevent Norovirus Infections in Retail and Food Service Operations.

PubMed

Chao, Morgan G; Dubé, Anne-Julie; Leone, Cortney M; Moore, Christina M; Fraser, Angela M

2016-11-01

Human noroviruses are the leading cause of foodborne disease in the United States, sickening 19 to 21 million Americans each year. Vomit and diarrhea are both highly concentrated sources of norovirus particles. For this reason, establishing appropriate cleanup procedures for these two substances is critical. Food service establishments in states that have adopted the 2009 or 2013 U.S. Food and Drug Administration Food Code are required to have a program detailing specific cleanup procedures. The aim of our study was to determine the alignment of existing vomit and diarrhea cleanup procedures with the 11 elements recommended in Annex 3 of the 2011 Supplement to the 2009 Food Code and to determine their readability and clarity of presentation. In July 2015, we located vomit and diarrhea cleanup procedures by asking Norovirus Collaborative for Outreach, Research, and Education stakeholders for procedures used by their constituency groups and by conducting a Google Advanced Search of the World Wide Web. We performed content analysis to determine alignment with the recommendations in Annex 3. Readability and clarity of presentation were also assessed. A total of 38 artifacts were analyzed. The mean alignment score was 7.0 ± 1.7 of 11 points; the mean clarity score was 6.7 ± 2.5 of 17 points. Only nine artifacts were classified as high clarity, high alignment. Vomit and diarrhea cleanup procedures should align with Annex 3 in the Food Code and should, as well, be clearly presented; yet, none of the artifacts completely met both conditions. To reduce the spread of norovirus infections in food service establishments, editable guidelines are needed that are aligned with Annex 3 and are clearly written, into which authors could insert their facility-specific information.

Tumescent liposuction: standard guidelines of care.

PubMed

Mysore, Venkataram

2008-01-01

Tumescent liposuction is a technique for the removal of subcutaneous fat under a special form of local anesthesia called tumescent anesthesia. PHYSICIAN'S QUALIFICATIONS: The physician performing liposuction should have completed postgraduate training in dermatology or a surgical specialty and should have had adequate training in dermatosurgery at a center that provides training in cutaneous surgery. In addition, the physician should obtain specific liposuction training or experience at the surgical table ("hands on") under the supervision of an appropriately trained and experienced liposuction surgeon. In addition to the surgical technique, training should include instruction in fluid and electrolyte balance, potential complications of liposuction, tumescent and other forms of anesthesia as well as emergency resuscitation and care. Liposuction can be performed safely in an outpatient day care surgical facility, or a hospital operating room. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place with which all nursing staff should be familiar. A physician trained in emergency medical care and acute cardiac emergencies should be available in the premises. It is recommended but not mandatory, that an anesthetist be asked to stand by. Liposuction is recommended for all localized deposits of fat. Novices should restrict themselves to the abdomen, thighs, buttocks and male breasts. Arms, the medial side of the thigh and the female breast need more experience and are recommended for experienced surgeons. Liposuction may be performed for non-cosmetic indications such as hyperhidrosis of axillae after adequate experience has been acquired, but is not recommended for the treatment of obesity. Detailed history is to be taken with respect to any previous disease, drug intake and prior surgical procedures. Liposuction is contraindicated in patients with severe cardiovascular disease, severe coagulation disorders including thrombophilia, and during pregnancy. Physical evaluation should be detailed and should include assessment of general physical health to determine the fitness of the patient for surgery, as well as the examination of specific sites that need liposuction to check for potential problems. The patient should sign a detailed consent form listing details about the procedure and possible complications. The consent form should specifically state the limitations of the procedure and should mention whether more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, computer presentations, and personal discussions. Preoperative laboratory studies to be performed include Hb%, blood counts including platelet counts, bleeding and clotting time (or prothrombin and activated partial thromboplastin time) and blood chemistry profile; ECG is advisable. Liver function tests, and pregnancy test for women of childbearing age are performed as mandated by the individual patient's requirements. Ultrasound examination is recommended in cases of gynecomastia. Preoperative antibiotics and non-sedative analgesics such as paracetamol are recommended. The choice of antibiotic and analgesic agents depends on the individual physician's preference and the prevailing local conditions. Lidocaine is the preferred local anesthetic; its recommended dose is 35-45 mg/kg and doses should not exceed 55 mg/kg wt. The recommended concentration of epinephrine in tumescent solutions is 0.25-1.5 mg/L. The total dosage of epinephrine should be minimized and should not exceed 50 microg/kg. t is always advisable not to combine liposuction with other procedures to avoid exceeding the recommended dosage of lignocaine. However, such combinations may be attempted if the total required dose of lignocaine does not exceed the maximum dose indicated above. The recommended cannula size for liposuction is not to be larger than 3.5 mm in diameter. The recommended volume of fat removed is in proportion to the fat content and/or size and/or weight of the patient being treated. It is recommended that the volume of fat removed not exceed 5000 mL in a single operative session. arge volume liposuctions or mega-liposuctions are not recommended. Baseline vital signs including blood pressure and heart rate, are recorded pre- and postoperatively. Pulse oximeter monitoring is essential in all cases. Postoperative antibiotics should be selected by the physician and taken for five days. Postoperative antiinflammatory drugs such as Cox 2 Inhibiters may be given for 5-7 days; specialized compression garments, binders, and tape help to reduce bruising, hematomas, seromas, and pain. Generally, compression is recommended for two weeks although this is variable according to the needs of the individual patient.

Identifying problems and generating recommendations for enhancing complex systems: applying the abstraction hierarchy framework as an analytical tool.

PubMed

Xu, Wei

2007-12-01

This study adopts J. Rasmussen's (1985) abstraction hierarchy (AH) framework as an analytical tool to identify problems and pinpoint opportunities to enhance complex systems. The process of identifying problems and generating recommendations for complex systems using conventional methods is usually conducted based on incompletely defined work requirements. As the complexity of systems rises, the sheer mass of data generated from these methods becomes unwieldy to manage in a coherent, systematic form for analysis. There is little known work on adopting a broader perspective to fill these gaps. AH was used to analyze an aircraft-automation system in order to further identify breakdowns in pilot-automation interactions. Four steps follow: developing an AH model for the system, mapping the data generated by various methods onto the AH, identifying problems based on the mapped data, and presenting recommendations. The breakdowns lay primarily with automation operations that were more goal directed. Identified root causes include incomplete knowledge content and ineffective knowledge structure in pilots' mental models, lack of effective higher-order functional domain information displayed in the interface, and lack of sufficient automation procedures for pilots to effectively cope with unfamiliar situations. The AH is a valuable analytical tool to systematically identify problems and suggest opportunities for enhancing complex systems. It helps further examine the automation awareness problems and identify improvement areas from a work domain perspective. Applications include the identification of problems and generation of recommendations for complex systems as well as specific recommendations regarding pilot training, flight deck interfaces, and automation procedures.

Current operator volumes of invasive coronary procedures in Medicare patients: implications for future manpower needs in the catheterization laboratory.

PubMed

Maroney, Justin; Khan, Saba; Powell, Wayne; Klein, Lloyd W

2013-01-01

We seek to assess the per-operator volume of diagnostic catheterizations and percutaneous coronary interventions (PCI) among US cardiologists, and its implication for future manpower needs in the catheterization laboratory. The number of annual Medicare PCIs peaked in 2004 and has trended downward since, however the total number of catheterization laboratories nationwide has increased. It is unknown whether these trends have resulted in a dilution of per-operator volumes, and whether the current supply of interventional cardiologists is appropriate to meet future needs. We analyzed the Centers for Medicare and Medicaid Services 2008 Medicare 5% sample file, and extracted the total number of Medicare fee-for-service (Medicare FFS) diagnostic catheterizations and PCIs performed in 2008. We then determined per-physician procedure volumes using National Provider Identifier numbers. There were 1,198,610 Medicare FFS diagnostic catheterizations performed by 11,029 diagnostic cardiologists, and there were 378,372 Medicare FFS PCIs performed by 6,443 interventional cardiologists in 2008. The data reveal a marked difference in the 2008 distribution of diagnostic catheterizations and PCIs among operators. Just over 10% of diagnostic catheterizations were performed by operators performing 40 or fewer Medicare FFS diagnostic catheterizations, contrasted with almost 30% of PCIs performed by operators with 40 of fewer Medicare FFS PCIs. A significant majority of interventional cardiologists (61%) performed 40 or fewer Medicare FFS PCIs in 2008. There is a high percentage of low-volume operators performing PCI, raising questions regarding annual volume recommendations for procedural skill maintenance, and the future manpower requirements in the catheterization laboratory. Copyright © 2012 Wiley Periodicals, Inc.

Antibiotics Prophylaxis for Operative Hysteroscopy.

PubMed

Muzii, Ludovico; Di Donato, Violante; Boni, Terenzio; Gaglione, Raffaele; Marana, Riccardo; Mazzon, Ivan; Imperiale, Ludovica; De Medici, Caterina; Ruggiero, Alfonso; Panici, Pierluigi Benedetti

2017-04-01

To evaluate the incidence of infectious complications and effect of prophylactic antibiotic administration during operative hysteroscopic procedures. A multicentric randomized controlled trial was conducted between January 2012 and December 2013. Women (n = 180) affected by endometrial hyperplasia, myomas, or endometrial polyps undergoing operative hysteroscopy were randomized to receive cefazolin 2 g intravenously 30 minutes prior to the procedure (n = 91) and no treatment (n = 89). No statistical difference in terms of postoperative fever (2.4% vs 2.3%, P = .99), endometritis (0% vs 0%), pain (6.0% vs 10.4%, P = .40), cervicitis-vaginitis (0% vs 0%), pelvic abscess (0% vs 0%), pelvic inflammatory disease (0% vs 0%), and bleeding (0% vs 0%) was noticed. No statistical difference in terms of side effects attributable to antibiotic prophylaxis such as allergy (0% vs 4.8%, P = .12), nausea (10.7% vs 17.4%, P = .27), vomiting (3.6% vs 4.6%, P = .99), diarrhea (4.8% vs 5.4%, P = .99), cephalea (9.5% vs 3.5%, P = .13), dizziness (4.8% vs 2.3%, P = .44), and meteorism (5.4% vs 3.4%, P = .99) was noticed. The results of the current study support the recommendation not to prescribe routine antibiotic prophylaxis prior to operative hysteroscopy.

Battery Reinitialization of the Photovoltaic Module of the International Space Station

NASA Technical Reports Server (NTRS)

Hajela, Gyan; Cohen, Fred; Dalton, Penni

2002-01-01

The photovoltaic (PV) module on the International Space Station (ISS) has been operating since November 2000 and supporting electric power demands of the ISS and its crew of three. The PV module contains photovoltaic arrays that convert solar energy to electrical power and an integrated equipment assembly (IEA) that houses electrical hardware and batteries for electric power regulation and storage. Each PV module contains two independent power channels for fault tolerance. Each power channel contains three batteries in parallel to meet its performance requirements and for fault tolerance. Each battery consists of 76 Ni-Hydrogen (Ni-H2) cells in series. These 76 cells are contained in two orbital replaceable units (ORU) that are connected in series. On-orbit data are monitored and trended to ensure that all hardware is operating normally. Review of on-orbit data showed that while five batteries are operating very well, one is showing signs of mismatched ORUs. The cell pressure in the two ORUs differs by an amount that exceeds the recommended range. The reason for this abnormal behavior may be that the two ORUs have different use history. An assessment was performed and it was determined that capacity of this battery would be limited by the lower pressure ORU. Steps are being taken to reduce this pressure differential before battery capacity drops to the point of affecting its ability to meet performance requirements. As a first step, a battery reinitialization procedure was developed to reduce this pressure differential. The procedure was successfully carried out on-orbit and the pressure differential was reduced to the recommended range. This paper describes the battery performance and the consequences of mismatched ORUs that make a battery. The paper also describes the reinitialization procedure, how it was performed on orbit, and battery performance after the reinitialization. On-orbit data monitoring and trending is an ongoing activity and it will continue as ISS assembly progresses.

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

The load shedding advisor: An example of a crisis-response expert system

NASA Technical Reports Server (NTRS)

Bollinger, Terry B.; Lightner, Eric; Laverty, John; Ambrose, Edward

1987-01-01

A Prolog-based prototype expert system is described that was implemented by the Network Operations Branch of the NASA Goddard Space Flight Center. The purpose of the prototype was to test whether a small, inexpensive computer system could be used to host a load shedding advisor, a system which would monitor major physical environment parameters in a computer facility, then recommend appropriate operator reponses whenever a serious condition was detected. The resulting prototype performed significantly to efficiency gains achieved by replacing a purely rule-based design methodology with a hybrid approach that combined procedural, entity-relationship, and rule-based methods.

[Quantitative analysis of blood loss in liposuction].

PubMed

Schor, N; Zatz, R M; Mendonça, A R; Takatu, P M; Patto, G S

1989-01-01

This study was performed in 15 female patients submitted to suction lipectomy as an isolated procedure, to establish blood loss in the procedure. A wide variation of blood-to-fat ratios was observed (17 to 59%) with a mean blood loss in lipoaspirates of 34 +/- 3%. Internal blood losses occurring in the first 72 post-operative hours were as important as or more important than external losses, and responsible for a mean 7% fall in the level of hemoglobin. Internal blood losses occurred between 72 hours and the 7th to the 10th post-operative days and were responsible for a mean 3% fall in the level of hemoglobin. Blood losses occurring in this study were demonstrated to be greater than usually assumed. Some prophylactic measures are recommended to provide for a safer treatment of these patients: an iron supplementation during the pre-operative period; careful clinical and laboratorial screening for bleeding disorders and for the intake of drugs that can interfere with coagulation; use of smaller-diameter cannulas for aspiration, auto-transfusion when aspirating in excess of 1,000 ml, and limiting the aspiration to 1,500 ml.

To treat or not to treat: On what should surgical therapy be based?

PubMed

Jones, James W; McCullough, Laurence B

2015-12-01

Dr C. Autious has just returned from the most prestigious vascular surgery meeting in America. At the meeting, one of the most prominent complex aneurysm surgeons arose to discuss a paper concerning a procedure he had developed and popularized over the last decade. Dr L. Uminous stunned the audience with his declaration that he no longer recommends that his namesake procedure be performed. Instead, he proclaimed that a new, radically different procedure be adopted immediately. He showed slides detailing the novel proposal but did not give data concerning results obtained. The recommended procedure is technically possible but seems to require a different skill set. Dr Autious has a patient scheduled for elective surgery that he had planned to use the Uminous procedure to treat. What should he do? A. Do the recommended procedure as best you can. B. Refer the patient to Dr Uminous. C. Offer the recommended procedure with full disclosure. D. Give full disclosure and let the patient decide which procedure to use. E. Put the procedure on hold until more information becomes available. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

A procedure to evaluate environmental rehabilitation in limestone quarries.

PubMed

Neri, Ana Claudia; Sánchez, Luis Enrique

2010-11-01

A procedure to evaluate mine rehabilitation practices during the operational phase was developed and validated. It is based on a comparison of actually observed or documented practices with internationally recommended best practices (BP). A set of 150 BP statements was derived from international guides in order to establish the benchmark. The statements are arranged in six rehabilitation programs under three categories: (1) planning (2) operational and (3) management, corresponding to the adoption of the plan-do-check-act management systems model to mine rehabilitation. The procedure consists of (i) performing technical inspections guided by a series of field forms containing BP statements; (ii) classifying evidences in five categories; and (iii) calculating conformity indexes and levels. For testing and calibration purposes, the procedure was applied to nine limestone quarries and conformity indexes were calculated for the rehabilitation programs in each quarry. Most quarries featured poor planning practices, operational practices reached high conformity levels in 50% of the cases and management practices scored moderate conformity. Despite all quarries being ISO 14001 certified, their management systems pay low attention to issues pertaining to land rehabilitation and biodiversity. The best results were achieved by a quarry whose expansion was recently submitted to the environmental impact assessment process, suggesting that public scrutiny may play a positive role in enhancing rehabilitation practices. Conformity indexes and levels can be used to chart the evolution of rehabilitation practices at regular intervals, to establish corporate goals and for communication with stakeholders. Copyright 2010 Elsevier Ltd. All rights reserved.

Oral surgical handpiece use time parameters.

PubMed

Roberts, Howard W; Cohen, Mark E; Murchison, David F

2005-07-01

To evaluate the clinical usage time parameters of handpieces used in oral surgical procedures. One hundred randomly selected clinical oral surgery exodontia procedures were timed to record lengths of continuous segments of both handpiece use and non-usage. Providers with experience ranging from general dentists to board certified oral surgeons were timed during surgical exodontia treatment involving 1 to 4 teeth of various complexities. Usage times were compared with manufacturers' recommendations that on times should not exceed 20 seconds in any 50-second interval (20/50 rule). Handpiece run time increased with the number of teeth and surgical case complexity (both P < .001) but was unrelated to operator experience (P = .763), in a 3-predictor model (R2 = 0.20; P < .001). Ninety-four of the 100 cases experienced at least 1 second in violation of the 20/50 rule and 42% of all run seconds were in violation. Clinicians should be aware of recommended handpiece duty use cycles. Manufacturers' recommendations about handpiece use time cycles do not reflect actual clinical usage. Under the conditions of this study, actual surgical handpiece use time was not correlated with user experience. Less experienced providers did require longer to complete treatment, but increased treatment times were due to time spent that did not require surgical handpiece use.

[Deep brain stimulation in movement disorders: evidence and therapy standards].

PubMed

Parpaley, Yaroslav; Skodda, Sabine

2017-07-01

The deep brain stimulation (DBS) in movement disorders is well established and in many aspects evidence-based procedure. The treatment indications are very heterogeneous and very specific in their course and therapy. The deep brain stimulation plays very important, but usually not the central role in this conditions. The success in the application of DBS is essentially associated with the correct, appropriate and timely indication of the therapy in the course of these diseases. Thanks to the good standardization of the DBS procedure and sufficient published data, the recommendations for indication, diagnosis and operative procedures can be generated. The following article attempts to summarize the most important decision-making criteria and current therapy standards in this fairly comprehensive subject and to present them in close proximity to practice. Georg Thieme Verlag KG Stuttgart · New York.

In-flight disinsection as an efficacious procedure for preventing international transport of insects of public health importance.

PubMed Central

Russell, R. C.; Paton, R.

1989-01-01

Aircraft disinsection with aerosol insecticides during flight has generally been held to be inadvisable because it was assumed that the insecticides would be rapidly removed by the cabin air-conditioning system. We have developed protocols to deliver 2% d-phenothrin at a dose of 35 g per 100 m3 in various aircraft, and trials undertaken on Boeing 747 and 767 aircraft showed that their air-conditioning systems do not preclude effective disinsection. Mortality levels of 100% for Culex quinquefasciatus and Musca domestica test insects were recorded under normal operating conditions during routine scheduled passenger flights with disinsection procedures undertaken at "blocks-away" or at "top-of-descent". As a result, "top-of-descent" disinsection has been introduced as the recommended procedure for aircraft landing in Australia. PMID:2611975

In-flight disinsection as an efficacious procedure for preventing international transport of insects of public health importance.

PubMed

Russell, R C; Paton, R

1989-01-01

Aircraft disinsection with aerosol insecticides during flight has generally been held to be inadvisable because it was assumed that the insecticides would be rapidly removed by the cabin air-conditioning system. We have developed protocols to deliver 2% d-phenothrin at a dose of 35 g per 100 m3 in various aircraft, and trials undertaken on Boeing 747 and 767 aircraft showed that their air-conditioning systems do not preclude effective disinsection. Mortality levels of 100% for Culex quinquefasciatus and Musca domestica test insects were recorded under normal operating conditions during routine scheduled passenger flights with disinsection procedures undertaken at "blocks-away" or at "top-of-descent". As a result, "top-of-descent" disinsection has been introduced as the recommended procedure for aircraft landing in Australia.

15 CFR 10.7 - Procedure when a recommended standard is not supported by a consensus.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Procedure when a recommended standard is not supported by a consensus. 10.7 Section 10.7 Commerce and Foreign Trade Office of the Secretary... recommended standard is not supported by a consensus. If the Department determines that a recommended standard...

Recent developments in the Dorfman-Berbaum-Metz procedure for multireader ROC study analysis.

PubMed

Hillis, Stephen L; Berbaum, Kevin S; Metz, Charles E

2008-05-01

The Dorfman-Berbaum-Metz (DBM) method has been one of the most popular methods for analyzing multireader receiver-operating characteristic (ROC) studies since it was proposed in 1992. Despite its popularity, the original procedure has several drawbacks: it is limited to jackknife accuracy estimates, it is substantially conservative, and it is not based on a satisfactory conceptual or theoretical model. Recently, solutions to these problems have been presented in three papers. Our purpose is to summarize and provide an overview of these recent developments. We present and discuss the recently proposed solutions for the various drawbacks of the original DBM method. We compare the solutions in a simulation study and find that they result in improved performance for the DBM procedure. We also compare the solutions using two real data studies and find that the modified DBM procedure that incorporates these solutions yields more significant results and clearer interpretations of the variance component parameters than the original DBM procedure. We recommend using the modified DBM procedure that incorporates the recent developments.

Pressure control and analysis report: Hydrogen Thermal Test Article (HTTA)

NASA Technical Reports Server (NTRS)

1971-01-01

Tasks accomplished during the HTTA Program study period included: (1) performance of a literature review to provide system guidelines; (2) development of analytical procedures needed to predict system performance; (3) design and analysis of the HTTA pressurization system considering (a) future utilization of results in the design of a spacecraft maneuvering system propellant package, (b) ease of control and operation, (c) system safety, and (d) hardware cost; and (4) making conclusions and recommendations for systems design.

Pretest information for a test to validate plume simulation procedures (FA-17)

NASA Technical Reports Server (NTRS)

Hair, L. M.

1978-01-01

The results of an effort to plan a final verification wind tunnel test to validate the recommended correlation parameters and application techniques were presented. The test planning effort was complete except for test site finalization and the associated coordination. Two suitable test sites were identified. Desired test conditions were shown. Subsequent sections of this report present the selected model and test site, instrumentation of this model, planned test operations, and some concluding remarks.

Silicone rubber band treatment of rectal prolapse.

PubMed Central

Jackaman, F. R.; Francis, J. N.; Hopkinson, B. R.

1980-01-01

Fifty-two patients with rectal prolapse have been treated by the silicone rubber band perianal suture technique and satisfactory results have been obtained in 46 (89%). Eleven patients required reoperation to achieve this result. The procedure is a minor one, with little morbidity and no mortality. Provided that faecal impaction can be avoided in patients having this operation a successful outcome, can be expected. It is recommended especially for the frail and elderly with rectal prolapse. PMID:7002011

Recommendations for Evaluating Multiple Filters in Ballast Water Management Systems for US Type Approval

DTIC Science & Technology

2016-01-01

is extremely unlikely to be practicable . A second approach is to conduct a full suite of TA testing on a BWMS with a “base filter” configuration...that of full TA testing. Here, three land-based tests would be conducted, and O&M and component testing would also occur. If time or practicality ... Practical salinity units SAE Society of Automotive Engineers SDI Silt density index SOP Standard operating procedure STEP Shipboard Technology

The Advanced Trauma Operative Management course--a two student to one faculty model.

