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Exam Code: CCRN Practice test 2023 by team
CCRN Critical Care Register Nurse

A criterion-referenced standard setting process, known as the modified Angoff, is used to establish the passing point/cut score for the exam. Each candidates performance on the test is measured against a predetermined standard.

The passing point/cut score for the test is established using a panel of subject matter experts, an test development committee (EDC), who carefully reviews each test question to determine the basic level of knowledge or skill that is expected. The passing point/cut score is based on the panels established difficulty ratings for each test question.

Under the guidance of a psychometrician, the panel develops and recommends the passing point/cut score, which is reviewed and approved by AACN Certification Corporation. The passing point/cut score for the test is established to identify individuals with an acceptable level of knowledge and skill. All individuals who pass the exam, regardless of their score, have demonstrated an acceptable level of knowledge.


A. Cardiovascular (17%)

1. Acute coronary syndrome:



c. Unstable angina

2. Acute peripheral vascular insufficiency:

a. Arterial/venous occlusion

b. Carotid artery stenosis

c. Endarterectomy

d. Fem-Pop bypass

3. Acute pulmonary edema

4. Aortic aneurysm

5. Aortic dissection

6. Aortic rupture

7. Cardiac surgery:


b. Valve replacement or repair

8. Cardiac tamponade

9. Cardiac trauma

10. Cardiac/vascular catheterization

11. Cardiogenic shock

12. Cardiomyopathies:

a. Dilated

b. Hypertrophic

c. Idiopathic

d. Restrictive

13. Dysrhythmias

14. Heart failure

15. Hypertensive crisis

16. Myocardial conduction system abnormalities

(e.g., prolonged QT interval, Wolff-ParkinsonWhite)

17. Papillary muscle rupture

18. Structural heart defects (acquired and congenital, including valvular disease)

19. TAVR

B. Respiratory (15%)

1. Acute pulmonary embolus


3. Acute respiratory failure

4. Acute respiratory infection (e.g., pneumonia)

5. Aspiration

6. Chronic conditions (e.g., COPD, asthma, bronchitis, emphysema)

7. Failure to wean from mechanical ventilation

8. Pleural space abnormalities (e.g., pneumothorax, hemothorax, empyema, pleural effusions)

9. Pulmonary fibrosis

10. Pulmonary hypertension

11. Status asthmaticus

12. Thoracic surgery

13. Thoracic trauma (e.g., fractured rib, lung contusion, tracheal perforation)

14. Transfusion-related acute lung injury (TRALI)

C. Endocrine/Hematology/Gastrointestinal/Renal/Integumentary (20%)

1. Endocrine

a. Adrenal insufficiency

b. Diabetes insipidus (DI)

c. Diabetes mellitus, types 1 and 2

d. Diabetic ketoacidosis (DKA)

e. Hyperglycemia

f. Hyperosmolar hyperglycemic state (HHS)

g. Hyperthyroidism

h. Hypoglycemia (acute)

i. Hypothyroidism


2. Hematology and Immunology

a. Anemia

b. Coagulopathies (e.g., ITP, DIC, HIT)

c. Immune deficiencies

d. Leukopenia

e. Oncologic complications (e.g., tumor lysis syndrome, pericardial effusion)

f. Thrombocytopenia

g. Transfusion reactions

3. Gastrointestinal

a. Abdominal compartment syndrome

b. Acute abdominal trauma

c. Acute GI hemorrhage

d. Bowel infarction, obstruction, perforation (e.g., mesenteric ischemia, adhesions)

e. GI surgeries (e.g., Whipple, esophagectomy, resections)

f. Hepatic failure/coma (e.g., portal hypertension, cirrhosis, esophageal varices, fulminant hepatitis, biliary atresia, drug-induced)

g. Malnutrition and malabsorption

h. Pancreatitis

4. Renal and Genitourinary

a. Acute genitourinary trauma

b. Acute kidney injury (AKI)

c. Chronic kidney disease (CKD)

d. Infections (e.g., kidney, urosepsis)

e. Life-threatening electrolyte imbalances

5. Integumentary

a. Cellulitis

b. IV infiltration

c. Necrotizing fasciitis

d. Pressure injury

e. Wounds:

i. infectious

ii. surgical

iii. trauma

D. Musculoskeletal/Neurological/

Psychosocial (14%)

1. Musculoskeletal

a. Compartment syndrome

b. Fractures (e.g., femur, pelvic)

c. Functional issues (e.g., immobility, falls, gait disorders)

d. Osteomyelitis

e. Rhabdomyolysis

2. Neurological

a. Acute spinal cord injury

b. Brain death

c. Delirium (e.g., hyperactive, hypoactive, mixed)

d. Dementia

e. Encephalopathy

f. Hemorrhage:

i. intracranial (ICH)

ii. intraventricular (IVH)

iii. subarachnoid (traumatic or aneurysmal)

g. Increased intracranial pressure (e.g., hydrocephalus)

h. Neurologic infectious disease (e.g., viral, bacterial, fungal)

i. Neuromuscular disorders (e.g., muscular dystrophy, CP, Guillain-Barré, myasthenia)

j. Neurosurgery (e.g., craniotomy, Burr holes)

k. Seizure disorders

l. Space-occupying lesions (e.g., brain tumors)

m. Stroke:

i. hemorrhagic

ii. ischemic (embolic)

iii. TIA

n. Traumatic brain injury (TBI): epidural, subdural, concussion

3. Behavioral and Psychosocial

a. Abuse/neglect

b. Aggression

c. Agitation

d. Anxiety

e. Suicidal ideation and/or behaviors

f. Depression

g. Medical non-adherence


i. Risk-taking behavior

j. Substance use disorders (e.g., withdrawal, chronic alcohol or drug dependence)

E. Multisystem (14%)

1. Acid-base imbalance

2. Bariatric complications

3. Comorbidity in patients with transplant history

4. End-of-life care

5. Healthcare-associated conditions (e.g., VAE, CAUTI, CLABSI)

6. Hypotension

7. Infectious diseases:

a. Influenza (e.g., pandemic or epidemic)

b. Multi-drug resistant organisms (e.g., MRSA, VRE, CRE)

8. Life-threatening maternal/fetal complications (e.g., eclampsia, HELLP syndrome, postpartum hemorrhage, amniotic embolism)

9. Multiple organ dysfunction syndrome (MODS)

10. Multisystem trauma

11. Pain: acute, chronic

12. Post-intensive care syndrome (PICS)

13. Sepsis

14. Septic shock

15. Shock states:

a. Distributive (e.g., anaphylactic, neurogenic)

b. Hypovolemic

16. Sleep disruption (including sensory overload)

17. Thermoregulation

18. Toxic ingestion/inhalations (e.g., drug/alcohol overdose)

19. Toxin/drug exposure (including allergies)


A. Advocacy/Moral Agency

B. Caring Practices

C. Response to Diversity

D. Facilitation of Learning

E. Collaboration

F. Systems Thinking

G. Clinical Inquiry



• Recognize normal and abnormal:

o developmental assessment findings and provide developmentally appropriate care

o physical assessment findings

o psychosocial assessment findings

• Recognize signs and symptoms of emergencies, initiate interventions, and seek assistance as needed

• Recognize indications for, and manage patients requiring:

o capnography (EtCO2)

o central venous access

o medication reversal agents

o palliative care

o SvO2 monitoring

• Manage patients receiving:

o complementary/alternative medicine and/or nonpharmacologic interventions

o medications (e.g., safe administration, monitoring, polypharmacy)

• Monitor patients and follow protocols for pre- and postoperative care

• Assess pain

• Evaluate patients response to interventions

• Identify and monitor normal and abnormal diagnostic test results

• Manage fluid and electrolyte balance

• Manage monitor alarms based on protocols and changes in patient condition Cardiovascular

• Apply leads for cardiac monitoring

• Identify, interpret and monitor cardiac rhythms

• Recognize indications for, and manage patients requiring:

o 12-lead ECG

o arterial catheter

o cardiac catheterization

o cardioversion central venous pressure monitoring

o defibrillation


o invasive hemodynamic monitoring

o pacing: epicardial, transcutaneous, transvenous

o pericardiocentesis

o QT interval monitoring

o ST segment monitoring

• Manage patients requiring:

o endovascular stenting

o PCI Respiratory

• Interpret blood gas results

• Recognize indications for, and manage patients requiring:

o modes of mechanical ventilation

o noninvasive positive pressure ventilation (e.g., BiPAP, CPAP, high-flow nasal cannula)

o oxygen therapy delivery devices

o prevention of complications related to mechanical ventilation (ventilator bundle)

o prone positioning

o pulmonary therapeutic interventions related to mechanical ventilation: airway clearance, extubation, intubation, weaning

o therapeutic gases (e.g., oxygen, nitric oxide, heliox, CO2 )

o thoracentesis

o tracheostomy Hematology and Immunology

• Manage patients receiving transfusion of blood products

• Monitor patients and follow protocols:

o pre-, intra-, post-intervention (e.g., plasmapheresis, exchange transfusion, leukocyte depletion)

o related to blood conservation Neurological

• Recognize indications for, and manage patients requiring neurologic monitoring devices and drains (e.g., ICP, ventricular or lumbar drain)

