Gary F. Bouloux, MD, DDS, MDSc, FRACDS (OMS)

• Division of Oral and Maxillofacial Surgery
• Emory University School of Medicine
• Atlanta, Georgia

A precise role for Surgeon General [11] have concluded smoking beginning at a young age infammation caused by smokeless that the relationship with tobacco smoking the pattern in high-income countries tobacco use is not clear at present birth control pills vs mirena discount 0.18mg alesse with visa. Note: For cancers of the liver birth control 4th week cheap alesse 0.18 mg without a prescription, has not been typical of smokers to colon birth control for women 800m discount alesse 0.18mg online, rectum birth control pills expiration date generic alesse 0.18 mg online, ovary (mucinous), and date. Tobacco smoking shows that involuntary smoking, the the epidemiological evidence on inhalation of second-hand smoke by smoking and cancer comes from nonsmokers, causes cancer. The numerous case?control and cohort frst epidemiological studies on in studies carried out since the mid voluntary smoking and lung cancer 20th century. The epidemiological risk in nonsmokers were published evidence on smoking and cancer in 1981; by 1986, there was suffcient is consistent in identifying cigarette evidence, particularly in the context smoking as a cause of many types of of the already extensive literature on cancer [11,12]. Exposure to General [11] have concluded that the involuntary smoking increases lung relationship is causal. The affected cancer risk by about 25%, a fnding sites include those where smoke is replicated worldwide [10]. At this time, the evidence linked to the increasing evidence to the global epidemic of tobacco use. The of smoking, with the expectation ing, promotion, and sponsorship; a level of risk experienced by us that they would stop. Since then, ban on misleading descriptors such ers depends largely on the type of we have learned that tobacco con as light?; and a mandate to place product they are using. Risk esti trol requires far more complex ap rotating warnings that cover at least mates for cancer associated with proaches that acknowledge the hi 30% of tobacco packaging and en smokeless tobacco use in case? erarchy of factors that determine the couragement for even larger, graphic control studies increase with fre use of tobacco and the interplay of quency of use per day and with du these factors across the life-course, Fig. Chewing tobacco has been as health is damaged by smoking proven to cause oesophageal, oral, blad ration of use in years, and women from conception onward. Smokeless initiation to promoting successful tobacco users often have pre cessation. Particular issues include cancerous oral mucosal lesions, avoiding exposure to second-hand such as leukoplakia. These white smoke and discouraging pregnant lesions tend to disappear within women from smoking. In addition, 1?2 months after discontinuation tobacco control efforts need to be of tobacco use. These lesions are dynamic in time, changing as the to more common in smokers who bacco industry attempts to counter also use smokeless tobacco, and control measures. Areca nut chewing is popular provisions requiring Parties to imple als are also smokers. Information about the impact of India have been formulated based For multiple sites, including lung initiatives designed to encourage on a study of the characteristics and cancer in smokers and oral cancer in individuals to cease smoking is pre needs of target groups. The circumstances involving cancer de Smokeless tobacco interventions have involved the stu velopment, and causality is proven. Tobacco control needs to include dents in interactive classroom and Thus, tobacco control provides a smokeless tobacco in its purview. Hence, taxation needs to cover non-intervention schools have been effective tobacco control policies. Information cam ernment for application across the preventing initiation and promoting paigns need to explicitly address the country in government schools [21]. The risk of oral cancer ed messages to diffuse information is very high for smokeless tobacco at mass level and in small groups as users, especially if use is initiated at well as by one-to-one interaction with 94 References 1. Consequences of Smoking: A Report venting tobacco use among adolescents of the Surgeon General. Department of Health and Human National Tobacco Control Programme in Services (2010). Personal habits and in and preventing tobacco use among low Center for Chronic Disease Prevention door combustions. Reducing Tobacco Use: of Tobacco-Related Cancers and Other A Report of the Surgeon General. The Health Indian J Occup Environ Med, 13:97? Tobacco use among youth and adults in Consequences of Involuntary Smoking: 103. Department of under the Global Tobacco Surveillance Health