PubMed

Ali, Jameel; Sorvari, Anne; Henry, Sharon; Kortbeek, John; Tremblay, Lorraine

2013-09-01

The internationally recognized Advanced Trauma Operative Management (ATOM) course uses a 1:1 student-to-faculty teaching model. This study examines a two student to one faculty ATOM teaching model. We randomly assigned 16 residents to four experienced ATOM faculty members. Half started with the one-student model and the other half with the two-student model and then switched using the same faculty. Students and faculty completed forms on the educational value of the two models (1 = very poor; 2 = poor; 3 = average; 4 = good; and 5 = excellent) and identified educational preferences and recommendations. We assigned educational values for the 13 procedures as follows: All faculty rated the one-student model as excellent; six members rated the two-student model as excellent, and seven as good. Students rated 50%-75% as excellent and 12%-44% as good for the two-student model, and 56%-81% as excellent and 12%-44% as good for the one-student model. Given resource constraints, all faculty and 88% of students preferred the two-student model. With no resource constraints, 75% of students and 50% of faculty chose the two-student model. All faculty and students rated both models "acceptable." Overall, 81% of students and 50% of faculty rated the two-student model better. All faculty members recommended that the models be optional; 94% of students recommended that they be either optional (50%) or a two-student model (44%). Performing or assisting on each procedure twice was considered an advantage of the two-student model. The two-student teaching model was acceptable and generally preferred in this study. With appropriately trained faculty and students, the two-student model is feasible and should result in less animal usage and possibly wider promulgation. Copyright © 2013 Elsevier Inc. All rights reserved.

Planning Risk-Based SQC Schedules for Bracketed Operation of Continuous Production Analyzers.

PubMed

Westgard, James O; Bayat, Hassan; Westgard, Sten A

2018-02-01

To minimize patient risk, "bracketed" statistical quality control (SQC) is recommended in the new CLSI guidelines for SQC (C24-Ed4). Bracketed SQC requires that a QC event both precedes and follows (brackets) a group of patient samples. In optimizing a QC schedule, the frequency of QC or run size becomes an important planning consideration to maintain quality and also facilitate responsive reporting of results from continuous operation of high production analytic systems. Different plans for optimizing a bracketed SQC schedule were investigated on the basis of Parvin's model for patient risk and CLSI C24-Ed4's recommendations for establishing QC schedules. A Sigma-metric run size nomogram was used to evaluate different QC schedules for processes of different sigma performance. For high Sigma performance, an effective SQC approach is to employ a multistage QC procedure utilizing a "startup" design at the beginning of production and a "monitor" design periodically throughout production. Example QC schedules are illustrated for applications with measurement procedures having 6-σ, 5-σ, and 4-σ performance. Continuous production analyzers that demonstrate high σ performance can be effectively controlled with multistage SQC designs that employ a startup QC event followed by periodic monitoring or bracketing QC events. Such designs can be optimized to minimize the risk of harm to patients. © 2017 American Association for Clinical Chemistry.

[The incidence and prevalence of complications after urogynaecological and reconstructive pelvic floor prosthetic surgery and management of these complications in women].

PubMed

Martan, A; Svabík, K; Masata, J

2007-12-01

The aim of this article is to review the incidence and prevalence of complications after prosthetic surgery for POP (pelvic organ prolaps) and USI (urodynamic stress incontinence) and to introduce diagnostic and therapeutic advice into clinical practice. Review article. Gynecological and Obstetric Clinic, 1st LF UK and VFN, Prague. Summary of complications, recent findings, opinions and specific diagnostic and therapeutic recommendations with special focus to vaginal erosion, post-operative voiding difficulties, persisting leakage of urine and de novo urgency. In the last decade the surgical treatment of female USI by prosthetic slings procedures has been shown to be effective with high cure rate and low morbidity. Similary, prosthetic reconstruction of pelvic organ prolapse through the different compartments has been introduced into clinical practice with good anatomical and promising functional results. The article is structured to the different sections, describing the epidemiology and management of complications after prosthetic slings procedures and after vaginal prosthetic treatment of pelvic organ prolapse. The effect of various operations of pelvic floor and USI using synthetic implants may differ, depending on the material of the implant used. Current recommendation for the implants material: a light-weight, flexible polypropylene; Amid's classification: type 1, i.e macro-porous, monofilament material. The advantage of surgical treatment of pelvic floor defect using implants comprises a low percentage of recurrence of the descensus.

Mental Health Evaluations for Adolescents Prior to Bariatric Surgery: A Review of Existing Practices and a Specific Example of Assessment Procedures.

PubMed

Sysko, Robyn; Zandberg, Laurie J; Devlin, Michael J; Annunziato, Rachel A; Zitsman, Jeffrey L; Walsh, B Timothy

2013-06-01

Best practice guidelines for adolescents considering bariatric surgery recommend a pre-operative mental health evaluation. However, only general information about these assessments appears in the literature, which makes consistency of administration challenging. This review proposes a specific empirically-derived format for pre-surgical mental health evaluations and summarizes currently available data on the psychiatric functioning of adolescents seeking bariatric surgery. Studies of mental health evaluations for adults preparing for bariatric surgery are reviewed, as is the limited literature relevant to adolescent evaluations. A specific and detailed example of an evaluation (clinical interview, self-report questionnaires, cognitive assessment) used for younger patients at a major metropolitan hospital center is presented, followed by data from an initial group of adolescents completing this evaluation. 200 adolescents (n=139 female; age: 14-18 y, BMI: 35.4-83.3 kg/m 2 ) presenting for bariatric surgery. A notable subset of adolescents reported current Axis I conditions (31.5%) and current mental health treatment (29.5%), but reports of current illicit drug use (1.5%) and regular alcohol use (0.5%) were relatively rare. Procedures for using the completed evaluation and post-surgery monitoring of psychosocial issues are discussed. Adolescents considering weight loss surgery should receive comprehensive pre-surgical mental health evaluations, but additional data are needed to develop specific recommendations the use of these evaluations in post-operative care.

Oil spill impacts on mangroves: Recommendations for operational planning and action based on a global review.

PubMed

Duke, Norman C

2016-08-30

Mangrove tidal wetland habitats are recognised as highly vulnerable to large and chronic oil spills. This review of current literature and public databases covers the last 6 decades, summarising global data on oil spill incidents affecting, or likely to have affected, mangrove habitat. Over this period, there have been at least 238 notable oil spills along mangrove shorelines worldwide. In total, at least 5.5milliontonnes of oil has been released into mangrove-lined, coastal waters, oiling possibly up to around 1.94millionha of mangrove habitat, and killing at least 126,000ha of mangrove vegetation since 1958. However, there were assessment limitations with incomplete and unavailable data, as well as unequal coverage across world regions. To redress the gaps described here in reporting on oil spill impacts on mangroves and their recovery worldwide, a number of recommendations and suggestions are made for refreshing and updating standard operational procedures for responders, managers and researchers alike. Copyright © 2016 Elsevier Ltd. All rights reserved.

Automatic Generation of Conditional Diagnostic Guidelines.

PubMed

Baldwin, Tyler; Guo, Yufan; Syeda-Mahmood, Tanveer

2016-01-01

The diagnostic workup for many diseases can be extraordinarily nuanced, and as such reference material text often contains extensive information regarding when it is appropriate to have a patient undergo a given procedure. In this work we employ a three task pipeline for the extraction of statements indicating the conditions under which a procedure should be performed, given a suspected diagnosis. First, we identify each instance in the text where a procedure is being recommended. Next we examine the context around these recommendations to extract conditional statements that dictate the conditions under which the recommendation holds. Finally, corefering recommendations across the document are linked to produce a full recommendation summary. Results indicate that each underlying task can be performed with above baseline performance, and the output can be used to produce concise recommendation summaries.

10 CFR 712.22 - Hearing officer's report and recommendation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Hearing officer's report and recommendation. 712.22 Section 712.22 Energy DEPARTMENT OF ENERGY HUMAN RELIABILITY PROGRAM Establishment of and Procedures for the Human Reliability Program Procedures § 712.22 Hearing officer's report and recommendation. Within...

Efficacy of Negative Pressure Wound Treatment in Preventing Surgical Site Infections after Whipple Procedures.

PubMed

Gupta, Ryan; Darby, Geoffrey C; Imagawa, David K

2017-10-01

Surgical site infections (SSIs) occur at an average rate of 21.1 per cent after Whipple procedures per NSQIP data. In the setting of adherence to standard National Surgery Quality Improvement Program (NSQIP) Hepatopancreatobiliary recommendations including wound protector use and glove change before closing, this study seeks to evaluate the efficacy of using negative pressure wound treatment (NPWT) over closed incision sites after a Whipple procedure to prevent SSI formation. We retrospectively examined consecutive patients from January 2014 to July 2016 who met criteria of completing Whipple procedures with full primary incision closure performed by a single surgeon at a single institution. Sixty-one patients were included in the study between two cohorts: traditional dressing (TD) (n = 36) and NPWT dressing (n = 25). There was a statistically significant difference (P = 0.01) in SSI formation between the TD cohort (n = 15, SSI rate = 0.41) and the NPWT cohort (n = 3, SSI rate = 0.12). The adjusted odds ratio (OR) of SSI formation was significant for NPWT use [OR = 0.15, P = 0.036] and for hospital length of stay [OR = 1.21, P = 0.024]. Operative length, operative blood loss, units of perioperative blood transfusion, intraoperative gastrojejunal tube placement, preoperative stent placement, and postoperative antibiotic duration did not significantly impact SSI formation (P > 0.05).

40 CFR 246.202-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... techniques. (b) Directly contacting buyers and determining the buyers' quality specifications, potential...

40 CFR 246.201-4 - Recommended procedures: Market study.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... research techniques. (b) Directly contacting buyers and determining the buyers' quality specifications...

40 CFR 246.202-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... techniques. (b) Directly contacting buyers and determining the buyers' quality specifications, potential...

40 CFR 246.202-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... techniques. (b) Directly contacting buyers and determining the buyers' quality specifications, potential...

40 CFR 246.201-4 - Recommended procedures: Market study.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... research techniques. (b) Directly contacting buyers and determining the buyers' quality specifications...

40 CFR 246.201-4 - Recommended procedures: Market study.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... research techniques. (b) Directly contacting buyers and determining the buyers' quality specifications...

Radiometry of water turbidity measurements

NASA Technical Reports Server (NTRS)

Mccluney, W. R.

1974-01-01

An examination of a number of measurements of turbidity reported in the literature reveals considerable variability in the definitions, units, and measurement techniques used. Many of these measurements differ radically in the optical quantity measured. The radiometric basis of each of the most common definitions of turbidity is examined. Several commercially available turbidimeters are described and their principles of operation are evaluated radiometrically. It is recommended that the term turbidity be restricted to measurements based upon the light scattered by the sample with that scattered by standard suspensions of known turbidity. It is also recommended that the measurement procedure be standardized by requiring the use of Formazin as the turbidity standardizing material and that the Formazin Turbidity Unit (FTU) be adopted as the standard unit of turbidity.

Arthroscopic hip preservation surgery practice patterns: an international survey

PubMed Central

Smith, Kevin M.; Gerrie, Brayden J.; McCulloch, Patrick C.; Lewis, Brian D.; Mather, R. Chad; Van Thiel, Geoffrey; Nho, Shane J.

2017-01-01

Abstract To design and conduct a survey analyzing pre-, intra- and post- hip arthroscopy practice patterns among hip arthroscopists worldwide. A 21-question, IRB-exempt, HIPAA-compliant, cross-sectional survey was conducted via email using SurveyMonkey to examine pre-operative evaluation, intra-operative techniques and post-operative management. The survey was administered internationally to 151 hip arthroscopists identified from publicly available sources. Seventy-five respondents completed the survey (151 ± 116 hip arthroscopy procedures per year; 8.6 ± 7.1 years hip arthroscopy experience). Standing AP pelvis, false profile and Dunn 45 were the most common radiographs utilized. CT scans were utilized by 54% of surgeons at least some of the time. Only 56% of participants recommended an arthrogram with MRI. Nearly all surgeons either never (40%) or infrequently (58%) performed arthroscopy in Tönnis grade-2 or grade-3 osteoarthritis. Surgeons rarely performed hip arthroscopy on patients with dysplasia (51% never; 44% infrequently). Only 25% of participants perform a routine ‘T’ capsulotomy and 41% close the capsule if the patient is at risk for post-operative instability. Post-operatively, 52% never use a brace, 39% never use a continuous passive motion, 11% never recommended heterotopic ossification prophylaxis and 30% never recommended formal thromboembolic disease prophylaxis. Among a large number of high-volume experienced hip arthroscopists worldwide, pre-, intra- and post- hip arthroscopy practice patterns have been established and reported. Within this cohort of respondents, several areas of patient evaluation and management remain discordant and controversial without universal agreement. Future research should move beyond expert opinion level V evidence towards high-quality appropriately designed and conducted investigations. PMID:28630717

40 CFR 246.200-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... techniques; (b) Directly contacting buyers, and determining the buyers' quality specifications, the exact...

40 CFR 246.200-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... techniques; (b) Directly contacting buyers, and determining the buyers' quality specifications, the exact...

40 CFR 246.200-3 - Recommended procedures: Market study.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... techniques; (b) Directly contacting buyers, and determining the buyers' quality specifications, the exact...

14 CFR 11.27 - Are there other ways FAA collects specific rulemaking recommendations before we issue an NPRM?

Code of Federal Regulations, 2014 CFR

2014-01-01

... rulemaking recommendations before we issue an NPRM? 11.27 Section 11.27 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES GENERAL RULEMAKING PROCEDURES... before we issue an NPRM? Yes, the FAA obtains advice and recommendations from rulemaking advisory...

14 CFR 11.27 - Are there other ways FAA collects specific rulemaking recommendations before we issue an NPRM?

Code of Federal Regulations, 2011 CFR

2011-01-01

... rulemaking recommendations before we issue an NPRM? 11.27 Section 11.27 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES GENERAL RULEMAKING PROCEDURES... before we issue an NPRM? Yes, the FAA obtains advice and recommendations from rulemaking advisory...

14 CFR 11.27 - Are there other ways FAA collects specific rulemaking recommendations before we issue an NPRM?

Code of Federal Regulations, 2013 CFR

2013-01-01

... rulemaking recommendations before we issue an NPRM? 11.27 Section 11.27 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES GENERAL RULEMAKING PROCEDURES... before we issue an NPRM? Yes, the FAA obtains advice and recommendations from rulemaking advisory...

14 CFR 11.27 - Are there other ways FAA collects specific rulemaking recommendations before we issue an NPRM?

Code of Federal Regulations, 2012 CFR

2012-01-01

... rulemaking recommendations before we issue an NPRM? 11.27 Section 11.27 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES GENERAL RULEMAKING PROCEDURES... before we issue an NPRM? Yes, the FAA obtains advice and recommendations from rulemaking advisory...

14 CFR 11.27 - Are there other ways FAA collects specific rulemaking recommendations before we issue an NPRM?

Code of Federal Regulations, 2010 CFR

2010-01-01

... rulemaking recommendations before we issue an NPRM? 11.27 Section 11.27 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES GENERAL RULEMAKING PROCEDURES... before we issue an NPRM? Yes, the FAA obtains advice and recommendations from rulemaking advisory...

Recommended Procedures for Handling Emergency Illnesses and Accidents at School.

ERIC Educational Resources Information Center

North Dakota State Dept. of Health, Bismarck.

Recommended procedures for handling emergency illnesses and accidents are provided in this guide for school personnel prepared by the North Dakota State Department of Health. Following five general recommendations for steps to take in emergency situations, advice and techniques are given for handling: nose bleeds; abdominal pain; toothaches and…

Surgical Management of Benign Biliary Stricture in Chronic Pancreatitis: A Single-Center Experience.

PubMed

Ray, Sukanta; Ghatak, Supriyo; Das, Khaunish; Dasgupta, Jayanta; Ray, Sujay; Khamrui, Sujan; Sonar, Pankaj Kumar; Das, Somak

2015-12-01

Biliary stricture in chronic pancreatitis (CP) is not uncommon. Previously, all cases were managed by surgery. Nowadays, three important modes of treatment in these patients are observation, endoscopic therapy, and surgery. In the modern era, surgery is recommended only in a subset of patients who develop biliary symptoms or those who have asymptomatic biliary stricture and require surgery for intractable abdominal pain. We want to report on our experience regarding surgical management of CP-induced benign biliary stricture. Over a period of 5 years, we have managed 340 cases of CP at our institution. Bile duct stricture was found in 62 patients. But, surgical intervention was required in 44 patients, and the remaining 18 patients were managed conservatively. Demographic data, operative procedures, postoperative complications, and follow-up parameters of these patients were collected from our prospective database. A total 44 patients were operated for biliary obstruction in the background of CP. Three patients were excluded, so the final analysis was based on 41 patients. The indication for surgery was symptomatic biliary stricture in 27 patients and asymptomatic biliary stricture with intractable abdominal pain in 14 patients. The most commonly performed operation was Frey's procedure. There was no inhospital mortality. Thirty-five patients were well at a mean follow-up of 24.4 months (range 3 to 54 months). Surgery is still the best option for CP-induced benign biliary stricture, and Frey's procedure is a versatile operation unless you suspect malignancy as the cause of biliary obstruction.

A comprehensive and efficient daily quality assurance for PBS proton therapy

NASA Astrophysics Data System (ADS)

Actis, O.; Meer, D.; König, S.; Weber, D. C.; Mayor, A.

2017-03-01

There are several general recommendations for quality assurance (QA) measures, which have to be performed at proton therapy centres. However, almost each centre uses a different therapy system. In particular, there is no standard procedure for centres employing pencil beam scanning and each centre applies a specific QA program. Gantry 2 is an operating therapy system which was developed at PSI and relies on the most advanced technological innovations. We developed a comprehensive daily QA program in order to verify the main beam characteristics to assure the functionality of the therapy delivery system and the patient safety system. The daily QA program entails new hardware and software solutions for a highly efficient clinical operation. In this paper, we describe a dosimetric phantom used for verifying the most critical beam parameters and the software architecture developed for a fully automated QA procedure. The connection between our QA software and the database allows us to store the data collected on a daily basis and use it for trend analysis over longer periods of time. All the data presented here have been collected during a time span of over two years, since the beginning of the Gantry 2 clinical operation in 2013. Our procedure operates in a stable way and delivers the expected beam quality. The daily QA program takes only 20 min. At the same time, the comprehensive approach allows us to avoid most of the weekly and monthly QA checks and increases the clinical beam availability.

Occupational noise exposure during endourologic procedures.

PubMed

Soucy, Frédéric; Ko, Raymond; Denstedt, John D; Razvi, Hassan

2008-08-01

Long-term noise exposure in the workplace is a known cause of hearing loss. There has been limited study on the potential harm related to shock wave lithotripsy (SWL) or intracorporeal devices on patients and operating room personnel. We used a digital sound meter to measure decibel levels in the operating room during several endourologic procedures. The decibel levels were recorded during SWL (Storz SLX-F2), percutaneous nephrolithotomy using single- and dual-probe ultrasonic lithotripters (Olympus LUS-2, CyberWand), and during ureteroscopy using the Versa Pulse Holmium:YAG laser. Findings were compared with the U.S. Department of Labor Occupational Health and Safety Administration and Canadian Centre for Occupational Health recommendations on permissible noise levels in the workplace. The background sound level in the operating room prior to endourologic procedures ranged between 58 and 60 dB. In the SWL control room, 5 m from the source, the mean sound level was 68 dB (range 64-75) during treatment. The mean corresponding decibel level recorded at the patient's head during SWL was 77 dB (range 73-83). Noises produced by intracorporeal lithotripters were recorded at the surgeon's head, 2 m from the source. Measurements of the CyberWand (dual-probe) device revealed a higher mean decibel reading of 93 dB (range 85-102). Noise levels recorded for the Olympus LUS-2 (single-probe) ultrasound and the holmium laser were 65 dB (62 -68) and 60 dB (58-62), respectively. Although we noted that patients and urologists maybe exposed to significant noise levels during endourologic procedures, the duration of exposure is short. This risk appears to be minimal, based on current occupational guidelines, for most operating personnel.

Best practice guidelines for the operation of a donor human milk bank in an Australian NICU.

PubMed

Hartmann, B T; Pang, W W; Keil, A D; Hartmann, P E; Simmer, K

2007-10-01

Until the establishment of the PREM Bank (Perron Rotary Express Milk Bank) donor human milk banking had not occurred in Australia for the past 20 years. In re-establishing donor human milk banking in Australia, the focus of the PREM Bank has been to develop a formal and consistent approach to safety and quality in processing during the operation of the human milk bank. There is currently no existing legislation in Australia that specifically regulates the operation of donor human milk banks. For this reason the PREM Bank has utilised existing and internationally recognised management practices for managing hazards during food production. These tools (specifically HACCP) have been used to guide the development of Standard Operating Procedures and Good Manufacturing Practice for the screening of donors and processing of donor human milk. Donor screening procedures are consistent with those recommended by other human milk banks operating internationally, and also consistent with the requirements for blood and tissue donation in Australia. Controlled documentation and record keep requirements have also been developed that allow complete traceability from individual donation to individual feed dispensed to recipient and maintain a record of all processing and storage conditions. These operational requirements have been developed to reduce any risk associated with feeding pasteurised donor human milk to hospitalised preterm or ill infants to acceptable levels.

Effect of non-normality on test statistics for one-way independent groups designs.

PubMed

Cribbie, Robert A; Fiksenbaum, Lisa; Keselman, H J; Wilcox, Rand R

2012-02-01

The data obtained from one-way independent groups designs is typically non-normal in form and rarely equally variable across treatment populations (i.e., population variances are heterogeneous). Consequently, the classical test statistic that is used to assess statistical significance (i.e., the analysis of variance F test) typically provides invalid results (e.g., too many Type I errors, reduced power). For this reason, there has been considerable interest in finding a test statistic that is appropriate under conditions of non-normality and variance heterogeneity. Previously recommended procedures for analysing such data include the James test, the Welch test applied either to the usual least squares estimators of central tendency and variability, or the Welch test with robust estimators (i.e., trimmed means and Winsorized variances). A new statistic proposed by Krishnamoorthy, Lu, and Mathew, intended to deal with heterogeneous variances, though not non-normality, uses a parametric bootstrap procedure. In their investigation of the parametric bootstrap test, the authors examined its operating characteristics under limited conditions and did not compare it to the Welch test based on robust estimators. Thus, we investigated how the parametric bootstrap procedure and a modified parametric bootstrap procedure based on trimmed means perform relative to previously recommended procedures when data are non-normal and heterogeneous. The results indicated that the tests based on trimmed means offer the best Type I error control and power when variances are unequal and at least some of the distribution shapes are non-normal. © 2011 The British Psychological Society.

10 CFR 10.32 - Recommendation of the NRC Personnel Security Review Panel.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Recommendation of the NRC Personnel Security Review Panel. 10.32 Section 10.32 Energy NUCLEAR REGULATORY COMMISSION CRITERIA AND PROCEDURES FOR DETERMINING... Procedures § 10.32 Recommendation of the NRC Personnel Security Review Panel. (a) The Deputy Executive...

10 CFR 10.32 - Recommendation of the NRC Personnel Security Review Panel.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Recommendation of the NRC Personnel Security Review Panel. 10.32 Section 10.32 Energy NUCLEAR REGULATORY COMMISSION CRITERIA AND PROCEDURES FOR DETERMINING... Procedures § 10.32 Recommendation of the NRC Personnel Security Review Panel. (a) The Deputy Executive...

