Jasa Konsultasi Disertasi Keuangan (1) dan Perbankan S3, hubungi WA 0821 2230 7021: MANUAL FOR THE PREPARATION OF THESES AND DISSERTATIONS

MANUAL FOR THE PREPARATION OF THESES AND DISSERTATIONS

The page after the title page of your dissertation is intentionally left blank, or it may contain the copyright statement shown here. In either case it is not numbered nor counted.

Full Legal Name of Author

2013

TABLE OF CONTENTS

I. Procedures to follow for the final semester 4

II. Submitting final copies of theses and dissertations 4

Processing fees ..4

Procedures for copyright 5

III. Manuals and formbooks 5

IV. Parts and order of the manuscript 5

V. Manuscript presentation 6

VI. Margins and spacing 6

VII. Pagination 6

VIII. Special pages 7

Title Page 7

Vita 7

Abstract 7

IX. Electronic submission of theses and dissertations 7

Appendix 8

MANUAL FOR PREPARATION OF THESES AND DISSERTATIONS AddRan College of Liberal Arts

Section I: Procedures to follow for the final semester

a. File an “Intent to Graduate” (available in the AddRan Dean’s Office, Scharbauer 2001) during the first four weeks of the semester. NOTE: A graduation fee is charged when the “intent” is filed. If you postpone your graduation, you must cancel the intent. You will need to file a new intent the next semester and pay the graduation fee again.

b. The Registrar’s office will send instructions, forms to complete, and information about payment of graduation fees. NOTE: There are deadlines for refunds of cap and gown rental and diploma fees.

c. Submit a completed draft of your thesis or dissertation to your committee for review.

All committee members must read the draft of a thesis.

At least three (but preferably all) committee members must read the draft of a dissertation.

d. Prepare a revised draft incorporating all changes required by your committee.

e. Ask your major professor to schedule the final thesis oral or dissertation defense with AddRan.

f. Refer to the “Instructions” at the UMI website, http://dissertations.umi.com/tcu/.

Section II: Submitting final copies of theses and dissertations

a. Bring the entire completed manuscript (including preliminary, vita, and abstract pages) to AddRan for checking at least two days before your final oral. This does not need to be on bond paper. NOTE: During peak times, the return of these to the student may take several days.

b. Make corrections called for by AddRan and your committee for the final copy.

c. Bring publishing fee form and pay required processing fee ($10 for thesis or dissertation) at the Cashier’s Office in Sadler 2011. Return the original receipt to the AddRan Dean’s Office prior to electronic submission of the manuscript.

d. If you choose to have ProQuest/UMI file for copyright for you, there is an additional fee of $65 which should also be paid at the Cashier’s Office in Sadler Hall prior to electronic submission of the manuscript.

e. TCU no longer requires bound copies of your thesis or dissertation. If you would like bound copies for your own use, you can order them from UMI while submitting your file or you can order them from a list of binderies in the Online Submission Guidelines at http://lib.tcu.edu/NDLTD.

f. Students should also refer to http://dissertations.umi.com/tcu/. Section III. Manuals and formbooks

AddRan College does not require all departments to use the same format. Because the thesis or dissertation should reflect the requirements of the discipline, documentation should be in accordance with professional stylebooks.

The latest editions of style manuals listed here are to be consulted.

English The MLA Style Manual

History Turabian, A Manual for Writers

Section IV. Parts and order of the manuscript

A manuscript generally has three main parts: the preliminaries, the text, and the reference material. The order of these may vary, but is usually as follows:

The Preliminaries

One blank page

Title page

One blank page or copyright notice if the dissertation is to be copyrighted (see

preliminary pages of this manual)

Preface, including acknowledgments (optional)

Table of contents, with page references

List of figures, with titles and page references (if there are figures)

List of tables, with titles and page references (if there are tables)

The Text

Introduction

Main body, with the larger divisions and important minor divisions indicated

by suitable, consistent headings

Reference

Appendices

Bibliography

Vita (See examples in this manual)

Abstract (See examples in this manual)

Section V. Manuscript presentation

The manuscript, as a demonstration of your ability in research, analysis, and effectiveness of expression, should have an appearance in keeping with such a document. Unacceptable manuscripts will be rejected by the college. Both theses and dissertations will be archived electronically after submission and approval.

You are responsible for final proofreading. This is to be done before bringing it to AddRan for checking (see II a). An indication that careful proofreading has not been done is cause for complete rejection of the manuscript and possible delay of graduation by at least one semester. Because it is difficult for proofreading to be done adequately by persons already familiar with the material, competent outside proofreaders are advisable, but you retain full responsibility for good proofreading and satisfactory correction, and you should wait until after your oral examination to make final corrections. In this way you will have a composite list of all corrections requested by your examination committee and the AddRan office.

Section VI. Margins and spacing

a. The text of the manuscript is double-spaced. Footnotes are single-spaced. Indented quotations may be single or double-spaced. Consult the approved format for your discipline for additional guidance on spacing.

b. The left margin should be no less than 1.25 inches, and the top margin not less than 1 inch. The right and bottom margins must have a clearance of not less than .75 inch from the typed material. Any of the approved formbooks will give rules for margins well within these limits. Charts, maps, and other illustrative material must meet these margin requirements also.

Section VII. Pagination

a. Each page in the manuscript should be assigned a number except for the blank pages preceding and following the title page, the abstract pages, and the vita page. Header and footer margins for page numbers are 1/2 inch; i.e., there is 1/2 inch margin between the page number and the top or bottom of the page.

b. For the preliminary pages, small Roman numerals (i, ii, iii, iv, etc.) are used. The

numbering should begin with ii; the title page counts as page i, but the number does not appear. The blank page or copyright page following the title page is not counted or numbered. These page numbers are at the bottom of the page, centered or at the right margin.

c. For the remainder of the manuscript including the text, illustrations, appendices, and bibliography, Arabic numerals are used. All pages are numbered, except the vita and abstract pages. Do not use letter suffixes such as 10a, 10b, etc. The numbering should begin with “1”, and run consecutively to the end of the manuscript. Page numbers should be placed at the right margin , consistently either above or below the text. If page numbers are above the text and the page carries a major heading, such as the first page of a chapter or of the bibliography, the page number may be placed at the center bottom. If the description of an illustration is too long to be placed on the same page, it should be placed on the preceding page, not on an unnumbered page.

Section VIII. Special pages

a. Title Page: The title page contains: (1) the title, in capitals, double-spaced if longer than one line, (2) the full name of the student, (3) the degree or degrees held, (4) sources and dates of the degree or degrees, (5) the “partial fulfillment” statement, (6) the degree sought, the date the degree is to be conferred. These details are shown on the sample pages (thesis, page 8; dissertation, page 9). Proper spacing is assured if the sample page is used as a guide.

b. Vita: The vita page should be written in the third person, and should include: (1) personal data, (2) education, and (3) professional experience. The vita may be written in either paragraph form or in an outline form as are professional résumés (see samples in the appendix of this manual). The vita does not bear a page number, and must not be more than one page in length.

c. Abstract: The purpose of the abstract is to give a succinct account of the

manuscript so that the reader will be able to determine whether it is advisable to read the complete manuscript. The abstract does not bear a page number, and must not be longer than 350 words for a dissertation or 150 words for a thesis.

Section IX. Electronic Submission of Theses and Dissertations

After successfully defending their theses or dissertations, all students will be required to submit a final copy electronically. Students can access the “Online Submission Guidelines” at http://lib.tcu.edu/NDLTD/.

Appendix: Additional Sample Pages

Sample thesis title page

TITLE OF THESIS IN CAPITAL LETTERS DOUBLE-SPACED IF MORE THAN

ONE LINE

MARY BROWN DOE

Bachelor of Arts, 1991

Rice University

Houston, Texas

Submitted to the Graduate Faculty of

AddRan College of Liberal Arts

Texas Christian University

in partial fulfillment of the requirements

for the degree of

Master of Arts

August*, 2012

*This date can only be May, August, or December

Sample dissertation title page

TITLE OF DISSERTATION IN CAPITAL LETTERS

DOUBLE-SPACED IF MORE THAN

ONE LINE

MARY BROWN DOE

Bachelor of Arts, 1988

Rice University

Houston, Texas

Master of Arts, 1990

University of Texas

Austin, Texas

Submitted to the Graduate Faculty of

AddRan College of Liberal Arts

Texas Christian University

in partial fulfillment of the requirements

for the degree of

Doctor of Philosophy

May*, 2012

*This date can only be May, August, or December

Sample vita, paragraph form

VITA*

Mary Brown Doe was born November 21, 1966, in Dallas, Texas. She is the daughter of Clarence Phillips and Alice Bradley Brown. A 1984 graduate of Woodrow Wilson High School, Dallas, she received a Bachelor of Arts degree with a major in English from Rice University, Houston, in 1988.

After receiving her Master of Arts degree in English from the University of Texas, Austin, in 1981, she joined Markham Industries, Inc., Dallas, as a technical writer.

In September, 1991, she enrolled in graduate study at Texas Christian University. While working on her doctorate in English, she held a University Fellowship during the years 1991-93 and a Teaching Assistantship in 1994-95. Since September, 1995, she has been an assistant professor in the English department at Midwestern University, Wichita Falls. She is a member of the Modern Language Association and the Conference on College Composition and Communication.

She is married to John Butler Doe of Dallas. They have two children.

*The vita is limited to one page.

Sample vita, outline form

VITA*

Personal Mary Brown Doe

Background Born November 21, 1966, Dallas, Texas

Daughter of Clarence Philip and Alice Bradley Brown

Married John Butler Doe October 6, 1979

Two children

Education Diploma, Woodrow Wilson High School, Dallas,

1984

Bachelor of Arts, English, Rice University,

Houston, 1988

Master of Arts, English, University of Texas, Austin, 1990

Doctor of Philosophy, English, Texas Christian University, Fort Worth, 1995

Experience Technical writer, EDS, 1990-91

TCU Fellow, Texas Christian University

Fort Worth, 1991-93

Teaching Assistantship, Texas Christian University

1994-95

Assistant Professor of English, Midwestern University

Wichita Falls, September 1995-present

Professional Modern Language Association

Memberships Conference on College Composition and Communication

*The vita is limited to one page.

Sample abstract

ABSTRACT

TITLE OF THESIS OR DISSERTATION IN CAPITAL LETTERS

SINGLE SPACED IF MORE THAN ONE LINE

by Mary Brown Doe, Ph.D., 2013

Department of English

Texas Christian University

Thesis or Dissertation Advisor: Name of Professor, Rank

Examples: Ray L. Smith, Assistant Professor of Biology

Barbara C. Thomas, Associate Professor of Chemistry

Ernest Powell, Professor of Psychology

James Kennedy, Professor of History and Chair of the Department

Ellen Kessler, Professor and Jones Chair of English

The double spaced text of the abstract goes here. The abstract may have multiple pages, but cannot be longer than 350 words for a dissertation or 150 words for a thesis.

CHAPTER

Introduction to Construction

Plan Implementation

Introduction to Construction Plan Implementation

Preconstruction Meetings

Developing & Implementing a Quality Assurance Program

Project Closure

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INTRODUCTION TO CONSTRUCTION PLAN IMPLEMENTATION

he success of any construction project starts with good construction site management and the use and implementation of the construction plans, including the storm water pollution prevention plan.

Good construction site management is key to the application of the principles and implementation of the storm water management measures specified in the storm water pollution prevention plan. This includes each measure being installed according to the sequence of construction, in the proper location(s), and according to design/installation specifications. Storm water management measures that are improperly installed may have little or no effect and potentially may cause more damage.

Implementation of the construction plans and the storm water pollution prevention plan through good construction site management can be a very cost-effective process. Following is a partial list of construction site management tips that should be implemented on every project site.

* Prior to beginning the project, review all permits and permit conditions associated with the project. It is important that all permits are secured prior to the initiation of any land-disturbing activity. If there are permits that have not been obtained or are in the process of being obtained, do not work in those areas that are directly related to the permit.

* In an effort to ensure construction plans are appropriately implemented it is important that contractors, subcontractors, and others involved in the project understand the objectives of the project. One way to achieve good coordination and communication is to hold a precon-struction meeting. Preconstruction meetings are discussed in more depth in the Preconstruc-tion Meetings section on pages 5-9 in this chapter.

* Preconstruction meetings are an important part of implementing a construction plan. However, it is also important to conduct routine meetings throughout the life of the project to explain issues and coordinate activities associated with the construction process and the implementation of the storm water pollution prevention plan.

* Prior to initiating any land-disturbing activities, a representative for the project should walk the site with the construction plans in hand and mark the limits of construction that were established during the planning phase. Areas to be protected should be marked with rope, safety fencing (commonly orange colored), or surveyor flags. Signage can also be used to identify and explain limits of construction and areas that are to be protected from construction activities.

* Individuals responsible for the installation and maintenance of storm water quality measures must be skilled, experienced, trained, and have an understanding of the purpose and function of storm water quality measures. At a minimum, at least one individual should be assigned the responsibility of overseeing installation and maintenance of the storm water quality measures.

* Each storm water quality measure should be inspected for performance. In fact, the entire project should be monitored to assess the performance of each measure and the effective

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INTRODUCTION TO CONSTRUCTION PLAN IMPLEMENTATION

ness of the storm water pollution prevention plan. When deficiencies are discovered, appropriate steps should be taken to repair, replace, or select alternative measures that adequately address the issue. Additional information for the development of a quality assurance plan and site inspections can be found in Chapter 6, “Developing & Implementing a Quality Assurance Program.”

* The objective of storm water pollution prevention plans is to eliminate or reduce problems associated with storm water runoff. Plan designers do their best to anticipate project activities and site management issues that may be associated with the project. However, the nature of construction and project dynamics can heavily influence the need for modification or an amendment to the plan. It is not practical or possible to anticipate every conceivable situation that may occur during the life of the project. It is for this reason that every project should have a quality assurance plan. A project’s quality assurance plan should outline specific requirements for the inspection and monitoring of the overall effectiveness of the storm water pollution prevention plan.

Storm water pollution prevention plans should be flexible documents and changes to the project should be anticipated. Most corrective actions and modifications will occur in the field. These changes may require modifications to the plans, especially when there is a change in design, construction operations, or maintenance activities that could have a significant effect on the discharge of storm water from the site. Modifications may also be required if an inspection indicates that the plan or a specific storm water quality measure is not effective at addressing storm water discharge or runoff management.

Regulatory agencies may require resubmittal of plans and approvals for plan modifications when changes must be made to a project. Therefore, project site managers and other representatives of the project should become familiar with local regulatory requirements for plan modifications and resubmittal.

4 Chapter 6 October 2007

PRECONSTRUCTION MEETINGS

efore any land disturbance occurs on a project site, it is important that all participants have a clear understanding of the project and associated construction activities. One method to ensure that the project will run smoothly and that construction activities are coordinated is to hold a preconstruction meeting. The intent of preconstruction meetings is to coordinate project activities in relation to the construction plans.

Typically preconstruction meetings are held after construction plans have been approved by regulatory agencies. This manual is focused on environmental and natural resource issues; however a preconstruction meeting is not limited to this topic alone and can be beneficial to the overall coordination of the project. The intent of this section of the storm water manual is to focus on coordination of storm water issues and environmental aspects of the project.

As noted above, all projects should start with a preconstruction meeting. Preconstruction meetings can prevent or preempt many problems commonly associated with construction sites. Pre-construction meetings are an opportunity for all interested parties to meet face to face. These meetings help establish working relationships and provide a strong foundation for open communication with all parties involved in the project.

Preconstruction meetings should focus on design components, storm water quality issues, environmental issues, and other project components that warrant interaction and coordination between parties involved in project development and implementation. Plans are often designed without considering the dynamics of a construction site or the manner in which a contractor will approach work at the construction site. From the contractor’s perspective, “Does the plan make sense?” There should be dialogue between the plan designer and contractor(s) to exchange ideas and solutions. This dialogue is generally initiated by the plan designer. Project site managers and inspectors also have an interest in these discussions because eventually they will be responsible for implementation of the plan and overall management of the site. The closer the working relationship between all project participants, the more successful the project.

Potential participants in preconstruction meetings include but are not limited to project site owners or their representatives, plan designers, project engineers, site managers, general or primary contractors, construction foremen/managers, subcontractors, key construction staff, utility representatives, and local and state regulatory officials.

Construction plans should be the focal point of a preconstruction meeting. Participants should receive copies of the construction plans and have ample time to review them prior to the meeting. When reviewing the plans, participants should pay special attention to construction phases, design drawings, details and specifications of construction elements, the sequence of construction, and other key elements that are associated with the project.

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PRECONSTRUCTION MEETINGS

Preconstruction Meeting Guidance

* Develop a meeting agenda.

* Introduce all attendees and identify their role in the project.

* Hold the meeting at or near the site. It can be advantageous to hold the meeting at a facility that enables formal presentations of project details. However, it is also important that time is spent walking the entire project area to familiarize everyone with the project and the site conditions.

* Take minutes of the meeting and record all issues and decisions. Assign responsibility for each action item and assign one individual to ensure that all actions are addressed according to schedule.

* Changes that are made during the meeting may need approval from the regulating entity. If those changes are required through plan modification or other means the project site owner or their representative should submit the information to the appropriate regulatory authority. Additionally, project changes may also prompt the need for amended or additional permits to conduct a specific activity. It is the responsibility of the project site owner or their representative to investigate the need for additional permits and obtain those permits.

* Develop a directory of all participants (see the Project Resource Directory section on pages 8-9 in this chapter).

Topics & Information to Be Covered

* Discuss the scope of the project, including goals and objectives.

* Designate individuals who will be responsible for critical issues associated with the project.

* Identify who is responsible for the implementation of the storm water pollution prevention plan, including proper installation and maintenance of storm water quality measures.

* Identify who will have daily responsibility for inspection of project activities on behalf of the project site owner.

* Identify a designated individual(s) who will specifically communicate with regulatory agency personnel.

* Review the construction plans, including the storm water pollution prevention plan.

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PRECONSTRUCTION MEETINGS

* Discuss construction operations, including plans and schedules for clearing, grading, and cut and fill operations.

* Identify and discuss the limitations of construction activities.

* Identify all buffers and/or natural areas that are to be protected. Discuss the measures that have been identified for protection of these areas and re-enforce that these areas are not to be used for staging, parking, material storage, waste disposal, or other unintended uses.

* Discuss all significant resources within the watershed and identify construction limits and storm water quality measures chosen to minimize environmental impacts to these resources.

* Review and discuss storm water quality measures that are to be implemented, including location, design standards, installation procedures, and maintenance requirements.

* Review and discuss the construction sequence, especially the relationship between land disturbance and the installation of appropriate storm water quality measures. All parties should understand the construction sequence. Elements of the construction sequence that may cause conflict in the overall operational procedures of the project should be discussed and addressed so that revisions to the plan can be made.

* Explain phasing of any project operations.

* Identify and locate existing utilities. If utilities are to be relocated, coordinate the operation with the appropriate utility representative.

* Review all permits associated with the project.

* Ensure that everyone has a clear understanding of permit conditions and requirements.

* Verify that all appropriate permits have been obtained.

* Explain the status of any permits that have not been applied for or that are pending approval. Explain the consequences and impact that the permit will have on operations if the permits are not issued before an activity begins.

* Describe the project’s quality assurance program.

* Explain the inspection schedule that will be implemented.

* Explain the authority of the inspector and how project deficiencies will be addressed.

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PRECONSTRUCTION MEETINGS

* Additional information regarding development of a quality assurance program can be found in the Developing & Implementing a Quality Assurance Program section on pages 11-21 in this chapter.

* Review procedures for handling and storage of on-site construction materials and proper emergency response protocols in the event there is a spill or leak.

* Review other specific items applicable to the project.

Topics & Information to Be Covered

by Regulatory Authority

* Emphasize to all parties involved with the project that the storm water regulations are performance based and that they will be enforced.

* All storm water quality measures should be installed according to the plans and the sequence of construction.

* Additional storm water quality measures may be required beyond the scope of the plan to address those issues that could not be predicted during plan development.

* Explain the regulatory process to all parties.

* Make sure everyone understands regulatory procedures including submittal of paperwork and official notifications that will occur.

* Explain the process for changing or modifying plans. Discuss pre-approval of plan modifications and who is responsible for approving the modifications.

NOTE: This process may vary based on local and state regulations because it is the responsibility of the regulatory agency to establish criteria and procedures in accordance with their ordinances, rules, and laws that establish their authority. In fact, some regulatory authorities may not require any pre-approval for the change or modification of plans.

* Advise participants that inspections for compliance will be conducted and explain the procedures that will be used to conduct inspections.

* Discuss the consequences of non-compliance.

Project Resource Directory

A project resource directory should be created for every project. A project resource directory is a document containing information that can be used to expedite response times to emergencies, project site problems, and other project

8 Chapter 6 October 2007

PRECONSTRUCTION MEETINGS

related issues. A typical project resource directory includes the names, mailing addresses, phone numbers, e-mail addresses, and fax numbers of various individuals involved in the project. The directory normally includes the project site owner, project engineer, primary contractor, site managers, project inspector, subcontractors, and regulatory and enforcement personnel. In addition to this information, the directory should include the responsibility of each individual.

If plan implementation and the project are to be successful, it is essential that everyone involved with the project understand the construction plans, their role and responsibility in the project, and the roles and responsibilities of others involved with the project.

October 2007 Chapter 6 9

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DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

esponsibility for storm water management does not end with the installation of storm water measures. Storm water measures require a high level of maintenance if they are to function efficiently. In general, failure to monitor and maintain storm water quality measures is the primary reason for their failure. Therefore, to ensure that the storm water measures function as designed, a quality assurance plan should be developed and implemented on every project.

A quality assurance plan should outline site management strategies, including inspection and maintenance of the individual storm water management measures. It is also important to designate a person or persons responsible for implementing the quality assurance plan. They should be responsible for ensuring that storm water quality measures are installed at appropriate times and in a timely manner, that the measures are functioning properly, and that the measures are properly maintained.

This section of the storm water manual provides insight into the development and implementation of a quality assurance plan, including an inspection and maintenance program for the overall construction project. Maintenance requirements for individual erosion and sediment con-trol/storm water management measures can be found in Chapter 7, and the requirements for individual, structural post-construction storm water management measures can be found in Chapter 8.

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DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

Contents of a Quality Assurance Plan

An effective quality assurance plan contains two key components. The first component focuses on coordinating plan implementation. The second component focuses on the inspection and maintenance of each storm water measure. Each of these components has specific criteria that should be included in their respective sections of the quality assurance plan. Following is a brief listing of some of these elements.

Elements that should be included in the plan implementation section of a quality assurance plan includes, but is not limited to:

* A description of the process that will be used to ensure long-term maintenance of storm water measures, including those implemented for erosion and sediment control.

* Backup contingency plans that can be implemented in the event that supplies are unavailable for the timely installation of specific storm water management measures and the name(s) of the individual(s) responsible for authorizing and performing emergency or corrective actions.

* Provisions for educating all parties associated with the project. Contractors will be involved in a wide array of construction activities throughout the project site and may observe deficiencies or problems. They should be aware of the importance of the quality assurance plan and who to contact when they have concerns.

Elements that should be included in the inspection and maintenance section of a quality assurance plan include but are not limited to:

* Identification of all storm water measures, including erosion and sediment control measures, and critical areas to be inspected.

* An inspection schedule for each construction activity and each storm water measure.

* Instructions for regularly scheduled maintenance and repair of each storm water measure, including the procedure for the repair, who is responsible for the repair, and who should be notified of the repair.

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DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

Responsible Staff or Personnel

The individual or individuals designated as the project manager/inspector responsible for implementing the quality assurance plan should be identified early in the process. This individual(s) should be knowledgeable and experienced in erosion and sediment control principles, storm water management, and the installation, function, and maintenance of all storm water measures. The quality assurance plan project manager/inspector should also be familiar with all environmental permits and permit requirements associated with the project.

The project manager/inspector should have a clear understanding of their responsibility to inspect and document site deficiencies, their authority to initiate changes in the field, and if there is a monetary limit associated with the required corrective actions they can initiate.

Once the authority of the project manager/inspector has been established, it should be made known to all contractors and subcontractors associated with the project. Regulatory inspectors should also be notified who the project site owner has designated as the project manager/inspector and what authorities and responsibilities have been granted to this individual.

Installation & Oversight

Project site management involves more than just implementing the storm water pollution prevention plan. It also requires that someone supervise and oversee the implementation of erosion and sediment control measures, on-site construction activities that may generate other pollutants, and post-construction storm water measures.

Project managers/inspectors should be familiar with the project’s storm water pollution prevention plan, including the location of all storm water measures and when they are to be installed. He or she should also be knowledgeable about specific locations within the project site that pose a threat for the discharge of pollutants off-site or to a water of the state. In order to achieve full implementation of the plan, it is necessary for the project manager/inspector to coordinate all construction activities with contractors and subcontractors working on the project site. He or she should ensure that the plan is implemented in accordance with the project’s construction sequence schedule and that appropriate storm water management measures are installed in conjunction with associated land-disturbing activities.

The project manager/inspector should oversee the installation of all storm water measures to ensure that they are installed according to the standards and specifications contained in the storm water pollution prevention plan. For the storm water measures to function efficiently and effectively, it is critical that they be continuously monitored and evaluated.

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DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

Inspection

It is not uncommon to have an excellent storm water pollution prevention plan only to find that an oversight was made in a specific area. The purpose of on-site inspections is to provide the project site owner and/or their representatives with a process to monitor and manage the construction project and address such oversights. Regularly scheduled inspections are essential to maintaining the efficiency and effectiveness of the construction site storm water measures.

An on-site inspection consists of evaluating all storm water measures to ensure they have been installed correctly and that they are functioning properly. Inspections are also a valuable tool for monitoring the implementation of the construction sequence schedule and ensuring that the storm water measures are installed at appropriate times.

To ensure the integrity of storm water measures, it is critical to identify measures that are in need of repair and to identify any areas where additional measures should be implemented to correct a problem. Installed measures will be of little or no use if they have not been properly maintained. Some common reasons why storm water measures often fail include:

* Measures were not adequately maintained.

* Extreme weather conditions.

* Damage from equipment operated by contractors and/or subcontractors.

* Inadequate analysis of the site.

* The design of the measure does not fit the site conditions.

* Measures were incorrectly installed.

* Measures are inadequately sized.

* Improper materials were used.

When implementing an inspection program, it is important to remember that storm water pollution prevention plans are dynamic documents and that it may be necessary to modify some storm water measures or even add additional measures throughout the life of the project.

One final thing to remember in regard to inspection programs is that they are one of the most effective methods for ensuring that all construction activities are in compliance with local, state, and federal regulations.

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DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

Inspection and Maintenance Timeline

Quality assurance plans should include a specific schedule for monitoring activities associated with the construction project. The plan should also outline procedures to assure that soil erosion and sediment control measures and storm water management measures are functioning properly.

Once construction activities have begun at a project site, it is not uncommon to have the focus of on-site personnel shift from the storm water pollution prevention plan to other issues associated with construction activities. Therefore, it is critical to establish and implement a schedule ensuring that routine inspections are completed in a timely manner. There are two types of inspections (routine and non-routine) that are critical to the success of a project.

Routine Inspections

Routine inspections are performed at regularly scheduled intervals to ensure that each storm water measure is functioning properly and that construction activities at the project site are in conformance with the storm water pollution prevention plan. At a minimum the entire project site should be inspected weekly during active construction. While this is the minimum requirement, there are several storm water measures that may require more frequent inspection. To maintain the integrity of these later measures, it may be necessary to adjust or increase the frequency of the inspection intervals. Inspection and maintenance guidelines for individual erosion and sediment control measures are provided in Chapter 7 of this manual. Structural post-construction storm water quality measure inspection and maintenance guidelines are provided in Chapter 8.

Non-Routine Inspections

Non-routine inspections are inspections that are conducted in response to a rainfall event or in anticipation of a rainfall event. Non-routine inspections should be conducted following each measurable rainfall event. As a general rule, measurable rainfall events are defined as one-half inch or more of precipitation. In some jurisdictions, the local regulatory authority may have more stringent rules that require more frequent inspections.

Non-routine inspections conducted following a measurable rainfall event are done to ensure that all storm water measures are performing adequately. The inspection should focus on identifying measures that need to be repaired or replaced and areas within the project site that may be contributing to off-site discharge of sediment or other pollutants.

Non-routine inspections conducted prior to a predicted storm event are done as a precautionary measure to ensure that all storm water quality measures are in

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DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

working order. In most situations, it is easier to take corrective action before a rainfall event rather than following the event.

Conducting non-routine inspections requires monitoring rainfall events. The easiest way to achieve this is to install a rainfall gauge on the project site. Rainfall gauges should be unobstructed and located away from trees, buildings, and construction equipment. The gauge should be placed atop a sturdy stake or pole and should be emptied after each rainfall event. Rainfall records should be maintained as part of the quality assurance plan and project files. Rainfall data can either be entered directly on the inspection report or tracked on a separate data log.

In addition to routine and non-routine inspections consideration should be given to inspecting the project site after each phase of construction. Below is a list of general guidelines for establishing a construction phase inspection schedule.

* Initial inspections should be performed prior to land grading to ensure all required storm water quality measures have been installed according to the plan.

* Rough grading inspections typically occur during land grading operations and the installation of infrastructure.

* Storm water pollution prevention plan compliance inspections are conducted after sediment traps and other storm water management control measures have been installed and during seeding operations.

* Final grading inspections are conducted when all grading has been completed and drainage systems, paving, and infrastructure have been installed.

* Final stabilization inspections are completed to ensure that all temporary storm water quality measures have been removed, permanent vegetation is established, and permanent storm water quality measures are installed and functioning properly.

Conducting Inspections

Inspection programs can be implemented once an inspection schedule has been finalized and appropriate personnel are in place.

The quality assurance plan project manager/inspector should be familiar with the overall project site and the implementation of the storm water pollution prevention plan, including when all storm water measures are to be installed in relation to grading activities and other construction activities associated with the project. It is especially important that the project manager/inspector be familiar with areas of the project where there is potential for sediment and other pollutants to discharge from the site. This should include areas of concentrated flow or dis

16 Chapter 6 October 2007

DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

charge points that have the potential to impact sensitive resources or adjacent properties. Areas of ingress/egress to the project site are another area that needs to be closely monitored and maintained to ensure that tracking of soil material from the site is minimized.

Following is a list of key elements that should be monitored and evaluated when conducting on-site inspections.

* Evaluate the overall effectiveness of each storm water measure and that it meets the design criteria established in the storm water pollution prevention plan. The effectiveness of erosion control measures should be evaluated based on the condition of vegetative cover or evidence of erosion. Effectiveness of sediment control measures will be based on the presence of sediment behind or within the sediment control measure. Each storm water measure should be evaluated to ensure that:

* Each measure has been installed correctly and to the standards and specifications outlined in the storm water pollution prevention plan.

* Each measure is functioning and/or performing properly.

* Measures have not been damaged.

* Each measure has not exceeded its maintenance requirements.

* Deficient measures noted on prior inspection reports have been appropriately addressed and corrective actions taken.

* Measures posing an off-site pollutant discharge threat are identified.

* Evaluate construction activities that may impact the implementation of the storm water pollution prevention plan. Construction and land-disturbing activities are dynamic processes. Sites subject to grading and earthmoving operations can drastically change drainage patterns and increase the size of the drainage area above a storm water management measure. If it is anticipated that the drainage area above a storm water management measure will increase significantly once construction activities begin, the measure within the watershed should be designed to accommodate the additional storm water runoff. If the increased size in the drainage area was not anticipated, it will most likely be necessary to adjust or modify the design of the existing storm water measure and/or install new or additional measures. The project manager/inspector must be cognizant of all land-disturbing activities and must be prepared to make field modifications as the situation warrants.

* Assess areas left void of protective cover. Erosion control is the most effective form of sediment control. Areas that have been brought to final grade or that will remain idle for a period of time (e.g., 15 days or more; local ordi

October 2007 Chapter 6 17

DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

nances may be more restrictive) should be stabilized as quickly as possible. If areas can not be stabilized quickly because of weather, construction activities, or other site conditions, the project manager/inspector should be prepared to offer alternatives to address the area of concern.

* Evaluate areas that have been stabilized. Vegetative measures should be evaluated in the early stages of growth to determine the viability of the stand. Evaluate vegetation to determine if there is a need for reseeding, application of fertilizer or lime, or other maintenance items.

* Good housekeeping is another important aspect to any project. The

project manager/inspector should always be aware of the other activities at the site that may generate pollutants. This includes but is not limited to chemical storage, waste disposal, concrete washout, and on-site fuel storage. An effective approach to evaluating these types of pollutants includes verifying the adequacy of trash receptacles, reviewing waste disposal practices and procedures (recycling, hazardous waste bins, etc.), reviewing spill prevention plans, and checking the use and integrity of containment systems.

Once deficiencies and issues have been identified and documented, corrective actions need to be taken to ensure the integrity of the storm water measures. Some of these actions include:

* Removal of sediment from sediment control structures.

* Replacement or repair of damaged measures.

* Repair of damaged surface stabilization measures.

* Revised or modified procedures for clean-up of spills and improper handling of project site waste.

Follow-Up and Corrective Actions

One of the most critical steps of any inspection is follow-up and implementation of corrective actions. An inspection may indicate that an existing storm water quality measure is ineffective. A measure that is ineffective or has failed requires immediate corrective action(s). Depending on the severity of the situation corrective actions may require a re-assessment of the impacted area and modification of an existing measure or selection and design of a new measure. The project manager/inspector is the best qualified individual to oversee and coordinate corrective actions. In most situations, he or she can identify who is responsible for taking actions to correct the deficiencies, provide guidance and direction in correcting the deficiency(ies), select alternative measures, and make recommendations. This individual should also be available to meet on site with the project engineer, site designer, and/or contractors to clarify documented deficiencies

18 Chapter 6 October 2007

DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

and resolve issues that may be associated with the required corrective actions. However, not every situation will warrant a field meeting. Often, issues can be resolved through a telephone call or e-mail.

Some corrective actions may require engineering and design. Therefore, the project manager/inspector may need to coordinate with the project engineer and or site designer to make the appropriate changes. These design changes may also require modification to the construction plans and/or storm water pollution prevention plan.

Corrective actions should be scheduled within 24 hours of an inspection. This is especially true in situations where pending storm conditions are apparent. Deficiencies should be prioritized and corrective actions planned for the most serious deficiencies first, followed by corrective actions for all areas of concern. It is very important to have routine maintenance materials and supplies available at the project site if corrective actions are to be made in a timely manner. Items and materials that should be readily available to project personnel include but are not limited to seed, mulch, and silt fence. Some structural repairs are not always easily corrected, but these types of situations should be anticipated and procedures in place for addressing the area of concern.

Inspection & Project Documentation

When conducting an inspection it is important that the project manager/inspector document his or her findings through a written inventory report or an inspection log.

Information included in the inspection report should include but is not limited to:

* The name of the project manager/inspector.

* Qualifications of the project manager/inspector (may be required by local regulating authorities).

* Date and time of the inspection.

* Weather conditions at the time of the inspection.

* A record of storm events (0.5 inches or more) that have occurred since the last inspection.

* Overall condition of the construction site.

* The condition of each storm water measure and/or area of the project.

* Identification of project areas that may require an alternative storm water quality measure(s) or installation of a measure(s) that had not been identified on the original plan.

October 2007 Chapter 6 19

DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

* Required or recommended maintenance actions needed for each storm water measure.

* Actions taken to address deficiencies.

* Recommendations for corrective action; and/or

* Corrective action implemented to address the deficiencies.

* Maintenance and repair activities that were performed since the last inspection, who they were performed by, and the condition of the measure.

* Recommendations to amend the plan if unexpected conditions are present that require attention.

* Documentation showing who was given responsibility to address each deficiency.

* Documentation showing who received copies of the report.

* Statement of certification by the inspector that the report is accurate and true.

As the project manager/inspector evaluates a project, he or she should record all their observations. For ease of recording, site inspections can be documented using a standard inspection form or using a small tape recorder. If a tape recorder is used during the evaluation, the information should be transcribed into a written report as soon as possible after the inspection is completed.

A camera can be an invaluable tool for documenting activities and problems observed during the inspection. Digital cameras are particularly well suited for use on construction site inspections. They are small, easy to use, and can provide immediate visual documentation. Pictures should clearly show the deficiency(ies) observed and there should be a clear cross-reference between the photographs and the inspection report.

It is important that inspection logs and/or reports used on the project site meet the individual needs of the project manager/inspector and the project site owner. Reports should adequately represent the project site and should be written in a clear, concise manner. References, deficiencies, and corrective action should be recorded in adequate detail and at a level that is easily understood by project site owners, contractors, and others who need to understand the corrective actions recommended. In some situations, inspection reports may include specific standards and specifications that provide maintenance and/or installation requirements for storm water management measures.

20 Chapter 6 October 2007

DEVELOPING & IMPLEMENTING A QUALITY ASSURANCE PROGRAM

Retention of Project Records

From the very start of a project, all reports and correspondence should be filed in a project site logbook or project file. The purpose of a logbook or project file is to maintain a written record of all correspondence, telephone logs, site inspections, corrective actions and other documents related to the project. Project logbooks or project files should also include all correspondence and inspection reports received from the local regulatory authority, including all corrective actions taken in response to deficiencies noted on the local regulatory authority’s on-site inspection reports. A well-maintained logbook or project file will serve as a record of performance and compliance with the storm water pollution prevention plan and local, state, or federal regulations applicable to the project.

It is recommended that all project site records be maintained for a minimum of three years following termination of the project, unless specified otherwise by a regulatory requirement or legal counsel. On some projects it may be necessary to maintain project site records for longer periods of time, especially if there is a pending enforcement or legal action against the project.

October 2007 Chapter 6 21

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PROJECT CLOSURE

roject closure is the culmination of construction activities and the final step associated with a project. As construction activities are brought to a close it is important to verify that the project has been built as designed and that any outstanding issues are resolved prior to equipment being removed from the project site.

One of the first steps in the project closure process is to review all project documentation, including project logs and inspection reports, to ensure that all requirements, conditions, and specifications have been met. If there are any outstanding issues, they should be addressed and appropriate actions or measures taken.

In addition to reviewing project documentation, project representatives should make a field assessment of the project and develop and implement a final closure plan for the project site. The field assessment should include the following:

* An assessment of the overall condition of the project, including but not limited to density of vegetation, proper disposal of all accumulated waste and debris, and removal of accumulated sediment.

* All storm water management systems (e.g., storm sewer systems) should be in working order.

* All storm water measures that will remain as permanent features at the site should be evaluated to ensure that they will function according to design standards. This may require the removal of sediment and other debris from the system.

* Any measures that were modified to treat runoff during construction should be returned to the original design specifications so that they function to meet the objectives of post-construction treatment.

* Once construction and all land-disturbing activities have been completed and the area has been stabilized, remove all temporary erosion and sediment control measures in a manner that minimizes land disturbance. Areas left void of protective cover due to the removal of a measure should be stabilized immediately.

The process used to verify a site is properly closed is primarily left to the project site owner and/or their representatives. One option is to hold a closeout meeting at the site with key individuals that have been involved with the project. Attendance at this meeting should include but is not limited to the owner of the project, design engineer, contractors, local planning, staff, and regulatory inspectors.

While the overall purpose of project closure is to ensure that all construction activities are complete, areas are stable, and everything is in working condition, there may also be regulatory requirements that need to be met. Regulatory agencies may require an on-site inspection to ensure that permit conditions have been met before they sign off on a project. If a final inspection is required, it is important that all regulatory requirements be fulfilled prior to scheduling the inspection.

October 2007 Chapter 6 23

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Course Description

ABB University Australia

Measurement & Analytics

Z2301 PGC5000 Operations & Maintenance Training

Overview

Part of the global initiative program by ABB is to ensure all ABB customers are adequately trained on the product / equipment’s supplied to users. ABB Australia is committed to this global initiative and are organising a training course on the PGC5000 series Gas Chromatograph, basic Operations & Maintenance training for customers in Australia and the South Asian region.

This training program is designed to train the participants on the understanding of Gas Chromatography and an introduction to the PGC5000 in terms of operation, service and troubleshooting.

Course Duration

The duration is 3.5 days.

Course Type

This is an instructor led course with approximately one

third consisting of hands-on activities.

Course Goal

The goal of this course is to give students a practical understanding of the PGC5000 Process Gas Chromatograph.

Training Location

ABB Australia

Measurement & Analytics Training Room

Bapaume Road

Moorebank, NSW, 2170

Australia

Training class hours & Refreshments

9.00am - 4.00pm

Morning tea, lunch & refreshments will be supplied

during training.

Materials

Training equipment, materials and manuals supplied

by ABB Australia.

Class Size

3 to 6 Students

Course Fee & Inclusions

A$4,395 per student

LBU Training Administrator

Joann Skinner

Ph: 02 9753 7970

Email: joann.skinner@au.abb.com

LBU Training Manager

Michael Tooher

Ph: 02 9753 7968

Mob: 0407 479 013

Email: michael.tooher@au.abb.com

LBU Service Manager

Adrian Mather

Ph: 02 9753 7963

Mob: 0408 565 794

Email: adrian.mather@au.abb.com

Scheduled Dates

Please refer to the back page of this flyer for the current

year training calendar.