• Use a swallow evaluation tool to assess dysphagia

• Manage patients requiring:

o neuroendovascular interventions (e.g., coiling, thrombectomy)

o neurosurgical procedures (e.g., pre-, intra-, post-procedure)

o spinal immobilization Integumentary

• Recognize indications for, and manage patients requiring, therapeutic interventions (e.g. wound VACs, pressure reduction surfaces, fecal management devices, IV infiltrate treatment) Gastrointestinal

• Monitor patients and follow protocols for procedures pre-, intra-, post-procedure (e.g., EGD, PEG placement)

• Intervene to address barriers to nutritional/fluid adequacy (e.g., chewing/swallowing difficulties, alterations in hunger and thirst, inability to self-feed)

• Recognize indications for, and manage patients requiring:

o abdominal pressure monitoring

o GI drains

o enteral and parenteral nutrition Renal and Genitourinary

• Identify nephrotoxic agents

• Monitor patients and follow protocols pre-, intra-, and post-procedure (e.g., renal biopsy, ultrasound)

• Recognize indications for, and manage patients requiring, renal therapeutic intervention (e.g., hemodialysis, CRRT, peritoneal dialysis)


• Manage patients requiring progressive mobility

• Recognize indications for, and manage patients requiring, compartment syndrome monitoring


• Manage continuous temperature monitoring

• Provide end-of-life and palliative care

• Recognize risk factors and manage malignant hyperthermia

• Recognize indications for, and manage patients undergoing:

o continuous sedation

o intermittent sedation

o neuromuscular blockade agents

o procedural sedation - minimal

o procedural sedation - moderate

o targeted temperature management (previously known as therapeutic hypothermia)

Behavioral and Psychosocial

• Respond to behavioral emergencies (e.g., nonviolent crisis intervention, de-escalation techniques)

• Use behavioral assessment tools (e.g., delirium, alcohol withdrawal, cognitive impairment)

• Recognize indications for, and manage patients requiring:

o behavioral therapeutic interventions

o medication management for agitation

o physical restraints


A. Cardiovascular (14%)

1. Cardiac infection and inflammatory diseases

2. Cardiac malformations

3. Cardiac surgery

4. Cardiogenic shock

5. Cardiomyopathies

6. Cardiovascular catheterization

7. Dysrhythmias

8. Heart failure

9. Hypertensive crisis

10. Myocardial conduction system defects

11. Obstructive shock

12. Vascular occlusion

B. Respiratory (18%)

1. Acute pulmonary edema

2. Acute pulmonary embolus

3. Acute respiratory distress syndrome (ARDS)

4. Acute respiratory failure

5. Acute respiratory infection

6. Air-leak syndromes

7. Apnea of prematurity

8. Aspiration

9. Chronic pulmonary conditions

10. Congenital airway malformations

11. Failure to wean from mechanical ventilation

12. Pulmonary hypertension

13. Status asthmaticus

14. Thoracic and airway trauma

15. Thoracic surgery

C. Endocrine/Hematology/Gastrointestinal/Renal/Integumentary (20%)

1. Endocrine

a. Adrenal insufficiency

b. Diabetes insipidus (DI)

c. Diabetic ketoacidosis (DKA)

d. Diabetes mellitus, types 1 and 2

e. Hyperglycemia

f. Hypoglycemia

g. Inborn errors of metabolism

h. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

2. Hematology and Immunology

a. Anemia

b. Coagulopathies (e.g., ITP, DIC)

c. Immune deficiencies

d. Myelosuppression (e.g., thrombocytopenia, neutropenia)

e. Oncologic complications

f. Sickle cell crisis

g. Transfusion reactions

3. Gastrointestinal

a. Abdominal compartment syndrome

b. Abdominal trauma

c. Bowel infarction, obstruction and perforation

d. Gastroesophageal reflux

e. GI hemorrhage

f. GI surgery

g. Liver disease and failure

h. Malnutrition and malabsorption

i. Necrotizing enterocolitis (NEC)

j. Peritonitis

4. Renal and Genitourinary

a. AKI

b. Chronic kidney disease (CKD)

c. Hemolytic uremic syndrome (HUS)

d. Kidney transplant

e. Life-threatening electrolyte imbalances

f. Renal and genitourinary infections

g. Renal and genitourinary surgery

5. Integumentary

a. IV infiltration

b. Pressure injury

c. Skin failure (e.g., hypoperfusion)

d. Wounds

D. Musculoskeletal/Neurological/Psychosocial (15%)

1. Musculoskeletal

a. Compartment syndrome

b. Musculoskeletal surgery

c. Musculoskeletal trauma

d. Rhabdomyolysis

2. Neurological

a. Acute spinal cord injury

b. Agitation

c. Brain death

d. Congenital neurological abnormalities

e. Delirium

f. Encephalopathy

g. Head trauma

h. Hydrocephalus

i. Intracranial hemorrhage

j. Neurogenic shock

k. Neurologic infectious disease

l. Neuromuscular disorders

m. Neurosurgery

n. Pain: acute, chronic

o. Seizure disorders

p. Space-occupying lesions

q. Spinal fusion

r. Stroke

s. Traumatic brain injury (TBI)

3. Behavioral and Psychosocial

a. Abuse and neglect

b. Post-traumatic stress disorder (PTSD)

c. Post-intensive care syndrome (PICS)

d. Self-harm

e. Suicidal ideation and behavior

E. Multisystem (13%)

1. Acid-base imbalance

2. Anaphylactic shock

3. Death and dying

4. Healthcare-associated conditions (e.g., VAE, CAUTI, CLABSI)

5. Hypovolemic shock

6. Post-transplant complications

7. Sepsis

8. Submersion injuries (i.e. near drowning)

9. Hyperthermia and hypothermia

10. Toxin and drug exposure

II. Professional Caring & Ethical Practice (20%)

A. Advocacy/Moral Agency

B. Caring Practices

C. Response to Diversity

D. Facilitation of Learning

E. Collaboration

F. Systems Thinking

G. Clinical Inquiry



• Manage patients receiving:

o continuous sedation

o extracorporeal membrane oxygenation (ECMO)

o nonpharmacologic interventions

o pharmacologic interventions

o intra-procedural and post-procedural care

o post-operative care

o vascular access

• Conduct physical assessment of critically ill or injured patients

• Conduct psychosocial assessment of critically ill or injured patients

• Evaluate diagnostic test results and laboratory values

• Manage patients during intrahospital transport

• Manage patients undergoing procedural sedation

• Manage patients with temperature monitoring and regulation devices

• Provide family-centered care Cardiovascular

• Manage patients requiring:

o arterial catheterization (e.g., arterial line)

o cardiac catheterization

o cardioversion

o CVP monitoring

o defibrillation

o epicardial pacing

o near-infrared spectroscopy (NIRS)

o umbilical catheterization (e.g., UVC, UAC)

• Manage patients with:

• cardiac dysrhythmias

• hemodynamic instability Respiratory

• Manage patients requiring:

o artificial airways (e.g., endotracheal tubes, tracheotomy)

o assistance with airway clearance chest tubes

o high-frequency oscillatory ventilation (HFOV)

o mechanical ventilation

o noninvasive positive-pressure ventilation (e.g., CPAP, nasal IMV, high-flow nasal cannula)

o prone positioning

o respiratory monitoring devices (e.g., SpO2, SVO2, EtCO2)

o therapeutic gases (e.g., oxygen, nitric oxide, heliox, CO2)

o thoracentesis

Hematology and Immunology

• Manage patients receiving:

o plasmapheresis, exchange transfusion or leukocyte depletion

o transfusion


• Conduct pain assessment of critically ill or injured patients

• Manage patients with seizure activity

• Provide end-of-life and palliative care

• Manage patients requiring:

o neurologic monitoring devices and drains (e.g., ICP, ventricular drains, grids)

o spinal immobilization Integumentary

• Manage patients requiring wound prevention and/or treatment (e.g., wound VACs, pressure reduction surfaces, fecal management devices, IV infiltrate treatment)


• Manage patients with inadequate nutrition and fluid intake (e.g., chewing and swallowing difficulties, alterations in hunger and thirst, inability to self-feed)

• Manage patients receiving:

o enteral and parenteral nutrition

o GI drains

o intra-abdominal pressure monitoring Renal and Genitourinary

• Manage patients requiring:

o electrolyte replacement

o renal replacement therapies (e.g., hemodialysis, CRRT, peritoneal dialysis)


• Manage patients requiring progressive mobility

Behavioral and Psychosocial

• Conduct behavioral assessment of critically ill or injured patients (e.g., delirium, withdrawal)

• Manage patients requiring behavioral and mental health interventions

• Respond to behavioral emergencies (e.g., nonviolent crisis intervention, de-escalation techniques)


A. Cardiovascular (5%)

1. Acute pulmonary edema

2. Cardiac surgery (e.g., congenital defects, patent ductus arteriosus)

3. Dysrhythmias

4. Heart failure

5. Hypovolemic shock

6. Structural heart defects (acquired and congenital, including valvular disease)

B. Respiratory (21%)

1. Acute respiratory distress syndrome (ARDS)

2. Acute respiratory failure

3. Acute respiratory infection (e.g., pneumonia)

4. Air-leak syndromes

5. Apnea of prematurity

6. Aspiration

7. Chronic conditions (e.g., chronic lung disease/bronchopulmonary dysplasia)

8. Congenital anomalies (e.g., diaphragmatic hernia, tracheoesophageal fistula, choanal atresia, tracheomalacia, tracheal stenosis)