10 CFR 10.32 - Recommendation of the NRC Personnel Security Review Panel.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Recommendation of the NRC Personnel Security Review Panel. 10.32 Section 10.32 Energy NUCLEAR REGULATORY COMMISSION CRITERIA AND PROCEDURES FOR DETERMINING... Procedures § 10.32 Recommendation of the NRC Personnel Security Review Panel. (a) The Deputy Executive...

Don't mess with H/sub 2/S

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

Not Available

1987-09-01

The American Petroleum Institute issued a report on ''Recommended Practices for Safe Drilling of Wells Containing Hydrogen Sulfide.'' The study (RP49) updates a first edition published in September 1974. It provides a solid overview of preventive steps that should be taken to safeguard crew and equipment when drilling through H/sub 2/S zones. Discussions cover personnel training, protective equipment, wellsite layout, rig and well equipment, general rig operations and contingency planning and emergency procedures. This article summarizes the report.

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

Nephew, E.A.; Abbatiello, L.A.; Ballou, M.L.

The basic concept of the Annual Cycle Energy System (ACES) - an integrated system for supplying space heating, hot water, and air conditioning to a building - and the theory underlying its design and operation are described. Practical procedures for designing an ACES for a single-family residence, together with recommended guidelines for the construction and installation of system components, are presented. Methods are discussed for estimating the life-cycle cost, component sizes, and annual energy consumption of the system for residential applications in different climatic regions of the US.

TERSSE: Definition of the Total Earth Resources System for the Shuttle Era. Volume 7: User Models: A System Assessment

NASA Technical Reports Server (NTRS)

1974-01-01

User models defined as any explicit process or procedure used to transform information extracted from remotely sensed data into a form useful as a resource management information input are discussed. The role of the user models as information, technological, and operations interfaces between the TERSSE and the resource managers is emphasized. It is recommended that guidelines and management strategies be developed for a systems approach to user model development.

Shedding light: laser physics and mechanism of action.

PubMed

De Felice, E

2010-02-01

Lasers have affected health care in many ways. Clinical applications have been found in a number of medical and surgical specialities. In particular, applications of laser technology in phlebology has made it essential for vein physicians to obtain a fundamental knowledge of laser physics, laser operation and also to be well versed in laser safety procedures. This article reviews recommended text books and current literature to detail the basics of laser physics and its application to venous disease. Laser safety and laser side effects are also discussed.

Task-shifting of orthopaedic surgery to non-physician clinicians in Malawi: effective and safe?

PubMed

Wilhelm, Torsten J; Dzimbiri, Kondwani; Sembereka, Victoria; Gumeni, Martin; Bach, Olaf; Mothes, Henning

2017-10-01

There is a shortage of orthopaedic surgeons in Malawi. Orthopaedic clinical officers (OCOs) treat trauma patients and occasionally perform major orthopaedic surgery. No studies have assessed the efficacy and safety of their work. The aim of this study was to evaluate their contribution to major orthopaedic surgery at Zomba Central Hospital. Data about orthopaedic procedures during 2006-2010 were collected from theatre books. We selected major amputations and open reductions and plating for outcome analysis and collected details from files. We compared patients operated by OCOs alone ('OCOs alone' group) and by surgeons or OCOs assisted by surgeons ('Surgeon present' group). OCOs performed 463/1010 major (45.8%) and 1600/1765 minor operations (90.7%) alone. There was no difference in perioperative outcome between both groups. OCOs carry out a large proportion of orthopaedic procedures with good clinical results. Shifting of clinical tasks including major orthopaedic surgery can be safe. Further prospective studies are recommended.

Thermal control system corrosion study

NASA Technical Reports Server (NTRS)

Yee, Robert; Folsom, Rolfe A.; Mucha, Phillip E.

1990-01-01

During the development of an expert system for autonomous control of the Space Station Thermal Control System (TCS), the thermal performance of the Brassboard TCS began to gradually degrade. This degradation was due to filter clogging by metallic residue. A study was initiated to determine the source of the residue and the basic cause of the corrosion. The investigation focused on the TCS design, materials compatibility, Ames operating and maintenance procedures, and chemical analysis of the residue and of the anhydrous ammonia used as the principal refrigerant. It was concluded that the corrosion mechanisms involved two processes: the reaction of water alone with large, untreated aluminum parts in a high pH environment and the presence of chlorides and chloride salts. These salts will attack the aluminum oxide layer and may enable galvanic corrosion between the aluminum and the more noble stainless steel and other metallic elements present. Recommendations are made for modifications to the system design, the materials used, and the operating and maintenance procedures, which should largely prevent the recurrence of these corrosion mechanisms.

EANM Dosimetry Committee series on standard operational procedures for pre-therapeutic dosimetry II. Dosimetry prior to radioiodine therapy of benign thyroid diseases.

PubMed

Hänscheid, Heribert; Canzi, Cristina; Eschner, Wolfgang; Flux, Glenn; Luster, Markus; Strigari, Lidia; Lassmann, Michael

2013-07-01

The EANM Dosimetry Committee Series "Standard Operational Procedures for Pre-Therapeutic Dosimetry" (SOP) provides advice to scientists and clinicians on how to perform patient-specific absorbed dose assessments. This particular SOP describes how to tailor the therapeutic activity to be administered for radioiodine therapy of benign thyroid diseases such as Graves' disease or hyperthyroidism. Pretherapeutic dosimetry is based on the assessment of the individual (131)I kinetics in the target tissue after the administration of a tracer activity. The present SOP makes proposals on the equipment to be used and guides the user through the measurements. Time schedules for the measurement of the fractional (131)I uptake in the diseased tissue are recommended and it is shown how to calculate from these datasets the therapeutic activity necessary to administer a predefined target dose in the subsequent therapy. Potential sources of error are pointed out and the inherent uncertainties of the procedures depending on the number of measurements are discussed. The theoretical background and the derivation of the listed equations from compartment models of the iodine kinetics are explained in a supplementary file published online only.

Plastic surgery after weight loss: current concepts in massive weight loss surgery.

PubMed

Gusenoff, Jeffrey A; Rubin, J Peter

2008-01-01

The authors begin their discussion of current concepts in massive weight loss (MWL) surgery by offering terminological guidelines that help define reconstructive and aesthetic concepts and procedures for the post-MWL patient. Measures for effective preoperative nutritional and metabolic screening include assessment of weight fluctuations over time, constitutional symptoms, and medications and nutritional supplements. Although there is no established body-mass index (BMI) threshold above which surgery should be refused, higher BMIs have been associated with increased complications. Residual medical problems and psychosocial issues require assessment before surgery, with appropriate specialist consultation as necessary. Consultation with patients concerning the different expectations for functional versus aesthetic procedures and issues such as postoperative scarring and the common incidence of wound healing problems is essential. Patient safety is paramount in decisions to combine multiple procedures and plan stages. The authors often recommend combining abdominoplasty and mastopexy. Surgeon experience, operative setting, and a patient's medical status are factors which influence how much surgery should be performed in the same operative setting. Centers of Excellence in body contouring that provide a team approach combining comprehensive patient evaluation, outcomes research, and surgical training may be the optimal approach for treating the massive weight loss patient.

Partial pressure analysis in space testing

NASA Technical Reports Server (NTRS)

Tilford, Charles R.

1994-01-01

For vacuum-system or test-article analysis it is often desirable to know the species and partial pressures of the vacuum gases. Residual gas or Partial Pressure Analyzers (PPA's) are commonly used for this purpose. These are mass spectrometer-type instruments, most commonly employing quadrupole filters. These instruments can be extremely useful, but they should be used with caution. Depending on the instrument design, calibration procedures, and conditions of use, measurements made with these instruments can be accurate to within a few percent, or in error by two or more orders of magnitude. Significant sources of error can include relative gas sensitivities that differ from handbook values by an order of magnitude, changes in sensitivity with pressure by as much as two orders of magnitude, changes in sensitivity with time after exposure to chemically active gases, and the dependence of the sensitivity for one gas on the pressures of other gases. However, for most instruments, these errors can be greatly reduced with proper operating procedures and conditions of use. In this paper, data are presented illustrating performance characteristics for different instruments and gases, operating parameters are recommended to minimize some errors, and calibrations procedures are described that can detect and/or correct other errors.

Current status and recommendations for biomarkers and biobanking in neurofibromatosis.

PubMed

Hanemann, C Oliver; Blakeley, Jaishri O; Nunes, Fabio P; Robertson, Kent; Stemmer-Rachamimov, Anat; Mautner, Victor; Kurtz, Andreas; Ferguson, Michael; Widemann, Brigitte C; Evans, D Gareth; Ferner, Rosalie; Carroll, Steven L; Korf, Bruce; Wolkenstein, Pierre; Knight, Pamela; Plotkin, Scott R

2016-08-16

Clinically validated biomarkers for neurofibromatosis 1 (NF1), neurofibromatosis 2 (NF2), and schwannomatosis (SWN) have not been identified to date. The biomarker working group's goals are to (1) define biomarker needs in NF1, NF2, and SWN; (2) summarize existing data on biomarkers in NF1, NF2, and SWN; (3) outline recommendations for sample collection and biomarker development; and (4) standardize sample collection and methodology protocols where possible to promote comparison between studies by publishing standard operating procedures (SOPs). The biomarker group reviewed published data on biomarkers in NF1, NF2, and SWN and on biobanking efforts outside these diseases via literature search, defined the need for biomarkers in NF, and developed recommendations in a series of consensus meetings. We describe existing biomarkers in NF and report consensus recommendations for SOP and a minimal clinical dataset to accompany samples derived from patients with NF1, NF2, and SWN in decentralized biobanks. These recommendations are intended to provide clinicians and researchers with a common set of guidelines to collect and store biospecimens and for establishment of biobanks for NF1, NF2, and SWN. © 2016 American Academy of Neurology.

Current status and recommendations for biomarkers and biobanking in neurofibromatosis

PubMed Central

Blakeley, Jaishri O.; Nunes, Fabio P.; Robertson, Kent; Stemmer-Rachamimov, Anat; Mautner, Victor; Kurtz, Andreas; Ferguson, Michael; Widemann, Brigitte C.; Evans, D. Gareth; Ferner, Rosalie; Carroll, Steven L.; Korf, Bruce; Wolkenstein, Pierre; Knight, Pamela; Plotkin, Scott R.

2016-01-01

Objective: Clinically validated biomarkers for neurofibromatosis 1 (NF1), neurofibromatosis 2 (NF2), and schwannomatosis (SWN) have not been identified to date. The biomarker working group's goals are to (1) define biomarker needs in NF1, NF2, and SWN; (2) summarize existing data on biomarkers in NF1, NF2, and SWN; (3) outline recommendations for sample collection and biomarker development; and (4) standardize sample collection and methodology protocols where possible to promote comparison between studies by publishing standard operating procedures (SOPs). Methods: The biomarker group reviewed published data on biomarkers in NF1, NF2, and SWN and on biobanking efforts outside these diseases via literature search, defined the need for biomarkers in NF, and developed recommendations in a series of consensus meetings. Results: We describe existing biomarkers in NF and report consensus recommendations for SOP and a minimal clinical dataset to accompany samples derived from patients with NF1, NF2, and SWN in decentralized biobanks. Conclusions: These recommendations are intended to provide clinicians and researchers with a common set of guidelines to collect and store biospecimens and for establishment of biobanks for NF1, NF2, and SWN. PMID:27527649

[Conservative treatment of metacarpal fracture].

PubMed

Prokop, A; Helling, H J; Kulus, S; Rehm, K E

2002-01-01

Conservative treatment of meatacarpale fracture is recommended if there are no joint displacement, rotation failures, displacement over 30 degrees ad axim and shortening over 5 mm. Operative procedures should be done in open fractures and serial of fractures of metacarpale bones. Early functionally treatment should be done in stable, not displaced fractures. Cast can be used only for a short time in full extended position of fingers and flexion in metacarpo-phalangeal joint in 60-90 degrees. Twin-tapes after reduction of edema allowed free range of motion by fixed rotation. Closed reduction of displaced fractures of fifth metacarpal bone (boxer's fracture) isn't successful. Cases with displacement over 30 degrees may be operatively treated by intramedullary stabilization.

Statistics for demodulation RFI in inverting operational amplifier circuits

NASA Astrophysics Data System (ADS)

Sutu, Y.-H.; Whalen, J. J.

An investigation was conducted with the objective to determine statistical variations for RFI demodulation responses in operational amplifier (op amp) circuits. Attention is given to the experimental procedures employed, a three-stage op amp LED experiment, NCAP (Nonlinear Circuit Analysis Program) simulations of demodulation RFI in 741 op amps, and a comparison of RFI in four op amp types. Three major recommendations for future investigations are presented on the basis of the obtained results. One is concerned with the conduction of additional measurements of demodulation RFI in inverting amplifiers, while another suggests the employment of an automatic measurement system. It is also proposed to conduct additional NCAP simulations in which parasitic effects are accounted for more thoroughly.

Adjustment in University Students Admitted by High School Recommendations as Compared with Their Classmates

ERIC Educational Resources Information Center

Cheung, Chau-Kiu; Lok, David Ping-Pui; Chan, David Kin-keung

2005-01-01

Adjustment in university students admitted based on their high school counselors' or advisors' recommendation is an issue for revealing the appropriateness and fairness of the nontraditional admissions procedure. The newly-issued admissions procedure in Hong Kong has not been subject to empirical investigation. To evaluate the procedure, the…

Robot-assisted rectopexy is a safe and feasible option for treatment of rectal prolapse.

PubMed

Haahr, Camilla; Jakobsen, Henrik Loft; Gögenur, Ismail

2014-05-01

Rectal prolapse is seen in up to one in 100 elderly women and results in symptoms such as incontinence, mucus secretion and constipation. The aim of this study was to present short- and longterm outcomes after robot-assisted rectopexy in patients with rectal prolapse. All patients diagnosed with rectal prolapse at our institution underwent robot-assisted rectopexy. Data regarding the surgical procedure and post-operative morbidity were collected retrospectively. Patients were contacted to register long-term results regarding recurrence, incontinence and satisfaction. A total of 24 consecutive patients underwent robot-assisted rectopexy from October 2010 to July 2012. Data regarding their long-term outcome was available for 18 patients at follow-up (average ten months). 50% of the patients suffered from faecal incontinence before surgery (n = 9/18, 50%). The mean age at surgery was 72 years (28-93 years). The mean duration of surgery was 123 min. (70-245 min.). The median length of stay in hospital was 4.1 days (0-15 days). There was one procedure-related complication (small-bowel obstruction) resulting in reoperation. At the time of follow-up, two patients (11%) had a subjective recurrence of rectal prolapse, and three patients (17%) had faecal incontinence. 89% were satisfied with the operation, and 94% would recommend this operation to other patients with the same condition. Robot-assisted rectopexy is a safe procedure for patients with rectal prolapse and is associated with acceptable functional outcomes and recurrence rates. There is no evidence in the literature of advantages compared with the corresponding laparoscopic procedure. not relevant. not relevant.

Eye lens monitoring for interventional radiology personnel: dosemeters, calibration and practical aspects of H p (3) monitoring. A 2015 review.

PubMed

Carinou, Eleftheria; Ferrari, Paolo; Bjelac, Olivera Ciraj; Gingaume, Merce; Merce, Marta Sans; O'Connor, Una

2015-09-01

A thorough literature review about the current situation on the implementation of eye lens monitoring has been performed in order to provide recommendations regarding dosemeter types, calibration procedures and practical aspects of eye lens monitoring for interventional radiology personnel. Most relevant data and recommendations from about 100 papers have been analysed and classified in the following topics: challenges of today in eye lens monitoring; conversion coefficients, phantoms and calibration procedures for eye lens dose evaluation; correction factors and dosemeters for eye lens dose measurements; dosemeter position and influence of protective devices. The major findings of the review can be summarised as follows: the recommended operational quantity for the eye lens monitoring is H p (3). At present, several dosemeters are available for eye lens monitoring and calibration procedures are being developed. However, in practice, very often, alternative methods are used to assess the dose to the eye lens. A summary of correction factors found in the literature for the assessment of the eye lens dose is provided. These factors can give an estimation of the eye lens dose when alternative methods, such as the use of a whole body dosemeter, are used. A wide range of values is found, thus indicating the large uncertainty associated with these simplified methods. Reduction factors from most common protective devices obtained experimentally and using Monte Carlo calculations are presented. The paper concludes that the use of a dosemeter placed at collar level outside the lead apron can provide a useful first estimate of the eye lens exposure. However, for workplaces with estimated annual equivalent dose to the eye lens close to the dose limit, specific eye lens monitoring should be performed. Finally, training of the involved medical staff on the risks of ionising radiation for the eye lens and on the correct use of protective systems is strongly recommended.

[From Science to Law: Findings of Reha XI Project on Ascertaining the Need for Rehabilitation in Medical Service Assessments].

PubMed

Kalwitzki, T; Huter, K; Runte, R; Breuninger, K; Janatzek, S; Gronemeyer, S; Gansweid, B; Rothgang, H

2017-03-01

Introduction: In the broad-based consortium project "Reha XI - Identifying rehabilitative requirements in medical service assessments: evaluation and implementation", a comprehensive analysis of the corresponding procedures was carried out by the medical services of the German Health Insurance Funds (MDK). On the basis of this analysis, a Good Practice Standard (GPS) for assessments was drawn up and scientifically evaluated. This article discusses the findings and applicability of the GPS as the basis for a nationwide standardized procedure in Germany as required by the Second Act to Strengthen Long-Term Care (PSG II) under Vol. XI Para. 18 (6) of the German Social Welfare Code. Method: The consortium project comprised four project phases: 1. Qualitative and quantitative situation analysis of the procedures for ascertaining rehabilitative needs in care assessments carried out by the MDK; 2. Development of a Good Practice Standard (GPS) in a structured, consensus-based procedure; 3. Scientific evaluation of the validity, reliability and practicability of the assessment procedure according to the GPS in the MDK's operational practice; 4. Survey of long-term care insurance funds with respect to the appropriateness of the rehabilitation recommendations drawn up by care assessors in line with the GPS for providing a qualified recommendation for the applicant. The evaluation carried out in the third project phase was subject to methodological limitations that may have given rise to distortions in the findings. Findings: On the basis of the situation analysis, 7 major thematic areas were identified in which improvements were implemented by applying the GPS. For the evaluation of the GPS, a total of 3 247 applicants were assessed in line with the GPS; in 6.3% of the applicants, an indication for medical rehabilitation was determined. The GPS procedure showed a high degree of reliability and practicability, but the values for the validity of the assessment procedure were highly unsatisfactory. The degree of acceptance by the long-term care insurance funds with respect to the recommendations for rehabilitation following the GPS procedure was high. Conclusion: The application of a general standard across all MDKs shows marked improvements in the quality of the assessment procedure and leads more frequently to the ascertainment of an indication for medical rehabilitation. The methodological problems and the unsatisfactory findings with respect to the validity of the assessors' decisions require further scientific scrutiny. © Georg Thieme Verlag KG Stuttgart · New York.

A continuous process for the development of Kodak Aerochrome Infrared Film 2443 as a negative

NASA Astrophysics Data System (ADS)

Klimes, D.; Ross, D. I.

1993-02-01

A process for the continuous dry-to-dry development of Kodak Aerochrome Infrared Film 2443 as a negative (CIR-neg) is described. The process is well suited for production processing of long film lengths. Chemicals from three commercial film processes are used with modifications. Sensitometric procedures are recommended for the monitoring of processing quality control. Sensitometric data and operational aerial exposures indicate that films developed in this process have approximately the same effective aerial film speed as films processed in the reversal process recommended by the manufacturer (Kodak EA-5). The CIR-neg process is useful when aerial photography is acquired for resources management applications which require print reproductions. Originals can be readily reproduced using conventional production equipment (electronic dodging) in black and white or color (color compensation).

9 CFR 147.31 - Laboratory procedures recommended for the real-time polymerase chain reaction test for Mycoplasma...

Code of Federal Regulations, 2014 CFR

2014-01-01

... the real-time polymerase chain reaction test for Mycoplasma gallisepticum (MGLP ReTi). 147.31 Section... Examination Procedures § 147.31 Laboratory procedures recommended for the real-time polymerase chain reaction.... Following incubation, 100 µl of 100 percent ethanol is added to lysate. Wash and centrifuge following...

9 CFR 147.31 - Laboratory procedures recommended for the real-time polymerase chain reaction test for Mycoplasma...

Code of Federal Regulations, 2013 CFR

2013-01-01

... the real-time polymerase chain reaction test for Mycoplasma gallisepticum (MGLP ReTi). 147.31 Section... Examination Procedures § 147.31 Laboratory procedures recommended for the real-time polymerase chain reaction.... Following incubation, 100 µl of 100 percent ethanol is added to lysate. Wash and centrifuge following...

9 CFR 147.31 - Laboratory procedures recommended for the real-time polymerase chain reaction test for Mycoplasma...

Code of Federal Regulations, 2012 CFR

2012-01-01

... the real-time polymerase chain reaction test for Mycoplasma gallisepticum (MGLP ReTi). 147.31 Section... Examination Procedures § 147.31 Laboratory procedures recommended for the real-time polymerase chain reaction.... Following incubation, 100 µl of 100 percent ethanol is added to lysate. Wash and centrifuge following...

9 CFR 147.30 - Laboratory procedure recommended for the polymerase chain reaction (PCR) test for Mycoplasma...

Code of Federal Regulations, 2010 CFR

2010-01-01

... the polymerase chain reaction (PCR) test for Mycoplasma gallisepticum and M. synoviae. 147.30 Section... Examination Procedures § 147.30 Laboratory procedure recommended for the polymerase chain reaction (PCR) test... should consist of the following sequences: ER12JA07.005 (c) Polymerase chain reaction. (1) Treat each...

9 CFR 147.30 - Laboratory procedure recommended for the polymerase chain reaction (PCR) test for Mycoplasma...

Code of Federal Regulations, 2011 CFR

2011-01-01

... the polymerase chain reaction (PCR) test for Mycoplasma gallisepticum and M. synoviae. 147.30 Section... Examination Procedures § 147.30 Laboratory procedure recommended for the polymerase chain reaction (PCR) test... should consist of the following sequences: ER12JA07.005 (c) Polymerase chain reaction. (1) Treat each...

Pain management in the neonatal piglet during routine management procedures. Part 2: Grading the quality of evidence and the strength of recommendations

USDA-ARS?s Scientific Manuscript database

Piglets reared in swine production in the US undergo painful procedures that include castration, tail docking, teeth clipping, and identification with ear notching or tagging. These procedures are usually performed without pain mitigation. The objective of this project was to develop recommendations...

Cross-chest liposuction in gynaecomastia.

PubMed

Murali, Biju; Vijayaraghavan, Sundeep; Kishore, P; Iyer, Subramania; Jimmy, Mathew; Sharma, Mohit; Paul, George; Chavare, Sachin

2011-01-01

Gynaecomastia is usually treated with liposuction or liposuction with excision of the glandular tissue. The type of surgery chosen depends on the grade of the condition. Because gynaecomastia is treated primarily as a cosmetic procedure, we aimed at reducing the invasiveness of the surgery. The technique complies with all recommended protocols for different grades of gynaecomastia. It uses liposuction, gland excision, or both, leaving only minimal post-operative scars. The use of cross-chest liposuction through incisions on the edge of the areola helps to get rid of all the fat under the areola without an additional scar as in the conventional method. This is a short series of 20 patients, all with bilateral gynaecomastia (i.e., 40 breasts), belonging to Simon's Stage 1 and 2, studied over a period of 2 years. The average period of follow-up was 15 months. Post-operative complications were reported in only two cases, with none showing long-term complications or issues specifically due to the procedure. Cross-chest liposuction for gynaecomastia is a simple yet effective surgical tool in bilateral gynaecomastia treatment to decrease the post-operative scars. The use of techniques like incision line drain placement and post-drain removal suturing of wounds aid in decreasing the scar.