and Human Services, Public System. Indian J Public Health, 55:169? Health Service, Offce on Smoking and Websites 176. Allen (reviewer) Kevin Shield Min Dai (reviewer) Elisabete Weiderpass (reviewer) such as reduction of availability, [3?5]. Tumour types caused by Summary increases in price, and marketing drinking alcoholic beverages include bans. For renal risk has been known since the the association between alcohol cell carcinoma and non-Hodgkin beginning of the 20th century. Further known beverages are responsible for 337 400 deaths and neck cancers compared with other fruit wines, cider, and a broad worldwide, predominantly people who abstained from drink range of very diverse spirits, includ among men, with liver cancer ing for religious reasons, and that ing shochu, sake, lotus or agave accounting for the largest pro such abstainers had a markedly based spirits, and various types portion of deaths among the lower risk of these forms of cancers of country-made liquor in India. Alcoholic beverages are com produced alcoholic beverages, servations, several thousand more plex mixtures, but ethanol, me analytical studies followed to ex such as sorghum beer, palm wine, diating a genotoxic effect upon plore the biology and epidemiology or sugar-cane spirits, continue to metabolism to acetaldehyde, of the relationship between alcohol be the main available beverage is recognized as the agent consumption and risk of cancer. Alcopops favoured, often predominantly accounting for a result, alcoholic beverages were sweet, alcoholic beverages have carcinogenesis. These meta the risk of mortality from cancers of often contain very high concentra analyses establish that a signifcant the upper digestive tract (except can tions of ethanol and may also con positive dose?response association cers of the mouth and oral cavity) and tain higher alcohols and toxic con exists between alcohol consumption from cancer of the female breast is ex centrations of methanol and other and cancers of the mouth, pharynx, ponential. When epidemiological drinkers (people who have not con where the majority of participants criteria were examined for causal sumed alcohol within the past year consume low to moderate amounts of ity [12], the association between al but who have consumed it before in alcohol, that have found a signifcant cohol consumption and cancers of their lifetime) were found to have a positive association, an absence of the mouth, pharynx, oesophagus, higher risk of cancer compared with a signifcant association, or a signif colorectum, liver, larynx, and fe lifetime abstainers. It should be noted cant negative association between male breast was found to be causal that there is evidence that the risk of alcohol consumption and the risk of [4,5,13]. To determine whether an associated with alcohol consumption [14]; however, more data are need association exists between alcohol through at least one meta-analysis ed to explore the effect of drinking Chapter 2. The relationship between average daily alcohol consumption and relative risk of cancer. Neoplasms of the upper digestive tract Cancers of the mouth Oesophageal Laryngeal and oropharynx cancer cancer 0 50 100 150 0 50 100 150 0 50 100 150 Alcohol consumption (grams/day) Alcohol consumption (grams/day) Alcohol Consumption (grams/day) Neoplasms of the lower digestive tract Colon cancer Rectal cancer Liver cancer 0 50 100 150 0 50 100 150 0 50 100 150 Alcohol consumption (grams/day) Alcohol consumption (grams/day) Alcohol consumption (grams/day) Other neoplasms Cancer of the female breast functions presented in Box 2. However, the rela Observational research has tive risk functions for alcohol-related suggested that there is a signifcant cancers may be different for mortal positive dose?response association ity and incidence (as a difference between alcohol consumption and between relative risks of mortality risk of prostate cancer, with multiple and incidence has been observed meta-analyses confrming this rela for other alcohol-related diseases, tionship. Thus, ing how alcohol consumption may in 0 50 100 150 more research is needed to system crease the risk of prostate cancer are Alcohol consumption (grams/day) atically determine whether there is a currently unknown (see below), and difference between the relative risks thus additional research is needed to of incidence and mortality for alco clarify a possible causal association. A nonsignifcant positive causally associated with alcohol pharynx, larynx, and oesophagus, association has been observed consumption [13]. The relative risk with very high risks observed in between alcohol consumption and 98 cancers of the endometrium and cancer of the cervix, endometrium, for 2010, can be calculated using ovary [13]. Epidemiological Global Burden of Disease