Please contact above or your local ABB representative to book & secure a seat on these scheduled courses. You can also confirm a slot for candidates by emailing or faxing the completed registration form (page 3) as soon as possible.

Course Description

ABB University Australia

Measurement & Analytics

Z2301 PGC5000 Operations & Maintenance Training

Who Should Attend?

The training is intended for end user analyser technicians, operators or engineers responsible for the operation of the PGC5000 Process Gas Chromatograph.

Course Objectives

Upon completion of this course, student will have a basic understanding of the operation of the PGC5000 Process Gas Chromatograph. In addition, they will be able to utilise the unique benefits and features of the analyser.

Main Topics

* Introduction to PGC5000 Gas Chromatography

* Hardware components and function

* Software architecture & operating platform

* Function Tabs familiarization

* Programs & Associated directories

* Function Set-Up & Operating procedure

* PGC5000 Controller & Oven operating procedure

* Multifunction CAN-bus Network within the

Controller & Oven

* PGC5000 & Sample Conditioning system control sequence

* Data Control & Filing format procedure

Course Description

ABB University Australia

Measurement & Analytics

Z2301 PGC5000 Operations & Maintenance Training

REGISTRATION FORM

COMPANY DETAILS

Company Name: Mailing Address:

ABN:

Phone Number:

Please Check One: ? Customer

Fax Number:

* Representative

Email Address:

* Internal Staff

CLASS RESERVATION

Date of Class:

Level of Experience with GC’s (Please Check One):

Name of Individual:

* <

1 year

Expert

Contact Number:

* >

Email Address:

Name of Individual:

* <

1 year

Expert

Contact Number:

* >

Email Address:

Name of Individual:

* <

1 year

Expert

Contact Number:

* >

Email Address:

Name of Individual:

* <

1 year

Expert

Contact Number:

* >

Email Address:

Name of Individual:

* <

1 year

Expert

Contact Number:

* >

Email Address:

Course Description

ABB University Australia

Measurement & Analytics

Z2301 PGC5000 Operations & Maintenance Training

2017 PGC5000 SCHEDULED TRAINING

Tuesday 7t' February – Friday 10t' February 2017

Tuesday 4t' April – Friday 7t' April 2017

Tuesday 6t' June – Friday 9t' June 2017

Tuesday 8t' August – Friday 11t' August 2017

Tuesday 10t' October – Friday 13t' October 2017

INT. J. SOCIAL RESEARCH METHODOLOGY, 2002, VOL. 5, NO. 3, 193 ± 197

Editorial

Qualitative research and computing: methodological issues and practices in using QSR NVivo and NUD*IST

COLM CROWLEY, ROM HARRE´ and CLARE TAGG

Software for qualitative research has now existed for just over two decades. However, the research community often continues to be sharply divided about its use, with, on the one hand, those who believe qualitative software is an anathema and on the other, its enthusiastic champions. On the electronic discussion lists such as QUALRS_L, QUAL-SOFTWARE and QSR-FORUM, polarized opinions for or against can be so robustly expressed that the more subtle impacts of specialist software for qualitative research can be obscured.

A number of key concerns centre on the loss of data, at the extreme by turning words into numbers. These concerns are about both the losses involved in putting data into the computer and about the abstraction that occurs once the data are in the computer. Data loss is not unique to qualitative software (it routinely occurs when tapes are transcribed or field notes are typed, for example) but some software, by only accepting plain text, can certainly cause further loss: for example underlining, italics, bold or those comments in red ink are not available. Other software, however, accepts rich text, thereby supporting such distinctions in writing, just as contemporary word processing software does. One of the characteristics of qualitative research is the abstraction of ideas from data, but the question is whether qualitative software is merely assisting in this process, or if it is somehow actually driving the abstraction in unintended ways. The answer is, it depends upon the user, but software can both assist with and enrich the abstraction. Computers can count very easily so it can be tempting to substitute numbers for words, but whether this is undertaken depends on the user not the software. Moreover, use of software opens up the opportunities for mixed methods.

There are those, particularly in disciplines where qualitative research is in its infancy, who espouse the view that use of software makes research more reliable or robust. This depends upon how the software is used, although it could be argued that (any) use of such software makes analysis more visible, thereby enhancing transparency, and so the quality of evidence and argument might be more easily judged. This is another example of a deeper issue: is the software just a tool or does it in some way drive the research? In this matter we would argue for the middle ground.

International Journal of Social Research Methodology

ISSN 1364-5579 print/ISSN 1464-5300 online # 2002 Taylor & Francis Ltd

http://www.tandf.co.uk/journals

DOI: 10.1080/13645570210146258

194 EDITORIAL

The user is obviously in control of current qualitative software, as existing packages do not contain elements of artificial intelligence1—t hey do not even go as far as the kind of auto-correction that occurs in word-processing packages such as Word.2 However, use of the software in different ways will undoubtedly shape the analysis process. For example, the order in which coded text is presented for inspection may well impact on the researcher’s perceptions.

Concerns about the effects of technology on practice are not new and often lead to polarized debates between those for and against a technology. In the case of qualitative research and computing, the debate has also polarized around comparisons of different types of software and whether specific software favours or precludes particular research methods. While specific capabilities of software can either enhance or limit particular research activities undertaken with it, the leading qualitative analysis packages now provide a range of general-purpose techniques that may be used in a variety of ways to support different research approaches. Consequent challenges for users include determining how best to use the capabilities of the software to further their research goals, and being aware of and reflecting on the impact of their use of software.

To address these challenges, a series of interdisciplinary conferences on qualitative research and computing has been convened at the Institute of Education, University of London since 1999.3 This special issue brings together key papers from the last two conferences.

The aim of the conferences has been to bring together researchers conducting qualitative projects or teaching with the NUD*IST software developed by Qualitative Solutions and Research (QSR).4 The conferences have provided an opportunity to discuss methodology, share experience, develop research strategies, to report and critique the software’s use in projects (and its effects on methods), consider teaching and supervision issues and to debate and drive future directions.

The conferences (and consequently this special issue) have been explicitly restricted to issues and research emanating from the use of the NUD*IST range of software (at first N3 and N4, but more recently NVivo, N5 and N6) for the following reasons. By nominating a particular range of software, papers have been able to assume shared background knowledge rather than having to set out how the software package works. The time and repetition saved have meant that descriptions of software use have focused on its more unusual applications and on the connection with method. This focus on specific software has thus led to debate that is more about impact on method than about which software, if any, to use. The arguments presented in the papers are thus often relevant to computer-assisted analysis of qualitative data whichever package is being used.

QSR software is generally regarded as being one of the more sophisticated qualitative analysis packages (Weitzman and Miles 1995) and is well used world-wide. There are now two distinct QSR software packages (N6 and NVivo) but as explained in the first paper in this issue, these have developed from one root and use the same underlying concepts. The software provides facilities for data management, for coding and retrieving text, and for theory testing. The software is open-ended so that it

EDITORIAL 195

may be used in many different ways. In the same way that a word-processing package does not dictate whether you write a novel or a sermon, QSR software does not determine nor constitute a method despite some literature that links the software to grounded theory. However, like most of the qualitative analysis software that facilitates ‘code and retrieve’, it does provide particular support for the many methods that require the development of an organizing system (Tesch 1990).

Both QSR software packages use the document and node as central organizing concepts. The document either contains some data in textual form or represents some external data (e.g. a book, video, audio tape or still image). In NVivo, inserting hyperlinks makes it easier and faster to ‘jump’ to external data. Nodes represent ideas and may, if a coding approach to analysis is being used, be linked to marked up passages in documents. Nodes may be organized into hierarchical trees. There is sometimes a deep misgiving that the Node Tree structuring facility equates to a correspondingly hierarchic (and perhaps, equally worryingly, ‘fixed’) conceptualization, however inappropriate it might be to the investigation in hand. Others fear that, while it might not necessarily impose a hierarchic approach to substantive conceptualization, the concrete representation of the Tree system (perhaps ‘bushes’ would seem less authoritarian?) might lead less independent-minded users to reflect it unquestioningly in their conceptualization. This can lead to a deterrent ‘Down with all this sort of thing!’ position on software use, when it has not been understood that the Tree structure is simply an organizing system in the software that enables more efficient interrogation of its databases; it can be restructured very simply at any time and it can also be completely ignored and not used.

In our role as guest editors of this issue of the journal, we bring to bear a variety of experience with qualitative software, straddling a spectrum from using, teaching and supervising its use in research of different traditions, to software development. Myths about qualitative software abound—typically among research students at the outset of their methodology training, but they are not unheard of among experienced supervisors and directors of large-scale funded research. For example, the misconception that the software does something (a notion of some automated process of analysis) is not uncommon. The question of who is in charge, the software or the researcher, is tellingly reflected in enquiries such as ‘Will it let me. .. ?’ It is sometimes forgotten by those new to qualitative software that any lack in its ability to do something in particular certainly does not preclude them from including such strategies in their research. It is always possible to leave the software to one side and use other means as well—to get out of the car and perhaps walk, cycle or a take a boat for parts of the journey, as it were. It must be emphasized that, although the limitations it imposes continue to decrease, the researcher is not a hostage to qualitative software

Questions such as ‘Will the software save me time?’ and ‘Is it worth the effort of learning to use it?’ are inevitably the crux of the matter for prospective users. To address such issues users need to be informed enough about the general considerations to be able to apply them to their particular situations. It is not the remit of the articles in this special issue to dispel

196 EDITORIAL

basic misconceptions or to provide an introduction for the uninitiated. That is more appropriately the province of instructional texts and two such books relating to NVivo are reviewed. In contrast to the reference manuals produced by software developers, this literature aims to address the progressively developing questions and needs of those embarking on research with the software. Reflecting the varying backgrounds of new users, such books either assume an existing knowledge of qualitative methodology or aim to provide an introduction to methodology in conjunction with support in mastering the use of the software to serve the preferred methodology. In view of the call from the Economic and Social Research Council5 for the inclusion of instruction on qualitative software in postgraduate methodology training (ESRC 2001) the new literature will be a welcome resource.

However, some questions do not readily find space for discussion in introductory texts, and so it is on the more searching questions and specialized issues that we focus in this special issue of the journal. The articles are concerned with methodological and practical implications of using QSR software. The more technical among them presuppose a background knowledge of the software (we hope that users of other qualitative software packages will nevertheless find aspects of the discussion relevant, technical differences notwithstanding). However, the first article by Tom Richards provides a definitive account of the development of NUD*IST. The increasing power of personal computers has been exploited by the developers to both overcome the limitations of earlier versions in replicating manual methods and to extend the techniques available to qualitative researchers. Tom Richards shows how new facilities have been added to the software both in response to researcher demand and at the instigation of the developers, suggesting a push-pull relationship between computerization and the development of method.

The symbiotic relationship between the software and the researcher is a thread picked up by the next article. Linda Gilbert draws material from a detailed study of qualitative researchers experienced in using both manual techniques of analysis and NUD*IST. She thoroughly explores the debate surrounding the potential restrictions on ‘closeness to data’ imposed by the use of software and identifies three levels of ‘distance’. These findings have implications for teaching and evaluating research using qualitative software but they also show how the maturation of the NUD*IST software brings considerations of closeness and distance into sharper focus.

The question of how computerization may have encouraged greater collaboration between qualitative and quantitative researchers (noted by Tom Richards) is extended in Pat Bazeley’s article. In it she describes, by tracing the evolution of a mixed-methods project, how succeeding versions of the software have increasingly facilitated the integration of qualitative and quantitative analysis. She concludes that without developments in qualitative software it would have been virtually impossible to integrate textual and statistical analysis while retaining the richness of the data.

In the next article, Michael Rich and Jennifer Patashnick similarly conclude that their use of the software ‘significantly enhanced our ability to analyse’. They discuss a diary project involving very large quantities of

EDITORIAL 197

video, which was at first analysed manually. Their rationale for choosing to adopt NVivo for the analysis, in spite of some compromises having to be made as a result of using it, will be of interest to those faced with similar challenges. It also illustrates how functions in the software have been used to meet the particular requirements of the research project.

Neither NVivo nor N6 enable multiple researchers to work on a data set simultaneously (although colleagues can of course take turns on the computer); however, as Clare Tagg outlines in an article on working practice, separate work by researchers can be ‘merged’ using ancillary software. Four strategies are presented for using merge procedures effectively in team research.

Lyn Richards, in her article, argues that the methodological and practical implications of using qualitative software that are highlighted in this special issue are seldom discussed in the literature. She explores possible reasons for the paucity of debate about the effects of computing on qualitative methods, and outlines the potentially serious consequences for research.

We would like to thank the editors of the International Journal of Social Research Methodology for devoting a special issue to selected papers from the Strategies in Qualitative Research conference; our thanks go also to Silvana di Gregorio and Ann Lewins for editorial advice and moral support given as members of the Strategies in Qualitative Research conference committee; and to the panel of referees for the special issue who generously gave their time. We hope that this collection of articles will serve to stimulate further debate.

Notes

1. However, things move quickly in software development and as we go to press a new qualitative analysis package with artificial intelligence capabilities has been released (Qualrus2 www.ideaworks.com).

2. Microsoft Word 2000 word-processing software www.microsoft.com/office

3. www.ioe.ac.uk/conferences/strategies for information on previous and forthcoming conferences (the next conference in the series takes place on 8 – 9 May 2003).

4. Qualitative Solutions and Research (QSR International), Melbourne, Australia www.qsrinternational.com

5. The Economic and Social Research Council (ESRC) is one of seven research councils established under Royal Charter in the UK. As part of its brief it supports postgraduate training in the social sciences through research studentship funding and through guidelines for postgraduate training: www.esrc.ac.uk

References

ESRC (2001) Postgraduate Training Guidelines, third edition (Swindon, UK: Economic and Social Research Council).

Tesch, R. (1990) Qualitative Research: Analysis Types and Software Tools (Basingstoke: Falmer). Weitzman, E.A. and Miles, M.B. (1995) Computer Programs for Qualitative Data Analysis: A Software Sourcebook (Thousand Oaks, California: Sage).

PEDIATRIC ANESTHESIA MANUAL

A.Matveevskii, S.White

Second edition

2007

Introduction

The purpose of the pediatric anesthesia rotation is to provide an initial exposure to a variety of pediatric cases. The length of this rotation, 4 weeks, is enough to allow participation in the care of about 100 patients. Residents on this rotation should be able to develop skills for setting up OR’s for pediatric patients of different ages and should master skills in mask ventilation and intubation of pediatric patients including neonates. Topics for discussion should include neonatal emergencies, pediatric airways, ENT cases, general surgical cases, and questions from written and oral boards. One of the goals of this rotation is to prepare residents for routine “bread and butter” cases, to be safe with pediatric patients, and to be able to identify situations in which he or she might need help.

Content

OR set up for pediatric cases

Preoperative evaluation

Prematurity

Premedication

Equipment, monitoring and set up

Fluids, electrolytes and transfusion therapy

Emergence and recovery

Newborn physiology and development

Anesthesia for otolaryngology surgery

Anesthesia for ophthalmic surgery

Anesthesia for children with musculoskeletal disorders

Anesthesia for children with congenital heart disease

Anesthetic management children with hematologic and oncologic disorder

Delivery room resuscitation

PALS

Anesthesia and sedation outside of OR (new)

Anesthesia for ambulatory surgery in children (new)

Pediatric pain management (new)

Written exam questions

Oral exam questions

OR set up for pediatric cases/Shands Hospital/

For pediatric cases, the OR should be warmed, as high as 85 F for neonates and especially premature patients. Warming lights, a circulating water warming blanket on the OR table, and an infant forced air warming blanket (“Bair Hugger”) may be helpful. The anesthesia machine should be preset for ventilation of small patients. Pressure controlled ventilation may be the best choice- since it will deliver whatever volume will generate the set pressure (such as 20 mm Hg). Be SURE the ventilator is NOT set to deliver an adult volume (which could cause pneumothorax in an infant). Monitors should be changed appropriately, to neonatal or pediatric, with alarms adjusted. All tools for intubation should be appropriate size including blades (Miller or WH), masks and ETT. ETT size should be 4 + (age in years/4). You can confirm that the ETT size is appropriate by comparing the tube to the external nare or the diameter of the little finger. Normal newborns can accommodate a 3.5 ETT. {The marking that should appear at the lips should be 12 plus [age in years/2]. For tiny infants the distance should be 6 plus the weight in kg.} You should have a stylet in the ETT you plan to use, and have available two other ET tubes, one size larger and one size smaller. You will need a selection of different size airways and a tongue blade. The wrong size artificial airway can obstruct the child’s airway. An oral airway that is too small can indent the tongue and push it back into the hypopharynx, effectively preventing air exchange. An oral airway that is too long can touch the tip of the epiglottis and cause laryngospasm. When measuring the oral airway on the outside of the jaw, make sure that the tip will not extend past the angle of the mandible. A pulse oximeter should be the first monitor placed on the child, followed by a precordial stethoscope. The pulse oximeter will count the heart rate and also confirmation that each beat generates a pulse. When left to right shunting may occur (as in all infants), two oximeters (one on the right arm or right ear) and another on one of the other three extremities will reflect the amount of shunting occurring. The precordial stethoscope will tell you that air is moving in the trachea, the patient is not having laryngospasm (hopefully!), and the heart tones are not muffled. (Cases of previously unsuspected cardiomyopathy have been diagnosed by alert residents using precordial stethoscopes!) Also- the precordial stethoscope is an excellent monitor for transporting the patient to the Recovery Room when the pulse oximeter must be disconnected, unless clinical conditions necessitate a portable transport monitor. ECG leads should be appropriately positioned considering the location of the surgery as well as patient position. Suction should be checked and working. Suction tubing should be connected to a suction catheter of appropriate size. Be careful not to have a suction catheter that is too small.

On the anesthesia cart you should have succinylcholine, atropine, and a syringe with a mixture of succinylcholine and atropine. If you put 4 cc of succinylcholine (80 mg) with 1 cc atropine (0.4 mg) in a 5 cc syringe you will have the intramuscular dose for a 20 kg child. Half the syringe (2.5 cc) will be the dose for a 10 kg child (usually about a one year old), and 1/4 of the syringe (1.25 cc) will be the dose for a 5 kg child. Use of this syringe will be necessary extremely rarely- in the instance where a child develops laryngospasm during inhalation induction before intravenous access has been achieved. However- if it is needed, it will be needed emergently. Succinylcholine is only given in the most life-threatening circumstances in children because some children may have an undiagnosed muscular disorder that could result in hyperkalemic cardiac arrest, or MH. Propofol and paralyzing agent should also be available. Pediatric patients are more likely than adults to require dextrose in their intravenous fluids. Almost all adults will react to the stress of surgery with a rise in their serum glucose. Unfortunately, at least 15% of toddlers will react to the stress of surgery with a FALL in their serum glucose.

NICU patients may have almost no glucose stores, and generally should receive dextrose in maintenance infusions. Other patients with increased glucose requirements are children with FTT (failure to thrive- weights lower than expected on the basis of age), liver failure, or sepsis. A normal newborn should weigh about 3 kg. They should double their birthweight by 3 months of age, and triple it by one year. A normal 4 year old should be 40 pounds and 40 inches.

For a simple procedure like hernia repair, simply adding 40 cc of D5LR to the buretrol (and adding an equal amount of LR from the hanging bag to create 80 cc of D2.5 LR) should be adequate. Never use dextrose containing solutions for fluid boluses or to replace third space or intravascular volume losses. If there is any concern about procuring the airway, dextrose administration should be deferred until this has been accomplished as dextrose infusions have been associated with worsening the outcomes of hypoxic episodes.

Preoperative evaluation

Meeting pediatric patients and parents prior to induction is very important. The preoperative interview should meet the following objectives:

1. to obtain essential details of the child’s present illness and medical history

2. to assess potential anesthetic risk factors and discuss their likelihood and treatment with the patient and family

3. to initiate an anesthetic plan that is acceptable to the patient and family

4. to discuss recovery, postoperative analgesia and discharge planning

5. to allay anxiety and to establish trust and confidence with the patient and family

6. to find topics of interest to the child (pets, sports, games, TV shows)

7. to offer play therapy and tours of operating, induction and recovery rooms (if you are having the luxury of seeing the patients prior to the day of surgery)

Prematurity

Infants are considered premature if they are born before 38 weeks of gestation or

weigh less than 2500 g at birth.

Age definitions: the term newly born is used to describe the infant in the first

minutes to hours after birth; the term neonate describes infants in the first 28

days/first month/ of life; the term infant includes the neonatal period and up to 12

months.

Chronic respiratory dysfunction with risk of apnea is the most common sequela of

prematurity. Controversy persists regarding at what age former premature infants

are no longer at risk for postoperative apnea, with ages ranging from 44 weeks

PCA to 60 weeks PCA. Common problems of prematurity:

Respiratory distress syndrome/RSD/

Meconium aspiration syndrome

Apnea

Bronchopulmonary dysplasia/BPD/

Persistent pulmonary hypertension

Patent ductus arteriosus

Congenital heart disease

Necrotizing enterocolitis/NEC/

Gastroesophageal reflux

Jaundice

Anemia

Hypoglycemia

Hypocalcemia

Congenital infections/STORCH/

Group B streptococcal infection

Intraventricular hemorrhage

Neonatal seizures

Retinopathy of prematurity

Common problems of prematurity. Respiratory distress syndrome – absence or deficiency of surfactant; characterized by hypercarbia and hypoxia with resultant acidosis; may be complicated by pneumothorax, pneumomediastinum, and pulmonary interstitial emphysema.

Meconium aspiration syndrome – characterized by respiratory insufficiency, pneumonia, and asphyxia.

Apnea – absence of breathing for 15 to 30 sec, often accompanied by bradycardia and cyanosis.

Bronchopulmonary dysplasia – chronic obstructive lung disease of neonates exposed to barotraumas and high inspired oxygen concentration; characterized by persistent respiratory difficulty and radiographic evidence of diffuse linear densities and radiolucent areas.

Persistent pulmonary hypertension – pulmonary hypertension and vascular hyperreactivity with resultant right to left shunting and cyanosis; associated with cardiac anomalies, respiratory distress syndrome, meconium aspiration syndrome, diaphragmatic hernia, and group B streptococcal sepsis. Treatment: oxygen, mechanical ventilation, high-frequency oscillatory ventilation, vasodilator drugs such as tolazoline, nitric oxide, and ECMO/extracorporeal membrane oxygenation/.

Patent ductus arteriosus/PDA/ - left-to-right shunt from the aorta to the pulmonary artery through the ductal remnant of fetal circulation; commonly found in premature infants with RDS; the shunt can result in congestive heart failure and apnea.

Necrotizing enterocolitis /NEC/ - ischemic injury to intestinal mucosa, often

complicated by bowel necrosis and perforation, causing abdominal distention, bloody diarrhea, apnea, acidosis, and septic shock.

Gastroesophageal reflux – involuntary movement of stomach contents into the esophagus; physiologic reflux is found in all newborns; pathologic reflux can result in failure to thrive, recurrent respiratory problems/aspiration, bronchospasm, and apnea, irritability, esophagitis, ulceration and gastrointestinal bleeding.

Jaundice – hyperbilirubinemia from increased bilirubin load and poor hepatic

conjugation/unconjugated, physiologic/ or abnormalities of bilirubin production, metabolism, or excretion/non-physiologic/.

Hypoglycemia – blood sugar less than 40 mg/100ml, characterized by lethargy, hypotonia, tremors, apnea, and seizures.

Hypocalcemia – total serum calcium concentration less than 7 mg/100ml or ionized calcium less than 3.0 to 3.5 mg/dl; characterized by irritability, jitterness, hypotonia, and seizures.

Intraventricular hemorrhage/IVH/ - periventricular-intraventricular hemorrhage associated with immaturity and hypoxemia. Characterized by bradycardia, respiratory irregularity, apnea, seizures, and hypotonia. Treatment – shunting and supportive care.

Retinopathy of prematurity /ROP/ - vasoproliferative retinopathy seen in premature infants exposed to high concentrations of oxygen for prolonged periods. Treatment – cryotherapy or laser to the avascular retina.

Premedication

The primary goals of premedication in children are to facilitate a smooth separation

from the parents and to ease the induction of anesthesia. Other effects that may

be achieved by premedication include:

Amnesia

Anxiolysis

Prevention of physiologic stress

Reduction of total anesthetic requirements

Decreased probability of aspiration

Vagolysis

Decreased salivation and secretions

Antiemesis

Analgesia

Children greater than 10 months usually receive midazolam 0.5 mg/kg/max10-15

mg/. These medications should be given about 15-20 min prior to entering the

OR.

Dose: midazolam 0.5 mg/kg PO

0.3 mg.kg intranasal

0.08 to 0.5 mg/kg IM

0.2 mg/kg OT

1 mg/kg PR

Midazolam is commonly administered in Ibuprofen, 10 mg/kg to provide

postoperative pain relief.

Barbiturates: pentobarbital or secobarbital.

Opioids: morphine or meperidine, fentanyl; sufentanyl.

Dose: morphine 0.1 to 0.2 mg/kg IM

Meperidine 1 to 2 mg/kg IM

Fentanyl 10 to 15 mcg/kg OT

Sufentanyl 1.5 to 3 mcg/kg IN

Clonidine is an alpha-2 agonist that given in combination with atropine produces

satisfactory preoperative sedation, easy separation from parents and mask

acceptance within 30-60 min.

Dose: clonidine 4 mcg/kg PO

Atropine 0.03 mg/kg PO administered together

Hypnotics: Chloral hydrate 25 to 75 mg/kg and triclofos 70 mg/kg PO.

Anticholinergics: atropine 0.02 mg/kg IM, PO

scopolamine 0.02 mg/kg IM

glycopyrrolate 0.01 mg/kg IV, IM

Antihistamine : hydroxyzine 0.5 to 1 mg/kg PO, IM

Premedication/induction: methohexital 1%-10% solution to 20-30 mg/kg PR

Thiopental 1 to 2 mg/kg IV

Propofol 2-4 mg/kg IV (over 1 year)

Ketamine 2 to 5 mg/kg IM

6 mg/kg PO

3 mg/kg IN

8 to 10 mg/kg PR

Equipment and monitoring

Airway equipment

Circuits commonly used for children under 12 to 15 kg include Mapleson D, Bain, Jackson-Rees modification of Ayre’s T-piece and pediatric circle.

The circuits used for pediatrics were traditionally designed specifically to decrease the resistance to breathing by eliminating valves; decrease the amount of dead space in the circuit; and in the case of the Bain circuit, decrease the amount of heat loss by having a coaxial circuit with warm exhaled gas surrounding and warming the fresh gas flow.

The reservoir bag should contain a volume similar to that of the child’s vital capacity.

Airways: To determine whether an oral airway is the proper size, hold the airway beside the patient’s face with the top of the airway beside the mouth. The bottom of the airway should end just before the angle of the mandible. If the airway is too long, it may touch the epiglottis and trigger laryngospasm. If the airway is too short- it can indent the tongue and push the posterior portion of the tongue into the hypopharynx, CAUSING (rather than alleviating) upper airway obstruction.

Laryngoscopes: The use of small pediatric handle is recommended. It is less

bulky, allowing laryngoscopy to be performed while cricoid pressure is applied with the fifth finger of the same hand.

In general straight blades/Miller/ are used in infants to facilitate picking up the elongated epiglottis and exposing the vocal cords.The wider-phlanged Wis

Hippel or Robert-Shaw blades are sometimes preferred for ease of exposure.

The oxyscope has a separate port to which oxygen tubing can be attached. The light wand facilitates blind intubation of the trachea . The Bullard laryngoscope consists of a rigid blade with a fixed fiberoptic bundle. The Shikani optical stylet is a combination of a lightwand, stylet and fiberoptic scope.

Endotracheal tubes: small-diameter endotracheal tubes increase airway resistance and work of breathing. The anesthesiologist should calculate ideal tube size and have available one size larger and one size smaller.

Age/yr/+16/4 or wt/kg/+35/10

Cuffed tubes are generally not used for patients under age 8. Ultimately the proper tube size is confirmed by the ability to generate positive pressure greater than 30 cm H2O and by the presence of a leak at less than 20 cm H2O.

A stylet should be placed in the ET or be readily available to facilitate tracheal intubation.

The tube should be secured so that the second mark at the tip just passes through the cords. Extending the neck decreases tube depth (“EX”tension tends to “EX”tubate); flexing the neck deepens the tube position within the trachea.

Laryngospasm is defined as approximation of true vocal cords or both true and false cords. It is caused most often by inadequate depth of anesthesia with sensory stimulation /secretions, manipulation of airway, surgical stimulation/. Treatment includes removal of stimulus, 100% oxygen, continuous positive pressure by mask, and muscle relaxants. Usually laryngospasm will break under positive pressure but on the rare occasion that this fails, only a very small dose of succinylcholine is required for relaxation of the vocal cords, which are quite sensitive to muscle relaxation. While 1-2 mg/kg maybe required for complete relaxation, only one tenth of this will generally relax the vocal cords.

Laryngeal mask airway/LMA/ consists of a silicone tube fused to a spoon-shaped mask with an inflatable cuff. It is manufactured now in following sizes: 1. 11/2, 2. 21/2, 3. LMA is indicated in patients who are candidates for inhalation anesthesia who do not require intubation; LMA is useful in children with possibility of difficult intubation; for neonatal resuscitation; for anesthesia outside OR. Elective LMA placement may not be recommended for children under 2 years; LMA may increase dead space. ProSeal LMA available now in pediatric sizes starting from

1 1/2.

ECG: the T waves in infants are much larger, because the electrodes are situated much closer to the heart; the most prominent P wave in infants is seen in lead 3, because of R axis shift.

Blood pressure monitoring: Cuff size can be determined using the following criteria: cuff bladder width should be approximately 40% of the arm circumference; bladder length should be 90 to 100% of the arm circumference. Placement of two BP cuffs on upper and lower extremities may be recommended when there is no arterial line.

Invasive monitoring ( intraarterial catheters); Smaller catheters provide greater accuracy in monitoring, but larger are more practical for blood sampling.

Generally neonates and infants will need 24G.

Temperature monitoring. The consequences of thermal stress include cerebral and cardiac depression, increased oxygen demand, acidosis, hypoxia, and intracardiac shunt reversal.

Oximetry. Use of the oximeter is particularly important in pediatrics because of the greater tendency of the infant to develop rapid desaturation and hypoxemia. The goal of neonatal oxygen monitoring is to maintain saturation in the low 90s to minimize risks of oxygen toxicity. In infants, two probes/preductal (right ear or right arm) and postductal (left arm or either leg) will reflect the amount of right to left shunting occurring.

Gas monitoring. The ASA lists capnometry as a monitoring standard. Indeed it may be THE most important monitor, especially in patients being sedated, particularly if supplemental oxygen is being administered. Extra oxygen will be stored in the FRC, meaning that a patient can be apneic for a while before there will be a drop in oxygen saturation. Constant monitoring of ETCO2 will guarantee that apnea is

identified promptly. Also, while a patient may become noticeably cyanotic when the sat drops below 90%, there is no level of hypercarbia that is reliably clinically evident. In the recovery area, hypercarbia itself acts as a sedative and will contribute to delayed emergence. Patient pathophysiology may contribute to an increased gradient between end-tidal and arterial CO2 measurements, usually by increasing shunt and increasing dead space. ETCO2 will not accurately reflect arterial CO2 if something is interfering with delivery of CO2 to the lungs, such as pulmonary embolism (clot or air). Decreased cardiac output of any etiology will decrease CO2 deliver to the lungs. ETCO2 shows adequacy of cardiopulmonary resuscitation. Factors that increase West’s Zone I of the lungs (where alveolar pressure surpasses arterial pressure) will increase gradient. Such factors include hypovolemia (decreasing arterial pressure) and increased mean airway pressure (increasing alveolar pressure). In children with cyanotic heart disease, end-tidal underestimates arterial CO2.

Neuromuscular blockade. Infants will not display head lift or respond to

commands, even with full return of neuromuscular function. Lifting both legs may indicate that the patient can generate adequate negative inspiratory force. Nerve stimulation is recommended at the superficial ulnar nerve and posterior tibial nerve. The facial nerve is not recommended as the orbicularis oculi muscle is more resistant to blockade and if one successfully blocks this muscle, the

patient’s neuromuscular blockade may be unreversible. Also, direct muscle stimulation in this area may result in the administration of excessive amounts of relaxant.

Intravenous equipment. Small-gauge catheters are available for venous cannulation: 24G, 22G; a 25 or 27-gauge for very small premature infants. Use of a T-piece connector with stop-cock is recommended in children. It speeds delivery of medication by limiting tubing dead space. Most infants are going to have a patent foramen ovale. Because of the possibility of an intracardiac shunt, all IV’s should have air bubbles scrupulously removed. Tubing with built-in stopcocks is notorious for trapping air. It will be much easier to administer medications and remove air from the intravenous system by using a separate stopcock and attaching it to a plain piece of extension tubing. In children who weigh less than 10kg a burette/150cc/ should be used for fluid administration. For children weighing over ~15kg minidrop /60gtt/ml/ is useful. Extensions for intravenous systems are particularly advisable as intravenous access is sometimes obtained in lower extremities.

Fluids, electrolytes and transfusion therapy

Preterm and small infants have a relatively high percentage of total body water/85% in a preterm and 75% in a full-term infant/.The minimum amount of water required to meet ongoing insensible losses is 60 to 100 ml/kg/day. Preoperative assessment of the child’s fluid status is important to determine intraoperative needs. Dehydration is classified by its tonicity according to the concentration of serum sodium.

Replacement of fluid deficits: ”easy- to- use” formula – 4-2-1; 4ml for first 10kg. 2ml for second 10kg and 1ml for the rest per hour. Generally either lactated Ringer’s or normal saline is used for routine intraoperative fluid administration.

When acute intravascular volume loss has occurred, the rapid administration of 10 to 20 ml/kg of lactated Ringer’s or normal saline may be warranted.

Glycogen stores in the neonatal liver are limited and are rapidly depleted within the first few hours of life. Preterm infants may be hypoglycemic without demonstrable symptoms, necessitating close monitoring of blood glucose levels. Full-term neonates undergo a metabolic adjustment after birth with regard to glucose. Hypoglycemia is defined in full-term infants as a serum glucose concentration less than 30mg/100ml in the first day of life or less than 40 mg/100ml in the second day of life. The routine intravenous replacement solution for normal neonates contains 5- 10% dextrose.

Transfusion of blood components is indicated to increase oxygen-carrying capacity or to improve coagulation. Fresh whole blood may also be chosen for trauma patients, transplant patient, or infants needing exchange transfusion or having open heart surgery.

Transfusion reactions: Acute hemolytic reactions are usually the result of clinical errors. Extravascular hemolysis is usually seen when antibodies other than ABO are present. Nonimmune hemolysis is caused by mechanical or osmotic factors. Febrile reactions occur when antibodies against leuckocytes or platelets are transfused. Anaphylaxis is seen in patients with IgA deficiency who have anti-IgA antibodies as a result of previous transfusion.

Emergence and recovery

The primary goal of the postanesthesia care unit/PACU/ is to provide a safe environment, where patients can return to their preanesthetic homeostasis. The most important aspect of awakening is the return of cardiorespiratory reflexes: the ability to gag and cough to protect the airway, the return of baroreceptor reflexes to support perfusion, and the return of chemoreceptor responses to hypercapnia and hypoxia.

Ventilation: Upon the patient’s arrival in the recovery room, attention should be focused on patency of the airway and adequacy of ventilation.

Oxygenation: Children recovering from general anesthesia are at greater risk for hypoxia; continuous administration of oxygen during monitoring of SpO2 has been advocated for children. It may be necessary to administer oxygen and monitor SpO2 in the transfer from OR to PACU.

Normothermia: Both hypothermia and hyperthermia are common intraoperative problems, particularly in infants.

Neuromuscular Blockade: Reversal of neuromuscular blockade in toddlers and school-age children can be assessed by the same clinical indices as in adults: full train-of-four and sustained tetany on NMB monitor, inspiratory force greater than –20 cm H2O and a vital capacity of at least 15 ml/kg. Brisk flexion of the hips and knees is an indication of return of adequate peripheral muscle strength in infants. Leg lift in children may be an equivalent of head lift in adults.

Analgesia: Preverbal children cannot convey their perception of pain. Prompt treatment of pain is urged. Crying is not always an indicator of pain but may represent anxiety, hunger, thirst or nausea. Intravenous opiates are used most commonly to treat moderate to severe pain.

Control of nausea and vomiting: Nausea and vomiting occur frequently after eye and ear surgery but can occur after any procedure or anesthetic. Control of nausea and vomiting begins in the selection of agents/techniques used for anesthesia. Pretreatment with ondansetron 0.1mg/kg has been very successful in reducing nausea and vomiting for patients at higher risk/tonsillectomy, strabismus repair, or chemotherapy./ Metoclopramide is less preferred for post operative nausea and vomiting since it has a 10% incidence of dystonic reactions. { Metoclopramide 0.3 mg/kg remains useful in children who have sustained trauma (at which time gastric emptying ceases). The important time interval is the time between the last ingestion and the time the trauma occurred. In other words, if a child fell off his bicycle at 7 pm and hadn’t had anything to eat since 11 AM, he would not be considered to have a full stomach. On the other hand, if he had just eaten dinner at 6 pm- he will continue to have a full stomach for many hours (possibly even more than 24 hours). This latter child is one who might benefit from metoclopramide (“chemically emptying the stomach”). However, the risk of dystonic reactions must be considered.}

Newborn physiology and development

Circulatory changes at birth: Expansion of the lungs, increased Po2 to 60 mm Hg, and release of vasoactive substances and arachidonic acid metabolites lead to an 80% decrease in the PVR. As a result, both pulmonary circulation and oxygenation increased dramatically. Amputation of the placenta results in an increase of systemic vascular resistance. The ductus arteriosus will constrict in 90% of term neonates in the first three days of life as Po2 increases, pH becomes less acidotic, and the placental contribution of prostaglandin/PGE2/ ceases. The increase in pulmonary blood flow will result in increased blood volume in the left atrium and subsequent closure of the flap of the foramen ovale.

The cardiac output of the neonate is dependent upon heart rate and left ventricular filling pressure. Infant ventricular myocytes can not increase contractility, so heart rate and volume status determine output. The neonate can achieve twice the cardiac output of the fetus with volume loading and heart rate increases. At birth, the lungs undergo the transition from a fluid-filled organ to an air-filled organ for gaseous exchange. In order to overcome surface active forces and fully expand the lungs, the neonate must generate negative intrathoracic pressures of up to 70 cm H2O.

Tidal volume is the same for neonates and adults/7 to 10 ml/kg/. Because neonatal oxygen consumption is two to three times that of the adult, respiratory rate must be increased proportionally. The high minute ventilation/FRC ratio may result in rapid desaturation in the neonate during periods of apnea or airway obstruction. Neonatal closing volumes are higher than for adults.

In infants less than 3 weeks of age, hypoxia initially stimulates ventilation, followed by a decrease in ventilation. After 3 weeks, hypoxia causes sustained hyperventilation.

Large surface area, poor insulation, a small mass from which heat is generated, and inability to shiver place newborn at a disadvantage for maintaining temperature. Catecholamine-stimulated nonshivering thermogenesis (brown fat metabolism) may cause such complications as elevated pulmonary and systemic vascular resistance and higher O2 consumption with resultant stress on the newborn heart.

General principles of anesthetic management for airway procedures

The anesthesiologist must share the airway with the surgical team. The technique selected for airway control/mask, ETT, LMA/ must protect the airway from blood and obstruction and not hinder surgical visualization. Securing the airway may also involve a cooperative effort between the surgeon and the anesthesiologist. The anatomic location of the surgical procedure has direct anesthetic implications. For nasal procedures the airway can be secured orally. Oropharyngeal lesions may increase the difficulties of intubation or maintaining mask ventilation. Throat packs may help to decrease aspiration of blood and secretions. Be SURE they are removed at the end of the case, after which they can cause obstruction of the airway in the Recovery Room. To avoid fires, delivered oxygen concentration should be kept as low as possible when electrocautery is being used. Procedures involving the larynx, trachea and bronchi necessitate the greatest anesthetic depth to prevent airway hyperreactivity. Spontaneous ventilation may also be required.

Induction techniques. Inhalation inductions are commonly used in children undergoing otolaryngologic procedures. Brief procedures such as myringotomy and tube placement often can be completed safely with mask and inhalation anesthesia without IV placement.

In children with airway edema or foreign body, inhalation agents may improve bronchodilation and decrease airway reactivity. In children with airway emergencies an inhalation induction allows for continuous maintenance of spontaneous ventilation and delivery of high concentration of oxygen. An intravenous induction is appropriate for removal of esophageal foreign body or airway lesions without airway compromise but with high risk of aspiration. Intravenous induction may also be used for upper airway obstruction when mask ventilation may be very difficult but uneventful intubation is anticipated. Intravenous agents such as propofol may also be beneficial adjuncts to primarily inhalational anesthetics.