Mental Health Evaluations for Adolescents Prior to Bariatric Surgery: A Review of Existing Practices and a Specific Example of Assessment Procedures

PubMed Central

Sysko, Robyn; Zandberg, Laurie J.; Devlin, Michael J.; Annunziato, Rachel A.; Zitsman, Jeffrey L.; Walsh, B. Timothy

2013-01-01

Objective Best practice guidelines for adolescents considering bariatric surgery recommend a pre-operative mental health evaluation. However, only general information about these assessments appears in the literature, which makes consistency of administration challenging. This review proposes a specific empirically-derived format for pre-surgical mental health evaluations and summarizes currently available data on the psychiatric functioning of adolescents seeking bariatric surgery. Design Studies of mental health evaluations for adults preparing for bariatric surgery are reviewed, as is the limited literature relevant to adolescent evaluations. A specific and detailed example of an evaluation (clinical interview, self-report questionnaires, cognitive assessment) used for younger patients at a major metropolitan hospital center is presented, followed by data from an initial group of adolescents completing this evaluation. Subjects 200 adolescents (n=139 female; age: 14–18 y, BMI: 35.4–83.3 kg/m2) presenting for bariatric surgery. Results A notable subset of adolescents reported current Axis I conditions (31.5%) and current mental health treatment (29.5%), but reports of current illicit drug use (1.5%) and regular alcohol use (0.5%) were relatively rare. Procedures for using the completed evaluation and post-surgery monitoring of psychosocial issues are discussed. Conclusions Adolescents considering weight loss surgery should receive comprehensive pre-surgical mental health evaluations, but additional data are needed to develop specific recommendations the use of these evaluations in post-operative care. PMID:24073019

Radiation exposure to the eye lens of orthopaedic surgeons during various orthopaedic procedures.

PubMed

Romanova, K; Vassileva, J; Alyakov, M

2015-07-01

The aim of the present study was to assess the radiation dose to the eye lens of orthopaedic surgeons during various orthopaedic procedures and to make efforts to ensure that radiation protection is optimised. The study was performed for Fractura femoris and Fractura cruris procedures performed in orthopaedic operating theatres, as well as for fractures of wrist, ankle and hand/shoulder performed in the emergency trauma room. The highest mean value of the eye lens dose of 47.2 μSv and higher mean fluoroscopy time of 3 min, as well as the corresponding highest maximum values of 77.1 μSv and 5.0 min were observed for the Fractura femoris procedure performed with the Biplanar 500e fluoroscopy systems. At a normal workload, the estimated mean annual dose values do not exceed the annual occupational dose limit for the lens of eye, but at a heavy workload in the department, this dose limit could be achieved or exceeded. The use of protective lead glasses is recommended as they could reduce the radiation exposure of the lens of the eye. The phantom measurements demonstrated that the use of half-dose mode could additionally reduce dose to the operator's eye lens. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Piezosurgery versus conventional surgery in radicular cyst enucleation.

PubMed

Kocyigit, Ismail Doruk; Atil, Fethi; Alp, Yunus Emre; Tekin, Umut; Tuz, Hakan H

2012-11-01

This study compared the use of piezosurgery and conventional surgery in radicular cyst enucleation. The study was conducted with 29 patients who were radiologically and cytologically prediagnosed with radicular cysts in the jaw region. Nineteen patients were treated using piezosurgery, and 10 were treated using conventional surgical procedures. Surgical procedures were evaluated according to the following criteria: hemorrhage, soft-tissue damage, manipulation complexity, major perforation areas on the enucleated cyst tissue, and approximate operation duration. Patients were monitored postoperatively and evaluated for hemorrhaging at 24, 48, and 72 hours following surgery. Follow-up was conducted to check for recurrences and ranged from 5 to 24 months. No complications were observed in any of the 20 patients treated using piezosurgery, although the duration of surgery was longer than expected. Of the 10 patients treated using conventional methods, hemorrhaging that affected the operation occurred in 3 cases, perforation of the cyst epithelium and difficulties in enucleation occurred in 5 cases, postoperative hemorrhage occurred in 2 cases, and recurrence was observed in 2 cases. Piezosurgery may be considered effective in procedures such as enucleation that require sensitive manipulation, despite the increase in the length of the overall surgical procedure. Given the results of the present study and the current lack of information in the literature regarding postoperative pain, infection, and long-term success rates associated with the use of piezosurgery in cyst enucleation, further study in this area is recommended.

Calibration of ground-based microwave radiometers - Accuracy assessment and recommendations for network users

NASA Astrophysics Data System (ADS)

Pospichal, Bernhard; Küchler, Nils; Löhnert, Ulrich; Crewell, Susanne; Czekala, Harald; Güldner, Jürgen

2016-04-01

Ground-based microwave radiometers (MWR) are becoming widely used in atmospheric remote sensing and start to be routinely operated by national weather services and other institutions. However, common standards for calibration of these radiometers and a detailed knowledge about the error characteristics is needed, in order to assimilate the data into models. Intercomparisons of calibrations by different MWRs have rarely been done. Therefore, two calibration experiments in Lindenberg (2014) and Meckenheim (2015) were performed in the frame of TOPROF (Cost action ES1303) in order to assess uncertainties and differences between various instruments. In addition, a series of experiments were taken in Oklahoma in autumn 2014. The focus lay on the performance of the two main instrument types, which are currently used operationally. These are the MP-Profiler series by Radiometrics Corporation as well as the HATPRO series by Radiometer Physics GmbH (RPG). Both instrument types are operating in two frequency bands, one along the 22 GHz water vapour line, the other one at the lower wing of the 60 GHz oxygen absorption complex. The goal was to establish protocols for providing quality controlled (QC) MWR data and their uncertainties. To this end, standardized calibration procedures for MWR were developed and recommendations for radiometer users were compiled. We focus here mainly on data types, integration times and optimal settings for calibration intervals, both for absolute (liquid nitrogen, tipping curve) as well as relative (hot load, noise diode) calibrations. Besides the recommendations for ground-based MWR operators, we will present methods to determine the accuracy of the calibration as well as means for automatic data quality control. In addition, some results from the intercomparison of different radiometers will be discussed.

Traffic flow and microbial air contamination in operating rooms at a major teaching hospital in Ghana.

PubMed

Stauning, M T; Bediako-Bowan, A; Andersen, L P; Opintan, J A; Labi, A-K; Kurtzhals, J A L; Bjerrum, S

2018-07-01

Current literature examining the relationship between door-opening rate, number of people present, and microbial air contamination in the operating room is limited. Studies are especially needed from low- and middle-income countries, where the risk of surgical site infections is high. To assess microbial air contamination in operating rooms at a Ghanaian teaching hospital and the association with door-openings and number of people present. Moreover, we aimed to document reasons for door-opening. We conducted active air-sampling using an MAS 100 ® portable impactor during 124 clean or clean-contaminated elective surgical procedures. The number of people present, door-opening rate and the reasons for each door-opening were recorded by direct observation using pretested structured observation forms. During surgery, the mean number of colony-forming units (cfu) was 328 cfu/m 3 air, and 429 (84%) of 510 samples exceeded a recommended level of 180 cfu/m 3 . Of 6717 door-openings recorded, 77% were considered unnecessary. Levels of cfu/m 3 were strongly correlated with the number of people present (P = 0.001) and with the number of door-openings/h (P = 0.02). In empty operating rooms, the mean cfu count was 39 cfu/m 3 after 1 h of uninterrupted ventilation and 52 (51%) of 102 samples exceeded a recommended level of 35 cfu/m 3 . The study revealed high values of intraoperative airborne cfu exceeding recommended levels. Minimizing the number of door-openings and people present during surgery could be an effective strategy to reduce microbial air contamination in low- and middle-income settings. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

[Management of breast nipple discharge: Recommendations].

PubMed

Ouldamer, L; Kellal, I; Legendre, G; Ngô, C; Chopier, J; Body, G

2015-12-01

To investigate diagnostic value of imaging procedures and management strategies of the patients with nipple discharge (ND) to establish management recommendations. Bibliographical search in French and English languages by consultation of PubMed, Cochrane and Embase databases. Although, all ND require an systematic evaluation guided by clinical data, bloody ND could be a predictor of breast cancer risk among different colors of discharge particularly in patients of more than 50 years (LE2). The mammography and breast ultrasography are the imaging procedures to realize in first intention (grade C) but they turn out useful only when they detect radiological abnormalities (LE4). Galactography has only a localizing value of possible ductal abnormalities (when standard imaging procedures is not contributive) (LE4). Thus, in the diagnostic investigation of a suspicious ND, galactography it is not recommended in standard practice (grade C). The breast Magnetic Resonance Imaging (MRI) is recommended when breast standard imaging procedures are not contributive (grade C). The ND cytology is useful only if it is positive (i.e. reveal cancer cells). There is no proof on the diagnostic performance of the cytological analysis of the ND to allow a recommendation on its realization or not. In front of a suspicious ND, when breast-imaging procedures reveals an associated radiological lesion, an adapted percutaneous biopsy is recommended by percutaneous way (grade C). Vacuum-assisted breast biopsies is a diagnostic tool but can also be therapeutic allowing to avoid surgery in case of benign lesion but current literature data do not allow recommendations on the therapeutic aspect of vacuum-assisted breast biopsy (LE4). In the absence of associated radiological signal, and in case of reproducible bloody persistent ND, a pyramidectomy is recommended (grade C). Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Work Package 5: Contingency Management. Mission Planning Requirements Document: Preliminary Version. Revision A

NASA Technical Reports Server (NTRS)

2005-01-01

The purpose of this document is to identify the general flight/mission planning requirements for same-day file-and-fly access to the NAS for both civil and military High-Altitude Long Endurance (HALE) Unmanned Aircraft System (UAS). Currently the scope of this document is limited to Step 1, operations above flight level 43,000 feet (FL430). This document describes the current applicable mission planning requirements and procedures for both manned and unmanned aircraft and addresses HALE UAS flight planning considerations in the future National Airspace System (NAS). It also discusses the unique performance and operational capabilities of HALE UAS associated with the Access 5 Project, presents some of the projected performance characteristics and conceptual missions for future systems, and provides detailed analysis of the recommended mission planning elements for operating HALE UAS in the NAS.

9 CFR 147.31 - Laboratory procedures recommended for the real-time polymerase chain reaction test for Mycoplasma...

Code of Federal Regulations, 2010 CFR

2010-01-01

... the real-time polymerase chain reaction test for Mycoplasma gallisepticum (MGLP ReTi). 147.31 Section... Examination Procedures § 147.31 Laboratory procedures recommended for the real-time polymerase chain reaction... lp gene. (c) MGLP ReTi. Primers and probe should be utilized in a 25 µl reaction containing 12.5 µl...

9 CFR 147.31 - Laboratory procedures recommended for the real-time polymerase chain reaction test for Mycoplasma...

Code of Federal Regulations, 2011 CFR

2011-01-01

... the real-time polymerase chain reaction test for Mycoplasma gallisepticum (MGLP ReTi). 147.31 Section... Examination Procedures § 147.31 Laboratory procedures recommended for the real-time polymerase chain reaction... lp gene. (c) MGLP ReTi. Primers and probe should be utilized in a 25 µl reaction containing 12.5 µl...

RH Packaging Program Guidance

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

Washington TRU Solutions, LLC

The purpose of this program guidance document is to provide technical requirements for use, operation, inspection, and maintenance of the RH-TRU 72-B Waste Shipping Package and directly related components. This document complies with the requirements as specified in the RH-TRU 72-B Safety Analysis Report for Packaging (SARP), and Nuclear Regulatory Commission (NRC) Certificate of Compliance (C of C) 9212. If there is a conflict between this document and the SARP and/or C of C, the SARP and/or C of C shall govern. The C of C states: ''...each package must be prepared for shipment and operated in accordance with themore » procedures described in Chapter 7.0, ''Operating Procedures,'' of the application.'' It further states: ''...each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, ''Acceptance Tests and Maintenance Program of the Application.'' Chapter 9.0 of the SARP tasks the Waste Isolation Pilot Plant (WIPP) Management and Operating (M&O) contractor with assuring the packaging is used in accordance with the requirements of the C of C. Because the packaging is NRC approved, users need to be familiar with 10 CFR {section} 71.11, ''Deliberate Misconduct.'' Any time a user suspects or has indications that the conditions of approval in the C of C were not met, the Carlsbad Field Office (CBFO) shall be notified immediately. CBFO will evaluate the issue and notify the NRC if required. This document details the instructions to be followed to operate, maintain, and test the RH-TRU 72-B packaging. This Program Guidance standardizes instructions for all users. Users shall follow these instructions. Following these instructions assures that operations are safe and meet the requirements of the SARP. This document is available on the Internet at: ttp://www.ws/library/t2omi/t2omi.htm. Users are responsible for ensuring they are using the current revision and change notices. Sites may prepare their own document using the word-for-word steps in th is document, in sequence, including Notes and cautions. Site specific information may be included as necessary. The document, and revisions, must then be submitted to CBFO at sitedocuments@wipp.ws for approval. A copy of the approval letter from CBFO shall be available for audit purposes. Users may develop site-specific procedures addressing preoperational activities, quality assurance (QA), hoisting and rigging, and radiation health physics to be used with the instructions contained in this document. Users may recommend changes to this document by submitting their recommendations (in writing) to the WIPP M&O Contractor RH Packaging Maintenance Engineer for evaluation. If approved, the change(s) will be incorporated into this document for use by ALL users. Before first use and every 12 months after, user sites will be audited to this document to ensure compliance. They will also be audited within one year from the effective date of revisions to this document.« less

AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy: report of Task Group 192.

PubMed

Podder, Tarun K; Beaulieu, Luc; Caldwell, Barrett; Cormack, Robert A; Crass, Jostin B; Dicker, Adam P; Fenster, Aaron; Fichtinger, Gabor; Meltsner, Michael A; Moerland, Marinus A; Nath, Ravinder; Rivard, Mark J; Salcudean, Tim; Song, Danny Y; Thomadsen, Bruce R; Yu, Yan

2014-10-01

In the last decade, there have been significant developments into integration of robots and automation tools with brachytherapy delivery systems. These systems aim to improve the current paradigm by executing higher precision and accuracy in seed placement, improving calculation of optimal seed locations, minimizing surgical trauma, and reducing radiation exposure to medical staff. Most of the applications of this technology have been in the implantation of seeds in patients with early-stage prostate cancer. Nevertheless, the techniques apply to any clinical site where interstitial brachytherapy is appropriate. In consideration of the rapid developments in this area, the American Association of Physicists in Medicine (AAPM) commissioned Task Group 192 to review the state-of-the-art in the field of robotic interstitial brachytherapy. This is a joint Task Group with the Groupe Européen de Curiethérapie-European Society for Radiotherapy & Oncology (GEC-ESTRO). All developed and reported robotic brachytherapy systems were reviewed. Commissioning and quality assurance procedures for the safe and consistent use of these systems are also provided. Manual seed placement techniques with a rigid template have an estimated in vivo accuracy of 3-6 mm. In addition to the placement accuracy, factors such as tissue deformation, needle deviation, and edema may result in a delivered dose distribution that differs from the preimplant or intraoperative plan. However, real-time needle tracking and seed identification for dynamic updating of dosimetry may improve the quality of seed implantation. The AAPM and GEC-ESTRO recommend that robotic systems should demonstrate a spatial accuracy of seed placement ≤1.0 mm in a phantom. This recommendation is based on the current performance of existing robotic brachytherapy systems and propagation of uncertainties. During clinical commissioning, tests should be conducted to ensure that this level of accuracy is achieved. These tests should mimic the real operating procedure as closely as possible. Additional recommendations on robotic brachytherapy systems include display of the operational state; capability of manual override; documented policies for independent check and data verification; intuitive interface displaying the implantation plan and visualization of needle positions and seed locations relative to the target anatomy; needle insertion in a sequential order; robot-clinician and robot-patient interactions robustness, reliability, and safety while delivering the correct dose at the correct site for the correct patient; avoidance of excessive force on radioactive sources; delivery confirmation of the required number or position of seeds; incorporation of a collision avoidance system; system cleaning, decontamination, and sterilization procedures. These recommendations are applicable to end users and manufacturers of robotic brachytherapy systems.

Consensus-based recommendations for the management of juvenile dermatomyositis

PubMed Central

Enders, Felicitas Bellutti; Bader-Meunier, Brigitte; Baildam, Eileen; Constantin, Tamas; Dolezalova, Pavla; Feldman, Brian M; Lahdenne, Pekka; Magnusson, Bo; Nistala, Kiran; Ozen, Seza; Pilkington, Clarissa; Ravelli, Angelo; Russo, Ricardo; Uziel, Yosef; van Brussel, Marco; van der Net, Janjaap; Vastert, Sebastiaan; Wedderburn, Lucy R; Wulffraat, Nicolaas; McCann, Liza J; van Royen-Kerkhof, Annet

2017-01-01

Background In 2012, a European initiative called Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile dermatomyositis (JDM) is a rare disease within the group of paediatric rheumatic diseases (PRDs) and can lead to significant morbidity. Evidence-based guidelines are sparse and management is mostly based on physicians' experience. Consequently, treatment regimens differ throughout Europe. Objectives To provide recommendations for diagnosis and treatment of JDM. Methods Recommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was constituted, consisting of 19 experienced paediatric rheumatologists and 2 experts in paediatric exercise physiology and physical therapy, mainly from Europe. Recommendations derived from a validated systematic literature review were evaluated by an online survey and subsequently discussed at two consensus meetings using nominal group technique. Recommendations were accepted if >80% agreement was reached. Results In total, 7 overarching principles, 33 recommendations on diagnosis and 19 recommendations on therapy were accepted with >80% agreement among experts. Topics covered include assessment of skin, muscle and major organ involvement and suggested treatment pathways. Conclusions The SHARE initiative aims to identify best practices for treatment of patients suffering from PRD. Within this remit, recommendations for the diagnosis and treatment of JDM have been formulated by an evidence-informed consensus process to produce a standard of care for patients with JDM throughout Europe. PMID:27515057

40 CFR 240.205-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

....205-2 Section 240.205-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... air pollution control technology. (b) All emissions, including dust from vents, should be controlled. ...

40 CFR 240.205-2 - Recommended procedures: Design.

Code of Federal Regulations, 2011 CFR

2011-07-01

....205-2 Section 240.205-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... air pollution control technology. (b) All emissions, including dust from vents, should be controlled. ...

Congenital penile curvature: update and management.

PubMed

Makovey, Iryna; Higuchi, Ty T; Montague, Drogo K; Angermeier, Kenneth W; Wood, Hadley M

2012-08-01

Congenital penile curvature results from disproportionate development of the tunica albuginea of the corporal bodies and is not associated with urethral malformation. Patients usually present after reaching puberty as the curvature becomes more apparent with erections, and severe curvature can make intercourse difficult or impossible, at which point surgical repair is recommended. Excellent outcomes can be expected with surgical intervention. The three most commonly used repair techniques are the original Nesbit procedure, modified Nesbit procedure, and plication. Nesbit and modified Nesbit techniques require that an incision is made in the tunica albuginea while plication techniques utilize plicating sutures without an incision. While Nesbit and modified Nesbit techniques are more complex operations, these generally result in less recurrences and more satisfactory outcomes as opposed to the quicker and simpler plication technique.

Recommendations for field measurements of aircraft noise

NASA Technical Reports Server (NTRS)

Marsh, A. H.

1982-01-01

Specific recommendations for environmental test criteria, data acquisition procedures, and instrument performance requirements for measurement of noise levels produced by aircraft in flight are provided. Recommendations are also given for measurement of associated airplane and engine parameters and atmospheric conditions. Recommendations are based on capabilities which were available commercially in 1981; they are applicable to field tests of aircraft flying subsonically past microphones located near the surface of the ground either directly under or to the side of a flight path. Aircraft types covered by the recommendations include fixed-wing airplanes powered by turbojet or turbofan engines or by propellers. The recommended field-measurement procedures are consistent with assumed requirements for data processing and analysis.

Optimizing tubal ligation service delivery: a prospective cohort study to measure the task-sharing experience of Marie Stopes International Ethiopia.

PubMed

Nuccio, Olivia; Sendek, Birhanu; Park, Min Hae; Mesele, Tesfaye; Okello, Francis Ogojo; Gordon-Maclean, Cristin

2017-03-01

The Ethiopian government implements a progressive task-sharing policy for health services as a strategy to address shortages of highly skilled providers and increase access to critical services, such as family planning. Since 2009, Marie Stopes International Ethiopia has trained health officers to provide tubal ligations, a permanent method of family planning, as part of its task-sharing strategy. The objectives of this research were to evaluate task-sharing tubal ligations to health officers at Marie Stopes International Ethiopia, specifically: (a) to investigate safety, as measured by the proportion of major adverse events; (b) to evaluate the feasibility, as measured by adherence to the standard tubal ligation procedure protocol and (c) to investigate acceptability to clients of the tubal ligation procedure provided by health officers. We established a prospective cohort of women aged  ≥18 years presenting for tubal ligation at Marie Stopes International Ethiopia sites in three regions in Ethiopia (March–May 2014). Data on adverse events (incomplete procedure, pain, bleeding, infection, perforation) were collected intra-operatively; peri-operatively (1-h post-procedure); and post-operatively (7 days post-procedure). To measure feasibility, 65% of procedures were selected for ‘audit’, where a nurse observed and scored health officers adherence to standard protocol using an 18-item checklist. To assess acceptability, women were asked about their satisfaction with the procedure. In total, 276 women were enrolled in the study. 97.5% of procedures took place in rural settings. All participants were followed up 7 days post-procedure (100% response rate). The overall proportion of major adverse events was 3% (95% CI 1–6%). The most frequent adverse event was ‘failure to complete the TL’ (2.2%, n = 6). The average score on protocol adherence was 96.9%. Overall, 98.2% (n = 271) of clients would recommend the procedure to a friend. Findings from this study, indicating safety, feasibility and acceptability, are consistent with the existing literature, which indicate safety and acceptability for task-sharing tubal ligations, and other methods of contraception with non-physician health providers. This study adds to scant literature on task-sharing tubal ligations in rural and low-resource settings.

Chemoprophylaxis of infective endocarditis.

PubMed

Finch, R

1990-01-01

Infective endocarditis is a serious disease with a continuing mortality of approximately 20%. Risk factors include a variety of congenital and acquired heart diseases. Infection follows an episode of bacteraemia which is most commonly due to oral bacteria, notably streptococci. Less commonly bacteraemia may arise from surgical procedures or diseases of the gastrointestinal and genitourinary tracts or from sepsis at other body sites, including intravenous drug abuse. Several societies and associations have published recommendations for the prevention of bacteraemia in those at risk from endocarditis through the use of perioperative antibiotic chemoprophylaxis. The recommendations are targetted at patients with defined cardiovascular lesions undergoing dental and other procedures known to predictably produce bacteraemia. The major recommendations for standard risk patients undergoing dental procedures without general anaesthesia is high-dose oral penicillin or amoxycillin. Alternative agents include erythromycin and clindamycin. For those requiring general anaesthesia, parenteral regimens are generally recommended although the British Society for Antimicrobial Chemotherapy permits an oral amoxycillin regimen 4 hours preoperatively. For specified gastrointestinal and genitourinary procedures a 2-drug regimen of ampicillin/amoxycillin (or vancomycin for penicillin-allergic patients) plus an aminoglycoside is generally recommended. The emphasis has been to simplify the earlier regimens without compromising the antimicrobial protection with a view to encouraging maximum compliance. The latter continues to be a problem where drug recommendations are either complex or include multiple drug or dosage recommendations. The emphasis on maintaining good dental health is endorsed by all authorities.

