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922-111 - Communication Server 1000 to Rls. 6.0 Upgrades for Technicians - BrainDump Information

Vendor Name : Nortel
Exam Code : 922-111
Exam Name : Communication Server 1000 to Rls. 6.0 Upgrades for Technicians
Questions and Answers : 27 Q & A
Updated On : January 18, 2019
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922-111 exam Dumps Source : Communication Server 1000 to Rls. 6.0 Upgrades for Technicians

Test Code : 922-111
Test Name : Communication Server 1000 to Rls. 6.0 Upgrades for Technicians
Vendor Name : Nortel
Q&A : 27 Real Questions

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Nortel Nortel Communication Server 1000

Nortel Builds on its Unified Communications vision, solutions Portfolio | killexams.com Real Questions and Pass4sure dumps

Nortel

NYSE : NTTSX : NT

Nortel

March 05, 2007 09:02 ET

CEO Mike Zafirovski Outlines Nortel UC vision at VoiceCon 2007

ORLANDO, FLORIDA--(CCNMatthews - March 5, 2007) - At VoiceCon Spring 2007 this week, Nortel(1) (TSX:NT)(NYSE:NT) is outlining its imaginative and prescient for unified communications (UC) and unveiling new solutions designed to supply organizations with elementary and legit the way to bring voice, video and statistics over IP and allow superior unified communications.

Nortel President and CEO Mike Zafirovski could be a keynote speaker on Tuesday, and may discuss how unified communications solutions and converged functions are poised to radically change enterprise communications.

"Unified communications basically alterations the way organizations speak, simplifying the deluge of communications with a single, seamless interface," mentioned Zafirovski. "Nortel and our partners are working to create a UC event that makes workers more productive and responsive, with a wealthy communications journey within the workplace or on the go."

Nortel's unified communications vision specializes in proposing options that align to the business atmosphere the commercial enterprise uses today. These options allow clients to journey streamlined communications within their business software while leveraging their current IT investments - basically UC your way.

As part of its increasing unified communications portfolio, Nortel is introducing several new solutions that bring a richer set of UC equipment while guaranteeing the resiliency of the communications network.

Nortel's cornerstone IP Telephony answer, the communication Server (CS) a thousand will carry new capabilities and enhancements to extra support this main VoIP platform. a brand new unencumber of CS one thousand will provide enhanced reliability and redundancy, improved network and voice call security and new E911 capabilities, all aimed at guaranteeing agencies can rely on their community for critical communications needs. via deliberate interoperability with Microsoft office Communications Server 2007, this new unlock will deliver unified communications capabilities as a part of the imaginative Communications Alliance roadmap.

the new CS 1000 architecture will prolong its assist for open standards, with aid for an open operating device and birth on business off-the-shelf (COTS) hardware from IBM and other suppliers, to increase deployment flexibility and manageability of the network. huge simplification of the portfolio points and pricing bundles will make it less complicated for partners and resellers to quote and sell. This new unencumber is deliberate for availability in 2Q07.

moreover nowadays Nortel introduced the commonplace availability of a brand new release of the award-profitable Multimedia verbal exchange Server (MCS) 5100. This new free up improves productivity through featuring users with tight integration of telephony and multimedia purposes inside IBM Lotus Notes. It also aspects a few significant enhancements, including more desirable and simplified collaboration capabilities that permit a full range of voice, video, conferencing, email, IM and presence capabilities at the click on of a mouse, together with more desirable mobility capabilities that give a rich communications experience for cellular people. the new MCS 5100 unlock also introduces help for new SIP-primarily based IP telephones improving usability and suppleness and improves the usual protection, reliability, manageability and scalability of the core platform, which now operates on IBM servers with a Linux working gadget.

Nortel is also introducing Unified Messaging (UM) 2000, a feature-prosperous, provider-grade answer supporting up to 1000000 users that permits voicemail, fax and electronic mail to be accessed collectively via usual e-mail applications and integrates with Microsoft's lively listing®. UM 2000 is specifications-based mostly so that it could possibly function in a multivendor voice community, and is centered to world agencies in addition to carriers that offer their valued clientele unified messaging options.

To help firms deploy UC-optimized networks, Nortel is also unveiling converged facts networking enhancements to its North American advertising and marketing campaigns, which build on the a success IPT 1-2-three crusade launched remaining year. These campaign enhancements include accomplice tools, concentrated demand generation actions, pre-engineered facts packages, and not obligatory features that make it more straightforward and extra affordable for authorized channel partners to install a LAN that supports valued clientele' VoIP and UC needs.

These records applications and features may also be quoted beginning in April 2007 and encompass alternatives to allow the complete deployment of vigour over Ethernet, VoIP-Optimized at ease Routing for WAN entry, and WLAN for mobility and non-compulsory preservation, installation and technical assist services. Nortel's North American campaign additionally contains advertising and incentive classes available nowadays through authorized Nortel channel partners for firms who're customizing their community for unified communications.

About Nortel

Nortel is a recognized leader in delivering communications capabilities that make the promise of company Made essential a reality for our consumers. Our subsequent-technology technologies, for each provider provider and enterprise networks, guide multimedia and company-critical functions. Nortel's applied sciences are designed to help get rid of cutting-edge boundaries to efficiency, velocity and performance by using simplifying networks and connecting americans to the assistance they need, once they want it. Nortel does business in additional than one hundred fifty international locations around the world. For more counsel, discuss with Nortel on the internet at www.nortel.com. For the latest Nortel news, consult with www.nortel.com/information.

