Analysis of the systems of ventilation of residential houses of Ukraine and Estonia

NASA Astrophysics Data System (ADS)

Savchenko, Olena; Zhelykh, Vasyl; Voll, Hendrik

2017-12-01

The most common ventilation system in residential buildings in Ukraine is natural ventilation. In recent years, due to increased tightness of structures, an increase in the content of synthetic finishing materials in them, the quality of microclimate parameters deteriorated. One of the measures to improve the parameters of indoor air in residential buildings is the use of mechanical inflow and exhaust ventilation system. In this article the regulatory documents concerning the design of ventilation systems in Ukraine and Estonia and the requirements for air exchange in residential buildings are considered. It is established that the existing normative documents in Ukraine are analogous to European norms, which allow design the system of ventilation of residential buildings according to European standards. However, the basis for the design of ventilation systems in Ukraine is the national standards, in which mechanical ventilation, unfortunately, is provided only for the design of high-rise buildings. To maintain acceptable microclimate parameters in residential buildings, it is advisable for designers to apply the requirements for designing ventilation systems in accordance with European standards.

A complete audit cycle to assess adherence to a lung protective ventilation strategy.

PubMed

Joynes, Emma; Dalay, Satinder; Patel, Jaimin M; Fayek, Samia

2014-11-01

There is clear evidence for the use of a protective ventilation protocol in patients with acute respiratory distress syndrome (ARDS). There is evidence to suggest that protective ventilation is beneficial in patients at risk of ARDS. A protective ventilation strategy was implemented on our intensive care unit in critical care patients who required mechanical ventilation for over 48 h, with and at risk for ARDS. A complete audit cycle was performed over 13 months to assess compliance with a safe ventilation protocol in intensive care. The ARDS network mechanical ventilation protocol was used as the standard for our protective ventilation strategy. This recommends ventilation with a tidal volume (V t) of 6 ml/kg of ideal body weight (IBW) and plateau airway pressure of ≤30 cm H2O. The initial audit failed to meet this standard with V t's of 9.5 ml/kg of IBW. Following the implementation of a ventilation strategy and an educational program, we demonstrate a significant improvement in practice with V t's of 6.6 ml/kg of IBW in the re-audit. This highlights the importance of simple interventions and continuous education in maintaining high standards of care.

British Thoracic Society Quality Standards for acute non-invasive ventilation in adults

PubMed Central

Davies, Michael; Allen, Martin; Bentley, Andrew; Bourke, Stephen C; Creagh-Brown, Ben; D’Oliveiro, Rachel; Glossop, Alastair; Gray, Alasdair; Jacobs, Phillip; Mahadeva, Ravi; Moses, Rachael; Setchfield, Ian

2018-01-01

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the provision of acute non-invasive ventilation in adults together with measurable markers of good practice. Methods Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 6 quality statements have been developed, each describing a standard of care for the provision of acute non-invasive ventilation in the UK, together with measurable markers of good practice. Conclusion BTS Quality Standards for acute non-invasive ventilation in adults form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline’s recommendations. PMID:29636979

46 CFR 154.1205 - Mechanical ventilation system: Standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

... operational controls outside the ventilated space. (g) No ventilation duct for a gas-dangerous space may pass... Section 154.1205 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and...

46 CFR 154.1205 - Mechanical ventilation system: Standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... operational controls outside the ventilated space. (g) No ventilation duct for a gas-dangerous space may pass... Section 154.1205 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and...

46 CFR 154.1205 - Mechanical ventilation system: Standards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... operational controls outside the ventilated space. (g) No ventilation duct for a gas-dangerous space may pass... Section 154.1205 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and...

Procedures and Standards for Residential Ventilation System Commissioning: An Annotated Bibliography

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

Stratton, J. Chris; Wray, Craig P.

2013-04-01

Beginning with the 2008 version of Title 24, new homes in California must comply with ANSI/ASHRAE Standard 62.2-2007 requirements for residential ventilation. Where installed, the limited data available indicate that mechanical ventilation systems do not always perform optimally or even as many codes and forecasts predict. Commissioning such systems when they are installed or during subsequent building retrofits is a step towards eliminating deficiencies and optimizing the tradeoff between energy use and acceptable IAQ. Work funded by the California Energy Commission about a decade ago at Berkeley Lab documented procedures for residential commissioning, but did not focus on ventilation systems.more » Since then, standards and approaches for commissioning ventilation systems have been an active area of work in Europe. This report describes our efforts to collect new literature on commissioning procedures and to identify information that can be used to support the future development of residential-ventilation-specific procedures and standards. We recommend that a standardized commissioning process and a commissioning guide for practitioners be developed, along with a combined energy and IAQ benefit assessment standard and tool, and a diagnostic guide for estimating continuous pollutant emission rates of concern in residences (including a database that lists emission test data for commercially-available labeled products).« less

Should Title 24 Ventilation Requirements Be Amended to include an Indoor Air Quality Procedure?

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

Dutton, Spencer M.; Mendell, Mark J.; Chan, Wanyu R.

Minimum outdoor air ventilation rates (VRs) for buildings are specified in standards, including California?s Title 24 standards. The ASHRAE ventilation standard includes two options for mechanically-ventilated buildings ? a prescriptive ventilation rate procedure (VRP) that specifies minimum VRs that vary among occupancy classes, and a performance-based indoor air quality procedure (IAQP) that may result in lower VRs than the VRP, with associated energy savings, if IAQ meeting specified criteria can be demonstrated. The California Energy Commission has been considering the addition of an IAQP to the Title 24 standards. This paper, based on a review of prior data and newmore » analyses of the IAQP, evaluates four future options for Title 24: no IAQP; adding an alternate VRP, adding an equivalent indoor air quality procedure (EIAQP), and adding an improved ASHRAE-like IAQP. Criteria were established for selecting among options, and feedback was obtained in a workshop of stakeholders. Based on this review, the addition of an alternate VRP is recommended. This procedure would allow lower minimum VRs if a specified set of actions were taken to maintain acceptable IAQ. An alternate VRP could also be a valuable supplement to ASHRAE?s ventilation standard.« less

30 CFR 75.333 - Ventilation controls.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Ventilation controls. 75.333 Section 75.333... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.333 Ventilation controls. (a) For... ventilation control devices constructed after November 15, 1992, shall be built and maintained— (1) Between...

30 CFR 75.333 - Ventilation controls.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Ventilation controls. 75.333 Section 75.333... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.333 Ventilation controls. (a) For... ventilation control devices constructed after November 15, 1992, shall be built and maintained— (1) Between...

Nasal mask ventilation is better than face mask ventilation in edentulous patients.

PubMed

Kapoor, Mukul Chandra; Rana, Sandeep; Singh, Arvind Kumar; Vishal, Vindhya; Sikdar, Indranil

2016-01-01

Face mask ventilation of the edentulous patient is often difficult as ineffective seating of the standard mask to the face prevents attainment of an adequate air seal. The efficacy of nasal ventilation in edentulous patients has been cited in case reports but has never been investigated. Consecutive edentulous adult patients scheduled for surgery under general anesthesia with endotracheal intubation, during a 17-month period, were prospectively evaluated. After induction of anesthesia and administration of neuromuscular blocker, lungs were ventilated with a standard anatomical face mask of appropriate size, using a volume controlled anesthesia ventilator with tidal volume set at 10 ml/kg. In case of inadequate ventilation, the mask position was adjusted to achieve best-fit. Inspired and expired tidal volumes were measured. Thereafter, the face mask was replaced by a nasal mask and after achieving best-fit, the inspired and expired tidal volumes were recorded. The difference in expired tidal volumes and airway pressures at best-fit with the use of the two masks and number of patients with inadequate ventilation with use of the masks were statistically analyzed. A total of 79 edentulous patients were recruited for the study. The difference in expiratory tidal volumes with the use of the two masks at best-fit was statistically significant (P = 0.0017). Despite the best-fit mask placement, adequacy of ventilation could not be achieved in 24.1% patients during face mask ventilation, and 12.7% patients during nasal mask ventilation and the difference was statistically significant. Nasal mask ventilation is more efficient than standard face mask ventilation in edentulous patients.

Pretest Predictions for Phase II Ventilation Tests

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

Yiming Sun

The objective of this calculation is to predict the temperatures of the ventilating air, waste package surface, and concrete pipe walls that will be developed during the Phase II ventilation tests involving various test conditions. The results will be used as inputs to validating numerical approach for modeling continuous ventilation, and be used to support the repository subsurface design. The scope of the calculation is to identify the physical mechanisms and parameters related to thermal response in the Phase II ventilation tests, and describe numerical methods that are used to calculate the effects of continuous ventilation. The calculation is limitedmore » to thermal effect only. This engineering work activity is conducted in accordance with the ''Technical Work Plan for: Subsurface Performance Testing for License Application (LA) for Fiscal Year 2001'' (CRWMS M&O 2000d). This technical work plan (TWP) includes an AP-2.21Q, ''Quality Determinations and Planning for Scientific, Engineering, and Regulatory Compliance Activities'', activity evaluation (CRWMS M&O 2000d, Addendum A) that has determined this activity is subject to the YMP quality assurance (QA) program. The calculation is developed in accordance with the AP-3.12Q procedure, ''Calculations''. Additional background information regarding this activity is contained in the ''Development Plan for Ventilation Pretest Predictive Calculation'' (DP) (CRWMS M&O 2000a).« less

A Chemical-Biological-Radio-Nuclear (CBRN) Filter can be Added to the Air-Outflow Port of a Ventilator to Protect a Home Ventilated Patient From Inhalation of Toxic Industrial Compounds.

PubMed

Be'eri, Eliezer; Owen, Simon; Beeri, Maurit; Millis, Scott R; Eisenkraft, Arik

2018-02-21

Chemical-biological-radio-nuclear (CBRN) gas masks are the standard means for protecting the general population from inhalation of toxic industrial compounds (TICs), for example after industrial accidents or terrorist attacks. However, such gas masks would not protect patients on home mechanical ventilation, as ventilator airflow would bypass the CBRN filter. We therefore evaluated in vivo the safety of adding a standard-issue CBRN filter to the air-outflow port of a home ventilator, as a method for providing TIC protection to such patients. Eight adult patients were included in the study. All had been on stable, chronic ventilation via a tracheostomy for at least 3 months before the study. Each patient was ventilated for a period of 1 hour with a standard-issue CBRN filter canister attached to the air-outflow port of their ventilator. Physiological and airflow measurements were made before, during, and after using the filter, and the patients reported their subjective sensation of ventilation continuously during the trial. For all patients, and throughout the entire study, no deterioration in any of the measured physiological parameters and no changes in measured airflow parameters were detected. All patients felt no subjective difference in the sensation of ventilation with the CBRN filter canister in situ, as compared with ventilation without it. This was true even for those patients who were breathing spontaneously and thus activating the ventilator's trigger/sensitivity function. No technical malfunctions of the ventilators occurred after addition of the CBRN filter canister to the air-outflow ports of the ventilators. A CBRN filter canister can be added to the air-outflow port of chronically ventilated patients, without causing an objective or subjective deterioration in the quality of the patients' mechanical ventilation. (Disaster Med Public Health Preparedness. 2018;page 1 of 5).

ETS levels in hospitality environments satisfying ASHRAE standard 62-1989: "ventilation for acceptable indoor air quality"

NASA Astrophysics Data System (ADS)

Moschandreas, D. J.; Vuilleumier, K. L.

Prior to this study, indoor air constituent levels and ventilation rates of hospitality environments had not been measured simultaneously. This investigation measured indoor Environmental Tobacco Smoke-related (ETS-related) constituent levels in two restaurants, a billiard hall and a casino. The objective of this study was to characterize ETS-related constituent levels inside hospitality environments when the ventilation rates satisfy the requirements of the ASHRAE 62-1989 Ventilation Standard. The ventilation rate of each selected hospitality environment was measured and adjusted. The study advanced only if the requirements of the ASHRAE 62-1989 Ventilation Standard - the pertinent standard of the American Society of Heating, Refrigeration and Air Conditioning Engineers - were satisfied. The supply rates of outdoor air and occupant density were measured intermittently to assure that the ventilation rate of each facility satisfied the standard under occupied conditions. Six ETS-related constituents were measured: respirable suspended particulate (RSP) matter, fluorescent particulate matter (FPM, an estimate of the ETS particle concentrations), ultraviolet particulate matter (UVPM, a second estimate of the ETS particle concentrations), solanesol, nicotine and 3-ethenylpyridine (3-EP). ETS-related constituent levels in smoking sections, non-smoking sections and outdoors were sampled daily for eight consecutive days at each hospitality environment. This study found that the difference between the concentrations of ETS-related constituents in indoor smoking and non-smoking sections was statistically significant. Differences between indoor non-smoking sections and outdoor ETS-related constituent levels were identified but were not statistically significant. Similarly, differences between weekday and weekend evenings were identified but were not statistically significant. The difference between indoor smoking sections and outdoors was statistically significant. Most importantly, ETS-related constituent concentrations measured indoors did not exceed existing occupational standards. It was concluded that if the measured ventilation rates of the sampled facilities satisfied the ASHRAE 62-1989 Ventilation Standard requirements, the corresponding ETS-related constituents were measured at concentrations below known harmful levels as specified by the American Conference of Governmental Industrial Hygiene (ACGIH).

The performances of standard and ResMed masks during bag-valve-mask ventilation.

PubMed

Lee, Hyoung Youn; Jeung, Kyung Woon; Lee, Byung Kook; Lee, Seung Joon; Jung, Yong Hun; Lee, Geo Sung; Min, Yong Il; Heo, Tag

2013-01-01

A tight mask seal is frequently difficult to obtain and maintain during single-rescuer bag-valve-mask (BVM) ventilation. The ResMed mask (Bella Vista, NSW, Australia) is a continuous-positive-airway-pressure mask (CM) designed for noninvasive ventilation. In this study, we compared the ventilation performances of a standard mask (SM) and a ResMed CM using a simulation manikin in an out-of-hospital single-rescuer BVM ventilation scenario. Thirty emergency medical technicians (EMTs) performed two 2-minute attempts to ventilate a simulation manikin using BVM ventilation, alternatively, with the SM or the ResMed CM in a randomized order. Ventilation parameters including tidal volume and peak airway pressure were measured using computer analysis software connected to the simulation manikin. Successful volume delivery was defined as delivery of 440-540 mL of tidal volume in accord with present cardiopulmonary resuscitation guidelines. BVM ventilation using the ResMed CM produced higher mean (± standard deviation) tidal volumes (452 ± 50 mL vs. 394 ± 113 mL, p = 0.014) and had a higher proportion of successful volume deliveries (65.3% vs. 26.7%, p < 0.001) than that using the SM. Peak airway pressure was higher in BVM ventilation using the ResMed CM (p = 0.035). Stomach insufflation did not occur during either method. Twenty-nine of the participants (96.7%) preferred BVM ventilation using the ResMed CM. BVM ventilations using ResMed CM resulted in a significantly higher proportion of successful volume deliveries meeting the currently recommended range of tidal volume. Clinical studies are needed to determine the value of the ResMed CM for BVM ventilation.

Nasal mask ventilation is better than face mask ventilation in edentulous patients

PubMed Central

Kapoor, Mukul Chandra; Rana, Sandeep; Singh, Arvind Kumar; Vishal, Vindhya; Sikdar, Indranil

2016-01-01

Background and Aims: Face mask ventilation of the edentulous patient is often difficult as ineffective seating of the standard mask to the face prevents attainment of an adequate air seal. The efficacy of nasal ventilation in edentulous patients has been cited in case reports but has never been investigated. Material and Methods: Consecutive edentulous adult patients scheduled for surgery under general anesthesia with endotracheal intubation, during a 17-month period, were prospectively evaluated. After induction of anesthesia and administration of neuromuscular blocker, lungs were ventilated with a standard anatomical face mask of appropriate size, using a volume controlled anesthesia ventilator with tidal volume set at 10 ml/kg. In case of inadequate ventilation, the mask position was adjusted to achieve best-fit. Inspired and expired tidal volumes were measured. Thereafter, the face mask was replaced by a nasal mask and after achieving best-fit, the inspired and expired tidal volumes were recorded. The difference in expired tidal volumes and airway pressures at best-fit with the use of the two masks and number of patients with inadequate ventilation with use of the masks were statistically analyzed. Results: A total of 79 edentulous patients were recruited for the study. The difference in expiratory tidal volumes with the use of the two masks at best-fit was statistically significant (P = 0.0017). Despite the best-fit mask placement, adequacy of ventilation could not be achieved in 24.1% patients during face mask ventilation, and 12.7% patients during nasal mask ventilation and the difference was statistically significant. Conclusion: Nasal mask ventilation is more efficient than standard face mask ventilation in edentulous patients. PMID:27625477

Automatic control of pressure support for ventilator weaning in surgical intensive care patients.

PubMed

Schädler, Dirk; Engel, Christoph; Elke, Gunnar; Pulletz, Sven; Haake, Nils; Frerichs, Inéz; Zick, Günther; Scholz, Jens; Weiler, Norbert

2012-03-15

Despite its ability to reduce overall ventilation time, protocol-guided weaning from mechanical ventilation is not routinely used in daily clinical practice. Clinical implementation of weaning protocols could be facilitated by integration of knowledge-based, closed-loop controlled protocols into respirators. To determine whether automated weaning decreases overall ventilation time compared with weaning based on a standardized written protocol in an unselected surgical patient population. In this prospective controlled trial patients ventilated for longer than 9 hours were randomly allocated to receive either weaning with automatic control of pressure support ventilation (automated-weaning group) or weaning based on a standardized written protocol (control group) using the same ventilation mode. The primary end point of the study was overall ventilation time. Overall ventilation time (median [25th and 75th percentile]) did not significantly differ between the automated-weaning (31 [19-101] h; n = 150) and control groups (39 [20-118] h; n = 150; P = 0.178). Patients who underwent cardiac surgery (n = 132) exhibited significantly shorter overall ventilation times in the automated-weaning (24 [18-57] h) than in the control group (35 [20-93] h; P = 0.035). The automated-weaning group exhibited shorter ventilation times until the first spontaneous breathing trial (1 [0-15] vs. 9 [1-51] h; P = 0.001) and a trend toward fewer tracheostomies (17 vs. 28; P = 0.075). Overall ventilation times did not significantly differ between weaning using automatic control of pressure support ventilation and weaning based on a standardized written protocol. Patients after cardiac surgery may benefit from automated weaning. Implementation of additional control variables besides the level of pressure support may further improve automated-weaning systems. Clinical trial registered with www.clinicaltrials.gov (NCT 00445289).

Standard operating procedure changed pre-hospital critical care anaesthesiologists’ behaviour: a quality control study

PubMed Central

2013-01-01

Introduction The ability of standard operating procedures to improve pre-hospital critical care by changing pre-hospital physician behaviour is uncertain. We report data from a prospective quality control study of the effect on pre-hospital critical care anaesthesiologists’ behaviour of implementing a standard operating procedure for pre-hospital controlled ventilation. Materials and methods Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region prospectively registered pre-hospital advanced airway-management data according to the Utstein-style template. We collected pre-intervention data from February 1st 2011 to January 31st 2012, implemented the standard operating procedure on February 1st 2012 and collected post intervention data from February 1st 2012 until October 31st 2012. We included transported patients of all ages in need of controlled ventilation treated with pre-hospital endotracheal intubation or the insertion of a supraglottic airways device. The objective was to evaluate whether the development and implementation of a standard operating procedure for controlled ventilation during transport could change pre-hospital critical care anaesthesiologists’ behaviour and thereby increase the use of automated ventilators in these patients. Results The implementation of a standard operating procedure increased the overall prevalence of automated ventilator use in transported patients in need of controlled ventilation from 0.40 (0.34-0.47) to 0.74 (0.69-0.80) with a prevalence ratio of 1.85 (1.57-2.19) (p = 0.00). The prevalence of automated ventilator use in transported traumatic brain injury patients in need of controlled ventilation increased from 0.44 (0.26-0.62) to 0.85 (0.62-0.97) with a prevalence ratio of 1.94 (1.26-3.0) (p = 0.0039). The prevalence of automated ventilator use in patients transported after return of spontaneous circulation following pre-hospital cardiac arrest increased from 0.39 (0.26-0.48) to 0.69 (0.58-0.78) with a prevalence ratio of 1.79 (1.36-2.35) (p = 0.00). Conclusion We have shown that the implementation of a standard operating procedure for pre-hospital controlled ventilation can significantly change pre-hospital critical care anaesthesiologists’ behaviour. PMID:24308781

Inspiratory capacity at inflation hold in ventilated newborns: a surrogate measure for static compliance of the respiratory system.

PubMed

Hentschel, Roland; Semar, Nicole; Guttmann, Josef

2012-09-01

To study appropriateness of respiratory system compliance calculation using an inflation hold and compare it with ventilator readouts of pressure and tidal volume as well as with measurement of compliance of the respiratory system with the single-breath-single-occlusion technique gained with a standard lung function measurement. Prospective clinical trial. Level III neonatal unit of a university hospital. Sixty-seven newborns, born prematurely or at term, ventilated for a variety of pathologic conditions. A standardized sigh maneuver with a predefined peak inspiratory pressure of 30 cm H2O, termed inspiratory capacity at inflation hold, was applied. Using tidal volume, exhaled from inspiratory pause down to ambient pressure, as displayed by the ventilator, and predefined peak inspiratory pressure, compliance at inspiratory capacity at inflation hold conditions could be calculated as well as ratio of tidal volume and ventilator pressure using tidal volume and differential pressure at baseline ventilator settings: peak inspiratory pressure minus positive end-expiratory pressure. For the whole cohort, the equation for the regression between tidal volume at inspiratory capacity at inflation hold and compliance of the respiratory system was: compliance of the respiratory system = 0.052 * tidal volume at inspiratory capacity at inflation hold - 0.113, and compliance at inspiratory capacity at inflation hold conditions was closely related to the standard lung function measurement method of compliance of the respiratory system (R = 0.958). In contrast, ratio of tidal volume and ventilator pressure per kilogram calculated from the ventilator readouts and displayed against compliance of the respiratory system per kilogram yielded a broad scatter throughout the whole range of compliance; both were only weakly correlated (R = 0.309) and also the regression line was significantly different from the line of identity (p < .05). Peak inspiratory pressure at study entry did not affect the correlation between compliance at inspiratory capacity at inflation hold conditions and compliance of the respiratory system. After a standard sigh maneuver, inspiratory capacity at inflation hold and the derived quantity compliance at inspiratory capacity at inflation hold conditions can be regarded as a valid, accurate, and reliable surrogate measure for standard compliance of the respiratory system in contrast to ratio of tidal volume and ventilator pressure calculated from the ventilator readouts during ongoing mechanical ventilation at respective ventilator settings.

49 CFR 192.173 - Compressor stations: Ventilation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Design of Pipeline Components § 192.173 Compressor stations: Ventilation. Each compressor station building must be ventilated to ensure...

Worsening respiratory function in mechanically ventilated intensive care patients: feasibility and value of xenon-enhanced dual energy CT.

PubMed

Hoegl, Sandra; Meinel, Felix G; Thieme, Sven F; Johnson, Thorsten R C; Eickelberg, Oliver; Zwissler, Bernhard; Nikolaou, Konstantin

2013-03-01

To evaluate the feasibility and incremental diagnostic value of xenon-enhanced dual-energy CT in mechanically ventilated intensive care patients with worsening respiratory function. The study was performed in 13 mechanically ventilated patients with severe pulmonary conditions (acute respiratory distress syndrome (ARDS), n=5; status post lung transplantation, n=5; other, n=3) and declining respiratory function. CT scans were performed using a dual-source CT scanner at an expiratory xenon concentration of 30%. Both ventilation images (Xe-DECT) and standard CT images were reconstructed from a single CT scan. Findings were recorded for Xe-DECT and standard CT images separately. Ventilation defects on xenon images were matched to morphological findings on standard CT images and incremental diagnostic information of xenon ventilation images was recorded if present. Mean xenon consumption was 2.95 l per patient. No adverse events occurred under xenon inhalation. In the visual CT analysis, the Xe-DECT ventilation defects matched with pathologic changes in lung parenchyma seen in the standard CT images in all patients. Xe-DECT provided additional diagnostic findings in 4/13 patients. These included preserved ventilation despite early pneumonia (n=1), more confident discrimination between a large bulla and pneumothorax (n=1), detection of an airway-to-pneumothorax fistula (n=1) and exclusion of a suspected airway-to-mediastinum fistula (n=1). In all 4 patients, the additional findings had a substantial impact on patients' management. Xenon-enhanced DECT is safely feasible and can add relevant diagnostic information in mechanically ventilated intensive care patients with worsening respiratory function. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Setting individualized positive end-expiratory pressure level with a positive end-expiratory pressure decrement trial after a recruitment maneuver improves oxygenation and lung mechanics during one-lung ventilation.

PubMed

Ferrando, Carlos; Mugarra, Ana; Gutierrez, Andrea; Carbonell, Jose Antonio; García, Marisa; Soro, Marina; Tusman, Gerardo; Belda, Francisco Javier

2014-03-01

We investigated whether individualized positive end-expiratory pressure (PEEP) improves oxygenation, ventilation, and lung mechanics during one-lung ventilation compared with standardized PEEP. Thirty patients undergoing thoracic surgery were randomly allocated to the study or control group. Both groups received an alveolar recruitment maneuver at the beginning and end of one-lung ventilation. After the alveolar recruitment maneuver, the control group had their lungs ventilated with a 5 cm·H2O PEEP, while the study group had their lungs ventilated with an individualized PEEP level determined by a PEEP decrement trial. Arterial blood samples, lung mechanics, and volumetric capnography were recorded at multiple timepoints throughout the procedure. The individualized PEEP values in study group were higher than the standardized PEEP values (10 ± 2 vs 5 cm·H2O; P < 0.001). In both groups, arterial oxygenation decreased when bilateral-lung ventilation was switched to one-lung ventilation and increased after the alveolar recruitment maneuver. During one-lung ventilation, oxygenation was maintained in the study group but decreased in the control group. After one-lung ventilation, arterial oxygenation was significantly higher in the study group (306 vs 231 mm·Hg, P = 0.007). Static compliance decreased in both groups when bilateral-lung ventilation was switched to one-lung ventilation. Static compliance increased significantly only in the study group (P < 0.001) after the alveolar recruitment maneuver and optimal PEEP adjustment. The alveolar recruitment maneuver did not decrease cardiac index in any patient. During one-lung ventilation, the improvements in oxygenation and lung mechanics after an alveolar recruitment maneuver were better preserved by ventilation by using individualized PEEP with a PEEP decrement trial than with a standardized 5 cm·H2O of PEEP.

Inadequate ventilation for nosocomial tuberculosis prevention in public hospitals in Central Thailand.

PubMed

Jiamjarasrangsi, W; Bualert, S; Chongthaleong, A; Chaindamporn, A; Udomsantisuk, N; Euasamarnjit, W

2009-04-01

Forty-two community and general hospitals in central Thailand. To examine the adequacy of indoor ventilation for nosocomial tuberculosis (TB) prevention in public hospitals in central Thailand. A cross-sectional survey was conducted among 323 patient care and ancillary areas in the target hospitals. Data on indoor ventilation rate were collected by the tracer gas method and reported as air changes per hour (ACH). The adequacy of the measured ventilation rates were then determined by comparison with the international recommended standard values. Indoor ventilation rates were inadequate in almost half of the studied areas (144/323, 44.6%). The inadequacy was particularly serious in the emergency rooms (ERs) and radiological areas, where 73.8% (31/42 each) of the rooms had ACH below the recommended standards. Detailed analysis showed that most of the rooms with natural ventilation had air exchange rates that exceeded the recommended standards, while the opposite was the case for rooms with air-conditioning, particularly the window or wall-mount type. Indoor ventilation in high-risk nosocomial TB areas in public hospitals in Thailand was inadequate due to the installation of air-conditioning systems in modern buildings.

30 CFR 75.350 - Belt air course ventilation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.350 Belt air course ventilation... manager may approve lower velocities in the ventilation plan based on specific mine conditions. Air... or alarm signal. This training must be conducted prior to working underground in a mine that uses...

NASA Clean-Sheet Fans: Design, Build Analyze, Test, and Report

NASA Technical Reports Server (NTRS)

Koch, L. Danielle

2008-01-01

A suggested topic in small fan research is presented. Presentation briefly describes the scope of an effort to design, build and test a ventilation class cooling fan. Comments are included for the following categories: information (available and needed), benefits and values, concerns, variations and alternatives, and interest.

Contaminant levels, source strengths, and ventilation rates in California retail stores.

PubMed

Chan, W R; Cohn, S; Sidheswaran, M; Sullivan, D P; Fisk, W J

2015-08-01

This field study measured ventilation rates and indoor air quality in 21 visits to retail stores in California. Three types of stores, such as grocery, furniture/hardware stores, and apparel, were sampled. Ventilation rates measured using a tracer gas decay method exceeded the minimum requirement of California's Title 24 Standard in all but one store. Concentrations of volatile organic compounds (VOCs), ozone, and carbon dioxide measured indoors and outdoors were analyzed. Even though there was adequate ventilation according to standard, concentrations of formaldehyde and acetaldehyde exceeded the most stringent chronic health guidelines in many of the sampled stores. The whole-building emission rates of VOCs were estimated from the measured ventilation rates and the concentrations measured indoor and outdoor. Estimated formaldehyde emission rates suggest that retail stores would need to ventilate at levels far exceeding the current Title 24 requirement to lower indoor concentrations below California's stringent formaldehyde reference level. Given the high costs of providing ventilation, effective source control is an attractive alternative. Field measurements suggest that California retail stores were well ventilated relative to the minimum ventilation rate requirement specified in the Building Energy Efficiency Standards Title 24. Concentrations of formaldehyde found in retail stores were low relative to levels found in homes but exceeded the most stringent chronic health guideline. Looking ahead, California is mandating zero energy commercial buildings by 2030. To reduce the energy use from building ventilation while maintaining or even lowering formaldehyde in retail stores, effective formaldehyde source control measures are vitally important. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

75 FR 52980 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

.../maintaining): $303,512. Description: The Safety Standards for Underground Coal Mine Ventilation Belt Entry rule provides safety requirements for the use of the conveyor belt entry as a ventilation intake to... Underground Coal Mine Ventilation--Belt Entry Used as an Intake Air Course to Ventilate Working Sections and...

[Aerosolized gadolinium-DTPA for demonstration of pulmonary ventilation in magnetic resonance tomography].

PubMed

Haage, P; Adam, G; Misselwitz, B; Karaagac, S; Pfeffer, J G; Glowinski, A; Döhmen, S; Tacke, J; Günther, R W

2000-04-01

Magnetic resonance assessment of lung ventilation with aerosolized Gd-DTPA. Eleven experimental procedures were carried out in a domestic pig model. The intubated pigs were aerosolized for 30 minutes with an aqueous formulation of Gd-DTPA. The contrast agent aerosol was generated by a small particle aerosol generator. Imaging was performed on a 1.5 T MR imager using a T1-weighted turbo spin echo sequence with respiratory gating (TR 141 ms, TE 8.5 ms, 6 averages, slice thickness 10 mm). Pulmonary signal intensities before and after ventilation were measured in peripheral portions of both lungs. Immediately after ventilation with aerosolized Gd-DTPA, the signal intensity in both lungs increased significantly in all animals with values up to 237% above baseline (mean 139% +/- 48%), but with in some cases considerable regional intra- and interindividual intensity differences. Distinctive parenchymal enhancement was readily visualized in all eleven cases with good spatial resolution. The presented data indicate that Gd-DTPA in aerosolized form can be used to demonstrate pulmonary ventilation in large animals with lung volumes comparable to man. Further experimental trials are necessary to improve reproducibility and to define the scope of this method for depicting lung disease.

In-depth survey report: Assisting furniture strippers in reducing the risk from methylene chloride stripping formulations at Los Angeles Stripping and Refinishing Center, Los Angeles, California

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

Estill, C.F.; Kovein, R.J.; Jones, J.H.

1999-03-26

The National Institute for Occupational Safety and Health (NIOSH) is currently conducting research on ventilation controls to reduce furniture stripping exposures to methylene chloride to the OSHA PEL of 25 ppm. Low cost ventilation systems were designed by NIOSH researchers along with Benny Bixenman of Benco Sales, Inc. (Forney, TX). The controls were constructed and installed by Benco Sales. This report compares the methylene chloride levels of one worker stripping furniture using the recently installed ventilation controls and using the existing controls. During the survey, two different chemical stripping solutions (a standard formulation and a low methylene chloride content formulation)more » were used and compared. This survey tested three control combinations: (1) new ventilation, low methylene chloride stripper, (2) new ventilation, standard stripping solution, and (3) old ventilation, standard stripping solution. During each test, sorbent tube sampling and real-time sampling were employed. Sorbent tube, data collected in the worker's breathing zone, ranged from 300 to 387 ppm. Real-time data showed breathing zone exposures to range from 211 to 383 ppm while stripping and 164 to 230 ppm while rinsing. Data were inconclusive to determine which ventilation system or stripping solution produced the lowest exposures. Recommendations are made in the report to improve the newly installed ventilation controls.« less

State Skill Standards: Heating, Ventilation, Air Conditioning, and Refrigeration

ERIC Educational Resources Information Center

Ball, Larry; Soukup, Dennis

2006-01-01

The Department of Education has undertaken an ambitious effort to develop statewide career and technical education skill standards. The standards in this document are for Heating, Ventilation, Air Conditioning and Refrigeration (HVAC&R) programs and are designed to clearly state what the student should know and be able to do upon completion of…

30 CFR 75.350 - Belt air course ventilation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Belt air course ventilation. 75.350 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.350 Belt air course ventilation. (a) The belt air course must not be used as a return air course; and except as provided in paragraph...

30 CFR 75.350 - Belt air course ventilation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Belt air course ventilation. 75.350 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.350 Belt air course ventilation. (a) The belt air course must not be used as a return air course; and except as provided in paragraph...

30 CFR 75.350 - Belt air course ventilation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Belt air course ventilation. 75.350 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.350 Belt air course ventilation. (a) The belt air course must not be used as a return air course; and except as provided in paragraph...

30 CFR 75.350 - Belt air course ventilation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Belt air course ventilation. 75.350 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.350 Belt air course ventilation. (a) The belt air course must not be used as a return air course; and except as provided in paragraph...

29 CFR 1910.94 - Ventilation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... shot or similar abrasive which may create a slipping hazard. (8) Scope. This paragraph (a) applies to... wheels, the thickness of which is not more than one forty-eighth of their diameter for those up to, and including, 20 inches in diameter, and not more than one-sixtieth of their diameter for those larger than 20...

29 CFR 1910.94 - Ventilation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... areas, located on sides away from any occupied area, to provide for pressure relief in case of explosion... shot or similar abrasive which may create a slipping hazard. (8) Scope. This paragraph (a) applies to... wheels, the thickness of which is not more than one forty-eighth of their diameter for those up to, and...

29 CFR 1910.94 - Ventilation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... areas, located on sides away from any occupied area, to provide for pressure relief in case of explosion... shot or similar abrasive which may create a slipping hazard. (8) Scope. This paragraph (a) applies to... wheels, the thickness of which is not more than one forty-eighth of their diameter for those up to, and...

29 CFR 1910.94 - Ventilation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... areas, located on sides away from any occupied area, to provide for pressure relief in case of explosion... shot or similar abrasive which may create a slipping hazard. (8) Scope. This paragraph (a) applies to... wheels, the thickness of which is not more than one forty-eighth of their diameter for those up to, and...

46 CFR 108.187 - Ventilation for brush type electric motors in classified spaces.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Ventilation for brush type electric motors in classified... Ventilation for brush type electric motors in classified spaces. Ventilation for brush type electric motors in classified locations must meet N.F.P.A. 496-1974 “Standard for Purged and Pressurized Enclosures for...

Effects of positive end-expiratory pressure and recruitment maneuvers in a ventilator-induced injury mouse model

PubMed Central

Franzi, Lisa M.; Linderholm, Angela L.; Last, Jerold A.; Adams, Jason Y.; Harper, Richart W.

2017-01-01

Background Positive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury. Objectives To evaluate the effects of positive end-expiratory pressure and recruitment maneuvers in reducing lung injury in a ventilator-induced lung injury murine model in short- and longer-term ventilation. Methods 5–12 week-old female BALB/c mice (n = 85) were anesthetized, placed on mechanical ventilation for either 2 hrs or 4 hrs with either low tidal volume (8 ml/kg) or high tidal volume (15 ml/kg) with or without positive end-expiratory pressure and recruitment maneuvers. Results Alteration of the alveolar-capillary barrier was noted at 2 hrs of high tidal volume ventilation. Standardized histology scores, influx of bronchoalveolar lavage albumin, proinflammatory cytokines, and absolute neutrophils were significantly higher in the high-tidal volume ventilation group at 4 hours of ventilation. Application of positive end-expiratory pressure resulted in significantly decreased standardized histology scores and bronchoalveolar absolute neutrophil counts at low- and high-tidal volume ventilation, respectively. Recruitment maneuvers were essential to maintain pulmonary compliance at both 2 and 4 hrs of ventilation. Conclusions Signs of ventilator-induced lung injury are evident soon after high tidal volume ventilation (as early as 2 hours) and lung injury worsens with longer-term ventilation (4 hrs). Application of positive end-expiratory pressure and recruitment maneuvers are protective against worsening VILI across all time points. Dynamic compliance can be used guide the frequency of recruitment maneuvers to help ameloriate ventilator-induced lung injury. PMID:29112971

Artificial humidification for the mechanically ventilated patient.

PubMed

Selvaraj, N

Caring for patients who are mechanically ventilated poses many challenges for critical care nurses. It is important to humidify the patient's airways artificially to prevent complications such as ventilator-associated pneumonia. There is no gold standard to determine which type of humidification is best for patients who are artificially ventilated. This article provides an overview of commonly used artificial humidification for mechanically ventilated patients and discusses nurses' responsibilities in caring for patients receiving artificial humidification.

Association between substandard classroom ventilation rates and students' academic achievement.

PubMed

Haverinen-Shaughnessy, U; Moschandreas, D J; Shaughnessy, R J

2011-04-01

This study focuses on the relationship between classroom ventilation rates and academic achievement. One hundred elementary schools of two school districts in the southwest United States were included in the study. Ventilation rates were estimated from fifth-grade classrooms (one per school) using CO(2) concentrations measured during occupied school days. In addition, standardized test scores and background data related to students in the classrooms studied were obtained from the districts. Of 100 classrooms, 87 had ventilation rates below recommended guidelines based on ASHRAE Standard 62 as of 2004. There is a linear association between classroom ventilation rates and students' academic achievement within the range of 0.9-7.1 l/s per person. For every unit (1 l/s per person) increase in the ventilation rate within that range, the proportion of students passing standardized test (i.e., scoring satisfactory or above) is expected to increase by 2.9% (95%CI 0.9-4.8%) for math and 2.7% (0.5-4.9%) for reading. The linear relationship observed may level off or change direction with higher ventilation rates, but given the limited number of observations, we were unable to test this hypothesis. A larger sample size is needed for estimating the effect of classroom ventilation rates higher than 7.1 l/s per person on academic achievement. The results of this study suggest that increasing the ventilation rates toward recommended guideline ventilation rates in classrooms should translate into improved academic achievement of students. More studies are needed to fully understand the relationships between ventilation rate, other indoor environmental quality parameters, and their effects on students' health and achievement. Achieving the recommended guidelines and pursuing better understanding of the underlying relationships would ultimately support both sustainable and productive school environments for students and personnel. © 2010 John Wiley & Sons A/S.

THE SCHOOL PLANT GUIDE FOR PLANNING SCHOOL PLANTS OF PENNSYLVANIA. ARCHITECTURAL DESIGN REQUIREMENTS AND GENERAL, ELECTRIC, HEATING AND VENTILATING, AND PLUMBING STANDARDS.

ERIC Educational Resources Information Center

Pennsylvania State Dept. of Public Instruction, Harrisburg.

A GUIDE COVERING ARCHITECTURAL DESIGN REQUIREMENTS, ELECTRIC, HEATING AND VENTILATING, AND PLUMBING STANDARDS AS APPROVED BY THE STATE BOARD OF EDUCATION IN 1966. THE FOLLOWING MINIMUM STANDARD FOR NEW BUILDING, ALTERATIONS, AND ADDITIONS ARE OUTLINED--(1) SPATIAL ENVIRONMENTAL FACTORS, SUCH AS CEILING HEIGHTS, INTERIOR SANITARY FACILITIES, ROOMS…

Winter ventilation rates at primary schools: comparison between Portugal and Finland.

PubMed

Canha, N; Almeida, S M; Freitas, M C; Täubel, M; Hänninen, O

2013-01-01

This study focused on examination of ventilation rates in classrooms with two different types of ventilation systems: natural and mechanical. Carbon dioxide (CO2) measurements were conducted in primary schools of Portugal characterized by natural ventilation and compared to Finland where mechanical ventilation is the norm. The winter period was selected since this season exerts a great influence in naturally ventilated classrooms, where opening of windows and doors occurs due to outdoor atmospheric conditions. The ventilation rates were calculated by monitoring CO2 concentrations generated by the occupants (used as a tracer gas) and application of the buildup phase method. A comparison between both countries' results was conducted with respect to ventilation rates and how these levels corresponded to national regulatory standards. Finnish primary schools (n = 2) registered a mean ventilation rate of 13.3 L/s per person, which is higher than the recommended ventilation standards. However, the Finnish classroom that presented the lowest ventilation rate (7.2 L/s per person) displayed short-term CO2 levels above 1200 ppm, which is the threshold limit value (TLV) recommended by national guidelines. The Portuguese classrooms (n = 2) showed low ventilation rates with mean values of 2.4 L/s per person, which is markedly lower than the minimum recommended value of 7 L/s per person as defined by ASHRAE and 20% less than the REHVA minimum of 3 L/s per person. Carbon dioxide levels of 1000 ppm, close to the TLV of 1200 ppm, were also reached in both Portuguese classrooms studied. The situation in Portugal indicates a potentially serious indoor air quality problem and strengthens the need for intervention to improve ventilation rates in naturally ventilated classrooms.

75 FR 52701 - Approval and Promulgation of Implementation Plans; State of Missouri

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-27

... information claimed to be Confidential Business Information (CBI) or other information whose disclosure is.... Ventilation Limits 5. Ongoing Ventilation Testing and Reporting Requirements 6. Winter Construction Work..., including building enclosure and ventilation projects, implementation of work practice standards, process...

78 FR 70329 - Modification to the Scopes of Recognition of Several NRTLs; Final Determination

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-25

... determination to delete specific test standards from the scopes of recognition of several Nationally Recognized Testing Laboratories (NRTLs), and to incorporate replacement test standards into the scopes of recognition... proposed to delete specific test standards from the scopes of recognition of several NRTLs, and incorporate...

Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit.

PubMed

Blamoun, John; Alfakir, Maria; Rella, Marie E; Wojcik, Janice M; Solis, Roberto A; Anees Khan, M; DeBari, Vincent A

2009-03-01

The ventilator bundle (VB) includes a group of clinical maneuvers (head-of-bed elevation, "sedation vacation," deep vein thrombosis prophylaxis, and peptic ulcer disease prophylaxis) to improve outcomes in patients undergoing mechanical ventilation. We modified the standard VB in our medical intensive care unit to include a group of respiratory therapist-driven protocols and, postimplementation, observed a statistically significant (P = .0006) reduction in ventilator-associated pneumonia (VAP), from a median of 14.1 cases/10(3) ventilator-days (interquartile range [IQR] = 12.1 to 20.6) to 0 cases/10(3) ventilator-days (IQR = 0 to 1.1).

77 FR 20700 - Examinations of Work Areas in Underground Coal Mines for Violations of Mandatory Health or Safety...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-06

... safety standards related to ventilation, methane, roof control, combustible materials, rock dust, other... standards related to ventilation, methane, roof control, combustible materials, rock dust, other safeguards... and unsafe conditions, such as methane accumulations, water accumulations, and adverse roof conditions...

78 FR 64538 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Safety...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-29

... for OMB Review; Comment Request; Safety Standards for Underground Coal Mine Ventilation--Belt Entry... the Mine Safety and Health Administration (MSHA) sponsored information collection request (ICR) titled, ``Safety Standards for Underground Coal Mine Ventilation--Belt Entry Used as an Intake Air Course to...

Building America Top Innovations 2014 Profile: ASHRAE Standard 62.2. Ventilation and Acceptable Indoor Air Quality in Low-Rise Residential Buildings

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

none,

2014-11-01

This 2014 Top Innovations profile describes Building America research and support in developing and gaining adoption of ASHRAE 62.2, a residential ventilation standard that is critical to transforming the U.S. housing industry to high-performance homes.

Protocol for Usability Testing and Validation of the ISO Draft International Standard 19223 for Lung Ventilators

PubMed Central

2017-01-01

Background Clinicians, such as respiratory therapists and physicians, are often required to set up pieces of medical equipment that use inconsistent terminology. Current lung ventilator terminology that is used by different manufacturers contributes to the risk of usage errors, and in turn the risk of ventilator-associated lung injuries and other conditions. Human factors and communication issues are often associated with ventilator-related sentinel events, and inconsistent ventilator terminology compounds these issues. This paper describes our proposed protocol, which will be implemented at the University of Waterloo, Canada when this project is externally funded. Objective We propose to determine whether a standardized vocabulary improves the ease of use, safety, and utility as it relates to the usability of medical devices, compared to legacy medical devices from multiple manufacturers, which use different terms. Methods We hypothesize that usage errors by clinicians will be lower when standardization is consistently applied by all manufacturers. The proposed study will experimentally examine the impact of standardized nomenclature on performance declines in the use of an unfamiliar ventilator product in clinically relevant scenarios. Participants will be respiratory therapy practitioners and trainees, and we propose studying approximately 60 participants. Results The work reported here is in the proposal phase. Once the protocol is implemented, we will report the results in a follow-up paper. Conclusions The proposed study will help us better understand the effects of standardization on medical device usability. The study will also help identify any terms in the International Organization for Standardization (ISO) Draft International Standard (DIS) 19223 that may be associated with recurrent errors. Amendments to the standard will be proposed if recurrent errors are identified. This report contributes a protocol that can be used to assess the effect of standardization in any given domain that involves equipment, multiple manufacturers, inconsistent vocabulary, symbology, audio tones, or patterns in interface navigation. Second, the protocol can be used to experimentally evaluate the ISO DIS 19223 for its effectiveness, as researchers around the world may wish to conduct such tests and compare results. PMID:28887292

Implementation of a Goal-Directed Mechanical Ventilation Order Set Driven by Respiratory Therapists Improves Compliance With Best Practices for Mechanical Ventilation.

