Role of arginine vasopressin and corticotropin-releasing factor in mediating alcohol-induced adrenocorticotropin and vasopressin secretion in male rats bearing lesions of the paraventricular nuclei cortisone injections for arthritis in feet feldene 20 mg fast delivery. Total water and tapwater intake in the United States population-based estimates of quantities and sources medication used arthritis purchase feldene 20mg amex. Water consumption in the United States in 1994 96 and implications for water fluoridation policy can arthritis in neck cause ear problems buy feldene 20 mg without prescription. The effect of dietary caffeine on urinary excretion of calcium arthritis in knee wiki discount 20 mg feldene with mastercard, magnesium arthritis in the knee natural remedies order feldene without prescription, sodium and potassium in healthy young females arthritis in lower back supplements discount feldene on line. Coffee consumption and total body water homeostasis as measured by fluid balance and bioelectrical impedance analysis arthritis in dogs glucosamine buy feldene 20mg. Caffeine vs caffeine-free sports drinks: effects on urine production at rest and during prolonged exercise arthritis pain gin soaked raisins generic feldene 20mg without a prescription. Tolerance and cross-tolerance in the human subject to the diuretic effect of caffeine, theobromine and theophylline. Risk factors for lower urinary tract cancer: the role of total fluid consumption, nitrites and nitrosamines, and selected foods. N nitrosoproline excretion by rural Nebraskans drinking water of varied nitrate content. Fluid intake and the incidence of bladder cancer among middle-aged men and women in a three-county area of western Washington. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospect study. Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. The relationship between dehydration and parotid salivary gland function in young and older healthy adults. Effect of mineral water containing calcium and magnesium on calcium oxalate urolithiasis risk factors. Environmental and nutritional factors significantly associated with cancer of the urinary tract among different ethnic groups. Drinking, micturition habits, and urine concentration as potential risk factors in urinary bladder cancer. Iguchi M, Umekawa T, Ishikawa Y, Katayama Y, Kodama M, Takada M, Katoh Y, Kataoka K, Kohri K, Kurita T. Mild dehydration induces echocardiographic signs of mitral valve prolapse in healthy females with prior normal cardiac findings. Nutritional and lifestyle habits and water-fiber interaction in colorectal adenoma etiology. Intake of fluids and methylxanthine containing beverages: association with colon cancer. Fluid consumption and the risk of bladder cancer: results of a multicenter case-control study. Water, other fluids, and fatal coronary heart disease: the Adventist Health Study. Exposure to fluoridated drinking water and dental caries experience in Australian army recruits, 1996. They are acquired by the contact of water with rocks and soil and the effects of the geological setting, including climate (1-4). However, the chemical composition of drinking water also depends on the contaminating effects of industry, human settlements, agricultural activities and water treatment and distribution (1-4). Depending on water quality at the source, filtration, coagulation, and addition of chemicals to adjust pH and/or control corrosion treatments are employed (1-5). In addition, chlorination or iodination may be used for disinfection and fluoridation for the prevention of dental caries (6-8). Leaching of minerals from metal components used in water treatment plants and plumbing materials occurs when pH and hardness of water are not adjusted. Some of the main sources of dissolved metals include: for Cu copper or brass plumbing system; Fe cast iron, steel, and galvanised plumbing system; Zn zinc galvanised pipes; Ni chromium nickel stainless plumbing system; Pb derived from tin-lead or lead solder; and for Cd as an impurity in zinc galvanised pipes or cadmium containing solders (1-4,9). Recently, fortification of drinking water has been used in the prevention of iron deficiency in children (10) and to provide iodine in select populations (11). Basal requirement is the ?intake needed to prevent pathologically relevant and clinically detectable signs of impaired function attributable to inadequacy of the nutrient. However, the basal requirement does not account for the needs to maintain nutrient reserves in the body or consider the amount sufficient to ensure that absorption and retention were not operating at maximum capacity. Therefore, the value needed to fulfill the basal requirement plus these additional needs to maintain a level of tissue storage or other reserves constitutes the normative requirement (12). The criterion utilised to define nutrient inadequacy may differ for individuals at different life stage. On the other hand, the knowledge of the criteria used to define nutrient inadequacy is important to integrate and/or compare requirements obtained from different sources of evidence. Several methods have been utilised to estimate requirements and each has particular strengths and weaknesses. Nutrient requirements can be calculated by using metabolic balance studies at different levels of intake, factorial modelling, in which the amount of the nutrient needed to replace utilisation and losses is calculated, depletion/repletion studies, and/or epidemiological