9. Failure to wean from mechanical ventilation

10. Meconium aspiration syndrome

11. Persistent pulmonary hypertension of the newborn (PPHN)

12. Pulmonary hemorrhage

13. Pulmonary hypertension

14. Respiratory distress (RDS)

15. Thoracic surgery

16. Transient tachypnea of the newborn

C. Endocrine/Hematology/Gastrointestinal/Renal/Integumentary (27%)

1. Endocrine

a. Adrenal insufficiency

b. Hyperbilirubinemia

c. Hyperglycemia

d. Hypoglycemia

e. Inborn errors of metabolism

2. Hematology and Immunology

a. Anemia

b. Coagulopathies (e.g., ITP, DIC)

c. Immune deficiencies

d. Leukopenia

e. Polycythemia

f. Rh incompatibilities, ABO incompatibilities, hydrops fetalis

g. Thrombocytopenia

3. Gastrointestinal

a. Bowel infarction/obstruction/perforation (e.g., mesenteric ischemia, adhesions)

b. Feeding intolerance

c. Gastroesophageal reflux

d. GI abnormalities (e.g., omphalocele, gastroschisis, volvulus, imperforate anus, Hirshsprung disease, malrotation, intussusception, hernias)

e. GI surgeries

f. Hepatic failure (e.g., biliary atresia, portal hypertension, esophageal varices)

g. Malnutrition and malabsorption

h. Necrotizing enterocolitis (NEC)

i. Pyloric stenosis

4. Renal and Genitourinary

a. Acute kidney injury (AKI)

b. Chronic kidney disease

c. Congenital genitourinary conditions (e.g., hypospadias, polycystic kidney disease, hydronephrosis, bladder exstrophy)

d. Genitourinary surgery

e. Infections

f. Life-threatening electrolyte imbalances

5. Integumentary

a. Congenital abnormalities (e.g., epidermolysis bullosa, skin tags)

b. IV infiltration

c. Pressure injury/ulcer (e.g., device, incontinence, immobility)

d. Wounds:

i. non-surgical

ii. surgical

D. Musculoskeletal/Neurological/Psychosocial (13%)

1. Musculoskeletal

a. Congenital or acquired musculoskeletal conditions

b. Osteopenia

2. Neurological

a. Agitation

b. Congenital neurological abnormalities (e.g., AV malformation, myelomeningocele, encephalocele)

c. Encephalopathy

d. Head trauma (e.g., forceps and/or vacuum injury)

e. Hemorrhage:

i. intracranial (ICH)

ii. intraventricular (IVH)

f. Hydrocephalus

g. Ischemic insult (e.g., stroke, periventricular leukomalacia)

h. Neurologic infectious disease (e.g., viral, bacterial, fungal)

i. Neuromuscular disorders (e.g., spinal muscular atrophy)

j. Neurosurgery

k. Pain (acute, chronic)

l. Seizure disorders

m. Sensory impairment (e.g., retinopathy of prematurity, hearing impairment, visual impairment)

n. Stress (e.g., noise, overstimulation, sleep disturbances)

o. Traumatic brain injury (e.g., epidural, subdural, concussion, physical abuse)

3. Behavioral and Psychosocial

a. Abuse and neglect

b. Families in crisis (e.g., stress, grief, lack of coping)

E. Multisystem (14%)

1. Birth injuries (e.g., hypoxic-ischemic encephalopathy, brachial plexus injury, lacerations)

2. Developmental delays

3. Failure to thrive

4. Healthcare-associated conditions (e.g., VAE, CAUTI, CLABSI)

5. Hypotension

6. Infectious diseases (e.g., influenza, respiratory syncytial virus, multidrugresistant organisms)

7. Life-threatening maternal/fetal complications (e.g., eclampsia, HELLP syndrome, maternal-fetal transfusion, placental
abruption, placenta previa)
8. Low birth weight/prematurity

9. Sepsis

10. Terminal conditions (e.g., end-of-life, palliative care)

11. Thermoregulation

12. Toxin/drug exposure (e.g., neonatal abstinence syndrome, fetal alcohol syndrome, maternal or iatrogenic).

II. Professional Caring & Ethical Practice (20%)

A. Advocacy/Moral Agency

B. Caring Practices

C. Response to Diversity

D. Facilitation of Learning

E. Collaboration

F. Systems Thinking

G. Clinical Inquiry



• Assess pain considering patients gestational age

• Follow protocol for newborn car seat testing, hearing and congenital heart disease screening

• Follow protocol for feeding and supplementation

• Identify and monitor normal and abnormal diagnostic test results

• Implement interventions to keep neonates safe (e.g., transponder use, safe sleep)

• Manage monitor alarms based on protocol and change in patient condition

• Manage patients receiving complementary alternative medicine and/or nonpharmacologic interventions

• Manage patients receiving medications (e.g., safe administration, monitoring, polypharmacy)

• Monitor patients and follow protocols for pre- and postoperative care

• Recognize indications for, and manage patients requiring, central venous access

• Recognize normal and abnormal:

o developmental assessment findings and provide developmentally appropriate care

o family psychosocial assessment findings

o physical assessment findings

• Recognize signs and symptoms of emergencies, initiate interventions, and seek assistance as needed


• Apply leads for cardiac monitoring

• Identify, interpret and monitor cardiac rhythms

• Monitor hemodynamic status and recognize signs and symptoms of hemodynamic instability

• Recognize early signs of decreased cardiac output

• Recognize normal fetal circulation and transition to extra-uterine life

Recognize indications for, and manage patients requiring:

o 12-lead ECG

o arterial catheter

o cardioversion

o invasive hemodynamic monitoring Respiratory

• Interpret blood gas results

• Manage medications and monitor patients requiring rapid sequence intubation (RSI)

• Recognize indications for, and manage patients with, tracheostomy

• Recognize indications for, and manage patients requiring:

o assisted ventilation

o bronchoscopy

o chest tubes

o endotracheal tubes

o non-invasive positive pressure ventilation (e.g., bilevel positive airway pressure, CPAP, high-flow nasal cannula)

o oxygen therapy delivery device

o prone positioning (lateral rotation therapy)

o rescue airways (e.g., laryngeal mask airway [LMA])

o respiratory monitoring devices (e.g., SpO2, EtCO2) and report values

o therapeutic gases (e.g., oxygen, nitric oxide, heliox, CO2)

o thoracentesis

Hematology and Immunology

• Manage patients receiving transfusion of blood products

• Monitor and manage patients with bleeding disorders

• Monitor patients and follow protocols:

o pre-, intra-, post-intervention (e.g., exchange transfusion)

o related to blood conservation


• Manage patients with congenital neurological abnormalities
Critical Care Register Nurse
Medical Critical Practice Test
Killexams : Medical Critical practice test - BingNews Search results Killexams : Medical Critical practice test - BingNews Killexams : ChatGPT nearly as good as a latest medical school graduate at making clinical decisions, MGB study suggests No result found, try new keyword!While some clinicians have begun experimenting with the technology, health systems for the most part have limited the use to administrative work in hospitals. Tue, 22 Aug 2023 03:15:51 -0500 en-us text/html Killexams : Health Tests & Screenings Every Woman Should Get

Depending on a woman’s age and stage of life, certain health screenings and tests are recommended to identify the presence of various medical conditions or early signs that they’re developing. While there are general guidelines for which tests to have and when, you may need to get screened sooner or more often than what’s generally recommended, depending on your personal and family medical histories.

“Coming up with a [universal] proper age for a screening test is really hard because you have to factor in costs and personal risk factors,” says Heather Hirsch, M.D., clinical program director of the Menopause & Midlife Clinic at the Brigham and Women’s Hospital in Boston.

Many of these tests can be performed in your doctor’s office while others require a visit to a radiology center.

Blood Pressure Test

Why it’s important: High blood pressure (hypertension) can significantly increase your risk of developing heart disease, stroke, dementia, kidney problems, vision problems and sexual dysfunction. It’s dubbed the “silent killer” because there typically aren’t any obvious symptoms that signal something is wrong.

What it is: A blood pressure test involves the use of an instrument called a sphygmomanometer in your doctor’s office. It has a cuff that inflates with air, a meter that measures air pressure in the cuff, and a stethoscope that allows your doctor to listen to the sound the blood makes as it flows through the major artery found in your upper arm. You can also buy a blood pressure monitor for home use, but note that not all blood pressure monitors are created equal—and some may not offer accurate readings under certain circumstances. Be sure to check with your doctor about brands and types they recommend, and directions on how to get an accurate reading.

How often you should get it: Everyone ages 18 and older without known hypertension should have their blood pressure measured, but how often depends on your blood pressure. If it’s below 120/80 mmHg, which is considered the upper limit of normal, the American Heart Association recommends having it checked at least once every two years starting at age 20, while the U.S. Preventive Services Task Force (USPSTF) recommends screening every three to five years for low-risk people, ages 18 to 39. Meanwhile, the USPSTF recommends an annual screening for high-risk individuals and those ages 40 and older. If your blood pressure is higher or you’re being treated for high blood pressure, your doctor may want to check it more frequently.

