RESUMO
The Environmental Protection Agency's (EPA) Office of Emergency and Remedial Response (OERR) requires environmental data of known quality to support Superfund hazardous waste site projects. The Quality Assurance Technical Support (QATS) Program is operated by Shaw Environmental and Infrastructure, Inc. to provide EPA's Analytical Operations Center (AOC) with performance evaluation samples, reference materials, on-site laboratory auditing capabilities, data audits (including electronic media data audits), methods development, and other support services. The new QATS contract awarded in November 2000 required that the QATS Program become ISO 9000 certified. In a first for an EPA contractor, the QATS staff and management successfully transformed EPA's QA/R-2 type Quality Management Plan into a Quality Management System (QMS) that complies with the requirements of the internationally recognized ISO 9002 standard and achieved certification in the United States, Canada, and throughout Europe. The presentation describes how quality system elements of ISO 9002 were implemented on an already existing quality system. The psychological and organizational challenges of the culture change in QATS' day-to-day operations will be discussed for the benefit of other ISO 9000 aspirants.
Assuntos
Monitoramento Ambiental/normas , Resíduos Perigosos , Controle de Qualidade , Gestão da Qualidade Total/organização & administração , Humanos , Capacitação em Serviço , Laboratórios/normas , Técnicas de Planejamento , Padrões de Referência , Projetos de Pesquisa/normas , Estados Unidos , United States Environmental Protection AgencyRESUMO
The incidence of an aberrant internal carotid artery in the middle ear is approximately one per cent and most patients are asymptomatic. We present two patients with an aberrant internal carotid artery who presented with pulsatile tinnitus and an intra-tympanic mass. Here we discuss the clinical presentation, relevant radiographic investigations and further management of these patients.
Assuntos
Artéria Carótida Interna/anormalidades , Orelha Média/anormalidades , Perda Auditiva Condutiva/etiologia , Zumbido/etiologia , Adolescente , Artéria Carótida Interna/diagnóstico por imagem , Criança , Diagnóstico Diferencial , Orelha Média/diagnóstico por imagem , Feminino , Perda Auditiva Condutiva/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Zumbido/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
We present one patient who was admitted with a peritonsillar haematoma as a complication of acute tonsillitis and concomitant warfarin therapy for prosthetic aortic valves. While tonsillar haemorrhage as a result of acute tonsillitis has been well described, no cases of isolated haematoma formation have been documented, nor has it been recognized previously as a complication of long-term anticoagulant therapy. We discuss establishing the diagnosis, the likely aetiology and implications of this complication.