WorldWideScience

Sample records for sedation guidelines design

  1. Palliative sedation largely in accordance with Dutch national guideline

    NARCIS (Netherlands)

    Swart, S. J.; Rietjens, J. A.; Brinkkemper, T.; Zuylen, L. van; Burg-Verhage, W. A. van; Zuurmond, W. W.; Ribbe, M. W.; Blanker, M. H.; Perez, R. S.; Heide, A. van der

    2011-01-01

    OBJECTIVE: To evaluate the practice of continuous palliative sedation after the introduction of a national guideline. DESIGN: Investigation by questionnaire. METHOD: In 2008, 1580 physicians were asked to fill out a questionnaire regarding the last patient for whom they had prescribed continuous

  2. Palliative Sedation: An Analysis of International Guidelines and Position Statements.

    Science.gov (United States)

    Gurschick, Lauren; Mayer, Deborah K; Hanson, Laura C

    2015-09-01

    To describe the suggested clinical practice of palliative sedation as it is presented in the literature and discuss available guidelines for its use. CINAHL, PubMed, and Web of Science were searched for publications since 1997 for recommended guidelines and position statements on palliative sedation as well as data on its provision. Keywords included palliative sedation, terminal sedation, guidelines, United States, and end of life. Inclusion criteria were palliative sedation policies, frameworks, guidelines, or discussion of its practice, general or oncology patient population, performance of the intervention in an inpatient unit, for humans, and in English. Exclusion criteria were palliative sedation in children, acute illness, procedural, or burns, and predominantly ethical discussions. Guidelines were published by American College of Physicians-American Society of Internal Medicine (2000), Hospice and Palliative Nurses Association (2003), American Academy of Hospice and Palliative Medicine (2006), American Medical Association (2008), Royal Dutch Medical Association (2009), European Association for Palliative Care (2009), National Hospice and Palliative Care Organization (2010), and National Comprehensive Cancer Network (2012). Variances throughout guidelines include definitions of the practice, indications for its use, continuation of life-prolonging therapies, medications used, and timing/prognosis. The development and implementation of institutional-based guidelines with clear stance on the discussed variances is necessary for consistency in practice. Data on provision of palliative sedation after implementation of guidelines needs to be collected and disseminated for a better understanding of the current practice in the United States. © The Author(s) 2014.

  3. Prospective Observational Evaluation of Sedation and Pain Management Guideline Adherence Across New Jersey Intensive Care Units.

    Science.gov (United States)

    Brophy, Alison; Cardinale, Maria; Andrews, Liza B; Kaplan, Justin B; Adams, Christopher; Opsha, Yekaterina; Brandt, Kimberly A; Dixit, Deepali; Nerenberg, Steven F; Saleh, Julie A

    2018-01-01

    The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation. The primary outcomes included adherence to 4 guideline recommendations: treatment of pain before sedation, use of nonnarcotic analgesic medications, use of nonbenzodiazepine sedative medications, and use of goal-directed sedation. Of 138 patients evaluated, 50% had a primary medical diagnosis (as opposed to surgical, cardiac, or neurological diagnosis), and the median Sequential Organ Failure Assessment (SOFA) score was 7. Pain was treated prior to administration of sedatives in 55.4% of subjects, with fentanyl being the primary analgesic used. In addition, 19% received no analgesia, and 11.5% received nonopioid analgesia. Sedative agents were administered to 87 subjects (48 nonbenzodiazepine and 39 benzodiazepine). Of those receiving benzodiazepines, 22 received intermittent bolus regimens and 16 received continuous infusions, of which 5 were for another indication besides sedation. Validated scales measuring the degree of sedation were completed at least once in 56 (81.6%) patients receiving sedatives. Current sedation practices suggest that integration of evidence-based PAD guidelines across New Jersey adult ICUs is inconsistent despite pharmacist involvement.

  4. Proposed Guideline Revisions for Dental Sedation and General Anesthesia: Why Target the Safest Level of Sedation?

    Science.gov (United States)

    Dionne, Raymond A

    2016-09-01

    Recently proposed revisions to the American Dental Association's Guidelines for the Use of Sedation and General Anesthesia by Dentists, aimed at improving safety in dental offices, differentiate between levels of sedation based on drug-induced changes in physiologic and behavioral states. However, the author of this op-ed is concerned the proposed revisions may have far-reaching and unintended consequences.

  5. A national guideline for palliative sedation in the Netherlands

    NARCIS (Netherlands)

    Verkerk, Marian; van Wijlick, Eric; Legemaate, Johan; de Graeff, Alexander

    2007-01-01

    The first national guideline on palliative sedation in The Netherlands has been adopted by the General Board of the Royal Dutch Medical Association. By law, the physician is obliged to take this guideline into consideration. In this paper, we present the main principles of the guideline. Palliative

  6. Palliative sedation: not just normal medical practice. Ethical reflections on the Royal Dutch Medical Association's guideline on palliative sedation.

    Science.gov (United States)

    Janssens, Rien; van Delden, Johannes J M; Widdershoven, Guy A M

    2012-11-01

    The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline.

  7. Palliative sedation in the Netherlands : starting-points and contents of a national guideline

    NARCIS (Netherlands)

    Legemaate, J.; Verkerk, M.; van Wijlick, E.; de Graeff, Alexander

    2007-01-01

    In December 2005 the first national guideline for palliative sedation in the Netherlands was published. This guideline was developed by a committee of the Royal Dutch Medical Association, at the request of the Dutch government. The guideline defines palliative sedation as 'the intentional lowering

  8. Palliative sedation in the Netherlands: starting-points and contents of a national guideline

    NARCIS (Netherlands)

    Legemaate, Johan; Verkerk, Marian; van Wijlick, Eric; de Graeff, Alexander

    2007-01-01

    In December 2005 the first national guideline for palliative sedation in the Netherlands was published. This guideline was developed by a committee of the Royal Dutch Medical Association, at the request of the Dutch government. The guideline defines palliative sedation as 'the intentional lowering

  9. Towards a standardised approach for evaluating guidelines and guidance documents on palliative sedation: study protocol.

    Science.gov (United States)

    Abarshi, Ebun; Rietjens, Judith; Caraceni, Augusto; Payne, Sheila; Deliens, Luc; Van Den Block, Lieve

    2014-01-01

    Sedation in palliative care has received growing attention in recent years; and so have guidelines, position statements, and related literature that provide recommendations for its practice. Yet little is known collectively about the content, scope and methodological quality of these materials. According to research, there are large variations in palliative sedation practice, depending on the definition and methodology used. However, a standardised approach to comparing and contrasting related documents, across countries, associations and governmental bodies is lacking. This paper reports on a protocol designed to enable thorough and systematic comparison of guidelines and guidance documents on palliative sedation. A multidisciplinary and international group of palliative care researchers, identified themes and clinical issues on palliative sedation based on expert consultations and evidence drawn from the EAPC (European Association of Palliative Care) framework for palliative sedation and AGREE II (Appraisal Guideline Research and Evaluation) instrument for guideline assessment. The most relevant themes were selected and built into a comprehensive checklist. This was tested on people working closely with practitioners and patients, for user-friendliness and comprehensibility, and modified where necessary. Next, a systematic search was conducted for guidelines in English, Dutch, Flemish, or Italian. The search was performed in multiple databases (PubMed, CancerLit, CNAHL, Cochrane Library, NHS Evidence and Google Scholar), and via other Internet resources. Hereafter, the final version of the checklist will be used to extract data from selected literature, and the same will be compiled, entered into SPSS, cleaned and analysed systematically for publication. We have together developed a comprehensive checklist in a scientifically rigorous manner to allow standardised and systematic comparison. The protocol is applicable to all guidelines on palliative sedation, and

  10. Continuous palliative sedation until death: practice after introduction of the Dutch national guideline.

    Science.gov (United States)

    Swart, Siebe J; van der Heide, Agnes; Brinkkemper, Tijn; van Zuylen, Lia; Perez, Roberto; Rietjens, Judith

    2012-09-01

    In 2005, a national palliative guideline was launched in The Netherlands. The authors describe the practice of continuous palliative sedation until death (CPS) after the introduction of this guideline. In 2008, a random sample of physicians (n=1580) were asked to fill out a questionnaire regarding the last patient in whom they had provided CPS until death. The response was 38%. In all, 82% of the respondents were aware of the existence of the national guideline. Dyspnoea, pain and physical exhaustion were most often mentioned as decisive indications for continuous sedation. The decision to use sedation was discussed with all competent patients, but in 18% this merely involved informing the patient. Life expectancy at the start of continuous sedation was estimated to be less than 2 weeks in 97% of the cases. In 14%, the physicians had felt pressure to start the sedation, predominantly from patients and relatives. Physicians were present at the start of the sedation in 81% of the cases. Midazolam was used to induce the sedation in 92%. Overall, 41% of the physicians estimated that continuous sedation had hastened death to some extent. Most physicians thought that patients' complaints were adequately relieved by continuous sedation, that relatives were satisfied and that a good quality of dying was achieved. Continuous palliative sedation practice in The Netherlands largely reflects the recommendations from the national guideline. Issues needing further attention are the pressure felt by physicians to start continuous sedation and the potential life-shortening effect as mentioned by the physicians.

  11. Sedation in a radiology department--do radiologists follow their own guidelines?

    Science.gov (United States)

    Eason, D; Chakraverty, S; Wildsmith, J A W

    2011-05-01

    The Royal College of Radiologists (RCR) published guidelines in 2003 which aimed to standardise and improve the safety of sedation in the modern Radiology department. As sedation requirements increase, we decided to audit our own departments understandings and practice with respect to sedation. A repeat audit cycle was performed following a re-educational lecture, one year later. Three common sedation case scenarios were incorporated into a questionnaire which detailed questioning on requirements for fasting, monitoring and the order and use of sedation drugs alongside analgesics. These were compared to the 2003 RCR guidelines. The audit was recycled at one year. Despite the RCR guidelines, freely available on the RCR website, there was a persisting variation in practice which revealed a lack of awareness of the requirements for adequate fasting and the importance of giving the opiate before the benzodiazepine (sedative) agent in cases where a combination are chosen. The audit did show a trend towards using shorter acting benzodiazepines, which is in keeping with the guidelines. Monitoring of vital signs was generally, well carried out. General awareness of the RCR guidelines for safe sedation in the Radiology department was initially low and practice found to be variable. Re-education saw some improvements but also, some persisting habitual deviations from the guidelines, particularly with respect to the order in which the opiate and sedative benzodiazepine were given.

  12. Developmental procedures for the clinical practice guidelines for conscious sedation in dentistry for the Korean Academy of Dental Sciences.

    Science.gov (United States)

    An, So-Youn; Seo, Kwang-Suk; Kim, Seungoh; Kim, Jongbin; Lee, Deok-Won; Hwang, Kyung-Gyun; Kim, Hyun Jeong

    2016-12-01

    Evidence-based clinical practice guidelines (CPGs) are defined as "statements that are scientifically reviewed about evidence and systematically developed to assist in the doctors' and patients' decision making in certain clinical situations." This recommendation aims to promote good clinical practice for the provision of safe and effective practices of conscious sedation in dentistry. The development of this clinical practice guideline was conducted by performing a systematic search of the literature for evidence-based CPGs. Existing guidelines, relevant systematic reviews, policy documents, legislation, or other recommendations were reviewed and appraised. To supplement this information, key questions were formulated by the Guideline Development Group and used as the basis for designing systematic literature search strategies to identify literature that may address these questions. Guideline documents were evaluated through a review of domestic and international databases for the development of a renewing of existing conscious sedation guidelines for dentistry. Clinical practice guidelines were critically appraised for their methodologies using Appraisal of guidelines for research and evaluation (AGREE) II. A total of 12 existing CPGs were included and 13 recommendations were made in a range of general, adult, and pediatric areas. The clinical practice guidelines for conscious sedation will be reviewed in 5 years' time for further updates to reflect significant changes in the field.

  13. Medication and monitoring in palliative sedation therapy: a systematic review and quality assessment of published guidelines.

    Science.gov (United States)

    Schildmann, Eva Katharina; Schildmann, Jan; Kiesewetter, Isabel

    2015-04-01

    Palliative sedation therapy (PST) is increasingly used in patients at the end of life. However, consensus about medications and monitoring is lacking. To assess published PST guidelines with regard to quality and recommendations on drugs and monitoring. We searched CINAHL, the Cochrane Library, Embase, PsycINFO, PubMed, and references of included articles until July 2014. Search terms included "palliative sedation" or "sedation" and "guideline" or "policy" or "framework." Guideline selection was based on English or German publications that included a PST guideline. Two investigators independently assessed the quality of the guidelines according to the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II) and extracted information on drug selection and monitoring. Nine guidelines were eligible. Eight guidelines received high quality scores for the domain "scope and purpose" (median 69%, range 28-83%), whereas in the other domains the guidelines' quality differed considerably. The majority of guidelines suggest midazolam as drug of first choice. Recommendations on dosage and alternatives vary. The guidelines' recommendations regarding monitoring of PST show wide variation in the number and details of outcome parameters and methods of assessment. The published guidelines on PST vary considerably regarding their quality and content on drugs and monitoring. Given the need for clear guidance regarding PST in patients at the end of life, this comparative analysis may serve as a starting point for further improvement. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  14. International variations in clinical practice guidelines for palliative sedation: a systematic review.

    Science.gov (United States)

    Abarshi, Ebun; Rietjens, Judith; Robijn, Lenzo; Caraceni, Augusto; Payne, Sheila; Deliens, Luc; Van den Block, Lieve

    2017-09-01

    Palliative sedation is a highly debated medical practice, particularly regarding its proper use in end-of-life care. Worldwide, guidelines are used to standardise care and regulate this practice. In this review, we identify and compare national/regional clinical practice guidelines on palliative sedation against the European Association for Palliative Care (EAPC) palliative sedation Framework and assess the developmental quality of these guidelines using the Appraisal Guideline Research and Evaluation (AGREE II) instrument. Using the PRISMA criteria, we searched multiple databases (PubMed, CancerLit, CINAHL, Cochrane Library, NHS Evidence and Google Scholar) for relevant guidelines, and selected those written in English, Dutch and Italian; published between January 2000 and March 2016. Of 264 hits, 13 guidelines-Belgium, Canada (3), Ireland, Italy, Japan, the Netherlands, Norway, Spain, Europe, and USA (2) were selected. 8 contained at least 9/10 recommendations published in the EAPC Framework; 9 recommended 'pre-emptive discussion of the potential role of sedation in end-of-life care'; 9 recommended 'nutrition/hydration while performing sedation' and 8 acknowledged the need to 'care for the medical team'. There were striking differences in terminologies used and in life expectancy preceding the practice. Selected guidelines were conceptually similar, comparing closely to the EAPC Framework recommendations, albeit with notable variations. Based on AGREE II, 3 guidelines achieved top scores and could therefore be recommended for use in this context. Also, domains 'scope and purpose' and 'editorial independence' ranked highest and lowest, respectively-underscoring the importance of good reportage at the developmental stage. 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/.

  15. D 59 Design Guidelines

    DEFF Research Database (Denmark)

    Burcharth, Hans F.; Lamberti, Alberto

    The present guidelines are specifically dedicated to Low Crested Structures on attempt to provide methodological tools both for the engineering design of structures and for prediction of performance and environmental impacts. It is anticipated that the guidelines will provide valuable inputs to c...

  16. Consensus guidelines on analgesia and sedation in dying intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Lemieux-Charles Louise

    2002-08-01

    Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

  17. Into the Wild Country: Epistemic Issues in Professional Guidelines for Palliative Sedation in End-of-Life Care

    Science.gov (United States)

    Wackers, Ger

    2015-01-01

    End-of-life care is an important object of governance. Using the linguistic notions of polysemy, metaphorical blending and counterfactual reasoning, this paper critically examines epistemic issues in professional guidelines for palliative sedation of the dying. As a last resort option, palliative sedation is described as the intentional,…

  18. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015 – short version

    Directory of Open Access Journals (Sweden)

    DAS-Taskforce 2015

    2015-11-01

    Full Text Available In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine, twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM in conjunction with Society of Critical Care Medicine (SCCM and American Society of Health-System Pharmacists (ASHP from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation, Grade “B” (recommendation and Grade “0” (open recommendation. The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

  19. Continuous Deep Sedation Until Death in Nursing Home Residents with Dementia: A Case Series

    NARCIS (Netherlands)

    Anquinet, L.; Rietjens, J.A.C.; Vandervoort, A.; van der Steen, J.T.; van der Stichele, R.; Deliens, L.; Block, L.

    2013-01-01

    Objectives To describe the characteristics of continuous deep sedation until death and the prior decision-making process of nursing home residents dying with dementia and to evaluate this practice according to features reflecting sedation guideline recommendations. Design Epidemiological

  20. FDH radiological design review guidelines

    International Nuclear Information System (INIS)

    Millsap, W.J.

    1998-01-01

    These guidelines discuss in more detail the radiological design review process used by the Project Hanford Management Contractors as described in HNF-PRO-1622, Radiological Design Review Process. They are intended to supplement the procedure by providing background information on the design review process and providing a ready source of information to design reviewers. The guidelines are not intended to contain all the information in the procedure, but at points, in order to maintain continuity, they contain some of the same information

  1. FDH radiological design review guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Millsap, W.J.

    1998-09-29

    These guidelines discuss in more detail the radiological design review process used by the Project Hanford Management Contractors as described in HNF-PRO-1622, Radiological Design Review Process. They are intended to supplement the procedure by providing background information on the design review process and providing a ready source of information to design reviewers. The guidelines are not intended to contain all the information in the procedure, but at points, in order to maintain continuity, they contain some of the same information.

  2. Designing Instructional Materials: Some Guidelines.

    Science.gov (United States)

    Burbank, Lucille; Pett, Dennis

    Guidelines for the design of instructional materials are outlined in this paper. The principles of design are presented in five major categories: (1) general design (structural appeal and personal appeal); (2) instructional design (attention, memory, concept learning, and attitude change); (3) visual design (media considerations, pictures, graphs…

  3. The practice of palliative sedation in the Netherlands after the launch of the national guideline

    NARCIS (Netherlands)

    S.J. Swart (Siebe)

    2013-01-01

    textabstractPalliative sedation is a medical intervention aimed at relieving intractable suff ering by inducing decreased awareness of symptoms. It is typically considered a palliative option for patients suff ering unbearably in the last days of life. The estimated frequency of palliative sedation

  4. [Austrian guideline for palliative sedation therapy (long version) : Results of a Delphi process of the Austrian Palliative Society (OPG)].

    Science.gov (United States)

    Weixler, Dietmar; Roider-Schur, Sophie; Likar, Rudolf; Bozzaro, Claudia; Daniczek, Thomas; Feichtner, Angelika; Gabl, Christoph; Hammerl-Ferrari, Bernhard; Kletecka-Pulker, Maria; Körtner, Ulrich H J; Kössler, Hilde; Meran, Johannes G; Miksovsky, Aurelia; Pusswald, Bettina; Wienerroither, Thomas; Watzke, Herbert

    2017-02-01

    Palliative sedation therapy (PST) is an important and ethically accepted therapy in the care of selected palliative care patients with otherwise unbearable suffering from refractory distress. PST is increasingly used in end-of-life care. Austria does not have a standardized ethical guideline for this exceptional practice near end of life, but there is evidence that practice varies throughout the country. The Austrian Palliative Society (OPG) nominated a multidisciplinary working group of 16 palliative care experts and ethicists who established the national guideline on the basis of recent review work with the aim to adhere to the Europeans Association of Palliative Care's (EAPC) framework on palliative sedation therapy respecting Austrians legal, structural and cultural background. Consensus was achieved by a four-step sequential Delphi process. The Delphi-process was strictly orientated to the recently published EUROIMPACT-sedation-study-checklist and to the AGREE-2-tool. Additionally national stakeholders participated in the reflection of the results. As a result of a rigorous consensus process the long version of the Austrian National Palliative Sedation Guideline contains 112 statements within eleven domains and is supplemented by a philosophers excursus on suffering. By establishing a national guideline for palliative sedation therapy using the Delphi technique for consensus and stakeholder involvement the Austrian Palliative Society aims to ensure nationwide good practice of palliative sedation therapy. Screening for the practicability and efficacy of this guideline will be a future task.

  5. The practice of palliative sedation in the Netherlands after the launch of the national guideline

    OpenAIRE

    Swart, Siebe

    2013-01-01

    textabstractPalliative sedation is a medical intervention aimed at relieving intractable suff ering by inducing decreased awareness of symptoms. It is typically considered a palliative option for patients suff ering unbearably in the last days of life. The estimated frequency of palliative sedation varies considerably in scientifi c literature, partly due to diff erences in defi nition and research setting and diff erences in terminology. Whereas in the English medical scientifi c literature ...

  6. Current UK dental sedation practice and the 'National Institute for Health and Care Excellence' (NICE) guideline 112: sedation in children and young people.

    Science.gov (United States)

    Coulthard, P; Craig, D; Holden, C; Robb, N D; Sury, M; Chopra, S; Holroyd, I

    2015-04-24

    Describe current dental sedation practice for under 19-year-olds in the UK and compare it with the recommendations of NICE guidance 112. Members of the Society for the Advancement of Anaesthesia in Dentistry and members of the Dental Sedation Teachers Group were invited to participate in an online survey. Two hundred and sixty-six dentists and doctors completed the survey. Eighty-two percent were operator and sedationist (operator-sedationist). Ninety-five percent provided written information and 94% obtained written consent. Eighty-four percent kept a written or electronic sedation record. Eighty-six percent complied with life support training expectations. Eighty-six percent had immediate access to resuscitation equipment. Sixty-seven percent of sedationists reported that treatment could not be completed under sedation for sedation was unsuccessful, 61% said they would schedule general anaesthesia and 54.5% would schedule advanced sedation care. Forty-nine percent believed that a dentist was an appropriate person to provide advanced sedation for 12-18 years. Only 24% thought a dentist should provide advanced sedation for childrensedation was thought to be primary care by 33% and secondary care by 68%. We found good agreement between the current practice of sedation and the recommendations of the NICE guidance 112.

  7. K-Basins design guidelines

    International Nuclear Information System (INIS)

    Roe, N.R.; Mills, W.C.

    1995-06-01

    The purpose of the design guidelines is to enable SNF and K Basin personnel to complete fuel and sludge removal, and basin water mitigation by providing engineering guidance for equipment design for the fuel basin, facility modifications (upgrades), remote tools, and new processes. It is not intended to be a purchase order reference for vendors. The document identifies materials, methods, and components that work at K Basins; it also Provides design input and a technical review process to facilitate project interfaces with operations in K Basins. This document is intended to compliment other engineering documentation used at K Basins and throughout the Spent Nuclear Fuel Project. Significant provisions, which are incorporated, include portions of the following: General Design Criteria (DOE 1989), Standard Engineering Practices (WHC-CM-6-1), Engineering Practices Guidelines (WHC 1994b), Hanford Plant Standards (DOE-RL 1989), Safety Analysis Manual (WHC-CM-4-46), and Radiological Design Guide (WHC 1994f). Documents (requirements) essential to the engineering design projects at K Basins are referenced in the guidelines

  8. Design patterns for modelling guidelines

    NARCIS (Netherlands)

    Serban, Radu; Ten Teije, Annette; Marcos, Mar; Polo-Conde, Cristina; Rosenbrand, Kitty C J G M; Wittenberg, Jolanda; van Croonenborg, Joyce

    2005-01-01

    It is by now widely accepted that medical guidelines can help to significantly improve the quality of medical care. Unfortunately, constructing the required medical guidelines is a very labour intensive and costly process. The cost of guideline construction would decrease if guidelines could be

  9. ITER physics design guidelines: 1989

    International Nuclear Information System (INIS)

    Uckan, N.A.

    1990-01-01

    The physics basis for ITER has been developed from an assessment of the results of the last twenty-five years of tokamak research and from detailed analysis of important physics issues specifically for the ITER design. This assessment has been carried out with direct participation of members of the experimental teams of each of the major tokamaks in the world fusion program through participation in ITER workshops, contributions to the ITER Physics R and D Program, and by direct contacts between the ITER team and the cognizant experimentalists. Extrapolations to the present data base, where needed, are made in the most cautious way consistent with engineering constraints and performance goals of the ITER. In cases where a working assumptions had to be introduced, which is insufficiently supported by the present data base, is explicitly stated. While a strong emphasis has been placed on the physics credibility of the design, the guidelines also take into account that ITER should be designed to be able to take advantage of potential improvements in tokamak physics that may occur before and during the operation of ITER. (author). 33 refs

  10. Design Guidelines for Low Crested Structures

    DEFF Research Database (Denmark)

    Burcharth, H. F.; Lamberti, Alberto

    2004-01-01

    1998-2002. The Guidelines comprise engineering aspects related to morphological impact and structure stability, biological aspects related to ecological impact, and socio-economical aspects related to the implementation of LCS-schemes. The guidelines are limited to submerged and regularly overtopped......The paper presents an overview of the design guidelines for low crested structures (LCS's) to be applied in coastal protection schemes. The design guidelines are formulated as a part of the research project: Environmental Design of Low Crested Coastal Defence Structures (DELOS) within the EC 5FP...

  11. Guidelines for preparing IAEA design information questionnaires

    International Nuclear Information System (INIS)

    Swartz, J.M.; Bieber, A.M.

    1980-01-01

    The format of the IAEA Design Information Questionnaires and the SAI prepared guidelines for completing them, is described. The guidelines should assist facility operators in meeting the time constraints set forth in the Subsidiary Arrangements by effectively supplying the information needed by the IAEA and in minimizing resource allocations to the preparation effort. 8 refs

  12. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults

    NARCIS (Netherlands)

    Hinkelbein, Jochen; Lamperti, Massimo; Akeson, Jonas; Santos, Joao; Costa, Joao; De Robertis, Edoardo; Longrois, Dan; Novak-Jankovic, Vesna; Petrini, Flavia; Struys, Michel M. R. F.; Veyckemans, Francis; Fuchs-Buder, Thomas; Fitzgerald, Robert

    2018-01-01

    Procedural sedation and analgesia (PSA) has become a widespread practice given the increasing demand to relieve anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures. The role of, and credentialing required by, anaesthesiologists and practitioners performing PSA has been

  13. Comfort and patient-centred care without excessive sedation

    DEFF Research Database (Denmark)

    Vincent, Jean-Louis; Shehabi, Yahya; Walsh, Timothy S

    2016-01-01

    We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation...... and Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical...... requirements for deeper sedation. Effective pain relief is the first priority for implementation of eCASH: we advocate flexible multimodal analgesia designed to minimise use of opioids. Sedation is secondary to pain relief and where possible should be based on agents that can be titrated to a prespecified...

  14. Engineering design guidelines for nuclear criticality safety

    International Nuclear Information System (INIS)

    Waltz, W.R.

    1988-08-01

    This document provides general engineering design guidelines specific to nuclear criticality safety for a facility where the potential for a criticality accident exists. The guide is applicable to the design of new SRP/SRL facilities and to major modifications Of existing facilities. The document is intended an: A guide for persons actively engaged in the design process. A resource document for persons charged with design review for adequacy relative to criticality safety. A resource document for facility operating personnel. The guide defines six basic criticality safety design objectives and provides information to assist in accomplishing each objective. The guide in intended to supplement the design requirements relating to criticality safety contained in applicable Department of Energy (DOE) documents. The scope of the guide is limited to engineering design guidelines associated with criticality safety and does not include other areas of the design process, such as: criticality safety analytical methods and modeling, nor requirements for control of the design process

  15. Guideline for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016.

    Science.gov (United States)

    2016-10-15

    The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase thepotential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.

  16. [General practitioner and palliative sedation].

    Science.gov (United States)

    Schweitzer, Bart

    2014-01-01

    Recent publications in Dutch national newspapers on palliative sedation have raised concerns about its use in general practice. There is now evidence that there is no significant increase in the incidence of palliative sedation. Euthanasia requests were pending in 20.8% of the cases in which palliative sedation was performed, but the general practitioners could clearly justify why they made this choice. This is important because it indicates that they are aware of a sharp distinction between euthanasia and palliative sedation. Although the decision to perform palliative sedation was discussed with almost all cancer patients, patient involvement was less present in non-cancer conditions. This may be related to different disease trajectories, but it also indicates that attention should be devoted to earlier identification of patients in need of palliative care. The findings confirm that the practice of palliative sedation by general practitioners largely reflects the recommendations of the Dutch National Guideline on Palliative Sedation.

  17. Physical Activity Design Guidelines for School Architecture.

    Science.gov (United States)

    Brittin, Jeri; Sorensen, Dina; Trowbridge, Matthew; Lee, Karen K; Breithecker, Dieter; Frerichs, Leah; Huang, Terry

    2015-01-01

    Increasing children's physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students' physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 school environments conducive to healthy physical activity, and to engage scientists in transdisciplinary perspectives toward improved knowledge of the school environment's impact. We used a qualitative review process to develop evidence-based and theory-driven school design guidelines that promote increased physical activity among students. The design guidelines include specific strategies in 10 school design domains. Implementation of the guidelines is expected to enable students to adopt healthier physical activity behaviors. The tool bridges a translational gap between research and environmental design practice, and may contribute to setting new industry and education standards.

  18. Physical Activity Design Guidelines for School Architecture.

    Directory of Open Access Journals (Sweden)

    Jeri Brittin

    Full Text Available Increasing children's physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students' physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 school environments conducive to healthy physical activity, and to engage scientists in transdisciplinary perspectives toward improved knowledge of the school environment's impact. We used a qualitative review process to develop evidence-based and theory-driven school design guidelines that promote increased physical activity among students. The design guidelines include specific strategies in 10 school design domains. Implementation of the guidelines is expected to enable students to adopt healthier physical activity behaviors. The tool bridges a translational gap between research and environmental design practice, and may contribute to setting new industry and education standards.

  19. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016.

    Science.gov (United States)

    Coté, Charles J; Wilson, Stephen

    2016-07-01

    The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children. Copyright © 2016 American Academy of Pediatric Dentistry and American Academy of Pediatrics. This report is being published concurrently in Pediatric Dentistry July 2016. The articles are identical. Either citation can be used when citing this report.

  20. Development of human factors design review guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Woon; Oh, In Suk; Suh, Sang Moon; Lee, Hyun Chul [Korea Atomic Energy Research Institute, Taejon (Korea)

    1997-10-01

    The objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: 25. Human Factors Engineering Program Review Model and 26. Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation, which are related to the development of human factors safety regulation guides being performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and reviewing the reference documents of NUREG-0711. We also computerized the Korean version of NUREG-0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm systems. Then we will update the guidelines by reviewing the literature related to alarm design published after 1994. (author). 12 refs., 5 figs., 2 tabs.

  1. Development of human factors design review guidelines

    International Nuclear Information System (INIS)

    Lee, Jung Woon; Oh, In Suk; Suh, Sang Moon; Lee, Hyun Chul

    1997-10-01

    The Objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: '25, Human factors engineering program review model' and '26, Review criteria for human actors aspects of advanced controls and instrumentation', which are related to the development of human factors safety regulation guides be ing performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and reviewing the reference documents of NUREG-0711. We also computerized the Korean version of NUREG-0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm systems. Then we well update the guidelines by reviewing the literature related to alarm design published after 1994

  2. [Sedation and analgesia practices among Spanish neonatal intensive care units].

    Science.gov (United States)

    Avila-Alvarez, A; Carbajal, R; Courtois, E; Pertega-Diaz, S; Muñiz-Garcia, J; Anand, K J S

    2015-08-01

    Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. A multicenter, observational, longitudinal and prospective study. Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (Pneonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the "state of the art", and could serve as the basis of preparing clinical practice guidelines at a national level. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  3. Design guidelines for mini-roundabouts

    CSIR Research Space (South Africa)

    Emslie, I

    1997-03-01

    Full Text Available Guidelines for Traffic Calming. Concepts and principles relating to the use of mini-roundabouts as a form of intersection control and in the traffic calming context are discussed. Warrants for the implementation of mini-roundabouts and design standards...

  4. Design Guidelines for Coffee Vending Machines

    OpenAIRE

    Schneidermeier, Tim; Burghardt, Manuel; Wolff, Christian

    2013-01-01

    Walk-up-and-use-systems such as vending and self-service machines request special attention concerning an easy to use and self-explanatory user interface. In this paper we present a set of design guidelines for coffee vending machines based on the results of an expert-based usability evaluation of thirteen different models.

  5. Healthy eating design guidelines for school architecture.

    Science.gov (United States)

    Huang, Terry T-K; Sorensen, Dina; Davis, Steven; Frerichs, Leah; Brittin, Jeri; Celentano, Joseph; Callahan, Kelly; Trowbridge, Matthew J

    2013-01-01

    We developed a new tool, Healthy Eating Design Guidelines for School Architecture, to provide practitioners in architecture and public health with a practical set of spatially organized and theory-based strategies for making school environments more conducive to learning about and practicing healthy eating by optimizing physical resources and learning spaces. The design guidelines, developed through multidisciplinary collaboration, cover 10 domains of the school food environment (eg, cafeteria, kitchen, garden) and 5 core healthy eating design principles. A school redesign project in Dillwyn, Virginia, used the tool to improve the schools' ability to adopt a healthy nutrition curriculum and promote healthy eating. The new tool, now in a pilot version, is expected to evolve as its components are tested and evaluated through public health and design research.

  6. Guidelines for control room design reviews

    International Nuclear Information System (INIS)

    1981-09-01

    The control room design review is part of a broad program being undertaken by the nuclear industry and the government to ensure consideration of human factors in nuclear power plant design and operation. The purpose of the control room design review described by these guidelines is to (1) review and evaluate the control room workspace, instrumentation, controls, and other equipment from a human factors engineering point of view that takes into account both system demands and operator capabilities; and (2) to identify, assess, and implement control room design modifications that correct inadequate or unsuitable items. The scope of the control room design review described by these guidelines covers the human engineering review of completed control rooms; i.e., operational control rooms or those at that stage of the licensing process where control room design and equipment selection are committed. These guidelines should also be of use during the design process for new control rooms. However, additional analyses to optimize the allocation of functions to man and machine, and further examination of advanced control system technology, are recommended for new control rooms. Guidelines and references for comprehensive system analyses designed to incorporate human factors considerations into the design and development of new control rooms are presented in Appendix B. Where possible, a generic approach to the control room design review process is encouraged; for example, when control room designs are replicated wholly or in part in two or more units. Even when designs are not replicated exactly, generic reviews which can be modified to account for specific differences in particular control rooms should be considered. Industry organizations and owners groups are encouraged to coordinate joint efforts and share data to develop generic approaches to the design review process. The control room design review should accomplish the following specific objectives. To determine

  7. Design Guidelines for New Generation Network Architecture

    Science.gov (United States)

    Harai, Hiroaki; Fujikawa, Kenji; Kafle, Ved P.; Miyazawa, Takaya; Murata, Masayuki; Ohnishi, Masaaki; Ohta, Masataka; Umezawa, Takeshi

    Limitations are found in the recent Internet because a lot of functions and protocols are patched to the original suite of layered protocols without considering global optimization. This reveals that end-to-end argument in the original Internet was neither sufficient for the current societal network and nor for a sustainable network of the future. In this position paper, we present design guidelines for a future network, which we call the New Generation Network, which provides the inclusion of diverse human requirements, reliable connection between the real-world and virtual network space, and promotion of social potentiality for human emergence. The guidelines consist of the crystal synthesis, the reality connection, and the sustainable & evolutional guidelines.

  8. Sustainable design guidelines to support the Washington State ferries terminal design manual : design guideline application and refinement.

    Science.gov (United States)

    2013-08-01

    The Sustainable Design Guidelines were developed in Phase I of this research program (WA-RD : 816.1). Here we are reporting on the Phase II effort that beta-tested the Phase I Guidelines on : example ferry terminal designs and refinements made ...

  9. Guidelines for determining design basis ground motions

    International Nuclear Information System (INIS)

    1993-11-01

    This report develops and applies a method for estimating strong earthquake ground motion. The emphasis of this study is on ground motion estimation in Eastern North America (east of the Rocky Mountains), with particular emphasis on the Eastern United States and southeastern Canada. Specifically considered are ground motions resulting from earthquakes with magnitudes from 5 to 8, fault distances from 0 to 500 km, and frequencies from 1 to 35 Hz. The two main objectives were: (1) to develop generic relations for estimating ground motion appropriate for site screening; and (2) to develop a guideline for conducting a thorough site investigation needed to define the seismic design basis. For the first objective, an engineering model was developed to predict the expected ground motion on rock sites, with an additional set of amplification factors to account for the response of the soil column over rock at soil sites. The results incorporate best estimates of ground motion as well as the randomness and uncertainty associated with those estimates. For the second objective, guidelines were developed for gathering geotechnical information at a site and using this information in calculating site response. As a part of this development, an extensive set of geotechnical and seismic investigations was conducted at three reference sites. Together, the engineering model and guidelines provide the means to select and assess the seismic suitability of a site

  10. Guidelines for designing messages in risk communication

    International Nuclear Information System (INIS)

    Takashita, Hirofumi; Horikoshi, Hidehiko

    2004-07-01

    Risk Communication Study Team (hereafter called RC team) has designed messages for risk communication based on the analysis of the local residents' opinions which were expressed in several questionnaire surveys. The messages are described in a side format (Power Point format) every single content. This report provides basic guidelines for making messages that are used for risk communication, and does not include concrete messages which RC team designed. The RC team has already published the report entitled 'Information materials for risk communication' (JNC TN8450 2003-008) separately, and it gives the concrete messages. This report shows general cautions and checklists in designing messages, comments on the messages from outside risk communication experts, and opinions from local residents. (author)

  11. Residential neighbourhoods in Kathmandu: Key design guidelines

    Directory of Open Access Journals (Sweden)

    Bijaya K. Shrestha

    2013-01-01

    Full Text Available Residential neighbourhoods developed using various techniques in Kathmandu by both the public and private sectors have not only provided a poor urban setting and failed to address socio-cultural needs, but are also poor at building a community and creating links to the built environment, with the result that the planned areas lack a sense of place and the inhabitants lack a feeling of home. Although traditional neighbourhoods in the historic core area had many features of a good residential neighbourhood in the past, they are currently undergoing rapid destruction. The residents of these neighbourhoods have little awareness of these issues. The existing legal and institutional frameworks are inadequate and ineffective and cannot address these problems, and so the formulation of design guidelines, their strict implementation, and enhancement of socio-cultural events including social networking are recommended for future residential neighbourhood development.

  12. No-sedation during mechanical ventilation

    DEFF Research Database (Denmark)

    Laerkner, Eva; Stroem, Thomas; Toft, Palle

    2016-01-01

    BACKGROUND: Evidence is growing that less or no-sedation is possible and beneficial for patients during mechanical ventilation. AIM: To investigate if there was a difference in patient consciousness and nursing workload comparing a group of patients receiving no-sedation with a group of sedated...... patients with daily wake up, and also to estimate economic consequences of a no-sedation strategy. DESIGN AND METHODS: Data were collected during a prospective trial of 140 mechanically ventilated patients randomized to either no-sedation or to sedation with daily wake up. From day 1 to 7 in the intensive...

  13. Palliative sedation: reliability and validity of sedation scales.

    Science.gov (United States)

    Arevalo, Jimmy J; Brinkkemper, Tijn; van der Heide, Agnes; Rietjens, Judith A; Ribbe, Miel; Deliens, Luc; Loer, Stephan A; Zuurmond, Wouter W A; Perez, Roberto S G M

    2012-11-01

    Observer-based sedation scales have been used to provide a measurable estimate of the comfort of nonalert patients in palliative sedation. However, their usefulness and appropriateness in this setting has not been demonstrated. To study the reliability and validity of observer-based sedation scales in palliative sedation. A prospective evaluation of 54 patients under intermittent or continuous sedation with four sedation scales was performed by 52 nurses. Included scales were the Minnesota Sedation Assessment Tool (MSAT), Richmond Agitation-Sedation Scale (RASS), Vancouver Interaction and Calmness Scale (VICS), and a sedation score proposed in the Guideline for Palliative Sedation of the Royal Dutch Medical Association (KNMG). Inter-rater reliability was tested with the intraclass correlation coefficient (ICC) and Cohen's kappa coefficient. Correlations between the scales using Spearman's rho tested concurrent validity. We also examined construct, discriminative, and evaluative validity. In addition, nurses completed a user-friendliness survey. Overall moderate to high inter-rater reliability was found for the VICS interaction subscale (ICC = 0.85), RASS (ICC = 0.73), and KNMG (ICC = 0.71). The largest correlation between scales was found for the RASS and KNMG (rho = 0.836). All scales showed discriminative and evaluative validity, except for the MSAT motor subscale and VICS calmness subscale. Finally, the RASS was less time consuming, clearer, and easier to use than the MSAT and VICS. The RASS and KNMG scales stand as the most reliable and valid among the evaluated scales. In addition, the RASS was less time consuming, clearer, and easier to use than the MSAT and VICS. Further research is needed to evaluate the impact of the scales on better symptom control and patient comfort. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  14. Nurse administered propofol sedation for pulmonary endoscopies requires a specific protocol

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Banning, Anne-Marie; Clementsen, Paul

    2012-01-01

    This study provides an evaluation and risk analysis of propofol sedation for endoscopic pulmonary procedures according to our unit's "gastroenterologic nurse-administered propofol sedation (NAPS) guideline".......This study provides an evaluation and risk analysis of propofol sedation for endoscopic pulmonary procedures according to our unit's "gastroenterologic nurse-administered propofol sedation (NAPS) guideline"....

  15. Demarcating Mobile Phone Interface Design Guidelines to Expedite Selection

    Directory of Open Access Journals (Sweden)

    Karen Vera Renaud

    2017-12-01

    Full Text Available Guidelines are recommended as a tool for informing user interface design. Despite a proliferation of guidelines in the research literature, there is little evidence of their use in industry, nor their influence in academic literature. In this paper, we explore the research literature related to mobile phone design guidelines to find out why this should be so. We commenced by carrying out a scoping literature review of the mobile phone design guideline literature to gain insight into the maturity of the field. The question we wanted to explore was: “Are researchers building on each others’ guidelines, or is the research field still in the foundational stage?” We discovered a poorly structured field, with many researchers proposing new guidelines, but little incremental refinement of extant guidelines. It also became clear that the current reporting of guidelines did not explicitly communicate their multi-dimensionality or deployment context. This leaves designers without a clear way of discriminating between guidelines, and could contribute to the lack of deployment we observed. We conducted a thematic analysis of papers identified by means of a systematic literature review to identify a set of dimensions of mobile phone interface design guidelines. The final dimensions provide a mechanism for differentiating guidelines and expediting choice.

  16. Building Design Guidelines for Solar Energy Technologies

    Science.gov (United States)

    Givoni, B.

    1989-01-01

    There are two main objectives to this publication. The first is to find out the communalities in the experience gained in previous studies and in actual applications of solar technologies in buildings, residential as well as nonresidential. The second objective is to review innovative concepts and products which may have an impact on future developments and applications of solar technologies in buildings. The available information and common lessons were collated and presented in a form which, hopefully, is useful for architects and solar engineers, as well as for teachers of "solar architecture" and students in Architectural Schools. The publication is based mainly on the collection and analysis of relevant information. The information included previous studies in which the performance of solar buildings was evaluated, as well as the personal experience of the Author and the research consultants. The state of the art, as indicated by these studies and personal experience, was summarized and has served as basis for the development of the Design Guidelines. In addition to the summary of the state of the art, as was already applied in solar buildings, an account was given of innovative concepts and products. Such innovations have occurred in the areas of thermal storage by Phase Change Materials (PCM) and in glazing with specialized or changeable properties. Interesting concepts were also developed for light transfer, which may enable to transfer sunlight to the core areas of large multi story nonresidential buildings. These innovations may have a significant impact on future developments of solar technologies and their applications in buildings.

  17. Energy Design Guidelines for High Performance Schools: Tropical Island Climates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2004-11-01

    Design guidelines outline high performance principles for the new or retrofit design of K-12 schools in tropical island climates. By incorporating energy improvements into construction or renovation plans, schools can reduce energy consumption and costs.

  18. Energy Design Guidelines for High Performance Schools: Tropical Island Climates

    Energy Technology Data Exchange (ETDEWEB)

    2004-11-01

    The Energy Design Guidelines for High Performance Schools--Tropical Island Climates provides school boards, administrators, and design staff with guidance to help them make informed decisions about energy and environmental issues important to school systems and communities. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school in tropical island climates. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs.

  19. Designing algorithm visualization on mobile platform: The proposed guidelines

    Science.gov (United States)

    Supli, A. A.; Shiratuddin, N.

    2017-09-01

    This paper entails an ongoing study about the design guidelines of algorithm visualization (AV) on mobile platform, helping students learning data structures and algorithm (DSA) subject effectively. Our previous review indicated that design guidelines of AV on mobile platform are still few. Mostly, previous guidelines of AV are developed for AV on desktop and website platform. In fact, mobile learning has been proved to enhance engagement in learning circumstances, and thus effect student's performance. In addition, the researchers highly recommend including UI design and Interactivity in designing effective AV system. However, the discussions of these two aspects in previous AV design guidelines are not comprehensive. The UI design in this paper describes the arrangement of AV features in mobile environment, whereas interactivity is about the active learning strategy features based on learning experiences (how to engage learners). Thus, this study main objective is to propose design guidelines of AV on mobile platform (AVOMP) that entails comprehensively UI design and interactivity aspects. These guidelines are developed through content analysis and comparative analysis from various related studies. These guidelines are useful for AV designers to help them constructing AVOMP for various topics on DSA.

  20. Pediatric neuro MRI. Tricks to minimize sedation

    Energy Technology Data Exchange (ETDEWEB)

    Barkovich, Matthew J.; Desikan, Rahul S. [University of California, San Francisco, Department of Radiology and Diagnostic Imaging, San Francisco, CA (United States); Xu, Duan; Barkovich, A.J. [University of California, San Francisco, Department of Radiology and Diagnostic Imaging, San Francisco, CA (United States); UCSF-Benioff Children' s Hospital, Department of Radiology, San Francisco, CA (United States); Williams, Cassandra [UCSF-Benioff Children' s Hospital, Department of Radiology, San Francisco, CA (United States)

    2018-01-15

    Magnetic resonance imaging (MRI) is the workhorse modality in pediatric neuroimaging because it provides excellent soft-tissue contrast without ionizing radiation. Until recently, studies were uninterpretable without sedation; however, given development of shorter sequences, sequences that correct for motion, and studies showing the potentially deleterious effects of sedation on immature laboratory animals, it is prudent to minimize sedation when possible. This manuscript provides basic guidelines for performing pediatric neuro MRI without sedation by both modifying technical factors to reduce scan time and noise, and using a multi-disciplinary team to coordinate imaging with the patient's biorhythms. (orig.)

  1. Pediatric Gastrointestinal Endoscopic Sedation: A 2010 Nationwide Survey in Taiwan

    Directory of Open Access Journals (Sweden)

    Po-Hon Chen

    2012-06-01

    Conclusion: A majority of pediatric EGD in Taiwan was performed under sedation and applied more often to younger children. Endoscopists were more satisfied during EGD when practicing sedation. This survey should help formulate updated practice guidelines and policies regarding endoscopic sedation.

  2. Reliability Based Calibration of Fatigue Design Guidelines for Ship Structures

    DEFF Research Database (Denmark)

    Folsø, Rasmus; Otto, S.; Parmentier, G.

    2002-01-01

    A simple reliability based framework is applied to calibrate a new set of fatigue design guidelines. This new guideline considers two different approaches for the assessment of both loads, stresses and local stress raising effects, and partial safety factors must be given for any combination...

  3. Engineering policy guidelines for design of earth slopes.

    Science.gov (United States)

    2011-10-01

    These guidelines were developed as part of a comprehensive research program undertaken by the Missouri Department of Transportation (MoDOT) to reduce costs associated with design and construction of bridge foundations while maintaining appropriate le...

  4. Engineering policy guidelines for design of spread footings.

    Science.gov (United States)

    2011-10-01

    These guidelines were developed as part of a comprehensive research program undertaken by the Missouri Department of Transportation (MoDOT) to reduce costs associated with design and construction of bridge foundations while maintaining appropriate le...

  5. Engineering policy guidelines for design of drilled shafts.

    Science.gov (United States)

    2011-10-01

    These guidelines were developed as part of a comprehensive research program undertaken by the Missouri Department of Transportation (MoDOT) to reduce costs associated with design and construction of bridge foundations while maintaining appropriate le...

  6. Engineering policy guidelines for design of driven piles.

    Science.gov (United States)

    2011-08-01

    These guidelines were developed as part of a comprehensive research program undertaken by the Missouri Department of : Transportation (MoDOT) to reduce costs associated with design and construction of bridge foundations while maintaining appropriate ...

  7. Integrated Human Factors Design Guidelines for Sound Interface

    International Nuclear Information System (INIS)

    Lee, Jung Woon; Lee, Yong Hee; Oh, In Seok; Lee, Hyun Chul; Cha, Woo Chang

    2004-05-01

    Digital MMI, such as CRT, LCD etc., has been used increasingly in the design of main control room of the Korean standard nuclear power plants following the YGN units 3 and 4. The utilization of digital MMI may introduce various kind of sound interface into the control room design. In this project, for five top-level guideline items, including Sound Formats, Alarms, Sound Controls, Communications, and Environments, a total of 147 detail guidelines were developed and a database system for these guidelines was developed. The integrated human factors design guidelines for sound interface and the database system developed in this project will be useful for the design of sound interface of digital MMI in Korean NPPs

  8. Integrated Human Factors Design Guidelines for Sound Interface

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Woon; Lee, Yong Hee; Oh, In Seok; Lee, Hyun Chul [KAERI, Daejeon (Korea, Republic of); Cha, Woo Chang [Kumoh National Univ. of Technology, Gumi (Korea, Republic of)

    2004-05-15

    Digital MMI, such as CRT, LCD etc., has been used increasingly in the design of main control room of the Korean standard nuclear power plants following the YGN units 3 and 4. The utilization of digital MMI may introduce various kind of sound interface into the control room design. In this project, for five top-level guideline items, including Sound Formats, Alarms, Sound Controls, Communications, and Environments, a total of 147 detail guidelines were developed and a database system for these guidelines was developed. The integrated human factors design guidelines for sound interface and the database system developed in this project will be useful for the design of sound interface of digital MMI in Korean NPPs.

  9. Advanced human-system interface design review guidelines

    International Nuclear Information System (INIS)

    O'Hara, J.M.

    1990-01-01

    Advanced, computer-based, human-system interface designs are emerging in nuclear power plant (NPP) control rooms. These developments may have significant implications for plant safety in that they will greatly affect the ways in which operators interact with systems. At present, however, the only guidance available to the US Nuclear Regulatory Commission (NRC) for the review of control room-operator interfaces, NUREG-0700, was written prior to these technological changes and is thus not designed to address them. The objective of the project reported in this paper is to develop an Advanced Control Room Design Review Guideline for use in performing human factors reviews of advanced operator interfaces. This guideline will be implemented, in part, as a portable, computer-based, interactive document for field use. The paper describes the overall guideline development methodology, the present status of the document, and the plans for further guideline testing and development. 21 refs., 3 figs

  10. Seismic Design Guidelines For Port Structures

    DEFF Research Database (Denmark)

    Burcharth, H. F.; Bernal, Alberto; Blazquez, Rafael

    In order to mitigate hazards and losses due to earthquakes, seismic design methodologies have been developed and implemented in design practice in many regions since the early twentieth century, often in the form of codes and standards. Most of these methodologies are based on a force-balance app...

  11. Technical guidelines for aseismic design of nuclear power plants

    International Nuclear Information System (INIS)

    Park, Y.J.; Hofmayer, C.H.

    1994-06-01

    This document is a translation, in its entirety, of the Japan Electric Association (JEA) publication entitled open-quotes Technical Guidelines for Aseismic Design of Nuclear Power Plants - JEAG 4601-1987.close quotes This guideline describes in detail the aseismic design techniques used in Japan for nuclear power plants. It contains chapters dealing with: (a)the selection of earthquake ground motions for a site, (b) the investigation of foundation and bedrock conditions, (c) the evaluation of ground stability and the effects of ground movement on buried piping and structures, (d) the analysis and design of structures, and (e) the analysis and design of equipment and distribution systems (piping, electrical raceways, instrumentation, tubing and HVAC duct). The guideline also includes appendices which summarize data, information and references related to aseismic design technology

  12. Design guidelines for audio presentation of graphs and tables

    OpenAIRE

    Brown, L.M.; Brewster, S.A.; Ramloll, S.A.; Burton, R.; Riedel, B.

    2003-01-01

    Audio can be used to make visualisations accessible to blind and visually impaired people. The MultiVis Project has carried out research into suitable methods for presenting graphs and tables to blind people through the use of both speech and non-speech audio. This paper presents guidelines extracted from this research. These guidelines will enable designers to implement visualisation systems for blind and visually impaired users, and will provide a framework for researchers wishing to invest...

  13. Seismic isolation design guidelines for KALIMER(Revision A)

    International Nuclear Information System (INIS)

    Yoo, B; Koo, Gyeong Hoi; Lee, J. H.

    2000-04-01

    The main purpose of this report is to develop the seismic isolation design guideline for KALIMER(Korea Advanced LIquid MEtal Reactor). The proposed design rules(revision A) are only applicable to the seismic isolation design with using the high damping laminated rubber bearings. When using other seismic isolation devices and applying to 3-dimensional isolation, the proposed guidelines shall be modified and added with proper research data. The rules described in this report are based on the research results performed up to now but needed to be upgraded and verified with more detail research works for the future

  14. Texas perpetual pavements : new design guidelines.

    Science.gov (United States)

    2010-06-01

    Since 2001, the State of Texas has been designing and constructing perpetual pavements : on some of its heavily trafficked highways where the expected 20-year truck-traffic estimate of : 18 kip ESALs is in excess of 30 million (TxDOT, 2001). To date,...

  15. Designing User-Computer Dialogues: Basic Principles and Guidelines.

    Science.gov (United States)

    Harrell, Thomas H.

    This discussion of the design of computerized psychological assessment or testing instruments stresses the importance of the well-designed computer-user interface. The principles underlying the three main functional elements of computer-user dialogue--data entry, data display, and sequential control--are discussed, and basic guidelines derived…

  16. Human-system interface design review guideline -- Process and guidelines: Final report. Revision 1, Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    None

    1996-06-01

    NUREG-0700, Revision 1, provides human factors engineering (HFE) guidance to the US Nuclear Regulatory Commission staff for its: (1) review of the human system interface (HSI) design submittals prepared by licensees or applications for a license or design certification of commercial nuclear power plants, and (2) performance of HSI reviews that could be undertaken as part of an inspection or other type of regulatory review involving HSI design or incidents involving human performance. The guidance consists of a review process and HFE guidelines. The document describes those aspects of the HSI design review process that are important to the identification and resolution of human engineering discrepancies that could adversely affect plant safety. Guidance is provided that could be used by the staff to review an applicant`s HSI design review process or to guide the development of an HSI design review plan, e.g., as part of an inspection activity. The document also provides detailed HFE guidelines for the assessment of HSI design implementations. NUREG-0700, Revision 1, consists of three stand-alone volumes. Volume 1 consists of two major parts. Part 1 describes those aspects of the review process of the HSI design that are important to identifying and resolving human engineering discrepancies. Part 2 contains detailed guidelines for a human factors engineering review which identify criteria for assessing the implementation of an applicant`s or licensee`s HSI design.

  17. Human-system interface design review guideline -- Process and guidelines: Final report. Revision 1, Volume 1

    International Nuclear Information System (INIS)

    1996-06-01

    NUREG-0700, Revision 1, provides human factors engineering (HFE) guidance to the US Nuclear Regulatory Commission staff for its: (1) review of the human system interface (HSI) design submittals prepared by licensees or applications for a license or design certification of commercial nuclear power plants, and (2) performance of HSI reviews that could be undertaken as part of an inspection or other type of regulatory review involving HSI design or incidents involving human performance. The guidance consists of a review process and HFE guidelines. The document describes those aspects of the HSI design review process that are important to the identification and resolution of human engineering discrepancies that could adversely affect plant safety. Guidance is provided that could be used by the staff to review an applicant's HSI design review process or to guide the development of an HSI design review plan, e.g., as part of an inspection activity. The document also provides detailed HFE guidelines for the assessment of HSI design implementations. NUREG-0700, Revision 1, consists of three stand-alone volumes. Volume 1 consists of two major parts. Part 1 describes those aspects of the review process of the HSI design that are important to identifying and resolving human engineering discrepancies. Part 2 contains detailed guidelines for a human factors engineering review which identify criteria for assessing the implementation of an applicant's or licensee's HSI design

  18. Landfill gas management facilities design guidelines

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-03-15

    In British Columbia, municipal solid waste landfills generate over 1000 tonnes of methane per year; landfill gas management facilities are required to improve the environmental performance of solid waste landfills. The aim of this document, developed by the British Columbia Ministry of the Environment, is to provide guidance for the design, installation, and operation of landfill gas management facilities to address odor and pollutant emissions issues and also address health and safety issues. A review of technical experience and best practices in landfill gas management facilities was carried out, as was as a review of existing regulations related to landfill gas management all over the world. This paper provides useful information to landfill owners, operators, and other professionals for the design of landfill gas management facilities which meet the requirements of landfill gas management regulations.

  19. Guidelines for CubeSat's Thermal Design

    Science.gov (United States)

    Rodriguez-Ruiz, Juan; Patel, Deepak

    2015-01-01

    Thermal and Fluids Analysis Workshop 2015, Silver Spring, MD. NCTS 19104-15. What does it take to thermally designlow cost, low mass cubesats? What are the differences in the approach when you compare with large scale missions?What additional risk is acceptable? What is the approach to hardware? How is the testing campaign run? These aresome of the questions that will be addressed in this course, which is designed to equip the attendees to support thedevelopment of cubesats at their organization.