Study of the application of advanced technologies to long range transport aircraft. Volume 2: Advanced technology program recommendations

NASA Technical Reports Server (NTRS)

1972-01-01

The benefits of the application of advanced technology to future transport aircraft were investigated. The noise reduction goals established by the CARD (Civil Aviation Research and Development) study for the 1981-1985 time period can be satisfied. Reduced terminal area and airway congestion can result from use of advanced on-board systems and operating procedures. The use of advanced structural design concepts can result in greatly reduced gross weight and improved operating economics. The full potential of these benefits can be realized in a 1985 airplane by implementing a research and development program that is funded to an average level of approximately $55 million per year over a ten year period.

Proceedings of the Public Workshop on Alternative Separation Concepts: Presentations, Discussions and Recommendations, held at Atlantic City Airport, New Jersey, January 7, 8 and 9, 1981.

DTIC Science & Technology

1981-06-01

going on with the MITRE Corporation taking a look at the methods of providing ATARS ser- vice to aircraft in the traffic pattern. And we’re using some...SRDS ... "DABS, BCAS and ATARS " 31 QUESTIONS AND ANSWERS . ... ........................ 37 SPEAKERS Andres Zellweger, FAA, OSEM ... 񕍜 Replacement...either EFR or normal IFR procedures is provided either by the DABS/ ATARS operating in a traffic separation rather than collision avoidance mode or by

Verification approach for the Shuttle/Payload Contamination Evaluation computer program - Spacelab induced environment

NASA Technical Reports Server (NTRS)

Bareiss, L. E.

1978-01-01

The paper presents a compilation of the results of a systems level Shuttle/payload contamination analysis and related computer modeling activities. The current technical assessment of the contamination problems anticipated during the Spacelab program are discussed and recommendations are presented on contamination abatement designs and operational procedures based on experience gained in the field of contamination analysis and assessment, dating back to the pre-Skylab era. The ultimate test of the Shuttle/Payload Contamination Evaluation program will be through comparison of predictions with measured levels of contamination during actual flight.

[Lop ear - knife, tape, or nothing at all?].

PubMed

Klockars, Tuomas

2013-01-01

More than 200 different surgical techniques of correction of lop ear have been published. The operation is usually recommended to be performed at the age of six years or after. In addition, lop ear surgery involves risks, the most common complications being bleeding, infections, sensory alterations and scarring problems. Surgical preference and decision should always be based on realistic expectations of the patient or the parents, and prior to the decision they should have adequate information about the nature of the procedure and potential complications. Splint therapy of lop ear is possible for infants.

Water-molten uranium hazard analysis. Final report. LATA report No. 92

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

Hughes, P.S.; Rigdon, L.D.; Donham, B.J.

1979-08-21

The hazard potential of cooling water leakage into the crucible of molten uranium in the MARS laser isotope separation experiment was investigated. A vapor-phase explosion is highly unlikely in any of the scenarios defined for MARS. For the operating basis accident, the gas pressure transient experienced by the vessel wall is 544 psia peak with a duration of 200 ..mu..s, and the peak hoop stress is about 20,000 psi in a 0.5-in. wall. Design and procedural recommendations are given for reducing the hazard. (DLC)

Crisis Management of Accidental Extubation in a Prone-Positioned Patient with Klippel-Feil Syndrome.

PubMed

Spond, Matthew; Burns, Tyler; Rosenbaum, Thea; Lienhart, Kristen

2016-06-15

We present the case of an accidental extubation in a prone-positioned patient with a challenging airway because of Klippel-Feil syndrome and previous cervical spine fusions. The surgical procedure was well underway when this occurred, which added substantially to the difficulties produced by this event. We herein highlight the corrective steps we took in our case. We also recommend the need for a comprehensive preoperative briefing with all operating room personnel together with an action plan for how to prevent this particular scenario.

40 CFR 240.201-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

... carcasses, automobile bodies, dewatered sludges from water treatment plants, and industrial process wastes. ... WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... or excluded wastes inadvertently left at the facility should be considered in design. (b) Examples of...

40 CFR 240.204-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

....204-2 Section 240.204-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... indiscriminately. Consideration should be given to onsite treatment of process and waste waters before discharge...

40 CFR 240.207-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

....207-2 Section 240.207-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... attractive. The tipping, residue discharge, and waste salvage areas should be screened from public view, and...

40 CFR 240.201-2 - Recommended procedures: Design.

Code of Federal Regulations, 2011 CFR

2011-07-01

....201-2 Section 240.201-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... or excluded wastes inadvertently left at the facility should be considered in design. (b) Examples of...

40 CFR 246.200-8 - Recommended procedures: Cost analysis.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures..., storage, and transportation costs have been made, and estimated tonnages of both recoverable high-grade... for revenue from paper sales and savings from diverting recycled materials from disposal. Potential...

40 CFR 246.202-6 - Recommended procedures: Cost analysis.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., storage and transportation costs have been made, and estimated tonnages of both recoverable material and...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... paper sales and savings from diverting recycled materials from disposal. Potential costs to upgrade...

40 CFR 246.201-7 - Recommended procedures: Cost analysis.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., storage and transportation costs have been made, and estimated tonnages of both recoverable materials and...) SOLID WASTES SOURCE SEPARATION FOR MATERIALS RECOVERY GUIDELINES Requirements and Recommended Procedures... paper sales and savings from diverting recycled materials from disposal. Potential costs to upgrade...

16 CFR 1702.2 - Procedural requirements and recommendations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Procedural requirements and recommendations. 1702.2 Section 1702.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION POISON PREVENTION PACKAGING ACT OF 1970 REGULATIONS PETITIONS FOR EXEMPTIONS FROM POISON PREVENTION PACKAGING ACT REQUIREMENTS...

16 CFR 1702.2 - Procedural requirements and recommendations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Procedural requirements and recommendations. 1702.2 Section 1702.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION POISON PREVENTION PACKAGING ACT OF 1970 REGULATIONS PETITIONS FOR EXEMPTIONS FROM POISON PREVENTION PACKAGING ACT REQUIREMENTS...

Splash Safety During Dermatologic Procedures Among US Dermatology Residents.

PubMed

Korta, Dorota Z; Chapman, Lance W; Lee, Patrick K; Linden, Kenneth G

2017-07-01

Dermatologists are at potential risk of acquiring infections from contamination of the mucous membranes by blood and body fluids. However, there are little data on splash safety during procedural dermatology. To determine dermatology resident perceptions about splash risk during dermatologic procedures and to quantify the rate of protective equipment use. An anonymous on-line survey was sent to 108 United States ACGME-approved dermatology residency programs assessing frequency of facial protection during dermatologic procedures, personal history of splash injury, and, if applicable, reasons for not always wearing facial protection. A total of 153 dermatology residents responded. Rates of facial protection varied by procedure, with the highest rates during surgery and the lowest during local anesthetic injection. Over 54% of respondents reported suffering facial splash while not wearing facial protection during a procedure. In contrast, 88.9% of respondents correctly answered that there is a small risk of acquiring infection from mucosal splash. Residency program recommendations for facial protection seem to vary by procedure. The authors' results demonstrate that although facial splash is a common injury, facial protection rates and protective recommendations vary significantly by procedure. These data support the recommendation for enhanced facial protection guidelines during procedural dermatology.

[Current Situation of Antibiotic Prophylaxis in Obesity and Metabolic Surgery - Data Analysis from the Study for Quality Assurance in Operative Treatment of Obesity in Germany].

PubMed

Stroh, C; Wilhelm, B; Weiner, R; Ludwig, K; Benedix, F; Knoll, C; Lippert, H; Manger, T; Adipositas, Kompetenznetz

2016-02-01

Since January 2005, the situation of metabolic and obesity surgery in Germany has been constantly evaluated by the German Bariatric Surgery Registry (GBSR). Data registration is performed using an internet online database with prospective data collection. All registered data were analysed in cooperation with the Institute of Quality Assurance at the Otto-von-Guericke University Magdeburg. Data collection includes primary and revision/redo-procedures. A main focus of the current study is the analysis of data regarding the perioperative management, in particular, administration of antibiotics. Since 2005 a significant increase of primary bariatric procedures has been reported. For evaluation of the antibiotic regimen 12 296 primary operations including 684 balloons (BIB), 2950 gastric bandings (GB), 5115 Roux-en-Y-gastric bypasses (RYGBP), 120 Scopinaro's biliopancreatic diversions (BPD), 164 duodenal switches (DS), 3125 sleeve gastrectomies (SG) and 138 other procedures were analysed. In total 77.3 % of the patients with primary procedures received perioperative antibiotics. Patients without concomitant comorbidities received antibiotics significantly less often compared to those with comorbidities. Wound infection rates were comparable for patients who underwent either gastric banding or sleeve gastrectomy. Surgery has been accepted step by step as a treatment for morbid obesity and its comorbidities in Germany during the last few years. There is only little experience in the literature regarding antibiotic therapy as well as prophylaxis in bariatric surgery. Based on the results of the current study we recommend rather the selective than the routine use of antibiotics depending on different parameters, e.g., operative time, preoperative BMI and concomitant comorbidities. Georg Thieme Verlag KG Stuttgart · New York.

EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis.

PubMed

van Eijk-Hustings, Yvonne; van Tubergen, Astrid; Boström, Carina; Braychenko, Elena; Buss, Beate; Felix, José; Firth, Jill; Hammond, Alison; Harston, Benny; Hernandez, Cristina; Huzjak, Masa; Korandová, Jana; Kukkurainen, Marja Leena; Landewé, Robert; Mezieres, Maryse; Milincovic, Marijana; Moretti, Antonella; Oliver, Susan; Primdahl, Jette; Scholte-Voshaar, Marieke; de la Torre-Aboki, Jenny; Waite-Jones, Jennifer; Westhovens, Rene; Zangi, Heidi Andersen; Heiberg, Turid; Hill, Jackie

2012-01-01

The authors aim to develop European League Against Rheumatism recommendations for the role of the nurse in the management of patients with chronic inflammatory arthritis, to identify a research agenda and to determine an educational agenda. A task force made up of a multidisciplinary expert panel including nurses, rheumatologists, occupational therapist, physiotherapist, psychologist, epidemiologist and patient representatives, representing 14 European countries, carried out the development of the recommendations, following the European League Against Rheumatism standardised operating procedures. The task force met twice. In the first meeting, the aims of the task force were defined, and eight research questions were developed. This was followed by a comprehensive, systematic literature search. In the second meeting, the results from the literature review were presented to the task force that subsequently formulated the recommendations, research agenda and educational agenda. In total, 10 recommendations were formulated. Seven recommendations covered the contribution of nurses to care and management: education, satisfaction with care, access to care, disease management, psychosocial support, self-management and efficiency of care. Three recommendations focused on professional support for nurses: availability of guidelines or protocols, access to education and encouragement to undertake extended roles. The strength of the recommendations varied from A to C, dependent on the category of evidence (1A-3), and a high level of agreement was achieved. Additionally, the task force agreed upon 10 topics for future research and an educational agenda. 10 recommendations for the role of the nurse in the management of chronic inflammatory arthritis were developed using a combination of evidence-based and expert consensus approach.

Internal quality control: planning and implementation strategies.

PubMed

Westgard, James O

2003-11-01

The first essential in setting up internal quality control (IQC) of a test procedure in the clinical laboratory is to select the proper IQC procedure to implement, i.e. choosing the statistical criteria or control rules, and the number of control measurements, according to the quality required for the test and the observed performance of the method. Then the right IQC procedure must be properly implemented. This review focuses on strategies for planning and implementing IQC procedures in order to improve the quality of the IQC. A quantitative planning process is described that can be implemented with graphical tools such as power function or critical-error graphs and charts of operating specifications. Finally, a total QC strategy is formulated to minimize cost and maximize quality. A general strategy for IQC implementation is recommended that employs a three-stage design in which the first stage provides high error detection, the second stage low false rejection and the third stage prescribes the length of the analytical run, making use of an algorithm involving the average of normal patients' data.

Standard operating procedures improve acute neurologic care in a sub-Saharan African setting

PubMed Central

Jaiteh, Lamin E.S.; Helwig, Stefan A.; Jagne, Abubacarr; Ragoschke-Schumm, Andreas; Sarr, Catherine; Walter, Silke; Lesmeister, Martin; Manitz, Matthias; Blaß, Sebastian; Weis, Sarah; Schlund, Verena; Bah, Neneh; Kauffmann, Jil; Fousse, Mathias; Kangankan, Sabina; Ramos Cabrera, Asmell; Kronfeld, Kai; Ruckes, Christian; Liu, Yang; Nyan, Ousman

2017-01-01

Objective: Quality of neurologic emergency management in an under-resourced country may be improved by standard operating procedures (SOPs). Methods: Neurologic SOPs were implemented in a large urban (Banjul) and a small rural (Brikama) hospital in the Gambia. As quality indicators of neurologic emergency management, performance of key procedures was assessed at baseline and in the first and second implementation years. Results: At Banjul, 100 patients of the first-year intervention group exhibited higher rates of general procedures of emergency management than 105 control patients, such as neurologic examination (99.0% vs 91.4%; p < 0.05) and assessments of respiratory rate (98.0% vs 81.9%, p < 0.001), temperature (60.0% vs 36.2%; p < 0.001), and glucose levels (73.0% vs 58.1%; p < 0.05), in addition to written directives by physicians (96.0% vs 88.6%, p < 0.05), whereas assessments of other vital signs remained unchanged. In stroke patients, rates of stroke-related procedures increased: early CT scanning (24.3% vs 9.9%; p < 0.05), blood count (73.0% vs 49.3%; p < 0.01), renal and liver function tests (50.0% vs 5.6%, p < 0.001), aspirin prophylaxis (47.3% vs 9.9%; p < 0.001), and physiotherapy (41.9% vs 4.2%; p < 0.001). Most effects persisted until the second-year evaluation. SOP implementation was similarly feasible and beneficial at the Brikama hospital. However, outcomes did not significantly differ in the hospitals. Conclusions: Implementing SOPs is a realistic, low-cost option for improving process quality of neurologic emergency management in under-resourced settings. Classification of evidence: This study provides Class IV evidence that, for patients with suspected neurologic emergencies in sub-Saharan Africa, neurologic SOPs increase the rate of performance of guideline-recommended procedures. PMID:28600460

40 CFR 240.208-2 - Recommended procedures: Design.

Code of Federal Regulations, 2010 CFR

2010-07-01

....208-2 Section 240.208-2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR THE THERMAL PROCESSING OF SOLID WASTES Requirements and Recommended Procedures... allow for removal from the site of residue or other solids in a manner that protects the environment. ...

[Standards, options, and recommendations for initial management of patients with malignant ovarian epithelial tumors].

PubMed

Kerbrat, P; Lhommé, C; Fervers, B; Guastalla, J P; Thomas, L; Basuyau, J P; Duvillard, P; Cohen-Solal, C; Dauplat, J; Tournemaine, N

2000-12-09

Suprapubic and transvaginal pelvic ultrasound exploration is indicated for suspected ovarian tumor (standard). Diagnosis and search for extension require surgery and pathology examination. Systematic preoperative computed tomography is not recommended (standard). Surgery for cancer of the ovary is a specialized procedure requiring skill in cancer, gynecology, visceral surgery and laparoscopic surgery. If the patient is referred to a specialized center after a primary procedure considered to be inadequate, a new procedure is recommended for staging. Residual tumor volume after the primary procedure has prognostic value. Systematic second look procedures are not recommended for routine practice (standard). For patients with grade IA G1 tumors, there is no indication for complementary treatment (standard). For patients with grade IA G2-3 or clear cell tumors, IB, IC, IIA, there is no standard. no complementary treatment, complementary chemotherapy using platinum, complementary external abdominopelvic radiotherapy. A complementary treatment is recommended for grades IC and IIA. Complementary treatment for grades IIB (no residual tissue), IIC (with residual tissue), III (no residual tissue), is based on: complementary chemotherapy with platinium, complementary external abdominopelvic radiotherapy (options). Complementary treatment for advanced forms (IIB (with residual tissue), IIC (with residual tissue), III (with residual tissue) and IV) is based on polychemotherapy with platinium (standard). platinium combined with paclitaxel (intravenous), platinium combined with cyclophosphamide and/or doxorubicin (intravenous) or intraperitoneal cisplatin combined with cyclophosphamide (intravenous). The chemotherapy work-up includes physical examination, assay of serum markers (particularly CA125) and abdominopelvic computed tomography (proof level B) (standard). Physical examination is recommended for monitoring patients in complete remission with no sign of suspected recurrence (standard). This document was reviewed in April 1977. The working group again validated the Standards, OPTIONS and Recommendations, without modifications in June 1999.

DEVELOPMENT OF AGENTS AND PROCEDURES FOR DECONTAMINATION OF THE YANKEE REACTOR PRIMARY COOLANT SYSTEM

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

Watkins, R.M.

1959-03-01

Developments relative to decontamination achieved under the Yankee Reasearch and Development program are reported. The decontamination of a large test loop which had been used to conduct corrosion rate studies for the Yankee reactor program is described. The basic permanganate-citrate decontamination procedure suggested for application in Yankee reactor primary system cleanup was used. A study of the chemistry of this decontamination operation is presented, together with conclusions pertaining to the effectiveness of the solutions under the conditions studied. In an attempt to further improve the efficiency of the procedure, an additional series of static and dynamic tests was performcd usingmore » contaminated sections of stainless steel tubing from the original SlW steam generator. Survival variables in the process (reagent composition, contact time, temperature, and flow velocity) were studied. The changes in decontamination efficiency produced by these variations are discussed and compared with results obtained throughthe use of similar procedures. Based on the observations made, conclusions are drawn concerning the optimum conditions for this cleanup process, a new set of suggested basic permanganate-citrate decontamination instructions is presented, and recommendations are made concerning future studies involving this procedure. (auth)« less

HGVS Recommendations for the Description of Sequence Variants: 2016 Update.

PubMed

den Dunnen, Johan T; Dalgleish, Raymond; Maglott, Donna R; Hart, Reece K; Greenblatt, Marc S; McGowan-Jordan, Jean; Roux, Anne-Francoise; Smith, Timothy; Antonarakis, Stylianos E; Taschner, Peter E M

2016-06-01

The consistent and unambiguous description of sequence variants is essential to report and exchange information on the analysis of a genome. In particular, DNA diagnostics critically depends on accurate and standardized description and sharing of the variants detected. The sequence variant nomenclature system proposed in 2000 by the Human Genome Variation Society has been widely adopted and has developed into an internationally accepted standard. The recommendations are currently commissioned through a Sequence Variant Description Working Group (SVD-WG) operating under the auspices of three international organizations: the Human Genome Variation Society (HGVS), the Human Variome Project (HVP), and the Human Genome Organization (HUGO). Requests for modifications and extensions go through the SVD-WG following a standard procedure including a community consultation step. Version numbers are assigned to the nomenclature system to allow users to specify the version used in their variant descriptions. Here, we present the current recommendations, HGVS version 15.11, and briefly summarize the changes that were made since the 2000 publication. Most focus has been on removing inconsistencies and tightening definitions allowing automatic data processing. An extensive version of the recommendations is available online, at http://www.HGVS.org/varnomen. © 2016 WILEY PERIODICALS, INC.

Integrating environment into land-use planning through strategic environmental assessment in China: Towards legal frameworks and operational procedures

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

Tao Tang; Tan Zhu; He Xu

China currently put forwards 'striving to build an environmentally friendly society' as one of the most important development goals. The land administration authorities are facing the challenge of effectively incorporating environment considerations into their planning system. This paper aims to investigate why and how Strategic Environmental Assessment (SEA) is enacted as an effective tool to integrate the environment into land-use planning during the construction process of an environmentally friendly society in China, and identify factors that influence the integration. It presents characteristics of the land-use planning system, and reviews the progress and current state of SEA in China. Results showmore » that SEA provides many benefits in promoting environmental considerations into the land-use planning process. The legal frameworks and operational procedures, in the context of land-use master planning SEA, are summarized and an assessment made of their effectiveness. Some barriers are highlighted through examination of the latest case studies, and several recommendations are presented to overcome these obstacles.« less

Industrial Fuel Gas Demonstration Plant Program: environmental permit compliance plan

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

Bodamer, Jr., James W.; Bocchino, Robert M.

1979-11-01

This Environmental Permit Compliance Plan is intended to assist the Memphis Light, Gas and Water Division in acquiring the necessary environmental permits for their proposed Industrial Fuel Gas Demonstration Plant in a time frame consistent with the construction schedule. Permits included are those required for installation and/or operation of gaseous, liquid and solid waste sources and disposal areas. Only those permits presently established by final regulations are described. The compliance plan describes procedures for obtaining each permit from identified federal, state and local agencies. The information needed for the permit application is presented, and the stepwise procedure to follow whenmore » filing the permit application is described. Information given in this plan was obtained by reviewing applicable laws and regulations and from telephone conversations with agency personnel on the federal, state and local levels. This Plan also presents a recommended schedule for beginning the work necessary to obtain the required environmental permits in order to begin dredging operations in October, 1980 and construction of the plant in September, 1981. Activity for several key permits should begin as soon as possible.« less

Online Calibration of Polytomous Items Under the Generalized Partial Credit Model

PubMed Central

Zheng, Yi

2016-01-01

Online calibration is a technology-enhanced architecture for item calibration in computerized adaptive tests (CATs). Many CATs are administered continuously over a long term and rely on large item banks. To ensure test validity, these item banks need to be frequently replenished with new items, and these new items need to be pretested before being used operationally. Online calibration dynamically embeds pretest items in operational tests and calibrates their parameters as response data are gradually obtained through the continuous test administration. This study extends existing formulas, procedures, and algorithms for dichotomous item response theory models to the generalized partial credit model, a popular model for items scored in more than two categories. A simulation study was conducted to investigate the developed algorithms and procedures under a variety of conditions, including two estimation algorithms, three pretest item selection methods, three seeding locations, two numbers of score categories, and three calibration sample sizes. Results demonstrated acceptable estimation accuracy of the two estimation algorithms in some of the simulated conditions. A variety of findings were also revealed for the interacted effects of included factors, and recommendations were made respectively. PMID:29881063

Management of antithrombotic therapy in patients with coronary artery disease or atrial fibrillation who underwent abdominal surgical operations.