PubMed

Radosevich, Misty A; Wanta, Brendan T; Meyer, Todd J; Weber, Verlin W; Brown, Daniel R; Smischney, Nathan J; Diedrich, Daniel A

2017-01-01

Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice. We evaluated 1302 patients undergoing invasive mechanical ventilation (1693 separate episodes of invasive mechanical ventilation) prior to and after institution of a standardized, goal-directed mechanical ventilation order set using a controlled before-and-after study design. Patient-specific goals for oxygenation partial pressure of oxygen in arterial blood (Pao 2 ), ARDS Network [Net] positive end-expiratory pressure [PEEP]/fraction of inspired oxygen [Fio 2 ] table use) and ventilation (pH, partial pressure of carbon dioxide) were selected by prescribers and implemented by RTs. Compliance with the new mechanical ventilation order set was high: 88.2% compliance versus 3.8% before implementation of the order set ( P < .001). Adherence to the PEEP/Fio 2 table after implementation of the order set was significantly greater (86.0% after vs 82.9% before, P = .02). There was no difference in duration of mechanical ventilation, intensive care unit (ICU) length of stay, and in-hospital or ICU mortality. A standardized best practice mechanical ventilation order set can be implemented by a multidisciplinary team and is associated with improved compliance to written orders and adherence to the ARDSNet PEEP/Fio 2 table.

Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial.

PubMed

Ferrando, Carlos; Soro, Marina; Unzueta, Carmen; Suarez-Sipmann, Fernando; Canet, Jaume; Librero, Julián; Pozo, Natividad; Peiró, Salvador; Llombart, Alicia; León, Irene; India, Inmaculada; Aldecoa, Cesar; Díaz-Cambronero, Oscar; Pestaña, David; Redondo, Francisco J; Garutti, Ignacio; Balust, Jaume; García, Jose I; Ibáñez, Maite; Granell, Manuel; Rodríguez, Aurelio; Gallego, Lucía; de la Matta, Manuel; Gonzalez, Rafael; Brunelli, Andrea; García, Javier; Rovira, Lucas; Barrios, Francisco; Torres, Vicente; Hernández, Samuel; Gracia, Estefanía; Giné, Marta; García, María; García, Nuria; Miguel, Lisset; Sánchez, Sergio; Piñeiro, Patricia; Pujol, Roger; García-Del-Valle, Santiago; Valdivia, José; Hernández, María J; Padrón, Oto; Colás, Ana; Puig, Jaume; Azparren, Gonzalo; Tusman, Gerardo; Villar, Jesús; Belda, Javier

2018-03-01

The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m 2 . Patients were randomly assigned (1:1:1:1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O 2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0·89 [95% CI 0·74-1·07; p=0·25]), OLA-CPAP (111 [47%] of 238, 0·91 [0·76-1·09; p=0·35]), or STD-CPAP groups (118 [48%] of 244, 0·95 [0·80-1·14; p=0·65]) when compared with patients in the STD-O 2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation. Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness, and Grants Programme of the European Society of Anaesthesiology. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive Care Unit

DTIC Science & Technology

2016-04-01

oxygenation and ventilation Goal Adequate oxygenation and/or ventilation Goal Skin grafting Objective Surgical operation (implicit goal = achieve...Abdominal Pressures, [TTE/IVC measurement] Assure effective Ventilation & Sedation (Standard ICU) EtCO2, A-Line, ±CVP 4E Compatible Decrease...commands) Participatory (expresses self)  minimize oxygen demand  maximize perfusion  protect grafts  patient ventilator

Economic, Environmental and Health Implications of Enhanced Ventilation in Office Buildings.

PubMed

MacNaughton, Piers; Pegues, James; Satish, Usha; Santanam, Suresh; Spengler, John; Allen, Joseph

2015-11-18

Current building ventilation standards are based on acceptable minimums. Three decades of research demonstrates the human health benefits of increased ventilation above these minimums. Recent research also shows the benefits on human decision-making performance in office workers, which translates to increased productivity. However, adoption of enhanced ventilation strategies is lagging. We sought to evaluate two of the perceived potential barriers to more widespread adoption-Economic and environmental costs. We estimated the energy consumption and associated per building occupant costs for office buildings in seven U.S. cities, representing different climate zones for three ventilation scenarios (standard practice (20 cfm/person), 30% enhanced ventilation, and 40 cfm/person) and four different heating, ventilation and air conditioning (HVAC) system strategies (Variable Air Volume (VAV) with reheat and a Fan Coil Unit (FCU), both with and without an energy recovery ventilator). We also estimated emissions of greenhouse gases associated with this increased energy usage, and, for comparison, converted this to the equivalent number of vehicles using greenhouse gas equivalencies. Lastly, we paired results from our previous research on cognitive function and ventilation with labor statistics to estimate the economic benefit of increased productivity associated with increasing ventilation rates. Doubling the ventilation rate from the American Society of Heating, Refrigeration and Air-Conditioning Engineers minimum cost less than $40 per person per year in all climate zones investigated. Using an energy recovery ventilation system significantly reduced energy costs, and in some scenarios led to a net savings. At the highest ventilation rate, adding an ERV essentially neutralized the environmental impact of enhanced ventilation (0.03 additional cars on the road per building across all cities). The same change in ventilation improved the performance of workers by 8%, equivalent to a $6500 increase in employee productivity each year. Reduced absenteeism and improved health are also seen with enhanced ventilation. The health benefits associated with enhanced ventilation rates far exceed the per-person energy costs relative to salary costs. Environmental impacts can be mitigated at regional, building, and individual-level scales through the transition to renewable energy sources, adoption of energy efficient systems and ventilation strategies, and promotion of other sustainable policies.

Economic, Environmental and Health Implications of Enhanced Ventilation in Office Buildings

PubMed Central

MacNaughton, Piers; Pegues, James; Satish, Usha; Santanam, Suresh; Spengler, John; Allen, Joseph

2015-01-01

Introduction: Current building ventilation standards are based on acceptable minimums. Three decades of research demonstrates the human health benefits of increased ventilation above these minimums. Recent research also shows the benefits on human decision-making performance in office workers, which translates to increased productivity. However, adoption of enhanced ventilation strategies is lagging. We sought to evaluate two of the perceived potential barriers to more widespread adoption—Economic and environmental costs. Methods: We estimated the energy consumption and associated per building occupant costs for office buildings in seven U.S. cities, representing different climate zones for three ventilation scenarios (standard practice (20 cfm/person), 30% enhanced ventilation, and 40 cfm/person) and four different heating, ventilation and air conditioning (HVAC) system strategies (Variable Air Volume (VAV) with reheat and a Fan Coil Unit (FCU), both with and without an energy recovery ventilator). We also estimated emissions of greenhouse gases associated with this increased energy usage, and, for comparison, converted this to the equivalent number of vehicles using greenhouse gas equivalencies. Lastly, we paired results from our previous research on cognitive function and ventilation with labor statistics to estimate the economic benefit of increased productivity associated with increasing ventilation rates. Results: Doubling the ventilation rate from the American Society of Heating, Refrigeration and Air-Conditioning Engineers minimum cost less than $40 per person per year in all climate zones investigated. Using an energy recovery ventilation system significantly reduced energy costs, and in some scenarios led to a net savings. At the highest ventilation rate, adding an ERV essentially neutralized the environmental impact of enhanced ventilation (0.03 additional cars on the road per building across all cities). The same change in ventilation improved the performance of workers by 8%, equivalent to a $6500 increase in employee productivity each year. Reduced absenteeism and improved health are also seen with enhanced ventilation. Conclusions: The health benefits associated with enhanced ventilation rates far exceed the per-person energy costs relative to salary costs. Environmental impacts can be mitigated at regional, building, and individual-level scales through the transition to renewable energy sources, adoption of energy efficient systems and ventilation strategies, and promotion of other sustainable policies. PMID:26593933

Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate.

PubMed

Ivanov, Vadim A

2016-02-01

The reduction of instrumental dead space is a recognized approach to preventing ventilation-induced lung injury in premature infants. However, there are no published data regarding the effectiveness of instrumental dead-space reduction in endotracheal tube (ETT) connectors. We tested the impact of the Y-piece/ETT connector pairs with reduced instrumental dead space on CO2 elimination in a model of the premature neonate lung. The standard ETT connector was compared with a low-dead-space ETT connector and with a standard connector equipped with an insert. We compared the setups by measuring the CO2 elimination rate in an artificial lung ventilated via the connectors. The lung was connected to a ventilator via a standard circuit, a 2.5-mm ETT, and one of the connectors under investigation. The ventilator was run in volume-controlled continuous mandatory ventilation mode. The low-dead-space ETT connector/Y-piece and insert-equipped standard connector/Y-piece pairs had instrumental dead space reduced by 36 and 67%, respectively. With set tidal volumes (VT) of 2.5, 5, and 10 mL, in comparison with the standard ETT connector, the low-dead-space connector reduced CO2 elimination time by 4.5% (P < .05), 4.4% (P < .01), and 7.1% (not significant), respectively. The insert-equipped standard connector reduced CO2 elimination time by 13.5, 25.1, and 16.1% (all P < .01). The low-dead-space connector increased inspiratory resistance by 17.8% (P < .01), 9.6% (P < .05), and 5.0% (not significant); the insert-equipped standard connector increased inspiratory resistance by 9.1, 8.4, and 5.9% (all not significant). The low-dead-space connector decreased expiratory resistance by 6.8% (P < .01) and 1.8% (not significant) and increased it by 1.4% (not significant); the insert-equipped standard connector decreased expiratory resistance by 1.5 and 1% and increased it by 1% (all not significant). The low-dead-space connector increased work of breathing by 4.7% (P < .01), 3.8% (P < .01), and 2.5% (not significant); the insert-equipped standard connector increased it by 0.8% (not significant), 2.5% (P < .01), and 2.8% (P < .01). Both methods of instrumental dead-space reduction led to improvements in artificial lung ventilation. Negative effects on resistance and work of breathing appeared minimal. Further testing in vivo should be performed to confirm the lung model results and, if successful, translated into clinical practice. Copyright © 2016 by Daedalus Enterprises.

Ventilation, indoor air quality, and health in homes undergoing weatherization.

PubMed

Francisco, P W; Jacobs, D E; Targos, L; Dixon, S L; Breysse, J; Rose, W; Cali, S

2017-03-01

Ventilation standards, health, and indoor air quality have not been adequately examined for residential weatherization. This randomized trial showed how ASHRAE 62-1989 (n=39 houses) and ASHRAE 62.2-2010 (n=42 houses) influenced ventilation rates, moisture balance, indoor air quality, and self-reported physical and mental health outcomes. Average total airflow was nearly twice as high for ASHRAE 62.2-2010 (79 vs. 39 cfm). Volatile organic compounds, formaldehyde and carbon dioxide were all significantly reduced for the newer standard and first-floor radon was marginally lower, but for the older standard, only formaldehyde significantly decreased. Humidity in the ASHRAE 62.2-2010 group was only about half that of the ASHRAE 62-1989 group using the moisture balance metric. Radon was higher in the basement but lower on the first floor for ASHRAE 62.2-2010. Children in each group had fewer headaches, eczema, and skin allergies after weatherization and adults had improvements in psychological distress. Indoor air quality and health improve when weatherization is accompanied by an ASHRAE residential ventilation standard, and the 2010 ASHRAE standard has greater improvements in certain outcomes compared to the 1989 standard. Weatherization, home repair, and energy conservation projects should use the newer ASHRAE standard to improve indoor air quality and health. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Field evaluation of ventilation system performance in enclosed parking garages

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

Ayari, A.M.; Grot, D.A.; Krarti, M.

2000-07-01

This paper summarizes the results of a field study to determine the ventilation requirements and the contaminant levels in existing enclosed parking garages. The testing was conducted in seven parking garages with different sizes, traffic flow patterns, vehicle types, and locations. In particular, the study compares the actual ventilation rates measured using the tracer gas technique with the ventilation requirements of ANSI/ASHRAE Standard 62-1989. In addition, the field test evaluated the effectiveness of the existing ventilation systems in maintaining acceptable contaminant levels within enclosed parking garages.

The Potential of Bee-Generated Carbon Dioxide for Control of Varroa Mite (Mesostigmata: Varroidae) in Indoor Overwintering Honey bee (Hymenoptera: Apidae) Colonies.

PubMed

Bahreini, Rassol; Currie, Robert W

2015-10-01

The objective of this study was to manipulate ventilation rate to characterize interactions between stocks of honey bees (Apis mellifera L.) and ventilation setting on varroa mite (Varroa destructor Anderson and Trueman) mortality in honey bee colonies kept indoors over winter. The first experiment used colonies established from stock selected locally for wintering performance under exposure to varroa (n = 6) and unselected bees (n = 6) to assess mite and bee mortality and levels of carbon dioxide (CO2) and oxygen (O2) in the bee cluster when kept under a simulated winter condition at 5°C. The second experiment, used colonies from selected bees (n = 10) and unselected bees (n = 12) that were exposed to either standard ventilation (14.4 liter/min per hive) or restricted ventilation (0.24 liter/min per hive, in a Plexiglas ventilation chamber) during a 16-d treatment period to assess the influence of restricted air flow on winter mortality rates of varroa mites and honey bees. Experiment 2 was repeated in early, mid-, and late winter. The first experiment showed that under unrestricted ventilation with CO2 concentrations averaging <2% there was no correlation between CO2 and varroa mite mortality when colonies were placed under low temperature. CO2 was negatively correlated with O2 in the bee cluster in both experiments. When ventilation was restricted, mean CO2 level (3.82 ± 0.31%, range 0.43-8.44%) increased by 200% relative to standard ventilation (1.29 ± 0.31%; range 0.09-5.26%) within the 16-d treatment period. The overall mite mortality rates and the reduction in mean abundance of varroa mite over time was greater under restricted ventilation (37 ± 4.2%) than under standard ventilation (23 ± 4.2%) but not affected by stock of bees during the treatment period. Selected bees showed overall greater mite mortality relative to unselected bees in both experiments. Restricting ventilation increased mite mortality, but did not affect worker bee mortality relative to that for colonies under standard ventilation. Restricted ventilation did not affect the overall level of Nosema compared with the control. However, there was an interaction between stock, season, and time of the trial. Unselected stock showed an increase in Nosema over time in the late winter trial that did not occur in the selected stock. In conclusion, these findings suggested that restricted ventilation has potential to suppress varroa mite in overwintering honey bee colonies via a low-cost and environmentally friendly measure. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

33 CFR 183.630 - Standards for natural ventilation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... boat achieved by having: (1) A supply opening or duct from the atmosphere or from a ventilated compartment or from a compartment that is open to the atmosphere; and (2) An exhaust opening into another ventilated compartment or an exhaust duct to the atmosphere. (b) Each exhaust opening or exhaust duct must...

33 CFR 183.630 - Standards for natural ventilation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... boat achieved by having: (1) A supply opening or duct from the atmosphere or from a ventilated compartment or from a compartment that is open to the atmosphere; and (2) An exhaust opening into another ventilated compartment or an exhaust duct to the atmosphere. (b) Each exhaust opening or exhaust duct must...

33 CFR 183.630 - Standards for natural ventilation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... boat achieved by having: (1) A supply opening or duct from the atmosphere or from a ventilated compartment or from a compartment that is open to the atmosphere; and (2) An exhaust opening into another ventilated compartment or an exhaust duct to the atmosphere. (b) Each exhaust opening or exhaust duct must...

Evaluation of manual and automatic manually triggered ventilation performance and ergonomics using a simulation model.

PubMed

Marjanovic, Nicolas; Le Floch, Soizig; Jaffrelot, Morgan; L'Her, Erwan

2014-05-01

In the absence of endotracheal intubation, the manual bag-valve-mask (BVM) is the most frequently used ventilation technique during resuscitation. The efficiency of other devices has been poorly studied. The bench-test study described here was designed to evaluate the effectiveness of an automatic, manually triggered system, and to compare it with manual BVM ventilation. A respiratory system bench model was assembled using a lung simulator connected to a manikin to simulate a patient with unprotected airways. Fifty health-care providers from different professional groups (emergency physicians, residents, advanced paramedics, nurses, and paramedics; n = 10 per group) evaluated manual BVM ventilation, and compared it with an automatic manually triggered device (EasyCPR). Three pathological situations were simulated (restrictive, obstructive, normal). Standard ventilation parameters were recorded; the ergonomics of the system were assessed by the health-care professionals using a standard numerical scale once the recordings were completed. The tidal volume fell within the standard range (400-600 mL) for 25.6% of breaths (0.6-45 breaths) using manual BVM ventilation, and for 28.6% of breaths (0.3-80 breaths) using the automatic manually triggered device (EasyCPR) (P < .0002). Peak inspiratory airway pressure was lower using the automatic manually triggered device (EasyCPR) (10.6 ± 5 vs 15.9 ± 10 cm H2O, P < .001). The ventilation rate fell consistently within the guidelines, in the case of the automatic manually triggered device (EasyCPR) only (10.3 ± 2 vs 17.6 ± 6, P < .001). Significant pulmonary overdistention was observed when using the manual BVM device during the normal and obstructive sequences. The nurses and paramedics considered the ergonomics of the automatic manually triggered device (EasyCPR) to be better than those of the manual device. The use of an automatic manually triggered device may improve ventilation efficiency and decrease the risk of pulmonary overdistention, while decreasing the ventilation rate.

12 CFR 560.100 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 6 2013-01-01 2012-01-01 true Real estate lending standards; purpose and scope... Real estate lending standards; purpose and scope. This section, and § 560.101 of this subpart, issued.... 1828(o), prescribe standards for real estate lending to be used by savings associations and all their...

12 CFR 560.100 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 6 2014-01-01 2012-01-01 true Real estate lending standards; purpose and scope... Real estate lending standards; purpose and scope. This section, and § 560.101 of this subpart, issued.... 1828(o), prescribe standards for real estate lending to be used by savings associations and all their...

The impact of hospital-wide use of a tapered-cuff endotracheal tube on the incidence of ventilator-associated pneumonia.

PubMed

Bowton, David L; Hite, R Duncan; Martin, R Shayn; Sherertz, Robert

2013-10-01

Aspiration of colonized oropharyngeal secretions is a major factor in the pathogenesis of ventilator-associated pneumonia (VAP). A tapered-cuff endotracheal tube (ETT) has been demonstrated to reduce aspiration around the cuff. Whether these properties are efficacious in reducing VAP is not known. This 2-period, investigator-initiated observational study was designed to assess the efficacy of a tapered-cuff ETT to reduce the VAP rate. All intubated, mechanically ventilated patients over the age of 18 were included. During the baseline period a standard, barrel-shaped-cuff ETT (Mallinckrodt Hi-Lo) was used. All ETTs throughout the hospital were then replaced with a tapered-cuff ETT (TaperGuard). The primary outcome variable was the incidence of VAP per 1,000 ventilator days. We included 2,849 subjects, encompassing 15,250 ventilator days. The mean ± SD monthly VAP rate was 3.29 ± 1.79/1,000 ventilator days in the standard-cuff group and 2.77 ± 2.00/1,000 ventilator days in the tapered-cuff group (P = .65). While adherence to the VAP prevention bundle was high throughout the study, bundle adherence was significantly higher during the standard-cuff period (96.5 ± 2.7%) than in the tapered-cuff period (90.3 ± 3.5%, P = .01). In the setting of a VAP rate very near the average of ICUs in the United States, and where there was high adherence to a VAP prevention bundle, the use of a tapered-cuff ETT was not associated with a reduction in the VAP rate.

The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons

PubMed Central

Urrego, Juliana; Ko, Albert I.; da Silva Santos Carbone, Andrea; Paião, Dayse Sanchez Guimarães; Sgarbi, Renata Viebrantz Enne; Yeckel, Catherine W.; Andrews, Jason R.; Croda, Julio

2015-01-01

Prisoners have among the highest incidence of tuberculosis (TB) globally. However, the contribution of the prison environment on transmission is not well understood and structural characteristics have received little attention as effective epidemiological interventions in TB control. We evaluated architectural characteristics and estimated ventilation rates in 141 cells in three prisons in central west Brazil using steady-state exhaled carbon dioxide (CO2) levels. We used a modified Wells–Riley equation to estimate the probability of infection for inmates sharing a cell with an infectious case and projected the impact of interventions, including early diagnosis and improved ventilation. Overall, prison cells were densely populated (mean 2.1 m2 per occupant) and poorly ventilated, with only three cells meeting World Health Organization (WHO) standards for per-person ventilation (60 L/s) applied in infection control settings. In the absence of interventions, projected mean risk of infection was 78.0% during a 6-month period. Decreasing time-to-diagnosis by 25% reduced transmission risk by 8.3%. Improving ventilation to WHO standards decreased transmission by 38.2%, whereas optimizing cross-ventilation reduced transmission by 64.4%. Prison environments promote high infection risk over short-time intervals. In this context, enhanced diagnostics have a limited impact on reducing transmission. Improving natural ventilation may be required to effectively control TB in prisons. PMID:26195459

The Impact of Ventilation and Early Diagnosis on Tuberculosis Transmission in Brazilian Prisons.

PubMed

Urrego, Juliana; Ko, Albert I; da Silva Santos Carbone, Andrea; Paião, Dayse Sanchez Guimarães; Sgarbi, Renata Viebrantz Enne; Yeckel, Catherine W; Andrews, Jason R; Croda, Julio

2015-10-01

Prisoners have among the highest incidence of tuberculosis (TB) globally. However, the contribution of the prison environment on transmission is not well understood and structural characteristics have received little attention as effective epidemiological interventions in TB control. We evaluated architectural characteristics and estimated ventilation rates in 141 cells in three prisons in central west Brazil using steady-state exhaled carbon dioxide (CO2) levels. We used a modified Wells-Riley equation to estimate the probability of infection for inmates sharing a cell with an infectious case and projected the impact of interventions, including early diagnosis and improved ventilation. Overall, prison cells were densely populated (mean 2.1 m(2) per occupant) and poorly ventilated, with only three cells meeting World Health Organization (WHO) standards for per-person ventilation (60 L/s) applied in infection control settings. In the absence of interventions, projected mean risk of infection was 78.0% during a 6-month period. Decreasing time-to-diagnosis by 25% reduced transmission risk by 8.3%. Improving ventilation to WHO standards decreased transmission by 38.2%, whereas optimizing cross-ventilation reduced transmission by 64.4%. Prison environments promote high infection risk over short-time intervals. In this context, enhanced diagnostics have a limited impact on reducing transmission. Improving natural ventilation may be required to effectively control TB in prisons. © The American Society of Tropical Medicine and Hygiene.

Reproductive Performance of Mice in Disposable and Standard Individually Ventilated Cages

PubMed Central

Ferguson, Danielle R; Bailey, Michele M

2013-01-01

This study assessed the reproductive performance of mice housed in 2 types of individually ventilated caging systems. Breeding pairs from 48 female and 24 male mice of 3 established transgenic mouse breeding colonies were placed in either a standard or disposable ventilated caging system. For 3 breeding cycles, the number of pups born, pup survival rate to weaning, time interval between litters, and pup weights were monitored for each breeding pair. Disposable and standard cages were maintained in the same location during breeding. Environmental parameters included intracage temperature, humidity, and ammonia and carbon dioxide levels and room light intensity and sound. Overall, 776 offspring were produced. Breeding performance did not differ significantly between the 2 cage types. By 11 wk of age, the weights of pups from both cage types were equivalent. The intracage temperature was 1.1 °F warmer and light intensity at the site of the nest was 34 lx dimmer in disposable cages than in standard caging. The difference in lighting likely was due to nest location; the nests in the disposable cages were at the back of the cages and away from the anterior air supply, whereas in standard caging, nests were at the front of the cages, with the air supply at the rear. Under these husbandry conditions, mice housed in disposable caging systems have comparable breeding performance to those housed in standard individually ventilated cages. PMID:23849403

The Use of High-Frequency Percussive Ventilation for Whole-Lung Lavage: A Case Report.

PubMed

Kinthala, Sudhakar; Liang, Mark; Khusid, Felix; Harrison, Sebron

2018-04-23

Whole-lung lavage (WLL) remains the gold standard in the treatment of pulmonary alveolar proteinosis. However, anesthetic management during WLL can be challenging because of the risk of intraoperative hypoxemia and various cardiorespiratory complications of 1-lung ventilation. Here, we describe a novel strategy involving the application of high-frequency percussive ventilation using a volumetric diffusive respirator (VDR-4) during WLL in a 47-year-old woman with pulmonary alveolar proteinosis. Our observations suggest that high-frequency percussive ventilation is a potentially effective ventilation strategy during WLL that may reduce the risk of hypoxemia and facilitate lavage.

Measure Guideline: Ventilation Guidance for Residential High-Performance New Construction - Multifamily

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

Lstiburek, Joseph

2017-01-01

The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamilymore » units that satisfies the requirements of ASHRAE 62.2-2016.« less

Measure Guideline: Ventilation Guidance for Residential High-Performance New Construction - Multifamily

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

Lstiburek, Joseph

The measure guideline provides ventilation guidance for residential high performance multifamily construction that incorporates the requirements of the ASHRAE 62.2 ventilation and indoor air quality standard. The measure guideline focus is on the decision criteria for weighing cost and performance of various ventilation systems. The measure guideline is intended for contractors, builders, developers, designers and building code officials. The guide may also be helpful to building owners wishing to learn more about ventilation strategies available for their buildings. The measure guideline includes specific design and installation instructions for the most cost effective and performance effective solutions for ventilation in multifamilymore » units that satisfies the requirements of ASHRAE 62.2-2016.« less

[Assessment of the air quality improment of cleaning and disinfection on central air-conditioning ventilation system].

PubMed

Liu, Hongliang; Zhang, Lei; Feng, Lihong; Wang, Fei; Xue, Zhiming

2009-09-01

To assess the effect of air quality of cleaning and disinfection on central air-conditioning ventilation systems. 102 air-conditioning ventilation systems in 46 public facilities were sampled and investigated based on Hygienic assessment criterion of cleaning and disinfection of public central air-conditioning systems. Median dust volume decreased from 41.8 g/m2 to 0.4 g/m2, and the percentage of pipes meeting the national standard for dust decreased from 17.3% (13/60) to 100% (62/62). In the dust, median aerobic bacterial count decreased from 14 cfu/cm2 to 1 cfu/cm2. Median aerobic fungus count decreased from 10 cfu/cm2 to 0 cfu/cm2. The percentage of pipes with bacterial and fungus counts meeting the national standard increased from 92.4% (171/185) and 82.2% (152/185) to 99.4% (165/166) and 100% (166/166), respectively. In the ventilation air, median aerobic bacterial count decreased from 756 cfu/m3 to 229 cfu/m3. Median aerobic fungus count decreased from 382 cfu/m3 to 120 cfu/m3. The percentage of pipes meeting the national standard for ventilation air increased from 33.3% (81/243) and 62.1% (151/243) to 79.8% (292/366) and 87.7% (242/276), respectively. But PM10 rose from 0.060 mg/m3 to 0.068 mg/m3, and the percentage of pipes meeting the national standard for PM10 increased from 74.2% (13/60) to 90.2% (46/51). The cleaning and disinfection of central air-conditioning ventilation systems could have a beneficial effect of air quality.

Death by acid rain: VAP or EXIT?

PubMed

Thorburn, Kentigern; Darbyshire, Andrew

2009-01-01

Ventilator-associated pneumonia (VAP) is a new (nosocomial) lower respiratory tract infection diagnosed in mechanically ventilated patients 48 or more hours after intubation. There is no gold standard for establishing the diagnosis and its pathogenesis is iatrogenic and multifactorial. Gastro-oesophageal reflux is common in mechanically ventilated children, but its role in VAP remains speculative. VAP is associated with increased mortality and morbidity, prolonged duration of ventilation and hospital stay, and escalated costs of hospitalisation. VAP 'bundles' are championed as the antidote.

Chemical Emissions of Residential Materials and Products: Review of Available Information

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

Willem, Henry; Singer, Brett

2010-09-15

This report is prepared in the context of a larger program whose mission is to advance understanding of ventilation and indoor air quality in U.S. homes. A specific objective of this program is to develop the scientific basis ? through controlled experiments, monitoring and analysis ? for health risk-based ventilation standards. Appropriate and adequate ventilation is a basic element of a healthy home. Ventilation provides outdoor air and in the process removes indoor odors and contaminants including potentially unhealthful chemicals emitted by indoor materials, products and activities. Ventilation traditionally was assured to occur via infiltration of outdoor air through cracksmore » and other leakage pathways in the residential building envelope. As building air tightness is improved for energy efficiency, infiltration can be reduced to inadequate levels. This has lead to the development of standards requiring mechanical ventilation. Though nominally intended to ensure acceptable indoor air quality, the standards are not explicitly tied to health risk or pollutant exposure targets. LBNL is currently designing analyses to assess the impact of varying ventilation standards on pollutant concentrations, health risks and energy use. These analyses require information on sources of chemical pollutant emissions, ideally including emission rates and the impact of ventilation on emissions. Some information can be obtained from recent studies that report measurements of various air contaminants and their concentrations in U.S. residences. Another way to obtain this information is the bottom-up approach of collecting and evaluating emissions data from construction and interior materials and common household products. This review contributes to the latter approach by summarizing available information on chemical emissions from new residential products and materials. We review information from the scientific literature and public sources to identify and discuss the databases that provide information on new or low-emission materials and products. The review focuses on the primary chemical or volatile organic compound (VOC) emissions from interior surface materials, furnishings, and some regularly used household products; all of these emissions are amenable to ventilation. Though it is an important and related topic, this review does not consider secondary pollutants that result from reactions of ozone and unsaturated organics bound to or emitted from material surfaces. Semi-volatile organic compounds (SVOCs) have been largely excluded from this review because ventilation generally is not an effective way to control SVOC exposures. Nevertheless, health concerns about exposures to SVOCs emitted from selected materials warrant some discussion.« less

46 CFR 154.707 - Cargo boil-off as fuel: Ventilation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment Cargo Pressure and Temperature Control § 154.707 Cargo boil-off as fuel: Ventilation. (a) A...

46 CFR 154.707 - Cargo boil-off as fuel: Ventilation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment Cargo Pressure and Temperature Control § 154.707 Cargo boil-off as fuel: Ventilation. (a) A...

46 CFR 154.707 - Cargo boil-off as fuel: Ventilation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment Cargo Pressure and Temperature Control § 154.707 Cargo boil-off as fuel: Ventilation. (a) A...

46 CFR 154.707 - Cargo boil-off as fuel: Ventilation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment Cargo Pressure and Temperature Control § 154.707 Cargo boil-off as fuel: Ventilation. (a) A...

46 CFR 154.707 - Cargo boil-off as fuel: Ventilation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment Cargo Pressure and Temperature Control § 154.707 Cargo boil-off as fuel: Ventilation. (a) A...

Closed-loop mechanical ventilation for lung injury: a novel physiological-feedback mode following the principles of the open lung concept.

PubMed

Schwaiberger, David; Pickerodt, Philipp A; Pomprapa, Anake; Tjarks, Onno; Kork, Felix; Boemke, Willehad; Francis, Roland C E; Leonhardt, Steffen; Lachmann, Burkhard

2018-06-01

Adherence to low tidal volume (V T ) ventilation and selected positive end-expiratory pressures are low during mechanical ventilation for treatment of the acute respiratory distress syndrome. Using a pig model of severe lung injury, we tested the feasibility and physiological responses to a novel fully closed-loop mechanical ventilation algorithm based on the "open lung" concept. Lung injury was induced by surfactant washout in pigs (n = 8). Animals were ventilated following the principles of the "open lung approach" (OLA) using a fully closed-loop physiological feedback algorithm for mechanical ventilation. Standard gas exchange, respiratory- and hemodynamic parameters were measured. Electrical impedance tomography was used to quantify regional ventilation distribution during mechanical ventilation. Automatized mechanical ventilation provided strict adherence to low V T -ventilation for 6 h in severely lung injured pigs. Using the "open lung" approach, tidal volume delivery required low lung distending pressures, increased recruitment and ventilation of dorsal lung regions and improved arterial blood oxygenation. Physiological feedback closed-loop mechanical ventilation according to the principles of the open lung concept is feasible and provides low tidal volume ventilation without human intervention. Of importance, the "open lung approach"-ventilation improved gas exchange and reduced lung driving pressures by opening atelectasis and shifting of ventilation to dorsal lung regions.

40 CFR 262.103 - What is the scope of the laboratory environmental management standard?

Code of Federal Regulations, 2014 CFR

2014-07-01

... University Laboratories XL Project-Laboratory Environmental Management Standard § 262.103 What is the scope... 40 Protection of Environment 26 2014-07-01 2014-07-01 false What is the scope of the laboratory environmental management standard? 262.103 Section 262.103 Protection of Environment ENVIRONMENTAL PROTECTION...

40 CFR 262.103 - What is the scope of the laboratory environmental management standard?

Code of Federal Regulations, 2012 CFR

2012-07-01

... University Laboratories XL Project-Laboratory Environmental Management Standard § 262.103 What is the scope... 40 Protection of Environment 27 2012-07-01 2012-07-01 false What is the scope of the laboratory environmental management standard? 262.103 Section 262.103 Protection of Environment ENVIRONMENTAL PROTECTION...

40 CFR 262.103 - What is the scope of the laboratory environmental management standard?

Code of Federal Regulations, 2013 CFR

2013-07-01

... University Laboratories XL Project-Laboratory Environmental Management Standard § 262.103 What is the scope... 40 Protection of Environment 27 2013-07-01 2013-07-01 false What is the scope of the laboratory environmental management standard? 262.103 Section 262.103 Protection of Environment ENVIRONMENTAL PROTECTION...

40 CFR 262.103 - What is the scope of the laboratory environmental management standard?

Code of Federal Regulations, 2011 CFR

2011-07-01

... University Laboratories XL Project-Laboratory Environmental Management Standard § 262.103 What is the scope... 40 Protection of Environment 26 2011-07-01 2011-07-01 false What is the scope of the laboratory environmental management standard? 262.103 Section 262.103 Protection of Environment ENVIRONMENTAL PROTECTION...

29 CFR 457.1 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 2 2014-07-01 2014-07-01 false Purpose and scope. 457.1 Section 457.1 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR STANDARDS OF CONDUCT GENERAL Purpose and Scope § 457.1 Purpose and scope. The regulations contained in this subchapter are designed to...

29 CFR 457.1 - Purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 2 2012-07-01 2012-07-01 false Purpose and scope. 457.1 Section 457.1 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR STANDARDS OF CONDUCT GENERAL Purpose and Scope § 457.1 Purpose and scope. The regulations contained in this subchapter are designed to...

29 CFR 457.1 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 2 2011-07-01 2011-07-01 false Purpose and scope. 457.1 Section 457.1 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR STANDARDS OF CONDUCT GENERAL Purpose and Scope § 457.1 Purpose and scope. The regulations contained in this subchapter are designed to...

29 CFR 457.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false Purpose and scope. 457.1 Section 457.1 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR STANDARDS OF CONDUCT GENERAL Purpose and Scope § 457.1 Purpose and scope. The regulations contained in this subchapter are designed to...

29 CFR 457.1 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 2 2013-07-01 2013-07-01 false Purpose and scope. 457.1 Section 457.1 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR STANDARDS OF CONDUCT GENERAL Purpose and Scope § 457.1 Purpose and scope. The regulations contained in this subchapter are designed to...

Face mask ventilation in edentulous patients: a comparison of mandibular groove and lower lip placement.

PubMed

Racine, Stéphane X; Solis, Audrey; Hamou, Nora Ait; Letoumelin, Philippe; Hepner, David L; Beloucif, Sadek; Baillard, Christophe

2010-05-01

In edentulous patients, it may be difficult to perform face mask ventilation because of inadequate seal with air leaks. Our aim was to ascertain whether the "lower lip" face mask placement, as a new face mask ventilation method, is more effective at reducing air leaks than the standard face mask placement. Forty-nine edentulous patients with inadequate seal and air leak during two-hand positive-pressure ventilation using the ventilator circle system were prospectively evaluated. In the presence of air leaks, defined as a difference of at least 33% between inspired and expired tidal volumes, the mask was placed in a lower lip position by repositioning the caudal end of the mask above the lower lip while maintaining the head in extension. The results are expressed as mean +/- SD or median (25th-75th percentiles). Patient characteristics included age (71 +/- 11 yr) and body mass index (24 +/- 4 kg/m2). By using the standard method, the median inspired and expired tidal volumes were 450 ml (400-500 ml) and 0 ml (0-50 ml), respectively, and the median air leak was 400 ml (365-485 ml). After placing the mask in the lower lip position, the median expired tidal volume increased to 400 ml (380-490), and the median air leak decreased to 10 ml (0-20 ml) (P < 0.001 vs. standard method). The lower lip face mask placement with two hands reduced the air leak by 95% (80-100%). In edentulous patients with inadequate face mask ventilation, the lower lip face mask placement with two hands markedly reduced the air leak and improved ventilation.

A comprehensive evaluation of the toxicology resulting from laser-generated ventilation holes in cigarette filters.

PubMed

Coggins, Christopher R E; Merski, Jerome A; Oldham, Michael J

2013-01-01

Recent technological advances allow ventilation holes in (or adjacent to) cigarette filters to be produced using lasers instead of using the mechanical procedures of earlier techniques. Analytical chemistry can be used to compare the composition of mainstream smoke from experimental cigarettes having filters with mechanically produced ventilation holes to that of cigarettes with ventilation holes that were produced using laser technology. Established procedures were used to analyze the smoke composition of 38 constituents of mainstream smoke generated using standard conditions. There were no differences between the smoke composition of cigarettes with filter ventilation holes that were produced mechanically or through use of laser technology. The two methods for producing ventilation holes in cigarette filters are equivalent in terms of resulting mainstream smoke chemistry, at two quite different filter ventilation percentages.

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

Mendell, Mark J.; Apte, Mike G.

This report considers the question of whether the California Energy Commission should incorporate the ASHRAE 62.1 ventilation standard into the Title 24 ventilation rate (VR) standards, thus allowing buildings to follow the Indoor Air Quality Procedure. This, in contrast to the current prescriptive standard, allows the option of using ventilation rate as one of several strategies, which might include source reduction and air cleaning, to meet specified targets of indoor air concentrations and occupant acceptability. The research findings reviewed in this report suggest that a revised approach to a ventilation standard for commercial buildings is necessary, because the current prescriptivemore » ASHRAE 62.1 Ventilation Rate Procedure (VRP) apparently does not provide occupants with either sufficiently acceptable or sufficiently healthprotective air quality. One possible solution would be a dramatic increase in the minimum ventilation rates (VRs) prescribed by a VRP. This solution, however, is not feasible for at least three reasons: the current need to reduce energy use rather than increase it further, the problem of polluted outdoor air in many cities, and the apparent limited ability of increasing VRs to reduce all indoor airborne contaminants of concern (per Hodgson (2003)). Any feasible solution is thus likely to include methods of pollutant reduction other than increased outdoor air ventilation; e.g., source reduction or air cleaning. The alternative 62.1 Indoor Air Quality Procedure (IAQP) offers multiple possible benefits in this direction over the VRP, but seems too limited by insufficient specifications and inadequate available data to provide adequate protection for occupants. Ventilation system designers rarely choose to use it, finding it too arbitrary and requiring use of much non-engineering judgment and information that is not readily available. This report suggests strategies to revise the current ASHRAE IAQP to reduce its current limitations. These strategies, however, would make it more complex and more prescriptive, and would require substantial research. One practical intermediate strategy to save energy would be an alternate VRP, allowing VRs lower than currently prescribed, as long as indoor VOC concentrations were no higher than with VRs prescribed under the current VRP. This kind of hybrid, with source reduction and use of air cleaning optional but permitted, could eventually evolve, as data, materials, and air-cleaning technology allowed gradual lowering of allowable concentrations, into a fully developed IAQP. Ultimately, it seems that VR standards must evolve to resemble the IAQP, especially in California, where buildings must achieve zero net energy use within 20 years.« less

Overview of existing regulations for ventilation requirements of enclosed vehicular parking facilities

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

Krarti, M.; Ayari, A.M.

1999-07-01

This paper provides an overview of the current standards and regulations regarding the ventilation in enclosed parking facilities in the US and other countries. First, the paper discusses the emission rates of motor vehicle pollutants and their health effects. In particular, typical emission rates for different vehicle and fuel types are presented to highlight the effect of various parameters on the ventilation rate requirements for parking garages. In addition, the paper provides a brief description of some of the common ventilation problems reported in the literature for enclosed parking garages.

49 CFR 541.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 6 2010-10-01 2010-10-01 false Scope. 541.1 Section 541.1 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR VEHICLE THEFT PREVENTION STANDARD § 541.1 Scope. This standard...

7 CFR 3015.60 - Scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Standards for Financial Management Systems § 3015.60 Scope. This subpart contains standards for financial management systems of recipients. No additional financial... 7 Agriculture 15 2012-01-01 2012-01-01 false Scope. 3015.60 Section 3015.60 Agriculture...

7 CFR 3015.60 - Scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Standards for Financial Management Systems § 3015.60 Scope. This subpart contains standards for financial management systems of recipients. No additional financial... 7 Agriculture 15 2014-01-01 2014-01-01 false Scope. 3015.60 Section 3015.60 Agriculture...

7 CFR 3015.60 - Scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Standards for Financial Management Systems § 3015.60 Scope. This subpart contains standards for financial management systems of recipients. No additional financial... 7 Agriculture 15 2013-01-01 2013-01-01 false Scope. 3015.60 Section 3015.60 Agriculture...

7 CFR 3015.60 - Scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Standards for Financial Management Systems § 3015.60 Scope. This subpart contains standards for financial management systems of recipients. No additional financial... 7 Agriculture 15 2011-01-01 2011-01-01 false Scope. 3015.60 Section 3015.60 Agriculture...

Active-passive measurements and CFD based modelling for indoor radon dispersion study.

PubMed

Chauhan, Neetika; Chauhan, R P

2015-06-01

Computational fluid dynamics (CFD) play a significant role in indoor pollutant dispersion study. Radon is an indoor pollutant which is radioactive and inert gas in nature. The concentration level and spatial distribution of radon may be affected by the dwelling's ventilation conditions. Present work focus at the study of indoor radon gas distribution via measurement and CFD modeling in naturally ventilated living room. The need of the study is the prediction of activity level and to study the effect of natural ventilation on indoor radon. Two measurement techniques (Passive measurement using pin-hole dosimeters and active measurement using continuous radon monitor (SRM)) were used for the validation purpose of CFD results. The CFD simulation results were compared with the measurement results at 15 points, 3 XY planes at different heights along with the volumetric average concentration. The simulation results found to be comparable with the measurement results. The future scope of these CFD codes is to study the effect of varying inflow rate of air on the radon concentration level and dispersion pattern. Copyright © 2015 Elsevier Ltd. All rights reserved.

WE-AB-BRA-06: 4DCT-Ventilation: A Novel Imaging Modality for Thoracic Surgical Evaluation

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

Vinogradskiy, Y; Jackson, M; Schubert, L

Purpose: The current standard-of-care imaging used to evaluate lung cancer patients for surgical resection is nuclear-medicine ventilation. Surgeons use nuclear-medicine images along with pulmonary function tests (PFT) to calculate percent predicted postoperative (%PPO) PFT values by estimating the amount of functioning lung that would be lost with surgery. 4DCT-ventilation is an emerging imaging modality developed in radiation oncology that uses 4DCT data to calculate lung ventilation maps. We perform the first retrospective study to assess the use of 4DCT-ventilation for pre-operative surgical evaluation. The purpose of this work was to compare %PPO-PFT values calculated with 4DCT-ventilation and nuclear-medicine imaging. Methods:more » 16 lung cancer patients retrospectively reviewed had undergone 4DCTs, nuclear-medicine imaging, and had Forced Expiratory Volume in 1 second (FEV1) acquired as part of a standard PFT. For each patient, 4DCT data sets, spatial registration, and a density-change based model were used to compute 4DCT-ventilation maps. Both 4DCT and nuclear-medicine images were used to calculate %PPO-FEV1 using %PPO-FEV1=pre-operative FEV1*(1-fraction of total ventilation of resected lung). Fraction of ventilation resected was calculated assuming lobectomy and pneumonectomy. The %PPO-FEV1 values were compared between the 4DCT-ventilation-based calculations and the nuclear-medicine-based calculations using correlation coefficients and average differences. Results: The correlation between %PPO-FEV1 values calculated with 4DCT-ventilation and nuclear-medicine were 0.81 (p<0.01) and 0.99 (p<0.01) for pneumonectomy and lobectomy respectively. The average difference between the 4DCT-ventilation based and the nuclear-medicine-based %PPO-FEV1 values were small, 4.1±8.5% and 2.9±3.0% for pneumonectomy and lobectomy respectively. Conclusion: The high correlation results provide a strong rationale for a clinical trial translating 4DCT-ventilation to the surgical domain. Compared to nuclear-medicine, 4DCT-ventilation is cheaper, does not require a radioactive contrast agent, provides a faster imaging procedure, and has improved spatial resolution. 4DCT-ventilation can reduce the cost and imaging time for patients while providing improved spatial accuracy and quantitative results for surgeons. YV discloses grant from State of Colorado.« less

Tracheostomy and invasive mechanical ventilation in amyotrophic lateral sclerosis: decision-making factors and survival analysis.