study (see increase in the risk of pancreatic can research is required to support pre [16]). It tion since the biological mechanisms combines years of life lost due to pre should be noted that alcohol-attrib are not understood and confounding mature mortality and years of healthy utable cancer data for 2010 refect and/or misclassifcation of abstainers life lost due to disability) from can the level of drinking in the early may be responsible for the observa cers that are currently determined to 1990s, due to the long time it takes tions that have been made. Associations have been reported consumption and from other disease the rates of alcohol-attribut between alcohol consumption and conditions and injuries, in each case able cancer deaths and of alcohol Fig. Percentage of deaths from various forms of cancer attributable to alcohol consumption, in 2010. The these deaths); and for men, oesoph from cancers of the mouth and number of deaths and the number ageal cancer (responsible for 27. In of the conditions related to alcohol In 2010, the largest contributors 2010, alcohol consumption was re consumption, see [16]). Cancer deaths attributable to alcohol consumption, by sex and by Global Burden of Disease region, for 2010a Sex Global Burden Female Male Total of Disease regionb Deaths per Deaths per Deaths per Deaths Deaths Deaths 100 000 people 100 000 people 100 000 people Asia Pacifc, high-income 4 000 2. Female drinking has risen steadily for the past 20 years, with more women hol consumed increases, the risk of than men drinking heavily on single occasions. This means that any reduction in alco hol consumption will be benefcial for health through the reduction of cancer risk. There are cost-effective ways to reduce alcohol consump tion: most notably, restrictions in availability; increases in price for alcoholic beverages, which could be achieved by increasing taxation or increasing minimum prices; and marketing bans [21]. In addition, the risk of cancer for high-risk heavy alcohol consumers can be reduced by providing more opportunities for brief interventions and treatment for alcohol use disorders [22]. Br J Cancer, 106:1881? carcinogens in alcoholic beverages using Arch Mal Appar Dig Mal Nutr, 4:451?475.

The value of a minimally traumatic procedure that allowed excellent visualization of internal structures even in very small patients soon became evident to many practitioners birth control kurvelo discount alesse uk. Avian medicine has seen spectacular growth in its knowledge base over the past ffteen years birth control for women in their 50s buy alesse 0.18 mg low cost. Rigid endoscopes were frst employed in birds to visualize the gonads for purposes of sex identifcation in those species where external characteristics were diffcult or impossible to rely upon birth control pills buy discount alesse 0.18mg. The superior resolution and light transmission characteristics of even the earliest rod lens endoscopes made them far superior to other optical systems for avian applications birth control pills 40s buy 0.18 mg alesse. A number of pioneering avian veterinarians soon realized that endoscopy offered far more than gonad identifcation capabilities. The unique anatomy of the avian respiratory system allowed relatively easy access to many organ systems. Secondary hand instruments could be guided into the viewing feld to collect biopsies or retrieve materials. Endoscopic collection of hepatic and renal biopsies allowed precise targeting of lesions with minimal patient trauma. He was also the frst to suggest the use of some method whereby hand instruments could be manipulated in concert with the endoscope. The sheath design allowed a variety of hand instruments to be guided to the tip of the endoscope through an instrument channel increasing operator ease and preventing iatrogenic trauma. A number of parenteral agents, either singly or in combination, have been used such as ketamine, xylazine, diazepam, midazolam and propafol. Birds are readily intubated by placing a soft, uncuffed endotracheal tube into the unencumbered glottis (Fig. The unique anatomy of the avian respiratory system facilitates endoscopic Great horned owl (Bubo virginianas). They provide access to most internal organs without the need for secondary insuffation. The caudal thoracic air sacs are the key entry points to the avian air sac system. The cranial thoracic and abdominal air sacs can be easily accessed from a single entry point into the caudal thoracic sacs via the lateral thoracic wall (Fig. The liver is surrounded by the right and left ventral and dorsal hepatic peritoneal cavities. The rest of the abdominal viscera are suspended within the midline intestinal peritoneal cavity as they would be in the typical mammal. Green winged macaw (Ara chloroptera) positioned