Commonly anticipated complications include airway edema or obstruction, bleeding, and nausea and vomiting.

Anesthesia for otolaryngologic surgery

Diagnostic procedures: radiographs, CT, MRI; transnasal flexible fiberoptic bronchoscopy; direct laryngoscopy and rigid bronchoscopy.

For direct laryngoscopy and rigid bronchoscopy a gentle inhalation induction may be preferred. An FiO2 of 1.0 is used if respiratory insufficiency or airway compromise is present. A careful incremental IV induction with propofol may also maintain spontaneous ventilation. Spontaneous ventilation is important if there is a suspicion of tracheomalacia or laryngomalacia. Otherwise, muscle relaxation during rigid bronchoscopy is an excellent method of preventing coughing or bucking on the bronchoscope which could cause the life-threatening complication

of bronchial rupture. Primary intubation can be performed before bronchoscopy when the airway must be rapidly secured. Intravenous atropine or glycopyrrolate/10 to 20 mcg/kg/ may be useful as an antisialogue. Topical lidocaine spray to the vocal cords will help to minimize reactivity. The rigid bronchoscope is placed under direct vision by the surgeon. An oxyscope may be useful. Sometimes by closing the pop-off valve on anesthesia machine you may create PEEP in the airway. The anesthesia circuit can be connected to the rigid bronchoscope from a proximal side port. Use of 100% oxygen while the bronchoscope is in the trachea offers a margin of reserve against possible hypoxia. Hypercapnia frequently occurs because passive ventilation is difficult with the high airway resistance caused by the narrow bronchoscope. High flows may be necessary if there is much discrepancy between the size of the bronchoscope and the size of the trachea. On the other hand, if there is a tight fit, air trapping and “stacking” of ventilation (lungs unable to completely deflate prior to the next inflation) can lead to pneumothorax or impede venous return. For children spontaneous or assisted ventilation through a ventilating bronchoscope is preferred to jet ventilation because of the risk of barotraumas and air trapping. If jet ventilation is used, limit delivered pressure and place a hand on the chest to detect “stacking”. At the end of procedure an anesthesia mask can be used for emergence but intubation is preferred in the presence of airway compromise, edema, blood or secretions.

Laser excision of lesions in the lower airway is accomplished under direct vision using the carbon dioxide laser. Shavers may be used as well, in which cases more blood loss and secretions may occur.

Anesthetic for laser microsurgery of the airway :

A small ETT is used. If it is a cuffed tube, the cuff is filled with methylene blue so that if the balloon is lasered it will be immediately obvious. Laser safe tubes should be used. PVC tubes are not recommended as they burn easily and release hydrochloric acid. Muscle relaxants are used. The patient’s eyes are protected with moist pads. The use of flammable O2 and N2O is minimized. Air decreases fire hazards. A combination of helium and oxygen may be used to improve flow characteristics. PEEP may be added to the breathing circuit during laser operation to decrease the risk of airway fires. The use of highly reflective instruments is avoided in the surgical field. If a fire occurs, the flow of O2 is discontinued, the ETT removed, the fire extinguished with saline, and tissue damage is assessed with bronchoscopy.

The difficult airway

Awake intubation is used most commonly for neonates with complicated airways but some sedation/IV versed/may be required. An oxyscope is useful. The lightwand or LMA may assist in blind or fiberoptic tube placement if direct laryngoscopy is not successful. In older children an inhalation induction with maintenance of spontaneous ventilation is usually advocated. Topical anesthesia may help to decrease anesthesia requirements during laryngoscopy.

The lightwand is useful for blind intubations in older children in whom a tube which will fit over the lightwand can be used.

The LMA has been advocated for use in children with difficult airways. A blindly placed LMA serves as an easy guide for the fiberoptic bronchoscope, and may be helpful if mask ventilation unexpectedly becomes difficult. Don’t forget that if laryngospasm is the cause of difficult mask ventilation it will not be relieved and may be exacerbated by an LMA. However, constant positive pressure or a small dose of lidocaine or propofol may correct the problem. Cricothyrotomy may become necessary in emergent situations (such as a foreign body inextricably stuck partly through the cords). This procedure may be quite difficult in the infant, whose trachea is small.

Percutaneous transtracheal jet ventilation is frequently advocated as the system of choice for emergency ventilation. Remember that the lungs must have some route for deflation. The rapid delivery of high-pressure oxygen to the lungs of an infant could result in barotrauma and pneumothoraces. It may be safer to ventilate more gradually using anesthesia circuit despite the risk of hypercapnea, until tracheostomy can be performed.

Indications for tracheostomy in children include chronic airway obstruction/laryngomalacia, bilateral vocal cord palsy, pulmonary toilet when chronic ventilator support is required, as part of major head and neck surgery, to urgently secure airway after cricothyrotomy, rarely for prolonged ventilation. When caring for children with tracheostomies, there should always be an extra tracheostomy tube available since tubes with such small lumens can easily become obstructed by tenacious secretions. Tracheostomy in infants is performed as a last resort since it is associated with such a high mortality.

Congenital disorders of the airway

Choanal atresia (obstruction of nares- if bilateral, infants can’t feed since normally they breathe through their nose while eating), tracheomalacia (stridor on inspiration due to collapse of the trachea which usually responds well to positive pressure distending the airway or intubation, children tend to out grow this), laryngomalacia (where inspiration pulls laryngeal structures down over the vocal cords effectively obstructing them, ENT surgeons trim supraglottic area to treat this), laryngeal atresia and webs (problems at birth), and cleft lip and palate (which can cause feeding difficulties and failure to thrive). Difficulty of ventilation and intubation may be encountered in the presence of micrognathia and dysmorphic syndromes, subglottic hemangiomas , cysts, and subglottic stenosis.

Tonsillar hypertrophy

Children with this diagnosis may have obstructive sleep apnea. Here history is important- Does the child have daytime drowsiness, difficulty concentrating, noisy breathing, apnea ended by a snorting or gasping breath? A preoperative sleep study may document hypoxia, hypercarbia, apnea. Echocardiography may demonstrate the presence of right heart dilation or failure. Children with right heart failure are particularly susceptible to postobstructive /negative-pressure

pulmonary edema and to volume overload. Premedication should be used judiciously, if at all, in children with sleep apnea. A mask inhalation induction is usually preferred although with extreme hypertrophy, IV induction might be less hazardous.

In patients with sleep apnea, intraoperative opioids should be probably avoided. Patients with sleep apnea must be completely awake with intact reflexes and normal ventilatory pattern before tracheal extubation.

Postoperative problems include vomiting, pain, bleeding, and airway obstruction.

Overnight observation with apnea monitoring and oximetry is recommended for patients with T&A who have documented obstructive sleep apnea or meet any of the following criteria: less than 2 years old, craniofacial abnormalities, failure to thrive, hypotonia, cor pulmonale, morbid obesity, history of airway trauma, or concomitant uvulopalatopharyngoplasty.

Foreign body aspiration

Any recent aspiration is considered urgent. A peanut, because it releases inflammatory mediators, may cause pneumonitis and should also be urgently removed.

Most foreign bodies lodge in the right mainstem bronchus. A greater degree of obstruction can result in a ball-valve phenomenon, leading to gas trapping and hyperinflation. Most foreign bodies are radiolucent. Chronic cough and recurrent pneumonia are often the manifestations of a foreign body when there is no known history of aspiration.

Inhalation induction with maintenance of spontaneous ventilation is the induction of choice. Avoidance of N2O is advised. IV atropine, lidocaine spray and IV propofol also help to maintain anesthesia depth. Foreign bodies are usually removed by surgeons using rigid bronchoscopy. The patient may be intubated or masked following removal.

Epiglottitis

Epiglottitis is an acute, life-threatening infection of the supraglottic area, usually due to H. influenzae. There is sudden onset of sore throat, fever, inspiratory stridor, and respiratory distress. The child will be leaning forward to breathe, drooling, and appearing quite toxic. The patient should be kept calm and comforted by the parents as agitation worsens the ventilatory state. A physician with the ability to perform emergent cricothyrotomy/tracheostomy in children should always be in attendance. The induction may be performed with the child sitting upright, possibly on a parent’s lap. Inhalation anesthesia is induced with halothane/sevoflurane and oxygen. Spontaneous ventilation is maintained regardless of the patient’s oral intake status. Yankauer suction should be readily available. After a deep plane of anesthesia is obtained, an IV cannula is placed and atropine administered.

Direct laryngoscopy and oral endotracheal intubation are performed using an endotracheal tube one size smaller than normal. Spontaneous ventilation should always be maintained and muscle relaxants avoided. (Lateral radiographs of the airway may help in diagnosis, showing a “thumb-like” swelling of the epiglottis,

but children must never be sent to the radiology area unaccompanied by a practitioner skilled in airway maintenance.)

Laryngotracheobronchitis/croup/

Symptoms include an insidious onset of low-grade fever, a croupy or seal-bark cough, inspiratory stridor, retractions, and sometimes cyanosis. Differentiation from epiglottitis may be difficult. Similar presentations include bacterial tracheitis, laryngeal foreign body, retropharyngeal abscess, and diphtheria. In croup subglottic edema appears as a “steeple” sign (narrowing) on AP radiographs. Basic guidelines for care include keeping the patient calm and providing oxygen in a cold steam/croup tent/. Racemic epinephrine may temporarily improve symptoms but one should always remember rebound obstruction often occurs 46 hours later. The use of steroids remains controversial. The need for intubation is unusual.

Peritonsillar abscess

This problem tends to occur in older children or young adults. Incision and drainage are required if response to antibiotic therapy is inadequate. Severe pharyngeal swelling, trismus, distortion of pharyngeal anatomy and airway obstruction can occur.

Rapid-sequence induction is performed in young children if no airway difficulty is suspected. If significant trismus or difficult intubation is anticipated, an inhalation induction with spontaneous ventilation can be performed. An extremely critical airway might require tracheostomy under local anesthesia.

Myringotomy with placement of tubes helps to control recurrent otitis media in children and may improve hearing loss. The very short duration of this procedure often precludes the need for IV catheter placement. General anesthesia is usually provided using mask. Ketorolac/IV/ or acetaminophen/PR/ or postoperative oral ibuprofen (if not given preoperatively with midazolam) can be used for analgesia without prolonging discharge.

Trauma. Lacerations, bleeding, edema, and fractures of the maxillofacial area make airway management extremely difficult. Awake intubation is preferred. Open or closed injuries to the larynx and trachea can occur from direct trauma but are unusual in children. Subcutaneous emphysema, dyspnea, hoarseness, cough, hemoptysis and in particular, voice changes indicate the possibility of laryngeal damage. Cricoid pressure is not used with laryngeal or tracheal trauma. One of the safest approaches to securing the airway is the use of fiberoptic broncoscopy. Tracheostomy under local anesthesia may be necessary.

Anesthesia for ophthalmic surgery

The presence of an ocular abnormality always should alert the anesthesiologist to the possibility of other associated anomalies. Inhalation agents cause dose

related decreases in intraocular pressure. Narcotics, barbiturates, propofol and etomidate all lower IOP, assuming that normocapnia is present.

Asphyxia, hypoventilation or administration of carbon dioxide will raise IOP, while hypothermia, nondepolarizing muscle relaxants, ganglionic blockers or hypertonic solutions such as dextran, urea, mannitol, or sorbitol will reduce IOP.

Succinylcholine raises IOP as much as 8 mm Hg; the efficacy of pretreatment with nondepolarizing muscle relaxants to prevent increases in IOP caused by succinylcholine is still questionable. Nondepolarizing agents will lower IOP as long as hypercapnea is avoided.

Strabismus surgery

Strabismus surgery is associated with an increased incidence masseter spasm and of MH. The oculocardiac reflex has trigeminal/V/ afferent and vagal/X/ efferent pathways. It is triggered by pressure on the globe or traction of the extraocular muscles, the conjunctiva, or orbital structures. The most common manifestation is sinus bradycardia. Different arrhythmias may occur. For strabismus surgery routine prophylaxis with atropine 0.02mg/kg IV or glycopyrrolate 0.01 mg/kg can be administered.

Treatment depends upon its nature and severity. Severe bradycardia or hypotension is treated by asking the surgeon to stop ocular manipulation. If the heart rate does not return to normal, atropine/0.01mg/kg/ should be given.

Oculocardiac reflex prophylaxis is advised before intubation. Postoperative nausea and vomiting are common. Antiemetics include droperidol 0.075 mg/kg IV, metoclopramide 0.25 mg/kg IV, ondansetron 0.05 to 0.15 mg/kg IV/max dose 4 mg/, and lidocaine 1 to 2 mg/kg IV.

Open-eye and full-stomach situations

Trauma is the typical cause of an open globe. Any unnecessary stimulation should be avoided because coughing or vomiting can raise IOP as much as 40 mm Hg. The use of a slightly larger mask will help to avoid pressure on the eyes. Aspiration prophylaxis with an H2-receptor antagonist is advised. After pretreatment with a nondepolarizing agent, rapid-sequence induction is generally the method of choice. Rocuronium may be a useful drug in this setting.

Anesthetic implications of topical ocular drugs

Systemic absorption occurs from either the conjunctiva or nasal mucosa. Topical ocular drugs with systemic toxicity to which the anesthesiologist should be alert are found among commonly used mydriatics/atropine, scopolamine, cyclopentolate/as well as antiglaucoma agents/echothiophate iodide,epinephrine, timolol, betaxolol/, and vasoconstictors/cocaine, phenylephrine/. One drop of 4% cocaine solution contains 2 mg of cocaine;phenyephrine 2,5% – one drop – 1,25 mg. Cocaine should not be administered in combination with epinephrine because of the facilitation of dysrhythmias (especially in the presence of halothane). Cocaine is contraindicated in patients with hypertension or those receiving drugs which modify the adrenergic nervous system.

Anesthesia for children with musculoskeletal disorders

Scoliosis is defined as lateral deviation of the spine. Severity is determined by the degree of angulation measured by the Cobb method.

Cardiorespiratory effects of scoliosis include ventilation/perfusion abnormalities, decreased total lung volume, decreased PaO2, blunted ventilatory response to CO2, and pulmonary hypertension.

The main anesthetic management concerns are positioning and blood loss, which can be minimized by hyperventilation/vasoconstriction, hemodilution, autologous storage, and controlled hypotension. Cell saver is often helpful.

Hyperventilation with hypotension may lead to spinal cord ischemia.

Monitoring spinal cord function is done by either an intraoperative “wake-up” test or SSEP.

Dwarfism – The most common disorder is achondroplasia. Anesthetic

management mandates suspicion of an abnormal airway. Preoperative sedation should not be given in order to avoid upper airway obstruction. Antisialagogues are particularly useful. Both awake intubation and mask inhalation induction with spontaneous ventilation have been used successfully. Muscle relaxants may be best avoided until the airway is secured. Succinylcholine is avoided if muscle wasting is present. (Succinylcholine is best avoided in all children under the age of 12).

Juvenile rheumatoid arthritis is an autoimmune disease associated with chronic nonsuppurative inflammation of synovium and connective tissue. Anesthetic management necessitates evaluation of glottic position; cervical spine x-rays for evaluation of atlanto-axial joint stability, cardiac exam (auscultation, ECG, and possibly echocardiogram). Perioperative stress steroid coverage is indicated if the patient is on chronic steroid therapy or if there is a history of recent steroid use. Hydrocortisone 4 to 8 mg/kg/day in 3 divided doses should suffice. All pressure points should be padded carefully.

Neuromuscular disorders

Von Recklinghausen disease/ neurofibromatosis/: The hallmark of the disease is café-au-lait spots/more than 6 that are greater than 1,5 cm in diameter/ and neurofibromas.

Associated conditions are laryngeal and tracheal compression, a high incidence of kyphosis and progressive scoliosis, an increased incidence of neural tumors, compression of spinal roots, and an increased incidence of cancer. Anesthetic considerations: Airway abnormalities may lead to difficulties with intubation. Patients may have increased intracranial pressure or a prolonged response to nondepolarizing muscle relaxants.

Tuberous sclerosis is an autosomal dominant disease with cutaneous and neurological manifestations. It consists of a triad of mental retardation, epileptic seizures, and facial angiofibromas. Anesthetic considerations include respiratory compromise in the presence of scoliosis, antiepileptic medications, and considerations for patients with seizure disorders.

Myotonic dystrophy is an autosomal dominant trait affecting primarily the limb muscles but it may also involve extraocular and facial muscles. Clinical features include poor sucking and swallowing, muscle atrophy, facial weakness, ptosis, cataracts, frontal baldness, gonadal atrophy, endocrine failure, and mental retardation. These patients are predisposed to aspiration, atelectasis, and pneumonia, bradycardia and intraventricular conduction delays, and hypoxemia and hypercapnia. Myotonia worsens with hypothermia. Succinylcholine may precipitate a myotonic crisis. Nondepolarizing agents can be used safely but reversal with neostigmine and an antimuscarinic can precipitate contracture. The trachea should not be extubated until the patient has completely recovered.

Muscular dystrophy, Duchenne is an X-linked recessive trait that usually presents with waddling gait in a child between the ages of 3 and 5 years. The hallmark of the disease is muscle degeneration. Death is usually secondary to CHF, cardiomyopathy or pneumonia by 20 years of age. Succinylcholine may cause hyperkalemia, myoglobinemia and cardiac arrest, or at least rhabdomyolisis. Sensitivity to nondepolarizing agents is common. As the disease progresses patients are unable to protect their airways from secretions, pneumonias occur, kyphoscoliosis occurs, and cardiac muscle degenerates. Muscular dystrophy may be associated with MH therefore atropine and scopolamine should be avoided. These patients have an increased risk of aspiration. There was report about propofol infusion causing rhabdomyolisis in patient with Duchenne muscular dystrophy. Remifentanyl infusion may be anesthetic of choice.

Myasthenia gravis is an autoimmune disorder that results in a decrease in the number of acetylcholine receptors at the neuromuscular junction. Antibodies to the receptors may be present. Affected individuals suffer weakness and fatigability of voluntary muscles. The treatment is oral neostigmine and pyridostigmine. In the perioperative period anticholinesterase therapy should be continued. Premedication may be best avoided. If nondepolarizing agents are needed they should be used in 1/20 of the usual dose and titrated to effect. Reversal may be ineffective. Hypothermia and hypokalemia can further decrease respiratory function. Narcotics must be titrated carefully. Patients should be extubation only after meeting strict criteria.

Myastenic syndrome/Eaton-Lambert/ primary involves proximal limb muscles. There is decreased of acetylcholine available at the end plate. This syndrome is associated with leukemia, neuroblastoma, SLE, rheumatoid arthritis, hypothyroidism and hyperthyroidism. Anesthetic considerations are similar to those for myasthenia gravis.

Anesthesia for children with congenital heart disease

Congenital lesions of the heart are generally classified according to the physiologic problems: left-to-right shunt: single connection between the venous and arterial systems; children display right-sided failure because of increased pulmonary blood flow; right-to-left shunt: a connection between the venous and arterial systems with obstruction to outflow on the right side will shunt blood right to left; venous blood is ejected systemically by the left ventricle and these children are

cyanotic; complex: complex shunts or mixing lesions are cardiac defects where all venous and arterial blood is mixed before being ejected from the heart; obstructive: obstructive lesions such as valvular stenosis or coarction of the aorta, can prevent ventricular outflow from either side of the heart, diminishing cardiac output and causing ventricular failure.

Left-to-Right Shunts

Simple left-to-right shunts include the defects which connect the arterial and venous circulation resulting in increased pulmonary blood flow: atrial septal defect; ventricular septal defect; patent ductus arteriosus; atrioventricular canal;aortopulmonic window.

Long standing left-to-right shunts can eventually cause pulmonary hypertension; if pulmonary hypertension becomes severe PVR may exceed SVR resulting in shunt reversal – Eisenmenger’s syndrome. Anesthetic considerations: premedication should be used judiciously; endocarditis prophylaxis; meticulous removal of all air bubbles; induction of anesthesia may include intravenous or inhalation techniques; positive pressure ventilation increases PVR; low FiO2 limits pulmonary blood flow; inhalation agents-reduce SVR; ketamine- increases both PVR and SVR, which may increase left-to-right shunt; opiates-in the failing heart--high-dose fentanyl techniques have the least effec on myocardial performance.

Right-to-Left Shunts

Lesions that produce a right-to-left shunt contain not only a connection between the right and left heart, but also must offer increased resistance to blood flow through the pulmonary vasculature. Patients have marked hypoxemia and cyanosis: tetralogy of Fallot; tricuspid atresia; pulmonary atresia; Ebstein’s anomaly. Anesthetic management: infusions of prostaglandin E1 will help to maintain patency of the ductus arteriosus to increase pulmonary blood flow; palliative shunts are usually placed to provide additional pulmonary blood flow;

endocarditis prophylaxis is recommended; inhalation induction is prolonged; IV induction is more rapid; the goal of induction is to improve pulmonary blood flow to reduce hypoxemia and cyanosis; oxygen is the cornerstone of intraoperative management; hydration helps to maintain adequate right filling pressures; spontaneous ventilation or gentle assisted ventilation is recommended; ketamine raises both PVR and SVR and is ideal for fixed pulmonary obstructions;

morphine is also useful, it may lowers both PVR and SVR; fentanyl decreases mortality in infants undergoing open-heart surgery; b- blockade has been used in children over 6 m to relax infundibular spasm; halothane offers similar effects to beta blockade therapy-slow heart rate and negative inotropy to relax infundibular spasm.

Right-to-Left shunts usually slow inhalation induction; Left-to-Right shunts do not affect induction significantly, may attenuate Right-to-Left shunts.

Tetralogy of Fallot

This disease complex comprises about 10% of all CHD and is the most common R-to-L shunt. Four anomalies: RV outflow tract obstruction; subaortic VSD; overriding aorta; RVH. Primary pulmonary artery reconstruction with complete repair at any earlier age is now more common. Treatment of hypercyanotic spells: high FiO2; hydration; morphine; ketamine; phenylephrine; propranolol; halothane; thiopenthal; squatting, abdominal compression. Anesthetic agents contraindicated: atropine; N2O; isoflurane; epinephrine; dopamine.

Drugs of choice for induction are: halothane, ketamine/IV or IM/.

Anesthetic management of noncardiac surgery in children with CHD

A current cardiac physiology profile is critical for determining shunt direction and therefore anesthetic management. It is important to remember that postoperative pain can increase catecholamines and will affect vascular resistance and shunt direction. Most of these patients are not candidates for outpatient surgery. Important is: obtain history and physical; review most recent Echo and cath data; antibiotic prophylaxis; plan induction based upon primary shunt flow; anticipate severe conduction disturbances; plan postoperative ICU stay.

Cardiomyopathies

Cardiomyopathies in children – primary/idiopathic and secondary, when they occur in association with an underlying disorder. They also may be classified as dilated, hypertrophic or restrictive.

Dilated cardiomyopathy in many cases is result of viral or inflammatory process. The functional profile includes decreased ejection fraction and stroke volume, increased ventricular volume and filling pressures and normal or decreased ventricular compliance.

Combinations of diuretics, inotropics and vasodilators may improve symptoms and clinical status. Another important cause of dilated cardiomyopathy in children is the anthracycline anticancer agents, such as doxorubicin, adriamycin.

Goals of anesthetic management: preserving ventricular filling and intravascular volume status, minimizing drug-induced myocardial depression, and avoiding significant increases in afterload.

Hypertrophic cardiomyopathy is often hereditary, transmitted as an autosomal dominant trait. It usually occurs as asymmetric hypertrophy of the interventricular septum. Left ventricular outflow tract obstruction and diastolic dysfunction are common. Ventricular tachycardia or fibrillation is the most frequent cause of sudden death in these patients.

IHSS : symptoms of dyspnea, angina on exertion, and orthionea are most consistently present; sudden death occurs in 3% to 4% of cases.

The mainstays of treatment are beta blockade/negative inotropy to reduce outflow stenosis and slow heart rate/ and maintenance of adequate preload and afterload. Filling volumes must be monitored so that hypovolemia, hypotension, reflex tachycardia, and vasodilation can be avoided. Sinus rhythm should be maintained. Primary fentanyl techniques help to maintain a slow heart rate with few hemodynamic changes. Halothane helps to relax dynamic ventricular outflow and maintain a slow rate. One should remember about its negative inotropic properties.

Anesthetic management of children with hematologic and oncologic disorders

In the normal newborn b-chain production shifts from Hb F to Hb A; over the first few weeks of life, Hb levels fall to an average nadir of 11 g/dl. The lowest levels are usually seen between 8 and 12 weeks of age. It is rare for infants to develop any clinically significant symptoms from physiologic anemia of the newborn.

Sickle cell disease

The single-gene amino acid substitution of valine for glutamic acid at position 6 in the b-hemoglobin chain results in the production of Hb S. About 10% of the African-American population has the Hb S gene, with increased prevalence also noted in those of Middle Eastern, Indian or Mediterranean descent.

Hb S, when deoxygenated, can polymerize with itself, leading to damage to the red cell that causes it to assume the sickled shape. Vasoocclusive symptoms predominate after the first year of life.

SCD: organ system dysfunction - hemolysis, anemia, leukocytosis, jaundice; renal-loss of concentrating ability; splenic autoinfarction, immunoincompetence; pulmonary – diminished function due to recurrent infarcts; cardiac-cor pulmonale; neurologic-stroke, seizures; chronic leg ulcers; growth retardation, delay in sexual maturity; skeletal – osteomyelitis/femoral head/; genital-priapism; cholelithiasis, bowel infarcts.

Anesthetic management: should be designed to minimize the possibility of hypoxia, vascular stasis, hypothermia and catecholamine production, which can trigger vasoocclusive episodes. Ideally it is recommended that the percentage of Hb S be decreased below 50% and if it is possible to about 30% before operation. Aggressive hydration with crystalloid or colloid is recommended. Intraoperative normothermia is maintained. Preoxygenation and an increased delivered FiO2 minimize the opportunity for hypoxia. Spinal anesthesia has been avoided traditionally. Tourniquet use is avoided. Postoperative pain should be managed aggressively to avoid vasoconstriction and hypoventilation.

Hemophilia

Hemophilia is the most common of the inherited coagulation disorders. They are inherited as X-linked disorders. Patients with hemophilia A have deficiency in factor VIII while those with hemophilia B are deficient in factor IX. Symptoms: usually normal hemostasis with minor cuts; bleeding with circumcision as a neonate; joint and muscle bleeding by age 1 year; spontaneous hemorrhage into deep tissues. Diagnostic tests: normal PT, prolonged PTT, normal platelet count, normal bleeding time, reduced amounts of factor VIII or IX. Anesthetic management: IM injections should be avoided; replacement with factor VIII or IX 15 to 20 min before invasive procedures.

Von Willebrand Disease

VWD is an autosomal dominant coagulation defect caused by deficiency of von Willebrand factor found in platelets, plasma and endothelial cells. There is variable penetrance of the defective gene, considerable variability in clinical manifestations classified into types I, II and III. The majority of patients have type I with prolonged bleeding time and PTT.

Clinical manifestations: history of abnormal bleeding that dates back to early childhood; epistaxis, mucosal and gum bleeding, bruising and menorrhagia are common.

Anesthetic management: consultation with the hematologist; many patients can achieve adequate plasma level of vWF after administration of DDAVP alone; patients with type II b vWD should not receive DDAVP; DDAVP is given as 0.3 mcg/kg IV over 20 min in 50 ml of normal saline; if more than three doses of DDAVP are required in 48 hr, the risk of hyponatremia and fluid retention is increased.; cryoprecipitate or fresh frozen plasma can provide a source of vWF if DDAVP is contraindicated or ineffective.

Oncology

Leukemias accounts for about 50% of pediatric malignancies; varying degrees of pancytopenia are common; DIC may be seen in children with AML; massive hepatosplenomegaly or cervical adenopathy may exert mass effect; electrolyte abnormalities may be present; renal function may be significantly compromised; treatment of leukemias/chemotherapy/ should be taken into consideration.

Mediastinal masses: masses may occur in all of the anatomic compartments of the mediastinum, but those of the anterior mediastinum are the most challenging to the anesthesiologist; compression of the trachea and larger bronchi by tumor mass has contributed to anesthetic difficulty or poor outcome. In those cases it is prudent to avoid muscle relaxants. In patients with severe airway/respiratory compromise, preanesthesia radiation therapy has been advocated. Preoperative assessment should include CT or MRI.

Wilms tumor is the most commonly occurring childhood abdominal malignancy/1:15000 live birth/; is usually diagnosed when a large intraabdominal mass is discovered; complete surgical resection remains the mainstay of treatment usually followed by chemotherapy and radiation.

Neuroblastoma – the most common tumor of infancy, usually diagnosed in children less than 2 years of age. Most commonly found in the abdomen/adrenal medulla/ it is not uncommonly found in the mediastinum/usually posterior/; intracranial tumors also occur. Staging is the major determinant of survival. Conventional treatment remains surgical excision followed chemotherapy and radiation. Mass effect of the tumor place most patients at risk for aspiration. Rapid-sequence induction with cricoid pressure may be indicated. Large fluid shifts should be anticipated; heat loss from surgical exposure and fluid infusions; nitrous oxide should be avoided.

Intracranial tumors – the preoperative assessment should include documentation of any neurologic deficits and signs of elevated ICP. The induction technique

selected should consider the presence of increased ICP from the mass. Invasive monitoring is recommended/a-line/; CVP monitoring is useful; Foley catheter is necessary for fluid management.

Chemotherapy in children: pancytopenia; anorexia, nausea, vomiting; stomatitis, alopecia; all patients are immunocompromised; prophylactic AB and antiviral agents; treatment with high-dose corticosteroids-stress dose coverage.

Complications: cyclophosphamide-hemorrhagic cystitis; methotrexate-hepatitis, nephrotoxicity, pulmonary fibrosis; doxorubicin, daunorubicin-cardiomyopathy; bleomycin-pulmonary fibrosis.

HIV – infection with HIV has become the leading cause of immunodeficiency in children. Greater than 90% of cases of HIV infection in children are caused by perinatal transmission. Primary HIV infection usually causes an acute illness resembling mononucleosis. The acute phase is followed by the clinical latency period, which can last for several years. Ultimately, CD4 T lymphocytes are depleted with onset of opportunistic infections or malignancies.

Delivery room resuscitation

Fetal monitoring: monitors for uterine activity; fetal heart rate monitors. An external transabdominal Doppler probe monitors fetal heart rate. Early decelerations-compression of fetal head, causing vagal tone; variable decelerations-compression of umbilical cord; late decelerations-occurs if fetal hypoxia is present prior to stress of contractions.

Fetal acid-base monitoring: normal pH 7.25 to 7.35; preacidotic 7.20 to 7.25; acidotic < 7,20.

Treatment of fetal compromise: O2 to mother; left uterine displacement; maternal volume expansion/without dextrose/; discontinuation of oxytocin.

Goals of newborn resuscitation: assuring airway patency; maintaining ventilation/oxygenation; maintaining cardiac output; reducing metabolic requirements.

Airway: light suction; airway patency-bag-and-mask ventilation of the newborn can be difficult, use of LMA may be advised; positioning: placing a rolled towel under the shoulders will improve airway patency and make bag mask ventilation easier; ventilation-after 3-4 min of apnea acidosis will cause a drop in cardiac output; treatment of neonatal asphyxia includes basic techniques; cardiac output-cardiac output of the neonate is largely rate and preload dependent; the normal heart rate is greater than 120; heart rate 80-100 required assisted ventilation with 100% O2; heart rate 60-80 – chest compressions should begin; a newborn who required chest compressions should be intubated; if volume loss is suspected 10 ml/kg of NS or LR can be administered repeatedly;

Metabolic requirements: heat is produced in the newborn by metabolism of brown fat/nonshivering thermogenesis/; hypothermia causes hypoxia, hypercapnia, acidosis and hypoglycemia.

Basic resuscitation in the delivery room: Apgar scores are useful; documentation of the 1-, 5-, and 10- min Apgar scores is important; drugs used in neonatal resuscitation: epinephrine 0.01 mg/kg, atropine 0.01-0.03 mg/kg, bicarbonate

1mEq, calcium chloride 10mg/kg, glucose D10 5-10 ml, naloxone 0.1 mg/kg; endotracheal route – epi, atropine, naloxone.

Pediatric Advanced Cardiac Life Support 2006

Airway adjuncts. Endotracheal intubation remains the ‘gold standard’ approach to secure the airway of a pediatric victim of cardiopulmonary arrest. Only properly trained individuals must attempt endotracheal intubation. Bag-mask ventilation has been shown to be very effective means of ventilating and oxygenating children when properly trained personal is not available. Confirmation of initial endotracheal placement of the tube is very important. Detection of exhaled carbon dioxide using either a capnograph or colorimetric device is strongly recommended. The LMA well known to anesthesiologists as an effective ventilating device used in the OR, has not been studied sufficiently to allow an evidenced-based recommendation for its use in pediatric CPR. The opinion of resuscitation experts recommends that the LMA be considered as a potentially useful adjunct device for airway control when bag-valve-mask ventilation is inadequate or airway cannot be secured by endotracheal intubation.

The suggested AHA mnemonic for making the differential diagnosis when an intubated patient deteriorates is to think, “DOPE”: Displacement of the tube, Obstruction of the tube, Pneumothorax, and Equipment failure. Cricothyroidotomy is an effective way to provide secure airway in a child when airway cannot be obtained by endotracheal intubation.

Vascular access in pediatric patients may be problematic. The CPR goal is to establish vascular access as rapid as possible. The intraosseous space is a noncollapsible venous plexus and its cannulation takes 30-60 sec. The recommended cannulation sites include the anterior tibia, distal femur, medial malleolus and anterior superior iliac spine. Intraosseous vascular access should be used for all age children.

Pharmacological agents. Epinephrine continues to be a mainstay of CPR pharmacology. Its a-adrenergic vasoconstrictive effect is key to successful CPR. The use of high-dose epinephrine in pediatric ACLS has been de-emphasized in the current PALS protocol.

The recommended dose for epinephrine for the unconscious, asystolic, pulseless cardiopulmonary arrest patient: initial dose 0.01 mg/kg IV/IO; 0.1 mg/kg, tracheal route; subsequent doses/every 3-5 min/ - repeat initial dose; may consider high – dose protocol, 0.1 mg/kg IV.

Amiodorone/5mg/kg/ may be considered in the treatment algorithms for supraventricular and ventricular arrhythmias. Adenosine /0.1mg/kg up to 6 mg/ remains the first choice medication for treatment of supraventricular arrhythmias.

Non-pharmacological treatment of arrhythmias. Vagal maneuvers have been added to the treatment protocol for supraventricular tachycardia for children who are hemodynamically stable and/or being prepared for cardioversion. Utilization of vagal maneuvers must not delay cardioversion or administration of adenosine for children with poor perfusion state. The most effective vagal stimulant in infants and children is the application of a bag with ice/ice water to the face. Carotid massage and Valsalva maneuver are effective treatments in older children. Current recommendations for AED therapy in the pediatric population include use of: an adult AED for pediatric patients > 8 years of age, 150-200 joule shock/6-8 joules/kg for the average weight 8 years old/ and an AED with

pediatric paddles delivering a ~50-75 joules for children <8 years old. There is little evidence to justify use of the AED for children <1 year of age.

Ambulatory anesthesia for the pediatric patient

About 70% of all pediatric surgical cases are done on ambulatory basis. Children are very good candidates for ambulatory surgery because majority of them are healthy, surgical procedures are simple and recovery period is short. Avoiding hospitalization for children is very beneficial – minimal separation from parents, less risk of exposure to hospital infections.

Patient selection criteria: the most important for selecting a child for ambulatory surgery are the physical status of the patient, and the type of surgical procedure. These factors should be also combined with how well facility is equipped and the ability to deal with complications.

The child preferred to be in good health or any systemic disease must be optimized or under good control.

For example, the premature infant is not a good candidate for ambulatory surgery because of immaturity of respiratory center, temperature control, and gag reflex. The age at which a former premature infant (ex-preemie) is no longer at increased risk for postoperative apnea is controversial and should be considered individually. Many anesthesiologists will admit all ex-preemies to a hospital for 23 hr who are younger than 50-55 weeks of PCA.

The child with a runny nose may have benign condition like allergic rhinitis or URI without fever and when child does not look toxic in which case surgeon should be informed and elective surgery may be performed. The preanesthetic exam should include history and physical exam, including auscultation of child’s chest to rule out lower respiratory infection and possible pneumonia. When the pediatric patient looks toxic, has fever and you can not rule out lower respiratory infection and possible pneumonia elective cases should be postponed, surgeon informed; chest x-ray may be advisable and ambulatory treatment by primary pediatrician should be instituted. Elective cases may be rescheduled in 4-6 weeks.

Asthma is common chronic disease of childhood, and many pediatric patients with asthma being scheduled for ambulatory surgery. The decision to proceed with each case depends on severity of asthma and patient’s condition (control of disease). Children with moderate asthma who do require daily medications to control their symptoms should be instructed to continue their medications until the morning of surgery. A beta agonist (albuterol) may be administered by nebulizer. Sometimes glycopyrrolate (robinul) or small dose of steroids (for patients who are on steroid containing inhaler) may be beneficial in these patients, specifically when they have some respiratory infection symptoms. If patient with history of asthma on daily medications is wheezing, has coexisting URI on the day of surgery it is best to reschedule procedure. The choice of anesthetic technique depends on procedure. The use of LMA may decrease risk of bronchospasm; if endotracheal tube is used sufficient depth of anesthesia should be established first. ETT may allow better control of secretions in patients with URI. Deep extubation may be recommended.

Most ambulatory surgical centers do screen their patients before surgery. It may be visit for preoperative anesthesia evaluation or even a phone interview. Information is sought concerning past or present risk factors like prematurity, chronic cardiac or pulmonary conditions and so forth. Assessment of current health status is performed, acute illness is ruled out and NPO status reinforced (2 hr for clear liquids, 4 hr for breast milk, 6 hr for

formula and 8 hr for heavy meal in teenagers). On the day of surgery, all patients getting physical exam, screen for acute illness and NPO status, allergies are checked. Vital signs are evaluated. Many ambulatory centers have presurgical orientation programs when pediatric patients coming few days before surgery to facility and getting a tour with explanations.

Pharmacologic premedication usually includes oral midazolam in dose of 0.5-1 mg/kg and rarely exceeds 10-12 mg; Parents presence during induction is another option and use of induction rooms in some institutions is helpful. For uncooperative child IM injections of ketamine, nasal midazolam may be a viable option.

Inhalation induction is a popular choice for ambulatory surgery in children and sevoflurane is induction agent of choice. Sometimes after induction with sevoflurane anesthesia provider may switch to isoflurane for maintenance. Maintenance of anesthesia with sevoflurane too possible but risk of emergence delirium should be entertained.

Intravenous induction with propofol in children is an option in older pediatric population when IV access may be established in preoperative area. Combination of propofol with lidocaine is recommended to decrease pain on injection. Propofol infusion may be combined with inhalation agent and may prevent nausea and vomiting, specifically in strabismus surgery. Other antiemetic drugs may include: zofran, low dose of dexametasone, phenergan, compazine.

Postoperative analgesia: preference for acetaminophen, total daily dose should not exceed 100 mg/kg. Rectal dose varies between 10-30 and more mg/kg. NSAID, ketorolac have proved to be effective in children but side effects should be taken in consideration – renal complications and effect on platelet function. Potent narcotic analgesics: short acting should be preferred (fentanyl is drug of choice often). Nasal fentanyl may be used for BMT surgery. Regional analgesia like field block and other peripheral blocks provide excellent postoperative pain relief and early ambulation and extremely important in pediatric ambulatory surgery.

Rapid recovery and ambulation are must for ambulatory surgery. In certain cases patients may bypass PACU (fast-tracking) and stay with parents right after surgery; it is quite beneficial in majority of cases. Other pediatric patients being discharged home after they meet certain criteria. Every child must have an escort home.

Analgesia and sedation for children outside of the operating room

Analgesia and sedation outside of the operating room also in offices and free standing medical facilities becoming more prevalent for pediatric patients and requires special approach and protocol. Sedation for children may be required in the ER, for CT and MRI studies , GI exams, bronchoscopy, cardiac evaluations ( echocardiography, catheterizations), in burn unit (dressing change), and others (chest tube removal, et cet.). These procedures may require various depth of sedation. Some procedures are associated with loss of airway reflexes and are at increased risk of complications. Anesthesiologists may not be directly involved in the care of these patients but their input is very significant in organization and training sedation team/service.

The JCAHO regulations have recommendations made by the ASA. The definition of the four levels of sedation and anesthesia are:

Minimal sedation (anxiolysis): A drug induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected. This level of sedation

is rarely adequate for diagnostic or therapeutic procedures in children.

Moderate sedation: A drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patient airway and spontaneous ventilation is adequate. Cardio-vascular function is usually maintained.

Deep sedation: A drug induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. Reflex withdrawal is not considered a purposeful response. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate. CV function is usually maintained.

Anesthesia: General anesthesia is a drug induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug induced depression of neuromuscular function. CV function may be impaired.