  20. Sustainable design guidelines to support the Washington State ferries terminal design manual : stormwater and material issues.

    Science.gov (United States)

    2011-08-01

    In an effort to assist the developers of the terminal design manual in potentially addressing : sustainable design issues, the overall goal is to produce Sustainable Design Guidelines that : will specifically address the unique needs and requirements...

  1. Additional guideline for the design of BWR reload patterns

    International Nuclear Information System (INIS)

    Burte, D.P.

    1990-01-01

    The problems of the high magnitude of the reactivity worths of control rods/notches and the thermal shocks to fuel due to control rod withdrawals are considered in this paper. These problems are shown to be mitigated if in addition to complying with the traditional guidelines for designing fuel bundles and reload patterns the proposed additional guideline (in the form of the condition that the shape of the K∞ distribution remains constant throughout the cycle) is also complied with. It is argued that application of the additional guideline for operating conditions ensures that the core can operate with a constant power profile throughout the cycle without control rod movement. Fixed (integral or stand-alone) burnable poisons are thought to be useful in this regard. Some comments on how this may be attempted are included. Additional advantages resulting from the additional guideline are discussed. (author)

  2. HVAC design guidelines for effective indoor air quality

    International Nuclear Information System (INIS)

    Bladykas, M.P.

    1993-01-01

    Building owners, designers and occupants need to consider all the design measures that contribute to high indoor air quality. Building occupants, furnishings, equipment, and ambient air pollution all contribute to surmounting indoor air quality concerns. However, these can be minimized by following HVAC design guidelines which promote high indoor air quality while maintaining reasonable energy-efficiency. The possible liabilities and loss of business productivity due to air quality problems are too great to ignore

  3. Palliative Sedation in Patients With Cancer.

    Science.gov (United States)

    Maltoni, Marco; Setola, Elisabetta

    2015-10-01

    Palliative sedation involves the use of sedative medication to relieve refractory symptoms in patients by reducing their level of consciousness. Although it is considered an acceptable clinical practice from most ethical points of view, palliative sedation is still a widely debated procedure and merits better understanding. The relevant medical literature pertaining to palliative sedation was analyzed and reviewed from various technical, relational, and bioethical perspectives. Proportionate palliative sedation is considered to be the most clinically appropriate modality for performing palliative sedation. However, guidelines must be followed to ensure that it is performed correctly. Benzodiazepines represent the first therapeutic option and careful monitoring of dosages is essential to avoid oversedation or undersedation. Proportionate palliative sedation is used to manage and relieve refractory symptoms in patients with cancer during their last days or hours of life. Evidence suggests that its use has no detrimental effect on survival. A different decision-making process is used to manage the withdrawal of hydration than the process used to determine whether proportionate palliative sedation is appropriate. Communication between patients, their relatives, and the health care staff is important during this medical intervention.

  4. Development of human factors design review guidelines(III)

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Woon; Oh, In Suk; Suh, Sang Moon; Lee, Hyun Chul [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

    1999-02-15

    The objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: '25, human factors engineering program review model' and '26, review criteria for human factors aspects of advanced controls and instrumentation', which are related to the development of human factors safety regulation guides being performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and reviewing the reference documents NUREG--0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm system. Then we will update the guidelines by reviewing the literature related to alarm design published after 1994.

  5. Development of human factors design review guidelines(II)

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Woon; Oh, In Suk; Suh, Sang Moon; Lee, Hyun Chul [Korea Atomic Energy Research Institute, Taejon (Korea)

    1998-06-01

    The objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: 25. Human Factors Engineering Program Review Model and 26. Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation, which are related to the development of human factors safety regulation guides being performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and reviewing the reference documents of NUREG-0711. We also computerized the Korean version of NUREG-0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm systems. Then we will update the guidelines by reviewing the literature related to alarm design published after 1994. (author). 11 refs., 2 figs., 2 tabs.

  6. Development of human factors design review guidelines(III)

    International Nuclear Information System (INIS)

    Lee, Jung Woon; Oh, In Suk; Suh, Sang Moon; Lee, Hyun Chul

    1999-02-01

    The objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: '25, human factors engineering program review model' and '26, review criteria for human factors aspects of advanced controls and instrumentation', which are related to the development of human factors safety regulation guides being performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and reviewing the reference documents NUREG--0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm system. Then we will update the guidelines by reviewing the literature related to alarm design published after 1994

  7. Development of human factors design review guidelines(II)

    International Nuclear Information System (INIS)

    Lee, Jung Woon; Oh, In Suk; Suh, Sang Moon; Lee, Hyun Chul

    1998-06-01

    The objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: '25, human factors engineering program review model' and '26, review criteria for human factors aspects of advanced controls and instrumentation', which are related to the development of human factors safety regulation guides being performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and reviewing the reference documents NUREG--0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm system. Then we will update the guidelines by reviewing the literature related to alarm design published after 1994

  8. Development of human factors design review guidelines(III)

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Woon; Oh, In Suk; Suh, Sang Moon; Lee, Hyun Chul [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

    1999-02-15

    The objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: '25, human factors engineering program review model' and '26, review criteria for human factors aspects of advanced controls and instrumentation', which are related to the development of human factors safety regulation guides being performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and reviewing the reference documents NUREG--0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guides in KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm system. Then we will update the guidelines by reviewing the literature related to alarm design published after 1994.

  9. Screen Design Guidelines for Motivation in Interactive Multimedia Instruction: A Survey and Framework for Designers.

    Science.gov (United States)

    Lee, Sung Heum; Boling, Elizabeth

    1999-01-01

    Identifies guidelines from the literature relating to screen design and design of interactive instructional materials. Describes two types of guidelines--those aimed at enhancing motivation and those aimed at preventing loss of motivation--for typography, graphics, color, and animation and audio. Proposes a framework for considering motivation in…

  10. Introducing guidelines for eco-dynamic development and design

    NARCIS (Netherlands)

    Van Koningsveld, M.; Van Raalte, G.H.

    2011-01-01

    One of the key activities within the Building with Nature innovation programme is the development of a guideline for Eco-dynamic Development and Design. This guidance will be focussed on implementation of the Building with Nature principles throughout all of the stages of hydraulic engineering

  11. Designing, Developing, and Implementing Diversity Training: Guidelines for Practitioners.

    Science.gov (United States)

    Kincaid, Tanna M.; Horner, Erin R.

    1997-01-01

    Discusses diversity in the workplace and offers guidelines for practitioners in designing, developing, and implementing diversity training. Highlights include linking the diversity initiative to the organization's mission, cultural climate assessments, reviewing policies and procedures, needs assessment, learner analysis, establishing objectives,…

  12. Selection of low-risk design guidelines for energetic events

    International Nuclear Information System (INIS)

    Ferguson, D.; Marchaterre, J.; Graham, J.

    1982-01-01

    This paper recommends the establishment of specific design guidelines for protection against potential, but low-probability, energetic events. These guidelines recognize the plant protective features incorporated to prevent such events, as well as the inherent capability of the plant to accommodate a certain level of energy release. Further, their application is recommended within the context of necessary standardized and agreed-upon acceptance criteria which are less restrictive than ASME code requirements. The paper provides the background upon which the selection of the design is made, including the characterization of energetic events dependent on various core-design parameters, and including the necessity of a low-risk design balanced between prevention of accidents and the mitigation of consequences

  13. Sedation for pediatric diagnostic imaging: use of pediatric and nursing resources as an alternative to a radiology department sedation team

    International Nuclear Information System (INIS)

    Ruess, Lynne; O'Connor, Stephen C.; Mikita, Cecilia P.; Creamer, Kevin M.

    2002-01-01

    Objective. To develop a pathway to provide safe, effective, and efficient sedation for pediatric diagnostic imaging studies using non-radiology personnel. Materials and methods. A multidisciplinary team considered manpower and training requirements and national sedation standards before designing a sedation pathway, which included scheduling, pre-sedation history and physical, medication protocols, and monitoring. Oral and IV medication protocols were developed based on patient age and weight. Sedation delays were defined as >15 min (IV) or >30 min (PO) from start of sedation to start of imaging. A sedation failure resulted in an incomplete diagnostic imaging study. Failure rates of 124 sedations before and 388 sedations after the pathway were compared.Results. The sedation failure rate for 7 months prior to pathway initiation was 15% (19/124). In the first 25 months after pathway initiation, failures were significantly reduced to 1.5% (6/388) (P 55 min). Deviation from the recommended medication protocol accounted for most of the 115 delays. Only minor adverse events were seen (12/388, 3.1%).Conclusion. Implementing a pediatric sedation pathway significantly decreases the sedation failure rate. Pediatric residents and nurses can safely, effectively and efficiently sedate pediatric patients for routine diagnostic imaging procedures without the need for a radiology department sedation team in a department with a small-to-moderate volume of pediatric patients. (orig.)

  14. Palliative sedation versus euthanasia: an ethical assessment.

    Science.gov (United States)

    ten Have, Henk; Welie, Jos V M

    2014-01-01

    The aim of this article was to review the ethical debate concerning palliative sedation. Although recent guidelines articulate the differences between palliative sedation and euthanasia, the ethical controversies remain. The dominant view is that euthanasia and palliative sedation are morally distinct practices. However, ambiguous moral experiences and considerable practice variation call this view into question. When heterogeneous sedative practices are all labeled as palliative sedation, there is the risk that palliative sedation is expanded to include practices that are actually intended to bring about the patients' death. This troublesome expansion is fostered by an expansive use of the concept of intention such that this decisive ethical concept is no longer restricted to signify the aim in guiding the action. In this article, it is argued that intention should be used in a restricted way. The significance of intention is related to other ethical parameters to demarcate the practice of palliative sedation: terminality, refractory symptoms, proportionality, and separation from other end-of-life decisions. These additional parameters, although not without ethical and practical problems, together formulate a framework to ethically distinguish a more narrowly defined practice of palliative sedation from practices that are tantamount to euthanasia. Finally, the article raises the question as to what impact palliative sedation might have on the practice of palliative care itself. The increasing interest in palliative sedation may reemphasize characteristics of health care that initially encouraged the emergence of palliative care in the first place: the focus on therapy rather than care, the physical dimension rather than the whole person, the individual rather than the community, and the primacy of intervention rather than receptiveness and presence. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  15. Advanced control room design review guidelines: Merging old and new

    International Nuclear Information System (INIS)

    Carter, R.J.; Wachtel, J.A.

    1992-01-01

    The nuclear power industry is currently developing operator interface systems based on innovative applications of digital computers. To assure that this advanced technology is incorporated in a way that maximizes the potential safety benefits of the technology and minimizes the potential negative effects on human performance, human factors principles must be considered. NUREG-0700 contains guidelines for the review of operator interfaces. However, in light of the rapid technological advances in digital technology which have taken place in the eleven years since its publication, it is no longer adequate to assess the rapidly changing human-system interfaces. A research program, the purpose of which is to upgrade NUREG-0700, has been initiated. Thus far a set of draft advanced control room design review (ACRDR) guidelines has been complied. Three tasks, which were oriented towards integrating the applicable guidelines in NUREG-0700 into the ACRDR document, are described in the paper

  16. Environmental Design Guidelines for Low Crested Coastal Structures

    DEFF Research Database (Denmark)

    Burcharth, Hans F.; Hawkins, Stephen J.; Zanuttigh, Barbara

    selected to represent a variety of environmental conditions (Chapter 11); the application of the proposed methodology to a real prototype case, in order to give a practical example to designers (Chapter 12). The third part contains all the formulae and tools to help engineers (Chapter 13), ecologists....... The guidelines have been drafted in a generic way to be appropriate throughout the European Union taking into regard current European Commission policy and directives to promote sustainable development and integrated coastal zone management. The guidelines are composed of three main parts. The first part...... (Chapters 1-10) contains the description of the design methodology, from the preliminary identification of design alternatives till the selection of the sustainable scheme and its construction. The second part presents: the analysis of the performance of beach defences in DELOS study sites, which were...

  17. Advanced human-system interface design review guideline. General evaluation model, technical development, and guideline description

    International Nuclear Information System (INIS)

    O'Hara, J.M.

    1994-07-01

    Advanced control rooms will use advanced human-system interface (HSI) technologies that may have significant implications for plant safety in that they will affect the operator's overall role in the system, the method of information presentation, and the ways in which operators interact with the system. The U.S. Nuclear Regulatory Commission (NRC) reviews the HSI aspects of control rooms to ensure that they are designed to good human factors engineering principles and that operator performance and reliability are appropriately supported to protect public health and safety. The principal guidance available to the NRC, however, was developed more than ten years ago, well before these technological changes. Accordingly, the human factors guidance needs to be updated to serve as the basis for NRC review of these advanced designs. The purpose of this project was to develop a general approach to advanced HSI review and the human factors guidelines to support NRC safety reviews of advanced systems. This two-volume report provides the results of the project. Volume I describes the development of the Advanced HSI Design Review Guideline (DRG) including (1) its theoretical and technical foundation, (2) a general model for the review of advanced HSIs, (3) guideline development in both hard-copy and computer-based versions, and (4) the tests and evaluations performed to develop and validate the DRG. Volume I also includes a discussion of the gaps in available guidance and a methodology for addressing them. Volume 2 provides the guidelines to be used for advanced HSI review and the procedures for their use

  18. Advanced human-system interface design review guideline. General evaluation model, technical development, and guideline description

    Energy Technology Data Exchange (ETDEWEB)

    O`Hara, J.M.

    1994-07-01

    Advanced control rooms will use advanced human-system interface (HSI) technologies that may have significant implications for plant safety in that they will affect the operator`s overall role in the system, the method of information presentation, and the ways in which operators interact with the system. The U.S. Nuclear Regulatory Commission (NRC) reviews the HSI aspects of control rooms to ensure that they are designed to good human factors engineering principles and that operator performance and reliability are appropriately supported to protect public health and safety. The principal guidance available to the NRC, however, was developed more than ten years ago, well before these technological changes. Accordingly, the human factors guidance needs to be updated to serve as the basis for NRC review of these advanced designs. The purpose of this project was to develop a general approach to advanced HSI review and the human factors guidelines to support NRC safety reviews of advanced systems. This two-volume report provides the results of the project. Volume I describes the development of the Advanced HSI Design Review Guideline (DRG) including (1) its theoretical and technical foundation, (2) a general model for the review of advanced HSIs, (3) guideline development in both hard-copy and computer-based versions, and (4) the tests and evaluations performed to develop and validate the DRG. Volume I also includes a discussion of the gaps in available guidance and a methodology for addressing them. Volume 2 provides the guidelines to be used for advanced HSI review and the procedures for their use.

  19. Considerations of physicians about the depth of palliative sedation at the end of life

    Science.gov (United States)

    Swart, Siebe J.; van der Heide, Agnes; van Zuylen, Lia; Perez, Roberto S.G.M.; Zuurmond, Wouter W.A.; van der Maas, Paul J.; van Delden, Johannes J.M.; Rietjens, Judith A.C.

    2012-01-01

    Background: Although guidelines advise titration of palliative sedation at the end of life, in practice the depth of sedation can range from mild to deep. We investigated physicians’ considerations about the depth of continuous sedation. Methods: We performed a qualitative study in which 54 physicians underwent semistructured interviewing about the last patient for whom they had been responsible for providing continuous palliative sedation. We also asked about their practices and general attitudes toward sedation. Results: We found two approaches toward the depth of continuous sedation: starting with mild sedation and only increasing the depth if necessary, and deep sedation right from the start. Physicians described similar determinants for both approaches, including titration of sedatives to the relief of refractory symptoms, patient preferences, wishes of relatives, expert advice and esthetic consequences of the sedation. However, physicians who preferred starting with mild sedation emphasized being guided by the patient’s condition and response, and physicians who preferred starting with deep sedation emphasized ensuring that relief of suffering would be maintained. Physicians who preferred each approach also expressed different perspectives about whether patient communication was important and whether waking up after sedation is started was problematic. Interpretation: Physicians who choose either mild or deep sedation appear to be guided by the same objective of delivering sedation in proportion to the relief of refractory symptoms, as well as other needs of patients and their families. This suggests that proportionality should be seen as a multidimensional notion that can result in different approaches toward the depth of sedation. PMID:22331961

  20. Cultural changes in ICU sedation management

    DEFF Research Database (Denmark)

    Egerod, Ingrid

    2009-01-01

    The aim of this study was to explore physicians' views and perceptions of sedation, and offer a new approach to the understanding of issues of sedation. I used a qualitative, descriptive, and explorative multicenter design. Data were generated by seven key-informant interviews using...... a semistructured interview guide. One experienced doctor was selected at each of the seven largest intensive care units in Denmark. Interpretational analysis was performed by comprehensive overview, individual case analysis, cross-case analysis, and integrated thematic analysis and identification of emerging...... provide an understanding of contextual issues of sedation, safety, and comfort, and suggest that a cultural change in sedation strategies might reduce the duration of sedation and mechanical ventilation while containing cost and improving the well-being of the patients....

  1. Some difference of concepts between design guideline for FBR base isolation system and aseismic design guideline of LWR in Japan

    International Nuclear Information System (INIS)

    Shibata, Heki

    1992-01-01

    This paper deals with the concept and the relation of 'the Base Isolation System and FBR' to the Safety Criteria and the Guideline of the Aseismic Design of LWR in Japan. The Central Research Institute of Electric Power Industries have been working for FBR last several years. The author has been contribute to their works, and this is one of the subjects. He described his own idea obtained through the cooperative work with CRIEPI. (author)

  2. Procedural sedation analgesia

    Directory of Open Access Journals (Sweden)

    Sheta Saad

    2010-01-01

    Full Text Available The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA. The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interventions. The goals of PSA in four different multidisciplinary practices namely; emergency, dentistry, radiology and gastrointestinal endoscopy are discussed in this review article. Some procedures are painful, others painless. Therefore, goals of PSA vary widely. Sedation management can range from minimal sedation, to the extent of minimal anesthesia. Procedural sedation in emergency department (ED usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. However, in dental practice, moderate sedation analgesia (known to the dentists as conscious sedation is usually what is required. It is usually most effective with the combined use of local anesthesia. The mainstay of success for painless imaging is absolute immobility. Immobility can be achieved by deep sedation or minimal anesthesia. On the other hand, moderate sedation, deep sedation, minimal anesthesia and conventional general anesthesia can be all utilized for management of gastrointestinal endoscopy.

  3. Agile Contracts: Designing an Agile Team Selection Guideline

    DEFF Research Database (Denmark)

    Pries-Heje, Lene; Pries-Heje, Jan

    2014-01-01

    with “endless” re-negotiation of the requirements; you need a more flexible way to develop IS. A new way of coping with many changes is to use an agile development approach and a fixed budget and resources contract. This paper presents an example case. We analyse the case and design a guideline for how......When you have stable and non-ambiguous requirements then a classic contract for IS between a supplier and a public sector institution based on a requirements specification may be well suited. However, if you have to accept many changes or have ambiguous requirements then you may end up...... to implement a fixed budget and resources contract in the public sector. The guideline includes elements to cope with challenges in a tender process such as transparency, criteria for supplier selection, and live assessment of resource skills and capabilities, as well as achieving the flexibility for change...

  4. The proportionate value of proportionality in palliative sedation.

    Science.gov (United States)

    Berger, Jeffrey T

    2014-01-01

    Proportionality, as it pertains to palliative sedation, is the notion that sedation should be induced at the lowest degree effective for symptom control, so that the patient's consciousness may be preserved. The pursuit of proportionality in palliative sedation is a widely accepted imperative advocated in position statements and guidelines on this treatment. The priority assigned to the pursuit of proportionality, and the extent to which it is relevant for patients who qualify for palliative sedation, have been overstated. Copyright 2014 The Journal of Clinical Ethics. All rights reserved.

  5. Palliative sedation at home in the Netherlands: a nationwide survey among nurses

    NARCIS (Netherlands)

    Brinkkemper, T.; Klinkenberg, M.; Deliens, L.; Eliel, M.; Rietjens, J.A.C.; Zuurmond, W.W.A.; Perez, R.S.G.M.

    2011-01-01

    Aim. This paper is a report of a nationwide study conducted to assess experiences of nurses involved in palliative sedation at home after introduction of a physicians' guideline for palliative sedation. Background. Most studies investigating the practice of palliative sedation focus on physicians'

  6. Outcomes following implementation of a pediatric procedural sedation guide for referral to general anesthesia for magnetic resonance imaging studies.

    Science.gov (United States)

    Grunwell, Jocelyn R; Marupudi, Neelima K; Gupta, Rohan V; Travers, Curtis D; McCracken, Courtney E; Williamson, Julie L; Stockwell, Jana A; Fortenberry, James D; Couloures, Kevin; Cravero, Joseph; Kamat, Pradip P

    2016-06-01

    Guidelines for referral of children to general anesthesia (GA) to complete MRI studies are lacking. We devised a pediatric procedural sedation guide to determine whether a pediatric procedural sedation guide would decrease serious adverse events and decrease failed sedations requiring rescheduling with GA. We constructed a consensus-based sedation guide by combining a retrospective review of reasons for referral of children to GA (n = 221) with published risk factors associated with the inability to complete the MRI study with sedation. An interrupted time series analysis of 11 530 local sedation records from the Pediatric Sedation Research Consortium between July 2008 and March 2013, adjusted for case-mix differences in the pre- and postsedation guide cohorts, evaluated whether a sedation guide resulted in decreased severe adverse events (SAE) and failed sedation rates. A significant increase in referrals to GA following implementation of a sedation guide occurred (P pediatric procedural sedation services. © 2016 John Wiley & Sons Ltd.

  7. Design guidelines for teaching about design guidelines for educational WWW-sites

    NARCIS (Netherlands)

    Collis, Betty; Winnips, Koos; Ottmann, Thomas; Tomek, Ivan

    1998-01-01

    This paper describes how the authors use a mixture of World Wide Web (WWW)-based functionalities and new didactics to teach educational technology students at the University of Twente (Netherlands) about the design of WWW-based learning environments. Topics discussed include: (1) the content of

  8. Similarities and differences between continuous sedation until death and euthanasia - professional caregivers' attitudes and experiences: A focus group study

    NARCIS (Netherlands)

    Anquinet, L.; Raus, K.; Sterckx, S.; Smets, T.; Deliens, L.; Rietjens, J.A.C.

    2013-01-01

    Background: According to various guidelines about continuous sedation until death, this practice can and should be clearly distinguished from euthanasia, which is legalized in Belgium. Aim: To explore professional caregivers perceptions of the similarities and differences between continuous sedation

  9. Design guidelines for multi-seam mining at Elliot Lake

    International Nuclear Information System (INIS)

    Hedley, D.G.F.

    1978-04-01

    With the current expansion in uranium mining, multi-seam mining could again be practised at Elliot Lake as it was in the 1960s. Information on the dimensions of stopes, pillars, and parting zone was gathered from plans and sections of the relevant closed mines. Discussions were held with personnel familiar with these mines to establish instances of pillar, roof, and parting zone failures. Design guidelines are formulated for stope and pillar dimensions in multi-seam mining for a range of orebody configurations using past practice in a back-analysis approach. Constraints imposed by dip and seam thickness on the choice of equipment and mining layout are evaluated. An attempt is made to bring together the engineering aspects, including rock mechanics, of multi-seam mine design with uranium recovery and other economic factors for three alternative mine layouts: single-seam mining, double-seam mining, and seams-and-parting mining. A series of examples are worked through, showing how the design guidelines can be applied for typical orebody configurations

  10. Advanced control room design review guidelines: Integration of the NUREG-0700 guidelines and development of new human-system interface guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Carter, R.J.

    1997-07-01

    This report documents the work conducted in four tasks of the Nuclear Regulatory Commission (NRC) project entitled Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation. The purpose of the first task was to integrate the applicable sections of NUREG-0700 into the advanced control room design review (ACRDR) guidelines to ensure that all applicable guidelines are together in one document and conveniently accessible to users. The primary objective of the second task was to formulate a strategy for the development of new ACRDR guidelines that have not otherwise been identified. The main focus of the third task was to modify the individual ACRDR guidelines generated to date to ensure that they are suitable for the intended nuclear power plant (NPP) control station system application. The goal of the fourth task was to develop human factors guidelines for two human-system interface categories that are missing from the current ACRDR guidelines document. During the first task those areas in NUREG-0700 that are not addressed by the ACRDR guidelines document were identified, the areas were subsequently reviewed against six recent industry human factors engineering review guidelines, and the NUREG-0700 guidelines were updated as necessary. In the second task 13 general categories of human-system interface guidelines that are either missing from or not adequately addressed by the ACRDR document were discovered. An approach was derived for the development of new ACRDR guidelines, a preliminary assessment of the available sources that may be useful in the creation of new guidelines and their applicability to the identified human-system interface categories was performed, and an estimate was made of the amount of time and level of effort required to complete the development of needed new ACRDR guidelines. During the third task those NPP control station systems to which the NUREG-0700 and ACRDR guidelines apply were identified, matrices of such

  11. Advanced control room design review guidelines: Integration of the NUREG-0700 guidelines and development of new human-system interface guidelines

    International Nuclear Information System (INIS)

    Carter, R.J.

    1997-07-01

    This report documents the work conducted in four tasks of the Nuclear Regulatory Commission (NRC) project entitled Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation. The purpose of the first task was to integrate the applicable sections of NUREG-0700 into the advanced control room design review (ACRDR) guidelines to ensure that all applicable guidelines are together in one document and conveniently accessible to users. The primary objective of the second task was to formulate a strategy for the development of new ACRDR guidelines that have not otherwise been identified. The main focus of the third task was to modify the individual ACRDR guidelines generated to date to ensure that they are suitable for the intended nuclear power plant (NPP) control station system application. The goal of the fourth task was to develop human factors guidelines for two human-system interface categories that are missing from the current ACRDR guidelines document. During the first task those areas in NUREG-0700 that are not addressed by the ACRDR guidelines document were identified, the areas were subsequently reviewed against six recent industry human factors engineering review guidelines, and the NUREG-0700 guidelines were updated as necessary. In the second task 13 general categories of human-system interface guidelines that are either missing from or not adequately addressed by the ACRDR document were discovered. An approach was derived for the development of new ACRDR guidelines, a preliminary assessment of the available sources that may be useful in the creation of new guidelines and their applicability to the identified human-system interface categories was performed, and an estimate was made of the amount of time and level of effort required to complete the development of needed new ACRDR guidelines. During the third task those NPP control station systems to which the NUREG-0700 and ACRDR guidelines apply were identified, matrices of such

  12. Sound & Vibration 20 Design Guidelines for Health Care Facilities

    CERN Document Server

    Tocci, Gregory; Cavanaugh, William

    2013-01-01

    Sound, vibration, noise and privacy have significant impacts on health and performance. As a result, they are recognized as essential components of effective health care environments. However, acoustics has only recently become a prominent consideration in the design, construction, and operation of healthcare facilities owing to the absence, prior to 2010, of clear and objective guidance based on research and best practices. Sound & Vibration 2.0 is the first publication to comprehensively address this need. Sound & Vibration 2.0 is the sole reference standard for acoustics in health care facilities and is recognized by: the 2010 FGI Guidelines for the Design and Construction of Health Care Facilities (used in 60 countries); the US Green Building Council’s LEED for Health Care (used in 87 countries); The Green Guide for Health Care V2.2; and the International Code Council (2011). Sound & Vibration 2.0 was commissioned by the Facility Guidelines Institute in 2005, written by the Health Care Acous...

  13. Leo Spacecraft Charging Design Guidelines: A Proposed NASA Standard

    Science.gov (United States)

    Hillard, G. B.; Ferguson, D. C.

    2004-01-01

    Over the past decade, Low Earth Orbiting (LEO) spacecraft have gradually required ever-increasing power levels. As a rule, this has been accomplished through the use of high voltage systems. Recent failures and anomalies on such spacecraft have been traced to various design practices and materials choices related to the high voltage solar arrays. NASA Glenn has studied these anomalies including plasma chamber testing on arrays similar to those that experienced difficulties on orbit. Many others in the community have been involved in a comprehensive effort to understand the problems and to develop practices to avoid them. The NASA Space Environments and Effects program, recognizing the timeliness of this effort, commissioned and funded a design guidelines document intended to capture the current state of understanding. This document, which was completed in the spring of 2003, has been submitted as a proposed NASA standard. We present here an overview of this document and discuss the effort to develop it as a NASA standard.

  14. Euthanasia and palliative sedation in Belgium.

    Science.gov (United States)

    Cohen-Almagor, Raphael; Ely, E Wesley

    2018-01-04

    The aim of this article is to use data from Belgium to analyse distinctions between palliative sedation and euthanasia. There is a need to reduce confusion and improve communication related to patient management at the end of life specifically regarding the rapidly expanding area of patient care that incorporates a spectrum of nuanced yet overlapping terms such as palliative care, sedation, palliative sedation, continued sedation, continued sedation until death, terminal sedation, voluntary euthanasia and involuntary euthanasia. Some physicians and nurses mistakenly think that relieving suffering at the end of life by heavily sedating patients is a form of euthanasia, when indeed it is merely responding to the ordinary and proportionate needs of the patient. Concerns are raised about abuse in the form of deliberate involuntary euthanasia, obfuscation and disregard for the processes sustaining the management of refractory suffering at the end of life. Some suggestions designed to improve patient management and prevent potential abuse are offered. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Contrasting Perspectives of Anesthesiologists and Gastroenterologists on the Optimal Time Interval between Bowel Preparation and Endoscopic Sedation

    Directory of Open Access Journals (Sweden)

    Deepak Agrawal

    2015-01-01

    Full Text Available Background. The optimal time interval between the last ingestion of bowel prep and sedation for colonoscopy remains controversial, despite guidelines that sedation can be administered 2 hours after consumption of clear liquids. Objective. To determine current practice patterns among anesthesiologists and gastroenterologists regarding the optimal time interval for sedation after last ingestion of bowel prep and to understand the rationale underlying their beliefs. Design. Questionnaire survey of anesthesiologists and gastroenterologists in the USA. The questions were focused on the preferred time interval of endoscopy after a polyethylene glycol based preparation in routine cases and select conditions. Results. Responses were received from 109 anesthesiologists and 112 gastroenterologists. 96% of anesthesiologists recommended waiting longer than 2 hours until sedation, in contrast to only 26% of gastroenterologists. The main reason for waiting >2 hours was that PEG was not considered a clear liquid. Most anesthesiologists, but not gastroenterologists, waited longer in patients with history of diabetes or reflux. Conclusions. Anesthesiologists and gastroenterologists do not agree on the optimal interval for sedation after last drink of bowel prep. Most anesthesiologists prefer to wait longer than the recommended 2 hours for clear liquids. The data suggest a need for clearer guidelines on this issue.

  16. Palliative sedation, not slow euthanasia: a prospective, longitudinal study of sedation in Flemish palliative care units.

    Science.gov (United States)

    Claessens, Patricia; Menten, Johan; Schotsmans, Paul; Broeckaert, Bert

    2011-01-01

    Palliative sedation remains a much debated and controversial issue. The limited literature on the topic often fails to answer ethical questions concerning this practice. The aim of this study was to describe the characteristics of patients who are being sedated for refractory symptoms in palliative care units (PCUs) from the time of admission until the day of death. A prospective, longitudinal, descriptive design was used to assess data in eight PCUs. The total sample consisted of 266 patients. Information on demographics, medication, food and fluid intake, decision making, level of consciousness, and symptom experience were gathered by nurses and researchers three times a week. If patients received palliative sedation, extra information was gathered. Of all included patients (n=266), 7.5% received palliative sedation. Sedation started, on average, 2.5 days before death and for half of these patients, the form of sedation changed over time. At the start of sedation, patients were in the end stage of their illness and needed total care. Patients were fully conscious and had very limited oral food or fluid intake. Only three patients received artificial fluids at the start of sedation. Patients reported, on average, two refractory symptoms, the most important ones being pain, fatigue, depression, drowsiness, and loss of feeling of well-being. In all cases, the patient gave consent to start palliative sedation because of increased suffering. This study revealed that palliative sedation is only administered in exceptional cases where refractory suffering is evident and for those patients who are close to the ends of their lives. Moreover, this study supports the argument that palliative sedation has no life-shortening effect. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  17. Advanced human-system interface design review guidelines

    International Nuclear Information System (INIS)

    O'Hara, J.M.

    1990-01-01

    Advanced, computer-based, human-system interface designs are emerging in nuclear power plant control rooms as a result of several factors. These include: (1) incorporation of new systems such as safety parameter display systems, (2) backfitting of current control rooms with new technologies when existing hardware is no longer supported by equipment vendors, and (3) development of advanced control room concepts. Control rooms of the future will be developed almost exclusively with advanced instrumentation and controls based upon digital technology. In addition, the control room operator will be interfacing with more intelligent systems which will be capable of providing information processing support to the operator. These developments may have significant implications for plant safety in that they will greatly affect the operator's role in the system as well as the ways in which he interacts with it. At present, however, the only guidance available to the Nuclear Regulatory Commission (NRC) for the review of control room-operator interfaces is NUREG-0700. It is a document which was written prior to these technological changes and is, therefore, tailored to the technologies used in traditional control rooms. Thus, the present guidance needs to be updated since it is inadequate to serve as the basis for NRC staff review of such advanced or hybrid control room designs. The objective of the project reported in this paper is to develop an Advanced Control Room Design Review Guideline suitable for use in performing human factors reviews of advanced operator interfaces. This guideline will take the form of a portable, interactive, computer-based document that may be conveniently used by an inspector in the field, as well as a text-based document

  18. Development of guidelines for inelastic analysis in design of fast reactor components

    International Nuclear Information System (INIS)

    Nakamura, Kyotada; Kasahara, Naoto; Morishita, Masaki; Shibamoto, Hiroshi; Inoue, Kazuhiko; Nakayama, Yasunari

    2008-01-01

    The interim guidelines for the application of inelastic analysis to design of fast reactor components were developed. These guidelines are referred from 'Elevated Temperature Structural Design Guide for Commercialized Fast Reactor (FDS)'. The basic policies of the guidelines are more rational predictions compared with elastic analysis approach and a guarantee of conservative results for design conditions. The guidelines recommend two kinds of constitutive equations to estimate strains conservatively. They also provide the methods for modeling load histories and estimating fatigue and creep damage based on the results of inelastic analysis. The guidelines were applied to typical design examples and their results were summarized as exemplars to support users

  19. Volunteered Geographic Information System Design: Project and Participation Guidelines

    Directory of Open Access Journals (Sweden)

    José-Pablo Gómez-Barrón

    2016-07-01

    Full Text Available This article sets forth the early phases of a methodological proposal for designing and developing Volunteered Geographic Information (VGI initiatives based on a system perspective analysis in which the components depend and interact dynamically among each other. First, it focuses on those characteristics of VGI projects that present different goals and modes of organization, while using a crowdsourcing strategy to manage participants and contributions. Next, a tool is developed in order to design the central crowdsourced processing unit that is best suited for a specific project definition, associating it with a trend towards crowd-based or community-driven approaches. The design is structured around the characterization of different ways of participating, and the task cognitive demand of working on geo-information management, spatial problem solving and ideation, or knowledge acquisition. Then, the crowdsourcing process design helps to identify what kind of participants are needed and outline subsequent engagement strategies. This is based on an analysis of differences among volunteers’ participatory behaviors and the associated set of factors motivating them to contribute, whether on a crowd or community-sourced basis. From a VGI system perspective, this paper presents a set of guidelines and methodological steps in order to align project goals, processes and volunteers and thus successfully attract participation. This methodology helps establish the initial requirements for a VGI system, and, in its current state, it mainly focuses on two components of the system: project and participants.

  20. Palliative pharmacological sedation for terminally ill adults.

    Science.gov (United States)

    Beller, Elaine M; van Driel, Mieke L; McGregor, Leanne; Truong, Shani; Mitchell, Geoffrey

    2015-01-02

    Terminally ill people experience a variety of symptoms in the last hours and days of life, including delirium, agitation, anxiety, terminal restlessness, dyspnoea, pain, vomiting, and psychological and physical distress. In the terminal phase of life, these symptoms may become refractory, and unable to be controlled by supportive and palliative therapies specifically targeted to these symptoms. Palliative sedation therapy is one potential solution to providing relief from these refractory symptoms. Sedation in terminally ill people is intended to provide relief from refractory symptoms that are not controlled by other methods. Sedative drugs such as benzodiazepines are titrated to achieve the desired level of sedation; the level of sedation can be easily maintained and the effect is reversible. To assess the evidence for the benefit of palliative pharmacological sedation on quality of life, survival, and specific refractory symptoms in terminally ill adults during their last few days of life. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 11), MEDLINE (1946 to November 2014), and EMBASE (1974 to December 2014), using search terms representing the sedative drug names and classes, disease stage, and study designs. We included randomised controlled trials (RCTs), quasi-RCTs, non-RCTs, and observational studies (e.g. before-and-after, interrupted-time-series) with quantitative outcomes. We excluded studies with only qualitative outcomes or that had no comparison (i.e. no control group or no within-group comparison) (e.g. single arm case series). Two review authors independently screened titles and abstracts of citations, and full text of potentially eligible studies. Two review authors independently carried out data extraction using standard data extraction forms. A third review author acted as arbiter for both stages. We carried out no meta-analyses due to insufficient data for pooling on any outcome; therefore, we reported

  1. Design guidelines of triboelectric nanogenerator for water wave energy harvesters

    KAUST Repository

    Ahmed, Abdelsalam

    2017-04-11

    Ocean waves are one of the cleanest and most abundant energy sources on earth, and wave energy has the potential for future power generation. Triboelectric nanogenerator (TENG) technology has recently been proposed as a promising technology to harvest wave energy. In this paper, a theoretical study is performed on a duck-shaped TENG wave harvester recently introduced in our work. To enhance the design of the duck-shaped TENG wave harvester, the mechanical and electrical characteristics of the harvester\\'s overall structure, as well as its inner configuration, are analyzed, respectively, under different wave conditions, to optimize parameters such as duck radius and mass. Furthermore, a comprehensive hybrid 3D model is introduced to quantify the performance of the TENG wave harvester. Finally, the influence of different TENG parameters is validated by comparing the performance of several existing TENG wave harvesters. This study can be applied as a guideline for enhancing the performance of TENG wave energy harvesters.

  2. Design guidelines of triboelectric nanogenerator for water wave energy harvesters

    KAUST Repository

    Ahmed, Abdelsalam; Hassan, Islam; Jiang, Tao; Youssef, Khalid; Liu, Lian; Hedaya, Mohammad; Yazid, Taher Abu; Zu, Jean; Wang, Zhong Lin

    2017-01-01

    Ocean waves are one of the cleanest and most abundant energy sources on earth, and wave energy has the potential for future power generation. Triboelectric nanogenerator (TENG) technology has recently been proposed as a promising technology to harvest wave energy. In this paper, a theoretical study is performed on a duck-shaped TENG wave harvester recently introduced in our work. To enhance the design of the duck-shaped TENG wave harvester, the mechanical and electrical characteristics of the harvester's overall structure, as well as its inner configuration, are analyzed, respectively, under different wave conditions, to optimize parameters such as duck radius and mass. Furthermore, a comprehensive hybrid 3D model is introduced to quantify the performance of the TENG wave harvester. Finally, the influence of different TENG parameters is validated by comparing the performance of several existing TENG wave harvesters. This study can be applied as a guideline for enhancing the performance of TENG wave energy harvesters.

  3. Design guidelines of triboelectric nanogenerator for water wave energy harvesters.

    Science.gov (United States)

    Ahmed, Abdelsalam; Hassan, Islam; Jiang, Tao; Youssef, Khalid; Liu, Lian; Hedaya, Mohammad; Yazid, Taher Abu; Zu, Jean; Wang, Zhong Lin

    2017-05-05

    Ocean waves are one of the cleanest and most abundant energy sources on earth, and wave energy has the potential for future power generation. Triboelectric nanogenerator (TENG) technology has recently been proposed as a promising technology to harvest wave energy. In this paper, a theoretical study is performed on a duck-shaped TENG wave harvester recently introduced in our work. To enhance the design of the duck-shaped TENG wave harvester, the mechanical and electrical characteristics of the harvester's overall structure, as well as its inner configuration, are analyzed, respectively, under different wave conditions, to optimize parameters such as duck radius and mass. Furthermore, a comprehensive hybrid 3D model is introduced to quantify the performance of the TENG wave harvester. Finally, the influence of different TENG parameters is validated by comparing the performance of several existing TENG wave harvesters. This study can be applied as a guideline for enhancing the performance of TENG wave energy harvesters.

  4. "Sedation is tricky": A qualitative content analysis of nurses' perceptions of sedation administration in mechanically ventilated intensive care unit patients.

    Science.gov (United States)

    Hetland, Breanna; Guttormson, Jill; Tracy, Mary Fran; Chlan, Linda

    2018-03-20

    Critical care nurses are responsible for administering sedative medications to mechanically ventilated patients. With significant advancements in the understanding of the impact of sedative exposure on physiological and psychological outcomes of ventilated patients, updated practice guidelines for assessment and management of pain, agitation, and delirium in the intensive care unit were released in 2013. The primary aim of this qualitative study was to identify and describe themes derived from critical care nurses' comments regarding sedation administration practices with mechanically ventilated patients. This is a qualitative content analysis of secondary text data captured through a national electronic survey of members of the American Association of Critical-Care Nurses. A subsample (n = 67) of nurses responded to a single, open-ended item at the end of a survey that evaluated nurses' perceptions of current sedation administration practices. Multiple factors guided sedation administration practices, including individual patient needs, nurses' synthesis of clinical evidence, application of best practices, and various personal and professional practice perspectives. Our results also indicated nurses desire additional resources to improve their sedation administration practices including more training, better communication tools, and adequate staffing. Critical care nurses endorse recommendations to minimise sedation administration when possible, but a variety of factors, including personal perspectives, impact sedation administration in the intensive care unit and need to be considered. Critical care nurses continue to encounter numerous challenges when assessing and managing sedation of mechanically ventilated patients. Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Designing with the mind in mind simple guide to understanding user interface design guidelines

    CERN Document Server

    Johnson, Jeff

    2014-01-01

    In this completely updated and revised edition of Designing with the Mind in Mind, Jeff Johnson provides you with just enough background in perceptual and cognitive psychology that user interface (UI) design guidelines make intuitive sense rather than being just a list or rules to follow. Early UI practitioners were trained in cognitive psychology, and developed UI design rules based on it. But as the field has evolved since the first edition of this book, designers enter the field from many disciplines. Practitioners today have enough experience in UI design that they have been exposed to

  6. Sedation in Pediatric Esophagogastroduodenoscopy

    Directory of Open Access Journals (Sweden)

    Seak Hee Oh

    2018-03-01

    Full Text Available Pediatric esophagogastroduodenoscopy (EGD has become an established diagnostic and therapeutic modality in pediatric gastroenterology. Effective sedation strategies have been adopted to improve patient tolerance during pediatric EGD. For children, safety is a fundamental consideration during this procedure as they are at a higher risk of severe adverse events from procedural sedation compared to adults. Therefore, a detailed risk evaluation is required prior to the procedure, and practitioners should be aware of the benefits and risks associated with sedation regimens during pediatric EGD. In addition, pediatric advanced life support by endoscopists or immediate intervention by anesthesiologists should be available in the event that severe adverse events occur during pediatric EGD.

  7. Palliative sedation at home in the Netherlands: a nationwide survey among nurses.

    Science.gov (United States)

    Brinkkemper, Tijn; Klinkenberg, Marianne; Deliens, Luc; Eliel, Miriam; Rietjens, Judith A C; Zuurmond, Wouter W A; Perez, Roberto S G M

    2011-08-01

    This paper is a report of a nationwide study conducted to assess experiences of nurses involved in palliative sedation at home after introduction of a physicians' guideline for palliative sedation. Most studies investigating the practice of palliative sedation focus on physicians' practices and attitudes. However, little is known about experiences and attitudes of nurses. A web-based structured questionnaire was offered to 387 nurses providing medical technical care in 2007, assessing their experiences concerning decision-making, treatment policy and communication, focussing on the last patient receiving palliative sedation. The questionnaire was filled out by 201 nurses (response rate 52%). The majority of respondents agreed with the indication for palliative sedation. However, 21% reported to have refused carrying out a palliative sedation in the preceding year. The general practitioner was not present at the start of palliative sedation in a third of the cases, but was available when needed. The sedation was considered insufficiently effective by 42% of the respondents. According to a third of the respondents, the level of sedation was not related to the required level of symptom relief nor were changes in dosage based on the severity of symptoms. Although the guideline for palliative sedation appears to be followed adequately in the majority of cases with respect to indication for palliative sedation and reportage. The survey findings revealed shortcomings in medication policy, communication, medical control over the start and continued monitoring of palliative sedation. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  8. Role of operator response guidelines in CANDU 9 design program

    International Nuclear Information System (INIS)

    Jaitly, R.K.

    2000-01-01

    The CANDU 9 is a large version of the CANDU Pressurized Heavy Water Reactor (PHWR) system developed in Canada. With an electrical output of approximately 935 MWe, the CANDU 9 complements the established mid-size CANDU 6 (700 MWe) and makes use of proven technology updated with state of the art features resulting from ongoing development. The CANDU 9 builds on the reactor and process system designs of the operating Darlington and Bruce B plants, and incorporates a modified CANDU 6 station layout, as well as improved construction methods and operational features. A high level of standardization has always been a feature of CANDU reactors. This theme is emphasized in the CANDU 9; all key components (reactor core, steam generators, coolant pumps, pressure tubes, etc.) are of the same design as those proven in service in the operating CANDU power stations. Including Probabilistic Safety Assessment (PSA) as part of the CANDU 9 design process from the outset of the program was seen as key to ensuring completeness of safety related requirements. The PSA work provided an in-depth understanding of the plant response to various postulated accidents. As well, the time frame for recovery and the related operator actions were identified. This information together with AECL's experience in supporting the development of Emergency Operating Procedures (EOPs) for the operating CANDU reactors are the basis for preparation of CANDU 9 Operator Response Guidelines (ORGs). Technical content, format and human factors considerations adopted for the ORGs are such that these can be readily converted to EOPs. The scope of ORGs includes generic as well as event specific ORGs. This dual approach is required to provide defense-in-depth. This paper describes the process used to prepare ORGs for the CANDU 9 reactor and discusses important benefits gained from the application of ORGs as input to the control center design and future preparation of the EOPs. (author)

  9. Flight critical system design guidelines and validation methods

    Science.gov (United States)

    Holt, H. M.; Lupton, A. O.; Holden, D. G.

    1984-01-01

    Efforts being expended at NASA-Langley to define a validation methodology, techniques for comparing advanced systems concepts, and design guidelines for characterizing fault tolerant digital avionics are described with an emphasis on the capabilities of AIRLAB, an environmentally controlled laboratory. AIRLAB has VAX 11/750 and 11/780 computers with an aggregate of 22 Mb memory and over 650 Mb storage, interconnected at 256 kbaud. An additional computer is programmed to emulate digital devices. Ongoing work is easily accessed at user stations by either chronological or key word indexing. The CARE III program aids in analyzing the capabilities of test systems to recover from faults. An additional code, the semi-Markov unreliability program (SURE) generates upper and lower reliability bounds. The AIRLAB facility is mainly dedicated to research on designs of digital flight-critical systems which must have acceptable reliability before incorporation into aircraft control systems. The digital systems would be too costly to submit to a full battery of flight tests and must be initially examined with the AIRLAB simulation capabilities.

  10. Reentry Vehicle Flight Controls Design Guidelines: Dynamic Inversion

    Science.gov (United States)

    Ito, Daigoro; Georgie, Jennifer; Valasek, John; Ward, Donald T.

    2002-01-01

    This report addresses issues in developing a flight control design for vehicles operating across a broad flight regime and with highly nonlinear physical descriptions of motion. Specifically it addresses the need for reentry vehicles that could operate through reentry from space to controlled touchdown on Earth. The latter part of controlled descent is achieved by parachute or paraglider - or by all automatic or a human-controlled landing similar to that of the Orbiter. Since this report addresses the specific needs of human-carrying (not necessarily piloted) reentry vehicles, it deals with highly nonlinear equations of motion, and then-generated control systems must be robust across a very wide range of physics. Thus, this report deals almost exclusively with some form of dynamic inversion (DI). Two vital aspects of control theory - noninteracting control laws and the transformation of nonlinear systems into equivalent linear systems - are embodied in DI. Though there is no doubt that the mathematical tools and underlying theory are widely available, there are open issues as to the practicality of using DI as the only or primary design approach for reentry articles. This report provides a set of guidelines that can be used to determine the practical usefulness of the technique.

  11. Procedural sedation analgesia

    OpenAIRE

    Sheta, Saad A

    2010-01-01

    The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA). The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interve...

  12. Guidelines for the design and management of artificial raptor ...

    African Journals Online (AJOL)

    The aim of this paper is to provide timber growers with silvicultural guidelines for the establishment of raptor perches and nest stands on forestry estates. Rodents do extensive damage to young saplings and as an ecologically friendly alternative to rodenticides, we provide guidelines on perch height and densities that can ...

  13. Design guidelines for high dimensional stability of CFRP optical bench

    Science.gov (United States)

    Desnoyers, Nichola; Boucher, Marc-André; Goyette, Philippe

    2013-09-01

    In carbon fiber reinforced plastic (CFRP) optomechanical structures, particularly when embodying reflective optics, angular stability is critical. Angular stability or warping stability is greatly affected by moisture absorption and thermal gradients. Unfortunately, it is impossible to achieve the perfect laminate and there will always be manufacturing errors in trying to reach a quasi-iso laminate. Some errors, such as those related to the angular position of each ply and the facesheet parallelism (for a bench) can be easily monitored in order to control the stability more adequately. This paper presents warping experiments and finite-element analyses (FEA) obtained from typical optomechanical sandwich structures. Experiments were done using a thermal vacuum chamber to cycle the structures from -40°C to 50°C. Moisture desorption tests were also performed for a number of specific configurations. The selected composite material for the study is the unidirectional prepreg from Tencate M55J/TC410. M55J is a high modulus fiber and TC410 is a new-generation cyanate ester designed for dimensionally stable optical benches. In the studied cases, the main contributors were found to be: the ply angular errors, laminate in-plane parallelism (between 0° ply direction of both facesheets), fiber volume fraction tolerance and joints. Final results show that some tested configurations demonstrated good warping stability. FEA and measurements are in good agreement despite the fact that some defects or fabrication errors remain unpredictable. Design guidelines to maximize the warping stability by taking into account the main dimensional stability contributors, the bench geometry and the optical mount interface are then proposed.

  14. The use of observational scales to monitor symptom control and depth of sedation in patients requiring palliative sedation: a systematic review.

    Science.gov (United States)

    Brinkkemper, Tijn; van Norel, Arjanne M; Szadek, Karolina M; Loer, Stephan A; Zuurmond, Wouter W A; Perez, Roberto S G M

    2013-01-01

    Palliative sedation is the intentional lowering of consciousness of a patient in the last phase of life to relieve suffering from refractory symptoms such as pain, delirium and dyspnoea. In this systematic review, we evaluated the use of monitoring scales to assess the degree of control of refractory symptoms and/or the depth of the sedation. A database search of PubMed and Embase was performed up to January 2010 using the search terms 'palliative sedation' OR 'terminal sedation'. Retro- and prospective studies as well as reviews and guidelines containing information about monitoring of palliative sedation, written in the English, German or Dutch language were included. The search yielded 264 articles of which 30 were considered relevant. Most studies focused on monitoring refractory symptoms (pain, fatigue or delirium) or the level of awareness to control the level of sedation. Four prospective and one retrospective study used scales validated in other settings: the Numeric Pain Rating Scale, the Visual Analogue Scale, the Memorial Delirium Assessment Scale, the Communication Capacity Scale and Agitation Distress Scale. Only the Community Capacity Scale was partially validated for use in a palliative sedation setting. One guideline described the use of a scale validated in another setting. A minority of studies reported the use of observational scales to monitor the effect of palliative sedation. Future studies should be focused on establishing proper instruments, most adequate frequency and timing of assessment, and interdisciplinary evaluation of sedation depth and symptom control for palliative sedation.

  15. Patient safety during procedural sedation using capnography monitoring : A systematic review and meta-analysis

    NARCIS (Netherlands)

    Saunders, Rhodri; Struys, Michel M. R. F.; Pollock, Richard F.; Mestek, Michael; Lightdale, Jenifer R.

    2017-01-01

    Objective: To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery relative to visual assessment and pulse oximetry alone. Design and setting: Systematic literature review and random

  16. Expert validation of fit-for-purpose guidelines for designing programmes of assessment

    Directory of Open Access Journals (Sweden)

    Dijkstra Joost

    2012-04-01

    Full Text Available Abstract Background An assessment programme, a purposeful mix of assessment activities, is necessary to achieve a complete picture of assessee competence. High quality assessment programmes exist, however, design requirements for such programmes are still unclear. We developed guidelines for design based on an earlier developed framework which identified areas to be covered. A fitness-for-purpose approach defining quality was adopted to develop and validate guidelines. Methods First, in a brainstorm, ideas were generated, followed by structured interviews with 9 international assessment experts. Then, guidelines were fine-tuned through analysis of the interviews. Finally, validation was based on expert consensus via member checking. Results In total 72 guidelines were developed and in this paper the most salient guidelines are discussed. The guidelines are related and grouped per layer of the framework. Some guidelines were so generic that these are applicable in any design consideration. These are: the principle of proportionality, rationales should underpin each decisions, and requirement of expertise. Logically, many guidelines focus on practical aspects of assessment. Some guidelines were found to be clear and concrete, others were less straightforward and were phrased more as issues for contemplation. Conclusions The set of guidelines is comprehensive and not bound to a specific context or educational approach. From the fitness-for-purpose principle, guidelines are eclectic, requiring expertise judgement to use them appropriately in different contexts. Further validation studies to test practicality are required.

  17. A study on design guidelines for the icons used in nuclear power plants

    International Nuclear Information System (INIS)

    Lee, Jung Woon; Lee, Yong Hee; Oh, In Seok; Lee, Hyun Chul; Lee, Dhong Ha

    2004-05-01

    In this project, advantages and disadvantages of icons on electronic displays were analyzed, and design procedures, design evaluation principles, and design guidelines for icons on electronic displays were developed. In addition, as design guidelines for special effects applicable to icons on electronic displays, guidelines for color coding, flashing, and 3-dimensional effects were developed. A questionnaire survey was performed to investigate how NPP operators consider methods representing icons on electronic displays (such as colors, dynamic effects, and 3-dimensional effects) compared to methods representing icons by using outlines in the P and ID drawings. NPP operators' preference of the icons designed in accordance with icon design guidelines to the icons without considering the guidelines was also investigated

  18. Reinforced soil structures. Volume I, Design and construction guidelines

    Science.gov (United States)

    1990-11-01

    This report presents comprehensive guidelines for evaluating and using soil reinforcement techniques in the construction of retaining walls, embankment slopes, and natural or cut slopes. A variety of available systems for reinforced soil including in...

  19. Strategy Guideline: Modeling Enclosure Design in Above-Grade Walls

    Energy Technology Data Exchange (ETDEWEB)

    Lstiburek, J. [Building Science Corporation, Westford, MA (United States); Ueno, K. [Building Science Corporation, Westford, MA (United States); Musunuru, S. [Building Science Corporation, Westford, MA (United States)

    2016-02-24

    The Strategy Guideline describes how to model and interpret results of models for above grade walls. The Measure Guideline analyzes the failure thresholds and criteria for above grade walls. A library of above-grade walls with historically successful performance was used to calibrate WUFI (Warme Und Feuchte Instationar) software models. The information is generalized for application to a broad population of houses within the limits of existing experience.

  20. Guidelines for planning and design of mobile radiological units

    International Nuclear Information System (INIS)

    Schelenz, R.

    1995-01-01

    A significant number of mobile radiological units are in operation worldwide aiming to provide reliable radiological data. They mainly have been designed and constructed on a national basis according to the particular needs and commitments of the specific laboratory or country. In most cases, these units are intended to be used in emergency situations for in-situ radiological measurements of accidentally released radioactivity, sometimes for monitoring environmental pollution. As the purpose of these units is very diversified in regard to the kind of vehicle and its in-built measuring equipment the varying outfit of these units cannot be adopted in general for other countries aiming to improve their capability for in-situ radiological measurement. In order to achieve harmonization of equipment and comparability of radiological data being obtained from field measurements it is necessary to have general guidelines available for designing mobile radiological units taking into account different sceneries and tasks to be achieved. In the very early stages of an accident most of the information available on the quantity of radioactive material being released, its radionuclide composition and the likely progression of the accident will come from the operator, and will be based on the conditions in the plant. Few environmental monitoring results from off-side can be expected within the first few hours. In this very early phase, decisions on the application of protective measures will therefore, be based largely on plant status and forecasts of changes in that status as well as on meteorological data. As time progresses, results will increasingly become available from the monitoring of radionuclides in the environment (e.g. dose rates and concentration of radionuclides in air and particular materials such as water, food etc). Monitoring results can be used to estimate potential doses to people and the need for further protective measures can thus be determined from a

  1. Guidelines for planning and design of mobile radiological units

    Energy Technology Data Exchange (ETDEWEB)

    Schelenz, R [Federal Office for Environmental Radioactivity in Food, Total Diet and Infant Food, Federal Research Centre for Nutrition, Karlsruhe (Germany)

    1995-07-01

    A significant number of mobile radiological units are in operation worldwide aiming to provide reliable radiological data. They mainly have been designed and constructed on a national basis according to the particular needs and commitments of the specific laboratory or country. In most cases, these units are intended to be used in emergency situations for in-situ radiological measurements of accidentally released radioactivity, sometimes for monitoring environmental pollution. As the purpose of these units is very diversified in regard to the kind of vehicle and its in-built measuring equipment the varying outfit of these units cannot be adopted in general for other countries aiming to improve their capability for in-situ radiological measurement. In order to achieve harmonization of equipment and comparability of radiological data being obtained from field measurements it is necessary to have general guidelines available for designing mobile radiological units taking into account different sceneries and tasks to be achieved. In the very early stages of an accident most of the information available on the quantity of radioactive material being released, its radionuclide composition and the likely progression of the accident will come from the operator, and will be based on the conditions in the plant. Few environmental monitoring results from off-side can be expected within the first few hours. In this very early phase, decisions on the application of protective measures will therefore, be based largely on plant status and forecasts of changes in that status as well as on meteorological data. As time progresses, results will increasingly become available from the monitoring of radionuclides in the environment (e.g. dose rates and concentration of radionuclides in air and particular materials such as water, food etc). Monitoring results can be used to estimate potential doses to people and the need for further protective measures can thus be determined from a

  2. Energy Design Guidelines for High Performance Schools: Arctic and Subarctic Climates

    Energy Technology Data Exchange (ETDEWEB)

    2004-11-01

    The Energy Design Guidelines for High Performance Schools--Arctic and Subarctic Climates provides school boards, administrators, and design staff with guidance to help them make informed decisions about energy and environmental issues important to school systems and communities. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school in arctic and subarctic climates. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs.