in right lateral recumbency with the left leg positioned cranially. The entry site is located by fnding the point where the semimembranosus muscle (m. A blunt entry is recommended through the thin body Red tailed hawk (Buteo jamaicensis). Except in individuals with moderately to markedly increased fat entry point for most avian coeleoscopy. A major advantage in placing the leg forward is that the thin, lateral body wall can be more easily approached without the interference of the femoral musculature. This becomes particularily important in birds with heavily muscled upper thighs (eg. With this approach the endoscope enters the caudal thoracic air sac at or near its caudal border. Upon entering the left caudal thoracic air sac and looking cranially the lateral septal surface of the lung with its large ostium will be visible (Fig. Running from approximately two to three o?clock is the transparent membrane formed by the confuent walls of the caudal thoracic air sac and the abdominal air sac. Passing through this wall would place the endoscope within the abdominal air sac (Fig. At four to six o?clock is the ventrolateral border of the proventriculus and ventriculus. The lateral edge of the left lobe of the liver may be seen at seven to eight o?clock, draped upon Caudal thoracic air sac. From nine to ten o?clock is another transparent membrane View through to abdominal air sac composed of the walls of the confuent caudal thoracic air sac and cranial red tailed hawk (Buteo jamaicensis). Passing through this membrane would place the tip of the endoscope in the cranial thoracic air sac. The controller, which contains all of the electronic circuitry for the camera, is placed out of the surgical feld. The sterilized camera may be used for the real time visualization of procedures and is preferred by some clinicians as an aid to performing certain manipulations. The procedure is observed on a monitor without the need for the surgeon to view the ocular. This can be a valuable research tool allowing comparison of many different examinations. High quality still photographs may only be obtained by the use of a specialized fash generator (eg. Uses of Endovideo Documentation Improved Ergonomics: As an aid to performing instrumented proce dures avoiding the need to keep head at eyepiece during instrument manipulation, more procedures can be performed with less fatigue. For Case Documentation: Particularily useful for showing relation ships in space and time, medico-legal recording. Teaching and Demonstration: Superb education and marketing tool for clients, colleagues, staff. In species with strong mandibular musculature such as psittacines, it is recommended that the patient be anesthetized for most oral examinations. If manual restraint is used extra care must be taken to prevent damage to equipment. The avian tongue may exhibit a number of adaptions for food prehension and manipulation. In many species it is a fat, triangular shaped organ with a relatively smooth epithelium. They are the only order with intrinsic lingual muscles that allow a great variety of movement and fexibility. In many species, including parrots there are a group of mucus secreting salivary glands at the base of the tongue. Inspissation of keratinized debris due to squamous metaplasia will be seen in birds suffering from hypovitaminosis A (Fig. The laryngeal mound is visualized at the base of the tongue on the midline of the caudal foor of the oropharynx. The paired, feshy laryngeal prominences open and close to form the conspicuous glottis. The syrinx is the site of sound production and is located where the trachea bifurcates into the primary bronchi. Tracheoscopy to the level of the syrinx is possible in medium to large birds using a 180 mm long 2. The surface of the esophagus is thrown into a series of longitudinal folds that vary depending upon the types of food items that the species consumes. For example, the number and size of folds and the degree of distensibility are less in insectivores and seed eaters than in carnivores like hawks and owls (Fig. Birds that consume large boluses of food have noticeable folds of the esophageal mucosa. Some pressure will need to be maintained around the proximal cervical esophagus to retain the infused air within the crop. It is also important to remember to fast patients undergoing elective ingluvioscopy for several hours before the procedure to reduce the effects of retained food materials upon visualization. Due to the tremendous amount of work that has been done in mammalian gastroscopy, the clinician might assume that a fexible 7 Ingluvies and esophageal sphincter endoscope would be the frst choice for this examination. Smaller fexible instruments the esophageal sphincter is open due to the degree of insuffation present.