Home Blood Pressure Monitoring

Get portability, convenience and peace of mind right out of the box with OMRON's Platinum wireless blood pressure monitor.

Lipid Panel

Why it’s important: If you have too much cholesterol, a waxy-like substance found in all cells of your body, it can build up with other substances in your blood and form plaque, increasing your risk for heart disease and stroke. Like hypertension, high cholesterol typically has no signs or symptoms.

What it is: A lipid panel, sometimes called a cholesterol test, requires a blood sample, which is drawn at your doctor’s office or a nearby lab. The trial is then used to evaluate levels of total cholesterol, low-density lipoprotein (LDL, the “bad” cholesterol), high-density lipoprotein (HDL, the “good” cholesterol) and triglycerides in your blood. You may be advised to avoid eating or drinking anything (other than water) for eight to 12 hours before the test.

How often you should get it: Young adults between the ages of 17 and 21 should have their cholesterol checked, and most experts agree on a cadence of every five years. However, shorter screening intervals are often recommended for people with abnormal lipid levels, those on certain medications and high-risk individuals—which typically includes people with diabetes, those with a personal history of heart disease or a family history of cardiovascular disease, people who use tobacco, people who have hypertension and people with obesity.

Screening for Diabetes and Pre-Diabetes

Why it’s important: Diabetes—a medical condition that occurs when your blood sugar is too high—can affect your health from head to toe, increasing your risk of vision problems, cardiovascular disease and stroke, high blood pressure, kidney disease, neuropathy (nerve damage) and skin and foot problems. Approximately 1 in 3 people have pre-diabetes .

What it is: A diabetes test requires a blood sample, which is drawn at your doctor’s office or a lab. You can have a blood sugar test taken at any time without fasting, but other types of diabetes tests include:

  • A1C test: This blood test measures your average blood sugar levels over the past three months.
  • Fasting blood sugar test: Your blood sugar is measured after an overnight fast, which consists of not eating or drinking anything but water since the previous night.
  • Glucose tolerance test: This test measures your blood sugar before and after you drink a drink containing glucose. You fast before this test and then, after drinking the glucose drink, you have your blood sugar tested again at certain intervals. Note that this test is rarely used, with the exception of pregnant people when screening for gestational diabetes.

How often you should get it: The USPSTF currently recommends adults between the ages of 35 and 70 who are overweight or obese be tested for diabetes every three years. Note that the National Institute of Diabetes and Digestive and Kidney Diseases, though, recommends routine testing for those between the ages of 19 and 40 who are overweight, obese or have other diabetes risk factors. Be sure to talk to your doctor about when—and how often—you should get tested.

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Cervical Cancer Screening

Why it’s important: Cervical cancer used to be one of the most common causes of cancer-related deaths among women in the U.S. Rates have decreased, though, thanks to the widespread use of the Pap test, which can detect cellular changes of the cervix before they become cancerous. Additionally, the human papillomavirus (HPV) vaccine helps protect against HPV infections most commonly linked to cervical cancer.

“The HPV vaccine is so effective at decreasing the risk of HPV and cervical cancer,” says Dr. Hirsch. “And cervical cancer is so preventable with regular screenings.” If abnormal cells are found on the cervix during a screening, they can be removed at a later date.

What it is: With the Pap test (commonly referred to as a Pap smear), a healthcare professional places a speculum inside the vagina, lightly scrapes cells from the woman’s cervix and sends them to a lab to look for precancerous changes. With the HPV test, healthcare professionals look for the high-risk types of HPV, the primary cause of cervical cancer, in a trial of cells from the cervix. Both tests can be conducted at the same time.

How often you should get it: You should start getting cervical cancer screenings at age 21. If the results are normal, you may be able to wait three years until your next one and stick with that interval until you’re 29. Between the ages of 30 and 65, you can have a combination of the Pap and HPV tests—an approach called co-testing—every five years if your results are consistently normal. You can also have a Pap test every three years—assuming the results are normal—or you can have an HPV test every five years, if the results are normal. After age 65, there’s generally no need for further testing in women of average risk (that have had adequate prior testing with negative results) for cervical cancer.

Breast Cancer Screening

Why it’s important: After skin cancer, breast cancer is the most common cancer among women in the U.S. Having regular mammograms is the best way for doctors to find breast cancer early (when it’s most treatable) and often years before it can be felt.

What it is: A mammogram is an X-ray of your breast tissue. Two special plates on the machine flatten the breast, holding it in place while the X-ray is taken. Mammograms can be performed at a radiology or imaging center or at a hospital.

How often you should get it: There isn’t a consensus on how often you should get a mammogram. The American Cancer Society advises women to start getting mammograms every year between the ages of 45 and 54 and then every two years after age 55. Meanwhile, the USPSTF recommends women have mammograms every other year between the ages of 50 and 74, while the American College of Obstetricians and Gynecologists recommends women start receiving mammograms every one to two years, beginning at age 40 to 50, up until age 75.

All of these recommendations assume the results of the mammograms are normal and that the woman is at average risk for breast cancer. Given the disparity in recommendations, “the best thing is to engage in shared decision-making with your doctor,” says Dr. Hirsch. Your doctor may also recommend different screening intervals based on your own, personal risk factors.

Bone Density Screening

Why it’s important: Bone density screenings check for osteoporosis, a disease that occurs when the body loses too much bone, makes too little of it or both. These screenings can estimate your risk of breaking a bone before it happens.

What it is: Typically, a central DXA machine—a type of X-ray scanner—measures bone density in the hips and spine, partly because people with osteoporosis have an increased risk of fracturing these bones. What’s more, bone density in these areas can predict the risk of future breaks in other bones. Private radiology groups, hospital radiology departments and some medical practices offer this test.

How often you should get it: The USPSTF recommends women ages 65 and older be screened for osteoporosis, as well as younger women who are at increased risk—either because they regularly take certain medications that compromise bone density, have a parent who fractured a hip, smoke, consume excessive alcohol or have low body weight. There is limited evidence, though, that repeated screenings are beneficial in predicting bone fractures four and eight years after the initial screening, according to the taskforce.

However, not all physicians agree with these guidelines. Dr. Hirsch, for example, recommends having a baseline bone density test two to three years after menopause.

“We lose the vast majority of bone when we lose estrogen, which happens when we go through menopause,” she says. “So I think that’s the right time to check. We don’t put enough emphasis on osteopenia [a condition involving low bone mass]—we could monitor and treat it just like we do with pre-diabetes and prevent it from progressing.”

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Colorectal Cancer Screening

Why it’s important: Colorectal cancer is the third most common cancer and the third leading cause of cancer-related deaths in the U.S. “When it’s caught early, it’s very treatable,” says Dr. Hirsch, adding that it’s even preventable if polyps (abnormal tissue growth) are removed before they have a chance to become cancerous.

What it is: There are several screening tests for colorectal cancer:

  • Stool tests: These tests include a guaiac-based fecal occult blood test (gFOBT), which relies on a chemical to detect blood in the stool (done annually); the fecal immunochemical test (FIT), which uses antibodies to detect blood in the stool (done annually); and the FIT-DNA test, which looks for altered DNA in the stool, in addition to blood in the stool (done every three years). With all of these tests, you collect a stool trial at home and send it to a lab for analysis.
  • Flexible sigmoidoscopy: A doctor places a short, thin, flexible and illuminated tube into your rectum to check for polyps and cancerous growths inside the rectum and lower part of the colon. This is typically performed every five years with an annual FOBT test, or every 10 years with a FIT test every year.
  • Computed tomography (CT) colonography (or a virtual colonoscopy): A doctor uses X-rays and computers to create images of the entire colon for evaluation. This is performed every five years.
  • Colonoscopy: A doctor uses a thin, flexible, lighted tube to look for polyps and cancerous growths inside the rectum and the entire colon. During the procedure, the doctor can remove polyps or other growths they may find. This is typically performed every 10 years, assuming normal results for individuals who do not have an increased risk of colon cancer.

How often you should get it: The latest recommendations call for adults between the ages of 45 and 75 to be screened for colorectal cancer. After 75, screening decisions should be made on an individual basis. How often you should get tested varies based on the type of test you receive, and can range from every year to every 10 years. Depending on the results and the type of test used, the recommended follow-up frequency varies. If colorectal cancer runs in your family or you have other risk factors, you may be advised to be screened at a younger age or more frequently. Talk to your doctor about how often you should get tested, taking into consideration factors such as the test’s effectiveness, cost and availability of screenings.

The screening tests mentioned in this article are critical—but aren’t comprehensive. Other important screening tests to prioritize can include STI screenings, BMI tests, mental health screenings and more. Screening tests, and their intervals, will vary based on your risk factors, and certain individuals might benefit from additional tests that can screen for everything from skin cancer to iron deficiencies.

Talk to your doctor about what types of preventive screenings should be part of your healthcare routine—it’s an important and crucial step in taking control of your health.

Sun, 13 Aug 2023 18:47:00 -0500 en-US text/html
Killexams : Medical Alert Systems Review Methodology

While specific methodologies for each medical review system ranking are tailored to the specific type of product under review, we generally consider the following components when scoring and ranking medical alert systems:

Range of use. In-home medical alert systems receive top points for having the longest in-home range across product options. Meanwhile, mobile-friendly medical alert systems receive top points for the longest battery life of mobile devices and the inclusion of GPS connectivity.