Those terms were not specifically designed for children. Some children are

developmentally delayed or too young to understand and follow verbal commands. Clear examples of the stages of sedation for different age groups would be very helpful in clarifying any misconceptions. There is also the assumption that there is a consistent correlation between different levels of sedation and the ability to maintain a patent airway.

Most hospitals have sedation policy and sedation flow sheet. The updated regulations require similar standards for moderate and deep sedation as are used for patients having general anesthesia. Qualified individuals must have competency based education, training, and experience: in evaluation of patients, in performing sedation, to “rescue” the patient from the next level of sedation/anesthesia.

BLS certification is required for practitioners of moderate sedation. PALS certification is required for practitioners of deep sedation. PALS training should provide airway and cardiovascular support training and thus allow rescue from general anesthesia. Risks of sedation: all sedatives and narcotics have caused problems even in “recommended doses”, all areas using sedation have reported adverse events, children 1-5 yr of age are at most risk (most had no severe underlying disease), respiratory depression and obstruction are the most frequent causes of adverse events, adverse events involved – multiple drugs, drug errors or overdose, inadequate evaluation, inadequate monitoring, inadequate practitioner skills, and premature discharge. There obvious need for uniform, specialty-independent guidelines for monitoring children during sedation both inside and outside of the hospital setting.

Sedation techniques: Local anesthetics play very important role in analgesia during painful procedures. Application of local anesthetics to skin and mucosal membranes as well as local and regional blocks usually easily to perform. Maximum doses ( lidocaine 5 mg/kg – 7 mg/kg with Epi, tracheal lidocaine 2 mg/kg, marcaine 2 mg/kg – 3 mg/kg with Epi, cocaine 3 mg/kg, tetracaine 1.5 mg/kg ) should be calculated. The toxic effects of local anesthetics are additive. The cocaine component can cause arrhythmias and CV collapse if given mucosally.

Chloral hydrate is one commonly used sedative inj infants and children. Doses range from 25-100 mg/kg with maximum of 1.0 g per dose (2 g per day ). It may be given orally or rectally. It has slow onset time – 30-60 min and prolonged duration (1/2 life 10 hr in toddlers ). It may cause airway obstruction.

Midazolam has amnestic effect, short duration (half-life 100 min) and easily being

administered; reversibility (flumazenil 0.1 mg/kg IV) make it very useful. The doses are: oral 0.5-0.75 mg/kg – 10-30 min onset time; rectal 0.3-0.5 mg/kg – 20-30 min; IV doses start at 0.05-0.1 mg/kg. Sedation doses may cause mild respiratory depression. Severe respiratory depression can occur when narcotics are combined with midazolam. Fentanyl is potent opioid (100 times more potent than morphine) with rapid onset, intermediate duration (30-45 min) and reversibility (naloxone 0.1 mg/kg IM or IV). The respiratory depressant effect is much longer (4 hr) than its analgesic effect. Can cause apnea and chest wall rigidity when given rapidly. Doses start at 0.5-1.0 mcg/kg and should be titrated to effect with maximum of 5 mcg/kg.

Nitrous oxide used alone in concentrations less than 50% is a useful mild anxiolytic, sedative agent which causes analgesia. Verbal contact must be maintained with the patient.

Ketamine is an excellent analgesic and amnesic which can be given intravenously (0.25-0.5 mg/kg), orally or rectally (6-10 mg/kg) or intramuscularly (2 mg/kg). It increases HR, BP, and ICP. It can cause copious secretions and lead to laryngospasm; it can also cause vivid dreams. Ketamine in large doses can cause an incompetent gag reflex, deep sedation or general anesthesia.

Propofol has sedative and hypnotic effect, fast onset and extremely short duration time. Propofol administered by anesthesiologists as a continuous infusion of 50-200 mcg/kg/min IV is extremely useful in non-painful pediatric deep sedation procedures (for example MRI) where a quick wake up is desirable. Its antiemetic effect makes it particularly useful for outpatient procedures. Currently general ASA recommendation is that propofol should be used for sedation by an anesthesiologist.

MRI – sedation service for MRI should be supervised by an anesthesiologist. Small children (newborn, 1-2 m of age) may undergo study without sedation. Sometimes sedation with IV midazolam (0.1 mg at a time) in controlled situation is feasible alternative. Longer studies (1hr or more) may require secured airway (intubation). Many anesthesia practitioners comfortable with LMA in small children. If MRI compatible anesthesia machine is available so general anesthesia or sedation may be provided using inhalation agent. If not – propofol infusion with proper monitoring ( CO2, pulse oxymetry) is reasonable choice. Ideally it should be holding area next to MRI scanner which is properly equipped (similar to OR), and recovery space with nursing staff available so pediatric patient may be discharged home without going to main recovery.

Pediatric pain management.

The treatment of pain is a basic in medicine and applicable to every patient regardless of age. Children frequently receive no treatment, or inadequate treatment for pain and for painful procedures. The newborn and critically ill children are especially vulnerable to no treatment or under-treatment. Children less than 3 years of age or critically ill children may be unable to adequately verbalize when or where they hurt. They may be afraid to report their pain. Fears of opioid addiction are also causal factors in the under treatment of pediatric pain. Pain management in children is often dependent on the ability of parents to recognize and assess pain and on their decision to treat pr not to treat it. This is very much true in patients who are too young or developmentally delayed to self report pain. Pediatric pain service should provide the pain management for acute, postoperative, terminal, neuropathic and chronic pain.

Non-opioid analgesics. Acetaminophen (Tylenol), salicylated (aspirin), ibuprofen, naproxen, diclofenac acid are the classic examples, comprise a group of non-steroidal anti-inflammatory drugs (NSAID) and non-opioid analgesics. They provide pain relief mostly by blocking peripheral prostaglandin production. These agents are administered

enterally: oral, or rectal route and are very useful for inflammatory, bony, or rheumatic pain. Ketorolac (Toradol) may be administered parenterally. Regardless of dose, the non-opioid analgesics reach a “ceiling effect” above which pain can not be relieved by these drugs alone. Aspirin has been abandoned in pediatric practice because of its possible role in Reye’s syndrome, its effects on platelet function, and its gastric irritant properties. Acetaminophen works mostly centrally and has minimal anti-inflammatory activity. Rectal doses for acetaminophen being recommended by some authors are as high as 30-40 mg/kg as loading dose. Follow-up doses are 10-20 mg/kg every 4-6 hr. Regardless of route of delivery, the daily maximum acetaminophen dose in the preterm, term, and older child is 60, 80, 90 mg/kg respectively.

Opioid drugs. Factors to consider when opioids are appropriate are: pain intensity, patient age, co-existing disease, potential drug interactions, prior treatment history, physician preference, patient preference, and route of administration. All opioids are capable of treating pain regardless of its intensity if dose is adjusted appropriately and at equipotent doses most opioids have similar effects and side effects.

Codeine, oxycodone (Tylox, Percocet) and hydrocodone (Vicodin, Lortab) are opioids which are frequently used to treat pain in children and adults. They are most commonly administered in the oral form, usually in combination with acetaminophen or aspirin. In equipotent doses, codeine, oxycodone, and morphine are equal as analgesics and respiratory depressants. They all cause sedation, respiratory depression, and nausea. Nausea is particularly true for codeine. The analgesic effects for codeine and oxycodone occur in ~ 20 min following oral intake and reach maximum at 60-120 minutes. The plasma half-life of elimination is 2.5-4 hr. Approximately 10% of codeine is metabolized into morphine and is responsible for analgesic effect. Approximately 10% of the patients and most newborns cannot metabolize codeine into morphine so codeine has little analgesic effect in these patients. Morphine is effective given orally but only 20-30% of an oral dose reaches the systemic circulation. Codeine is usually prescribed 0.5-1 mg/kg in elixirs which contain 120 mg acetaminophen and 12 mg codeine per teaspoon (5 ml). Codeine and acetaminophen also available as tablets – Tylenol number 1, 2, 3, or 4. The number refers to how much of codeine is in every tablet. Tylenol 4 has 60 mg of codeine, and number 1 has 7.5 mg. In all combination drugs be aware of hepatotoxic acetaminophen doses (in adults, 7.5-10 g daily for 1-2 days, children 60-420 mg/kg/day for 1-42 days). Hydrocodone is prescribed in a dose of 0.05-0.1 mg/kg. The elixir is available as 2.5 mg/5 ml combined with acetaminophen 167 mg/5ml. As a tablet it is available in doses between 2.5-10 mg, combined with 500-650 mg acetaminophen. Oxycodone is prescribed in a dose of 0.05-0.1 mg/kg. In tablet form oxycodone is commonly available as a 5 mg tablet or as Tylox ( 500 mg acetaminophen and 5 mg oxycodone ) or Percocet (325 mg acetaminophen and 5 mg oxycodone ). Oxycodone is also available in sustained-release tablet for use in chronic pain. It must not be crushed and cannot be administered via gastric tube. Oral morphine is available as a liquid in different concentrations, a tablet (MSIR 15 and 30 mg ) and as a sustained-release (MS Contin and Oramorph tablets, “sprinkle capsules”).

Patient controlled analgesia. Intravenous boluses of morphine may need to be given at intervals of 1-2 hr based on pharmacokinetics of the opioids. Continuous intravenous infusions may provide steady analgesic levels. Rational pain management requires some form of titration to effect whenever any opioid is administered. In order to give patients some measure of control over their pain demand analgesia or PCA devices have been developed. Usually morphine (20 mcg/kg), hydromorphone (4 mcg/kg) or fentanyl (o.5 mcg/kg) per bolus at a rate 5 boluses/hr with a 6-8 min lock-out interval between each bolus been prescribed. Most PCA allow low continuous infusion ( morphine, 20-30 mcg/kg/hr, hydromorphone 3-4 mcg/kg/hr, fentanyl 0.5 mcg/kg/hr) in

addition to boluses. PCA requires a patient with enough intelligence to operate the pump. The lower age limit in whom this treatment modality can be used continues to fall. Some authors suggesting that any child able to play Nintendo can operate a PCA pump. All opioids can produce some unwanted side effects, such as pruritis, nausea and vomiting, constipation, urinary retention, cognitive impairment, tolerance, and dependence.

Written exam questions

What is prematurity?

Infants are considered premature if they are born before 38 weeks of gestation or weigh less than 2500 g at birth. Intrauterine asphyxia is common. Anesthetic considerations: impaired temperature regulation – increased surface-to-volume ratio; lack of fat insulation; fewer brown fat cells/cells stimulated by norepinephrine to increase heat production/ than in full-term infants; thin skin, resulting in heat and water loss; hypothermia may cause: hypoglycemia, apnea, bradycardia, and/or metabolic acidosis; respiratory distress syndrome/ hyaline membrane disease/ – RDS occurs more often in those born by cesarean section; prenatal risk factors-maternal diabetes and perinatal asphyxia; is caused by a deficiency in surfactant; pneumothorax should be considered if oxygenation deteriorates abruptly; immediate treatment with surfactant has reduced mortality associated with RDS; bronchopulmonary dysplasia/BPD/ - continued oxygen requirement at 28 days of life in an neonate with a history of RDS; the more severe the RDS, the greater the degree of BPD; risk factors associated with BPD include increased FiO2, positive-pressure ventilation, infection, patent PDA and fluid overload in the first 5 to 6 days of life; pulmonary hypertension and cor pulmonale can result from severe BPD;

apnea – cessation of breathing that lasts for 15 to 20 sec or produces cyanosis and bradycardia; risk of apnea spells is increased postoperatively especially in preterm infants less than 44 weeks postconceptual age/risk is reduced after 44 to 60 weeks PCA/; in hospital monitoring is recommended for at least 12 hr after surgery;

patent ductus arteriosus – may result in congestive heart failure and respiratory distress; PDA results in a left-to-right shunt, LVH and increased pulmonary blood flow; first line of treatment-indomethacin;

infection – is a threat to premature infants; sepsis can develop in the absence of a positive blood culture, elevated WBC or fever;

necrotizing enterocolitis /NEC/ - primarily a disease of small preterm infants; hypoperfusion of the GI tract, resulting in ischemia; initial signs are abdominal distention and bloody feces; shock may develop; patients are often hypovolemic and require fluid resuscitation before anesthesia; rapid fluid administration may cause in preterm neonates intracranial hemorrhage or reopening of ductus arteriosus; nitrous oxide should be avoided;

retinopathy of prematurity/ROP/ - is inversely related to birth weight; although the

role of oxygen as risk factor is controversial, it remains prudent to minimize

oxygen exposure in premature infants less than 44 weeks old; it is recommended that PO2 be maintained between 60 and 80 mm Hg whenever possible;

intracranial hemorrhage – subdural, primary subarachnoid, periventricular-intraventricular/most common/, intracerebral; newborn immaturity is the single most important factor; intracranial hemorrhage is unusual after 10 days of life; it is prudent to avoid hypoxemia and hypercapnia and to avoid cerebral hyperperfusion/BP in normal range/; hyperosmolarity is a contributing factor.

What is Down syndrome?

Trisomy-21/Down’s syndrome/ - is the most common chromosomal

abnormality/1:700/; is associated with mental retardation/IQ below 65/; many features of the airway are abnormal: narrow nasopharynx, large tonsils and adenoids; tongue becomes progressively larger; intubation is usually not difficult;

cervical spinal malformations – cervical spinal stenosis/10%/, atlantoaxial subluxation/31%/; lateral cervical spine radiographs in flexion and extention may be useful;

congenital heart disease – VSD/25%/, TF, ASD.PDA; increased incidence of respiratory complications following cardiac surgery; patients are predisposed to the development of pulmonary hypertension;

other findings: obesity, laxity of the skin and joints, duodenal atresia, hearing loss, hematologic malignancy.

Anesthetic implications: potentially difficult airway, select ETT one size smaller than anticipated. Decreased CNS catecholamine stores, may decrease MAC. Exaggerated response to muscle relaxants. Consider obtaining C-spine films prior to neck manipulations. Preoperative cardiac evaluation required ; may require prophylactic antibiotics.

What is omphalocele and gastroschisis?

Omphalocele and gastroschisis – anesthetic management is essentially the same; knowledge of the associated anomalies may influence decisions; omphalocele and gastroschisis are congenital defects of the anterior abdominal wall permitting external herniation of abdominal viscera; gastroschisis is not midline, has normally situated umbilical cord/not covered with a hernia sac / and is rarely associated with other congenital anomalies, does have an increased incidence of prematurity; omphalocele has a 75% prevalence of other congenital defects, including cardiac anomalies/VSD most common/, trisomy 21 and Beckwith-Wiedemann syndrome/omphalocele, organomegaly, macroglossia and hypoglycemia/; epigastric omphaloceles are associated with cardiac and lung anomalies, hypogastric – exstrophy of the bladder and other genitourinary anomalies; preoperative care – limit heat loss, deficits of fluid and electrolytes, correct hypoglycemia, decompress the stomach;

intraoperative management – general endothracheal anesthesia; N2O should be avoided; preoxygenation followed by awake or rapid sequence intubation. Elevated intraabdominal pressures, high ventilatory pressures and inferior vena cava compression can cause low BP, desaturation and lower limbs

hypoperfusion – if this is a case, abdomen should be reopen and surgery converted to silo procedure.

What is NEC?

Necrotizing enterocolitis/NEC/ - disease of small preterm infants, multifactorial etiology with the common feature of hypoperfusion of the GI tract, resulting in ischemia; initial signs-abdominal distention and bloody feces; shock may develop from multiple bowel perforations; patients often are hypovolemic; NEC is often associated with DIC and thrombocytopenia; N2O should be avoided and preoperative pressure maintained.

Anesthetic management: most infants are hypovolemic with a metabolic acidosis requiring fluid resuscitation; blood and blood products should be ordered; awake intubation is intubation of choice; anesthetic agents-opioids and ketamine; hypothermia is common problem.

What is pyloric stenosis?

Pyloric stenosis – incidence is higher in males; common in first-born males of parents who had pyloric stenosis; presentation: persistent, bile-free vomiting; the infant is dehydrated and lethargic; vomiting may be projectile, causing loss of hydrogen, chloride, sodium, and potassium ions from stomach; this results in hypokalemic, hypochloremic metabolic alkalosis. Olive-sized mass may be palpated in the mid-epigastrium; noninvasive diagnostic tests include ultrasound; pyloric stenosis is a medical emergency not a surgical emergency. Management of anesthesia: patients are at risk for pulmonary aspiration; the stomach should be emptied as completely as possible; induction of anesthesia may be variable-rapid sequence or modified rapid sequence , an awake oral intubation; NG tube should be inserted and left in place during procedure; narcotics are seldom necessary, rectal tylenol can be given.

When should you expect difficulty in managing a pediatric airway?

Congenital pediatric airway problem. Anatomically pediatric airways are

narrower, resulting in greater resistance to air flow, and the tongue is relatively larger; all patients can be divided into those who will be difficult to intubate but can be ventilated by mask and those who are difficult or impossible to ventilate by mask. The latter group poses a more difficult anesthetic challenge and may require emergency tracheostomy; if child can be ventilated by mask, then a number of options-fiberoptic intubation, blind nasal intubation or use of a retrograde transtracheal wire can be attempted.

Hurler’s syndrome /mucopolysaccharidosis type 1H/-associated with severe mental retardation, deafness, stiff joints, dwarfism, pectus excavatum, hepatosplenomegaly and severe valvular and early coronary artery disease; upper airway obstruction and difficult intubation are common, getting worse with age.

Pierre Robin syndrome-cleft palate, micrognathia, glossoptosis, CHD; early significant airway problems; intubation may be very difficult and should initially be

attempted awake; tracheostomy should be considered early; positioning patient prone, pulling the tongue forward, nasopharyngeal airway may be helpful.

Treacher Collins syndrome – the most common of the mandibulofacial synostoses; features: micrognathia, aplastic zygomatic arches, microstomia, choanal atresia, and CHID; fiberoptic intubation may be intubation of choice.

Goldenhar’s syndrome – unilateral facial hypoplasia, mandibular hypoplasia, CHID and eye, ear and vertebral abnormalities; difficulty of tracheal intubation may be variable.

Crouzon’s syndrome – congenital craniofacial synostosis, wide, towering skull with proptosis, maxillary hypoplasia and a beaked nose; maxillary hypoplasia can make mask ventilation difficult.

Cleft lip and palate – associated with more than 150 syndromes; risk for pulmonary aspiration; large defects can cause difficulty with intubation; postoperative airway problems are also common.

Anesthetic management: preservation of spontaneous ventilation is strongly recommended; H2 blockers preoperatively; several intubation approaches should be considered-awake, blind nasal, fiberoptic; with alternative methods immediately available/emergency bronchoscopy, cricothyrotomy or

tracheostomy; variety of laryngoscopy blades, ETT, stylets; preoxygenation is recommended; all equipment should be also available before extubation.

What is tracheoesophageal fistula?

Tracheoesophageal fistula – type C, esophageal atresia with a distal TEF, is the most common/90%/ type; maternal polyhydramnios; diagnosis-excessive drooling, cyanotic episodes, coughing, inability to pass a soft catheter into the stomach. Associated conditions: prematurity, CHID, other midline defects, VATER syndrome. Pulmonary complications of TEF will not resolve until the fistula is ligated; often a preliminary gastrostomy may be performed. Intraoperative management: induction-inhalation, rapid sequence and awake intubation; avoid nitrous oxide; avoid intubating the fistula; optimal position of ETT-above carina but below fistula; attempt spontaneous ventilation to avoid gastric distention until fistula has been ligated, then controlled ventilation. Postoperative complications-tracheal compression, gastroesophageal reflux, esophageal stricture.

Fluid management in infants-normal daily water consumption in the infant is 10% to 15% of body weight; estimated fluid requirements may be calculated using formula”4-2-1” for weight less than 10kg – 4 ml/kg/hr, 10-20kg - 2ml/kg/hr. more than 20kg add 1 ml/kg/hr. When patient is NPO replacing one-half of the deficit in the first hour and one-fourth in the second and third hours in addition to maintenance requirements has been suggested. The sodium deficit/in mEq/ can be calculated as normal sodium – measured sodium x 0.6 x weight/kg/; for metabolic acidosis give one-half of the HCO3 calculated requirement/base deficit x weight/kg/ x 0.3/0,4 for infants/; potassium replacement is initiated only after adequate urinary output has been established. Blood replacement: estimated blood volume ranges from 90 ml/kg in neonates to 65 ml/kg in teenagers; the decision to transfuse depends on preoperative hemoglobin level, estimated surgical loss, the patient cardiovascular response.

Approximately 4 ml of PRBC per kg of body weight is required to increase the hemoglobin level by 1 mg/dL. Generally anything less than one-third acceptable

blood loss/ABL/ is replaced with 3 to 4 ml of crystalloid per ml of blood loss. Above ABL replace the total blood loss with red blood cells. Glucose management: one point of view is to give glucose containing solution to only infants and younger children/0-6m/; the easy way to prevent hypoglycemia and hyperglycemia is to use a D5LR solution at a maintenance rate.

What is persistent pulmonary hypertension in the neonate?

Persistent pulmonary hypertension in the neonate – leads to respiratory failure and death unless treated. It may be primary or secondary; secondary causes: meconium aspiration syndrome, hyaline membrane disease, neonatal sepsis with pneumonia, CDH, certain congenital heart defects. The key in this syndrome is increased PVR which induces a R-to-L shunt/PFO,PDA/. Treatment: mechanical ventilation, tolazoline, prostaglandin E2 and prostacyclin, isoproterenol, ECMO, nitric oxide.

How does croup differ from epiglottitis?

Croup versus epiglottitis – both present with evidence of airway obstruction; in 80% of all pediatric patients with acquired stridor, infection is the etiology. Of these 90% are due to laryngotracheobronchitis. Other causes of respiratory distress-foreign body, subglottic stenosis, tracheitis, retropharyngeal abscess.

Acute epiglottitis Croup

3-7 years 6m-5 years

prodrome none, or sore throat usually URI

onset abrupt, 6-24 hr gradual

clinical course rapid, may progress to usually self limited cardioresp. arrest

hoarseness no yes

dysphagia yes no

dyspnea severe no

appearance toxic, anxious, sitting nontoxic

upright

anteroposterior tracheal narrowing subglottic narrowing radiograph

WBC marked elevation with variable

left shift

bacteriology H. influenza viral etiology, parainfluenza

Croup – in mild cases humidified air, fever control, hydration; racemic epinephrine; rarely is intubation or tracheostomy needed.

Acute epiglottitis – child must be disturbed as little as possible; transport to OR in the sitting position with airway equipment and skilled physician; do not attempt to visualize the pharynx; OR should be set for direct laryngoscopy, bronchoscopy and tracheostomy; inhalation induction with oxygen in sitting position; establish IV line; atropine may be given; perform laryngoscopy and intubate with tube smaller than predicted for age; extubation after AB therapy in 12 to 36 hr when air leak has developed around ETT.

What are some differences between pediatric and adult airways?

The Infant airway - position: larynx is more cephalad, rima glottitis is opposite the interspace of the C3 and C4; larynx is more anterior in infants. Epiglottis: is longer and stiffer, it tends to be U- or V-shaped, where the adult epiglottis is flatter and more flexible. Tongue: is relatively larger and more bulky. Laryngeal exposure: blade may have to be passed perpendicularly with the head in the neutral position; lifting an infants upper back and shoulder area is helpful in obtaining proper neck extension; gentleness in manipulation of the laryngeal tissues is important. Vocal cords: as the cartilaginous portion is angled down the trachea and inward, the infantile cords are concave, whereas concavity is minimal in the adult. The concavity of the cords in the infant may impede passage of a curved endotracheal tube. Pushing the tube slightly posteriorly with the blade will aid advancement. Cricoid ring: the narrowest point of the infant larynx is at the level of the cricoid cartilage, whereas the rima glottides is the narrowest point of the adult upper respiratory tract.

Selection of endotracheal tube size: 1-2-3/7-8-9 rule/1kg infant: 7cm at lip/; Idx3 gives the approximate position at the lip, add 2-3 cm for nasotracheal ETT; term newborn-3,0 or 3,5 ETT; 6-12m – 4,0 ETT; after 2 y/o – 16 + age/years divided by 4. Tubes one size smaller and larger should be immediately available during intubation. Confirmation of tube placement: suprasternal notch palpation/balloon/; condensation in ETT; ET CO2; bilateral breath sounds; O2 saturation.

How is temperature regulated in neonates ?

Four mechanisms of heat loss: radiation, convection, conduction, evaporation. Factors that increase heat loss in infants: relatively larger body surface area, less keratin in skin/preemies/.

There are three mechanisms by which heat can be produced: increased physical activity, shivering – ability to shiver not present until~3 m old, nonshivering thermogenesis – the only means of heat production in anesthetized neonate, a result of brown fat metabolism. Cold body temperature - increase in norepinephrine production: 1.peripheral vasoconstriction, 2. pulmonary vasoconstriction/R-to-L shunting with hypoxia/, 3. brown fat metabolism, energy and heat production.

Very important is to keep OR temperature high; you may use warming lights, warming mattress, fluid warmer, warming blanket.

What is meconium aspiration?

Meconium aspiration pneumonitis is the leading cause of respiratory death in the full-term newborn. Meconium staining is present in 12% to 13% of all live birth and 36% of postdate pregnancies have meconium-stained fluid.

The immediate tracheal suctioning of infants born through meconium was first suggested in 1960. Recently the value of routine intratracheal suctioning has been questioned. Conditions associated with meconium staining: uteroplacental

insufficiency/late decelerations/, post-term pregnancies, maternal hypertension, placenta previa, maternal pulmonary disease, placental abruptions, cord prolapse and cord compression.

Meconium is the sterile breakdown product of swallowed amniotic fluid, gastrointestinal cells and intestinal secretions. Mechanical airway obstruction by particles of meconium plays the most important role in meconium aspiration syndrome. With complete obstruction atelectasis of distal alveoli occurs , causing R-to-L intrapulmonary shunt. Radiologic findings: infiltrates, hyperexpansion, and extra-alveolar air. Meconium aspiration may increase risk for persistent pulmonary hypertension after birth.

Current recommendations include the early suction of fetal mouth and pharynx before the delivery pf the shoulders. Intubation and tracheal suctioning are reserved only for depressed infants or exposed to thick particulate matter on emergence. The best treatment is the prevention of meconium aspiration.

What is Tetralogy of Fallot?

Tetralogy of Fallot consists of: pulmonary stenosis, VSD, overriding aorta and RVH. Physiology of TET spell: increase in right to left shunting via VSD, cyanosis. Management of TET spells: hyperventilate with 100% O2, decrease pulmonary resistance; phenylephrine IV – increase in SVR and SVR>PVR; L to R shunting, best used for acute treatment; fluid bolus; propranolol-best used for prevention.

Anesthetic management: must consider what will cause R to L shunting-decrease SVR, increase in PVR, increase in myocardial contractility. Factors that decrease SVR: volatile agents, histamine-releasing drugs, ganglionic blockers, a-blockade. Anesthetic factors that increase PVR: acidosis, hypercarbia, hypoxia, positive pressure ventilation/PEEP/, loss of negative intrapleural pressure when chest is open, nitrous oxide. Preoperative management: hydrate, continue b-blockers, avoid noxious stimuli/crying/. Induction – consider ketamine/increases SVR/; inhalation technique/halothane/.

What is CDH?

CDH most commonly presents shortly after birth as a true surgical emergency with respiratory distress and cyanosis. The primary problem in CDH is hypoplasia of the lung parenchyma and pulmonary vasculature with pulmonary hypertension. Left-sided hernias/left foramen of Bochdalek/ occur five times more often. Associated congenital problems: polyhydramnios, CNS anomalies, GI

anomalies, genitourinary abnormalities, congenital heart defects. Clinical presentation: shifted cardiac sounds, scaphoid abdomen, diminished breath sounds on the affected side. The primary cause of death is progressive hypoxia and acidosis. The immediate therapy is endotracheal intubation along with placement of nasogastric tube.

Anesthetic management: most infants are urgently intubated in the delivery room. Positive-pressure ventilation with bag and mask should be avoided. The usual technique is oxygen/narcotic/relaxant. Nitrous oxide is contraindicated. Contralateral pneumothorax should be suspected if sudden changes in heart rate, blood pressure, PaO2 happening. The postoperative care of infants with CDH is critical. High frequency ventilation, ECMO, nitric oxide may be utilized

pre- or postoperatively. Selection criteria for ECMO may include hemodynamic instability, persistent acidosis, severe barotrauma. ECMO may be veno-venous or arterio-venous; in latter case there is possibility to support BP in patient. ECMO requires some degree of anticoagulation.

How is inhalation induction in children different from adults?

Anesthetic levels in the brain depend on anesthetic levels in the alveolus. The speed of induction depends on the speed at which alveolar concentration approaches the inspired concentration [rate of rise of Fa/Fi ]. Factors speeding the rate of rise Fa/Fi : high gas inflow rates; high alveolar ventilation; high concentration of inspired gas; augmented alveolar ventilation; the concentration effect; the second gas effect; anything that reduces uptake of agent.

Factors affecting uptake of inhaled agents: 1. solubility: quantified by blood/gas partition coefficient, 2. cardiac output, 3. uptake by tissues, 4. intracardiac shunts - a R-to-L shunt will slow induction; L-to-R shunt have little effect on speed of induction, they can reduce effect of R-to-L shunts a little bit.

Inhalation induction is faster in children because: 1. smaller FRC, proportionately more alveolar ventilation, 3. organs are better perfused, 4. disproportionately large amount of blood flow to the vessel-rich group of organs/the brain/.

How does one provide neonatal resuscitation ?

Fetal assessment at delivery is via the Apgar score: Appearance/color/, Pulse, Grimace/reflexes/, Activity/muscle tone/, Respirations. Management of the abnormal Apgar: 7-10 – warm the baby, nasal/oral suction only; 4-6 – stimulate baby, suction airway, bag-mask ventilation with FiO2 1,0; if heart rate stays < 60, intubate; if heart rate remains < 80, begin compressions; additional resuscitation as needed.

Differential diagnosis for neonatal depression: drug addiction, perinatal drugs, hypovolemia, hypocalcemia, hypoglycemia, hypermagnesemia/treat with calcium/. Neonatal effects of hypermagnesemia: hypotonia, ventilatory depression, hypotension, increased sensitivity to muscle relaxants.

Neonatal resuscitation drugs: volume expansion, epinephrine 10-30mcg/kg, naloxone 10mcg/kg, NaHCO3-rarely indicated, dose 1-2 mEq/kg; effects of administration-hypercarbia, hypotension, intravascular volume overload and intracranial hemorrhage, decreased hematocrit.

What are pediatric breathing circuits ?

The T-piece was used initially for spontaneous ventilation during anesthesia for infants. FGF of only 1.5 to2 times the minute volume is required to prevent rebreathing or dilution of inspired gases, minimal airway resistance and improved humidification are advantages of this system.

Mapelson added overflow valves and reservoir bag to the T-piece for better

controlled ventilation. Mapelson D circuit: fresh gas enters at the patient end, and the overflow valve is near the reservoir bag. With inspiration, the patient inspires a mixture of fresh gas, alveolar gas and deadspace gas. The fresh gas flow determines the gas mixture in the corrugated tube. Because of rebreathing, all of

these systems require relatively high fresh gas flows to prevent hypercarbia. In general with infants FGF that is three times the minute ventilation can be used.

The Bain circuit places the fresh gas flow coaxial to the expiratory limb. The Bain circuit functions identically to the Mapelson D circuit. Advantages are: less equipment, less likelihood of kinking the endotracheal tube, ability to mount the Bain circuit on the anesthesia machine. The resistance in the pediatric circle systems is low, less than 0.3 cm H2O at flow rate of 10 L/min.

How is respiratory function different in infants as compared to adults ?

Infants must generate negative pressure 40-60 cm H2O for first few breath of life. Work of breathing more than in adults due to increased chest wall compliance and decreased lung compliance. Ribs are horizontally situated allowing less chest expansion than the angled ribs of the adult. The chest muscles are ineffective in assuming any work of breathing. Diaphragm is main muscle of respiration and is comprised of easily fatigued fibers. Neonates are at risk for respiratory failure whenever there is increased respiratory work..

Pulmonary parameters: TLC in infants/60cc/kg/ is less than adults/80cc/kg/; FRC is equal to adult on cc/kg basis; closing capacity constitutes ~ 50% of infant TLC whereas adult is only~35%; tidal volume is equal to adult/6-7 cc/kg/; O2 consumption is 2 to 3 times adult values; alveolar ventilation must be at least twice as much as adult value and this is achieved by an increased respiratory rate. Children have more alveolar ventilation and dead space ventilation than adults but their Vd/Vt is the same as for adults.

Factors that contribute to rapid desaturation in infants: high O2 consumption and smaller total volume at FRC; FRC is less than closing capacity, therefore during tidal exhalation they have airway closure occurring before they reach FRC/shunting during tidal breathing/; the elastic recoil of the lung exceeds the expansive forces of the chest wall; infants set their FRC by auto-PEEPing, ceasing their exhalation above the lung relaxation volume; in the apneic infant there is a smaller store to obtain oxygen from than in the apneic adult.

Causes of hypoxemia in neonates: intrapulmonary shunting secondary to unexpanded areas of lung; extrapulmonary shunting through patent foramen ovale or ductus arteriosus; undiagnosed congenital heart disease; high resting O2 consumption; hypothermia-increases O2 consumption.

Perioperative desaturation in neonates: /see above/ plus- airway obstruction; apnea; hypoventilation due to incomplete reversal of neuromuscular blockade, anesthetics; decreased FRC due to general anesthesia.

Factors predisposing neonates to postoperative apnea: prematurity/44-60 weeks PCA/; immaturity of central respiratory drive centers; hypothermia; hypoglycemia; hypocalcemia; acidosis; hypoxia.

What is a patent ductus arteriosus?

Most common cardiovascular anomaly that presents in the neonatal period. Common causes of PDA in newborns: prematurity, neonatal sepsis, pneumonia, acidosis, hypoxemia. Initial medical management involves digitalis, diuretics, and fluid restriction. Indomethacin can be given to stimulate closure of the ductus. Nitrous oxide, fentanyl, and ketamine in some combination are well tolerated in most of these infants. A fluid bolus at the start of the case improves tolerance to

anesthetics. Prostaglandin E2 can be infused in these patients to maintain ductal patency if necessary.

In shunt lesions the PVR-SVR ratios can be altered to improve ventricular workloads. High doses of narcotics and deep level of anesthesia can attenuate some pulmonary vascular responses. Vasopressors, usually a-agents, can be used to reduce R-to-L shunting and maintain coronary perfusion. Manipulations that alter PVR: increase PVR –

Hypoxia, hypercarbia, acidosis, hyperventilation, atelectasis, sympathetic

stimulation, high hematocrit level, surgical constriction; decrease PVR – oxygen, hypocarbia, alkalosis, normal FRC, blocking sympathetic stimulation, low hematocrit level.

How do neuromuscular blockers act in neonates ?

The neuromuscular system is incompletely developed at birth and matures throughout the first year of life. The neonatal diaphragm is paralyzed simultaneously with peripheral muscles, in contrast to the resistance to diaphragmatic relaxation seen in adults. Infants have a greater extracellular fluid and blood volume in proportion to skeletal muscle weight than older children and adults, resulting in increased drug requirements. The reduced glomerular filtration rate in neonates is responsible for slower elimination of agents excreted by the kidneys. The neonatal myoneural junction is more sensitive to neuromuscular blockade and has less neuromuscular reserve when exposed to titanic stimulation.

Succinylcholine: neonates have a decreased sensitivity to its effects/50% less response than an adult to an equivalent dose/;the duration of muscle paralysis from succinylcholine is shorter in neonates. Masseter spasm can occur after succinylcholine administration. Inability to open patient’s mouth may be a reason to cancel a case. Controversy exists as to the actual incidence of malignant hyperthermia/MH/ associated with masseter spasm. Bradycardia can occur with an intravenous bolus of succinylcholine.

Factors prolonging neuromuscular blockade: deficient pseudocholinesterase; abnormal variant of pseudocholinesterase;anticholinesterase-containing drugs; phase 2 block; hepatic dysfunction; hypermagnesemia; hypothermia; respiratory acidosis; hypokalemia; antibiotics-aminoglycosides, tetracyclines; lincomycines; polymyxines; other drugs – inhalation agents, local anesthetics, lithium, dantrolene, certain chemotherapeutic agents.

How can blood volume be calculated ?

An estimation of circulating blood volume should be made before induction of anesthesia. The blood volume of a premature infant /90 to 100 ml/kg/ constitutes a greater portion of body weight than that of full-term newborn/ 80 to 90 ml/kg/, an infant 3 m to 1 year old/70 to 80 ml/kg/, or an older child/70 ml/kg/. In an obese child the blood volume would be 60 to 65 ml/kg. From the estimated blood volume/EBV/, the initial hematocrit and the minimum acceptable hematocrit an estimation can be made of the maximum allowable blood loss/MABL/.

EBV x /pt’s Hct – minimum accepted Hct/

MABL =

Pt’s Hct

What are toxic effects of local anesthetics ?

The major toxic effects of local anesthetics are on the cardiovascular and central nervous systems. Local anesthetics readily cross the blood-brain barrier to cause alterations in CNS function. Sequence of symptoms can be observed as plasma local anesthetic concentrations progressively increase, although this may not be readily apparent in infants and small children. With bupivacaine, cardiac toxicity and neurotoxicity may occur virtually simultaneously in pediatric patients, or cardiac toxicity may even precede neurotoxicity. The risk of cardiac toxicity may be increased by the concomitant use of volatile anesthetics and the CNS effects of the general anesthetic may obscure any signs of neurotoxicity until devastating cardiovascular effects are apparent.

In adults the earliest symptom reported is circumoral paresthesia, which is followed by the prodromal CNS symptoms of lightheadedness and dizziness, which progress to both visual and auditory disturbances/difficulty in focusing and tinnutis/. Objective signs of CNS toxicity during this time are shivering, slurred speech and muscle twitching. If plasma level of local anesthetic continue to rise CNS excitation causes generalized seizures.

Bupivacaine appears to have particular affinity for the fast sodium channels and perhaps also for the calcium and the slow potassium channels in the myocardium why it is so difficult to resuscitate patients after toxic dose. Ropivacaine is safer in relation to cardiac toxicity.

Careful observation of the ECG during test dose administration may be a sensitive indicator of unintended intravascular injection in the child. The significantly higher levels of free lidocaine and bupivacaine that result in infants are due primarily to the decreased level of a –1 – glycoprotein, which is the primary binding protein of these drugs.

There may be differences in the susceptibility of the neonate to the toxic effects. Plasma levels of lidocaine that produce cardiovascular and respiratory depression are about half of those causing toxicity in adults. Seizures and cardiovascular collapse have been reported in human infants at normal adult bupivacaine levels.

Caution should be exercised in the use of local anesthetics in infants. Infants and children may develop signs of systemic toxicity, including dysrhythmias, seizures and cardiovascular compromise from accumulation of epidural infusions of bupivacaine. Some recommend that both bolus and infusion doses of bupivacaine and lidocaine be reduced by 30% for infants under 6 m of age to decrease the risk for toxicity.

Treatment of toxic reactions. Inhaled anesthetics may actually raise the threshold for seizures and delay the detection of toxicity until cardiovascular collapse occurs. The progression from prodromal signs to frank cardiovascular collapse may be very rapid and the initial definitive therapy in some cases may need to be directed at re-establishing circulation and normal cardiac rhythm. Initial management – establishing and maintaining patent airway and providing supplemental oxygen. Administration of a CNS depressant that alters the seizure threshold /midazolam 0.05-0.2 mg/kg, thiopental 2-3 mg/kg, propofol 1-3 mg/kg/

may prevent seizures. Initial stage of cardiovascular toxicity consists of

peripheral vasodilation so treatment should consist of IV fluid loading/10-20 ml/kg LR or NS/, titration of phenylephrine. Bretylium has been reported to be useful in restoring normal cardiac rhythm and perfusion. A report in infants found that phenytoin/5 mg/kg/ was particularly effective even when all other agents had failed.

Excretion of local anesthetic agents is hastened by hydration and alkalization of the urine by intravenous administration of sodium bicarbonate. Successful resuscitation of bupivacaine-induced cardiac toxicity was achieved by prolonged resuscitation or by placing the patient on cardiopulmonary bypass.

Oral exam questions

1. 5 year old boy had tonsillectomy done 2 days ago, developed bleeding from his mouth earlier today; pale, HR 110. How would you induce this patient?

Problems: hypovolemia, full stomach, blood in airway/difficult intubation/

Answer: I would start IV; give bolus of fluids and perform rapid sequence induction with cricoid pressure; would have suction with Yankauer tip ready. IV may be started under different conditions including cut down, central line. Patient may be positioned on a side for induction so blood will be coming out.

2. 6 years old coming to a hospital for BMT; has running nose fever with t-37.8 C; no significant PMH; family lives 50 m away from hospital.

Would you intubate this patient?

Problems: chronic otitis media; respiratory infection.