  3. Application of core structural design guidelines in conceptual fuel pin design

    International Nuclear Information System (INIS)

    Patel, M.R.; Stephen, J.D.

    1979-01-01

    The paper describes an application of the Draft RDT Standards F9-7, -8, and -9 to conceptual design of Fast Breeder Reactor (FBR) fuel pins. The Standards are being developed to provide guidelines for structural analysis and design of the FBR core components which have limited ductility at high fluences and are not addressed by the prevalent codes. The development is guided by a national working group sponsored by the Division of Reactor Researcch and Technology of the Department of Energy. The development program summarized in the paper includes establishment of design margins consistent with the test data and component performance requirements, and application of the design rules in various design activities. The application program insures that the quantities required for proper application of the design rules are available from the analysis methods and test data, and that the use of the same design rules in different analysis tools used at different stages of a component design producees consistent results. This is illustrated in the paper by application of the design rules in the analysis methods developed for conceptual and more detailed designs of an FBR fuel pin

  4. Design considerations of a randomized controlled trial of sedation level during hip fracture repair surgery: a strategy to reduce the incidence of postoperative delirium in elderly patients.

    Science.gov (United States)

    Li, Tianjing; Wieland, L Susan; Oh, Esther; Neufeld, Karin J; Wang, Nae-Yuh; Dickersin, Kay; Sieber, Frederick E

    2017-06-01

    Background Delirium is an acute change in mental status characterized by sudden onset, fluctuating course, inattention, disorganized thinking, and abnormal level of consciousness. The objective of the randomized controlled trial "A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients" (STRIDE) is to assess the effectiveness of light versus heavy sedation on delirium and other outcomes in elderly patients undergoing hip fracture repair surgery. Our goal is to describe the design considerations and lessons learned in planning and implementing the STRIDE trial. Methods Discussed are challenges encountered including (1) how to ensure that we quickly identify, assess the eligibility of, and randomize traumatic hip fracture patients; (2) how to implement interventions that involve continuous monitoring and adjustment during the surgery; and (3) how to measure and ascertain the primary outcome, delirium. Results To address the first challenge, we monitored the operating room schedule more actively than anticipated. We constructed and organized eligibility assessment data collection forms by purpose and by source of information needed to complete them. We decided that randomization needs to take place in the operating room. To address the second challenge, we designed and implemented a treatment protocol and covered the bispectral index monitor to prevent the Anesthesiologist/Anesthetist from being influenced by the bispectral index reading while administering the intervention. Finally, clinical assessment of delirium consisted of standardized interviews of the patient using validated instruments, interviews of those caring for the patient, and review of the medical record. A consensus panel made the final determination of a delirium diagnosis. We note that STRIDE is a single-center trial. The decisions we took may have different implications for multi-center trials. Conclusions Lessons learned are likely to provide useful information to others

  5. Design Guidelines of a Spring-Damper System for Emergency Diesel Generator Sets

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Kyu; Choun, Young Sun; Seo, Jeong Moon

    2007-05-15

    This guidelines described about the procedure of isolation system design for Emergency Diesel Generator (EDG) of Nuclear Power Plant (NPP). First of all, a vibration concept including the ground vibration was described and vibration control system and seismic isolation system were considered. The behavior characteristics and design consideration of coil spring-viscose damper system were summarized. The material properties of foundation of EDG system and the ground were considered. A design load and seismic load for isolation system design were described and an analysis method was explained. Finally, a design example for an EDG in Yonggwang Nuclear Unit 5 and 6 was attached of Appendix. First of all, this design guideline can apply to design of a vibration and seismic isolation system for EDG system and the design example present a design procedure practically. Moreover, this design guideline can be used for isolation design of other rotational machines and other isolation system except spring-damper system.

  6. Consistent natural phenomena design and evaluation guidelines for U.S. Department of Energy facilities

    International Nuclear Information System (INIS)

    Murray, R.C.; Short, S.A.

    1989-01-01

    Uniform design and evaluation guidelines for protection against natural phenomena hazards such as earthquakes, extreme winds, and flooding for facilities at Department of Energy (DOE) sites throughout the United States have been developed. The guidelines apply to design of new facilities and to evaluation or modification of existing facilities. These guidelines are an approach for design or evaluation for mitigating the effects of natural phenomena hazards. These guidelines are intended to control the level of conservatism introduced in the design/evaluation process such that all hazards are treated on a reasonably consistent and uniform basis and such that the level of conservatism is appropriate for facility characteristics such as importance, cost, and hazards to on-site personnel, the general public, and the environment. The philosophy and goals of these guidelines are covered by this paper

  7. Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy

    DEFF Research Database (Denmark)

    Burtea, Daniela Elena; Dimitriu, Anca; Maloş, Anca Elena

    2015-01-01

    the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become......, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures....

  8. Ergonomics standards and guidelines for computer workstation design and the impact on users' health - a review.

    Science.gov (United States)

    Woo, E H C; White, P; Lai, C W K

    2016-03-01

    This paper presents an overview of global ergonomics standards and guidelines for design of computer workstations, with particular focus on their inconsistency and associated health risk impact. Overall, considerable disagreements were found in the design specifications of computer workstations globally, particularly in relation to the results from previous ergonomics research and the outcomes from current ergonomics standards and guidelines. To cope with the rapid advancement in computer technology, this article provides justifications and suggestions for modifications in the current ergonomics standards and guidelines for the design of computer workstations. Practitioner Summary: A research gap exists in ergonomics standards and guidelines for computer workstations. We explore the validity and generalisability of ergonomics recommendations by comparing previous ergonomics research through to recommendations and outcomes from current ergonomics standards and guidelines.

  9. Palliative sedation in nursing anesthesia.

    Science.gov (United States)

    Wolf, Michael T

    2013-04-01

    Palliative sedation is a technique of providing a sedative for end-of-life care to patients with intractable pain. The literature discusses the techniques and use of palliative sedation. Numerous articles have been written regarding the issues surrounding its use, but no literature has discussed the prescription or administration of palliative sedation by a nurse anesthetist. By understanding the concept and ethics involved in its use and providing nursing care that is theory based, the author argues that the involvement of nursing anesthesia is appropriate and within the scope of practice. Few other healthcare disciplines can provide the patient care and empirical knowledge that is imperative in the care of the dying patient. This article discusses the concept and ethics of palliative sedation and presents a case of providing palliative sedation to a terminally ill patient by an experienced nurse anesthetist. Palliative sedation should be understood, embraced, and utilized as an area of expertise suited for nursing anesthesia.

  10. Considerable variability of procedural sedation and analgesia practices for gastrointestinal endoscopic procedures in Europe

    NARCIS (Netherlands)

    Vaessen, Hermanus H B; Knape, Johannes T A

    2016-01-01

    Background/Aims: The use of moderate to deep sedation for gastrointestinal endoscopic procedures has increased in Europe considerably. Because this level of sedation is a risky medical procedure, a number of international guidelines have been developed. This survey aims to review if, and if so

  11. The design guidelines of mobile augmented reality for tourism in Malaysia

    Science.gov (United States)

    Shukri, Saidatul A'isyah Ahmad; Arshad, Haslina; Abidin, Rimaniza Zainal

    2017-10-01

    Recent data shows that one in every five people in the world owns a Smartphone and spends most of their time on the phone using apps. Visitors prefer this type of portable, convenient, practical and simple technology when travelling, especially geo location-enabled applications such as the GPS. The aim of this paper is to develop design guidelines for Mobile Augmented Reality (MAR) for tourism. From the analysis of existing design guidelines of Mobile Augmented Reality (MAR) for tourism, an application design guidelines are proposed based on Human-computer interaction principle and usability design that would fulfils the user's requirement in a better way. Six design principles were examined in this analysis. The analysis identified eleven suggestions for design principles. These recommendations are offered towards designing principles and developing prototype app for tourist in Malaysia. This paper identifies design principles to reduce cognitive overhead of tourist, learn ability and suitable context for providing content whiles their travel in Malaysia.

  12. Advanced human-system interface design review guideline. Evaluation procedures and guidelines for human factors engineering reviews

    International Nuclear Information System (INIS)

    O'Hara, J.M.; Brown, W.S.; Baker, C.C.; Welch, D.L.; Granda, T.M.; Vingelis, P.J.

    1994-07-01

    Advanced control rooms will use advanced human-system interface (HSI) technologies that may have significant implications for plant safety in that they will affect the operator's overall role in the system, the method of information presentation, and the ways in which operators interact with the system. The U.S. Nuclear Regulatory Commission (NRC) reviews the HSI aspects of control rooms to ensure that they are designed to good human factors engineering principles and that operator performance and reliability are appropriately supported to protect public health and safety. The principal guidance available to the NRC, however, was developed more than ten years ago, well before these technological changes. Accordingly, the human factors guidance needs to be updated to serve as the basis for NRC review of these advanced designs. The purpose of this project was to develop a general approach to advanced HSI review and the human factors guidelines to support. NRC safety reviews of advanced systems. This two-volume report provides the results of the project. Volume I describes the development of the Advanced HSI Design Review Guideline (DRG) including (1) its theoretical and technical foundation, (2) a general model for the review of advanced HSIs, (3) guideline development in both hard-copy and computer-based versions, and (4) the tests and evaluations performed to develop and validate the DRG. Volume I also includes a discussion of the gaps in available guidance and a methodology for addressing them. Volume 2 provides the guidelines to be used for advanced HSI review and the procedures for their use

  13. Advanced human-system interface design review guideline. Evaluation procedures and guidelines for human factors engineering reviews

    Energy Technology Data Exchange (ETDEWEB)

    O`Hara, J.M.; Brown, W.S. [Brookhaven National Lab., Upton, NY (United States); Baker, C.C.; Welch, D.L.; Granda, T.M.; Vingelis, P.J. [Carlow International Inc., Falls Church, VA (United States)

    1994-07-01

    Advanced control rooms will use advanced human-system interface (HSI) technologies that may have significant implications for plant safety in that they will affect the operator`s overall role in the system, the method of information presentation, and the ways in which operators interact with the system. The U.S. Nuclear Regulatory Commission (NRC) reviews the HSI aspects of control rooms to ensure that they are designed to good human factors engineering principles and that operator performance and reliability are appropriately supported to protect public health and safety. The principal guidance available to the NRC, however, was developed more than ten years ago, well before these technological changes. Accordingly, the human factors guidance needs to be updated to serve as the basis for NRC review of these advanced designs. The purpose of this project was to develop a general approach to advanced HSI review and the human factors guidelines to support. NRC safety reviews of advanced systems. This two-volume report provides the results of the project. Volume I describes the development of the Advanced HSI Design Review Guideline (DRG) including (1) its theoretical and technical foundation, (2) a general model for the review of advanced HSIs, (3) guideline development in both hard-copy and computer-based versions, and (4) the tests and evaluations performed to develop and validate the DRG. Volume I also includes a discussion of the gaps in available guidance and a methodology for addressing them. Volume 2 provides the guidelines to be used for advanced HSI review and the procedures for their use.

  14. Strategy Guideline. Modeling Enclosure Design in Above-Grade Walls

    Energy Technology Data Exchange (ETDEWEB)

    Lstiburek, J. [Building Science Corporation, Westford, MA (United States); Ueno, K. [Building Science Corporation, Westford, MA (United States); Musunuru, S. [Building Science Corporation, Westford, MA (United States)

    2016-02-01

    The Strategy Guideline, written by the U.S. Department of Energy's research team Building Science Corporation, 1) describes how to model and interpret results of models for above-grade walls, and 2) analyzes the failure thresholds and criteria for above-grade walls. A library of above-grade walls with historically successful performance was used to calibrate WUFI (Wärme und Feuchte instationär) software models. The information is generalized for application to a broad population of houses within the limits of existing experience.

  15. Structural design guidelines for concrete bridge decks reinforced with corrosion-resistant reinforcing bars.

    Science.gov (United States)

    2014-10-01

    This research program develops and validates structural design guidelines and details for concrete bridge decks with : corrosion-resistant reinforcing (CRR) bars. A two-phase experimental program was conducted where a control test set consistent : wi...

  16. Guidelines for the design and operation of makeup water treatment systems

    International Nuclear Information System (INIS)

    Lee, Y.H.; Planek, M.A.; Sopocy, D.M.; Tomaga, C.M.; Abrams, I.M.; Anderson, C.C.; Balazs, M.K.; Houskava, J.; Williams, R.

    1989-06-01

    These guidelines present the industry with a standardized program to ensure the optimum design and operation of their individual makeup water treatment systems. These guidelines present, in a non-technical and non-proprietary format, the makeup water treatment system design and operating topics that are discussed in detail in Volumes 1 and 2 of NP-6377-SL. The individual guidelines contained in Volumes 1 and 2 are presented as separate imperative statements, followed by a technical justification discussion, which provides further explanations. In addition and when applicable, the guidelines relate pertinent operational in regard to monitoring parameters for operation, alternative actions, troubleshooting, management responsibilities and shutdown practices. Design considerations are also addressed, when applicable, in regard to equipment cost and advantages and disadvantages for the design recommendations. Appendices provide background information for performance criteria, component description, economic evaluation procedures and definitions. 4 refs

  17. Revising the South African guidelines for human settlement planning and design (the red book)

    CSIR Research Space (South Africa)

    Van Niekerk, Willemien

    2015-11-01

    Full Text Available The Guidelines for Human Settlement Planning and Design, commonly known as the Red Book, is a South African publication aimed at providing practical guidance to built environment professionals in support of the creation of sustainable and vibrant...

  18. Virtual reality verification of workplace design guidelines for the process plant control room

    International Nuclear Information System (INIS)

    Droeivoldsmo, Asgeir; Nystad, Espen; Helgar, Stein

    2001-02-01

    Early identification of potential human factors guideline-violations and corrective input into the design process is desired for efficient and cost-effective control room design. Virtual reality (VR) technology makes it possible to perform evaluation of the design of the control room at an early stage of the design process, but can we trust the results from such evaluations? This paper describes an experimental validation of a VR model against the real world in five different guideline verification tasks. Results indicate that guideline verification in the VR model can be done with satisfactory accuracy for a number of evaluations. However, some guideline categories require further development of measurement tools and use of a model with higher resolution than the model used in this study. (Author). 30 refs., 4 figs., 1 tab

  19. Palliative Sedation at Home

    Science.gov (United States)

    Barathi, B

    2012-01-01

    Patients with advanced cancer often suffer from multiple intractable physical symptoms. Though majority of the symptoms can be controlled, in some of the patients these symptoms remain refractory and uncontrolled till the end. Palliative sedation (PS) is one of the ways to relieve intractable suffering of the dying cancer patients. The main concern while using PS is its life-shortening effect. This case report describes the feasibility of administering PS in Indian home settings. PMID:22837615

  20. Palliative sedation at home

    Directory of Open Access Journals (Sweden)

    B Barathi

    2015-04-01

    Full Text Available Patients with advanced cancer often suffer from multiple intractable physical symptoms. Though majority of the symptoms can be controlled, in some of the patients these symptoms remain refractory and uncontrolled till the end. Palliative sedation (PS is one of the ways to relieve intractable suffering of the dying cancer patients. The main concern while using PS is its life-shortening effect. This case report describes the feasibility of administering PS in Indian home settings.

  1. DOE (Department of Energy) natural phenomena guidelines flood design and evaluation

    International Nuclear Information System (INIS)

    McCann, M.W.; Savy, J.B.

    1989-01-01

    Design and evaluation guidelines for DOE (Department of Energy) facilities subjected to earthquake, wind/tornado, and flood have been developed and presented in UCRL-15910 (Ref.1). This paper summarizes Chapter 6 of UCRL-15910 describing the philosophy and procedures for the design or evaluation of facilities for flood. The flood design and evaluation guidelines seek to ensure that DOE facilities satisfy the performance goals described in UCRL-15910. The guidelines are applicable to new and existing construction; however, in the evaluation of existing facilities, fewer design options may be available to satisfy the performance goals. Evaluation of the flood design for a facility consists of: (1) defining the design basis flood (DBFL), (2) evaluating site conditions (e.g., facility location, location of openings and doorways), and (3) assessing flood design strategies (e.g., build above DBFL levels, harden the site)

  2. Outline of the seismic design guideline of an FBR - a tentative draft

    International Nuclear Information System (INIS)

    Akiyama, Hiroshi; Ohtsubo, Hideomi; Nakamura, Hideharu; Matsuura, Shinichi; Hagiwara, Yutaka; Yuhara, Tetsuo; Hirayama, Hiroshi; Kokubo, Kunio; Ooka, Yuji.

    1993-01-01

    Central Research Institute of Electric Power Industry (Japan) is carrying out the Demonstration Test and Research Program of Buckling of FBR (FY 1987-FY 1993). The first half of the research program was finished after establishing a seismic buckling design guideline (a tentative draft). The purpose of this paper is to describe the dynamic buckling characteristics of FBR main vessels and the outline of the rationalized buckling design guideline for seismic loadings. (orig.)

  3. Guidelines for the structural design of experimental multi-purpose VHTR at the elevated temperature services

    International Nuclear Information System (INIS)

    Nomura, Sueo; Uga, Takeo; Miyamoto, Yoshiaki; Muto, Yasushi; Ikushima, Takeshi

    1976-02-01

    The guidelines are presented for structural design of the experimental multi-purpose VHTR(Very High Temperature Reactor) at the elevated temperature services. Covered are features of the VHTR structural design, specifications, safety design, seismic design, failure modes to be considered, stress criteria for various load combinations and the mechanical properties of the materials. The guidelines were prepared by referring to safety criteria of high-temperature gas cooled reactors, ASME Boiler and Pressure Vessel code, Section III, case 1592 and the domestic seismic design guide of nuclear power facilities. (auth.)

  4. Design Guidelines for Collaboration and Participation with Examples from the LN4LD (Learning Network for Learning Design)

    NARCIS (Netherlands)

    Burgos, Daniel; Hummel, Hans; Tattersall, Colin; Brouns, Francis; Koper, Rob

    2007-01-01

    Burgos, D., Hummel, H. G. K., Tattersall, C., Brouns, F., & Koper, R. (2009). Design Guidelines for Collaboration and Participation with Examples from the LN4LD (Learning Network for Learning Design). In L. Lockyer, S. Bennett, S. Agostinho & B. Harper (Eds.), Handbook of Research on Learning Design

  5. Guidelines for sustainable building design: Recommendations from the Presidio of San Francisco energy efficiency design charrette

    Energy Technology Data Exchange (ETDEWEB)

    Brown, K.; Sartor, D.; Greenberg, S. [and others

    1996-05-01

    In 1994, the Bay Chapter of the Association of Energy Engineers{reg_sign} organized a two-day design charrette for energy-efficient redevelopment of buildings by the National Park Services (NPS) at the Presidio of San Francisco. This event brought together engineers, researchers, architects, government officials, and students in a participatory environment to apply their experience to create guidelines for the sustainable redesign of Presidio buildings. The venue for the charrette was a representative barracks building located at the Main Post of the Presidio. Examination of this building allowed for the development of design recommendations, both for the building and for the remainder of the facilities. The charrette was organized into a committee structure consisting of: steering, measurement and monitoring, modeling, building envelope and historic preservation (architectural), HVAC and controls, lighting, and presentation. Prior to the charrette itself, the modeling and measurement/monitoring committees developed substantial baseline data for the other committees during the charrette. An integrated design approach was initiated through interaction between the committees during the charrette. Later, committee reports were cross-referenced to emphasize whole building design and systems integration.

  6. Supporting industrial equipment development through a set of design-for-maintenance guidelines

    NARCIS (Netherlands)

    Mulder, W.; Basten, Robertus Johannes Ida; Jauregui Becker, Juan Manuel; Blok, Jeroen; Hoekstra, Sipke; Kokkeler, Frans; Marjanovic, Dorian; Storga, Mario; Pavkovic, Neven; Bojcetic, Nenad

    2014-01-01

    This paper presents a leaflet with design-for-maintenance guidelines. It aims at supporting developers of industrial equipment in their design-for-maintenance practices. The use of this leaflet should lead to increased attention for design-for-maintenance aspects and to improve idea generation. The

  7. Experiences of Family Members of Dying Patients Receiving Palliative Sedation.

    Science.gov (United States)

    Tursunov, Olga; Cherny, Nathan I; Ganz, Freda DeKeyser

    2016-11-01

    part of the core nursing curriculum. Nursing administrators in areas that use palliative sedation should enforce good nursing clinical practice as recommended by international practice guidelines, such as those of the European Association for Palliative Care.

  8. A Review of Palliative Sedation.

    Science.gov (United States)

    Bobb, Barton

    2016-09-01

    Palliative sedation has become a standard practice to treat refractory symptoms at end-of-life. Dyspnea and delirium are the two most commonly treated symptoms. The medications used in palliative sedation are usually benzodiazepines, barbiturates, antipsychotics, and/or anesthetics. Some ethical considerations remain, especially surrounding the use of palliative sedation in psychological distress and existential suffering. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Therapeutics and Sedation in Dentistry

    OpenAIRE

    Young, Earle R.

    1988-01-01

    Sedation can help to overcome the fear that prevents many Canadians from accepting dental treatment. This article discusses the indications and contraindications for oral, intramuscular, and inhalation sedation as used by the general dental practitioner for both adult and child patients, with a note on the growing number of specialist dental anesthetists who provide intravenous out-patient sedation. Local anesthesia is discussed with reference to allergic reactions, malignant hyperthermia, an...

  10. THE FIQH OF THE IMAM AND CONGREGATION POSITION AS DESIGN GUIDELINES IN DESIGNING A VERTICAL MOSQUE

    Directory of Open Access Journals (Sweden)

    Muhammar Khamdevi

    2013-12-01

    Full Text Available Abstract In the books of hadeeth and fiqh, it has been narrated many instructions about the imam and congregation position, especially about the position between the imam and the congregation and about the farthest and highest distance of the last row. Suprisingly, if we look closely, these lead us to the possibility in designing a vertical mosque. That is important to address the problem of urban sprawl, where the buildings would have to be directed vertically to solve urban density and to avoid further loss of urban green space. But, is there any high restriction in the hadeeth and the fiqh? Would it be opposed to other hadeeths about the warning of vying to build a magnificent tall mosque? This paper discussed about the possibility in designing a vertical mosque in terms of islamic fiqh and architecture. The research aimed to create a design guideline for vertical mosque and to correct some misconceptions in designing a mosque. This research used a qualitative method, namely literature review. The outcome of this research is the guidelines in designing a vertical mosque. Keywords: Fiqh, Islamic Architecture, Imam and Congregation, Mosque     Abstrak Dalam buku-buku hadits dan fiqh banyak diriwayatkan petunjuk-petunjuk mengenai posisi imam dan jamaah, terutama tentang posisi antara imam dan jamaah dan tentang jarak terjauh dan tertinggi dari baris shaf terakhir. Ternyata jika dicermati, ini membawa kita kepada kemungkinan dalam merancang sebuah masjid vertikal. Hal ini sangat penting untuk menjawab masalah urban sprawl, di mana bangunan harus diarahkan secara vertikal untuk mengatasi kepadatan kota dan menghindari kehilangan lebih lanjut dari ruang terbuka hijau. Tapi, apakah ada pembatasan tingginya pada hadits dan fiqh? Apakah itu akan bertentangan dengan hadits lain mengenai peringatan berlomba membangun masjid mewah dan tinggi? Makalah  ini membahas kemungkinan dalam merancang sebuah masjid vertikal dari segi fiqh islam dan arsitektur

  11. Human factors design guidelines for maintainability of Department of Energy nuclear facilities

    International Nuclear Information System (INIS)

    Bongarra, J.P. Jr.; VanCott, H.P.; Pain, R.F.; Peterson, L.R.; Wallace, R.I.

    1985-01-01

    Intent of these guidelines is to provide design and design review teams of DOE nuclear facilities with human factors principles to enhance the design and aid in the inspection of DOE nuclear facilities, systems, and equipment. These guidelines are concerned with design features of DOE nuclear facilities which can potentially affect preventive and corrective maintenance of systems within DOE nuclear facilities. Maintenance includes inspecting, checking, troubleshooting, adjusting, replacing, repairing, and servicing activities. Other factors which influence maintainability such as repair and maintenance suport facilities, maintenance information, and various aspects of the environment are also addressed

  12. Human factors design guidelines for maintainability of Department of Energy nuclear facilities

    Energy Technology Data Exchange (ETDEWEB)

    Bongarra, J.P. Jr.; VanCott, H.P.; Pain, R.F.; Peterson, L.R.; Wallace, R.I.

    1985-06-18

    Intent of these guidelines is to provide design and design review teams of DOE nuclear facilities with human factors principles to enhance the design and aid in the inspection of DOE nuclear facilities, systems, and equipment. These guidelines are concerned with design features of DOE nuclear facilities which can potentially affect preventive and corrective maintenance of systems within DOE nuclear facilities. Maintenance includes inspecting, checking, troubleshooting, adjusting, replacing, repairing, and servicing activities. Other factors which influence maintainability such as repair and maintenance suport facilities, maintenance information, and various aspects of the environment are also addressed.

  13. Design guideline to prevent the pipe rupture by radiolysis gases in BWR steam piping

    International Nuclear Information System (INIS)

    Inagaki, T.; Miyagawa, M.; Ota, T.; Sato, T.; Sakata, K.

    2009-01-01

    In late 2001, pipe rupture accidents due to fast combustion of radiolysis gas occurred in Japan and elsewhere's BWR power plants. TENPES began to set up the guideline as action to such a new problem to prevent accumulation and combustion of radiolysis gas in BWR steam piping. And then, the first edition of guideline was published in October 2005. Afterwards, the experimental study about combustion/detonation of radiolysis gas have been continued. And in March 2007, TENPES published a revised edition of the guideline. This is the report of the revised edition of that guideline. According to this guideline, it became possible to design BWR's steam piping to prevent accumulation of radiolysis gas. (author)

  14. Advanced Strategy Guideline. Air Distribution Basics and Duct Design

    Energy Technology Data Exchange (ETDEWEB)

    Arlan Burdick

    2011-12-01

    This report discusses considerations for designing an air distribution system for an energy efficient house that requires less air volume to condition the space. Considering the HVAC system early in the design process will allow adequate space for equipment and ductwork and can result in cost savings.

  15. Performing bone marrow biopsies with or without sedation: a comparison.

    Science.gov (United States)

    Giannoutsos, I; Grech, H; Maboreke, T; Morgenstern, G

    2004-06-01

    Although intravenous sedation (ISED) in addition to a local anaesthetic (LA) is commonly used in the performance of a bone marrow aspirate and trephine (BMAT), it is not clear under what circumstances and in which way sedation may be most beneficial. In this study, information was gathered using a questionnaire, from 112 patients shortly after undergoing BMAT; the duration of the procedures and the length of the biopsy cores were measured and any complications noted. Most patients (68%) chose to receive LA only, and almost all (74/76) were happy with their decision. Patients who received sedation gave lower pain scores than patients receiving LA only (1 vs. 3) and were found to have lower levels of apprehension at the thought of having a repeat procedure. Patients having a repeat BMAT showed a slightly increased preference for having sedation compared with patients who were undergoing it for the first time. There is some concern that guidelines regarding the use of ISED for procedures other than BMAT are not always adhered to, and current practice may be best revealed by a large-scale audit of sedation practice for the performance of BMAT. Patients should be given the choice of having ISED if the appropriate resources are available, but in most cases the additional small risk of receiving sedation can be avoided.

  16. Advanced Strategy Guideline: Air Distribution Basics and Duct Design

    Energy Technology Data Exchange (ETDEWEB)

    Burdick, A.

    2011-12-01

    This report discusses considerations for designing an air distribution system for an energy efficient house that requires less air volume to condition the space. Considering the HVAC system early in the design process will allow adequate space for equipment and ductwork and can result in cost savings. Principles discussed that will maximize occupant comfort include delivery of the proper amount of conditioned air for appropriate temperature mixing and uniformity without drafts, minimization of system noise, the impacts of pressure loss, efficient return air duct design, and supply air outlet placement, as well as duct layout, materials, and sizing.

  17. Sedation in palliative care – a critical analysis of 7 years experience

    Science.gov (United States)

    Muller-Busch, H Christof; Andres, Inge; Jehser, Thomas

    2003-01-01

    Background The administration of sedatives in terminally ill patients becomes an increasingly feasible medical option in end-of-life care. However, sedation for intractable distress has raised considerable medical and ethical concerns. In our study we provide a critical analysis of seven years experience with the application of sedation in the final phase of life in our palliative care unit. Methods Medical records of 548 patients, who died in the Palliative Care Unit of GK Havelhoehe between 1995–2002, were retrospectively analysed with regard to sedation in the last 48 hrs of life. The parameters of investigation included indication, choice and kind of sedation, prevalence of intolerable symptoms, patients' requests for sedation, state of consciousness and communication abilities during sedation. Critical evaluation included a comparison of the period between 1995–1999 and 2000–2002. Results 14.6% (n = 80) of the patients in palliative care had sedation given by the intravenous route in the last 48 hrs of their life according to internal guidelines. The annual frequency to apply sedation increased continuously from 7% in 1995 to 19% in 2002. Main indications shifted from refractory control of physical symptoms (dyspnoea, gastrointestinal, pain, bleeding and agitated delirium) to more psychological distress (panic-stricken fear, severe depression, refractory insomnia and other forms of affective decompensation). Patients' and relatives' requests for sedation in the final phase were significantly more frequent during the period 2000–2002. Conclusion Sedation in the terminal or final phase of life plays an increasing role in the management of intractable physical and psychological distress. Ethical concerns are raised by patients' requests and needs on the one hand, and the physicians' self-understanding on the other hand. Hence, ethically acceptable criteria and guidelines for the decision making are needed with special regard to the nature of refractory

  18. Sedation in palliative care – a critical analysis of 7 years experience

    Directory of Open Access Journals (Sweden)

    Andres Inge

    2003-05-01

    Full Text Available Abstract Background The administration of sedatives in terminally ill patients becomes an increasingly feasible medical option in end-of-life care. However, sedation for intractable distress has raised considerable medical and ethical concerns. In our study we provide a critical analysis of seven years experience with the application of sedation in the final phase of life in our palliative care unit. Methods Medical records of 548 patients, who died in the Palliative Care Unit of GK Havelhoehe between 1995–2002, were retrospectively analysed with regard to sedation in the last 48 hrs of life. The parameters of investigation included indication, choice and kind of sedation, prevalence of intolerable symptoms, patients' requests for sedation, state of consciousness and communication abilities during sedation. Critical evaluation included a comparison of the period between 1995–1999 and 2000–2002. Results 14.6% (n = 80 of the patients in palliative care had sedation given by the intravenous route in the last 48 hrs of their life according to internal guidelines. The annual frequency to apply sedation increased continuously from 7% in 1995 to 19% in 2002. Main indications shifted from refractory control of physical symptoms (dyspnoea, gastrointestinal, pain, bleeding and agitated delirium to more psychological distress (panic-stricken fear, severe depression, refractory insomnia and other forms of affective decompensation. Patients' and relatives' requests for sedation in the final phase were significantly more frequent during the period 2000–2002. Conclusion Sedation in the terminal or final phase of life plays an increasing role in the management of intractable physical and psychological distress. Ethical concerns are raised by patients' requests and needs on the one hand, and the physicians' self-understanding on the other hand. Hence, ethically acceptable criteria and guidelines for the decision making are needed with special regard to

  19. Design guidelines for natural ventilation systems in tertiary sector buildings

    OpenAIRE

    Van Moeseke, Geoffrey; Bruyère, Isabelle; De Herde, André; CISBAT 2005: Renewables in a changing climate

    2005-01-01

    Parameters determining efficiency of natural ventilation systems are numerous. The most important are architecture and system design. This article get onto both but focuses on system design. Through dynamic simulations it shows that natural ventilation management has a large impact on energy saving but most of all on thermal comfort. Natural ventilation techniques are also weighted against hybrid solutions and high efficiency mechanical cooling solutions. Natural ventilation techniques show t...

  20. Play for All Guidelines: Planning, Design and Management of Outdoor Play Settings for All Children. Second Edition.

    Science.gov (United States)

    Moore, Robin C., Ed.; Goltsman, Susan M., Ed.; Iacofano, Daniel S., Ed.

    These guidelines assist professional designers, park and recreation managers, and community groups when making decisions about the planning, design, and ongoing management of children's public play environments. The guidelines are updated to meet or exceed the requirements of the Americans with Disabilities Act Guidelines (July 26, 1991) and the…

  1. Palliative Sedation: Reliability and Validity of Sedation Scales

    NARCIS (Netherlands)

    Arevalo Romero, J.; Brinkkemper, T.; van der Heide, A.; Rietjens, J.A.; Ribbe, M.W.; Deliens, L.; Loer, S.A.; Zuurmond, W.W.A.; Perez, R.S.G.M.

    2012-01-01

    Context: Observer-based sedation scales have been used to provide a measurable estimate of the comfort of nonalert patients in palliative sedation. However, their usefulness and appropriateness in this setting has not been demonstrated. Objectives: To study the reliability and validity of

  2. Wireless application guidelines for usability design and evaluation for developing countries

    International Nuclear Information System (INIS)

    Khoja, S.A.; Ursani, A.A.; Ali, A.

    2009-01-01

    The aim of this paper is to provide guidelines for designing wireless applications. These guidelines are developed with the help of Human Computer Interaction based Usability Evaluation surveys and tests results. These guidelines will help in making wireless applications more usable and attractive for users and will help designers to plan effective interactive applications. The guidelines presented in the paper have been derived from the results of surveys, usability tests and SET (Summative Evaluation Tests) carried out over 200 people of Karachi, Pakistan, from different walks of life with different academic and professional backgrounds, making imperative suggestions not only to improve the usability of exciting features given in wireless and mobile products, but also provide suggestions to improve usability of basic components such as, text, navigation, interactivity, multimedia, control and behavior. (author)

  3. Safe Driving After Propofol Sedation.

    Science.gov (United States)

    Summerlin-Grady, Lee; Austin, Paul N; Gabaldon, Dion A

    2017-10-01

    Propofol is a short-acting medication with fast cognitive and psychomotor recovery. However, patients are usually instructed not to drive a motor vehicle for 24 hours after receiving propofol. The purpose of this article was to review the evidence examining when it is safe to drive after receiving propofol for sedation for diagnostic and surgical procedures. This is a systematic review of the literature. A search of the literature was conducted using Google Scholar, PubMed, and the Cochrane Library for the time period 1990 to 2015. Two randomized controlled trials and two observational studies met the inclusion criteria. Using a simulator, investigators examined driving ability of subjects who received modest doses (about 100 mg) of propofol for endoscopic procedures and surveyed subjects who drove immediately after discharge. There were methodological concerns with the studies such as small sample sizes, modest doses of propofol, and three of the four studies were done in Japan by the same group of investigators limiting generalizability. This limited research suggests that it may be safe for patients to drive sooner than 24 hours after receiving propofol. However, large multicenter trials using heterogenous samples using a range of propofol doses are needed to support an evidence-based revision to the current discharge guidelines for patients receiving propofol. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  4. Designing usable web forms- Empirical evaluation of web form improvement guidelines

    DEFF Research Database (Denmark)

    Seckler, Mirjam; Heinz, Silvia; Bargas-Avila, Javier A.

    2014-01-01

    This study reports a controlled eye tracking experiment (N = 65) that shows the combined effectiveness of 20 guidelines to improve interactive online forms when applied to forms found on real company websites. Results indicate that improved web forms lead to faster completion times, fewer form...... submission trials, and fewer eye movements. Data from subjective questionnaires and interviews further show increased user satisfaction. Overall, our findings highlight the importance for web designers to improve their web forms using UX guidelines....

  5. Guidelines for control room systems design. Working material. Report

    International Nuclear Information System (INIS)

    1993-01-01

    This report contains comprehensive technical and methodological information and recommendations for the benefit of Member States for advice and assistance in ''NPP control room systems'' design backfitting existing nuclear power plants and design for future stations. The term ''Control Room Systems'' refers to the entire human/machine interface for the nuclear stations - including the main control room, back-ups control room and the emergency control rooms, local panels, technical support centres, operating staff, operating procedures, operating training programs, communications, etc. Refs, figs and tabs

  6. Human factors guidelines and methodology in the design of a user computer interface: a case study

    International Nuclear Information System (INIS)

    Richards, R.E.; Gilmore, W.E.; Haney, L.N.

    1986-01-01

    In this case study, human factors personnel were requested to participate in a project team of programmers and operations specialists to design a cathode ray tube (CRT) display system for a complex process control application. This presentation describes the process and benefits obtained by incorporating human factors guidelines and methods in system design. Standard human engineering guidelines and techniques were utilized by the project team. In addition, previously published documents and research findings sponsored by the US Nuclear Regulatory Commission (USNRC) were used. Preliminary tasks involved a review of the draft plant procedures. Then, interviews with operators were conducted to establish the initial information for the displays. These initial requirements were evaluated against existing guidelines and criteria to determine the optimal presentation formats. Detailed steps of the approaches used, design decisions made, and tradeoffs that resulted in the final user acceptable design are discussed. 7 refs., 2 figs

  7. Guidelines for design and development of computer/microprocessor based systems in research and power reactors

    International Nuclear Information System (INIS)

    Dhodapkar, S.D.; Chandra, A.K.

    1993-01-01

    Computer systems are being used in Indian research reactors and nuclear power plants in the areas of data acquisition, process monitoring and control, alarm annunciation and safety. The design and evaluation of these systems requires a special approach particularly due to the unique nature of the software which is an essential constituent of these systems. It was decided to evolve guidelines for designing and review of computer/microprocessor based systems for use in nuclear power plants in India. The present document tries to address various issues and presents guidelines which are as comprehensive as possible and cover all issues relating to the design and development of computer based systems. These guidelines are expected to be useful to the specifiers, designers and reviewers of such systems. (author). 6 refs., 1 fig

  8. Comparison of propofol deep sedation versus moderate sedation during endosonography.

    Science.gov (United States)

    Nayar, D S; Guthrie, W G; Goodman, A; Lee, Y; Feuerman, M; Scheinberg, L; Gress, F G

    2010-09-01

    The purposes of this study are: (1) to prospectively evaluate clinically relevant outcomes including sedation-related complications for endoscopic ultrasound (EUS) procedures performed with the use of propofol deep sedation administered by monitored anesthesia care (MAC), and (2) to compare these results with a historical case-control cohort of EUS procedures performed using moderate sedation provided by the gastrointestinal (GI) endoscopist. Patients referred for EUS between January 1, 2001 and December 31, 2002 were enrolled. Complication rates for EUS using MAC sedation were observed and also compared with a historical case-control cohort of EUS patients who received meperidine/midazolam for moderate sedation, administered by the GI endoscopist. Logistic regression analysis was used to isolate possible predictors of complications. A total of 1,000 patients underwent EUS with propofol sedation during the period from January 1, 2001 through December 31, 2002 (mean age 64 years, 53% female). The distribution of EUS indications based on the primary area of interest was: 170 gastroduodenal, 92 anorectal, 508 pancreaticohepatobiliary, 183 esophageal, and 47 mediastinal. The primary endpoint of the study was development of sedation-related complications occurring during a performed procedure. A total of six patients experienced complications: duodenal perforation (one), hypotension (one), aspiration pneumonia (one), and apnea requiring endotracheal intubation (three). The complication rate with propofol was 0.60%, compared with 1% for the historical case-control (meperidine/midazolam moderate sedation) group. There does not appear to be a significant difference between complication rates for propofol deep sedation with MAC and meperidine/midazolam administered for moderate sedation.

  9. Guidelines of the Design of Electropyrotechnic Firing Circuit for Unmanned Flight and Ground Test Projects

    Science.gov (United States)

    Gonzalez, Guillermo A.; Lucy, Melvin H.; Massie, Jeffrey J.

    2013-01-01

    The NASA Langley Research Center, Engineering Directorate, Electronic System Branch, is responsible for providing pyrotechnic support capabilities to Langley Research Center unmanned flight and ground test projects. These capabilities include device selection, procurement, testing, problem solving, firing system design, fabrication and testing; ground support equipment design, fabrication and testing; checkout procedures and procedure?s training to pyro technicians. This technical memorandum will serve as a guideline for the design, fabrication and testing of electropyrotechnic firing systems. The guidelines will discuss the entire process beginning with requirements definition and ending with development and execution.

  10. Deriving guidelines for the design of plate evaporators in heat pumps using zeotropic mixtures

    DEFF Research Database (Denmark)

    Mancini, Roberta; Zühlsdorf, Benjamin; Jensen, Jonas Kjær

    2018-01-01

    This paper presents a derivation of design guidelines for plate heat exchangers used for evaporation of zeotropic mixtures in heat pumps. A mapping of combined heat exchanger and cycle calculations for different combinations of geometrical parameters and working fluids allowed estimating the trade....... It was found that the pressure drop limit leading to infeasible designs was dependent on the working fluid, thereby making it impossible to define a guideline based on maximum allowable pressure drops. It was found that economically feasible designs could be obtained by correlating the vapour Reynolds number...

  11. Bioinformatic tools and guideline for PCR primer design | Abd ...

    African Journals Online (AJOL)

    Bioinformatics has become an essential tool not only for basic research but also for applied research in biotechnology and biomedical sciences. Optimal primer sequence and appropriate primer concentration are essential for maximal specificity and efficiency of PCR. A poorly designed primer can result in little or no ...

  12. Universal Design for Learning: Guidelines for Accessible Online Instruction

    Science.gov (United States)

    Rogers-Shaw, Carol; Carr-Chellman, Davin J.; Choi, Jinhee

    2018-01-01

    Universal Design for Learning (UDL) is a framework for the teaching-learning transaction that conceptualizes knowledge through learner-centered foci emphasizing accessibility, collaboration, and community. Given the importance of access to achieving social justice, UDL is a promising approach to meeting all learners' needs more effectively. In…

  13. Organizational Design within University Extension Units: Some Concepts, Options, and Guidelines

    Science.gov (United States)

    Baker, Harold R.

    1976-01-01

    Drawing on the behavioral sciences, the author outlines alternative modes of structuring and organizing an extension unit. The advantages and disadvantages of several organizational design options, the purposes and management of the temporary task force, and some general guidelines for making organizational design decisions are discussed.…

  14. Towards Cognitive Load Theory as Guideline for Instructional Design in Science Education

    Science.gov (United States)

    Meissner, Barbara; Bogner, Franz X.

    2013-01-01

    We applied cognitive load theory in an heuristic out-of-school science lesson. The lesson comprises experiments concerning major attributes of NaCl and was designed for 5th to 8th grade students. Our interest focused on whether cognitive load theory provides sufficient guidelines for instructional design in the field of heuristic science…

  15. Acoustical Design Guidelines for Living Rooms for Adults with intellectual Disabilities

    NARCIS (Netherlands)

    Saher, K.

    2013-01-01

    The aim of this thesis is to investigate the effects of building design tools on acoustical quality parameters in living rooms for adults with intellectual disabilities (ID) and develop acoustical design guidelines for architects. This study is specifically concerned with the validation of

  16. Safe sedation in general practice

    African Journals Online (AJOL)

    anxiolysis, amnesia, sedation or pain control? ∙ What will the effect of the drugs be on the airway, spontaneous breathing and cardiovascular system? The patient. As more procedures are performed OOR, the operator has retained the opportunity to evaluate patients pre-operatively. However, the sedation provider usually ...

  17. Toward best practice in Human Machine Interface design for older drivers: A review of current design guidelines.

    Science.gov (United States)

    Young, K L; Koppel, S; Charlton, J L

    2017-09-01

    Older adults are the fastest growing segment of the driving population. While there is a strong emphasis for older people to maintain their mobility, the safety of older drivers is a serious community concern. Frailty and declines in a range of age-related sensory, cognitive, and physical impairments can place older drivers at an increased risk of crash-related injuries and death. A number of studies have indicated that in-vehicle technologies such as Advanced Driver Assistance Systems (ADAS) and In-Vehicle Information Systems (IVIS) may provide assistance to older drivers. However, these technologies will only benefit older drivers if their design is congruent with the complex needs and diverse abilities of this driving cohort. The design of ADAS and IVIS is largely informed by automotive Human Machine Interface (HMI) guidelines. However, it is unclear to what extent the declining sensory, cognitive and physical capabilities of older drivers are addressed in the current guidelines. This paper provides a review of key current design guidelines for IVIS and ADAS with respect to the extent they address age-related changes in functional capacities. The review revealed that most of the HMI guidelines do not address design issues related to older driver impairments. In fact, in many guidelines driver age and sensory cognitive and physical impairments are not mentioned at all and where reference is made, it is typically very broad. Prescriptive advice on how to actually design a system so that it addresses the needs and limitations of older drivers is not provided. In order for older drivers to reap the full benefits that in-vehicle technology can afford, it is critical that further work establish how older driver limitations and capabilities can be supported by the system design process, including their inclusion into HMI design guidelines. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Contamination control engineering design guidelines for the aerospace community

    Science.gov (United States)

    Tribble, A. C. (Principal Investigator); Boyadjian, B.; Davis, J.; Haffner, J.; McCullough, E.

    1996-01-01

    Thermal control surfaces, solar arrays, and optical devices may be adversely affected by a small quantity of molecular and/or particulate contamination. What is rarely discussed is how one: (1) quantifies the level of contamination that must be maintained in order for the system to function properly, and (2) enforces contamination control to ensure compliance with requirements. This document is designed to address these specific issues and is intended to serve as a handbook on contamination control for the reader, illustrating process and methodology while providing direction to more detailed references when needed. The effects of molecular contamination on reflecting and transmitting surfaces are examined and quantified in accordance with MIL STD 1246C. The generation, transportation, and deposition of molecular contamination is reviewed and specific examples are worked to illustrate the process a design engineer can use to estimate end of life cleanliness levels required by solar arrays, thermal control surfaces, and optical surfaces. A similar process is used to describe the effect of particulate contamination as related to percent area coverage (PAC) and bi-directional reflectance distribution function (BRDF). Relationships between PAC and surface cleanliness, which include the effects of submicron sized particles, are developed and BRDF is related to specific sensor design parameters such as Point Source Transmittance (PST). The pros and cons of various methods of preventing, monitoring, and cleaning surfaces are examined and discussed.

  19. Pediatric procedural sedation and analgesia

    Directory of Open Access Journals (Sweden)

    Meredith James

    2008-01-01

    Full Text Available Procedural sedation and analgesia (PSA is an evolving field in pediatric emergency medicine. As new drugs breach the boundaries of anesthesia in the Pediatric Emergency Department, parents, patients, and physicians are finding new and more satisfactory methods of sedation. Short acting, rapid onset agents with little or no lingering effects and improved safety profiles are replacing archaic regimens. This article discusses the warning signs and areas of a patient′s medical history that are particularly pertinent to procedural sedation and the drugs used. The necessary equipment is detailed to provide the groundwork for implementing safe sedation in children. It is important for practitioners to familiarize themselves with a select few of the PSA drugs, rather than the entire list of sedatives. Those agents most relevant to PSA in the pediatric emergency department are presented.

  20. A proposal to develop a high temperature structural design guideline for HTGR components

    International Nuclear Information System (INIS)

    Hada, K.

    1989-01-01

    This paper presents some proposals for developing a high-temperature structural design guideline for HTGR structural components. It is appropriate that a basis for developing high-temperature structural design rules is rested on well-established elevated-temperature design guidelines, if the same failure modes are expected for high-temperature components as considered in such design guidelines. As for the applicability of ASME B and PV Code Case N-47 to structural design rules for high-temperature components (service temperatures ≥ 900 deg. C), the following critical issues on material properties and service life evaluation rules have been pointed out. (i) no work-hardening of stress-strain curves at high temperatures due to dynamic recrystallization; (ii) issues relating to very significant creep; (iii) ductility loss after long-term ageing at high temperatures; (iv) validity of life-fraction rule (Robinson-Taira rule) as creep-fatigue damage evaluation rule. Furthermore, the validity of design margins of elevated-temperature structural design guidelines to high-temperature design rules should be clarified. Solutions and proposals to these issues are presented in this paper. Concerning no work-hardening due to dynamic recrystallization, it is shown that viscous effects cannot be neglected even at high extension rate for tensile tests, and that changes in viscous deformation rates by dynamic recrystallization should be taken into account. The extension rate for tensile tests is proposed to change at high temperatures. The solutions and proposals to the above-mentioned issues lead to the conclusion that the design methodologies of N-47 are basically applicable to the high-temperature structural design guideline for HTGR structural components in service at about 900 deg. C. (author). 9 refs, 5 figs

  1. Molecular Orbital Based Design Guidelines for Hypergolic Energetic Ionic Liquids

    Science.gov (United States)

    2015-01-01

    energy content of the anion must also be taken into account in the design strategy ; substitution should be carried out in such a way that does not...substitution strategy . So far in the litera- ture, HP (with energy gap similar to DCA) is the lowest DHf anion (661.9 kJmol1) for which EIL hypergolicity...T. Nakajima, Y. Honda , O. Kitao, H. Nakai, M. Klene, X. Li, J. E. Knox, H. P. Hratchian, J. B. Cross, V. Bakken, C. Adamo, J. Jaramillo, R. Gomperts

  2. Guidelines for safe design of shipping packages against brittle fracture

    International Nuclear Information System (INIS)

    1993-08-01

    In 1992, the ninth meeting of the Standing Advisory Group on the Safe Transport of Radioactive Materials recommended the publication of this TECDOC in an effort to promote the widest debate on the criteria for the brittle fracture safe design of transport packages. The published IAEA advice on the influence of brittle fracture on material integrity is contained in Appendix IX of the Advisory Material for the IAEA Regulations for the Safety Transport of Radioactive Material (1985 Edition, as amended 1990), Safety Series No. 37. This guidance is limited in scope, dealing only with ferritic steels in general terms. It is becoming more common for designers to specify materials other than austenitic stainless steel for packaging components. The data on ferritic steels cannot be assumed to apply to other metals, hence the need for further guidance on the development of relationships describing material properties at low temperatures. The methods described in this TECDOC will be considered by the Revision Panel for inclusion in the 1996 Edition of the IAEA Regulations for the Safe Transport of Radioactive Material and the supporting documents. If accepted by the Revision Panel, this advice will be a candidate for upgrading to a Safety Practice. In the interim period, this TECDOC offers provisional advice on brittle fracture evaluation. It is acknowledged that, at this stage, the views expressed do not necessarily reflect those of the governments of Member States or organizations under whose auspices this manuscript was produced. Refs and figs

  3. Development of new canine and feline preventive healthcare guidelines designed to improve pet health.

    Science.gov (United States)

    2011-01-01

    The American Veterinary Medical Association (AVMA) and American Animal Hospital Association (AAHA) have jointly introduced the first Canine and Feline Preventive Healthcare Guidelines. These consensus statements provide veterinarians with a new resource for improving patient care by emphasizing the value and scope of regular pet examinations. The two guidelines provide complete recommendations for comprehensive preventive healthcare programs, published as accessible, single-page documents. The guidelines are based on the subjective-objective-assessment-plan (SOAP) methodology of case management, a proven approach traditionally used with sick or injured patients. This logical and disciplined process is equally applicable to healthy patients and is designed to consistently deliver optimal patient care. The guidelines recommend visits for health examinations on at least an annual basis, recognizing that for many pets, more frequent visits may be appropriate, depending on the individual needs of the patient. The guidelines also provide detailed diagnostic, therapeutic, prevention, and follow up plans, to be accompanied by appropriate documentation. The inclusive content and concise format of the guidelines are designed to maximize their practical value and make them easy to implement.

  4. Guidelines for the design of synchronous-type coilguns

    International Nuclear Information System (INIS)

    Levi, E.; He, J.L.; Zabar, Z.; Birenbaum, L.

    1991-01-01

    Smooth acceleration and evenly distributed mechanical and thermal stresses can be achieved in a coilgun type of electromagnetic launcher by the interaction between an electromagnetic wave-packet traveling along the barrel and a moving cylindrical conductor (sleeve) carrying a system of currents. The barrel consists of an array of cylindrical coils energized by polyphase currents; upon the sleeve is impressed a sinusoidal distribution of azimuthal currents. Design guides and scaling laws are developed for such a launcher. In this paper it is shown that muzzle velocities up to 10 km/s might be attainable with a barrel length of less than 15 m with high efficiencies. However, for velocities far in excess of that range, the need to maintain the physical integrity of solid armatures leads to barrel lengths which may be impractical for most applications

  5. Design Guideline for Primary Heat Exchanger in a Research Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sunil; Seo, Kyoung-Woo; Kim, Seong-Hoon; Chi, Dae-Young; Park, Cheol [KAERI, Daejeon (Korea, Republic of)

    2016-05-15

    In this paper, analytical study is conducted to track the variation of the PCS outlet temperature in conditions of the constant core power and constant SCS inlet temperature. The PCS circulates demineralized water to remove the heat generated in reactor core. The heat is transferred to the cold water of the SCS through the primary heat exchanger. In JRTR, Plate-type Heat Exchanger (PHE) was used as the primary heat exchanger. The cooling tower automatically sets the SCS inlet temperature constant by fan speed control. The flow rate of SCS is adjusted to be identical with the PCS flow rate. To design the PHE, the inlet and outlet temperatures and the flow rates for both systems should be determined. The flow rate has the allowable band for the safe operation from the lower limit to upper limit resulting in different temperature distribution in the PHE. Specially, the PCS outlet temperature which is the core inlet temperature is used for a safety parameter for the reactor shutdown. Therefore, we need to figure out which limit for the flow rate should be used from the conservative point of view. At 200 kg/s of PCS and SCS flow rates, the inlet and outlet temperatures are 41.3℃and 34℃, respectively. With increase of the flow rate, both of PCS inlet and outlet temperatures decrease to 33.6℃ and 39.9℃. This result means the low limit of the allowable flow band should be used for the conservative design of primary heat exchanger. If the upper limit of the allowable flow band is used, the PCS outlet temperature which is the safety parameter used for the reactor shutdown increases with decrease of the flow rate.

  6. Design Guideline for Primary Heat Exchanger in a Research Reactor

    International Nuclear Information System (INIS)

    Lee, Sunil; Seo, Kyoung-Woo; Kim, Seong-Hoon; Chi, Dae-Young; Park, Cheol

    2016-01-01

    In this paper, analytical study is conducted to track the variation of the PCS outlet temperature in conditions of the constant core power and constant SCS inlet temperature. The PCS circulates demineralized water to remove the heat generated in reactor core. The heat is transferred to the cold water of the SCS through the primary heat exchanger. In JRTR, Plate-type Heat Exchanger (PHE) was used as the primary heat exchanger. The cooling tower automatically sets the SCS inlet temperature constant by fan speed control. The flow rate of SCS is adjusted to be identical with the PCS flow rate. To design the PHE, the inlet and outlet temperatures and the flow rates for both systems should be determined. The flow rate has the allowable band for the safe operation from the lower limit to upper limit resulting in different temperature distribution in the PHE. Specially, the PCS outlet temperature which is the core inlet temperature is used for a safety parameter for the reactor shutdown. Therefore, we need to figure out which limit for the flow rate should be used from the conservative point of view. At 200 kg/s of PCS and SCS flow rates, the inlet and outlet temperatures are 41.3℃and 34℃, respectively. With increase of the flow rate, both of PCS inlet and outlet temperatures decrease to 33.6℃ and 39.9℃. This result means the low limit of the allowable flow band should be used for the conservative design of primary heat exchanger. If the upper limit of the allowable flow band is used, the PCS outlet temperature which is the safety parameter used for the reactor shutdown increases with decrease of the flow rate

  7. Human factors design review guidelines for advanced nuclear control room technologies

    International Nuclear Information System (INIS)

    O'Hara, J.; Brown, W.; Granda, T.; Baker, C.