PubMed

Schizas, Dimitrios; Kariori, Maria; Boudoulas, Konstantinos Dean; Siasos, Gerasimos; Patelis, Nikolaos; Kalantzis, Charalampos; Carmen-Maria, Moldovan; Vavuranakis, Manolis

2018-04-02

Patients treated with antithrombotic therapy that require abdominal surgical procedures has progressively increased overtime. The management of antithrombotics during both the peri- and post- operative period is of crucial importance. The goal of this review is to present current data concerning the management of antiplatelets in patients with coronary artery disease and of anticoagulants in patients with atrial fibrillation who had to undergo abdominal surgical operations. For this purpose, incidence of major adverse cardiovascular events (MACE) and risk of antithrombotic use during surgical procedures, as well as the recommendations based on recent guidelines were reported. A thorough search of PubMed, Scopus and the Cochrane Databases was conducted to identify randomized controlled trials, observational studies, novel current reviews, and ESC and ACC/AHA guidelines on the subject. Antithrombotic use in daily clinical practice results to two different pathways: reduction of thromboembolic risk, but a simultaneous increase of bleeding risk. This may cause a therapeutic dilemma during the perioperative period. Nevertheless, careless cessation of antithrombotics can increase MACE and thromboembolic events, however, maintenance of antithrombotic therapy may increase bleeding complications. Studies and current guidelines can assist clinicians in making decisions for the treatment of patients that undergo abdominal surgical operations while on antithrombotic therapy. Aspirin should not be stopped perioperatively in the majority of surgical operations. Determining whether to discontinue the use of anticoagulants before surgery depends on the surgical procedure. In surgical operations with a low risk for bleeding, oral anticoagulants should not be discontinued. Bridging therapy should only be considered in patients with a high risk of thromboembolism. Finally, patients with an intermediate risk for thromboembolism, management should be individualized according to patient's thrombotic and bleeding risk. Management of antithrombotics therapy during the perioperative period in patients undergoing abdominal surgery should follow a patient-centered approach according to a patient's medical history and thrombotic risk weighted for bleeding risk. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Simple Circumcision Device: Proof-of-Concept for a Single-visit, Adjustable Device to Facilitate Safe Adult Male Circumcision

PubMed Central

Hotaling, James M; Leddy, Laura S; Haider, Mahum A; Mossanen, Matthew; Bailey, Michael R; MacConaghy, Brian; Olson, Francis; Krieger, John N

2014-01-01

Objective To conduct a proof-of-concept study to determine the potential utility of a novel, adjustable single-visit, disposable device to facilitate rapid adult circumcision. Design Prospective pilot trial of a novel surgical device Setting Tertiary care Veterans Administration medical center Patients 5 adult males Interventions Circumcisions performed by junior trainees using an adjustable, single-size surgical-assist device constructed by the University of Washington Applied Physics Laboratory. Main Outcome Measure(s) The attending surgeon and trainees completed standardized forms after each procedure to assess technical problems and ease of use. Follow-up visits were scheduled to evaluate adverse events, post-operative pain, cosmetic outcomes and participant satisfaction at 3, 8, 30 and 90 days post-operatively. Results The average operative time was 16.4 minutes. All cases were performed with local anesthesia and no case required electrocautery or conversion to standard surgery. At the post-operative day 3 visit all subjects were happy with their results and would recommend the procedure to another patient. One participant had a minor wound separation noted at the 30-day visit that resolved during follow-up. There were no wound infections, hematomas or other adverse events. Conclusions This proof-of-study suggests that the Simple Circumcision Device (SCD) may facilitate delivery of safe adult male circumcision services. PMID:24613534

Impact of a bronchial genomic classifier on clinical decision making in patients undergoing diagnostic evaluation for lung cancer.

PubMed

Ferguson, J Scott; Van Wert, Ryan; Choi, Yoonha; Rosenbluth, Michael J; Smith, Kate Porta; Huang, Jing; Spira, Avrum

2016-05-17

Bronchoscopy is frequently used for the evaluation of suspicious pulmonary lesions found on computed tomography, but its sensitivity for detecting lung cancer is limited. Recently, a bronchial genomic classifier was validated to improve the sensitivity of bronchoscopy for lung cancer detection, demonstrating a high sensitivity and negative predictive value among patients at intermediate risk (10-60 %) for lung cancer with an inconclusive bronchoscopy. Our objective for this study was to determine if a negative genomic classifier result that down-classifies a patient from intermediate risk to low risk (<10 %) for lung cancer would reduce the rate that physicians recommend more invasive testing among patients with an inconclusive bronchoscopy. We conducted a randomized, prospective, decision impact survey study assessing pulmonologist recommendations in patients undergoing workup for lung cancer who had an inconclusive bronchoscopy. Cases with an intermediate pretest risk for lung cancer were selected from the AEGIS trials and presented in a randomized fashion to pulmonologists either with or without the patient's bronchial genomic classifier result to determine how the classifier results impacted physician decisions. Two hundred two physicians provided 1523 case evaluations on 36 patients. Invasive procedure recommendations were reduced from 57 % without the classifier result to 18 % with a negative (low risk) classifier result (p < 0.001). Invasive procedure recommendations increased from 50 to 65 % with a positive (intermediate risk) classifier result (p < 0.001). When stratifying by ultimate disease diagnosis, there was an overall reduction in invasive procedure recommendations in patients with benign disease when classifier results were reported (54 to 41 %, p < 0.001). For patients ultimately diagnosed with malignant disease, there was an overall increase in invasive procedure recommendations when the classifier results were reported (50 to 64 %, p = 0.003). Our findings suggest that a negative (low risk) bronchial genomic classifier result reduces invasive procedure recommendations following an inconclusive bronchoscopy and that the classifier overall reduces invasive procedure recommendations among patients ultimately diagnosed with benign disease. These results support the potential clinical utility of the classifier to improve management of patients undergoing bronchoscopy for suspect lung cancer by reducing additional invasive procedures in the setting of benign disease.

Operating room sound level hazards for patients and physicians.

PubMed

Fritsch, Michael H; Chacko, Chris E; Patterson, Emily B

2010-07-01

Exposure to certain new surgical instruments and operating room devices during procedures could cause hearing damage to patients and personnel. Surgical instruments and related equipment generate significant sound levels during routine usage. Both patients and physicians are exposed to these levels during the operative cases, many of which can last for hours. The noise loads during cases are cumulative. Occupational Safety and Health Administration (OSHA) and National Institute for Occupational Safety and Health (NIOSH) standards are inconsistent in their appraisals of potential damage. Implications of the newer power instruments are not widely recognized. Bruel and Kjaer sound meter spectral recordings for 20 major instruments from 5 surgical specialties were obtained at the ear levels for the patient and the surgeon between 32 and 20 kHz. Routinely used instruments generated sound levels as high as 131 dB. Patient and operator exposures differed. There were unilateral dominant exposures. Many instruments had levels that became hazardous well within the length of an average surgical procedure. The OSHA and NIOSH systems gave contradicting results when applied to individual instruments and types of cases. Background noise, especially in its intermittent form, was also of significant nature. Some patients and personnel have additional predisposing physiologic factors. Instrument noise levels for average length surgical cases may exceed OSHA and NIOSH recommendations for hearing safety. Specialties such as Otolaryngology, Orthopedics, and Neurosurgery use instruments that regularly exceed limits. General operating room noise also contributes to overall personnel exposures. Innovative countermeasures are suggested.

PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain.

PubMed

Neugebauer, E A M; Wilkinson, R C; Kehlet, H; Schug, S A

2007-07-01

Many patients still suffer severe acute pain in the postoperative period. Although guidelines for treating acute pain are widely published and promoted, most do not consider procedure-specific differences in pain experienced or in techniques that may be most effective and appropriate for different surgical settings. The procedure-specific postoperative pain management (PROSPECT) Working Group provides procedure-specific recommendations for postoperative pain management together with supporting evidence from systematic literature reviews and related procedures at http://www.postoppain.org The methodology for PROSPECT reviews was developed and refined by discussion of the Working Group, and it adapts existing methods for formulation of consensus recommendations to the specific requirements of PROSPECT. To formulate PROSPECT recommendations, we use a methodology that takes into account study quality and source and level of evidence, and we use recognized methods for achieving group consensus, thus reducing potential bias. The new methodology is first applied in full for the 2006 update of the PROSPECT review of postoperative pain management for laparoscopic cholecystectomy. Transparency in PROSPECT processes allows the users to be fully aware of any limitations of the evidence and recommendations, thereby allowing for appropriate decisions in their own practice setting.

Parametric study of STOL short-haul transport engine cycles and operational techniques to minimize community noise impact

NASA Technical Reports Server (NTRS)

1974-01-01

The effect of aircraft operational techniques in the terminal area on community noise impact of future short haul aircraft was investigated. Aircraft equipped with mechanical flap (MF) and aircraft with externally blown flap (EBF) were used to study the noise impact at four U.S. airports. The four airports were: (1) Hanscom Field (Boston), (2) Washington National (D.C.), (3) Midway (Chicago) and (4) Orange County (California). With the exception of Washington National (D.C.), the study showed that a reduction of approximately 40 percent in the number of people highly annoyed can be obtained by using the recommended operational techniques. The evaluation procedures and methodology developed in the study represent an advance in acoustical state-of-the-art and provide an effective and useful tool for determining aircraft noise impact on the airport community.

Study of safety implications for shuttle launched spacecraft using fluorinated oxidizers. Volume 1: Complete text

NASA Technical Reports Server (NTRS)

1975-01-01

The safety implications of space shuttle launched spacecraft using liquid flourine as the oxidizer for spacecraft propulsion were investigated. Feasibility of safe operation was investigated and the equipment and procedures necessary to maximize the chance of success determined. Hazards to the shuttle were found to be similar in kind if not degree to those encountered in use of nitrogen tetroxide (also toxic oxidizer). It was concluded that residual risks from spacecraft using fluorine and nitrogen tetroxide during ground and flight handling may be reduced by isolation of the oxidizer to only its tank. Operation of planetary spacecraft propulsion in the vicinity of the shuttle in earth orbit is not required. The primary hazard to personnel was identified as propellant loading operations, which should be accomplished in an area reasonably remote from personnel and facilities concentrations. Clearing the pad during spacecraft mating with the shuttle orbiter is recommended.

Computational analysis of the SSME fuel preburner flow

NASA Technical Reports Server (NTRS)

Wang, T. S.; Farmer, R. C.

1986-01-01

A computational fluid dynamics model which simulates the steady state operation of the SSME fuel preburner is developed. Specifically, the model will be used to quantify the flow factors which cause local hot spots in the fuel preburner in order to recommend experiments whereby the control of undesirable flow features can be demonstrated. The results of a two year effort to model the preburner are presented. In this effort, investigating the fuel preburner flowfield, the appropriate transport equations were numerically solved for both an axisymmetric and a three-dimensional configuration. Continuum's VAST (Variational Solution of the Transport equations) code, in conjunction with the CM-1000 Engineering Analysis Workstation and the NASA/Ames CYBER 205, was used to perform the required calculations. It is concluded that the preburner operational anomalies are not due to steady state phenomena and must, therefore, be related to transient operational procedures.

Development of preliminary design concept for a multifunction display and control system for the Orbiter crew station. Task 4: Design concept recommendation

NASA Technical Reports Server (NTRS)

Spiger, R. J.; Farrell, R. J.; Holcomb, G. A.

1982-01-01

Application of multifunction display and control systems to the NASA Orbiter spacecraft offers the potential for reducing crew workload and improving the presentation of system status and operational data to the crew. A design concept is presented for the application of a multifunction display and control system (MFDCS) to the Orbital Maneuvering System and Electrical Power Distribution and Control System on the Orbiter spacecraft. The MFDCS would provide the capability for automation of procedures, fault prioritization and software reconfiguration of the MFDCS data base. The MFDCS would operate as a stand-alone processor to minimize the impact on the current Orbiter software. Supervisory crew command of all current functions would be retained through the use of several operating modes in the system. Both the design concept and the processes followed in defining the concept are described.

40 CFR 255.24 - Procedure for identifying interstate regions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Procedure for identifying interstate regions. 255.24 Section 255.24 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... recommendation, the local consensus, or a neighboring Governor's recommendation is that an interstate region be...

Prudent Practices for Handling Hazardous Chemicals in Laboratories.

ERIC Educational Resources Information Center

National Academy of Sciences-National Research Council, Washington, DC. Assembly of Mathematical and Physical Sciences.

This guide recommends procedures for safe handling and disposal of hazardous substances, along with broad recommendations for developing comprehensive laboratory safety programs. Although specific information is provided, general principles which can be adapted to activities in any laboratory are emphasized. Section 1 focuses on procedures for…

16 CFR § 1702.2 - Procedural requirements and recommendations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Procedural requirements and recommendations. § 1702.2 Section § 1702.2 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION POISON PREVENTION PACKAGING ACT OF 1970 REGULATIONS PETITIONS FOR EXEMPTIONS FROM POISON PREVENTION PACKAGING ACT...

Field Test Evaluation of Conservation Retrofits of Low-Income, Single-Family Buildings in Wisconsin: Blower-Door-Directed Infiltration Reduction Procedure, Field Test Implementation and Results

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

Gettings, M.B.

A blower-door-directed infiltration retrofit procedure was field tested on 18 homes in south central Wisconsin. The procedure, developed by the Wisconsin Energy Conservation Corporation, includes recommended retrofit techniques as well as criteria for estimating the amount of cost-effective work to be performed on a house. A recommended expenditure level and target air leakage reduction, in air changes per hour at 50 Pascal (ACH50), are determined from the initial leakage rate measured. The procedure produced an average 16% reduction in air leakage rate. For the 7 houses recommended for retrofit, 89% of the targeted reductions were accomplished with 76% of themore » recommended expenditures. The average cost of retrofits per house was reduced by a factor of four compared with previous programs. The average payback period for recommended retrofits was 4.4 years, based on predicted energy savings computed from achieved air leakage reductions. Although exceptions occurred, the procedure's 8 ACH50 minimum initial leakage rate for advising retrofits to be performed appeared a good choice, based on cost-effective air leakage reduction. Houses with initial rates of 7 ACH50 or below consistently required substantially higher costs to achieve significant air leakage reductions. No statistically significant average annual energy savings was detected as a result of the infiltration retrofits. Average measured savings were -27 therm per year, indicating an increase in energy use, with a 90% confidence interval of 36 therm. Measured savings for individual houses varied widely in both positive and negative directions, indicating that factors not considered affected the results. Large individual confidence intervals indicate a need to increase the accuracy of such measurements as well as understand the factors which may cause such disparity. Recommendations for the procedure include more extensive training of retrofit crews, checks for minimum air exchange rates to insure air quality, and addition of the basic cost of determining the initial leakage rate to the recommended expenditure level. Recommendations for the field test of the procedure include increasing the number of houses in the sample, more timely examination of metered data to detect anomalies, and the monitoring of indoor air temperature. Though not appropriate in a field test of a procedure, further investigation into the effects of air leakage rate reductions on heating loads needs to be performed.« less

A componential view of children's difficulties in learning fractions.

PubMed

Gabriel, Florence; Coché, Frédéric; Szucs, Dénes; Carette, Vincent; Rey, Bernard; Content, Alain

2013-01-01

Fractions are well known to be difficult to learn. Various hypotheses have been proposed in order to explain those difficulties: fractions can denote different concepts; their understanding requires a conceptual reorganization with regard to natural numbers; and using fractions involves the articulation of conceptual knowledge with complex manipulation of procedures. In order to encompass the major aspects of knowledge about fractions, we propose to distinguish between conceptual and procedural knowledge. We designed a test aimed at assessing the main components of fraction knowledge. The test was carried out by fourth-, fifth- and sixth-graders from the French Community of Belgium. The results showed large differences between categories. Pupils seemed to master the part-whole concept, whereas numbers and operations posed problems. Moreover, pupils seemed to apply procedures they do not fully understand. Our results offer further directions to explain why fractions are amongst the most difficult mathematical topics in primary education. This study offers a number of recommendations on how to teach fractions.

Secondhand Smoke in the Operating Room? Precautionary Practices Lacking for Surgical Smoke

PubMed Central

Steege, Andrea L.; Boiano, James M.; Sweeney, Marie H.

2016-01-01

Background Consensus organizations, government bodies, and healthcare organization guidelines recommend that surgical smoke be evacuated at the source by local exhaust ventilation (LEV) (i.e., smoke evacuators or wall suctions with inline filters). Methods Data are from NIOSH’s Health and Safety Practices Survey of Healthcare Workers module on precautionary practices for surgical smoke. Results Four thousand five hundred thirty-three survey respondents reported exposure to surgical smoke: 4,500 during electrosurgery; 1,392 during laser surgery procedures. Respondents were mainly nurses (56%) and anesthesiologists (21%). Only 14% of those exposed during electrosurgery reported LEV was always used during these procedures, while 47% reported use during laser surgery. Those reporting LEV was always used were also more likely to report training and employer standard procedures addressing the hazards of surgical smoke. Few respondents reported use of respiratory protection. Conclusions Study findings can be used to raise awareness of the marginal use of exposure controls and impediments for their use. PMID:27282626

A componential view of children's difficulties in learning fractions

PubMed Central

Gabriel, Florence; Coché, Frédéric; Szucs, Dénes; Carette, Vincent; Rey, Bernard; Content, Alain

2013-01-01

Fractions are well known to be difficult to learn. Various hypotheses have been proposed in order to explain those difficulties: fractions can denote different concepts; their understanding requires a conceptual reorganization with regard to natural numbers; and using fractions involves the articulation of conceptual knowledge with complex manipulation of procedures. In order to encompass the major aspects of knowledge about fractions, we propose to distinguish between conceptual and procedural knowledge. We designed a test aimed at assessing the main components of fraction knowledge. The test was carried out by fourth-, fifth- and sixth-graders from the French Community of Belgium. The results showed large differences between categories. Pupils seemed to master the part-whole concept, whereas numbers and operations posed problems. Moreover, pupils seemed to apply procedures they do not fully understand. Our results offer further directions to explain why fractions are amongst the most difficult mathematical topics in primary education. This study offers a number of recommendations on how to teach fractions. PMID:24133471

[Necessary and unnecessary treatment options for hemorrhoids].

PubMed

Zindel, Joel; Inglin, Roman; Brügger, Lukas

2014-12-01

Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the expense of a higher recurrence rate. These relatively "new" procedures equally qualify for the treatment of grade III and IV hemorrhoids, and, in the case of stapled hemorrhoidopexy, may even be employed in the emergency situation of an acute anal prolapse. While under certain circumstances different treatment options are equivalent, there is a clear specificity with respect to the application of those procedures in other situations. The respective pros and cons need to be discussed separately with every patient. According to their own requirements a treatment strategy has to be defined according to their individual requirements.

Randomized clinical trial of ligasure™ versus conventional splenectomy for injured spleen in blunt abdominal trauma.

PubMed

Amirkazem, Vejdan Seyyed; Malihe, Khosravi

2017-02-01

Spleen is the most common organ damaged in cases of blunt abdominal trauma and splenectomy and splenorrhaphy are the main surgical procedures that are used in surgical treatment of such cases. In routine open splenectomy cases, after laparotomy, application of sutures in splenic vasculature is the most widely used procedure to cease the bleeding. This clinical trial evaluates the role and benefits of the Ligasure™ system in traumatic splenectomy without using any suture materials and compares the result with conventional method of splenectomy. After making decision for splenectomy secondary to a blunt abdominal trauma, patients in control group (39) underwent splenectomy using conventional method with silk suture ligation of splenic vasculature. In the interventional group (41) a Ligasure™ vascular sealing system was used for ligating of the splenic vein and artery. The results of operation time, volume of intra-operation bleeding and post-operative complications were compared in both groups. The mean operation times in control and interventional group were 21 and 12 min respectively (p < 0.05). The average volume of bleeding in control group during open splenectomy was 280 cc, but in the interventional group decreased significantly to 80 ml (p < 0.05) using the Ligasure system. Post-operative complications such as bleeding were non-existent in both groups. The application of Ligasure™ in blunt abdominal trauma for splenectomy not only can decrease the operation time but also can decrease the volume of bleeding during operation without any additional increase in post-operative complications. This method is recommendable in traumatic splenic injuries that require splenectomy in order to control the bleeding as opposed to use of traditional silk sutures. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Health and safety plan for the Environmental Restoration Program at Oak Ridge National Laboratory

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

Clark, C. Jr.; Burman, S.N.; Cipriano, D.J. Jr.

1994-08-01

This Programmatic Health and Safety plan (PHASP) is prepared for the U.S. Department of Energy (DOE) Oak Ridge National Laboratory (ORNL) Environmental Restoration (ER) Program. This plan follows the format recommended by the U.S. Environmental Protection Agency (EPA) for remedial investigations and feasibility studies and that recommended by the EM40 Health and Safety Plan (HASP) Guidelines (DOE February 1994). This plan complies with the Occupational Safety and Health Administration (OSHA) requirements found in 29 CFR 1910.120 and EM-40 guidelines for any activities dealing with hazardous waste operations and emergency response efforts and with OSHA requirements found in 29 CFR 1926.65.more » The policies and procedures in this plan apply to all Environmental Restoration sites and activities including employees of Energy Systems, subcontractors, and prime contractors performing work for the DOE ORNL ER Program. The provisions of this plan are to be carried out whenever activities are initiated that could be a threat to human health or the environment. This plan implements a policy and establishes criteria for the development of procedures for day-to-day operations to prevent or minimize any adverse impact to the environment and personnel safety and health and to meet standards that define acceptable management of hazardous and radioactive materials and wastes. The plan is written to utilize past experience and best management practices to minimize hazards to human health and safety and to the environment from event such as fires, explosions, falls, mechanical hazards, or any unplanned release of hazardous or radioactive materials to air, soil, or surface water.« less

A critical appraisal of drainage in syringomyelia.

PubMed

Sgouros, S; Williams, B

1995-01-01

The use of drains in the treatment of syringomyelia has a simple and immediate appeal and has been practiced widely since the report of Abbe and Coley over 100 years ago. Good short-term results have been claimed in the past, but long-term outcome is largely unknown. An experience in Birmingham, England is reviewed in which 73 patients who had had some form of syrinx drainage procedure performed were subsequently followed up. In these cases, a total of 56 syringopleural and 14 syringosubarachnoid shunts had been inserted. Ten years after the operations, only 53.5% and 50% of the patients, respectively, continued to remain clinically stable. A 15.7% complication rate was recorded, including fatal hemorrhage, infection, and displacement of the drain from the pleural and syrinx cavities. At second operation or necropsy, at least 5% of shunts were discovered to be blocked. The effect of other drainage procedures that do not use artificial tubing, such as syringotomy and terminal ventriculostomy, was analyzed but found not to offer any substantial benefit. These results indicate that drainage procedures are not an effective solution to remedying the progressive, destructive nature of syringomyelia. It is suggested that, rather than attempting to drain the syrinx cavity, disabling the filling mechanism of the syrinx is more appropriate. Most forms of syringomyelia have a blockage at the level of the foramen magnum or in the subarachnoid space of the spine. Surgical measures that aim to reconstruct the continuity of the subarachnoid space at the site of the block are strongly recommended. Lowering the overall pressure of the cerebrospinal fluid is advocated when reestablishment of the pathways proves impossible. Syrinx drainage as an adjuvant to more physiological surgery may have a place in the treatment of syringomyelia. If two procedures are done at the same time, however, it is difficult to ascribe with certainty a success or failure, and it is suggested that the drainage procedure be reserved for a later attempt if the elective first operation fails.

CCBD's Position Summary on Physical Restraint & Seclusion Procedures in School Settings

ERIC Educational Resources Information Center

Peterson, Reece; Albrecht, Susan; Johns, Bev

2009-01-01

This document is a summary of policy recommendations from two longer and more detailed documents available from the Council for Children with Behavioral Disorders (CCBD) regarding the use of physical restraint and seclusion procedures in schools. These recommendations include: (1) CCBD believes that physical restraint or seclusion procedures…

9 CFR 147.11 - Laboratory procedure recommended for the bacteriological examination of salmonella.

Code of Federal Regulations, 2014 CFR

2014-01-01

... procedure recommended for the bacteriological examination of salmonella. (a) For egg- and meat-type chickens... the bacteriological examination of salmonella. 147.11 Section 147.11 Animals and Animal Products... 25 birds, and birds from Salmonella enteritidis (SE) positive environments should be cultured in...