We have to distinguish between upper and lower respiratory infection/pneumonia/; physical exam will be helpful/ chest auscultation/; can we relate fever to chronic otitis media ? Proceed with acute PNA will be not safe; risk of complications much higher when you

intubate a patient as oppose to masking a patient; but you should be ready for intubation if you have to.

Answer: I would do physical exam, listen to patient’s chest, rule put pneumonia; if there no PNA I would do this case and after premedication will mask this patient; will start IV if I have to/suspect possibility for difficult intubation, significant cardiac or lung history/.

3. 15 m old boy is scheduled for orchiopexy; there is strong family history of MH; no

significant PMH; patient’s weight is 10 kg.

How would you induce this patient?

Problems: family history of MH; should not use inhalation induction.

Patients with family history of MH may not develop MH on first exposure to inhalation agents but safety is always first so avoiding inhalation induction will be a good

choice. Other option will be starting IV and use propofol infusion alone or with combination with O2+N2O or narcotics/remifentanyl/. Premedication with versed/ 0.5 mg/kg/is a good choice and then IM injection of ketamine /5-8 mg/kg with robinyl /5-10 mcg/kg will make possible to start IV. Proper preparation of OR and anesthesia machine/vaporizers off/; flashing machine with high flows for ~ 20 min/ is very important. Proper observation of this patient in PACU; dantrolene is not given these days as prophylaxis.

First signs of MH will be unexplained hypercarbia and tachycardia.

4. 12 m girl with Tetralogy of Fallot scheduled for inguinal hernia repair; cardiac surgery not performed yet; O2 sat on RA ~ 90%; good physical tolerance. Otherwise no significant PMH.

How would you induce this patient?

Problems: TF/intracardiac shunt/; risk of air embolus. LV function?

TF: RVH, RV outflow tract obstruction; ASD/VSD; overriding aorta. Ideal agent for inhalation induction is halothane /decrease in myocardial contractility, relieve of RV outflow obstruction, bradycardia/; ketamine is also drug of choice; volume resuscitation is important before induction; avoid N2O; gentle ventilation; deair IV lines; for maintenance isoflurane may be used. Your actions should not decrease pulmonary blood flow. Antibiotic prophylaxis may be considered.

5. You are called to help with induction of a child. On your arrival to OR you see 4 year old boy with monitors on, colleague of yours is attempting mask ventilation; O2 sat is 60 and going down; ventilation with oral airway, LMA been attempted – unsuccessfully, DL – unable to intubate; as you approach OR table O2 sat is 50.

What would you do?

Obviously this is can not intubate, can not ventilate situation. Using difficult airway algorithm the only choice is left – cricothyrotomy. It is helpful to separate all airway tools and options in a way you can use them above or below vocal cords: above-oral airway, ETT, LMA, lightwand, Shikany stylet; below – tracheostomy or cricothyrotomy.

6. 6 y/o boy aspirated foreign body into a trachea; had full meal 2 hr ago; otherwise healthy; currently not in respiratory distress; no IV access.

How would you induce this patient?

Problems: foreign body in airway/may loose ability to ventilate/; full stomach

This is not a win - win situation. Mask induction may cause vomiting so it is very important to be prepared for that and have suction ready. Foreign body can move and obstruct airway and cause inability to ventilate so bronchoscope and a surgeon should be in OR. Option number one. You may bring parent in OR, keep child calm and start inhalation induction with 100% O2 and sevoflurane. In case of vomiting – put patient in lateral position, use suction. Start IV, then – propofol infusion and let a surgeon to do

bronchoscopy and remove foreign body. In case when during induction you are loosing ability to ventilate surgeon should perform bronchoscopy and either remove foreign body or push it forward below carina so you can ventilate at least one lung. Other option is to use IM injection of ketamine first and be prepared for possible complications.

7. 12 m old swallowed coin 4 hr ago; last meal ~ 4 hr ago; term baby, no significant PMH.

How would you induce this patient?

Problems: full stomach.

Ideally it should be rapid sequence IV induction with cricoid pressure. You may attempt to start IV when patient is awake. Other option will be slow inhalation induction with cricoid pressure, start IV and intubate. Suction with Yankauer tip should be readily available.

8. 8 years old autistic boy is scheduled for dental procedure. Refusing to drink oral versed, aggressive, combative; normal pediatric airway; no other significant PMH.

How would you approach this patient?

Problem here is to make transition from preoperative area to OR. There are several ways to do it. Oral premedication with versed is common practice and dose varies between 0.5-1.0 mg/kg. Additionally ketamine, atropine can de added to oral meds. Ketamine dart/IM injection/ 5-8 mg/kg alone or in combination with robinul/5-10 mcg/kg/ works fast and provides good condition even to start IV. Parents presence is always comforting for a child but not always helpful.

9. Term baby born in respiratory distress; cyanotic; breath sounds diminished on left side; flat abdomen.

Would you mask this baby with 100% of O2?

With this minimal information we should suspect possibility of CDH so this baby needs emergent intubation; mask ventilation is contraindicated because air in stomach will deteriorate respiratory status even more. This patient needs endotracheal intubation which should be performed by experienced person; “gentle” ventilation/low PIP pressures/, no N2O. Main problem is pulmonary hypertension which can compromise cardiac function as well. These patients may need nitric oxide, high frequency ventilation, ECMO and cardiac inotropic support.

10. 12 year old brought to ER, status post MVA, combined trauma, head trauma, bleeding out of his mouth; vital signs: BP-100/60 mm Hg, HR-120, O2 Sat on RA – 92%; mental status – obtunded. You are called to ER to help trauma team.

What would you do?

With combined trauma including head trauma and compromised mental status “A,B,C” sequence will be very much applicable for this situation. Patient most probably will go for CT study so securing his airway beforehand will be advisable.

How would you secure his airway?

Intubation with ETT is best choice. But head trauma and oral bleeding may make intubation difficult. One of the options may be DL after some sedation.

You did DL of this patient, he is still breathing spontaneously; you can see blood in his mouth but can not see epiglottis; O2 Sat is going down.

What would you do next?

In this situation further attempts to intubate patient or use LMA would only compromise

patients status. You should proceed to emergency tracheostomy, under local anesthesia when other MD is masking this patient.

11. 1500g premature baby /ex 29 week, now 7 d old/ brought to OR for exploratory laparotomy, possible NEC; baby is currently on RA, no inotropic support; BP-45/28 mm Hg/mean 30/, HR 145.

How would you induce and intubate this patient?

Problems: low weight premature baby, possible NEC what may by lethal for this particular patient.

For this case “A,B,C” rule is very much applicable and there is not much room for mistake. OR set up and preparation is very important; temperature control also/OR temp, warming lights, warming blanket on OR table/. After all monitors applied baby may be intubated using 100% + sevo/5-6%/, breathing spontaneously; ETT size 3.0 should be appropriate; adequate IV access/2 IV lines/ is must; air and oxygen, no N2O; blood in OR and resuscitation drugs/including epi /- all should be available; inotropic drugs/dopamine, epi, dobutamine infusions/ should be prepared.

12. 3 weeks old term baby with history of vomiting for one week scheduled for pyloromyotomy.

Would you do this case today? And if yes how would you induce this patient?

Pyloric stenosis is medical emergency, not surgical. So patient first should be resuscitated with fluids and when electrolytes are in safe range/K >3.0; Cl >88, HCO3 < 30/ patient may be taken to OR. Pyloric stenosis causes hypokalemic hypochloremic metabolic alkalosis. Patient’s stomach should be suctioned/x 2/ when patient is awake; rapid sequence induction with cricoid pressure /STP or propofol + succinylcholine/ is advisable. Patient is usually extubated by the end of procedure after muscle paralysis is reversed.

13. 2 years old girl with Down syndrome scheduled for BMT and hearing test; patent ductus arteriosus; running nose, cough, no fever; never had general anesthesia before; weight 16 kg; NPO for 12 hr.

Would you do this case? If yes would you intubate this patient?

Problems: upper respiratory infection; difficult intubation; cardiac status; can we flex her neck?/atlanto-axial instability/

Mother tells that there is no other cardiac problems present as per pediatrician. On physical exam-lungs clear; as usually we have to differentiate between upper and lower /pneumonia/ respiratory infection. If we have strong suspicion for pneumonia CXR may be done. Baby sits in mothers lap and extends and flexes her neck significantly without any problem. Intubation in patients with Down syndrome is usually not difficult.

Anesthetic concerns in patients with Down syndrome: poor IV access; mental retardation; obesity; airway: large tonsils, large tongue, small subglottic area; cervical spinal stenosis, atlantoaxial subluxation; cardiac: VSD, ASD, TF, pulmonary hypertension.

After oral versed inhalation induction is method of choice; will start IV and place LMA; robinul may decrease secretions.

14. Two days old baby scheduled for TEF repair; he is in NICU, on RA, has PIV, weight 3,5 kg.

How would you induce this patient?

Problems: this patient has a high risk for developing pneumonia/TEF/ also we should look for possibility of VATER syndrome.

VATER syndrome: Vertebral defects, Anal malformation, Tracheo-esophageal fistula/TEF/, Radial and Renal dysplasia. Complete and intensive workup is necessary with special attention to cardiac and renal function. Type C, esophageal atresia with distal TEF is the most common/90%/ type. Sometimes gastrostomy under local anesthesia is done first.

Induction techniques include inhalation, rapid sequence and awake intubation. Avoid nitrous oxide; avoid intubating the fistula. You may attempt spontaneous ventilation

to avoid gastric distention. Tip of ETT should be above carina but below fistula.

15. Term baby is born with omphalocele and transported to OR; PIV started in LD and baby received bolus of NS.

What problems you may encounter during this case?

Problems: other associated anomalies/cardiac, trisomy 21, Beckwith-Wiedemann syndrome-omphalocele, organomegaly, macroglossia, and hypoglycemia/; heat loss; dehydration; infection; hypoglycemia.

Anesthetic management is practically the same for omphalocele and gastroschisis. They are congenital defects of the anterior abdominal wall permitting external herniation of

abdominal viscera. Gastroschisis is not midline, has normally situated umbilical cord/not covered with a hernia sac/, and is rarely associated with other congenital anomalies.

The exposed viscera must be covered with a sterile plastic bag or film to limit evaporative heat loss. Deficit of fluid should be replaced aggressively; decompress the stomach. Awake or rapid sequence intubation is preferred.

Elevated intra-abdominal pressures, high ventilatory pressures and IVC compression can cause circulatory stasis in lower limbs – you have to open abdomen!

16. 12 years old boy with foreign body in left eye/open eye/ brought to OR; had full dinner 1,5 hr ago; no significant PMH. Has PIV.

How would you induce this patient?

Problems: open eye; full stomach.

Methods and agents useful in protecting against aspiration of gastric contents must be balanced against potential to increase IOP.

Simultaneous injuries need to be excluded before operation. Any unnecessary stimulation should be avoided because coughing or vomiting can raise IOP as much as 40 mm Hg or more. Avoid any external pressure/by mask/. Aspiration prophylaxis with an H2-receptor antagonist is advised.

After pretreatment with a nondepolarizing agent, rapid-sequence induction is generally the method of choice. Patient may be extubated in lateral position. Rocuronium may be a useful drug in this setting.

In case where possibility of difficult airway may be present succinylcholine may be used in combination with thiopental.

17. 16 years old girl, 260 lb, with history of fever for 2 m, cough, unable to lie flat scheduled for lymph node biopsy; short neck, otherwise fits criteria for easy airway; peripheral IV.

How would you induce this patient?

Problems: obesity, possible mass in mediastinum

You have to be very careful with patients if you suspect anterior mediastinal mass. Ideally imaging study (CT or MRI ) should be performed before procedure. If you have results you should look and assess relationship between trachea and the mass. Clinical sign when patient is unable to lie flat points to tracheal compression.

Induction with paralysis of such patient may cause complete tracheal obstruction and inability to ventilate. If you are already in this situation you may try to reposition this patient – put her on a side or even prone and this maneuver may relive obstruction. Small chances for success may be offered by placing patient on CPB.

Ideally lymph node biopsy should be performed under local anesthesia with some sedation (ketamine) and chemo- or radiation therapy should be done first. In response mass may shrink and tracheal compression may become less prominent.

References

1. A Practice of Anesthesia for Infants and Children, 2001, Cote C.J., Todres D., Ryan J.F., Goudsouzian N.G

2. Anesthesiology Review, edited by R.J. Faust, 2002

3. The Pediatric Anesthesia Handbook, edited by Bell C., Kain Z. N. 1997

4. Anesthesiology Boards, Starr M., 2000

5. ASA, 2006 Annual Meeting, Refresher Course Lectures

CDP-03S

CDP-TX-03S & CDP-RX-03AS

UHF FM-NARROW BAND RADIO DATA MODULE

Operation Guide

Version 1.3 (August 2000)

CIRCUIT DESIGN, INC.,

International Business Division

7557-1 Hotaka, Hotaka-machi, Minamiazumi, Nagano 399-8303. JAPAN

Tel: + +(0263)-82-1010 Fax: + +(0263)-82-1016

e-mail cdint@po.circuitdesign.co.jp

http:www.circuitdesign.co.jp

CIRCUIT DESIGN, INC.

CONTENTS

GENERAL DESCRIPTION & FEATURES

CDP-TX-03S transmitter module

CDP-RX-03AS receiver module

OPERATION INSTRUCTIONS.

Supply voltage

Data input

Data format

Start up

Outputs

Antennas

SPECIFICATIONS

PIN DESCRIPTION

BLOCK DIAGRAM

DIMENSIONS

TEST DATA OF CDP-TX-03S

TEST DATA OF CDP-RX-03AS

CDP-03S UHF Synthesized Radio Data Module Operation Guide 2

CIRCUIT DESIGN, INC.

GENERAL DESCRIPTION & FEATURES

Features

* 868-870 MHz & 433-434MHz (RX only) UHF band, compatible with European EN 300 220 standard

* Very small compact integrated device with robust metal housing

* FM narrow band modulation and high frequency stability

* Low current consumption, ideal for mobile application

* Control terminal for switching the power on/off

Applications

* Remote control system

* Telemetry system

* Social alarm system

* Security alarm system

* Paging system

General description

The CDP-03S is developed to cover band plan of ERC Recommendation on Short Range Device (SRD) in the range of 868-870MHz. And the CDP-RX-03AS also covers 433-434MHz ISM band.

The PLL controlled radio data modules CDP-TX-03S (transmitter) and CDP-RX-03AS (receiver) are suitable for various application fields such as wireless data communication, remote control, telemetry or wireless security systems. It is easy to use and integrate into application systems.

The small size and low power consumption of the CDP-03S make it ideal for mobile applications where its interference rejection and practical distance range is far better than similar RF modules based on wide band SAW-resonator frequency generators. Narrow band RF technique gives you the advantage of receiver sensitivity and the reliability for communication.

Digital data and signals from standard encoder-decoder circuits of the given AF bandwidth can be transmitted.

CDP-03S UHF Synthesized Radio Data Module Operation Guide 3

CIRCUIT DESIGN, INC.

CDP-TX-03S transmitter module

The CDP-TX-03S is an UHF FM-narrow band transmitter with PLL controlled oscillator for high frequency stability.

The narrow band FM modulation (direct FSK) allows efficient use of the available RF spectrum. Different modules can operate in a 25 KHz channel spacing scheme unlike SAW resonator transmitters which use a very broad band of the frequency spectrum.

The CDP-TX-03S can transmit 3-5 Volt digital input data in the specified frequency range.

About 10mS is needed for PLL lock. 20mS after the transmitter is connected to a power source, data can be transmitted without further control or synchronization.

The transmission is physically done by a flexible Lambda/4 antenna fixed to the transmitter module. The amount of radiated power and directional behavior is influenced by the surrounding of the transmitter module. Installation in a bigger metal housing with ground connected to the transmitter module housing and transmitter antenna put into an upright position outside the metal housing will reduce the antenna impedance and increase the radiated power. For best performance in a user system general rules of radio frequency technology should be taken into consideration. The same should be applied to the receiver.

CDP-RX-03AS receiver module

The CDP-RX-03AS is an UHF receiver for FM-narrow band modulated signals. The receiver design is based on the double Super-heterodyne principle with PLL control enabling high signal sensitivity, high selectivity, and high frequency stability not achieved by simple SAW resonator receivers or other low cost designs.

Extensive filtering by an integrated unique SAW filter element enables operation in hazardous areas where interference may be expected. Steadily increasing use of the available frequency spectrum demands the application of narrow band systems for maximum operation reliability and fairness to other users of the ISM band.

The CDP-RX-03AS receiver module is designed to match the CDP-TX-03S and the CDP-TX-04S transmitter modules, though signals from other FM-narrow transmitters can be received as well.

The receiver frequency must match with the transmitter frequency to enable reception. The CDP-RX-03AS is designed for PCB mounting. A simple wire can be soldered to the antenna input or the antenna can be printed on the PC board. Antenna of impedance matching with each frequency should be used.

The receiver module has AF, DATA and RSSI signal out puts, and one control pin.

CDP-03S UHF Synthesized Radio Data Module Operation Guide 4

CIRCUIT DESIGN, INC.

OPERATION INSTRUCTIONS

Please read these instructions before you start using the CDP-03S.

The CDP-03S is designed as a module that will be integrated into a user system. It is not a ready-made product for private users. It can be regarded more like a special component for part of an electronic system. The user needs basic knowledge about electronics. Special knowledge about RF technology is helpful, but the most difficult parts are integrated into the modules to enable easy operation. Some additional information is given here:

Supply voltage:

The transmitter and receiver module contains a voltage regulator to guarantee stable performance in the given range of supply voltage.

The design was made for operation with a battery. TX and RX module must be used with the voltage specified. The module shows unstable function with the voltage lower than specified. If the voltage connected to the Vcc (+) and Ground (-) terminal is beyond the maximum voltage given in the technical specification or reversed, the module will be permanently damaged.

To enable a low minimum voltage no internal circuit is used to prevent damage by incorrect polarity.

If a higher supply voltage is available then a simple diode can be inserted in connection line to the Vcc terminal to prevent damage by incorrect polarity. The diode must be rated for the maximum supply current detailed in the technical specifications.

Data input:

The voltage of the data signal should be between 0V (Ground level) and 3-5V. The data can be digital signal. Analog signals will be converted to a digital 1 or 0 inside the transmitter.

It is not necessary to synchronize the data signal of the transmitter, but the data signal should be fed to the transmitter 20ms after the transmitter power on.

Data format:

The digital data fed to the transmitter is passed through an internal low-pass filter to limit the bandwidth of the digital data. This is needed for an efficient use of the available RF spectrum. At the receiver, a low-pass filter is used to recover the data signal from noise. At the receiver, the signal is converted back into a digital signal for compatibility with succeeding digital systems. The type of digital data signals transmittable is limited because of the bandwidth of the system.

Long intervals of HIGH or LOW bits should be avoided. Succeeding bits can be distorted in their bit length. If the sequence of HIGH or LOW bits is too long it is possible that the logic level of the data output will change.

The best countermeasure is to use a digital-encoding scheme, which guarantees that no low frequency components are included in the data signal. This can be achieved for example with the “Manchester” encoding. A digital 1 is coded in a sequence of 10 and a digital 0 is encoded

CDP-03S UHF Synthesized Radio Data Module Operation Guide 5

CIRCUIT DESIGN, INC.

into a sequence of 01.

It will be very helpful to have a conduct pulse in front of the data. A conduct pulse of 1200bps, 50% duty cycle in 20ms is recommended.

At higher data rates (4800 Baud) the internal signal is shaped into a slope and bit-length distortion at the receiver data output increases.

Further advice can be given if the precise format of the data and system requirement is notified to the dealer or directly to Circuit Design, Inc. Your inquiries and comments are welcome .

Start-up:

After Vcc is connected to the transmitter the RF oscillator will start-up and, after about 10ms, the output frequency and power will reach the normal value. The same start-up time is needed by the receiver after it is switched on.

Data transmission is not possible, or the data will be distorted, during this start-up time.

Therefore the input signal should be fed to the transmitter 20ms after TX power ON.

The transmitter is active as long as the power supply is on. The power should be switched off immediately after the data transmission is finished in order to save valuable battery power and avoid unnecessary use of the RF spectrum. Control terminal can be helpful for this purpose. It is recommended to use this terminal to switch on/off supplying Vcc into internal circuit for the purpose of power saving.

Outputs:

At the receiver side 3 output (AF, DATA and RSSI) signals and one control terminal are available.

AF output is the analog output from the FM detector circuit. This signal can be used for checking the receiver and in cases where signals with additional analog modulation are to be received.

The DATA output is a digital output. This is the signal after AF signal pass through band pass filter and comparator. For simple FSK modulation of digital data, the DATA out terminal can be used. The digital output signal can easily be connected to other digital circuits.

The receiver has no internal mute circuit to avoid delays and achieve maximum sensitivity. The AF and DATA output will show noise on the output when no signal is received. Valid data signals can be detected by utilizing the RSSI output.

The third output is called RSSI. It is an indicator of the received signal strength. It can be used to drive an external mute circuit.

Control terminal can be used to control supplying Vcc into internal circuit.

CDP-03S UHF Synthesized Radio Data Module Operation Guide 6

CIRCUIT DESIGN, INC.

Antennas:

Most important for effective data transmission is selection of a good antenna, and RF grounding, both for the transmitter and the receiver. Without an antenna it is impossible to transmit data over a long distance range.

The receiver has a simple antenna input pin. Any suitable UHF antenna can be connected to it. The easiest way to connect an antenna to the CDP-RX-03AS is to solder an 8.6cm (868MHz) or 17.3cm (434MHz) wire directly to the antenna input. If the receiving antenna is installed away from the receiver module, a 50-Ohm Coax antenna wire can be used. The shielding of the antenna wire should be soldered to the case near the antenna input of the CDP-RX-03AS.

It is possible, but not recommended to connect the receiver module and the antenna by a connection on a PCB. This will decrease the receiver performance in most cases.

In most cases the following basic rules will help you.

* Connect an antenna with 50-Ohm impedance.

* Lambda/4 whip antenna length is approximately 17.3cm for 434MHz and 8.6cm for 868Mhz.

* Place the antenna vertically, straight up or down from the transmitter and receiver module.

* Do not cover the antenna with metal parts.

* The connection of the metal surface of the transmitter case to a larger metal part (ground plane) will increase radiation efficiency. Such metal part should not be placed near the antenna.

* The human body can have similar effects like metal objects. Pocket transmitters should be taken in the hand and put in a position away from the body and pointed in the direction of the receiver.

* Best range is achieved if the transmitter and receiver antenna have a direct visual connection. Any object in between the transmitter and receiver antenna, and metallic objects in particular, will decrease the range.

* The transmission is influenced by reflections of the transmitter signal on metallic surfaces and building. There is possibility to have data error by overlaying the direct and reflected signal.

CDP-03S UHF Synthesized Radio Data Module Operation Guide 7

CIRCUIT DESIGN, INC.

SPECIFICATIONS

TRANSMITTER : CDP-TX-03S

COMMUNICATION FORM One Way

FREQUENCIES Fixed channel 869.750MHz

FREQUENCY STABILITY +/- 3.0KHz ( -10 to +55 C )

PULSE WIDTH Min. 208uS Max.20mS

DATA RATE 100-4800bps FSK

TRANSMITTER TYPE FSK Modulation, PLL Controlled Fixed Channel.

RF OUTPUT POWER 5mW + 0, -3dB at 50 Ohm

SPURIOUS EMISSION < -56dBm (Fx < 1GHz), <-30dBm (Fx > 1GHz)

MODULATION FM narrow

DEVIATION 2.5 – 3.0KHz

INPUT FREQUENCY 150Hz to 2.4KHz

DATA INPUT LEVEL 3 - 5Vp-p

SUPPLY VOLTAGE 5 to 14 V DC

SUPPLY CURRENT 30 mA (Typ.)

ANTENNA L/4 whip antenna or 50Ohm cable.

I/O TERMINALS Vcc, Data In, Gnd, Power Control

SIZE & WEIGHT 36 x 26 x 8 mm (7.5cc), 11g

RECEIVER: CDP-RX-03AS

RECEIVER TYPE Double Superheat, PLL Controlled Fixed channel

FREQUENCIES Fixed channel 433.920, 434.075, 868.3, 869.2625, 869.75MHz

FREQUENCY STABILITY +/- 2.5KHz (-10 to +55 C) / 434MHz

+/- 3.0KHz (-10 to +55C) / 868MHz

PULSE WIDTH Min. 208uS Max.20mS

DATA RATE 100-4800bps FSK

SENSITIVITY -120 dBm / 434MHz (12dB/SINAD, CCITT filter )

-117 dBm / 868MHz (12dB/SINAD, CCITT filter )

SELECTIVITY +/-5 KHz at -6 dB point

DEMODULATION FM narrow

DISTORTION <5% at 1 KHz (AF output)

S/N RATIO 50 dB overall ( AF output )

DATA OUTPUT Digital output, pulled up to Vcc (22 Kohm)

OTHER OUTPUT RSSI, AF (-11 dBm typ. at Fm=1KHz /Fmod=+/-3KHz , 100Kohm)

SUPPLY VOLTAGE 3.0 to 14V DC

SUPPLY CURRENT 18 mA ( Typ. )

I/O TERMINALS Ant, Gnd, Vcc, Data out, AF out, RSSI out, Power Control

SIZE & WEIGHT 36 x 26 x 8 mm(7.5cc), 12g

Note: Above specifications are subject to change for improvement without prior notice.

CDP-03S UHF Synthesized Radio Data Module Operation Guide 8

CIRCUIT DESIGN, INC.

PIN DESCRIPTION

CDP-TX-03S

Pin-No.

Pin-Name

I/O

Description

Equivalent internal circuit

CN1-1

GND

Ground.

Connect to the ground of the control board

CN1-2

No connection

CN1-3

DATA

The data input terminal for transmission

Data rage is 300-4800bps

Input signal level is 3 to 5V p-p

CN1-4

CTRL

The power on/off control terminal. (Lo active)

The voltage which Vcc-1.8V or lower voltage make the circuit active.

CN1-5

VCC

The power supply terminal

Operates on 5V to 14V

CN2

ANT

The antenna terminal

Connect the antenna with 50 ohm impedance

GND

The ground terminal for the antenna

CDP-03S UHF Synthesized Radio Data Module Operation Guide 9

CIRCUIT DESIGN, INC.

CDP-RX-03AS

Pin-No.

Pin-Name

I/O

Description

Equivalent internal circuit

CN1-1

DATA

The data signal output

The terminal is pulled up with resister

Vcc

22k

100 p

CN1-2

The AF signal output terminal

The signal output level is –11dBm typ.

(Fm=1KHz /Fmod=+/-3KHz, 100Kohm)

AFOut

1uF

LowPass Filter

IF IC

CN1-3

RSSI

The receiving level output

The level indicate the strength of RF level

100K

RSSI

IF IC 103

CN1-4

CTRL

The power on/off control terminal. (Lo active)

The voltage which Vcc-1.8V or lower voltage make the circuit active.

Vcc

Cont

56K

10K

Voltage Regulator

CN1-5

VCC

The power supply terminal

Operates on 3.0 to 14V

Vin

4.7u

Voltage Regulator

CN1-6

GND

The ground

Connect to the ground of the control board.

CN2-1

ANT

The antenna terminal

Connect the antenna with 50 ohm impedance

ANT

GND

CN2-1

GND

The ground terminal for the antenna

CDP-03S UHF Synthesized Radio Data Module Operation Guide 10

CIRCUIT DESIGN, INC.

BLOCK DIAGRAM

CDP-TX-03S

CDP-RX-03AS

CDP-03S UHF Synthesized Radio Data Module Operation Guide 11

CIRCUIT DESIGN, INC.

DIMENSIONS

CDP-TX-03S

PIN CONECTION

CN1- 1: GND

2: NC

3: DATA

4: CTRL

5: Vcc

CN2: ANT

CDP-03S UHF Synthesized Radio Data Module Operation Guide 12

CIRCUIT DESIGN, INC.

CDP-RX-03AS

PIN CONECTION

CN1

1: DATA

2: AF

3: RSSI

4: CTRL

5: Vcc

6: GND

CN2- 1: ANT

2: GND

CDP-03S UHF Synthesized Radio Data Module Operation Guide 13

CIRCUIT DESIGN, INC.

TEST DATA OF CDP-TX-03S

SPURIOUS EMISSION (dBm)

TEST DATA OF CDP-RX-03AS

RSSI (V)

434MHz 868MHz SIGNAL/NOISE RATIO (dB)

434MHz 868MHz

CDP-03S UHF Synthesized Radio Data Module Operation Guide 14

Chapter 1: Introduction

1.2 Introduction to the Corporate Human

Resources Management Policy Manual

(Manual 500)

The Corporate Human Resources Management Policy Manual (Manual 500) contains the Nova Scotia Government’s corporate human resource policies. The Public Service Commission (PSC), the central human resources department of Government, has oversight for the content of Manual 500.

Manual 500 contains corporate human resource policies that may apply to both bargaining unit and non-bargaining unit employees. Generally, each policy contains an

application section that sets out the employee groups to whom the policy applies.

* Bargaining unit employees should note that their collective agreements take precedence over policies contained in this Manual. Therefore, those agreements should also be referenced when seeking the most current provisions related to a specific topic.

* Non-bargaining unit employees should also refer to the Civil Service Act and its regulations, particularly for assistance in locating information on issues for which there may be no corporate policy in this Manual.

* Casual and other direct employees of government should also refer to the Labour Standards Code.

* Contract employees should also refer to the specific terms of their contracts of employment.

Key Links for More Information

Collective Agreements

http://gov.ns.ca/psc/employeeCentre/collectiveAgreements/

Civil Service Act

http://nslegislature.ca/legc/statutes/civils.htm

Regulations under the Civil Service Act

http://www.gov.ns.ca/just/regulations/rxaa-l.htm#civsvc

Labour Standards Code

http://nslegislature.ca/legc/statutes/labourst.htm

Government of Nova Scotia 1-3 Human Resources Management Manual

Chapter 1: Introduction

1.2 Introduction to the Human Resources

Management Manual

Changes – Spring 2012

In the spring of 2012, the PSC undertook some changes to the Manual that resulted in the repeal and removal of some policies and the reorganization of some of the remaining contents. Please refer to the Manual 500 Changes – Spring 2012 web page for a description of the changes, and direction on where to find information on topics that are no longer included in the Manual.

The revision, addition and repeal of policies contained in Manual 500 are carried out in

accordance with the Management Manuals Policy, accessible at the following link:

http://www.gov.ns.ca/treasuryboard/manuals/PDF/100/10102-15.pdf

Managers and employees are encouraged to register for the Corporate Policy Manuals ListServ http://www.gov.ns.ca/treasuryboard/manuals/registerlistserv.htm so they can be advised of changes to the Corporate Policy Manuals, including Manual 500, as they happen.

About the Public Service Commission

The PSC is responsible for developing, implementing, and evaluating human resource policies, programs, services and standards while ensuring high quality corporate human resource management principles, values and practices. The PSC is the government’s agent for collective bargaining with unions that represent direct government employees and provides advice to government on collective bargaining in the broader public service. Fulfilling this mandate ensures that the Nova Scotia Government has the human resources required to create and deliver high quality programs and services to citizens.

Enquiries

Public Service Commission, Policy and Programs Unit (902) 424-5901 email: PSC-Policy-Inquiries@gov.ns.ca

Approval date: January 15, 2003 Effective date: January 15, 2003

Approved by: Public Service Commissioner Administrative update: June 26, 2012

Government of Nova Scotia 1-4 Human Resources Management Manual

MCA 401 OPERATIONS RESEARCH

Module I

Linear programming problems - Mathematical formulation, graphical method of solution,

simplex method

Module II

Duality in linear programming problems, dual simplex method, sensitivity analysis,

transportation and assignment problems, Traveling salesman Problem.

Module III

Game theory Introduction, two-person zero-sum games, some basic terms, the maxmini

minimax principle, games without saddle points-Mixed Strategies, graphic solution of 2 *

n and m*2 games, dominance property.

CPM & PERT- project scheduling, critical path calculations, Crashing.

Module IV

Queueing theory -basic structure of queuing systems, roles of the Poisson and exponential distributions, classification of queues basic results of M/M/1: FIFO systems, extension to multi-server queues.

Module V

Simulation: simulation concepts, simulation of a queuing system using event list,pseudo random numbers, multiplication congruential algorithm, inverse transformation method, basic ideas of Monte-Carlo simulation.

References

* Taha.H.A ,operation Research : An Introduction, McMilan publishing Co., 1982. 7th ed.

* Ravindran A, Philips D.T & Solbery.J.J, Operations Research: Principles and practice, John Wiley & Sons, New York, 1987.

* Frank S. Budnick, Dennis Mcleavey and Richard Mojena, Principles of Operations Research for Management. All India Traveler Book seller, Delhi.

* Gillet.B.E., Introduction to Operations Research - A Computer oriented algorithmic approach, McGraw Hill, 1987.

* Joseph.G.Ecker & Michael Kupper Schimd, Introduction to operations Research, John Wiley & Sons, 1988.

* Hillier.F.S & Liberman.G.J, operation Research, Second Edition, Holden Day Inc, 1974.

* Kanti Swarup, Gupta.P.K. & Man Mohan, operations Research, S.Chand & Sons.

MCA 402 COMPUTER NETWORKS

Module I

Networking Concepts: Simplified network model. Classification of networks: LAN, MAN, WAN and the Internet. Protocols and protocol architecture. The OSI ref. Model, TCP/IP ref. model, its origin, the Internet layer, the TCP layer, the application layer. Comparison of the OSI and TCP/IP ref. models. A critiques of the OSI model and protocols, A critique of the TCP/IP ref. model, Novel Netware.

Data Link Layer: Need for data link control, Frame synchronization - flag fields, bit stuffing, flow control - stop and wait , sliding window protocol, error detection - parity check, CRC, Error control - Stop and wait ARQ, Go back-N ARQ, HDLC protocol, other data link protocols - LAPB, LAPD.

Module II

Local Area Networks: LAN protocol architecture (IEEE - 802 reference model), Topologies - Bus, tree, ring and star. Logic link control. Medium access control:-Random access- Aloha, CSMA, CSMA/CD, Exponential Back off algorithm ,CSMA/CA, controlled access-Reservation, Polling, Token Passing.

LAN systems: Traditional Ethernet:-MAC sub layer access method(CSMA/CD) ,IEEE 802.3 MAC frame, Addressing physical layer, Physical Layer, Physical Layer, Implementation, Bridged Ethernet, Switched Ethernet, Full-Duplex Ethernet.

FAST ETHERNET:- Mac Sublayer, Physical Layer, Physical Layer Implementation, GIGABIT ETHERNET:- MAC Sublayer, Physical Layer, Physical Layer

Implementation.

LAN Connecting Devices-Repeaters, Hubs, Bridges:- filtering, Transparent Bridges, Spaning Tree Algorithm.Two-Layer Switch.

Backbone Networks- Bus Backbone, Star Backbone, Connecting Remote LANs.

Module III

Wireless LAN Technology:-Overview-Wireless LAN Applications, Wireless LAN Requirements, Wireless LAN Technology. Infrared LANs-Strengths and Weakness, Transmission Techniques. Spread Spectrum LANs- Configuration, Transmission Issues. Narrowband Microwave LANs.

IEEE 802.11 Wireless LAN Standard:- IEEE 802.11 Architecture and Services, Medium Access Control-CSMA/CA, Physical Layer-IEEE-802.11 FHSS, IEEE-802.11 DSSS, IEEE-802.11a OFDM, IEEE-802.11b HR-DSSS, IEEE-802.11g OFDM. IEEE-802.11 Addressing Mechanism.

Blue Tooth:- Architecture, Bluetooth Layers, Radio Layer, Baseband Layer, L2CAP, Other Upper Layers.

VIRTUAL LANS:- VLAN Technology, Membership, Configuration, Communication

Between Switches, IEEE Standard, Advantages.

Module IV

Network Layer: Services of NW layer, Routing: Characteristics, performance criteria, routing strategies: fixed routing, flooding, random routing, Adaptive routing, congestion control,

Switched WAN – Virtual Circuit Switching, Global addressing, Virtual circuit identifier, Connection Setup:- Permanent Virtual Circuit, Switched Virtual Circuit, X.25 WAN, X.25 layers and protocols.

Module V

High Speed Switched WANs.

Frame Relay:- Back ground, Architecture, Frame Relay Layers, Frame Relay frame –

LAPF core, LAPF control.

ATM :- design goals, Cell Network, Asynchronous TDM, ATM Architecture, Identifiers,

ATM Layers:- ATM layer, ATM Headers, ATM Adaptation Layer:- AAL1, AAL2,

AAL3/4, AAL5.

Transport Layer: Services, elements of transport protocol, simple transport protocol.

References

* Behrouz A. Forouzan – Data Communications and Networking- Fourth Edition-Tata McGraw Hill

* William Stallings- Data and computer communications- PHI- Seventh Edition.

* Andrew S Tanenbaum- Computer Networks - Fourth Edition- PHI.

* William Stallings – Wireless Communications and Networks- Pearson Education.

* William Stallings- ISDN and BROADBAND ISDN WITH FRAME RELAY AND ATM-Fourth Edition - Pearson Education.

* Gerd Keiser – Local Area Networks- Second Edition - Tata McGraw Hill

MCA 403 LINUX AND SHELL PROGRAMMING

Module I

Introduction to Linux - History, Architecture, Comparison with UNIX, Features and Facilities of Linux, Basic commands in Linux, Files and File Structure - Linux File System, Boot block, Super block, Inode table, Data blocks, Linux standard directories. File naming Conventions, Path, Types of file names and Users, File Commands in Linux, file comparisons, Directory Commands, Text Editors-Functions of a Text Editor, vi Editor, Locating Files, File Access Permissions [FAP], Viewing and Changing FAPs, Redirection, Filters, Pipes.

Module II

Basics of shell programming, various types of shell available in Linux, comparisons between various shells, shell programming in bash - Conditional and looping statements, Iterations, Command Substitution - expr command, arithmetic expansion, parameter passing and arguments, Shell variables, system shell variables, shell keywords, Creating Shell programs for automating system tasks.

Module III

Common administrative tasks, identifying administrative files configuration and log files, Role of system administrator, Managing user accounts-adding &deleting users, changing permissions and ownerships, Creating and managing groups, modifying group attributes, Temporary disabling of users accounts, creating and mounting file system.

Module IV

Checking and monitoring system performance - file security & Permissions, becoming super user using su. Getting system information with uname, host name, disk partitions & sizes, users, kernel. Installing and removing packages. Backup, restore and Compress utilities - tar, cpio, dump,rsync and restore utilities,

Module V

Communication in Linux - mesg, who- T, talk, write, wall, finger, chfn, ping, traceroute utilities, email facilities . Configuration of servers- Telnet, FTP, DHCP,NFS, SSH, Proxy Server(Squid), Web server (Apache), Samba. Daemons- init, crond, atd, xinetd, inetd, the services file. named, sshd, httpd.

References

* Operating System - Linux, NUT Press, PHI Publisher, 2006 Edition

* Red Hat Linux Bible, Cristopher Negus, Wiley Dreamtech India

* UNIX Shell Programming by YeswantKanetkar, BPB

* Linux Administration Handbook, EviNemeth,Garth Snyder, Trent KHein - Pearson Education.

* Beginning Linux Programming by Neil Mathew & Richard Stones, Wiley Dreamtech India

MCA 404 OBJECT ORIENTED MODELING AND DESIGN

Module I Introduction and Inception

Object – Oriented Analysis and Design, Iterative Development, Inception ,

Evolutionary Requirements ,Use Cases and Other Requirements Artifacts

Module II Elaboration - Iteration 1

Iteration 1 Basics, Domain Models , System Sequence Diagrams , Operation

Contracts Requirements to design, Logical Architecture and UML Package Diagrams, Object Design , UML Interaction Diagrams ,UML Class Diagrams

Module III Design Patterns and Elaboration - Iteration 1 continued

Objects and Responsibilities - Grasp , Object Design Examples , Visibility and Design , Mapping Designs to Code , Test Driven Development and Refactoring

Module IV Elaboration - Iteration 2 and Patterns continued

Iteration 2 Basics , UML Tools and UML as Blueprint , Quick Analysis Update , GRASP : More Object Design ,GoF Patterns

Module V Elaboration - Iteration 3

Iteration 3 Basics, Activity Diagrams and Modeling , State Machine Diagrams and Modeling , Relating Use Cases , Domain Model Refinement , Architectural Analysis , Logical Architecture Refinement, UML deployment and component diagrams

References

* Larman, Craig, Applying UML and Patterns: An Introduction to Object-Oriented Analysis, Pearson Education, 3nd Ed., 2004.

* Michael Bleha, James Rambaugh, Object-Oriented Modelling & Design with UML, Pearson, 2nd Ed., 2005.

* Bahrami A., Object Oriented Systems Development using Unified Modeling Language, McGraw Hill, 1999.

* Grady Booch et al., Unified Modeling Language User Guide, Pearson Education, 1999

* Martin Fowler et al., UML Distilled, Pearson Education, 2002

* Bruegge B., Object-Oriented Software Engineering, Pearson, 2000.