    1991-01-01

    Advanced control rooms (ACRs) for future nuclear power plants are being designed utilizing computer-based technologies. The US Nuclear Regulatory Commission reviews the human engineering aspects of such control rooms to ensure that they are designed to good human factors engineering principles and that operator performance and reliability are appropriately supported in order to protect public health and safety. This paper describes the rationale, general approach, and initial development of an NRC Advanced Control Room Design Review Guideline. 20 refs., 1 fig

  8. Quality of care in palliative sedation: audit and compliance monitoring of a clinical protocol.

    Science.gov (United States)

    Benitez-Rosario, Miguel Angel; Castillo-Padrós, Manuel; Garrido-Bernet, Belén; Ascanio-León, Belen

    2012-10-01

    The European Association for Palliative Care and the U.S. National Hospice and Palliative Care Organization have published statements that recommend an audit of palliative sedation practices. The aim was to assess the feasibility of a quality care project in palliative sedation. We carried out an audit of adherence to a guideline regarding palliative sedation, undertaken as a yearly assessment during two years, of a sample of patient charts. With an audit tool, the charts were evaluated as to the presence of the ethical sedation checklist, information that justified palliative sedation, patient and/or family agreement, and the appropriateness of treatment in concordance with the clinical protocol. An educational program and result feedback meetings were used as the implementation strategy. Roughly 25% of the medical charts of patients who died in the palliative care unit were evaluated, 94 in 2007 and 110 in 2008. In 2007 and 2008, 63% and 57% of the patients, respectively, whose median age was 65 years, were sedated, with a median length of two days. The main reason for sedation was agitation concomitant with respiratory failure in roughly 60% and 75% of the cases in 2007 and 2008, respectively. Agreement of the patient/family about sedation was collected from 100% of the cases. The concordance of procedures with the sedation guideline was 100% in both years. Our quality-of-care strategy was shown to obtain a higher level of compliance with the palliative sedation guideline for at least two years. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  9. Requirements and Design Guidelines for a Trusted Hypervisor Interface

    Science.gov (United States)

    Weber, Dirk; Weber, Arnd; Presti, Stéphane Lo

    Hypervisor technology in combination with tamper-resistant hardware such as Trusted Platform Modules has the potential of providing a significant new level of security for computers. These new systems will be able to protect legacy applications from applications such as malware, and they will enable the creation of new secure applications. This paper analyses the requirements for the graphical user interface (GUI) of such a system. First, application scenarios are presented to illustrate how extended Trusted Computing (TC) systems might be used in the future. Requirements for a trusted GUI are then derived from the analysis of articles on TC found in the media and from a survey of experts in information technology. These requirements are compared to existing proposals, showing how some of them are either inconvenient or insecure in the hands of end users. Based on this analysis, proposals are derived for the design of a trusted GUI suitable for laypersons and administrators, which uses familiar patterns, and yet protects against visual mimicry attacks. These proposals pave the way for hypervisors’ security-enhanced GUI.

  10. Review of palliative sedation and its distinction from euthanasia and lethal injection.

    Science.gov (United States)

    Hahn, Michael P

    2012-01-01

    Palliative sedation evolved from within the practice of palliative medicine and has become adopted by other areas of medicine, such as within intensive care practice. Clinician's usually come across this practice for dying patients who are foregoing or having life support terminated. A number of intolerable and intractable symptom burdens can occur during the end of life period that may require the use of palliative sedation. Furthermore, when patients receive palliative sedation, the continued use of hydration and nutrition becomes an issue of consideration and there are contentious bioethical issues involved in using or withholding these life-sustaining provisions. A general understanding of biomedical ethics helps prevent abuse in the practice of palliative sedation. Various sedative drugs can be employed in the provision of palliative sedation that can produce any desired effect, from light sedation to complete unconsciousness. Although there are some similarities in the pharmacotherapy of palliative sedation, euthanasia, physician-assisted suicide, and lethal injection, there is a difference in how the drugs are administered with each practice. There are some published guidelines about how palliative sedation should be practiced, but currently there is not any universally accepted standard of practice.

  11. Nuclear waste repository in basalt: preconceptual design guidelines

    International Nuclear Information System (INIS)

    1979-06-01

    The development of the basalt waste isolation program parallels the growing need for permanent, environmentally safe, and secure means to store nuclear wastes. The repository will be located within the Columbia Plateau basalt formations where these ends can be met and radiological waste can be stored. These wastes will be stored such that the wastes may be retrieved from storage for a period after placement. After the retrieval period, the storage locations will be prepared for terminal storage. The terminal storage requirements will include decommissioning provisions. The facility boundaries will encompass no more than several square miles of land which will be above a subsurface area where the geologic makeup is primarily deep basaltic rock. The repository will receive, from an encapsulation site(s), nuclear waste in the form of canisters (not more than 18.5 feet x 16 inches in diameter) and containers (55-gallon drums). Canisters will contain spent fuel (after an interim 5-year storage period), solidified high-level wastes (HLW), or intermediate-level wastes (ILW). The containers (drums) will package the low-level transuranic wastes (LL-TRU). The storage capacity of the repository will be expanded in a time-phased program which will require that subsurface development (repository expansion) be conducted concurrently with waste storage operations. The repository will be designed to store the nuclear waste generated within the predictable future and to allow for reasonable expansion. The development and assurance of safe waste isolation is of paramount importance. All activities will be dedicated to the protection of public health and the environment. The repository will be licensed by the US Nuclear Regulatory Commission (NRC). Extensive efforts will be made to assure selection of a suitable site which will provide adequate isolation

  12. Nuclear waste repository in basalt: preconceptual design guidelines

    Energy Technology Data Exchange (ETDEWEB)

    1979-06-01

    The development of the basalt waste isolation program parallels the growing need for permanent, environmentally safe, and secure means to store nuclear wastes. The repository will be located within the Columbia Plateau basalt formations where these ends can be met and radiological waste can be stored. These wastes will be stored such that the wastes may be retrieved from storage for a period after placement. After the retrieval period, the storage locations will be prepared for terminal storage. The terminal storage requirements will include decommissioning provisions. The facility boundaries will encompass no more than several square miles of land which will be above a subsurface area where the geologic makeup is primarily deep basaltic rock. The repository will receive, from an encapsulation site(s), nuclear waste in the form of canisters (not more than 18.5 feet x 16 inches in diameter) and containers (55-gallon drums). Canisters will contain spent fuel (after an interim 5-year storage period), solidified high-level wastes (HLW), or intermediate-level wastes (ILW). The containers (drums) will package the low-level transuranic wastes (LL-TRU). The storage capacity of the repository will be expanded in a time-phased program which will require that subsurface development (repository expansion) be conducted concurrently with waste storage operations. The repository will be designed to store the nuclear waste generated within the predictable future and to allow for reasonable expansion. The development and assurance of safe waste isolation is of paramount importance. All activities will be dedicated to the protection of public health and the environment. The repository will be licensed by the US Nuclear Regulatory Commission (NRC). Extensive efforts will be made to assure selection of a suitable site which will provide adequate isolation.

  13. Palliative sedation for intolerable suffering.

    Science.gov (United States)

    Maltoni, Marco; Scarpi, Emanuela; Nanni, Oriana

    2014-07-01

    The purpose of this review is to provide an update on palliative sedation in palliative and end-of-life care. Palliative sedation is the medical procedure used to deal with refractory symptoms in advanced cancer patients when all other specific approaches have failed. Palliative sedation, in the strictest sense of the term, is a proportionate (proportionate palliative sedation, PPS) and intrinsically variable procedure used on an individual basis to relieve refractory symptoms in terminally ill patients, without the intention of hastening death. Completely separate from any other end-of-life decision and not intended to hasten death, palliative sedation has been shown not to have a detrimental impact on survival. To maintain palliative sedation as a legitimate clinical procedure from any ethical or clinical point of view, it must be limited to the restricted area for which it was conceived, that is, relief from refractory suffering as deemed necessary by a patient and by an experienced palliative care team. In this way, there is no risk of associating palliative sedation with other end-of-life decisions. Close collaboration is needed between oncologists and palliative care physicians for this clinical procedure.

  14. A systematic literature review on the ethics of palliative sedation: an update (2016).

    Science.gov (United States)

    Henry, Blair

    2016-09-01

    Palliative sedation has been the subject of intensive debate since its first appearance in 1990. In a 2010 review of palliative sedation, the following areas were identified as lacking in consensus: inconsistent terminology, its use in nonphysical suffering, the ongoing experience of distress, and concern that the practice of palliative sedation may hasten death. This review looks at the literature over the past 6 years and provides an update on these outstanding concerns. Good clinical guidelines and policies are still required to address issues of emotional distress and waylay concerns that palliative sedation hastens death. The empirical evidence suggests some movement toward consensus on the practice of palliative sedation. However, a continued need exists for evidence-informed practice guidelines, education, and research to support the ethical practice of palliative sedation at the end of life. Until that time, clinicians are advised to adopt a framework or guideline that has been expert driven to ensure consistent and ethical use of palliative sedation at the end of life.

  15. Dissociations in the expression of the sedative effects of triazolam.

    Science.gov (United States)

    Weingartner, H J; Sirocco, K; Rawlings, R; Joyce, E; Hommer, D

    1995-05-01

    Fifteen normal volunteers were administered 0.250, 0.375, and 0.500 mg of triazolam and placebo in a double-blind repeated measures cross-over design. Subjects demonstrated dose-dependent impairments in free recall, a test of explicit memory requiring awareness and reflection, and sedation as assessed by objective behavioral measures (the digit symbol substitution task) and subjective visual analogue scales. The sedative drug response did not account for the impairment in free recall. Differences in performance of the two tests of sedation indicated that the effect of this drug on reflective processes accounts for impairment in episodic memory and the inability to track the sedative effects of this drug at the higher doses tested in this study.

  16. DOE (Department of Energy) natural phenomena guidelines earthquake design and evaluation

    International Nuclear Information System (INIS)

    Short, S.A.; Murray, R.C.; Kennedy, R.P.

    1989-01-01

    Design and evaluation guidelines for DOE (Department of Energy) facilities subjected to earthquake, wind/tornado, and flood have been developed. This paper describes the philosophy and procedures fr the design or evaluation of facilities for earthquake ground shaking. The guidelines are intended to meet probabilistic-based performance goals expressed in terms of annual probability of exceedance of some level of structural damage. Meeting performance goals can be accomplished by specifying hazard probabilities of exceedance along with seismic behavior evaluation procedures in which the level of conservatism introduced is controlled such that desired performance can be achieved. Limited inelastic behavior is permitted by permitting demand determined from elastic response spectrum analyses to exceed capacity by an allowable inelastic demand-capacity ratio specified in the guidelines for different materials and construction

  17. Keeping Kids Safe from a Design Perspective: Ethical and Legal Guidelines for Designing a Video-Based App for Children

    Science.gov (United States)

    Zydney, Janet Mannheimer; Hooper, Simon

    2015-01-01

    Educators can use video to gain invaluable information about their students. A concern is that collecting videos online can create an increased security risk for children. The purpose of this article is to provide ethical and legal guidelines for designing video-based apps for mobile devices and the web. By reviewing the literature, law, and code…

  18. Safety Standard for Oxygen and Oxygen Systems: Guidelines for Oxygen System Design, Materials Selection, Operations, Storage, and Transportation

    Science.gov (United States)

    1996-01-01

    NASA's standard for oxygen system design, materials selection, operation, and transportation is presented. Minimum guidelines applicable to NASA Headquarters and all NASA Field Installations are contained.

  19. Colour Size Illusion on Liquid Crystal Displays and Design Guidelines for Bioinformatics Tools

    Science.gov (United States)

    Yoo, Hyun Seung; Smith-Jackson, Tonya L.

    2011-01-01

    Although the influence of colour on size perception has been known for a century, there is only limited research on interventions that can reduce this effect. This study was therefore undertaken in order to identify appropriate interventions and propose design guidelines for information visualisation, especially in applications where size…

  20. Design guidelines for self-assessment support for adult academic distance learning

    NARCIS (Netherlands)

    Menendez Blanco, Maria; Van der Veer, Gerrit; Benvenuti, Laura; Kirschner, Paul A.

    2011-01-01

    Menendez Blanco, M., Van der Veer, G., Benvenuti, L., & Kirschner, P. A. (2011). Design guidelines for self-assessment support for adult academic distance learning. In H-J Shalin (Ed.), Constructing self-discovery learning spaces online: scaffolding and decision making technologies (pp. 169-198).

  1. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    NARCIS (Netherlands)

    Blanker, M.H.; Koerhuis-Roessink, M.; Swart, S.J.; Zuurmond, W.W.A.; van der Heide, A.; Perez, R.S.G.M.; Rietjens, J.A.C.

    2012-01-01

    Background: Little is known about pressure from patients or relatives on physician's decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using

  2. Review of revised Japanese seismic guidelines for Nuclear Power Plant design

    International Nuclear Information System (INIS)

    Kato, M.

    1987-01-01

    Development of aseismic design for nuclear power plants in Japan has evolved roughly in three stages. The first phase, which continued by 1978, was a period progressive development when design for each siteplant has referred to designs of predecessor plants and have added the latest knowledge and experience in that time. The second phase from issuance of 'Regulatory Guide for Aseismic Design of Nuclear Power Reactor Facilities' (1978, revised in 1981), or 1978 to 1986, was a period when the application of customary conservative design method was continued, while standardization of the aseismic design technology have been proceded. It is in this phase when new knowledge was accumulated by aseismic proof studies. The third phase represents a transient period to rational design when the conservative aseismic design technology has been reviewed due to the new knowledge and revision of the above JEAG guideline has progressed for incorporation in design, and ont the other hand by-laws of the Ministry of International Trade and Industry are being provided. In this report a review is given of aseismic design and its guideline after the second phase onward and an overview of the revised JEAG - Recent Aseismic Design Method - and the by-laws including rationalization of aseismic design technology

  3. The selection of low-risk design guidelines for energetic events

    International Nuclear Information System (INIS)

    Fergusson, Donald; Marchaterre, John; Graham, John

    1982-01-01

    This paper recommends the establishment of specific design guidelines for protection against potential, but low probability, energetic events. These guidelines recognize the plant protective features incorporated to prevents such events, as well as the inherent capability of the plant to accommodate a certain level of energy release. Further, their application is recommended within the context of necessary standardized and agreed upon acceptance criteria which are less restrictive than ASME code requirements. The paper provides the background upon which the selection of the design is made, including the characterization of energetic events dependent on various core-design parameters, and including the necessity of a low-risk design balanced between prevention of accidents and the mitigation of consequences

  4. Revised guideline for the approval procedure of package designs in Germany

    International Nuclear Information System (INIS)

    Nitsche, F.; Roedel, R.

    2004-01-01

    The IAEA Regulations for the Safe Transport of Radioactive Material, TS-R-1 are applied in Germany through the implementation of the Dangerous Goods Transport Regulations for class 7 of the International Modal Organisations (ADR, RID, IMDG-Code, ICAO-TI). Based on this the approval procedures for packages designs applied in Germany are in compliance with the provisions of TS-R-1. The Guideline R 003 issued by the Ministry of Transport, Building and Housing (BMVBW) in 1991 is the basis for the package design approval procedures in Germany. This Guideline has been reviewed and revised to reflect latest developments in the regulations as well as in the regulatory practice. In particular it has been extended to the approval procedures of Type C packages, packages subject to transitional arrangements, special form and low dispersible radioactive material and provides more detailed information to the applicant about the requested documentation. Publication of this revised guideline has been delayed but it is expected to take place in October 2004. The paper gives an overview about the main parts and provisions of this revised Guideline R 003 with the focus on package design approval procedures

  5. Intranasal sedatives in pediatric dentistry

    Science.gov (United States)

    AlSarheed, Maha A.

    2016-01-01

    Objectives: To identify the intranasal (IN) sedatives used to achieve conscious sedation during dental procedures amongst children. Methods: A literature review was conducted by identifying relevant studies through searches on Medline. Search included IN of midazolam, ketamine, sufentanil, dexmedetomidine, clonidine, haloperidol and loranzepam. Studies included were conducted amongst individuals below 18 years, published in English, and were not restricted by year. Exclusion criteria were articles that did not focus on pediatric dentistry. Results: Twenty studies were included. The most commonly used sedatives were midazolam, followed by ketamine and sufentanil. Onset of action for IN midazolam was 5-15 minutes (min), however, IN ketamine was faster (mean 5.74 min), while both IN sufentanil (mean 20 min) and IN dexmedetomidine (mean 25 min) were slow in comparison. Midazolam was effective for modifying behavior in mild to moderately anxious children, however, for more invasive or prolonged procedures, stronger sedatives, such as IN ketamine, IN sufentanil were recommended. In addition, ketamine fared better in overall success rate (89%) when compared with IN midazolam (69%). Intranasal dexmedetomidine was only used as pre-medication amongst children. While its’ onset of action is longer when compared with IN midazolam, it produced deeper sedation at the time of separation from the parent and at the time of anesthesia induction. Conclusion: Intranasal midazolam, ketamine and sufentanil are effective and safe for conscious sedation, while intranasal midazolam, dexmedetomidine and sufentanil have proven to be effective premedications. PMID:27570849

  6. Increase in palliative sedation and reasons in cancer patients in Dutch general practice 2005–2014.

    OpenAIRE

    Donker, G.A.; Dijk, C.E. van

    2015-01-01

    Background: Little is known about the quantity and reasons for use of palliative sedation in cancer patients in general practice and the reason to apply palliative sedation when a request for euthanasia was pending. Aim: To gain more insight into the reasons for palliative sedation at the end of life, also when a request for euthanasia was pending in cancer patients in Dutch general practice. Design and setting: Dynamic cohort study using registrations and questionnaire data of Dutch GPs. Met...

  7. Opinions of the Dutch public on palliative sedation: a mixed-methods approach.

    Science.gov (United States)

    van der Kallen, Hilde T H; Raijmakers, Natasja J H; Rietjens, Judith A C; van der Male, Alex A; Bueving, Herman J; van Delden, Johannes J M; van der Heide, Agnes

    2013-10-01

    Palliative sedation is defined as deliberately lowering a patient's consciousness, to relieve intolerable suffering from refractory symptoms at the end of life. Palliative sedation is considered a last resort intervention in end-of-life care that should not be confused with euthanasia. To inform healthcare professionals about attitudes of the general public regarding palliative sedation. design and setting: A cross-sectional survey among members of the Dutch general public followed by qualitative interviews. One thousand nine hundred and sixty members of the general public completed the questionnaire, which included a vignette describing palliative sedation (response rate 78%); 16 participants were interviewed. In total, 22% of the responders indicated knowing the term 'palliative sedation'. Qualitative data showed a variety of interpretations of the term. Eighty-one per cent of the responders agreed with the provision of sedatives as described in a vignette of a patient with untreatable pain and a life expectancy of sedatives to alleviate his suffering. This percentage was somewhat lower for a patient with a life expectancy of sedatives with the aim of ending the patient's life (79%, P = 0.54). Most of the general public accept the use of palliative sedation at the end of life, regardless of a potential life-shortening effect. However, confusion exists about what palliative sedation represents. This should be taken into account by healthcare professionals when communicating with patients and their relatives on end-of-life care options.

  8. Building Design Guidelines for Interior Architecture Concerned with Animal Researches Facilities

    International Nuclear Information System (INIS)

    ElDib, A.A. E.

    2014-01-01

    This paper discusses the most important design guidelines elements and characteristics for animal facilities, in order to achieve and maintain highest efficiency can be, with respect to the pivot role of Interior Architecture as one of the accurate specializations for completing the Architectural Sciences, for designer/s concerned with those types of facilities, (specially those using radioactive materials). These building types known as vivariums, are specially designed, accommodating and having sophisticated controlled environments for the care and maintenance of experimental animals, and are related to, but distinct from other research laboratories premises

  9. Design and evaluation guidelines for Department of Energy facilities subjected to natural phenomena hazards

    International Nuclear Information System (INIS)

    Kennedy, R.P.; Short, S.A.; McDonald, J.R.; McCann, M.W. Jr.; Murray, R.C.; Hill, J.R.

    1990-06-01

    The Department of Energy (DOE) and the DOE Natural Phenomena Hazards Panel have developed uniform design and evaluation guidelines for protection against natural phenomena hazards at DOE sites throughout the United States. The goal of the guidelines is to assure that DOE facilities can withstand the effects of natural phenomena such as earthquakes, extreme winds, tornadoes, and flooding. The guidelines apply to both new facilities (design) and existing facilities (evaluation, modification, and upgrading). The intended audience is primarily the civil/structural or mechanical engineers conducting the design or evaluation of DOE facilities. The likelihood of occurrence of natural phenomena hazards at each DOE site has been evaluated by the DOE Natural Phenomena Hazard Program. Probabilistic hazard models are available for earthquake, extreme wind/tornado, and flood. Alternatively, site organizations are encouraged to develop site-specific hazard models utilizing the most recent information and techniques available. In this document, performance goals and natural hazard levels are expressed in probabilistic terms, and design and evaluation procedures are presented in deterministic terms. Design/evaluation procedures conform closely to common standard practices so that the procedures will be easily understood by most engineers. Performance goals are expressed in terms of structure or equipment damage to the extent that: (1) the facility cannot function; (2) the facility would need to be replaced; or (3) personnel are endangered. 82 refs., 12 figs., 18 tabs

  10. Design and evaluation guidelines for Department of Energy facilities subjected to natural phenomena hazards

    Energy Technology Data Exchange (ETDEWEB)

    Kennedy, R.P. (Structural Mechanics Consulting, Inc., Yorba Linda, CA (USA)); Short, S.A. (ABB Impell Corp., Mission Viejo, CA (USA)); McDonald, J.R. (Texas Tech Univ., Lubbock, TX (USA)); McCann, M.W. Jr. (Benjamin (J.R.) and Associates, Inc., Mountain View, CA (USA)); Murray, R.C. (Lawrence Livermore National Lab., CA (USA)); Hill, J.R. (USDOE Assistant Secretary for Environment, Safety, and He

    1990-06-01

    The Department of Energy (DOE) and the DOE Natural Phenomena Hazards Panel have developed uniform design and evaluation guidelines for protection against natural phenomena hazards at DOE sites throughout the United States. The goal of the guidelines is to assure that DOE facilities can withstand the effects of natural phenomena such as earthquakes, extreme winds, tornadoes, and flooding. The guidelines apply to both new facilities (design) and existing facilities (evaluation, modification, and upgrading). The intended audience is primarily the civil/structural or mechanical engineers conducting the design or evaluation of DOE facilities. The likelihood of occurrence of natural phenomena hazards at each DOE site has been evaluated by the DOE Natural Phenomena Hazard Program. Probabilistic hazard models are available for earthquake, extreme wind/tornado, and flood. Alternatively, site organizations are encouraged to develop site-specific hazard models utilizing the most recent information and techniques available. In this document, performance goals and natural hazard levels are expressed in probabilistic terms, and design and evaluation procedures are presented in deterministic terms. Design/evaluation procedures conform closely to common standard practices so that the procedures will be easily understood by most engineers. Performance goals are expressed in terms of structure or equipment damage to the extent that: (1) the facility cannot function; (2) the facility would need to be replaced; or (3) personnel are endangered. 82 refs., 12 figs., 18 tabs.

  11. Anxiety in Children Undergoing VCUG: Sedation or No Sedation?

    Directory of Open Access Journals (Sweden)

    David W. Herd

    2008-01-01

    Full Text Available Background. Voiding cystourethrograms are distressing for children and parents. Nonpharmacological methods reduce distress. Pharmacological interventions for VCUG focus on sedation as well as analgesia, anxiolysis, and amnesia. Sedation has cost, time, and safety issues. Which agents and route should we use? Are we sure that sedation does not influence the ability to diagnose vesicoureteric reflux? Methods. Literature search of Medline, EMBASE, and the Cochrane Database. Review of comparative studies found. Results. Seven comparative studies including two randomised controlled trials were reviewed. Midazolam given orally (0.5-0.6 mg/kg or intranasally (0.2 mg/kg is effective with no apparent effect on voiding dynamics. Insufficient evidence to recommend other sedating agents was found. Deeper sedating agents may interfere with voiding dynamics. Conclusion. Midazolam reduces the VCUG distress, causes amnesia, and does not appear to interfere with voiding dynamics. Midazolam combined with simple analgesia is an effective method to reduce distress to children undergoing VCUG.

  12. Palliative sedation in advanced cancer patients hospitalized in a specialized palliative care unit.

    Science.gov (United States)

    Parra Palacio, Santiago; Giraldo Hoyos, Clara Elisa; Arias Rodríguez, Camilo; Mejía Arrieta, Daniel; Vargas Gómez, John Jairo; Krikorian, Alicia

    2018-03-29

    To describe the practice of palliative sedation (PS) in patients with advanced cancer in a specialized palliative care (PC) unit in Colombia. Descriptive prospective study including all adults with cancer hospitalized under PS in a cancer institute between January and July 2015 in Colombia. Variables examined were diagnosis, physical functioning, symptoms at the start of sedation, medications and dosages used, and type, level, and time of sedation. Descriptive and correlational statistics were obtained. Sixty-six patients were included, 70% of which were women. The patients had an average age of 61 years (range 24-87), and 74% had a Karnofsky Index (KI) of 50% or less. The most frequent diagnosis was breast cancer (22%), and 82% had metastatic cancer. The prevalence of palliative sedation was 2% and the most common symptoms indicating it were dyspnea (59%), delirium (45%), and pain (32%). All patients received midazolam as a sedative. The average time between the interval start and culmination of sedation was 44 h. There was a significant and inverse relationship between functionality and time under sedation. Palliative sedation is a valid therapeutic option for refractory symptoms causing suffering. The results correspond to international reports and guidelines, which suggests that PS is tailored to the needs of the individual patient while maintaining a high scientific standard, even in a context where PC is under development. However, further development of strategies and clear indications towards the use of PS in Colombia are needed, given its still scarce use.

  13. Reducing aquatic hazards of industrial chemicals: probabilistic assessment of sustainable molecular design guidelines.

    Science.gov (United States)

    Connors, Kristin A; Voutchkova-Kostal, Adelina M; Kostal, Jakub; Anastas, Paul; Zimmerman, Julie B; Brooks, Bryan W

    2014-08-01

    Basic toxicological information is lacking for the majority of industrial chemicals. In addition to increasing empirical toxicity data through additional testing, prospective computational approaches to drug development aim to serve as a rational basis for the design of chemicals with reduced toxicity. Recent work has resulted in the derivation of a "rule of 2," wherein chemicals with an octanol-water partition coefficient (log P) less than 2 and a difference between the lowest unoccupied molecular orbital and the highest occupied molecular orbital (ΔE) greater than 9 (log P9 eV) are predicted to be 4 to 5 times less likely to elicit acute or chronic toxicity to model aquatic organisms. The present study examines potential reduction of aquatic toxicity hazards from industrial chemicals if these 2 molecular design guidelines were employed. Probabilistic hazard assessment approaches were used to model the likelihood of encountering industrial chemicals exceeding toxicological categories of concern both with and without the rule of 2. Modeling predicted that utilization of these molecular design guidelines for log P and ΔE would appreciably decrease the number of chemicals that would be designated to be of "high" and "very high" concern for acute and chronic toxicity to standard model aquatic organisms and end points as defined by the US Environmental Protection Agency. For example, 14.5% of chemicals were categorized as having high and very high acute toxicity to the fathead minnow model, whereas only 3.3% of chemicals conforming to the design guidelines were predicted to be in these categories. Considerations of specific chemical classes (e.g., aldehydes), chemical attributes (e.g., ionization), and adverse outcome pathways in representative species (e.g., receptor-mediated responses) could be used to derive future property guidelines for broader classes of contaminants. © 2014 SETAC.

  14. Guidelines for the development of natural phenomena hazards design criteria for surface facilities

    International Nuclear Information System (INIS)

    Nelson, T.A.; Hossain, Q.A.; Murray, R.C.

    1992-01-01

    This paper discusses the rationale behind the guidelines, criteria, and methodologies that are currently used for natural phenomena hazard design and evaluation of DOE nuclear and non-nuclear facilities. The bases for the performance goals and usage categories specified in UCRL-15910 are examined, and the sources of intentional conservatism in the analyses, design, and evaluation methods and criteria are identified. Outlines of recent developments/changes in DOE Orders related to Natural Phenomena hazard mitigation are also presented. Finally, the authors recommend the use of DOE methodologies as embodied in UCRL-15910 for design and evaluation of surface facilities of the high level nuclear waste repository site

  15. Clean air program : design guidelines for bus transit systems using compressed natural gas as an alternative fuel

    Science.gov (United States)

    1996-06-01

    This report documents design guidelines for the safe use of Compressed Natural Gas (CNG). The report is designed to provide guidance, information on safe industry practices, applicable national codes and standards, and reference data that transit age...

  16. Cognitive Effects and Sedation.

    Science.gov (United States)

    Dhingra, Lara; Ahmed, Ebtesam; Shin, Jae; Scharaga, Elyssa; Magun, Maximilian

    2015-10-01

    Cognitive effects and sedation (CES) are prevalent in chronic nonmalignant pain populations receiving long-term opioid therapy and are among the most common reasons patients discontinue opioid use. In this narrative review, we describe the phenomenology, epidemiology, mechanisms, assessment, and management of opioid-related CES. We reviewed the empirical and theoretical literature on CES in opioid-treated populations with chronic pain. Data on long-term opioid therapy (≥ 3 months in duration) in chronic nonmalignant pain patients were sought. The phenomenology of CES includes: inattention, concentration difficulties, memory deficits, psychomotor dysfunction, perceptual distortions, and executive dysfunction and somnolence, sleep disorders, and lethargy. Deficits may be caused by unrelieved pain or opioid therapy alone, or from a combination of these and other factors. Mechanisms include central nervous system effects, for example, direct toxic effects on neurons resulting in decreased consciousness; direct effects on processing and reaction resulting in cognitive or psychomotor impairment, and inhibitory effects on cholinergic activity. Pharmacological management approaches may include opioid dose reduction and rotation or psychostimulant use. Nonpharmacological approaches may include cognitive-behavioral therapy, mindfulness-based stress reduction, acupuncture, exercise, and yoga. The most prevalent CES include: memory deficits (73-81%), sleep disturbance (35-57%), and fatigue (10%). At its most severe, extreme cognitive dysfunction can result in frank delirium and decreased alertness can result in coma. Emotional distress, sleep disorders, and other comorbidities and treatments can worsen CES, particularly among the elderly. Conclusions about the neuropsychological domains affected by opioids are limited due to the heterogeneity of studies and methodological issues. Wiley Periodicals, Inc.

  17. Practical Design Guidelines of qZSI Based Step-Up DC/DC Converter

    Science.gov (United States)

    Zakis, Janis; Vinnikov, Dmitri; Roasto, Indrek; Jalakas, Tanel

    2010-01-01

    This paper presents some design guidelines for a new voltage fed step-up DC/DC isolated converter. The most significant advantage of proposed converter is voltage buck-boost operation on single stage. The most promising application for proposed converter is in the field of distributed power generation e.g. fuel cells or photovoltaic. The most sensitive issues - such as power losses caused by high currents in the input side of converter and high transient overvoltages across the inverter bridge caused by stray inductances were discussed and solved. The proposals and recommendations to overcome these issues are given in the paper. The Selection and design guidelines of converter elements are proposed and explained. The prototype of proposed converter was built and experimentally tested. Some results are presented and evaluated.

  18. Modeling and Design Guidelines for P⁺ Guard Rings in Lightly Doped CMOS Substrates

    DEFF Research Database (Denmark)

    Shen, Ming; Mikkelsen, Jan H.; Zhang, Ke

    2013-01-01

    of ${rm P}^{+}$ guard rings in terms of S-parameters, which is useful for substrate noise mitigation in mixed-signal system-on-chips. Validation of the model has been done by both electromagnetic simulation and experimental results from guard rings implemented using a standard 0.18-$mu{rm m}$ CMOS process....... In addition, design guidelines have been drawn for minimizing the guard ring size while maintaining the noise suppression performance....

  19. Design as if people matter: aesthetic guidelines for the wind industry

    International Nuclear Information System (INIS)

    Gipe, P.

    1995-01-01

    Opinion surveys show that wind has high public support, but a worrisome NIMBY factor. This support erodes once specific projects are proposed. Because support is fragile and can be squandered by ill-conceived projects, the industry must do everything it can to ensure that wind turbines and wind power plants become good neighbours. One means of maximizing acceptance is to incorporate aesthetic guidelines into the design of wind turbines and wind power plants. (Author)

  20. Conducting wine marketing research with impact in China: Guidelines for design, execution and dissemination

    OpenAIRE

    Justin Cohen; Larry Lockshin

    2017-01-01

    China is the fastest growing wine market, but conducting research there is fraught with a variety of issues. This article explores some of the issues the authors have dealt with in conducting wine marketing research in China over the last five years. We discuss issues with the design of research to focus on important issues for both academics and the industry. We relate the key problems in gaining proper translation and useful sampling procedures. Finally, we provide some guidelines for commu...

  1. The risk of shorter fasting time for pediatric deep sedation.

    Science.gov (United States)

    Clark, Mathew; Birisci, Esma; Anderson, Jordan E; Anliker, Christina M; Bryant, Micheal A; Downs, Craig; Dalabih, Abdallah

    2016-01-01

    Current guidelines adopted by the American Academy of Pediatrics calls for prolonged fasting times before performing pediatric procedural sedation and analgesia (PSA). PSA is increasingly provided to children outside of the operating theater by sedation trained pediatric providers and does not require airway manipulation. We investigated the safety of a shorter fasting time compared to a longer and guideline compliant fasting time. We tried to identify the association between fasting time and sedation-related complications. This is a prospective observational study that included children 2 months to 18 years of age and had an American Society of Anesthesiologists physical status classification of I or II, who underwent deep sedation for elective procedures, performed by pediatric critical care providers. Procedures included radiologic imaging studies, electroencephalograms, auditory brainstem response, echocardiograms, Botox injections, and other minor surgical procedures. Subjects were divided into two groups depending on the length of their fasting time (4-6 h and >6 h). Complication rates were calculated and compared between the three groups. In the studied group of 2487 subjects, 1007 (40.5%) had fasting time of 4-6 h and the remaining 1480 (59.5%) subjects had fasted for >6 h. There were no statistically significant differences in any of the studied complications between the two groups. This study found no difference in complication rate in regard to the fasting time among our subjects cohort, which included only healthy children receiving elective procedures performed by sedation trained pediatric critical care providers. This suggests that using shorter fasting time may be safe for procedures performed outside of the operating theater that does not involve high-risk patients or airway manipulation.

  2. [DESIGN AND VALIDATION OF AN IMAGE FOR DISSEMINATION AND IMPLEMENTATION OF CHILEAN DIETARY GUIDELINES].

    Science.gov (United States)

    Olivares Cortés, Sonia; Zacarías Hasbún, Isabel; González González, Carmen Gloria; Fonseca Morán, Lilian; Mediano Stoltze, Fernanda; Pinheiro Fernandes, Anna Christina; Rodríguez Osiac, Lorena

    2015-08-01

    Food-Based Dietary Guidelines (FBDG) are usually accompanied by an image for dissemination and implementation. to design and validate an image to represent the variety and proportions of the new Chilean dietary guidelines, include foods high in critical nutrients that should be avoided and physical activity guidelines. a panel of experts tested seven graphics and selected three that were validated with 12 focus groups of people aged 10-14 and 20-40 years, of both sexes, from different socioeconomic groups and from both rural and urban areas. We analyzed the perception of variety and proportions of the food groups for daily intake and motivation for action in diet and physical activity. We utilized the METAPLAN method used previously in the validation of FBDG. the final image was a circle that showed the variety and proportions of each food group for daily consumption (in pictures), included physical activity guidelines in a strip around the middle of the circle and a rectangle towards of bottom of the image with examples of foods high in critical nutrients in black and white. The chosen picture was modified using input from participants and validated with three additional focus groups, improving its understanding and acceptance. most participants understood that the image represented the relationship between healthy eating and daily physical activity, correctly identifying the food groups for which increased intake was suggested and those groups in which intake should be reduced or avoided. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  3. Energy Design Guidelines for High Performance Schools: Hot and Humid Climates

    Energy Technology Data Exchange (ETDEWEB)

    2002-06-01

    School districts around the country are finding that the smart energy choices can help them save money and provide healthier, more effective learning environments. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs. These savings can be redirected to educational needs such as additional teachers, instructional materials, or new computers. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school. By incorporating these principles, you can create and exemplary building that is both energy and resource efficient.

  4. Energy Design Guidelines for High Performance Schools: Temperate and Humid Climates

    Energy Technology Data Exchange (ETDEWEB)

    2002-06-01

    School districts around the country are finding that the smart energy choices can help them save money and provide healthier, more effective learning environments. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs. These savings can be redirected to educational needs such as additional teachers, instructional materials, or new computers. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school. By incorporating these principles, you can create and exemplary building that is both energy and resource efficient.

  5. Energy Design Guidelines for High Performance Schools: Temperate and Mixed Climates

    Energy Technology Data Exchange (ETDEWEB)

    2002-06-01

    School districts around the country are finding that the smart energy choices can help them save money and provide healthier, more effective learning environments. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs. These savings can be redirected to educational needs such as additional teachers, instructional materials, or new computers. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school. By incorporating these principles, you can create and exemplary building that is both energy and resource efficient.

  6. Energy Design Guidelines for High Performance Schools: Cold and Humid Climates

    Energy Technology Data Exchange (ETDEWEB)

    2002-06-01

    School districts around the country are finding that the smart energy choices can help them save money and provide healthier, more effective learning environments. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs. These savings can be redirected to educational needs such as additional teachers, instructional materials, or new computers. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school. By incorporating these principles, you can create and exemplary building that is both energy and resource efficient.

  7. Energy Design Guidelines for High Performance Schools: Cool and Dry Climates

    Energy Technology Data Exchange (ETDEWEB)

    2002-06-01

    School districts around the country are finding that the smart energy choices can help them save money and provide healthier, more effective learning environments. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs. These savings can be redirected to educational needs such as additional teachers, instructional materials, or new computers. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school. By incorporating these principles, you can create and exemplary building that is both energy and resource efficient.

  8. Energy Design Guidelines for High Performance Schools: Hot and Dry Climates

    Energy Technology Data Exchange (ETDEWEB)

    2002-01-01

    School districts around the country are finding that smart energy choices can help them save money and provide healthier, more effective learning environments. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs. These savings can be redirected to educational needs such as additional teachers, instructional materials, or new computers. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school. By incorporating these principles, you can create an exemplary building that is both energy and resource efficient.

  9. Energy Design Guidelines for High Performance Schools: Cool and Humid Climates

    Energy Technology Data Exchange (ETDEWEB)

    2002-06-01

    School districts around the country are finding that the smart energy choices can help them save money and provide healthier, more effective learning environments. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs. These savings can be redirected to educational needs such as additional teachers, instructional materials, or new computers. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school. By incorporating these principles, you can create and exemplary building that is both energy and resource efficient.

  10. Energy Design Guidelines for High Performance Schools: Hot and Dry Climates (Revision)

    Energy Technology Data Exchange (ETDEWEB)

    2002-06-01

    School districts around the country are finding that the smart energy choices can help them save money and provide healthier, more effective learning environments. By incorporating energy improvements into their construction or renovation plans, schools can significantly reduce energy consumption and costs. These savings can be redirected to educational needs such as additional teachers, instructional materials, or new computers. These design guidelines outline high performance principles for the new or retrofit design of your K-12 school. By incorporating these principles, you can create and exemplary building that is both energy and resource efficient.

  11. Sedation with alfentanil and propofol for rhizotomies

    African Journals Online (AJOL)

    M Jansen van Rensburg

    Deep sedation can be avoided by maximising analgesia, and keeping patients ..... sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy ... electroencephalogram predicts conscious processing of information.

  12. Level of consciousness in dying patients. The role of palliative sedation: a longitudinal prospective study.

    Science.gov (United States)

    Claessens, Patricia; Menten, Johan; Schotsmans, Paul; Broeckaert, Bert

    2012-05-01

    Patients suffering from a terminal illness often are confronted with severe symptoms during the last phase of their lives. Palliative sedation, although one of the options of last resort, remains a much debated and controversial issue and is often referred to as a form of slow euthanasia or euthanasia in disguise. A prospective longitudinal and descriptive design was used. Each patient admitted in one of the 8 participating units was included if they met the inclusion criteria and gave written informed consent. 266 patients were included. The incidence of palliative sedation was 7;5%. For the group of sedated patients results show that 90% entered the palliative care unit being fully conscious. Two patients were comatose upon arrival. 90% of the patients remained fully conscious up to the day palliative sedation was started. When looking at the effect of palliative sedation on the level of consciousness the analysis strongly suggest that the palliative sedation - as expected- has an impact on the GCS score. Irrespective of the dichotomization of the score the probability of having a lower GCS increases substantially once sedation is initiated. Additionally, results show that once palliative sedation is administered, the level of consciousness gradually goes down up until the day of death. Palliative sedation is nor slow euthanasia nor an ambivalent practice. It is an intentional medical treatment which is administered in a proportional way when refractory suffering occurs. It occurs in extraordinary situations and at the very end of the dying process.

  13. Symphony: A case study for exploring and describing design methods and guidelines for learner-centered design

    Science.gov (United States)

    Quintana, Christopher

    Learner-centered design is an evolving software design perspective addressing the needs of learners---a specific audience trying to work in and understand new work practices in which they have a novice or naive understanding. Learner-centered design involves designing software that incorporates work support features (or scaffolding features) informed by social constructivist learning theories. By adopting a constructivist "learning by doing" perspective, scaffolds should support learners so they can mindfully engage in previously inaccessible work activity, which in turn allows those learners to progressively gain a better understanding of the new work. While there is an intuitive notion of "learner-centered design", there is less specific design information for developing learner-centered software. As a result, learner-centered software results from "educated guesses" and ad-hoc design approaches rather than from systematic design methods. Thus there is a need for specific design guidance to facilitate the development of learner-centered tools that help learners see the tasks, terminology, tools, etc. in the new work context and engage in that work. The research in this dissertation provides a more specific base of learner-centered design descriptions, methods, and guidelines to analyze work practices and design and evaluate scaffolds. The research approach involves using the development of Symphony---a scaffolded integrated tool environment for high-school students learning the work of computational science inquiry---as a case study to develop the learner-centered design approach. Symphony incorporates a variety of science tools with process scaffolding to support students in performing complex air pollution investigations. Six ninth-grade students used Symphony to investigate air quality questions for several weeks in an environmental science class. The student testing helped assess the effectiveness of the software scaffolding and in turn, the learner

  14. The experiences of relatives with the practice of palliative sedation: a systematic review.

    Science.gov (United States)

    Bruinsma, Sophie M; Rietjens, Judith A C; Seymour, Jane E; Anquinet, Livia; van der Heide, Agnes

    2012-09-01

    Guidelines about palliative sedation typically include recommendations to protect the well-being of relatives. The aim of this study was to systematically review evidence on the experiences of relatives with the practice of palliative sedation. PubMed, Embase, Web of Science, PsycINFO, and CINAHL were searched for empirical studies on relatives' experiences with palliative sedation. We investigated relatives' involvement in the decision-making and sedation processes, whether they received adequate information and support, and relatives' emotions. Of the 564 studies identified, 39 were included. The studies (30 quantitative, six qualitative, and three mixed methods) were conducted in 16 countries; three studies were based on relatives' reports, 26 on physicians' and nurses' proxy reports, seven on medical records, and three combined different sources. The 39 studies yielded a combined total of 8791 respondents or studied cases. Caregivers involved relatives in the decision making in 69%-100% of all cases (19 quantitative studies), and in 60%-100% of all cases, relatives were reported to have received adequate information (five quantitative studies). Only two quantitative studies reported on relatives' involvement in the provision of sedation. Despite the fact that the majority of relatives were reported to be comfortable with the use of palliative sedation (seven quantitative studies, four qualitative studies), several studies found that relatives were distressed by the use of sedation (five quantitative studies, five qualitative studies). No studies reported specifically about the support provided to the relatives. Relatives' experiences with palliative sedation are mainly studied from the perspective of proxies, mostly professional caregivers. The majority of relatives seems to be comfortable with the use of palliative sedation; however, they may experience substantial distress by the use of sedation. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published

  15. US Department of Energy natural phenomena design/evaluation guidelines/lessons learned

    International Nuclear Information System (INIS)

    Conrads, T.J.

    1991-08-01

    In the spring of 1988, DOE Order 6430.1A, General Design Criteria [1], was issued for use. This document references UCRL-15910, Design and Evaluation Guidelines for DOE Facilities Subjected to Natural Phenomena Hazards [2], which is to be used as the basis for the design and evaluation of new and existing facilities to natural phenomena loading. Rather than use the historical deterministic methods for computing structural and component loading from potential natural phenomena, UCRL-15910 incorporated the years of hazards studies conducted throughout the US Department of Energy complex into probabilistic-based methods. This paper describes the process used to incorporate US Department of Energy natural phenomena design guidelines into the Hanford Plant Standards -- Standard Design Criteria for Architectural and Civil Standards [3]. It also addresses the subsequent use of these criteria during structural assessments of facilities, systems, and components of various vintage in support of updating safety analysis reports. The paper includes comparison of results using these most recent probabilistic-based natural phenomena loading criteria to those obtained from previous assessments, and it addresses the lessons learned from the many structural evaluations of 1940--1960 vintage buildings

  16. Seismic design evaluation guidelines for buried piping for the DOE HLW Facilities

    International Nuclear Information System (INIS)

    Lin, Chi-Wen; Antaki, G.; Bandyopadhyay, K.; Bush, S.H.; Costantino, C.; Kennedy, R.

    1995-01-01

    This paper presents the seismic design and evaluation guidelines for underground piping for the Department of Energy (DOE) High-Level-Waste (HLW) Facilities. The underground piping includes both single and double containment steel pipes and concrete pipes with steel lining, with particular emphasis on the double containment piping. The design and evaluation guidelines presented in this paper follow the generally accepted beam-on-elastic-foundation analysis principle and the inertial response calculation method, respectively, for piping directly in contact with the soil or contained in a jacket. A standard analysis procedure is described along with the discussion of factors deemed to be significant for the design of the underground piping. The following key considerations are addressed: the design feature and safety requirements for the inner (core) pipe and the outer pipe; the effect of soil strain and wave passage; assimilation of the necessary seismic and soil data; inertial response calculation for the inner pipe; determination of support anchor movement loads; combination of design loads; and code comparison. Specifications and justifications of the key parameters used, stress components to be calculated and the allowable stress and strain limits for code evaluation are presented

  17. Speaker-Oriented Classroom Acoustics Design Guidelines in the Context of Current Regulations in European Countries

    DEFF Research Database (Denmark)

    Pelegrin Garcia, David; Brunskog, Jonas; Rasmussen, Birgit

    2014-01-01

    Most European countries have regulatory requirements or guidelines for reverberation time in classrooms which have the goal of enhancing speech intelligibility and reducing noise levels in schools. At the same time, school teachers suffer frequently from voice problems due to high vocal load...... experienced at work. With the aim of improving working conditions for teachers, this article presents guidelines for classroom acoustics design that meet simultaneously criteria of vocal comfort and speech intelligibility, which may be of use in future discussions for updating regulatory requirements...... in classroom acoustics. Two room acoustic parameters are shown relevant for a speaker: the voice support, linked to vocal effort, and the decay time derived from an oral-binaural impulse response, linked to vocal comfort. Theoretical prediction models for room-averaged values of these parameters are combined...

  18. [Use of sedation in the palliative care situation by respiratory physicians].

    Science.gov (United States)

    Grijol-Cariou, A-L; Goupil, F; Hubault, P; Jouanneau, J

    2014-01-01

    The prognosis of advanced stage chronic lung disease, including lung cancer, is often poor and associated with uncomfortable symptoms for the patient, especially in the end of life phase. In the case of intolerable symptoms, refractory to maximal treatment, sedation may then be considered. This is sometimes a source of confusion and difficulty for clinicians who need to know the official guidelines. The purpose of this study was to investigate the use of sedation by respiratory physicians, in order to understand their difficulties in these complex situations. The study was conducted using semi-structured, anonymous interviews of volunteers. The topics discussed included their definition of sedation, its indications, their possible difficulties or reluctance in using it, the information given to the patient and the traceability of the sedation prescription. All respiratory physicians agreed to participate in the study, indicating a major interest in this topic. No sedation decision is taken without careful consideration. The majority of physicians understand the difference between anxiolysis and sedation, most defining the latter as using a drug to sedate a patient faced with uncontrollable symptoms. All doctors refused to link sedation to euthanasia, although half expressed a feeling of causality between sedation and the patient's death - knowing that few consider the possibility of transient sedation. The main reluctance among doctors is in chronic respiratory insufficiency. Any decision concerning sedation should be discussed beforehand with the care team and the resident in charge of the patient, but not necessarily with another colleague. There is rarely evidence of this discussion in the medical records or of the information given to the patient and his family, thus increasing the difficulties of decision-making, especially at nights or weekends. The decision to start sedation is seen as difficult because it presupposes that a life-threatening short

  19. Implementation of seismic design and evaluation guidelines for the Department of Energy high-level waste storage tanks and appurtenances

    International Nuclear Information System (INIS)

    Conrads, T.J.

    1993-06-01

    In the fall of 1992, a draft of the Seismic Design and Evaluation Guidelines for the Department of Energy (DOE) High-level Waste Storage Tanks and Appurtenances was issued. The guidelines were prepared by the Tanks Seismic Experts Panel (TSEP) and this task was sponsored by DOE, Environmental Management. The TSEP is comprised of a number of consultants known for their knowledge of seismic ground motion and expertise in the analysis of structures, systems and components subjected to seismic loads. The development of these guidelines was managed by staff from Brookhaven National Laboratory, Engineering Research and Applications Division, Department of Nuclear Energy. This paper describes the process used to incorporate the Seismic Design and Evaluation Guidelines for the DOE High-Level Waste Storage Tanks and Appurtenances into the design criteria for the Multi-Function Waste Tank Project at the Hanford Site. This project will design and construct six new high-level waste tanks in the 200 Areas at the Hanford Site. This paper also discusses the vehicles used to ensure compliance to these guidelines throughout Title 1 and Title 2 design phases of the project as well as the strategy used to ensure consistent and cost-effective application of the guidelines by the structural analysts. The paper includes lessons learned and provides recommendations for other tank design projects which might employ the TSEP guidelines

  20. Implementation of seismic design and evaluation guidelines for the Department of Energy high-level waste storage tanks and appurtenances

    International Nuclear Information System (INIS)

    Conrads, T.J.

    1993-01-01

    In the fall of 1992, a draft of the Seismic Design and Evaluation Guidelines for the U.S. Department of Energy (DOE) High-level Waste Storage Tanks and Appurtenances was issued. The guidelines were prepared by the Tanks Seismic Experts Panel (TSEP) and this task was sponsored by DOE, Environmental Management. The TSEP comprises a number of consultants known for their understanding of seismic ground motion and expertise in the analysis of structures, systems and components subjected to seismic loads. The development of these guidelines was managed by staff from Brookhaven National Laboratory, Engineering Research and Applications Division, Department of Nuclear Energy. This paper describes the process used to incorporate the Seismic Design and Evaluation guidelines for the DOE High-Level Waste Storage Tanks and Appurtenances into the design criteria for the Multi-Function Waste Tank Project at the Hanford Site. This project will design and construct six new high-level waste tanks in the 200 Areas at the Hanford Site. This paper also discusses the vehicles used to ensure compliance to these guidelines throughout Title 1 and Title 2 design phases of the project as well as the strategy used to ensure consistent and cost-effective application of the guidelines by the structural analysts. The paper includes lessons learned and provides recommendations for other tank design projects that might employ the TSEP guidelines

  1. When there are no good choices: illuminating the borderland between proportionate palliative sedation and palliative sedation to unconsciousness.

    Science.gov (United States)

    Reid, Thomas T; Demme, Richard A; Quill, Timothy E

    2011-01-01

    Despite state-of-the-art palliative care, some patients will require proportionate palliative sedation as a last-resort option to relieve intolerable suffering at the end of life. In this practice, progressively increasing amounts of sedation are provided until the target suffering is sufficiently relieved. Uncertainty and debate arise when this practice approaches palliative sedation to unconsciousness (PSU), especially when unconsciousness is specifically intended or when the target symptoms are more existential than physical. We constructed a case series designed to highlight some of the common approaches and challenges associated with PSU and the more aggressive end of the spectrum of proportionate palliative sedation as retrospectively identified by palliative care consultants over the past 5 years from a busy inpatient palliative care service at a tertiary medical center in Rochester (NY, USA). Ten cases were identified as challenging by the palliative care attendings, of which four were selected for presentation for illustrative purposes because they touched on central issues including loss of capacity, the role of existential suffering, the complexity of clinical intention, the role of an institutional policy and use of anesthetics as sedative agents. Two other cases were selected focusing on responses to two special situations: a request for PSU that was rejected; and anticipatory planning for total sedation in the future. Although relatively rare, PSU and more aggressive end-of-the-spectrum proportionate palliative sedation represent responses to some of the most challenging cases faced by palliative care clinicians. These complex cases clearly require open communication and collaboration among caregivers, patients and family. Knowing how to identify these circumstances, and how to approach these interventions of last resort are critical skills for practitioners who take care of patients at the end of life.

  2. Guidelines for calculation of atmospheric dispersion and radiological consequences of design basis reactor accidents - Severe accident calculation guidelines, EPR

    International Nuclear Information System (INIS)

    Martens, R.; Schmitz, B.M.; Horn, M.

    1999-01-01

    The activities carried out within the (reduced) project period (1. Sept. until 31. Dec. 1998) for coordinated harmonization between France and Germany, of guidelines for calculation of the radiological consequences of a severe reactor accident, are summarized. (orig./CB) [de

  3. Passive solar design strategies: Remodeling guidelines for conserving energy at home

    Energy Technology Data Exchange (ETDEWEB)

    1991-01-01

    The idea of passive solar is simple, but applying it effectively does require information and attention to the details of design and construction. Some passive solar techniques are modest and low-cost, and require only small changes in remodeler's typical practice. At the other end of the spectrum, some passive solar systems can almost eliminate a house's need for purchased heating (and in some cases, cooling) energy -- but probably at a relatively high first cost. In between are a broad range of energy-conserving passive solar techniques. Whether or not they are cost-effective, practical and attractive enough to offer a market advantage to any individual remodeler depends on very specific factors such as local costs, climate, and market characteristics. Passive solar design strategies: Remodeling Guidelines For Conserving Energy At Homes is written to help give remodelers the information they need to make these decisions. Passive Solar Design Strategies is a package in three basic parts: The Guidelines contain information about passive solar techniques and how they work, and provides specific examples of systems which will save various percentages of energy; The Worksheets offer a simple, fill-in-the-blank method to pre-evaluate the performance of a specific design; The Worked Example demonstrates how to complete the worksheets for a typical residence.

  4. Passive solar design strategies: Remodeling guidelines for conserving energy at home. [Final report

    Energy Technology Data Exchange (ETDEWEB)

    1991-12-31

    The idea of passive solar is simple, but applying it effectively does require information and attention to the details of design and construction. Some passive solar techniques are modest and low-cost, and require only small changes in remodeler`s typical practice. At the other end of the spectrum, some passive solar systems can almost eliminate a house`s need for purchased heating (and in some cases, cooling) energy -- but probably at a relatively high first cost. In between are a broad range of energy-conserving passive solar techniques. Whether or not they are cost-effective, practical and attractive enough to offer a market advantage to any individual remodeler depends on very specific factors such as local costs, climate, and market characteristics. Passive solar design strategies: Remodeling Guidelines For Conserving Energy At Homes is written to help give remodelers the information they need to make these decisions. Passive Solar Design Strategies is a package in three basic parts: The Guidelines contain information about passive solar techniques and how they work, and provides specific examples of systems which will save various percentages of energy; The Worksheets offer a simple, fill-in-the-blank method to pre-evaluate the performance of a specific design; The Worked Example demonstrates how to complete the worksheets for a typical residence.

  5. Crew aiding and automation: A system concept for terminal area operations, and guidelines for automation design

    Science.gov (United States)

    Dwyer, John P.

    1994-01-01

    This research and development program comprised two efforts: the development of guidelines for the design of automated systems, with particular emphasis on automation design that takes advantage of contextual information, and the concept-level design of a crew aiding system, the Terminal Area Navigation Decision Aiding Mediator (TANDAM). This concept outlines a system capable of organizing navigation and communication information and assisting the crew in executing the operations required in descent and approach. In service of this endeavor, problem definition activities were conducted that identified terminal area navigation and operational familiarization exercises addressing the terminal area navigation problem. Both airborne and ground-based (ATC) elements of aircraft control were extensively researched. The TANDAM system concept was then specified, and the crew interface and associated systems described. Additionally, three descent and approach scenarios were devised in order to illustrate the principal functions of the TANDAM system concept in relation to the crew, the aircraft, and ATC. A plan for the evaluation of the TANDAM system was established. The guidelines were developed based on reviews of relevant literature, and on experience gained in the design effort.

  6. Passive solar design strategies: Remodeling guidelines for conserving energy at home

    Science.gov (United States)

    The idea of passive solar is simple, but applying it effectively does require information and attention to the details of design and construction. Some passive solar techniques are modest and low-cost, and require only small changes in remodeler's typical practice. At the other end of the spectrum, some passive solar systems can almost eliminate a house's need for purchased heating (and in some cases, cooling) energy - but probably at a relatively high first cost. In between are a broad range of energy-conserving passive solar techniques. Whether or not they are cost-effective, practical, and attractive enough to offer a market advantage to any individual remodeler depends on very specific factors such as local costs, climate, and market characteristics. Passive Solar Design Strategies: Remodeling Guidelines For Conserving Energy At Home is written to help give remodelers the information they need to make these decisions. Passive Solar Design Strategies is a package in three basic parts: the guidelines contain information about passive solar techniques and how they work, and provides specific examples of systems which will save various percentages of energy; the worksheets offer a simple, fill-in-the-blank method to pre-evaluate the performance of a specific design; and the worked example demonstrates how to complete the worksheets for a typical residence.

  7. Sedating children in South Africa

    African Journals Online (AJOL)

    bRed Cross War Memorial Children's Hospital, Cape Town, South Africa. cSedation and Pain ... As the authors indicate, there is increasing pressure from practitioners, funders and patients or parents for procedures to take place outside the ...