definite statements during this press liberate may also comprise phrases corresponding to "may", "expects", "might also", "anticipates", "believes", "intends", "estimates", "goals", "envisions", "seeks" and other equivalent language and are considered ahead-looking statements or information under relevant securities law. These statements are in response to Nortel's current expectations, estimates, forecasts and projections about the working atmosphere, economies and markets in which Nortel operates. These statements are subject to important assumptions, dangers and uncertainties, that are elaborate to predict and the precise outcomes can be materially different. additional, genuine results or hobbies might range materially from those reflected in ahead-looking statements as a result of the following(i) risks and uncertainties relating to Nortel's restatements and related concerns together with: Nortel's most fresh restatement and two old restatements of its economic statements and related activities; the negative have an effect on on Nortel and NNL of their most contemporary restatement and prolong in filing their financial statements and related periodic reports; felony judgments, fines, penalties or settlements, or any colossal regulatory fines or other penalties or sanctions, regarding the continuing regulatory and crook investigations of Nortel within the U.S. and Canada; any huge pending civil litigation movements no longer encompassed by using Nortel's proposed category action agreement; any giant cash charge and/or significant dilution of Nortel's latest equity positions as a consequence of the approval of its proposed category action agreement; any unsuccessful remediation of Nortel's material weaknesses in interior manage over financial reporting resulting in an inability to document Nortel's effects of operations and economic condition accurately and in a well timed method; the time required to implement Nortel's remedial measures; Nortel's lack of ability to access, in its current form, its shelf registration filed with the us Securities and exchange fee (SEC), and Nortel's beneath investment grade credit rating and any extra adversarial impact on its credit rating as a result of Nortel's restatements of its economic statements; any adversarial affect on Nortel's enterprise and market fee of its publicly traded securities bobbing up from carrying on with negative publicity involving Nortel's restatements; Nortel's talents lack of ability to attract or preserve the personnel fundamental to achieve its enterprise pursuits; any breach via Nortel of the continued listing necessities of the NYSE or TSX inflicting the NYSE and/or the TSX to begin suspension or delisting strategies;(ii) risks and uncertainties relating to Nortel's enterprise including: yearly and quarterly fluctuations of Nortel's operating results; decreased demand and pricing pressures for its items because of world financial situations, massive competition, competitive pricing apply, cautious capital spending by shoppers, accelerated industry consolidation, abruptly changing applied sciences, evolving industry standards, frequent new product introductions and brief product existence cycles, and different developments and industry qualities affecting the telecommunications industry; the sufficiency of currently announced restructuring moves, together with the expertise for better specific fees to be incurred in reference to these restructuring moves compared to the estimated prices of such moves and the capacity to obtain the targeted can charge rate reductions and savings of Nortel's unfunded pension liability deficit; any material and adversarial affects on Nortel's efficiency if its expectations involving market demand for specific products show to be wrong or because of definite limitations in its efforts to expand internationally; any reduction in Nortel's operating outcomes and any related volatility in the market price of its publicly traded securities arising from any decline in its gross margin, or fluctuations in overseas currency change rates; any negative traits associated with Nortel's supply contract and contract manufacturing agreements together with on account of using a sole organization for key optical networking options add-ons, and any defects or errors in Nortel's current or deliberate products; any poor affect to Nortel of its failure to obtain its business transformation aim; extra valuation allowances for all or a element of its deferred tax belongings; Nortel's failure to give protection to its intellectual property rights, or any hostile judgments or settlements coming up out of disputes concerning highbrow property; adjustments in rules of the web and/or other elements of the trade; Nortel's failure to efficaciously function or integrate its strategic acquisitions, or failure to consummate or succeed with its strategic alliances; any poor impact of Nortel's failure to adapt properly its fiscal and managerial manage and reporting techniques and techniques, manage and grow its enterprise, or create an excellent chance management method; and(iii) dangers and uncertainties concerning Nortel's liquidity, financing arrangements and capital together with: the impact of Nortel's most recent restatement and two previous restatements of its economic statements; any inability of Nortel to control cash flow fluctuations to fund working capital necessities or obtain its company aims in a well timed method or obtain extra sources of funding; excessive ranges of debt, barriers on Nortel capitalizing on business opportunities as a result of support facility covenants, or on obtaining further secured debt pursuant to the provisions of indentures governing certain of Nortel's public debt issues and the provisions of its guide facility; any increase of constrained cash requirements for Nortel whether it is unable to comfy choice support for duties arising from certain common path business actions, or any inability of Nortel's subsidiaries to give it with satisfactory funding; any terrible impact to Nortel of the should make bigger defined advantage plans contributions in the future or exposure to consumer credit score dangers or inability of purchasers to meet price obligations under customer financing arrangements; any poor impact on Nortel's means to make future acquisitions, lift capital, situation debt and retain employees bobbing up from inventory rate volatility and extra declines in the market price of Nortel's publicly traded securities, or the proportion consolidation leading to a decrease total market capitalization or adverse effect on the liquidity of Nortel's regular shares. For additional information with appreciate to certain of those and different elements, see Nortel's Annual file on Form10-k/A, Quarterly reviews on form 10-Q and other securities filings with the SEC. until otherwise required by means of relevant securities legal guidelines, Nortel disclaims any intention or responsibility to replace or revise any forward-looking statements, even if because of new guidance, future activities or otherwise.

(1)Nortel, the Nortel logo and the Globemark are trademarks of Nortel Networks.


Nortel Fleshes Out Unified Communications imaginative and prescient | killexams.com Real Questions and Pass4sure dumps

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Title: C-degree/President manager VP personnel (associate/Analyst/and many others.) Director

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Microsoft and Nortel present Alliance Roadmap | killexams.com Real Questions and Pass4sure dumps

information

Microsoft and Nortel existing Alliance Roadmap Six months after saying a telecommunications alliance, Microsoft and Nortel this week presented some early effects of their efforts and outlined a roadmap for future tasks.

the two corporations first introduced their collaboration final summer season.

The highway map includes three new joint options “to dramatically increase business communications by using breaking down the barriers between voice, email, fast messaging, multimedia conferencing and different forms of communique,” according to an announcement through both corporations.

additionally protected in the announcement are eleven new implementation capabilities from Nortel and the outlet of more than 20 joint demonstration facilities where customers can experience the expertise, the statement endured.

furthermore, both groups noted they've signed agreements with dozens of consumers, and have developed a “pipeline of a whole bunch of prospects who wish to recognise the benefits of unified communications.”

From Microsoft's standpoint, it's all part of the business's long-time period play to merge all kinds of communications and messaging right into a single framework. A year in the past, the company announced that it become merging its alternate Server neighborhood with its precise-Time Collaboration (RTC) group, and that it had begun to consider of both technologies comprising a "platform."

the new group become named the Unified Communications group (UCG) and resides in Microsoft's enterprise Division. The theory for the new group emanated from a imaginative and prescient of adding continuity to a myriad of communications gadgets, applied sciences and modes -- from e-mail and quick messaging to Voice over internet Protocol (VoIP), audio/video and net conferencing -- in a unified method.

