Maintenance safety increased

If adequate therapeutic effect is not observed within 5 minutes, repeat loading dose and follow with maintenance infusion increased to 100 mcg/kg/min. Continue titration procedure, repeating loading infusion, increasing maintenance infusion by increments of 50 mcg/kg/min (for 4 minutes). As desired heart rate or a safety endpoint (eg, lowered blood pressure) is approached, omit loading infusion and titrate the maintenance dosage up or down to endpoint. Also, if desired, increase interval between titration steps from 5 to 10 minutes. 

The NRC issued a letter in 1994 to the nuclear industry reemphasizing NRC guidance on voluntary online maintenance. Specifically, the letter stated that l)the practice should represent a net safety benefit and be warranted by operational necessity, not by convenience, 2) the practice should not be abused by repeated entry into and exit from the limited condition of operation, 3) the removal from service of safety systems and important non-safety equipment should be minimized, 4) Any component testing or maintenance that increases the likelihood of a plant transient should be avoided plant operation should be stable, and 5) Configuration control and system/train unavailability must be effectively managed to minimize risk during maintenance activities. 

Lile JA, Stoops WW, Hays LR, Rush CR. The safety, tolerability, and subject-rated effects of acute intranasal cocaine administration during aripiprazole maintenance II increased aripiprazole dose and maintenance period. Am J Drug Alcohol Abuse 2008 34(6) 721-9. 

New approaches in the field of machine safety also cause changes in the conditions for their maintenance. The ISO/TS 16949 Standard for the automobile industry and its suppliers mainly requires the implementation of predictive maintenance to increase the quality level. The directive on machine safety states a requirement to be followed at the stage of construction and design in case of automated devices, and if deemed necessary, other devices, a connecting device must be provided for mounting [a] failure diagnostics device. ... 

There can be an element of maintenance costs that is fixed and an element which is variable. Fixed maintenance costs cover routine maintenance such as regular maintenance on safety valves which must be carried out irrespective of the rate of production. There also can be an element of maintenance costs which is variable. This arises from the fact that certain items of equipment can need more maintenance as the production rate increases. Also, royalties which cover the cost of purchasing another company s process technology may have different bases. Royalties may be a variable cost, since they can sometimes be paid in proportion to the rate of production. Alternatively, the royalty might be a single-sum payment at the beginning of the project. In this case, the single-sum payment will become part of the project s capital investment. As such, it will be included in the annual capital repayment, and this becomes part of the fixed cost. 

Withdrawn) 1989 AMD 3 Code of practice for selection, installation and maintenance of electncal apparatus for use m potentially explosive atmospheres (other than mining applications or explosives processing and manufacture). Part 1 General recommendations (AMD 7871) dated 15 September 1993. Withdrawn, superseded by BS EN 60079-14 1997 (Withdrawn) 1978 AMD 1 Code of practice for selection, installation and maintenance of electncal apparatus for use m potentially explosive atmospheres (other than mining applications or explosives processing and manufacture). Part 6 Recommendations for type of protection. Increased safety (AMD 5557) dated 30 November 1989. Withdrawn, superseded by BS EN 60079... 

Increased maintenance cost for process equipment due to safety requirements (for example, safety permits, cleaning and purging equipment, personal protective equipment, training, and restricted access to process areas). 

The confluence of sharply rising Operations and Maintenance (O M) costs. NRC requested Individual Plant Examinations (IPEs) and increased personal computer capabilities gave rise to the R R Workstation. Its uses and maintains-current PSA models and databases for individual plants to perform O M planning and scheduling, and uses the PSA in IPE models to identify plant design, procedure and operational vulnerabilities. The Risk and Reliability Workstation Alliance was organized by EPRI to support the R R Workshop in order to achieve O M cost reduction, plant productivity and safety enhancement through risk-based, user-friendly, windowed software louls (Table 3.6 8). The Alliance, initiated in 1992, includes 25 U.S. utilities and four international partners from Spain, France, Korea, and Mexico. SAIC is the prime contractor for the R R Workstation, with participation of five other PSA vendors. 

A successful project is defined as one that meets its stated objectives (safety, improved reliability, increased liquid yield, reduced maintenance costs, etc.) on or under-budget and is completed on or ahead of schedule. Some of the helpful criteria that ensure a successful project are as follows ... 

Identified hazards can either be reduced at the root (e.g., reduction of inventory) or by introduction of protective systems (e.g., automatic emergency shutdown). The increased understanding of the chemistry and the process that is obtained from hazard evaluation procedures provides guidance for many other elements of process safety management as well (e.g., procedural instructions, emergency strategies, personnel training, and preventive maintenance). 

Atmospheric vapor releases or liquid spills within a petroleum or related facilities commonly occur every day. They are a major source of the origin of catastrophic incidents. In order to provide an inherently safer facility the common release of process vapors to atmosphere or liquids to grade within the facility should be prevented or eliminated wherever practical. Not only does this improve the safety of a facility it also decreases the amount of fugitive emissions or liquids that occur therefore decreasing any potential harm to the environment. Containment of waste gases and liquids, human surveillance, increased testing, inspection and maintenance, gas detection and adequate vapor dispersion features are all measures to lesson the probability of an incident occurring. 

Concurrent immunosuppressants Sirolimus has been administered concurrently with cyclosporine and corticosteroids. The efficacy and safety of the use of sirolimus in combination with other immunosuppressive agents have not been determined. Renai function impairment Mean serum creatinine was increased and mean glomerular filtration rate was decreased in patients treated with sirolimus and cyclosporine compared with those treated with cyclosporine and placebo or azathioprine controls. Monitor renal function during the administration of maintenance immunosuppression regimens including sirolimus in combination with cyclosporine, and consider appropriate adjustment of the immunosuppression... 

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