* The Unified Modeling Language Reference Manual., Rumbaugh, Jacobson and Booch., Addison-Wesley

MCA 406 Linux Lab

Installation of Linux, network based installation

Basic Overview of various commands- cal, pwd, cd, ls, mv, cd, cp, rm, mkdir, rmdir, more, less, touch. Creating and viewing files using cat, file comparisons, disk related commands, checking disk free spaces. Batch commands, kill, ps, who, Printing commands, find, sort, touch, file, file processing commands- wc, cut, paste etc - mathematical commands - expr, factor etc. Filter commands- pr, head, tail, cut, sort, uniq, tr - Filter using regular expression grep, egrep, sed, awk

Shell Programming -Shells, Scripting Rationale Creating a bash Script, bash Start up Files, A Script's Environment, Exporting Variables, Exit Status, Programming the Shell, Parameter Passing, Operators, looping, Input and Output.

Process Management with Linux, File System management, User Administration, Linux Start up and Shutdown, Software package Management

Network Administration

LAN Card configuration, Server Configuration- DHCP, DNS, FTP, Telnet, SSH, NFS, Web Server, SQUID Proxy server.

References

* Operating System - Linux, NUT Press, PHI Publisher, 2006 Edition

* Red Hat Linux Bible, Cristopher Negus, Wiley Dreamtech India

* UNIX Shell Programming by YeswantKanetkar, BPB

* Linux Administration Handbook, EviNemeth,Garth Snyder, Trent KHein -

Pearson Education.

* Beginning Linux Programming by Neil Mathew & Richard Stones, Wiley

Dreamtech India

MCA 407(A) Open Source Lab - Python

1. Data Types and Data Structures :

Introduction to Python: - using the Python interpreter, Overview of programming in

Python, Python built-in types, Arithmetic in Python, Program input and Program output,

Variables and assignment.

Strings and string operations, List basics, List operations, Dictionaries, Dictionary basics

and Tuples,

(a) Simple programs using elementary data items, lists, dictionaries and tuples.

2. Control Structures:

Control Statements:-if statements, while statement, for statements, functions, formal

arguments, variable-length arguments, Exceptions, detecting and handling exceptions.

(a) Programs using conditional branches, loops.

(b) Programs using functions

3. Classes ,files and modules

Introduction to Classes and Objects:-classes, class attributes, instances, instance attributes, binding and method invocation, inheritance, polymorphism, Built-in functions for classes and instances.

Files and input/output, reading and writing files, methods of file objects, using standard library functions, dates and times

(a) Programs using classes and objects

(b) Programs using inheritance

(d) Programs to implement file operations.

(e) Programs using modules.

4. Database and web programming

Python database application programmer’s interface (DB- API), connection and

cursor objects, Type objects and constructors, python database adapters.

Creating simple web clients, introduction to CGI, CGI module, building CGI

applications, python web application frameworks: django .

(a) Programs using python database API.

(b) Programs for creating simple web pages.

5. Development of sample web applications using python.

Sample applications may include

i) Web based polling

ii) Social networking site

iii) Online transaction system

iv) Content management system

References

1. Core Python Programming by Wesley J. Chun, 2nd Edition , Pearson Education

2. An Introduction to Python by Guido Van Russom, Fred L.Drake, Network Theory Limited.

3. Beginning Python: From Novice To Professional By Magnus Lie Hetland, Second Edition Apress

4. Programming in Python 3 by Mark Summerfield, Pearson Education

Websites :

Online version of An Introduction To Python

http://www.network-theory.co.uk/docs/pytut/

online python tutorials

http://docs.python.org/tutorial/

http://zetcode.com/tutorials/pythontutorial/

http://www.sthurlow.com/python/

http://www.tutorialspoint.com/python/

A site for django resources

http://www.djangoproject.com/

Online book on django Framework

http://www.djangobook.com/

MCA 407(B) Open Source Lab- PHP

PHP Basics- Syntax, Operators, Variables, Constants, Control Structures, Language

Constructs and Functions.

Functions- Syntax, Arguments, Variables, References, Returns, Variable Scope

Arrays- Enumerated Arrays, Associative Arrays, Array Iteration, Multi-Dimensional

Arrays, Array Functions, SPL.

Object Oriented Programming- Instantiation, Modifiers/Inheritance, Interfaces,

Exceptions, Static Methods & Properties, Autoload, Reflection, Type Hinting, Class

Constants.

Strings and Patterns- Quoting, Matching, Extracting, Searching, Replacing, Formatting

Web Features- Sessions, Forms, GET and POST data, Cookies, HTTP Headers Databases and SQL - SQL, Joins, Analyzing Queries, Prepared Statements, Transactions. Streams and Network Programming- Files, Reading, Writing, File System Functions, Streams

Sample web applications using PHP

References

* Professional PHP 6 EdcLecky –Thompson, Steven D. Nowicki,Thomas Myer Wrox Publishers

* PHP6 and MySQL Bible – Steve Suehring,TimConverse,and Joyce Park Wiley India Pvt.Ltd

MCA 405(1) VISUAL PROGRAMMING

Module I

Parts of Visual C++ program - application object – main window object, view object document object. Event oriented window programming , device context. Elements of GUI & Visual design, Designing and Creating a Visual C++ Program, Project work spaces, Debug and Release Targets, Cleaning up.

Exception handling and Debugging .

Module II

Basics of MFC & MFC-based executables. Event Handling : Reading keystrokes, handling mouse , creating menus, tool bars, buttons, status bar prompts, dialog box, check box, radio buttons, list boxes, combo boxes, sliders, serialization , file handling, multiple documents.

Module III

Understanding Message maps and message loops, Events and Event handling, Mouse events, Keyboard events, Dynamic data Exchange and verification, creating Menus, Modeless dialog boxes. Device contexts, working with images, bitmaps and icons, creating bitmap buttons, creating and using Pens, Brushes, and Fonts.

Module IV

Document - View Architecture basics, the document class and view class, creating SDI applications, Multitasking, creating MDI Applications, Working with menu in documents, Toolbar and status bar.

Module V

Multi threaded Programming- Worker threads , user interface threads, thread synchronization. Basics of COM- ActiveX Technology, The component Object Model, Real COM with

MFC Library, Containment and Aggregation vs. Inheritance

References

* Yeshwant Kanetkar , Visual C++ Programming , BPB

* David Kruglinski, George Shepherd & Scot Wingo, Programming Visual C++, Microsoft Press

* Indian Reprint, 2000

* Holzner Steven, “Visual C++ 6 in record time”, BPB publications

* Jeff Prosise, Programming Windows with MFC, Microsoft Press, 2000

* Charles Petzold, “Programming Windows”, 5th Edition, Microsoft Press, 1999.

* Mickey Williams , David Bennett,Visual C++ 6 Unleashed (Hardcover) , SAMS

* Yeshwant Kanetkar,Visual C++ Projects.

* David Kruglinski, George Shepherd & Scot Wingo, Programming Visual C++, Microsoft Press

* Indian Reprint, 2000

* Chuck Sphar, Learn Visual C++ Now, Microsoft Press/Phi, 1999

* Ivor Horton, Programming Visual C++ Standard Edition, Wrox Press, 1999

* Herbert Schildt,MFC Programming for the GROUND UP,Second Edition, Tata McgrawHill,2000

* Richard.C.Leinecker and Tom Archer,Visual C++ Programming Bible, Wiley Dream Tech, 2005

MCA 405(2) SOFTWARE QUALITY MANAGEMENT

Module I Quality Concepts

Basic Quality Concepts, Companywide Assessment of Quality, Quality Improvement and Cost Reduction, Quality Control

Module II Basic Quality Management concepts

Process Management, Organization for Quality, Strategic Quality Management, Developing a Quality Culture, Understanding Customer Needs

Module III Software Quality Management

Software Quality in Business Context, Managing Software Quality in an Organization, Planning for Software Quality Assurance, Product Quality and Process Quality

Module IV Metrics and Audits

Software Measurement and Metrics, Walkthroughs and Inspections, Software Configuration Management, Quality Assurance Audits

Module V Techniques for Quality Improvement

ISO 9001, Software CMM and Other Process Improvement Models, Software Testing, Quality Related Additional topics - SQC and SPC, Software Maintenance Models, Maintainability in OO and e-Business Era

References

* Frank Gryna, Richard Chua, Joseph Defeo, "Juran's Quality Planning and Analysis for Enterprise Quality", Fifth Edition, Tata McGraw Hill

* Nina S Godbole, "Software Quality Assurance", 2004, Narosa

* Stephen H.Kan, “Metrics and Models in Software Quality Engineering”, Second Edition, Pearson, 2003.

* Jeff Tian, "Software Quality Engineering", 2005, Wiley Student Edition

* Pankaj Jalote, "Software Project Management in Practice",2002, Pearson

* Roger S. Pressman, “Software Engineering - A Practitioner’s Approach”, Seventh Edition, McGraw Hill, 2010.

* Humphrey Watts, “Managing the Software Process”, Addison Wesley, 1986.

MCA 405(3) BUSINESS DATA PROCESSING AND COBOL

PROGRAMMING

Module I

INTRODUCTION

Business Data Processing, Types of COBOL, Mainframe COBOL, Transaction Files, Master Files, File Processing, Coding Format for Cobol Program, Structure of a Cobol Program, Character set, Cobol words, Data names and identifiers, Literal, Figurative Constants, Continuation of lines and notations. IDENTIFICATION , ENVIRONMENT DIVISION AND DATA DIVISION :General formats, Configuration section, Input-output section, Level Structure, Data description entries, Picture clause, Value clause, File section, Working - Storage Section, Editing characters of different data and examples, special-names paragraph, Classes and categories of data.

Module II

PROCEDURE DIVISION, VERBS AND CLAUSES

Structure of procedure division, Data movement verb and other options of move statements, Arithmetic verbs, Sequence control verbs, Input & Output verbs, conditional verb : simple IF, Categories of COBOL statements. Usage Clause, Synchronized clause, Justified clause, Redefines clause and Renames clause, qualification of data names, sign clause, Elementary and Group moves, corresponding option : Move Corresponding, Add Corresponding & Subtract Corresponding, Rounded option, On size error option, compute verb.

Module III

COMPUTATION AND DECISION MAKING

Interactive processing using screen sections, Intrinsic Functions, Conditions: Relational,

class, Condition-name, compound, sign, IF statements, Alter statements, Perform

statements, Exit statements.

Module IV

ARRAY PROCESSING AND TABLE HANDLING

Occurs clause, subscripting, Assigning values to table elements, Multidimensional tables,

Perform & table handling, Indexed tables & Indexing. Set verb, search verb, Occurs

depending clause, Index data item.

Module V

SEQUENTIAL,INDEXED & RELATIVE FILE PROCESSING, REPORT WRITER AND SUBROUTINES

File characteristics, file control entries, file description. Statements for sequential files, Sequential file with variable length records, I/O control paragraph, Simple sort verb, file updation, variation of updation, Simple merge verb, input and output procedure in sort statements, Merge verb with output procedure. File control paragraph, for relative files, Procedure division statements for relative files, Indexed sequential files, General format of a report, File section, Report clause, Outline of a report section, Report section - report description entry, report group, procedure division statements, Sample program, Structure of COBOL subroutine, Calling of a Subroutine, State of subroutine and cancel statement, Advantages and Disadvantages of cobol subroutines.

References

* M.K Roy and d Ghosh Dastigar, COBOL Programming, including MS COBOL and COBOL 85, Tata McGraw Hill 1997

* 2.Nancy Stern and Robert a Stern, Structered COBOL Programming, 8th Edition, john Wiley 1997

* 3. Structured Cobol Programming , Shelly Cashman , Thomson aLearning 2Edn.

MCA 405(4) ENTERPRISE RESOURCE PLANNING

Module I

ERP Overview - Definition, History, Benefits, Enterprise Applications. ERP Life Cycle,Implementation Methodology. Costs of ERP Implementation. Selecting Consulting Partner. ERP package Selection, Project Team and Organizational Structure.

Module II

ERP Project Management, Requirements, Business Process Re-engineering - re

engineering phases, role of IT in BPR, benchmarking, Business Process Modeling and Business Modeling, Gaps, Gap management Strategy, Configuration and Testing

Module III

ERP Security, Data Migration, Cut-over Planning and Go Live Preparation, Training, Change management, ASAP Methodology, Success/failure of an ERP implementation, Application Support-Support Cycle, Transition Cycle, Service levels and SLAs, Support Models.

Module IV

ERP functional Modules- Human capital management, financial Management, Procurement and Inventory Management, Supplier Relationship Management, supply Chain Planning, Sales and Service, CRM, Quality Management, Product Life Cycle management, Logistics.

Module V

Technology for ERP- Portal, Content Management System, Business Intelligence, Data

warehousing. Emerging trends in ERP.

Case Studies-ITC, Nestle, Maruti Suzuki, Airtel, Asian Paints.

References

* Enterprise Resource Planning, Rajesh Ray, 1st Edition, McGraw Hill Publications

* Enterprise Resource Planning, Alexis Leon, Tata McGraw Hill Publications

* Enterprise Resource Planning, Jagan Nathan Vaman, Tata McGraw Hill Publications

* Enterprise Resource Planning, Sumner, Pearson Publications

MCA 405(5) MULTIMEDIA SYSTEMS

Module I

Media and data streams – Medium, Properties of a multimedia system, Traditional data streams, Continuous data stream, Information Units. Sound concepts, Music – MIDI, MIDI Devices, MIDI and SMPTE timing standards, MIDI software. Speech – Generation, Analysis, Transmission.

Module II

Images and Graphics – Concepts, Image processing. Video and Animation – Concepts, television , Computer based animation. Data compression – Coding, JPEG-Image preparation, Lossy DCT based Mode, Hierarchical mode, H.261- Image Preparation, Coding Algorithms, Data Stream, MPEG-Video/Audio Encoding, Data stream, MPEG-2,MPEG-4, DVI.

Module III

Multimedia OS – Realtime, Resource Management, Process Management, File Systems, OS Issues, System Architecture. Multimedia Communication Systems – application Subsystem, Transport Subsystem, QoS and Resource Management.

Module IV

Multimedia DBMS- Characteristics, Data Structure, Operations, Database Model.

Hypertext and Hypermedia, SGML, ODA, MHEG.

Module V

Synchronization – Notion of synchronization, Presentation requirements, Reference model for synchronization, Synchronization Specifications, Synchronization Case Studies – MHEG, HyTime, MODE, ACME.

References:

* Multimedia: Computing, Communications and Applications, Steinmetz & Nahrstedt, Pearson Education

* Multimedia communications, Fred Halsall, Pearson Education

* Multimedia Systems, Koegel Buford, Pearson Education

MCA 405(6) NEURAL NETWORKS AND FUZZY LOGIC

Module I

Neural Networks:- Basic Concepts of Neural Networks, Characteristics -

Human Brain – Artificial Neural Network – Terminologies, Model of an Artificial Neuron –Architectures – Learning Methods, Some Application Domains .

Module II

Functional Units for Pattern Recognition :- Pattern recognition problem, Basic functional units, Pattern recognition tasks by functional units.

Module III

Feedforward Neural Networks:-Analysis of pattern classification networks: Pattern Classification problem, Perceptron- Learning Law, Convergence Theorem, Representation problem.

Linear inseparability : - Hard problems, Geometrical Interpretation of Hard problems: Multilayer perceptrons. Back propagation- Learning: Features, Performance, Limitations.

Module IV

Fuzzy Logic:- Fuzzy Versus Crisp – Crisp sets – Operations on Crisp Sets, Properties of Crisp Sets , Fuzzy Sets, Basic Fuzzy Set Operations, Properties of Fuzzy Sets – Crisp Relations, Operations on Crisp Relations - Fuzzy Relations – Operations on Fuzzy Relations , Properties, Membership Functions,

Fuzzification, Defuzzification Methods.

Module V

Fuzzy Systems:- Fuzzy Rule Base- Fuzzy Reasoning, Fuzzy Inference systems , Fuzzy Logic Control Systems, Applications.

References

* Yegnanarayana B , Artificial Neural Networks, Prentice-Hall of India Pvt.Ltd

* Haykin S, Neural Networks – A Comprehensive Foundation, Second Edition, Pearson Education Asia, 1999.

* S. N. Sivanandan and S. N. Deepa , Principles of Soft Computing , Wiley India 2nd Ed, 2011.

* John Yen, Reza Langari , Fuzzy Logic –Intelligence, Control and Information, Pearson Education,2005.

* Anderson J A, An Introduction to Neural Networks, Prentice-Hall of India, 1995.

* S. Rajasekaran and G.A Vijayalakshmi Pai, Neural Networks, Fuzzy Logic, and Genetic Algorithms Synthesis and Applications, Prentice-Hall of India Pvt.Ltd ,2004.

* Bose N K, Neural Network Fundamentals with Graphs, algorithms, and Applications, Tata McGraw-Hill, 2001.

MCA 405(7) ARTIFICIAL INTELLIGENCE

Module I

Introduction to Artificial Intelligence – Architecture of Artificial Intelligence Systems-problem solving : Problems and problem spaces. Problem Definition – production systems – control strategies – search strategies, problem characteristics – production system characteristics.

Module II

Knowledge Representation Schemes:- Proposition and predicate logic – Syntax and semantics- Properties of WFFS – Conversion to clausal form – Inference rules – Resolution – Non Deductive Inference Methods – Representation using Rules. Associative Network, Frames and Object Oriented Repn. of knowledge. Associative Networks – Frame Structure, conceptual dependencies and scripts.

Module III

Search and control strategies – examples of search problem – Uniformed or Blind search problem – Informed search – searching And OR graphs. Matching Techniques – Structures used for Matching – Measures for Matching, knowledge organization and management – indexing and retrieval techniques.

Module IV

General concepts in knowledge Acquisition – Types of learning, Difficulty in knowledge Acquisition, General Learning model. Early work in Machine Learning – Analogical and Explanation based learning – Analogical Reasoning and Learning – Examples, Explanation based learning. Expert System Architectures – Rule based system, Non production system, Dealing with uncertainty.

Module V

Natural language Processing – Overview of Linguistics, Grammers and Languages, Basic Parsing Techniques, Semantic analysis and Repn structures Natural language system. Pattern Recognition – Recognition and classification process – classification patterns recognizing and understanding speech. Perception – solving perceptual problem.

References

* Introduction to A.I and Expert system – D.W. Patterson, Prentice Hall of India.

* Artificial Intelligence – Elainc Rich, Mc Graw Hill.

* Principles of Artificial Intelligence – Nilson N. J, Springer Verlag.

* Introduction to Artificial Intelligence – Charvanak. E and Mc dermoit D, Addison Wesley

MCA 405(8) MANAGEMENT INFORMATION SYSTEMS

Module I

Digital Firm- Concepts, Definition, Role, Control System, Management Support, Management Effectiveness, Digital Firm. E-Business and E-Commerce, System Concepts, Feedback and Control, Corporate Planning, Types of strategies, Business Planning, Balance Score Card, Strategic Business Planning. Security Challenges- threats and vulnerabilities, controlling threats, disaster management, information security.

Module II

DSS, Decision Analysis, Organizational Decision Making, concepts on information, Information Classification, Knowledge and Knowledge management. Business Intelligence, Expert Systems. System Analysis, General Model of MIS, Need and role of System Analysis, System development Model, OOA, SSAD, OOSAD Development Life Cycle. Development process of MIS, Process Model.

Module III

Business Process Re-engineering, Value Stream Model, MIS and BPR. DSS, GDSS, Knowledge Management Systems, DSS in E-enterprises, Enterprise Management System, ERP, SCM, CRM, EMS and MIS.

Module IV

Technology of IS – Data Processing, Transaction Processing, OLAP, TQM, Networks – Topology, Data Communication, Unified Communications, Components of UC, WiMAX. Database- Database Models, Database Design, RDBMS, Client-Server Architecture and implementation strategies. Data Warehouse, Architecture of Data Warehouse, Implementation.

Module V

E-Business, Internet and WWW, E-Commerce, categories of E-Commerce, Electronic payment Systems, Content Management Systems, Enterprise Portal, Security in e-business, privacy issues, Tools for security management, Systems Control and Audit, Global MIS – Outsourcing and Off shoring, Global Business strategies.

References

* Management Information Systems, Waman S Jawadekar, 4th Edition, McGraw Hill

* Management Information Systems, O'Brien, Marakas and Behl, 9th Edition, Tata Mcgraw Hill Publication.

* Management Information System, Laudon, Laudon & Dass, 11th Edition, Pearson Education

* Management Information System, Davis & Olson, Tata McgrawHill Publication.

* Information system for Modern management, Murdick, Rose & Cloggett, PHI Publications.

Running head: RESEARCH MANUAL FOR EDD AND EDS 1

RESEARCH MANUAL

FOR THE EDD DISSERTATION

AND

EDS PROJECT/THESIS

Planning and Conducting a Research Study

For the

Doctor of Education Degree (EdD)

and

Educational Specialist Degree (EdS)

COLLEGE OF EDUCATION

Florida Gulf Coast University

Approved by Post-Master’s Admissions and Policy Committee

Fall 2009

Revised Spring 2011

EdD Added Summer 2011

RESEARCH MANUAL FOR EDD AND EDS 2

TABLE OF CONTENTS

Research Project Overview 3

Purpose of the EdD Dissertation and EdS Project 3

Graduate Candidate Responsibility 3

Advising, EdD Dissertation Committee and EdS Project Committee 3

Course Requirements, Credits, and IRB 4

Assistance with the Research Study 5

Timeline for Completing the Research Study 6

Steps in the Process 11

STEP 1: Identification of topic for the study and developing a problem statement 11

STEP 2: Review of literature (Note thatfor the pre-proposal or prospectus, chapter 1, the candidate is only expected to provide a summary of the literature review consisting of the

major research findings) 12

STEP 3: Development of a Research Pre-Proposal or Prospectus 13

STEP 4: Expand and Refine Review ofLiterature (Chapter Two) 14

STEP 5: Methodology section (Chapter Three) 14

STEP 6: Submission to IRB 14

https://www.citiprogram.org/ 14

STEP 7: Proposal hearing 14

STEP 8: Data Collection and Analysis 15

STEP 9: Writing 15

STEP 10: Defense of the Research Study 17

STEP 11: Submission to Library and Committee Chair 18

Role of Candidates, Committee Chairs, Committee Members, 19

Requesting a Change in Chair, and Forms Required 19

Role of the Candidate 19

Role of the Committee Chair 20

Role of the Committee Member 20

If the interaction between the candidate and committee chair or committee member is no longer viable, the candidate may request reassignment to a new committee chair or replace a committee member. This request will be made to the Post-Master’s program coordinator. However, in doing

so, the candidate must understand that this action may result in a delay of project completion 21

Forms Required 21

References 22

RESEARCH MANUAL FOR EDD AND EDS 3

Research Project Overview

Purpose of the EdD Dissertation and EdS Project

All EdD candidates will complete a dissertation and all EdS candidates will complete a final EdS Project as a requirement for the degree. In the EdS program, we refer to the culminating research requirement as the “EdS Project.” We use this term to distinguish it from a master’s thesis or a doctoral dissertation; however, it is essentially a thesis. Both the dissertation and the project will be a research study using quantitative, qualitative, or mixed methods research. Advanced graduate candidates should be able to conduct research or program evaluation studies in their area of concentration. Whereas the purpose of the EdS project is a smaller scale or perhaps pilot study, the dissertation is a larger scale project. Each of these culminating research projects is intended to teach candidates how to carry out research and to evaluate their own research skills. Candidates also learn scholarly writing skills for presentation to a professional audience, and to be consumers of good research

Candidates learn about the Internal Review Board (IRB) process that must be followed prior to engaging in the data collection process. The IRB policies and forms can be accessed at the following URL: http://www.fgcu.edu/orsp/ProposalPreparation.html

Candidates will follow the Office of Graduate Studies thesis and dissertation guidelines at the following URL: http://www.fgcu.edu/Graduate/thesisguidelines.html. In addition, there are guidelines in this manual that must be followed.

A research study is the result of research, scholarly, or creative activity that provides evidence of professional writing skills, and of a candidate’s ability to complete an independent, critical, and creative investigation. It is one indicator of the candidate’s ability to define and develop a problem; understand and synthesize relevant literature; use appropriate methodology; analyze and interpret data; draw reasonable conclusions, and recommend further investigation. Another indicator of candidate competence will be the candidate’s defense of the study to the candidate’s EdS Final Project Committee or EdD Dissertation Committee.

Graduate Candidate Responsibility

Graduate candidates assume responsibility for engaging in intellectual activities at the graduate level as well as responsibility for complying with all policies and procedures set forth in the Graduate Catalog, in the Research Study Manual, and in college and program regulations. It is the responsibility of the candidate to adhere to these policies and procedures. Requirements will not be waived, and exceptions will not be granted because a candidate fails to learn policies, requirements, or procedures for graduate study at FGCU.

Advising, EdD Dissertation Committee and EdS Project Committee

Upon acceptance to the graduate program, a candidate is assigned a graduate advisor. A graduate advisor is different from the role of the chair of the EdD dissertation or the EdS project/thesis. The Graduate advisor will work with the candidate at the beginning of the program, helping the

RESEARCH MANUAL FOR EDD AND EDS 4

candidate complete the Plan of Study, especially in the selection of cognate classes. The graduate advisor may or may not serve as the advisor and chair of the EdD dissertation or EdS project/thesis. During the candidate’s coursework, he or she will hopefully develop interests in a specific topical area for his or her EdD dissertation or EdS project. Course faculty members and the candidate’s advisor will assist the candidate in selecting a topic. Once a topic is selected by a candidate, the advisor will assist the candidate in selecting an appropriate faculty member to serve as the EdD dissertation advisor or EdS project advisor and committee members. Three additional faculty members will be selected to serve on the dissertation committee for a total of four members, and two additional faculty will be selected by the EdS Advising Committee for a total of three members. Typically, these faculty members will represent the candidate’s concentration and cognate areas. The advisor must be a full-time faculty member in the College of Education at FGCU and a member of the university Graduate Faculty. All committee

members must also be members, associate members, or adjunct members of the university Graduate Faculty.

Course Requirements, Credits, and IRB

For the EdD dissertation, candidates must enroll in two classes: a one credit class (ADD CLASS) to develop a prospectus (chapter 1), and a two credit class (ADD CLASS) to complete the dissertation proposal (chapters 2 and 3). For the EdS project candidates are required to enroll in EDG 7974 Specialist Proposal Development for 3 credits during which they learn to develop a proposal (chapters 1-3). Although candidates are in a class with a professor, they must keep in close contact with their dissertation committee or project committee who has final authority to approve the proposal.

Prior to implementing the research design, the candidate must receive approval by the FGCU Institutional Review Board (IRB). See procedure for the IRB on the FGCU website: http://www.fgcu.edu/ORSP/Compliance.html

Most candidate research will fall under one of the following IRB categories:

* Research Considered Under the “Exempt from Further Review” Category

* Research Considered Under the “Expedited Review” Category

The IRB requires completion of human subject training to accompany the protocol. Candidates are required to complete the following tutorial. Please print the certificate at the end of the tutorial and send it to ORSP. Make a copy for yourself and for your committee chair:

* http://phrp.nihtraining.com/users/login.php

The semester after completing the dissertation proposal, candidates will enroll in 9 to 12 credits of dissertation work. A total of 21 credits are required, so the following semester will also require from 9 to 12 credit hours. If the dissertation is not completed by the end of the 21 credit hours, the candidate will be required to enroll in at least one credit hour for the dissertation. The number of credit hours will depend on how much work still needs to be accomplished. The candidate’s committee will make this determination in consultation with the candidate.

RESEARCH MANUAL FOR EDD AND EDS 5

The semester after EDG 7974 Specialist Proposal Development, the candidates will enroll in EDG 7975 Specialist Culminating Project for 3 credits, during which time they will complete their project. If the candidate has successfully completed his or her project defense before the end of the semester, he or she will not be required to enroll for another 3 credits. Alternatively, if the candidates do not successfully defend by the end of the semester, they must enroll in at least one additional credit the next semester. The number of credit hours will depend on how much work still needs to be accomplished. The candidate’s committee will make this determination in consultation with the candidate.

Assistance with the Research Study

The following are opportunities for candidates seeking assistance with writing the research study:

1. The committee chair and other committee members serve as resources. Candidates should be in frequent contact with their committee. Typically, numerous drafts are needed. Candidates need to provide the committee chair and committee members with sufficient time to read the work and provide feedback. It is important for candidates to be open-minded about accepting constructive criticism.

2. The Writing Center can serve as a resource. The staff at the Writing Center will not write the research study, but can provide assistance in learning how to write more effectively and to produce a research study that is formatted correctly.

3. The Library staff can provide assistance in locating relevant resources. Items may also be ordered through Inter-Library Loan. Various helpful library links are contained in this manual.

4. Other offices and online assistance may be available to assist with specific needs, The following resources are available:

Resource

Contact Information

http://www.copyright.gov/

Library Reference

Desk

239-590-7630

http://library.fgcu.edu/ADMIN/Forms/my librarian.htm

Library Information

239-590-7618

Office of Graduate

Studies

Lutgert Hall

239-590-7988

http://www.fgcu.edu/Graduate/graduateresources.html

Office of Sponsored

Research & Projects

Holmes Hall, Suite 112

239-590-7024

http://www.fgcu.edu/orsp/

Writing Center

Library

Located in Library 202C (Old Library entrance) http://www.fgcu.edu/cas/english/writingcenter/

Thesis and

Dissertation

Guidelines

http://www.fgcu.edu/Graduate/files/ThesisGuidelines021406.pdf

RESEARCH MANUAL FOR EDD AND EDS 6

Information on copyright registration is available from the U.S. Copyright Office (http://www.copyright.gov/).

* The candidate is responsible for any fees associated with securing a copyright.

* The candidate is also responsible for inserting the copyright notice on an unnumbered page immediately preceding the title page.

Timeline for Completing the Research Study

Completing a research study is a time-consuming process. A research study cannot be rushed through at the last minute. This is a process that often involves several drafts with input from committee members. Care must be taken to follow guidelines for style and format using the most recent edition of the Publication Manual of the American Psychological Association (APA). The suggested timeline on the following page can be used to plan the work on the research study and to avoid a delay in graduation.

The candidate will need to project the date for the anticipated graduation. This will allow the work plan to be tailored to the individual’s time sequence. Planning, organizing and completing sections of the dissertation or project/thesis will assist the candidate in maintaining a successful timeline and graduate on time. It is helpful for the candidate to have the class professor and committee members to approve each chapter as it is completed. While a chapter is being read and reviewed by the committee, the candidate can be drafting the next chapter.

Candidates should meet on a formal and informal basis with their faculty committee chair or other committee members as needed. When setting meeting times, it is important to remember that the professors have professional and personal commitments and may not be able to meet with you immediately. Committee chairs have been selected because of their expertise and their commitment to helping candidates with their research, and they will do the best they can to accommodate your needs. It is also important to reemphasize completing a research study is a time-consuming process and cannot be rushed through at the last minute. Candidates should continue to confirm their timelines and monitor progress on completed tasks.

Suggested Timeline for Completing the EdS Project

Item

TASK

SUGGESTED

COMPLETION

DATE

NOTES

Enroll in EDG

7974 Specialist

Proposal

Development

Semester 1

Selection of Topic

Semester 1

Discuss with Advisor & Instructor; contact other EdS

Project Committee members as needed.

Begin initial

review of the

literature; Define

problem

Semester 1

Work with Advisor & Instructor for the course; contact

other EdS Project Committee members as needed.

Draft Pre-Proposal for Research Study

Semester 1

Work with Advisor & Instructor for the course

throughout this process; contact other EdS Project

Committee members as needed.

Typically requires numerous drafts

Approval of Pre-

Proposal;

this will become

CHAPTER ONE

INTRODUCTION

Semester 1

Continue to work with Advisor & Instructor for the

course; contact other EdS Project Committee members

as needed. Work with the Writing Center; Typically

requires numerous drafts prior to securing approval

signatures.

Submit forms to IRB, including certificate of completion of training program

Semester 1 (possibly summer)

Obtain forms from Office of Research and Sponsored

Programs or via website. Must be completed and filed

before data collection can begin.

Main ORSP Compliance Website: http://www.fgcu.edu/orsp/compliance.html

Online tutorials:

http://phrp.nihtraining.com/users/login.php

https://www.citiprogram.org/

Draft CHAPTER

TWO

REVIEW OF THE

LITERATURE

Semester 1

Continue to work with Advisor & Instructor throughout

the Research Study; contact other EdS Project

Committee members as needed; requires time for

reading and providingfeedback, requires numerous

drafts; Continue to work with the Writing Center as

needed.

Draft CHAPTER

THREE

METHODOLOGY

(as appropriate to

the study)

Semester 1

Continue to Work with Advisor & Instructor; contact

other EdS Project Committee members as needed.

Send Chapters 1-3

to all Committee

Members

Semester I

When approved by the Chair, provide a copy of chapters 1-3 to all committee members for feedback.

Proposal Approval

End of Semester 1

Or Early Semester 2

Work with Committee members, and Research and Evaluation faculty as needed. The proposal (first 3 chapters) must be approved by all members of the committee. A proposal hearing should be scheduled once all of the committee members agree that that

proposal is ready.

Typically requires numerous drafts

Enroll in EDG

7975 Specialist

Culminating

Project

Semester 2

If candidates do not finish the project in semester 2, then

they will enroll in a minimum of 1 additional credit hour

the following semester. The committee will determine

how many credits depending on candidate progress.

Upon receiving

approval from IRB

begin collection of

data

Semester 2

Notify EdS Project Committee members; Begin

collection of data as per design of study.

Analyze and

evaluate data;

Draft CHAPTER

FOUR RESULTS

Semester 2

Continue to Work with EdS Project Committee

members.

Draft CHAPTER

FIVE

DISCUSSION

Semester 2

Continue to Work with Advisor EdS Project Committee

members.

Complete

Research Study

Manuscript

Semester 2

Continue to Work with EdS Project Committee

members; Distribute copies to all committee members;

Typically requires revisions.

Schedule Project

Study Defense

Semester 2

Allow ample time (minimum 10 days) for committee

members to read the research study.

Project Study

Defense

Semester 2

Must be scheduled 3 weeks before end of semester.

Review Project Study manuscript.

Approval by EdS

Project Committee

members

Semester 2

Revisions will most likely be required.

Deliver one bound

copy to committee

chair

Semester 2

Follow procedures in Thesis/Dissertations Guideline

document.

Deliver one bound

copy to college

coordinator of post

master’s programs

Semester 2

Follow procedures in Thesis/Dissertations Guideline

document.

Deliver two bound copies to library

Semester 2

Follow procedures in Thesis/Dissertations Guideline

document.

Suggested Timeline for Completing the EdD Dissertation

Item

TASK

SUGGESTED

COMPLETION

DATE

NOTES

Enroll in EDG

7975 Dissertation

Prospectus and

EDG 7986

Dissertation

Proposal

Semester 1

Selection of Topic

Semester 1

Discuss with Advisor & Instructor; contact other Dissertation

Committee members as needed.

Begin initial review

of the literature;

Define problem

Semester 1

Work with Advisor & Instructor for the course; contact other

Dissertation Committee members as needed.

Draft Prospectus

for Research

Study—Chapter 1

Semester 1

Work with Advisor & Instructor for the course throughout this

process; contact other Dissertation Committee members as

needed.

Typically requires numerous drafts

Approval of

Prospectus;

this will become

CHAPTER ONE

INTRODUCTION

Semester 1

Continue to work with Advisor & Instructor for the course;

contact other Dissertation Committee members as needed. Work

with the Writing Center; Typically requires numerous drafts prior

to securing approval signatures.

Submit forms to

IRB, including

certificate of

completion of

training program

Semester 1

Obtain forms from Office of Research and Sponsored Programs

or via website. Must be completed and filed before data

collection can begin.

Main ORSP Compliance Website: http://www.fgcu.edu/orsp/compliance.html

Online tutorials:

http://phrp.nihtraining.com/users/login.php

https://www.citiprogram.org/

Draft CHAPTER

TWO

REVIEW OF THE

LITERATURE

Semester 1

Continue to work with Advisor & Instructor throughout the

Research Study; contact other Dissertation Committee members as needed; requires time for reading and providingfeedback, requires numerous drafts; Continue to work with the Writing

Center as needed.

Draft CHAPTER

THREE

METHODOLOGY

(as appropriate to

the study)

Semester 1

Continue to Work with Advisor & Instructor; contact other

Dissertation Committee members as needed.

Send the complete

proposal (Chapters 1-3) to all Committee Members

Semester I

When approved by the Chair, provide a copy of chapters 1-3 to all committee members for feedback.

Proposal Approval

End of Semester

Or Early

Semester 2

Work with Committee members, and Research and Evaluation

faculty as needed. The proposal (first 3 chapters) must be approved by all members of the committee. A proposal hearing should be scheduled once all of the committee members agree

that that proposal is ready.

Typically requires numerous drafts

Enroll in EDG 7980 Dissertation for 9 or 12

credit hours

Semester 2

and 3

You are required to complete 21 hours of

dissertation credits prior to graduation. If

candidates do not finish the project in

semester 2, then they will enroll in a

minimum of 1 additional credit hour the

following semester. The committee will

determine how many credits depending on

candidate progress.

Upon receiving approval from IRB begin

collection of data

Semester 2

Notify EdS Project Committee members; Begin collection of data as per design of

study

Analyze and evaluate data;

Draft CHAPTER FOUR RESULTS

Semester 2-3

Continue to Work with Advisor and

Dissertation Committee members

Draft CHAPTER FIVE DISCUSSION

Semester 3

Continue to Work with Advisor and

Dissertation Committee members

Complete Research Study Manuscript

Semester 3

Continue to Work with Advisor and

Dissertation Committee members;

Distribute copies to all committee

members; Typically requires revisions.

Schedule Project Study Defense

Semester 3

Allow ample time (minimum 10 days) for

committee members to read the research

study

Project Study Defense

Semester 3

Must be scheduled 3 weeks before end of

semester.

Review Project Study manuscript

Approval by Dissertation Committee

members

Semester 3

Revisions will most likely be required

Deliver one bound copy to committee chair

Semester 3

Follow procedures in Thesis/Dissertations

Guideline document.

Deliver one bound copy to college

coordinator of post master’s programs

Semester 2

Follow procedures in Thesis/Dissertations

Guideline document.

Deliver two bound copies to library

Semester 3

Follow procedures in Thesis/Dissertations

Guideline document.

Steps in the Process

The steps in the process of developing your proposal can begin in the proposal development classes. However, candidates are encouraged to begin thinking about topics of interest early in their program. They are encouraged to discuss topics and research design elements with their advisor prior to enrolling in the proposal development course. Topic selection will be a natural occurrence for many candidates as they take classes, read current research literature, and begin developing areas of personal research interest.

STEP 1: Identification of topic for the study and developing a problem statement

1. Candidates should choose a topic and a problem statement that is of interest to them, that

is important, and that is of timely topical interest in their career area. In addition, they should select a topic that will contribute to the literature base and that will not be simply one of many research studies on a topic that has been overworked in the literature or one that appears to have been resolved in the research literature. On the other hand, looking at an old problem in a new way or with a different population is encouraged.

2. Candidates should insure that they have the resources necessary to complete the study. The university will not provide money for research study costs.

3. Candidates should consider the timeframe required to complete the study. It is best to choose the desired completion date and then using the “Suggested Timeframe” above, work backward.

4. Candidates need to receive approval of their study from the organization in which the study will be carried out. It is each candidate’s responsibility to seek and receive this approval. Those organizations, especially school districts, may have their own IRB process.

5. Examples of possible research topics may include:

a. Action research projects that look at the effectiveness of a program.

b. Action research projects that look at the implementation fidelity of a program.

c. School climate studies.

d. Effectiveness of new curriculum.

e. Entrance test scores and student success.

f. Effectiveness of school counseling programs.

g. Retention of minority students (e.g., at FGCU).

h. Effects of cyber-bullying on children or effectiveness of cyber-bullying prevention programs.

6. Candidates should develop a title for their research project that includes the names of the

variables under study.

a. Poor title example: Action Research in an Elementary School Classroom

b. Good title example: The Effect of Cooperative Learning Strategies on Fifth Grade Student Engagement in a Title I School

STEP 2: Review of literature (Note that for the pre-proposal or prospectus, chapter 1, the candidate is only expected to provide a summary of the literature review consisting of the major research findings)

A. Candidates should begin their review of the literature by using preliminary sources (databases, indexes etc.) to locate recent secondary sources such as literature reviews or compilations (for example, Review ofEducational Research, Review ofResearch in Education, Encyclopedia ofEducational Research, Encyclopedia ofEducational Research or various handbooks written in an area of interest). These sources should help you identify some of the most respected research on a topic. Another good source would be to locate metaanalyses or metasyntheses on your topic.

B. Good preliminary sources are the research guides developed by our college librarian. There is one for Educational Leadership and one for Curriculum and Instruction.

1. http://fgcu.libguides.com/ed leadership

2. http://fgcu.libguides.com/curriculum

C. Good secondary sources lead to primary sources. It is the candidate’s responsibility to find the most recent research in the topic area, so searches of current journals is critical. This may require a hand search of journals that may not yet be archived in databases.