The three new joint options announced by the alliance this week are named Unified Communications integrated branch, Unified Messaging, and Conferencing.

When it is accessible within the fourth quarter, UC integrated branch will comprise Nortel and Microsoft technology on a single piece of hardware that supplies VoIP and unified communications in far off places of work.

Coming just a little prior within the second quarter, Unified Messaging will aim to simplify client deployments, native session initiation protocol (SIP) interoperability between the Nortel verbal exchange Server 1000 and Microsoft trade Server 2007. The solution comprises Nortel professional features for design, deployment and assist.

additionally coming within the fourth quarter, Conferencing will lengthen Nortel Multimedia Conferencing to Microsoft workplace Communicator 2007. It goals to give a single client event constant throughout purposes reminiscent of voice, fast messaging, presence, and audio- and videoconferencing.

This yr, the businesses additionally plan to prolong their existing unified communications answer — a unified computer and gentle phone for VoIP, e mail, instant messaging and presence — to the Nortel verbal exchange Server 2100, a carrier-grade business telephony product aiding as much as 200,000 clients on a single system, in response to enterprise statements.

As for the highway map, the two organizations have geared up more than 20 joint demonstration centers in North the usa, Europe and Asia, with greater than 100 extra facilities scheduled to open by midyear.

Nortel has also brought eleven core integration features to help shoppers build, set up and aid joint unified communications solutions, including end-to-conclusion challenge administration. Nortel claims it has already trained greater than 2,200 VoIP experts to bring these capabilities and will add greater as deployment ramps up.

in regards to the creator

Stuart J. Johnston has coated technology, specifically Microsoft, considering that February 1988 for InfoWorld, Computerworld, tips Week, and computer World, in addition to for business Developer, XML & web capabilities, and .web magazines.




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Vendor Name : Nortel
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Communication Server 1000 to Rls. 6.0 Upgrades for Technicians

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VoIP certification tracks - Nortel's support certifications | killexams.com real questions and Pass4sure dumps

As mentioned in a previous tip, companies are implementing IP telephony more frequently on their data infrastructures. The increased deployment has created a need for certified IP telephony engineers to provide proven, best-of-breed technology.

The IP telephony certifications Nortel currently offers are divided into four categories: Support Specialist, Design Specialist, Support Expert, and Design Expert. This tip discusses the Nortel Support track.

Support Specialist

The Support Specialist certifications are intended to demonstrate an individual's ability to implement, operate, and troubleshoot a Nortel Networks IP Telephony solution. The Support Specialist certification reflects a candidate with three to six months of experience that can handle routine technical issues of a standard Nortel IP Telephony Solution.

NNCSS - VoIP Succession BCM 3.0

This certification tests the capability to implement, operate, and troubleshoot the Business Communications Manager 3.0. This certification covers hardware, start-up, data and voice networking, applications, and troubleshooting the BCM. To pass the certification, two exams must be successfully completed: Technology Standards and Protocols for IP Telephony Solutions, and Succession BCM 3.0. The Technology Standards and Protocols for IP Telephony Solutions Exam is an overview of convergence technologies.

NNCSS - CallPilot Rls. 2.0

This certification tests the ability to implement, operate, and troubleshoot the VoIP CallPilot 2.0. This certification covers hardware, administration, interoperability with Meridian 1 switches, and security of a single site CallPilot system. To pass the certification, two exams must be successfully completed: Meridian Database and CallPilot 2.0.

NNCSS - Symposium Call Center Server or Symposium Call Center Server Installation and Maintenance

These two certifications test the ability to implement, operate, and troubleshoot the Symposium Call Center Server. Both certifications cover hardware, software installation, administration, and maintenance of Symposium Call Center Server 4.2, Symposium Web Client 4.0, and Symposium Express 3.0. However, the Symposium Call Center Server certification also tests the architecture, custom configuration and integration of the server. To pass either of these certifications, one exam must be successfully completed: Symposium Call Center or Symposium Call Center Installation and Maintenance, respectively.

NNCSS - Symposium Call Center TAPI/Agent or Call Center TAPI/Agent Installation and Maintenance

These two certifications test the ability to implement, operate, and troubleshoot the Symposium Call Center TAPI/Agent. Both certifications cover hardware, software installation, administration, and maintenance of Symposium TAPI 2.3 and Symposium Agent 2.3. However, the Symposium Call Center TAPI/Agent certification also tests the architecture, integration, and custom configuration of the TAPI/Agent. To pass either of these certifications, one exam must be successfully completed: Symposium Call Center TAPI/Agent or Symposium Call Center TAPI/Agent Inst/Main, respectively.

NNCSS - Symposium Express Call Center or Symposium Express Call Center Installation and Maintenance

These certifications test the ability to implement, operate, and troubleshoot the Symposium Express Call Center. Both certifications cover hardware, software installation, administration, and maintenance of Symposium Express Call Center 4.2. However, the Symposium Express Call Center certification also tests the architecture and integration of the call center. To pass either of the certifications, one exam must be successfully completed: Symposium Express Call Center or Symposium Express Call Center Inst and Maint respectively.

NNCSS - VoIP Multimedia Communication Server (MCS) 5100 2.0

This certification tests the ability to implement, operate, and troubleshoot the VoIP Multimedia Communication Server (MCS) 5100 2.0. This certification covers installation of the hardware and software, configuration, maintenance, and management of the Multimedia Communication Server (MCS) 5100 2.0. To pass the certification, two exams must be successfully completed: Technology Standards and Protocols for IP Telephony Solutions, and VoIP Multimedia Communication Server (MCS) 5100 2.0. The Technology Standards and Protocols for IP Telephony Solutions Exam is an overview of convergence technologies.

NNCSS - VoIP Succession 1000/1000M Rls. 3.0 DB Administrator

This certification tests the ability to maintain and troubleshoot the VoIP Succession 1000/1000M Rls. 3.0 DB Administrator. This certification covers the architecture, configuration, maintenance, and management of the Meridian 1, Succession 1000 Rls. 3.0, and Succession 1000M Rls. 3.0 using Basic Alternate Route Selection (BARS) and Network Alternate Route Selection (NARS). To pass the certification, two exams must be successfully completed: Technology Standards and Protocols for IP Telephony Solutions, and Succession 1000/1000M Rls. 3.0 DB Administrator.