We only need to read the requirements in the problem description carefully and code it birth control pills canada purchase 0.18mg alesse with amex. Here are some examples: Programming Exercises related to Ad Hoc String Processing: 1 birth control pill 93 alesse 0.18mg overnight delivery. We discuss these data structures and several specialized algorithms using these data structures in Section 6 birth control for women 2 best purchase for alesse. Although we do not know which one is the best birth control pills zoely alesse 0.18mg for sale, we can try all possibilities while avoiding re-computation of overlapping subproblems. Follow the dashed (red) arrows from the bottom right cell to reconstruct the solution Diagonal arrow means a match or a mismatch. We do not put this topic in Chapter 2 as these two data structures are special for strings. We can then read the starting indices of such substrings that are stored in the leaves of the sub tree. The leaves of this vertex x point to index 1 (substring: acacag$) and index 3 (substring: acag$). The fact that X is the deepest internal vertex (from root) implies that its path-label is the longest repeated substring. For example, with S1 = acgat#? and S2 = cgt$?, the Longest Common Substring is cg? of length 2. Note that we regard the terminating symbol $ as the lexicographically smallest character. The O(m log n) complexity comes from the fact that we can do O(log n)binary search on a sorted su? For the common substring between S1 = acgat#? and S2 = cgt$?,wecan concatenate the two string into S = acgat#cgt$?, build the Su? The Longest Common Subsequence problem can be solved in O(n log n) when all characters are distinct [24]. B utfor many contest problems involving string, using library functions like C strstr in <string. If a faster string matching algorithm is needed during contest time, we suggest using Su? There are several other string processing problems that we have not touched yet: Gram mar and Parsing. Backus Naur Form), Encoding/Decoding/Cypher/Cryptography, Shortest Common Superstring, Regular Expression (using Java), Hashing techniques for String Processing, Su? Some others skip these problems as they forgot some important for mulas and unable to derive the required formulas from basic concepts. If you are lucky, it ask you for some geometry solution that you have learned in pre-University which you still remember or the solution can be derived by drawing the geometrical objects. We review many (not all) English geometric terminologies and formulas that are commonly used in programming contests. Here, we try to provide a list which cannot be exhaustive to be used as a quick reference when contestants are given geometry problems. Usually, we treat the vertical lines separately in the solution code (example of the special cases in geometry problems). In a 2-D Cartesian coordinate system, the Circle centered at (a, b) with radius r is the set of all points (x, y) such that (x? The area of a Segment of a circle can be found by subtracting the area of the corre sponding Sector with the area of an Isosceles Triangle with sides: r, r, and Chord-length. There are several types of triangles: Equilateral Triangle, all three edges have the same length and all inside/interior angles are 60 degrees; 122 7. In Trigonometry, the Pythagorean Triple is a triple with three positive integers a, b,andc, such that a2 + b2 = c2. If (a, b, c) is a Pythagorean triple, then so is (ka, kb, kc) for any positive integer k. Primitive Pythagorean Triples describe the three integer side lengths of a Right Triangle, although the converse may not be true. A Trapezium is a polygon with four edges, four vertices, and one pair of parallel edges. If the two non-parallel sides of the trapezium have the same length, we have an Isosceles Trapezium. The Area A of a trapezium with base w1, another edge parallel with the base w2and height h is A =0. A Quadrilateral or Quadrangle is a polygon with with four edges (and four vertices). The Great-Circle Distance between any two points A and B on sphere [38] is the shortest distance along a path on the surface of the sphere. Thispathisequaltothe length of the Arc of the Great-Circle of that sphere that pass through the two points AandB. Usually, the two points on the surface of a sphere are given as (latitude, longitude) pair. The following library code will help us obtain the shortest great-circle distance given two points on the sphere and the radius of the sphere. A polygon is said to be Convex if any line segment drawn inside the polygon does not intersect any edge of the polygon. The area A of an n-sided polygon (either convex or concave) with n pairs of vertex coordinates given in some order (clockwise or counter-clockwise) is: |x1 y1| |x2 y2| 1 | x3 y3 | A = * |. Notice that our default setting is all integer coordinates and use all-integer operations whenever possible. You need to change a part of this code if the given points are not integers: struct point { int x, y; } // a point has two members int determinant(vector<point> P) { // default: integer computation int result = 0, x1, y1, x2, y2; for (int i = 0; i < P. The perimeter p of an n-sided polygon with n pairs of coordinates given in some order (clockwise or counter-clockwise) can be computed with Pythagorean theorem: double perimeter(vector<point> P) { // point has x & y double result = 0. This test takesin3pointsp, q, r in a plane and determine if the sequence p > q > r is a left turn4. This test can be implemented with the following library code: int turn(point p, point q, point r) { int result = (r. P, Q, R are collinear } // Note: sometimes, we change the > 0? to >= 0? to accept collinear points bool ccw(point p, point q, point r) { return (turn(p, q, r) > 0); } With the library code above, we can now check if a polygon is convex by verifying if all three consecutive points in the polygon make left-turns if visited in counter clockwise order. What we have covered so far are the ones which appear more frequently in programming contests. Other Programming Exercises related to Basic Geometry that are not listed above: 1. Rodriguez Problem (simulation) 3Geometric programs are preferred to be robust, namely, no numerical errors. To help achieving that quality, computations are often done by predicate tests. Moreover, arithmetic operations used are limited to additions, subtractions and multiplications on integers only (exact arithmetics). In our example, we pick bottommost and rightmost point in P as pivot (see point 0 and the counter-clockwise order of the remaining points in Figure 7. The stack previously contains (bottom) 11-0-1-2 (top), but when we try to insert 3, 1-2-3 is a right turn, so we pop 2. Now 0-1-3 is a left turn, so we insert 3 to the stack, which now contains (bottom) 11-0-1-3 (top). Check that the sequence of vertices in S always makes left turns a convex polygon. P0, skipping Polygon [0] pivot = Polygon[0]; // use this global variable as reference sort(++Polygon. We can test whether two line segments intersect or not by using several ccw tests (code is shown below). We then compare this value with the expected arc length to decide whether we have to enlarge or reduce the length L. There is a computational geometry technique that has not been discussed yet: plane sweep. This person should master basic geometry formulas and advanced computational geometry techniques. He must train himself to be familiar with many degenerate (special) cases in certain geometry problems, able to deal with precision errors, etc. So far, we have contacted the following problem setters and obtained their permissions: Sohel Ha? If any of the author of a particular problem discussed in this book that we have not contacted yet does not allow his/her problem to be used in this book, we will replace that particular problem with another similar problem from di?