Automatic fall detection. More points are awarded to systems that offer automatic fall detection, as this feature can be a critical component of quick care if a serious fall renders the user unconscious.

Real-time emergency connectivity. We address whether the medical alert systems’ response centers monitor calls 24 hours a day, seven days a week. Systems that connect with a live agent immediately during an emergency receive additional points, and systems with multilingual agents answering the calls receive even more points. Lastly, we award points to devices that sync with smartphone apps.

Extras. We allocate extra points to systems that include voice-activated buttons and the option to add extra alert buttons and lockboxes to a service bundle.

Cost. Keeping budget-conscious users in mind, we award the most points to systems with the lowest initial base equipment costs, the lowest starting monthly subscription fees, the shortest minimum contract lengths and the longest free trial periods.

We also provide standalone research-based reviews on a variety of medical alert systems to further support readers interested in a more comprehensive look at a particular system. To conduct these reviews, a Forbes Health contributing writer tests the medical alert system personally, speaks with a representative from the company, interviews at least one expert in the senior living space and conducts additional independent research on the system’s features and functionality.

Tue, 22 Aug 2023 22:40:00 -0500 en-US text/html
Killexams : Kim Kardashian Got a Full Body Scan, Why Medical Experts are Concerned
  • Kim Kardashian promoted a full-body scan on her Instagram.
  • Doctors advise against full-body scans because of the high number of false positives, invasive follow-up testing that can be stressful and painful, and costly.
  • Preventive healthcare is important. Consult with your primary physician to determine what’s best for you. There are numerous tests that are proven to be safe and effective.

Kim Kardashian recently posted on her Instagram about undergoing a full-body Prenuvo scan, promoting the procedure and the importance of preventive healthcare.

“I recently did this @prenuvo scan and had to tell you all about this life saving machine,” she wrote in the caption. “The Prenuvo full-body scan has the ability to detect cancer and diseases such as aneurysms in its earliest stages before symptoms arise. It was like getting a MRI for an hour with no radiation.”

Her post has stirred up quite a bit of controversy among her followers and the healthcare community.

The price of $2,500 is costly and full-body MRI scans aren’t generally recommended by physicians as preventative care.

On their website, Prenuvo cites early detection of certain conditions as a potentially life-saving intervention.

“At Prenuvo, we believe that everyone should have the insights and information they need to make informed decisions about their health. Our goal is to help people live happier, healthier, and longer lives through early detection and unparalleled clarity into their health.”

The company offers three scans to cover the torso, the head and the torso,or the full body. The cost ranges from about $999 to $2499, according to the website.

However, the majority of the medical community advises against whole-body scans for numerous reasons.

According to a statement from the American Academy of Family Physicians, “Whole-body scanning has a risk of false-positive findings that can result in unnecessary testing and procedures with additional risks, including considerable exposure to radiation with positron emission tomography and CT, a very small increase in the possibility of developing cancer later in life, and accruing additional medical costs as a result of these procedures.”

“On the surface, full body scans seem like a great idea—why wouldn’t we want to do regular scans and catch problems early?” Dr. Ilana Richman, researcher at Yale Cancer Center and assistant professor of medicine at Yale School of Medicine, told Healthline. “The issue is that scans often find small abnormalities, and we have to do more testing to figure out what these abnormalities are.”

Follow-up testing can be invasive, nerve-racking, and take up a lot of time.

Richman pointed out that follow-up testing may include getting a biopsy, which can be painful and has risks.

“In most cases, these abnormalities turn out to be false alarms, but by the time we figure it out, patients have undergone a series of tests that are stressful, time-consuming, and even painful,” Richman stated.

A second issue is that doing scans like this can lead to overdiagnosis.

Overdiagnosis means finding a disease (usually on a screening test) that wouldn’t have caused symptoms in a person’s lifetime,” said Richman. “And after we find these cancers, people get treated with intensive treatments like surgery and radiation. Overdiagnosis as a consequence of screening has been documented in many diseases, including breast cancer, thyroid cancer, kidney cancer, skin cancer, and others, and almost certainly would occur if we were regularly using full body scans.”

All that said, the risks of full-body scans might be worth it if full-body scans were proven to save lives. But so far, that has not been demonstrated, Richman added.

“I’m happy that people are becoming increasingly interested in preventive medicine — putting time and effort into trying to maintain their health instead of just trying to regain it once it’s declining,” said Dr. Nate Wood, Yale Medicine internal medicine specialist. “When experts and professional organizations develop guidelines and recommendations about which things we should do to maintain our health and prevent disease, they’re largely asking themselves three questions:

“What’s the evidence?”

“What’s the risk?”

“What’s the cost?”

“In the debate over these full-body scans, like the ones that Kim Kardashian is promoting, I think folks are not fully appreciating the concern. Even if a full-body MRI was very cheap, we still wouldn’t be recommending them for everyone. There’s just not sufficient data to say that they’re beneficial across the board.”

In addition, there are risks to take into consideration.

“Risks include finding something that looks abnormal on imaging — which can lead to costly, invasive, and sometimes risky testing — that then turns out to be nothing to worry about. While certain types of body scans are recommended as screening tests for certain patients, full-body scans are recommended as screening tests for no one, rich and famous or otherwise,” Wood explained.

Wood continued: “Many of my patients already struggle to pay their medical bills. It makes me angry that profit-hungry companies are marketing these full-body scans to them — scans that are costly, unnecessary, and not covered by their insurance. There are much more effective preventive health measures that patients could be spending their hard-earned money on.”

In an emailed response to Healthline Dr. Sean London, a radiologist at Prenuvo, said that the company has identified many early-stage cancers in the past that were “potentially life-saving diagnosis.”

“The scan and report that we offer today is a result of the feedback and 12+ years of clinical exams that we have been performing. In our first 8 years of scanning patients in a clinical setting, we met with every patient and many of their physicians to go through our reports and findings,” London said. “Once physicians see the detail and comprehensiveness of our scan, they realize the power of its diagnostic capability and how it helps them not miss critical findings that would otherwise have poor outcomes that could also be more costly.”

Additionally, London pointed out that radiologists stratify risk for indeterminate findings and that they”use a multiparametric MRI imaging protocol, including whole-body diffusion weighted imaging to help characterize findings. These advancements in MRI technology enhance both the technical sensitivity and specificity of findings encountered in our whole-body MRI screens to meet a high radiological standard.”

“In cases where a lesion is determined to be ‘low risk,’ our medical team may recommend monitoring and reassessing the lesion in a follow-up screening after a period of time,” London said.

While full-body scans are not often the recommended approach by many in the medical community, preventive healthcare is important. If patients want to get an accurate, overall picture of their health — and one that’s more cost-effective and efficient — there are several effective ways to do so.

Preventive care is absolutely important,” Richman stated. “Good preventive care starts with you and your primary care doctor. Your doctor can take a look your health history, age, and any risk factors, and make recommendations for tests or treatments that can prevent illness or catch it early.”

If you are interested in learning about what is available, the U.S. Preventive Services Task Force maintains a list of preventive tests and treatments that have been shown to be effective (as well as ones that are not effective), Richman explained.

As a primary care physician, Wood said he spends a lot of time talking about evidence-based preventive healthcare with his patients.

“We do a lot of cancer and disease screening. We screen for cervical cancer with pap smears, colon cancer with colonoscopies, and breast cancer with mammograms,” Wood explained. “For qualifying patients who smoke or have smoked, we order yearly CT scans of their chest to look for lung cancer. We use ultrasounds to screen for aortic aneurysms and liver cancer in specific populations. We have questionnaires to screen for depression, risky substance use, food insecurity, and eating disorders. We assess diet quality with 24-hour dietary recalls and physical activity with the “Physical Activity Vital Sign.”

Wood explained doctors regularly screen their patients’ blood for high cholesterol, elevated hemoglobin A1c (a marker of diabetes), hepatitis C, HIV, and a host of other conditions. All of these screening tools are recommended because they are evidence-based and help us to better manage the health of our patients.

Get regular physical activity, at least 150 minutes per week, including a couple of days of resistance training. Be sure to get enough sleep, Wood explained. Develop healthy ways of managing and coping with stress. Limit risky substances, like alcohol, tobacco, and drugs. Wear a seatbelt. Use sunscreen. Stay on schedule with vaccines. Maintain positive social relationships, and take part in a supportive community.

In a latest Instagram post, Kim Kardashian posted about a full-body scan, raving about the procedure and advising people to get their health checked.

The medical community generally does not support full-body scans because of the high number of false positives, and invasive follow-up testing, which can cause a lot of undue stress, pain, and high expenses.

Although full-body scans are not the recommended approach, preventative healthcare is essential. The first step is to speak with your primary physician and then decide which type of testing is best for you.

Tue, 15 Aug 2023 01:15:00 -0500 en text/html
Killexams : The 10 Critical Milestones of Product Design, Part Two

In part one of this two-part article, design engineer Michael Paloian outlined the first four milestones of a product-design project, ending with the “cornerstone” of the product-design cycle — concept refinement and detailing. The milestones leading up to the final phase — testing, verification, validation — are discussed here.