  8. Design and implementation of speed humps: supplement to national guidelines for traffic calming

    CSIR Research Space (South Africa)

    Emslie, I

    1997-03-01

    Full Text Available This report presents guidelines to assist local authorities and traffic engineers with a uniform approach to the implementation of speed humps. It is recommended that these guidelines be read in conjunction with The National Guidelines for Traffic...

  9. Conscious sedation for endoscopic and non-endoscopic interventional gastrointestinal procedures: meeting patients' expectations, missing the standard

    Energy Technology Data Exchange (ETDEWEB)

    Marriott, P.; Laasch, H.-U.; Wilbraham, L.; Marriott, A.; England, R.E.; Martin, D.F. E-mail: derrick.martin@smtr.nhs.uk

    2004-02-01

    AIM: To assess the level of sedation, patient satisfaction and frequency of unplanned events with conscious sedation for interventional procedures. MATERIALS AND METHODS: One hundred and seventeen patients were assessed prospectively before, during and after procedures. Blood pressure, pulse, oxygen saturation and sedation level were monitored and patients followed up after 24 h. Sedation was scored after drugs were given in accordance with an established protocol. Doses were recorded, as were patients' weight, age and ASA grade and any unplanned events and their management. RESULTS: Seventy-six of the 117 patients (65%) had no unplanned event, 20 (17.1%) became agitated, 15 (12.8%) hypotensive, three (2.6%) hypoxic and three (2.6%) had more than one response. Twelve patients required active management. Fifty-two (44.4%) had a sedation level of {<=}3 (responsive to verbal commands), but 39 (33.3%) reached level 6. Median doses were midazolam 6 mg (1-20 mg) and pethidine 50 mg (12.5-100 mg). Ninety-three percent were satisfied with their sedation. No adverse effects were observed after 24 h. CONCLUSION: Despite using a sedation protocol, unplanned events occurred in 35% (95% CI=27-44%) of patients, although not all required active management. The sedation levels reached in some exceeded guidelines. Unplanned events were commoner with increased sedation level. Patient satisfaction was high and no permanent damage was observed.

  10. Conscious sedation for endoscopic and non-endoscopic interventional gastrointestinal procedures: meeting patients' expectations, missing the standard

    International Nuclear Information System (INIS)

    Marriott, P.; Laasch, H.-U.; Wilbraham, L.; Marriott, A.; England, R.E.; Martin, D.F.

    2004-01-01

    AIM: To assess the level of sedation, patient satisfaction and frequency of unplanned events with conscious sedation for interventional procedures. MATERIALS AND METHODS: One hundred and seventeen patients were assessed prospectively before, during and after procedures. Blood pressure, pulse, oxygen saturation and sedation level were monitored and patients followed up after 24 h. Sedation was scored after drugs were given in accordance with an established protocol. Doses were recorded, as were patients' weight, age and ASA grade and any unplanned events and their management. RESULTS: Seventy-six of the 117 patients (65%) had no unplanned event, 20 (17.1%) became agitated, 15 (12.8%) hypotensive, three (2.6%) hypoxic and three (2.6%) had more than one response. Twelve patients required active management. Fifty-two (44.4%) had a sedation level of ≤3 (responsive to verbal commands), but 39 (33.3%) reached level 6. Median doses were midazolam 6 mg (1-20 mg) and pethidine 50 mg (12.5-100 mg). Ninety-three percent were satisfied with their sedation. No adverse effects were observed after 24 h. CONCLUSION: Despite using a sedation protocol, unplanned events occurred in 35% (95% CI=27-44%) of patients, although not all required active management. The sedation levels reached in some exceeded guidelines. Unplanned events were commoner with increased sedation level. Patient satisfaction was high and no permanent damage was observed

  11. Survey of Sedation and Analgesia Practice Among Canadian Pediatric Critical Care Physicians.

    Science.gov (United States)

    Garcia Guerra, Gonzalo; Joffe, Ari R; Cave, Dominic; Duff, Jonathan; Duncan, Shannon; Sheppard, Cathy; Tawfik, Gerda; Hartling, Lisa; Jou, Hsing; Vohra, Sunita

    2016-09-01

    Despite the fact that almost all critically ill children experience some degree of pain or anxiety, there is a lack of high-quality evidence to inform preferred approaches to sedation, analgesia, and comfort measures in this environment. We conducted this survey to better understand current comfort and sedation practices among Canadian pediatric intensivists. The survey was conducted after a literature review and initial focus groups. The survey was then pretested and validated. The final survey was distributed by email to 134 intensivists from 17 PICUs across Canada using the Research Electronic Data Capture system. The response rate was 73% (98/134). The most commonly used sedation scores are Face, Legs, Activity, Cry, and Consolability (42%) and COMFORT (41%). Withdrawal scores are commonly used (65%). In contrast, delirium scores are used by only 16% of the respondents. Only 36% of respondents have routinely used sedation protocols. The majority (66%) do not use noise reduction methods, whereas only 23% of respondents have a protocol to promote day/night cycles. Comfort measures including music, swaddling, soother, television, and sucrose solutions are frequently used. The drugs most commonly used to provide analgesia are morphine and acetaminophen. Midazolam and chloral hydrate were the most frequent sedatives. Our survey demonstrates great variation in practice in the management of pain and anxiety in Canadian PICUs. Standardized strategies for sedation, delirium and withdrawal, and sleep promotion are lacking. There is a need for research in this field and the development of evidence-based, pediatric sedation and analgesia guidelines.

  12. The guideline and practical procedures for earthquake-resistant design of nuclear power plants in Japan

    International Nuclear Information System (INIS)

    Watabe, M.

    1985-01-01

    The Guideline for the aseismic design of nuclear reactor facilities, revised in 1981, is introduced. The basic philosophy entails structural integrity against a major earthquake, rigid structure for less deformation and foundation on rock. The classification of facilities is then explained. Some practical examples are tabulated. In the light of the above classifications, evaluation procedures for aseismic design are defined. Design basis earthquake ground motions, S1 and S2, are defined. S1 is the maximum possible earthquake ground motion, while S2 is the maximum credible one. The relation between active faults and S1, S2 motions is explained, seismic forces induced by S1 and S2 are expressed in terms of response spectra. Static seismic coefficient procedures are also applied to evaluate seismic forces, as a minimum guide-line based on dynamic analysis. Combinations of seismic forces and allowable limits are then explained. In the second part of the paper, seismic analysis for reactor buildings as a part of design practice is outlined. There are three major key points in practical aseismic design. The first one is input design earthquake motions, in which soil/foundation interaction problems are also included. In practice, ground motions at the free field rock surface have to be convoluted or deconvoluted to obtain base rock motions, which are applied to estimate input design earthquake motions by way of finite element analysis or a lumped mass lattice model. Also introduced is dynamic modelling of the reactor building with its non-linear behaviour represented by plastic deformation of reinforced concrete members as well as by uplift characteristics of foundations. Then an evaluation of aseismic safety is introduced. (author)

  13. LMFBR safety criteria and guidelines for consideration in the design of future plants

    International Nuclear Information System (INIS)

    1990-01-01

    For many years the Commission of the European Communities has been conducting activities aimed at the progressive harmonization of safety requirements and criteria applied to nuclear installations in the Community. These activities cover thermal and fast reactors. This publication represents a major achievement in reaching this goal. The document, which has been prepared in the framework of activities of the CEC fast-reactor safety working group (SWG), consists of safety criteria and guidelines for fast reactors. It represents the common view of all EC Member States which have a fast-reactor programme or are interested in fast-reactor development. The criteria and guidelines are structured according to different types of possible faults, such as core reactivity faults, general cooling faults, subassembly faults, faults outside the core and causes external to the station. Only those events are considered which are in the design basis of current fast-reactor projects. Proposed measures or guidelines to satisfy the criteria are based on the present knowledge and proven technology

  14. Framework for continuous palliative sedation therapy in Canada.

    Science.gov (United States)

    Dean, Mervyn M; Cellarius, Victor; Henry, Blair; Oneschuk, Doreen; Librach Canadian Society Of Palliative Care Physicians Taskforce, S Lawrence

    2012-08-01

    Canada does not have a standardized ethical and practice framework for continuous palliative sedation therapy (CPST). Although a number of institutional and regional guidelines exist, Canadian practice varies. Given the lack of international and national consensus on CPST, the Canadian Society for Palliative Care Physicians (CSPCP) formed a special task force to develop a consensus-based framework for CPST. Through a preliminary review of sedation practices nationally and internationally, it was determined that although considerable consensus was emerging on this topic, there remained both areas of contention and a lack of credible scientific evidence to support a definitive clinical practice guideline. This led to the creation of a framework to help guide policy, practice, and research. This framework was developed through the following steps: 1) literature review; 2) identification of issues; 3) preparation of a draft framework; 4) expert consultation and revision; 5) presentation at conferences and further revision; and 6) further revision and national consensus building. A thorough literature review, including gray literature, of sedation therapy at the end of life was conducted from which an initial framework was drafted. This document was reviewed by 30 multidisciplinary experts in Canada and internationally, revised several times, and then submitted to CSPCP members for review. Consensus was high on most parts of the framework. The framework for CPST will provide a basis for the development of safe, effective, and ethical use of CPST for patients in palliative care and at the end of life.

  15. Relationship between energy systems and landscapes. Guidelines and tools for design and management

    Directory of Open Access Journals (Sweden)

    Elisabetta Ginelli

    2014-10-01

    Full Text Available Landscapes undergoing conservation, valorisation, management and reconstruction policies, become a fundamental factor for the local/global development of natural, cultural, human and social potentials of territories. With the contribution of technological design culture, the research, having a strong multidisciplinary character, focuses on managing the relationship between energy systems and landscapes with the general aim of subverting and transforming apparent conflicts in synergies, in order to overcome a sectorial and segmented approach barely based on energy performances. Through the introduction of a complex multidimensional methodology of analysis and evaluation the goal of this work, is to develop standards of acceptability, meta-design criteria and guidelines for design, intro- ducing a methodology for multidimen- sional complex analysis and evaluation, to support Public Authorities.

  16. Conducting wine marketing research with impact in China: Guidelines for design, execution and dissemination

    Directory of Open Access Journals (Sweden)

    Justin Cohen

    2017-12-01

    Full Text Available China is the fastest growing wine market, but conducting research there is fraught with a variety of issues. This article explores some of the issues the authors have dealt with in conducting wine marketing research in China over the last five years. We discuss issues with the design of research to focus on important issues for both academics and the industry. We relate the key problems in gaining proper translation and useful sampling procedures. Finally, we provide some guidelines for communicating results effectively to different members of the wine trade.

  17. Analgesia and sedation practices for incarcerated inguinal hernias in children.

    Science.gov (United States)

    Al-Ansari, Khalid; Sulowski, Christopher; Ratnapalan, Savithiri

    2008-10-01

    In this study, the use of medications for analgesia and/or sedation for incarcerated inguinal hernia reductions in the emergency department was analyzed. A retrospective chart review was conducted for all patients presenting to a pediatric emergency department with incarcerated inguinal hernia from 2002 to 2005. A total of 99 children presented with incarcerated hernias during the study period. The median age was 11 months. Forty-four percent of children received medication for the procedure, of them 75% received parenteral and 25% oral or intranasal medications. Forty-five percent of children who received medication went through at least 1 hernia reduction attempt initially without medications. More than half the children with incarcerated inguinal hernias did not receive any medication for pain and/or sedation prior to hernia reduction. Guidelines for medication use for children with incarcerated inguinal hernias need to be developed.

  18. An Exploration of Smart Product-Service System Design : Guidelines and Insights for Design Management

    NARCIS (Netherlands)

    Valencia Cardona, A.M.

    2017-01-01

    This thesis reports on the findings of a research project funded by the Dutch Ministry of Education, Culture and Science. The thesis investigates the design of Smart Product-Service Systems (Smart PSSs), defined as the integration of smart, connected products and e-services, presented to consumers

  19. Human-system interface design review guideline -- Reviewer`s checklist: Final report. Revision 1, Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-06-01

    NUREG-0700, Revision 1, provides human factors engineering (HFE) guidance to the US Nuclear Regulatory Commission staff for its: (1) review of the human system interface (HSI) design submittals prepared by licensees or applications for a license or design certification of commercial nuclear power plants, and (2) performance of HSI reviews that could be undertaken as part of an inspection or other type of regulatory review involving HSI design or incidents involving human performance. The guidance consists of a review process and HFE guidelines. The document describes those aspects of the HSI design review process that are important to the identification and resolution of human engineering discrepancies that could adversely affect plant safety. Guidance is provided that could be used by the staff to review an applicant`s HSI design review process or to guide the development of an HSI design review plan, e.g., as part of an inspection activity. The document also provides detailed HFE guidelines for the assessment of HSI design implementations. NUREG-0700, Revision 1, consists of three stand-alone volumes. Volume 2 is a complete set of the guidelines contained in Volume 1, Part 2, but in a checklist format that can be used by reviewers to assemble sets of individual guidelines for use in specific design reviews. The checklist provides space for reviewers to enter guidelines evaluations and comments.

  20. Pediatrician Ambiguity in Understanding Palliative Sedation at the End of Life.

    Science.gov (United States)

    Henderson, Carrie M; FitzGerald, Michael; Hoehn, K Sarah; Weidner, Norbert

    2017-02-01

    Palliative sedation is a means of relieving intractable symptoms at the end of life, however, guidelines about its use lack consistency. In addition, ethical concerns persist around the practice. There are reports of palliative sedation in the pediatric literature, which highlight various institutional perspectives. This survey of 4786 pediatric providers sought to describe their knowledge of and current practices around pediatric palliative sedation. Our survey was administered to pediatricians who care for children at the end of life. The survey assessed agreement with a definition of palliative sedation, as well as thoughts about its alignment with aggressive symptom management. Bivariate analyses using χ 2 and analysis of variance were calculated to determine the relationship between responses to closed-ended questions. Open-ended responses were thematically coded by the investigators and reviewed for agreement. Nearly half (48.6%) of the respondents indicated that the stated definition of palliative sedation "completely" reflected their own views. Respondents were split when asked if they viewed any difference between palliative sedation and aggressive symptom management: Yes (46%) versus No (54%). Open-ended responses revealed specifics about the nature of variation in interpretation. Responses point to ambiguity surrounding the concept of palliative sedation. Pediatricians were concerned with a decreased level of consciousness as the goal of palliative sedation. Respondents were split on whether they view palliative sedation as a distinct entity or as one broad continuum of care, equivalent to aggressive symptom management. Institutional-based policies are essential to clarify acceptable practice, enable open communication, and promote further research.

  1. Design guidelines for the use of audio cues in computer interfaces

    Energy Technology Data Exchange (ETDEWEB)

    Sumikawa, D.A.; Blattner, M.M.; Joy, K.I.; Greenberg, R.M.

    1985-07-01

    A logical next step in the evolution of the computer-user interface is the incorporation of sound thereby using our senses of ''hearing'' in our communication with the computer. This allows our visual and auditory capacities to work in unison leading to a more effective and efficient interpretation of information received from the computer than by sight alone. In this paper we examine earcons, which are audio cues, used in the computer-user interface to provide information and feedback to the user about computer entities (these include messages and functions, as well as states and labels). The material in this paper is part of a larger study that recommends guidelines for the design and use of audio cues in the computer-user interface. The complete work examines the disciplines of music, psychology, communication theory, advertising, and psychoacoustics to discover how sound is utilized and analyzed in those areas. The resulting information is organized according to the theory of semiotics, the theory of signs, into the syntax, semantics, and pragmatics of communication by sound. Here we present design guidelines for the syntax of earcons. Earcons are constructed from motives, short sequences of notes with a specific rhythm and pitch, embellished by timbre, dynamics, and register. Compound earcons and family earcons are introduced. These are related motives that serve to identify a family of related cues. Examples of earcons are given.

  2. Randomized Controlled Trials in Music Therapy: Guidelines for Design and Implementation.

    Science.gov (United States)

    Bradt, Joke

    2012-01-01

    Evidence from randomized controlled trials (RCTs) plays a powerful role in today's healthcare industry. At the same time, it is important that multiple types of evidence contribute to music therapy's knowledge base and that the dialogue of clinical effectiveness in music therapy is not dominated by the biomedical hierarchical model of evidence-based practice. Whether or not one agrees with the hierarchical model of evidence in the current healthcare climate, RCTs can contribute important knowledge to our field. Therefore, it is important that music therapists are prepared to design trials that meet current methodological standards and, equally important, are able to respond appropriately to those design aspects that may not be feasible in music therapy research. To provide practical guidelines to music therapy researchers for the design and implementation of RCTs as well as to enable music therapists to be well-informed consumers of RCT evidence. This article reviews key design aspects of RCTs and discusses how to best implement these standards in music therapy trials. A systematic presentation of basic randomization methods, allocation concealment strategies, issues related to blinding in music therapy trials and strategies for implementation, the use of treatment manuals, types of control groups, outcome selection, and sample size computation is provided. Despite the challenges of meeting all key design demands typical of an RCT, it is possible to design rigorous music therapy RCTs that accurately estimate music therapy treatment benefits.

  3. Bridging Theory and Practice: Developing Guidelines to Facilitate the Design of Computer-based Learning Environments

    Directory of Open Access Journals (Sweden)

    Lisa D. Young

    2003-10-01

    Full Text Available Abstract. The design of computer-based learning environments has undergone a paradigm shift; moving students away from instruction that was considered to promote technical rationality grounded in objectivism, to the application of computers to create cognitive tools utilized in constructivist environments. The goal of the resulting computer-based learning environment design principles is to have students learn with technology, rather than from technology. This paper reviews the general constructivist theory that has guided the development of these environments, and offers suggestions for the adaptation of modest, generic guidelines, not mandated principles, that can be flexibly applied and allow for the expression of true constructivist ideals in online learning environments.

  4. Moving Average Filter-Based Phase-Locked Loops: Performance Analysis and Design Guidelines

    DEFF Research Database (Denmark)

    Golestan, Saeed; Ramezani, Malek; Guerrero, Josep M.

    2014-01-01

    this challenge, incorporating moving average filter(s) (MAF) into the PLL structure has been proposed in some recent literature. A MAF is a linear-phase finite impulse response filter which can act as an ideal low-pass filter, if certain conditions hold. The main aim of this paper is to present the control...... design guidelines for a typical MAF-based PLL. The paper starts with the general description of MAFs. The main challenge associated with using the MAFs is then explained, and its possible solutions are discussed. The paper then proceeds with a brief overview of the different MAF-based PLLs. In each case......, the PLL block diagram description is shown, the advantages and limitations are briefly discussed, and the tuning approach (if available) is evaluated. The paper then presents two systematic methods to design the control parameters of a typical MAF-based PLL: one for the case of using a proportional...

  5. Sedation and monitoring for gastrointestinal endoscopy.

    Science.gov (United States)

    Amornyotin, Somchai

    2013-02-16

    The safe sedation of patients for diagnostic or therapeutic procedures requires a combination of properly trained physicians and suitable facilities. Additionally, appropriate selection and preparation of patients, suitable sedative technique, application of drugs, adequate monitoring, and proper recovery of patients is essential. The goal of procedural sedation is the safe and effective control of pain and anxiety as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation practices for gastrointestinal endoscopy (GIE) vary widely. The majority of GIE patients are ambulatory cases. Most of this procedure requires a short time. So, short acting, rapid onset drugs with little adverse effects and improved safety profiles are commonly used. The present review focuses on commonly used regimens and monitoring practices in GIE sedation. This article is to discuss the decision making process used to determine appropriate pre-sedation assessment, monitoring, drug selection, dose of sedative agents, sedation endpoint and post-sedation care. It also reviews the current status of sedation and monitoring for GIE procedures in Thailand.

  6. Palliative sedation and ethical dilemma

    Directory of Open Access Journals (Sweden)

    Juri Salamah

    2018-01-01

    Full Text Available Palliative sedation is a unique concern for the patient as well as the family. It is a difficult serious ethical dilemma for the physicians to handle. The conflicting ethical principles of autonomy, beneficence and nonmaleficence in continuing versus discontinuing all supportive devices raise concerns among health professionals whether this is euthanasia (physician-assisted suicide or is just prolonging the patient's unnecessary suffering.

  7. Low-Energy Building Design Guidelines: Energy-Efficient Design for New Federal Facilities

    International Nuclear Information System (INIS)

    Zachman, W.; Carlisle, N.

    2001-01-01

    This guidebook has been prepared primarily for Federal energy managers to provide practical information for applying the principles of low-energy, whole-building design in new Federal buildings. An important objective of this guidebook is to teach energy managers how to be advocates for renewable energy and energy-efficient technologies, and how to apply specific strategies during each phase of a given project's time line. These key action items are broken out by phase and appear in abbreviated form in this guidebook

  8. Low-Energy Building Design Guidelines: Energy-Efficient Design for New Federal Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Zachman, W.; Carlisle, N.

    2001-07-19

    This guidebook has been prepared primarily for Federal energy managers to provide practical information for applying the principles of low-energy, whole-building design in new Federal buildings. An important objective of this guidebook is to teach energy managers how to be advocates for renewable energy and energy-efficient technologies, and how to apply specific strategies during each phase of a given project's time line. These key action items are broken out by phase and appear in abbreviated form in this guidebook.

  9. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures.

    Science.gov (United States)

    McQuaid, Kenneth R; Laine, Loren

    2008-05-01

    Numerous agents are available for moderate sedation in endoscopy. Our purpose was to compare efficacy, safety, and efficiency of agents used for moderate sedation in EGD or colonoscopy. Systematic review of computerized bibliographic databases for randomized trials of moderate sedation that compared 2 active regimens or 1 active regimen with placebo or no sedation. Unselected adults undergoing EGD or colonoscopy with a goal of moderate sedation. Sedation-related complications, patient assessments (satisfaction, pain, memory, willingness to repeat examination), physician assessments (satisfaction, level of sedation, patient cooperation, examination quality), and procedure-related efficiency outcomes (sedation, procedure, or recovery time). Thirty-six studies (N = 3918 patients) were included. Sedation improved patient satisfaction (relative risk [RR] = 2.29, range 1.16-4.53) and willingness to repeat EGD (RR = 1.25, range 1.13-1.38) versus no sedation. Midazolam provided superior patient satisfaction to diazepam (RR = 1.18, range 1.07-1.29) and less frequent memory of EGD (RR = 0.57, range 0.50-0.60) versus diazepam. Adverse events and patient/physician assessments were not significantly different for midazolam (with or without narcotics) versus propofol except for slightly less patient satisfaction (RR = 0.90, range 0.83-0.97) and more frequent memory (RR = 3.00, range 1.25-7.21) with midazolam plus narcotics. Procedure times were similar, but sedation and recovery times were shorter with propofol than midazolam-based regimens. Marked variability in design, regimens tested, and outcomes assessed; relatively poor methodologic quality (Jadad score sedation provides a high level of physician and patient satisfaction and a low risk of serious adverse events with all currently available agents. Midazolam-based regimens have longer sedation and recovery times than does propofol.

  10. Decreasing spatial disorientation in care-home settings: How psychology can guide the development of dementia friendly design guidelines.

    Science.gov (United States)

    O'Malley, Mary; Innes, Anthea; Wiener, Jan M

    2017-04-01

    Alzheimer's disease results in marked declines in navigation skills that are particularly pronounced in unfamiliar environments. However, many people with Alzheimer's disease eventually face the challenge of having to learn their way around unfamiliar environments when moving into assisted living or care-homes. People with Alzheimer's disease would have an easier transition moving to new residences if these larger, and often more institutional, environments were designed to compensate for decreasing orientation skills. However, few existing dementia friendly design guidelines specifically address orientation and wayfinding. Those that do are often based on custom, practice or intuition and not well integrated with psychological and neuroscientific knowledge or navigation research, therefore often remaining unspecific. This paper discusses current dementia friendly design guidelines, reports findings from psychological and neuropsychological experiments on navigation and evaluates their potential for informing design guidelines that decrease spatial disorientation for people with dementia.

  11. Development of safety and regulatory requirements for Korean next generation reactor - Development of human factors design review guidelines (II)

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Woon; Oh, In Suk; Lee, Hyun Chul; Cheon, Se Woo [Korea Atomic Energy Research Institute, Taejon (Korea)

    1999-02-01

    The objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: '25. Human Factors Engineering Program Review Model' and '26. Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation', which are related to the development of human factors safety regulation guides being performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and the characteristics of the KNGR design, and reviewing the reference documents of NURGE-0711. We also computerized the Korean version of NUREG-0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides at KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system design review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm systems. Then we updated the guidelines by reviewing the literature related to alarm design that published after 1994. 12 refs., 11 figs., 2 tabs. (Author)

  12. Development of safety and regulatory requirements for Korean next generation reactor - Development of human factors design review guidelines (II)

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Woon; Oh, In Suk; Lee, Hyun Chul; Cheon, Se Woo [Korea Atomic Energy Research Institute, Taejon (Korea)

    1999-02-01

    The objective of this study is to develop human factors engineering program review guidelines and alarm system review guidelines in order to resolve the two major technical issues: '25. Human Factors Engineering Program Review Model' and '26. Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation', which are related to the development of human factors safety regulation guides being performed by KINS. For the development of human factors program review guidelines, we made a Korean version of NUREG-0711 and added our comments by considering Korean regulatory situation and the characteristics of the KNGR design, and reviewing the reference documents of NURGE-0711. We also computerized the Korean version of NUREG-0711, additional comments, and selected portion of the reference documents for the developer of safety regulation guides at KINS to see the contents comparatively at a glance and use them easily. For the development of alarm system design review guidelines, we made a Korean version of NUREG/CR-6105, which was published by NRC in 1994 as a guideline document for the human factors review of alarm systems. Then we updated the guidelines by reviewing the literature related to alarm design that published after 1994. 12 refs., 11 figs., 2 tabs. (Author)

  13. Sedation-related complications in gastrointestinal endoscopy

    OpenAIRE

    Amornyotin, Somchai

    2013-01-01

    Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk fa...

  14. Sedation and monitoring for gastrointestinal endoscopy

    OpenAIRE

    Amornyotin, Somchai

    2013-01-01

    The safe sedation of patients for diagnostic or therapeutic procedures requires a combination of properly trained physicians and suitable facilities. Additionally, appropriate selection and preparation of patients, suitable sedative technique, application of drugs, adequate monitoring, and proper recovery of patients is essential. The goal of procedural sedation is the safe and effective control of pain and anxiety as well as to provide an appropriate degree of memory loss or decreased awaren...

  15. Pediatric dental sedation: challenges and opportunities

    OpenAIRE

    Nelson, Travis; Xu,Zheng

    2015-01-01

    Travis M Nelson, Zheng Xu Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA Abstract: High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases th...

  16. Pediatric dental sedation: challenges and opportunities

    Directory of Open Access Journals (Sweden)

    Nelson TM

    2015-08-01

    Full Text Available Travis M Nelson, Zheng Xu Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA Abstract: High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a

  17. Comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation

    Directory of Open Access Journals (Sweden)

    Werther Brunow de Carvalho

    1999-09-01

    Full Text Available CONTEXT: A high number of hospitalized children do not receive adequate sedation due to inadequate evaluation and use of such agents. With the increase in knowledge of sedation and analgesia in recent years, concern has also risen, such that it is now not acceptable that incorrect evaluations of the state of children's pain and anxiety are made. OBJECTIVE: A comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation. DESIGN: Prospective cohort study. SETTING: A pediatric intensive care unit with three beds at an urban teaching hospital. PATIENTS: Thirty simultaneous and independent observations were conducted by specialists on 18 patients studied. DIAGNOSTIC TEST: Comfort and Hartwig scales were applied, after 3 minutes of observation. MAIN MEASUREMENTS: Agreement rate (kappa. RESULTS: On the Comfort scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 20.28 (SD 2.78, 27.5 (SD 0.70, and 15.1 (SD 1.10, respectively, whereas on the Hartwig scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 16.35 (SD 0.77, 20.85 (SD 1.57, and 13.0 (SD 0.89, respectively. The observed agreement rate was 63% (p = 0.006 and the expected agreement rate was 44% with a Kappa coefficient of 0.345238 (z = 2.49. CONCLUSIONS: In our study there was no statistically significant difference whether the more complex Comfort scale was applied (8 physiological and behavioral parameters or the less complex Hartwig scale (5 behavioral parameters was applied to assess the sedation of mechanically ventilated pediatric patients.

  18. Classroom acoustics design guidelines based on the optimization of speaker conditions

    DEFF Research Database (Denmark)

    Pelegrin Garcia, David; Brunskog, Jonas

    2012-01-01

    School teachers suffer frequently from voice problems due to the high vocal load that they experience and the not-always-ideal conditions under which they have to teach. Traditionally, the purpose of the acoustic design of classrooms has been to optimize speech intelligibility. New guidelines...... and noise level measurements in classrooms. Requirements of optimum vocal comfort, average A-weighted speech levels across the audience higher than 50 dB, and a physical volume higher than 6 m3/student are combined to extract optimum acoustic conditions, which depend on the number of students....... These conditions, which are independent on the position of the speaker, cannot be optimum for more than 50 students. For classrooms with 10 students, the reverberation time in occupied conditions shall be between 0.5 and 0.65 s, and the volume between 60 and 170 m3. For classrooms with 40 students...

  19. Integration of Educational Methods and Physical Settings: Design Guidelines for High/Scope Methodology in Pre-Schools

    Science.gov (United States)

    Izadpanah, Shirin; Günçe, Kaðan

    2014-01-01

    Quality design and appropriate space organization in preschool settings can support preschool children's educational activities. Although the relationship between the well-being and development of children and physical settings has been emphasized by many early childhood researchers, there is still a need for theoretical design guidelines that are…

  20. Memory in humans is unaffected by central H1-antagonism, while objectively and subjectively measured sedation is increased.

    Science.gov (United States)

    Van Ruitenbeek, P; Vermeeren, A; Riedel, W J

    2010-04-01

    Animal literature suggests an important role for histamine in memory. In humans, this hypothesis has been scarcely tested and results from studies that have addressed this are conflicting. Second, impaired memory performance may be secondary to sedation. This study aimed to determine whether a centrally active antihistamine impairs memory performance and to dissociate such effects from sedation. Eighteen healthy volunteers received single oral doses of dexchlorpheniramine 4 mg, lorazepam 1mg and placebo in a 3-way, double blind, crossover designed study. The active control lorazepam impaired episodic- and working memory performance and increased sedation, while dexchlorpheniramine only increased sedation. 2009 Elsevier B.V. and ECNP. All rights reserved.

  1. Sedation-related complications in gastrointestinal endoscopy.

    Science.gov (United States)

    Amornyotin, Somchai

    2013-11-16

    Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patient's age and underlying medical diseases. Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management.

  2. Proposed Modifications to Engineering Design Guidelines Related to Resistivity Measurements and Spacecraft Charging

    Science.gov (United States)

    Dennison, J. R.; Swaminathan, Prasanna; Jost, Randy; Brunson, Jerilyn; Green, Nelson; Frederickson, A. Robb

    2005-01-01

    A key parameter in modeling differential spacecraft charging is the resistivity of insulating materials. This determines how charge will accumulate and redistribute across the spacecraft, as well as the time scale for charge transport and dissipation. Existing spacecraft charging guidelines recommend use of tests and imported resistivity data from handbooks that are based principally upon ASTM methods that are more applicable to classical ground conditions and designed for problems associated with power loss through the dielectric, than for how long charge can be stored on an insulator. These data have been found to underestimate charging effects by one to four orders of magnitude for spacecraft charging applications. A review is presented of methods to measure the resistive of highly insulating materials, including the electrometer-resistance method, the electrometer-constant voltage method, the voltage rate-of-change method and the charge storage method. This is based on joint experimental studies conducted at NASA Jet Propulsion Laboratory and Utah State University to investigate the charge storage method and its relation to spacecraft charging. The different methods are found to be appropriate for different resistivity ranges and for different charging circumstances. A simple physics-based model of these methods allows separation of the polarization current and dark current components from long duration measurements of resistivity over day- to month-long time scales. Model parameters are directly related to the magnitude of charge transfer and storage and the rate of charge transport. The model largely explains the observed differences in resistivity found using the different methods and provides a framework for recommendations for the appropriate test method for spacecraft materials with different resistivities and applications. The proposed changes to the existing engineering guidelines are intended to provide design engineers more appropriate methods for

  3. Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

    Directory of Open Access Journals (Sweden)

    Clark Michael E

    2010-04-01

    Full Text Available Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR, and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The

  4. The Relationship of Microorganism Classification by US Government Guidelines to the Design pof Laboratory Facilities

    International Nuclear Information System (INIS)

    Robinson, D.

    2007-01-01

    When the first edition of the Biosafety in Microbiological and Biomedical Laboratories, (BMBL) series was published approximately 40 years ago its purpose was to provide a code of practice, guidelines and standards for the prevention of laboratory acquired infections to the laboratorian working in an infectious disease laboratory. The BMBL is based on the microorganism being worked on and is a set of recommendations, which are advisory. While this is true, many agencies in the US government have incorporated all or parts of the BMBL in their regulations. This has led to the BMBL being accepted as the de facto US standard for the design and operation of infectious disease laboratories. The concept of biosecurity has evolved as a result of concerns related o access to microorganisms by terrorists following the anthrax letters of October 2001. While related to biosafety the specific requirements vary from those related to biosafety and are based on laws passed by the US Congress. The Select Agent Program of the US Centres for Disease Control has been given the responsibility for codifying and enforcing these regulations. Both biosafety and biosecurity need to be considered in the design of a laboratory facility. The occasionally conflicting regulatory requirements can be best resolved by conducting a Risk Assessment, which takes into account the microorganisms and the manipulations planned for the laboratory. This is an essential step for both laboratory design and subsequent laboratory operation. (author)

  5. Reflexology: its effects on physiological anxiety signs and sedation needs.

    Science.gov (United States)

    Akin Korhan, Esra; Khorshid, Leyla; Uyar, Mehmet

    2014-01-01

    To investigate whether reflexology has an effect on the physiological signs of anxiety and level of sedation in patients receiving mechanically ventilated support, a single blinded, randomized controlled design with repeated measures was used in the intensive care unit of a university hospital in Turkey. Patients (n = 60) aged between 18 and 70 years and were hospitalized in the intensive care unit and receiving mechanically ventilated support. Participants were randomized to a control group or an intervention group. The latter received 30 minutes of reflexology therapy on their feet, hands, and ears for 5 days. Subjects had vital signs taken immediately before the intervention and at the 10th, 20th, and 30th minutes of the intervention. In the collection of the data, "American Association of Critical-Care Nurses Sedation Assessment Scale" was used. The reflexology therapy group had a significantly lower heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate than the control group. A statistically significant difference was found between the averages of the scores that the patients included in the experimental and control groups received from the agitation, anxiety, sleep, and patient-ventilator synchrony subscales of the American Association of Critical-Care Nurses Sedation Assessment Scale. Reflexology can serve as an effective method of decreasing the physiological signs of anxiety and the required level of sedation in patients receiving mechanically ventilated support. Nurses who have appropriate training and certification may include reflexology in routine care to reduce the physiological signs of anxiety of patients receiving mechanical ventilation.

  6. Sedation practice in Nordic and non-Nordic ICUs

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Albarran, John W; Ring, Mette

    2013-01-01

    A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries....

  7. Efficacy of two types of palliative sedation therapy defined using intervention protocols: proportional vs. deep sedation.

    Science.gov (United States)

    Imai, Kengo; Morita, Tatsuya; Yokomichi, Naosuke; Mori, Masanori; Naito, Akemi Shirado; Tsukuura, Hiroaki; Yamauchi, Toshihiro; Kawaguchi, Takashi; Fukuta, Kaori; Inoue, Satoshi

    2018-06-01

    This study investigated the effect of two types of palliative sedation defined using intervention protocols: proportional and deep sedation. We retrospectively analyzed prospectively recorded data of consecutive cancer patients who received the continuous infusion of midazolam in a palliative care unit. Attending physicians chose the sedation protocol based on each patient's wish, symptom severity, prognosis, and refractoriness of suffering. The primary endpoint was a treatment goal achievement at 4 h: in proportional sedation, the achievement of symptom relief (Support Team Assessment Schedule (STAS) ≤ 1) and absence of agitation (modified Richmond Agitation-Sedation Scale (RASS) ≤ 0) and in deep sedation, the achievement of deep sedation (RASS ≤ - 4). Secondary endpoints included mean scores of STAS and RASS, deep sedation as a result, and adverse events. Among 398 patients who died during the period, 32 received proportional and 18 received deep sedation. The treatment goal achievement rate was 68.8% (22/32, 95% confidence interval 52.7-84.9) in the proportional sedation group vs. 83.3% (15/18, 66.1-100) in the deep sedation group. STAS decreased from 3.8 to 0.8 with proportional sedation at 4 h vs. 3.7 to 0.3 with deep sedation; RASS decreased from + 1.2 to - 1.7 vs. + 1.4 to - 3.7, respectively. Deep sedation was needed as a result in 31.3% (10/32) of the proportional sedation group. No fatal events that were considered as probably or definitely related to the intervention occurred. The two types of intervention protocol well reflected the treatment intention and expected outcomes. Further, large-scale cohort studies are promising.

  8. Pediatric dental sedation: challenges and opportunities.

    Science.gov (United States)

    Nelson, Travis M; Xu, Zheng

    2015-01-01

    High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of

  9. Guidelines and criteria for nuclear piping and support evaluation and design

    International Nuclear Information System (INIS)

    Rehn, D.L.; Stout, D.H. Jr.; Minichiello, J.C.

    1993-05-01

    The EPRI Research Project 2967-2 has set its fundamental goal to be the development of realistic guidelines and criteria for piping and pipe support design and evaluation. The focus is on items that are most critical to utilities and consists of a variety of tasks relating to piping and pipe support design. One objective of this report is to summarize the recommendations from the seven task reports of the first phase of the project and to provide examples of how to use those recommendations. Criteria and methods for evaluating both short and long term system operation are addressed. Benefits gained from applying the recommendations to actual systems are discussed. The report also reviews other work currently being done within the nuclear industry and assesses the impact of that work on the recommended criteria/methods of this project. The second objective of the report is to discuss possible changes needed in the governing codes or licensing commitments in order to implement the recommendations. Finally, the report describes further research which can be done to advance the criteria presented and answer questions concerning applicability of the proposed criteria to designs not tested/investigated. The basic conclusion reached in the project is that many of the criteria/methods used today in piping analysis/design are overly conservative. The report's conclusion is supported by extensive literature searches, tests, and analyses. The report presents a robust source of reference to utilities which wish to implement changes in criteria and methods. Most of the criteria and methodologies described in the seven task reports and summarized in the following sections will require some effort in licensing or Code changes

  10. Designing the Health-related Internet of Things: Ethical Principles and Guidelines

    Directory of Open Access Journals (Sweden)

    Brent Mittelstadt

    2017-07-01

    Full Text Available The conjunction of wireless computing, ubiquitous Internet access, and the miniaturisation of sensors have opened the door for technological applications that can monitor health and well-being outside of formal healthcare systems. The health-related Internet of Things (H-IoT increasingly plays a key role in health management by providing real-time tele-monitoring of patients, testing of treatments, actuation of medical devices, and fitness and well-being monitoring. Given its numerous applications and proposed benefits, adoption by medical and social care institutions and consumers may be rapid. However, a host of ethical concerns are also raised that must be addressed. The inherent sensitivity of health-related data being generated and latent risks of Internet-enabled devices pose serious challenges. Users, already in a vulnerable position as patients, face a seemingly impossible task to retain control over their data due to the scale, scope and complexity of systems that create, aggregate, and analyse personal health data. In response, the H-IoT must be designed to be technologically robust and scientifically reliable, while also remaining ethically responsible, trustworthy, and respectful of user rights and interests. To assist developers of the H-IoT, this paper describes nine principles and nine guidelines for ethical design of H-IoT devices and data protocols.

  11. Guidelines for the design of a healing garden for the rehabilitation of psychiatric patients

    Directory of Open Access Journals (Sweden)

    Chantal Erbino

    2015-06-01

    Full Text Available Healing gardens are green spaces designed to promote and improve health and well-being for people suffering from illness. This paper proposes a methodology for defining a master plan for healing gardens. The methodology is based on site analysis (identification, limitations and potentials of the area and the evaluation of user needs (patients, staff, relatives. The aim of the master plan is to provide guidelines for the definition of the executive plan, and to set up a sufficiently flexible project suitable for future new categories of patients, according to the different needs of the regional health authorities. The methodology has been applied to a case study: this paper considers the design of the healing garden of a building named Villa Bianca, part of the wider complex of the clinic for mental disorders Villa di Salute located in Trofarello (in the province of Turin, Piedmont, Italy. The main kinds of disturbances treated at Villa di Salute are schizophrenia and personality disorders; there are also some patients with severe depression. At the present time the building and the garden of Villa Bianca are not being used and are undergoing renovation.

  12. Progress towards developing consistent design and evaluation guidelines for DOE facilities subjected to natural phenomena hazards

    International Nuclear Information System (INIS)

    Kennedy, R.P.; Short, S.A.; McDonald, J.R.; McCann, M.W. Jr.; Reed, J.W.

    1985-01-01

    Probabilistic definitions of earthquake, wind and tornado natural phenomena hazards for many Department of Energy (DOE) facilities throughout the United States have been developed. In addition, definitions of the flood hazards which might affect these locations are currently being developed. The Department of Energy Natural Phenomena Hazards Panel is now preparing a document to provide guidance and criteria for DOE facility managers to assure that DOE facilities are adequately constructed to resist the effects of natural phenomena such as earthquake, strong wind and flood. The intent of this document is to provide instruction on how to utilize the hazard definitions to evaluate existing facilities and design new facilities in a manner such that the risk of adverse consequences is consistent with the cost, function, and danger to the public or environment of the facility. Potential effects on facilities of natural phenomena hazards are emphasized in this paper. The philosophy for mitigating these effects to be employed in the design and evaluation guidelines is also presented

  13. Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons.

    NARCIS (Netherlands)

    Donker, G.A.; Slotman, F.G.; Spreeuwenberg, P.; Francke, A.L.

    2013-01-01

    Background: Little is known about the quantity and reasons for use of palliative sedation in general practice. Aim: To gain more insight into the trends of and reasons for palliative sedation in Dutch general practice. Design and setting: Dynamic cohort study using registrations and questionnaire

  14. Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons

    NARCIS (Netherlands)

    Donker, G.A.; Slotman, F.G.; Spreeuwenberg, P.; Francke, A.L.

    2013-01-01

    Background: Little is known about the quantity and reasons for use of palliative sedation in general practice. Aim: To gain more insight into the trends of and reasons for palliative sedation in Dutch general practice. Design and setting: Dynamic cohort study using registrations and questionnaire

  15. The sedative and analgesic potentials of dexmedtomidine ...

    African Journals Online (AJOL)

    Venous access was secured thirty minutes later, the fluid was connected to the cannula and was set to flow at daily fluid maintenance rate of 90mlkgday-1. Neither sedation nor analgesia was achieved with 20μgkg-1. Slight to moderate sedative effect was achieved at 40μg/kg with significant reduction in heart, pulse and ...

  16. Sedation in the ICU Less is more

    DEFF Research Database (Denmark)

    Strom, T.

    2012-01-01

    . The intervention group received only bolus doses of morphine or haloperidol if delirium was suspected. The control group received standard infusion of sedatives to RAMSAY 3-4 and sedatives were interrupted on a daily basis. Both groups received morphine as intravenous bolus doses (2.5 to 5 mg). The primary outcome...

  17. Nurse-administered propofol sedation for endoscopy

    DEFF Research Database (Denmark)

    Jensen, J T; Vilmann, P; Horsted, T

    2011-01-01

    The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program.......The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program....

  18. Sedation practice among Nigerian radiology residents

    African Journals Online (AJOL)

    Background: Providing safe and effective sedation to patients, especially those with multiple medical problems, can be ... This study aimed to determine knowledge, attitude and practice of Nigerian radiology ..... works. Conclusion. Sedation and resuscitation are an integral part of radiology .... An evaluation of a virtual reality.

  19. Palliative Sedation in Advanced Cancer Patients: Does it Shorten Survival Time? - A Systematic Review.

    Science.gov (United States)

    Barathi, B; Chandra, Prabha S

    2013-01-01

    Patients with advanced cancer often suffer from multiple refractory symptoms in the terminal phase of their life. Palliative sedation is one of the few ways to relieve this refractory suffering. This systematic review investigated the effect of palliative sedation on survival time in terminally ill cancer patients. Six electronic databases were searched for both prospective and retrospective studies which evaluated the effect of palliative sedation on survival time. Only those studies which had a comparison group that did not receive palliative sedation were selected for the review. Abstracts of all retrieved studies were screened to include the most relevant studies and only studies which met inclusion criteria were selected. References of all retrieved studies were also screened for relevant studies. Selected studies were assessed for quality and data extraction was done using the structured data extraction form. Eleven studies including four prospective and seven retrospective studies were identified. Mean survival time (MST) was measured as the time from last admission until death. A careful analysis of the results of all the 11 studies indicated that MST of sedated and non-sedated group was not statistically different in any of the studies. This systematic review supports the fact that palliative sedation does not shorten survival in terminally ill cancer patients. However, this conclusion needs to be taken with consideration of the methodology, study design, and the population studied of the included studies in this review.

  20. Determinants of the administration of continuous palliative sedation: a systematic review.

    Science.gov (United States)

    van Deijck, Rogier H P D; Hasselaar, Jeroen G J; Verhagen, Stans C A H H V M; Vissers, Kris C P; Koopmans, Raymond T C M

    2013-12-01

    Little is known about the determining factors related to the administration of continuous palliative sedation. Knowledge of these determinants may assist physicians in identifying patients who are at high risk of developing refractory symptoms, enable physicians to inform patients, and optimize close monitoring. The aim of this systematic review was to identify determinants of the administration of continuous palliative sedation. A systematic review of PubMed, EMBASE, and CINAHL was performed to identify English, Dutch, and German language papers published from January 1990 through April 2011. Inclusion was based on the following criteria: patient-based research on continuous palliative sedation, studies investigating determinants of palliative sedation and/or comparison between sedated and nonsedated cohorts, and studies using multivariate analyses and of fair to good or good methodological quality. In total, eight papers were reviewed. The following nine factors were found to be associated with the administration of continuous palliative sedation: younger age, male sex, having cancer, feelings of hopelessness, dying in a hospital, living in a Dutch speaking community setting, very nonreligious or extremely nonreligious physicians, physicians working in "other hospital" specialties, and physicians in favor of assisted death. Given the variation in study designs and the limitations of the included studies, the outcomes should be interpreted carefully. Further research is needed, particularly regarding factors that can be influenced and that may alter the course of a patient's symptoms and the patient's eventual need for palliative sedation.

  1. Palliative sedation in advanced cancer patients: Does it shorten survival time? - A systematic review

    Directory of Open Access Journals (Sweden)

    B Barathi

    2013-01-01

    Full Text Available Background: Patients with advanced cancer often suffer from multiple refractory symptoms in the terminal phase of their life. Palliative sedation is one of the few ways to relieve this refractory suffering. Objectives: This systematic review investigated the effect of palliative sedation on survival time in terminally ill cancer patients. Materials and Methods: Six electronic databases were searched for both prospective and retrospective studies which evaluated the effect of palliative sedation on survival time. Only those studies which had a comparison group that did not receive palliative sedation were selected for the review. Abstracts of all retrieved studies were screened to include the most relevant studies and only studies which met inclusion criteria were selected. References of all retrieved studies were also screened for relevant studies. Selected studies were assessed for quality and data extraction was done using the structured data extraction form. Results: Eleven studies including four prospective and seven retrospective studies were identified. Mean survival time (MST was measured as the time from last admission until death. A careful analysis of the results of all the 11 studies indicated that MST of sedated and non-sedated group was not statistically different in any of the studies. Conclusion: This systematic review supports the fact that palliative sedation does not shorten survival in terminally ill cancer patients. However, this conclusion needs to be taken with consideration of the methodology, study design, and the population studied of the included studies in this review.

  2. [Sedation with nitrous oxide in daily practice].

    Science.gov (United States)

    Martens, Luc C; Marks, Luc A

    2003-01-01

    Conscious sedation is recommended, together with behaviour management techniques, to facilitate treatment of dental fear or dental phobia patients. In this article the authors focus on inhalation sedation by means of nitrous oxide. The procedures and indications are explained and illustrated with clinical cases. On the strength of the literature and their own experience the authors reach the conclusion that Inhalation sedation is a kind of pharmacological behaviour management and an important additional tool to increase patient cooperation. Inhalation sedation can only be performed by trained practitioners under internationally accepted safety conditions. Inhalation sedation has a future in Belgium providing the appropriate law is adapted. This technique deserves a place in the dental curriculum.

  3. Propofol sedation in children: sleep trumps amnesia☆

    Science.gov (United States)

    Veselis, Robert; Kelhoffer, Eric; Mehta, Meghana; Root, James C.; Robinson, Fay; Mason, Keira P.

    2017-01-01

    Objective Detailed assessments of the effects of propofol on memory in children are lacking. We assessed the feasibility of measuring memory during propofol infusion, as commonly performed in sedation for MRI scanning. In addition, we determined the onset of memory loss in relation to the onset of sedation measured by verbal responsiveness. Materials and methods Children scheduled for sedation for MRI received a 10-min infusion of propofol (3 mg/kg) as they viewed and named 100 simple line drawings, one shown every five seconds, until they were no longer responsive (encoding). A control group receiving no sedation for MRI underwent similar tasks. Sedation was measured as any verbal response, regardless of correctness. After recovery from sedation, recognition memory was tested, with correct yes/no recognitions matched to sedation responses during encoding (subsequent memory paradigm). Results Of the 48 children who received propofol, 30 could complete all study tasks (6.2 ± 1.6 years, 16 males). Individual responses could be modeled in all 30 children. On average, there was a 50% probability of no verbal response 3.1 min after the start of infusion, with 50% memory loss at 2.7 min. Children receiving propofol recognized 65 ± 16% of the pictures seen, whereas the control group recognized 93 ± 5%. Conclusion Measurement of memory and sedation is possible in verbal children receiving propofol by infusion in a clinical setting. Despite propofol being an amnestic agent, there was little or no amnestic effect of propofol while the child was verbally responsive. It is important for sedation providers to realize that propofol sedation does not always produce amnesia while the child is responsive. ClinicalTrials.gov number NCT02278003. PMID:27938911

  4. Propofol sedation in children: sleep trumps amnesia.

    Science.gov (United States)

    Veselis, Robert; Kelhoffer, Eric; Mehta, Meghana; Root, James C; Robinson, Fay; Mason, Keira P

    Detailed assessments of the effects of propofol on memory in children are lacking. We assessed the feasibility of measuring memory during propofol infusion, as commonly performed in sedation for MRI scanning. In addition, we determined the onset of memory loss in relation to the onset of sedation measured by verbal responsiveness. Children scheduled for sedation for MRI received a 10-min infusion of propofol (3 mg/kg) as they viewed and named 100 simple line drawings, one shown every five seconds, until they were no longer responsive (encoding). A control group receiving no sedation for MRI underwent similar tasks. Sedation was measured as any verbal response, regardless of correctness. After recovery from sedation, recognition memory was tested, with correct yes/no recognitions matched to sedation responses during encoding (subsequent memory paradigm). Of the 48 children who received propofol, 30 could complete all study tasks (6.2 ± 1.6 years, 16 males). Individual responses could be modeled in all 30 children. On average, there was a 50% probability of no verbal response 3.1 min after the start of infusion, with 50% memory loss at 2.7 min. Children receiving propofol recognized 65 ± 16% of the pictures seen, whereas the control group recognized 93 ± 5%. Measurement of memory and sedation is possible in verbal children receiving propofol by infusion in a clinical setting. Despite propofol being an amnestic agent, there was little or no amnestic effect of propofol while the child was verbally responsive. It is important for sedation providers to realize that propofol sedation does not always produce amnesia while the child is responsive. CLINICALTRIALS. NCT02278003. Copyright © 2016. Published by Elsevier B.V.

  5. Human-system interface design review guideline -- Review software and user's guide: Final report. Revision 1, Volume 3

    International Nuclear Information System (INIS)

    1996-06-01

    NUREG-0700, Revision 1, provides human factors engineering (HFE) guidance to the US Nuclear Regulatory Commission staff for its: (1) review of the human system interface (HSI) design submittals prepared by licensees or applications for a license or design certification of commercial nuclear power plants, and (2) performance of HSI reviews that could be undertaken as part of an inspection or other type of regulatory review involving HSI design or incidents involving human performance. The guidance consists of a review process and HFE guidelines. The document describes those aspects of the HSI design review process that are important to the identification and resolution of human engineering discrepancies that could adversely affect plant safety. Guidance is provided that could be used by the staff to review an applicant's HSI design review process or to guide the development of an HSI design review plan, e.g., as part of an inspection activity. The document also provides detailed HFE guidelines for the assessment of HSI design implementations. NUREG-0700, Revision 1, consists of three stand-alone volumes. Volume 3 contains an interactive software application of the NUREG-0700, Revision 1 guidance and a user's guide for this software. The software supports reviewers during review preparation, evaluation design using the human factors engineering guidelines, and in report preparation. The user's guide provides system requirements and installation instructions, detailed explanations of the software's functions and features, and a tutorial on using the software

  6. Remote maintenance systems requirements are being developed to provide design guidelines for machine components, to define maintenance interfaces, and to quantify maintenance equipment and procedures needed

    International Nuclear Information System (INIS)

    Spampinato, P.T.; Tabor, M.A.

    1988-01-01

    Remote maintenance systems requirements are being developed to provide design guidelines for machine components, to define maintenance interfaces, and to quantify maintenance equipment and procedures needed

  7. Sleep and Sedative States Induced by Targeting the Histamine and Noradrenergic Systems

    Directory of Open Access Journals (Sweden)

    Xiao Yu

    2018-01-01

    Full Text Available Sedatives target just a handful of receptors and ion channels. But we have no satisfying explanation for how activating these receptors produces sedation. In particular, do sedatives act at restricted brain locations and circuitries or more widely? Two prominent sedative drugs in clinical use are zolpidem, a GABAA receptor positive allosteric modulator, and dexmedetomidine (DEX, a selective α2 adrenergic receptor agonist. By targeting hypothalamic neuromodulatory systems both drugs induce a sleep-like state, but in different ways: zolpidem primarily reduces the latency to NREM sleep, and is a controlled substance taken by many people to help them sleep; DEX produces prominent slow wave activity in the electroencephalogram (EEG resembling stage 2 NREM sleep, but with complications of hypothermia and lowered blood pressure—it is used for long term sedation in hospital intensive care units—under DEX-induced sedation patients are arousable and responsive, and this drug reduces the risk of delirium. DEX, and another α2 adrenergic agonist xylazine, are also widely used in veterinary clinics to sedate animals. Here we review how these two different classes of sedatives, zolpidem and dexmedetomideine, can selectively interact with some nodal points of the circuitry that promote wakefulness allowing the transition to NREM sleep. Zolpidem enhances GABAergic transmission onto histamine neurons in the hypothalamic tuberomammillary nucleus (TMN to hasten the transition to NREM sleep, and DEX interacts with neurons in the preoptic hypothalamic area that induce sleep and body cooling. This knowledge may aid the design of more precise acting sedatives, and at the same time, reveal more about the natural sleep-wake circuitry.

  8. Dreaming in sedation during spinal anesthesia: a comparison of propofol and midazolam infusion.

    Science.gov (United States)

    Kim, Duk-Kyung; Joo, Young; Sung, Tae-Yun; Kim, Sung-Yun; Shin, Hwa-Yong

    2011-05-01

    Although sedation is often performed during spinal anesthesia, the details of intraoperative dreaming have not been reported. We designed this prospective study to compare 2 different IV sedation protocols (propofol and midazolam infusion) with respect to dreaming during sedation. Two hundred twenty adult patients were randomly assigned to 2 groups and received IV infusion of propofol or midazolam for deep sedation during spinal anesthesia. Patients were interviewed on emergence and 30 minutes later to determine the incidence, content, and nature of their dreams. Postoperatively, patient satisfaction with the sedation was also evaluated. Two hundred fifteen patients (108 and 107 in the propofol and midazolam groups, respectively) were included in the final analysis. The proportion of dreamers was 39.8% (43/108) in the propofol group and 12.1% (13/107) in the midazolam group (odds ratio=4.78; 95% confidence interval: 2.38 to 9.60). Dreams of the patients receiving propofol were more memorable and visually vivid than were those of the patients receiving midazolam infusion. The majority of dreams (36 of 56 dreamers, 64.3%) were simple, pleasant ruminations about everyday life. A similarly high level of satisfaction with the sedation was observed in both groups. In cases of spinal anesthesia with deep sedation, dreaming was almost 5 times more common in patients receiving propofol infusion than in those receiving midazolam, although this did not influence satisfaction with the sedation. Thus, one does not need to consider intraoperative dreaming when choosing propofol or midazolam as a sedative drug in patients undergoing spinal anesthesia. © 2011 International Anesthesia Research Society

  9. Regulatory principles, criteria and guidelines for site selection, design, construction and operation of uranium tailings retention systems

    International Nuclear Information System (INIS)

    Coady, J.R.; Henry, L.C.

    1978-01-01

    Principles, criteria and guidelines developed by the Atomic Energy Control Board for the management of uranium mill tailings are discussed. The application of these concepts is considered in relation to site selection, design and construction, operation and decommissioning of tailings retention facilities

  10. Integration of educational methods and physical settings: design guidelines for High/Scope methodology in pre-schools

    Directory of Open Access Journals (Sweden)

    Shirin Izadpanah

    2014-06-01

    Full Text Available Quality design and appropriate space organization in preschool settings can support preschool children's educational activities. Although the relationship between the well-being and development of children and physical settings has been emphasized by many early childhood researchers, there is still a need for theoretical design guidelines that are geared towards the improvement of this issue. This research focuses on High/Scope education and aims to shape a theoretical guideline that raises teachers' awareness about the potential of learning spaces and guides them to improve the quality of the physical spaces. To create a theoretical framework, reliable sources are investigated in the light of High/Scope education and the requirements of pre-school children educational spaces. Physical space characteristics, the preschool child's requirements and High/Scope methodology identified design inputs, design considerations and recommendations that shape the final guideline for spatial arrangement in a High/Scope setting are integrated. Discussions and suggestions in this research benefit both designers and High/ Scope teaching staff. Results help High/Scope teaching staff increase the quality of a space in an educational setting without having an architectural background. The theoretical framework of the research allows designers to consider key features and users' possible activities in High/ Scope settings and shape their designs accordingly.