PubMed

Kimura, Fumiharu

2016-04-28

Invasive and/or non-invasive mechanical ventilation are most important options of respiratory management in amyotrophic lateral sclerosis. We evaluated the frequency, clinical characteristics, decision-making factors about ventilation and survival analysis of 190 people with amyotrophic lateral sclerosis patients from 1990 until 2013. Thirty-one percentage of patients underwent tracheostomy invasive ventilation with the rate increasing more than the past 20 years. The ratio of tracheostomy invasive ventilation in patients >65 years old was significantly increased after 2000 (25%) as compared to before (10%). After 2010, the standard use of non-invasive ventilation showed a tendency to reduce the frequency of tracheostomy invasive ventilation. Mechanical ventilation prolonged median survival (75 months in tracheostomy invasive ventilation, 43 months in non-invasive ventilation vs natural course, 32 months). The life-extending effects by tracheostomy invasive ventilation were longer in younger patients ≤65 years old at the time of ventilation support than in older patients. Presence of partners and care at home were associated with better survival. Following factors related to the decision to perform tracheostomy invasive ventilation: patients ≤65 years old: greater use of non-invasive ventilation: presence of a spouse: faster tracheostomy: higher progression rate; and preserved motor functions. No patients who underwent tracheostomy invasive ventilation died from a decision to withdraw mechanical ventilation. The present study provides factors related to decision-making process and survival after tracheostomy and help clinicians and family members to expand the knowledge about ventilation.

Tracheal intubation in the ice-pick position with video laryngoscopes: a randomised controlled trial in a manikin.

PubMed

Wetsch, Wolfgang A; Hellmich, Martin; Spelten, Oliver; Schier, Robert; Böttiger, Bernd W; Hinkelbein, Jochen

2013-09-01

Tracheal intubation in nonstandardised positions is associated with a higher risk of tube misplacement and may have deleterious consequences for patients. Video laryngoscopes for tracheal intubation facilitate both glottic view and success rates. However, their use in the ice-pick position has not been evaluated. To evaluate the role of video laryngoscopes for tracheal intubation in the ice-pick position. A randomised, controlled manikin trial. A standardised airway manikin was placed in the corner of a room. Tracheal intubation was only possible from the lower right side of the manikin. In randomised order, participants used a standard Macintosh laryngoscope and GlideScope Ranger, Storz C-MAC, Pentax AWS, Airtraq and McGrath Series5 video laryngoscopes. Statistical analysis was performed using the Wilcoxon signed-rank and McNemar's tests; A P value of less than 0.05 was deemed statistically significant. Twenty anaesthesiologists, all emergency medicine board-certified. Time to first ventilation (primary); time to glottic view and confirmation of tube position (secondary). Successful ventilation was achieved most rapidly with the Macintosh laryngoscope (36.1 ± 13.4 s; reference method), followed by the Airtraq (38.4 ± 36.3 s; P = n.s.), Pentax AWS (51.6 ± 43.3 s; P = n.s.) and Storz C-Mac (62.7 ± 49.7 s; P = n.s.). The use of the GlideScope Ranger (79.8 ± 61.9 s, P = 0.01) and McGrath series5 (79.8 ± 58.5 s, P = 0.023) resulted in significantly longer times. When comparing overall intubation success, the rate of successful tracheal intubation was higher with the Airtraq than with the McGrath Series5 (P = 0.031; all others n.s.). The use of video laryngoscopes did not result in higher success rates or faster tracheal intubation in the ice-pick position when compared with conventional laryngoscopy in this manikin study. www.clinicaltrials.gov, NCT01210105.

40 CFR 262.103 - What is the scope of the laboratory environmental management standard?

Code of Federal Regulations, 2010 CFR

2010-07-01

... University Laboratories XL Project-Laboratory Environmental Management Standard § 262.103 What is the scope of the laboratory environmental management standard? The Laboratory Environmental Management Standard... environmental management standard? 262.103 Section 262.103 Protection of Environment ENVIRONMENTAL PROTECTION...

Music interventions for mechanically ventilated patients.

PubMed

Bradt, Joke; Dileo, Cheryl; Grocke, Denise

2010-12-08

Mechanical ventilation often causes major distress and anxiety in patients. Music interventions have been used to reduce anxiety and distress and improve physiological functioning in medical patients; however its efficacy for mechanically ventilated patients needs to be evaluated. To examine the effects of music interventions with standard care versus standard care alone on anxiety and physiological responses in mechanically ventilated patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1), MEDLINE, CINAHL, AMED, EMBASE, PsycINFO, LILACS, Science Citation Index, www.musictherapyworld.net, CAIRSS for Music, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the National Research Register, and NIH CRISP (all to January 2010). We handsearched music therapy journals and reference lists and contacted relevant experts to identify unpublished manuscripts. There was no language restriction. We included all randomized and quasi-randomized controlled trials that compared music interventions and standard care with standard care alone for mechanically ventilated patients. Two authors independently extracted the data and assessed the methodological quality. Additional information was sought from the trial researchers, when necessary. Results were presented using mean differences for outcomes measured by the same scale and standardized mean differences for outcomes measured by different scales. Post-test scores were used. In cases of significant baseline difference, we used change scores. We included eight trials (213 participants). Music listening was the main intervention used, and seven of the studies did not include a trained music therapist. Results indicated that music listening may be beneficial for anxiety reduction in mechanically ventilated patients; however, these results need to be interpreted with caution due to the small sample size. Findings indicated that listening to music consistently reduced heart rate and respiratory rate, suggesting a relaxation response. No strong evidence was found for blood pressure reduction.Music listening did not improve oxygen saturation level.No studies could be found that examined the effects of music interventions on quality of life, patient satisfaction, post-discharge outcomes, mortality, or cost-effectiveness. Music listening may have a beneficial effect on heart rate, respiratory rate, and anxiety in mechanically ventilated patients. However, the quality of the evidence is not strong. Most studies examined the effects of listening to pre-recorded music. More research is needed on the effects of music offered by a trained music therapist.

Shortening the length of stay and mechanical ventilation time by using positive suggestions via MP3 players for ventilated patients.

PubMed

K Szilágyi, Adrienn; Diószeghy, Csaba; Fritúz, Gábor; Gál, János; Varga, Katalin

2014-03-01

Long stay in intensive care unit (ICU) and prolonged ventilation are deleterious for subsequent quality of life and surcharge financial capacity. We have already demonstrated the beneficial effects of using suggestive communication on recovery time during intensive care. The aim of our present study was to prove the same effects with standardized positive suggestive message delivered by an MP3 player. Patients ventilated in ICU were randomized into a control group receiving standard ICU treatment and two groups with a standardized pre-recorded material delivered via headphones: a suggestive message about safety, self-control, and recovery for the study group and a relaxing music for the music group. Groups were similar in terms of age, gender, and mortality, but the SAPS II scores were higher in the study group than that in the controls (57.8 ± 23.6 vs. 30.1 ± 15.5 and 33.7 ± 17.4). Our post-hoc analysis results showed that the length of ICU stay (134.2 ± 73.3 vs. 314.2 ± 178.4 h) and the time spent on ventilator (85.2 ± 34.9 vs. 232.0 ± 165.6 h) were significantly shorter in the study group compared to the unified control. The advantage of the structured positive suggestive message was proven against both music and control groups.

Shortening the length of stay and mechanical ventilation time by using positive suggestions via MP3 players for ventilated patients

PubMed Central

Diószeghy, Csaba; Fritúz, Gábor; Gál, János; Varga, Katalin

2014-01-01

Long stay in intensive care unit (ICU) and prolonged ventilation are deleterious for subsequent quality of life and surcharge financial capacity. We have already demonstrated the beneficial effects of using suggestive communication on recovery time during intensive care. The aim of our present study was to prove the same effects with standardized positive suggestive message delivered by an MP3 player. Patients ventilated in ICU were randomized into a control group receiving standard ICU treatment and two groups with a standardized pre-recorded material delivered via headphones: a suggestive message about safety, self-control, and recovery for the study group and a relaxing music for the music group. Groups were similar in terms of age, gender, and mortality, but the SAPS II scores were higher in the study group than that in the controls (57.8 ± 23.6 vs. 30.1 ± 15.5 and 33.7 ± 17.4). Our post-hoc analysis results showed that the length of ICU stay (134.2 ± 73.3 vs. 314.2 ± 178.4 h) and the time spent on ventilator (85.2 ± 34.9 vs. 232.0 ± 165.6 h) were significantly shorter in the study group compared to the unified control. The advantage of the structured positive suggestive message was proven against both music and control groups. PMID:24672669

The ventilation problem in schools: literature review

DOE PAGES

Fisk, W. J.

2017-07-06

Based on a review of literature published in refereed archival journals, ventilation rates in classrooms often fall far short of the minimum ventilation rates specified in standards. We report that there is compelling evidence, from both cross-sectional and intervention studies, of an association of increased student performance with increased ventilation rates. There is evidence that reduced respiratory health effects and reduced student absence are associated with increased ventilation rates. Increasing ventilation rates in schools imposes energy costs and can increase heating, ventilating, and air-conditioning system capital costs. The net annual costs, ranging from a few dollars to about 10 dollarsmore » per person, are less than 0.1% of typical public spending on elementary and secondary education in the United States. Finally, such expenditures seem like a small price to pay given the evidence of health and performance benefits.« less

The ventilation problem in schools: literature review

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

Fisk, W. J.

Based on a review of literature published in refereed archival journals, ventilation rates in classrooms often fall far short of the minimum ventilation rates specified in standards. We report that there is compelling evidence, from both cross-sectional and intervention studies, of an association of increased student performance with increased ventilation rates. There is evidence that reduced respiratory health effects and reduced student absence are associated with increased ventilation rates. Increasing ventilation rates in schools imposes energy costs and can increase heating, ventilating, and air-conditioning system capital costs. The net annual costs, ranging from a few dollars to about 10 dollarsmore » per person, are less than 0.1% of typical public spending on elementary and secondary education in the United States. Finally, such expenditures seem like a small price to pay given the evidence of health and performance benefits.« less

Validating and improving CT ventilation imaging by correlating with ventilation 4D-PET/CT using {sup 68}Ga-labeled nanoparticles

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

Kipritidis, John, E-mail: john.kipritidis@sydney.edu.au; Keall, Paul J.; Siva, Shankar

Purpose: CT ventilation imaging is a novel functional lung imaging modality based on deformable image registration. The authors present the first validation study of CT ventilation using positron emission tomography with{sup 68}Ga-labeled nanoparticles (PET-Galligas). The authors quantify this agreement for different CT ventilation metrics and PET reconstruction parameters. Methods: PET-Galligas ventilation scans were acquired for 12 lung cancer patients using a four-dimensional (4D) PET/CT scanner. CT ventilation images were then produced by applying B-spline deformable image registration between the respiratory correlated phases of the 4D-CT. The authors test four ventilation metrics, two existing and two modified. The two existing metricsmore » model mechanical ventilation (alveolar air-flow) based on Hounsfield unit (HU) change (V{sub HU}) or Jacobian determinant of deformation (V{sub Jac}). The two modified metrics incorporate a voxel-wise tissue-density scaling (ρV{sub HU} and ρV{sub Jac}) and were hypothesized to better model the physiological ventilation. In order to assess the impact of PET image quality, comparisons were performed using both standard and respiratory-gated PET images with the former exhibiting better signal. Different median filtering kernels (σ{sub m} = 0 or 3 mm) were also applied to all images. As in previous studies, similarity metrics included the Spearman correlation coefficient r within the segmented lung volumes, and Dice coefficient d{sub 20} for the (0 − 20)th functional percentile volumes. Results: The best agreement between CT and PET ventilation was obtained comparing standard PET images to the density-scaled HU metric (ρV{sub HU}) with σ{sub m} = 3 mm. This leads to correlation values in the ranges 0.22 ⩽ r ⩽ 0.76 and 0.38 ⩽ d{sub 20} ⩽ 0.68, with r{sup ¯}=0.42±0.16 and d{sup ¯}{sub 20}=0.52±0.09 averaged over the 12 patients. Compared to Jacobian-based metrics, HU-based metrics lead to statistically significant improvements in r{sup ¯} and d{sup ¯}{sub 20} (p < 0.05), with density scaled metrics also showing higher r{sup ¯} than for unscaled versions (p < 0.02). r{sup ¯} and d{sup ¯}{sub 20} were also sensitive to image quality, with statistically significant improvements using standard (as opposed to gated) PET images and with application of median filtering. Conclusions: The use of modified CT ventilation metrics, in conjunction with PET-Galligas and careful application of image filtering has resulted in improved correlation compared to earlier studies using nuclear medicine ventilation. However, CT ventilation and PET-Galligas do not always provide the same functional information. The authors have demonstrated that the agreement can improve for CT ventilation metrics incorporating a tissue density scaling, and also with increasing PET image quality. CT ventilation imaging has clear potential for imaging regional air volume change in the lung, and further development is warranted.« less

29 CFR 1910.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 5 2010-07-01 2010-07-01 false Purpose and scope. 1910.1 Section 1910.1 Labor Regulations... consensus standard, and any established Federal standard, unless he determines that the promulgation of such... national consensus standards or established Federal standards. ...

10 CFR 435.301 - Scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Scope. 435.301 Section 435.301 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY EFFICIENCY STANDARDS FOR NEW FEDERAL LOW-RISE RESIDENTIAL BUILDINGS Mandatory Energy Efficiency Standards for Federal Residential Buildings § 435.301 Scope. (a) The energy...

10 CFR 435.301 - Scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Scope. 435.301 Section 435.301 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY EFFICIENCY STANDARDS FOR NEW FEDERAL LOW-RISE RESIDENTIAL BUILDINGS Mandatory Energy Efficiency Standards for Federal Residential Buildings § 435.301 Scope. (a) The energy...

Hospital ventilation standards and energy conservation: a summary of the literature with conclusions and recommendations. Final report, FY 78

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

Hollowell, C.; Rosenfeld, A.

1978-09-01

This research examines the basis of current hospital HVAC standards and determines if they can be relaxed on criteria that do not compromise the health, safety, and comfort of patients and staff and has acceptance of the health care community. Chapter 2 summarizes existing standards in use throughout the United States governing hospital ventilation systems and the thermal environment. Chapter 3 explores the role of air in hospital-acquired infections. Chapter 4 explores the realm of indoor air quality within the hospital. Chapter 5 contains a discussion concerning the influence of thermal factors on patient comfort. Chapter 6 discusses the hospitalmore » odor problem with regards to ventilation rates. The final chapter includes conclusions and recommendations developed from the literature review and from a small working conference sponsored by the University of Minnesota School of Public Health.« less

46 CFR 28.340 - Ventilation of enclosed engine and fuel tank spaces.

Code of Federal Regulations, 2010 CFR

2010-10-01

... prevent the entrapment of vapors or be ventilated by a mechanical exhaust system with a nonsparking fan. The fan motor must comply with 46 CFR 111.105-23. (c) Alternative standards. A vessel less than 65...

Randomised comparison of two neonatal resuscitation bags in manikin ventilation.

PubMed

Thallinger, Monica; Ersdal, Hege Langli; Ombay, Crescent; Eilevstjønn, Joar; Størdal, Ketil

2016-07-01

To compare ventilation properties and user preference of a new upright neonatal resuscitator developed for easier cleaning, reduced complexity, and possibly improved ventilation properties, with the standard Laerdal neonatal resuscitator. Eighty-seven Tanzanian and Norwegian nursing and medical students without prior knowledge of newborn resuscitation were briefly trained in bag-mask ventilation. The two resuscitators were used in random order on a manikin connected to a test lung with normal or low lung compliance. Data were collected with the Laerdal Newborn Resuscitation Monitor. The students graded mask seal and ease of air entry on a four-point scale ranging from 1 ('difficult') to 4 ('easy') and stated which device they preferred. (Equipment from Laerdal Global Health and Laerdal Medical). For upright versus standard resuscitator and normal lung compliance, mean expiratory lung volume was 15.5 mL vs 13.9 mL (p=0.001), mean mask leakage 48% vs 58% (p<0.001), and mean airway pressure 20 cm H2O vs 19 cm H2O (p=0.003), respectively. For low lung compliance, mean expiratory lung volume was 8.6 mL vs 8.1 mL (p=0.045), mean mask leakage 53% vs 62% (p<0.001), and mean airway pressure 21 cm H2O vs 20 cm H2O (p=0.004) for upright versus standard. The upright resuscitator was preferred by 82% and 68% of students during ventilation with normal and low lung compliance, respectively (p=0.001). Expiratory volumes were higher, mask leakage lower, and mean airway pressure slightly higher with upright versus standard resuscitator when ventilating a manikin. The majority of students preferred the upright resuscitator. 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/

16 CFR 1207.1 - Scope, purpose, and findings.

Code of Federal Regulations, 2010 CFR

2010-01-01

... SAFETY STANDARD FOR SWIMMING POOL SLIDES § 1207.1 Scope, purpose, and findings. (a) Scope and purpose... Commission for the manufacture and construction of slides for use in swimming pools. The requirements of this... swimming pool slides. This standard also makes certain recommendations regarding the installation...

Energy Use Consequences of Ventilating a Net-Zero Energy House

PubMed Central

Ng, Lisa C.; Payne, W. Vance

2016-01-01

A Net-Zero Energy Residential Test Facility (NZERTF) has been constructed at the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland to demonstrate that a home similar in size, aesthetics, and amenities to those in the surrounding communities can achieve net-zero energy use over the course of a year while meeting the average electricity and water use needs of a family of four in the United States. The facility incorporates renewable energy and energy efficient technologies, including an air-to-air heat pump system, a solar photovoltaic system, a solar thermal domestic hot water system, and a heat recovery ventilation system sized to meet American Society of Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE) Standard 62.2-2010 ventilation requirements. The largest energy end use within the home was space conditioning, which included heat loss through the building envelope, ventilation air supplied by the heat recovery ventilator (HRV), and internal loads. While HRVs are often described as being able to save energy when compared to ventilating without heat recovery, there have been no studies using a full year of measured data that determine the thermal load and energy impacts of HRV-based ventilation on the central heating and cooling system. Over the course of a year, continuous operation of the HRV at the NZERTF resulted in an annual savings of 7 % in heat pump energy use compared with the hypothetical case of ventilating without heat recovery. The heat pump electrical use varied from an increase of 5 % in the cooling months to 36 % savings in the heating months compared with ventilation without heat recovery. The increase in the cooling months occurred when the outdoor temperature was lower than the indoor temperature, during which the availability of an economizer mode would have been beneficial. Nevertheless, the fan energy required to operate the selected HRV at the NZERTF paid for itself in the heat pump energy saved compared with ventilation without heat recovery. PMID:26903776

Energy Use Consequences of Ventilating a Net-Zero Energy House.

PubMed

Ng, Lisa C; Payne, W Vance

2016-03-05

A Net-Zero Energy Residential Test Facility (NZERTF) has been constructed at the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland to demonstrate that a home similar in size, aesthetics, and amenities to those in the surrounding communities can achieve net-zero energy use over the course of a year while meeting the average electricity and water use needs of a family of four in the United States. The facility incorporates renewable energy and energy efficient technologies, including an air-to-air heat pump system, a solar photovoltaic system, a solar thermal domestic hot water system, and a heat recovery ventilation system sized to meet American Society of Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE) Standard 62.2-2010 ventilation requirements. The largest energy end use within the home was space conditioning, which included heat loss through the building envelope, ventilation air supplied by the heat recovery ventilator (HRV), and internal loads. While HRVs are often described as being able to save energy when compared to ventilating without heat recovery, there have been no studies using a full year of measured data that determine the thermal load and energy impacts of HRV-based ventilation on the central heating and cooling system. Over the course of a year, continuous operation of the HRV at the NZERTF resulted in an annual savings of 7 % in heat pump energy use compared with the hypothetical case of ventilating without heat recovery. The heat pump electrical use varied from an increase of 5 % in the cooling months to 36 % savings in the heating months compared with ventilation without heat recovery. The increase in the cooling months occurred when the outdoor temperature was lower than the indoor temperature, during which the availability of an economizer mode would have been beneficial. Nevertheless, the fan energy required to operate the selected HRV at the NZERTF paid for itself in the heat pump energy saved compared with ventilation without heat recovery.

16 CFR § 1611.1 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... FOR THE FLAMMABILITY OF VINYL PLASTIC FILM The Standard § 1611.1 Purpose and scope. The purpose of this standard is to promulgate a minimum standard for flammability of vinyl plastic film which are...

30 CFR 828.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PERFORMANCE STANDARDS SPECIAL PERMANENT PROGRAM PERFORMANCE STANDARDS-IN SITU PROCESSING § 828.1 Scope. This part sets forth special environmental protection performance, reclamation and design standards for in situ processing activities. [44 FR 15455, Mar. 13, 1979] ...

30 CFR 828.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PERFORMANCE STANDARDS SPECIAL PERMANENT PROGRAM PERFORMANCE STANDARDS-IN SITU PROCESSING § 828.1 Scope. This part sets forth special environmental protection performance, reclamation and design standards for in situ processing activities. [44 FR 15455, Mar. 13, 1979] ...

30 CFR 828.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PERFORMANCE STANDARDS SPECIAL PERMANENT PROGRAM PERFORMANCE STANDARDS-IN SITU PROCESSING § 828.1 Scope. This part sets forth special environmental protection performance, reclamation and design standards for in situ processing activities. [44 FR 15455, Mar. 13, 1979] ...

30 CFR 828.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PERFORMANCE STANDARDS SPECIAL PERMANENT PROGRAM PERFORMANCE STANDARDS-IN SITU PROCESSING § 828.1 Scope. This part sets forth special environmental protection performance, reclamation and design standards for in situ processing activities. [44 FR 15455, Mar. 13, 1979] ...

Field and Laboratory Testing of Approaches to Smart Whole-House Mechanical Ventilation Control

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

Martin, Eric; Fenaughty, Karen; Parker, Danny

Whole-house mechanical ventilation is a critical component to a comprehensive strategy for good indoor air quality (IAQ). However, due to lack of integration with standard heating and cooling systems, and perceptions from a portion of the homebuilding industry about risks related to increased energy use, increased cost, and decreased comfort, voluntary and code-required adoption varies among regions. Smart ventilation controls (SVC) balance energy consumption, comfort, and IAQ by optimizing mechanical ventilation operation to reduce the heating and/or cooling loads, improve management of indoor moisture, and maintain IAQ equivalence according to ASHRAE 62.2.

Field and Laboratory Testing of Approaches to Smart Whole-House Mechanical Ventilation Control

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

Martin, Eric; Fenaughty, Karen; Parker, Danny

Whole-house mechanical ventilation is a critical component to a comprehensive strategy for good indoor air quality (IAQ). However, due to lack of integration with standard heating and cooling systems, and perceptions from a portion of the homebuilding industry about risks related to increased energy use, increased cost, and decreased comfort, voluntary and code-required adoption varies amongst regions. Smart ventilation controls (SVC) balance energy consumption, comfort, and IAQ by optimizing mechanical ventilation operation to reduce the heating and/or cooling loads, improve management of indoor moisture, and maintain IAQ equivalence according to ASHRAE 62.2.

Improving Patient Safety with X-Ray and Anesthesia Machine Ventilator Synchronization: A Medical Device Interoperability Case Study

NASA Astrophysics Data System (ADS)

Arney, David; Goldman, Julian M.; Whitehead, Susan F.; Lee, Insup

When a x-ray image is needed during surgery, clinicians may stop the anesthesia machine ventilator while the exposure is made. If the ventilator is not restarted promptly, the patient may experience severe complications. This paper explores the interconnection of a ventilator and simulated x-ray into a prototype plug-and-play medical device system. This work assists ongoing interoperability framework development standards efforts to develop functional and non-functional requirements and illustrates the potential patient safety benefits of interoperable medical device systems by implementing a solution to a clinical use case requiring interoperability.

Variable tidal volumes improve lung protective ventilation strategies in experimental lung injury.

PubMed

Spieth, Peter M; Carvalho, Alysson R; Pelosi, Paolo; Hoehn, Catharina; Meissner, Christoph; Kasper, Michael; Hübler, Matthias; von Neindorff, Matthias; Dassow, Constanze; Barrenschee, Martina; Uhlig, Stefan; Koch, Thea; de Abreu, Marcelo Gama

2009-04-15

Noisy ventilation with variable Vt may improve respiratory function in acute lung injury. To determine the impact of noisy ventilation on respiratory function and its biological effects on lung parenchyma compared with conventional protective mechanical ventilation strategies. In a porcine surfactant depletion model of lung injury, we randomly combined noisy ventilation with the ARDS Network protocol or the open lung approach (n = 9 per group). Respiratory mechanics, gas exchange, and distribution of pulmonary blood flow were measured at intervals over a 6-hour period. Postmortem, lung tissue was analyzed to determine histological damage, mechanical stress, and inflammation. We found that, at comparable minute ventilation, noisy ventilation (1) improved arterial oxygenation and reduced mean inspiratory peak airway pressure and elastance of the respiratory system compared with the ARDS Network protocol and the open lung approach, (2) redistributed pulmonary blood flow to caudal zones compared with the ARDS Network protocol and to peripheral ones compared with the open lung approach, (3) reduced histological damage in comparison to both protective ventilation strategies, and (4) did not increase lung inflammation or mechanical stress. Noisy ventilation with variable Vt and fixed respiratory frequency improves respiratory function and reduces histological damage compared with standard protective ventilation strategies.

Scope It Out: What's In and What's Out.

PubMed

Price, M Greta

It has been nearly a year since the third edition of the Nursing Professional Development: Scope and Standards of Practice was released. During that time, many nursing professional development (NPD) departments across the nation have incorporated this foundational document into their practice. This column describes the activities of one NPD department to align their scope of practice with the NPD scope and standards and optimize their contributions to their organization.

10 CFR 1015.300 - Scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Scope. 1015.300 Section 1015.300 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) COLLECTION OF CLAIMS OWED THE UNITED STATES Standards for the Compromise of Claims § 1015.300 Scope. This subpart sets forth the standards for the compromise of claims under this...

48 CFR 30.000 - Scope of part.

Code of Federal Regulations, 2011 CFR

2011-10-01

... REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION 30.000 Scope of part. This part describes policies and procedures for applying the Cost Accounting Standards Board (CASB) rules and regulations (48 CFR chapter 99... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Scope of part. 30.000...

49 CFR 525.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OF TRANSPORTATION EXEMPTIONS FROM AVERAGE FUEL ECONOMY STANDARDS § 525.1 Scope. This part establishes... automobiles to exempt them from the average fuel economy standards for passenger automobiles and to establish alternative average fuel economy standards for those manufacturers. ...

49 CFR 525.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... OF TRANSPORTATION EXEMPTIONS FROM AVERAGE FUEL ECONOMY STANDARDS § 525.1 Scope. This part establishes... automobiles to exempt them from the average fuel economy standards for passenger automobiles and to establish alternative average fuel economy standards for those manufacturers. ...

16 CFR 1611.1 - Purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... FLAMMABILITY OF VINYL PLASTIC FILM The Standard § 1611.1 Purpose and scope. The purpose of this standard is to promulgate a minimum standard for flammability of vinyl plastic film which are subject to the requirements of...

16 CFR 1611.1 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... FLAMMABILITY OF VINYL PLASTIC FILM The Standard § 1611.1 Purpose and scope. The purpose of this standard is to promulgate a minimum standard for flammability of vinyl plastic film which are subject to the requirements of...

16 CFR 1611.1 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... FLAMMABILITY OF VINYL PLASTIC FILM The Standard § 1611.1 Purpose and scope. The purpose of this standard is to promulgate a minimum standard for flammability of vinyl plastic film which are subject to the requirements of...

16 CFR 1611.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... FLAMMABILITY OF VINYL PLASTIC FILM The Standard § 1611.1 Purpose and scope. The purpose of this standard is to promulgate a minimum standard for flammability of vinyl plastic film which are subject to the requirements of...

[Statement of the Association of Pneumological Clinics and the German Respiratory Society on the coding of invasive and non-invasive ventilation in intensity care].

PubMed

2013-07-01

Mechanical ventilation in patients with respiratory failure represents one of the most important aspects of intensity care. It can be performed invasively and non-invasively depending on the clinical situation and the underlying disease. The expenditure and consumption of resources is the basis of the compensation for each patient case in the German diagnosis related group system. For ventilated patients it is calculated based on the hours of ventilation, according to the standard coding guideline. In this statement, the German Respiratory Society and the Association of Pneumological Clinics aim to clarify some aspects of the coding of invasive and non-invasive ventilation. © Georg Thieme Verlag KG Stuttgart · New York.

[Spontaneous positive end-expiratory pressure ventilation in elderly patients with cardiogenic pulmonary edema. Assessment in an emergency admissions unit].

PubMed

L'Her, E; Duquesne, F; Paris, A; Mouline, J; Renault, A; Garo, B; Boles, J M

1998-06-20

Intubation and ventilatory assistance are often required in patients presenting severe hypoxemic respiratory distress, but may be contraindicated in elderly subjects due to an underlying condition. The aim of this study was to assess the feasibility, acceptability and contribution of early assistance with spontaneous positive end-expiratory pressure ventilation for elderly subjects admitted to an emergency unit for acute respiratory distress due to cardiogenic pulmonary edema. In our emergency admission unit, all patients with life-threatening hypoxemic respiratory distress are initially assisted with noninvasive spontaneous positive end-expiratory pressure ventilation using a standardized commercial device. We retrospectively analyzed the the files of all patients aged over 70 years who were treated with this standard protocol for cardiogenic pulmonary edema from April 1996 through September 1997. During the study period, 36 patients aged over 70 years required ventilatory assistance according to the standard protocol. Intubation was not reasonable in most of the patients (n = 30). After 1 hour of ventilation, none of the patients developed clinical signs of life-threatening distress. Blood gases demonstrated improved oxygenation (AEPO2 = +184.9 +/- 105.4 mmHg; p < 0.000001). Thirty-two patients were considered to be cured (88.9%) and were discharged; the cardiovascular condition was fatal in 4 patients (11.1%). The rapid improvement in clinical signs and blood gases as well as the final outcome suggests that early assistance with spontaneous positive end-expiratory pressure ventilation is warranted at admission for elderly patients with respiratory distress due to cardiogenic pulmonary edema. Compared with a control group of hospitalized patients cared for during the preceding year and who were not treated with the standard protocol, we also demonstrated a clear improvement in mortality (11% versus 20%).

The use of a modified technique to reduce radioactive air contamination in aerosol lung ventilation imaging.

PubMed

Avison, M; Hart, G

2001-06-01

The aim of this study was to reduce airborne contamination resulting from the use of aerosols in lung ventilation scintigraphy. Lung ventilation imaging is frequently performed with 99mTc-diethylenetriaminepentaacetate aerosol (DTPA), derived from a commercial nebuliser. Airborne contamination is a significant problem with this procedure; it results in exposure of staff to radiation and can reduce gamma camera performance when the ventilation is performed in the camera room. We examined the level of airborne contamination resulting from the standard technique with one of the most popular nebuliser kits and tested a modification which significantly reduced airborne contamination. Air contamination was measured while ventilating 122 patients. The modified technique reduced air contamination by a mean value of 64% (p = 0.028) compared with the standard control technique. Additionally, differences in contamination were examined when a mask or mouthpiece was used as well as differences between operators. A simplified method of monitoring air contamination is presented using a commonly available surface contamination monitor. The index so derived was proportional to air contamination (r = 0.88). The problems and regulations associated with airborne contamination are discussed.

Comparison of three humidifiers during high-frequency percussive ventilation using the VDR-4® Fail-safe Breathing Circuit Hub.

PubMed

Tiffin, Norman H; Short, Kathy A; Jones, Samuel W; Cairns, Bruce A

2011-01-01

The VDR-4® high-frequency percussive ventilator (HFPV) has been shown to be beneficial in the management of inhalation injury by improving secretion clearance while maintaining oxygenation and ventilation. Delivery of gas flow during HFPV could lack adequate humidification delivered to the patient because a major portion of the delivered gas flow would bypass the humidifier when using the original VDR-4® ventilator circuit. The authors tested a novel inline vaporizing humidifier and two gas-water interface humidifiers during HFPV using the new VDR-4® Fail-safe Breathing Circuit Hub® to determine whether delivered humidification could be improved. This new humidification system, the Hydrate Omni™, delivers water vapor into the gas flow of the ventilator circuit rather than water droplets as delivered by the gas-water interface humidifiers. Measurements of absolute humidity and gas temperature were made on the three different humidification systems using a test lung model under standard ambient conditions. The authors found that when using the novel inline vaporizer, it provided better humidification when compared with the standard gas-water interface humidifier during HFPV using the new VDR-4® breathing circuit.

Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents.

PubMed

Kozlowski, L T; O'Connor, R J

2002-03-01

To review tobacco industry documents on filter ventilation in light of published studies and to explore the role of filter ventilation in the design of cigarettes that deliver higher smoke yields to smokers than would be expected from standard machine smoked tests (Federal Trade Commission (FTC), International Organization for Standardization (ISO)). Searched from November 1999 to November 2000 internet databases of industry documents (www.pmdocs.com, www.rjrtdocs.com, www.lorillarddocs.com, www.bw.aalatg.com, www.cdc.gov/tobacco/industrydocs, www.tobaccodocuments.org, www.tobaccopapers.org, www.hlth.gov.bc.ca/Guildford, www.cctc.ca/ncth/Guildford, www.cctc.ca/ncth/Guildford2) for documents related to filter ventilation. Documents found dated from 1955 through 1994. Those documents judged to contain the most relevant information or data on filter ventilation related to cigarette taste and compensatory smoking, while also trying to avoid redundancy from various documents deriving from the same underlying data. Filter ventilation is a crucial design feature creating three main problems for lower tar cigarettes as measured by official smoking machine testing. Firstly, it misleadingly makes cigarettes taste lighter and milder, and, therefore, they appear less dangerous to smokers. Secondly, it promotes compensation mainly by facilitating the taking of larger puffs. Thirdly, for very heavily ventilated cigarettes (that is, > 65% filter air dilution), behavioural blocking of vents with lips or fingers is an additional contributor to compensatory smoking. These three effects are found in industry research as well as published research. Filter ventilation is a dangerous, defective technology that should be abandoned in less hazardous nicotine delivery systems. Health interested groups should test cigarettes in a way that reflects compensatory smoking. Lower tar (vented filter) cigarettes should be actively countermarketed.

Efficacy of respiratory muscle training in weaning of mechanical ventilation in patients with mechanical ventilation for 48hours or more: A Randomized Controlled Clinical Trial.

PubMed

Sandoval Moreno, L M; Casas Quiroga, I C; Wilches Luna, E C; García, A F

2018-02-02

To evaluate the efficacy of respiratory muscular training in the weaning of mechanical ventilation and respiratory muscle strength in patients on mechanical ventilation of 48hours or more. Randomized controlled trial of parallel groups, double-blind. Ambit: Intensive Care Unit of a IV level clinic in the city of Cali. 126 patients in mechanical ventilation for 48hours or more. The experimental group received daily a respiratory muscle training program with treshold, adjusted to 50% of maximal inspiratory pressure, additional to standard care, conventional received standard care of respiratory physiotherapy. MAIN INTEREST VARIABLES: weaning of mechanical ventilation. Other variables evaluated: respiratory muscle strength, requirement of non-invasive mechanical ventilation and frequency of reintubation. intention-to-treat analysis was performed with all variables evaluated and analysis stratified by sepsis condition. There were no statistically significant differences in the median weaning time of the MV between the groups or in the probability of extubation between groups (HR: 0.82 95% CI: 0.55-1.20 P=.29). The maximum inspiratory pressure was increased in the experimental group on average 9.43 (17.48) cmsH20 and in the conventional 5.92 (11.90) cmsH20 (P=.48). The difference between the means of change in maximal inspiratory pressure was 0.46 (P=.83 95%CI -3.85 to -4.78). respiratory muscle training did not demonstrate efficacy in the reduction of the weaning period of mechanical ventilation nor in the increase of respiratory muscle strength in the study population. Registered study at ClinicalTrials.gov (NCT02469064). Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Ventilation of Welding Fumes in Vocational Agriculture Laboratories in Missouri.

ERIC Educational Resources Information Center

Carr, Brenda; And Others

1982-01-01

This study was intended to measure the effectiveness of ventilation systems in removing airborne contaminants produced by arc welding in vocational agriculture laboratories in Missouri. It was found that most schools did not meet the minimum Occupational Safety and Health Administration standards. (SK)

Healthy Zero Energy Buildings (HZEB) Program - Cross-Sectional Study of Contaminant Levels, Source, Strengths, and Ventilation Rates in Retail Stores

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

Chan, Wanyu R.; Sidheswaran, Meera; Cohn, Sebastian

2014-02-01

This field study measured ventilation rates and indoor air quality parameters in 21 visits to retail stores in California. The data was collected to guide the development of new, science-based commercial building ventilation rate standards that balance the dual objectives of increasing energy efficiency and maintaining acceptable indoor air quality. Data collection occurred between September 2011 and March 2013. Three types of stores participated in this study: grocery stores, furniture/hardware stores, and apparel stores. Ventilation rates and indoor air contaminant concentrations were measured on a weekday, typically between 9 am and 6 pm. Ventilation rates measured using a tracer gasmore » decay method exceeded the minimum requirement of California’s Title 24 Standard in all but one store. Even though there was adequate ventilation according to Title 24, concentrations of formaldehyde, acetaldehyde, and acrolein exceeded the most stringent chronic health guidelines. Other indoor air contaminants measured included carbon dioxide (CO{sub 2}), carbon monoxide (CO), ozone (O{sub 3}), and particulate matter (PM). Concentrations of CO{sub 2} were kept low by adequate ventilation, and were assumed low also because the sampling occurred on a weekday when retail stores were less busy. CO concentrations were also low. The indoor-outdoor ratios of O{sub 3} showed that the first-order loss rate may vary by store trade types and also by ventilation mode (mechanical versus natural). Analysis of fine and ultrafine PM measurements showed that a substantial portion of the particle mass in grocery stores with cooking-related emissions was in particles less than 0.3 μm. Stores without cooking as an indoor source had PM size distributions that were more similar indoors and outdoors. The whole-building emission rates of volatile organic compounds (VOCs) and PM were estimated from the measured ventilation rates and indoor and outdoor contaminant concentrations. Mass balance models were then used to determine the ventilation rates, filtration strategies, or source reductions needed to maintain indoor contaminant concentrations below reference levels. Several scenarios of potential concern were considered: (i) formaldehyde levels in furniture/hardware stores, (ii) contaminants associated with cooking (e.g., PM, acrolein, and acetaldehyde) in grocery stores, and (iii) outdoor contaminants (e.g., PM and O{sub 3}) impacting stores that use natural ventilation. Estimated formaldehyde emission rates suggest that retail stores would need to ventilate at levels far exceeding the current Title 24 requirement to lower indoor concentrations below California’s stringent formaldehyde reference level. Given the high costs of providing ventilation but only modest chronic health benefit is expected, effective source control is an attractive alternative, as demonstrated by some retail stores in this study. Predictions showed that grocery stores need MERV 13 air filters, instead of MERV 8 filters that are more commonly used, to maintain indoor PM at levels that meet the chronic health standards for PM. Exposure to acrolein is a potential health concern in grocery stores, and should be addressed by increasing the use of kitchen range hoods or improving their contaminant removal efficiency. In stores that rely on natural ventilation, indoor PM can be a health concern if the stores are located in areas with high outdoor PM. This concern may be addressed by switching to mechanical ventilation when the outdoor air quality is poor, while continuing natural ventilation when outdoor air quality is good.« less

Testing of mechanical ventilators and infant incubators in healthcare institutions.

PubMed

Badnjevic, Almir; Gurbeta, Lejla; Jimenez, Elvira Ruiz; Iadanza, Ernesto

2017-01-01

The medical device industry has grown rapidly and incessantly over the past century. The sophistication and complexity of the designed instrumentation is nowadays rising and, with it, has also increased the need to develop some better, more effective and efficient maintenance processes, as part of the safety and performance requirements. This paper presents the results of performance tests conducted on 50 mechanical ventilators and 50 infant incubators used in various public healthcare institutions. Testing was conducted in accordance to safety and performance requirements stated in relevant international standards, directives and legal metrology policies. Testing of output parameters for mechanical ventilators was performed in 4 measuring points while testing of output parameters for infant incubators was performed in 7 measuring points for each infant incubator. As performance criteria, relative error of output parameters for mechanical ventilators and absolute error of output parameters for infant incubators was calculated. The ranges of permissible error, for both groups of devices, are regulated by the Rules on Metrological and Technical Requirements published in the Official Gazette of Bosnia and Herzegovina No. 75/14, which are defined based on international recommendations, standards and guidelines. All ventilators and incubators were tested by etalons calibrated in an ISO 17025 accredited laboratory, which provides compliance to international standards for all measured parameters.The results show that 30% of the tested medical devices are not operating properly and should be serviced, recalibrated and/or removed from daily application.

10 CFR 2.100 - Scope of subpart.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Scope of subpart. 2.100 Section 2.100 Energy NUCLEAR... for Issuance, Amendment, Transfer, or Renewal of a License, and Standard Design Approval § 2.100 Scope... at the request of the licensee; transfer and renewal of a license; and issuance of a standard design...

10 CFR 2.100 - Scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Scope of subpart. 2.100 Section 2.100 Energy NUCLEAR... for Issuance, Amendment, Transfer, or Renewal of a License, and Standard Design Approval § 2.100 Scope... at the request of the licensee; transfer and renewal of a license; and issuance of a standard design...

29 CFR 4.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Purpose and scope. 4.1 Section 4.1 Labor Office of the Secretary of Labor LABOR STANDARDS FOR FEDERAL SERVICE CONTRACTS Service Contract Labor Standards Provisions and Procedures § 4.1 Purpose and scope. This part contains the Department of Labor's rules relating to...

24 CFR 3280.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS General § 3280.1 Scope. This standard covers all equipment and installations in the design, construction, transportation, fire safety, plumbing, heat-producing...

24 CFR 3280.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS General § 3280.1 Scope. This standard covers all equipment and installations in the design, construction, transportation, fire safety, plumbing, heat-producing...

24 CFR 3280.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS General § 3280.1 Scope. This standard covers all equipment and installations in the design, construction, transportation, fire safety, plumbing, heat-producing...

24 CFR 3280.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS General § 3280.1 Scope. This standard covers all equipment and installations in the design, construction, transportation, fire safety, plumbing, heat-producing...

[The numerical simulation of the internal flow field inside the pressure generator of a continuous positive airway pressure ventilator].

PubMed

Cheng, Yunzhang; Zhu, Lihua; Zhang, Weiguo; Wu, Wenquan

2011-12-01

The problem of noise in ventilator has always been an important topic to study in the development of the ventilator. A great number of data are showing that there are still large gaps of research and application levels in noise control of the ventilator between China and some more advanced foreign countries. In this study, with cooperation of the Shanghai Medical Equipment Limited Liability Company, we used the computational fluid dynamics (CFD), software FLUENT, adopted the standard k-epsilon turbulence model and the SIMPLE algorithm to simulate the inner flow field of the continuous positive airway pressure (CPAP) ventilator's pressure generator. After a detailed analysis, we figured out that there are several deficiencies in this ventilator, like local reflow in volute, uneven velocity distribution and local negative pressure in inlet of the impeller, which easily lead to noise and affect the ventilator's performances. So, it needs to be improved to a certain extent.

Basic principles of respiratory function monitoring in ventilated newborns: A review.

PubMed

Schmalisch, Gerd

2016-09-01

Respiratory monitoring during mechanical ventilation provides a real-time picture of patient-ventilator interaction and is a prerequisite for lung-protective ventilation. Nowadays, measurements of airflow, tidal volume and applied pressures are standard in neonatal ventilators. The measurement of lung volume during mechanical ventilation by tracer gas washout techniques is still under development. The clinical use of capnography, although well established in adults, has not been embraced by neonatologists because of technical and methodological problems in very small infants. While the ventilatory parameters are well defined, the calculation of other physiological parameters are based upon specific assumptions which are difficult to verify. Incomplete knowledge of the theoretical background of these calculations and their limitations can lead to incorrect interpretations with clinical consequences. Therefore, the aim of this review was to describe the basic principles and the underlying assumptions of currently used methods for respiratory function monitoring in ventilated newborns and to highlight methodological limitations. Copyright © 2016 Elsevier Ltd. All rights reserved.

10 CFR 430.31 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... OF ENERGY ENERGY CONSERVATION ENERGY CONSERVATION PROGRAM FOR CONSUMER PRODUCTS Energy and Water Conservation Standards § 430.31 Purpose and scope. This subpart contains energy conservation standards and water conservation standards (in the case of faucets, showerheads, water closets, and urinals) for...

FRACTIONAL AEROSOL FILTRATION EFFICIENCY OF IN-DUCT VENTILATION AIR CLEANERS

EPA Science Inventory

The filtration efficiency of ventilation air cleaners is highly particle-size dependent over the 0.01 to 3 μm diameter size range. Current standardized test methods, which determine only overall efficiencies for ambient aerosol or other test aerosols, provide data of limited util...

Smart ventilation energy and indoor air quality performance in residential buildings: A review

DOE PAGES

Guyot, Gaelle; Sherman, Max H.; Walker, Iain S.

2017-12-30

To better address energy and indoor air quality issues, ventilation needs to become smarter. A key smart ventilation concept is to use controls to ventilate more at times it provides either an energy or indoor air quality (IAQ) advantage (or both) and less when it provides a disadvantage. A favorable context exists in many countries to include some of the existing smart ventilation strategies in codes and standards. As a result, demand-controlled ventilation (DCV) systems are widely and easily available on the market, with more than 20 DCV systems approved and available in countries such as Belgium, France and themore » Netherlands. This paper provides a literature review on smart ventilation used in residential buildings, based on energy and indoor air quality performance. This meta-analysis includes 38 studies of various smart ventilation systems with control based on CO 2, humidity, combined CO 2 and total volatile organic compounds (TVOC), occupancy, or outdoor temperature. In conclusion, these studies show that ventilation energy savings up to 60% can be obtained without compromising IAQ, even sometimes improving it. However, the meta-analysis included some less than favorable results, with 26% energy overconsumption in some cases.« less

Smart ventilation energy and indoor air quality performance in residential buildings: A review

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

Guyot, Gaelle; Sherman, Max H.; Walker, Iain S.