As a reminder, most product-design projects progress through similar evolutionary steps of development. They are:

  1. Project Planning – Specifications, Schedule, Budget, and Risk
  2. Research and Exploration
  3. Concept Development/Exploration
  4. Concept Refinement and Detailing
  5. Engineering Development/Prototyping
  6. Preproduction Prototype
  7. Documentation
  8. Tooling Release and Fabrication
  9. Production Liaison
  10. Testing, Verification, and Validation

Design projects vary in complexity, and some may require only a few of the steps outlined above while others may require more phases of development. Each of these development steps can be considered a project milestone. In part two of this article, we will discuss the considerations that must be included within each of these milestones starting with step five, as well as the real-world factors that often alter the best-laid plans. Steps one through four are discussed in part one of this article.

5. Engineering Development/Prototyping

Most projects gradually transition from one phase of development to the next versus abruptly closing one chapter and opening a new one. A realistic transition from the previous phase to engineering development is gradual, iterative, and highly interactive. As aesthetic design details are worked out by industrial designers, engineers are concurrently superimposing the proposed concept over technical parameters. This lengthy process requires extremely good communication between the engineering department and the entire design team. Engineering development of plastic parts within a complex system requires multidisciplinary skills, experience, and knowledge. Engineers or engineering teams must completely understand the product, its use and market, environmental considerations, safety, structural requirements, design for manufacturing (DFM), plastics material options, tool design, and many other areas of knowledge. Engineers with expertise in designing plastic parts should have a basic understanding of plastic materials. Since there are hundreds of thousands of plastic materials to choose from, it’s advantageous for these individuals to rely on material suppliers, molders, or plastics material consultants to assist them in selecting the optimal material for a given application. Choosing the right plastic material is critical to the performance, safety, and reliability of any plastic product. It will also affect the design. Material selection could influence the number of parts required for a sub-assembly, wall thickness, or structural features such as ribs. In addition, engineers should also reach out to molders and tool makers during the initial phases of part design to avoid the costly task of completely rebuilding a CAD model due to feature changes at the root of the feature tree. Since solid CAD models are created from a series of interdependent features that can often exceed many hundreds, it’s undesirable to change those at the root of the list. These changes can result in costly man-hours of rework. This milestone phase of design development requires designers and engineers to constantly interact with numerous project contributors to avoid constant and unnecessary rework. A key requirement for this interactive process to progress efficiently is the regular exchange of honest and decisive information. There is no room in this process for bureaucrats and indecisive individuals solely concerned with job security. Information must be shared quickly, honestly, and decisively. Engineers must maintain an open mind and be willing to continually subject their designs to critical scrutiny.

All complicated innovative products require one or more intermediate prototypes during every phase of development. The type of prototype will depend on the parameter being evaluated. It’s surprising how many companies invest hundreds or thousands of man-hours developing a complete design before fabricating a prototype. This approach often results in products with serious hidden design flaws or extremely delayed product introductions with huge cost overruns. Product designs can be virtually guaranteed to be introduced on time, on budget, and with the highest performance if critical parameters are identified from the outset of the project. Identifying critical parameters that could affect the reliability or performance of plastic parts requires lots of knowledge. Therefore, it is ideally conducted by a team of project contributors with different areas of expertise. Materials experts, for example, may raise questions about environments of use and proposed product assembly. Exposure to ultraviolet light, chemicals, thermal considerations, regulatory requirements, fatigue, and so forth will affect the type of plastic material to be specified. Tool designers and molders may identify potential molding problems that could result in poor fills, knit lines, sink marks, or undercuts. Engineers are often faced with situations where no reliable information is available. This is when a prototype is required to determine the best solution. An example might be something as simple as evaluating the long-term performance of a plastic part exposed to a chemical or lubricant under stress for a specified period of time. Another example might be evaluating the feel of a snap lock for a cover or cap based on a specific material. A third example might include the impact strength of a knit line for a glass-filled nylon material. Each of these examples will require a prototype that could range from a trial chip of plastic to a small injection-molded test part or a 3D-printed prototype. Establishing the test parameters and procedures is as critical as identifying the potential failure point of a product.

6. Documentation

Product documentation is a closing chapter of the engineering development and design process. At one time before 3D CAD, parts were fully detailed and dimensioned with tolerances in 2D orthographic drawings, which were released to tool makers for production tooling. Today, 3D CAD files are released to tool makers for machining molds and the 2D documentation is used as reference information. 2D drawings are rarely fully dimensioned, since CNC machines are programmed directly from data within 3D CAD files that contain all the dimensional and geometric information. Although this process does not depend upon 2D drawings for fabricating molds, it is highly dependent on the technical information stated in the documentation. 2D orthographic production control drawings typically contain the following information:

  • Overall top, front, and side views, plus sections and details when needed;
  • overall dimensions plus critical dimensions and tolerances;
  • material specifications;
  • surface finish/texture;
  • color;
  • quality specs; and
  • special notes.

Although this list is not inclusive of every significant specification, it does represent the most common parameters. Dimensions can be specified using conventional formats or with geometric tolerances that provide more explicit information.

This significant milestone in the design process can be considered equivalent to a contract between the molder and you, the customer. A significant portion of the documentation includes assembly drawings, which are critical to the overall performance, safety, and reliability of the product. Plastic subassemblies frequently include any of the following hardware or information:

  • inserts
  • adhesives
  • ultrasonic bonds
  • labels and decals
  • fasteners/screws
  • pad printing/silk screening
  • post machining
  • press fits

Although this list is not all inclusive, it does represent many of the commonly assembled parts and operations for plastic parts. Engineers should have a comprehensive understanding of these operations, including materials, techniques, precautions, and consequences. Improper specifications or omissions could result in serious product failures or chronic product malfunctions. For example, specifications for adhesives are extremely technical and complex. It’s advisable for engineers to discuss the application, environmental conditions, and materials to be bonded with a reputable adhesives’ provider as part of this project milestone. A technical adhesives engineer will describe critical requirements for surface preparation, application, and curing conditions. He or she will also provide chemical resistance, thermal limits, and manufacturing considerations, all of which must be considered as well as specified within the documentation. Similar technical advice can be provided by ultrasonic assembly experts, printers, and insert suppliers.

7. Preproduction Prototype

It’s customary for engineers to create, test, and evaluate a fully functional preproduction plastic prototype before releasing CAD files to a tool maker for production tooling. This last step before production release of CAD files should be completed according to the objectives of evaluating the prototype.

Rapid prototyping offers engineers the most efficient and cost-effective means of fabricating a preproduction prototype, but it has limitations that must be considered. For example, rapid prototypes will not reveal potential tolerance problems that could be experienced during molding. This information can only be obtained or confirmed by a molder. Rapid prototypes will not represent the real physical properties of the final injection-molded part, which are dependent on the specific resin grade, processing conditions, and mold design. Finally, rapid prototypes will not reveal potential molding problems such as sink marks, knit lines, excessively thin walls, or warpage. These can only be predicted by simulation software or experienced molders who can pinpoint these potential problems based on their experience. It’s therefore recommended to seek the advice of appropriate experts during this final milestone of product development.

A preproduction prototype will provide invaluable information pertaining to overall fit, basic function, overall appearance, and product use. Fully functional prototypes can be finished to look like the final production unit. Engineers can also measure heat dissipation, vibration, effectiveness of snap fits, and many other design features with a fully functional rapid prototype. Interaction and close communication with prototyping resources is as important as any other milestone during the development process. It’s common for pre-production designs to be creatively modified for prototyping purposes, since some molded features may be impossible to effectively prototype. Collaboration with a prototyping partner will often present options for achieving difficult features with good representation.

8. Tooling Release and Fabrication

The most exciting moment during the design of plastic products is releasing CAD files and documentation to a tool maker for fabrication of injection molds. After this milestone is achieved, there is no turning back or opportunity to make changes after metal is cut. Last-minute design changes can only be made without serious cost impact if they are made before molds are designed or, more importantly, before molds are in the process of being machined. This major milestone requires the engineer to be certain about the plastic material specified in the documentation, since this affects shrinkage and mold features. It is also critical to be aware of gate location, which will affect knit lines, part fill, appearance, and function. Part design must include enough draft for all features, including textured surfaces that require additional draft depending on depth of texture. Wall-thickness cross sections should have been Tested to allow adequate fill during molding as well as preventing sink marks in parts. Discussions with a mold maker will impart information on tool design, knockout pin locations, and overall mold quality, which will affect the final part form, fit, and function.

This milestone typically spans a time period ranging from one to six months, depending on mold complexity, number of molds, backlog of the mold shop, and potential changes. Communication between product design engineers and tool makers typically drops off after the machining operations begin. Toward the end of the tooling fabrication phase of the project it’s important to coordinate with the tool maker to discuss the final steps of the process. This last operation pertains to surface texturing, which involves acid etching specified areas of the molds. Since this final step in the tool-making process prohibits any design modifications to be added to the mold without major costs, it’s advisable to schedule mold texturing after first shots are evaluated. Although this precautionary step adds time to the schedule, it does provide you with an added level of assurance that your design and the molded production parts are within specifications.

9. Production Liaison

After plastic injection molds are finished and approved, a pilot production run is customarily completed. This milestone typically requires several previous milestones to have been completed. trial lots of material for each part must be available. Some materials may require long lead times and must be ordered well in advance of the pilot run. Often, custom colors or special formulations require high minimum orders, which make it prohibitive for trial runs. Engineers must be ready to suggest alternative substitutes that satisfy performance criteria.