  11. Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions

    Energy Technology Data Exchange (ETDEWEB)

    Karian, V.E.; Burrows, P.E.; Connor, L. [Dept. of Radiology, Children' s Hospital, Boston, MA (United States); Zurakowski, D. [Dept. of Biostatistics, Children' s Hospital, Boston, MA (United States); Mason, K.P. [Dept. of Anesthesiology, Children' s Hospital, Boston, MA (United States)

    1999-11-01

    Background. Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur. Objective. The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes. Materials and methods. Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression. Results. Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV. Conclusion. The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives. (orig.)

  12. Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions

    International Nuclear Information System (INIS)

    Karian, V.E.; Burrows, P.E.; Connor, L.; Zurakowski, D.; Mason, K.P.

    1999-01-01

    Background. Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur. Objective. The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes. Materials and methods. Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression. Results. Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV. Conclusion. The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives. (orig.)

  13. Guidelines for the Selection of Near-Earth Thermal Environment Parameters for Spacecraft Design

    Science.gov (United States)

    Anderson, B. J.; Justus, C. G.; Batts, G. W.

    2001-01-01

    Thermal analysis and design of Earth orbiting systems requires specification of three environmental thermal parameters: the direct solar irradiance, Earth's local albedo, and outgoing longwave radiance (OLR). In the early 1990s data sets from the Earth Radiation Budget Experiment were analyzed on behalf of the Space Station Program to provide an accurate description of these parameters as a function of averaging time along the orbital path. This information, documented in SSP 30425 and, in more generic form in NASA/TM-4527, enabled the specification of the proper thermal parameters for systems of various thermal response time constants. However, working with the engineering community and SSP-30425 and TM-4527 products over a number of years revealed difficulties in interpretation and application of this material. For this reason it was decided to develop this guidelines document to help resolve these issues of practical application. In the process, the data were extensively reprocessed and a new computer code, the Simple Thermal Environment Model (STEM) was developed to simplify the process of selecting the parameters for input into extreme hot and cold thermal analyses and design specifications. In the process, greatly improved values for the cold case OLR values for high inclination orbits were derived. Thermal parameters for satellites in low, medium, and high inclination low-Earth orbit and with various system thermal time constraints are recommended for analysis of extreme hot and cold conditions. Practical information as to the interpretation and application of the information and an introduction to the STEM are included. Complete documentation for STEM is found in the user's manual, in preparation.

  14. Factors controlling volume errors through 2D gully erosion assessment: guidelines for optimal survey design

    Science.gov (United States)

    Castillo, Carlos; Pérez, Rafael

    2017-04-01

    The assessment of gully erosion volumes is essential for the quantification of soil losses derived from this relevant degradation process. Traditionally, 2D and 3D approaches has been applied for this purpose (Casalí et al., 2006). Although innovative 3D approaches have recently been proposed for gully volume quantification, a renewed interest can be found in literature regarding the useful information that cross-section analysis still provides in gully erosion research. Moreover, the application of methods based on 2D approaches can be the most cost-effective approach in many situations such as preliminary studies with low accuracy requirements or surveys under time or budget constraints. The main aim of this work is to examine the key factors controlling volume error variability in 2D gully assessment by means of a stochastic experiment involving a Monte Carlo analysis over synthetic gully profiles in order to 1) contribute to a better understanding of the drivers and magnitude of gully erosion 2D-surveys uncertainty and 2) provide guidelines for optimal survey designs. Owing to the stochastic properties of error generation in 2D volume assessment, a statistical approach was followed to generate a large and significant set of gully reach configurations to evaluate quantitatively the influence of the main factors controlling the uncertainty of the volume assessment. For this purpose, a simulation algorithm in Matlab® code was written, involving the following stages: - Generation of synthetic gully area profiles with different degrees of complexity (characterized by the cross-section variability) - Simulation of field measurements characterised by a survey intensity and the precision of the measurement method - Quantification of the volume error uncertainty as a function of the key factors In this communication we will present the relationships between volume error and the studied factors and propose guidelines for 2D field surveys based on the minimal survey

  15. Deep sedation during pneumatic reduction of intussusception.

    Science.gov (United States)

    Ilivitzki, Anat; Shtark, Luda Glozman; Arish, Karin; Engel, Ahuva

    2012-05-01

    Pneumatic reduction of intussusception under fluoroscopic guidance is a routine procedure. The unsedated child may resist the procedure, which may lengthen its duration and increase the radiation dose. We use deep sedation during the procedure to overcome these difficulties. The purpose of this study was to summarize our experience with deep sedation during fluoroscopic reduction of intussusception and assess the added value and complication rate of deep sedation. All children with intussusception who underwent pneumatic reduction in our hospital between January 2004 and June 2011 were included in this retrospective study. Anesthetists sedated the children using propofol. The fluoroscopic studies, ultrasound (US) studies and the childrens' charts were reviewed. One hundred thirty-one attempted reductions were performed in 119 children, of which 121 (92%) were successful and 10 (8%) failed. Two perforations (1.5%) occurred during attempted reduction. Average fluoroscopic time was 1.5 minutes. No complication to sedation was recorded. Deep sedation with propofol did not add any complication to the pneumatic reduction. The fluoroscopic time was short. The success rate of reduction was high,raising the possibility that sedation is beneficial, possibly by smooth muscle relaxation.

  16. [Sedation with midazolam for ambulatory pediatric dentistry].

    Science.gov (United States)

    Shavlokhova, E A; Ostreĭkov, I F; Korolenkova, M V

    2014-01-01

    To improve the quality of dental treatment in children by using combined anaesthesia technique including local anaesthesia and conscious sedation, and to assess the effectiveness of conscious sedation for younger children undergoing dental treatment. The study included 208 children aged 14-88 months who received dental treatment for tooth decay and its complication under combined anaesthesia. Midazolam was used as sedative medication. Sedation level was assessed by visual scale and BIS-monitoring. ANI-monitoring was also used for pain sensitiveness evaluation. Results All 208 children were successfully treated under combined anaesthesia which showed satisfactory sedation rates both by visual scale and and BIS-monitoring values. While mean patient age was 39 months 20.6% were younger than 24 months. These data are extremely valuable as according to literature review conscious sedation in early infancy remains controversial. Our results proved conscious sedation to be effective in younger children undergoing dental treatment thus representing important alternative for general anaesthesia and providing a basis for later behavior management.

  17. The indicator of sedation need (IOSN).

    Science.gov (United States)

    Coulthard, Paul

    2013-01-01

    Conscious sedation in dentistry is usually indicated because a patient's anxiety can prohibit the necessary dental treatment being undertaken. It may also be indicated because of unpleasant or lengthy treatment or to prevent exacerbation of a patient's medical or behavioural condition by anxiety. The indicator of sedation need (IOSN) tool has been developed to help support dentists in their clinical decision-making and uses information about a patient's anxiety, medical and behavioural status and treatment complexity. The IOSN has been used to measure sedation need and has shown that 5.1% of patients attending general dental practices have a high need of conscious sedation. IOSN has also been used to investigate the need for conscious sedation in the general population among dental practice attenders and those who don't attend. The proportion was found to be 6.7%. Some patients require conscious sedation in order to access dental care. The indicator of sedation need (IOSN) tool helps in the decision-making process.

  18. Bispectral Index Monitoring Reduces the Dosage of Propofol and Adverse Events in Sedation for Endobronchial Ultrasound.

    Science.gov (United States)

    Quesada, Natividad; Júdez, Diego; Martínez Ubieto, Javier; Pascual, Ana; Chacón, Enrique; De Pablo, Francisco; Mincholé, Elisa; Bello, Salvador

    2016-01-01

    Current guidelines recommend monitoring the anesthetic depth of sedation during respiratory endoscopy by using clinical scales despite their subjective nature and the potential change in the level of sedation caused by frequent stimulation. Monitoring by means of the bispectral index (BIS) has shown its utility in reducing the use of drugs and their adverse events in general anesthesia, but evidence in prolonged sedation is insufficient. Our objective was to evaluate BIS in patients undergoing endobronchial ultrasound (EBUS). A randomized cohort study of 90 patients with mediastinal lymph node involvement and/or lung or mediastinal lesions for whom EBUS was indicated, comparing the modified observer's assessment of alertness/sedation scale clinical evaluation (n = 45) versus the BIS evaluation (n = 45) of sedation with propofol-remifentanil, was conducted in order to evaluate the clinical parameters, doses used, adverse events, and tolerance of the procedure. We found a shorter waking time and a significantly lower dose of total propofol in the BIS group. Significantly fewer overall adverse events were recorded in the BIS group and included desaturation, hypotension, and bradypnea. Tolerance was better in the BIS group. No significant differences were found in terms of cough, memory of the procedure, or the level of difficulty of EBUS on the part of the pulmonologists. BIS monitoring of sedation in EBUS makes it possible to reduce the dosage of propofol, thereby shortening the waking time and reducing adverse events. This form of monitoring should be taken into consideration in the future for systematic use in prolonged sedation, as in the case of EBUS. © 2016 S. Karger AG, Basel.

  19. Oral Sedation in the Dental Office.

    Science.gov (United States)

    Sebastiani, Francesco R; Dym, Harry; Wolf, Joshua

    2016-04-01

    This article highlights the commonly used medications used in dentistry and oral surgery. General dentists and specialists must be knowledgeable about the pharmacology of the drugs currently available along with their risks and benefits. Enteral sedation is a useful adjunct for the treatment of anxious adult and pediatric patients. When enteral sedation is used within the standards of care, the interests of the public and the dental profession are served through a cost-effective, effective service that can be widely available. Oral sedation enables dentists to provide dental care to millions of individuals who otherwise would have unmet dental needs. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Nitrous Oxide-Oxygen Sedation: USAF Dental Guidelines.

    Science.gov (United States)

    1981-11-01

    the patient with a history of a seizure disorder that is controlled by anticonvulsives . The patient probably at the highest risk of developing...Refusal by patient (be sure to get parent’s pert;,ission for all pediatric patients). 2. Nasal obstruction. 3. O.per respiratory tract infection. 4

  1. Physics-based process modeling, reliability prediction, and design guidelines for flip-chip devices

    Science.gov (United States)

    Michaelides, Stylianos

    -down devices without the underfill, based on the thorough understanding of the failure modes. Also, practical design guidelines for material, geometry and process parameters for reliable flip-chip devices have been developed.

  2. Sedation at the end of life - a nation-wide study in palliative care units in Austria.

    Science.gov (United States)

    Schur, Sophie; Weixler, Dietmar; Gabl, Christoph; Kreye, Gudrun; Likar, Rudolf; Masel, Eva Katharina; Mayrhofer, Michael; Reiner, Franz; Schmidmayr, Barbara; Kirchheiner, Kathrin; Watzke, Herbert Hans

    2016-05-14

    Sedation is used to an increasing extent in end-of-life care. Definitions and indications in this field are based on expert opinions and case series. Little is known about this practice at palliative care units in Austria. Patients who died in Austrian palliative care units between June 2012 and June 2013 were identified. A predefined set of baseline characteristics and information on sedation during the last two weeks before death were obtained by reviewing the patients' charts. The data of 2414 patients from 23 palliative care units were available for analysis. Five hundred two (21 %) patients received sedation in the last two weeks preceding their death, 356 (71 %) received continuous sedation until death, and 119 (24 %) received intermittent sedation. The median duration of sedation was 48 h (IQR 10-72 h); 168 patients (34 %) were sedated for less than 24 h. Indications for sedation were delirium (51 %), existential distress (32 %), dyspnea (30 %), and pain (20 %). Midazolam was the most frequently used drug (79 %), followed by lorazepam (13 %), and haloperidol (10 %). Sedated patients were significantly younger (median age 67 years vs. 74 years, p ≤ 0.001, r = 0.22), suffered more often from an oncological disease (92 % vs. 82 %, p ≤ 0.001, φ = 0.107), and were hospitalized more frequently (94 % vs. 76 %, p ≤ 0.001, φ = 0.175). The median number of days between admission to a palliative care ward/mobile palliative care team and death did not differ significantly in sedated versus non-sedated patients (10 vs. 9 days; p = 0.491). This study provides insights into the practice of end-of-life sedation in Austria. Critical appraisal of these data will serve as a starting point for the development of nation-wide guidelines for palliative sedation in Austria.

  3. Effect of environmental noise and music on dexmedetomidine-induced sedation in dogs

    Directory of Open Access Journals (Sweden)

    Julia D. Albright

    2017-07-01

    Full Text Available Background Previous studies in human patients suggest depth of sedation may be affected by environmental noise or music; however, related data in domestic animals is limited. The objective of the current study was to investigate the effect of noise and music on dexmedetomidine-induced (DM- 10 µg/kg, IM sedation in 10 dogs. Methods In a crossover design, post-DM injection dogs were immediately subjected to recorded human voices at either 55–60 decibel (dB (Noise 1 or 80–85 dB (Noise 2; classical music at 45–50 dB (Music; or background noise of 40–45 dB (Control+. Control− included IM saline injection and exposure to 40–45 dB background noise. Sedation was assessed via monitoring spontaneous behavior and accelerometry (delta-g throughout three 20-min evaluation periods: baseline, noise exposure, and post-treatment. Sedation was further assessed during two restraint tests at 30 min (R1 and 40 min (R2 post-injection. A mixed model for crossover design was used to determine the effect of noise exposure and time on either spontaneous behavior scores or delta-g. The restraint scores were analyzed using a two-way repeated measures ANOVA. Results Spontaneous behavior scores indicated less sedation during Noise 2 compared to Control+ (P = 0.05. R2 restraint scores for all DM treatments except Noise 2 indicated significantly higher sedation than Control− [C+ (P = 0.003, M (P = 0.014 and N1 (P = 0.044]. Discussion Results suggest that the quality of sedation is negatively impacted by high-intensity noise conditions (80–85 dB, but exposure to music did not improve sedation in this population of research dogs.

  4. Sedation for procedures outside the operating room in children

    International Nuclear Information System (INIS)

    Molina Rodriguez, Ericka

    2014-01-01

    Sedation is defined in the pediatric population. An adequate preoperative assessment is established in patients subjected to a sedation. Fundamental characteristics of drugs used during a sedation are determined. Recommendations about surveillance and monitoring are established in a patient sedated. Principal characteristics of sedation are defined in patients exposed to radiological diagnostic and therapeutic procedures. Considerations in sedation are identified for procedures in the laboratory of digestive endoscopy. Alternatives of sedation are mentioned for oncological patients subjected to invasive procedures. Working conditions and specifications of anesthesia are determined in the cardiac catheterization room [es

  5. Sedation with nitrous oxide compared with no sedation during catheterization for urologic imaging in children

    International Nuclear Information System (INIS)

    Zier, Judith L.; Kvam, Kathryn A.; Kurachek, Stephen C.; Finkelstein, Marsha

    2007-01-01

    Various strategies to mitigate children's distress during voiding cystourethrography (VCUG) have been described. Sedation with nitrous oxide is comparable to that with oral midazolam for VCUG, but a side-by-side comparison of nitrous oxide sedation and routine care is lacking. The effects of sedation/analgesia using 70% nitrous oxide and routine care for VCUG and radionuclide cystography (RNC) were compared. A sample of 204 children 4-18 years of age scheduled for VCUG or RNC with sedation or routine care were enrolled in this prospective study. Nitrous oxide/oxygen (70%/30%) was administered during urethral catheterization to children in the sedated group. The outcomes recorded included observed distress using the Brief Behavioral Distress Score, self-reported pain, and time in department. The study included 204 patients (99 nonsedated, 105 sedated) with a median age of 6.3 years (range 4.0-15.2 years). Distress and pain scores were greater in nonsedated than in sedated patients (P < 0.001). Time in department was longer in the sedated group (90 min vs. 30 min); however, time from entry to catheterization in a non-imaging area accounted for most of the difference. There was no difference in radiologic imaging time. Sedation with nitrous oxide is effective in reducing distress and pain during catheterization for VCUG or RNC in children. (orig.)

  6. Downbeat Nystagmus Induced by Sedation in Lasik

    Directory of Open Access Journals (Sweden)

    Miguel Paciuc-Beja

    2012-01-01

    Full Text Available Nystagmus was elicited during lasik under sedation in two patients that were treated for depression. Nystagmus was not present before or after surgery. Nystagmus can be pharmacologically induced and can be a hazard to refractive surgery.

  7. Usability and Safety in Electronic Medical Records Interface Design: A Review of Recent Literature and Guideline Formulation.

    Science.gov (United States)

    Zahabi, Maryam; Kaber, David B; Swangnetr, Manida

    2015-08-01

    The objectives of this study were to (a) review electronic medical record (EMR) and related electronic health record (EHR) interface usability issues, (b) review how EMRs have been evaluated with safety analysis techniques along with any hazard recognition, and (c) formulate design guidelines and a concept for enhanced EMR interfaces with a focus on diagnosis and documentation processes. A major impact of information technology in health care has been the introduction of EMRs. Although numerous studies indicate use of EMRs to increase health care quality, there remain concerns with usability issues and safety. A literature search was conducted using Compendex, PubMed, CINAHL, and Web of Science databases to find EMR research published since 2000. Inclusion criteria included relevant English-language papers with subsets of keywords and any studies (manually) identified with a focus on EMR usability. Fifty studies met the inclusion criteria. Results revealed EMR and EHR usability problems to include violations of natural dialog, control consistency, effective use of language, effective information presentation, and customization principles as well as a lack of error prevention, minimization of cognitive load, and feedback. Studies focusing on EMR system safety made no objective assessments and applied only inductive reasoning methods for hazard recognition. On the basis of the identified usability problems and structure of safety analysis techniques, we provide EMR design guidelines and a design concept focused on the diagnosis process and documentation. The design guidelines and new interface concept can be used for prototyping and testing enhanced EMRs. © 2015, Human Factors and Ergonomics Society.

  8. Clonidine Sedation Effects in Children During Electroencephalography

    Directory of Open Access Journals (Sweden)

    Mohammad Barzegar

    2017-10-01

    Full Text Available It is very important to have proper management in children with Seizure. Electroencephalography (EEG as a diagnostic instrument has a key role in determining the management method of seizure in children. Because of poor cooperation of some children (especially children with attention deficit hyperactivity disorders and developmental disorders in performing EEG, it is the best choice to sedate children before EEG. The aim of present study is to evaluate the sedation efficacy of clonidine in children before EEG. In a randomized clinical trial, 45 children age 2 to 12 with seizure, who referred to Children Hospital of Tabriz University of Medical Sciences and candidate for EEG, were studied. Sedation before EEG induced by 0.5 to 2.0 mg clonidine orally. Sedation score (0 to 5 measured by using eyes condition, response to voice, and response to touch. Successful sedation, EEG performing, and hemodynamic stability were evaluated during sedation. Of all patients, 40 patients (88.88% were sedated successfully, and EEG was performed for all of the children. Mean onset time of clonidine effect was 35.47±13.56 minutes and mean time of that the patients’ level of consciousness back to the level before administrating of clonidine was 77.55±26.87 minutes. Hemodynamic states of all patients were stable during the study, and there were no significant changes in vital sign of patients. In conclusion, clonidine can be considered as a safe alternative medication for sedation for EEG, which is fortunately associated with no significant change in vital signs, which may complicate overall status of patients.

  9. Safety of Conscious Sedation In Interventional Radiology

    International Nuclear Information System (INIS)

    Arepally, Aravind; Oechsle, Denise; Kirkwood, Sharon; Savader, Scott J.

    2001-01-01

    Purpose: To identify rates of adverse events associated with the use of conscious sedation in interventional radiology.Methods: In a 5-month period, prospective data were collected on patients undergoing conscious sedation for interventional radiology procedures (n = 594). Adverse events were categorized as respiratory, sedative, or major adverse events. Respiratory adverse events were those that required oral airway placement, ambu bag, or jaw thrust. Sedation adverse events were unresponsiveness, oxygen saturation less than 90%, use of flumazenil/naloxone, or agitation. Major adverse events were hypotension, intubation, CPR, or cardiac arrest. The frequency of adverse events for the five most common radiology procedures were determined.Results: The five most common procedures (total n = 541) were biliary tube placement/exchange (n = 182), tunneled catheter placement (n 135), diagnostic arteriography (n = 125), vascular interventions (n = 52), and other catheter insertions (n = 46). Rates for respiratory, sedation, and major adverse events were 4.7%, 4.2%, and 2.0%, respectively. The most frequent major adverse event was hypotension (2.0%). Biliary procedures had the highest rate of total adverse events (p < .05) and respiratory adverse events (p < .05).Conclusion: The frequency of adverse events is low with the use of conscious sedation during interventional procedures. The highest rates occurred during biliary interventions

  10. Nurse-administered propofol sedation for endoscopy

    DEFF Research Database (Denmark)

    Jensen, J T; Vilmann, P; Horsted, T

    2011-01-01

    BACKGROUND AND STUDY AIMS: The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program. PATIENTS AND METHODS: A structured training program was developed both for endosco......BACKGROUND AND STUDY AIMS: The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program. PATIENTS AND METHODS: A structured training program was developed both...... pressure was recorded in 451 patients (26%). Independent risk factors were type of intervention and level of experience of the staff performing the sedation. CONCLUSION: These results were obtained after development of a structured training program both for endoscopists and nurses using propofol...... for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy....

  11. Analgesia, sedation, and memory of intensive care.

    Science.gov (United States)

    Capuzzo, M; Pinamonti, A; Cingolani, E; Grassi, L; Bianconi, M; Contu, P; Gritti, G; Alvisi, R

    2001-09-01

    The purpose of this article was to investigate the relationship between analgesia, sedation, and memory of intensive care. One hundred fifty-two adult, cooperative intensive care unit (ICU) patients were interviewed 6 months after hospital discharge about their memory of intensive care. The patient was considered to be cooperative when he/she was aware of self and environment at the interview. The patients were grouped as follows: A (45 patients) substantially no sedation, B (85) morphine, and C (22) morphine and other sedatives. The patients having no memory of intensive care were 38%, 34%, and 23% respectively, in the three groups. They were less ill, according to SAPS II (P memories was not different among the three groups. Females reported at least one emotional memory more frequently than males (odds ratio 4.17; 95% CI 10.97-1.59). The patients receiving sedatives in the ICU are not comparable with those receiving only opiates or nothing, due to the different clinical condition. The lack of memory of intensive care is present in one third of patients and is influenced more by length of stay in ICU than by the sedation received. Sedation does not influence the incidence of factual, sensation, and emotional memories of ICU admitted patients. Females have higher incidences of emotional memories than males. Copyright 2001 by W.B. Saunders Company

  12. Web 2.0 systems supporting childhood chronic disease management: design guidelines based on information behaviour and social learning theories.

    Science.gov (United States)

    Ekberg, Joakim; Ericson, Leni; Timpka, Toomas; Eriksson, Henrik; Nordfeldt, Sam; Hanberger, Lena; Ludvigsson, Johnny

    2010-04-01

    Self-directed learning denotes that the individual is in command of what should be learned and why it is important. In this study, guidelines for the design of Web 2.0 systems for supporting diabetic adolescents' every day learning needs are examined in light of theories about information behaviour and social learning. A Web 2.0 system was developed to support a community of practice and social learning structures were created to support building of relations between members on several levels in the community. The features of the system included access to participation in the culture of diabetes management practice, entry to information about the community and about what needs to be learned to be a full practitioner or respected member in the community, and free sharing of information, narratives and experience-based knowledge. After integration with the key elements derived from theories of information behaviour, a preliminary design guideline document was formulated.

  13. Design Guidelines for the Development of Virtual Reality and Augmented Reality Training Systems for Maintenance and Assembly Tasks

    Directory of Open Access Journals (Sweden)

    Tecchia Franco

    2011-12-01

    Full Text Available The current work describes design guidelines for the development of Virtual Reality (VR and Augmented Reality (AR platforms to train technicians on maintenance and assembly tasks of industrial machineries. The main skill involved in this kind of tasks is the procedural skill. Based on past literature and studies conducted within the SKILLS project, several main design guidelines were formulated. First, observational learning integrated properly within the training protocol increases training efficiency. Second, training protocols combining physical and cognitive fidelity enhances procedural skills acquisition. Third, guidance aids should be provided in a proper and controlled way. And last, enriched information about the task helps trainees to develop a useful mental model of the task. These recommendations were implemented in both VR and AR training platforms.

  14. Seismic design and evaluation guidelines for the Department of Energy high-level waste storage tanks and appurtenances

    International Nuclear Information System (INIS)

    Bandyopadhyay, K.; Cornell, A.; Costantino, C.; Kennedy, R.; Miller, C.; Veletsos, A.

    1993-01-01

    This document provides guidelines for the design and evaluation of underground high-level waste storage tanks due to seismic loads. Attempts were made to reflect the knowledge acquired in the last two decades in the areas of defining the ground motion and calculating hydrodynamic loads and dynamic soil pressures for underground tank structures. The application of the analysis approach is illustrated with an example. The guidelines are developed for specific design of underground storage tanks, namely double-shell structures. However, the methodology discussed is applicable for other types of tank structures as well. The application of these and of suitably adjusted versions of these concepts to other structural types will be addressed in a future version of this document

  15. Sedation and Analgesia in Burn

    Directory of Open Access Journals (Sweden)

    Özkan Akıncı

    2011-07-01

    Full Text Available Burn injury is one of the most serious injuries that mankind may face. In addition to serious inflammation, excessive fluid loss, presence of hemodynamic instability due to intercurrent factors such as debridements, infections and organ failure, very different levels and intensities of pain, psychological problems such as traumatic stress disorder, depression, delirium at different levels that occur in patient with severe burn are the factors which make it difficult to provide the patient comfort. In addition to a mild to moderate level of baseline permanent pain in burn patients, which is due to tissue damage, there is procedural pain as well, which occurs by treatments such as grafting and dressings, that are severe, short-term burst style 'breakthrough' pain. Movement and tactile stimuli are also seen in burn injury as an effect to sensitize the peripheral and central nervous system. Even though many burn centers have established protocols to struggle with the pain, studies show that pain relief still inadequate in burn patients. Therefore, the treatment of burn pain and the prevention of possible emergence of future psychiatric problems suc as post-traumatic stress disorder, the sedative and anxiolytic agents should be used as a recommendation according to the needs and hemodynamic status of individual patient. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 26-30

  16. Disruption of cortical integration during midazolam-induced light sedation.

    Science.gov (United States)

    Liang, Peipeng; Zhang, Han; Xu, Yachao; Jia, Wenbin; Zang, Yufeng; Li, Kuncheng

    2015-11-01

    This work examines the effect of midazolam-induced light sedation on intrinsic functional connectivity of human brain, using a randomized, double-blind, placebo-controlled, cross-over, within-subject design. Fourteen healthy young subjects were enrolled and midazolam (0.03 mg/kg of the participant's body mass, to a maximum of 2.5 mg) or saline were administrated with an interval of one week. Resting-state fMRI was conducted before and after administration for each subject. We focus on two types of networks: sensory related lower-level functional networks and higher-order functions related ones. Independent component analysis (ICA) was used to identify these resting-state functional networks. We hypothesize that the sensory (visual, auditory, and sensorimotor) related networks will be intact under midazolam-induced light sedation while the higher-order (default mode, executive control, salience networks, etc.) networks will be functionally disconnected. It was found that the functional integrity of the lower-level networks was maintained, while that of the higher-level networks was significantly disrupted by light sedation. The within-network connectivity of the two types of networks was differently affected in terms of direction and extent. These findings provide direct evidence that higher-order cognitive functions including memory, attention, executive function, and language were impaired prior to lower-level sensory responses during sedation. Our result also lends support to the information integration model of consciousness. © 2015 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

  17. The effect of neuromuscular blockade on oxygen consumption in sedated and mechanically ventilated pediatric patients after cardiac surgery.

    NARCIS (Netherlands)

    Lemson, J.; Driessen, J.J.; Hoeven, J.G. van der

    2008-01-01

    OBJECTIVE: To measure the effect of intense neuromuscular blockade (NMB) on oxygen consumption (VO(2)) in deeply sedated and mechanically ventilated children on the first day after complex congenital cardiac surgery. DESIGN: Prospective clinical interventional study. SETTING: Pediatric intensive

  18. Wearables for all : development of guidelines to stimulate accessible wearable technology design

    NARCIS (Netherlands)

    Wentzel, Jobke; Velleman, Eric; van der Geest, Thea

    2016-01-01

    In this paper, we present the rationale and approach for establishing guidelines for the development of accessible wearables. Wearable technology is increasingly integrated in our everyday lives. Therefore, ensuring accessibility is pivotal to prevent a digital divide between persons who have and

  19. 77 FR 25632 - Guidelines for Designating Biobased Products for Federal Procurement

    Science.gov (United States)

    2012-05-01

    ... section 3201.2 and adding a definition of the term ``relevant stakeholder,'' which is used in the proposed...,'' ``Qualifying biobased product,'' and ``Relevant stakeholder'' to read as follows: Sec. 3201.2 Definitions... current program guidelines, gather input from government, industry, and public stakeholders on different...

  20. Guidelines for applying criteria to designate routes for transporting hazardous materials. Final report

    International Nuclear Information System (INIS)

    1989-07-01

    These guidelines were prepared to assist State and local officials in the analysis of alternate routes to be used by highway vehicles transportating hazardous materials. A methodology for assessing comparative risks of routing alternatives is discussed and demonstrated through a hypothetical example. Mathematical models are provided for situations in which measured local data may not be easily obtained or adequate

  1. The Use of a Well-Designed Instructional Guideline in Online MBA Teaching

    Science.gov (United States)

    Duesing, Robert J.; Ling, Juan; Yang, Jiaqin

    2016-01-01

    This study investigated the positive impact of a teaching practice on student learning outcomes in an online MBA program. An instructional project guideline was developed to help online students enhance their achieving required learning objectives corresponding to five categories of Bloom's Taxonomy. The course learning objectives are based on…

  2. Design of a Real-Time and Continua-Based Framework for Care Guideline Recommendations

    Directory of Open Access Journals (Sweden)

    Yu-Feng Lin

    2014-04-01

    Full Text Available Telehealth is an important issue in the medical and healthcare domains. Although a number of systems have been developed to meet the demands of emerging telehealth services, the following problems still remain to be addressed: (1 most systems do not monitor/predict the vital signs states so that they are able to send alarms to caregivers in real-time; (2 most systems do not focus on reducing the amount of work that caregivers need to do, and provide patients with remote care; and (3 most systems do not recommend guidelines for caregivers. This study thus proposes a framework for a real-time and Continua-based Care Guideline Recommendation System (Cagurs which utilizes mobile device platforms to provide caregivers of chronic patients with real-time care guideline recommendations, and that enables vital signs data to be transmitted between different devices automatically, using the Continua standard. Moreover, the proposed system adopts the episode mining approach to monitor/predict anomalous conditions of patients, and then offers related recommended care guidelines to caregivers so that they can offer preventive care in a timely manner.

  3. The role of sedation tests in identifying sedative drug effects in healthy volunteers and their power to dissociate sedative-related impairments from memory dysfunctions

    NARCIS (Netherlands)

    Wezenberg, E.; Sabbe, B.G.C.; Hulstijn, W.; Ruigt, G.S.F.; Verkes, R.J.

    2007-01-01

    The study investigated whether four specified drugs would show similar patterns on tests considered to measure sedation. In addition, their drug-effect patterns on sedation and memory performance were compared to determine whether the sedative effects could be differentiated from the memory effects.

  4. The role of sedation tests in identifying sedative drug effects in healthy volunteers and their power to dissociate sedative-related impairments from memory dysfunctions.

    NARCIS (Netherlands)

    Wezenberg, E.; Sabbe, B.G.C.; Hulstijn, W.; Ruigt, G.S.F.; Verkes, R.J.

    2007-01-01

    The study investigated whether four specified drugs would show similar patterns on tests considered to measure sedation. In addition, their drug-effect patterns on sedation and memory performance were compared to determine whether the sedative effects could be differentiated from the memory

  5. Generic Design, Technical Guidelines and Optimal Location of Tsetse Fly Mass-Rearing Facilities. Working Material

    International Nuclear Information System (INIS)

    2004-01-01

    Tsetse and trypanosomosis (T and T) severely affect human health - sleeping sickness - and there is evidence for a causal relationship of T and T with food insecurity, rural poverty and overall development constraints for people living in 36 countries of sub-Saharan Africa. Direct annual losses in livestock production and the cost of continuous control measures have been estimated to range between US$ 600 million and $1.2 billion, and the lost potential in agriculture and livestock productivity may be as high as $ 4.75 billion per year. T and T must be considered and treated as one of the most serious pest problems and development constraints in the world today. Several developments in recent years contributed to an increased feasibility and sustainability of efforts against the T and T problem: 1. Following a decision of the African Heads of State and Government at their Lome summit in 2000, to eventually eradicate tsetse flies from Africa, there is an increased commitment among the national and international authorities and other stakeholders to solve the T and T problem in a sustainable manner through the creation and subsequent expansion of T and T free zones. 2. The concept of areawide integrated pest management (AW-IPM), including a sterile insect technique (SIT) component, where feasible and justifiable, was adopted for intervention against the T and T problem in the context of overall efforts towards sustainable agriculture and rural development (SARD). 3. The AU-Pan-African Tsetse and Trypanosomosis Eradication Campaign (PATTEC) and the Programme Against African Trypanosomiases (PAAT; a forum used by AU, FAO, IAEA and WHO to harmonize their efforts against T and T) jointly developed criteria and guidelines for identifying priority areas for T and T intervention, where there is high potential for agriculture and livestock development and where intervention measures would likely result in early and sustainable success. SIT will likely play a role in several

  6. Safety investigation of 'Mutsu', the first nuclear ship in Japan (the correspondence to the guideline of safety design examination, etc.)

    International Nuclear Information System (INIS)

    1981-01-01

    Japan Nuclear Ship Development Agency had made previously application for the permission of the alteration of the reactor installation in the nuclear ship Mutsu (the first of this kind in Japan), based on the overall safety investigation of the ship made by JNDA. Taking the opportunity of the governmental safety examination concerning the permission, the correspondence of the safety aspects of the n.s. Mutsu to the existing guidelines for the safety of nuclear reactor facilities was examined. These results to further enhance the safety of the n.s. Mutsu are described concerning the following matters: the safety design examination guideline for power-generating LWR facilities (58 items); the safety evaluation guideline for power-generating LWR facilities (the analysis of abnormal transients during operation and accidents); the safety countermeasures to be adopted in the reactor plant of the n.s. Mutsu from the situation of the TMI nuclear accident in U.S. (7 in design and 10 in operation management); the analysis simulating the TMI accident. (J.P.N.)

  7. Sedation and Monitoring in the Pediatric Patient during Gastrointestinal Endoscopy.

    Science.gov (United States)

    Chung, Hyun Kee; Lightdale, Jenifer R

    2016-07-01

    Sedation is a fundamental component of pediatric gastrointestinal procedures. The 2 main types of sedation for pediatric endoscopy remain general anesthesia and procedural sedation. Although anesthesiologist-administered sedation protocols are more common, there is no ideal regimen for endoscopy in children. This article discusses specific levels of sedation for endoscopy as well as various regimens that can be used to achieve each. Risks and considerations that may be specific to performing gastrointestinal procedures in children are reviewed. Finally, potential future directions for sedation and monitoring that may change the practice of pediatric gastroenterology and ultimately patient outcomes are examined. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Seismic PSA implementation standards by AESJ and the utilization of the advanced safety examination guideline for seismic design for nuclear power plant

    International Nuclear Information System (INIS)

    Ebisawa, Katsumi; Hibino, Kenta

    2008-01-01

    The Advanced Safety Examination Guideline for Seismic Design for Nuclear Power Plant (the advanced safety examination guideline) was worked out on September 19, 2006. In this paper, a summary of the method of probability theory in the advanced safety examination guideline and the Seismic PSA Implementation Standards is stated. On utilization of the probability theory for the advanced safety examination guideline, the uncertainty resulting from the process of the decision of the basic design earthquake ground motion (Ss) is stated to be considered using the proper method. The references of the extra probability for evaluation of earthquake hazard and combination of the working load and the earthquake load are stated. Definition, evaluation method and effort to lower the 'residual risks', and relation between the residual risks and the extra probability of Ss are described. A summary of the earthquake-resistant design for nuclear power facilities is explained by the old guideline. (S.Y.)

  9. Designing a guideline for selecting a supplier for an agile fixed budget & resource contract in the public sector

    DEFF Research Database (Denmark)

    Pries-Heje, Lene; Pries-Heje, Jan

    2014-01-01

    A classic contract for IS between a supplier and a public sector institution based on a requirements specification is well suited for a stable situation. However, if you have to accept many changes or have ambiguous requirements then you may end up with “endless” re-negotiation of the requirements...... and the technical support structure. This paper presents a case where that was done. We analyse the case using the iron triangle for projects as our theoretical lens and design a guideline for how to implement a fixed budget and resources contract in the public sector. The guideline includes elements to cope...... with challenges in a tender process such as transparency, criteria for supplier selection, and live assessment of resource skills and capabilities, as well as achieving the flexibility for change needed....

  10. [AWAKE CRANIOTOMY: IN SEARCH FOR OPTIMAL SEDATION].

    Science.gov (United States)

    Kulikova, A S; Sel'kov, D A; Kobyakov, G L; Shmigel'skiy, A V; Lubnin, A Yu

    2015-01-01

    Awake craniotomy is a "gold standard"for intraoperative brain language mapping. One of the main anesthetic challenge of awake craniotomy is providing of optimal sedation for initial stages of intervention. The goal of this study was comparison of different technics of anesthesia for awake craniotomy. Materials and methods: 162 operations were divided in 4 groups: 76 cases with propofol sedation (2-4mg/kg/h) without airway protection; 11 cases with propofol sedation (4-5 mg/kg/h) with MV via LMA; 36 cases of xenon anesthesia; and 39 cases with dexmedetomidine sedation without airway protection. Results and discussion: brain language mapping was successful in 90% of cases. There was no difference between groups in successfulness of brain mapping. However in the first group respiratory complications were more frequent. Three other technics were more safer Xenon anesthesia was associated with ultrafast awakening for mapping (5±1 min). Dexmedetomidine sedation provided high hemodynamic and respiratory stability during the procedure.

  11. Rectal Sedation with Thiopental in Children

    International Nuclear Information System (INIS)

    Granados, Ana Maria; Levy, Wilma; Badiel, Marisol; Cruz Libreros, Alejandro; Toro Gutierrez, Juan Sebastian

    2012-01-01

    Objective: to determine the effectiveness of a rectal sedation protocol with sodium thiopental in children undergoing diagnostic imaging studies in a level-four-complexity health care facility. Materials and Methods: this case series observational study was developed between the months of January and March 2004 in the Fundacion clinica Valle del Lili. All pediatric patients between the ages of three months and eight years of age who underwent an imaging study were included. A dose of 25-40 mg/kg of sodium thiopental was administered rectally. Successful sedation was defined as one that allowed the successful completion of the study with the least number of motion artifacts. The features of the sedation and the adverse effects were evaluated. Results: the study population included 103 children with a median age of two years. The imaging studies were successfully concluded in 97% of the patients. The average total time until complete awakening was 2.9 hours. With respect to the interruption of sedation, we found statistically significant differences between the children who were kept awake the night before the procedure and those who were not. The most common adverse effect was diarrhea, which was recorded in 13 patients. Five of the patients required a supplemental dose of the sedative. There were two cases of increased salivation and one of vomiting, yet they resolved spontaneously. Conclusions: this rectal sodium thiopental protocol is a safe and effective procedure for the completion of diagnostic imaging studies in the pediatric population at our health care center.

  12. Anaesthesia and Sedation for the Autistic Patient.

    Science.gov (United States)

    Sacoor, Sarah

    2017-01-01

    Autism is a disability that affects how a person communicates and relates to the world around them. Patients on the autistic spectrum may be referred to a Special Care Dentistry service to be managed under sedation or general anaesthetic, as their visit to the dentist can be stressful and disruptive to their routine. As it is a spectrum disorder, each patient needs to be assessed individually in order to determine whether sedation or general anaesthetic would be appropriate for them. Some autistic patients may have good verbal communication and mild learning difficulties, and may be able to tolerate treatment under local anaesthetic with behavioural management alone. On the other end of the spectrum, patients with severe autism and learning difficulties may not permit the dentist to even examine them and will require a general anaesthetic. There will also be patients on the autistic spectrum who are suitable for conscious sedation depending on their level of learning difficulty and cooperation. Oral and transmucosal sedation can also be useful for providing presedation to a patient to facilitate venous access. In order to minimise distress to the patient, it is important that adequate sedation, anaesthesia and analgesia are achieved both perioperatively and post-operatively.

  13. Ketamine-propofol sedation in circumcision

    Directory of Open Access Journals (Sweden)

    Handan Gulec

    2015-10-01

    Full Text Available ABSTRACTBACKGROUND AND OBJECTIVE: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation.METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II.RESULTS: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p > 0.050. Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p < 0.050.CONCLUSION: Propofol-ketamine (Ketofol provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

  14. Guideline for the licensing of various designs of ionisation smoke alarms

    International Nuclear Information System (INIS)

    1978-01-01

    The purpose of the guideline is to set up criteria for the construction licensing of ionisation smoke alarms and to determine their use. This guarantees that only those ISA are licensed which correspond to the level of science and technology and that the ISA to be licensed fulfills the demands of radiation protection. The recommendations of OECD/NEA are also born in mind. (orig./HP) [de

  15. Development of a nutritionally balanced pizza as a functional meal designed to meet published dietary guidelines.

    Science.gov (United States)

    Combet, Emilie; Jarlot, Amandine; Aidoo, Kofi E; Lean, Michael E J

    2014-11-01

    To develop a worked example of product reformulation of a very popular 'junk food' to meet nutritional guidelines for public health in a ready meal. Indicative survey of popular Margherita pizzas, followed by product reformulation, applying dietary guidelines to generate a single-item pizza meal containing 30 % daily amounts of energy and all nutrients. An iterative process was used; first to optimize nutrient balance by adjusting the proportions of bread base, tomato-based sauce and mozzarella topping, then adding ingredients to provide specific nutrients and consumer tasting. Urban areas of contrasting socio-economic status. Untrained unselected adults (n 49) and children (n 63), assessing pizza at tasting stations. Most commercial pizzas provide insufficient information to assess all nutrients and traditional Margherita pizza ingredients provide insufficient Fe, Zn, iodine, and vitamins C and B12. Energy content of the portions currently sold as standard range from 837 to 2351 kJ (200 to 562 kcal), and most exceed 30 % Guideline Daily Amounts for saturated fat and Na when a 2510 kJ (600 kcal) notional meal is considered. The 'nutritionally balanced pizza' provides the required energy for a single-item meal (2510 kJ/600 kcal), with all nutrients within recommended ranges: Na (473 mg, ∼45 % below recommended level), saturated fat (<11 % energy) and dietary fibre (13·7 g). Most adults (77 %) and children (81 %) rated it 'as good as' or 'better than' their usual choice. Nutritional guidelines to reduce chronic diseases can be applied to reformulate 'junk food' ready meals, to improve public health through a health-by-stealth approach without requiring change in eating habits.

  16. Practice and documentation of palliative sedation: a quality improvement initiative

    Science.gov (United States)

    McKinnon, M.; Azevedo, C.; Bush, S.H.; Lawlor, P.; Pereira, J.

    2014-01-01

    Background Palliative sedation (ps), the continuous use of sedating doses of medication to intentionally reduce consciousness and relieve refractory symptoms at end of life, is ethically acceptable if administered according to standards of best practice. Procedural guidelines outlining the appropriate use of ps and the need for rigorous documentation have been developed. As a quality improvement strategy, we audited the practice and documentation of ps on our palliative care unit (pcu). Methods A pharmacy database search of admissions in 2008 identified, for a subsequent chart review, patients who had received either a continuous infusion of midazolam (≥10 mg/24 h), regular parenteral dosing of methotrimeprazine (≥75 mg daily), or regular phenobarbital. Documentation of the decision-making process, consent, and medication use was collected using a data extraction form based on current international ps standards. Results Interpretation and comparison of data were difficult because of an apparent lack of a consistent operational definition of ps. Patient records had no specific documentation in relation to ps initiation, to clearly identified refractory symptoms, and to informed consent in 60 (64.5%), 43 (46.2%), and 38 (40.9%) charts respectively. Variation in the medications used was marked: 54 patients (58%) were started on a single agent and 39 (42%), on multiple agents. The 40 patients (43%) started on midazolam alone received a mean daily dose of 21.4 mg (standard deviation: 24.6 mg). Conclusions The lack of documentation and standardized practice of ps on our pcu has resulted in a quality improvement program to address those gaps. They also highlight the importance of conducting research and developing clinical guidelines in this area. PMID:24764700

  17. Palliative sedation: from the family perspective.

    Science.gov (United States)

    Vayne-Bossert, Petra; Zulian, Gilbert B

    2013-12-01

    Palliative sedation (PS) is a treatment option in case of refractory symptoms at the end of life. The emotional impact on nurses and doctors has been widely studied. We explore the experience of family members during a PS procedure. An anonymous questionnaire was sent to the closest family members (n = 17) of patients who died while receiving palliative sedation. The response rate was 59% (10 of 17). Nine relatives were sufficiently informed about PS. In all, 70% evaluated the chosen moment for initiation of PS as adequate. All the relatives noticed a significant improvement in the refractory symptom with a mean reduction in the estimated suffering of 6.25 points on a visual analog scale. Palliative sedation should be performed in the best possible way for the patient and his family in order to efficiently reduce a refractory symptom.

  18. Office-based deep sedation for pediatric ophthalmologic procedures using a sedation service model.

    Science.gov (United States)

    Lalwani, Kirk; Tomlinson, Matthew; Koh, Jeffrey; Wheeler, David

    2012-01-01

    Aims. (1) To assess the efficacy and safety of pediatric office-based sedation for ophthalmologic procedures using a pediatric sedation service model. (2) To assess the reduction in hospital charges of this model of care delivery compared to the operating room (OR) setting for similar procedures. Background. Sedation is used to facilitate pediatric procedures and to immobilize patients for imaging and examination. We believe that the pediatric sedation service model can be used to facilitate office-based deep sedation for brief ophthalmologic procedures and examinations. Methods. After IRB approval, all children who underwent office-based ophthalmologic procedures at our institution between January 1, 2000 and July 31, 2008 were identified using the sedation service database and the electronic health record. A comparison of hospital charges between similar procedures in the operating room was performed. Results. A total of 855 procedures were reviewed. Procedure completion rate was 100% (C.I. 99.62-100). There were no serious complications or unanticipated admissions. Our analysis showed a significant reduction in hospital charges (average of $1287 per patient) as a result of absent OR and recovery unit charges. Conclusions. Pediatric ophthalmologic minor procedures can be performed using a sedation service model with significant reductions in hospital charges.

  19. Office-Based Deep Sedation for Pediatric Ophthalmologic Procedures Using a Sedation Service Model

    Directory of Open Access Journals (Sweden)

    Kirk Lalwani

    2012-01-01

    Full Text Available Aims. (1 To assess the efficacy and safety of pediatric office-based sedation for ophthalmologic procedures using a pediatric sedation service model. (2 To assess the reduction in hospital charges of this model of care delivery compared to the operating room (OR setting for similar procedures. Background. Sedation is used to facilitate pediatric procedures and to immobilize patients for imaging and examination. We believe that the pediatric sedation service model can be used to facilitate office-based deep sedation for brief ophthalmologic procedures and examinations. Methods. After IRB approval, all children who underwent office-based ophthalmologic procedures at our institution between January 1, 2000 and July 31, 2008 were identified using the sedation service database and the electronic health record. A comparison of hospital charges between similar procedures in the operating room was performed. Results. A total of 855 procedures were reviewed. Procedure completion rate was 100% (C.I. 99.62–100. There were no serious complications or unanticipated admissions. Our analysis showed a significant reduction in hospital charges (average of $1287 per patient as a result of absent OR and recovery unit charges. Conclusions. Pediatric ophthalmologic minor procedures can be performed using a sedation service model with significant reductions in hospital charges.

  20. technical guidelines for the design and construction of the next generation of nuclear power plants with pressurized water reactors

    International Nuclear Information System (INIS)

    2009-01-01

    These technical guidelines present the opinion of the French 'Groupe Permanent charge des Reacteurs nucleaires' (GPR) concerning the safety philosophy and approach as well as the general safety requirements to be applied for the design and construction of the next generation of nuclear power plants of the PWR (pressurized water reactor) type, assuming the construction of the first units of this generation would start at the beginning of the 21. century. These technical guidelines are based on common work of the French Institut de Protection et de Surete Nucleaire (IPSN) and of the German Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS). Moreover, these technical guidelines were extensively discussed with members of the German Reaktor Sicherheitskommission (RSK) until the end of 1998 and further with German experts. The context of these technical guidelines must be clearly understood. Faced with the current situation of nuclear energy in the world, the various nuclear steam supply system designers are developing new products, all of them claiming their intention of obtaining a higher safety level, by various ways. GPR believes that, for the operation of a new series of nuclear power plants at the beginning of the next century, the adequate way is to derive the design of these plants in an 'evolutionary' way from the design of existing plants, taking into account the operating experience and the in-depth studies conducted for such plants. Nevertheless, introduction of innovative features must also be considered in the frame of the design of the new generation of plants, especially in preventing and mitigating severe accidents. GPR underlines here that a significant improvement of the safety of the next generation of nuclear power plants at the design stage is necessary, compared to existing plants. If the search for improvement is a permanent concern in the field of safety, the necessity of a significant step at the design stage clearly derives from better

  1. [Sedation in the terminal phase of life].

    Science.gov (United States)

    Verhagen, E H; Eliel, M R; de Graeff, A; Teunissen, S C

    1999-12-25

    In 2 patients, a woman aged 38 years and a man aged 48 years, in the terminal phase of life due to metastasized+ malignancy, palliative care failed. They suffered seriously from pain, delirium, restlessness, nausea, and fear. Deep sedation was given to induce almost continuous sleep without the intention of causing death. After one and five quiet days respectively the patients died. Deep sedation is an option when palliative care fails to diminish serious suffering. Midazolam, given by continuous subcutaneous infusion is the drug of choice.

  2. System Guidelines for EMC Safety-Critical Circuits: Design, Selection, and Margin Demonstration

    Science.gov (United States)

    Lawton, R. M.

    1996-01-01

    Demonstration of safety margins for critical points (circuits) has traditionally been required since it first became a part of systems-level Electromagnetic Compatibility (EMC) requirements of MIL-E-6051C. The goal of this document is to present cost-effective guidelines for ensuring adequate Electromagnetic Effects (EME) safety margins on spacecraft critical circuits. It is for the use of NASA and other government agencies and their contractors to prevent loss of life, loss of spacecraft, or unacceptable degradation. This document provides practical definition and treatment guidance to contain costs within affordable limits.

  3. Safety Standard for Hydrogen and Hydrogen Systems: Guidelines for Hydrogen System Design, Materials Selection, Operations, Storage and Transportation. Revision

    Science.gov (United States)

    1997-01-01

    The NASA Safety Standard, which establishes a uniform process for hydrogen system design, materials selection, operation, storage, and transportation, is presented. The guidelines include suggestions for safely storing, handling, and using hydrogen in gaseous (GH2), liquid (LH2), or slush (SLH2) form whether used as a propellant or non-propellant. The handbook contains 9 chapters detailing properties and hazards, facility design, design of components, materials compatibility, detection, and transportation. Chapter 10 serves as a reference and the appendices contained therein include: assessment examples; scaling laws, explosions, blast effects, and fragmentation; codes, standards, and NASA directives; and relief devices along with a list of tables and figures, abbreviations, a glossary and an index for ease of use. The intent of the handbook is to provide enough information that it can be used alone, but at the same time, reference data sources that can provide much more detail if required.

  4. Simulation as a tool to develop guidelines for the design of portable library in the campus of Mansoura university

    Energy Technology Data Exchange (ETDEWEB)

    Ahmed, Ahmed Nabih; Farag, M.A.; Samann Osama, Mina Michael; El Aishy, Alaa Shams [Department of Architectural Engineering, University of Mansoura (Egypt)

    2010-07-01

    In recent years, due to population growth, the numbers of enrolled students in Mansoura University, Egypt, has significantly increased, leading to a lack of library space. As a solution to this issue, the aim of this paper is to present the design procedures for building a portable library. The process consists of conducting a feasibility study, then identifying the most relevant parameters and using a software to create an energy efficient structure. A case study was conducted in Mansoura University on a portable library measuring 6.60mx9.90mx4.20m; simulations were carried out with the Ecotect simulation software. Results showed that the proposed methodology was successful in designing a portable library and that it allowed a reduction in energy consumption of 40% compared to the baseline case. This paper provided design guidelines for the construction of portable libraries through the use of transient building performance.

  5. Development of Design Standards and Guidelines for Electromagnetic Compatibility and Lightning Protection for Spacecraft Utilizing Composite Materials

    Science.gov (United States)

    Camp, Dennis W.

    1997-01-01

    This final report presents information concerning technical accomplishments by Tec-Masters, Inc. (TMI) for this contract effort. This effort included the accomplishment and/or submission by TMI of the following items: (1) Literature Survey Report, Electrical Properties of Non-Metallic Composites by Mr. Hugh W. Denny; (2) Interim Report, Composite Materials - Conductivity, Shielding Effectiveness, and Current Carrying Capability by Mr. Ross W. Evans; (3) Fault Current Test Plan by Mr. Ross W. Evans (4) Fault Current Test Procedure by Mr. Ross W. Evans (5) Test Report, Fault Current Through Graphite Filament Reinforced Plastic, NASA CR-4774, Marshall Space Flight Center, Alabama, September 1996, by Mr. Ross W. Evans; (6) Test Plan, Lightning Effects on Composite Materials by Mr. Ross W. Evans; (7) Test Report, Lightning Effects on Composite Materials, NASA CR-4783, Marshall Space Flight Center, Alabama, February 1997, by Mr. Ross W. Evans; (8) Design Guidelines for Shielding Effectiveness, Current Carrying Capability, and the Enhancement of Conductivity of Composite Materials, NASA CR-4784, Marshall Space Flight Center, Alabama, September 1996, by Mr. Ross W. Evans. These items are not attached but are considered to be a part of this final report. Efforts on two additional items were accomplished at no increase in cost to NASA/MSFC. These items consisted of updating the 'MSFC EMC Design and Interference Control Handbook,' and revising the 'Design Guidelines for Shielding Effectiveness, Current Carrying Capability, and the Enhancement of Conductivity of Composite Materials.'

  6. Auditory processing during deep propofol sedation and recovery from unconsciousness

    OpenAIRE

    Koelsch, Stefan; Heinke, Wolfgang; Sammler, Daniela; Olthoff, Derk

    2006-01-01

    Objective Using evoked potentials, this study investigated effects of deep propofol sedation, and effects of recovery from unconsciousness, on the processing of auditory information with stimuli suited to elicit a physical MMN, and a (music-syntactic) ERAN. Methods Levels of sedation were assessed using the Bispectral Index (BIS) and the Modified Observer's Assessment of Alertness and Sedation Scale (MOAAS). EEG-measurements were performed during wakefulness, deep propofol sedation (MOAAS 2–3...

  7. Færre indikationer for sedation ved respiratorbehandling

    DEFF Research Database (Denmark)

    Strøm, Thomas; Rian, Omar; Toft, Palle

    2012-01-01

    Critically ill patients undergoing mechanical ventilation have traditionally been deeply sedated. In the latest decade growing evidence supports less sedation as being beneficial for the patients. A daily interruption of sedation has been shown to reduce the length of mechanical ventilation and t...

  8. Neural correlates of successful semantic processing during propofol sedation

    NARCIS (Netherlands)

    Adapa, Ram M.; Davis, Matthew H.; Stamatakis, Emmanuel A.; Absalom, Anthony R.; Menon, David K.

    Sedation has a graded effect on brain responses to auditory stimuli: perceptual processing persists at sedation levels that attenuate more complex processing. We used fMRI in healthy volunteers sedated with propofol to assess changes in neural responses to spoken stimuli. Volunteers were scanned

  9. Moderate and deep nurse-administered propofol sedation is safe

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Møller, Ann; Hornslet, Pernille

    2015-01-01

    INTRODUCTION: Non-anaesthesiologist-administered propofol sedation (NAPS/NAAP) is increasingly used in many countries. Most regimens aim for light or moderate sedation. Little evidence on safety of deep NAPS sedation is available. The aim of this study was to explore the safety of intermittent deep...

  10. Aseismic Design Licensings and guidelines for nuclear power plant in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Yoshizawa, Kazumi [Agency of Natural Resources and Energy, Tokyo (Japan)

    1997-03-01

    This paper describes Aseismic Design Licensing for Japanese Nuclear Power Plants which includes system, procedures and brief contents concerned application, permit and inspection, and the `Examination Guide for Aseismic Design of the Nuclear Power Reactor Facilities` which focused principals of seismic design loads, load combinations, and allowable limits. (J.P.N.)