D. Candidates need to focus mainly on peer-reviewed journal. However, recent scholarly papers presented at professional conferences are encouraged due to their recent development.

E. Some professional websites also may be good sources, but candidates must be careful since some website may have a particular politically/social orientation. For example, the Cato Institute often has their research publications challenged by others. A good source that debunks poor research is Education and the Public Interest Center, a consortium of universities that work together to review research that attempts to influence public policy: http://www.epicpolicy.org/

F. On the other hand, there are many good online sources that are non-partisan and publish

quality research (e.g., Center on Education Policy: www.cep-dc.org; the above mentioned Education and the Public Interest Center: http://www.epicpolicy.org/

G. The Literature Review (LR) is a summary of research:

* It is not a “list” of found research but a coherent and articulate account of past and current research findings. The LR should be synthesized:

a) The review should not only be coherent, but should organize the studies reviewed under themes or topics.

b) The review is a guide and should be able to provide readers with in-depth analysis and current status of research in a given area.

* Suggestion: read two or three LRs in order to become familiar with summary styles.

* Start with most current research and work backwards.

* The sources typically are journal articles, books and other documents that describe past and present status of research in a given field.

* The LR should be exhaustive and as current as possible.

* How many articles? There is no set number. As long as the search is exhaustive and

focused on the research topic, the review will be acceptable. Exhaustive does mean everything. It means the best research that you find in your search that is cited by other sources. You will see the same publications and authors appearing in multiple publications.

* How far back should one search? A reasonable and widely accepted timeframe includes research conducted during the past 10 years. Important studies (i.e., seminal/classic studies that had a significant impact on the field of study) should also be mentioned even if these go beyond the mentioned timeframe.

* Organize the Literature (Creswell, 2003)

a) Create a “file” or “abstract” system to keep track of what you read. Each article you read should be summarized in one page containing:

* Title (use APA to type the title so that you can later copy-paste this into the References section of your paper)

* Source: journal article, book, glossary, etc.

* Research problem: one or two lines will suffice

* Research Questions or Hypotheses

* Data collection procedure (a description of sample characteristics can be very handy as well)

* Results or findings of the study

b) Sort these abstracts into groups of related topics or areas which can then become the different sections of your review.

H. Use this checklist for your LR:

– Provides contextual background

– Reveals related issues

– Reviews similar problems elsewhere

– Provides significance to your approach to the study

– Includes major/seminal research articles pertaining to study – Written in an integrated manner

– Synthesizes rather than summarizes findings

– Uses contrast/compare when possible

– Uses proper APA writing style

I. For the pre-proposal, limit the LR to the most compelling research that supports the need to the study and provides context for your research questions or hypotheses.

STEP 3: Development of a Research Pre-Proposal or Prospectus

A. The pre-proposal or prospectus becomes CHAPTER ONE of your final project.

B. The pre-proposal includes the following:

1. background

2. an introduction with several citations from important sources identified in the initial

3. brief review of the literature

4. statement of the problem

5. research questions or hypotheses

6. definitions of terms

7. significance of the study

8. outline of the remainder of the study

The pre-proposal or prospectus is approximately six to ten pages in length for the EdS project, and approximately 8 to 12 pages for the dissertation. The length may vary depending on the topic, amount of contextual literature, and preferences of the candidate’s committee.

STEP 4: Expand and Refine Review ofLiterature (Chapter Two)

Once the pre-proposal or prospectus has been reviewed and approved, additional literature review is necessary to develop CHAPTER TWO, REVIEW OF THE LITERATURE. Most EdS Project research studies have approximately 10 to 15 pages for the review of the literature, and dissertations typically have from 15 to 20 pages

STEP 5: Methodology section (Chapter Three)

Chapter Three consists of the Methods section of the project. Candidates work with their class instructor and committees on this chapter. The methodology chapter should consist of the following sections:

A. Description of the population to whom results of the study will be generalized.

B. Sample design and composition.

C. Research questions and hypotheses

D. Measures

a. Variables and definitions of variables

b. Data collection instruments (if appropriate)

c. Validity and reliability of measures (if appropriate)

E. Research design

a. Design

b. Data collection procedures

c. Internal and external validity threats

F. Data analysis procedures

G. Delimitations

STEP 6: Submission to IRB

A. Once the candidate’s pre-proposal or prospectus has been reviewed and approved by his or her committee, a copy of an approved IRB application form must be completed before the research can go forward. A copy of the signed application form must be filed with the Office of Research and Sponsored Programs (ORSP) and with the candidates’ committee chair.

A description of the IRB process and all supporting documents are available at this URL: http://www.fgcu.edu/ORSP/Compliance.html

B. The IRB requires completion of human subject training to accompany the protocol.

Candidates are required to complete the following tutorial. Please print the certificate at the end of the tutorial and send it to ORSP. Make a copy for yourself and for your committee chair:

Online tutorials:

http://phrp.nihtraining.com/users/login.php

https://www.citiprogram.org/

STEP 7: Proposal hearing

Upon completing the proposal (the first three chapters), a candidate schedules a proposal hearing with all the committee members. The purpose of the proposal hearing is to ensure

that the methodology proposed is appropriate for the research study and that the study may be conducted as proposed by the candidate. The committee should reach consensus on approval of the dissertation or thesis. If consensus cannot be reached, and one member of the committee disagrees with the study, then this committee chair will consult with the committee and program coordinator. The chair may reorganize the committee if necessary.

After the proposal is approved by the committee, the Proposal Approval form must be signed and placed in the candidate’s file.

STEP 8: Data Collection and Analysis

A. This step involves gathering data through questionnaires, surveys, interviews, observations, and utilizing the appropriate procedures to analyze the data, which have been collected.

B. Reminder: No data may be collected until the IRB Application has been approved and filed properly.

C. Candidates must follow the procedure approved by their committee and included in their proposal.

STEP 9: Writing

A. Candidates must follow guidelines for the APA style and format of the written research study and the writing guidelines of the FGCU Office of Graduate Studies that can be found at: http://www.fgcu.edu/Graduate/gradresources.html, Where guidelines form APA contradict the FGCU Office of Graduate Studies or the College of Education guidelines the local rules take precedence over APA. Candidates should purchase and use the following reference:

American Psychological Association. (2009). Publication manual of the American Psychological Association (6th ed.). Washington, D.C.: American Psychological Association.

Helpful websites:

From FGCU’s research guide in Educational Leadership:

http://fgcu.libguides.com/ed leadership

From Harvard Graduate School of Education:

http://isites.harvard.edu/icb/icb.do?keyword=apa exposed

From Purdue University (The Owl at Purdue):

http://owl.english.purdue.edu/owl/resource/560/01/

B. The candidate should only submit material that is mechanically and grammatically representative of graduate candidates completing an advanced degree. Consequently, the candidate is responsible for editing the work prior to submission of each draft. The candidate’s chair and committee will not function as editors for the candidate.

C. The candidate will need to allow time for review by faculty. Candidates should plan on allowing committee members 10 business days to review documents.

D. Below are some guidelines on style, mechanics and language usage

1. Avoid overusing direct quotations, especially long ones. See APA manual about use of quotations.

a. Check APA style manual for correct use of citations: (Doe, 2005); Doe (2005); (Doe & Smith, 2005); Doe and Smith (2005); (Black, 2005; Brown, 2006; Yellow, 2007)

2. Avoid using synonyms for recurring words as this is not creative writing. Stay consistent

with terminology

a. Group I, 5th Grade Group, Experimental Group

3. Spell out all acronyms when first using them for example:

a. American Psychological Association (APA) or Florida Comprehensive

Achievement Test (FCAT): traditional acronyms for known groups, achievement tests, etc.

b. Collective Efficacy (CE) or Student Group 3 (SG3): acronyms that a candidate may make up for his or her study.

4. Yes - Do NOT use contractions; No – Don’t use contractions

5. Coined terms should be set off by quotation marks

6. Avoid the following:

a. Slang – “cool”

b. Colloquialisms – “thing”, “item” or “feature”

c. Idioms – “rise to the pinnacle” or “to become prominent” etc.

d. Using the word “prove”

7. Use great care to avoid Plagiarism

8. Common Mistakes:

* “Effect and affect are often confused because of their similar spelling and pronunciation. The verb 2affect usually has to do with pretense <she affected a cheery disposition despite feeling down>. The more common 3affect denotes having an effect or influence <the weather affected everyone's mood>. The verb effect goes beyond mere influence; it refers to actual achievement of a final result <the new administration hopes to effect a peace settlement>. The uncommon noun affect, which has a meaning relating to psychology, is also sometimes mistakenly used for the very common effect. In ordinary use, the noun you will want is effect <waiting for the new law to take effect> <the weather had an effect on everyone's mood>.” (Merriam-Webster Online, 2007)

* Particular care should be given to referencing within text and at the end of the document. Only references cited in the text are included in the references. These items are listed on the last pages of your project, prior to any appendices. The list has a centered title (References), and it is alphabetized by the first author's last name.

* The source of all information must be referenced. The source of all information in each paragraph should be clear to the reader. The only items that are not referenced are your own ideas, and conclusions and recommendations drawn from your research. The introduction and conclusion to a chapter do not need referencing, but they may contain references. If all information in a paragraph is from one source, it is best to place the reference either at the beginning or at the end of the paragraph.

* Subject and verb agreement, particularly when they are separated by a prepositional phrase.

* Spelling.

* Parallel construction, particularly noun-to-pronoun agreement.

* Misplaced and dangling modifiers.

* Using "who", when "that" or "which" should be used. "Who" is reserved for human beings.

* Using "which" when "that" should be used. The easiest solution is to use "that" for all restrictive clauses, unless it becomes overused in a sentence, then you may use “which” for restrictive clauses also. “Which” should mainly be used when the information is not essential to the meaning of the sentence.

* Continuity of thought and transition of ideas. The use of transitional words helps, such as "therefore", "similarly", "however", and others. If this is not possible, then use a new heading.

* Shift in verb tense. This can be a tricky problem. The best solution is to use the past tense when reporting research results (even results from your current research), and to use the present tense to discuss the results, and to present conclusions and recommendations.

* Punctuation. Most problems seem to be using semicolons, colons, and dashes.

* Writing phrases, not complete sentences.

* Anthropomorphisms. For example,” An experiment cannot attempt to demonstrate..., nor can tables or figures compare (all of these can, however, display, show or indicate)”.

* Split infinitives. Do not say, to effectively write. Do say, to write effectively.

* Some candidates tend to use gender bias, referring to the male gender, particularly when using pronouns. To avoid this problem, you need to use either "he or she", or write in the third person plural, using "they", "their", and the like.

* In general, as per APA guidelines, it is now preferable to write in the first person when referring to the researchers (“I” or “we”).

STEP 10: Defense of the Research Study

A. When the research study is completed and changes have been made, a defense of the research study must be scheduled and completed. All committee members need to have a copy of the research study at least 10 days in advance of the defense. Send electronic copies to all of your committee members. Some committee members may prefer that you print copies for them. These copies are to be bound in some way so that it is easy for the committee to read. Suggested bindings include spiral binding or hole-punched and placed in a notebook.

B. Candidates will “defend” their research to their committee by answering questions related to the content. Questions could be from any section of the research project, including research design, literature review, data collection and analysis, and conclusion. The defense will last a minimum of about one hour. The committee will keep the proceedings as relaxed and

comfortable as possible. Doctoral candidates are expected to make few, if any, mistakes, since they are now at the highest level of their education and are expected to be experts in their field.

Rules for defense hearings:

1. Committee chair facilitates the meeting. It is the chair’s responsibility to maintain decorum and professional behavior among participants.

2. Introduction of candidate and committee members.

2. Presentation by candidate.

3. Questions by committee members.

4. Questions from other faculty and/or other observers. The committee chair may limit

the number of questions based on time available.

5. Candidate and observers leave the examination room.

6. Deliberation and voting by the committee only; Sign documentation if defense is successful.

7. The candidate shall be informed of the vote.

8. The record of the successful defense (to be determined by the College or Department) is forwarded to the College/Department for the student’s file.

C. The following are examples of questions that the candidate could anticipate being asked during the defense:

1) How did you select the topic of study?

2) What have you learned from your study?

3) Questions related to topic selected, population, design, variables, limitations, etc.

4) Any plans to use the findings from the study?

5) What are some of the implications for future study?

6) Would you do anything differently if you were to do this study again?

7) What is you assessment of the process or experience of completing the research study?

D. The committee may recommend changes in the research study before approving. The candidate should be prepared to make notes about potential changes that may be required.

E. Once the research study has been approved, the committee members sign the EdS Project Approval Page or the Dissertation Approval Page.

STEP 11: Submission to Library and Committee Chair

A. Once the candidate has successfully defended the study; the candidate is responsible for taking the signed copies of the study to the library to make arrangements for binding.

B. Copying and Binding: A minimum of four copies of the research study is required.

? Library Services must hold two bound copies of the thesis/dissertation along with applicable accompanying materials for each. One copy is for the general, circulating collection and the other for archival purposes.

* Additional bound copies must be provided to: the candidate’s principal advisor and the College of Education.

* An uneditable electronic copy of the entire document must be submitted to the College of Education. This may be in PDF format.

Candidates must follow all requirements in the FGCU document, Thesis/Dissertation Guidelines available at http://www.fgcu.edu/Graduate/thesisguidelines.html

STEP 12: Presentation of Findings at Conference

A. Candidates are encouraged to submit their research findings for presentation at a local, state, national, or international conference and/or at the FGCU Research Day (held in the spring of each year).

B. Candidates are also encouraged to submit a manuscript of their study for publication in a peer-reviewed journal.

Role of Candidates, Committee Chairs, Committee Members,

Requesting a Change in Chair, and Forms Required

Role of the Candidate

Throughout the process, the candidate is expected to

* be enrolled in order to receive advising and other services from FGCU.

* abide by the School Candidate Code of Conduct.

http://candidateservices.fgcu.edu/judicialaffairs/files/Code of Conduct book 08-09.pdf

* submit documents to the committee chair using Microsoft Word. If the chair uses the reviewing and tracking features in Microsoft Word, the candidate should become proficient with those features.

* submit work that conforms to the FGCU and APA guidelines for format and style.

* maintain contact and communication with the chair at least once a month.

* understand that the working relationship between candidate and chair is unique and based on a trusting interaction between professionals. The candidate should contact the chair for clarification on points in questions concerning research and writing and for advice and information regarding the writing process.

* utilize the information received from the committee chair and members to make the recommended organizational, content, format, and style changes in the proposal, the IRB review, and final project.

* inform the chair in reference to any changes in position, address, and other contact information, as well as professional and personal changes that might affect progress.

* follow the policies and procedures established by the university’s IRB for research with human subjects and the regulations that the candidate’s own agency or institution may have concerning the protection of human subjects in research.

Role of the Committee Chair

It is the role of the committee chair to encourage the candidate and to review and make

recommendations on the work submitted. The committee chair is expected to

* maintain regular communication with the candidate.

* schedule and chair committee meetings as needed.

* evaluate and provide written feedback to the candidate regarding the development of the proposal, IRB submission, and final project.

* provide feedback to the candidate within 10 business days after receipt of document submissions.

* ensure that candidate submissions follow FGCU and APA guidelines for format and style.

* maintain a professional and collaborative relationship with the candidate.

* assist the candidate in identifying resources, such as those for improving writing skills, that may help in the writing process.

* complete the Live Text critical task rubric.

Role of the chair for defense proceedings:

1. Secure a room with a podium for the candidate’s defense. This should be a classroom in the event outside faculty, students, or family want to observe.

2. Work with the candidate to develop an announcement of the candidate’s defense.

3. Send the announcement to all university faculty and administration for dissertation defenses and to all COE faculty and administration for EdS defenses inviting them and their students to the defense.

4. Post the announcement on the space provided in the College of Education office area.

5. Chair the defense and monitor the defense proceedings as described above.

Role of the Committee Member

The committee member interacts mainly with the chair, and responds to candidate work in a timely manner. The committee may meet with the candidate as needed, but this is not required, except for committee meeting. The committee member is expected to:

* evaluate and provide written feedback to the research project chair regarding the development of the candidates proposal, IRB submission, and final project.

* provide feedback within 10 business days after receipt of document.

* attend committee meetings as called by the chair.

* ensure that candidate submissions follow FGCU and APA guidelines for format and style.

* work collaboratively with the candidate and the other committee members to insure the integrity of the process. If a member disagrees with the majority of the committee members about the candidate’s study, then the committee member should withdraw from the committee.

Procedure for Requesting a Change of Committee Chair or Committee Member

Forms Required

All forms are available in electronic format in the Student Handbook website:

1. Plan of Study

2. Committee Assignment Form (for either EdS project or dissertation committee)

3. EdS Project Proposal Approval

4. Dissertation Proposal Approval

5. Approval to Defend (either either EdS project or dissertation)

6. EdS Project Final Defense Approval

7. Dissertation Final Defense Approval

8. Thesis/Dissertation Binding Request Form

http://library.fgcu.edu/ACQ/ThesisBindingForm.pdf

References

Creswell, J.W. (2003). Educational research: Qualitative, quantitative and mixed methods approaches (2nd ed). Thousand Oaks, CA: Sage Publications.

Merriam Webster (2007). Retrieved on January 5, 2007 from http://www.merriam-webster.com/.

University of Pennsylvania

Doctoral Dissertation Manual

Approved by the Graduate Council of the Faculties September 2010

Table of Contents

3 Introduction

3 Open Access and Traditional Publication

4 Use of Copyrighted, Previously Published, or Coauthored material

4 Patents

5 Preparing Your Manuscript

5 Organization of the Manuscript

5 Margins

5 Line Spacing

6 Font

6 Bold, Underlining, Paragraph Indentation

6 Pagination

6 Abstract

8 Title Page

11 Paper

11 Copyright Notice

12 Footnotes/Endnotes

12 Bibliography

12 Supplementary Digital Files

13 Depositing Your Dissertation

13 Make an Appointment at the Graduate Division

13 Depositing an Open Access Dissertation

14 Depositing a Dissertation the Traditional Way

15 Delaying Publication

15 Dissertation Deposit Fee

15 ProQuest Copyright Registration Fee

16 Accompanying Forms and Documentation

16 ProQuest Publishing Agreement

16 ProQuest Copyright Registration

16 Copyright Permission Letter

16 Survey of Earned Doctorates

16 PhD Exit Survey

17 Where to Get Help

17 Ordering Your Transcript & Getting Your Diploma

18 Checklist

19 Appendix Official Names of the Graduate Groups

Introduction

Writing and filing the dissertation are among the final steps leading to the award of the PhD degree. At Penn, a student presents and defends the dissertation publicly, and with the approval of the dissertation committee and graduate group chair, submits the final manuscript for publication. The Graduate Division of Arts and Sciences is the administrative clearinghouse for deposit of all Penn PhD dissertations. The PhD degree is awarded upon the recommendation of the Graduate Council of the Faculties.

This manual documents the University’s requirements regarding the format for the manuscript, explains options for publication and the process for deposit of the dissertation and supporting documents. Follow the instructions carefully and, should further questions arise, consult the Graduation Coordinator at the Graduate Division of Arts and Sciences (Suite 322A, 3401 Walnut Street/6228; phone 898-7444).

Open Access and Traditional Publication

Publication of the dissertation is a requirement of the PhD degree. Give careful thought to how you want to publish.

There are two options for publishing that graduate students have available to them. The first is the “traditional” process in which students provide two hard copies; one is shelved in the library’s permanent collection and made available to the world via interlibrary loan. The other copy is sent to ProQuest, which will make the Abstract publicly available online, and the full dissertation manuscript available by subscription to other libraries or by purchase to individuals.

Second, students also have the “open access” option in which students submit an electronic copy toScholarly Commons. Scholarly Commons will make the electronic copy fully available (including ability to download the copy and post it on other websites and searchable, through search engines like Google, to anyone in the world. Additionally the hard copy of the dissertation will be made available in the library and an electronic copy will be made available through ProQuest in the same way as

“traditional” publication.

There are advantages and disadvantages to both types of publication. Keep in mind, you have the same legal and copyright protections with both “traditional” and “open access” publication. “Traditional” publication will limit the availability of the dissertation, and for those disciplines where publishers do not want copies available online or where there are patents or other intellectual property concerns, it may be beneficial for you to utilize “traditional” publication. On the other hand “open access” publication provides a much wider audience for you, can help to market your ideas to potential employers, and can help make plagiarism or theft much easier to detect. So, in many cases “open access” publication may be more beneficial to you.

Regardless of which option you choose, you should definitely discuss your plan in advance with your adviser, to see which option is best for you and to make sure that there are no conflicts or concerns about copyright, patents, etc.

Either way -- whether you chose traditional or open access publication -- you will format your dissertation manuscript the same way, but the process for final submission will differ according to your choice. See the section on Depositing Your Dissertation for further details.

Use of Copyrighted, Previously Published, or Coauthored Material

Previously published articles may be submitted as part of the dissertation, with written permission of the copyright holder (such as the journal or publisher) and approval of the dissertation committee and Graduate Group Chairperson.

For use of other copyrighted material (images, quotations, datasets), you are responsible for clearing permission for re-use of that material. In most cases, you are able to use copyrighted material under the “fair use” provisions of copyright law. If you have questions about “fair use” consult http://fairuse.stanford.edu/Copyright_and_Fair_Use_Overview/chapter9/index.html or email repository@upenn.edu for any questions you may have.

University of Pennsylvania policy permits dissertations based on joint work with other researchers, provided that, in such cases, a unique and separate dissertation is presented by each degree candidate. The candidate must include a concise account of his or her contribution to the whole work. Authorship of a dissertation by more than one degree candidate is not allowed.

Questions regarding copyright and “fair use” may be directed to Shawn Martin at Van Pelt Library, repository@pobox.upenn.edu

Patents

Any inventions that you make as part of your research for your degree and disclosed as part of your dissertation, and any patent or other intellectual property rights arising therefrom, are governed by the policies of the University of Pennsylvania, including the Patent and Tangible Research Property Policies and Procedures http://www.med.upenn.edu/postdoc/documents/patent.policy.02.22.05.pdf

and the Policy Relating to Copyrights and Commitment of Effort for Faculty. For more information, please contact the University’s Center for Technology Transfer.

Preparing Your Manuscript

Overall Appearance: The manuscript must be clear and legible, free of errors, and attractive in appearance. All pages must be printed single-sided.

Organization of the Manuscript: Pages must appear in the following order: Preliminary Pages, in the following order:

Title Page

Dedication (optional)

Acknowledgment (optional)

Abstract

Table of Contents

List of Tables

List of Illustrations

Preface (optional)

Main Text

Appendices (optional)

Bibliography

Index (optional except for graduate groups in Architecture, City & Regional Planning, Earth & Environmental Science, East Asian Languages & Civilization, Folklore & Folklife, Near Eastern Languages & Civilization, South Asia Regional Studies)

Margins:

Left-hand margin: 1.5 inches

Right-hand margin: 1 inch

Top and bottom margins: 1 inch

All text, including footnotes and page numbers, must be inside these boundaries. Nothing may appear in the margin area.

Line spacing: For the sake of readability, it is recommended that the text of the dissertation be double-spaced (except for footnotes, long quoted passages, and lists of tables and figures, which are single-spaced). If desired, authors may chose to single-space the dissertation manuscript.

Font: Any non-italic font 10-12 points in size may be used. Headings may be larger. For enhanced screen readability, use Arial (10pt), Courier New (10pt), Georgia (11pt), Times New Roman (12 pt), or Verdana (10pt) font. For footnotes, figures, citations, charts and graphs, a font of 8 point or larger may be used. Italic type may be used for quotations, words in a foreign language, occasional emphasis, or book titles.

Use of Bold, Underlining and Paragraph Indentation: Spare use of these formatting features is permitted, in order to enhance the readability of the manuscript.

Pagination: Every page in the dissertation has a number, except for the Title Page and the copyright notice (if desired).

For the preliminary pages – dedication (optional), acknowledgements (optional), abstract, table of contents, list of tables, graphs, illustrations and preface (optional) – use small Roman numerals (i, ii, iii, iv, v, ...). These may be placed either at the top or the bottom of the page. The title page is counted as page i, and the copyright page (if there is one) as page ii, but do not print the page numbers on either of these two pages (e.g., in a dissertation with a copyright notice, the first numbered page is iii; in a dissertation without a copyright notice, the first numbered page is ii).

For the text, use Arabic numbers (1, 2, 3, 4, 5, ...) starting with page 1 (the first page of the text itself). These may be placed either at the top or the bottom of the page. If you use footnotes, it is recommended that you print page numbers at the page top. Do not print page numbers, footnotes, or anything else in the margins. Each page must be consecutively numbered, including tables, graphs, illustrations, and bibliography/index (if they are included); letter suffixes (such as 10a, 10b) are not allowed.

Check pagination carefully. Do not include blank pages. All pages must have a page number and be accounted for.

Abstract: The Abstract is a condensed summary of the dissertation, not to exceed 350 words. All words count towards the total. The abstract, which is normally a single paragraph, consists of four parts: the statement of the problem; the procedure and methods used to investigate the problem; the results of the investigation; and the conclusions.

The abstract is published online by ProQuest in “Dissertation Abstracts International,” providing information to interested readers about the general content of the dissertation.

The abstract is double-spaced. Below the word "ABSTRACT" (in upper case), list the title of the dissertation (upper case), your name, and your dissertation supervisor's name.

Sample

ABSTRACT

PRACTICAL ADVICE: THE EFFECT OF "POOR RICHARD'S ALMANAC”

ON DOMESTIC LIFE IN THE AMERICAN COLONIES

Author's Name

Supervisor's Name

The same elements that transformed the political structure of the British colonies in North America, first through revolution and later through a new constitution, were also eager to promote a similar transformation of social relations among Americans. But at the time of the Revolution, there was no widespread consensus on how Americans should act towards one another nor an official aristocracy whose manners were expected to set the tone for the larger society. Benjamin Franklin's "Poor Richard's Almanack" sought to fill this void through the means of pithy homilies issued by an "ordinary" American of the day. Examining its text, one finds both significant guidance concerning interpersonal relations in a society which officially had shed the formal class distinctions of the mother country, practical suggestions for new arrivals in the cities, and useful tips for those working the land in a country that was still largely unsettled. The book also served as the original model for a uniquely American literary form, the self-help book, which in the United States soon took the place of custom and clan as a means of providing the average individual with clues to proper behavior. Through this book, Franklin had an influence on everyday American manners that was every bit as significant as his influence on American scientific and intellectual life.

Title Page: The Title Page must contain the TITLE (in upper case); the author's name; the graduate group name (see Appendix 1 for official names); the year the degree is being granted; the name, faculty title (rank and department), and signature of the dissertation supervisor (or co-supervisors, if there is more than one); and the name, faculty title (rank and department), and signature of the graduate group chairperson. The names and faculty titles (rank and department) of the Dissertation Committee members should be listed on the Title Page (their signatures are not necessary). If you want to use a format for your name that differs from the current name in the Penn In Touch System (e.g., a married name, or a full middle name rather than a middle initial), contact the Registrar’s Office and provide the necessary documentation to make that change.

NOTE: The Library copy of the manuscript must be signed by the dissertation supervisor (or co-supervisors) and the graduate group chairperson, but no signatures are required in the pdf submitted electronically to Scholarly Commons.

Students in the Graduate Group in Managerial Science and Applied Economics (Wharton Doctoral) also include their field of specialization above the graduate group name.

The title page is understood to be page “i” for counting purposes, but no page number should be printed on the title page.

See sample Title pages on the pages that follow.

Sample Title Page (except for Wharton students)

PRACTICAL ADVICE: THE IMPACT OF “POOR RICHARD’S ALMANAC”

ON DOMESTIC HABITS IN THE AMERICAN COLONIES

Author’s Name

A DISSERTATION

History

Presented to the Faculties of the University of Pennsylvania

Partial Fulfillment of the Requirements for the

Degree of Doctor of Philosophy

2009

Supervisor of Dissertation Co-Supervisor (if applicable)

Signature Signature

Typed Name Typed Name

Title (e.g. Richard Poor, Associate Professor, History) Title

Graduate Group Chairperson

____Signature

Typed Name and faculty title (e.g. Eric Franklin, Professor of History)

Dissertation Committee (Typed Names and faculty title; no signatures necessary)

Sample Title Page for Wharton Doctoral Students

PRACTICAL ADVICE: THE IMPACT OF “POOR RICHARD’S ALMANAC”

ON DOMESTIC HABITS IN THE AMERICAN COLONIES

Author’s Name

A DISSERTATION

Management

For the Graduate Group in Managerial Science and Applied Economics

Presented to the Faculties of the University of Pennsylvania

Partial Fulfillment of the Requirements for the

Degree of Doctor of Philosophy

2009

Supervisor of Dissertation

Signature

Typed Name(s) and Title: (e.g. Richard Poor, Associate Professor, Management)

Graduate Group Chairperson

Signature

Typed Name and Title (e.g. Eric Bradlow, Professor of Marketing, Statistics, and Education)

Dissertation Committee (Typed Names and title; no signatures necessary)

Paper: The dissertation is printed single-sided on acid-free white paper, 20 lb. (or heavier stock), 8 1/2 x 11 inches in size. Copier paper is fine.

Copyright Notice: The dissertation submitted as a part of the requirements for a degree is the property of the University. However, the author of the dissertation owns and retains the copyright in the dissertation, without further registration formalities. If you choose to include a copyright notice in your manuscript, place it on a separate page immediately following the Title Page. Display the title of the dissertation, then the word “COPYRIGHT” (or symbol ©), the year of first publication, and your name. The author may also reference a Creative Commons License Deed on this page. (See Sample 2 below.) Do not print a page number on this page; it is understood to be page "ii" for counting purposes.

Sample 1: Traditional Copyright page

TITLE

Year of Publication

Author's Full Legal Name

Sample 2: Copyright page referencing a Creative Commons License Deed

TITLE

Year of Publication

Author’s Full Legal Name

This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License

To view a copy of this license, visit

http://creativecommons.org/licenses /by-ny-sa/2.0/

You can copyright your manuscript online with the U.S. Copyright Office, although this is not required. There are legal advantages, however, to obtaining a federal copyright registration. (See, generally, http://www.copyright.gov/circs/circ1.pdf.) The cost is $35. See the Library of Congress website at http://www.copyright.gov.

Alternatively, you can authorize ProQuest to act as your agent and apply to register your copyright as part of their publishing process at a cost of $65.

Questions regarding copyright and “fair use” may be directed to Shawn Martin at Van Pelt Library, repository@pobox.upenn.edu

Footnotes/Endnotes: Notes can appear as footnotes below the text on a page, or as endnotes at the end of each chapter. Footnotes at the bottom of a page should be numbered continuously throughout the dissertation. Endnotes at the end of a chapter are numbered separately for each chapter (i.e., the first note of each chapter will always be numbered “1”). A bottom-of-the-page footnote must begin on the same page as the text to which it refers, but it may continue on a following page if necessary. Nothing may appear in the margin area.

Bibliography: This is an alphabetical listing of all references. It may be a single alphabetical list by chapters, or an alphabetical list by authors for subject and class of publications. Page numbers in the bibliography continue the pagination of the text; do not number the bibliography separately.

Supplementary Digital Files: Supplementary digital files of essential supporting material may be submitted along with the dissertation manuscript.

* In the case of open access publication of the dissertation through Scholarly Commons, simply upload your supplementary files as attachments.

* In the case of traditional (non-open access) publication, you can submit a CD or DVD with supplementary files along with the core manuscript. Such “compound dissertations” (paper and digital) will be distributed by ProQuest as hardbound publications, with the CD or DVD sleeve on the inside of the binding. ProQuest guidelines must be satisfied, and any 3rd party software licenses necessary for the use, viewing and publication of the content on the CD or DVD must be provided. See ProQuest “Supplementary Materials Guide” form online at http://www.proquest.com/assets/downloads/products/UMI_SupplementaryMaterialsGuide.pdf for information regarding supporting documents.

Depositing Your Dissertation

Make an appointment at the Graduate Division: The Graduate Division of Arts and Sciences is the administrative clearinghouse for deposit of all Penn PhD dissertations. Appointments for deposit of the dissertation are made on a rolling basis. All revisions must be made before the completed dissertation is delivered.

For registration deadlines and procedures see:

http://www.sas.upenn.edu/GAS/home/grad&beyond/graduation.html

Depositing an Open Access Dissertation

* Follow instructions on embedding fonts at

http://www.sas.upenn.edu/computing/help/students/dissertation-pdf

* To facilitate the approval process, submit your dissertation to Scholarly Commons in advance of your appointment at the Graduate Division. These directions are also available at http://www.library.upenn.edu/scholcomm/dissertations.html

o Go to http://repository.upenn.edu and select “My Account” tab on the top of the screen. Then press the “sign up” button on the “Create a new account “ section. It is recommended that you use your Penn email account.

o Once you have finished entering your information the system will then send you from an e-mail, click on the link and the left navigation column and then select the "New User" option. After you provide your name, email address, and initial password, the system will confirm registration via email.

o Then, log in to your account by going to “My Account” (the same tab you used before from the left navigation column and then enter your email address and password. If you forget your password, you can enter your email address without a password, and will receive your password immediately by email. If you want to change your password, go to the "My Account" page and choose the "Edit Profile" option. If you have trouble logging in or the system will not send you your password, please send an email to repository@pobox.upenn.edu. We will help solve the problem as soon as possible.

o Then go to http://repository.upenn.edu/edissertations and click on “Submit Research” which is bolded on the left hand side of the screen. You will then go to a page that asks for title, authors, and other information. Fill this out and hit "Submit" when finished. If you have any problems, or if you can't submit the paper, contact repository@pobox.upenn.edu for assistance. After you have deposited your material, you will be notified

when it is publicly available on ScholarlyCommons after your dissertation has been approved by the Graduate office.

o More information can be found at the FAQ. Make sure you get permission for copyrighted material. You, and not ScholarlyCommons, bear responsibility for certifying compliance with any applicable copyright regulations. Also be aware of formatting issues. Documents in ScholarlyCommons are made available in PDF format. Submissions are acceptable in full-text searchable PDF, Microsoft Word, or RTF. (The latter two formats are converted to PDF by the system after submission.) Submissions can also include supplementary files in other formats (including data sets, computer programs, and so forth). Details on producing appropriate formats are available in the File format and conversion guide. The Library may add or change supported format choices to reflect format choice and presentation that reflect changing technological capabilities.

* Penn will automatically transfer the pdf from Scholarly Commons to ProQuest on your behalf.

* A single hardcopy of the dissertation manuscript with original signatures on the Title Page is required for the Library collection. Bring it to your appointment unbound in a box or sealable envelope.

Depositing a Dissertation the Traditional Way

You have options:

* Bring two paper copies of the manuscript to your appointment at the Graduate Division, one for the Library and one for ProQuest. The Library copy must have original signatures on the Title Page. The dissertation(s) and any supplementary digital files should be presented unbound in a box or sealable envelope at the time of the appointment.

* Bring one paper copy (for the Library) with original signatures on the Title Page and bring a CD or DVD with a pdf of the dissertation (for ProQuest). Submission of a pdf file ensures the highest quality reproduction of the manuscript. Pdfs will be in color, but hardcopy reprints will be black and white only. To preserve formatting, follow instructions on embedding fonts at http://www.sas.upenn.edu/computing/help/students/dissertation-pdf . Label the CD or DVD with your name and the title of your dissertation. The dissertation and disc should be presented unbound in a box or sealable envelope at the time of the appointment.

Delaying Publication

In cases where a paper is in press or a patent application is pending, you may request a delay of up to one year in the public release of the dissertation. A delay of more than one year requires special approval by your graduate group chair or graduate dean.

Indicate your preference for a delay of publication on the ProQuest form (Section III) and (if you are publishing in open access) in Scholarly Commons@Penn.

Dissertation Deposit Fee

A fee of $100 is payable to Trustees of the University of Pennsylvania to cover cost of graduation processing and publication by ProQuest. The Graduate Division will place the charge on your Bursar bill and it must be paid by the time you deposit the dissertation.

ProQuest Copyright Registration Fee (Optional)

Notify the Graduate Division Office in advance of your appointment to deposit if you desire the optional Copyright Registration by ProQuest. An additional charge of $65 will be placed on your Bursar bill and must be paid by the time you deposit the dissertation.

Accompanying Forms and Documentation

ProQuest Publishing Agreement: available online at

http://www.il.proquest.com/dissertationagree/umiagreement.pdf

User Name: dissertations

Password: publish

This form grants ProQuest the right to reproduce and disseminate your work. NOTE: Open access publication is available to Penn students at no charge through Scholarly Commons@Penn; it is unnecessary to pay an additional $165 for ProQuest open access publication.

ProQuest Copyright Registration (Optional): Complete page 6 of the Publishing Agreement if you desire the optional Copyright Registration by ProQuest.

Copyright Permission Letter: If someone other than you owns the copyright in content in your manuscript, including appendices, and your use of that content is not a fair use of that content, ProQuest requires submission of a permission letter from the copyright holder to use that content. Attach the permission letter to your ProQuest Publishing Agreement. For general guidance on what might constitute a fair use of copyrighted materials within your manuscript, see, e.g., the U.S. Copyright Office’s guidance at: http://www.copyright.gov/fls/fl102.html

For further guidance on fair use and copyright, contact the Scholarly Commons Librarian at repository@pobox.upenn.edu

Survey of Earned Doctorates: Completion of this online survey is a University degree requirement. Instructions for completing the survey will be forwarded to degree candidates by the Graduate Division.

PhD Exit Survey: Instructions for completing the online survey will be forwarded to degree candidates by the Graduate Division.

Where to Get Help

Computing Resource Center http://www.upenn.edu/computing/crc/

The Computing Resource Center (CRC) provides computing support services to graduate and professional students. The CRC is a walk-in support service facility located in Suite 202 Sansom West (Grad Tower B), 3650 Chestnut Street. If you are out of town, call them at 215-573-4778.

Scholarly Commons http://www.library.upenn.edu/scholcomm/

Contact the Scholarly Commons Librarian at <repository@pobox.upenn.edu>

The Graduate Division of Arts and Sciences

http://www.sas.upenn.edu/GAS/home/grad&beyond/graduation.html

Email: gas-degree@sas.upenn.edu

Telephone: 215-898-7444

Ordering a Transcript & Getting Your Diploma

Information on ordering transcripts is online at http://www.upenn.edu/registrar/student-services/transcripts.html

Diplomas are mailed to the address of record by the Office of the Secretary approximately two months after each degree cycle, (e.g., in early October for August graduates, in March for December graduates, and in July for May graduates).

Checklist

1. Is every page of the dissertation correctly numbered? Are all pages included?

2. Is a bibliography and/or index required by your graduate group?

3. Does the author's name, in full, appear on the title page, the abstract, and the contract form? Is the name the same on all three? Is it in the same format as in the Penn In Touch system?

4. Is the title on the abstract and on the ProQuest Form the same, word for word, as on the dissertation?

5. Does the supervisor's name (without the faculty title) appear on the abstract? Is the name typed accurately and in the proper place, so that it is clearly indicated that s/he is the supervisor and not the author?

6. Are all charts, graphs, and other special illustrative materials legible? Are they in the correct order and position? Are they paginated?

7. If you are submitting electronically, did you embed the fonts to preserve all the formatting? (See instructions on embedding fonts at http://www.sas.upenn.edu/computing/help/students/dissertation-pdf)

8. Do you want to apply to register the copyright in the dissertation with the U.S. Copyright Office?

9. If a significant portion of a third person’s copyrighted work is included in your dissertation, have you obtained permission from the copyright owner? If the dissertation is submitted with a CD or DVD, have the following been included: a description of software or other applications used, including a list of files and file sizes; copies of licenses for third party software necessary to access, display, run, or print the dissertation; and written permission to reproduce copyrighted images, video, graphics, animation, data, and images of individuals, which is not considered “fair use”?

10. Have you completed the Survey of Earned Doctorates, the PhD Exit form, and the ProQuest Publishing Agreement? These forms are emailed to all degree candidates by the Graduate Division and must be completed on line prior to your appointment. Bring verification of completion of the two surveys to your appointment. If you have questions regarding these forms, call 215898-7444.