NNCSS - VoIP Succession 1000/1000M Rls. 3.0 Installation and Maintenance

This certification tests the ability to install, configure, and maintain the VoIP Succession 1000/1000M Rls. 3.0. This certification covers the installation, architecture, configuration, maintenance, and management of the Meridian 1, Succession 1000 Rls. 3.0, and Succession 1000M Rls. 3.0, Internet Telephones i2xxx, and Optivity Telephony Manager (OTM) 2.1. To pass the certification, three exams must be successfully completed: Technology Standards and Protocols for IP Telephony Solutions, and Succession 1000/1000M Rls. 3.0 for Technicians, and Succession 1000/1000M Rls. 3.0.

Support Expert

The Support Expert certifications build on the specialist's abilities by demonstrating their skill to implement, operate, and troubleshoot an advanced Nortel Networks IP Telephony solution. The Support Expert certifications reflect a candidate with six to twelve months of hands-on experience with the ability to lead or assist intermediate-level personnel to maintain complex Nortel IP Telephony solutions.

NNCSE - CallPilot 2.0 Unified Messaging Solutions

This certification tests the ability to implement, operate, troubleshoot and optimize the VoIP CallPilot Unified Messaging Solution 2.0. This certification covers the installation, administration, interoperability, security, upgrade procedures and feature usage for a multi site CallPilot system. To pass the certification, the candidate must first obtain their NNCSS - CallPilot Rls. 2.0. Subsequently, the CallPilot 2.0 Unified Messaging Solutions must be successfully completed to obtain this certification.

NNCSE - Contact Center

This certification tests the ability to implement, operate, troubleshoot and optimize the Contact Center Products. This certification covers the candidate's capabilities on the Symposium Call Center Server (SCCS)/Symposium Express Call Center/Symposium Web Client, Symposium TAPI Service Provider (TAPI SP), Symposium Agent, and the Symposium Web Center Portal. To pass the certification, the candidate must first obtain their NNCSS - Symposium Call Center Server and the NNCSS - Symposium Call Center TAPI/Agent certification. Subsequently, the Contact Center Exam must be successfully completed to obtain this certification.

NNCSE - IP Convergence Succession 1000/1000M Rls. 3.0

This certification tests the ability to install, configure, maintain, and optimize the VoIP Succession 1000/1000M Rls. 3.0. This certification covers the configuration, succession branch office (BO), remote office, operation, and Meridian 1 to Succession 1000M 3.0 migration procedures for the Succession 1000/1000M Rls. 3.0, Internet Telephones i2xxx, Remote Office 91xx, and Optivity Telephony Manager (OTM) 2.1. To pass the certification, the candidate must first obtain their NNCSS - VoIP Succession CSE 1000 Rls. 2.0 or the VoIP Succession 1000/1000M Rls. 3.0 Installation & Maintenance certification. Subsequently, another more difficult version of the Succession 1000/1000M Rls. 3.0 Exam must be successfully completed to obtain this certification.

In the IT industry, certifications are a means to validate an individual's expertise within a specified area. The above Nortel IP Telephony certifications are some of the tools that can demonstrate the capabilities of an IP Telephony support professional. These certifications could not replace years of industry experience, but they do provide the foundation to support and manage Nortel Voice over IP solutions.

The next tip will discuss Nortel's Design IP Telephony certification track.

Richard Parsons (CCIE#5719) is a Manager of Professional Services for Callisma Inc., a wholly owned subsidiary of SBC. He has built a solid foundation in networking concepts, advanced troubleshooting, and monitoring in areas such as optical, ATM, VoIP, routed, routing, and storage infrastructures. Rich resides in Atlanta GA, and is a graduate of Clemson University. His background includes senior and principal consulting positions at International Network Services, Lucent, and Callisma.


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The site, at www.avl.lib.al.us , was created by a partnership of the state's Supercomputer Authority and Computer Sciences Corp. The site retrieves information from McGraw-Hill Companies of New York, Encyclopedia Britannica, Online Computer Library Center Inc. of Dublin, Ohio, EBSCO Industries Inc. of Birmingham, Ala., and several other databases.

The site runs customized software and resides on a dual-processor 550-MHz Pentium III Dell PowerEdge server with 512 of RAM.

ALASKABUYER BEWARE. Launched this fall, the Law Department's Consumer Protection Web site offers citizens a place to handle complaints about products or businesses or check out businesses that have been reported for fraud or unfair practices. Visitors can download froms in Adobe Portable Document Format, print them out and mail them in.

The site also gives advice on such issues as credit cards and mail fraud.

Law Department officials will load consumer complaint information into a searchable database. The department then can discern patterns of unfairness, fraud or deception.

ARIZONA

CAMPAIGN FINANCE. Charity begins at home'or a home page. The Secretary of State's Office recently put the state's campaign finance data online. Secretary of State's Office chief information officer Mike Totherow wrote the program in Delphi from Inprise Corp. The data is stored in a Microsoft SQL Server Version 7.0 database. Visitors to the site, at www.sosaz.com/cfs/CampaignFinanceSearch .htm, can search the site by contributor, committee or date. Home addresses and phone numbers are excluded from the data for privacy reasons, said Jessica Funkhouser, director of the Office of Elections.

ARKANSAS

BRAINIACS ONLINE. Attention, all brainiacs. The Board of Education adopted Science Brainium, an online science program, for use in the state's public elementary and middle schools. Students log on at the site, at us.brainium.com , and enter a user ID and password. The program offers lessons and games on bugs, the solar system and other topics required by Arkansas curriculum standards.

Science Brainium is the brainchild of Brainium of Salt Lake City. The online program, which works with most browsers, requires the Shockwave plug-in from Macromedia Inc. of San Francisco and at least a 486 PC with 16M of RAM or a Macintosh 68040.

CALIFORNIA

DO YOU EVERDREAM? East of San Francisco lies Lafayette, a city of 23,500, which recently outsourced most of its desktop PC services to Everdream Corp. The Fremont, Calif., company will provide city employees with a 24-hour help desk, Microsoft Office 2000, Windows NT file, print and firewall servers, a virtual private network and a digital subscriber line connection.

The contract, which is valued at about $85,000 annually, includes 32 Hewlett- Packard PCs with 733-MHz Pentium III processors and 128M of RAM. The city will continue to run its own Web site and services, said Tracy Robinson, the city's administrative services director.