  11. Aseismic Design Licensings and guidelines for nuclear power plant in Japan

    International Nuclear Information System (INIS)

    Yoshizawa, Kazumi

    1997-01-01

    This paper describes Aseismic Design Licensing for Japanese Nuclear Power Plants which includes system, procedures and brief contents concerned application, permit and inspection, and the 'Examination Guide for Aseismic Design of the Nuclear Power Reactor Facilities' which focused principals of seismic design loads, load combinations, and allowable limits. (J.P.N.)

  12. Optimization-based guidelines to retirement planning and pension product design

    DEFF Research Database (Denmark)

    Konicz Bell, Agnieszka Karolina

    their retirement savings, this thesis presents some optimization techniques that could be applied by pension providers and financial advisers to provide individuals with such guidelines. For a given objective function and a number of constraints, we search for the optimal solution, which indicates, for example...... investigate the optimal annuity choice under inflation risk, which is often ignored both by practitioners advising on the retirement planning and by scholars investigating the consumption-investment problems. We search for an optimal level of retirement income in real terms, given investment opportunities...... in inflation-linked, nominal, and variable annuities, as well as in stocks and bonds. Our findings show that real annuities are a crucial asset in every portfolio, and that trying to hedge inflation without investing in inflation-linked products leads to a lower and more volatile retirement income. In the last...

  13. Mechanical Safety Subcommittee Guideline for Design of Thin Windows Regarding Roark’s Edge Condition Coefficient

    Energy Technology Data Exchange (ETDEWEB)

    Ader, C. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Voirin, E. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); McGee, M. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Nobrega, L. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States)

    2017-06-15

    An error was found in an edge stress coefficient used to calculate stresses in thin windows. This error is present in “Roark’s Formulas for Stress and Strain” 7th and 8th Edition. The 6th Edition is correct. This guideline specially discusses a major difference in regards to a coefficient used in calculating the edge stress in “Roark’s Formulas for Stress and Strain” 6th Edition compared to the 7th and 8th Editions. In Chapter 10: Flat Plates under “Circular plates under distributed load producing large deflections,” Case 3, which is “Fixed and held. Uniform pressure q over entire plate.” The coefficient for a fixed edge condition in the 6th Edition1 K4 = 0.476 while in the 7th and 8th Edition2, the coefficient is 1.73 which is significant difference.

  14. Heterogeneity of the gut microbiome in mice: guidelines for optimizing experimental design

    Science.gov (United States)

    Laukens, Debby; Brinkman, Brigitta M.; Raes, Jeroen; De Vos, Martine; Vandenabeele, Peter

    2015-01-01

    Targeted manipulation of the gut flora is increasingly being recognized as a means to improve human health. Yet, the temporal dynamics and intra- and interindividual heterogeneity of the microbiome represent experimental limitations, especially in human cross-sectional studies. Therefore, rodent models represent an invaluable tool to study the host–microbiota interface. Progress in technical and computational tools to investigate the composition and function of the microbiome has opened a new era of research and we gradually begin to understand the parameters that influence variation of host-associated microbial communities. To isolate true effects from confounding factors, it is essential to include such parameters in model intervention studies. Also, explicit journal instructions to include essential information on animal experiments are mandatory. The purpose of this review is to summarize the factors that influence microbiota composition in mice and to provide guidelines to improve the reproducibility of animal experiments. PMID:26323480

  15. Effects of music on sedation depth and sedative use during pediatric dental procedures.

    Science.gov (United States)

    Ozkalayci, Ozlem; Araz, Coskun; Cehreli, Sevi Burcak; Tirali, Resmiye Ebru; Kayhan, Zeynep

    2016-11-01

    The study aimed to investigate the effects of listening to music or providing sound isolation on the depth of sedation and need for sedatives in pediatric dental patients. Prospective, randomized, and controlled study. Tertiary, university hospital. In total, 180 pediatric patients, American Society of Anesthesiologists physical status I and II, who were scheduled for dental procedures of tooth extraction, filling, amputation, and root treatment. Patients were categorized into 3 groups: music, isolation, and control. During the procedures, the patients in the music group listened to Vivaldi's The Four Seasons violin concertos by sound-isolating headphones, whereas the patients in the isolation group wore the headphones but did not listen to music. All patients were sedated by 0.1 mg/kg midazolam and 1 mg/kg propofol. During the procedure, an additional 0.5 mg/kg propofol was administered as required. Bispectral index was used for quantifying the depth of sedation, and total dosage of the propofol was used for sedative requirements. The patients' heart rates, oxygen saturations, and Observer's Assessment of Alertness and Sedation Scale and bispectral index scores, which were monitored during the operation, were similar among the groups. In terms of the amount of propofol used, the groups were similar. Prolonged postoperative recovery cases were found to be significantly frequent in the control group, according to the recovery duration measurements (P = .004). Listening to music or providing sound isolation during pediatric dental interventions did not alter the sedation level, amount of medication, and hemodynamic variables significantly. This result might be due to the deep sedation levels reached during the procedures. However, listening to music and providing sound isolation might have contributed in shortening the postoperative recovery duration of the patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Sedatives for opiate withdrawal in newborn infants.

    Science.gov (United States)

    Osborn, David A; Jeffery, Heather E; Cole, Michael J

    2010-10-06

    Neonatal abstinence syndrome (NAS) due to opiate withdrawal may result in disruption of the mother-infant relationship, sleep-wake abnormalities, feeding difficulties, weight loss and seizures. Treatments used to ameliorate symptoms and reduce morbidity include opiates, sedatives and non-pharmacological treatments. To assess the effectiveness and safety of using a sedative compared to a non-opiate control for NAS due to withdrawal from opiates, and to determine which type of sedative is most effective and safe. This update included searches of the Cochrane Central Register of Controlled Trials (Issue 1, 2010), MEDLINE 1966 to April 2010 and abstracts of conference proceedings. Trials enrolling infants with NAS born to mothers with an opiate dependence with > 80% follow-up and using random or quasi-random allocation to sedative or control. Control could include another sedative or non-pharmacological treatment. Each author assessed study quality and extracted data independently. Seven studies enrolling 385 patients were included. There were substantial methodological concerns for most studies including the use of quasi-random allocation methods and sizeable, largely unexplained differences in reported numbers allocated to each group.One study reported phenobarbitone compared to supportive care alone did not reduce treatment failure or time to regain birthweight, but resulted in a significant reduction in duration of supportive care (MD -162.1 min/day, 95% CI -249.2, -75.1). Comparing phenobarbitone to diazepam, meta-analysis of two studies found phenobarbitone resulted in a significant reduction in treatment failure (typical RR 0.39, 95% CI 0.24, 0.62). Comparing phenobarbitone with chlorpromazine, one study reported no significant difference in treatment failure.In infants treated with an opiate, one study reported addition of clonidine resulted in no significant difference in treatment failure, seizures or mortality. In infants treated with an opiate, one study

  17. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    Directory of Open Access Journals (Sweden)

    Blanker Marco H

    2012-07-01

    Full Text Available Abstract Background Little is known about pressure from patients or relatives on physician’s decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs in cases of continuous sedation after the introduction of the Dutch practice guideline, using a questionnaire survey. Methods A sample of 918 Dutch GPs were invited to fill out a questionnaire about their last patient under continuous sedation. Cases in which GPs experienced pressure from the patient, relatives or other persons were compared to those without pressure. Results 399 of 918 invite GPs (43% returned the questionnaire and 250 provided detailed information about their most recent case of continuous sedation. Forty-one GPs (16% indicated to have experienced pressure from the patient, relatives or colleagues. In GPs younger than 50, guideline knowledge was not related to experienced pressure, whereas in older GPs, 15% with and 36% without guideline knowledge reported pressure. GPs experienced pressure more often when patients had psychological symptoms (compared to physical symptoms only and when patients had a longer estimated life expectancy. A euthanasia request of the patient coincided with a higher prevalence of pressure for GPs without, but not for GPs with previous experience with euthanasia. GPs who experienced pressure had consulted a palliative consultation team more often than GPs who did not experience pressure. Conclusion One in six GPs felt pressure from patients or relatives to start sedation. This pressure was related to guideline knowledge, especially in older GPs, longer life expectancy and the presence of a euthanasia request, especially for GPs without previous experience of euthanasia.

  18. Pressure during decision making of continuous sedation in end-of-life situations in Dutch general practice

    Science.gov (United States)

    2012-01-01

    Background Little is known about pressure from patients or relatives on physician’s decision making of continuous palliative sedation. We aim to describe experienced pressure by general practitioners (GPs) in cases of continuous sedation after the introduction of the Dutch practice guideline, using a questionnaire survey. Methods A sample of 918 Dutch GPs were invited to fill out a questionnaire about their last patient under continuous sedation. Cases in which GPs experienced pressure from the patient, relatives or other persons were compared to those without pressure. Results 399 of 918 invite GPs (43%) returned the questionnaire and 250 provided detailed information about their most recent case of continuous sedation. Forty-one GPs (16%) indicated to have experienced pressure from the patient, relatives or colleagues. In GPs younger than 50, guideline knowledge was not related to experienced pressure, whereas in older GPs, 15% with and 36% without guideline knowledge reported pressure. GPs experienced pressure more often when patients had psychological symptoms (compared to physical symptoms only) and when patients had a longer estimated life expectancy. A euthanasia request of the patient coincided with a higher prevalence of pressure for GPs without, but not for GPs with previous experience with euthanasia. GPs who experienced pressure had consulted a palliative consultation team more often than GPs who did not experience pressure. Conclusion One in six GPs felt pressure from patients or relatives to start sedation. This pressure was related to guideline knowledge, especially in older GPs, longer life expectancy and the presence of a euthanasia request, especially for GPs without previous experience of euthanasia. PMID:22759834

  19. Sustainability certification systems as guidelines for early-phase urban design processes

    OpenAIRE

    Jensen, Lotte Bjerregaard; Bjerre, Lærke; Mansfelt, Lise

    2016-01-01

    The German Sustainable Building Council (Deutsche Gesellschaft für Nachhaltiges Bauen or DGNB) has one of the most comprehensive sustainability certification systems for urban districts (UD). Their explicit aim is that the system should impact the very earliest design decisions. The Technical University of Denmark has tested the DGNB-UD system in two experimental design projects for similar locations to find out how it can be used in the early-phase design process. This paper describes these ...

  20. Engineering and Design. Guidelines on Ground Improvement for Structures and Facilities

    National Research Council Canada - National Science Library

    Enson, Carl

    1999-01-01

    .... It addresses general evaluation of site and soil conditions, selection of improvement methods, preliminary cost estimating, design, construction, and performance evaluation for ground improvement...

  1. Guideline for design and construction radiation monitoring equipments for Tokai reprocessing plant

    International Nuclear Information System (INIS)

    Miyabe, Kenjiro; Ninomiya, Kazushige; Jin, Kazumi; Morifuji, Masayuki; Nemoto, Kazuhiko; Sato, Akira; Kawai, Keiichi

    1999-12-01

    Various kind of radiation monitoring equipment are used in radiation controlled area at each facility of Tokai reprocessing plant. These equipments have been designed and constructed based on the users requirements, and permitted by governmental regulation office. And, design has been carried out in consideration of the adoption of the new technology and our operational experience. Then, it has been used effectively for the radiation control of the facilities. This report summarizes the technical requirements that should be taken into consideration in the design and installation of radiation monitoring equipments. These requirements are fundamentally applicable when the equipments of the new facilities will be designed or the present instruments will be replaced. (author)

  2. Design guidelines for adapting scientific research articles: An example from an introductory level, interdisciplinary program on soft matter

    Science.gov (United States)

    Langbeheim, Elon; Safran, Samuel A.; Yerushalmi, Edit

    2013-01-01

    We present design guidelines for using Adapted Primary Literature (APL) as part of current interdisciplinary topics to introductory physics students. APL is a text genre that allows students to comprehend a scientific article, while maintaining the core features of the communication among scientists, thus representing an authentic scientific discourse. We describe the adaptation of a research paper by Nobel Laureate Paul Flory on phase equilibrium in polymer-solvent mixtures that was presented to high school students in a project-based unit on soft matter. The adaptation followed two design strategies: a) Making explicit the interplay between the theory and experiment. b) Re-structuring the text to map the theory onto the students' prior knowledge. Specifically, we map the theory of polymer-solvent systems onto a model for binary mixtures of small molecules of equal size that was already studied in class.

  3. SEDATIVE AND ANALGESIC EFFECTS OF DETOMIDINE HYDROCHLORIDE IN GOATS

    OpenAIRE

    A. N. Tunio., A. B. Kalhoro and I.H. Kathio1

    2003-01-01

    The sedative and analgesic effects of three dose rates of detomidine (40, 50 and 60µg/kg body weight) were studied in six goats. Moderate to deep sedation occurred after administration of 40µg/kg of detomidine as compared to deep sedation produced by 50 and 60µg/kg of detomidine. The degree, onset and duration of sedation and onset and duration of maximum sedation were all dose dependent. Skin analgesia and recumbency were produced in all animals with higher doses (50 and 60µg/kg) and in thre...

  4. design guidelines for High/Scope methodology in pre-schools

    African Journals Online (AJOL)

    Quality design and appropriate space organization in preschool settings can support ... framework for teachers without any architectural background and designers with no ... books and journal articles related to preschool education and children's ..... Brown JE, Isaacs JS, Krinke UB, Lechtenberg E & Murtaugh MA 2011.

  5. Anti-earthquake design guideline and safety of nuclear power plants

    International Nuclear Information System (INIS)

    Shibata, Heki

    2004-01-01

    This paper deals with the evaluation of regulatory codes for anti-earthquake design of industrial facilities including a nuclear power plant. There are several ways to describe the anti-earthquake design, in general, and the case for a nuclear power plant is one of the extreme. The comparison of various codes was made briefly also. (author)

  6. Applications of EVA guidelines and design criteria. Volume 3: EVA systems cost model formating

    Science.gov (United States)

    Brown, N. E.

    1973-01-01

    The development of a model for estimating the impact of manned EVA costs on future payloads is discussed. Basic information on the EV crewman requirements, equipment, physical and operational characteristics, and vehicle interfaces is provided. The cost model is being designed to allow system designers to quantify the impact of EVA on vehicle and payload systems.

  7. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

    Science.gov (United States)

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-05-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. Copyright: © Singapore Medical Association.

  8. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia

    Science.gov (United States)

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-01-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively ‘dead’. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma’s position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. PMID:27211055

  9. A favorable course of palliative sedation: searching for indicators using caregivers' perspectives.

    Science.gov (United States)

    Brinkkemper, Tijn; Rietjens, Judith A C; Deliens, Luc; Ribbe, Miel W; Swart, Siebe J; Loer, Stephan A; Zuurmond, Wouter W A; Perez, Roberto S G M

    2015-03-01

    Comparing characteristics of a favorable sedation course during palliative sedation to a less favorable course based on the reports Dutch physicians and nurses. Cases identified as having a favorable sedation course less often concerned a male patient (P = .019 nurses' cases), reached the intended sedation depth significantly quicker (P sedation (P = .015 physicians' cases), and had a shorter total duration of sedation compared (P sedation course. A favorable course during palliative sedation seems more probable when health care professionals report on a (relatively) shorter time to reach the required depth of sedation and when a deeper level of sedation can be obtained. © The Author(s) 2013.

  10. Guidelines for the Design and Conduct of Clinical Studies in Knee Articular Cartilage Repair

    Science.gov (United States)

    Mithoefer, Kai; Saris, Daniel B.F.; Farr, Jack; Kon, Elizaveta; Zaslav, Kenneth; Cole, Brian J.; Ranstam, Jonas; Yao, Jian; Shive, Matthew; Levine, David; Dalemans, Wilfried; Brittberg, Mats

    2011-01-01

    Objective: To summarize current clinical research practice and develop methodological standards for objective scientific evaluation of knee cartilage repair procedures and products. Design: A comprehensive literature review was performed of high-level original studies providing information relevant for the design of clinical studies on articular cartilage repair in the knee. Analysis of cartilage repair publications and synopses of ongoing trials were used to identify important criteria for the design, reporting, and interpretation of studies in this field. Results: Current literature reflects the methodological limitations of the scientific evidence available for articular cartilage repair. However, clinical trial databases of ongoing trials document a trend suggesting improved study designs and clinical evaluation methodology. Based on the current scientific information and standards of clinical care, detailed methodological recommendations were developed for the statistical study design, patient recruitment, control group considerations, study endpoint definition, documentation of results, use of validated patient-reported outcome instruments, and inclusion and exclusion criteria for the design and conduct of scientifically sound cartilage repair study protocols. A consensus statement among the International Cartilage Repair Society (ICRS) and contributing authors experienced in clinical trial design and implementation was achieved. Conclusions: High-quality clinical research methodology is critical for the optimal evaluation of current and new cartilage repair technologies. In addition to generally applicable principles for orthopedic study design, specific criteria and considerations apply to cartilage repair studies. Systematic application of these criteria and considerations can facilitate study designs that are scientifically rigorous, ethical, practical, and appropriate for the question(s) being addressed in any given cartilage repair research project

  11. Present activities for the preparation of a Japanese draft of structural design guidelines for the experimental fusion reactor

    International Nuclear Information System (INIS)

    Miya, K.; Muto, Y.; Takatsu, H.; Hada, K.; Koizumi, K.; Jitsukawa, S.; Arai, T.; Ohkawa, Y.; Shimakawa, T.; Aoto, K.; Shiraishi, H.; Takagi, T.; Miki, N.; Takahashi, S.; Sato, K.; Takemasa, F.; Kasaba, M.; Kudough, F.; Fujita, J.; Kajiura, S.; Kinoshita, S.

    1996-01-01

    Since November 1990, systematic research has been carried out in preparation for a Japanese draft of structural design guidelines for the experimental fusion reactor. This report summarizes the major results of the work and the status of these efforts. A classification of components and definition of operating conditions are proposed on the basis of the ITER-CDA design, in the light of the safety characteristics of the fusion reactor and relevant conventions for the existing fission reactor design code. Specific issues regarding the structural design of the experimental fusion reactor are discussed based on the experimental and analytical work. The validity of the existing structural design method is confirmed for the use of irradiated 316 SS, irrespective of the significant reduction in uniform elongation capability caused by heavy neutron irradiation. Further important phenomena are treated such as magnetic damping, magnetic stiffness and fracture due to electromagnetic forces. Finally, the issues concerned with welding and non-destructive examinations are discussed with relevance to component classification. (orig.)

  12. Guidelines for the integrated planning and design of underground coal mines.

    CSIR Research Space (South Africa)

    Fourie, GA

    2001-11-01

    Full Text Available Mine planning and design involves the compilation and integration of all relevant geological, geotechnical, mining, engineering and economic data into a single document to define and describe the exploitation strategy for a particular mineral...

  13. Design Guidelines for Impressed-Current Cathodic Protection Systems on Surface-Effect Ships

    Science.gov (United States)

    1975-05-01

    result, design data, particularly regarding current levels and means to avoid overprotection corrosion, and design procedures have been pre- viously...degradation due to overprotection corrosion. To determine the limit of overprotection at high velocity, experiments were run on 1- x 4-inch aluminum... OVERPROTECTION EXPERIMENTS Potential Weight Corrosion mV Loss, g Rate, MPY specimen Appearance 1 •120C • ?5C 52.4 No visible corrosion , -I25O 0

  14. Wind Turbine Design Guideline DG03: Yaw and Pitch Rolling Bearing Life

    Energy Technology Data Exchange (ETDEWEB)

    Harris, T.; Rumbarger, J. H.; Butterfield, C. P.

    2009-12-01

    This report describes the design criteria, calculation methods, and applicable standards recommended for use in performance and life analyses of ball and roller (rolling) bearings for yaw and pitch motion support in wind turbine applications. The formulae presented here for rolling bearing analytical methods and bearing-life ratings are consistent with methods in current use by wind turbine designers and rolling-bearing manufacturers.

  15. Guidelines for the design and statistical analysis of experiments in papers submitted to ATLA.

    Science.gov (United States)

    Festing, M F

    2001-01-01

    In vitro experiments need to be well designed and correctly analysed if they are to achieve their full potential to replace the use of animals in research. An "experiment" is a procedure for collecting scientific data in order to answer a hypothesis, or to provide material for generating new hypotheses, and differs from a survey because the scientist has control over the treatments that can be applied. Most experiments can be classified into one of a few formal designs, the most common being completely randomised, and randomised block designs. These are quite common with in vitro experiments, which are often replicated in time. Some experiments involve a single independent (treatment) variable, while other "factorial" designs simultaneously vary two or more independent variables, such as drug treatment and cell line. Factorial designs often provide additional information at little extra cost. Experiments need to be carefully planned to avoid bias, be powerful yet simple, provide for a valid statistical analysis and, in some cases, have a wide range of applicability. Virtually all experiments need some sort of statistical analysis in order to take account of biological variation among the experimental subjects. Parametric methods using the t test or analysis of variance are usually more powerful than non-parametric methods, provided the underlying assumptions of normality of the residuals and equal variances are approximately valid. The statistical analyses of data from a completely randomised design, and from a randomised-block design are demonstrated in Appendices 1 and 2, and methods of determining sample size are discussed in Appendix 3. Appendix 4 gives a checklist for authors submitting papers to ATLA.

  16. Guidelines for the design of the working rules of the guarantee and quality control in radiotherapy commission

    International Nuclear Information System (INIS)

    Pardo, J.; Galmes, M.A.; Font, J.; Caro, J.; Serra, J.; Mata, F.; Bertan, S.; Biete, A.; Carceller, J.A.; Esco, R.; Palacios, A.; Veiras, C.; Vazquez, M.G.

    2001-01-01

    The 1566/1988 Royal Decree stated on July 17 th , focused on Quality Criteria in Radiation Therapy, was published in the Official Spanish Gazette on August 28 th . Its publication began a self-analysis process in all the Spanish Radiation Oncology Departments due to the fact that it implies the guidelines elaboration of each step of the radiation therapy process, including the patient post-treatment follow up and the equipment quality control. The Royal Decree orders the managers of the hospitals and facilities that have a radiation oncology department to create the Guarantee and Quality Control in Radiotherapy Commission. According to the Spanish law regulations, every single commission must have its own working rules based on the Chapter II, focused in 'Organos Colegiados', of the 30/1992 Law stated on November 27 th about Public Administration Legal Rules. The Guidelines for the design of the Guarantee and Quality Control in Radiotherapy Commission Working Rules here presented, have been done by consensus in Son Dureta University Hospital and afterwards sent to all Radiation Oncology Departments by the Spanish Society for Radiotherapy and Oncology. (author)

  17. Design and usability study of an iconic user interface to ease information retrieval of medical guidelines.

    Science.gov (United States)

    Griffon, Nicolas; Kerdelhué, Gaétan; Hamek, Saliha; Hassler, Sylvain; Boog, César; Lamy, Jean-Baptiste; Duclos, Catherine; Venot, Alain; Darmoni, Stéfan J

    2014-10-01

    Doc'CISMeF (DC) is a semantic search engine used to find resources in CISMeF-BP, a quality controlled health gateway, which gathers guidelines available on the internet in French. Visualization of Concepts in Medicine (VCM) is an iconic language that may ease information retrieval tasks. This study aimed to describe the creation and evaluation of an interface integrating VCM in DC in order to make this search engine much easier to use. Focus groups were organized to suggest ways to enhance information retrieval tasks using VCM in DC. A VCM interface was created and improved using the ergonomic evaluation approach. 20 physicians were recruited to compare the VCM interface with the non-VCM one. Each evaluator answered two different clinical scenarios in each interface. The ability and time taken to select a relevant resource were recorded and compared. A usability analysis was performed using the System Usability Scale (SUS). The VCM interface contains a filter based on icons, and icons describing each resource according to focus group recommendations. Some ergonomic issues were resolved before evaluation. Use of VCM significantly increased the success of information retrieval tasks (OR=11; 95% CI 1.4 to 507). Nonetheless, it took significantly more time to find a relevant resource with VCM interface (101 vs 65 s; p=0.02). SUS revealed 'good' usability with an average score of 74/100. VCM was successfully implemented in DC as an option. It increased the success rate of information retrieval tasks, despite requiring slightly more time, and was well accepted by end-users. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. DSRS guidelines. Reference document for the IAEA Design Safety Review Services

    International Nuclear Information System (INIS)

    1999-01-01

    The publication covers the general topic of design safety review of a nuclear power plant. It is intended to make Member States aware of the possibility of a service through which they can have a better appreciation of the overall design of a facility or of a plant already in operation. It includes a generic and procedural part followed by a technical part corresponding to different systems of a nuclear power plant. It is intended to be used mainly in preparation and execution of a design review service by the IAEA and to provide information to potential recipients of the service regarding the effort involved and the topics that can be covered. it is expected to be useful if Member States decide to conduct such reviews themselves either through regulatory authorities or as part of self assessment activities by plant management

  19. Building Design Guidelines of Interior Architecture for Bio safety Levels of Biology Laboratories

    International Nuclear Information System (INIS)

    ElDib, A.A.

    2014-01-01

    This paper discusses the pivotal role of the Interior Architecture As one of the scientific disciplines minute to complete the Architectural Sciences, which relied upon the achievement and development of facilities containing scientific research laboratories, in terms of planning and design, particularly those containing biological laboratories using radioactive materials, adding to that, the application of the materials or raw materials commensurate with each discipline of laboratory and its work nature, and by the discussion the processing of design techniques and requirements of interior architecture dealing with Research Laboratory for electronic circuits an their applications with the making of its prototypes

  20. Sustainability certification systems as guidelines for early-phase urban design processes

    DEFF Research Database (Denmark)

    Jensen, Lotte Bjerregaard; Bjerre, Lærke; Mansfelt, Lise

    2016-01-01

    The German Sustainable Building Council (Deutsche Gesellschaft für Nachhaltiges Bauen or DGNB) has one of the most comprehensive sustainability certification systems for urban districts (UD). Their explicit aim is that the system should impact the very earliest design decisions. The Technical...

  1. 76 FR 53113 - Guidelines for Designating Biobased Products for Federal Procurement

    Science.gov (United States)

    2011-08-25

    ... Designating Biobased Products for Federal Procurement AGENCY: Office of Procurement and Property Management... that the Department of Agriculture, Office of Procurement and Property Management, is hereby requesting... comments to: Ron Buckhalt, USDA, Office of Procurement and Property Management, Room 361, Reporters...

  2. Comparative floorplan-analysis as a means to develop design guidelines

    NARCIS (Netherlands)

    Van Hoogdalem, H.; van der Voordt, D.J.M.; van Wegen, H.B.R.

    1985-01-01

    This study explores the usefulness of comparative floorplan-analysis for the development of spatio-organizational concepts in architectural design processes. Each floorplan can be considered as a reflection of the goals and activities of the users as interpreted by the architect. By comparing a wide

  3. On the design guideline for the low emittance synchrotron radiation source

    International Nuclear Information System (INIS)

    Kamiya, Y.; Kihara, M.

    1983-09-01

    In this note we will describe how the emittance of the electron storage ring is determined by the orbit parameters of the storage ring and show the lowest value of emittance which is achieved theoretically. Implication of this note with regard to the design of the low emittance storage ring will be discussed. (author)

  4. Design-based research and doctoral students: Guidelines for preparing a dissertation proposal

    NARCIS (Netherlands)

    Herrington, Jan; Montgomerie, C.; McKenney, Susan; Seale, J.; Reeves, Thomas C.; Oliver, Ron

    2007-01-01

    At first glance, design-based research may appear to be such a long-term and intensive approach to educational inquiry that doctoral students, most of whom expect to complete their Ph.D. degree in 4-5 years, should not attempt to adopt this approach for their doctoral dissertations. In this paper,

  5. Design guidelines for passive instability suppression - Task-11 report[Wind turbines

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, M.H.; Buhl, T.

    2006-12-15

    In these guidelines for passive instability suppression, eight relevant topics within aeroelastic stability of turbines are considered for the parameter variations: 1. Effect of airfoil aerodynamics: The airfoil aerodynamics given by the profile coefficients for aerodynamic lift, drag, and moment are shown to have a direct effect on aerodynamic damping of blade vibrations. A redesign of the airfoils can improve the power performance of the rotor without loss of aerodynamic damping. 2. Effect of flap/edgewise frequency coincidence: The natural frequencies of the first flapwise and first edgewise blade bending modes become closer as the blades become more slender. This 1-1 resonance may lead to a coupling flap- and edgewise blade vibrations which increases the edgewise blade mode damping. 3. Effect of flap/edgewise whirling coupling: The aerodynamic damping of blade vibrations close to the rotor plane are generally lower than the aerodynamic damping of vibrations out of the rotor plane. A structural coupling between the flapwise and edgewise whirling modes can increase the overall aerodynamic damping by adding more out of plane blade motion to the edgewise whirling modes. 4. Effect of torsional blade stiffness: A low torsional blade stiffness may lead to flutter where the first torsional blade mode couples to a flapwise bending mode in a flutter instability through the aerodynamic forces. 5. Can whirl flutter happen on a wind turbine? Whirl flutter is an aeroelastic instability similar to blade flutter. Whirl flutter can occur on turbines with very low natural frequencies of the tilt and yaw modes (about 5 % of their original values). 6. Edgewise/torsion coupling for large flapwise deflections: The large flapwise deflection of modern slender blades lead to a geometric coupling of edgewise bending and torsion. The aeroelastic damping of the blade modes are affected by a flapwise prebend of the blade. 7. Effect of yaw error on damping from wake: The wake behind the

  6. French Swiss physicians' attitude toward palliative sedation: Influence of prognosis and type of suffering.

    Science.gov (United States)

    Beauverd, M; Bernard, M; Currat, T; Ducret, S; Foley, R A; Borasio, G D; Blondeau, D; Dumont, S

    2014-10-01

    Palliative sedation is a last resort medical act aimed at relieving intolerable suffering induced by intractable symptoms in patients at the end-of-life. This act is generally accepted as being medically indicated under certain circumstances. A controversy remains in the literature as to its ethical validity. There is a certain vagueness in the literature regarding the legitimacy of palliative sedation in cases of non-physical refractory symptoms, especially "existential suffering." This pilot study aims to measure the influence of two independent variables (short/long prognosis and physical/existential suffering) on the physicians' attitudes toward palliative sedation (dependent variable). We used a 2 × 2 experimental design as described by Blondeau et al. Four clinical vignettes were developed (vignette 1: short prognosis/existential suffering; vignette 2: long prognosis/existential suffering; vignette 3: short prognosis/physical suffering; vignette 4: long prognosis/physical suffering). Each vignette presented a terminally ill patient with a summary description of his physical and psychological condition, medication, and family situation. The respondents' attitude towards sedation was assessed with a six-point Likert scale. A total of 240 vignettes were sent to selected Swiss physicians. 74 vignettes were completed (36%). The means scores for attitudes were 2.62 ± 2.06 (v1), 1.88 ± 1.54 (v2), 4.54 ± 1.67 (v3), and 4.75 ± 1.71 (v4). General linear model analyses indicated that only the type of suffering had a significant impact on the attitude towards sedation (F = 33.92, df = 1, p = 0.000). Significance of the results: The French Swiss physicians' attitude toward palliative sedation is more favorable in case of physical suffering than in existential suffering. These results are in line with those found in the study of Blondeau et al. with Canadian physicians and will be discussed in light of the arguments given by physicians to explain their decisions.

  7. Sedation and memory: studies with a histamine H-1 receptor antagonist.

    Science.gov (United States)

    Turner, Claire; Handford, Alison D F; Nicholson, Anthony N

    2006-07-01

    The influence of sedation on the effect of an H-1 receptor antagonist on various cognitive functions, including memory, were evaluated. Diphenhydramine (50, 75 and 100 mg) and lorazepam (0.5 and 1.5 mg) were given on single occasions to 12 healthy volunteers (six males, six females) aged 20-33 (mean 23.4) years. Subjective assessments of sedation, sleep latencies, digit symbol substitution, choice reaction time, sustained attention and memory recall were studied 1.0 h before and 0.5, 2.0 and 3.5 h after drug ingestion. The study was double blind, placebo controlled and with a crossover design. With all doses of diphenhydramine there was subjective sedation, reduced sleep latencies and impairments in performance on the digit symbol substitution, choice reaction time and sustained attention tasks. No effects were observed with 0.5 mg lorazepam. With 1.5 mg lorazepam there was subjective sedation, fewer digit symbol substitutions, slowed choice reaction time, impaired attention and memory, but no effect on sleep latencies. Contrast analysis of data measured at all time points showed that although there was no difference in the effect of diphenhydramine (100 mg) and lorazepam (1.5 mg) on those tasks without a memory component, response times were slower with lorazepam on those tasks with a memory component. However, both 100 mg diphenhydramine and 1.5 mg lorazepam impaired prompted recall measured at 2 h post-ingestion only. It is considered that impaired memory is not necessarily associated with sedation, and that impairment of memory with drugs that lead to sedation may be effected through neuronal systems independent of those that affect arousal.

  8. Increased precuneus connectivity during propofol sedation.

    Science.gov (United States)

    Liu, Xiaolin; Li, Shi-Jiang; Hudetz, Anthony G

    2014-02-21

    Using functional magnetic resonance imaging in human participants, we show that sedation by propofol to the point of lost overt responsiveness during the performance of an auditory verbal memory task unexpectedly increases functional connectivity of the precuneus with cortical regions, particularly the dorsal prefrontal and visual cortices. After recovery of consciousness, functional connectivity returns to a pattern similar to that observed during the wakeful baseline. In the context of a recent proposal that highlights the uncoupling of consciousness, connectedness, and responsiveness in general anesthesia, the increased precuneus functional connectivity under propofol sedation may reflect disconnected endogenous mentation or dreaming that continues at a reduced level of metabolic activity. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  9. European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy

    DEFF Research Database (Denmark)

    Dumonceau, J.M.; Riphaus, A.; Aparicio, J.R.

    2010-01-01

    Propofol sedation by non-anesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim of this evi......Propofol sedation by non-anesthesiologists is an upcoming sedation regimen in several countries throughout Europe. Numerous studies have shown the efficacy and safety of this sedation regimen in gastrointestinal endoscopy. Nevertheless, this issue remains highly controversial. The aim...... of this evidence- and consensus-based set of guideline is to provide non-anesthesiologists with a comprehensive framework for propofol sedation during digestive endoscopy. This guideline results from a collaborative effort from representatives of the European Society of Gastrointestinal Endoscopy (ESGE...

  10. Toward Design Guidelines for Stream Restoration Structures: Measuring and Modeling Unsteady Turbulent Flows in Natural Streams with Complex Hydraulic Structures

    Science.gov (United States)

    Lightbody, A.; Sotiropoulos, F.; Kang, S.; Diplas, P.

    2009-12-01

    Despite their widespread application to prevent lateral river migration, stabilize banks, and promote aquatic habitat, shallow transverse flow training structures such as rock vanes and stream barbs lack quantitative design guidelines. Due to the lack of fundamental knowledge about the interaction of the flow field with the sediment bed, existing engineering standards are typically based on various subjective criteria or on cross-sectionally-averaged shear stresses rather than local values. Here, we examine the performance and stability of in-stream structures within a field-scale single-threaded sand-bed meandering stream channel in the newly developed Outdoor StreamLab (OSL) at the St. Anthony Falls Laboratory (SAFL). Before and after the installation of a rock vane along the outer bank of the middle meander bend, high-resolution topography data were obtained for the entire 50-m-long reach at 1-cm spatial scale in the horizontal and sub-millimeter spatial scale in the vertical. In addition, detailed measurements of flow and turbulence were obtained using acoustic Doppler velocimetry at twelve cross-sections focused on the vicinity of the structure. Measurements were repeated at a range of extreme events, including in-bank flows with an approximate flow rate of 44 L/s (1.4 cfs) and bankfull floods with an approximate flow rate of 280 L/s (10 cfs). Under both flow rates, the structure reduced near-bank shear stresses and resulted in both a deeper thalweg and near-bank aggradation. The resulting comprehensive dataset has been used to validate a large eddy simulation carried out by SAFL’s computational fluid dynamics model, the Virtual StreamLab (VSL). This versatile computational framework is able to efficiently simulate 3D unsteady turbulent flows in natural streams with complex in-stream structures and as a result holds promise for the development of much-needed quantitative design guidelines.

  11. Analgesics and sedatives in vascular interventionist radiologic

    International Nuclear Information System (INIS)

    Gregorio, M.A. de; Opta, J.M.; Pulido, J.M.; Encarnacion, C.E.; Arino, I., Fernandez, J.A.; Alfonso, E.R.

    1993-01-01

    Interventionist radiology routinely requires the use of different drugs (analgesics and sedatives) in the course of a procedure. Aside from their therapeutic action, these drugs can produce secondary or undesirable effects, making necessary an in-depth knowledge of them to assure their safe and efficient management. The aim of this work is to provide the vascular interventionist radiologist with additional information on the management of those drugs that contribute to minimizing patient discomfort and pain in interventionist procedures. Author

  12. Design guidelines for advanced LSI microcircuit packaging using thick film multilayer technology

    Science.gov (United States)

    Peckinpaugh, C. J.

    1974-01-01

    Ceramic multilayer circuitry results from the sequential build-up of two or more layers of pre-determined conductive interconnections separated by dielectric layers and fired at an elevated temperature to form a solidly fused structure. The resultant ceramic interconnect matrix is used as a base to mount active and passive devices and provide the necessary electrical interconnection to accomplish the desired electrical circuit. Many methods are known for developing multilevel conductor mechanisms such as multilayer printed circuits, welded wire matrices, flexible copper tape conductors, and thin and thick-film ceramic multilayers. Each method can be considered as a specialized field with each possessing its own particular set of benefits and problems. This design guide restricts itself to the art of design, fabrication and assembly of ceramic multilayer circuitry and the reliability of the end product.

  13. Case Study of Online Banking in India: User Behaviors and Design Guidelines

    Science.gov (United States)

    Iyengar, Jhumkee; Belvalkar, Manisha

    This paper documents online banking trends, behaviors and expectations of Indian consumers and banks. It is based on excerpts of a large industry case study of users from 4 leading banks. While banks view online banking essentially as a technology solution, it is a relatively new area for Indian consumers and not yet self-supporting. Being a savings based culture still, Indian consumers are cautious about their financial assets. They are also relatively recent entrants to internet based services. Design of these systems must therefore be based on an understanding of these users' outlook and priorities through task centric, security assured and service oriented solutions minus the technological challenges. Design lessons suggest viewing online banking not just as a convenience alone anymore but beyond it, to provide service, simplicity and security. This will create satisfied online banking customers and therefore profitability for the bank.

  14. Design guidelines for H-Darrieus wind turbines: Optimization of the annual energy yield

    International Nuclear Information System (INIS)

    Bianchini, Alessandro; Ferrara, Giovanni; Ferrari, Lorenzo

    2015-01-01

    Highlights: • Proposal for a new design criterion for H-Darrieus turbines based on the energy-yield maximization. • 21,600 design cases analyzed to identify the best solutions for each installation site (i.e. average wind speed). • Critical analysis of the best design choices in terms of turbine shape, dimensions, airfoils and constraints. • Notable energy increase provided by the new design approach. • Each site requires a specific turbine concept to optimize the energy yield. - Abstract: H-Darrieus wind turbines are gaining popularity in the wind energy market, particularly as they are thought to represent a suitable solution even in unconventional installation areas. To promote the diffusion of this technology, industrial manufacturers are continuously proposing new and appealing exterior solutions, coupled with tempting rated-power offers. The actual operating conditions of a rotor over a year can be, however, very different from the nominal one and strictly dependent on the features of the installation site. Based on these considerations, a turbine optimization oriented to maximize the annual energy yield, instead of the maximum power, is thought to represent a more interesting solution. With this goal in mind, 21,600 test cases of H-Darrieus rotors were compared on the basis of their energy-yield capabilities for different annual wind distributions in terms of average speed. The wind distributions were combined with the predicted performance maps of the rotors obtained with a specifically developed numerical code based on a Blade Element Momentum (BEM) approach. The influence on turbine performance of the cut-in speed was accounted for, as well as the limitations due to structural loads (i.e. maximum rotational speed and maximum wind velocity). The analysis, carried out in terms of dimensionless parameters, highlighted the aerodynamic configurations able to ensure the largest annual energy yield for each wind distribution and set of aerodynamic

  15. Practical Design Guidelines for Fugitive Gas Detection from Unmanned Aerial Vehicles

    Science.gov (United States)

    Tandy, William D., Jr.

    Simulation, design, and analysis are combined in this effort to realize a UAV-scale instrument for fugitive gas detection. The contributing material to the industry begins by extending and correlating an integrated Gaussian plume model useful for instrument predictions and trade studies, regardless of the instrument type or molecule of interest. A variety of generally applicable plots are produced from this foundation, including receiver operator curves for leak rate detectability vs. wind speed, beam diameter vs. leak rate detectability, and plots for required scan densities. The atmospheric and instrument parameter trade studies are followed by hardware-specific analyses applicable to differential absorption lidar (DIAL) instruments. A synopsis of the lessons learned from hands-on experiences in the lab further define the design space for DIAL sensors. The dissertation culminates in the detailed design and analysis of two DIAL instrument concepts. The conclusion is that a DIAL instrument capable of reliably detecting a 50 SCFH plume in winds speeds up to 7 mph is on the threshold of being achievable on a quadcopter platform. Of special note is that the effort was funded by a Pipeline and Hazardous Materials Safety Administration grant and performed in collaboration with Ball Aerospace & Technologies.

  16. Dreaming and recall during sedation for colonoscopy.

    Science.gov (United States)

    Stait, M L; Leslie, K; Bailey, R

    2008-09-01

    Dreaming is reported by one in five patients who are interviewed on emergence from general anaesthesia, but the incidence, predictors and consequences of dreaming during procedural sedation are not known. In this prospective observational study, 200 patients presenting for elective colonoscopy under intravenous sedation were interviewed on emergence to determine the incidences of dreaming and recall. Sedation technique was left to the discretion of the anaesthetist. The incidence of dreaming was 25.5%. Patients reporting dreaming were younger than those who did not report dreaming. Doses of midazolam and fentanyl were similar between dreamers and non-dreamers, however propofol doses were higher in patients who reported dreams than those who did not. Patients reported short, simple dreams about everyday life--no dream suggested near-miss recall of the procedure. Frank recall of the procedure was reported by 4% of the patients, which was consistent with propofol doses commensurate with light general anaesthesia. The only significant predictor of recall was lower propofol dose. Satisfaction with care was generally high, however dreamers were more satisfied with their care than non-dreamers.

  17. Cardiovascular, respiratory and sedative effects of intramuscular alfaxalone, butorphanol and dexmedetomidine compared with ketamine, butorphanol and dexmedetomidine in healthy cats.

    Science.gov (United States)

    Cremer, Jeannette; Riccó, Carolina H

    2017-11-01

    Objectives The aim of the study was to evaluate the cardiorespiratory effects, quality of sedation and recovery of intramuscular alfaxalone-dexmedetomidine-butorphanol (ADB) and ketamine-dexmedetomidine-butorphanol (KDB), in cats. Methods Nine adult, healthy cats (6.63 ± 1.42 kg) were enrolled in a blinded, randomized, crossover experimental design. Cats were sedated twice intramuscularly, once with ADB (alfaxalone 1 mg/kg, dexmedetomidine 0.005 mg/kg, butorphanol 0.2 mg/kg), and once with KDB (ketamine 5 mg/kg, dexmedetomidine 0.005 mg/kg, butorphanol 0.2 mg/kg), in random order. Data collected included heart rate (HR), arterial blood pressure and blood gas analysis, respiratory rate, and sedation score. Analysis of variance with Bonferroni post-hoc correction was used for parametric data, and a Wilcoxon signed rank test was used for non-parametric data. Significance was set at P <0.05. Results Total sedation time was shorter for ADB (90.71 ± 15.12 mins vs 147.00 ± 47.75 mins). Peak sedation was observed within 15 mins in both groups. Quality of recovery was excellent in both groups. HR decreased over time in both groups. Diastolic and mean arterial pressure decreased over time for ADB, becoming significant after 30 mins. All cardiovascular variables were within the clinically acceptable range in both groups. Arterial partial pressure of oxygen was significantly decreased from baseline for KDB at all time points (73 ± 2.5 mmHg [9.7 ± 0.3 kPa] vs ADB 83 ± 2.6 mmHg [11 ± 0.3 kPa]). Hypoventilation was not observed. Conclusions and relevance Both protocols produced acceptable cardiovascular stability. Sedation and recovery quality were good, albeit sedation was shorter with ADB. Although oxygenation was better maintained in the ADB group, all sedated cats should receive oxygen supplementation.

  18. The use of palliative sedation: A comparison of attitudes of French-speaking physicians from Quebec and Switzerland.

    Science.gov (United States)

    Dumont, Serge; Blondeau, Danielle; Turcotte, Véronique; Borasio, Gian Domenico; Currat, Thierry; Foley, Rose-Anna; Beauverd, Michel

    2015-08-01

    Previous literature has suggested that laws and regulations may impact the use of palliative sedation. Our present study compares the attitudes of French-speaking physicians practicing in the Quebec and Swiss environments, where different laws are in place regarding physician-assisted suicide. Data were drawn from two prior studies, one by Blondeau and colleagues and another by Beauverd and coworkers, employing the same two-by-two experimental design with length of prognosis and type of suffering as independent variables. Both the effect of these variables and the effect of their interaction on Swiss and Quebec physicians' attitudes toward sedation were compared. The written comments of respondents were submitted to a qualitative content analysis and summarized in a comparative perspective. The analysis of variance showed that only the type of suffering had an effect on physicians' attitudes toward sedation. The results of the Wilcoxon test indicated that the attitudes of physicians from Quebec and Switzerland tended to be different for two vignettes: long-term prognosis with existential suffering (p = 0.0577) and short-term prognosis with physical suffering (p = 0.0914). In both cases, the Swiss physicians were less prone to palliative sedation. The attitudes of physicians from Quebec and Switzerland toward palliative sedation, particularly regarding prognosis and type of suffering, seem similar. However, the results suggest that physicians from Quebec could be slightly more open to palliative sedation, even though most were not in favor of this practice as an answer to end-of-life existential suffering.

  19. Safeguards and security design guidelines for conceptual monitored retrievable storage (MRS) facilities

    International Nuclear Information System (INIS)

    Byers, K.R.; Clark, R.G.; Harms, N.L.; Roberts, F.P.

    1984-07-01

    Existing safeguards/security regulations and licensing requirements that may be applicable to an MRS facility are not currently well-defined. Protection requirements consistent with the NRC-graded safeguards approach are identified, as a baseline safeguards system with a comparison of the impacts on safeguards and security of salient features of the different storage concepts. In addition, MRS facility design features and operational considerations are proposed that would enhance facility protection and provide additional assurance that protection systems and procedures would be effectively implemented. 3 figures

  20. Variation in diurnal sedation in mechanically ventilated patients who are managed with a sedation protocol alone or a sedation protocol and daily interruption.

    Science.gov (United States)

    Mehta, Sangeeta; Meade, Maureen; Burry, Lisa; Mallick, Ranjeeta; Katsios, Christina; Fergusson, Dean; Dodek, Peter; Burns, Karen; Herridge, Margaret; Devlin, John W; Tanios, Maged; Fowler, Robert; Jacka, Michael; Skrobik, Yoanna; Olafson, Kendiss; Cook, Deborah

    2016-08-01

    Mechanically ventilated patients may receive more sedation during the night than during the day, potentially delaying extubation. We compared nighttime and daytime benzodiazepine and opioid administration in adult patients enrolled in a multicenter sedation trial comparing protocolized sedation alone or protocolized sedation combined with daily sedation interruption; and we evaluated whether nighttime and daytime doses were associated with liberation from mechanical ventilation. This is a secondary analysis of a randomized trial which was conducted in 16 North American medical-surgical ICUs. In all 423 patients, nurses applied a validated sedation scale hourly to titrate benzodiazepine and opioid infusions to achieve a light level of sedation. Using fentanyl equivalents and midazolam equivalents, we compared dosages administered during night (19:00 to 07:00) and day (07:00 to 19:00) shifts. Using multivariable logistic regression we evaluated the association between nighttime and daytime opioid and sedative doses, and spontaneous breathing trial (SBT) conduct, SBT success, and extubation. Nighttime benzodiazepine and opioid doses were significantly higher than daytime doses (mean difference midazolam equivalents 23.3 mg, 95 % CI 12.9, 33.8, p Patients were more often restrained during day shifts (76.3 % vs 73.7 %, p patient despite successful SBT. Patients received higher doses of opioids and benzodiazepines at night. Higher nighttime doses were associated with SBT failure and delayed extubation. ClinicalTrials.gov NCT00675363 . Registered 7 May 2008.

  1. Early Site Permit Demonstration Program: Guidelines for determining design basis ground motions

    International Nuclear Information System (INIS)

    1993-01-01

    This report develops and applies a methodology for estimating strong earthquake ground motion. The motivation was to develop a much needed tool for use in developing the seismic requirements for structural designs. An earthquake's ground motion is a function of the earthquake's magnitude, and the physical properties of the earth through which the seismic waves travel from the earthquake fault to the site of interest. The emphasis of this study is on ground motion estimation in Eastern North America (east of the Rocky Mountains), with particular emphasis on the Eastern United States and southeastern Canada. Eastern North America is a stable continental region, having sparse earthquake activity with rare occurrences of large earthquakes. While large earthquakes are of interest for assessing seismic hazard, little data exists from the region to empirically quantify their effects. Therefore, empirically based approaches that are used for other regions, such as Western North America, are not appropriate for Eastern North America. Moreover, recent advances in science and technology have now made it possible to combine theoretical and empirical methods to develop new procedures and models for estimating ground motion. The focus of the report is on the attributes of ground motion in Eastern North America that are of interest for the design of facilities such as nuclear power plants. Specifically considered are magnitudes M from 5 to 8, distances from 0 to 500 km, and frequencies from 1 to 35 Hz. This document, Volume IV, provides Appendix 8.B, Laboratory Investigations of Dynamic Properties of Reference Sites

  2. Early Site Permit Demonstration Program: Guidelines for determining design basis ground motions

    International Nuclear Information System (INIS)

    1993-01-01

    This report develops and applies a methodology for estimating strong earthquake ground motion. The motivation was to develop a much needed tool for use in developing the seismic requirements for structural designs. An earthquake's ground motion is a function of the earthquake's magnitude, and the physical properties of the earth through which the seismic waves travel from the earthquake fault to the site of interest. The emphasis of this study is on ground motion estimation in Eastern North America (east of the Rocky Mountains), with particular emphasis on the Eastern United States and southeastern Canada. Eastern North America is a stable continental region, having sparse earthquake activity with rare occurrences of large earthquakes. While large earthquakes are of interest for assessing seismic hazard, little data exists from the region to empirically quantify their effects. Therefore, empirically based approaches that are used for other regions, such as Western North America, are not appropriate for Eastern North America. Moreover, recent advances in science and technology have now made it possible to combine theoretical and empirical methods to develop new procedures and models for estimating ground motion. The focus of the report is on the attributes of ground motion in Eastern North America that are of interest for the design of facilities such as nuclear power plants. Specifically considered are magnitudes M from 5 to 8, distances from 0 to 500 km, and frequencies from 1 to 35 Hz

  3. 'Palliative sedation'? A retrospective cohort study on the use and labelling of continuously administered sedatives on a palliative care unit.

    Science.gov (United States)

    Schildmann, Eva; Pörnbacher, Sebastian; Kalies, Helen; Bausewein, Claudia

    2018-03-01

    Sedatives are frequently used towards the end of life. However, there is scarce information when their use is labelled as 'palliative sedation'. To assess the use and labelling of 'continuous administration of sedatives within the last 7 days of life', based on objective operational criteria, on a palliative care unit. Retrospective cohort study, using medical records. Explorative statistical analysis (SPSS 23). Patients who died on a palliative care unit from August 2014 to July 2015. Sedatives recorded were benzodiazepines, levomepromazine, haloperidol ⩾5 mg/day and propofol. Of the 192 patients, 149 (78%) patients received continuous sedatives within the last week of life. The prevalence of delirium/agitation was significantly higher in patients with continuous sedatives compared to those without continuous sedatives at admission to the unit (35% vs 16%, p = 0.02) and on the day before death (58% vs 40%, p = 0.04). The term '(palliative) sedation' was used in the records for 22 of 149 (15%) patients with continuous sedatives. These patients had significantly higher total daily midazolam doses 2 days before death (median (range), 15.0 (6.0-185.0) mg vs 11.5 (1.0-70.0) mg, p = 0.04) and on the day of death (median (range), 19.5 (7.5-240.0) mg vs 12.5 (2.0-65.0) mg, p = 0.01). The dose range was large in both groups. The prevalence of delirium/agitation was associated with the administration of continuous sedatives. There was no consistent pattern regarding labelling the use of continuous sedatives as '(palliative) sedation'. Multicentre mixed-methods research is needed for a better characterization of sedation practices in palliative care.

  4. Mitigating vestibular disturbances during space flight using virtual reality training and reentry vehicle design guidelines

    Science.gov (United States)

    Stroud, Kenneth Joshua

    Seventy to eighty percent of astronauts reportedly exhibit undesirable vestibular disturbances during the first few days of weightlessness, including space motion sickness (SMS) and spatial disorientation (SD). SMS presents a potentially dangerous situation, both because critical piloted tasks such as docking maneuvers and emergency reentry may be compromised, and because of the potential for asphyxiation should an astronaut vomit while wearing a space suit. SD can be provocative for SMS as well as become dangerous during an emergency in which it is critical for an astronaut to move quickly through the vehicle. In the U.S. space program, medication is currently used both for prevention and treatment of SMS. However, this approach has had only moderate success, and the side effects of drowsiness and lack of concentration are undesirable. Research suggests that preflight training in virtual reality devices can simulate certain aspects of microgravity and may prove to be an effective countermeasure for SMS and SD. It was hypothesized that exposing subjects preflight to variable virtual orientations, similar to those encountered during space flight, will reduce the incidence and/or severity of SMS and SD. Results from a study conducted at the NASA Johnson Space Center as part of this research demonstrated that this type of training is effective for reducing motion sickness and improving task performance in potentially disorienting visual surroundings, thus suggesting the possibility that such training may prove an effective countermeasure for SMS, SD and related performance decrements that occur in space flight. In addition to the effects associated with weightlessness, almost all astronauts experience vestibular disturbances associated with gravity-transitions incurred during the return to Earth, which could be exacerbated if traveling in a spacecraft that is designed differently than a conventional aircraft. Therefore, for piloted descent and landing operations

  5. Sedative effects of oral pregabalin premedication on intravenous sedation using propofol target-controlled infusion.

    Science.gov (United States)

    Karube, Noriko; Ito, Shinichi; Sako, Saori; Hirokawa, Jun; Yokoyama, Takeshi

    2017-08-01

    The sedative effects of pregabalin during perioperative period have not been sufficiently characterized. The aim of this study was to verify the sedative effects of premedication with pregabalin on intravenous sedation (IVS) using propofol and also to assess the influences of this agent on circulation, respiration, and postanesthetic complications. Ten healthy young volunteers underwent 1 h of IVS using propofol, three times per subject, on separate days (first time, no pregabalin; second time, pregabalin 100 mg; third time, pregabalin 200 mg). The target blood concentration (C T ) of propofol was increased in a stepwise fashion based on the bispectral index (BIS) value. Ramsay's sedation score (RSS) was determined at each propofol C T . Propofol C T was analyzed at each sedation level. Circulation and respiration during IVS and complications were also verified. Propofol C T was reduced at BIS values of 60 and 70 in both premedicated groups (100 mg: p = 0.043 and 0.041; 200 mg: p = 0.004 and 0.016, respectively) and at a BIS value of 80 in the pregabalin 200 mg group (p < 0.001). Propofol C T was decreased at RSS 4-6 in the pregabalin 100 mg group (RSS 4: p = 0.047; RSS 5: p = 0.007; RSS 6: p = 0.014), and at RSS 3-6 in the pregabalin 200 mg group (RSS 3-5: p < 0.001; RSS 6: p = 0.002). We conclude that oral premedication with pregabalin reduces the amount of propofol required to obtain an acceptable and adequate sedation level.

  6. Guidelines to design engineering education in the twenty-first century for supporting innovative product development

    Science.gov (United States)

    Violante, Maria Grazia; Vezzetti, Enrico

    2017-11-01

    In the twenty-first century, meeting our technological challenges demands educational excellence, a skilled populace that is ready for the critical challenges society faces. There is widespread consensus, however, that education systems are failing to adequately prepare all students with the essential twenty-first century knowledge and skills necessary to succeed in life, career, and citizenship. The purpose of this paper is to understand how twenty-first century knowledge and skills can be appropriately embedded in engineering education finalised to innovative product development by using additive manufacturing (AM). The study designs a learning model by which to achieve effective AM education to address the requirements of twenty-first century and to offer students the occasion to experiment with STEM (Science, technology, engineering, and mathematics) concepts. The study is conducted using the quality function deployment (QFD) methodology.

  7. Design guideline for Si/organic hybrid solar cell with interdigitated back contact structure

    Science.gov (United States)

    Bimo Prakoso, Ari; Rusli; Li, Zeyu; Lu, Chenjin; Jiang, Changyun

    2018-03-01

    We study the design of Si/organic hybrid (SOH) solar cells with interdigitated back contact (IBC) structure. SOH solar cells formed between n-Si and poly(3,4-ethylenedioxythiophene): polystyrenesulphonate (PEDOT:PSS) is a promising concept that combines the excellent electronic properties of Si with the solution-based processing advantage of an organic polymer. The IBC cell structure is employed to minimize parasitic absorption losses in the organic polymer, eliminate grid shadowing losses, and allow excellent passivation of the front Si surface in one step over a large area. The influence of Si thickness, doping concentration and contact geometry are simulated in this study to optimize the performance of the SOH-IBC solar cell. We found that a high power conversion efficiency of >20% can be achieved for optimized SOH-IBC cell based on a thin c-Si substrate of 40 μm thickness.