Appendix: Official Names of Graduate Groups

Africana Studies

Ancient History

Anthropology

Applied Mathematics and Computational Science

Architecture

Art and Archaeology of the Mediterranean World

Biochemistry and Molecular Biophysics

Bioengineering

Biology

Cell and Molecular Biology

Chemical and Biomolecular Engineering

Chemistry

City and Regional Planning

Classical Studies

Communication

Comparative Literature and Literary Theory

Computer and Information Science

Criminology

Demography

Earth and Environmental Science

East Asian Languages and Civilizations

Economics

Education

Electrical and Systems Engineering

English

Epidemiology and Biostatistics

Folklore and Folklife

Genomics and Computational Biology

Germanic Languages and Literatures

History of Art

History

History and Sociology of Science

Immunology

Linguistics

Managerial Science and Applied Economics

Accounting

Applied Economics

Ethics and Legal Studies

Finance

Health Care Management & Economics

Management

Marketing

Operations and Information Management

Statistics

Materials Science and Engineering

Mathematics

Mechanical Engineering and Applied Mechanics

Music

Near Eastern Languages and Civilizations

Neuroscience

Nursing

Pharmacology

Philosophy

Physics and Astronomy

Political Science

Psychology

Religious Studies

Romance Languages

Sociology

Social Welfare

South Asia Regional Studies

C2D

Course Index

Advanced Communication Skills (NLP) 1

Appraiser/ee Skills 2

Assertiveness at Work 3

Business Process Re-engineering 4

Coaching Skills for Managers 5

Communication skills 6

Discipline and Grievance 7

Effective Delegation 8

Effective Interactions (Introduction to Transactional Analysis) 9

Effective Planning 10

Effective Writing and Writing Reports 11

Excellence in Customer Service 12

Facilitation skills 13

First Steps in Management 14

Fundamentals of Project Management 15

I Just Want To Scream! (an Introduction to Stress Management) 16

Influence and Persuading skills 17

Interviewee skills 18

Interviewer skills 19

Let Me Tell You What I Think! (Effective Feedback) 20

Letter Writing 21

Managing Meetings 22

Managing Peoples Performance 23

Negotiation Skills 24

Presentation Skills for the Nervous 25

Presentation skills – The Next Steps 26

Problem Solving 27

Telephone skills 28

Where Am I Going? (Career Development) 29

Where Does My Time Go? (An Introduction to Time Management) 30

C2D

Advanced Communication Skills (NLP)

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

This programme is designed for anyone who feels that they need to increase their personal effectiveness and gain a better appreciation of the advantages of Neuro-Linguistic Programming (NLP) in helping enhance job performance.

Aim:

To provide an understanding of the basics of NLP and the implications for how we interact with the world

Outcomes:

On completion of the training each delegate will be able to:

* Understand and identify NLP Pre-Suppositions and how they operate

* Understand Visual, Auditory and Kinaesthetic language

* Understand Eye movement and Eye accessing cues

* Understand goal setting and the value of the Outcomes model in motivating/achieving them

* Understand the concept of Laddering and Chunking

After this course, next steps:

There are no formal next steps for this course, however the Influencing and Persuasion covers similar topics and expands on some of the items in this course.

John M Fisher 1 07980 743 613

C2D

Appraiser/ee Skills

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

This programme is suitable for all levels of management who have to conduct an appraisal interview and for anyone who will be appraised and wants to get the most out of the process.

Aim:

To introduce managers, team leaders and employees to the skills needed in conducting an effective Appraisal and will cover the need for appraisals, performance management, setting SMART objectives, interpersonal skills – e.g. rapport building, listening, questioning, etc. and giving feedback

Outcomes:

On completion of the training each delegate will be able to:

* Gain an understanding of how planned and structured appraisal interviews and objective setting will improve individual, team and organisation performance

* Understand the basics of performance management

* Develop the skills required in order to set S-M-A-R-T objectives

* Improve the way face to face appraisal interviews are planned and conducted in a way that encourages development and joint ownership

* Understand the “do’s and don’ts” of conducting effective appraisal interviews

* Understand how to set appraisee’s at ease and the “soft” skills required to conduct the appraisal interview

* Understand the advantages of giving effective feedback.

After this course, next steps:

* Coaching Skills for Managers

* Discipline and Grievance

* Effective Delegation

* Effective Feedback

* Influence and Persuading skills

* Managing Peoples Performance

The following course, whilst not necessarily a Next Step covers associated topics :

* First Steps in Management

John M Fisher 2 07980 743 613

C2D

Assertiveness at Work

Course Duration:

Two day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

This programme is designed for anyone who feels that they need to increase their personal effectiveness and self-confidence to enhance job performance.

Aim:

To enable delegates to understand their interpersonal style and its impact on others and to develop Assertiveness techniques.

Outcomes:

On completion of the training each delegate will be able to:

* Gain confidence in inter-personal relationships with colleagues, management, friends and family

* Understand that nobody is perfect and be aware of human relationships both at home and at work

* Eliminate stress as a result of people ‘walking all over you’

* Manage difficult people

* Know how to distinguish between assertive and non assertive behaviour

* Know how to behave assertively in difficult situations

* Know how to define their own behavioural style

* Know their rights

After this course, next steps:

John M Fisher 3 07980 743 613

C2D

Business Process Re-engineering

Course Duration:

Three days

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

This course is designed for those people who wish to apply a structured approach in order to improve the operation or service delivery of their area. It provides delegates with a mixture of analytical skills, idea generation techniques, along with quality tools for measurement purposes

Aim

To allow delegates to understand the principles and practices of business process reengineering and how to apply it to their area.

Outcomes:

On completion of the training each delegate will be able to:

* Understand the principles of BPR and how to see the organisation as a series of processes designed to deliver a given product or service which meets the needs of the customer

* Understand and be able to selectively employ a range of BPR techniques to use in the workplace

* Understand how to critically examine processes in order to identify where improvement can be made

* Collect and analyse information and identify where problems lie

* Make use of idea generation methods which can be used in all areas of work to support and encourage creativity and innovation

After this course, next steps:

John M Fisher 4 07980 743 613

C2D

Coaching Skills for Managers

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Any manager, team leader, supervisor or other member of staff who is responsible for the development and performance or others

Aim:

To increase operational effectiveness by enabling delegates to develop staff in line with business objectives

Outcomes:

On completion of the training each delegate will be able to:

* Understand what coaching is, the difference between coaching and mentoring

* Understand the skills of active listening and questioning

* Recognise performance issues early and identify the skills to deal with them

* Bring on the development of your people on a daily basis by using coaching tools and techniques

* Demonstrate more confidence and skill in giving feedback on an ongoing basis

* Conduct more informed and effective performance appraisals and reviews

* State when coaching and training is appropriate and identify any issues needing counselling and HR involvement

* Identify development needs and opportunities for staff, which in turn will lead to a more effective and productive workforce

* Develop high performers through coaching which will free up more management time

* Coach and develop new staff, which can increase retention rates and avoid misunderstanding of roles and responsibilities

* Understand the different styles of learning and the learning process

* Understand some tools and techniques to promote development

After this course, next steps:

* Managing Peoples Performance

John M Fisher 5 07980 743 613

C2D

Communication skills

Course Duration:

Two days

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

The programme is designed for anyone who wishes to expand and refine their communication techniques and help them understand their personal style of communication and its implications

Aim:

To explore ways to communicate in business to get results, to help delegates influence and persuade difficult people

Outcomes:

On completion of the training each delegate will be able to:

* Build rapport quickly and easily with anyone

* Get the message across in a way that others can understand

* Utilise the way that others filter information to make a more compelling case

* Reach agreement with others quickly and easily

* Handle difficult people more effectively

* Motivate and influence others

* Effectively step into another persons shoes and see the situation from their point of view

* Prepare effectively for key communications

After this course, next steps:

* Advanced Communication Skills (NLP)

* Influence and Persuading skills

John M Fisher 6 07980 743 613

C2D

Discipline and Grievance

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Any line/people manager with responsibilities for the performance of others. This course is not attended for members of HR.

Aim:

To provide delegates with a comprehensive understanding of the company disciplinary procedure (including updates and revisions), and the fit of the procedure with effective people management

Outcomes:

On completion of the training each delegate will be able to:

* Understand how an effective discipline and grievance procedure fits with good management practices

* Have a clear understanding of the policy and any revisions

* Understand when, and how, to apply the policy

* Understand the different stages of the policy and the importance of consistent application

* Understand the key skills of the different stages of the procedure and the application of the disciplinary interview.

After this course, next steps:

* Appraisal Process Workshop

* Appraiser/ee Skills

* Coaching Skills for Managers

* Effective Feedback

* Managing Peoples Performance

John M Fisher 7 07980 743 613

C2D

Effective Delegation

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Anyone wishing to improve their understanding of the process and stages of delegation.

Aim:

To develop the understanding and interpersonal skills needed delegate effectively in order to meet the goals of the organisation

Outcomes:

On completion of the training each delegate will be able to:

* Define the importance of delegation in the workplace.

* State what should be delegated and to whom.

* Understand the stages of delegation

* Plan the delegation process and develop positive systems to ensure success.

* Understand the steps of delegation

* Understand the difference between, and implications of, over and under delegation

After this course, next steps:

John M Fisher 8 07980 743 613

C2D

Effective Interactions (Introduction to Transactional

Analysis)

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Anyone who wants to gain a greater understanding of their own style of interacting and the impact they have on other people.

Aim:

* To provide delegates with an understanding of the basic concepts within transactional Analysis and to give delegates working knowledge of Transactional Analysis (TA) Drivers, ego states and games theory.

* Delegates will also get an understanding of their own preferred ego state and driver and the implications of their state in their communications

Outcomes:

On completion of the training each delegate will be able to:

* Understand and recognise TA ego states, the implications and characteristics of each state, etc.

* Understand and recognise the “OK Corrall” and it’s implications

* Understand and recognise TA drivers and their impact

* Understand and recognise TA games theory and how to recognise games

* Understand and recognise how TA can help improve communication and interpersonal interactions

After this course, next steps:

John M Fisher 9 07980 743 613

C2D

Effective Planning

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Anyone who want to improve their Planning skills

Aim:

To develop the understanding and interpersonal skills needed to plan effectively in order to meet their own and the goals of the organisation.

Outcomes:

On completion of the training each delegate will be able to:

* State the importance of planning in the workplace and produce an action plan.

* Understand and develop the main stages in the planning process and put these into practical use.

* Set specific business goals.

* Identify different types of planning, such as strategic, operational, single use plan, standing plan, budgeting.

After this course, next steps:

John M Fisher 10 07980 743 613

C2D

Effective Writing and Writing Reports

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 10

Who should attend:

This programme has been designed to provide participants with a methodology to improve the way reports are constructed and written within the workplace. During this programme participants will be tasked to critically analyse the way they would construct a report. Participants will undertake a project designed is to assess retention of the information delivered during the course, and whether a change in behaviour has taken place.

Aim:

To enable delegates to develop skills in writing memos, letters and business reports.

Outcomes:

On completion of the training each delegate will be able to:

* Identify the problems of writing business communications and measure the consequence of poor written work

* Analyse their own, and other’s, writing skills and what needs to be further developed (e.g. layout, spelling, etc.)

* Apply the techniques of writing clearly and concisely

* Plan and structure reports, memos and letters and know when it is appropriate to use each of them

* Consider the needs of the reader when writing in business

* Understand the use of appendices, graphs and tables

* Understand the need to consider the audience

* Understand the need to gather and analyse information, determine the solution

* Organise the report

* Present information effectively

After this course, next steps:

John M Fisher 11 07980 743 613

C2D

Excellence in Customer Service

Course Duration:

Two days

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

This programme is designed for individuals who are involved in delivering customer satisfaction. Additionally, the programme design supports individuals who have an involvement in setting and improving customer standards

Aim:

* To provide delegates with an awareness of the company’s service objectives and of their role in dealing with other department’s, and companies; internal and external customers

* To develop customer handling skills, both directly (i.e. face to face) and indirectly (i.e. phone, letter, fax, email, etc.)

Outcomes:

On completion of the training each delegate will be able to:

* State the importance of culture to delivering customer service/care and how to create the desirable characteristics of a customer-focused organisation

* State the importance of motivation in delivering quality customer service levels

* State the importance of customer retention and how to keep customers

* Be confident that any complaints will be handled in a professional and efficient way through a thorough understanding of the systems, process and techniques needed to handle difficult situations

* Be able to recognise and define valuable customer care skills which will result in improved confidence when working in any customer facing environment

* Be practiced in the use of essential communication skills needed to develop rapport, manage individuals and present a positive caring image

* Understand the true meaning of customer care and how to achieve world class excellence in delivering it

After this course, next steps:

John M Fisher 12 07980 743 613

C2D

Facilitation skills

Course Duration:

Two day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Anyone who might be required to facilitate a team meeting or group session.

Aim:

To enable delegates to understand what facilitation means and the benefits of becoming a facilitator and have the opportunity to practice the skills in a safe environment

Outcomes:

On completion of the training each delegate will be able to:

* Understand their personal style of interacting and the effect it has on others

* Understand when, and how, people learn and individual needs, motivations and aspirations

* Understand what a facilitator is and does and how they do it

* Understand the difference between “expert” facilitation and “non-expert” facilitation and the different techniques involved

* Use questioning and listening skills to help facilitate group consensus

* Recognise which facilitation skills to use, and how to facilitate appropriately with individuals and teams.

After this course, next steps:

John M Fisher 13 07980 743 613

C2D

First Steps in Management

Course Duration:

Two day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Any employee who is currently in a junior management position or who may be required to manage people in the short to medium term

Aim:

To enable delegates to recognise the different management styles and their own style in leading people and the impact different styles have on their team.

Outcomes:

On completion of the training each delegate will be able to:

* Understand their awareness of their own leadership style and its impact on others

* Have an awareness of other leadership styles and when to use them

* Have an awareness of your own style of behaviour, it’s impact on others and how people behave differently and their impact on you

* Understand the difference between good and poor performing teams

* Understand a number of tools and techniques to help you manage your teams output (e.g. delegation, motivation, coaching, performance management, etc.)

* Be aware of the impact of change and how to mitigate the effects of change.

After this course, next steps:

John M Fisher 14 07980 743 613

C2D

Fundamentals of Project Management

Course Duration:

Three days

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

This programme is designed for anyone with an interest in project management. It delivers a broad introduction to projects covering concepts and principles along with project management tools and techniques.

Aim:

To provide delegates with a basic understand of the principles of Project Management and to allow them to manage any jobs more effectively.

Outcomes:

On completion of the training each delegate will be able to:

* Understand the benefits of implementing change through project management

* Understand the components and terminology of Project Management

* Appreciate the differences between projects and day-to-day operations

* Understand and apply the basic tools and techniques of project management

* Be more efficient and effective as a Project Manager or project team member

After this course, next steps:

John M Fisher 15 07980 743 613

C2D

I Just Want To Scream! (an Introduction to Stress

Management)

Course Duration:

Two days

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

This course is designed for managers, supervisors, specialists and anyone else who is responsible for staff. The programme will assist them to recognise stress in themselves and others and provides a number of coping strategies for dealing with it. The programme also provides a methodology for carrying out work-based stress assessments in accordance with current HSE (Health and Safety Executive) guidelines

Aim:

To help employees understand the dangers, and impact of, stress on their work and daily lives and to help them identify possible stressors and ways to mitigate them

Outcomes:

On completion of the training each delegate will be able to:

* Recognise behavioural and physical symptoms of personal stress and to understand some coping strategies for dealing with them

* Recognise and deal with stress in the workplace and to be aware of the potential causes of stress and their impact on the individual

* Have an understanding of the legal aspects of work place stress including the Health and Safety at Work Act and its implications for employees and the organisation at large

* Be familiar with the HSE six Management Standards for recognising and managing stress factors. These explore stress factors related to the individual, the organisation and the environment

* Create an environment where employees want to come to work because they are able to cope with their work pressures positively. Combating the theory that stress reduces productivity

* Identify the possible causes of stress in the workplace and the risks associated with them, including assessment of those risks and their likelihood of existing in the organisation

* Help stressed employees find a solution

* Make it easier for team leaders and managers to effectively manage and empathise with members of their team who need support

After this course, next steps:

John M Fisher 16 07980 743 613

C2D

Influence and Persuading skills

Course Duration:

Two days

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Any member of staff who typically spends most of their time in an interpersonal situation; whether it is at the interpersonal, inter-group, intra-group, organisational, or external levels and who wishes to improve their personal effectiveness and expand and refine their Interpersonal influence skills

Aim:

To explore ways to get your point across and influence other people to your way of thinking in business to get results

Outcomes:

On completion of the training each delegate will be able to:

* Build rapport quickly and easily with anyone

* Get the message across in a way that others can understand

* Utilise the way that others filter information to make a more compelling case

* Understand Cialdini’s key influencers

* Understand Gardner’s “change levers”

* Understand Charvette’s Language & Behaviour profiles

* Reach agreement with others quickly and easily

* Handle difficult people more effectively

* Motivate and influence others

* Effectively step into another persons shoes and see the situation from their point of view

* Prepare effectively for key communications

After this course, next steps:

There are no Next Steps associated with this course, however the Negotiations Skills course covers similar content.

John M Fisher 17 07980 743 613

C2D

Interviewee skills

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Anyone who has to interview people as part of the recruitment process

Aim:

To provide delegates with the skills and knowledge required to carry out effective job interviews in order to select the most appropriate person for the role

Outcomes:

On completion of the training each delegate will be able to:

* Understand the benefits of objective recruitment and selection interviews within the current company and legal framework

* Understand how to design and prepare a structured interview

* Understand, and be able to demonstrate, effective questioning and listening skills

* Understand the link between Job Role, Job Spec and Competencies in the recruitment and interview process

* Provide evidence to support objective decision making

* Use the information gathered during the interview process to provide constructive feedback

NB. This course can be covered as an in-depth, focused, coaching session

After this course, next steps:

John M Fisher 18 07980 743 613

C2D

Interviewer skills

Course Duration:

One day

Minimum Delegates: 1

Maximum Delegates: 10

Who should attend:

Anyone who wants to understand the interview process and gain confidence in being interviewed

Aim:

To provide delegates with the skills and knowledge required to sell themselves effectively at a job interview

Outcomes:

On completion of the training each delegate will be able to:

* Understand the impact of personal presentation on interviewers

* Understand the importance of body language during the interview

* Understand how to prepare for a structured interview

* Understand, and be able to demonstrate, effective questioning and listening skills

* Understand the link between Job Role, Job Spec and Competencies in the recruitment and interview process

* Provide evidence to support questions/answers

NB. This course can be covered as an in-depth, focused, coaching session

After this course, next steps:

John M Fisher 19 07980 743 613

C2D

Let Me Tell You What I Think! (Effective Feedback)

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Any team leader or line manager who needs to give feedback as part of their role. Anyone who has to develop others.

Aim:

To give participants and understanding of the effective use of feedback to improve performance

Outcomes:

By the end of the course delegates will be able to:

* Understand the reasons why we need to give feedback on performance

* Understand feedback techniques

* Understand techniques for getting commitment

After this course, next steps:

John M Fisher 20 07980 743 613

C2D

Letter Writing

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Any employee who currently has to write letters and needs to improve their effectiveness.

Aim:

To enable delegates to improve the effectiveness of their letters.

Outcomes:

On completion of the training each delegate will be able to:

* Know how to collect and collate information accurately

* Understand the different types of letters and when to use them

* Understand basic grammar and punctuation

* Understand the writing process and stages of writing effective letters

After this course, next steps:

John M Fisher 21 07980 743 613

C2D

Managing Meetings

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Any employee who is currently managing meetings and wishes to ensure meeting time is more effectively managed. Anyone who attends meetings and want to understand the theory.

Aim:

To enable delegates to recognise the advantages and disadvantages of meetings, how to manage the meeting effectively and the costs associated with productive/non productive meetings

Outcomes:

On completion of the training each delegate will be able to:

* Plan and structure meetings to gain maximum effectiveness

* Identify when and who to meet

* Spend less time at the meeting and more doing the meeting actions

* Focus future discussions on the outcomes of meeting items

* Develop communication skills and lead and control discussions

* Understand the roles required to make meetings run smoothly

* Lead meetings with confidence

* Handle difficult participants

* Develop techniques to involve all participants in discussions and decisions

After this course, next steps:

* Influence and Persuading skills

John M Fisher 22 07980 743 613

C2D

Managing Peoples Performance

Course Duration:

Two days

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Any manager, supervisor or team leader looking to develop their management skills from a personal, team and task perspective

Aim:

* Recognise Good & Poor Performance issues

* Understand what responsibility ALL leaders of people have

* Employ techniques to deal with a range of performance levels - to raise overall performance

* Feel confident in tackling performance issues

Outcomes:

On completion of the training each delegate will be able to:

* Increase awareness of Performance issues

* Develop a broader understanding of the responsibility to performance that all leaders of people have

* Leave the session with actions to carry out to improve performance

* Increase the levels of good performance in the business

* Reduce the occurrences of poor performance in the business

* Take ownership of performance issues

* Pick up the necessary leadership skills to effectively motivate yourself and others to succeed

* State the differences between managing and leading

* Build confidence as a manager and gain respect and trust from your team

* Set SMART objectives, with measurable results

* Become capable of setting clear objectives for yourself and your team by using the objective setting for performance management

* Enhance team performance with strong leadership and direction

* Become more confident in delegating work to others

After this course, next steps:

* Coaching Skills for Managers

* Influence and Persuading skills

John M Fisher 23 07980 743 613

C2D

Negotiation Skills

Course Duration:

Two day

Minimum Delegates: 8

Maximum Delegates: 8

Who should attend:

This programme is designed for anyone who has to deal with other people and feels that they need to increase their personal effectiveness in any negotiation situation.

Aim:

To develop the negotiation skills required for resolving various negotiating situations and to improve management performance in the key area of communication

Outcomes:

On completion of the training each delegate will be able to:

* At the end of the workshop, the delegate will be able to:

* Participate effectively in meetings, getting ideas across

* Value teamwork when communicating the techniques

* Employ creative and practical influencing skills to identify the real source of the problem

* Reduce negotiation time and enhance the quality of the solutions reached

* Effectively communicate the decision made from the outcome of the negotiations

* Identify and use the common and differing objectives of the parties and the procedures they adopt to achieve them

* Adopt effective systems of communicating and consultation

* Prepare for negotiations

* Negotiate effectively by developing a strategy and portfolio of skills designed to achieve the desired objective

* Understand the roles used in team negotiations

After this course, next steps:

There are no next steps associated with this course, however the Influence and Persuasion course covers similar topics.

John M Fisher 24 07980 743 613

C2D

Presentation Skills for the Nervous

Course Duration:

Two day (not consecutive)

Minimum Delegates: 6

Maximum Delegates: 10

Who should attend:

Anyone who has to give presentations, informal or formal, as part of their role, or who wants to gain more confidence and experience in giving presentations.

Aim:

* To provide delegates with the skills, knowledge and confidence required to make successful presentations

* To provide delegates with an awareness of how to present to groups of people effectively.

* To provide delegates with practice in presenting to groups of people and getting feedback on their presentation style.

Outcomes:

On completion of the training each delegate will be able to:

* Approach any presentation situation with a confident, positive attitude

* Understand the need to take into account the audience in the planning and preparation of a presentation

* Understand the use of presentational aids/format and their effective use in presentations

* Plan, design, structure and prepare presentations to ensure maximum impact

* Design, prepare and use presentation aids

* Practice the delivery of a presentation, understand the impact of voice, tone and pace and the ability to handle audience behaviour and questions

NB.

Delegates will be expected to design and deliver a 15/20 minute presentation (depending on number of delegates) to be given on day 2. Some time will be available during the course although delegates will be expected to devote some of their own time to the presentation.

After this course, next steps:

* Presentation skills – The Next Steps

John M Fisher 25 07980 743 613

C2D

Presentation skills – The Next Steps

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 10

Who should attend:

Anyone who has attended a basic presentation skills course and wants to go to the next level

Aim:

To help delegates improve their presentations by looking at the format and structure of the presentation as well as providing a guide to presentation styles

What is covered:

* This course covers the following areas:

* Basic presentation skills recap

* Content

* Structure

* Audience

* Presentations and the senses

* 4MAT

Outcomes:

On completion of the training each delegate will be able to:

* Understand the effect of Visual, Auditory and Kinaesthetic language on presentations

* Understand the 4MAT structure of presentations

* Understand the use and application of “incident, point, benefit” within presentations

* Get feedback on their presentation style

After this course, next steps:

* Advanced Communication Skills (NLP)

John M Fisher 26 07980 743 613

C2D

Problem Solving

Course Duration:

Two days

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

The programme is designed for staff who are required to resolve problems and issues in terms of both day to day and project / organisational level change

Outcomes:

On completion of the training each delegate will be able to:

* Identify and explore their current capabilities in problem solving, innovation and creativity

* Have employees who are open and willing to take part in solving problems

* Motivate the workforce to recognise and tackle issues that impact on their productivity, in a positive manner

* Understand the requirements for improving problem-solving on both a personal and organisational level

* Explore options and techniques for addressing and resolving problems and for overcoming barriers to creative thinking

* Manage others in tackling problems in an effective way

* Define ways of remaining creative and keeping teams interested in solving problems successfully

* Select the right problem-solving mechanism and the optimal solution for the problem at hand using an overview of various techniques that may be employed

* Categorise problems in order to identify the most appropriate way of dealing with them

After this course, next steps:

John M Fisher 27 07980 743 613

C2D

Telephone skills

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Any employee who has to deal, on a regular basis, with people on the telephone

Aim:

To enable delegates to generate, and use, generic scripts for talking to people on the phone and give delegates tools and techniques for handling with difficult callers effectively.

Outcomes:

On completion of the training each delegate will be able to:

* Recognise effective and ineffective behaviours in handling calls

* Be able to use a range of skills, practical communication methods, behaviours and attitudes in an effective, consistent manner

* Be able to build and maintain rapport when dealing with callers/complaints

* Use strategies for dealing with difficult/angry callers

* Reduce stress.

After this course, next steps:

John M Fisher 28 07980 743 613

C2D

Where Am I Going? (Career Development)

Course Duration:

Half day

Minimum Delegates: 1

Maximum Delegates: 10

Who should attend:

This programme is designed for anyone who wants to explore the career options they have and look at some of the strategies they have for achieving them.

Aim:

To enable delegates to proactively take ownership of managing their career.

Outcomes:

On completion of the training each delegate will be able to:

* Understand their life path so far

* Understand what “Career Development” is

* Understand the importance of goals, how to set them and how to make them clear, realistic and meaningful

* Understand what is available to help support their career ambitions

* Create meaningful career goals and how to start meeting them

NB. This course can be covered as an in-depth, focused, coaching session

After this course, next steps:

John M Fisher 29 07980 743 613

C2D

Where Does My Time Go? (An Introduction to Time

Management)

Course Duration:

One day

Minimum Delegates: 6

Maximum Delegates: 12

Who should attend:

Any member of staff who wishes to make their time more productive

Aim:

* To introduce delegates to the concept of managing time to improve productivity and effectiveness.

* To make delegates aware of the need to plan, delegate and control their own time and be aware of the influence they have on other people’s time

Outcomes:

On completion of the training each delegate will be able to:

* Change the habits of a lifetime, not just at work but at home as well

* Become a more organised, efficient, reliable person, which will stand you in good stead for career development

* Change the way you work due to the hints and tips you pick up from the course

* Avoid late nights at work catching up because you didn’t prioritise

* Eliminate procrastination

* Reduce stress

* Balance home life and work life effectively

* Complete tasks on time

* Delegate where appropriate and free themselves up to do other tasks

* Understand who and what takes your time, and how to deal with it

After this course, next steps:

DDR New User Instructions for requesting a new CMS

User ID and Access to DDR

Prior to starting this process, please add the following email addresses to your

email address book and/or “safe senders list” to ensure delivery –

EUA@cms.hhs.gov, ESS@cms.hhs.gov, and DDR@cms.hhs.gov

1. Enter the EUA Front-End Interface (EFI) URL https://eua.cms.gov/efi making sure you are not in compatibility mode and are using IE 9+ or Firefox 35+. Please do not use Google Chrome at this time.

2. Click the “Register” button.

3. Enter your personal details in the respective boxes. Create your own “username” and “password”. Note – Both the user name and password are case sensitive. The password must be eight to twenty-four characters long, at least one uppercase letter, contain at least one special character (i.e.!, @, % etc.), and contain at least one number. The email address you use in EFI must be the same email address you will use in DDR under your User ID profile.

4. Click on the “Sign Up” tab and log out.

5. Check your email for an automated email from EUA to activate your account.

6. Click the “Activate EFI Account” link in the email you receive from eua@cms.hhs.gov.

7. Enter the “username” and “password” that you created when you registered and then click on the “Login” tab.

8. At the “Warning” screen click on the “Agree” Tab to continue.

9. Click on word “Access” and it will take you to the screen to enter User Details.

10. Under “User Category” select “Business Partner”.

11. Under “type”

* If you are a Drug Manufacturer, Select “Medicaid Drug Manufacturer”

* If you are a State User, Select “State Govt – XX - DDR”, substituting your applicable 2 character state code for the “XX”. Note – If you select the incorrect State Govt option, your request will not be sent to the correct Federal Approver and will delay your request.

12. In the “Request Justification” box type in the following statement: “To request CMS User ID and request access to the Drug Data Reporting for Medicaid (DDR) System”.

13. Select “Personal Details” and enter the required information in the boxes. Note – enter your Social Security number with the dashes included (xxx-xx-xxxx).

14. Select “Contact Details” and enter the required information in the boxes.

15. Select “Additional Details” and enter the following information. For “CMS Region/Facility” select the CMS Region/Facility where your office/state is located. Do not select any “Central Office” location.

16. For Drug Manufacturers ONLY (State Users, please go to #17) - In the labeler code(s) box, type in the labeler code(s) for which you are requesting DDR Access. Note – For multiple labeler codes, do not include spaces between the labeler code and commas (ex. – 00000,11111,22222).

17. Select “Access Details” and select “No” for ALL questions.

18. The “745a Details” section is Optional. You do not have to complete this section.

19. Select “Save” or “Submit”. If you choose to “save” your request, you can log back into EFI and modify the request details at a later time. Once you select “Submit”, you will receive notice on the screen that the submission was successful and an automated confirmation email from the system. If you are not the current Labeler Code Technical Contact or State DDR Contact on file with CMS, please make sure that the Labeler’s Technical Contact or State DDR Contact has entered you in DDR under a temporary profile and has granted you access rights to their labeler/state PRIOR to submitting your EFI Request. Your EFI request will be rejected if you are not listed as a Designee in the DDR system.

You will receive several system generated emails throughout the approval and

connection process. Please note that you are not connected to DDR until you

receive an email confirmation from DDR@cms.hhs.gov that your request has been

completed.

If you have questions or would like more detailed instructions please send an email to DDR@cms.hhs.gov.

Model SBB500SS-v3

Sonic Boom Alarm Clock & Bed Shaker

OPERATION INSTRUCTIONS

IMPORTANT – Please read these instructions carefully before use and retain for future reference. See operating instructions on back.

– Use only the supplied or recomended Sonic Alert adaptor to connect the unit.

Warning: To prevent fire or shock hazard do not expose this appliance to rain or moisture. Before connecting to mains/ power make sure that the requirements specified on the apparatus corresponds to the available power supply in that country i.e. AC100-240V~, 56/60 Hz.

– The ventilation should not be impeded by covering the ventilation

openings with items such as, newspaper, table cloth, curtains, etc;

– No naked flame sources, such as lighted candles should be placed on the

apparatus.

– It shall not be exposed to dripping or splashing and that no objects filled

with liquids, such as vases, shall be placed on the apparatus.

– Do not place the product in closed bookcases or racks without proper

ventilation.

– Where the mains/ power plug is used as the disconnect device, the disconnect device shall remain readily operable.

MODEL SBB500ss-v3

OPERATION INSTRUCTIONS

Features

Alarm 1 Indicator

9) Fast Min./ Hour Button

PM Indicator

/ 12 or 24 Hour

Snooze button /

Selector

Snooze Time

10) Slow Min./ Hour

Adjustment/ Dimmer

Button

Control

11) Battery Compartment

Volume Wheel

12) Alarm Mode Switch

Alarm Set / Alarm

13) DC Adaptor Input

Duration Adjustment

14) Tone Control Wheel

Time Set Button

15) Vibrator Output

Alarm Off Button

16) Flashing Light Display

Alarm Function Switch

17) Alarm 2 Indicator

Test Mode:

1) Press and hold the Snooze and Time buttons for 3 seconds to enter the Test Mode. The display will show "7ES7" to indicate it is in TEST Mode.

2) If within 1 minute no button is pressed, then it will exit the Test Mode and return back to the Time Mode.

3) Press any button within 1 minute (except the Snooze & Time buttons, which has no effect), it will exit the Test Mode immediately.

4) While in Test Mode, sliding the Function Switch will demonstrate the different functions of the clock:

a) Function Switch at OFF, it will have a continuous "Vee" sound to indicate it is in the Test Mode.

b) Function Switch at BUZZ, it will demonstrate the buzzer sound.

c) Function Switch at VIB, it will demonstrate the vibrator.

d) Function Switch at VIB & BUZZ, it will demonstrate the buzzer sound & the vibrator.

5) After finish with the Test Mode, press any button (except the Snooze & Time buttons, which has no effect) it will exit the Test Mode immediately.

Setting the Correct Time –

1) Press and hold the “TIME“ Button (6) and at the same time press the

“FAST“ Button (9) or the “SLOW“ button (10) to advance clock display unil you

have desired time.

2) The lighted dot (2) located in upper left corner of the clock display indicates the time is PM. For AM time, this dot will not light up.

Setting the Alarm Time–

Setting Alarm 1

1) Slide the “ALARM MODE SWITCH“ (12) to AL1 position, the alarm indicator “AL1“ (1) will light up.

2) Press and hold the “ALARM SET“ (5) button and at the same time press the “FAST“ Button (9) or the “SLOW“ button (10) to advance clock display until you reach desired alarm setting.

3) Make sure alarm time is correctly set for AM or PM (1).

Setting Alarm 2

4) Once alarm AL1 has been set, slide “ALARM MODE SWITCH“ (12) to AL2 position. , the alarm indicator “AL2“ (17) will light up.

5) Press and hold the “ALARM SET“ (5) button and at the same time press the

“FAST“ Button (9) or the “SLOW“ button (10) to advance clock display until you reach

desired alarm setting.

Selecting 12 or 24 hours format – Clock is set to 12 hour as the default setting Press and hold the Fast Button (9) for 6 seconds to enter the hour selection mode, release the Fast Button (9) when the display shows "12 H" or "24 H". Press and release the hour button to toggle between 12 or 24 hours. If no selection is made within 4 seconds, then the last displayed hour format will be chosen and the display will return to the normal Time mode.

Alarm –

Enable Alarms:

1) To enable Alarm 1, slide the “ALARM MODE SWITCH“ (12) to AL1 position. the alarm indicator “AL1“ (1) will light up.

2) To enable Alarm 2, slide the “ALARM MODE SWITCH“ (12) to AL2 position, the alarm indicator “AL2“ (17) will light up.

3) To enable both alarms, slide the “ALARM SELECTOR“ (1) to AL2 position, the alarm indicators “AL1“ (1) and “AL2“ (17) will light up.

To Select Wake up mode

To select the wake up mode, slide the “Alarm Mode Switch“ (8) to your desired position:

a) “BUZZ“ for sound b) “VIB“ for bed shaker c) “VIB/ BUZZ“ for both sound and bed

shaker

NOTE: once the wake up mode is chosen, this will apply to both alarms.

Alarm Patterns –

When the alarm is activated, alarm pattern of the buzzer / flashing display will be out of sync with the vibrator. This means that when the buzzer / flashing display is ON, the vibrator will be OFF and while the buzzer/ flashing display is OFF, the vibrator will be ON.

ALARM 1 - When Alarm 1 is activate, it will have 3 beeps for buzzer, then the vibrator. This pattern is repeated until the alarm is stopped.

ALARM 2 - When Alarm 2 is activate, it will have 4 beeps for buzzer, then the vibrator. This pattern is repeated until the alarm is stopped.

Adjusting The Alarm Duration Time

The default alarm duration time setting is 30 minutes; you may adjust the alarm duration

between 1 minute and 59 minutes as desired. To adjust the alarm duration:

* Press and hold the AL. SET button (5) for six seconds. The clock display will show the default alarm duration as ‘30’. Release the AL set button

* Press the “ MIN” button (10) to adjust the alarm duration to the desired setting, from 1 minute to 59 minutes.

* When the display is showing the desired alarm duration time, it will return to the normal clock mode after 3 seconds. The new alarm duration time setting becomes the new default and remains in the memory until you change it again.

Snooze Operation –

1. When the alarm turns on in the morning you may press the SNOOZE Button (8) to stop the alarm temporarily. The alarm will shut off for 9 minutes or for the predetermined time you select from 1-30 minutes, and then turn on again. The snooze operation may be repeated indefinitely until the alarm is turned off.

2. The SNOOZE function of Alarm 1 and Alarm 2 is independent of each other.

Adjusting The Snooze Time

The default snooze time setting is 9 minutes but you may adjust the snooze time between 1

minute and 30 minutes as desired. To adjust the snooze time:

* Press and hold the SNOOZE Button (8) for four seconds. The clock display will show the default snooze time ‘9’. Release the snooze button

* Press the “SLOW“ Button (7) to adjust the snooze time to the desired setting, from 1 minute to 30 minutes.

* When the display is showing the desired snooze time, it will return to the normal clock mode after 3 seconds. The new snooze time setting becomes the new default and remains in the memory until you change it again.

Shutting Off the Alarm –

Alarm can be shut off temporary for the day or permanently shut off.

1) When alarm goes off, press the “ALARM OFF“ (7) button to turn off for the day and come back on at the same time the next day, if alarm settings have not changed.

2) To shut the alarm off permanently, slide the “ Alarm Function Switch“ (8) down to the OFF position. The alarm will not come on until the “ Alarm Function Switch“ (8) is set to “VIB/BUZZ“, “VIB“, or “BUZZ“ position.

NOTE: The Alarm Off function of Alarm 1 and Alarm 2 is independent of each other.

Dimmer Operation

There is a 5-level brightness control for the LED display. Press the SNOOZE button once

to change the display brightness. The brightness will cycle from 5-4-3-2-1-2-3-4-5 (from

bright to dim then from dim to bright).

*NOTE*: The dimmer function will not work, when the clock is in snooze mode.

Volume Control –

1) To adjust the volume, rotate VOLUME wheel (4) located on the lower right corner of the

clock.

Tone Control –

1) To adjust the TONE, turn the TONE wheel (14) located on the top right corner of the clock.

Bed Shaker / Vibrator –

1) Attach the bed shaker jack to the back of clock at “VIBRATOR INPUT“ (15).

2) To turn on vibrator slide “Alarm Function Switch“ (8) to “VIB/BUZZ“ or “VIB“ position.

3) Place vibrator between mattress and box spring.

Battery Backup –

To use the battery backup, you can install a 9-volt alkaline battery in the back of the clock located under the Battery Compartment Cover (11). The battery needs to be purchased separately. Note the LED display will not show during power failure but the clock will still be running and keeping proper time until the power comes back. During a power failure, the alkaline battery can only keep the clock IC running for up to 30 days. (During a Power failure, the LED display will not show the time.)

NOTE: For the best results it is recommended that the battery be changed every 6 months. If the clock is not used for a while, it is recommended to remove the battery to avoid damage to the clock from battery leakage.

DC 9V Power Input –

Attach the “DC POWER INPUT“ (13) to the back of DC9V IN next to “VIBRATOR

INPUT“ (15); it is the smaller input of the two.

NOTE: IMPORTANT: do not confuse “DC POWER INPUT“ (13) with the “VIBRATOR

INPUT“ (15)

GENERAL DATA

UL listed Power Adaptor: AC100-240V~, 50/60Hz

Power Consumption: Adaptor Output: DC9V , 650mA

CAUTION:

TO REDUCE THE RISK

OF ELECTRICAL

SHOCK, DO NOT

The Lightening flash and

arrowhead within the

triangle is a warning sign

alerting you of dangerous

voltage inside the product.

REMOVE THE COVER

(OR BACK) FROM THE

PRODUCT. NO USER

SERVICEABLE PARTS

INSIDE. REFER

The exclamation mark

within the triangle is a

warning sign alerting you

of important instructions

accompanying the

SERVICING TO YOUR

SONIC ALERT DEALER.

product.

WARNING: TO PREVENT FIRE OR SHOCK HAZARD, DO NOT EXPOSE THIS APPLIANCE TO RAIN OR MOISTURE.

The normal function of the product may be disturbed by Strong Electro Magnetic Interference. If so, simply reset the product to resume normal operation by following the instruction manual. In case the function could not resume, please use the product in other location.

– Attention should be drawn to the environmental aspects of battery disposal.

– this indicating separate collection for electrical and electroinc equipment.

SONIC ALERT’S 1 YEAR LIMITED WARRANTY

The Sonic Boom Alarm Clock Model SBB500ss is warranted against manufacturing defects in materials and workmanship for one (1) year from the date of purchase. Within this period Sonic Alert will repair or replace at our option the SBB500ss without charge for parts and labor.

Simply contact our customer service department to obtain an RA (return authorization number) and instructions on how to process your product for return. Call 1-888-864-2446 or e-mail to RMA@sonicalert.info. You’ll need a copy of your receipt to process the return authorization.

Sonic Alert Inc., Troy MI 48083, USA.

Sonic Alert

Made in China

Sonic Alert , Troy, MI 48083

www.SonicAlert.com 1-888-864-2446

Apr 18 2020

Jasa Konsultasi Disertasi Keuangan (1) dan Perbankan S3, hubungi WA 0821 2230 7021

Senin, 08 Agustus 2022

MANUAL FOR THE PREPARATION OF THESES AND DISSERTATIONS

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