To better address energy and indoor air quality issues, ventilation needs to become smarter. A key smart ventilation concept is to use controls to ventilate more at times it provides either an energy or indoor air quality (IAQ) advantage (or both) and less when it provides a disadvantage. A favorable context exists in many countries to include some of the existing smart ventilation strategies in codes and standards. As a result, demand-controlled ventilation (DCV) systems are widely and easily available on the market, with more than 20 DCV systems approved and available in countries such as Belgium, France and themore » Netherlands. This paper provides a literature review on smart ventilation used in residential buildings, based on energy and indoor air quality performance. This meta-analysis includes 38 studies of various smart ventilation systems with control based on CO 2, humidity, combined CO 2 and total volatile organic compounds (TVOC), occupancy, or outdoor temperature. In conclusion, these studies show that ventilation energy savings up to 60% can be obtained without compromising IAQ, even sometimes improving it. However, the meta-analysis included some less than favorable results, with 26% energy overconsumption in some cases.« less

Wound, Ostomy, and Continence Nursing: Scope and Standards of Practice, 2nd Edition: An Executive Summary.

PubMed

2018-04-25

Wound, ostomy, and continence (WOC) nursing was recognized as a nursing specialty by the American Nurses Association in February 2010, and the Society published the original scope and standards of WOC nursing practice in May 2010. The Wound, Ostomy, and Continence Nursing: Scope and Standards of Practice, 2nd Edition is the definitive resource promoting excellence in professional practice, quality care, and improved patient outcomes in WOC specialty practice. It can be used to articulate the value of WOC nurses to administrators, legislators, payers, patients, and others. The second edition also provides an overview of the scope of WOC nursing practice including a description of the specialty, the history and evolution of WOC nursing, characteristics of WOC nursing practice, and description of the trispecialty. The document describes various WOC nurse roles, populations served, practice settings, care coordination, and collaboration. Educational preparation, levels of practice within WOC specialty nursing, certification, mandate for continuous professional development, ethics, current trends, future considerations and challenges, and standards of WOC nursing practice and professional performance with competencies for each standard are provided. The purpose of this Executive Summary is to describe the process for developing the scope and standards document, provide an overview of the scope of WOC nursing practice, and list the standards of practice and professional performance along with the competencies for each level of WOC nurse provider. The original document is available from the WOCN Society's online book store (www.wocn.org).

Change-over natural and mechanical ventilation system energy consumption in single-family buildings

NASA Astrophysics Data System (ADS)

Kostka, Maria; Szulgowska-Zgrzywa, Małgorzata

2017-11-01

The parameters of the outside air in Poland cause that in winter it is reasonable to use a mechanical ventilation equipped with a heat recovery exchanger. The time of spring, autumn, summer evenings and nights are often characterized by the parameters of the air, which allow for a natural ventilation and reduce the electricity consumption. The article presents the possibilities of energy consumption reduction for three energy standards of buildings located in Poland, ventilated by a change-over hybrid system. The analysis was prepared on the assumption that the air-to-water heat pump is the heat source for the buildings.

Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Nutrition and Dietetics Technician, Registered.

PubMed

2018-02-01

The Academy of Nutrition and Dietetics (Academy) is the world's largest organization of food and nutrition professionals and the association that represents credentialed nutrition and dietetics practitioners-nutrition and dietetics technicians, registered (NDTRs) and registered dietitian nutritionists (RDNs). An NDTR's scope of practice in nutrition and dietetics has flexible boundaries to capture the depth and breadth of the individual's practice. The NDTR's practice expands with advances in many areas, including nutrition, food production, food safety, food systems management, health care, public health, community health, and information and communication technology. The Revised 2017 Scope of Practice for the NDTR reflects the position of the Academy on the essential role of the NDTR in the management and delivery of food and nutrition services. The scope of practice for the NDTR is composed of education and credentialing, practice resources, Academy Standards of Practice and Standards of Professional Performance, codes of ethics, accreditation standards, state and federal regulations, national guidelines, and organizational policy and procedures. The Revised 2017 Scope of Practice for the NDTR is used in conjunction with the Revised 2017 Standards of Practice in Nutrition Care and the Standards of Professional Performance for NDTRs. The Standards of Practice address activities related to direct patient and client care. The Standards of Professional Performance address behaviors related to the technical role of NDTRs. These standards reflect the minimum competent level of nutrition and dietetics practice and professional performance for NDTRs. A companion document addresses the scope of practice for the RDN. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Mechanical ventilation for amyotrophic lateral sclerosis/motor neuron disease.

PubMed

Radunovic, Aleksandar; Annane, Djillali; Rafiq, Muhammad K; Mustfa, Naveed

2013-03-28

Amyotrophic lateral sclerosis, also known as motor neuron disease, is a fatal neurodegenerative disease. Neuromuscular respiratory failure is the commonest cause of death, usually within two to five years of the disease onset. Supporting respiratory function with mechanical ventilation may improve survival and quality of life. This is the first update of a review first published in 2009. The primary objective of the review is to examine the efficacy of mechanical ventilation (tracheostomy and non-invasive ventilation) in improving survival in ALS. The secondary objectives are to examine the effect of mechanical ventilation on functional measures of disease progression and quality of life in people with ALS; and assess adverse events related to the intervention. We searched The Cochrane Neuromuscular Disease Group Specialized Register (1 May 2012), CENTRAL (2012, Issue 4), MEDLINE (January 1966 to April 2012), EMBASE (January 1980 to April 2012), CINAHL Plus (January 1937 to April 2012), and AMED (January 1985 to April 2012). We also searched for ongoing studies on ClinicalTrials.gov. Randomised and quasi-randomised controlled trials involving non-invasive or tracheostomy assisted ventilation in participants with a clinical diagnosis of amyotrophic lateral sclerosis, independent of the reported outcomes. We planned to include comparisons with no intervention or the best standard care. For the original review, four authors independently selected studies for assessment and two authors reviewed searches for this update. All authors extracted data independently from the full text of selected studies and assessed the risk of bias in studies that met the inclusion criteria. We attempted to obtain missing data where possible. We planned to collect adverse event data from included studies. For the original Cochrane review, the review authors identified and included two randomised controlled trials involving 54 participants with ALS receiving non-invasive ventilation. There were no new randomised or quasi-randomised controlled trials at this first update.Incomplete data were published for one study and we contacted the trial authors who were not able to provide the missing data. Therefore, the results of the review were based on a single study of 41 participants that compared non-invasive ventilation with standard care. It was a well conducted study with low risk of bias.The study showed that the overall median survival was significantly different between the group treated with non-invasive ventilation and the standard care group. The median survival in the non-invasive ventilation group was 48 days longer (219 days compared to 171 days for the standard care group (estimated 95% CI 12 to 91 days, P = 0.0062)). This survival benefit was accompanied by an enhanced quality of life. On subgroup analysis, the survival and quality of life benefit was much more in the subgroup with normal to moderately impaired bulbar function (20 participants); median survival was 205 days longer (216 days in NIV group versus 11 days in the standard care group, P = 0.0059). Non-invasive ventilation did not prolong survival in participants with poor bulbar function (21 participants), although it showed significant improvement in the mean symptoms domain of the Sleep Apnoea Quality of Life Index but not in the Short Form-36 Health Survey Mental Component Summary score. Neither trial reported clinical data on intervention related adverse effects. Evidence from a single randomised trial of non-invasive ventilation in 41 participants suggests that it significantly prolongs survival and improves or maintains quality of life in people with ALS. Survival and some measures of quality of life were significantly improved in the subgroup of people with better bulbar function, but not in those with severe bulbar impairment. Future studies should examine the health economics of NIV and factors influencing access to NIV. We need to understand the factors, personal and socioeconomic, that determine access to NIV.

76 FR 23809 - Science Advisory Board Staff Office Notification of a Public Meeting of the Clean Air Scientific...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

...: Scope and Methods Plan for Welfare Risk and Exposure Assessment (April 2011 Draft). DATES: The CASAC... Ambient Air Quality Standards: Scope and Methods Plan for Health Risk and Exposure Assessment (April 2011), and Ozone National Ambient Air Quality Standards: Scope and Methods Plan for Welfare Risk and Exposure...

24 CFR 3280.901 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS Transportation § 3280.901 Scope. Subpart J of this standard covers the general requirement for designing the structure of the manufactured home to fully withstand...

Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting.

PubMed

Fot, Evgenia V; Izotova, Natalia N; Yudina, Angelika S; Smetkin, Aleksei A; Kuzkov, Vsevolod V; Kirov, Mikhail Y

2017-01-01

The discontinuation of mechanical ventilation after coronary surgery may prolong and significantly increase the load on intensive care unit personnel. We hypothesized that automated mode using INTELLiVENT-ASV can decrease duration of postoperative mechanical ventilation, reduce workload on medical staff, and provide safe ventilation after off-pump coronary artery bypass grafting (OPCAB). The primary endpoint of our study was to assess the duration of postoperative mechanical ventilation during different modes of weaning from respiratory support (RS) after OPCAB. The secondary endpoint was to assess safety of the automated weaning mode and the number of manual interventions to the ventilator settings during the weaning process in comparison with the protocolized weaning mode. Forty adult patients undergoing elective OPCAB were enrolled into a prospective single-center study. Patients were randomized into two groups: automated weaning ( n  = 20) using INTELLiVENT-ASV mode with quick-wean option; and protocolized weaning ( n  = 20), using conventional synchronized intermittent mandatory ventilation (SIMV) + pressure support (PS) mode. We assessed the duration of postoperative ventilation, incidence and duration of unacceptable RS, and the load on medical staff. We also performed the retrospective analysis of 102 patients (standard weaning) who were weaned from ventilator with SIMV + PS mode based on physician's experience without prearranged algorithm. Realization of the automated weaning protocol required change in respiratory settings in 2 patients vs. 7 (5-9) adjustments per patient in the protocolized weaning group. Both incidence and duration of unacceptable RS were reduced significantly by means of the automated weaning approach. The FiO 2 during spontaneous breathing trials was significantly lower in the automated weaning group: 30 (30-35) vs. 40 (40-45) % in the protocolized weaning group ( p  < 0.01). The average time until tracheal extubation did not differ in the automated weaning and the protocolized weaning groups: 193 (115-309) and 197 (158-253) min, respectively, but increased to 290 (210-411) min in the standard weaning group. The automated weaning system after off-pump coronary surgery might provide postoperative ventilation in a more protective way, reduces the workload on medical staff, and does not prolong the duration of weaning from ventilator. The use of automated or protocolized weaning can reduce the duration of postoperative mechanical ventilation in comparison with non-protocolized weaning based on the physician's decision.

Helmet Exhalation Capture System (HECS) Sizing Evaluation for an Advanced Space Suit Portable Life Support System

NASA Technical Reports Server (NTRS)

Paul, Heather L.; Waguespack, Glenn M.; Paul, Thomas H.; Conger, Bruce C.

2008-01-01

As part of NASA s initiative to develop an advanced portable life support system (PLSS), a baseline schematic has been chosen that includes gaseous oxygen in a closed circuit ventilation configuration. Supply oxygen enters the suit at the back of the helmet and return gases pass over the astronaut s body to be extracted at the astronaut s wrists and ankles through the liquid cooling and ventilation garment (LCVG). The extracted gases are then treated using a rapid cycling amine (RCA) system for carbon dioxide and water removal and activated carbon for trace gas removal before being mixed with makeup oxygen and reintroduced into the helmet. Thermal control is provided by a suit water membrane evaporator (SWME). As an extension of the original schematic development, NASA evaluated several Helmet Exhalation Capture System (HECS) configurations as alternatives to the baseline. The HECS configurations incorporate the use of full contact masks or non-contact masks to reduce flow requirements within the PLSS ventilation subsystem. The primary scope of this study was to compare the alternatives based on mass and volume considerations; however other design issues were also briefly investigated. This paper summarizes the results of this sizing analysis task.

24 CFR 3280.309 - Health Notice on formaldehyde emissions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... efficiency standards may allow formaldehyde and other contaminants to accumulate in the indoor air. Additional ventilation to dilute the indoor air may be obtained from a passive or mechanical ventilation... offered with this home. High indoor temperatures and humidity raise formaldehyde levels. When a home is to...

9 CFR 3.18 - Terminal facilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Dogs and... Animal Welfare regulations (9 CFR parts 1, 2, and 3) must not commingle shipments of dogs or cats with... mammals that are pests to dogs and cats. (c) Ventilation. Ventilation must be provided in any animal...

9 CFR 3.18 - Terminal facilities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Dogs and... Animal Welfare regulations (9 CFR parts 1, 2, and 3) must not commingle shipments of dogs or cats with... mammals that are pests to dogs and cats. (c) Ventilation. Ventilation must be provided in any animal...

9 CFR 3.18 - Terminal facilities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Dogs and... Animal Welfare regulations (9 CFR parts 1, 2, and 3) must not commingle shipments of dogs or cats with... mammals that are pests to dogs and cats. (c) Ventilation. Ventilation must be provided in any animal...

30 CFR 75.331 - Auxiliary fans and tubing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Auxiliary fans and tubing. 75.331 Section 75... HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.331 Auxiliary fans and tubing. (a) When auxiliary fans and tubing are used for face ventilation, each auxiliary fan shall be— (1...

9 CFR 3.18 - Terminal facilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Dogs and... Animal Welfare regulations (9 CFR parts 1, 2, and 3) must not commingle shipments of dogs or cats with... mammals that are pests to dogs and cats. (c) Ventilation. Ventilation must be provided in any animal...

9 CFR 3.18 - Terminal facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... WELFARE STANDARDS Specifications for the Humane Handling, Care, Treatment, and Transportation of Dogs and... Animal Welfare regulations (9 CFR parts 1, 2, and 3) must not commingle shipments of dogs or cats with... mammals that are pests to dogs and cats. (c) Ventilation. Ventilation must be provided in any animal...

ReactorHealth Physics operations at the NIST center for neutron research.

PubMed

Johnston, Thomas P

2015-02-01

Performing health physics and radiation safety functions under a special nuclear material license and a research and test reactor license at a major government research and development laboratory encompasses many elements not encountered by industrial, general, or broad scope licenses. This article reviews elements of the health physics and radiation safety program at the NIST Center for Neutron Research, including the early history and discovery of the neutron, applications of neutron research, reactor overview, safety and security of radiation sources and radioactive material, and general health physics procedures. These comprise precautions and control of tritium, training program, neutron beam sample processing, laboratory audits, inventory and leak tests, meter calibration, repair and evaluation, radioactive waste management, and emergency response. In addition, the radiation monitoring systems will be reviewed including confinement building monitoring, ventilation filter radiation monitors, secondary coolant monitors, gaseous fission product monitors, gas monitors, ventilation tritium monitor, and the plant effluent monitor systems.

49 CFR 178.700 - Purpose, scope and definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Performance-Oriented Standards § 178.700 Purpose, scope and definitions. (a) This subpart prescribes requirements applying to IBCs intended for the transportation of hazardous materials. Standards for these... subchapter and in paragraph (c) of this section. (c) The following definitions pertain to the IBC standards...

49 CFR 178.700 - Purpose, scope and definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Performance-Oriented Standards § 178.700 Purpose, scope and definitions. (a) This subpart prescribes requirements applying to IBCs intended for the transportation of hazardous materials. Standards for these... subchapter and in paragraph (c) of this section. (c) The following definitions pertain to the IBC standards...

Academic Emergency Medicine Physicians' Knowledge of Mechanical Ventilation.

PubMed

Wilcox, Susan R; Strout, Tania D; Schneider, Jeffrey I; Mitchell, Patricia M; Smith, Jessica; Lutfy-Clayton, Lucienne; Marcolini, Evie G; Aydin, Ani; Seigel, Todd A; Richards, Jeremy B

2016-05-01

Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) education or clinical practice. The objective of this study was to quantify EM attendings' education, experience, and knowledge regarding mechanical ventilation in the emergency department. We developed a survey of academic EM attendings' educational experiences with ventilators and a knowledge assessment tool with nine clinical questions. EM attendings at key teaching hospitals for seven EM residency training programs in the northeastern United States were invited to participate in this survey study. We performed correlation and regression analyses to evaluate the relationship between attendings' scores on the assessment instrument and their training, education, and comfort with ventilation. Of 394 EM attendings surveyed, 211 responded (53.6%). Of respondents, 74.5% reported receiving three or fewer hours of ventilation-related education from EM sources over the past year and 98 (46%) reported receiving between 0-1 hour of education. The overall correct response rate for the assessment tool was 73.4%, with a standard deviation of 19.9. The factors associated with a higher score were completion of an EM residency, prior emphasis on mechanical ventilation during one's own residency, working in a setting where an emergency physician bears primary responsibility for ventilator management, and level of comfort with managing ventilated patients. Physicians' comfort was associated with the frequency of ventilator changes and EM management of ventilation, as well as hours of education. EM attendings report caring for mechanically ventilated patients frequently, but most receive fewer than three educational hours a year on mechanical ventilation, and nearly half receive 0-1 hour. Physicians' performance on an assessment tool for mechanical ventilation is most strongly correlated with their self-reported comfort with mechanical ventilation.

A new prototype of an electronic jet-ventilator and its humidification system

PubMed Central

Kraincuk, Paul; Kepka, Anton; Ihra, Gerald; Schabernig, Christa; Aloy, Alexander

1999-01-01

Background: Adequate humidification in long-term jet ventilation is a critical aspect in terms of clinical safety. Aim: To assess a prototype of an electronic jet-ventilator and its humidification system. Methods: Forty patients with respiratory insufficiency were randomly allocated to one of four groups. The criterion for inclusion in this study was respiratory insufficiency exhibiting a Murray score above 2. The four groups of patients were ventilated with three different respirators and four different humidification systems. Patients in groups A and B received superimposed high-frequency jet ventilation (SHFJV) by an electronic jet-ventilator either with (group A) or without (group B) an additional humidification system. Patients in group C received high-frequency percussive ventilation (HFPV) by a pneumatic high-frequency respirator, using a hot water humidifier for warming and moistening the inspiration gas. Patients in group D received conventional mechanical ventilation using a standard intensive care unit respirator with a standard humidification system. SHFJV and HFPV were used for a period of 100 h (4days). Results: A significantly low inspiration gas temperature was noted in patients in group B, initially (27.2 ± 2.5°C) and after 2 days (28.0 ± 1.6°C) (P < 0.05). The percentage of relative humidity of the inspiration gas in patients in group B was also initially significantly low (69.8 ± 4.1%; P < 0.05) but rose to an average of 98 ± 2.8% after 2 h. The average percentage across all four groups amounted to 98 ± 0.4% after 2 h. Inflammation of the tracheal mucosa was found in patients in group B and the mucosal injury score (MIS) was significantly higher than in all the other groups. Patients in groups A, C and D showed no severe evidence of airway damage, exhibiting adequate values of relative humidity and temperature of the inspired gas. Conclusion: The problems of humidification associated with jet ventilation can be fully prevented by using this new jet-ventilator. These data were sustained by nondeteriorating MIS values at the end of the 4-day study period in groups A, C and D. PMID:11056732

12 CFR 560.100 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 6 2012-01-01 2012-01-01 false Real estate lending standards; purpose and... § 560.100 Real estate lending standards; purpose and scope. This section, and § 560.101 of this subpart....S.C. 1828(o), prescribe standards for real estate lending to be used by savings associations and all...

12 CFR 560.100 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Real estate lending standards; purpose and... § 560.100 Real estate lending standards; purpose and scope. This section, and § 560.101 of this subpart....S.C. 1828(o), prescribe standards for real estate lending to be used by savings associations and all...

75 FR 77671 - Expansion of the Scope of NRTL Recognition of MET Laboratories, Inc.; Correction of the Scope of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-13

... MET Laboratories, Inc., (MET) as an NRTL. MET's expansion covers the use of additional test standards... elements: (1) The type of products the NRTL may test, with each type specified by its applicable test... certification activities for test standards within the NRTL's scope; and (3) the supplemental program(s) that...

Indoor Air Quality Assessment of the San Francisco Federal Building

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

Apte, Michael; Bennett, Deborah H.; Faulkner, David

2008-07-01

An assessment of the indoor air quality (IAQ) of the San Francisco Federal Building (SFFB) was conducted on May 12 and 14, 2009 at the request of the General Services Administration (GSA). The purpose of the assessment was for a general screening of IAQ parameters typically indicative of well functioning building systems. One naturally ventilated space and one mechanically ventilated space were studied. In both zones, the levels of indoor air contaminants, including CO2, CO, particulate matter, volatile organic compounds, and aldehydes, were low, relative to reference exposure levels and air quality standards for comparable office buildings. We found slightlymore » elevated levels of volatile organic compounds (VOCs) including two compounds often found in"green" cleaning products. In addition, we found two industrial solvents at levels higher than typically seen in office buildings, but the levels were not sufficient to be of a health concern. The ventilation rates in the two study spaces were high by any standard. Ventilation rates in the building should be further investigated and adjusted to be in line with the building design. Based on our measurements, we conclude that the IAQ is satisfactory in the zone we tested, but IAQ may need to be re-checked after the ventilation rates have been lowered.« less

Infiltration as Ventilation: Weather-Induced Dilution

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

Sherman, Max H.; Turner, William J.N.; Walker, Iain S.

The purpose of outdoor air ventilation is to dilute or remove indoor contaminants to which occupants are exposed. It can be provided by mechanical or natural means. In most homes, especially older homes, weather-driven infiltration provides the dominant fraction of the total ventilation. As we seek to provide good indoor air quality at minimum energy cost, it is important to neither over-ventilate nor under-ventilate. Thus, it becomes critically important to evaluate correctly the contribution infiltration makes to the total outdoor air ventilation rate. Because weather-driven infiltration is dependent on building air leakage and weather-induced pressure differences, a given amount ofmore » air leakage will provide different amounts of infiltration. Varying rates of infiltration will provide different levels of contaminant dilution and hence effective ventilation. This paper derives these interactions and then calculates the impact of weather-driven infiltration for different climates. A new “N-factor” is introduced to provide a convenient method for calculating the ventilation contribution of infiltration for over 1,000 locations across North America. The results of this work could be used in indoor air quality standards (specifically ASHRAE 62.2) to account for the contribution of weather-driven infiltration towards the dilution of indoor pollutants.« less

pRotective vEntilation with veno-venouS lung assisT in respiratory failure: A protocol for a multicentre randomised controlled trial of extracorporeal carbon dioxide removal in patients with acute hypoxaemic respiratory failure.

PubMed

McNamee, J J; Gillies, M A; Barrett, N A; Agus, A M; Beale, R; Bentley, A; Bodenham, A; Brett, S J; Brodie, D; Finney, S J; Gordon, A J; Griffiths, M; Harrison, D; Jackson, C; McDowell, C; McNally, C; Perkins, G D; Tunnicliffe, W; Vuylsteke, A; Walsh, T S; Wise, M P; Young, D; McAuley, D F

2017-05-01

One of the few interventions to demonstrate improved outcomes for acute hypoxaemic respiratory failure is reducing tidal volumes when using mechanical ventilation, often termed lung protective ventilation. Veno-venous extracorporeal carbon dioxide removal (vv-ECCO 2 R) can facilitate reducing tidal volumes. pRotective vEntilation with veno-venouS lung assisT (REST) is a randomised, allocation concealed, controlled, open, multicentre pragmatic trial to determine the clinical and cost-effectiveness of lower tidal volume mechanical ventilation facilitated by vv-ECCO 2 R in patients with acute hypoxaemic respiratory failure. Patients requiring intubation and mechanical ventilation for acute hypoxaemic respiratory failure will be randomly allocated to receive either vv-ECCO 2 R and lower tidal volume mechanical ventilation or standard care with stratification by recruitment centre. There is a need for a large randomised controlled trial to establish whether vv-ECCO 2 R in acute hypoxaemic respiratory failure can allow the use of a more protective lung ventilation strategy and is associated with improved patient outcomes.

Hypercapnic encephalopathy syndrome: a new frontier for non-invasive ventilation?

PubMed

Scala, Raffaele

2011-08-01

According to the classical international guidelines, non-invasive ventilation is contraindicated in hypercapnic encephalopathy syndrome (HES) due to the poor compliance to ventilatory treatment of confused/agitated patients and the risk of aspirative pneumonia related to lack of airways protection. As a matter of fact, conventional mechanical ventilation has been recommended as "golden standard" in these patients. However, up to now there are not controlled data that have demonstrated in HES the advantage of conventional mechanical ventilation vs non-invasive ventilation. In fact, patients with altered mental status have been systematically excluded from the randomised and controlled trials performed with non-invasive ventilation in hypercapnic acute respiratory failure. Recent studies have clearly demonstrated that an initial cautious NPPV trial in selected HES patients may be attempt as long as there are no other contraindications and the technique is provided by experienced caregivers in a closely monitored setting where ETI is always readily available. The purpose of this review is to report the physiologic rationale, the clinical feasibility and the still open questions about the careful use of non-invasive ventilation in HES as first-line ventilatory strategy in place of conventional mechanical ventilation via endotracheal intubation. Copyright © 2011 Elsevier Ltd. All rights reserved.

On the Use of Windcatchers in Schools: Climate Change, Occupancy Patterns, and Adaptation Strategies

PubMed Central

Mumovic, D.

2009-01-01

Advanced naturally ventilated systems based on integration of basic natural ventilation strategies such as cross-ventilation and stack effect have been considered to be a key element of sustainable design. In this respect, there is a pressing need to explore the potential of such systems to achieve the recommended occupant comfort targets throughout their lifetime without relying on mechanical means. This study focuses on use of a windcatcher system in typical classrooms which are usually characterized by high and intermittent internal heat gains. The aims of this paper are 3-fold. First, to describe a series of field measurements that investigated the ventilation rates, indoor air quality, and thermal comfort in a newly constructed school located at an urban site in London. Secondly, to investigate the effect of changing climate and occupancy patterns on thermal comfort in selected classrooms, while taking into account adaptive potential of this specific ventilation strategy. Thirdly, to assess performance of the ventilation system using the newly introduced performance-based ventilation standards for school buildings. The results suggest that satisfactory occupant comfort levels could be achieved until the 2050s by a combination of advanced ventilation control settings and informed occupant behavior. PMID:27110216

30 CFR 75.326 - Mean entry air velocity.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Mean entry air velocity. 75.326 Section 75.326... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.326 Mean entry air velocity. In exhausting face ventilation systems, the mean entry air velocity shall be at least 60 feet per minute...

30 CFR 75.326 - Mean entry air velocity.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Mean entry air velocity. 75.326 Section 75.326... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.326 Mean entry air velocity. In exhausting face ventilation systems, the mean entry air velocity shall be at least 60 feet per minute...

40 CFR 63.8246 - How do I demonstrate continuous compliance with the emission limitations and work practice...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali Plants Continuous Compliance... practice standards? (a) By-product hydrogen streams and end box ventilation system vents. (1) For all by-product hydrogen streams and all end box ventilation system vents, if applicable, you must demonstrate...

40 CFR 63.8246 - How do I demonstrate continuous compliance with the emission limitations and work practice...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali Plants Continuous Compliance... practice standards? (a) By-product hydrogen streams and end box ventilation system vents. (1) For all by-product hydrogen streams and all end box ventilation system vents, if applicable, you must demonstrate...

40 CFR 63.8246 - How do I demonstrate continuous compliance with the emission limitations and work practice...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali Plants Continuous Compliance... practice standards? (a) By-product hydrogen streams and end box ventilation system vents. (1) For all by-product hydrogen streams and all end box ventilation system vents, if applicable, you must demonstrate...

40 CFR 63.8246 - How do I demonstrate continuous compliance with the emission limitations and work practice...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali Plants Continuous Compliance... practice standards? (a) By-product hydrogen streams and end box ventilation system vents. (1) For all by-product hydrogen streams and all end box ventilation system vents, if applicable, you must demonstrate...

40 CFR 63.8246 - How do I demonstrate continuous compliance with the emission limitations and work practice...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali Plants Continuous Compliance... practice standards? (a) By-product hydrogen streams and end box ventilation system vents. (1) For all by-product hydrogen streams and all end box ventilation system vents, if applicable, you must demonstrate...

30 CFR 75.311 - Main mine fan operation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Main mine fan operation. 75.311 Section 75.311... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.311 Main mine fan operation. (a) Main mine fans shall be continuously operated, except as otherwise approved in the ventilation plan, or when...

46 CFR 154.1205 - Mechanical ventilation system: Standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... openings to accommodations, service, control station, and other gas-safe spaces. (c) Each ventilation system under § 154.1200 (a) and (b)(1) must change the air in that space and its adjoining trunks at... top of each space that personnel enter during cargo handling operations. (b) The discharge end of each...

Mechanical ventilation for severe asthma.

PubMed

Leatherman, James

2015-06-01

Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting.

CFD Simulations to Improve Ventilation in Low-Income Housing

NASA Astrophysics Data System (ADS)

Ho, Rosemond; Gorle, Catherine

2017-11-01

Quality of housing plays an important role in public health. In Dhaka, Bangladesh, the leading causes of death include tuberculosis, lower respiratory infections, and chronic obstructive pulmonary disease, so improving home ventilation could potentially mitigate these negative health effects. The goal of this project is to use computational fluid dynamics (CFD) to predict the relative effectiveness of different ventilation strategies for Dhaka homes. A Reynolds-averaged Navier-Stokes CFD model of a standard Dhaka home with apertures of different sizes and locations was developed to predict air exchange rates. Our initial focus is on simulating ventilation driven by buoyancy-alone conditions, which is often considered the limiting case in natural ventilation design. We explore the relationship between ventilation rate and aperture area to determine the most promising configurations for optimal ventilation solutions. Future research will include the modeling of wind-driven conditions, and extensive uncertainty quantification studies to investigate the effect of variability in the layout of homes and neighborhoods, and in local wind and temperature conditions. The ultimate objective is to formulate robust design recommendations that can reduce risks of respiratory illness in low-income housing.

Noninvasive ventilation for acute exacerbations of asthma: A systematic review of the literature.

PubMed

Green, Elyce; Jain, Paras; Bernoth, Maree

2017-11-01

Asthma is a chronic disease characterised by reversible airway obstruction caused by bronchospasm, mucous and oedema. People with asthma commonly experience acute exacerbations of their disease requiring hospitalisation and subsequent utilisation of economic and healthcare resources. Noninvasive ventilation has been suggested as a treatment for acute exacerbations of asthma due to its ability to provide airway stenting, optimal oxygen delivery and decreased work of breathing. This paper is a systematic review of the available published research focused on the use of noninvasive ventilation for the treatment of acute exacerbations of asthma to determine if this treatment provides better outcomes for patients compared to standard medical therapy. Database searches were conducted using EBSCOhost, MEDLINE and PubMed. Search terms used were combinations of 'noninvasive ventilation', 'BiPAP', 'CPAP', 'wheez*' and 'asthma'. Articles were included if they were research papers focused on adult patients with asthma and a treatment of noninvasive ventilation, and were published in full text in English. Included articles were reviewed using the National Health and Medical Research Council (Australia) evidence hierarchy and quality appraisal tools. There were 492 articles identified from the database searches. After application of inclusion/exclusion criteria 13 articles were included in the systematic review. Studies varied significantly in design, endpoints and outcomes. There was a trend in better outcomes for patients with acute asthma who were treated with noninvasive ventilation compared to standard medical therapy, however, the variability of the studies meant that no conclusive recommendations could be made. More research is required before noninvasive ventilation can be conclusively recommended for the treatment of acute exacerbations of asthma. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Ventilation, temperature, and HVAC characteristics in small and medium commercial buildings in California.

PubMed

Bennett, D H; Fisk, W; Apte, M G; Wu, X; Trout, A; Faulkner, D; Sullivan, D

2012-08-01

This field study of 37 small and medium commercial buildings throughout California obtained information on ventilation rate, temperature, and heating, ventilating, and air-conditioning (HVAC) system characteristics. The study included seven retail establishments; five restaurants; eight offices; two each of gas stations, hair salons, healthcare facilities, grocery stores, dental offices, and fitness centers; and five other buildings. Fourteen (38%) of the buildings either could not or did not provide outdoor air through the HVAC system. The air exchange rate averaged 1.6 (s.d. = 1.7) exchanges per hour and was similar between buildings with and without outdoor air supplied through the HVAC system, indicating that some buildings have significant leakage or ventilation through open windows and doors. Not all buildings had sufficient air exchange to meet ASHRAE 62.1 Standards, including buildings used for fitness centers, hair salons, offices, and retail establishments. The majority of the time, buildings were within the ASHRAE temperature comfort range. Offices were frequently overcooled in the summer. All of the buildings had filters, but over half the buildings had a filter with a minimum efficiency reporting value rating of 4 or lower, which are not very effective for removing fine particles. Most U.S. commercial buildings (96%) are small- to medium-sized, using nearly 18% of the country's energy, and sheltering a large population daily. Little is known about the ventilation systems in these buildings. This study found a wide variety of ventilation conditions, with many buildings failing to meet relevant ventilation standards. Regulators may want to consider implementing more complete building inspections at commissioning and point of sale. © 2012 John Wiley & Sons A/S.

Building America Case Study: Ventilation System Effectiveness and Tested Indoor Air Quality Impacts, Tyler, Texas

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

?Ventilation system effectiveness testing was conducted at two unoccupied, single-family, detached lab homes at the University of Texas - Tyler. Five ventilation system tests were conducted with various whole-building ventilation systems. Multizone fan pressurization testing characterized building and zone enclosure leakage. PFT testing showed multizone air change rates and interzonal airflow filtration. Indoor air recirculation by a central air distribution system can help improve the exhaust ventilation system by way of air mixing and filtration. In contrast, the supply and balanced ventilation systems showed that there is a significant benefit to drawing outside air from a known outside location, andmore » filtering and distributing that air. Compared to the Exhaust systems, the CFIS and ERV systems showed better ventilation air distribution and lower concentrations of particulates, formaldehyde and other VOCs. System improvement percentages were estimated based on four System Factor Categories: Balance, Distribution, Outside Air Source, and Recirculation Filtration. Recommended System Factors could be applied to reduce ventilation fan airflow rates relative to ASHRAE Standard 62.2 to save energy and reduce moisture control risk in humid climates. HVAC energy savings were predicted to be 8-10%, or $50-$75/year. Cumulative particle counts for six particle sizes, and formaldehyde and other Top 20 VOC concentrations were measured in multiple zones. The testing showed that single-point exhaust ventilation was inferior as a whole-house ventilation strategy.« less

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

Kwok, A.G.

This paper examines the comfort criteria of ANSI/ASHRAE Standard 55-1992 for their applicability in tropical classrooms. A field study conducted in Hawaii used a variety of methods to collect the data: survey questionnaires, physical measurements, interviews, and behavioral observations. A total of 3,544 students and teachers completed questionnaires in 29 naturally ventilated and air-conditioned classrooms in six schools during two seasons. The majority of classrooms failed to meet the physical specifications of the Standard 55 comfort zone. Thermal neutrality, preference, and acceptability results are compared with other field studies and the Standard 55 criteria. Acceptability votes by occupants of bothmore » naturally ventilated and air-conditioned classrooms exceeded the standard`s 80% acceptability criteria, regardless of whether physical conditions were in or out of the comfort zone. Responses from these two school populations suggest not only a basis for separate comfort standards but energy conservation opportunities through raising thermostat set points.« less

12 CFR 160.100 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Real estate lending standards; purpose and... LENDING AND INVESTMENT § 160.100 Real estate lending standards; purpose and scope. This section, and § 160... Improvement Act of 1991, 12 U.S.C. 1828(o), prescribe standards for real estate lending to be used by Federal...

12 CFR 160.100 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Real estate lending standards; purpose and... LENDING AND INVESTMENT § 160.100 Real estate lending standards; purpose and scope. This section, and § 160... Improvement Act of 1991, 12 U.S.C. 1828(o), prescribe standards for real estate lending to be used by Federal...

12 CFR 160.100 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Real estate lending standards; purpose and... LENDING AND INVESTMENT § 160.100 Real estate lending standards; purpose and scope. This section, and § 160... Improvement Act of 1991, 12 U.S.C. 1828(o), prescribe standards for real estate lending to be used by Federal...

Cost containment and mechanical ventilation in the United States.

PubMed

Cohen, I L; Booth, F V

1994-08-01

In many ICUs, admission and discharge hinge on the need for intubation and ventilatory support. As few as 5% to 10% of ICU patients require prolonged mechanical ventilation, and this patient group consumes > or = 50% of ICU patient days and ICU resources. Prolonged ventilatory support and chronic ventilator dependency, both in the ICU and non-ICU settings, have a significant and growing impact on healthcare economics. In the United States, the need for prolonged mechanical ventilation is increasingly recognized as separate and distinct from the initial diagnosis and/or procedure that leads to hospitalization. This distinction has led to improved reimbursement under the prospective diagnosis-related group (DRG) system, and demands more precise accounting from healthcare providers responsible for these patients. Using both published and theoretical examples, mechanical ventilation in the United States is discussed, with a focus on cost containment. Included in the discussion are ventilator teams, standards of care, management protocols, stepdown units, rehabilitation units, and home care. The expanding role of total quality management (TQM) is also presented.

78 FR 52568 - TUV SUD America, Inc.: Modification of Scope of Recognition

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-23

... three test standards from the scope of recognition of the Nationally Recognized Testing Laboratory (NRTL... standards (1) UL 551 Transformer-type Arc-welding Machine, (2) UL 1484 Residential Gas Detectors, and (3) UL...

12 CFR 390.264 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Real estate lending standards; purpose and... Investment § 390.264 Real estate lending standards; purpose and scope. This section, and § 390.265, issued... for real estate lending to be used by State savings associations and all their includable subsidiaries...

12 CFR 390.264 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 5 2013-01-01 2013-01-01 false Real estate lending standards; purpose and... Investment § 390.264 Real estate lending standards; purpose and scope. This section, and § 390.265, issued... for real estate lending to be used by State savings associations and all their includable subsidiaries...

12 CFR 390.264 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Real estate lending standards; purpose and... Investment § 390.264 Real estate lending standards; purpose and scope. This section, and § 390.265, issued... for real estate lending to be used by State savings associations and all their includable subsidiaries...

12 CFR 560.100 - Real estate lending standards; purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Real estate lending standards; purpose and... TREASURY LENDING AND INVESTMENT Lending and Investment Provisions Applicable to all Savings Associations § 560.100 Real estate lending standards; purpose and scope. This section, and § 560.101 of this subpart...

Acupressure Improves the Weaning Indices of Tidal Volumes and Rapid Shallow Breathing Index in Stable Coma Patients Receiving Mechanical Ventilation: Randomized Controlled Trial

PubMed Central

Maa, Suh-Hwa; Wang, Chiu-Hua; Hsu, Kuang-Hung; Lin, Horng-Chyuan; Yee, Brian; MacDonald, Karen

2013-01-01

Background. Acupressure has been shown to improve respiratory parameters. We investigated the effects of acupressure on weaning indices in stable coma patients receiving mechanical ventilation. Methods. Patients were randomly allocated to one of three treatments: standard care with adjunctive acupressure on one (n = 32) or two days (n = 31) and standard care (n = 31). Acupressure in the form of 10 minutes of bilateral stimulation at five acupoints was administered per treatment session. Weaning indices were collected on two days before, right after, and at 0.5 hrs, 1 hr, 1.5 hrs, 2 hrs, 2.5 hrs, 3 hrs, 3.5 hrs, and 4 hrs after the start of treatment. Results. There were statistically significant improvements in tidal volumes and index of rapid shallow breathing in the one-day and two-day adjunctive acupressure study arms compared to the standard care arm immediately after acupressure and persisting until 0.5, 1 hr, and 2 hrs after adjustment for covariates. Conclusions. In the stable ventilated coma patient, adjunctive acupressure contributes to improvements in tidal volumes and the index of rapid shallow breathing, the two indices most critical for weaning patients from mechanical ventilation. These effects tend to be immediate and likely to be sustained for 1 to 2 hours. PMID:23710234

30 CFR 57.22206 - Main ventilation failure (I-A, II-A, III, and V-A mines).

Code of Federal Regulations, 2010 CFR

2010-07-01

... AND NONMETAL MINES Safety Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22206..., tests for methane shall be conducted in affected active workings until normal air flow has resumed. (b... less than 1.0 percent methane. Persons other than examiners shall not reenter a Subcategory II-A mine...

30 CFR 75.361 - Supplemental examination.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Supplemental examination. 75.361 Section 75.361... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.361 Supplemental examination. (a)(1...) and 75.220(a)(1)—roof control; (ii) §§ 75.333(h) and 75.370(a)(1)—ventilation, methane; (iii) §§ 75...

Fifty Years of Research in ARDS. Respiratory Mechanics in Acute Respiratory Distress Syndrome.

PubMed

Henderson, William R; Chen, Lu; Amato, Marcelo B P; Brochard, Laurent J

2017-10-01

Acute respiratory distress syndrome is a multifactorial lung injury that continues to be associated with high levels of morbidity and mortality. Mechanical ventilation, although lifesaving, is associated with new iatrogenic injury. Current best practice involves the use of small Vt, low plateau and driving pressures, and high levels of positive end-expiratory pressure. Collectively, these interventions are termed "lung-protective ventilation." Recent investigations suggest that individualized measurements of pulmonary mechanical variables rather than population-based ventilation prescriptions may be used to set the ventilator with the potential to improve outcomes beyond those achieved with standard lung protective ventilation. This review outlines the measurement and application of clinically applicable pulmonary mechanical concepts, such as plateau pressures, driving pressure, transpulmonary pressures, stress index, and measurement of strain. In addition, the concept of the "baby lung" and the utility of dynamic in addition to static measures of pulmonary mechanical variables are discussed.

Climate change and temperature-dependent biogeography: oxygen limitation of thermal tolerance in animals.

PubMed

Pörtner, H O

2001-04-01

Recent years have shown a rise in mean global temperatures and a shift in the geographical distribution of ectothermic animals. For a cause and effect analysis the present paper discusses those physiological processes limiting thermal tolerance. The lower heat tolerance in metazoa compared with unicellular eukaryotes and bacteria suggests that a complex systemic rather than molecular process is limiting in metazoa. Whole-animal aerobic scope appears as the first process limited at low and high temperatures, linked to the progressively insufficient capacity of circulation and ventilation. Oxygen levels in body fluids may decrease, reflecting excessive oxygen demand at high temperatures or insufficient aerobic capacity of mitochondria at low temperatures. Aerobic scope falls at temperatures beyond the thermal optimum and vanishes at low or high critical temperatures when transition to an anaerobic mitochondrial metabolism occurs. The adjustment of mitochondrial densities on top of parallel molecular or membrane adjustments appears crucial for maintaining aerobic scope and for shifting thermal tolerance. In conclusion, the capacity of oxygen delivery matches full aerobic scope only within the thermal optimum. At temperatures outside this range, only time-limited survival is supported by residual aerobic scope, then anaerobic metabolism and finally molecular protection by heat shock proteins and antioxidative defence. In a cause and effect hierarchy, the progressive increase in oxygen limitation at extreme temperatures may even enhance oxidative and denaturation stress. As a corollary, capacity limitations at a complex level of organisation, the oxygen delivery system, define thermal tolerance limits before molecular functions become disturbed.

Relationship between volume and survival in closed intensive care units is weak and apparent only in mechanically ventilated patients.

PubMed

Fernández, Rafael; Altaba, Susana; Cabre, Lluis; Lacueva, Victoria; Santos, Antonio; Solsona, Jose-Felipe; Añon, Jose-Manuel; Catalan, Rosa-Maria; Gutierrez, Maria-Jose; Fernandez-Cid, Ramon; Gomez-Tello, Vicente; Curiel, Emilio; Fernandez-Mondejar, Enrique; Oliva, Joan-Carles; Tizon, Ana Isabel; Gonzalez, Javier; Monedero, Pablo; Sanchez, Manuela Garcia; de la Torre, M Victoria; Ibañez, Pedro; Frutos, Fernando; Del Nogal, Frutos; Gomez, M Jesus; Marcos, Alfredo; Vera, Paula; Serrano, Jose Manuel; Umaran, Isabel; Carrillo, Andres; Lopez-Pueyo, M-Jose; Rascado, Pedro; Balerdi, Begoña; Suberviola, Borja; Hernandez, Gonzalo

2013-10-01

Recent studies have found an association between increased volume and increased intensive care unit (ICU) survival; however, this association might not hold true in ICUs with permanent intensivist coverage. Our objective was to determine whether ICU volume correlates with survival in the Spanish healthcare system. Post hoc analysis of a prospective study of all patients admitted to 29 ICUs during 3 months. At ICU discharge, the authors recorded demographic variables, severity score, and specific ICU treatments. Follow-up variables included ICU readmission and hospital mortality. Statistics include logistic multivariate analyses for hospital mortality according to quartiles of volume of patients. The authors studied 4,001 patients with a mean predicted risk of death of 23% (range at hospital level: 14-46%). Observed hospital mortality was 19% (range at hospital level: 11-35%), resulting in a standardized mortality ratio of 0.81 (range: 0.5-1.3). Among the 1,923 patients needing mechanical ventilation, the predicted risk of death was 32% (14-60%) and observed hospital mortality was 30% (12-61%), resulting in a standardized mortality ratio of 0.96 (0.5-1.7). The authors found no correlation between standardized mortality ratio and ICU volume in the entire population or in mechanically ventilated patients. Only mechanically ventilated patients in very low-volume ICUs had slightly worse outcome. In the currently studied healthcare system characterized by 24/7 intensivist coverage, the authors found wide variability in outcome among ICUs even after adjusting for severity of illness but no relationship between ICU volume and outcome. Only mechanically ventilated patients in very low-volume centers had slightly worse outcomes.

7 CFR 3015.60 - Scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Standards for Financial Management Systems § 3015.60 Scope. This subpart contains standards for financial management systems of recipients. No additional financial...

40 CFR 263.10 - Scope.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS APPLICABLE TO TRANSPORTERS OF HAZARDOUS WASTE General § 263.10 Scope. (a) These regulations establish standards which apply to persons transporting hazardous waste within the United States if the transportation...

40 CFR 263.10 - Scope.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS APPLICABLE TO TRANSPORTERS OF HAZARDOUS WASTE General § 263.10 Scope. (a) These regulations establish standards which apply to persons transporting hazardous waste within the United States if the transportation...