  8. Early Site Permit Demonstration Program: Guidelines for determining design basis ground motions

    International Nuclear Information System (INIS)

    1993-01-01

    This report develops and applies a methodology for estimating strong earthquake ground motion. The motivation was to develop a much needed tool for use in developing the seismic requirements for structural designs. An earthquake's ground motion is a function of the earthquake's magnitude, and the physical properties of the earth through which the seismic waves travel from the earthquake fault to the site of interest. The emphasis of this study is on ground motion estimation in Eastern North America (east of the Rocky Mountains), with particular emphasis on the Eastern United States and southeastern Canada. Eastern North America is a stable continental region, having sparse earthquake activity with rare occurrences of large earthquakes. While large earthquakes are of interest for assessing seismic hazard, little data exists from the region to empirically quantify their effects. The focus of the report is on the attributes of ground motion in Eastern North America that are of interest for the design of facilities such as nuclear power plants. This document, Volume II, contains Appendices 2, 3, 5, 6, and 7 covering the following topics: Eastern North American Empirical Ground Motion Data; Examination of Variance of Seismographic Network Data; Soil Amplification and Vertical-to-Horizontal Ratios from Analysis of Strong Motion Data From Active Tectonic Regions; Revision and Calibration of Ou and Herrmann Method; Generalized Ray Procedure for Modeling Ground Motion Attenuation; Crustal Models for Velocity Regionalization; Depth Distribution Models; Development of Generic Site Effects Model; Validation and Comparison of One-Dimensional Site Response Methodologies; Plots of Amplification Factors; Assessment of Coupling Between Vertical ampersand Horizontal Motions in Nonlinear Site Response Analysis; and Modeling of Dynamic Soil Properties

  9. Early Site Permit Demonstration Program: Guidelines for determining design basis ground motions. Volume 2, Appendices

    Energy Technology Data Exchange (ETDEWEB)

    1993-03-18

    This report develops and applies a methodology for estimating strong earthquake ground motion. The motivation was to develop a much needed tool for use in developing the seismic requirements for structural designs. An earthquake`s ground motion is a function of the earthquake`s magnitude, and the physical properties of the earth through which the seismic waves travel from the earthquake fault to the site of interest. The emphasis of this study is on ground motion estimation in Eastern North America (east of the Rocky Mountains), with particular emphasis on the Eastern United States and southeastern Canada. Eastern North America is a stable continental region, having sparse earthquake activity with rare occurrences of large earthquakes. While large earthquakes are of interest for assessing seismic hazard, little data exists from the region to empirically quantify their effects. The focus of the report is on the attributes of ground motion in Eastern North America that are of interest for the design of facilities such as nuclear power plants. This document, Volume II, contains Appendices 2, 3, 5, 6, and 7 covering the following topics: Eastern North American Empirical Ground Motion Data; Examination of Variance of Seismographic Network Data; Soil Amplification and Vertical-to-Horizontal Ratios from Analysis of Strong Motion Data From Active Tectonic Regions; Revision and Calibration of Ou and Herrmann Method; Generalized Ray Procedure for Modeling Ground Motion Attenuation; Crustal Models for Velocity Regionalization; Depth Distribution Models; Development of Generic Site Effects Model; Validation and Comparison of One-Dimensional Site Response Methodologies; Plots of Amplification Factors; Assessment of Coupling Between Vertical & Horizontal Motions in Nonlinear Site Response Analysis; and Modeling of Dynamic Soil Properties.

  10. Intention, procedure, outcome and personhood in palliative sedation and euthanasia.

    Science.gov (United States)

    Materstvedt, Lars Johan

    2012-03-01

    Palliative sedation at the end of life has become an important last-resort treatment strategy for managing refractory symptoms as well as a topic of controversy within palliative care. Furthermore, palliative sedation is prominent in the public debate about the possible legalisation of voluntary assisted dying (physician-assisted suicide and euthanasia). This article attempts to demonstrate that palliative sedation is fundamentally different from euthanasia when it comes to intention, procedure, outcome and the status of the person. Nonetheless, palliative sedation in its most radical form of terminal deep sedation parallels euthanasia in one respect: both end the experience of suffering. However, only the latter intentionally ends life and also has this as its goal. There is the danger that deep sedation could bring death forward in time due to particular side effects of the treatment. Still that would, if it happens, not be intended, and accordingly is defensible in view of the doctrine of double effect.

  11. Comparison of sedation strategies for critically ill patients

    DEFF Research Database (Denmark)

    Hutton, Brian; Burry, Lisa D.; Kanji, Salmaan

    2016-01-01

    Background: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug...... their efficacy and safety for mechanically ventilated patients. Methods: We will search the following from 1980 to March 2016: Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science. We will also search the Cochrane Library, gray literature, and the International Clinical Trials Registry Platform. We...... of interest include duration of mechanical ventilation, time to first extubation, ICU and hospital length of stay, re-intubation, tracheostomy, mortality, total sedative and opioid exposure, health-related quality of life, and adverse events. To inform our NMA, we will first conduct conventional pair...

  12. Techniques to administer oral, inhalational, and IV sedation in dentistry

    Directory of Open Access Journals (Sweden)

    Diana Krystyna Harbuz

    2016-02-01

    Full Text Available Background Sedation in dentistry is a controversial topic given the variety of opinions regarding its safe practice. Aims This article evaluates the various techniques used to administer sedation in dentistry and specific methods practiced to form a recommendation for clinicians. Methods An extensive literature search was performed using PubMed, Medline, Google Scholar, Google, and local library resources. Results Most of the literature revealed a consensus that light sedation on low-risk American Society of Anesthesiologists (ASA groups, that is ASA I, and possibly II, is the safest method for sedation in a dental outpatient setting. Conclusion Formal training is essential to achieve the safe practice of sedation in dentistry or medicine. The appropriate setting for sedation should be determined as there is an increased risk outside the hospital setting. Patients should be adequately assessed and medication titrated appropriately, based on individual requirements.

  13. SafeLand guidelines for landslide monitoring and early warning systems in Europe - Design and required technology

    Science.gov (United States)

    Bazin, S.

    2012-04-01

    Landslide monitoring means the comparison of landslide characteristics like areal extent, speed of movement, surface topography and soil humidity from different periods in order to assess landslide activity. An ultimate "universal" methodology for this purpose does not exist; every technology has its own advantages and disadvantages. End-users should carefully consider each one to select the methodologies that represent the best compromise between pros and cons, and are best suited for their needs. Besides monitoring technology, there are many factors governing the choice of an Early Warning System (EWS). A people-centred EWS necessarily comprises five key elements: (1) knowledge of the risks; (2) identification, monitoring, analysis and forecasting of the hazards; (3) operational centre; (4) communication or dissemination of alerts and warnings; and (5) local capabilities to respond to the warnings received. The expression "end-to-end warning system" is also used to emphasize that EWSs need to span all steps from hazard detection through to community response. The aim of the present work is to provide guidelines for establishing the different components for landslide EWSs. One of the main deliverables of the EC-FP7 SafeLand project addresses the technical and practical issues related to monitoring and early warning for landslides, and identifies the best technologies available in the context of both hazard assessment and design of EWSs. This deliverable targets the end-users and aims to facilitate the decision process by providing guidelines. For the purpose of sharing the globally accumulated expertise, a screening study was done on 14 EWSs from 8 different countries. On these bases, the report presents a synoptic view of existing monitoring methodologies and early-warning strategies and their applicability for different landslide types, scales and risk management steps. Several comprehensive checklists and toolboxes are also included to support informed

  14. IEEE 845 - a proposed guideline for use of human factors in design and retrofit design of nuclear power plants

    International Nuclear Information System (INIS)

    Schurman, D.L.

    1987-01-01

    This paper describes the development and content of the Institute of Electrical and Electronics Engineers (IEEE) Standard 845. This guide was developed by Working Group 7.2 of Subcommittee 7 of the Nuclear Power Engineering Committee of the Power Engineering Society of the IEEE. The guide has been approved by the Nuclear Power Engineering Committee (NPEC) and is now in the standards development and approval process. The guide is the first standards action approved by the NPEC of IEEE and is presented here to obtain wider peer response to its content. The guide provides a systematic framework for selection of human factors techniques and for the use of those techniques. The guide also provides a list of commonly used human factors techniques, along with a commentary about cost, ease of use, and other characteristics of each of the techniques. The guide is written with the project engineer and design engineer in mind. Thus, the guide attempts to provide a basis for the systematic selection of human factors techniques for various purposes and guidance regarding which of these techniques is likely to require the assistance of a human factors expert to apply

  15. The role of sedation tests in identifying sedative drug effects in healthy volunteers and their power to dissociate sedative-related impairments from memory dysfunctions.

    Science.gov (United States)

    Wezenberg, E; Sabbe, B G C; Hulstijn, W; Ruigt, G S F; Verkes, R J

    2007-08-01

    The study investigated whether four specified drugs would show similar patterns on tests considered to measure sedation. In addition, their drug-effect patterns on sedation and memory performance were compared to determine whether the sedative effects could be differentiated from the memory effects. Two double-blind, placebo-controlled, crossover studies, each with 16 healthy volunteers, were performed, one testing lorazepam (2.5 mg) and mirtazapine (15 mg) and the other olanzapine (10 mg) and haloperidol (2.5 mg). Subjective sedation was assessed by means of visual analogue scales (VAS) and objective sedation using a simple-reaction-time (SRT) task and a choice-reaction-time (CRT) task, code substitution (symbol digit substitution test (SDST)) and the peak velocity of saccadic eye movements (SEM). A verbal memory test (VMT) was administered to evaluate memory capacity. Apart from haloperidol, all drugs proved to impair performance on all five sedation indices. Contrary to the VAS, the objective measures yielded different response profiles. Two types of drug-effect patterns emerged: one for greater impairments in response speed (SRT, SEM) and one for greater impairments in information processing (CRT, SDST). Lorazepam and olanzapine impeded memory performance, whereas mirtazapine did not. With the use of standardized scores it proved possible to differentiate between the size of the effects of the drugs on the sedation and memory tests. To accurately assess the level and nature of sedation and to differentiate sedation from memory impairments different types of sedation measures are required. Besides studying the subjective effects, it is recommended to also test psychomotor responses and information processing speed.

  16. Intranasal dexmedetomidine for sedation for pediatric computed tomography imaging.

    Science.gov (United States)

    Mekitarian Filho, Eduardo; Robinson, Fay; de Carvalho, Werther Brunow; Gilio, Alfredo Elias; Mason, Keira P

    2015-05-01

    This prospective observational pilot study evaluated the aerosolized intranasal route for dexmedetomidine as a safe, effective, and efficient option for infant and pediatric sedation for computed tomography imaging. The mean time to sedation was 13.4 minutes, with excellent image quality, no failed sedations, or significant adverse events. Registered with ClinicalTrials.gov: NCT01900405. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. A study on regulatory guideline for the wireless network design digital I and C system

    International Nuclear Information System (INIS)

    Park, Y. C.; Kang, J. H.; Moon, Y. G.

    2006-06-01

    The paper represents the features of wireless communication in order to adopt to the atomic energy power plant system. The power plant environment of harsh for the robust and reliable wireless data transfer. Before practical installation and usage, it is necessary to evaluate the performance of wireless communication at such a harsh wireless communication environment. In the previous systems, high reliable wired data communication system has been used in common. We have checked the requirements which meet the reliability for that environment and analyzed the basic features of wireless communication. After that, we have a more detail analysis of wireless communication specification, such as IEEE 802 series, IMT-2000, Wibro, so on. Based on the result from analysis, the rules for the reliable system are defined. In the near future, low-power low-cost WSN(Wireless Sensor Network) would be dominant all over the industry. In this paper, the performance and considerations for the power plant is described when adopting to the atomic energy power system. The RF circuit design guide lines are defined, the reliability of the network protocol is defined and and elevated

  18. Soundscape design guidelines through noise mapping methodologies: An application to medium urban agglomerations

    Directory of Open Access Journals (Sweden)

    Vogiatzis Konstantinos

    2017-03-01

    Full Text Available In the framework of the European Directive 2002/49/EC, from 2012 to 2016, several cities in Greece have completed noise strategic maps with noise action plans that usually define the main strategies to reduce the noise residents are exposed to and introduce and preserve “quiet zones”. Several medium urban agglomerations in Greece (Volos, Larissa, Chania, Heraklion, Corfu, Agrinio, Thessaloniki have been chosen to also analyse the sound qualities of the soundscapes of specific urban neighbourhoods in order to generate recommendations for the urban design of the soundscapes of these agglomerations in a manner that complements conventional noise mitigation measures. The general principle of this approach is to relate quantitative data (e.g., from measurements, acoustic simulations, urban forms, topography, and traffic model with qualitative data (e.g., from type of sources, interviews, reports on environmental noise perception by creating quantitative and qualitative maps. The aim of this study is to propose possible action tools to the relevant authorities aiming at diminishing noise levels in affected areas and also to provide solutions towards a sustainable sound environment both in space and time. This paper presents the main current methodology, selected important results proposed for the urban agglomerations of a typical Southeast Mediterranean country such as Greece.

  19. Recommended guideline for designing and interpreting of Ramadan fasting studies in medical research

    Directory of Open Access Journals (Sweden)

    Zhaleh Shadman

    2015-12-01

    Full Text Available Ramadan fasting is specific intermittent fasting comprising significant changes in routine lifestyle pattern and may affect body homeostasis and metabolism. In spite of several studies conducted on the effects of Ramadan fasting on various aspects of health and disease, because of heterogeneity in methodology and procedures (sometimes inevitable, a comprehensive concluding for reliable results as in most conditions is impossible. Based on basic studies and those have been conducted in this field, this paper suggests a checklist contains, as far as possible, important factors to be considered in designing, interpreting and comparing the results of Ramadan fasting studies. Accordingly, circadian rhythm, season/latitude sensitivity, serum osmolarity and, lifestyle changes (including dietary intakes, physical activity, sleep quality and duration, smoking and, etc. may be of great importance. Also, a close definition of the number of fasting days and it consecutively or alternatively must be presented with reference to sex. Appropriate time points for blood/urine sampling would be varied case by case.

  20. Progress towards developing consistent design and evaluation guidelines for US Department of Energy facilities subjected to natural phenomena

    International Nuclear Information System (INIS)

    Murray, R.C.

    1987-01-01

    Probabilistic definitions of earthquake, wind, and tornado hazards for many DOE facilities throughout the United States have been developed. In addition, definitions of the flood hazards which might affect these locations are currently being developed. We have prepared a document to provide guidance and criteria for DOE facility managers to assure that DOE facilities are adequately constructed to resist the effects of natural phenomena such as earthquake, strong wind, and flood. The intent of this document is to provide instruction on how to utilize the hazard definitions to evaluate existing facilities and design new facilities in a manner such that the risk of adverse consequences is consistent with the cost, function, and danger to the public or environment. A conference and six mini-courses were organized on natural phenomena hazards mitigation. This provided a mechanism for technology transfer to the DOE community. Complementary manuals have also been developed for 1) suspended ceiling systems and recommendations for bracing them, 2) practical equipment seismic upgrade and strengthening guidelines, and 3) suggested structural details for wind design. These manuals are intended to provide input and guidance for ongoing site safety programs. (orig./HP)

  1. Progress towards developing consistent design and evaluation guidelines for US Department of Energy facilities subjected to natural phenomena

    International Nuclear Information System (INIS)

    Murray, R.C.

    1987-01-01

    Probabilistic definitions of earthquake, wind, and tornado hazards for many Department of Energy (DOE) facilities throughout the United States have been developed. In addition, definitions of the flood hazards which might affect these locations are currently being developed. The authors have prepared a document to provide guidance and criteria for DOE facility managers to assure that DOE facilities are adequately constructed to resist the effects of natural phenomena such as earthquake, strong wind, and flood. The intent of this document is to provide instruction on how to utilize the hazard definitions to evaluate existing facilities and design new facilities in a manner such that the risk of adverse consequences is consistent with the cost, function, and danger to the public or environment. A conference and six mini-courses were organized on natural phenomena hazards mitigation. This provided a mechanism for technology transfer to the DOE community. Complementary manuals have also been developed for 1) suspended ceiling systems and recommendations for bracing them, 2) practical equipment seismic upgrade and strengthening guidelines, and 3) suggested structural details for wind design. These manuals are intended to provide input and guidance for ongoing site safety programs

  2. Improving planning, design, reporting and scientific quality of animal experiments by using the Gold Standard Publication Checklist, in addition to the ARRIVE guidelines.

    Science.gov (United States)

    Hooijmans, Carlijn R; de Vries, Rob; Leenaars, Marlies; Curfs, Jo; Ritskes-Hoitinga, Merel

    2011-03-01

    Several studies have demonstrated serious omissions in the way research that use animals is reported. In order to improve the quality of reporting of animal experiments, the Animals in research: reporting in vivo experiments (ARRIVE) Guidelines were published in the British Journal of Pharmacology in August 2010. However, not only the quality of reporting of completed animal studies needs to be improved, but also the design and execution of new experiments. With both these goals in mind, we published the Gold Standard Publication Checklist (GSPC) in May 2010, a few months before the ARRIVE guidelines appeared. In this letter, we compare the GSPC checklist with the ARRIVE Guidelines. The GSPC describes certain items in more detail, which makes it both easier to use when designing and conducting an experiment and particularly suitable for making systematic reviews of animal studies more feasible. In order to improve not only the reporting but also the planning, design, execution and thereby, the scientific quality of animal experiments, we strongly recommend to all scientists involved in animal experimentation and to editors of journals publishing animal studies to take a closer look at the contents of both the ARRIVE guidelines and GSPC, and select the set of guidelines which is most appropriate for their particular situation. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

  3. Threats to validity in the design and conduct of preclinical efficacy studies: a systematic review of guidelines for in vivo animal experiments.

    Directory of Open Access Journals (Sweden)

    Valerie C Henderson

    Full Text Available The vast majority of medical interventions introduced into clinical development prove unsafe or ineffective. One prominent explanation for the dismal success rate is flawed preclinical research. We conducted a systematic review of preclinical research guidelines and organized recommendations according to the type of validity threat (internal, construct, or external or programmatic research activity they primarily address.We searched MEDLINE, Google Scholar, Google, and the EQUATOR Network website for all preclinical guideline documents published up to April 9, 2013 that addressed the design and conduct of in vivo animal experiments aimed at supporting clinical translation. To be eligible, documents had to provide guidance on the design or execution of preclinical animal experiments and represent the aggregated consensus of four or more investigators. Data from included guidelines were independently extracted by two individuals for discrete recommendations on the design and implementation of preclinical efficacy studies. These recommendations were then organized according to the type of validity threat they addressed. A total of 2,029 citations were identified through our search strategy. From these, we identified 26 guidelines that met our eligibility criteria--most of which were directed at neurological or cerebrovascular drug development. Together, these guidelines offered 55 different recommendations. Some of the most common recommendations included performance of a power calculation to determine sample size, randomized treatment allocation, and characterization of disease phenotype in the animal model prior to experimentation.By identifying the most recurrent recommendations among preclinical guidelines, we provide a starting point for developing preclinical guidelines in other disease domains. We also provide a basis for the study and evaluation of preclinical research practice. Please see later in the article for the Editors' Summary.

  4. Threats to validity in the design and conduct of preclinical efficacy studies: a systematic review of guidelines for in vivo animal experiments.

    Science.gov (United States)

    Henderson, Valerie C; Kimmelman, Jonathan; Fergusson, Dean; Grimshaw, Jeremy M; Hackam, Dan G

    2013-01-01

    The vast majority of medical interventions introduced into clinical development prove unsafe or ineffective. One prominent explanation for the dismal success rate is flawed preclinical research. We conducted a systematic review of preclinical research guidelines and organized recommendations according to the type of validity threat (internal, construct, or external) or programmatic research activity they primarily address. We searched MEDLINE, Google Scholar, Google, and the EQUATOR Network website for all preclinical guideline documents published up to April 9, 2013 that addressed the design and conduct of in vivo animal experiments aimed at supporting clinical translation. To be eligible, documents had to provide guidance on the design or execution of preclinical animal experiments and represent the aggregated consensus of four or more investigators. Data from included guidelines were independently extracted by two individuals for discrete recommendations on the design and implementation of preclinical efficacy studies. These recommendations were then organized according to the type of validity threat they addressed. A total of 2,029 citations were identified through our search strategy. From these, we identified 26 guidelines that met our eligibility criteria--most of which were directed at neurological or cerebrovascular drug development. Together, these guidelines offered 55 different recommendations. Some of the most common recommendations included performance of a power calculation to determine sample size, randomized treatment allocation, and characterization of disease phenotype in the animal model prior to experimentation. By identifying the most recurrent recommendations among preclinical guidelines, we provide a starting point for developing preclinical guidelines in other disease domains. We also provide a basis for the study and evaluation of preclinical research practice. Please see later in the article for the Editors' Summary.

  5. Mismatch oligonucleotides in human and yeast: guidelines for probe design on tiling microarrays

    Directory of Open Access Journals (Sweden)

    Jee Justin

    2008-12-01

    Full Text Available Abstract Background Mismatched oligonucleotides are widely used on microarrays to differentiate specific from nonspecific hybridization. While many experiments rely on such oligos, the hybridization behavior of various degrees of mismatch (MM structure has not been extensively studied. Here, we present the results of two large-scale microarray experiments on S. cerevisiae and H. sapiens genomic DNA, to explore MM oligonucleotide behavior with real sample mixtures under tiling-array conditions. Results We examined all possible nucleotide substitutions at the central position of 36-nucleotide probes, and found that nonspecific binding by MM oligos depends upon the individual nucleotide substitutions they incorporate: C→A, C→G and T→A (yielding purine-purine mispairs are most disruptive, whereas A→X were least disruptive. We also quantify a marked GC skew effect: substitutions raising probe GC content exhibit higher intensity (and vice versa. This skew is small in highly-expressed regions (± 0.5% of total intensity range and large (± 2% or more elsewhere. Multiple mismatches per oligo are largely additive in effect: each MM added in a distributed fashion causes an additional 21% intensity drop relative to PM, three-fold more disruptive than adding adjacent mispairs (7% drop per MM. Conclusion We investigate several parameters for oligonucleotide design, including the effects of each central nucleotide substitution on array signal intensity and of multiple MM per oligo. To avoid GC skew, individual substitutions should not alter probe GC content. RNA sample mixture complexity may increase the amount of nonspecific hybridization, magnify GC skew and boost the intensity of MM oligos at all levels.

  6. Driver-Array Based Flat-Panel Loudspeakers: Theoretical Background and Design Guidelines

    Science.gov (United States)

    Anderson, David Allan

    This thesis relates to the simulation and design of flat-panel loudspeakers using moving-coil driver elements. A brief history of the industry is given, including a collection of products and patents from 1925 until the present, an overview of research papers, and a discussion of current products available. The mechanics of bending flat panels are developed with respect to localized driving forces, both in the frequency domain and the time domain as an impulse response. These simulations are compared to measurements on prototype panels. Additional resonant elements influence the behavior of the system: an optional ported rear enclosure and the resonant characteristics of the drivers. The governing equations for these systems are derived and solutions are implemented using equivalent mechanical circuits and numerical methods. The idea of using driver arrays to independently actuate modes of the panel is discussed at length with respect to modal addressability, modal spillover, and experimental validation. The numerical approach to determining the optimal driver placement for a given set of modes is derived and experimentally validated. An investigation of the acoustic behavior of flat panel loudspeakers is presented, using mechanical simulation results to predict the acoustic radiation. The simulations are compared to measurements and found to accurately predict important mechanical and acoustical behaviors. It is demonstrated that a driver array, with the proper biasing, is capable of creating a flat panel loudspeaker which acts more like a piston than a "diffuse radiator" flat panel loudspeaker. The techniques of "Modal Crossover Networks" are introduced, which use multi-band filters to bias the driver array differently for different frequency bands, optimized for audio reproduction. The question of how many drivers are necessary for a modal crossover network is addressed and found to be dependent on the estimated quality factor (Q) of the panel material and edge

  7. Flow-excited acoustic resonance excitation mechanism, design guidelines, and counter measures

    International Nuclear Information System (INIS)

    Ziada, Samir; Lafon, Philippe

    2014-01-01

    The excitation mechanism of acoustic resonances has long been recognized, but the industry continues to be plagued by its undesirable consequences, manifested in severe vibration and noise problems in a wide range of industrial applications. This paper focuses on the nature of the excitation mechanism of acoustic resonances in piping systems containing impinging shear flows, such as flow over shallow and deep cavities. Since this feedback mechanism is caused by the coupling between acoustic resonators and shear flow instabilities, attention is focused first on the nature of various types of acoustic resonance modes and then on the aero-acoustic sound sources, which result from the interaction of the inherently unstable shear flow with the sound field generated by the resonant acoustic modes. Various flow-sound interaction patterns are discussed, in which the resonant sound field can be predominantly parallel or normal to the mean flow direction and the acoustic wavelength can be an order of magnitude longer than the length scale of the separated shear flow or as short as the cavity length scale. Since the state of knowledge in this field has been recently reviewed by Tonon et al. (2011, 'Aero-acoustics of Pipe Systems With Closed Branches', Int. J. Aeroacoust., 10(2), pp. 201-276), this article focuses on the more practical aspects of the phenomenon, including various flow sound interaction patterns and the resulting aero-acoustic sources, which are relevant to industrial applications. A general design guide proposal and practical means to alleviate the excitation mechanism are also presented. These are demonstrated by two examples of recent industrial case histories dealing with acoustic fatigue failure of the steam dryer in a boiling water reactor (BWR) due to acoustic resonance in the main steam piping and acoustic resonances in the roll posts of the Short Take-Off and Vertical Lift Joint Strike Fighter (JSF). (authors)

  8. Complications of three deep sedation methods for magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Solina Tith

    2012-01-01

    Conclusions: DS with a pentobarbital technique was associated with decreased odds for complications when compared to a propofol-based technique or a pentobarbital technique requiring supplemental sedation.

  9. Using continuous sedation until death for cancer patients: A qualitative interview study of physicians’ and nurses’ practice in three European countries

    Science.gov (United States)

    Rietjens, Judith; Bruinsma, Sophie; Deliens, Luc; Sterckx, Sigrid; Mortier, Freddy; Brown, Jayne; Mathers, Nigel; van der Heide, Agnes

    2015-01-01

    Background: Extensive debate surrounds the practice of continuous sedation until death to control refractory symptoms in terminal cancer care. We examined reported practice of United Kingdom, Belgian and Dutch physicians and nurses. Methods: Qualitative case studies using interviews. Setting: Hospitals, the domestic home and hospices or palliative care units. Participants: In all, 57 Physicians and 73 nurses involved in the care of 84 cancer patients. Results: UK respondents reported a continuum of practice from the provision of low doses of sedatives to control terminal restlessness to rarely encountered deep sedation. In contrast, Belgian respondents predominantly described the use of deep sedation, emphasizing the importance of responding to the patient’s request. Dutch respondents emphasized making an official medical decision informed by the patient’s wish and establishing that a refractory symptom was present. Respondents employed rationales that showed different stances towards four key issues: the preservation of consciousness, concerns about the potential hastening of death, whether they perceived continuous sedation until death as an ‘alternative’ to euthanasia and whether they sought to follow guidelines or frameworks for practice. Conclusion: This qualitative analysis suggests that there is systematic variation in end-of-life care sedation practice and its conceptualization in the United Kingdom, Belgium and the Netherlands. PMID:25062816

  10. Biomechanical energy harvesting from human motion: theory, state of the art, design guidelines, and future directions.

    Science.gov (United States)

    Riemer, Raziel; Shapiro, Amir

    2011-04-26

    Biomechanical energy harvesting from human motion presents a promising clean alternative to electrical power supplied by batteries for portable electronic devices and for computerized and motorized prosthetics. We present the theory of energy harvesting from the human body and describe the amount of energy that can be harvested from body heat and from motions of various parts of the body during walking, such as heel strike; ankle, knee, hip, shoulder, and elbow joint motion; and center of mass vertical motion. We evaluated major motions performed during walking and identified the amount of work the body expends and the portion of recoverable energy. During walking, there are phases of the motion at the joints where muscles act as brakes and energy is lost to the surroundings. During those phases of motion, the required braking force or torque can be replaced by an electrical generator, allowing energy to be harvested at the cost of only minimal additional effort. The amount of energy that can be harvested was estimated experimentally and from literature data. Recommendations for future directions are made on the basis of our results in combination with a review of state-of-the-art biomechanical energy harvesting devices and energy conversion methods. For a device that uses center of mass motion, the maximum amount of energy that can be harvested is approximately 1 W per kilogram of device weight. For a person weighing 80 kg and walking at approximately 4 km/h, the power generation from the heel strike is approximately 2 W. For a joint-mounted device based on generative braking, the joints generating the most power are the knees (34 W) and the ankles (20 W). Our theoretical calculations align well with current device performance data. Our results suggest that the most energy can be harvested from the lower limb joints, but to do so efficiently, an innovative and light-weight mechanical design is needed. We also compared the option of carrying batteries to the

  11. Utilizing bi-spectral index (BIS) for the monitoring of sedated adult ICU patients: a systematic review.

    Science.gov (United States)

    Bilgili, Beliz; Montoya, Juan C; Layon, A J; Berger, Andrea L; Kirchner, H L; Gupta, Leena K; Gloss, David S

    2017-03-01

    The ideal level of sedation in the ICU is an ongoing source of scrutiny. At higher levels of sedation, the current scoring systems are not ideal. BIS may be able to improve both. We evaluated literature on effectiveness of BIS monitoring in sedated mechanically ventilated (MV) ICU patients compared to clinical sedation scores (CSS). For this systematic review, full text articles were searched in OVID, MEDLINE, EMBASE, and Cochrane databases from 1986 - 2014. Additional studies were identified searching bibliographies/abstracts from national/international Critical Care Medicine conferences and references from searched articles retrieved. Search terms were: 'Clinical sedation scale, Bi-spectral Index, Mechanical ventilation, Intensive care Unit'. Included were prospective, randomized and non-randomized studies comparing BIS monitoring with any CSS in MV adult (>18 yr old) ICU patients. Studies were graded for quality of evidence based on bias as established by the GRADE guidelines. Additional sources of bias were examined. There were five studies which met inclusion criteria. All five studies were either unclear or high risk for blinding of participants and blinding of outcome assessment. All papers had at least one source of additional high risk, or unclear/unstated. BIS monitoring in the mechanically ventilated ICU patient may decrease sedative drug dose, recall, and time to wake-up. The studies suggesting this are severely limited methodologically. BIS, when compared to subjective CSSs, is not, at this time, clearly indicated. An appropriately powered randomized, controlled study is needed to determine if this monitoring modality is of use on the ICU.

  12. Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review.

    Science.gov (United States)

    Cruickshank, Moira; Henderson, Lorna; MacLennan, Graeme; Fraser, Cynthia; Campbell, Marion; Blackwood, Bronagh; Gordon, Anthony; Brazzelli, Miriam

    2016-03-01

    -analyses were used for data synthesis. Eighteen RCTs (2489 adult patients) were included. One trial at unclear risk of bias compared dexmedetomidine with clonidine and found that target sedation was achieved in a higher number of patients treated with dexmedetomidine with lesser need for additional sedation. The remaining 17 trials compared dexmedetomidine with propofol or benzodiazepines (midazolam or lorazepam). Trials varied considerably with regard to clinical population, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded outcome assessors. Compared with propofol or benzodiazepines (midazolam or lorazepam), dexmedetomidine had no significant effects on mortality [risk ratio (RR) 1.03, 95% confidence interval (CI) 0.85 to 1.24, I (2) = 0%; p = 0.78]. Length of ICU stay (mean difference -1.26 days, 95% CI -1.96 to -0.55 days, I (2) = 31%; p = 0.0004) and time to extubation (mean difference -1.85 days, 95% CI -2.61 to -1.09 days, I (2) = 0%; p comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded assessors. Evidence on the use of clonidine in ICUs is very limited. Dexmedetomidine may be effective in reducing ICU length of stay and time to extubation in critically ill ICU patients. Risk of bradycardia but not of overall mortality is higher among patients treated with dexmedetomidine. Well-designed RCTs are needed to assess the use of clonidine in ICUs and identify subgroups of patients that are more likely to benefit from the use of dexmedetomidine. This study is registered as PROSPERO CRD42014014101. The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

  13. Sedation and mechanical hypoalgesia after sublingual administration of detomidine hydrochloride gel to donkeys.

    Science.gov (United States)

    Lizarraga, Ignacio; Castillo-Alcala, Fernanda; Varner, Kelley M; Robinson, Lauren S

    2016-07-01

    OBJECTIVE To compare sedative and mechanical hypoalgesic effects of sublingual administration of 2 doses of detomidine gel to donkeys. DESIGN Randomized blinded controlled trial. ANIMALS 6 healthy castrated male donkeys. PROCEDURES In a crossover study design, donkeys received each of the following sublingual treatments 1 week apart in a randomly assigned order: 1 mL of molasses (D0) or detomidine hydrochloride gel at 20 μg/kg (9 μg/lb; D20) or 40 μg/kg (18 μg/lb; D40). Sedation score (SS), head height above the ground (HHAG), and mechanical nociceptive threshold (MNT) were assessed before and for 180 minutes after treatment. Areas under the effect change-versus-time curves (AUCs) from 0 to 30, 30 to 60, 60 to 120, and 120 to 180 minutes after administration were computed for SS, HHAG, and MNT and compared among treatments. RESULTS D20 and D40 resulted in greater SS AUCs from 60 to 120 minutes and smaller HHAG AUCs from 30 through 180 minutes than did D0. The D40 resulted in smaller HHAG AUCs from 60 to 120 minutes than did D20. Compared with D0 values, MNT AUCs from 60 to 120 minutes were higher for D20, whereas MNT AUCs from 30 through 180 minutes were higher for D40. CONCLUSIONS AND CLINICAL RELEVANCE D20 and D40 induced sedation and mechanical hypoalgesia in donkeys by > 30 minutes after administration, but only sedation was dose dependent. Sublingual administration of detomidine gel at 40 μg/kg may be useful for sedation of standing donkeys prior to potentially painful minor procedures.

  14. A Review of Agents for Palliative Sedation/Continuous Deep Sedation: Pharmacology and Practical Applications.

    Science.gov (United States)

    Bodnar, John

    2017-03-01

    Continuous deep sedation at the end of life is a specific form of palliative sedation requiring a care plan that essentially places and maintains the patient in an unresponsive state because their symptoms are refractory to any other interventions. Because this application is uncommon, many providers may lack practical experience in this specialized area and resources they can access are outdated, nonspecific, and/or not comprehensive. The purpose of this review is to provide an evidence- and experience-based reference that specifically addresses those medications and regimens and their practical applications for this very narrow, but vital, aspect of hospice care. Patient goals in a hospital and hospice environments are different, so the manner in which widely used sedatives are dosed and applied can differ greatly as well. Parameters applied in end-of-life care that are based on experience and a thorough understanding of the pharmacology of those medications will differ from those applied in an intensive care unit or other medical environments. By recognizing these different goals and applying well-founded regimens geared specifically for end-of-life sedation, we can address our patients' symptoms in a more timely and efficacious manner.

  15. Sedative medications outside the operating room and the pharmacology of sedatives

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2015-01-01

    PURPOSE OF REVIEW: There is a growing medical demand for suitable sedatives and analgesics to support the ongoing progress in diagnostic procedures and imaging techniques. This review provides an update of the pharmacology of the most commonly used drugs used for these procedures and shortly...

  16. Recall of intensive care unit stay in patients managed with a sedation protocol or a sedation protocol with daily sedative interruption: a pilot study.

    Science.gov (United States)

    Ethier, Cheryl; Burry, Lisa; Martinez-Motta, Carlos; Tirgari, Sam; Jiang, Depeng; McDonald, Ellen; Granton, John; Cook, Deborah; Mehta, Sangeeta

    2011-04-01

    Analgesics and sedatives are integral for the relief of pain and anxiety in critically ill patients. However, these agents may contribute to amnesia for intensive care unit (ICU) events; which has been associated with development of posttraumatic stress disorder. Drug administration strategies that minimize sedative use have been associated with less amnesia. The objective of this pilot study was to evaluate recall of ICU stay in patients managed with 2 sedation strategies: a sedation protocol or a combination of sedation protocol and daily sedative/analgesic interruption. A questionnaire was administered on day 3 following ICU discharge to evaluate patients' recollections of pain, anxiety, fear, and sleep, as well as memories for specific ICU procedures. Participants were ICU survivors who had been enrolled in SLEAP - a randomized pilot trial comparing two sedation strategies, at 3 university-affiliated medical/surgical ICUs. Twenty-one patients who regained orientation within 72 hours of ICU discharge completed the questionnaire. More than 50% of patients recalled experiencing pain, anxiety, and fear to a moderate or extreme extent; and 57% reported inadequate sleep while in the ICU. Of the 21 patients, 48%, 33%, and 29% had no memories of endotracheal tube suctioning, being on a "breathing machine," and being bathed, respectively. A notable percentage of patients discharged from the ICU report moderate to extreme pain, anxiety, and fear, and inability to sleep during their ICU stay; and 29% to 48% have no recall of specific ICU events. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists.

    Directory of Open Access Journals (Sweden)

    Alawi Luetz

    Full Text Available Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1 and 868 patients (part 2 were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%. In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524 and approved by the ethical committee.

  18. A randomized controlled trial of daily sedation interruption in critically ill children

    NARCIS (Netherlands)

    Vet, N.J.; Wildt, S.N. de; Verlaat, C.W.; Knibbe, C.A.; Mooij, M.G.; Woensel, J.B. van; Rosmalen, J. van; Tibboel, D.; Hoog, M. de

    2016-01-01

    PURPOSE: To compare daily sedation interruption plus protocolized sedation (DSI + PS) to protocolized sedation only (PS) in critically ill children. METHODS: In this multicenter randomized controlled trial in three pediatric intensive care units in the Netherlands, mechanically ventilated critically

  19. A randomized controlled trial of daily sedation interruption in critically ill children

    NARCIS (Netherlands)

    Vet, Nienke J.; de Wildt, Saskia N.; Verlaat, Carin W. M.; Knibbe, Catherijne A. J.; Mooij, Miriam G.; van Woensel, Job B. M.; van Rosmalen, Joost; Tibboel, Dick; de Hoog, Matthijs

    2016-01-01

    To compare daily sedation interruption plus protocolized sedation (DSI + PS) to protocolized sedation only (PS) in critically ill children. In this multicenter randomized controlled trial in three pediatric intensive care units in the Netherlands, mechanically ventilated critically ill children with

  20. Moderate sedation for MRI in young children with autism

    Energy Technology Data Exchange (ETDEWEB)

    Ross, Allison Kinder [Duke University Medical Center, Division of Pediatric Anesthesia, Durham (United States); Hazlett, Heather Cody; Garrett, Nancy T [University of North Carolina School of Medicine, Department of Psychiatry, Chapel Hill, NC (United States); Wilkerson, Christy [Duke University Medical Center, Department of Radiology, Durham, NC (United States); Piven, Joseph [University of North Carolina School of Medicine, Departments of Psychiatry and Pediatrics, Chapel Hill, NC (United States)

    2005-09-01

    Autism is a pervasive neurodevelopmental disorder. Because of the deficits associated with the condition, sedation of children with autism has been considered more challenging than sedation of other children. To test this hypothesis, we compared children with autism against clinical controls to determine differences in requirements for moderate sedation for MRI. Children ages 18-36 months with autism (group 1, n = 41) and children with no autistic behavior (group 2, n = 42) were sedated with a combination of pentobarbital and fentanyl per sedation service protocol. The sedation nurse was consistent for all patients, and all were sedated to achieve a Modified Ramsay Score of 4. Demographics and doses of sedatives were recorded and compared. There were no sedation failures in either group. Children in group 1 (autism) were significantly older than group 2 (32.02{+-}3.6 months vs 28.16{+-}6.7 months) and weighed significantly more (14.87{+-}2.1 kg vs 13.42{+-}2.2 kg). When compared on a per-kilogram basis, however, group 1 had a significantly lower fentanyl requirement than group 2 (1.25{+-}0.55 mcg/kg vs 1.57{+-}0.81 mcg/kg), but no significant difference was found in pentobarbital dosing between groups 1 and 2, respectively (4.92{+-}0.92 mg/kg vs 5.21{+-}1.6 mg/kg). Autistic children in this age range are not more difficult to sedate and do not require higher doses of sedative agents for noninvasive imaging studies. (orig.)

  1. Moderate sedation for MRI in young children with autism

    International Nuclear Information System (INIS)

    Ross, Allison Kinder; Hazlett, Heather Cody; Garrett, Nancy T.; Wilkerson, Christy; Piven, Joseph

    2005-01-01

    Autism is a pervasive neurodevelopmental disorder. Because of the deficits associated with the condition, sedation of children with autism has been considered more challenging than sedation of other children. To test this hypothesis, we compared children with autism against clinical controls to determine differences in requirements for moderate sedation for MRI. Children ages 18-36 months with autism (group 1, n = 41) and children with no autistic behavior (group 2, n = 42) were sedated with a combination of pentobarbital and fentanyl per sedation service protocol. The sedation nurse was consistent for all patients, and all were sedated to achieve a Modified Ramsay Score of 4. Demographics and doses of sedatives were recorded and compared. There were no sedation failures in either group. Children in group 1 (autism) were significantly older than group 2 (32.02±3.6 months vs 28.16±6.7 months) and weighed significantly more (14.87±2.1 kg vs 13.42±2.2 kg). When compared on a per-kilogram basis, however, group 1 had a significantly lower fentanyl requirement than group 2 (1.25±0.55 mcg/kg vs 1.57±0.81 mcg/kg), but no significant difference was found in pentobarbital dosing between groups 1 and 2, respectively (4.92±0.92 mg/kg vs 5.21±1.6 mg/kg). Autistic children in this age range are not more difficult to sedate and do not require higher doses of sedative agents for noninvasive imaging studies. (orig.)

  2. Results of the investigation on validity of Japanese seismic design guidelines of nuclear facilities, based on the 1995 Hyogoken-Nanbu Earthquake

    International Nuclear Information System (INIS)

    Watabe, Makoto

    1997-01-01

    This paper describes the reviewed results and main discussions on some items thought to be problems in the 'Examination Guide for Aseismatic Design of the Nuclear Power Reactor Facilities' of Japan, based on knowledge from the 1995 Hyogoken-Nanbu Earthquake, and the conclusion that validity of the Guideline was confirmed. (J.P.N.)

  3. Critical features of peer assessment of clinical performance to enhance adherence to a low back pain guideline for physical therapists: a mixed methods design

    NARCIS (Netherlands)

    Maas, M.J.M.; Dulmen, S.A. van; Sagasser, M.H.; Heerkens, Y.F.; Vleuten, C.P.M. van der; Nijhuis, M.W.; Wees, P.J. van der

    2015-01-01

    BACKGROUND: Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously

  4. Results of the investigation on validity of Japanese seismic design guidelines of nuclear facilities, based on the 1995 Hyogoken-Nanbu Earthquake

    Energy Technology Data Exchange (ETDEWEB)

    Watabe, Makoto [Keio Univ., Fujisawa, Kanagawa (Japan). Fac. of Environment and Information Engineering

    1997-03-01

    This paper describes the reviewed results and main discussions on some items thought to be problems in the `Examination Guide for Aseismatic Design of the Nuclear Power Reactor Facilities` of Japan, based on knowledge from the 1995 Hyogoken-Nanbu Earthquake, and the conclusion that validity of the Guideline was confirmed. (J.P.N.)

  5. Evaluation of adult outpatient magnetic resonance imaging sedation practices: are patients being sedated optimally?

    International Nuclear Information System (INIS)

    Middelkamp, J.E.; Forster, B.B; Keogh, C.; Lennox, P.; Mayson, K.

    2009-01-01

    To evaluate the use of anxiolytics in adult outpatient magnetic resonance imaging (MRI) centres and to determine whether utilisation is optimal based on the pharmacology of the drugs used, who prescribes these drugs, and how patients are managed after administration. Identical paper and Web-based surveys were used to anonymously collect data about radiologists' use of anxiolytic agents for adult outpatient MRI examinations. The survey questions were about the type of facility, percentage of studies that require sedation, the drug used and route of administration, who orders the drug, timing of administration, patient monitoring during and observation after the study, use of a dedicated nurse for monitoring, and use of standard sedation and discharge protocols. The χ2 analysis for statistical association among variables was used. Eighty-five of 263 surveys were returned (32% response rate). The radiologist ordered the medication (53%) in slightly more facilities than the referring physician (44%) or the nurse. Forty percent of patients received medication 15-30 minutes before MRI, which is too early for peak effect of oral or sublingual drugs. Lorazepam was most commonly used (64% first choice). Facilities with standard sedation protocols (56%) were more likely to use midazolam than those without standard sedation protocols (17% vs 10%), to have a nurse for monitoring (P = .032), to have standard discharge criteria (P = .001), and to provide written information regarding adverse effects (P = .002). Many outpatients in MRI centres may be scanned before the peak effect of anxiolytics prescribed. A standard sedation protocol in such centres is associated with a more appropriate drug choice, as well as optimized monitoring and postprocedure care. (author)

  6. [Palliative sedation: Current situation and areas of improvement].

    Science.gov (United States)

    Nabal, Maria; Palomar, Concepción; Juvero, M Teresa; Taberner, M Teresa; León, Miguel; Salud, Antonieta

    2014-01-01

    To determine the prevalence, epidemiology and registration status of palliative sedation (PS) prevalence in a teaching hospital, and to establish areas for improvement. A descriptive retrospective analysis was designed using the records from cancer patients who died between October and December 2010. The variables included were: epidemiological, inpatient unit, refractory symptom, drugs and dosages, and patient participation in the decision making process. The qualitative analysis followed a Delphi process: each participant received the overall performance of the group referred to as mean, median, 25th and 75th percentile. Items selected were those in which there was total or a high consensus. A total of 53 deaths were identified. Just over half (51.92%) received PS. The mean age was 67.46 and 64% were males. The most frequent diagnosis was lung cancer (32.14%). Fifteen of the patient patients were in the Oncology ward, 7 in Hematology, and 4 at the Emergency Department. The PC team took part in 14 of the sedations performed. A refractory symptom was identified in 20. There were 11 cases of dyspnea and 5 cases of delirium. The mean time between admission and PS was 9.5 days. The mean duration of PS was 1.2 days, with a mean number of 2.6 drugs used. There were 20 informed consents which were all verbal. The mean time from last chemotherapy to death was 82 days. For the Delphi process, 12 oncology or palliative care health professionals were included. A consensus was reached on the minimum data to be recorded in case of PS. This list includes: selection criteria, decision-making process and the sedation evolution. PS was applied in half of the patients who died due to dyspnea or delirium. Selection criteria were identified, as well as the type of PS and patient involvement in decision making process. A consensus was also reached on a minimum dataset that would help the clinician to record relevant information in PS. Copyright © 2013 SECA. Published by Elsevier

  7. Preliminary format design guidelines

    DEFF Research Database (Denmark)

    Tosello, Guido; Calaon, Matteo; Nørregaard, J.

    2013-01-01

    The strategic research centre PolyNano aims at becoming the Danish competence centre for production-ready fabrication of polymer, nano-scale lab-on-a-chip (LoC) devices. In order to provide a competitive edge for Danish biotech companies launching LoC products by removal of the technology barrier...

  8. Nitrosative Stress in the Nervous System: Guidelines for Designing Experimental Strategies to Study Protein S-Nitrosylation.

    Science.gov (United States)

    Nakamura, Tomohiro; Lipton, Stuart A

    2016-03-01

    Reactive nitrogen species, such as nitric oxide (NO), exert their biological activity in large part through post-translational modification of cysteine residues, forming S-nitrosothiols. This chemical reaction proceeds via a process that we and our colleagues have termed protein S-nitrosylation. Under conditions of normal NO production, S-nitrosylation regulates the activity of many normal proteins. However, in degenerative conditions characterized by nitrosative stress, increased levels of NO lead to aberrant S-nitrosylation that contributes to the pathology of the disease. Thus, S-nitrosylation has been implicated in a wide range of cellular mechanisms, including mitochondrial function, proteostasis, transcriptional regulation, synaptic activity, and cell survival. In recent years, the research area of protein S-nitrosylation has become prominent due to improvements in the detection systems as well as the demonstration that protein S-nitrosylation plays a critical role in the pathogenesis of neurodegenerative and other neurological disorders. To further promote our understanding of how protein S-nitrosylation affects cellular systems, guidelines for the design and conduct of research on S-nitrosylated (or SNO-)proteins would be highly desirable, especially for those newly entering the field. In this review article, we provide a strategic overview of designing experimental approaches to study protein S-nitrosylation. We specifically focus on methods that can provide critical data to demonstrate that an S-nitrosylated protein plays a (patho-)physiologically-relevant role in a biological process. Hence, the implementation of the approaches described herein will contribute to further advancement of the study of S-nitrosylated proteins, not only in neuroscience but also in other research fields.

  9. [Psychomotor agitation, pharmaceutical sedation and psychiatric emergency in psychotic patients].

    Science.gov (United States)

    Passamar, M; Tellier, O; Vilamot, B

    2011-12-01

    Psychomotor agitation, very common among psychiatric emergencies, raises the question of pharmaceutical sedation, its indications, and its issues, notably with regard to the observance in postemergency. A new approach to sedation places it within its therapeutic aim and also takes into account the sometimes harmful impact on the course of the patient's care. A pretherapeutical, analysis both clinical and environmental is crucial. The time spent on the initial meeting and assessment is essential. The evolution of professional practices in mental health allows us to distinguish three kinds of sedation (vigilance, behaviour and psychical) that guide the choice and the mode of psychotropic drug use. The harmful effects of an ever-increasing use of sedation is debated. The use of atypical antipsychotics and injectable forms is argued. Early psychical sedation is preferable to the obsolete practice of vigilance sedation and to behavioural sedation with its limited indications. The use of excessive or prolonged sedation might have a detrimental effect on the care offered after psychiatric emergency treatment. Copyright © 2011. Published by Elsevier Masson SAS.

  10. Continuous Palliative Sedation for Cancer and Noncancer Patients

    NARCIS (Netherlands)

    Swart, S.J.; Rietjens, J.A.C.; van Zuylen, L.; Zuurmond, W.W.A.; Perez, R.S.G.M.; van der Maas, P.J.; van Delden, J.J.M.; van der Heide, A.

    2012-01-01

    Context: Palliative care is often focused on cancer patients. Palliative sedation at the end of life is an intervention to address severe suffering in the last stage of life. Objectives: To study the practice of continuous palliative sedation for both cancer and noncancer patients. Methods: In 2008,

  11. Atelectasis on pediatric chest CT: comparison of sedation techniques

    International Nuclear Information System (INIS)

    Sargent, M.A.; McEachern, A.M.; Jamieson, D.H.

    1999-01-01

    Background. A change in practice at our institution resulted in increased use of anesthesia for CT scan of the chest in children who required sedation. Objective. To determine whether there is a difference in the frequency or severity of pulmonary atelectasis on CT scan in children sedated by anesthesiologists compared with children sedated by radiologists using intravenous pentobarbital. Materials and methods. Retrospective blinded review of 60 CT scans of the chest performed in 41 children. Forty-one studies in children sedated by radiologists (median age 29 months) were compared with 19 studies in children sedated by anesthesiologists (median age 25 months). Results. Atelectasis sufficient to obscure pulmonary metastases was shown in 5 of 41 (12 %) radiology sedations and 13 of 19 (68 %) anesthesiology sedations (P < 0.01). Higher grades of atelectasis were recorded in children under anesthesia (P < 0.01). Conclusion. Atelectasis is more frequent and more severe in children undergoing general anesthesia compared with intravenous pentobarbital sedation. Consideration should be given to the use of forced inspiration in children anesthetized for CT scan of the chest. (orig.)

  12. Sedative properties of Mitracarpus villosus leaves in mice

    African Journals Online (AJOL)

    admin

    anxiolytics increase the head-dip counts. The reduction in the number of head dips shown by the extract is therefore an indication of the presence of psychoactive constituents that are sedative in nature. The sedative property of the plant was confirmed by its ability to potentiate the duration of diazepam induced sleep.

  13. Recording EEG In Young Children Without Sedation | Curuneaux ...

    African Journals Online (AJOL)

    Background Although it has been considered that sedation in children undergoing EEG tests is effective and safe and complications are infrequent, occasionally adverse sedation-related events are presented. Objective The aim of this work was to determine if it is possible to carry out EEG in children up to 4 years old ...

  14. Propofol dose and incidence of dreaming during sedation.

    Science.gov (United States)

    Eer, Audrey Singyi; Padmanabhan, Usha; Leslie, Kate

    2009-10-01

    Dreaming is commonly reported after propofol-based sedation. We measured the incidence of dreaming and bispectral index (BIS) values in colonoscopy patients sedated with combinations of propofol, midazolam and fentanyl. Two hundred patients presenting for elective outpatient colonoscopy were sedated with combinations of propofol, midazolam and fentanyl. BIS was monitored throughout the procedure. Patients were interviewed immediately after they emerged from sedation. The primary end point was a report of dreaming during sedation. Ninety-seven patients were administered propofol alone, 44 were administered propofol and fentanyl, 16 were administered propofol and midazolam and 43 were administered propofol, midazolam and fentanyl. Dreaming was reported by 19% of patients. Dreamers received higher doses of propofol and had lower BIS values during sedation. Age of 50 years or less, preoperative quality of recovery score of less than 14, higher home dream recall, propofol dose of more than 300 mg and time to Observers' Assessment of Alertness/Sedation score equalling 5 of 8 min or less were independent predictors of dreaming. Dreaming during sedation is associated with higher propofol dose and lower BIS values.

  15. Use of sedation to relieve refractory symptoms in dying patients ...

    African Journals Online (AJOL)

    Indications. Agitated delirium was the most common reason (45%) for using sedation, followed by intractable vomiting due to inoperable malignant intestinal obstruction in 25% of patients. Three patients with persistent convulsions or myoclonic jerking and 2 patients with severe refractory dyspnoea required some sedation.

  16. Experience with Conscious sedation for Oocyte Retrieval in Nigeria

    African Journals Online (AJOL)

    elearning

    The aim of this study was to assess clients' pain experience, acceptance of conscious sedation and correlates of pain during oocyte retrieval ... Conscious sedation and analgesia are one of several methods used to relieve pain during oocyte retrieval in. IVF procedures. .... relieves anxiety and reduces the patient's memory.

  17. IMAGE Programming Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Stehfest, E; De Waal, L.

    2010-09-15

    This document describes the requirements and guidelines for the software of the IMAGE system. The motivation for this report was a substantial restructuring of the source code for IMAGE version 2.5. The requirements and guidelines relate to design considerations as well as to aspects of maintainability and portability. The design considerations determine guidelines about subjects, such as program structure, model hierarchy, the use of data modules, and the error message system. Maintainability and portability aspects determine the guidelines on, for example, the Fortran 90 standard, naming conventions, code lay-out, and internal documentation.

  18. Laryngospasm With Apparent Aspiration During Sedation With Nitrous Oxide.

    Science.gov (United States)

    Babl, Franz E; Grindlay, Joanne; Barrett, Michael Joseph

    2015-11-01

    Nitrous oxide and oxygen mixture has become increasingly popular for the procedural sedation and analgesia of children in the emergency department. In general, nitrous oxide is regarded as a very safe agent according to large case series. We report a case of single-agent nitrous oxide sedation of a child, complicated by laryngospasm and radiographically confirmed bilateral upper lobe pulmonary opacities. Although rarely reported with parenteral sedative agents, laryngospasm and apparent aspiration has not been previously reported in isolated nitrous oxide sedation. This case highlights that, similar to other sedative agents, nitrous oxide administration also needs to be conducted by staff and in settings in which airway emergencies can be appropriately managed. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  19. SEDATIVE AND ANALGESIC EFFECTS OF DETOMIDINE HYDROCHLORIDE IN GOATS

    Directory of Open Access Journals (Sweden)

    A. N. Tunio., A. B. Kalhoro and I.H. Kathio1

    2003-07-01

    Full Text Available The sedative and analgesic effects of three dose rates of detomidine (40, 50 and 60µg/kg body weight were studied in six goats. Moderate to deep sedation occurred after administration of 40µg/kg of detomidine as compared to deep sedation produced by 50 and 60µg/kg of detomidine. The degree, onset and duration of sedation and onset and duration of maximum sedation were all dose dependent. Skin analgesia and recumbency were produced in all animals with higher doses (50 and 60µg/kg and in three animals with lower dose (40µg/kg. Duration of recumbency was 22.66 ± 1.45, 35.16 ± 1.68 and 55.66 ± 1.64 minutes after administration of 40, 50 and 60µg/kg of detomidine, respectively.

  20. The rate of adverse events during IV conscious sedation.

    Science.gov (United States)

    Schwamburger, Nathan T; Hancock, Raymond H; Chong, Chol H; Hartup, Grant R; Vandewalle, Kraig S

    2012-01-01

    Conscious sedation has become an integral part of dentistry; it is often used to reduce anxiety or fear in some patients during oral surgery, periodontal surgery, implant placement, and general dentistry procedures. The purpose of this study was to evaluate the frequency of adverse events during IV conscious sedation provided by credentialed general dentists and periodontists in the United States Air Force (USAF). Sedation clinical records (Air Force Form 1417) from calendar year 2009 were requested from all USAF bases. A total of 1,468 records were reviewed and 19 adverse events were noted in 17 patients. IV complication (infiltration) was the most common adverse event. The overall adverse event rate was 1.3 per 100 patients treated. The results of this study show that moderate sedation provided by general dentists and periodontists in the USAF has a low incidence of adverse events, and conscious sedation remains a viable option for providers for the reduction of anxiety in select patients.