A computerized maintenance management system's requirements for standard operating procedures

From this review of the 6 aspects of opportunity for inconsistency to corrupt or skew the reliability of data, it becomes apparent why members of management must provide the standards of operation and use within the CMMS for their employees. The possibility of poor data integrity due to any one of these aspects may not be severe; however, the severity is compounded and inevitable when different aspects are combined. Responding to information collected through the CMMS can be effective only if the data are reliable. With SOPs, management has provided their personnel with the necessary tools to ensure department-wide consistency. Management cannot afford to allow any one [table: see text] individual to apply personal interpretations of the importance and requirements in their approach to using the CMMS. If this is permitted, the loss of integrity due to one individual's judgment grows rapidly when data are analyzed at the departmental level. Standard operating procedures go beyond creating a "how to" for the CMMS; they provide the critical elements for collecting responsible and reliable data.     

生态系统管理学的概念框架及其生态学基础

系统地要领了生态系统管理学产生的历史背景和发展进程,讨论了生态系统管理的一些基本概念,生态学基础,管理目标及管理体制与实施方式,详细地论述了生态系统的生态学完整性与边界和时空尺度,生态系统的结构,功能与生态系统整体性,生态系统演替与系统动力学特性,生态系统的干扰与系统稳定性,生态系统的复杂性与不确定性,生态系统多样性与可持续生态系统,生态模型与数据收集和监测,人类活动对环境影响的双重性等生态学基础问题,阐述了在维持生态系统产品和服务功能的可持续性总体目标下,各类生态系统管理的具体目标。     

Qualitative and quantitative procedures for health risk assessment.

Numerous reactive mutagenic electrophiles are present in the environment or are formed in the human body through metabolizing processes. Those electrophiles can directly react with DNA and are considered to be ultimate carcinogens. In the past decades more than 200 in vitro and in vivo genotoxic tests have been described to identify, monitor and characterize the exposure of humans to such agents. When the responses of such genotoxic tests are quantified by a weight-of-evidence analysis, it is found that the intrinsic potency of electrophiles being mutagens does not differ much for the majority of the agents studied. Considering the fact that under normal environmental circumstances human are exposed to low concentration of about a million electrophiles, the relation between exposure to such agents and adverse health effects (e.g., cancer) will become a 'Pandora's box'. For quantitative risk assessment it will be necessary not only to detect whether the agent is genotoxic, but also understand the mechanism of interaction of the agent with the DNA in target cells needs to be taken into account. Examples are given for a limited group of important environmental and carcinogenic agents for which such an approach is feasible. The groups identified are agents that form cross-links with DNA or are mono-alkylating agents that react with base-moieties in the DNA strands. Quantitative hazard ranking of the mutagenic potency of these groups of chemical can be performed and there is ample evidence that such a ranking corresponds with the individual carcinogenic potency of those agents in rodents. Still, in practice, with the exception of certain occupational or accidental exposure situations, these approaches have not be successful in preventing cancer death in the human population. However, this is not only due to the described 'Pandora's box' situation. At least three other factors are described. Firstly, in the industrial world the medical treatment of cancer in patients occurs with high levels of extremely mutagenic agents. Actually, both in number of persons and in exposure levels such medical treatment is the single largest exposure of humans to known carcinogens. Although such treatments are very effective in curing the tumor as present in the patient, the recurrence of cancer in those patients later in life is very high. In other words: "curing cancer is not the same as preventing cancer death in the human population". Secondly, the rate of cancer death in the human population is also determined by the efficacy in which other major causes of death are prevented. For instance, cardiovascular diseases are the major cause of death in humans in the industrialized world. There is evidence that the treatment of cardiovascular diseases is more successful than that of cancer. On a population level this will result in increase of cancer being the ultimate death cause. Finally, the improvement of medical treatment of diseases together with an improved quality of life will lead to increase average age of the population. Because the onset of most cancer is long after the exposure to carcinogens-in human often more than 30 years-cancer is predominantly a disease of the old age. This means that if the average age of human increases, there will be a selective preference of cancer becoming an even more important cause of death. This especially will be pronounced in those countries were the age distribution in a population is abnormal.     

A guideline for uniform and optimal atherosclerotic risk factor assessment across clinical specialities in a large hospital

Solid evidence is available concerning the beneficial effect of atherosclerotic risk factor management both in primary and secondary prevention. However, recent registries have indicated considerable potential for improvement of clinical practice concerning secondary prevention of atherosclerosis. The guideline ''Secondary Prevention of Atherosclerosis'' is aimed at the improvement and standardisation of atherosclerotic risk factor assessment in cardiovascular patients hospitalised at the Academic Medical Centre in Amsterdam. The guideline was developed by a task force, consisting of physicians from the Departments of Cardiology, Cardiothoracic Surgery, Internal Medicine, Interventional Radiology, Neurology, Pharmacology and Vascular Surgery. The guideline offers a standardised method for the identification of atherosclerotic risk factors and provides thresholds for treatment, treatment goals and the treatment of choice. A form listing all relevant data is completed before discharge and is mailed with the discharge letter to the referring physician and to the general practitioner.     

Japanese guideline for the management of hyperuricemia and gout: second edition

Gout is a urate deposition disease caused by persistent hyperuricemia. Because gout patients present with a variety of clinical symptoms, it is necessary to have a guideline for the standard management and care of gout and hyperuricemia. The Japanese Society of Gout and Nucleic Acid Metabolism, a scientific society committed to study nucleic acid metabolism and related diseases, established the first edition of the "Guideline for the Management of Hyperuricemia and Gout" in 2002, and published the revised version in January 2010. This second edition is not only evidence based on a search of systemic literature, but also includes consensus levels by a Delphi exercise to determine the strength of the recommendations. A draft version of this guideline was reviewed by internal and external reviewers as well as a patient. In this guideline, key messages from each chapter are listed as statements together with the evidence level, consensus level, and strength of the recommendation. In this proceeding, several selected chapters on the clinical management of gout and hyperuricemia are described. We hope this guideline is appropriately used for the standard management and care of patients with hyperuricemia and gout in daily practice.     