40 CFR 263.10 - Scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS APPLICABLE TO TRANSPORTERS OF HAZARDOUS WASTE General § 263.10 Scope. (a) These regulations establish standards which apply to persons transporting hazardous waste within the United States if the transportation...

40 CFR 263.10 - Scope.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS APPLICABLE TO TRANSPORTERS OF HAZARDOUS WASTE General § 263.10 Scope. (a) These regulations establish standards which apply to persons transporting hazardous waste within the United States if the transportation...

29 CFR 1928.1 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR AGRICULTURE General § 1928.1 Purpose and scope. This part contains occupational safety and health standards applicable to agricultural operations. ...

An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation

PubMed Central

Collaco, Joseph M.; Baker, Christopher D.; Carroll, John L.; Sharma, Girish D.; Brozek, Jan L.; Finder, Jonathan D.; Ackerman, Veda L.; Arens, Raanan; Boroughs, Deborah S.; Carter, Jodi; Daigle, Karen L.; Dougherty, Joan; Gozal, David; Kevill, Katharine; Kravitz, Richard M.; Kriseman, Tony; MacLusky, Ian; Rivera-Spoljaric, Katherine; Tori, Alvaro J.; Ferkol, Thomas; Halbower, Ann C.

2016-01-01

Background: Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children. Purpose: To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation. Methods: The Pediatric Assembly of the American Thoracic Society assembled an interdisciplinary workgroup with expertise in the care of children requiring chronic invasive ventilation. The experts developed four questions of clinical importance and used an evidence-based strategy to identify relevant medical evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to formulate and grade recommendations. Results: Clinical practice recommendations for the management of children with chronic ventilator dependence at home are provided, and the evidence supporting each recommendation is discussed. Conclusions: Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. Standardized hospital discharge criteria are suggested. An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child’s care. Standardized equipment for monitoring, emergency preparedness, and airway clearance are outlined. The recommendations presented are based on the current evidence and expert opinion and will require an update as new evidence and/or technologies become available. PMID:27082538

The general ventilation multipliers calculated by using a standard Near-Field/Far-Field model.

PubMed

Koivisto, Antti J; Jensen, Alexander C Ø; Koponen, Ismo K

2018-05-01

In conceptual exposure models, the transmission of pollutants in an imperfectly mixed room is usually described with general ventilation multipliers. This is the approach used in the Advanced REACH Tool (ART) and Stoffenmanager® exposure assessment tools. The multipliers used in these tools were reported by Cherrie (1999; http://dx.doi.org/10.1080/104732299302530 ) and Cherrie et al. (2011; http://dx.doi.org/10.1093/annhyg/mer092 ) who developed them by positing input values for a standard Near-Field/Far-Field (NF/FF) model and then calculating concentration ratios between NF and FF concentrations. This study revisited the calculations that produce the multipliers used in ART and Stoffenmanager and found that the recalculated general ventilation multipliers were up to 2.8 times (280%) higher than the values reported by Cherrie (1999) and the recalculated NF and FF multipliers for 1-hr exposure were up to 1.2 times (17%) smaller and for 8-hr exposure up to 1.7 times (41%) smaller than the values reported by Cherrie et al. (2011). Considering that Stoffenmanager and the ART are classified as higher-tier regulatory exposure assessment tools, the errors is general ventilation multipliers should not be ignored. We recommend revising the general ventilation multipliers. A better solution is to integrate the NF/FF model to Stoffenmanager and the ART.

Comparison of different functional EIT approaches to quantify tidal ventilation distribution.

PubMed

Zhao, Zhanqi; Yun, Po-Jen; Kuo, Yen-Liang; Fu, Feng; Dai, Meng; Frerichs, Inez; Möller, Knut

2018-01-30

The aim of the study was to examine the pros and cons of different types of functional EIT (fEIT) to quantify tidal ventilation distribution in a clinical setting. fEIT images were calculated with (1) standard deviation of pixel time curve, (2) regression coefficients of global and local impedance time curves, or (3) mean tidal variations. To characterize temporal heterogeneity of tidal ventilation distribution, another fEIT image of pixel inspiration times is also proposed. fEIT-regression is very robust to signals with different phase information. When the respiratory signal should be distinguished from the heart-beat related signal, or during high-frequency oscillatory ventilation, fEIT-regression is superior to other types. fEIT-tidal variation is the most stable image type regarding the baseline shift. We recommend using this type of fEIT image for preliminary evaluation of the acquired EIT data. However, all these fEITs would be misleading in their assessment of ventilation distribution in the presence of temporal heterogeneity. The analysis software provided by the currently available commercial EIT equipment only offers either fEIT of standard deviation or tidal variation. Considering the pros and cons of each fEIT type, we recommend embedding more types into the analysis software to allow the physicians dealing with more complex clinical applications with on-line EIT measurements.

Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).

PubMed

Kneyber, Martin C J; de Luca, Daniele; Calderini, Edoardo; Jarreau, Pierre-Henri; Javouhey, Etienne; Lopez-Herce, Jesus; Hammer, Jürg; Macrae, Duncan; Markhorst, Dick G; Medina, Alberto; Pons-Odena, Marti; Racca, Fabrizio; Wolf, Gerhard; Biban, Paolo; Brierley, Joe; Rimensberger, Peter C

2017-12-01

Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms. The Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with "strong agreement". The final iteration of the recommendations had none with equipoise or disagreement. These recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.

Clinical Practice Guideline of Acute Respiratory Distress Syndrome

PubMed Central

Cho, Young-Jae; Moon, Jae Young; Shin, Ein-Soon; Kim, Je Hyeong; Jung, Hoon; Park, So Young; Kim, Ho Cheol; Sim, Yun Su; Rhee, Chin Kook; Lim, Jaemin; Lee, Seok Jeong; Lee, Won-Yeon; Lee, Hyun Jeong; Kwak, Sang Hyun; Kang, Eun Kyeong; Chung, Kyung Soo

2016-01-01

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients. PMID:27790273

Ventilation System Effectiveness and Tested Indoor Air Quality Impacts

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

Rudd, Armin; Bergey, Daniel

In this project, Building America research team Building Science Corporation tested the effectiveness of ventilation systems at two unoccupied, single-family, detached lab homes at the University of Texas - Tyler. Five ventilation system tests were conducted with various whole-building ventilation systems. Multizone fan pressurization testing characterized building and zone enclosure leakage. PFT testing showed multizone air change rates and interzonal airflow. Cumulative particle counts for six particle sizes, and formaldehyde and other Top 20 VOC concentrations were measured in multiple zones. The testing showed that single-point exhaust ventilation was inferior as a whole-house ventilation strategy. This was because the sourcemore » of outside air was not direct from outside, the ventilation air was not distributed, and no provision existed for air filtration. Indoor air recirculation by a central air distribution system can help improve the exhaust ventilation system by way of air mixing and filtration. In contrast, the supply and balanced ventilation systems showed that there is a significant benefit to drawing outside air from a known outside location, and filtering and distributing that air. Compared to the exhaust systems, the CFIS and ERV systems showed better ventilation air distribution and lower concentrations of particulates, formaldehyde and other VOCs. System improvement percentages were estimated based on four system factor categories: balance, distribution, outside air source, and recirculation filtration. Recommended system factors could be applied to reduce ventilation fan airflow rates relative to ASHRAE Standard 62.2 to save energy and reduce moisture control risk in humid climates. HVAC energy savings were predicted to be 8-10%, or $50-$75/year.« less

Ventilation System Effectiveness and Tested Indoor Air Quality Impacts

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

Rudd, Armin; Bergey, Daniel

Ventilation system effectiveness testing was conducted at two unoccupied, single-family, detached lab homes at the University of Texas - Tyler. Five ventilation system tests were conducted with various whole-building ventilation systems. Multizone fan pressurization testing characterized building and zone enclosure leakage. PFT testing showed multizone air change rates and interzonal airflow. Cumulative particle counts for six particle sizes, and formaldehyde and other Top 20 VOC concentrations were measured in multiple zones. The testing showed that single-point exhaust ventilation was inferior as a whole-house ventilation strategy. It was inferior because the source of outside air was not direct from outside, themore » ventilation air was not distributed, and no provision existed for air filtration. Indoor air recirculation by a central air distribution system can help improve the exhaust ventilation system by way of air mixing and filtration. In contrast, the supply and balanced ventilation systems showed that there is a significant benefit to drawing outside air from a known outside location, and filtering and distributing that air. Compared to the Exhaust systems, the CFIS and ERV systems showed better ventilation air distribution and lower concentrations of particulates, formaldehyde and other VOCs. System improvement percentages were estimated based on four System Factor Categories: Balance, Distribution, Outside Air Source, and Recirculation Filtration. Recommended System Factors could be applied to reduce ventilation fan airflow rates relative to ASHRAE Standard 62.2 to save energy and reduce moisture control risk in humid climates. HVAC energy savings were predicted to be 8-10%, or $50-$75/year.« less

Work Scope for Developing Standards for Emergency Preparedness and Response: Fiscal Year 2004 Final Report

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

Stenner, Robert D.

2005-09-28

Summarizes the fiscal year 2004 work completed on PNNL's Department of Homeland Security Emergency Preparedness and Response Standards Development Project. Also, the report includes key draft standards, in various stages of development and publication, that were associated with various tasks of the fiscal year 2004 scope of the project.

16 CFR 1750.3 - Scope and application.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION REFRIGERATOR SAFETY ACT REGULATIONS STANDARD FOR DEVICES TO PERMIT THE OPENING OF HOUSEHOLD REFRIGERATOR DOORS FROM THE INSIDE § 1750.3 Scope and application. This standard shall apply to devices furnished with household refrigerators manufactured and...

40 CFR 273.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR UNIVERSAL WASTE MANAGEMENT General § 273.1 Scope. (a) This part establishes requirements for managing the... an alternative set of management standards in lieu of regulation under 40 CFR parts 260 through 272...

48 CFR 9900.000 - Scope of chapter.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Scope of chapter. 9900.000 Section 9900.000 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET SCOPE OF CHAPTER 9900.000 Scope of chapter. This chapter...

48 CFR 9900.000 - Scope of chapter.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Scope of chapter. 9900.000 Section 9900.000 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET SCOPE OF CHAPTER 9900.000 Scope of chapter. This chapter...

48 CFR 9900.000 - Scope of chapter.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 7 2011-10-01 2011-10-01 false Scope of chapter. 9900.000 Section 9900.000 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET SCOPE OF CHAPTER 9900.000 Scope of chapter. This chapter...

48 CFR 9900.000 - Scope of chapter.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Scope of chapter. 9900.000 Section 9900.000 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET SCOPE OF CHAPTER 9900.000 Scope of chapter. This chapter...

48 CFR 9900.000 - Scope of chapter.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Scope of chapter. 9900.000 Section 9900.000 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET SCOPE OF CHAPTER 9900.000 Scope of chapter. This chapter...

45 CFR 30.21 - Scope and application.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Scope and application. 30.21 Section 30.21 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Debt Compromise § 30.21 Scope and application. (a) Scope. The standards set forth in this subpart apply to the...

Clinical review: Long-term noninvasive ventilation

PubMed Central

Robert, Dominique; Argaud, Laurent

2007-01-01

Noninvasive positive ventilation has undergone a remarkable evolution over the past decades and is assuming an important role in the management of both acute and chronic respiratory failure. Long-term ventilatory support should be considered a standard of care to treat selected patients following an intensive care unit (ICU) stay. In this setting, appropriate use of noninvasive ventilation can be expected to improve patient outcomes, reduce ICU admission, enhance patient comfort, and increase the efficiency of health care resource utilization. Current literature indicates that noninvasive ventilation improves and stabilizes the clinical course of many patients with chronic ventilatory failure. Noninvasive ventilation also permits long-term mechanical ventilation to be an acceptable option for patients who otherwise would not have been treated if tracheostomy were the only alternative. Nevertheless, these results appear to be better in patients with neuromuscular/-parietal disorders than in chronic obstructive pulmonary disease. This clinical review will address the use of noninvasive ventilation (not including continuous positive airway pressure) mainly in diseases responsible for chronic hypoventilation (that is, restrictive disorders, including neuromuscular disease and lung disease) and incidentally in others such as obstructive sleep apnea or problems of central drive. PMID:17419882

Towards lung EIT image segmentation: automatic classification of lung tissue state from analysis of EIT monitored recruitment manoeuvres.

PubMed

Grychtol, Bartłomiej; Wolf, Gerhard K; Adler, Andy; Arnold, John H

2010-08-01

There is emerging evidence that the ventilation strategy used in acute lung injury (ALI) makes a significant difference in outcome and that an inappropriate ventilation strategy may produce ventilator-associated lung injury. Most harmful during mechanical ventilation are lung overdistension and lung collapse or atelectasis. Electrical impedance tomography (EIT) as a non-invasive imaging technology may be helpful to identify lung areas at risk. Currently, no automated method is routinely available to identify lung areas that are overdistended, collapsed or ventilated appropriately. We propose a fuzzy logic-based algorithm to analyse EIT images obtained during stepwise changes of mean airway pressures during mechanical ventilation. The algorithm is tested on data from two published studies of stepwise inflation-deflation manoeuvres in an animal model of ALI using conventional and high-frequency oscillatory ventilation. The timing of lung opening and collapsing on segmented images obtained using the algorithm during an inflation-deflation manoeuvre is in agreement with well-known effects of surfactant administration and changes in shunt fraction. While the performance of the algorithm has not been verified against a gold standard, we feel that it presents an important first step in tackling this challenging and important problem.

Ventilator-associated pneumonia management in critical illness.

PubMed

Albertos, Raquel; Caralt, Berta; Rello, Jordi

2011-03-01

Ventilator-associated pneumonia (VAP) is a frequent adverse event in the intensive care unit.We review recent publications about the management and prevention of VAP. The latest care bundles introduced standard interventions to facilitate implementation of evidence-based clinical guidelines and to improve the outcome of patients. Recent studies find that prevention management of ventilated patients decreases the risk of VAP. Enteral feeding, considered a risk factor for VAP, currently has been recommended, with appropriate administration, for all critical ill patients if no contraindications exist. In view of the recently available data, it can be concluded that the implementation of care bundles on the general management of ventilated patients in daily practice has reduced the VAP rates. The main pharmacological measures to prevent VAP are proper hands hygiene, high nurse-to-patient ratio, avoid unnecessary transfer of ventilated patients, use of noninvasive mechanical ventilation, shortening weaning period, avoid the use of nasal intubation, prevent bio-film deposition in endotracheal tube, aspiration of subglottic secretions, maintenance of adequate pressure of endotracheal cuffs, avoid manipulation of ventilator circuits, semi-recumbent position and adequate enteral feeding.In addition, updated guidelines incorporate more comprehensive diagnostic protocols to the evidence-based management of VAP.

The effect of electromagnetic interference from mobile communication on the performance of intensive care ventilators.

PubMed

Jones, R P; Conway, D H

2005-08-01

Electromagnetic interference produced by wireless communication can affect medical devices and hospital policies exist to address this risk. During the transfer of ventilated patients, these policies may be compromised by essential communication between base and receiving hospitals. Local wireless networks (e.g. Bluetooth) may reduce the 'spaghetti syndrome' of wires and cables seen on intensive care units, but also generate electromagnetic interference. The aim of this study was to investigate these effects on displayed and actual ventilator performance. Five ventilators were tested: Drager Oxylog 2000, BREAS LTV-1000, Respironics BiPAP VISION, Puritan Bennett 7200 and 840. Electromagnetic interference was generated by three devices: Simoco 8020 radio handset, Nokia 7210 and Nokia 6230 mobile phone, Nokia 6230 communicating via Bluetooth with a Palm Tungsten T Personal Digital Assistant. We followed the American National Standard Recommended Practice for On-Site, Ad Hoc Testing (ANSI C63) for electromagnetic interference. We used a ventilator tester, to simulate healthy adult lungs and measure ventilator performance. The communication device under test was moved in towards each ventilator from a distance of 1 m in six axes. Alarms or error codes on the ventilator were recorded, as was ventilator performance. All ventilators tested, except for the Respironics VISION, showed a display error when subjected to electromagnetic interference from the Nokia phones and Simoco radio. Ventilator performance was only affected by the radio which caused the Puritan Bennett 840 to stop functioning completely. The transfer ventilators' performance were not affected by radio or mobile phone, although the mobile phone did trigger a low-power alarm. Effects on intensive care ventilators included display reset, with the ventilator restoring normal display function within 2 s, and low-power/low-pressure alarms. Bluetooth transmission had no effect on the function of all the ventilators tested. In a clinical setting, high-power-output devices such as a two-way radio may cause significant interference in ventilator function. Medium-power-output devices such as mobile phones may cause minor alarm triggers. Low-power-output devices such as Bluetooth appear to cause no interference with ventilator function.

40 CFR 50.2 - Scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.2 Scope. (a) National primary and secondary ambient air quality standards under section 109 of the Act are set forth in this part. (b) National primary ambient air quality...

29 CFR 1990.142 - Initiation of a rulemaking.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR... Potential Carcinogen: (i) The proposed standard shall contain at least provisions for scope and application... proposed standard shall contain at least provisions for scope and application, definitions, notification of...

30 CFR 57.22233 - Actions at 0.5 percent methane (I-C mines).

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Actions at 0.5 percent methane (I-C mines). 57... MINES Safety Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22233 Actions at 0.5 percent methane (I-C mines). If methane reaches 0.5 percent in the mine atmosphere, ventilation changes...

30 CFR 57.22233 - Actions at 0.5 percent methane (I-C mines).

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Actions at 0.5 percent methane (I-C mines). 57... MINES Safety Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22233 Actions at 0.5 percent methane (I-C mines). If methane reaches 0.5 percent in the mine atmosphere, ventilation changes...

Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis.

PubMed

Muscedere, John; Rewa, Oleksa; McKechnie, Kyle; Jiang, Xuran; Laporta, Denny; Heyland, Daren K

2011-08-01

Aspiration of secretions containing bacterial pathogens into the lower respiratory tract is the main cause of ventilator-associated pneumonia. Endotracheal tubes with subglottic secretion drainage can potentially reduce this and, therefore, the incidence of ventilator-associated pneumonia. New evidence on subglottic secretion drainage as a preventive measure for ventilator-associated pneumonia has been recently published and to consider the evidence in totality, we conducted an updated systematic review and meta-analysis. We searched computerized databases, reference lists, and personal files. We included randomized clinical trials of mechanically ventilated patients comparing standard endotracheal tubes to those with subglottic secretion drainage and reporting on the occurrence of ventilator-associated pneumonia. Studies were meta-analyzed for the primary outcome of ventilator-associated pneumonia and secondary clinical outcomes. We identified 13 randomized clinical trials that met the inclusion criteria with a total of 2442 randomized patients. Of the 13 studies, 12 reported a reduction in ventilator-associated pneumonia rates in the subglottic secretion drainage arm; in meta-analysis, the overall risk ratio for ventilator-associated pneumonia was 0.55 (95% confidence interval, 0.46-0.66; p < .00001) with no heterogeneity (I = 0%). The use of subglottic secretion drainage was associated with reduced intensive care unit length of stay (-1.52 days; 95% confidence interval, -2.94 to -0.11; p = .03); decreased duration of mechanically ventilated (-1.08 days; 95% confidence interval, -2.04 to -0.12; p = .03), and increased time to first episode of ventilator-associated pneumonia (2.66 days; 95% confidence interval, 1.06-4.26; p = .001). There was no effect on adverse events or on hospital or intensive care unit mortality. In those at risk for ventilator-associated pneumonia, the use of endotracheal tubes with subglottic secretion drainage is effective for the prevention of ventilator-associated pneumonia and may be associated with reduced duration of mechanical ventilation and intensive care unit length of stay.

Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding.

PubMed

Ashktorab, Hassan; Etaati, Firoozeh; Rezaeean, Farahnaz; Nouraie, Mehdi; Paydar, Mansour; Namin, Hassan Hassanzadeh; Sanderson, Andrew; Begum, Rehana; Alkhalloufi, Kawtar; Brim, Hassan; Laiyemo, Adeyinka O

2016-07-28

To study the accuracy of using high definition (HD) scope with narrow band imaging (NBI) vs standard white light colonoscope without NBI (ST), to predict the histology of the colon polyps, particularly those < 1 cm. A total of 147 African Americans patients who were referred to Howard University Hospital for screening or, diagnostic or follow up colonoscopy, during a 12-mo period in 2012 were prospectively recruited. Some patients had multiple polyps and total number of polyps was 179. Their colonoscopies were performed by 3 experienced endoscopists who determined the size and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care. Of participants in the study, 55 (37%) were male and median (interquartile range) of age was 56 (19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were < 1 cm vs 87% in HD scope (P = 0.7). The ST scope had a positive predictive value (PPV) and positive likelihood ratio (PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope (68%) compare to ST scope (53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp (HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar. Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.

10 CFR 431.370 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... water conservation standard set forth in this part. Energy and water conservation standards include... 10 Energy 3 2011-01-01 2011-01-01 false Purpose and scope. 431.370 Section 431.370 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY EFFICIENCY PROGRAM FOR CERTAIN COMMERCIAL AND INDUSTRIAL...

40 CFR 146.1 - Applicability and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) UNDERGROUND INJECTION CONTROL PROGRAM: CRITERIA AND STANDARDS General Provisions § 146.1 Applicability and scope. (a) This part sets forth technical criteria and standards for the Underground Injection Control... of a State UIC program by the Administrator, any underground injection which is not authorized by the...

40 CFR 125.1 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Purpose and scope. 125.1 Section 125.1 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Criteria and Standards for Imposing Technology...

Impact of a monitored program of care on incidence of ventilator-associated pneumonia: results of a longterm performance-improvement project.

PubMed

Weireter, Leonard J; Collins, J N; Britt, Rebecca C; Reed, Scott F; Novosel, T J; Britt, L D

2009-05-01

Ventilator-associated pneumonia (VAP) remains a major source of morbidity, mortality, and expense in the ICU despite therapies directed against it. A retrospective review of a prospectively developed performance-improvement project monitoring the incidence of VAP in two adjacent ICUs was conducted. In response to an excessive VAP rate, weekly multidisciplinary team meetings were instituted to review data, develop care protocols, and modify care routines. Protocol compliance was monitored daily and feedback provided weekly to the care teams. VAP rates were determined by the institutional Infection Control Committee and reviewed monthly with the ICU multidisciplinary team. Duration of the investigational period was 10 years. A standardized ventilator-weaning protocol was instituted with confirmed 95% use. Additional modifications of care, such as patient positioning, use of specific endotracheal tubes to minimize aspiration of supraglottic secretions, an oral-care regimen, and aggressive antibiotic stewardship were standardized, with a compliance rate >90%. VAP rates dropped from 12.8 per 1,000 patient-days in 1998 to 1.1 in 2007 in the burn trauma ICU and from 21.2 to <1 in the neurotrauma ICU in the same time frame. Also, mean ventilator length of stay decreased from 6 days to 4.2 and from 5.8 days to 4.75 simultaneously in the respective ICUs. Such performance improvement has been sustained since implementation of the program. A systematic, monitored program of standardized care protocols can markedly reduce VAP rate in the ICU.

Health outcomes and green renovation of affordable housing.

PubMed

Breysse, Jill; Jacobs, David E; Weber, William; Dixon, Sherry; Kawecki, Carol; Aceti, Susan; Lopez, Jorge

2011-01-01

This study sought to determine whether renovating low-income housing using "green" and healthy principles improved resident health and building performance. We investigated resident health and building performance outcomes at baseline and one year after the rehabilitation of low-income housing using Enterprise Green Communities green specifications, which improve ventilation; reduce moisture, mold, pests, and radon; and use sustainable building products and other healthy housing features. We assessed participant health via questionnaire, provided Healthy Homes training to all participants, and measured ventilation, carbon dioxide, and radon. Adults reported statistically significant improvements in overall health, asthma, and non-asthma respiratory problems. Adults also reported that their children's overall health improved, with significant improvements in non-asthma respiratory problems. Post-renovation building performance testing indicated that the building envelope was tightened and local exhaust fans performed well. New mechanical ventilation was installed (compared with no ventilation previously), with fresh air being supplied at 70% of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers standard. Radon was < 2 picocuries per liter of air following mitigation, and the annual average indoor carbon dioxide level was 982 parts per million. Energy use was reduced by 45% over the one-year post-renovation period. We found significant health improvements following low-income housing renovation that complied with green standards. All green building standards should include health requirements. Collaboration of housing, public health, and environmental health professionals through integrated design holds promise for improved health, quality of life, building operation, and energy conservation.

Health Outcomes and Green Renovation of Affordable Housing

PubMed Central

Breysse, Jill; Jacobs, David E.; Weber, William; Dixon, Sherry; Kawecki, Carol; Aceti, Susan; Lopez, Jorge

2011-01-01

Objective This study sought to determine whether renovating low-income housing using “green” and healthy principles improved resident health and building performance. Methods We investigated resident health and building performance outcomes at baseline and one year after the rehabilitation of low-income housing using Enterprise Green Communities green specifications, which improve ventilation; reduce moisture, mold, pests, and radon; and use sustainable building products and other healthy housing features. We assessed participant health via questionnaire, provided Healthy Homes training to all participants, and measured ventilation, carbon dioxide, and radon. Results Adults reported statistically significant improvements in overall health, asthma, and non-asthma respiratory problems. Adults also reported that their children's overall health improved, with significant improvements in non-asthma respiratory problems. Post-renovation building performance testing indicated that the building envelope was tightened and local exhaust fans performed well. New mechanical ventilation was installed (compared with no ventilation previously), with fresh air being supplied at 70% of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers standard. Radon was <2 picocuries per liter of air following mitigation, and the annual average indoor carbon dioxide level was 982 parts per million. Energy use was reduced by 45% over the one-year post-renovation period. Conclusions We found significant health improvements following low-income housing renovation that complied with green standards. All green building standards should include health requirements. Collaboration of housing, public health, and environmental health professionals through integrated design holds promise for improved health, quality of life, building operation, and energy conservation. PMID:21563714

Investigating the adaptive model of thermal comfort for naturally ventilated school buildings in Taiwan.

PubMed

Hwang, Ruey-Lung; Lin, Tzu-Ping; Chen, Chen-Peng; Kuo, Nai-Jung

2009-03-01

Divergence in the acceptability to people in different regions of naturally ventilated thermal environments raises a concern over the extent to which the ASHRAE Standard 55 may be applied as a universal criterion of thermal comfort. In this study, the ASHRAE 55 adaptive model of thermal comfort was investigated for its applicability to a hot and humid climate through a long-term field survey performed in central Taiwan among local students attending 14 elementary and high schools during September to January. Adaptive behaviors, thermal neutrality, and thermal comfort zones are explored. A probit analysis of thermal acceptability responses from students was performed in place of the conventional linear regression of thermal sensation votes against operative temperature to investigate the limits of comfort zones for 90% and 80% acceptability; the corresponding comfort zones were found to occur at 20.1-28.4 degrees C and 17.6-30.0 degrees C, respectively. In comparison with the yearly comfort zones recommended by the adaptive model for naturally ventilated spaces in the ASHRAE Standard 55, those observed in this study differ in the lower limit for 80% acceptability, with the observed level being 1.7 degrees C lower than the ASHRAE-recommended value. These findings can be generalized to the population of school children, thus providing information that can supplement ASHRAE Standard 55 in evaluating the thermal performance of naturally ventilated school buildings, particularly in hot-humid areas such as Taiwan.

Investigating the adaptive model of thermal comfort for naturally ventilated school buildings in Taiwan

NASA Astrophysics Data System (ADS)

Hwang, Ruey-Lung; Lin, Tzu-Ping; Chen, Chen-Peng; Kuo, Nai-Jung

2009-03-01

Divergence in the acceptability to people in different regions of naturally ventilated thermal environments raises a concern over the extent to which the ASHRAE Standard 55 may be applied as a universal criterion of thermal comfort. In this study, the ASHRAE 55 adaptive model of thermal comfort was investigated for its applicability to a hot and humid climate through a long-term field survey performed in central Taiwan among local students attending 14 elementary and high schools during September to January. Adaptive behaviors, thermal neutrality, and thermal comfort zones are explored. A probit analysis of thermal acceptability responses from students was performed in place of the conventional linear regression of thermal sensation votes against operative temperature to investigate the limits of comfort zones for 90% and 80% acceptability; the corresponding comfort zones were found to occur at 20.1-28.4°C and 17.6-30.0°C, respectively. In comparison with the yearly comfort zones recommended by the adaptive model for naturally ventilated spaces in the ASHRAE Standard 55, those observed in this study differ in the lower limit for 80% acceptability, with the observed level being 1.7°C lower than the ASHRAE-recommended value. These findings can be generalized to the population of school children, thus providing information that can supplement ASHRAE Standard 55 in evaluating the thermal performance of naturally ventilated school buildings, particularly in hot-humid areas such as Taiwan.

SU-E-J-120: Comparing 4D CT Computed Ventilation to Lung Function Measured with Hyperpolarized Xenon-129 MRI

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

Neal, B; Chen, Q

2015-06-15

Purpose: To correlate ventilation parameters computed from 4D CT to ventilation, profusion, and gas exchange measured with hyperpolarized Xenon-129 MRI for a set of lung cancer patients. Methods: Hyperpolarized Xe-129 MRI lung scans were acquired for lung cancer patients, before and after radiation therapy, measuring ventilation, perfusion, and gas exchange. In the standard clinical workflow, these patients also received 4D CT scans before treatment. Ventilation was computed from 4D CT using deformable image registration (DIR). All phases of the 4D CT scan were registered using a B-spline deformable registration. Ventilation at the voxel level was then computed for each phasemore » based on a Jacobian volume expansion metric, yielding phase sorted ventilation images. Ventilation based upon 4D CT and Xe-129 MRI were co-registered, allowing qualitative visual comparison and qualitative comparison via the Pearson correlation coefficient. Results: Analysis shows a weak correlation between hyperpolarized Xe-129 MRI and 4D CT DIR ventilation, with a Pearson correlation coefficient of 0.17 to 0.22. Further work will refine the DIR parameters to optimize the correlation. The weak correlation could be due to the limitations of 4D CT, registration algorithms, or the Xe-129 MRI imaging. Continued development will refine parameters to optimize correlation. Conclusion: Current analysis yields a minimal correlation between 4D CT DIR and Xe-129 MRI ventilation. Funding provided by the 2014 George Amorino Pilot Grant in Radiation Oncology at the University of Virginia.« less

40 CFR 63.401 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., ventilation, or air conditioning system. Initial startup means the initiation of recirculation water flow... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission Standards for...

Effect of Ventilation Strategies on Residential Ozone Levels

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

Walker, Iain S.; Sherman, Max H.

Elevated outdoor ozone levels are associated with adverse health effects. Because people spend the vast majority of their time indoors, reduction in indoor levels of ozone of outdoor origin would lower population exposures and might also lead to a reduction in ozone-associated adverse health effects. In most buildings, indoor ozone levels are diminished with respect to outdoor levels to an extent that depends on surface reactions and on the degree to which ozone penetrates the building envelope. Ozone enters buildings from outdoors together with the airflows that are driven by natural and mechanical means, including deliberate ventilation used to reducemore » concentrations of indoor-generated pollutants. When assessing the effect of deliberate ventilation on occupant health one should consider not only the positive effects on removing pollutants of indoor origin but also the possibility that enhanced ventilation might increase indoor levels of pollutants originating outdoors. This study considers how changes in residential ventilation that are designed to comply with ASHRAE Standard 62.2 might influence indoor levels of ozone. Simulation results show that the building envelope can contribute significantly to filtration of ozone. Consequently, the use of exhaust ventilation systems is predicted to produce lower indoor ozone concentrations than would occur with balanced ventilation systems operating at the same air-­exchange rate. We also investigated a strategy for reducing exposure to ozone that would deliberately reduce ventilation rates during times of high outdoor ozone concentration while still meeting daily average ventilation requirements.« less

Effects of ventilation behaviour on indoor heat load based on test reference years.

PubMed

Rosenfelder, Madeleine; Koppe, Christina; Pfafferott, Jens; Matzarakis, Andreas

2016-02-01

Since 2003, most European countries established heat health warning systems to alert the population to heat load. Heat health warning systems are based on predicted meteorological conditions outdoors. But the majority of the European population spends a substantial amount of time indoors, and indoor thermal conditions can differ substantially from outdoor conditions. The German Meteorological Service (Deutscher Wetterdienst, DWD) extended the existing heat health warning system (HHWS) with a thermal building simulation model to consider heat load indoors. In this study, the thermal building simulation model is used to simulate a standardized building representing a modern nursing home, because elderly and sick people are most sensitive to heat stress. Different types of natural ventilation were simulated. Based on current and future test reference years, changes in the future heat load indoors were analyzed. Results show differences between the various ventilation options and the possibility to minimize the thermal heat stress during summer by using an appropriate ventilation method. Nighttime ventilation for indoor thermal comfort is most important. A fully opened window at nighttime and the 2-h ventilation in the morning and evening are more sufficient to avoid heat stress than a tilted window at nighttime and the 1-h ventilation in the morning and the evening. Especially the ventilation in the morning seems to be effective to keep the heat load indoors low. Comparing the results for the current and the future test reference years, an increase of heat stress on all ventilation types can be recognized.

Effects of ventilation behaviour on indoor heat load based on test reference years

NASA Astrophysics Data System (ADS)

Rosenfelder, Madeleine; Koppe, Christina; Pfafferott, Jens; Matzarakis, Andreas

2016-02-01

Since 2003, most European countries established heat health warning systems to alert the population to heat load. Heat health warning systems are based on predicted meteorological conditions outdoors. But the majority of the European population spends a substantial amount of time indoors, and indoor thermal conditions can differ substantially from outdoor conditions. The German Meteorological Service (Deutscher Wetterdienst, DWD) extended the existing heat health warning system (HHWS) with a thermal building simulation model to consider heat load indoors. In this study, the thermal building simulation model is used to simulate a standardized building representing a modern nursing home, because elderly and sick people are most sensitive to heat stress. Different types of natural ventilation were simulated. Based on current and future test reference years, changes in the future heat load indoors were analyzed. Results show differences between the various ventilation options and the possibility to minimize the thermal heat stress during summer by using an appropriate ventilation method. Nighttime ventilation for indoor thermal comfort is most important. A fully opened window at nighttime and the 2-h ventilation in the morning and evening are more sufficient to avoid heat stress than a tilted window at nighttime and the 1-h ventilation in the morning and the evening. Especially the ventilation in the morning seems to be effective to keep the heat load indoors low. Comparing the results for the current and the future test reference years, an increase of heat stress on all ventilation types can be recognized.

78 FR 32473 - Southwest Research Institute: Modification of Scope of Recognition

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-30

... test standard from the scope of recognition of a Nationally Recognized Testing Laboratory (NRTL... delete a test standard, UL 60950--Information Technology Equipment (see Exhibit OSHA- 2006-0041-003... David Michaels, Ph.D., MPH, Assistant Secretary of Labor for Occupational Safety and Health, 200...

30 CFR 75.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES General § 75.1 Scope. This part 75 sets forth safety standards compliance with which is mandatory in each underground coal mine subject to the Federal Mine Safety and Health Act...

30 CFR 75.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-07-01

... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES General § 75.1 Scope. This part 75 sets forth safety standards compliance with which is mandatory in each underground coal mine subject to the Federal Mine Safety and Health Act...

30 CFR 75.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-07-01

... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES General § 75.1 Scope. This part 75 sets forth safety standards compliance with which is mandatory in each underground coal mine subject to the Federal Mine Safety and Health Act...

30 CFR 75.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES General § 75.1 Scope. This part 75 sets forth safety standards compliance with which is mandatory in each underground coal mine subject to the Federal Mine Safety and Health Act...

30 CFR 75.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-07-01

... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES General § 75.1 Scope. This part 75 sets forth safety standards compliance with which is mandatory in each underground coal mine subject to the Federal Mine Safety and Health Act...

40 CFR 170.1 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... STANDARD General Provisions § 170.1 Scope and purpose. This part contains a standard designed to reduce the... used in the production of agricultural plants on farms or in nurseries, greenhouses, and forests and... workplace practices designed to reduce or eliminate exposure to pesticides and establishes procedures for...

An evaluation of the impact of the ventilator care bundle.

PubMed

Crunden, Eddie; Boyce, Carolyn; Woodman, Helen; Bray, Barbara

2005-01-01

A number of interventions have been shown to improve the outcomes of patients who are invasively ventilated in intensive care units (ICUs). However, significant problems still exist in implementing research findings into clinical practice. The aim of this study was to assess whether the systematic and methodical implementation of evidence-based interventions encapsulated in a care bundle influenced length of ventilation and ICU length of stay (LOS). A ventilator care bundle was introduced within a general ICU and evaluated 1 year later. The care bundle was composed of four protocols that consisted of prophylaxis against peptic ulceration, prophylaxis against deep vein thrombosis, daily cessation of sedation and elevation of the patient's head and chest to at least 30 degrees to the horizontal. Compliance with the bundle was assessed, as was ICU LOS, ICU mortality and ICU/high-dependency unit patient throughput. Mean ICU LOS was reduced from 13-75 [standard deviation (SD) 19.11] days to 8.36 (SD 10.21) days (p<0.05). Mean ventilator days were reduced from 10.8 (SD 15.58) days to 6.1 (SD 8.88) days. Unit patient throughput increased by 30.1% and the number of invasively ventilated patients increased by 39.5%. Care bundles encourage the consistent and systematic application of evidence-based protocols used in particular treatment regimes. Since the introduction of the ventilator care bundle, length of ventilation and ICU LOS have reduced significantly.

Performance of heated humidifiers with a heated wire according to ventilatory settings.

PubMed

Nishida, T; Nishimura, M; Fujino, Y; Mashimo, T

2001-01-01

Delivering warm, humidified gas to patients is important during mechanical ventilation. Heated humidifiers are effective and popular. The humidifying efficiency is influenced not only by performance and settings of the devices but the settings of ventilator. We compared the efficiency of humidifying devices with a heated wire and servo-controlled function under a variety of ventilator settings. A bench study was done with a TTL model lung. The study took place in the laboratory of the University Hospital, Osaka, Japan. Four devices (MR290 with MR730, MR310 with MR730; both Fisher & Paykel, ConchaTherm IV; Hudson RCI, and HummaxII; METRAN) were tested. Hummax II has been developed recently, and it consists of a heated wire and polyethylene microporous hollow fiber. Both wire and fiber were put inside of an inspiratory circuit, and water vapor is delivered throughout the circuit. The Servo 300 was connected to the TTL with a standard ventilator circuit. The ventilator settings were as follows; minute ventilation (V(E)) 5, 10, and 15 L/min, a respiratory rate of 10 breaths/min, I:E ratio 1:1, 1:2, and 1:4, and no applied PEEP. Humidifying devices were set to maintain the temperature of airway opening at 32 degrees C and 37 degrees C. The greater V(E) the lower the humidity with all devices except Hummax II. Hummax II delivered 100% relative humidity at all ventilator and humidifier settings. When airway temperature control of the devices was set at 32 degrees C, the ConchaTherm IV did not deliver 30 mg/L of vapor, which is the value recommended by American National Standards at all V(E) settings. At 10 and 15 L/min of V(E) settings MR310 with MR730 did not deliver recommended vapor, either. In conclusion, airway temperature setting of the humidifying devices influenced the humidity of inspiratory gas greatly. Ventilatory settings also influenced the humidity of inspiratory gas. The Hummax II delivered sufficient water vapor under a variety of minute ventilation.

[Appropriate dust control measures for jade carving operations].

PubMed

Liu, Jiang; Wang, Qiushui; Liu, Guangquan

2002-12-01

To provide the appropriate dust control measures for jade carving operations. Dust concentrations in the workplace were measured according to GB/T 5748-85. Ventilation system of dust control were measured according to GB/T 16157-1996. Dust particle size distributions for different sources and particle size fraction collecting efficiencies of the dust collectors were measured with WY-1 in-stack 7 stage cascade impactors. On the basis of adopting wet process in the carving operations, local exhaust ventilation system for dust control was installed, which included: the special designed slot exhaust hoods with hood face velocity of 2.5 m/s and exhaust volume of 600 m3/h. The pipe sizes were determined according to the air volume passing through the pipe and the reasonable air velocities. Impinging scrubber or bag filter dust collector were selected to treat the dust laden air from the local exhaust ventilation system, which gave a total collecting efficiency of 97% for impinging scrubber and 98% for bag filter; The type of fan and its size were selected according to the total air volume of the ventilation system and maximum total pressure needed for the longest pipe line plus the pressure drop of the dust collector. Practical application showed that, after installation and use of the appropriate dust control measures, the dust concentrations in the workplaces could meet or nearly meet the national hygienic standard and the dust laden air at the local exhaust ventilation system could meet the national emission standard.

Accelerated Fractional Ventilation Imaging with Hyperpolarized Gas MRI

PubMed Central

Emami, Kiarash; Xu, Yinan; Hamedani, Hooman; Profka, Harrilla; Kadlecek, Stephen; Xin, Yi; Ishii, Masaru; Rizi, Rahim R.

2013-01-01

PURPOSE To investigate the utility of accelerated imaging to enhance multi-breath fractional ventilation (r) measurement accuracy using HP gas MRI. Undersampling shortens the breath-hold time, thereby reducing the O2-induced signal decay and allows subjects to maintain a more physiologically relevant breathing pattern. Additionally it may improve r estimation accuracy by reducing RF destruction of HP gas. METHODS Image acceleration was achieved by using an 8-channel phased array coil. Undersampled image acquisition was simulated in a series of ventilation images and images were reconstructed for various matrix sizes (48–128) using GRAPPA. Parallel accelerated r imaging was also performed on five mechanically ventilated pigs. RESULTS Optimal acceleration factor was fairly invariable (2.0–2.2×) over the range of simulated resolutions. Estimation accuracy progressively improved with higher resolutions (39–51% error reduction). In vivo r values were not significantly different between the two methods: 0.27±0.09, 0.35±0.06, 0.40±0.04 (standard) versus 0.23±0.05, 0.34±0.03, 0.37±0.02 (accelerated); for anterior, medial and posterior slices, respectively, whereas the corresponding vertical r gradients were significant (P < 0.001): 0.021±0.007 (standard) versus 0.019±0.005 (accelerated) [cm−1]. CONCLUSION Quadruple phased array coil simulations resulted in an optimal acceleration factor of ~2× independent of imaging resolution. Results advocate undersampled image acceleration to improve accuracy of fractional ventilation measurement with HP gas MRI. PMID:23400938

Quality of resuscitation: flight attendants in an airplane simulator use a new mechanical resuscitation device--a randomized simulation study.

PubMed

Fischer, Henrik; Neuhold, Stephanie; Hochbrugger, Eva; Steinlechner, Barbara; Koinig, Herbert; Milosevic, Ljubisa; Havel, Christof; Frantal, Sophie; Greif, Robert

2011-04-01

Cardiopulmonary resuscitation (CPR) during flight is challenging and has to be sustained for long periods. In this setting a mechanical-resuscitation-device (MRD) might improve performance. In this study we compared the quality of resuscitation of trained flight attendants practicing either standard basic life support (BLS) or using a MRD in a cabin-simulator. Prospective, open, randomized and crossover simulation study. Study participants, competent in standard BLS were trained to use the MRD to deliver both chest compressions and ventilation. 39 teams of two rescuers resuscitated a manikin for 12 min in random order, standard BLS or mechanically assisted resuscitation. Primary outcome was "absolute hands-off time" (sum of all periods during which no hand was placed on the chest minus ventilation time). Various parameters describing the quality of chest compression and ventilation were analysed as secondary outcome parameters. Use of the MRD led to significantly less "absolute hands-off time" (164±33 s vs. 205±42 s, p<0.001). The quality of chest compression was comparable among groups, except for a higher compression rate in the standard BLS group (123±14 min(-1) vs. 95±11 min(-1), p<0.001). Tidal volume was higher in the standard BLS group (0.48±0.14 l vs. 0.34±0.13 l, p<0.001), but we registered fewer gastric inflations in the MRD group (0.4±0.3% vs. 16.6±16.9%, p<0.001). Using the MRD resulted in significantly less "absolute hands-off time", but less effective ventilation. The translation of higher chest compression rate into better outcome, as shown in other studies previously, has to be investigated in another human outcome study. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Effect of standardized orders and provider education on head-of-bed positioning in mechanically ventilated patients.

PubMed

Helman, Donald L; Sherner, John H; Fitzpatrick, Thomas M; Callender, Marcia E; Shorr, Andrew F

2003-09-01

Semirecumbent head-of-bed positioning in mechanically ventilated patients decreases the risk of developing ventilator-associated pneumonia (VAP). The purpose of this study was to determine whether the addition of a standardized order followed by the initiation of a provider education program would increase the frequency with which our patients were maintained in the semirecumbent position. Prospective, pre-, and postintervention observational study. A tertiary care, U.S. Army teaching hospital. Mechanically ventilated medical and surgical intensive care unit patients. The first intervention involved the addition of an order for semirecumbent head-of-bed positioning to our intensive care unit order sets. This was followed 2 months later with a second intervention, which was a nurse and physician education program emphasizing semirecumbent positioning. Data regarding head-of-bed positioning were collected on 100 patient observations at baseline and at 1 and 2 months after each of our interventions. The mean angle of head of bed increased from 24 +/- 9 degrees at baseline to 35 +/- 9 degrees (p <.05) 2 months after the addition of the standard order. The percentage of observations with head of bed >45 degrees increased from 3% to 16% 2 months after the standardized order (p <.05). Two months after our provider education program, the mean angle of the head of bed was 34 +/- 11 degrees and the percentage of patients with head of bed >45 degrees was 29% (p = NS compared with values after the first intervention). Data collected 6 months after completion of our education programs showed that these improvements were maintained. Standardizing the process of care via the addition of an order specifying head-of-bed position significantly increased the number of patients who were placed in the semirecumbent position. In an era of cost-conscious medicine, interventions that utilize protocols and education programs should be emphasized.

49 CFR 543.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 6 2010-10-01 2010-10-01 false Scope. 543.1 Section 543.1 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EXEMPTION FROM VEHICLE THEFT PREVENTION STANDARD § 543.1 Scope. This part...