COLORADO

SECRET IN SUMMIT. Blind and visually impaired voters in Summit County cast their votes using a secret ballot for the first time last month, thanks to the eSlate 3000, a tablet-sized portable PC developed by Hart InterCivic of Austin, Texas.

With eSlate, a voice synthesizer reads instructions and the choice of candidates to the voter. The device has large buttons that users click to record their votes.

In past elections, blind voters had to tell another person their choice of candidate.

CONNECTICUT

SMART ROADS. The Transportation Department received a $2.38 million federal Intelligent Transportation Systems grant to improve highway and road traffic conditions by using computer systems.

Connecticut has not yet decided how to use the funds.

DELAWARE

GOT JOBS? Applicants can now apply for state jobs on the Internet via the State Personnel Office's Web site, at www.state.de.us/spo . The online application is available for citizens to apply for nearly all positions statewide.

The state used Microsoft Visual Interdev 6.0 to build the site. The site accesses a Microsoft SQL 7.0 database and runs on a dual-processor 800-MHz Pentium III Xeon Dell PowerEdge 4400 server with 2G of RAM under Windows NT.

DISTRICT OF COLUMBIA

NOTES FROM UNDERGROUND. The Washington Metropolitan Area Transit Authority, which operates the Metro subway system, last month resumed using computers to operate its trains after 21 months of manual operation. Metro switched from automatic to manual operations in March 1999 after three relays failed, probably because of con- tamination that accumulated over time. Relays control critical functions of the rail cars, including brakes and doors.


Computer-Based Anesthesiology Paging System | killexams.com real questions and Pass4sure dumps

The efficient management of operating suites requires careful resource management. Most expenses of a health care organization are personnel related (1), and successful management of medical personnel determines whether an operational unit is a revenue center or a cost center (2,3). Patient outcomes, particularly in anesthesiology, depend on the availability of expensive personnel, especially physicians (4,5). In a crisis, rapid mobilization of trained personnel is critical to successful resolution (6).

Mayo Clinic has a long history of efficient management of personnel, by which the knowledge and expertise of its physicians are leveraged through extensive use of allied health personnel. One strategy, implemented >100 yr ago, is the use of visual communication systems to direct physicians and allied health personnel to where they are needed. This began with the introduction of colored wooden door tabs. Each color denoted the state of a room. For example, a green tab indicated that the patient was in the room and ready to be seen by a nurse. A blue tab indicated that the patient was ready to be seen by a physician. A red tab indicated that help was needed for an emergency.

This communication strategy spread from the outpatient practice to the hospitals, including the operating suites. Subsequently, door tabs were replaced by colored electric lights. A chime was sounded when the state of a room changed. This communication strategy was thought to improve the efficiency and quality of care in the operative environment. In 1981, a new operating suite was opened at Saint Marys Hospital, 1 of 2 hospitals associated with Mayo Clinic. This prompted updating the communication technology at both hospitals. Electric lights were replaced with video displays suspended from the ceilings or mounted on the walls in the operating rooms (OR), procedure rooms, and support areas.

This Video Paging System (VPS) used alphanumeric codes to communicate the state of each patient care location (7). Pages were initiated by use of electromechanical switches in each OR, procedure room, and preoperative and postoperative location. When a switch was closed (by pushing a button), an alphanumeric code, designating both the location and the individual needed, would be displayed throughout the operative or procedural suite, and in every procedure room, hallway, recovery and waiting area, lounge, office, and cafeteria. In addition, an emergency code was incorporated to rapidly direct staff to a particular location when a cardiac arrest, airway emergency, or other critical event occurred.

Over time, several problems emerged with the VPS. The black-and-white monitors that displayed the pages burned in after about 18 mo, making the displays unreadable. Replacement monitors were costly and difficult to find. The software was difficult to maintain, and software constraints became unacceptable as the practice grew and evolved. When seven additional ORs were built at Saint Marys Hospital, and OR numbering changed from two digits to three digits, the VPS could not accommodate the change. These problems triggered the decision to replace the VPS with a new communication system.

Design Criteria

Several types of devices were examined as possible solutions. Cell phones, digital pagers, and personal digital assistants were considered to possibly be less expensive and more flexible solutions than the existing hardwired approach. However, these options were rejected as being too dependent on personnel. If the paged individual did not respond, there would be no way to know whether the correct beeper was called, whether the person was unavailable, or to whom the page should be redirected. To respond to a page, one must interact with these devices, which can be impractical during procedures. It was concluded that a hands-free system would be designed and implemented.

With little review or documentation, the VPS had evolved on an ad hoc basis with additional functions and a broader geographic distribution. Missing comprehensive system documentation made determining where the current system was used and what information was transmitted challenging. A careful analysis of new requirements was completed, redundant and unnecessary functions were eliminated, and the geographic distribution of the new system was planned.

Prototyping technologic solutions occurred simultaneously. A distributed video architecture was rejected because of its inherent instability. Because the cathode-ray tube displays had only an 18- to 24-mo useful life, liquid crystal and light-emitting diode (LED) displays were considered. LED displays were chosen because they have a useful life of at least 15 yr and a greater luminosity that prevents washout from fluorescent and natural lighting. These displays are relatively expensive, but the cost can be amortized over a longer useful life. Choosing the size of the characters on the displays was a trade-off between the distance at which the displays could be read and the required information content. The size and information layout of the LED displays were determined by their expected placement, for example how low the displays could hang from hallway ceilings. The decision was made to develop in-house a configurable, centrally programmable keypad that would replace the electromechanical switches.

Several distribution architectures were considered. Use of the institutional Ethernet network was an attractive, inexpensive option, but pages could be delayed when network bandwidth demand was greatest. Because pages are time-sensitive, this risk was deemed unacceptable. Therefore, an independent Ethernet network was chosen to drive the system. The computer-based anesthesiology paging system (CAPS) was designed to be upgradeable and easily configured. Software running on standard hardware is more easily adaptable and requires fewer maintenance personnel. Use of commercially available components also reduces costs for development and maintenance (Fig. 1).