水环境毒物污染点源的生态风险管理现状与展望

评述了发达国家和我国在这一领域的进展和前景。目前国内外常用的基于水质标准／废水排放标准的特征化学污染物法,并不能有效控制组分复杂的废水中的有机毒物排放。因此,仅应用这一传统方法对水环境有机毒物污染点源难以实现有效的生态风险管理。同时采用全废水的生态毒性法可就弥补这一缺陷,根据生态风险管理要求可有效控制组份复杂的废水中有毒有机污染物的排放。鉴别出导致废水生态毒性的关键有机毒物的毒性鉴别评价,是毒物污染点源的生态风险管理核心。本文还对毒性鉴别评价方法学的发展以及全废水毒性法应用于我国水环境毒物污染点源生态风险管理的前景作了评述。     

NHS Diabetes guideline for the perioperative management of the adult patient with diabetes

These Joint British Diabetes Societies guidelines, commissioned by NHS Diabetes, for the perioperative management of the adult patient undergoing surgery are available in full in the Supporting Information. This document goes through the seven stages of the patient journey when having surgery. These are: primary care referral; surgical outpatients; preoperative assessment; hospital admission; surgery; post-operative care; discharge. Each stage is given its own considerations, outlining the roles and responsibilities of each group of healthcare professionals. The evidence base for the recommendations made at each stage, discussion of controversial areas and references are provided in the report. This document has two key recommendations. Firstly, that the management of the elective adult surgery patients should be with modification to their usual diabetes treatment if the fasting is minimized because the routine use of a variable rate intravenous insulin infusion is not recommended. Secondly, that poor preoperative glycaemic control leads to post-outcomes and thus, where appropriate, needs to be addressed prior to referral for surgery.     

A blueprint for the problem formulation phase of EPA-type ecological risk assessments for 316(b) determinations

The difference between management objectives focused on sustainability of fish populations and the indigenous aquatic community, and a management objective focused on minimizing entrainment and impingement losses accounts for much of the ongoing controversy surrounding paragraph 316(b). We describe the EPA's ecological risk assessment framework and recommend that this framework be used to more effectively address differences in management objectives and structure paragraph 316(b) determinations. We provide a blueprint for the problem formulation phase of EPA-type ecological risk assessments for cooling-water intake structures (CWIS) at existing power plant facilities. Our management objectives, assessment endpoints, conceptual model, and generic analysis plan apply to all existing facilities. However, adapting the problem formulation process for a specific facility requires consideration of the permitting agency's guidelines and level of regulatory concern, as well as site-specific ecological and technical differences. The facility-specific problem formulation phase is designed around the hierarchy of biological levels of organization in the generic conceptual model and the sequence of cause-effect events and risk hypotheses represented by this model. Problem formulation is designed to be flexible in that it can be tailored for facilities where paragraph 316(b) regulatory concern is low or high. For some facilities, we anticipate that the assessment can be completed based on consideration of susceptibility alone. At the other extreme, a high level of regulatory concern combined with the availability of extensive information and consideration of costly CWIS mitigation options may result in the ecological risk assessment relying on analyses at all levels. Decisions on whether to extend the ecological risk assessment to additional levels should be based on whether regulatory or generator concerns merit additional analyses and whether available information is adequate to support such analyses. In making these decisions, the functional dependence between levels of analysis must be considered in making the transition to the analysis phase and risk estimation component of the ecological risk assessment. Regardless of how the generic analysis plan is modified to develop a facility-specific analysis plan, the resulting plan should be viewed as a tool for comparing representative species and alternative CWIS options by focusing on relative changes (i.e., proportional or percent changes) in various measures. The analysis plan is specifically designed to encourage consideration of multiple lines of evidence and to characterize uncertainties in each line of evidence. Multiple lines of evidence from different levels of analysis, obtained using both prospective and retrospective techniques, provide a broader perspective on the magnitude of potential effects and associated uncertainties and risks. The implications of the EPA's recent (April 2002) proposed regulations for existing facilities on the applicability of this blueprint are briefly considered.     

An ecological approach to birdstrike risk analysis

Airports are peculiar developed habitats that, besides being extremely noisy and unappealing to some bird species, are highly attractive to others. Bird–aircraft collisions, or birdstrikes, cause losses in terms of human lives, direct monetary losses and associated costs for the civil aviation industry. In recent years, birdstrike risk assessment studies have focused on the economical aspects of the damage caused by wild animals and the hazards of wildlife–aircraft collisions, while an ecological approach, taking into account animal behaviour for the analysis of such events, has seldom been adopted. We conducted a risk analysis for birdstrikes at the Venice Marco Polo International Airport (VCE), Italy. We defined the key variables involved in these events and summarised their interactions in a single metric risk index we called the “Birdstrike Risk Index” (BRI). Our aim was to provide a tool for birdstrike risk analysis that described the risk on the basis of the actual presence of birds at airports. The application of the BRI at VCE allows relative risks across species to be defined, providing information for prioritising management actions. Furthermore, due to the seasonality of bird species presences, the application of the BRI to a long-term data series should give clues of birdstrike risk in future scenarios. This new ecological approach that we applied to a particular airport could easily be adapted for use at other airports worldwide and integrated into risk assessment procedures. The study results and the BRI tool are addressed to scientific consultants of airport safety managers.