49 CFR 213.51 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Scope. 213.51 Section 213.51 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRACK SAFETY STANDARDS Track Geometry § 213.51 Scope. This subpart prescribes requirements for the...

49 CFR 213.51 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Scope. 213.51 Section 213.51 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRACK SAFETY STANDARDS Track Geometry § 213.51 Scope. This subpart prescribes requirements for the...

29 CFR 96.51 - Purpose and scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Resolution § 96.51 Purpose and scope of subpart. This subpart prescribes standards for resolution of audit.... In cases where these standards conflict with statutes or other DOL regulations, the latter shall be controlling. The DOL Office of Inspector General (OIG) is available to assist agencies in the audit resolution...

78 FR 73208 - Underwriters Laboratories, Inc.: Application for Expansion

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-05

... Laboratories, Inc., requests the addition of multiple test standards to its scope of recognition. This... Laboratory (NRTL). UL requests the addition of multiple test standards to their NRTL scope of recognition... recognition has three elements: (1) The type of products the NRTL may test, with each type specified by its...

29 CFR 1915.171 - Scope and application of subpart.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 7 2010-07-01 2010-07-01 false Scope and application of subpart. 1915.171 Section 1915.171..., DEPARTMENT OF LABOR (CONTINUED) OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR SHIPYARD EMPLOYMENT Portable... application of subpart. The standards contained in this subpart shall apply to ship repairing and shipbuilding...

78 FR 38389 - Proposed Modification to the Scopes of Recognition of Several NRTLs

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-26

... the NRTL's written testing procedures.\\2\\ \\2\\ Such datasheets may be electronic records or hardcopies... particular test standard. OSHA reviews each NRTL's procedures to determine which approach the NRTL will use... standards from the scopes of recognition of several nationally recognized testing laboratories (NRTLs), and...

48 CFR 30.000 - Scope of part.

Code of Federal Regulations, 2010 CFR

2010-10-01

... REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION 30.000 Scope of part. This part describes policies and procedures for applying the Cost Accounting Standards Board (CASB) rules and regulations (48 CFR chapter 99... contracts or to any contract with a small business concern (see 48 CFR 9903.201-1(b) (FAR appendix) for...

30 CFR 57.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... The purpose of these standards is the protection of life, the promotion of health and safety, and the... Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES General § 57.1 Purpose and scope...

30 CFR 56.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... standards is the protection of life, the promotion of health and safety, and the prevention of accidents. ... Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES General § 56.1 Purpose and scope...

High-Flow Nasal Cannula Oxygenation in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study.

PubMed

Lemiale, Virginie; Resche-Rigon, Matthieu; Mokart, Djamel; Pène, Frédéric; Argaud, Laurent; Mayaux, Julien; Guitton, Christophe; Rabbat, Antoine; Girault, Christophe; Kouatchet, Achille; Vincent, François; Bruneel, Fabrice; Nyunga, Martine; Seguin, Amélie; Klouche, Kada; Colin, Gwenahel; Kontar, Loay; Perez, Pierre; Meert, Anne-Pascale; Benoit, Dominique D; Papazian, Laurent; Demoule, Alexandre; Chevret, Sylvie; Azoulay, Elie

2017-03-01

In immunocompromised patients with acute respiratory failure, invasive mechanical ventilation remains associated with high mortality. Choosing the adequate oxygenation strategy is of the utmost importance in that setting. High-flow nasal oxygen has recently shown survival benefits in unselected patients with acute respiratory failure. The objective was to assess outcomes of immunocompromised patients with hypoxemic acute respiratory failure treated with high-flow nasal oxygen. We performed a post hoc analysis of a randomized controlled trial of noninvasive ventilation in critically ill immunocompromised patients with hypoxemic acute respiratory failure. Twenty-nine ICUs in France and Belgium. Critically ill immunocompromised patients with hypoxemic acute respiratory failure. A propensity score-based approach was used to assess the impact of high-flow nasal oxygen compared with standard oxygen on day 28 mortality. Among 374 patients included in the study, 353 met inclusion criteria. Underlying disease included mostly malignancies (n = 296; 84%). Acute respiratory failure etiologies were mostly pneumonia (n = 157; 44.4%) or opportunistic infection (n = 76; 21.5%). Noninvasive ventilation was administered to 180 patients (51%). Invasive mechanical ventilation was ultimately needed in 142 patients (40.2%). Day 28 mortality was 22.6% (80 deaths). Throughout the ICU stay, 127 patients (36%) received high-flow nasal oxygen whereas 226 patients received standard oxygen. Ninety patients in each group (high-flow nasal oxygen or standard oxygen) were matched according to the propensity score, including 91 of 180 (51%) who received noninvasive ventilation. High-flow nasal oxygen was neither associated with a lower intubation rate (hazard ratio, 0.42; 95% CI, 0.11-1.61; p = 0.2) nor day 28 mortality (hazard ratio, 0.80; 95% CI, 0.45-1.42; p = 0.45). In immunocompromised patients with hypoxemic acute respiratory failure, high-flow nasal oxygen when compared with standard oxygen did not reduce intubation or survival rates. However, these results could be due to low statistical power or unknown confounders associated with the subgroup analysis. A randomized trial is needed.

Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management

PubMed Central

Johnson, Kathleen N; Botros, Daniel B; Groban, Leanne; Bryan, Yvon F

2015-01-01

There are many anatomical, physiopathological, and cognitive changes that occur in the elderly that affect different components of airway management: intubation, ventilation, oxygenation, and risk of aspiration. Anatomical changes occur in different areas of the airway from the oral cavity to the larynx. Common changes to the airway include tooth decay, oropharyngeal tumors, and significant decreases in neck range of motion. These changes may make intubation challenging by making it difficult to visualize the vocal cords and/or place the endotracheal tube. Also, some of these changes, including but not limited to, atrophy of the muscles around the lips and an edentulous mouth, affect bag mask ventilation due to a difficult face-mask seal. Physiopathologic changes may impact airway management as well. Common pulmonary issues in the elderly (eg, obstructive sleep apnea and COPD) increase the risk of an oxygen desaturation event, while gastrointestinal issues (eg, achalasia and gastroesophageal reflux disease) increase the risk of aspiration. Finally, cognitive changes (eg, dementia) not often seen as related to airway management may affect patient cooperation, especially if an awake intubation is required. Overall, degradation of the airway along with other physiopathologic and cognitive changes makes the elderly population more prone to complications related to airway management. When deciding which airway devices and techniques to use for intubation, the clinician should also consider the difficulty associated with ventilating the patient, the patient’s risk of oxygen desaturation, and/or aspiration. For patients who may be difficult to bag mask ventilate or who have a risk of aspiration, a specialized supralaryngeal device may be preferable over bag mask for ventilation. Patients with tumors or decreased neck range of motion may require a device with more finesse and maneuverability, such as a flexible fiberoptic broncho-scope. Overall, geriatric-focused airway management is necessary to decrease complications in this patient population. PMID:26673904

[Air quality control systems: heating, ventilating, and air conditioning (HVAC)].

PubMed

Bellucci Sessa, R; Riccio, G

2004-01-01

After a brief illustration of the principal layout schemes of Heating, Ventilating, and Air Conditioning (HVAC), the first part of this paper summarizes the standards, both voluntary and compulsory, regulating HVAC facilities design and installation with regard to the question of Indoor Air Quality (IAQ). The paper then examines the problem of ventilation systems maintenance and the essential hygienistic requirements in whose absence HVAC facilities may become a risk factor for people working or living in the building. Lastly, the paper deals with HVAC design strategies and methods, which aim not only to satisfy comfort and air quality requirements, but also to ensure easy and effective maintenance procedures.

Intravenous ketamine in a dissociating dose as a temporizing measure to avoid mechanical ventilation in adult patient with severe asthma exacerbation.

PubMed

Shlamovitz, Gil Z; Hawthorne, Tracy

2011-11-01

Patients experiencing severe asthma exacerbations occasionally deteriorate to respiratory failure requiring endotracheal intubation and mechanical ventilation. Mechanical ventilation in this setting exposes the patients to substantial iatrogenic risk and should be avoided if at all possible. To describe the use of intravenous ketamine in acute asthma exacerbation. We present a case of severe asthma exacerbation in an adult female patient who failed to improve with standard therapies, but promptly improved with the administration of intravenous ketamine (0.75 mg/kg i.v. bolus followed by continuous drip of 0.15 mg/kg/h). This case suggests that intravenous ketamine given in a dissociative dose may be an effective temporizing measure to avoid mechanical ventilation in adult patients with severe asthma exacerbations. Copyright © 2011 Elsevier Inc. All rights reserved.

Thermal Standard for Small Rural Schools.

ERIC Educational Resources Information Center

Strandberg (J.S.) Consulting Engineering, Fairbanks, AK.

The Standard's purpose is to provide design requirements that will improve energy utilization in new State of Alaska owned rural educational facilities ranging in size from 7,000 to 12,000 square feet. The Standard covers exterior envelopes and selection of heating, ventilating and air conditioning systems, service water systems, energy…

5 CFR 179.301 - Scope of regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Scope of regulations. 179.301 Section 179.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS CLAIMS COLLECTION STANDARDS Administrative Offset § 179.301 Scope of regulations. These regulations apply to the...

40 CFR 165.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 25 2012-07-01 2012-07-01 false Scope. 165.1 Section 165.1 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL General § 165.1 Scope. The part 165 regulations establish standards and requirements for...

40 CFR 165.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Scope. 165.1 Section 165.1 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL General § 165.1 Scope. The part 165 regulations establish standards and requirements for...

40 CFR 165.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 24 2011-07-01 2011-07-01 false Scope. 165.1 Section 165.1 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL General § 165.1 Scope. The part 165 regulations establish standards and requirements for...

Holistic nursing as a specialty: holistic nursing - scope and standards of practice.

PubMed

Mariano, Carla

2007-06-01

This article describes the Holistic Nursing: Scope and Standards of Practice. It defines holistic nursing, its five core values, and its practice standards. These include holistic philosophy, theory, and ethics; holistic caring process; holistic communication, therapeutic environment, and cultural diversity; holistic education and research; and holistic nurse self-care. Educational preparation for holistic nursing and settings in which holistic nurses practice are also explored.

Influence of face mask design on bag-valve-mask ventilation performance: a randomized simulation study.

PubMed

Na, J U; Han, S K; Choi, P C; Cho, J H; Shin, D H

2013-10-01

Different face mask designs can influence bag-valve-mask (BVM) ventilation performance during resuscitation. We compared a single-use, air-cushioned face mask (AM) with a reusable silicone face mask (SM) for quality of BVM ventilation on a manikin simulating cardiac arrest. Thirty-two physicians were recruited, and a prospective, randomized, crossover observational study was conducted after an American Heart Association-accredited basic life support provider course and standardized practice time were completed. Participants performed 12 cycles of BVM ventilation with both the AM and SM on a SmartMan lung simulator. Mean tidal volume was significantly higher in ventilations performed using the AM vs. the SM (548 ± 159 ml vs. 439 ± 163 ml, P < 0.01). In addition, the proportion of low-volume ventilation was significantly lower with the AM than the SM [6/12 (2-11) vs. 9/12 (5-12), P = 0.03]. Bag-valve-AM ventilation volume was not affected by the physical characteristics of the rescuers, except for sex. In contrast, bag-valve-SM ventilation volume was affected by most of the characteristics tested, including sex, height, weight, hand width, hand length, and grip power. The AM seems to be a more efficient face mask than the SM at delivering sufficient ventilation volumes. The performance of the AM did not seem to be associated with the physical characteristics of the rescuers, whereas that of the SM was affected by these factors. The SM may not be an appropriate face mask for performing one-person BVM ventilation during resuscitation for rescuers who are smaller in stature, have a smaller hand size, or have weaker grip power. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Actual performance of mechanical ventilators in ICU: a multicentric quality control study.

PubMed

Govoni, Leonardo; Dellaca', Raffaele L; Peñuelas, Oscar; Bellani, Giacomo; Artigas, Antonio; Ferrer, Miquel; Navajas, Daniel; Pedotti, Antonio; Farré, Ramon

2012-01-01

Even if the performance of a given ventilator has been evaluated in the laboratory under very well controlled conditions, inappropriate maintenance and lack of long-term stability and accuracy of the ventilator sensors may lead to ventilation errors in actual clinical practice. The aim of this study was to evaluate the actual performances of ventilators during clinical routines. A resistance (7.69 cmH(2)O/L/s) - elastance (100 mL/cmH(2)O) test lung equipped with pressure, flow, and oxygen concentration sensors was connected to the Y-piece of all the mechanical ventilators available for patients in four intensive care units (ICUs; n = 66). Ventilators were set to volume-controlled ventilation with tidal volume = 600 mL, respiratory rate = 20 breaths/minute, positive end-expiratory pressure (PEEP) = 8 cmH(2)O, and oxygen fraction = 0.5. The signals from the sensors were recorded to compute the ventilation parameters. The average ± standard deviation and range (min-max) of the ventilatory parameters were the following: inspired tidal volume = 607 ± 36 (530-723) mL, expired tidal volume = 608 ± 36 (530-728) mL, peak pressure = 20.8 ± 2.3 (17.2-25.9) cmH(2)O, respiratory rate = 20.09 ± 0.35 (19.5-21.6) breaths/minute, PEEP = 8.43 ± 0.57 (7.26-10.8) cmH(2)O, oxygen fraction = 0.49 ± 0.014 (0.41-0.53). The more error-prone parameters were the ones related to the measure of flow. In several cases, the actual delivered mechanical ventilation was considerably different from the set one, suggesting the need for improving quality control procedures for these machines.

Air quality and ventilation fan control based on aerosol measurement in the bi-directional undersea Bømlafjord tunnel.

PubMed

Indrehus, Oddny; Aralt, Tor Tybring

2005-04-01

Aerosol, NO and CO concentration, temperature, air humidity, air flow and number of running ventilation fans were measured by continuous analysers every minute for a whole week for six different one-week periods spread over ten months in 2001 and 2002 at measuring stations in the 7860 m long tunnel. The ventilation control system was mainly based on aerosol measurements taken by optical scatter sensors. The ventilation turned out to be satisfactory according to Norwegian air quality standards for road tunnels; however, there was some uncertainty concerning the NO2 levels. The air humidity and temperature inside the tunnel were highly influenced by the outside metrological conditions. Statistical models for NO concentration were developed and tested; correlations between predicted and measured NO were 0.81 for a partial least squares regression (PLS1) model based on CO and aerosol, and 0.77 for a linear regression model based only on aerosol. Hence, the ventilation control system should not solely be based on aerosol measurements. Since NO2 is the hazardous polluter, modelling NO2 concentration rather than NO should be preferred in any further optimising of the ventilation control.

Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding

PubMed Central

Ashktorab, Hassan; Etaati, Firoozeh; Rezaeean, Farahnaz; Nouraie, Mehdi; Paydar, Mansour; Namin, Hassan Hassanzadeh; Sanderson, Andrew; Begum, Rehana; Alkhalloufi, Kawtar; Brim, Hassan; Laiyemo, Adeyinka O

2016-01-01

AIM: To study the accuracy of using high definition (HD) scope with narrow band imaging (NBI) vs standard white light colonoscope without NBI (ST), to predict the histology of the colon polyps, particularly those < 1 cm. METHODS: A total of 147 African Americans patients who were referred to Howard University Hospital for screening or, diagnostic or follow up colonoscopy, during a 12-mo period in 2012 were prospectively recruited. Some patients had multiple polyps and total number of polyps was 179. Their colonoscopies were performed by 3 experienced endoscopists who determined the size and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care. RESULTS: Of participants in the study, 55 (37%) were male and median (interquartile range) of age was 56 (19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were < 1 cm vs 87% in HD scope (P = 0.7). The ST scope had a positive predictive value (PPV) and positive likelihood ratio (PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope (68%) compare to ST scope (53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp (HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar. CONCLUSION: Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology. PMID:27605888

The barriers to the prevention of ventilator-associated pneumonia from the perspective of critical care nurses: A qualitative descriptive study.

PubMed

Atashi, Vajihe; Yousefi, Hojatollah; Mahjobipoor, Hosein; Yazdannik, Ahmadreza

2018-03-01

The aim of this study was to explore the perspectives of Iranian critical care nurses on the barriers to ventilator-associated pneumonia prevention in intensive care units. Most patients hospitalized in intensive care units need mechanical ventilation. One of the most prevalent and serious complications of mechanical ventilation is ventilator-associated pneumonia. There are different barriers to the prevention of this kind of pneumonia. Qualitative descriptive design was used. In this qualitative study, 23 critical care nurses were recruited via purposive sampling. Semi-structured interviews were done for data collection. The interviews were recorded digitally, transcribed word by word, and analyzed using the inductive content analysis approach. The barriers to the prevention of ventilator-associated pneumonia fell into three main categories, namely nurses' limited professional competence, unfavorable environmental conditions, and passive human resource management. The 10 subcategories of these main categories were unfavorable professional attitude, limited professional knowledge, low job motivation, limited professional accountability, non-standard physical structure, inadequate or inappropriate equipment, heavy workload, staff shortage, inadequate staff training, and ineffective supervision. The barriers to the prevention of ventilator-associated pneumonia in intensive care units are very diverse and complex and include a wide range of interrelated personal, environmental, and organizational barriers. This study created a better understanding of the barriers to ventilator-associated pneumonia prevention. Moreover, highlighted the importance of sufficient resources, adequate staffing level, and contextually-appropriate evidence-based guidelines for effective ventilator-associated pneumonia prevention. © 2017 John Wiley & Sons Ltd.

Evidence of inadequate ventilation in portable classrooms: results of a pilot study in Los Angeles County.

PubMed

Shendell, D G; Winer, A M; Weker, R; Colome, S D

2004-06-01

The prevalence of prefabricated, portable classrooms (portables) for United States public schools has increased; in California, approximately one of three students learn inside portables. Limited research has been conducted on indoor air and environmental quality in American schools, and almost none in portables. Available reports and conference proceedings suggest problems from insufficient ventilation due to poor design, operation, and/or maintenance of heating, ventilation and air conditioning (HVAC) systems; most portables have one mechanical, wall-mounted HVAC system. A pilot assessment was conducted in Los Angeles County, including measurements of integrated ventilation rates based on a perfluorocarbon tracer gas technique and continuous monitoring of temperature (T) and relative humidity (RH). Measured ventilation rates were low [mean school day integrated average 0.8 per hour (range: 0.1-2.9 per hour)]. Compared with relevant standards, results suggested adequate ventilation and associated conditioning of indoor air for occupant comfort were not always provided to these classrooms. Future school studies should include integrated and continuous measurements of T, RH, and ventilation with appropriate tracer gas methods, and other airflow measures. Adequate ventilation has the potential to mitigate concentrations of chemical pollutants, particles, carbon dioxide, and odors in portable and traditional classrooms, which should lead to a reduction in reported health outcomes, e.g., symptoms of 'sick building syndrome', allergies, asthma. Investigations of school indoor air and environmental quality should include continuous temperature and relative humidity data with inexpensive instrumentation as indicators of thermal comfort, and techniques to measure ventilation rates.

40 CFR 165.81 - Scope of stationary pesticide containers included.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 24 2014-07-01 2014-07-01 false Scope of stationary pesticide... (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.81 Scope of stationary pesticide containers included. (a) What is a stationary pesticide...

40 CFR 165.81 - Scope of stationary pesticide containers included.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 24 2011-07-01 2011-07-01 false Scope of stationary pesticide... (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.81 Scope of stationary pesticide containers included. (a) What is a stationary pesticide...

40 CFR 165.81 - Scope of stationary pesticide containers included.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 25 2013-07-01 2013-07-01 false Scope of stationary pesticide... (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.81 Scope of stationary pesticide containers included. (a) What is a stationary pesticide...

40 CFR 165.81 - Scope of stationary pesticide containers included.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 25 2012-07-01 2012-07-01 false Scope of stationary pesticide... (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.81 Scope of stationary pesticide containers included. (a) What is a stationary pesticide...

40 CFR 165.81 - Scope of stationary pesticide containers included.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Scope of stationary pesticide... (CONTINUED) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.81 Scope of stationary pesticide containers included. (a) What is a stationary pesticide...

16 CFR 5.51 - Scope and applicability.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Scope and applicability. 5.51 Section 5.51 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE STANDARDS OF CONDUCT Disciplinary Actions Concerning Postemployment Conflict of Interest § 5.51 Scope and applicability...

40 CFR 401.10 - Scope and purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 29 2011-07-01 2009-07-01 true Scope and purpose. 401.10 Section 401.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GENERAL PROVISIONS § 401.10 Scope and purpose. Regulations promulgated or proposed under parts 402...

32 CFR Attachment B to Subpart B... - Standard B-Single Scope Background Investigation (SSBI)

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 1 2012-07-01 2012-07-01 false Standard B-Single Scope Background Investigation (SSBI) B Attachment B to Subpart B of Part 147 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN ADJUDICATIVE GUIDELINES FOR DETERMINING ELIGIBILITY...

32 CFR Attachment B to Subpart B... - Standard B-Single Scope Background Investigation (SSBI)

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 1 2013-07-01 2013-07-01 false Standard B-Single Scope Background Investigation (SSBI) B Attachment B to Subpart B of Part 147 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN ADJUDICATIVE GUIDELINES FOR DETERMINING ELIGIBILITY...

32 CFR Attachment B to Subpart B... - Standard B-Single Scope Background Investigation (SSBI)

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 1 2014-07-01 2014-07-01 false Standard B-Single Scope Background Investigation (SSBI) B Attachment B to Subpart B of Part 147 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN ADJUDICATIVE GUIDELINES FOR DETERMINING ELIGIBILITY...

32 CFR Attachment B to Subpart B... - Standard B-Single Scope Background Investigation (SSBI)

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 1 2011-07-01 2011-07-01 false Standard B-Single Scope Background Investigation (SSBI) B Attachment B to Subpart B of Part 147 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN ADJUDICATIVE GUIDELINES FOR DETERMINING ELIGIBILITY...

High-definition vs. standard-definition colonoscopy in the characterization of small colonic polyps: results from a randomized trial.

PubMed

Longcroft-Wheaton, G; Brown, J; Cowlishaw, D; Higgins, B; Bhandari, P

2012-10-01

The resolution of endoscopes has increased in recent years. Modern Fujinon colonoscopes have a charge-coupled device (CCD) pixel density of 650,000 pixels compared with the 410,000 pixel CCD in standard-definition scopes. Acquiring high-definition scopes represents a significant capital investment and their clinical value remains uncertain. The aim of the current study was to investigate the impact of high-definition endoscopes on the in vivo histology prediction of colonic polyps. Colonoscopy procedures were performed using Fujinon colonoscopes and EPX-4400 processor. Procedures were randomized to be performed using either a standard-definition EC-530 colonoscope or high-definition EC-530 and EC-590 colonoscopes. Polyps of <10 mm were assessed using both white light imaging (WLI) and flexible spectral imaging color enhancement (FICE), and the predicted diagnosis was recorded. Polyps were removed and sent for histological analysis by a pathologist who was blinded to the endoscopic diagnosis. The predicted diagnosis was compared with the histology to calculate the accuracy, sensitivity, and specificity of in vivo assessment using either standard or high-definition scopes. A total of 293 polyps of <10 mm were examined–150 polyps using the standard-definition colonoscope and 143 polyps using high-definition colonoscopes. There was no difference in sensitivity, specificity or accuracy between the two scopes when WLI was used (standard vs. high: accuracy 70% [95% CI 62–77] vs. 73% [95% CI 65–80]; P=0.61). When FICE was used, high-definition colonoscopes showed a sensitivity of 93% compared with 83% for standard-definition colonoscopes (P=0.048); specificity was 81% and 82%, respectively. There was no difference between high- and standard-definition colonoscopes when white light was used, but FICE significantly improved the in vivo diagnosis of small polyps when high-definition scopes were used compared with standard definition.

48 CFR 242.7200 - Scope of subpart.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Management and Accounting System 242.7200 Scope of subpart. (a) This subpart provides policies, procedures, and standards for use in the evaluation of a contractor's material management and accounting system... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Scope of subpart. 242.7200...

10 CFR 20.1002 - Scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Scope. 20.1002 Section 20.1002 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION General Provisions § 20.1002 Scope. The regulations in... byproduct, source, or special nuclear material or to operate a production or utilization facility under...

10 CFR 20.1002 - Scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Scope. 20.1002 Section 20.1002 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION General Provisions § 20.1002 Scope. The regulations in... byproduct, source, or special nuclear material or to operate a production or utilization facility under...

10 CFR 20.1002 - Scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Scope. 20.1002 Section 20.1002 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION General Provisions § 20.1002 Scope. The regulations in... byproduct, source, or special nuclear material or to operate a production or utilization facility under...

10 CFR 20.1002 - Scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Scope. 20.1002 Section 20.1002 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION General Provisions § 20.1002 Scope. The regulations in... byproduct, source, or special nuclear material or to operate a production or utilization facility under...

10 CFR 20.1002 - Scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Scope. 20.1002 Section 20.1002 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION General Provisions § 20.1002 Scope. The regulations in... byproduct, source, or special nuclear material or to operate a production or utilization facility under...

29 CFR 1915.151 - Scope, application and definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., DEPARTMENT OF LABOR (CONTINUED) OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR SHIPYARD EMPLOYMENT Personal Protective Equipment (PPE) § 1915.151 Scope, application and definitions. (a) Scope and application. This..., shoulders, chest and pelvis with means for attaching it to other components of a personal fall arrest system...

29 CFR 1915.151 - Scope, application and definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., DEPARTMENT OF LABOR (CONTINUED) OCCUPATIONAL SAFETY AND HEALTH STANDARDS FOR SHIPYARD EMPLOYMENT Personal Protective Equipment (PPE) § 1915.151 Scope, application and definitions. (a) Scope and application. This..., shoulders, chest and pelvis with means for attaching it to other components of a personal fall arrest system...

16 CFR 1210.1 - Scope, application, and effective date.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Scope, application, and effective date. 1210.1 Section 1210.1 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR CIGARETTE LIGHTERS Requirements for Child Resistance § 1210.1 Scope...

48 CFR 242.7200 - Scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Management and Accounting System 242.7200 Scope of subpart. (a) This subpart provides policies, procedures, and standards for use in the evaluation of a contractor's material management and accounting system... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Scope of subpart. 242.7200...

30 CFR 75.823 - Scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Scope. 75.823 Section 75.823 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Underground High-Voltage Distribution High-Voltage Longwalls § 75.823 Scope...

29 CFR 780.150 - Scope and limits of “preparation for market.”

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Scope and limits of âpreparation for market.â 780.150... STANDARDS ACT General Scope of Agriculture Preparation for Market § 780.150 Scope and limits of “preparation for market.” “Preparation for market” is also named as one of the practices which may be included in...

ASHRAE and residential ventilation

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

Sherman, Max H.

In the last quarter of a century, the western world has become increasingly aware of environmental threats to health and safety. During this period, people psychologically retreated away from outdoors hazards such as pesticides, smog, lead, oil spills, and dioxin to the seeming security of their homes. However, the indoor environment may not be healthier than the outdoor environment, as has become more apparent over the past few years with issues such as mold, formaldehyde, and sick-building syndrome. While the built human environment has changed substantially over the past 10,000 years, human biology has not; poor indoor air quality createsmore » health risks and can be uncomfortable. The human race has found, over time, that it is essential to manage the indoor environments of their homes. ASHRAE has long been in the business of ventilation, but most of the focus of that effort has been in the area of commercial and institutional buildings. Residential ventilation was traditionally not a major concern because it was felt that, between operable windows and envelope leakage, people were getting enough outside air in their homes. In the quarter of a century since the first oil shock, houses have gotten much more energy efficient. At the same time, the kinds of materials and functions in houses changed in character in response to people's needs. People became more environmentally conscious and aware not only about the resources they were consuming but about the environment in which they lived. All of these factors contributed to an increasing level of public concern about residential indoor air quality and ventilation. Where once there was an easy feeling about the residential indoor environment, there is now a desire to define levels of acceptability and performance. Many institutions--both public and private--have interests in Indoor Air Quality (IAQ), but ASHRAE, as the professional society that has had ventilation as part of its mission for over 100 years, is the logical place to provide leadership. This leadership has been demonstrated most recently by the publication of the first nationally recognized standard on ventilation in homes, ASHRAE Standard 62.2-2003, which builds on work that has been part of ASHRAE for many years and will presumably continue. Homeowners and occupants, which includes virtually all of us, will benefit from the application of Standard 62.2 and use of the top ten list. This activity is exactly the kind of benefit to society that the founders of ASHRAE envisioned and is consistent with ASHRAE's mission and vision. ASHRAE members should be proud of their Society for taking leadership in residential ventilation.« less

Humidification during mechanical ventilation in the adult patient.

PubMed

Al Ashry, Haitham S; Modrykamien, Ariel M

2014-01-01

Humidification of inhaled gases has been standard of care in mechanical ventilation for a long period of time. More than a century ago, a variety of reports described important airway damage by applying dry gases during artificial ventilation. Consequently, respiratory care providers have been utilizing external humidifiers to compensate for the lack of natural humidification mechanisms when the upper airway is bypassed. Particularly, active and passive humidification devices have rapidly evolved. Sophisticated systems composed of reservoirs, wires, heating devices, and other elements have become part of our usual armamentarium in the intensive care unit. Therefore, basic knowledge of the mechanisms of action of each of these devices, as well as their advantages and disadvantages, becomes a necessity for the respiratory care and intensive care practitioner. In this paper, we review current methods of airway humidification during invasive mechanical ventilation of adult patients. We describe a variety of devices and describe the eventual applications according to specific clinical conditions.

A Comprehensive Approach for the Ergonomic Evaluation of 13 Emergency and Transport Ventilators.

PubMed

Marjanovic, Nicolas; L'Her, Erwan

2016-05-01

Mechanical ventilation is an important part of emergency medicine and is frequently used for transportation. Human errors during ventilator settings are frequent and may be associated with high morbidity/mortality. The aim of the study was to provide a complete ergonomic evaluation of emergency and transport ventilators, taking into account objective and subjective human-machine interface assessments and individual mental work load. We performed a prospective bench ergonomic evaluation of 13 emergency and transport ventilators, using standardized conditions and a global methodological approach. The study was performed in an evaluation laboratory dedicated to respiratory care, and 12 emergency physicians unfamiliar with the tested devices were included in the evaluation. The ventilators were classified into 3 categories (simple, sophisticated, and ICU-like). Objective chronometric evaluations were conducted considering 9 tasks, and subjective evaluations were performed (ease of use, willingness to use, and user-friendliness of monitoring) using Likert scales. Mental work load evaluation was performed using the NASA Task Load Index scale. Overall task failure rate represented 4% of all attempts. Setting modifications, ventilation mode changes, and powering down durations were different between simple and other emergency and transport ventilator categories (P < .005). There was no difference between ventilator categories for the ease of use and user-friendliness of the monitoring. In contrast, the willingness to use was lower for simple devices, compared with sophisticated and ICU-like emergency and transport ventilators (2.9 ± 1.4 vs 3.9 ± 1.2, P = .002 and 4.3 ± 1, P < .001). No differences were observed between devices regarding the mental work load, except for several specific devices in the sophisticated category. A comprehensive ergonomic evaluation provides valuable information while investigating operational friendliness in emergency and transport ventilators. The choice of a device not only depends on its technical characteristics but should take into account its clinical operational setting and ergonomics in order to decrease mental work load. Sophisticated emergency and transport ventilators should only be used by clinicians who demonstrate expertise in mechanical ventilation. Copyright © 2016 by Daedalus Enterprises.

Retrospective Application of New Pediatric Ventilator-Associated Pneumonia Criteria Identifies a High-Risk Population.

PubMed

Gionfriddo, Ashley; Nonoyama, Mika L; Laussen, Peter C; Cox, Peter N; Clarke, Megan; Floh, Alejandro A

2018-06-01

To promote standardization, the Centers for Disease Control and Prevention introduced a new ventilator-associated pneumonia classification, which was modified for pediatrics (pediatric ventilator-associated pneumonia according to proposed criteria [PVAP]). We evaluated the frequency of PVAP in a cohort of children diagnosed with ventilator-associated pneumonia according to traditional criteria and compared their strength of association with clinically relevant outcomes. Retrospective cohort study. Tertiary care pediatric hospital. Critically ill children (0-18 yr) diagnosed with ventilator-associated pneumonia between January 2006 and December 2015 were identified from an infection control database. Patients were excluded if on high frequency ventilation, extracorporeal membrane oxygenation, or reintubated 24 hours following extubation. None. Patients were assessed for PVAP diagnosis. Primary outcome was the proportion of subjects diagnosed with PVAP. Secondary outcomes included association with intervals of care. Two hundred seventy-seven children who had been diagnosed with ventilator-associated pneumonia were eligible for review; 46 were excluded for being ventilated under 48 hours (n = 16), on high frequency ventilation (n = 12), on extracorporeal membrane oxygenation (n = 8), ineligible bacteria isolated from culture (n = 8), and other causes (n = 4). ICU admission diagnoses included congenital heart disease (47%), neurological (16%), trauma (7%), respiratory (7%), posttransplant (4%), neuromuscular (3%), and cardiomyopathy (3%). Only 16% of subjects (n = 45) met the new PVAP definition, with 18% (n = 49) having any ventilator-associated condition. Failure to fulfill new definitions was based on inadequate increase in mean airway pressure in 90% or FIO2 in 92%. PVAP was associated with prolonged ventilation (median [interquartile range], 29 d [13-51 d] vs 16 d [8-34.5 d]; p = 0.002), ICU (median [interquartile range], 40 d [20-100 d] vs 25 d [14-61 d]; p = 0.004) and hospital length of stay (median [interquartile range], 81 d [40-182 d] vs 54 d [31-108 d]; p = 0.04), and death (33% vs 16%; p = 0.008). Few children with ventilator-associated pneumonia diagnosis met the proposed PVAP criteria. PVAP was associated with increased morbidity and mortality. This work suggests that additional study is required before new definitions for ventilator-associated pneumonia are introduced for children.

Effects of staff training and electronic event monitoring on long-term adherence to lung-protective ventilation recommendations.

PubMed

Castellanos, Ixchel; Martin, Marcus; Kraus, Stefan; Bürkle, Thomas; Prokosch, Hans-Ulrich; Schüttler, Jürgen; Toddenroth, Dennis

2018-02-01

To investigate long-term effects of staff training and electronic clinical decision support (CDS) on adherence to lung-protective ventilation recommendations. In 2012, group instructions and workshops at two surgical intensive care units (ICUs) started, focusing on standardized protocols for mechanical ventilation and volutrauma prevention. Subsequently implemented CDS functions continuously monitor ventilation parameters, and from 2015 triggered graphical notifications when tidal volume (V T ) violated individual thresholds. To estimate the effects of these educational and technical interventions, we retrospectively analyzed nine years of V T records from routine care. As outcome measures, we calculated relative frequencies of settings that conform to recommendations, case-specific mean excess V T , and total ICU survival. Assessing 571,478 V T records from 10,241 ICU cases indicated that adherence during pressure-controlled ventilation improved significantly after both interventions; the share of conforming V T records increased from 61.6% to 83.0% and then 86.0%. Despite increasing case severity, ICU survival remained nearly constant over time. Staff training effectively improves adherence to lung-protective ventilation strategies. The observed CDS effect seemed less pronounced, although it can easily be adapted to new recommendations. Both interventions, which futures studies could deploy in combination, promise to improve the precision of mechanical ventilation. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Ventilation distribution in rats: Part 2 – A comparison of electrical impedance tomography and hyperpolarised helium magnetic resonance imaging

PubMed Central

2012-01-01

Background Hyperpolarised helium MRI (He3 MRI) is a new technique that enables imaging of the air distribution within the lungs. This allows accurate determination of the ventilation distribution in vivo. The technique has the disadvantages of requiring an expensive helium isotope, complex apparatus and moving the patient to a compatible MRI scanner. Electrical impedance tomography (EIT) a non-invasive bedside technique that allows constant monitoring of lung impedance, which is dependent on changes in air space capacity in the lung. We have used He3MRI measurements of ventilation distribution as the gold standard for assessment of EIT. Methods Seven rats were ventilated in supine, prone, left and right lateral position with 70% helium/30% oxygen for EIT measurements and pure helium for He3 MRI. The same ventilator and settings were used for both measurements. Image dimensions, geometric centre and global in homogeneity index were calculated. Results EIT images were smaller and of lower resolution and contained less anatomical detail than those from He3 MRI. However, both methods could measure positional induced changes in lung ventilation, as assessed by the geometric centre. The global in homogeneity index were comparable between the techniques. Conclusion EIT is a suitable technique for monitoring ventilation distribution and inhomgeneity as assessed by comparison with He3 MRI. PMID:22966835

Benefits of Manometer in Non-Invasive Ventilatory Support.

PubMed

Lacerda, Rodrigo Silva; de Lima, Fernando Cesar Anastácio; Bastos, Leonardo Pereira; Fardin Vinco, Anderson; Schneider, Felipe Britto Azevedo; Luduvico Coelho, Yves; Fernandes, Heitor Gomes Costa; Bacalhau, João Marcus Ramos; Bermudes, Igor Matheus Simonelli; da Silva, Claudinei Ferreira; da Silva, Luiza Paterlini; Pezato, Rogério

2017-12-01

Introduction Effective ventilation during cardiopulmonary resuscitation (CPR) is essential to reduce morbidity and mortality rates in cardiac arrest. Hyperventilation during CPR reduces the efficiency of compressions and coronary perfusion. Problem How could ventilation in CPR be optimized? The objective of this study was to evaluate non-invasive ventilator support using different devices. The study compares the regularity and intensity of non-invasive ventilation during simulated, conventional CPR and ventilatory support using three distinct ventilation devices: a standard manual resuscitator, with and without airway pressure manometer, and an automatic transport ventilator. Student's t-test was used to evaluate statistical differences between groups. P values <.05 were regarded as significant. Peak inspiratory pressure during ventilatory support and CPR was significantly increased in the group with manual resuscitator without manometer when compared with the manual resuscitator with manometer support (MS) group or automatic ventilator (AV) group. The study recommends for ventilatory support the use of a manual resuscitator equipped with MS or AVs, due to the risk of reduction in coronary perfusion pressure and iatrogenic thoracic injury during hyperventilation found using manual resuscitator without manometer. Lacerda RS , de Lima FCA , Bastos LP , Vinco AF , Schneider FBA , Coelho YL , Fernandes HGC , Bacalhau JMR , Bermudes IMS , da Silva CF , da Silva LP , Pezato R . Benefits of manometer in non-invasive ventilatory support. Prehosp Disaster Med. 2017;32(6):615-620.

Change Is In the Air: What You Need to Know About Pharmacy Ventilation Under United States Pharmacopeia <800>.

PubMed

Laniewicz, Cheryl

2017-01-01

On July 1, 2018, United States Pharmacopeia <800> takes effect in those states that adopt it, and the discussion within this article may be applicable to those states that develop their own standards. United States Pharmacopeia <800> changes requirements for storage and compounding of hazardous drugs. The new requirements have important implications for air management and ventilation in some pharmacies. This article discusses how United States Pharmacopeia <800> compares to United States Pharmacopeia <797>, how the changes impact room ventilation and pressurization requirements, and how high-performance airflow control systems that ensure compliance and safety are impacted. Copyright© by International Journal of Pharmaceutical Compounding, Inc.

32 CFR Attachment C to Subpart B... - Standard C-Single Scope Background Investigation Periodic Reinvestigation (SSBI-PR)

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 1 2013-07-01 2013-07-01 false Standard C-Single Scope Background Investigation Periodic Reinvestigation (SSBI-PR) C Attachment C to Subpart B of Part 147 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN ADJUDICATIVE GUIDELINES FOR...

32 CFR Attachment C to Subpart B... - Standard C-Single Scope Background Investigation Periodic Reinvestigation (SSBI-PR)

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 1 2012-07-01 2012-07-01 false Standard C-Single Scope Background Investigation Periodic Reinvestigation (SSBI-PR) C Attachment C to Subpart B of Part 147 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN ADJUDICATIVE GUIDELINES FOR...

49 CFR 383.1 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 5 2013-10-01 2013-10-01 false Purpose and scope. 383.1 Section 383.1... STANDARDS; REQUIREMENTS AND PENALTIES General § 383.1 Purpose and scope. (a) The purpose of this part is to... suspensions, revocations, or cancellations of certain driving privileges; (6) Establishes testing and...

49 CFR 383.1 - Purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 5 2012-10-01 2012-10-01 false Purpose and scope. 383.1 Section 383.1... STANDARDS; REQUIREMENTS AND PENALTIES General § 383.1 Purpose and scope. (a) The purpose of this part is to... suspensions, revocations, or cancellations of certain driving privileges; (6) Establishes testing and...

49 CFR 383.1 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 5 2014-10-01 2014-10-01 false Purpose and scope. 383.1 Section 383.1... STANDARDS; REQUIREMENTS AND PENALTIES General § 383.1 Purpose and scope. (a) The purpose of this part is to... suspensions, revocations, or cancellations of certain driving privileges; (6) Establishes testing and...

29 CFR 780.104 - How modern specialization affects the scope of agriculture.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false How modern specialization affects the scope of agriculture... EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED SUBJECTS UNDER THE FAIR LABOR STANDARDS ACT General Scope of Agriculture Introductory § 780.104 How modern specialization...

29 CFR 780.104 - How modern specialization affects the scope of agriculture.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 3 2012-07-01 2012-07-01 false How modern specialization affects the scope of agriculture... EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED SUBJECTS UNDER THE FAIR LABOR STANDARDS ACT General Scope of Agriculture Introductory § 780.104 How modern specialization...

29 CFR 780.104 - How modern specialization affects the scope of agriculture.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 3 2011-07-01 2011-07-01 false How modern specialization affects the scope of agriculture... EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED SUBJECTS UNDER THE FAIR LABOR STANDARDS ACT General Scope of Agriculture Introductory § 780.104 How modern specialization...

29 CFR 780.104 - How modern specialization affects the scope of agriculture.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 3 2014-07-01 2014-07-01 false How modern specialization affects the scope of agriculture... EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED SUBJECTS UNDER THE FAIR LABOR STANDARDS ACT General Scope of Agriculture Introductory § 780.104 How modern specialization...

29 CFR 780.104 - How modern specialization affects the scope of agriculture.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 3 2013-07-01 2013-07-01 false How modern specialization affects the scope of agriculture... EXEMPTIONS APPLICABLE TO AGRICULTURE, PROCESSING OF AGRICULTURAL COMMODITIES, AND RELATED SUBJECTS UNDER THE FAIR LABOR STANDARDS ACT General Scope of Agriculture Introductory § 780.104 How modern specialization...

28 CFR 115.401 - Frequency and scope of audits.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Frequency and scope of audits. 115.401 Section 115.401 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Auditing and Corrective Action § 115.401 Frequency and scope of audits. (a) During the...

28 CFR 115.401 - Frequency and scope of audits.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Frequency and scope of audits. 115.401 Section 115.401 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Auditing and Corrective Action § 115.401 Frequency and scope of audits. (a) During the...

28 CFR 115.401 - Frequency and scope of audits.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Frequency and scope of audits. 115.401 Section 115.401 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PRISON RAPE ELIMINATION ACT NATIONAL STANDARDS Auditing and Corrective Action § 115.401 Frequency and scope of audits. (a) During the...

6 CFR 7.2 - Scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 6 Domestic Security 1 2011-01-01 2011-01-01 false Scope. 7.2 Section 7.2 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLASSIFIED NATIONAL SECURITY INFORMATION § 7.2 Scope... Branch who are granted access to classified information by the DHS, in accordance with the standards in...

42 CFR 489.2 - Scope of part.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Scope of part. 489.2 Section 489.2 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION PROVIDER AGREEMENTS AND SUPPLIER APPROVAL General Provisions § 489.2 Scope of part...

40 CFR 165.82 - Scope of pesticide dispensing areas included.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 24 2011-07-01 2011-07-01 false Scope of pesticide dispensing areas...) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.82 Scope of pesticide dispensing areas included. (a) What pesticide dispensing areas are subject to the...

40 CFR 165.82 - Scope of pesticide dispensing areas included.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 24 2014-07-01 2014-07-01 false Scope of pesticide dispensing areas...) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.82 Scope of pesticide dispensing areas included. (a) What pesticide dispensing areas are subject to the...

40 CFR 165.82 - Scope of pesticide dispensing areas included.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 25 2012-07-01 2012-07-01 false Scope of pesticide dispensing areas...) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.82 Scope of pesticide dispensing areas included. (a) What pesticide dispensing areas are subject to the...

40 CFR 165.82 - Scope of pesticide dispensing areas included.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 25 2013-07-01 2013-07-01 false Scope of pesticide dispensing areas...) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.82 Scope of pesticide dispensing areas included. (a) What pesticide dispensing areas are subject to the...

40 CFR 165.82 - Scope of pesticide dispensing areas included.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Scope of pesticide dispensing areas...) PESTICIDE PROGRAMS PESTICIDE MANAGEMENT AND DISPOSAL Standards for Pesticide Containment Structures § 165.82 Scope of pesticide dispensing areas included. (a) What pesticide dispensing areas are subject to the...

30 CFR 77.1430 - Wire ropes; scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Wire ropes; scope. 77.1430 Section 77.1430... Hoisting Wire Ropes § 77.1430 Wire ropes; scope. (a) Sections 77.1431 through 77.1438 apply to wire ropes.... (b) These standards do not apply to wire ropes used for elevators. ...

30 CFR 77.1430 - Wire ropes; scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Wire ropes; scope. 77.1430 Section 77.1430... Hoisting Wire Ropes § 77.1430 Wire ropes; scope. (a) Sections 77.1431 through 77.1438 apply to wire ropes.... (b) These standards do not apply to wire ropes used for elevators. ...

10 CFR 20.1401 - General provisions and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false General provisions and scope. 20.1401 Section 20.1401 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION Radiological Criteria for License Termination § 20.1401 General provisions and scope. (a) The criteria in this subpart apply to the...

10 CFR 20.1401 - General provisions and scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false General provisions and scope. 20.1401 Section 20.1401 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION Radiological Criteria for License Termination § 20.1401 General provisions and scope. (a) The criteria in this subpart apply to the...