System Specifications

The CAPS runs on dual-processor, redundant Compaq servers (Compaq Computer, Houston, TX) using SQL Server 7.0 under the Windows NT 4.0 operating system (Microsoft, Redmond, WA). Because the system is used as an emergency indicator, continuous availability is required. A redundant Central Processing Unit architecture satisfies this up time requirement. Software was written in Microsoft’s Visual Basic 6.0 and Visual C++ 6.0. The distribution architecture is a star pattern of Ethernet and RS-422 devices connected by standard Category-5 cable. Terminal servers connect the RS-422 protocol LED displays and the programmable keypads to the Ethernet network. The server can send daily electronic mail with system statistics and maintenance needs. The CAPS can send a page to a beeper for urgent maintenance problems (Fig. 1). The server software connects to the terminal server ports (one device per port) via device controllers. A simple network management protocol manager restarts failed connections without manual intervention.

The software design optimizes the handling of new pages to assure the shortest possible time between placing a page and seeing it on the LED displays. If there are no active emergency pages, all new pages are processed and displayed within 1.5 s. The user initiates a page by either pressing a dedicated microswitch (hot key) or entering a numeric code on the keypad (Fig. 2). The page is sent to the keypad controller via the terminal server. The keypad controller associates the page with a specific keypad, the keypad’s workgroup (e.g., neurologic anesthesia or vascular radiology), and other necessary information. The page is then presented via a Microsoft ActiveX Data Object call to the SQL Server database engine. The database determines what text is to be displayed on the LED displays and then forwards the text to the queue manager. The database then returns control to the keypad controller, which illuminates an LED above the activated hot key. If a page for a physician or nurse is initiated from an OR, a light above that room’s door illuminates as a wayfinding aid.

The queue manager determines the workgroups for a new page and inserts the new page either into those groups’ new-page queues or emergency queues. Although there are seldom >15 active calls, each queue may hold up to 100 calls. At 1.5-s intervals, the display controllers query the queue manager for the next page. The display controller then forwards that page to each display. If the page is displayed for the first time, a chime sounds. The current time, synchronized with the atomic clock in Boulder, CO, is displayed in the upper right corner, except when emergency pages are displayed. The display controllers then perform housekeeping chores (e.g., querying displays for functional status), during the remainder of the 1.5-s interval before querying the queue manager for the next page. After a page has been displayed once, it is placed in the active-page queue. The queue manager then cycles through this queue while any pages are active. Emergency pages are not placed in the active-page queue. When an emergency page is initiated, it is the only page shown on the LED displays, the light above the room door blinks, and the chime is sounded repeatedly until the page is answered. In the unlikely event that two or more emergency pages are active simultaneously, only the emergency pages are cycled until answered.

The central servers, terminal servers, operating system, and database are all commercial products. The LED displays were initially custom-made products, but the manufacturer has subsequently added them to their standard product line. These displays are located throughout the hospitals where anesthesia services are provided or anesthesia personnel congregate.

The programmable keypads were designed in-house and were assembled and tested under contract. The keypads can accept new embedded code downloaded from the server. This allows for remote reprogramming of the keypads without maintenance personnel physically interacting with each keypad (i.e., removing >450 keypads from the wall and reprogramming them with a laptop computer). Therefore, upgrading the keypads is rapid and cost-effective.

An administrative program and several specialized tools for maintenance personnel were developed. The administrative program’s graphical user interface masks the relational database’s complexity and presents a more simplified view of the system. Pages, devices, reports, and other aspects of the system can be managed without use of the development engineering group. This feature allows maintenance personnel to be trained technicians, thereby decreasing the total cost of ownership and freeing the development engineering staff for other projects.

User Functionality

The CAPS presents two kinds of pages: 1) class page, which is a page for a class of individuals to come to a patient location, and 2) person page, which is a page for a specific individual to come to a multiple-patient location. Class pages have three parts. The prefix characters are alphabetic, denoting the work area (e.g., “N” for the north anesthesia area or “CL” for the catheterization laboratory). The middle characters denote the room number within that work group (e.g., “N 808” for room 808 in the north anesthesia area or “CL 109” for room 109 in the catheterization laboratory). The suffix character denotes the class of person needed in the room. Therefore, complete pages would be “N 808 A,” meaning that an anesthesiologist is needed in room 808 in the north anesthesia area, or “CL 109 N,” meaning that a nurse anesthetist is needed in room 109 of the catheterization laboratory. Person pages have two parts. The prefix denotes a multiple-patient location (e.g., “P” for postanesthesia care unit or “o” for outpatient recovery). The other characters are numeric, denoting the individual needed. Therefore, a complete person page would be “P49,” meaning that person “49” is needed in the postanesthesia care unit.

Using CAPS is reasonably straightforward. For example, if a resident physician in cardiac catheterization room 104 needs to confer with the attending anesthesiologist, the resident pushes the “Physician” button on the keypad mounted on the anesthesia machine (Fig. 3). An LED above the button illuminates, confirming that the page has been received. Every monitor throughout the cardiac catheterization suite, including the room initiating the page, displays “CL 104 A” in green and chimes briefly (Fig. 4). The page remains on the LED display for 1.5 s as the system cycles from page to page. A page cycles every 1.5 s until it is deactivated by a person; there is no timeout feature for pages. When the attending anesthesiologist enters the room and pushes the “Physician” button, the page is no longer displayed anywhere and the LED above the button turns off. If the resident considers the page to be urgent, the resident pushes the “Urgent” button (Fig. 3) and then the “Physician” button; “CL 104 A” would appear in orange and cycles with any other pages. If there is an emergency in the procedure room, the two side-by-side emergency buttons are pushed simultaneously (Fig. 3). This action persistently displays “CL 104 A” in bright red on every display in the catheterization laboratory, and a chime rings until the emergency buttons in the room are pushed simultaneously. In the unusual event of >1 simultaneous emergency page, the display will cycle from emergency page to emergency page every 1.5 s, sounding the chime persistently, until all emergency pages are deactivated.

Figure 3

Figure 3

Figure 4

Figure 4

This same basic feature is available throughout the environment of the CAPS. A hot key is pushed on the keypad and the defined page is displayed throughout the respective operating or procedural suite. Other examples of possible pages are shown in Table 1. The hot keys can vary from keypad to keypad. For example, in the operating suite, anesthesiologists and certified registered nurse-anesthetists are the only licensed providers with hot keys, whereas in the cardiac catheterization laboratory, a hot key pages registered nurses who provide sedation care. The system has the ability to add many additional pages through use of the numeric keys (Fig. 3). For example, by pressing “246” followed by the “Enter” key, a unique page can be displayed, such as “CL 104 MP” for medical photographer. The keypad screen (Fig. 3) displays the keyed page, confirming to the user that the page has been received. If >1 page is entered via the keypad, instead of the hot keys, the pages are cycled every 1.5 s on the keypad’s screen.