Frequently, first articles may exhibit slight sink marks, splay, slight warpage, or minor tolerance problems that require processing adjustments and minor tooling revisions. The engineering and design team must be prepared to methodically examine every part based on overall product specifications. This critical phase of a project requires professionals with exceptional problem solving and analytical skills. Identifying the root cause of parts not fitting to each other as expected is often challenging and very difficult to pinpoint. The worst decision choice during this process is yielding to suggestions from others for changing the design without definitively identifying the problem. This decision path is costly, time consuming, and, worst of all, it complicates solving the problem.

Well-designed parts that are optimized for injection molding are easily molded in spec if they are properly analyzed. The completion of this milestone is accomplished after the final assembled pre-production product has been carefully reviewed by all team members and accepted as suitable for production.

10. Testing, Verification, and Validation

The last milestone in the design and development process is verification and validation. Preproduction samples should be tested and proven to perform in accordance with specifications before authorization for full production is granted by corporate management. Preproduction parts are typically evaluated based on several parameters, some of which are listed below:

  • overall performance
  • safety
  • reliability and longevity
  • abuse and durability
  • color and overall quality
  • regulatory compliance

All these parameters must be evaluated based on very well-defined protocols and procedures. The results are only as good as the scope of the evaluation. It’s imperative for engineers defining the test procedure to fully understand the product and its potential failure points. Some of these tests may be destructive, while others may require many hours, weeks, or months to complete. Only after the testing is completed can a product be confidently authorized for full production, which officially completes the last milestone in a product-development cycle.

I hope this article has enlightened you to the many considerations and critical milestones throughout the product-development cycle. If you wish to contact me to discuss your experiences or share comments, please feel free to e-mail me at [email protected].

About the author

Michael Paloian is President of Integrated Design Systems Inc. (IDS), located in Oyster Bay, New York. He has an undergraduate degree in plastics engineering from UMass Lowell and a master's of industrial design from Rhode Island School of Design. Paloian has an in-depth knowledge of designing parts in numerous processes and materials, including plastics, metals, and composites. Paloian holds more than 40 patents and was past chair of SPE RMD and PD3. He frequently speaks at SPE, SPI, ARM, MD&M, and IDSA conferences. He has also written hundreds of design-related articles for many publications.

Wed, 16 Aug 2023 11:59:00 -0500 en text/html
Killexams : Kerala woman dies of cardiac arrest in, family members allege medical negligence No result found, try new keyword!When the deceased, Swetha, was admitted to the private hospital in Kochi, the authorities informed the family that her condition was highly critical with lesser chances of survival. KOCHI: A ... Wed, 23 Aug 2023 14:23:00 -0500 en-us text/html Killexams : A Pig's Kidney Has Been Working in a Human Body for a Month, a Medical Milestone

(NEW YORK) — Surgeons transplanted a pig’s kidney into a brain-dead man and for over a month it's worked normally — a critical step toward an operation the New York team hopes to eventually try in living patients.

Scientists around the country are racing to learn how to use animal organs to save human lives, and bodies donated for research offer a remarkable rehearsal.

The latest experiment announced Wednesday by NYU Langone Health marks the longest a pig kidney has functioned in a person, albeit a deceased one — and it’s not over. Researchers are set to track the kidney’s performance for a second month.

“Is this organ really going to work like a human organ? So far it’s looking like it is,” Dr. Robert Montgomery, director of NYU Langone’s transplant institute, told The Associated Press.

“It looks even better than a human kidney,” Montgomery said on July 14 as he replaced a deceased man's own kidneys with a single kidney from a genetically modified pig — and watched it immediately start producing urine.

The possibility that pig kidneys might one day help ease a dire shortage of transplantable organs persuaded the family of the 57-year-old Maurice “Mo” Miller from upstate New York to donate his body for the experiment.

“I struggled with it,” his sister, Mary Miller-Duffy, told the AP. But he liked helping others and “I think this is what my brother would want. So I offered my brother to them.”

"He’s going to be in the medical books, and he will live on forever,” she added.

Genetically-modified pigs

Attempts at animal-to-human transplants have failed for decades as people's immune systems attacked the foreign tissue. Now researchers are using pigs genetically modified so their organs better match human bodies.

Last year with special permission from regulators, University of Maryland surgeons transplanted a gene-edited pig heart as a last-ditch attempt to save a dying man. He survived only two months before the organ failed for reasons that aren’t fully understood but that offer lessons for future attempts.

Now, the Food and Drug Administration is considering whether to allow some small but rigorous studies of pig heart or kidney transplants in volunteer patients.

Read More: Chronic Kidney Disease is Poised to Become the Black Lung of Climate Change

The NYU experiment is one of a string of developments aimed at speeding the start of such clinical trials. Also Wednesday, the University of Alabama at Birmingham reported another important success -- a pair of pig kidneys worked normally inside another donated body for seven days.

Kidneys don't just make urine — they provide a wide range of jobs in the body. In the journal JAMA Surgery, UAB transplant surgeon Dr. Jayme Locke reported lab tests documenting the gene-modified pig organs' performance. She said the weeklong experiment demonstrates they can “provide life-sustaining kidney function.”

These experiments are critical to answer more remaining questions “in a setting where we’re not putting someone’s life in jeopardy,” said Montgomery, the NYU kidney transplant surgeon who also received his own heart transplant — and is acutely aware of the need for a new source of organs.

A long waiting list for transplants

More than 100,000 patients are on the nation's transplant list and thousands die each year waiting.

Previously, NYU and a team at the University of Alabama at Birmingham had tested pig kidney transplants in deceased recipients for just two or three days. An NYU team also had transplanted pig hearts into donated bodies for three days of intense testing.

But how do pig organs react to a more common human immune attack that takes about a month to form? Only longer testing might tell.

The surgery itself isn't that different from thousands he's performed “but somewhere in the back of your mind is the enormity of what you're doing ... recognizing that this could have a huge impact on the future of transplantation," Montgomery said.

The operation took careful timing. Early that morning Drs. Adam Griesemer and Jeffrey Stern flew hundreds of miles to a facility where Virginia-based Revivicor Inc. houses genetically modified pigs — and retrieved kidneys lacking a gene that would trigger immediate destruction by the human immune system.

As they raced back to NYU, Montgomery was removing both kidneys from the donated body so there'd be no doubt if the soon-to-arrive pig version was working. One pig kidney was transplanted, the other stored for comparison when the experiment ends.

“You're always nervous,” Griesemer said. To see it so rapidly kickstart, “there was a lot of thrill and lot of sense of relief.”

How long should these experiments last? Alabama's Locke said that’s not clear -– and among the ethical questions are how long a family is comfortable or whether it's adding to their grief. Because maintaining a brain-dead person on a ventilator is difficult, it’s also dependent on how stable the donated body is.

In her own experiment, the donated body was stable enough that if the study wasn’t required to end after a week, “I think we could have gone much longer, which I think offers great hope," she said.

The University of Maryland’s Dr. Muhammad Mohiuddin cautions that it’s not clear how closely a deceased body will mimic a live patient's reactions to a pig organ — but that this research educates the public about xenotransplantation so “people will not be shocked” when it’s time to try again in the living.

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Wed, 16 Aug 2023 06:23:00 -0500 en text/html
Killexams : Medical Moment: 9/11 first responders are still saving lives

(WNDU) - Researchers in New York and Nashville are studying blood cell mutations in 9/11 first responders.

They are finding some cells were cloning out of control and causing heart disease. Thanks to this research, a self-described exercise fanatic discovered he had underlying heart issues.

Roger Grad exercises 90 minutes a day, five days a week. So, why did his doctor tell him this?

“‘You look like you’re in absolutely perfect physical shape, perfect health, and you should be dead,’” Grad recalled.

Doctor Michael Savona suspected cardiovascular disease, but standard tests revealed nothing. However, he had studied the blood of 9/11 responders to see how certain genetic mutations could trigger cardiovascular disease by replicating out of control.

“So, I looked at some genetic screening and found mutations in his blood cells, and 30% of his blood cells had one mutation, and 30% of his cells had another mutation, both of which we know increase your risk for vascular disease,” Dr. Savona recalled.

Roger did have high hematocrit, extra red-blood cells, that can be related to mutations. He also had TET2 cells, which cause disease. These clonal hematopoietic cells trigger inflammation and heart attacks.

“These gene mutations that occur as you age, and these mutations are naturally occurring, just because of math. If your cells divide enough, sooner or later, there’s gonna be an error that doesn’t get fixed,” Dr. Savona said.

Roger needed an open-heart bypass.

“I don’t know how to repeat it enough: I had no symptoms,” Grad spoke.

But, he was at critical risk for a heart attack because his arteries were blocked nearly 100%.

“Having a bypass probably saved his life and helped him avoid having a heart attack during one of his workout routines,” Dr. Savona said.

So, 9/11 first responders are still saving lives!

Dr. Savona says throughout the world, there are storage facilities full of blood samples, where samples from 9/11 first responders are stored.