A systematic birth control changed womens lives alesse 0.18mg line, team-based approach is called for so that safety considerations are not compromised birth control pills early period order generic alesse canada. The second principle of human performance states: error-likely situations are predictable birth control patch buy alesse 0.18 mg with mastercard, manageable birth control for women men alesse 0.18 mg lowest price, and preventable. The simple presence of adverse conditions cannot be error-likely unless a specific action is to occur within that set of adverse conditions. Error precursors interfere with successful performance and 93 increase the probability for error. Examples include excessive workload, hurrying, concurrent actions, unclear roles and responsibilities, and vague standards. Examples are unfamiliarity with the task, unsafe attitudes, level of education, lack of knowledge, unpracticed skills, personality, inexperience, health and fitness, poor communication practices, fatigue, and low self-esteem. These include distractions, awkward equipment layout, complex tagout procedures, at-risk norms and values, work group attitudes toward various hazards, work control processes, and temperature, lighting, and noise. Error precursors are, by definition, prerequisite conditions for error and, therefore, exist before an error occurs. If discovered and removed, job-site conditions can be changed to minimize the chance for error. This is more likely if people possess an intolerance for error precursors or error traps. Examples include reporting an improperly marked valve or a malfunctioning gauge in a safety system, taking a broken ladder out of service, immediately cleaning up an oil spill, stopping work until a change can be made to the procedure, calling in a replacement to relieve a worker who has become ill, seeking technical help when unsure, asking for a peer review on engineering calculations, routinely performing safety self-assessments, and so on. These are the more common conditions associated with events triggered by human error. Some organizations distribute a plastic-coated error precursor card to their front line workers to carry with them on the job. Workers refer to these cards during pre-job briefings to help identify precursors related to the upcoming task. A more extensive list of error precursors and error precursor descriptions is provided in Attachments A and B of this chapter. Illness or fatigue; general poor health or injury Work Environment Human Nature 1. Irreversible actions are not necessarily precursors to error, but are often overlooked, leading to preventable events. A human act or task must be either planned or occurring concurrent with error precursors to be considered error-likely. Confusing displays and controls identical switches both pistol Precursors: grip style. Interruption verifying the status of several annunciator alarms just at the moment to start dilution. Repetitive action done several times during shift while performing system startup 3. Complacency, mind-set location of fluids on unmarked shelves next to each other. Assumptions containers appear nearly identical Many different factors can affect performance. Considering the number and variety of factors involved with a specific job, many things can change, even with simple, repetitive tasks. When people believe a job is routine, they subconsciously think that nothing can go wrong, and they expect only success. Then, when something does go wrong, people tend to 95 rationalize the situation away, inhibiting proper response in time to avert the consequences. The design of systems, structures, and components aids in performing the latter through engineered controls such as physical barriers, interlocks, keyed parts, shaped/color-coded controls, automation, and alarms. However, the prevention of or detection of errors also depends on people, either the performer or other people. For example, self-checking and procedures provide individuals with the means of avoiding or detecting mistakes, while peer-checking and three-way communication engage another person. Human performance tools are designed to help people anticipate, prevent, and catch active errors. Human Performance Improvement Handbook Volume 2: Human Performance Tools For Individuals, Work Teams, and Management, is a companion publication to this handbook. Volume 2 provides an explanation of numerous tools that individuals and work teams can employ to reduce errors. The fundamental purpose of human performance tools is to help the worker maintain positive control of a work situation; that is, what is intended to happen is what happens, and that is all that happens. Every person wants to do good work, to be 100 percent accurate, 100 percent complete, and meet 100 percent of the requirements. On occasion, people still err despite how rigorously they use human performance tools. System Changes Although this handbook focuses on what people can do to reduce human error, it is recognized there is another whole dimension associated with error reduction. This involves improvements or changes in the