The LED displays are more useful than the VPS cathode-ray tube monitors, which displayed a maximum of only four black-and-white characters. Like the CAPS, the VPS prefix character designated the workgroup, two digits identified the room number, and the suffix character indicated the personnel being paged. The CAPS displays allow a prefix, a room identifier, and a suffix, for a maximum of 10 characters that can be illuminated in 1 of 3 colors. Rooms can be specified by numbers, short words, or abbreviations. Without the limitations of the VPS, formerly cryptic pages are now displayed in unambiguous text. Whereas “P888” in the VPS meant that the postanesthesia care unit was full, this page is now displayed unambiguously on the CAPS as “PACU FULL.”

When anesthesia and OR personnel hear the “new call” chime, they can glance at the display and read the new call. If they miss seeing the new page, the system offers shortcuts so one does not need to watch all the pages cycle through the display. Personnel indicators in the lower left corner of the display (Fig. 5) identify the class of individual required (e.g., anesthesiologist, nurse, or technician). Zone indicators in the upper left corner of the display identify the work areas that have active calls (e.g., “N” for north anesthesia and “B” for cardiovascular anesthesia). If an anesthesiologist responsible for the B zone hears a new page chime but misses seeing the new page, the anesthesiologist can glance at the display (Fig. 5) and observe that the new call was for someone else (e.g., if only “D” is seen in the upper left of the display, only D zone personnel have active pages). If “B” is in the upper left and if “A” is not in the lower left, then the anesthesiologist no longer needs to look at the display because the new page was for someone else. Pages are sorted numerically within the zone, so people need to watch the display only until the codes for their rooms are either displayed or passed over. The personnel and zone shortcut indicators are cumulative for all active pages and are displayed for all except emergency pages.

Postimplementation Review

At Mayo Clinic, each of the two hospitals has a CAPS. During the first 6 mo of operation, there were 8 h of unexpected downtime. There were four additional hours of planned downtime for installing lower priority functions, downloading keypad corrections, installing operating system patches, and correcting miscellaneous problems. After this initial shake-down period, the CAPS was down a total of 14 min in 3 mo (i.e., 0.144 min/day). In contrast, the VPS was down an average of 28.3, 29.7, 21.9, and 16.8 min/day in 1996, 1997, 1998, and 1999, respectively. Starting in 2000, the reliability of the VPS began to deteriorate compared with its historic norms. The deterioration became another issue that helped initiate the CAPS project. Despite the difficulty of comparing old and new technologic systems, the data show that the CAPS is more reliable than was the VPS.

Clinical Evaluation

During the installation of the CAPS, there was a brief period during which neither the VPS nor the CAPS was available in all areas. The VPS was removed in segments as the CAPS was installed, and beepers were used temporarily as a bridging communications medium. Anesthesiologists and nurse anesthetists have used beepers for many years for person-to-person communications, such as consultations and outside telephone calls, and as a means to reach individuals when they are outside of the video paging environment (e.g., intensive care units and hospital wards). Because departmental personnel were experienced and comfortable with beepers and telephones are mounted on every anesthesia machine, it was decided to use these devices during the transition from the VPS to the CAPS. This allowed comparison of the efficiency of using beepers with the efficiency of using the CAPS.

Observations of paging with beepers occurred during a 4-day period, 2 days at each hospital. Each day, different ORs were studied on the basis of the implementation schedule of the CAPS. Data were gathered from within a randomly selected OR by recording the time a page was initiated to a beeper (beginning as the number was being dialed) and the time the responder entered the room. Because of the limitation of being able to observe only 1 OR at a time and the rapid installation of the CAPS, relatively few pages with beepers were observed (n = 12), all of which were routine, nonurgent calls. When the study was designed, it was expected that there would be 6 days of installation per hospital and, therefore, 12 days of observation for gathering beeper response times. Unfortunately for the study, but fortuitous for the practice, installation took only 2 days per hospital, which reduced the expected number of observations. The original CAPS installation schedule allowed more time for system verification in each work area than was actually needed and so the time allotted for beeper observations was significantly reduced.

Similarly, observations for the CAPS occurred over a 4-day period, 2 days at each hospital. Data were gathered by recording the time a page appeared on the LED display, which was within 1.5 s of the time the button was pressed from within the OR, and the time the responder entered the room. Because the CAPS displays its pages on LED displays located throughout the surgical suite, several ORs could be observed simultaneously by watching the displays, and more data were collected (n = 57). No urgent or emergency pages were observed.

The median response time for anesthesiologists paged with a beeper was 2.78 min (range, 1.00–7.23 min). Problem pages did occur, including incorrect beeper numbers that were given to next-shift personnel, multiple pages that were made because the caller was not certain that the correct number had been dialed, and missed or ignored pages that required repaging. The median response times for anesthesiologists paged with the CAPS was 1.57 min (range, 0.30–7.20 min). Because of the CAPS design, none of the problem pages observed with the beepers were observed with the CAPS. These results are summarized in Table 2 and Figure 6. A logarithmic transformation was applied to the data to satisfy the distributional assumptions required for the two-sample Student’s t-test. The t-test of the transformed data showed a statistically significant difference between the response times with beepers and the response times with the CAPS (P = 0.021, t 67 = 2.36). The CAPS had a shorter response time for anesthesiologists than the beeper method.

Table 2

Table 2

Figure 6

Figure 6

Discussion

Mayo Clinic anesthesiologists generally are responsible for more concurrent procedures than is common in an academic practice. For example, one anesthesiologist concurrently cares for two pediatric open-heart patients at Mayo Clinic, whereas the norm is one procedure per anesthesiologist at Duke and Stanford Universities (personal communication). Although there is no hard evidence that the CAPS directly allows for higher concurrency, the anesthesiology department and the institution have concluded that the CAPS is an important tool that allows for these ratios with safe delivery of anesthesia care. The reasoning is that when an anesthesiologist is busy caring for a patient in one location (e.g., placing a pulmonary artery catheter or inducing anesthesia) and is paged to another location, the page remains visible until it is answered. This prompts colleagues to answer the page, thereby ensuring that clinical problems are rapidly addressed. The system is used to indicate cardiac arrests and other emergencies, initiating an immediate response from many available personnel. The system is also used to page personnel in other services, such as the clinical laboratory, autotransfusion, surgical pathology, and housekeeping. By allowing communication with many groups, the CAPS can be used to manage procedural areas more efficiently.