9 CFR 147.11 - Laboratory procedure recommended for the bacteriological examination of salmonella.

Code of Federal Regulations, 2012 CFR

2012-01-01

... procedure recommended for the bacteriological examination of salmonella. (a) For egg- and meat-type chickens... the bacteriological examination of salmonella. 147.11 Section 147.11 Animals and Animal Products... 25 birds, and birds from Salmonella enteritidis (SE) positive environments should be cultured in...

9 CFR 147.11 - Laboratory procedure recommended for the bacteriological examination of salmonella.

Code of Federal Regulations, 2011 CFR

2011-01-01

... procedure recommended for the bacteriological examination of salmonella. (a) For egg- and meat-type chickens... the bacteriological examination of salmonella. 147.11 Section 147.11 Animals and Animal Products... 25 birds, and birds from Salmonella enteritidis (SE) positive environments should be cultured in...

9 CFR 147.11 - Laboratory procedure recommended for the bacteriological examination of salmonella.

Code of Federal Regulations, 2013 CFR

2013-01-01

... procedure recommended for the bacteriological examination of salmonella. (a) For egg- and meat-type chickens... the bacteriological examination of salmonella. 147.11 Section 147.11 Animals and Animal Products... 25 birds, and birds from Salmonella enteritidis (SE) positive environments should be cultured in...

9 CFR 147.11 - Laboratory procedure recommended for the bacteriological examination of salmonella.

Code of Federal Regulations, 2010 CFR

2010-01-01

... procedure recommended for the bacteriological examination of salmonella. (a) For egg- and meat-type chickens... the bacteriological examination of salmonella. 147.11 Section 147.11 Animals and Animal Products... 25 birds, and birds from Salmonella enteritidis (SE) positive environments should be cultured in...

Students with Attentional Disorders: Meeting Their Needs. A Guide for Schools and Families. Second Edition.

ERIC Educational Resources Information Center

Rhode Island State Dept. of Education, Providence.

This guide is designed to provide Rhode Island educators and families with information about appropriate interventions, recommended referral procedures, recommended diagnostic procedures, and legal issues regarding students with attention deficit disorders. It begins by answering frequently asked questions about attentional disorders and…

Joint road safety operations in tunnels and open roads

NASA Astrophysics Data System (ADS)

Adesiyun, Adewole; Avenoso, Antonio; Dionelis, Kallistratos; Cela, Liljana; Nicodème, Christophe; Goger, Thierry; Polidori, Carlo

2017-09-01

The objective of the ECOROADS project is to overcome the barrier established by the formal interpretation of the two Directives 2008/96/EC and 2004/54/EC, which in practice do not allow the same Road Safety Audits/Inspections to be performed inside tunnels. The projects aims at the establishment of a common enhanced approach to road infrastructure and tunnel safety management by using the concepts and criteria of the Directive 2008/96/CE on road infrastructure safety management and the results of related European Commission (EC) funded projects. ECOROADS has already implemented an analysis of national practices regarding Road Safety Inspections (RSI), two Workshops with the stakeholders, and an exchange of best practices between European tunnel experts and road safety professionals, which led to the definition of common agreed safety procedures. In the second phase of the project, different groups of experts and observers applied the above common procedures by inspecting five European road sections featuring both open roads and tunnels in Belgium, Albania, Germany, Serbia and Former Yugoslav Republic of Macedonia. This paper shows the feedback of the 5 joint safety operations and how they are being used for a set of - recommendations and guidelines for the application of the RSA and RSI concepts within the tunnel safety operations.

Cross-chest liposuction in gynaecomastia

PubMed Central

Murali, Biju; Vijayaraghavan, Sundeep; Kishore, P.; Iyer, Subramania; Jimmy, Mathew; Sharma, Mohit; Paul, George; Chavare, Sachin

2011-01-01

Background: Gynaecomastia is usually treated with liposuction or liposuction with excision of the glandular tissue. The type of surgery chosen depends on the grade of the condition. Objective: Because gynaecomastia is treated primarily as a cosmetic procedure, we aimed at reducing the invasiveness of the surgery. Materials and Methods: The technique complies with all recommended protocols for different grades of gynaecomastia. It uses liposuction, gland excision, or both, leaving only minimal post-operative scars. The use of cross-chest liposuction through incisions on the edge of the areola helps to get rid of all the fat under the areola without an additional scar as in the conventional method. Results: This is a short series of 20 patients, all with bilateral gynaecomastia (i.e., 40 breasts), belonging to Simon's Stage 1 and 2, studied over a period of 2 years. The average period of follow-up was 15 months. Post-operative complications were reported in only two cases, with none showing long-term complications or issues specifically due to the procedure. Conclusions : Cross-chest liposuction for gynaecomastia is a simple yet effective surgical tool in bilateral gynaecomastia treatment to decrease the post-operative scars. The use of techniques like incision line drain placement and post-drain removal suturing of wounds aid in decreasing the scar. PMID:21713166

Diagnosis and management of acute appendicitis. EAES consensus development conference 2015.

PubMed

Gorter, Ramon R; Eker, Hasan H; Gorter-Stam, Marguerite A W; Abis, Gabor S A; Acharya, Amish; Ankersmit, Marjolein; Antoniou, Stavros A; Arolfo, Simone; Babic, Benjamin; Boni, Luigi; Bruntink, Marlieke; van Dam, Dieuwertje A; Defoort, Barbara; Deijen, Charlotte L; DeLacy, F Borja; Go, Peter Mnyh; Harmsen, Annelieke M K; van den Helder, Rick S; Iordache, Florin; Ket, Johannes C F; Muysoms, Filip E; Ozmen, M Mahir; Papoulas, Michail; Rhodes, Michael; Straatman, Jennifer; Tenhagen, Mark; Turrado, Victor; Vereczkei, Andras; Vilallonga, Ramon; Deelder, Jort D; Bonjer, Jaap

2016-11-01

Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.

48 CFR 32.409-2 - Recommendation for disapproval.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Recommendation for... Recommendation for disapproval. If recommending disapproval, the contracting officer shall, under agency procedures, transmit— (a) The items prescribed in 32.409-1(a), (b), and (c); and (b) The recommendation for...

The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee recommendations for education and training in ultrasound-guided interventional pain procedures.

PubMed

Narouze, Samer N; Provenzano, David; Peng, Philip; Eichenberger, Urs; Lee, Sang Chul; Nicholls, Barry; Moriggl, Bernhard

2012-01-01

The use of ultrasound in pain medicine for interventional axial, nonaxial, and musculoskeletal pain procedures is rapidly evolving and growing. Because of the lack of specialty-specific guidelines for ultrasonography in pain medicine, an international collaborative effort consisting of members of the Special Interest Group on Ultrasonography in Pain Medicine from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies developed the following recommendations for education and training in ultrasound-guided interventional pain procedures. The purpose of these recommendations is to define the required skills for performing ultrasound-guided pain procedures, the processes for appropriate education, and training and quality improvement. Training algorithms are outlined for practice- and fellowship-based pathways. The previously published American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anaesthesia and Pain Therapy education and teaching recommendations for ultrasound-guided regional anesthesia served as a foundation for the pain medicine recommendations. Although the decision to grant ultrasound privileges occurs at the institutional level, the committee recommends that the training guidelines outlined in this document serve as the foundation for educational training and the advancement of the practice of ultrasonography in pain medicine.

Mucus retention cyst of the maxillary sinus: the endoscopic approach.

PubMed

Hadar, T; Shvero, J; Nageris, B I; Yaniv, E

2000-06-01

To present our experience of endoscopic surgery for symptomatic mucus retention cyst of the maxillary sinus. Retrospective study. Teaching hospital, Israel. 60 patients with 65 symptomatic cysts of the maxillary sinus who were operated on endoscopically. Only patients with large cysts that filled at least 50% of the sinus space were included. A rigid nasal endoscope was used in all cases; most of the cysts were removed through the natural sinus ostium. Cysts recurred in only two patients during the first postoperative year. There were no complications from the procedure. The endoscopic approach to the treatment of maxillary sinus cyst is associated with a low rate of recurrence (3% in this study) and no complications, and we recommend it as the surgical procedure of choice. Copyright 2000 The British Association of Oral and Maxillofacial Surgeons.

A Discussion of Procedures and Equipment for the Comprehensive Test Ban Treaty On-Site Inspection Environmental Sampling and Analysis

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

Wogman, Ned A.; Milbrath, Brian D.; Payne, Rosara F.

This paper is intended to serve as a scientific basis to start discussions of the available environmental sampling techniques and equipment that have been used in the past that could be considered for use within the context of the Comprehensive Nuclear-Test-Ban Treaty (CTBT) on-site inspections (OSI). This work contains information on the techniques, equipment, costs, and some operational procedures associated with environmental sampling that have actually been used in the past by the United States for the detection of nuclear explosions. This paper also includes a discussion of issues, recommendations, and questions needing further study within the context of themore » sampling and analysis of aquatic materials, atmospheric gases, atmospheric particulates, vegetation, sediments and soils, fauna, and drill-back materials.« less

Lift-(gasless) laparoscopic surgery under regional anesthesia.

PubMed

Kruschinski, Daniel; Homburg, Shirli

2005-01-01

The objective of this Chapter was to investigate the feasibility and outcome of gasless laparoscopy under regional anesthesia. A prospective evaluation of Lift-(gasless) laparoscopic procedures under regional anesthesia (Canadian Task Force classification II-1) was done at three endoscopic gynecology centers (franchise system of EndGyn(r)). Sixty-three patients with gynecological diseases comprised the cohort. All patients underwent Lift-laparoscopic surgery under regional anesthesia: 10 patients for diagnostic purposes, 17 for surgery of ovarian tumors, 14 to remove fibroids, and 22 for hysterectomies. All patients were operated without conversion to general anesthesia and without perioperative or anesthesiologic complications. Lift-laparoscopy under regional anesthesia can be recommended to all patients who desire laparoscopic intervention without general anesthesia. For elderly patients, those with cardiopulmonary risks, during pregnancy, or with contraindications for general anesthesia, Lift-laparoscopy under regional anesthesia should be the procedure of choice.

Lack of Consensus in Physician Recommendations Regarding Return to Driving After Cervical Spine Surgery.

PubMed

Moses, Michael J; Tishelman, Jared C; Hasan, Saqib; Zhou, Peter L; Zevgaras, Ioanna; Smith, Justin S; Buckland, Aaron J; Kim, Yong; Razi, Afshin; Protopsaltis, Themistocles S

2018-03-09

Cross-Sectional Study. The goal of this study is to investigate how surgeons differ in collar and narcotic use, as well as return to driving recommendations following cervical spine surgeries and the associated medico-legal ramifications of these conditions. Restoration of quality of life is one of the main goals of cervical spine surgery. Patients frequently inquire when they may safely resume driving after cervical spine surgery. There is no consensus regarding post-operative driving restrictions. This study addresses how surgeons differ in their recommendations concerning cervical immobilization, narcotic analgesia, and suggested timeline of return to driving following cervical spine surgery. Surgeons at the Cervical Spine Research Society annual meeting completed anonymous surveys assessing postoperative patient management following fusion and non-fusion cervical spine surgeries. 70% of surgeons returned completed surveys (n = 71). 80.3% were orthopaedic surgeons and 94.2% completed a spine fellowship. Experienced surgeons (>15y in practice) were more likely to let patients return to driving within 2 weeks than less experienced surgeons (47.1% vs 24.3%, p = .013) for multi-level ACDF and laminectomy with fusion procedures. There were no differences between surgeons practicing inside and outside the USA for prescribing collars or return to driving time. Cervical collars were used more for fusions than non-fusions (57.7% vs 31.0%, p = .001). Surgeons reported 75.3% of patients ask when they may resume driving. For cervical fusions, 31.4% of surgeons allowed their patients to resume driving while restricting them with collars for longer durations. Furthermore, 27.5% of surgeons allowed their patients to resume driving while taking narcotics post-operatively. This survey-based study highlights the lack of consensus regarding patient 'fitness to drive' following cervical spine surgery. The importance of establishing evidence-based guidelines is critical as recommendations for driving in the post-operative period may have significant medical, legal, and financial implications. 5.

Cost accounting in radiation oncology: a computer-based model for reimbursement.

PubMed

Perez, C A; Kobeissi, B; Smith, B D; Fox, S; Grigsby, P W; Purdy, J A; Procter, H D; Wasserman, T H

1993-04-02

The skyrocketing cost of medical care in the United States has resulted in multiple efforts in cost containment. The present work offers a rational computer-based cost accounting approach to determine the actual use of resources in providing a specific service in a radiation oncology center. A procedure-level cost accounting system was developed by using recorded information on actual time and effort spent by individual staff members performing various radiation oncology procedures, and analyzing direct and indirect costs related to staffing (labor), facilities and equipment, supplies, etc. Expenditures were classified as direct or indirect and fixed or variable. A relative value unit was generated to allocate specific cost factors to each procedure. Different costs per procedure were identified according to complexity. Whereas there was no significant difference in the treatment time between low-energy (4 and 6 MV) or high-energy (18 MV) accelerators, there were significantly higher costs identified in the operation of a high-energy linear accelerator, a reflection of initial equipment investment, quality assurance and calibration procedures, maintenance costs, service contract, and replacement parts. Utilization of resources was related to the complexity of the procedures performed and whether the treatments were delivered to inpatients or outpatients. In analyzing time motion for physicians and other staff, it was apparent that a greater effort must be made to train the staff to accurately record all times involved in a given procedure, and it is strongly recommended that each institution perform its own time motion studies to more accurately determine operating costs. Sixty-six percent of our facility's global costs were for labor, 20% for other operating expenses, 10% for space, and 4% for equipment. Significant differences were noted in the cost allocation for professional or technical functions, as labor, space, and equipment costs are higher in the latter. External beam treatment-related procedures accounted for more than 50% of all technical and professional revenues, simulation for 8% to 10%, and other physics/dosimetry procedures for 11% to 14% of revenues. Some discrepancies were identified between the actual cost and level of reimbursement of various procedures. Details are described in the manuscript. It is imperative to develop an equitable reimbursement system for radiation oncology services, based on cost accounting and other measures that may enhance productivity and reduce the cost per procedure unit, while at the same time preserving the highest quality of service provided to patients.

[Total laparoscopic hysterectomy--indications and complications of 158 patients].

PubMed

Malinowski, Andrzej; Makowska, Justyna; Antosiak, Beata

2013-04-01

Hysterectomy is one of the most common gynecological procedures. Development of modern laparoscopic techniques made it a crucial tool in contemporary gynecology both in diagnosis and treatment. Increasing experience and improved laparoscopic instruments enabled gynecologists to extend indications for laparoscopic procedures as well as the range of the operation itself. 1) to present data (particularly perioperative) of patients who underwent laparoscopic hysterectomy 2) to analyze various information including: indication for the procedure, surgery duration, evaluation of different parameters like: volume of the excised uterus, postoperative HB and HCT drop, length of hospital stay as well as short- and long-term complications. The analysis included peri- and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Indication for hysterectomy and duration of operation were analyzed. Uterine volume, postoperative HB and HCT drop, time of hospital stay and complications were evaluated. In the study a description of the method of laparoscopic hysterectomy was presented. Mean time of procedure was 68 min. (58-135 min.). Basing on operational protocols, the time of operation was measured from the moment laparoscopy started until the patient was fully awake after anesthesia. No adjustments were made for longer anesthetic recovery period. Estimated blood loss was 166.6 ml. Mean HB drop was 1.29 g/dl (0, 1-3 g/dl). Mean volume of the excised uterus was 108.24 cm3 (25.27-440.86 cm3). In 44 patients (27.84%) bilateral salpingo-oophorectomy was performed. In 4 cases (2.53%) there was an indication for postoperative antibiotics. None of the patients required blood transfusion or conversion to open surgery or the need to re-operate. Mean hospital stay after the surgery was 2.9 days. Overall, only 2 patients suffered long-term complications (1.26%): three weeks after the surgery urethro-vaginal fistulas occurred due to thermal injury to the ureter. That complication was noted during the first year of using this technique. Between 2008 and 2011 that type of adverse effect was not reported. The analysis included perioperative and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Data suggest that patients benefit from this procedure which is safe, associated with short postoperative recovery time, minimal blood loss and low complication rate, as well as good plastic result. We recommend laparoscopic hysterectomy as an alternative to open hysterectomy in cases when it can be safely performed.

Network operability of ground-based microwave radiometers: Calibration and standardization efforts

NASA Astrophysics Data System (ADS)

Pospichal, Bernhard; Löhnert, Ulrich; Küchler, Nils; Czekala, Harald

2017-04-01

Ground-based microwave radiometers (MWR) are already widely used by national weather services and research institutions all around the world. Most of the instruments operate continuously and are beginning to be implemented into data assimilation for atmospheric models. Especially their potential for continuously observing boundary-layer temperature profiles as well as integrated water vapor and cloud liquid water path makes them valuable for improving short-term weather forecasts. However until now, most MWR have been operated as stand-alone instruments. In order to benefit from a network of these instruments, standardization of calibration, operation and data format is necessary. In the frame of TOPROF (COST Action ES1303) several efforts have been undertaken, such as uncertainty and bias assessment, or calibration intercomparison campaigns. The goal was to establish protocols for providing quality controlled (QC) MWR data and their uncertainties. To this end, standardized calibration procedures for MWR have been developed and recommendations for radiometer users compiled. Based on the results of the TOPROF campaigns, a new, high-accuracy liquid-nitrogen calibration load has been introduced for MWR manufactured by Radiometer Physics GmbH (RPG). The new load improves the accuracy of the measurements considerably and will lead to even more reliable atmospheric observations. Next to the recommendations for set-up, calibration and operation of ground-based MWR within a future network, we will present homogenized methods to determine the accuracy of a running calibration as well as means for automatic data quality control. This sets the stage for the planned microwave calibration center at JOYCE (Jülich Observatory for Cloud Evolution), which will be shortly introduced.

A review of the International Atomic Energy Agency (IAEA) international standards for tissue banks.

PubMed

Morales Pedraza, Jorge; Lobo Gajiwala, Astrid; Martinez Pardo, María Esther

2012-03-01

The IAEA International Standards for Tissue Banks published in 2003 were based on the Standards then currently in use in the USA and the European Union, among others, and reflect the best practices associated with the operation of a tissue bank. They cover legal, ethical and regulatory controls as well as requirements and procedures from donor selection and tissue retrieval to processing and distribution of finished tissue for clinical use. The application of these standards allows tissue banks to operate with the current good tissue practice, thereby providing grafts of high quality that satisfy the national and international demand for safe and biologically useful grafts. The objective of this article is to review the IAEA Standards and recommend new topics that could improve the current version.

Using a Particle Counter to Inform the Creation of Similar Exposure Groups and Sampling Protocols in a Structural Steel Fabrication Facility

PubMed Central

Mino, James

2017-01-01

The objective of this project was to create similar exposure groups (SEGs) for occupational monitoring in a structural steel fabrication facility. Qualitative SEG formation involved worksite observation, interviews, and audits of materials and procedures. These were supplemented with preliminary task-based shop survey data collected using a condensation particle counter. A total of six SEGs were formed, with recommendations for occupational exposure sampling for five groups, as well as ambient sampling recommendations to address areas on the operational floor found to have higher particle concentrations. The combination of direct reading device data and qualitative SEG formation techniques is a valuable approach, as it contains both the monetary and temporal costs of worksite exposure monitoring. This approach also provides an empowering in-house analysis of potentially problematic areas, and results in the streamlining of occupational exposure assessment. PMID:29168761

Conducting a FERC environmental assessment: a case study and recommendations from the Terror Lake Project

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

Olive, S.W.; Lamb, B.L.

This paper is an account of the process that evolved during acquisition of the license to operate the Terror Lake hydro-electric power project under the auspices of the Federal Energy Regulatory Commission (FERC). The Terror River is located on Kodiak Island in Alaska. The river is within the Kodiak National Wildlife Refuge; it supports excellent runs of several species of Pacific Salmon which are both commercially important and a prime source of nutrition for the Kodiak brown bear. This paper discusses both the fish and wildlife questions, but concentrates on instream uses and how protection of these uses was decided.more » In this focus the paper explains the FERC process, gives a history of the Terror Lake Project, and, ultimately, makes recommendations for improved management of controversies within the context of FERC licensing procedures. 64 references.« less

MRI-guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations.

PubMed

Larson, Paul S; Willie, Jon T; Vadivelu, Sudhakar; Azmi-Ghadimi, Hooman; Nichols, Amy; Fauerbach, Loretta Litz; Johnson, Helen Boehm; Graham, Denise

2017-07-01

The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

SOHO Mission Interruption Joint NASA/ESA Investigation Board

NASA Technical Reports Server (NTRS)

1998-01-01

Contact with the SOlar Heliospheric Observatory (SOHO) spacecraft was lost in the early morning hours of June 25, 1998, Eastern Daylight Time (EDT), during a planned period of calibrations, maneuvers, and spacecraft reconfigurations. Prior to this the SOHO operations team had concluded two years of extremely successful science operations. A joint European Space Agency (ESA)/National Aeronautics and Space Administration (NASA) engineering team has been planning and executing recovery efforts since loss of contact with some success to date. ESA and NASA management established the SOHO Mission Interruption Joint Investigation Board to determine the actual or probable cause(s) of the SOHO spacecraft mishap. The Board has concluded that there were no anomalies on-board the SOHO spacecraft but that a number of ground errors led to the major loss of attitude experienced by the spacecraft. The Board finds that the loss of the SOHO spacecraft was a direct result of operational errors, a failure to adequately monitor spacecraft status, and an erroneous decision which disabled part of the on-board autonomous failure detection. Further, following the occurrence of the emergency situation, the Board finds that insufficient time was taken by the operations team to fully assess the spacecraft status prior to initiating recovery operations. The Board discovered that a number of factors contributed to the circumstances that allowed the direct causes to occur. The Board strongly recommends that the two Agencies proceed immediately with a comprehensive review of SOHO operations addressing issues in the ground procedures, procedure implementation, management structure and process, and ground systems. This review process should be completed and process improvements initiated prior to the resumption of SOHO normal operations.

An evaluation of periodontal assessment procedures among Indiana dental hygienists.

PubMed

Stephan, Christine A

2014-01-01

Using a descriptive correlational design, this study surveyed periodontal assessment procedures currently performed by Indiana dental hygienists in general dentistry practices to reveal if deficiencies in assessment exist. Members (n = 354) of the Indiana Dental Hygienists' Association (IDHA) were invited to participate in the survey. A 22 multiple choice question survey, using Likert scales for responses, was open to participants for three weeks. Descriptive and non-parametric inferential statistics analyzed questions related to demographics and assessment procedures practiced. In addition, an evaluation of the awareness of periodontal assessment procedures recommended by the American Academy of Periodontology (AAP) was examined. Of the 354 Indiana dental hygienists surveyed, a 31.9% response rate was achieved. Participants were asked to identify the recommended AAP periodontal assessment procedures they perform. The majority of respondents indicated either frequently or always performing the listed assessment procedures. Additionally, significant relationships were found between demographic factors and participants' awareness and performance of recommended AAP assessment procedures. While information gathered from this study is valuable to the body of literature regarding periodontal disease assessment, continued research with larger survey studies should be conducted to obtain a more accurate national representation of what is being practiced by dental hygienists.