10 CFR 20.1401 - General provisions and scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false General provisions and scope. 20.1401 Section 20.1401 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION Radiological Criteria for License Termination § 20.1401 General provisions and scope. (a) The criteria in this subpart apply to the...

10 CFR 20.1401 - General provisions and scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false General provisions and scope. 20.1401 Section 20.1401 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION Radiological Criteria for License Termination § 20.1401 General provisions and scope. (a) The criteria in this subpart apply to the...

10 CFR 20.1401 - General provisions and scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false General provisions and scope. 20.1401 Section 20.1401 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION Radiological Criteria for License Termination § 20.1401 General provisions and scope. (a) The criteria in this subpart apply to the...

6 CFR 7.2 - Scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Scope. 7.2 Section 7.2 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLASSIFIED NATIONAL SECURITY INFORMATION § 7.2 Scope... Branch who are granted access to classified information by the DHS, in accordance with the standards in...

10 CFR 63.201 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Purpose and scope. 63.201 Section 63.201 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN A GEOLOGIC REPOSITORY AT YUCCA MOUNTAIN, NEVADA Preclosure Public Health and Environmental Standards § 63.201 Purpose and scope. This...

10 CFR 63.201 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 2 2011-01-01 2011-01-01 false Purpose and scope. 63.201 Section 63.201 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN A GEOLOGIC REPOSITORY AT YUCCA MOUNTAIN, NEVADA Preclosure Public Health and Environmental Standards § 63.201 Purpose and scope. This...

10 CFR 63.301 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 2 2011-01-01 2011-01-01 false Purpose and scope. 63.301 Section 63.301 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN A GEOLOGIC REPOSITORY AT YUCCA MOUNTAIN, NEVADA Postclosure Public Health and Environmental Standards § 63.301 Purpose and scope. This...

10 CFR 63.301 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Purpose and scope. 63.301 Section 63.301 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN A GEOLOGIC REPOSITORY AT YUCCA MOUNTAIN, NEVADA Postclosure Public Health and Environmental Standards § 63.301 Purpose and scope. This...

40 CFR 792.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) GOOD LABORATORY PRACTICE STANDARDS General Provisions § 792.1 Scope. (a) This part prescribes good laboratory practices for conducting studies relating to health effects, environmental effects, and chemical...

24 CFR 3280.301 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS Body and Frame Construction Requirements § 3280.301 Scope...) Protection against corrosion, decay, insects and other similar destructive forces, (c) Protection against...

40 CFR 792.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) GOOD LABORATORY PRACTICE STANDARDS General Provisions § 792.1 Scope. (a) This part prescribes good laboratory practices for conducting studies relating to health effects, environmental effects, and chemical...

Safety in the Chemical Laboratory

ERIC Educational Resources Information Center

Steere, Norman V., Ed.

1975-01-01

The National Fire Protection Association has proposed national standards dealing with laboratory operations, ventilation, chemical handling and storage, compressed gases, fire prevention, and emergency procedures. The standards are likely to be used as guidelines by insurance companies, and governmental agencies that award grants and contracts for…

45 CFR 305.0 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

...), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES PROGRAM PERFORMANCE MEASURES, STANDARDS, FINANCIAL INCENTIVES, AND PENALTIES § 305.0 Scope. This part implements the incentive system...

49 CFR 585.11 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Requirements § 585.11 Scope. This subpart establishes requirements for manufacturers of passenger cars and... air bag requirements of Standard No. 208, Occupant crash protection (49 CFR 571.208). ...

49 CFR 585.11 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Requirements § 585.11 Scope. This subpart establishes requirements for manufacturers of passenger cars and... air bag requirements of Standard No. 208, Occupant crash protection (49 CFR 571.208). ...

49 CFR 585.11 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Requirements § 585.11 Scope. This subpart establishes requirements for manufacturers of passenger cars and... air bag requirements of Standard No. 208, Occupant crash protection (49 CFR 571.208). ...

49 CFR 585.11 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Requirements § 585.11 Scope. This subpart establishes requirements for manufacturers of passenger cars and... air bag requirements of Standard No. 208, Occupant crash protection (49 CFR 571.208). ...

49 CFR 585.11 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Requirements § 585.11 Scope. This subpart establishes requirements for manufacturers of passenger cars and... air bag requirements of Standard No. 208, Occupant crash protection (49 CFR 571.208). ...

49 CFR 238.601 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION PASSENGER EQUIPMENT SAFETY STANDARDS Specific Safety Planning Requirements for Tier II Passenger Equipment § 238.601 Scope. This subpart contains specific safety planning requirements for the operation of...

Household ventilation may reduce effects of indoor air pollutants for prevention of lung cancer: a case-control study in a Chinese population.

PubMed

Jin, Zi-Yi; Wu, Ming; Han, Ren-Qiang; Zhang, Xiao-Feng; Wang, Xu-Shan; Liu, Ai-Ming; Zhou, Jin-Yi; Lu, Qing-Yi; Kim, Claire H; Mu, Lina; Zhang, Zuo-Feng; Zhao, Jin-Kou

2014-01-01

Although the International Agency for Research on Cancer (IARC) has classified various indoor air pollutants as carcinogenic to humans, few studies evaluated the role of household ventilation in reducing the impact of indoor air pollutants on lung cancer risk. To explore the association between household ventilation and lung cancer. A population-based case-control study was conducted in a Chinese population from 2003 to 2010. Epidemiologic and household ventilation data were collected using a standardized questionnaire. Unconditional logistic regression was employed to estimate adjusted odds ratios (ORadj) and their 95% confidence intervals (CI). Among 1,424 lung cancer cases and 4,543 healthy controls, inverse associations were observed for good ventilation in the kitchen (ORadj = 0.86, 95% CI: 0.75, 0.98), bedroom (ORadj = 0.90, 95% CI: 0.79, 1.03), and both kitchen and bedroom (ORadj = 0.87, 95% CI: 0.75, 1.00). Stratified analyses showed lung cancer inversely associated with good ventilation among active smokers (ORadj = 0.85, 95% CI: 0.72, 1.00), secondhand smokers at home (ORadj = 0.77, 95% CI: 0.63, 0.94), and those exposed to high-temperature cooking oil fumes (ORadj = 0.82, 95% CI: 0.68, 0.99). Additive interactions were found between household ventilation and secondhand smoke at home as well as number of household pollutant sources. A protective association was observed between good ventilation of households and lung cancer, most likely through the reduction of exposure to indoor air pollutants, indicating ventilation may serve as one of the preventive measures for lung cancer, in addition to tobacco cessation.

Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function.

PubMed

Severgnini, Paolo; Selmo, Gabriele; Lanza, Christian; Chiesa, Alessandro; Frigerio, Alice; Bacuzzi, Alessandro; Dionigi, Gianlorenzo; Novario, Raffaele; Gregoretti, Cesare; de Abreu, Marcelo Gama; Schultz, Marcus J; Jaber, Samir; Futier, Emmanuel; Chiaranda, Maurizio; Pelosi, Paolo

2013-06-01

The impact of intraoperative ventilation on postoperative pulmonary complications is not defined. The authors aimed at determining the effectiveness of protective mechanical ventilation during open abdominal surgery on a modified Clinical Pulmonary Infection Score as primary outcome and postoperative pulmonary function. Prospective randomized, open-label, clinical trial performed in 56 patients scheduled to undergo elective open abdominal surgery lasting more than 2 h. Patients were assigned by envelopes to mechanical ventilation with tidal volume of 9 ml/kg ideal body weight and zero-positive end-expiratory pressure (standard ventilation strategy) or tidal volumes of 7 ml/kg ideal body weight, 10 cm H2O positive end-expiratory pressure, and recruitment maneuvers (protective ventilation strategy). Modified Clinical Pulmonary Infection Score, gas exchange, and pulmonary functional tests were measured preoperatively, as well as at days 1, 3, and 5 after surgery. Patients ventilated protectively showed better pulmonary functional tests up to day 5, fewer alterations on chest x-ray up to day 3 and higher arterial oxygenation in air at days 1, 3, and 5 (mmHg; mean ± SD): 77.1 ± 13.0 versus 64.9 ± 11.3 (P = 0.0006), 80.5 ± 10.1 versus 69.7 ± 9.3 (P = 0.0002), and 82.1 ± 10.7 versus 78.5 ± 21.7 (P = 0.44) respectively. The modified Clinical Pulmonary Infection Score was lower in the protective ventilation strategy at days 1 and 3. The percentage of patients in hospital at day 28 after surgery was not different between groups (7 vs. 15% respectively, P = 0.42). A protective ventilation strategy during abdominal surgery lasting more than 2 h improved respiratory function and reduced the modified Clinical Pulmonary Infection Score without affecting length of hospital stay.

Nonrapid Eye Movement-Predominant Obstructive Sleep Apnea: Detection and Mechanism.

PubMed

Yamauchi, Motoo; Fujita, Yukio; Kumamoto, Makiko; Yoshikawa, Masanori; Ohnishi, Yoshinobu; Nakano, Hiroshi; Strohl, Kingman P; Kimura, Hiroshi

2015-09-15

Obstructive sleep apnea (OSA) can be severe and present in higher numbers during rapid eye movement (REM) than nonrapid eye movement (NREM) sleep; however, OSA occurs in NREM sleep and can be predominant. In general, ventilation decreases an average 10% to 15% during transition from wakefulness to sleep, and there is variability in just how much ventilation decreases. As dynamic changes in ventilation contribute to irregular breathing and breathing during NREM sleep is mainly under chemical control, our hypothesis is that patients with a more pronounced reduction in ventilation during the transition from wakefulness to NREM sleep will have NREM- predominant rather than REM-predominant OSA. A retrospective analysis of 451 consecutive patients (apnea-hypopnea index [AHI] > 5) undergoing diagnostic polysomnography was performed, and breath-to-breath analysis of the respiratory cycle duration, tidal volume, and estimated minute ventilation before and after sleep onset were examined. Values were calculated using respiratory inductance plethysmography. The correlation between the percent change in estimated minute ventilation during wake-sleep transitions and the percentage of apnea-hypopneas in NREM sleep (%AHI in NREM; defined as (AHI-NREM) / [(AHI-NREM) + (AHI-REM)] × 100) was the primary outcome. The decrease in estimated minute ventilation during wake-sleep transitions was 15.0 ± 16.6% (mean ± standard deviation), due to a decrease in relative tidal volume. This decrease in estimated minute ventilation was significantly correlated with %AHI in NREM (r = -0.222, p < 0.01). A greater dynamic reduction in ventilation back and forth from wakefulness to sleep contributes to the NREM predominant OSA phenotype via induced ventilatory instability. © 2015 American Academy of Sleep Medicine.

Effect of lung-protective ventilation with lower tidal volumes on clinical outcomes among patients undergoing surgery: a meta-analysis of randomized controlled trials.

PubMed

Gu, Wan-Jie; Wang, Fei; Liu, Jing-Chen

2015-02-17

In anesthetized patients undergoing surgery, the role of lung-protective ventilation with lower tidal volumes is unclear. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of this ventilation strategy on postoperative outcomes. We searched electronic databases from inception through September 2014. We included RCTs that compared protective ventilation with lower tidal volumes and conventional ventilation with higher tidal volumes in anesthetized adults undergoing surgery. We pooled outcomes using a random-effects model. The primary outcome measures were lung injury and pulmonary infection. We included 19 trials (n=1348). Compared with patients in the control group, those who received lung-protective ventilation had a decreased risk of lung injury (risk ratio [RR] 0.36, 95% confidence interval [CI] 0.17 to 0.78; I2=0%) and pulmonary infection (RR 0.46, 95% CI 0.26 to 0.83; I2=8%), and higher levels of arterial partial pressure of carbon dioxide (standardized mean difference 0.47, 95% CI 0.18 to 0.75; I2=65%). No significant differences were observed between the patient groups in atelectasis, mortality, length of hospital stay, length of stay in the intensive care unit or the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen. Anesthetized patients who received ventilation with lower tidal volumes during surgery had a lower risk of lung injury and pulmonary infection than those given conventional ventilation with higher tidal volumes. Implementation of a lung-protective ventilation strategy with lower tidal volumes may lower the incidence of these outcomes. © 2015 Canadian Medical Association or its licensors.

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

Hodgson, Alfred T.; Shendell, Derek G.; Fisk, William J.

Indoor exposures to toxic and odorous volatile organic compounds (VOCs) are of general concern. Recently, VOCs in portable or relocatable classrooms (RCs) have received particular attention. However, very little was known about indoor environmental quality (IEQ) and the sources, composition, and indoor concentrations of VOCs in RCs. This project task focused on developing and demonstrating a process for selecting interior finish materials for RCs that have relatively low impacts with respect to their emissions of toxic and odorous VOCs. This task was part of a larger project to demonstrate the potential for simultaneous improvements in IEQ and energy efficiency inmore » four new RCs equipped both with a continuously ventilating advanced heating, ventilating, and air conditioning system (HVAC) and a standard HVAC system. These HVACs were operated on alternate weeks. One RC per pair was constructed with standard interior finish materials, and the other included alternate interior materials identified in our prior laboratory study to have low VOC emissions. The RCs were sited in side-by-side pairs at two elementary schools in distinct northern California climate zones. Classroom VOC emission rates (mg hr{sup -1}) and concentrations were predicted based on VOC emission factors ({micro}g m{sup -2} hr{sup -1}) measured for individual materials in the laboratory, the quantities of installed materials and design ventilation rates. Predicted emission rates were compared to values derived from classroom measurements of VOC concentrations and ventilation rates made at pre-occupancy, eight weeks, and 27 weeks. Predicted concentrations were compared to measured integrated VOC indoor minus outdoor concentrations during school hours in the fall cooling season with the advanced HVAC operated. These measured concentrations also were compared between standard and material-modified RCs. Our combined laboratory and field process proved effective by correctly predicting that IEQ impacts of material VOC emissions would be minor when RCs were ventilated at or above code-minimum requirements. Assuming code-minimum ventilation rates are maintained, the benefits attributable to the use of alternate interior finish materials in RC's constructed by the manufacturer associated with this study are small, implying that it is not imperative to use such alternative finishing materials. However, it is essential to avoid materials that can degrade IEQ, and the results of this study demonstrate that laboratory-based material testing combined with modeling and field validation can help to achieve that aim.« less

49 CFR 215.101 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components § 215.101 Scope. This subpart contains safety requirements prohibiting a railroad from placing or continuing in service a freight car...

49 CFR 215.101 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components § 215.101 Scope. This subpart contains safety requirements prohibiting a railroad from placing or continuing in service a freight car...

49 CFR 215.101 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components § 215.101 Scope. This subpart contains safety requirements prohibiting a railroad from placing or continuing in service a freight car...

49 CFR 215.101 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components § 215.101 Scope. This subpart contains safety requirements prohibiting a railroad from placing or continuing in service a freight car...

49 CFR 215.101 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components § 215.101 Scope. This subpart contains safety requirements prohibiting a railroad from placing or continuing in service a freight car...

49 CFR 531.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OF TRANSPORTATION PASSENGER AUTOMOBILE AVERAGE FUEL ECONOMY STANDARDS § 531.1 Scope. This part... Information and Cost Savings Act, as amended, for passenger automobiles. [43 FR 28204, June 29, 1978] ...

49 CFR 531.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF TRANSPORTATION PASSENGER AUTOMOBILE AVERAGE FUEL ECONOMY STANDARDS § 531.1 Scope. This part... Information and Cost Savings Act, as amended, for passenger automobiles. [43 FR 28204, June 29, 1978] ...

49 CFR 531.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF TRANSPORTATION PASSENGER AUTOMOBILE AVERAGE FUEL ECONOMY STANDARDS § 531.1 Scope. This part... Information and Cost Savings Act, as amended, for passenger automobiles. [43 FR 28204, June 29, 1978] ...

49 CFR 531.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OF TRANSPORTATION PASSENGER AUTOMOBILE AVERAGE FUEL ECONOMY STANDARDS § 531.1 Scope. This part... Information and Cost Savings Act, as amended, for passenger automobiles. [43 FR 28204, June 29, 1978] ...

49 CFR 531.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... OF TRANSPORTATION PASSENGER AUTOMOBILE AVERAGE FUEL ECONOMY STANDARDS § 531.1 Scope. This part... Information and Cost Savings Act, as amended, for passenger automobiles. [43 FR 28204, June 29, 1978] ...

Airway Pressure Release Ventilation During Ex Vivo Lung Perfusion Attenuates Injury

PubMed Central

Mehaffey, J. Hunter; Charles, Eric J.; Sharma, Ashish K.; Money, Dustin; Zhao, Yunge; Stoler, Mark H; Lau, Christine L; Tribble, Curtis G.; Laubach, Victor E.; Roeser, Mark E.; Kron, Irving L.

2016-01-01

Objective Critical organ shortages have resulted in Ex Vivo Lung Perfusion (EVLP) gaining clinical acceptance for lung evaluation and rehabilitation to expand the use of Donation after Circulatory Death (DCD) organs for lung transplantation. We hypothesized that an innovative use of airway pressure release ventilation (APRV) during EVLP improves lung function after transplantation. Methods Two groups (n=4 animals/group) of porcine DCD donor lungs were procured after hypoxic cardiac arrest and a 2-hour period of warm ischemia, followed by a 4-hour period of EVLP rehabilitation with either standard conventional volume-based ventilation or pressure-based APRV. Left lungs were subsequently transplanted into recipient animals and reperfused for 4 hours. Blood gases for PaO2/FiO2 ratios, airway pressures for calculation of compliance, and percent wet weight gain during EVLP and reperfusion were measured. Results APRV during EVLP significantly improved left-lung oxygenation at 2-hours (561.5±83.9 vs 341.1±136.1 mmHg) and 4-hours (569.1±18.3 vs 463.5±78.4 mmHg). Similarly, compliance was significantly higher at 2-hours (26.0±5.2 vs 15.0±4.6 mL/cmH2O) and 4-hours (30.6±1.3 vs 17.7±5.9 mL/cmH2O) after transplantation. Finally, APRV significantly reduced lung edema development on EVLP based on percentage weight gain (36.9±14.6 vs 73.9±4.9%). There was no difference in additional edema accumulation 4 hours after reperfusion. Conclusions Pressure-directed APRV ventilation strategy during EVLP improves rehabilitation of severely injured DCD lungs. After transplant these lungs demonstrate superior lung-specific oxygenation and dynamic compliance compared to lungs ventilated with standard conventional ventilation. This strategy, if implemented into clinical EVLP protocols, could advance the field of DCD lung rehabilitation to expand the lung donor pool. PMID:27742245

Residential ventilation in the United Kingdom: An overview

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

Woolliscroft, M.

1997-12-31

This paper describes the background to residential ventilation in the U.K. and its origin in the character of the housing stock, predominantly single-family dwellings and usually terraced or semi-detached but with an increasing proportion of detached houses. Houses in the U.K. have traditionally been leaky by international standards, except by comparison with houses in parts of the US. Current data and trends are presented. Inside temperatures have generally been low by international standards (again recent data are presented), which, combined with high absolute humidity, has led to a major problem of condensation and mold, with the latter affecting several millionmore » dwellings or 17% of the total stock. Thirty-five percent of dwellings are affected by condensation. Residential ventilation in recent years in the U.K. has been largely directed toward this problem. Earlier, when much of the existing stock was actually built, the use of coal fires and leaky dwellings overcame these problems but created other problems. A comparison is made of fuel costs and indoor air temperatures between the U.K. and a number of other countries, and the consequences for the choice of residential ventilation systems are considered. Recent changes in U.K. building regulations are described concerning both ventilation (e.g., extract ventilation from wet areas both active and passive) and insulation and airtightness, and some evidence from the English House Condition Survey (EHCS) and other research on the effects of these changes is presented. Increasing concern about other pollutants--notably nitrogen dioxide (NO{sub 2}), carbon dioxide (CO), and dust mites--is described together with the consequences for combustion appliances, for example. Future problems due to tighter, more highly insulated houses are considered. Some interesting new developments are also considered, such as through-the-wall combined supply and extract units with heat recovery.« less

Assessment of perioperative minute ventilation in obese versus non-obese patients with a non-invasive respiratory volume monitor.

PubMed

Mehta, Jaideep H; Cattano, Davide; Brayanov, Jordan B; George, Edward E

2017-04-26

Monitoring the adequacy of spontaneous breathing is a major patient safety concern in the post-operative setting. Monitoring is particularly important for obese patients, who are at a higher risk for post-surgical respiratory complications and often have increased metabolic demand due to excess weight. Here we used a novel, noninvasive Respiratory Volume Monitor (RVM) to monitor ventilation in both obese and non-obese orthopedic patients throughout their perioperative course, in order to develop better monitoring strategies. We collected respiratory data from 62 orthopedic patients undergoing elective joint replacement surgery under general anesthesia using a bio-impedance based RVM with an electrode PadSet placed on the thorax. Patients were stratified into obese (BMI ≥ 30) and non-obese cohorts and minute ventilation (MV) at various perioperative time points was compared against each patient's predicted minute ventilation (MV PRED ) based on ideal body weight (IBW) and body surface area (BSA). The distributions of MV measurements were also compared across obese and non-obese cohorts. Obese patients had higher MV than the non-obese patients before, during, and after surgery. Measured MV of obese patients was significantly higher than their MV PRED from IBW formulas, with BSA-based MV PRED being a closer estimate. Obese patients also had greater variability in MV post-operatively when treated with standard opioid dosing. Our study demonstrated that obese patients have greater variability in ventilation post-operatively when treated with standard opioid doses, and despite overall higher ventilation, many of them are still at risk for hypoventilation. BSA-based MV PRED formulas may be more appropriate than IBW-based ones when estimating the respiratory demand of obese patients. The RVM allows for the continuous and non-invasive assessment of respiratory function in both obese and non-obese patients.

Effects of Classroom Ventilation Rate and Temperature on Students' Test Scores.

PubMed

Haverinen-Shaughnessy, Ulla; Shaughnessy, Richard J

2015-01-01

Using a multilevel approach, we estimated the effects of classroom ventilation rate and temperature on academic achievement. The analysis is based on measurement data from a 70 elementary school district (140 fifth grade classrooms) from Southwestern United States, and student level data (N = 3109) on socioeconomic variables and standardized test scores. There was a statistically significant association between ventilation rates and mathematics scores, and it was stronger when the six classrooms with high ventilation rates that were indicated as outliers were filtered (> 7.1 l/s per person). The association remained significant when prior year test scores were included in the model, resulting in less unexplained variability. Students' mean mathematics scores (average 2286 points) were increased by up to eleven points (0.5%) per each liter per second per person increase in ventilation rate within the range of 0.9-7.1 l/s per person (estimated effect size 74 points). There was an additional increase of 12-13 points per each 1°C decrease in temperature within the observed range of 20-25°C (estimated effect size 67 points). Effects of similar magnitude but higher variability were observed for reading and science scores. In conclusion, maintaining adequate ventilation and thermal comfort in classrooms could significantly improve academic achievement of students.

Effects of Classroom Ventilation Rate and Temperature on Students’ Test Scores

PubMed Central

2015-01-01

Using a multilevel approach, we estimated the effects of classroom ventilation rate and temperature on academic achievement. The analysis is based on measurement data from a 70 elementary school district (140 fifth grade classrooms) from Southwestern United States, and student level data (N = 3109) on socioeconomic variables and standardized test scores. There was a statistically significant association between ventilation rates and mathematics scores, and it was stronger when the six classrooms with high ventilation rates that were indicated as outliers were filtered (> 7.1 l/s per person). The association remained significant when prior year test scores were included in the model, resulting in less unexplained variability. Students’ mean mathematics scores (average 2286 points) were increased by up to eleven points (0.5%) per each liter per second per person increase in ventilation rate within the range of 0.9–7.1 l/s per person (estimated effect size 74 points). There was an additional increase of 12–13 points per each 1°C decrease in temperature within the observed range of 20–25°C (estimated effect size 67 points). Effects of similar magnitude but higher variability were observed for reading and science scores. In conclusion, maintaining adequate ventilation and thermal comfort in classrooms could significantly improve academic achievement of students. PMID:26317643

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

Apte, Michael G.; Mendell, Mark J.; Sohn, Michael D.

Through mass-balance modeling of various ventilation scenarios that might satisfy the ASHRAE 62.1 Indoor Air Quality (IAQ) Procedure, we estimate indoor concentrations of contaminants of concern (COCs) in California “big box” stores, compare estimates to available thresholds, and for selected scenarios estimate differences in energy consumption. Findings are intended to inform decisions on adding performance-based approaches to ventilation rate (VR) standards for commercial buildings. Using multi-zone mass-balance models and available contaminant source rates, we estimated concentrations of 34 COCs for multiple ventilation scenarios: VRmin (0.04 cfm/ft2 ), VRmax (0.24 cfm/ft2 ), and VRmid (0.14 cfm/ft2 ). We compared COC concentrationsmore » with available health, olfactory, and irritant thresholds. We estimated building energy consumption at different VRs using a previously developed EnergyPlus model. VRmax did control all contaminants adequately, but VRmin did not, and VRmid did so only marginally. Air cleaning and local ventilation near strong sources both showed promise. Higher VRs increased indoor concentrations of outdoor air pollutants. Lowering VRs in big box stores in California from VRmax to VRmid would reduce total energy use by an estimated 6.6% and energy costs by 2.5%. Reducing the required VRs in California’s big box stores could reduce energy use and costs, but poses challenges for health and comfort of occupants. Source removal, air cleaning, and local ventilation may be needed at reduced VRs, and even at current recommended VRs. Also, alternative ventilation strategies taking climate and season into account in ventilation schedules may provide greater energy cost savings than constant ventilation rates, while improving IAQ.« less

Implications of Natural Occlusion of Ventilated Racks on Ammonia and Sanitation Practices

PubMed Central

Creamer, Michelle A; Petty, Joann; Martin, Tara; Bergdall, Valerie; Hickman-Davis, Judy M

2014-01-01

Examination of ventilated rat racks prior to semiannual sanitation revealed silicone nozzles and ventilation ports that were partially or completely occluded with granular debris. We subsequently sought to document performance standards for rack sanitation and investigate the effect of ventilation port occlusion on rack function and animal husbandry practices. We hypothesized that individually ventilated cages with occluded airflow would require more frequent cage changes, comparable to those for static cages (that is, every 3 to 4 d). Sprague–Dawley rats were housed under one of 4 conditions: no airflow occlusion, occluded air-supply inlet, occluded air-exhaust outlet, and occlusion of both inlet and outlet. Cages were changed when daily ammonia concentration exceeded 20 ppm or after 14 d had elapsed. Most cages with unoccluded or partial airflow occlusion remained below the 20 ppm limit until day 12 or 13. Cages with occlusion of both inlet and outlet exceeded 20 ppm ammonia by as early as day 5. Airflow was significantly lower in cages with occlusion of both inlet and outlet airflow. Weekly inspection revealed that occlusion of ventilation ports was detectable by 3 mo after semiannual sanitation. This study demonstrates that silicone nozzles should be removed prior to rack sanitation to improve the effectiveness of cleaning ventilation ports and nozzles. While the rack is in use, silicone nozzles and ventilation ports should be inspected regularly to identify occlusion that is likely to diminish environmental quality in the cage. Intracage ammonia levels are significantly higher when both inlet and outlet airflow are occluded. PMID:24602544

Implications of natural occlusion of ventilated racks on ammonia and sanitation practices.

PubMed

Creamer, Michelle A; Petty, Joann; Martin, Tara; Bergdall, Valerie; Hickman-Davis, Judy M

2014-03-01

Examination of ventilated rat racks prior to semiannual sanitation revealed silicone nozzles and ventilation ports that were partially or completely occluded with granular debris. We subsequently sought to document performance standards for rack sanitation and investigate the effect of ventilation port occlusion on rack function and animal husbandry practices. We hypothesized that individually ventilated cages with occluded airflow would require more frequent cage changes, comparable to those for static cages (that is, every 3 to 4 d). Sprague-Dawley rats were housed under one of 4 conditions: no airflow occlusion, occluded air-supply inlet, occluded air-exhaust outlet, and occlusion of both inlet and outlet. Cages were changed when daily ammonia concentration exceeded 20 ppm or after 14 d had elapsed. Most cages with unoccluded or partial airflow occlusion remained below the 20 ppm limit until day 12 or 13. Cages with occlusion of both inlet and outlet exceeded 20 ppm ammonia by as early as day 5. Airflow was significantly lower in cages with occlusion of both inlet and outlet airflow. Weekly inspection revealed that occlusion of ventilation ports was detectable by 3 mo after semiannual sanitation. This study demonstrates that silicone nozzles should be removed prior to rack sanitation to improve the effectiveness of cleaning ventilation ports and nozzles. While the rack is in use, silicone nozzles and ventilation ports should be inspected regularly to identify occlusion that is likely to diminish environmental quality in the cage. Intracage ammonia levels are significantly higher when both inlet and outlet airflow are occluded.

Laboratory evaluation of 10 heat and moisture exchangers using simulated aeromedical evacuation conditions.

PubMed

Suliman, Huda S; Fecura, Stephen E; Baskin, Jonathan; Kalns, John E

2011-06-01

Heat and moisture exchangers (HMEs) are used for airway humidification in mechanically ventilated patients and have been evaluated only under hospital conditions. U.S. Air Force aeromedical evacuation transports are performed under rugged conditions further complicated by the cold and dry environment in military aircrafts, and HMEs are used to provide airway humidification for patients. This study evaluated 10 commercial HMEs using a test system that simulated aeromedical evacuation conditions. Although the American National Standards Institute recommends inspired air to be at an absolute humidity value of > or = 30 mg/L for mechanically ventilated patients, the highest absolute humidity by any HME was approximately 20 mg/L. Although none of the HMEs were able to maintain a temperature high enough to achieve the humidity standard of the American National Standards Institute, the clinical significance of this standard may be less important than the relative humidity maintained in the respired air, especially on evacuation flights of short duration.

Fiber-type composition in the perivertebral musculature of lizards: Implications for the evolution of the diapsid trunk muscles.

PubMed

Moritz, Sabine; Schilling, Nadja

2013-03-01

The perivertebral musculature of lizards is critical for the stabilization and the mobilization of the trunk during locomotion. Some trunk muscles are also involved in ventilation. This dual function of trunk muscles in locomotion and ventilation leads to a biomechanical conflict in many lizards and constrains their ability to breathe while running ("axial constraint") which likely is reflected by their high anaerobic scope. Furthermore, different foraging and predator-escape strategies were shown to correlate with the metabolic profile of locomotor muscles in lizards. Because knowledge of muscle's fiber-type composition may help to reveal a muscle's functional properties, we investigated the distribution pattern of muscle fiber types in the perivertebral musculature in two small lizard species with a generalized body shape and subjected to the axial constraint (Dipsosaurus dorsalis, Acanthodactylus maculatus) and one species that circumvents the axial constraint by means of gular pumping (Varanus exanthematicus). Additionally, these species differ in their predator-escape and foraging behaviors. Using refined enzyme-histochemical protocols, muscle fiber types were differentiated in serial cross-sections through the trunk, maintaining the anatomical relationships between the skeleton and the musculature. The fiber composition in Dipsosaurus and Acanthodactylus showed a highly glycolytic profile, consistent with their intermittent locomotor style and reliance on anaerobic metabolism during activity. Because early representatives of diapsids resemble these two species in several postcranial characters, we suggest that this glycolytic profile represents the plesiomorphic condition for diapsids. In Varanus, we found a high proportion of oxidative fibers in all muscles, which is in accordance with its high aerobic scope and capability of sustained locomotion. Copyright © 2012 Wiley Periodicals, Inc.

76 FR 23755 - Release of Draft Risk and Exposure Assessments and Final Integrated Review Plan for the National...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... titled, ``Ozone National Ambient Air Quality Standards: Scope and Methods Plan for Health Risk and... Standards: Scope and Methods Plan for Welfare Risk and Exposure Assessment'' (REA Plan for the secondary... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Parts 50 and 58 [EPA-HQ-OAR-2008-0699; FRL-9300-4] RIN 2060...

30 CFR 75.1430 - Wire ropes; scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Wire ropes; scope. 75.1430 Section 75.1430... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Hoisting and Mantrips Wire Ropes § 75.1430 Wire ropes; scope. (a) Sections 75.1430 through 75.1438 apply to wire ropes in service used to hoist— (1) Persons in...

30 CFR 75.1430 - Wire ropes; scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Wire ropes; scope. 75.1430 Section 75.1430... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Hoisting and Mantrips Wire Ropes § 75.1430 Wire ropes; scope. (a) Sections 75.1430 through 75.1438 apply to wire ropes in service used to hoist— (1) Persons in...

36 CFR 1238.1 - What is the scope of this part?

Code of Federal Regulations, 2014 CFR

2014-07-01

... ADMINISTRATION RECORDS MANAGEMENT MICROFORMS RECORDS MANAGEMENT General § 1238.1 What is the scope of this part? This part covers the standards and procedures for using micrographic technology in the management of... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false What is the scope of this...

36 CFR 1238.1 - What is the scope of this part?

Code of Federal Regulations, 2012 CFR

2012-07-01

... ADMINISTRATION RECORDS MANAGEMENT MICROFORMS RECORDS MANAGEMENT General § 1238.1 What is the scope of this part? This part covers the standards and procedures for using micrographic technology in the management of... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false What is the scope of this...

36 CFR 1238.1 - What is the scope of this part?

Code of Federal Regulations, 2010 CFR

2010-07-01

... ADMINISTRATION RECORDS MANAGEMENT MICROFORMS RECORDS MANAGEMENT General § 1238.1 What is the scope of this part? This part covers the standards and procedures for using micrographic technology in the management of... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What is the scope of this...

29 CFR 553.2 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Purpose and scope. 553.2 Section 553.2 Labor Regulations... Purpose and scope. (a) The 1985 Amendments to the Fair Labor Standards Act (FLSA) changed certain provisions of the Act as they apply to employees of State and local public agencies. The purpose of part 553...

29 CFR 553.2 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 3 2011-07-01 2011-07-01 false Purpose and scope. 553.2 Section 553.2 Labor Regulations... Purpose and scope. (a) The 1985 Amendments to the Fair Labor Standards Act (FLSA) changed certain provisions of the Act as they apply to employees of State and local public agencies. The purpose of part 553...

42 CFR 493.602 - Scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS General Administration § 493.602 Scope of subpart. This... (the PHS Act) and the Federal validation of accredited laboratories and of CLIA-exempt laboratories...

42 CFR 493.602 - Scope of subpart.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS General Administration § 493.602 Scope of subpart. This... (the PHS Act) and the Federal validation of accredited laboratories and of CLIA-exempt laboratories...

40 CFR 160.1 - Scope and applicability.

Code of Federal Regulations, 2011 CFR

2011-07-01

... LABORATORY PRACTICE STANDARDS General Provisions § 160.1 Scope and applicability. (a) This part prescribes good laboratory practices for conducting studies that support or are intended to support applications...

Aerobiology in the operating room and its implications for working standards.

PubMed

Friberg, B; Friberg, S

2005-01-01

Two novel operating room (OR) ventilation concepts, i.e. the upward displacement or thermal convection system and the exponential ultra-clean laminar air flow (LAF) designed to function without extra walls, were evaluated from a bacteriological point of view. The thermal convection system (17 air changes/h) was compared with conventional ventilation (16 air changes/h) with an air inlet at the ceiling and evacuation at floor level. The exponential LAF was compared with the vertical ultra-clean LAF and the horizontal ultra-clean LAF, both with extra side walls. The comparison was made using strictly standardized simulated operations and, except for the horizontal LAF, it was performed in the same OR where the type of ventilation was changed. In the different areas important for surgical asepsis, the thermal system resulted in a twofold to threefold increase in bacterial air and surface counts compared to the conventional system (statistical significance = p < 0.05-0.0001). The bacteriological efficiency of the exponential LAF was equal to the horizontal and vertical LAF units with extra walls in the OR, and all three systems easily fulfilled the criteria for ultra-clean air, i.e. bacteria-carrying particles < 10/m3. In the areas important for surgical asepsis the turbulent ventilation systems yielded highly significant correlation between air and surface contamination (p < 0.02-0.0006). No such correlation existed in the LAF systems.

Increased ventilation by fish leads to a higher risk of parasitism.

PubMed

Mikheev, Victor N; Pasternak, Anna F; Valtonen, E Tellervo; Taskinen, Jouni

2014-06-23

Fish are common intermediate hosts of trematode cercariae and their gills can potentially serve as important sites of penetration by these larval stages. We experimentally tested the hypothesis that volume of ventilation flow across the gills contributes to acquisition of these parasites by fish. We manipulated the intensity of ventilation by using different oxygen concentrations. Juvenile Oncorhynchus mykiss were individually exposed for 10 minutes to a standard dose of Diplostomum pseudospathaceum cercariae at three levels of oxygen concentration, 30, 60 and 90%. Ventilation amplitude (measured as a distance between left and right operculum), operculum beat rate, and the number of cercariae established in the eyes of fish were recorded. Fish reacted to low oxygen concentration with wider expansion of opercula (but not with increasing beat rate), leading to an increase in ventilation volume. As expected, the intensity of infection increased with decreasing oxygen saturation-probably due to a higher exposure to cercariae caused by increased ventilation under low oxygen concentrations. The number of cercariae acquired by an individual fish was positively correlated with ventilation amplitude and with ventilation volume, but not with operculum beat rate. However, even though the infection rate increased under these circumstances, the proportion of larval trematodes successfully establishing in fish eyes decreased with increasing ventilation volume, suggesting that the high flow velocity, although increasing host exposure to cercarial parasites, may interfere with the ability of these parasites to penetrate their hosts. There was no difference in the behaviour of trematode cercariae exposed to low and high oxygen concentrations. A reduction in oxygen saturation resulted in an increase in ventilation volume across the gills and in doing so an increase in the exposure of fish to cercariae. A significant correlation between ventilation volume and parasitism represents the first experimental evidence that this physiological mechanism generates variation in transmission of parasites to fish hosts. Other factors that modify ventilation flow, e.g. physiological or social stressors, are expected to produce similar effects on the transmission success of the parasites penetrating fish hosts using the gills.

Increased ventilation by fish leads to a higher risk of parasitism

PubMed Central

2014-01-01

Background Fish are common intermediate hosts of trematode cercariae and their gills can potentially serve as important sites of penetration by these larval stages. We experimentally tested the hypothesis that volume of ventilation flow across the gills contributes to acquisition of these parasites by fish. We manipulated the intensity of ventilation by using different oxygen concentrations. Methods Juvenile Oncorhynchus mykiss were individually exposed for 10 minutes to a standard dose of Diplostomum pseudospathaceum cercariae at three levels of oxygen concentration, 30, 60 and 90%. Ventilation amplitude (measured as a distance between left and right operculum), operculum beat rate, and the number of cercariae established in the eyes of fish were recorded. Results Fish reacted to low oxygen concentration with wider expansion of opercula (but not with increasing beat rate), leading to an increase in ventilation volume. As expected, the intensity of infection increased with decreasing oxygen saturation—probably due to a higher exposure to cercariae caused by increased ventilation under low oxygen concentrations. The number of cercariae acquired by an individual fish was positively correlated with ventilation amplitude and with ventilation volume, but not with operculum beat rate. However, even though the infection rate increased under these circumstances, the proportion of larval trematodes successfully establishing in fish eyes decreased with increasing ventilation volume, suggesting that the high flow velocity, although increasing host exposure to cercarial parasites, may interfere with the ability of these parasites to penetrate their hosts. There was no difference in the behaviour of trematode cercariae exposed to low and high oxygen concentrations. Conclusion A reduction in oxygen saturation resulted in an increase in ventilation volume across the gills and in doing so an increase in the exposure of fish to cercariae. A significant correlation between ventilation volume and parasitism represents the first experimental evidence that this physiological mechanism generates variation in transmission of parasites to fish hosts. Other factors that modify ventilation flow, e.g. physiological or social stressors, are expected to produce similar effects on the transmission success of the parasites penetrating fish hosts using the gills. PMID:24954703

Effects of individualized electrical impedance tomography and image reconstruction settings upon the assessment of regional ventilation distribution: Comparison to 4-dimensional computed tomography in a porcine model

PubMed Central

Mudrak, Daniel; Kampusch, Stefan; Wielandner, Alice; Prosch, Helmut; Braun, Christina; Toemboel, Frédéric P. R.; Hofmanninger, Johannes; Kaniusas, Eugenijus

2017-01-01

Electrical impedance tomography (EIT) is a promising imaging technique for bedside monitoring of lung function. It is easily applicable, cheap and requires no ionizing radiation, but clinical interpretation of EIT-images is still not standardized. One of the reasons for this is the ill-posed nature of EIT, allowing a range of possible images to be produced–rather than a single explicit solution. Thus, to further advance the EIT technology for clinical application, thorough examinations of EIT-image reconstruction settings–i.e., mathematical parameters and addition of a priori (e.g., anatomical) information–is essential. In the present work, regional ventilation distribution profiles derived from different EIT finite-element reconstruction models and settings (for GREIT and Gauss Newton) were compared to regional aeration profiles assessed by the gold-standard of 4-dimensional computed tomography (4DCT) by calculating the root mean squared error (RMSE). Specifically, non-individualized reconstruction models (based on circular and averaged thoracic contours) and individualized reconstruction models (based on true thoracic contours) were compared. Our results suggest that GREIT with noise figure of 0.15 and non-uniform background works best for the assessment of regional ventilation distribution by EIT, as verified versus 4DCT. Furthermore, the RMSE of anteroposterior ventilation profiles decreased from 2.53±0.62% to 1.67±0.49% while correlation increased from 0.77 to 0.89 after embedding anatomical information into the reconstruction models. In conclusion, the present work reveals that anatomically enhanced EIT-image reconstruction is superior to non-individualized reconstruction models, but further investigations in humans, so as to standardize reconstruction settings, is warranted. PMID:28763474

A simple method for isocapnic hyperventilation evaluated in a lung model.

PubMed

Hallén, K; Stenqvist, O; Ricksten, S-E; Lindgren, S

2016-05-01

Isocapnic hyperventilation (IHV) has the potential to increase the elimination rate of anaesthetic gases and has been shown to shorten time to wake-up and post-operative recovery time after inhalation anaesthesia. In this bench test, we describe a technique to achieve isocapnia during hyperventilation (HV) by adding carbon dioxide (CO2) directly to the breathing circuit of a standard anaesthesia apparatus with standard monitoring equipment. Into a mechanical lung model, carbon dioxide was added to simulate a CO2 production (V(CO2)) of 175, 200 and 225 ml/min. Dead space (V(D)) volume could be set at 44, 92 and 134 ml. From baseline ventilation (BLV), HV was achieved by doubling the minute ventilation and fresh gas flow for each level of V(CO2), and dead space. During HV, CO2 was delivered (D(CO2)) by a precision flow meter via a mixing box to the inspiratory limb of the anaesthesia circuit to achieve isocapnia. During HV, the alveolar ventilation increased by 113 ± 6%. Tidal volume increased by 20 ± 0.1% during IHV irrespective of V(D) and V(CO2) level. D(CO2) varied between 147 ± 8 and 325 ± 13 ml/min. Low V(CO2) and large V(D) demanded a greater D(CO2) administration to achieve isocapnia. The FICO2 level during IHV varied between 2.3% and 3.3%. It is possible to maintain isocapnia during HV by delivering carbon dioxide through a standard anaesthesia circuit equipped with modern monitoring capacities. From alveolar ventilation, CO2 production and dead space, the amount of carbon dioxide that is needed to achieve IHV can be estimated. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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

Apte, Michael G.; Buchanan, Ian S.; Faulkner, David

The primary goals of this research effort are to develop, evaluate, and demonstrate a very practical HVAC system for classrooms that consistently provides classrooms with the quantity of ventilation in current minimum standards, while saving energy, and reducing HVAC-related noise levels. This research is motivated by the public benefits of energy efficiency, evidence that many classrooms are under-ventilated, and public concerns about indoor environmental quality in classrooms. This report presents an interim status update and preliminary findings from energy and indoor environmental quality (IEQ) measurements in sixteen relocatable classrooms in California. The field study includes measurements of HVAC energy use,more » ventilation rates, and IEQ conditions. Ten of the classrooms were equipped with a new HVAC technology and six control classrooms were equipped with a standard HVAC system. Energy use and many IEQ parameters have been monitored continuously, while unoccupied acoustic measurements were measured in one of four planned seasonal measurement campaigns. Continuously monitored data are remotely accessed via a LonWorks{reg_sign} network and stored in a relational database at LBNL. Preliminary results are presented here.« less

48 CFR 11.500 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... DESCRIBING AGENCY NEEDS Liquidated Damages 11.500 Scope. This subpart prescribes policies and procedures for... 19.705-7) or liquidated damages related to the Contract Work Hours and Safety Standards Act (see...

24 CFR 3280.501 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... MANUFACTURED HOME CONSTRUCTION AND SAFETY STANDARDS Thermal Protection § 3280.501 Scope. This subpart sets forth the requirements for condensation control, air infiltration, thermal insulation and certification for heating and comfort cooling. ...

Advanced airway management in hoist and longline operations in mountain HEMS - considerations in austere environments: a narrative review This review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

PubMed

Pietsch, Urs; Knapp, Jürgen; Kreuzer, Oliver; Ney, Ludwig; Strapazzon, Giacomo; Lischke, Volker; Albrecht, Roland; Phillips, Patrick; Rauch, Simon

2018-04-03

Providing sufficient oxygenation and ventilation is of paramount importance for the survival of emergency patients. Therefore, advanced airway management is one of the core tasks for every rescue team. Endotracheal intubation is the gold standard to secure the airway in the prehospital setting. This review aims to highlight special considerations for advanced airway management preceding human external cargo (HEC) evacuations. We systematically searched MEDLINE, EMBASE, and PubMed in August 2017 for articles on airway management and ventilation in patients before hoist or longline operation in HEMS. Relevant reference lists were hand-searched. Three articles with regard to advanced airway management and five articles concerning the epidemiology of advanced airway management in hoist or longline rescue missions were included. We found one case report regarding ventilation during hoist operations. The exact incidence of advanced airway management before evacuation of a patient by HEC is unknown but seems to be very low (< 5%). There are several hazards which can impede mechanical ventilation of patients during HEC extractions: loss of equipment, hyperventilation, inability to ventilate and consequent hypoxia, as well as inadequacy of monitoring. Advanced airway management prior to HEC operation is rarely performed. If intubation before helicopter hoist operations (HHO) and human cargo sling (HCS) extraction is considered by the rescue team, a risk/benefit analysis should be performed and a clear standard operating procedure (SOP) should be defined. Continuous and rigorous training including the whole crew is required. An international registry on airway management during HEC extraction would be desirable.

Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians.

PubMed

Berry, Marc P; Martí, Joan-Daniel; Ntoumenopoulos, George

2016-10-01

Clinicians often use numerous bedside assessments for secretion retention in participants who are receiving invasive mechanical ventilation. This study aimed to evaluate inter-rater agreement between clinicians when using standard clinical assessments of secretion retention and whether differences in clinician experience influenced inter-rater agreement. Seventy-one mechanically ventilated participants were assessed by a research clinician and by one of 13 ICU clinicians. Each clinician conducted a standardized assessment of lung auscultation, palpation for chest-wall (rhonchal) fremitus, and ventilator inspiratory/expiratory flow-time waveforms for the sawtooth pattern. On the presence of breath sounds, agreement ranged from absolute to moderate in the upper zones and the lower zones, respectively. Kappa values for abnormal and adventitious lung sounds achieved moderate agreement in the upper zones, less than chance agreement to substantial agreement in the middle zones, and moderate agreement to almost perfect agreement in the lower zones. Moderate to almost perfect agreement was established for palpable fremitus in the upper zones, moderate to substantial agreement in the middle zones, and less than chance to moderate agreement in the lower zones. Inter-rater agreement on the presence of expiratory sawtooth pattern identification showed moderate agreement. The level of percentage agreement between the research and ICU clinicians for each respiratory assessment studied did not relate directly to level of clinical experience. Inter-rater agreement for all assessments showed variability between lung regions but maintained reasonable percentage agreement in mechanically ventilated participants. The level of percentage agreement achieved between clinicians did not directly relate to clinical experience for all respiratory assessments. Therefore, these respiratory assessments should not necessarily be viewed in isolation but interpreted within the context of a full clinical assessment. Copyright © 2016 by Daedalus Enterprises.

[The aspiratory resistance and filtration penetration of N95 filtering-facepiece respirators used widely in China].

PubMed

Wang, Xinyan; Shi, Tingming; Lu, Wei; Qin, Shaoxian; Liu, Yuewei; Tao, Ying; Zhang, Hongge; Chen, Weihong

2015-01-01

The objective of this study was to investigate the aspiratory resistance, filtration penetration and their influence factors of N95 filtering-facepiece respirators used widely in China. The total of 6 brands and 21 models of N95 filtering-facepiece respirators which are certified and big sales on the market. The aspiratory resistance and filtration efficiency filter penetration were measured while air pump ran from 10 L/min to 100 L/min using differential pressure gauge and the PortaCount, respectively. The filtration penetrations for 2 of the 21 models were lower than 95%, and the qualified rate for all models was 90.47%. The filtration penetrations gradually decreased when ventilation flow of air pump increased. The negative correlation was observed between filtration penetration and ventilation flow (r(2) = 0.711, P < 0.05). The resistances of all 21 models of N95 respirators met the requirements of the national standard. The aspiratory resistance started to elevate with the increasing of ventilation flow, and a positive correlation between both (r(2) = 0.878, P < 0.05). Significant differences of filtration penetration and aspiratory resistance were observed among between different brands (P < 0.05) although no differences of filtration penetration existed among different models of one brand (P > 0.05). But the differences of the aspiratory resistance among different models of one brand were statistically significant (P < 0.05). The aspiratory resistances of all N95 filtering-facepiece respirators used in this study met the requirements of the national standard. And the qualified ratio of filtration penetration of all models was higher than 90%. The influencing factors of aspiratory resistance included materials, size and ventilation flow. And influencing factors for filtration penetration were materials and ventilation flow.

40 CFR 63.8256 - What records must I keep?

Code of Federal Regulations, 2014 CFR

2014-07-01

...) National Emission Standards for Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali... malfunction. (b) Records associated with the by-product hydrogen stream and end box ventilation system vent... the work practice standards. (1) If you choose not to institute a cell room monitoring program...

40 CFR 63.8256 - What records must I keep?

Code of Federal Regulations, 2010 CFR

2010-07-01

...) National Emission Standards for Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali... malfunction. (b) Records associated with the by-product hydrogen stream and end box ventilation system vent... the work practice standards. (1) If you choose not to institute a cell room monitoring program...

40 CFR 63.8256 - What records must I keep?

Code of Federal Regulations, 2011 CFR

2011-07-01

...) National Emission Standards for Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali... malfunction. (b) Records associated with the by-product hydrogen stream and end box ventilation system vent... the work practice standards. (1) If you choose not to institute a cell room monitoring program...

40 CFR 63.8256 - What records must I keep?

Code of Federal Regulations, 2013 CFR

2013-07-01

...) National Emission Standards for Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali... malfunction. (b) Records associated with the by-product hydrogen stream and end box ventilation system vent... the work practice standards. (1) If you choose not to institute a cell room monitoring program...

40 CFR 63.8256 - What records must I keep?

Code of Federal Regulations, 2012 CFR

2012-07-01

...) National Emission Standards for Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali... malfunction. (b) Records associated with the by-product hydrogen stream and end box ventilation system vent... the work practice standards. (1) If you choose not to institute a cell room monitoring program...

10 CFR 431.91 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... EQUIPMENT Commercial Air Conditioners and Heat Pumps § 431.91 Purpose and scope. This subpart specifies test procedures and energy conservation standards for certain commercial air conditioners and heat pumps, pursuant...

10 CFR 431.91 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... EQUIPMENT Commercial Air Conditioners and Heat Pumps § 431.91 Purpose and scope. This subpart specifies test procedures and energy conservation standards for certain commercial air conditioners and heat pumps, pursuant...

10 CFR 431.91 - Purpose and scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... EQUIPMENT Commercial Air Conditioners and Heat Pumps § 431.91 Purpose and scope. This subpart specifies test procedures and energy conservation standards for certain commercial air conditioners and heat pumps, pursuant...

10 CFR 431.91 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... EQUIPMENT Commercial Air Conditioners and Heat Pumps § 431.91 Purpose and scope. This subpart specifies test procedures and energy conservation standards for certain commercial air conditioners and heat pumps, pursuant...

10 CFR 431.91 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... EQUIPMENT Commercial Air Conditioners and Heat Pumps § 431.91 Purpose and scope. This subpart specifies test procedures and energy conservation standards for certain commercial air conditioners and heat pumps, pursuant...

45 CFR 1177.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.1 Purpose and scope. This part prescribes standards and procedures for officers and employees of the National Endowment for the Humanities...

45 CFR 1177.1 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.1 Purpose and scope. This part prescribes standards and procedures for officers and employees of the National Endowment for the Humanities...

49 CFR 192.451 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Requirements for Corrosion Control § 192.451 Scope. (a..., internal, and atmospheric corrosion. (b) [Reserved] [Amdt. 192-4, 36 FR 12302, June 30, 1971, as amended by...

49 CFR 192.451 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Requirements for Corrosion Control § 192.451 Scope. (a..., internal, and atmospheric corrosion. (b) [Reserved] [Amdt. 192-4, 36 FR 12302, June 30, 1971, as amended by...

49 CFR 192.451 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Requirements for Corrosion Control § 192.451 Scope. (a..., internal, and atmospheric corrosion. (b) [Reserved] [Amdt. 192-4, 36 FR 12302, June 30, 1971, as amended by...

49 CFR 192.451 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Requirements for Corrosion Control § 192.451 Scope. (a..., internal, and atmospheric corrosion. (b) [Reserved] [Amdt. 192-4, 36 FR 12302, June 30, 1971, as amended by...

Early versus late tracheostomy in pediatric intensive care unit: does it matter? A 6-year experience.

PubMed

Pizza, Alessandro; Picconi, Enzo; Piastra, Marco; Genovese, Orazio; Biasucci, Daniele G; Conti, Giorgio

2017-08-01

The aim of this study is to examine the clinical data of children who underwent tracheostomy during their stay in Pediatric Intensive Care Unit (PICU), in order to describe the relationship between the timing of tracheostomy, the length of PICU stay and the occurrence of ventilator-associated pneumonia (VAP). This is a retrospective cohort study that collects all patients undergoing tracheostomy during their PICU stay over a six-year period. Data collection included PICU length of stay, days of intubation, days of mechanical ventilation, primary indication for tracheostomy, information about VAP and decannulations. The early tracheostomy group was defined as patients who had ten or fewer days of continuous ventilation, whereas the late tracheostomy group had more than ten days of continuous ventilation. A significant decrease in the rate of VAP incidence was noticed in the early tracheostomy group vs. late group (P=0.004, OR=0.39, 95% CI: 0.18-0.85). No differences were observed about decannulation, need of long-term ventilation and death rate. Significant decreases of days of mechanical ventilation and PICU stay were found in subgroup of patients who underwent early tracheostomy and were decannulated within 18 months. No standard timing for tracheostomy placement has been established in the pediatric population. Early tracheostomy can shorten the days of ventilation and hospitalization in PICU and reduce the incidence of VAP, but further studies are needed to identify patient categories in which it can be of benefit.

46 CFR 58.16-1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SYSTEMS Liquefied Petroleum Gases for Cooking and Heating § 58.16-1 Scope. (a) This subpart prescribes standards for the use of liquefied petroleum gas for heating and cooking on inspected vessels, except...

31 CFR 31.200 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Purpose and scope. 31.200 Section 31.200 Money and Finance: Treasury Office of the Secretary of the Treasury TROUBLED ASSET RELIEF PROGRAM Conflicts of Interest § 31.200 Purpose and scope. (a) Purpose. This regulation sets forth standards to address and manage or to prohibit conflicts...

28 CFR 549.50 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Plastic Surgery § 549.50 Purpose and scope. The Bureau of Prisons does not ordinarily perform plastic... circumstances where plastic surgery is a component of a presently medically necessary standard of treatment (for...

40 CFR 63.1159 - Operational and equipment standards for existing, new, or reconstructed sources.

Code of Federal Regulations, 2014 CFR

2014-07-01

... atmosphere shall be equipped with a local fume capture system, ventilated through an air pollution control... pollution control equipment and monitoring equipment in a manner consistent with safety and good air... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS...

40 CFR 63.1159 - Operational and equipment standards for existing, new, or reconstructed sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... atmosphere shall be equipped with a local fume capture system, ventilated through an air pollution control... pollution control equipment and monitoring equipment in a manner consistent with safety and good air... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS...

Illinois Occupational Skill Standards: HVAC/R Technician Cluster.

ERIC Educational Resources Information Center

Illinois Occupational Skill Standards and Credentialing Council, Carbondale.

This document, which is intended to serve as a guide for work force preparation program providers, details the Illinois occupational skill standards for programs preparing students for employment in jobs in the heating, ventilation, air conditioning, and refrigeration (HVAC/R) industry. Agency partners involved in this project include: the…

24 CFR 902.21 - Physical condition standards for public housing-decent, safe, and sanitary housing in good repair...

Code of Federal Regulations, 2013 CFR

2013-04-01

..., electrical system, elevators, emergency power, fire protection, heating/ventilation/air conditioning (HVAC... HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.21 Physical condition standards for public... the major physical areas of public housing: Site, building exterior, building systems, dwelling units...

24 CFR 902.21 - Physical condition standards for public housing-decent, safe, and sanitary housing in good repair...

Code of Federal Regulations, 2014 CFR

2014-04-01

..., electrical system, elevators, emergency power, fire protection, heating/ventilation/air conditioning (HVAC... HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.21 Physical condition standards for public... the major physical areas of public housing: Site, building exterior, building systems, dwelling units...

24 CFR 902.21 - Physical condition standards for public housing-decent, safe, and sanitary housing in good repair...

Code of Federal Regulations, 2011 CFR

2011-04-01

..., electrical system, elevators, emergency power, fire protection, heating/ventilation/air conditioning (HVAC... HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.21 Physical condition standards for public... the major physical areas of public housing: Site, building exterior, building systems, dwelling units...

24 CFR 902.21 - Physical condition standards for public housing-decent, safe, and sanitary housing in good repair...

Code of Federal Regulations, 2012 CFR

2012-04-01

..., electrical system, elevators, emergency power, fire protection, heating/ventilation/air conditioning (HVAC... HOUSING ASSESSMENT SYSTEM Physical Condition Indicator § 902.21 Physical condition standards for public... the major physical areas of public housing: Site, building exterior, building systems, dwelling units...

16 CFR 1610.5 - Test apparatus and materials.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Test apparatus and materials. 1610.5 Section... STANDARD FOR THE FLAMMABILITY OF CLOTHING TEXTILES The Standard § 1610.5 Test apparatus and materials. (a) Flammability apparatus. The flammability test apparatus consists of a draft-proof ventilated chamber enclosing...

16 CFR 1610.5 - Test apparatus and materials.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Test apparatus and materials. 1610.5 Section... STANDARD FOR THE FLAMMABILITY OF CLOTHING TEXTILES The Standard § 1610.5 Test apparatus and materials. (a) Flammability apparatus. The flammability test apparatus consists of a draft-proof ventilated chamber enclosing...

Inventory of a Neurological Intensive Care Unit: Who Is Treated and How Long?

PubMed Central

Backhaus, Roland; Aigner, Franz; Steffling, Dagmar; Jakob, Wolfgang; Steinbrecher, Andreas; Kaiser, Bernhard; Hau, Peter; Boy, Sandra; Fuchs, Kornelius; Bogdahn, Ulrich; Ritzka, Markus

2015-01-01

Purpose. To characterize indications, treatment, and length of stay in a stand-alone neurological intensive care unit with focus on comparison between ventilated and nonventilated patient. Methods. We performed a single-center retrospective cohort study of all treated patients in our neurological intensive care unit between October 2006 and December 2008. Results. Overall, 512 patients were treated in the surveyed period, of which 493 could be included in the analysis. Of these, 40.8% had invasive mechanical ventilation and 59.2% had not. Indications in both groups were predominantly cerebrovascular diseases. Length of stay was 16.5 days in mean for ventilated and 3.6 days for nonventilated patient. Conclusion. Most patients, ventilated or not, suffer from vascular diseases with further impairment of other organ systems or systemic complications. Data reflects close relationship and overlap of treatment on nICU with a standardized stroke unit treatment and suggests, regarding increasing therapeutic options, the high impact of acute high-level treatment to reduce consequential complications. PMID:26199757

[Spontaneous ventilation in positive expiratory pressure in cardiogenic pulmonary edema. Prospective study].

PubMed

Bouquin, V; L'Her, E; Moriconi, M; Jobic, Y; Maheu, B; Guillo, P; Paris, A; Pennec, P Y; Boles, J M; Blanc, J J

1998-10-01

New equipment facilitating the use of spontaneous ventilation with positive expiratory pressure (PEP) has become available in France since January 1996. This technique was applied in 38 patients with severe cardiogenic pulmonary oedema and persistent respiratory distress despite high flow classical oxygen therapy and standard treatment. After 1 hour of ventilation with a flow of 220 l/min of 100% oxygen with an average PEP of 7.7 cm H20, a significant improvement of clinical (heart and respiratory rate) and biological parameters (arterial gases) was observed. There were no side effects. Four patients died during the hospital period and only 1 was intubated. Spontaneous ventilation with PEP is a simple technique for coronary care units and, compared with conventional oxygen therapy, it rapidly improves arterial oxygenation, reduces respiratory work and improves conditions of cardiac load. Acute severe cardiogenic pulmonary oedema seems to be an indication of choice, especially in the elderly, where it may help avoid an often controversial intubation.

Humidification during Mechanical Ventilation in the Adult Patient

PubMed Central

Al Ashry, Haitham S.; Modrykamien, Ariel M.

2014-01-01

Humidification of inhaled gases has been standard of care in mechanical ventilation for a long period of time. More than a century ago, a variety of reports described important airway damage by applying dry gases during artificial ventilation. Consequently, respiratory care providers have been utilizing external humidifiers to compensate for the lack of natural humidification mechanisms when the upper airway is bypassed. Particularly, active and passive humidification devices have rapidly evolved. Sophisticated systems composed of reservoirs, wires, heating devices, and other elements have become part of our usual armamentarium in the intensive care unit. Therefore, basic knowledge of the mechanisms of action of each of these devices, as well as their advantages and disadvantages, becomes a necessity for the respiratory care and intensive care practitioner. In this paper, we review current methods of airway humidification during invasive mechanical ventilation of adult patients. We describe a variety of devices and describe the eventual applications according to specific clinical conditions. PMID:25089275

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

Maxwell, S.; Berger, D.; Zuluaga, M.

In multifamily buildings, particularly in the Northeast, exhaust ventilation strategies are the norm as a means of meeting both local exhaust and whole-unit mechanical ventilation rates. The issue of where the "fresh" air is coming from is gaining significance as air-tightness standards for enclosures become more stringent. CARB researchers have found that most new high performance, multifamily housing in the Northeast use one of four strategies for ventilation: continuous exhaust only with no designated supply or make-up air source, continuous exhaust with ducted make-up air to apartments, continuous exhaust with supply through a make-up air device integral to the unitmore » HVAC, and continuous exhaust with supply through a passive inlet device, such as a trickle vent. Insufficient information is available to designers on how these various systems are best applied. Product performance data are based on laboratory tests, but there is no guarantee that those conditions will exist consistently in the finished building. In this research project, CARB evaluated the four ventilation strategies in the field to validate system performance.« less

An Extracorporeal Artificial Placenta Supports Extremely Premature Lambs for One Week

PubMed Central

Bryner, Benjamin; Gray, Brian; Perkins, Elena; Davis, Ryan; Hoffman, Hayley; Barks, John; Owens, Gabe; Bocks, Martin; Rojas-Peña, Alvaro; Hirschl, Ronald; Bartlett, Robert; Mychaliska, George

2015-01-01

Purpose The treatment of extreme prematurity remains an unsolved problem. We developed an artificial placenta (AP) based on extracorporeal life support (ECLS) that simulates the intrauterine environment and provides gas exchange without mechanical ventilation (MV), and compared it to the current standard of neonatal care. Methods Extremely premature lambs (110-120d; term=145d) were used. AP lambs (n=9) were cannulated (jugular drainage, umbilical vein reinfusion) for ECLS .Control lambs (n=7) were intubated, ventilated, given surfactant, and transitioned to high-frequency oscillatory ventilation. All lambs received parenteral nutrition, antibiotics, and steroids. Hemodynamics, blood gases, hemoglobin, and circuit flows were measured. Results Four premature lambs survived for 1 week on the AP; one survived 6 days. Adequate oxygenation and ventilation were provided by the AP. The MV lambs survived 2-8 hours. Each of these lambs experienced a transient improvement with surfactant, but developed progressive hypercapnea and hypoxia despite high airway pressures and HFOV. Conclusions Extremely premature lambs were supported for 1 week with the AP with hemodynamic stability and adequate gas exchange; mechanically ventilated lambs succumbed within 8 hours. Further studies will assess control of fetal circulation and organ maturation on the AP. PMID:25598091

Management of mechanical ventilation during laparoscopic surgery.

PubMed

Valenza, Franco; Chevallard, Giorgio; Fossali, Tommaso; Salice, Valentina; Pizzocri, Marta; Gattinoni, Luciano

2010-06-01

Laparoscopy is widely used in the surgical treatment of a number of diseases. Its advantages are generally believed to lie on its minimal invasiveness, better cosmetic outcome and shorter length of hospital stay based on surgical expertise and state-of-the-art equipment. Thousands of laparoscopic surgical procedures performed safely prove that mechanical ventilation during anaesthesia for laparoscopy is well tolerated by a vast majority of patients. However, the effects of pneumoperitoneum are particularly relevant to patients with underlying lung disease as well as to the increasing number of patients with higher-than-normal body mass index. Moreover, many surgical procedures are significantly longer in duration when performed with laparoscopic techniques. Taken together, these factors impose special care for the management of mechanical ventilation during laparoscopic surgery. The purpose of the review is to summarise the consequences of pneumoperitoneum on the standard monitoring of mechanical ventilation during anaesthesia and to discuss the rationale of using a protective ventilation strategy during laparoscopic surgery. The consequences of chest wall derangement occurring during pneumoperitoneum on airway pressure and central venous pressure, together with the role of end-tidal-CO2 monitoring are emphasised. Ventilatory and non-ventilatory strategies to protect the lung are discussed.

The effect of adaptive servo-ventilation on dyspnoea, haemodynamic parameters and plasma catecholamine concentrations in acute cardiogenic pulmonary oedema.

PubMed

Nakano, Shintaro; Kasai, Takatoshi; Tanno, Jun; Sugi, Keiki; Sekine, Yasumasa; Muramatsu, Toshihiro; Senbonmatsu, Takaaki; Nishimura, Shigeyuki

2015-08-01

Adaptive servo-ventilation has a potential sympathoinhibitory effect in acute cardiogenic pulmonary oedema (ACPO). To evaluate the acute effects of adaptive servo-ventilation in patients with ACPO. Fifty-eight consecutive patients with ACPO were divided into those who underwent adaptive servo-ventilation and those who received oxygen therapy alone as part of their immediate care. Visual analogue scale, vital signs, blood gas data and plasma catecholamine concentrations at baseline and 1 h during emergency care, and subsequent clinical events (death within 30 days, intubation within seven days or between seven and 30 days, and length of hospital stay) were assessed. Pre-matched and post-propensity score (PS)-matched datasets were analysed. During the first hour of adaptive servo-ventilation, plasma catecholamine concentrations fell significantly (baseline versus 1 h: epinephrine p = 0.003, norepinephrine p < 0.001, dopamine p < 0.001), with falls in blood pressure, heart rate, respiratory rate and pCO2, and rise in HCO3 and pH. In the PS-matched model, visual analogue scale (p = 0.036), systolic blood pressure (from 153.8 ± 30.7 to 133.1 ± 16.3 mmHg; p = 0.025) and plasma dopamine concentration (p = 0.034) fell significantly in the adaptive servo-ventilation group compared with the oxygen therapy alone group. The clinical outcomes between the groups were comparable. In patients with ACPO, emergency care using adaptive servo-ventilation attenuated plasma catecholamine concentrations and led to the improvement of dyspnoea, vital signs and acid-base balance, without adversely influencing clinical outcomes. Using adaptive servo-ventilation, rather than standard oxygen alone, may relieve dyspnoea and improve haemodynamic status, possibly by modulating sympathetic nerve activity. © The European Society of Cardiology 2014.

Chest CT in children: anesthesia and atelectasis.

PubMed

Newman, Beverley; Krane, Elliot J; Gawande, Rakhee; Holmes, Tyson H; Robinson, Terry E

2014-02-01

There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain reliable and reproducible high-quality, motion-free chest CT images in children.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2014-01-01

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

Impact of Extraperitoneal Dioxyde Carbon Insufflation on Respiratory Function in Anesthetized Adults: A Preliminary Study Using Electrical Impedance Tomography and Wash-out/Wash-in Technic

PubMed Central

Bordes, Julien; Mazzeo, Cecilia; Gourtobe, Philippe; Cungi, Pierre Julien; Antonini, Francois; Bourgoin, Stephane; Kaiser, Eric

2015-01-01

Background: Extraperitoneal laparoscopy has become a common technique for many surgical procedures, especially for inguinal hernia surgery. Investigations of physiological changes occurring during extraperitoneal carbon dioxide (CO2) insufflation mostly focused on blood gas changes. To date, the impact of extraperitoneal CO2 insufflation on respiratory mechanics remains unknown, whereas changes in respiratory mechanics have been extensively studied in intraperitoneal insufflation. Objectives: The aim of this study was to investigate the effects of extraperitoneal CO2 insufflation on respiratory mechanics. Patients and Methods: A prospective and observational study was performed on nine patients undergoing laparoscopic inguinal hernia repair. Anesthetic management and intraoperative care were standardized. All patients were mechanically ventilated with a tidal volume of 8 mL/kg using an Engström Carestation ventilator (GE Healthcare). Ventilation distribution was assessed by electrical impedance tomography (EIT). End-expiratory lung volume (EELV) was measured by a nitrogen wash-out/wash-in method. Ventilation distribution, EELV, ventilator pressures and hemodynamic parameters were assessed before extraperitoneal insufflation, and during insufflation with a PEEP of 0 cmH2O, 5 cmH20 and of 10 cmH20. Results: EELV and thoracopulmonary compliance were significantly decreased after extraperitoneal insufflation. Ventilation distribution was significantly higher in ventral lung regions during general anesthesia and was not modified after insufflation. A 10 cmH20 PEEP application resulted in a significant increase in EELV, and a shift of ventilation toward the dorsal lung regions. Conclusions: Extraperitoneal insufflation decreased EELV and thoracopulmonary compliance. Application of a 10 cmH20 PEEP increased EELV and homogenized ventilation distribution. This preliminary clinical study showed that extraperitoneal insufflation worsened respiratory mechanics, which may justify further investigations to evaluate the clinical impact. PMID:25789238

Simulation-based Randomized Comparative Assessment of Out-of-Hospital Cardiac Arrest Resuscitation Bundle Completion by Emergency Medical Service Teams Using Standard Life Support or an Experimental Automation-assisted Approach.

PubMed

Choi, Bryan; Asselin, Nicholas; Pettit, Catherine C; Dannecker, Max; Machan, Jason T; Merck, Derek L; Merck, Lisa H; Suner, Selim; Williams, Kenneth A; Jay, Gregory D; Kobayashi, Leo

2016-12-01

Effective resuscitation of out-of-hospital cardiac arrest (OHCA) patients is challenging. Alternative resuscitative approaches using electromechanical adjuncts may improve provider performance. Investigators applied simulation to study the effect of an experimental automation-assisted, goal-directed OHCA management protocol on EMS providers' resuscitation performance relative to standard protocols and equipment. Two-provider (emergency medical technicians (EMT)-B and EMT-I/C/P) teams were randomized to control or experimental group. Each team engaged in 3 simulations: baseline simulation (standard roles); repeat simulation (standard roles); and abbreviated repeat simulation (reversed roles, i.e., basic life support provider performing ALS tasks). Control teams used standard OHCA protocols and equipment (with high-performance cardiopulmonary resuscitation training intervention); for second and third simulations, experimental teams performed chest compression, defibrillation, airway, pulmonary ventilation, vascular access, medication, and transport tasks with goal-directed protocol and resuscitation-automating devices. Videorecorders and simulator logs collected resuscitation data. Ten control and 10 experimental teams comprised 20 EMT-B's; 1 EMT-I, 8 EMT-C's, and 11 EMT-P's; study groups were not fully matched. Both groups suboptimally performed chest compressions and ventilations at baseline. For their second simulations, control teams performed similarly except for reduced on-scene time, and experimental teams improved their chest compressions (P=0.03), pulmonary ventilations (P<0.01), and medication administration (P=0.02); changes in their performance of chest compression, defibrillation, airway, and transport tasks did not attain significance against control teams' changes. Experimental teams maintained performance improvements during reversed-role simulations. Simulation-based investigation into OHCA resuscitation revealed considerable variability and improvable deficiencies in small EMS teams. Goal-directed, automation-assisted OHCA management augmented select resuscitation bundle element performance without comprehensive improvement.

Academy of Nutrition and Dietetics: Scope of Practice for the Dietetic Technician, Registered.

PubMed

2013-06-01

The Scope of Practice for the Dietetic Technician, Registered provides standards and tools to guide competence in performing nutrition and dietetics practice. Composed of statutory and individual components, the DTR's scope of practice is determined by state statute and the DTR's education, training, credentialing, and demonstrated and documented competence in practice. The Scope of Practice for the Dietetic Technician, Registered reflects the Academy's position on the DTR scope of practice and the essential technical assistance role of the DTR in providing safe timely person-centered care for the delivery of quality food and nutrition services.

Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study.

PubMed

Martin-Loeches, Ignacio; Povoa, Pedro; Rodríguez, Alejandro; Curcio, Daniel; Suarez, David; Mira, Jean-Paul; Cordero, Maria Lourdes; Lepecq, Raphaël; Girault, Christophe; Candeias, Carlos; Seguin, Philippe; Paulino, Carolina; Messika, Jonathan; Castro, Alejandro G; Valles, Jordi; Coelho, Luis; Rabello, Ligia; Lisboa, Thiago; Collins, Daniel; Torres, Antonio; Salluh, Jorge; Nseir, Saad

2015-11-01

Ventilator-associated tracheobronchitis has been suggested as an intermediate process between tracheobronchial colonisation and ventilator-associated pneumonia in patients receiving mechanical ventilation. We aimed to establish the incidence and effect of ventilator-associated tracheobronchitis in a large, international patient cohort. We did a multicentre, prospective, observational study in 114 intensive care units (ICU) in Spain, France, Portugal, Brazil, Argentina, Ecuador, Bolivia, and Colombia over a preplanned time of 10 months. All patients older than 18 years admitted to an ICU who received invasive mechanical ventilation for more than 48 h were eligible. We prospectively obtained data for incidence of ventilator-associated lower respiratory tract infections, defined as ventilator-associated tracheobronchitis or ventilator-associated pneumonia. We grouped patients according to the presence or absence of such infections, and obtained data for the effect of appropriate antibiotics on progression of tracheobronchitis to pneumonia. Patients were followed up until death or discharge from hospital. To account for centre effects with a binary outcome, we fitted a generalised estimating equation model with a logit link, exchangeable correlation structure, and non-robust standard errors. This trial is registered with ClinicalTrials.gov, number NCT01791530. Between Sept 1, 2013, and July 31, 2014, we obtained data for 2960 eligible patients, of whom 689 (23%) developed ventilator-associated lower respiratory tract infections. The incidence of ventilator-associated tracheobronchitis and that of ventilator-associated pneumonia at baseline were similar (320 [11%; 10·2 of 1000 mechanically ventilated days] vs 369 [12%; 8·8 of 1000 mechanically ventilated days], p=0·48). Of the 320 patients with tracheobronchitis, 250 received appropriate antibiotic treatment and 70 received inappropriate antibiotics. 39 patients with tracheobronchitis progressed to pneumonia; however, the use of appropriate antibiotic therapy for tracheobronchitis was associated with significantly lower progression to pneumonia than was inappropriate treatment (19 [8%] of 250 vs 20 [29%] of 70, p<0·0001; crude odds ratio 0·21 [95% CI 0·11-0·41]). Significantly more patients with ventilator-associated pneumonia died (146 [40%] of 369) than those with tracheobronchitis (93 [29%] of 320) or absence of ventilator-associated lower respiratory tract infections (673 [30%] of 2271, p<0·0001). Median time to discharge from the ICU for survivors was significantly longer in the tracheobronchitis (21 days [IQR 15-34]) and pneumonia (22 [13-36]) groups than in the group with no ventilator-associated lower respiratory tract infections (12 [8-20]; hazard ratio 1·65 [95% CI 1·38-1·97], p<0·0001). This large database study emphasises that ventilator-associated tracheobronchitis is a major health problem worldwide, associated with high resources consumption in all countries. Our findings also show improved outcomes with use of appropriate antibiotic treatment for both ventilator-associated tracheobronchitis and ventilator-associated pneumonia, underlining the importance of treating both infections, since inappropriate treatment of tracheobronchitis was associated with a higher risk of progression to pneumonia. None. Copyright © 2015 Elsevier Ltd. All rights reserved.

Airway pressure release ventilation during ex vivo lung perfusion attenuates injury.

PubMed

Mehaffey, J Hunter; Charles, Eric J; Sharma, Ashish K; Money, Dustin T; Zhao, Yunge; Stoler, Mark H; Lau, Christine L; Tribble, Curtis G; Laubach, Victor E; Roeser, Mark E; Kron, Irving L

2017-01-01

Critical organ shortages have resulted in ex vivo lung perfusion gaining clinical acceptance for lung evaluation and rehabilitation to expand the use of donation after circulatory death organs for lung transplantation. We hypothesized that an innovative use of airway pressure release ventilation during ex vivo lung perfusion improves lung function after transplantation. Two groups (n = 4 animals/group) of porcine donation after circulatory death donor lungs were procured after hypoxic cardiac arrest and a 2-hour period of warm ischemia, followed by a 4-hour period of ex vivo lung perfusion rehabilitation with standard conventional volume-based ventilation or pressure-based airway pressure release ventilation. Left lungs were subsequently transplanted into recipient animals and reperfused for 4 hours. Blood gases for partial pressure of oxygen/inspired oxygen fraction ratios, airway pressures for calculation of compliance, and percent wet weight gain during ex vivo lung perfusion and reperfusion were measured. Airway pressure release ventilation during ex vivo lung perfusion significantly improved left lung oxygenation at 2 hours (561.5 ± 83.9 mm Hg vs 341.1 ± 136.1 mm Hg) and 4 hours (569.1 ± 18.3 mm Hg vs 463.5 ± 78.4 mm Hg). Likewise, compliance was significantly higher at 2 hours (26.0 ± 5.2 mL/cm H 2 O vs 15.0 ± 4.6 mL/cm H 2 O) and 4 hours (30.6 ± 1.3 mL/cm H 2 O vs 17.7 ± 5.9 mL/cm H 2 O) after transplantation. Finally, airway pressure release ventilation significantly reduced lung edema development on ex vivo lung perfusion on the basis of percentage of weight gain (36.9% ± 14.6% vs 73.9% ± 4.9%). There was no difference in additional edema accumulation 4 hours after reperfusion. Pressure-directed airway pressure release ventilation strategy during ex vivo lung perfusion improves the rehabilitation of severely injured donation after circulatory death lungs. After transplant, these lungs demonstrate superior lung-specific oxygenation and dynamic compliance compared with lungs ventilated with standard conventional ventilation. This strategy, if implemented into clinical ex vivo lung perfusion protocols, could advance the field of donation after circulatory death lung rehabilitation to expand the lung donor pool. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Scope of practice: freedom within limits.

PubMed

Schuiling, K D; Slager, J

2000-01-01

"Scope of practice" has a variety of meanings amongst midwives, other health professionals, health organizations, and consumers of midwifery care. For some, it refers to the Standards for the Practice of Midwifery; for others, it encompasses the legal base of practice; still others equate it with the components of the clinical parameters of practice. Because "scope of practice" is dynamic and parameters of practice can be impacted by many variables, succinctly defining "scope of practice" is difficult. This article provides a comprehensive discussion of the concept "scope of practice." Clinical scenarios are provided as case exemplars. The aim of this paper is to provide both new and experienced midwives with a substantive definition of the concept "scope of practice."

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.

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

Apte, Michael G.; Norman, Bourassa; Faulkner, David

An improved HVAC system for portable classrooms was specified to address key problems in existing units. These included low energy efficiency, poor control of and provision for adequate ventilation, and excessive acoustic noise. Working with industry, a prototype improved heat pump air conditioner was developed to meet the specification. A one-year measurement-intensive field-test of ten of these IHPAC systems was conducted in occupied classrooms in two distinct California climates. These measurements are compared to those made in parallel in side by side portable classrooms equipped with standard 10 SEER heat pump air conditioner equipment. The IHPAC units were found tomore » work as designed, providing predicted annual energy efficiency improvements of about 36 percent to 42 percent across California's climate zones, relative to 10 SEER units. Classroom ventilation was vastly improved as evidenced by far lower indoor minus outdoor CO2 concentrations. TheIHPAC units were found to provide ventilation that meets both California State energy and occupational codes and the ASHRAE minimum ventilation requirements; the classrooms equipped with the 10 SEER equipment universally did not meet these targets. The IHPAC system provided a major improvement in indoor acoustic conditions. HVAC system generated background noise was reduced in fan-only and fan and compressor modes, reducing the nose levels to better than the design objective of 45 dB(A), and acceptable for additional design points by the Collaborative on High Performance Schools. The IHPAC provided superior ventilation, with indoor minus outdoor CO2 concentrations that showed that the Title 24 minimum ventilation requirement of 15 CFM per occupant was nearly always being met. The opposite was found in the classrooms utilizing the 10 SEER system, where the indoor minus outdoor CO2 concentrations frequently exceeded levels that reflect inadequate ventilation. Improved ventilation conditions in the IHPAC lead to effective removal of volatile organic compounds and aldehydes, on average lowering the concentrations by 57 percent relative to the levels in the 10 SEER classrooms. The average IHPAC to 10 SEER formaldehyde ratio was about 67 percent, indicating only a 33 percent reduction of this compound in indoor air. The IHPAC thermal control system provided less variability in occupied classroom temperature than the 10 SEER thermostats. The average room temperatures in all seasons tended to be slightly lower in the IHPAC classrooms, often below the lower limit of the ASHRAE 55 thermal comfort band. State-wide and national energy modeling provided conservative estimates of potential energy savings by use of the IHPAC system that would provide payback a the range of time far lower than the lifetime of the equipment. Assuming electricity costs of $0.15/kWh, the perclassroom range of savings is from about $85 to $195 per year in California, and about $89 to $250 per year in the U.S., depending upon the city. These modelsdid not include the non-energy benefits to the classrooms including better air quality and acoustic conditions that could lead to improved health and learning in school. Market connection efforts that were part of the study give all indication that this has been a very successful project. The successes include the specification of the IHPAC equipment in the CHPS portable classroom standards, the release of a commercial product based on the standards that is now being installed in schools around the U.S., and the fact that a public utility company is currently considering the addition of the technology to its customer incentive program. These successes indicate that the IHPAC may reach its potential to improve ventilation and save energy in classrooms.« less

A ventilation intervention study in classrooms to improve indoor air quality: the FRESH study.

PubMed

Rosbach, Jeannette T M; Vonk, Machiel; Duijm, Frans; van Ginkel, Jan T; Gehring, Ulrike; Brunekreef, Bert

2013-12-17

Classroom ventilation rates often do not meet building standards, although it is considered to be important to improve indoor air quality. Poor indoor air quality is thought to influence both children's health and performance. Poor ventilation in The Netherlands most often occurs in the heating season. To improve classroom ventilation a tailor made mechanical ventilation device was developed to improve outdoor air supply. This paper studies the effect of this intervention. The FRESH study (Forced-ventilation Related Environmental School Health) was designed to investigate the effect of a CO2 controlled mechanical ventilation intervention on classroom CO2 levels using a longitudinal cross-over design. Target CO2 concentrations were 800 and 1200 parts per million (ppm), respectively. The study included 18 classrooms from 17 schools from the north-eastern part of The Netherlands, 12 experimental classrooms and 6 control classrooms. Data on indoor levels of CO2, temperature and relative humidity were collected during three consecutive weeks per school during the heating seasons of 2010-2012. Associations between the intervention and weekly average indoor CO2 levels, classroom temperature and relative humidity were assessed by means of mixed models with random school-effects. At baseline, mean CO2 concentration for all schools was 1335 ppm (range: 763-2000 ppm). The intervention was able to significantly decrease CO2 levels in the intervention classrooms (F (2,10) = 17.59, p < 0.001), with a mean decrease of 491 ppm. With the target set at 800 ppm, mean CO2 was 841 ppm (range: 743-925 ppm); with the target set at 1200 ppm, mean CO2 was 975 ppm (range: 887-1077 ppm). Although the device was not capable of precisely achieving the two predefined levels of CO2, our study showed that classroom CO2 levels can be reduced by intervening on classroom ventilation using a CO2 controlled mechanical ventilation system.

Bi-level positive pressure ventilation and adaptive servo ventilation in patients with heart failure and Cheyne-Stokes respiration.

PubMed

Fietze, Ingo; Blau, Alexander; Glos, Martin; Theres, Heinz; Baumann, Gert; Penzel, Thomas

2008-08-01

Nocturnal positive pressure ventilation (PPV) has been shown to be effective in patients with impaired left ventricular ejection fraction (LVEF) and Cheyne-Stokes respiration (CSR). We investigated the effect of a bi-level PPV and adaptive servo ventilation on LVEF, CSR, and quantitative sleep quality. Thirty-seven patients (New York heart association [NYHA] II-III) with LVEF<45% and CSR were investigated by electrocardiography (ECG), echocardiography and polysomnography. The CSR index (CSRI) was 32.3+/-16.2/h. Patients were randomly treated with bi-level PPV using the standard spontaneous/timed (S/T) mode or with adaptive servo ventilation mode (AutoSetCS). After 6 weeks, 30 patients underwent control investigations with ECG, echocardiography, and polysomnography. The CSRI decreased significantly to 13.6+/-13.4/h. LVEF increased significantly after 6 weeks of ventilation (from 25.1+/-8.5 to 28.8+/-9.8%, p<0.01). The number of respiratory-related arousals decreased significantly. Other quantitative sleep parameters did not change. The Epworth sleepiness score improved slightly. Daytime blood pressure and heart rate did not change. There were some differences between bi-level PPV and adaptive servo ventilation: the CSRI decreased more in the AutoSetCS group while the LVEF increased more in the bi-level PPV group. Administration of PPV can successfully attenuate CSA. Reduced CSA may be associated with improved LVEF; however, this may depend on the mode of PPV. Changed LVEF is evident even in the absence of significant changes in blood pressure.

Postmortem ventilation in cases of penetrating gunshot and stab wounds to the chest.

PubMed

Germerott, Tanja; Preiss, Ulrich S; Ross, Steffen G; Thali, Michael J; Flach, Patricia M

2013-11-01

We sought to determine the effect of postmortem ventilation in combination with a suction pump in cases showing penetrating trauma to the chest with haemo- and/or pneumothorax, for better evaluation of the lungs in postmortem computed tomography (PMCT). The study included 6 subjects (1 female, 5 male; age 32-67years) with a penetrating gunshot or stab wound to the chest and consecutive pneumo- and/or haemothorax. The pneumo- and haemothorax were evacuated by a suction pump, and postmortem ventilation was applied using a home care ventilator. PMCT images with and without postmortem ventilation were compared, as well as the autopsy results. In three cases haemo- and pneumothorax was clearly reduced. Postmortem ventilation led to distinct re-expansion of the lungs in two cases, and to re-expansion of single lung lobes in two cases with shotgun injuries. No visible effect was seen in the remaining two cases, because of extensive destruction of lung tissue and blood aspiration. In two cases the injuries sustained in the individual lung lobes were successfully located during postmortem ventilation. The bullet channel was apparent in one case; in another case, injury of the pericardium became visible by generating pneumopericardium. The present method is capable of improving evaluation of the postmortem lung in the presence of single stab or gunshot wounds and if there is no severe destruction of the respiratory system and aspiration. Forensic autopsy should still be considered as the gold standard, although in some cases the present method might be helpful, especially where no autopsy is required. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Exhaled Breath Condensate Collection in the Mechanically Ventilated Patient

PubMed Central

Carter, Stewart R; Davis, Christopher S; Kovacs, Elizabeth J

2012-01-01

Collection of exhaled breath condensate (EBC) is a non-invasive means of sampling the airway-lining fluid of the lungs. EBC contains numerous measurable mediators, whose analysis could change the management of patients with certain pulmonary diseases. While initially popularized in investigations involving spontaneously breathing patients, an increasing number of studies have been performed using EBC in association with mechanical ventilation. Collection of EBC in mechanically ventilated patients follows basic principles of condensation, but is influenced by multiple factors. Effective collection requires selection of a collection device, adequate minute ventilation, low cooling temperatures, and sampling times of greater than ten minutes. Condensate can be contaminated by saliva, which needs to be filtered. Dilution of samples occurs secondary to distilled water in vapors and humidification in the ventilator circuit. Dilution factors may need to be employed when investigating non-volatile biomarkers. Storage and analysis should occur promptly at −70° C to −80° C to prevent rapid degradation of samples. The purpose of this review is to examine and describe methodologies and problems of EBC collection in mechanically ventilated patients. A straightforward and safe framework has been established to investigate disease processes in this population, yet technical aspects of EBC collection still exist that prevent clinical practicality of this technology. These include a lack of standardization of procedure and analysis of biomarkers, and of normal reference ranges for mediators in healthy individuals. Once these procedural aspects have been addressed, EBC could serve as a non-invasive alternative to invasive evaluation of lungs in mechanically ventilated patients. PMID:22398157

49 CFR 193.2401 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY LIQUEFIED NATURAL GAS FACILITIES: FEDERAL SAFETY STANDARDS Equipment § 193.2401 Scope. After March 31, 2000, each new, replaced, relocated or significantly altered vaporization equipment, liquefaction equipment, and control systems must be...

Guidelines for Environmental Design in Schools (Revision of Design Note 17). Building Bulletin 87.

ERIC Educational Resources Information Center

Orlowski, Raf; Loe, David; Watson, Newton; Rowlands, Edward; Mansfield, Kevin; Venning, Bob; Seager, Andrew; Minikin, John; Hobday, Richard; Palmer, John

Both existing and new English school premises are required by law to comply with minimum construction standards published by the Department for Education and Employment. This building bulletin provides practical guidance on meeting these standards covering acoustics, lighting, heating and thermal performance, ventilation, water supplies, and…

10 CFR 431.408 - Preemption of State regulations for covered equipment other than electric motors and commercial...

Code of Federal Regulations, 2014 CFR

2014-01-01

... conservation standard, or water conservation standard (in the case of commercial prerinse spray valves or... other than electric motors and commercial heating, ventilating, air-conditioning and water heating products. 431.408 Section 431.408 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ENERGY EFFICIENCY PROGRAM...

40 CFR 63.11516 - What are my standards and management practices?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Testing Air-Cleaning Devices Used in General Ventilation for Removing Particulate Matter, June 4, 1992... requirements of this section and be re-certified every 5 years. (e) [Reserved] (f) Standards for welding. If you own or operate a new or existing welding affected source, you must comply with the requirements in...

40 CFR 63.8236 - How do I demonstrate initial compliance with the emission limitations and work practice standards?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Hazardous Air Pollutants: Mercury Emissions From Mercury Cell Chlor-Alkali Plants Initial Compliance... standards? (a) For each mercury cell chlor-alkali production facility, you have demonstrated initial compliance with the applicable emission limit for by-product hydrogen streams and end box ventilation system...