The design of the system is consistent with the communication philosophy that has developed at Mayo Clinic in both inpatient and outpatient environments. Patient care sites are equipped with a communication tool that identifies the state of the room. For the anesthesiology practice, the state of the room reflects the personnel needs in the room. If an anesthesiologist is needed, a visual page is displayed throughout the work environment informing both the anesthesiologist and the practice as a whole that assistance is requested in the procedure room. The postimplementation review demonstrates that the CAPS is more reliable than the system it replaced, with an average downtime of less than one minute per day.

When comparing the CAPS with a system of beepers, which are the standard communication devices in many medical centers, the time to answer a page was statistically significantly less when the page was initiated using the CAPS than using a beeper and the opportunity for communication errors are eliminated. This study has a number of limitations. The sample size of beeper paging is small (n = 12). However, we have no reason to believe that these data are not representative of our beeper paging system. Also, although a statistically significant difference in response time was detected between the beeper system and the CAPS, the clinical relevance of this difference is unclear. The clinical relevance of 1.21 minutes response time depends on the clinical situation that prompted the page. If a page is initiated to discuss fluid management, it is unlikely that the observed shorter response time would make any difference. However, if the page is to secure assistance for an airway-related problem, then 1.21 minutes could make a significant difference.

Another limitation of the study is that patient outcome data were not recorded as part of our data collection. All the pages observed were for routine matters (e.g., anesthesia induction, emergence, or routine questions). No emergencies or urgent pages were recorded in either group. A review of the CAPS database shows that there were 7 emergency pages during April 2002 when the paging system covered 97 ORs, 5 recovery rooms, and >46 nonoperative anesthetizing locations. The emergency pages were answered in an average of 35 ± 23 seconds. However, there are no data to compare this with emergency response to beeper pages. A much larger study would have to be undertaken to demonstrate an effect on patient outcomes. Although such a study was considered, the anesthesiology practice concluded that it was unwilling to investigate the clinical effect of paging without the CAPS because of concerns for patient safety and practice efficiency.

The CAPS has a subtle effect on the environment of the operating suite because there is not a constant din of overhead audio pages. Instead, a brief chime announces a new page to the entire staff. Anesthesiologists in the ORs are not straining to hear garbled pages. Anesthesiology residents and certified registered nurse anesthetists are not waiting in frustration, wondering whether their pages have been heard. Pages are persistently visible on ubiquitous displays until answered.

Mayo Clinic is a large group practice (>1000 attending physicians), and it can be difficult to ensure accountability of all members in a large organization (8). One drawback of using beepers is that staff may ignore or forget pages. With the CAPS, everyone in the procedural suites can see pages and be aware of pages that are not answered. The primary value of Mayo Clinic is “the needs of the patient come first.” Adherence to this principle encourages staff to respond to unanswered pages. However, even with assistance from colleagues, a continual pattern of ignoring pages becomes apparent. The CAPS promotes assistance from colleagues when a staff member is occupied with another patient and inhibits a pattern of unanswered pages in a manner not recognized by the anonymity of beepers. As a result, staff members are reluctant to have their pages displayed longer than necessary, even though there is no visible duration associated with any given page. The practice-wide result is that staff attend to the needs of patients in a timely manner without authoritarian management measures.

The CAPS was designed to be a hands-free, reliable, and low-maintenance communication system. The system is more reliable than the VPS it replaced. The development and installation of the CAPS is associated with anesthesiologists responding more rapidly to paging with the CAPS than to paging with beepers. This may be associated with improved patient outcomes and greater OR efficiency.

References 1. Marrin CA, Johnson LC, Beggs VL, Batalden PB. Clinical process cost analysis. Ann Thorac Surg 1997; 64: 690–4. 2. Macario A, Vitez TS, Dunn B, McDonald T. Where are the costs in perioperative care? Anesthesiology 1995; 83: 1138–44. 3. DeRiso B, Cantees K, Watkins WD. The operating rooms: cost center management in a managed care environment. Int Anesthesiol Clin 1995; 33: 133–50. 4. Abenstein JP, Warner MA. Anesthesia providers, patient outcomes, and costs. Anesth Analg 1996; 82: 1273–83. 5. Silber JH, Sean KK, Even-Shoshan O, et al. Anesthesiologist direction and patient outcomes. Anesthesiology 2000; 93: 152–63. 6. Gaba DM, Howard SK, Fish KJ. Crisis management in anesthesiology. New York: Churchill-Livingstone, 1994: 5–47. 7. Ereth MH, Byer DE, Behrens TL, Tri JL. Computer-based video paging [letter]. J Clin Monit 1989; 5: 217–9. 8. McMahon FB, McMahon JW. Psychology: the hybrid science. Homewood, IL: The Dorsey Press, 1982: 615–6. Attention Authors!

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© 2003 International Anesthesia Research Society Source

Anesthesia & Analgesia97(1):196-204, July 2003.

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References :


Dropmark : http://killexams.dropmark.com/367904/11704744
Wordpress : http://wp.me/p7SJ6L-1cn
Issu : https://issuu.com/trutrainers/docs/922-111
Dropmark-Text : http://killexams.dropmark.com/367904/12202427
Blogspot : http://killexamsbraindump.blogspot.com/2017/11/review-922-111-real-question-and.html
RSS Feed : http://feeds.feedburner.com/NeverMissThese922-111QuestionsBeforeYouGoForTest
Box.net : https://app.box.com/s/zwgjcqs8kl9728ozfsmfb74x7vvgissm
publitas.com : https://view.publitas.com/trutrainers-inc/once-you-memorize-these-922-111-q-a-you-will-get-100-marks
zoho.com : https://docs.zoho.com/file/5s0qs7cf24cff6e0743b68d7d0d2f43f9edb6






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