9 CFR 147.17 - Laboratory procedure recommended for the bacteriological examination of cull chicks and poults...

Code of Federal Regulations, 2013 CFR

2013-01-01

... the bacteriological examination of cull chicks and poults for salmonella. 147.17 Section 147.17... poults for salmonella. The laboratory procedure described in this section is recommended for the bacteriological examination of cull chicks from egg-type and meat-type chicken flocks and waterfowl, exhibition...

9 CFR 147.17 - Laboratory procedure recommended for the bacteriological examination of cull chicks and poults...

Code of Federal Regulations, 2011 CFR

2011-01-01

... the bacteriological examination of cull chicks and poults for salmonella. 147.17 Section 147.17... poults for salmonella. The laboratory procedure described in this section is recommended for the bacteriological examination of cull chicks from egg-type and meat-type chicken flocks and waterfowl, exhibition...

9 CFR 147.17 - Laboratory procedure recommended for the bacteriological examination of cull chicks and poults...

Code of Federal Regulations, 2012 CFR

2012-01-01

... the bacteriological examination of cull chicks and poults for salmonella. 147.17 Section 147.17... poults for salmonella. The laboratory procedure described in this section is recommended for the bacteriological examination of cull chicks from egg-type and meat-type chicken flocks and waterfowl, exhibition...

9 CFR 147.17 - Laboratory procedure recommended for the bacteriological examination of cull chicks and poults...

Code of Federal Regulations, 2010 CFR

2010-01-01

... the bacteriological examination of cull chicks and poults for salmonella. 147.17 Section 147.17... poults for salmonella. The laboratory procedure described in this section is recommended for the bacteriological examination of cull chicks from egg-type and meat-type chicken flocks and waterfowl, exhibition...

9 CFR 147.17 - Laboratory procedure recommended for the bacteriological examination of cull chicks and poults...

Code of Federal Regulations, 2014 CFR

2014-01-01

... the bacteriological examination of cull chicks and poults for salmonella. 147.17 Section 147.17... poults for salmonella. The laboratory procedure described in this section is recommended for the bacteriological examination of cull chicks from egg-type and meat-type chicken flocks and waterfowl, exhibition...

Ethical and Professional Guidelines for Use of Crisis Procedures

ERIC Educational Resources Information Center

Simonsen, Brandi; Sugai, George; Freeman, Jennifer; Kern, Laura; Hampton, Jane

2014-01-01

The use of crisis procedures, such as seclusion and physical restraint, in U.S. schools has garnered a great deal of national attention, resulting in reports from professional organizations, proposed legislation, and recent recommendations from the U.S. Department of Education (U.S. DOE; 2012). In this paper, we review the recommendations from the…

2016 update of the EULAR recommendations for the management of early arthritis.

PubMed

Combe, Bernard; Landewe, Robert; Daien, Claire I; Hua, Charlotte; Aletaha, Daniel; Álvaro-Gracia, Jose María; Bakkers, Margôt; Brodin, Nina; Burmester, Gerd R; Codreanu, Catalin; Conway, Richard; Dougados, Maxime; Emery, Paul; Ferraccioli, Gianfranco; Fonseca, Joao; Raza, Karim; Silva-Fernández, Lucía; Smolen, Josef S; Skingle, Diana; Szekanecz, Zoltan; Kvien, Tore K; van der Helm-van Mil, Annette; van Vollenhoven, Ronald

2017-06-01

Since the 2007 recommendations for the management of early arthritis have been presented, considerable research has been published in the field of early arthritis, mandating an update of the 2007 European League Against Rheumatism (EULAR) recommendations for management of early arthritis. In accordance with the 2014 EULAR Standardised Operating Procedures, the expert committee pursued an approach that was based on evidence in the literature and on expert opinion. The committee involved 20 rheumatologists, 2 patients and 1 healthcare professional representing 12 European countries. The group defined the focus of the expert committee and target population, formulated a definition of 'management' and selected the research questions. A systematic literature research (SLR) was performed by two fellows with the help of a skilled librarian. A set of draft recommendations was proposed on the basis of the research questions and the results of the SLR. For each recommendation, the categories of evidence were identified, the strength of recommendations was derived and the level of agreement was determined through a voting process. The updated recommendations comprise 3 overarching principles and 12 recommendations for managing early arthritis. The selected statements involve the recognition of arthritis, referral, diagnosis, prognostication, treatment (information, education, pharmacological and non-pharmacological interventions), monitoring and strategy. Eighteen items were identified as relevant for future research. These recommendations provide rheumatologists, general practitioners, healthcare professionals, patients and other stakeholders with an updated EULAR consensus on the entire management of early arthritis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Laboratory and clinical genomic data sharing is crucial to improving genetic health care: a position statement of the American College of Medical Genetics and Genomics.

PubMed

Acmg Board Of Directors

2017-07-01

Disclaimer: These recommendations are designed primarily as an educational resource for medical geneticists and other health-care providers, to help them provide quality medical genetic services. Adherence to these recommendations does not necessarily assure a successful medical outcome. These recommendations should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed to obtaining the same results. In determining the propriety of any specific procedure or test, the geneticist should apply his or her own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. It may be prudent, however, to document in the patient's record the rationale for any significant deviation from these recommendations.Genet Med advance online publication 05 January 2017.

[Abscess at the implant site following apical parodontitis. Hardware-related complications of deep brain stimulation].

PubMed

Sixel-Döring, F; Trenkwalder, C; Kappus, C; Hellwig, D

2006-08-01

Deep brain stimulation of the subthalamic nucleus is an important treatment option for advanced stages of idiopathic Parkinson's disease, leading to significant improvement of motor symptoms in suited patients. Hardware-related complications such as technical malfunction, skin erosion, and infections however cause patient discomfort and additional expense. The patient presented here suffered a putrid infection of the impulse generator site following only local dental treatment of apical parodontitis. Therefore, prophylactic systemic antibiotic treatment is recommended for patients with implanted deep brain stimulation devices in case of operations, dental procedures, or infectious disease.

TDRSS telecommunications system, PN code analysis

NASA Technical Reports Server (NTRS)

Dixon, R.; Gold, R.; Kaiser, F.

1976-01-01

The pseudo noise (PN) codes required to support the TDRSS telecommunications services are analyzed and the impact of alternate coding techniques on the user transponder equipment, the TDRSS equipment, and all factors that contribute to the acquisition and performance of these telecommunication services is assessed. Possible alternatives to the currently proposed hybrid FH/direct sequence acquisition procedures are considered and compared relative to acquisition time, implementation complexity, operational reliability, and cost. The hybrid FH/direct sequence technique is analyzed and rejected in favor of a recommended approach which minimizes acquisition time and user transponder complexity while maximizing probability of acquisition and overall link reliability.

European guidelines for workplace drug testing in oral fluid.

PubMed

Brcak, Michaela; Beck, Olof; Bosch, Tessa; Carmichael, Duncan; Fucci, Nadia; George, Claire; Piper, Mark; Salomone, Alberto; Schielen, Wim; Steinmeyer, Stefan; Taskinen, Sanna; Weinmann, Wolfgang

2018-03-01

These guidelines for Legally Defensible Workplace Drug Testing have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing should use these guidelines as a template for accreditation. These guidelines are relevant to laboratory-based testing only. These guidelines follow current best practices and are constantly under review. Copyright © 2017 John Wiley & Sons, Ltd.

Sensitivity Study of the Wall Interference Correction System (WICS) for Rectangular Tunnels

NASA Technical Reports Server (NTRS)

Walker, Eric L.; Everhart, Joel L.; Iyer, Venkit

2001-01-01

An off-line version of the Wall Interference Correction System (WICS) has been implemented for the NASA Langley National Transonic Facility. The correction capability is currently restricted to corrections for solid wall interference in the model pitch plane for Mach numbers less than 0.45 due to a limitation in tunnel calibration data. A study to assess output sensitivity to measurement uncertainty was conducted to determine standard operational procedures and guidelines to ensure data quality during the testing process. Changes to the current facility setup and design recommendations for installing the WICS code into a new facility are reported.

The development and regulation of occupational exposure limits in Taiwan.

PubMed

Shih, Tung-Sheng; Wu, Kuen-Yuh; Chen, Hong-I; Chang, Cheng-Ping; Chang, Ho-Yuan; Huang, Yi-Shiao; Liou, Saou-Hsing

2006-11-01

The occupational exposure limits (OELs) in Taiwan was promulgated in 1974 and has been revised five times since then. Many of the OELs were adopted from the most recent ACGIH TLVs and US OSHA PELs. A total of 483 chemicals were listed in the current Taiwan OELs Standard. The procedures of OELs development in Taiwan include the IOSH organized a recommended exposure limits (RELs) Committee to select the target chemicals and to recommend the RELs through literature review based on the health effects in the first stage, then, the CLA put policy needs, economical and technical feasibility into consideration and set up the final OELs at the second stage. A standard operation manual of RELs Committee has been developed. Based on our experience, several issues including the participation of representatives from a comprehensive spectrum, communication/education and training/enforcement, continuous collection of the local exposure data and health hazard information, use of health risk assessment, consideration of economic, and technical feasibility, as well as the globalization and information and experience sharing are critical in developing the appropriate OELs. Three examples including benzene, crystalline silica, and 2-methoxy ethanol are given to demonstrate the operation of system.

Prescribing and formulating neonatal intravenous feeding solutions by microcomputer.

PubMed Central

MacMahon, P

1984-01-01

This paper describes a computer programme for a low cost microcomputer designed to assist in the task of administering total parenteral nutrition to neonates: no knowledge of computers is necessary to operate the system. The programme displays recommended values for each of the total parenteral nutrition constituents that must be prescribed, based on detailed analysis of all the pertinent variables. The recommended values may be rejected but they do provide a useful prompt, especially for the more junior doctors. The programme includes a number of safeguards that protect against entering potentially dangerous values. As soon as the operator has completed the procedure of entering total parenteral nutrition requirements the calculations necessary to formulate a solution containing these are automatically performed. The print out contains this data plus instructions on the infusion rate and an analysis of the formulation's calorific content. This system makes it easier to vary the quantity of individual total parenteral nutrition constituents and time has been saved which was previously wasted performing laborious calculations. One of the most important contributions has been the virtual elimination of errors in the complex task of prescribing and formulating total parenteral nutrition for sick neonates. PMID:6430246

Characteristics of large thermal energy storage systems in Poland

NASA Astrophysics Data System (ADS)

Zwierzchowski, Ryszard

2017-11-01

In District Heating Systems (DHS) there are significant fluctuations in demand for heat by consumers during both the heating and the summer seasons. These variations are considered primarily in the 24-hour time horizon. These problems are aggravated further if the DHS is supplied by a CHP plant, because fluctuations in heat demand adversely affect to a significant degree the stable production of electricity at high overall efficiency. Therefore, introducing Thermal Energy Storage (TES) would be highly recommended on these grounds alone. The characteristics of Large (i.e. over 10 000 m3) TES in operation in Poland are presented. Information is given regarding new projects (currently in design or construction) that apply TES technology in DHS in Poland. The paper looks at the methodology used in Poland to select the TES system for a particular DHS, i.e., procedure for calculating capacity of the TES tank and the system to prevent water stored in the tank from absorbing oxygen from atmospheric air. Implementation of TES in DHS is treated as a recommended technology in the Polish District Heating sector. This technology offers great opportunities to improve the operating conditions of DHS, cutting energy production costs and emissions of pollutants to the atmosphere.

Surgical informed consent in obstetric and gynecologic surgeries: experience from a comprehensive teaching hospital in Southern Ethiopia.

PubMed

Teshome, Million; Wolde, Zenebe; Gedefaw, Abel; Tariku, Mequanent; Asefa, Anteneh

2018-05-24

Surgical Informed Consent (SIC) has long been recognized as an important component of modern medicine. The ultimate goals of SIC are to improve clients' understanding of the intended procedure, increase client satisfaction, maintain trust between clients and health providers, and ultimately minimize litigation issues related to surgical procedures. The purpose of the current study is to assess the comprehensiveness of the SIC process for women undergoing obstetric and gynecologic surgeries. A hospital-based cross-sectional study was undertaken at Hawassa University Comprehensive Specialized Hospital (HUCSH) in November and December, 2016. A total of 230 women who underwent obstetric and/or gynecologic surgeries were interviewed immediately after their hospital discharge to assess their experience of the SIC process. Thirteen components of SIC were used based on international recommendations, including the Royal College of Surgeon's standards of informed consent practices for surgical procedures. Descriptive summaries are presented in tables and figures. Forty percent of respondents were aged between 25 and 29 years. Nearly a quarter (22.6%) had no formal education. More than half (54.3%) of respondents had undergone an emergency surgical procedure. Only 18.4% of respondents reported that the surgeon performing the operation had offered SIC, while 36.6% of respondents could not recall who had offered SIC. All except one respondent provided written consent to undergo a surgical procedure. However, 8.3% of respondents received SIC service while already on the operation table for their procedure. Only 73.9% of respondents were informed about the availability (or lack thereof) of alternative treatment options. Additionally, a majority of respondents were not informed about the type of anesthesia to be used (88.3%) and related complications (87.4%). Only 54.2% of respondents reported that they had been offered at least six of the 13 SIC components used by the investigators. There is gap in the provision of comprehensive and standardized pre-operative counseling for obstetric and gynecologic surgeries in the study hospital. This has a detrimental effect on the overall quality of care clients receive, specifically in terms of client expectations and information needs.

Defining Staged Procedures for Percutaneous Coronary Intervention Trials: A Guidance Document.

PubMed

Spitzer, Ernest; McFadden, Eugène; Vranckx, Pascal; de Vries, Ton; Ren, Ben; Collet, Carlos; Onuma, Yoshinobu; Garcia-Garcia, Hector M; Lopes, Renato D; Stone, Gregg W; Cutlip, Donald E; Serruys, Patrick W

2018-05-14

Patients in coronary intervention trials may require more than 1 procedure to complete the intended revascularization strategy. However, these staged interventions are not consistently defined. Standardized definitions are needed to allow meaningful comparisons of this outcome among trials. This document provides guidance on relevant parameters involving staged procedures, including minimum data collection and consistent classification of coronary procedures initially identified as staged; the aim is to achieve consistency among clinical trialists, sponsors, health authorities, and regulators. Definitions were developed jointly among representatives of academic institutions and clinical research organizations based on clinical trial experience and published literature. Reasons for staged procedures were identified and include baseline kidney function, contrast load and radiation exposure, lesion complexity, and patient or operator fatigue. Moreover, nonclinical reasons include procedure scheduling and reimbursement. Management of staged procedures should be a standalone section in clinical trial protocols and clinical events committee charters. These documents should clearly define a time window for staged procedures that allows latitude for local policies, while respecting accepted clinical guidelines, and consistency with study objectives. Investigators should document in the case report form the intent to stage a procedure, the lesions to be treated, and the reasons for staging, preferably before randomization. Ideally, all reinterventions, or at least all procedures performed after the recommended time window, those in which data suggest an anticipated procedure due to a worsening condition and those where a revascularization is attempted in the target vessel, should be reviewed by an independent clinical events committee. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Fiscal Year 1999 Higher Education Budget Recommendations. Operations and Grants.

ERIC Educational Resources Information Center

Illinois State Board of Higher Education, Springfield.

This report presents staff recommendations of the Illinois Board of Higher Education concerning budget recommendations for higher education operations and grants for fiscal year 1999. General funds recommendations total $2,207.1 million, an increase of 6.1 percent over 1998 appropriations. Recommendations are also included for locally-held…

Variability in the quality of rectal cancer care in public hospitals in Catalonia (Spain): clinical audit as a basis for action.

PubMed

Manchon-Walsh, P; Borras, J M; Espinas, J A; Aliste, L

2011-04-01

Clinical practice guidelines in cancer are a relevant component of Catalonian Cancer Strategy aimed at promoting equity of access to therapy and quality of cancer care. The colorectal cancer (CRC) guideline was first published in 2003 and subsequently updated in 2008. This study examined the quality of therapy administered to patients with rectal cancer in public hospitals in Catalonia (Spain) in 2005 and 2007, according to CRC guideline recommendations. We conducted a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007. Data were drawn from clinical records. The study covered 1831 patients with rectal cancer. Performance of total mesorectal excision (TME) was poorly reported by surgeons (46.4%) and pathologists (36.2%). Pre-operative radiotherapy was performed on 52% of stage-II and -III patients. Compared to high-caseload hospitals, those with a low caseload (≤11 cases/year) registered more Hartman's procedures, worse TME quality, a higher rate of post-operative complications and lower adherence to recommended pre-operative radio-chemotherapy. Reporting quality of care is essential for ascertaining current performance status and opportunities for improvement. In our case, there is a need for the quality of the information included in clinical records to be improved, and variability in adherence to guideline recommendations to be reduced. In view of the fact that heterogeneity in the quality of the health care process was linked to hospital caseload, the health authorities have decided to reorganise the provision of rectal cancer care. Copyright © 2011 Elsevier Ltd. All rights reserved.

Test/score/report: Simulation techniques for automating the test process

NASA Technical Reports Server (NTRS)

Hageman, Barbara H.; Sigman, Clayton B.; Koslosky, John T.

1994-01-01

A Test/Score/Report capability is currently being developed for the Transportable Payload Operations Control Center (TPOCC) Advanced Spacecraft Simulator (TASS) system which will automate testing of the Goddard Space Flight Center (GSFC) Payload Operations Control Center (POCC) and Mission Operations Center (MOC) software in three areas: telemetry decommutation, spacecraft command processing, and spacecraft memory load and dump processing. Automated computer control of the acceptance test process is one of the primary goals of a test team. With the proper simulation tools and user interface, the task of acceptance testing, regression testing, and repeatability of specific test procedures of a ground data system can be a simpler task. Ideally, the goal for complete automation would be to plug the operational deliverable into the simulator, press the start button, execute the test procedure, accumulate and analyze the data, score the results, and report the results to the test team along with a go/no recommendation to the test team. In practice, this may not be possible because of inadequate test tools, pressures of schedules, limited resources, etc. Most tests are accomplished using a certain degree of automation and test procedures that are labor intensive. This paper discusses some simulation techniques that can improve the automation of the test process. The TASS system tests the POCC/MOC software and provides a score based on the test results. The TASS system displays statistics on the success of the POCC/MOC system processing in each of the three areas as well as event messages pertaining to the Test/Score/Report processing. The TASS system also provides formatted reports documenting each step performed during the tests and the results of each step. A prototype of the Test/Score/Report capability is available and currently being used to test some POCC/MOC software deliveries. When this capability is fully operational it should greatly reduce the time necessary to test a POCC/MOC software delivery, as well as improve the quality of the test process.

Obtaining accreditation by the pharmacy compounding accreditation board, part 2: developing essential standard operating procedures.

PubMed

Cabaleiro, Joe

2007-01-01

A key component of qualifying for accreditation with the Pharmacy Compounding Accreditation Board is having a set of comprehensive standard operating procedures that are being used by the pharmacy staff. The three criteria in standard operating procedures for which the Pharmacy Compounding Accreditation Board looks are: (1)written standard operating procedures; (2)standard operating procedures that reflect what the organization actualy does; and (3) whether the written standard operating procedures are implemented. Following specified steps in the preparation of standard operating procedures will result in procedures that meet Pharmacy Compounding Accreditation Board Requirements, thereby placing pharmacies one step closer to qualifying for accreditation.

AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy: Report of Task Group 192

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

Podder, Tarun K., E-mail: tarun.podder@uhhospitals.org; Beaulieu, Luc; Caldwell, Barrett

In the last decade, there have been significant developments into integration of robots and automation tools with brachytherapy delivery systems. These systems aim to improve the current paradigm by executing higher precision and accuracy in seed placement, improving calculation of optimal seed locations, minimizing surgical trauma, and reducing radiation exposure to medical staff. Most of the applications of this technology have been in the implantation of seeds in patients with early-stage prostate cancer. Nevertheless, the techniques apply to any clinical site where interstitial brachytherapy is appropriate. In consideration of the rapid developments in this area, the American Association of Physicistsmore » in Medicine (AAPM) commissioned Task Group 192 to review the state-of-the-art in the field of robotic interstitial brachytherapy. This is a joint Task Group with the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology (GEC-ESTRO). All developed and reported robotic brachytherapy systems were reviewed. Commissioning and quality assurance procedures for the safe and consistent use of these systems are also provided. Manual seed placement techniques with a rigid template have an estimated in vivo accuracy of 3–6 mm. In addition to the placement accuracy, factors such as tissue deformation, needle deviation, and edema may result in a delivered dose distribution that differs from the preimplant or intraoperative plan. However, real-time needle tracking and seed identification for dynamic updating of dosimetry may improve the quality of seed implantation. The AAPM and GEC-ESTRO recommend that robotic systems should demonstrate a spatial accuracy of seed placement ≤1.0 mm in a phantom. This recommendation is based on the current performance of existing robotic brachytherapy systems and propagation of uncertainties. During clinical commissioning, tests should be conducted to ensure that this level of accuracy is achieved. These tests should mimic the real operating procedure as closely as possible. Additional recommendations on robotic brachytherapy systems include display of the operational state; capability of manual override; documented policies for independent check and data verification; intuitive interface displaying the implantation plan and visualization of needle positions and seed locations relative to the target anatomy; needle insertion in a sequential order; robot–clinician and robot–patient interactions robustness, reliability, and safety while delivering the correct dose at the correct site for the correct patient; avoidance of excessive force on radioactive sources; delivery confirmation of the required number or position of seeds; incorporation of a collision avoidance system; system cleaning, decontamination, and sterilization procedures. These recommendations are applicable to end users and manufacturers of robotic brachytherapy systems.« less

Recommendations to enhance constructivist-based learning in Interprofessional Education using video-based self-assessment

PubMed Central

Dahmen, Uta; Schulze, Christine; Schindler, Claudia; Wick, Katharina; Schwartze, Dominique; Veit, Andrea; Smolenski, Ulrich

2016-01-01

Introduction: Interprofessional collaboration is crucial to the optimization of patient care. Aim: This paper aims to provide recommendations for implementing an innovative constructivist educational concept with the core element of video-based self-assessment. Methodology: A course for students in medicine, physiotherapy, and nursing was developed through interprofessional, cross-institutional collaboration. The course consisted of drawing on prior knowledge about the work done by each professional group in regard to a specific clinical scenario and an interprofessional treatment situation, filming a role play of this treatment situation, and a structured self-assessment of the role play. We evaluated the preparation and implementation of the three courses conducted thus far. Concrete recommendations for implementation were made based on evaluation sheets (students), open discussions (tutors, instructors, institutions) and recorded meeting minutes (project managers, project participants). Results: Basic recommendations for implementation include: selecting appropriate criteria for self-assessment and a simulated situation that offers members of each professional group an equal opportunity to act in the role play. In terms of administrative implementation we recommend early coordination among the professions and educational institutions regarding the target groups, scheduling and attendance policy to ensure participant recruitment across all professions. Procedural planning should include developing teaching materials, such as the case vignette and treatment scenario, and providing technical equipment that can be operated intuitively in order to ensure efficient recording. Conclusion: These recommendations serve as an aid for implementing an innovative constructivist educational concept with video-based self-assessment at its core. PMID:27280144