engineered systems so the machines and working conditions better support the human needs, thus reducing human error. The location of instruments and controls on operating control panels, the accessibility and positioning of monitoring equipment, the lighting in passage ways, the sounds of warning alarms, the heights of working surfaces, the distance from communication sources, the number of work a-rounds present, and numerous other conditions can either enhance or hinder human performance. Human error is more likely when tools and equipment, procedures, work processes, or technical support are inadequate. Human factors professionals study and report on adverse engineered and management systems within an organization and recommend modifications or improvements to eliminate these and other conditions. Implementation of such recommendations improves worker perform and reduces human error. Reporting errors and error precursors is an essential behavior needed to acquire feedback from the field about flawed engineered or management systems. Managers and supervisors should encourage workers to report adverse system-related conditions that promote error (error precursors) when ever they are encountered. With input from worker reporting, management can direct needed engineering and system changes. More will be said about how to encourage a reporting culture in Chapter of this handbook. Many references refer to error precursors as behavior-shaping factors or performance-shaping factors. The bolded error 96 precursors are more prevalent and are listed in order of impact. Guidelines for Preventing Human Error in Process Safety, American Institute of Chemical Engineers, 1994. Review of Findings for Human Error Contribution to Risk in Operating Events, 2001. Improving Compliance with Safety Procedures, Reducing Industrial Violations, 1995. The writer was employed by Westinghouse-Hanford as the 200 area training manager at the time of this incident. An internal study of errors across the nuclear industry revealed that 25 percent of errors were skill-based, 60 percent were rule-based, and 15 percent were knowledge-based. From that introduction, the reader will gain an appreciation of the importance of controls in preventing events. The various categories of controls used and their relative dependability will be addressed. Most importantly, the emphasis will be placed on how to identify and eliminate latent organizational conditions in the system that weaken controls by using a variety of available and familiar methods (tools) introduced herein. Depending on the linguistic traditions of various hazardous technological domains, the terms defenses, barriers, controls?, or similar terms may be used. In general, they all connote technological or organizational features specifically designed to protect against hazards. Proper understanding and use of controls are important to understanding and preventing accidents.

It supports animal and plant life through its gaseous content and provides rain to grow crops birth control blood clots alesse 0.18 mg visa. Because atmospheric gases other than oxygen and nitrogen are so low in percentage they will not be considered in this discussion birth control for women 7 weeks discount 0.18 mg alesse with mastercard. Therefore from this point on birth control yasmin discount alesse 0.18mg fast delivery, we will consider the atmosphere to be composed of only oxygen and nitrogen birth control pills list purchase alesse cheap. Supports body Oxygen (O2) 20 metabolism (the catabolic breakdown of glucose for the production of heat energy). Argon (A) trace Noble (no bodily function) Neon (Ne) trace Noble (no bodily function) Helium (He) trace Noble (no bodily function) Krypton (Kr) trace Noble (no bodily function) Xenon (Xe) trace Noble (no bodily function) Hydrogen (H2) trace (no bodily function) Carbon Dioxide trace End product of metabolism. Atmospheric pressure is the combined weight, or force, of all the atmospheric gases exerted at any given point. Weather Bureau in conjunction with the Bureau of Standards set forth the values used in measuring a standard day at sea level. This standard atmospheric pressure can be expressed in many different forms, depending on the method of measurement. The primary reason for this phenomenon lies in the kinetic nature of atoms and molecules. Molecules, especially those of a gas, are highly kinetic, or, in a constant state of motion. As pressure around the molecules is reduced, the molecules will travel further apart. This explains why air becomes less dense as altitude increases, thus explaining the phenomenon of gas expansion. The rays from the sun strike the earth at a very low angle at the poles and almost vertically at the equator. Thus, more heat is radiated into the air at the equator than at the poles causing the air to rise higher which can vary the heights of the Troposphere division listed below. All the divisions of the atmosphere have their own special characteristics that separate them from the others. The dangerous element here is the reduced partial pressure of oxygen found at this altitude. Since