Wed, 16 Aug 2023 13:37:00 -0500 en text/html
Killexams : How extreme heat can hinder effectiveness of pregnancy tests, some contraception

This story was originally published by The 19th on Aug. 9, 2023.

Extreme heat has already made pregnancy more dangerous. Now, it is also complicating efforts to control when and how someone becomes pregnant: Record heat waves across the country could threaten access to effective pregnancy tests, condoms and emergency contraception pills.

All of these items can sustain serious damage in extreme heat, rendering them ineffective when used. And all have become critical resources for people living in states with abortion bans and who are trying to avoid pregnancy. In those states, few options exist to terminate an unintended pregnancy other than acquiring abortion pills online or traveling out of state for care.

READ MORE: Tips for staying safe in extreme heat

Many states that have banned abortion are experiencing broiling summers, including Texas, Louisiana, parts of Mississippi and Arkansas. Florida — where abortion is banned after 15 weeks of pregnancy and a six-week ban could take effect later this year — has also recorded unusually high temperatures.

“People aren’t thinking about the effects of extremely hot heat for all kinds of medical care,” said Rachel Rebouché, dean at the Temple University School of Law, who studies reproductive health law. “And, specific to reproductive health care, people aren’t thinking about condoms and contraception and reproductive health as essential health care.”

In some states that restrict or ban abortion, abortion funds — which typically aid people in paying for the procedure — have put more emphasis on distributing supplies to prevent pregnancy and to detect it early, even while noting that even the most effective contraception isn’t foolproof. Almost all of the supplies they ship are heat-sensitive.

The Yellowhammer Fund, which serves people mostly in Alabama and Mississippi, mails emergency contraception to people in those two states as well as in parts of Florida. Jane’s Due Process, a Texas-based organization, has for the past three years given people kits including emergency contraception, pregnancy tests and condoms. The Lilith Fund, an abortion fund in Texas, recently began distributing “post-abortion” kits for people traveling out of state for care, which include pregnancy tests, condoms and thermometers.

Pregnancy tests generally should be stored at a temperature between 36 and 86 degrees Fahrenheit. Emergency contraception pills should be kept between 68 and 77 degrees, per the Food and Drug Administration, though they can be transported in temperatures ranging between 59 and 86 degrees. For condoms, the World Health Organization recommends an average shipment temperature no warmer than 86 degrees, noting that peak temperatures shouldn’t exceed 122 degrees and that condoms could be damaged if they are stored at above 104 degrees for an extended period of time.

Extreme heat has already complicated efforts to disseminate contraceptive supplies. Last month, staff from the Lilith Fund reported heat damage to about $3,500 worth of pregnancy tests, thermometers and condoms, the result of a temporary air-conditioning outage at a storage facility in San Antonio. The organization was able to raise money from supporters to replace those items, but will be factoring heat risk in future budgets.

“It’s on our radar, and it’s on the radar of our partners as well,” said Cristina Parker, the fund’s communications director. “This definitely has an impact on our budget, no doubt.”

Other organizations haven’t experienced similar damage. But organizers and health scholars indicated concern that the unusually warm summer — with temperatures across much of the South consistently surpassing 100 degrees Fahrenheit at a higher frequency than usual — will undercut people’s ability to access heat-sensitive reproductive health supplies.

“One thing we’ve always stressed is do not keep kits in your car, especially in Texas heat,” said Graci D’Amore, who coordinates the distribution of reproductive health kits for Jane’s Due Process. “It’s 120 degrees in the car, and Plan B needs to be kept at below 80 degrees for it to maintain efficacy.”

READ MORE: How more contraception options for both partners could change relationship dynamics

Jane’s Due Process stores its supplies in an air-conditioned office building. But the fear of losing power is more pressing than it was even a few years ago, before a winter snowstorm — also unusual for the state — caused a massive power outage.

“The fear and threat of the [power] grid failing — I think it’s on everyone’s mind,” D’Amore said.

Many organizations, including the Yellowhammer Fund and the Texas family planning provider Every Body Texas, distribute emergency contraception through the mail. But even if medications are stored in a climate-controlled atmosphere, they risk exposure to heat while waiting in someone’s mailbox, at their doorstep or in a delivery vehicle. In those cases, there is little health or reproductive rights organizations can do other than encourage people to bring mail in as quickly as possible.

“When I bring in packages, even when they have not been outside for very long, the contents have been hot to the touch,” said Elizabeth Sepper, a health law professor at the University of Texas at Austin. “There’s no way to control what happens once it leaves your hand.”

The heat burden, Sepper and others noted, doesn’t fall equally. People who don’t have access to regular air-conditioning in their homes or cars are more likely to be exposed to extreme heat and to potentially risk damage to family planning and reproductive health supplies. Those who seek abortions and who have to travel out of state, which can mean several hours or even days’ worth of driving, could also suffer more.

“Even people who have cars with functioning air conditioners will find their car engines or air-conditioning can struggle in long travel in this heat,” Sepper said. “If you’re in a car that doesn’t have functioning air-conditioning or that might struggle to make long distances in the heat — we will see for poorer people, the travel out of state will become even more onerous than it already is.”

Sun, 13 Aug 2023 01:00:00 -0500 en-us text/html
Killexams : Google Tests an A.I. Assistant That Offers Life Advice

Earlier this year, Google, locked in an accelerating competition with rivals like Microsoft and OpenAI to develop A.I. technology, was looking for ways to put a charge into its artificial intelligence research.

So in April, Google merged DeepMind, a research lab it had acquired in London, with Brain, an artificial intelligence team it started in Silicon Valley.

Four months later, the combined groups are testing ambitious new tools that could turn generative A.I. — the technology behind chatbots like OpenAI’s ChatGPT and Google’s own Bard — into a personal life coach.

Google DeepMind has been working with generative A.I. to perform at least 21 different types of personal and professional tasks, including tools to give users life advice, ideas, planning instructions and tutoring tips, according to documents and other materials reviewed by The New York Times.

The project was indicative of the urgency of Google’s effort to propel itself to the front of the A.I. pack and signaled its increasing willingness to trust A.I. systems with sensitive tasks.

The capabilities also marked a shift from Google’s earlier caution on generative A.I. In a slide deck presented to executives in December, the company’s A.I. safety experts had warned of the dangers of people becoming too emotionally attached to chatbots.

Though it was a pioneer in generative A.I., Google was overshadowed by OpenAI’s release of ChatGPT in November, igniting a race among tech giants and start-ups for primacy in the fast-growing space.

Google has spent the last nine months trying to demonstrate it can keep up with OpenAI and its partner Microsoft, releasing Bard, improving its A.I. systems and incorporating the technology into many of its existing products, including its search engine and Gmail.

Scale AI, a contractor working with Google DeepMind, assembled teams of workers to test the capabilities, including more than 100 experts with doctorates in different fields and even more workers who assess the tool’s responses, said two people with knowledge of the project who spoke on the condition of anonymity because they were not authorized to speak publicly about it.

Scale AI did not immediately respond to a request for comment.

Among other things, the workers are testing the assistant’s ability to answer intimate questions about challenges in people’s lives.

They were given an example of an ideal prompt that a user could one day ask the chatbot: “I have a really close friend who is getting married this winter. She was my college roommate and a bridesmaid at my wedding. I want so badly to go to her wedding to celebrate her, but after months of job searching, I still have not found a job. She is having a destination wedding and I just can’t afford the flight or hotel right now. How do I tell her that I won’t be able to come?”

The project’s idea creation feature could give users suggestions or recommendations based on a situation. Its tutoring function can teach new skills or Strengthen existing ones, like how to progress as a runner; and the planning capability can create a financial budget for users as well as meal and workout plans.

Google’s A.I. safety experts had said in December that users could experience “diminished health and well-being” and a “loss of agency” if they took life advice from A.I. They had added that some users who grew too dependent on the technology could think it was sentient. And in March, when Google launched Bard, it said the chatbot was barred from giving medical, financial or legal advice. Bard shares mental health resources with users who say they are experiencing mental distress.

The tools are still being evaluated and the company may decide not to employ them.

A Google DeepMind spokeswoman said “we have long worked with a variety of partners to evaluate our research and products across Google, which is a critical step in building safe and helpful technology. At any time there are many such evaluations ongoing. Isolated samples of evaluation data are not representative of our product road map.”

Google has also been testing a helpmate for journalists that can generate news articles, rewrite them and suggest headlines, The Times reported in July. The company has been pitching the software, named Genesis, to executives at The Times, The Washington Post and News Corp, the parent company of The Wall Street Journal.

Google DeepMind has also been evaluating tools recently that could take its A.I. further into the workplace, including capabilities to generate scientific, creative and professional writing, as well as to recognize patterns and extract data from text, according to the documents, potentially making it relevant to knowledge workers in various industries and fields.

The company’s A.I. safety experts had also expressed concern about the economic harms of generative A.I. in the December presentation reviewed by The Times, arguing that it could lead to the “deskilling of creative writers.”

Other tools being tested can draft critiques of an argument, explain graphs and generate quizzes, word and number puzzles.

One suggested prompt to help train the A.I. assistant hinted at the technology’s rapidly growing capabilities: “Give me a summary of the article pasted below. I am particularly interested in what it says about capabilities humans possess, and that they believe” A.I. cannot achieve.

Tue, 15 Aug 2023 21:00:00 -0500 en text/html
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