air is a mixture of gases, it will behave as such and, therefore, is subject to the laws that govern all gases. The following laws explain the effects of reduced barometric pressure and its interplay on the human body. As altitude increases, pressure decreases and nitrogen will attempt to leave the body and equalize with the surrounding environment. Additionally, the atmosphere, through aviation, provides career opportunity and a source for potential income. With all its benefits, the atmosphere can be your best friend, but, it can also be a formidable enemy. Precautions must be taken to curb the threats of hypoxia, decompression sickness, hypothermia, and spatial disorientation. Appreciate the atmosphere for what it does for you, but, respect it for what it can do to you. However, the areas of the body that are affected most directly are the respiratory and circulatory systems. Therefore, it is important for the individual to be familiar with the actions and limitations of the human respiratory and circulatory systems. The Concept of Respiration Respiration is defined as the exchange of gases between the organism and its environment. The more obvious features of this process are the absorption of oxygen from the atmosphere and the elimination of carbon dioxide from the body. The respiratory system is made up of the lungs, a series of conducting tubes called the bronchi, the trachea, the mouth, and the nose. Air first enters the nasal passages, or the mouth, where it is warmed, moisturized, and filtered. It passes down the throat to the trachea and then into the bronchial tubes and the lungs. Once inside the lungs, the large bronchial tubes will branch 16 times, while getting progressively smaller with each branch. Though each individual air sac is small, if every air sac was removed from your lungs, and placed on a flat surface in a rectangular fashion, it would occupy a space equal to half a tennis court. The capillaries are so dense that they actually resemble a sheet of blood around each air sac. Each air sac is constructed of a very thin membrane that is just one cell (1/50,000th of an inch) thick. This allows oxygen, as well as other gases, to diffuse across the membrane and into and out of the capillaries and blood. Cells in the body require oxygen for the burning of food material to produce energy. This process, called metabolism, converts glucose (blood sugar) and oxygen into carbon dioxide and water. The blood, at the same time, releases carbon dioxide into the lungs to be exhaled. Once the oxygen is in the cell, and metabolism has taken place, carbon dioxide then leaves the cell for the blood. Once in the blood, the carbon dioxide is transported back to the lungs for exhalation. External Respiration External respiration is the exchange of gasses between the lungs and the surrounding atmosphere. It is estimated that with every normal breath, you will inhale approximately 13 billion trillion oxygen molecules. This number is so large that it is difficult to grasp the sheer magnitude of the amount of molecules that are brought into the lungs. But, as mentioned before, partial pressure relies solely on the number of molecules available for gas exchange. The partial pressure of oxygen forces oxygen through the air sacs and into the blood (keep in mind that gaseous pressure in physiology depends entirely on concentration of molecules). The partial pressure of oxygen is approximately 20% of the total atmospheric pressure. If at sea level, this would be about 152mm of pressure (20% of the total atmospheric pressure ). When a breath is drawn into the lungs, one would expect the partial pressure of oxygen to remain at 152mm. However, the lungs contain other gases that exert a constant pressure (water vapor at 47mm and carbon dioxide at 40mm). Therefore, these gases reduce the partial pressure of the oxygen at the air sac level to 102mm. The high partial pressure of oxygen (102mm) now diffuses through the air sac wall and into the blood. This in turn, raises the partial pressure oxygen in venous blood (blood that has left the cells and therefore is low in oxygen) from 40mm to 102mm. At the same time this is happening, the high pressure of carbon dioxide (approximately 47mm) in the blood 2-2 will cause some of the carbon dioxide to diffuse into the airsac where carbon dioxide pressure is a constant 40mm. The same principle that applies to external respiration also applies to internal respiration (the exchange of gases from the blood to the cells). The high partial pressure of oxygen in arterial blood, causes the oxygen to move from the blood into the cells. Due to metabolism, the high partial pressure of carbon dioxide in the cell will causes it to diffuse into the blood for transport to the lungs. Function the circulatory system is concerned with the transportation of blood throughout the body. Blood carries food, oxygen, and water to the tissues and waste materials from the tissues. Structure the segments of the body that comprise the circulatory system are the heart, arteries, veins, and capillaries.

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