evidence (12-17). Balance studies and factorial analysis calculations can be biased since individuals can adapt to the level of nutrient intake by modifying absorption and/or losses. As previously mentioned, micromineral requirements can be studied by experimental diets with different micromineral intakes, thus determining the minimal nutrient intake that prevents the development of biochemical abnormalities or functions. However, these experimental diets may also have modifications in other nutrients that could affect absorption of the studied nutrient or influence the biochemical or physiological parameters employed in the assessment of its status. In addition, the biochemical parameters may not be sufficiently sensitive and/or specific in detecting marginal nutrient status. Another method is to calculate the requirements based on epidemiological studies of nutrient status carried out in healthy populations with different nutrient intake profiles (12-15,17). Dietary reference intakes are provided to promote optimal health by avoiding consequences of nutrient deficiency and excess. However, for some nutrients there is limited information to scientifically support the nutritional needs across age ranges, gender and physiological states. This value is intended to be used as a goal for daily intake by all individuals to be reached as an average over a given time; usually weeks or months. Hazard identification (identification of all known adverse effects associated with the nutrient). Application of an uncertainty factor, that compensates for extrapolation from the observed to the general population (13,18). The lower limit of the population mean intake is ?the lowest mean intake at which the population risks of depletion remain acceptable when judged by normative criteria?, while the upper limit is ?the maximum population mean intake at which the risks of toxicity remain tolerable. In addition, the lower limit of the population mean intake was established based on the basal requirement criteria. Below this limit there is a gradual increase on the prevalence of individuals expected to show demonstrable signs 42 of functional impairment. An interesting modification in the approach to define the regulatory framework for assessing risks for essential trace elements is the concept of including the risk of both deficiency and excess in the model. This model includes weighing the evidence of hazards linked to deficit with that related to excess and selecting relevant endpoints of deficiency and toxicity at different ages, gender and conditions. In addition, the probability of risk and the severity of various effects are quantified and those that are critical to determine cut-off points for deficiency and toxicity are selected. Calcium, Na, K, Cl, Mg, Fe, Zn, Cu, Cr, I, Co, Mo and Se are unequivocally essential for human health; although not commonly realised drinking water provides some of these elements. A second group of elements that have some beneficial health effects, include F in the prevention of dental caries and B, Mn, Ni, Si and Va, that may be considered essential for humans based on emerging information. The third group is composed of the potentially toxic elements Pb, Cd, Hg, As, Al, Li and Sn (1,3,12,21). The relative of contribution of water to total dietary intake of selected trace elements and electrolytes is between 1 and 20%. The micronutrients with the largest proportion of intake from drinking water relative to that provided by food are calcium and magnesium. For these elements water may provide up to 20% of the required total daily intake. For the majority of other elements drinking water provides less than 5 % of total intake (1,3,12,21). An exception may be the high contribution of fluoride and arsenic in in certain geographic regions (eg. It is customarily assumed that the intake of essential elements is primarily covered by foods, thus minimum desirable levels in drinking water are not considered necessary. Yet for populations that have low consumption of animal flesh foods the intake of Fe, Zn and Cu may in fact be marginal or lower than needed, in which case sufficiency may depend on the metal contamination of foods and water. Some epidemiological evidence suggests that water hardness is associated with beneficial effects for human health. The ample epidemiological evidence, which is supported by case control studies, demonstrates an inverse relationship between drinking water hardness and cardiovascular or cerebrovascular diseases (3). However, available information is insufficient to conclude that the relationship is causal. Determining values for requirements during pregnancy usually includes an estimate of the quantity of the element required by the foetus and other products of pregnancy, and required for body changes that occur during this stage of the life cycle. Requirements for lactation include the need to replace the amount of the nutrient lost daily in human milk (12,14,15,19). While the main effect of iron deficiency is anaemia, other manifestations of iron deficiency include impaired mental and motor development and altered behaviour. Other symptoms that may be observed with iron deficiency are delayed nerve conduction affecting the auditory and visual systems, decreased capacity for physical work, increased spontaneous motor activity, impaired cell-mediated immunity and bactericidal capacity of neutrophils, impaired thermoregulation, functional and histologic abnormalities of the gastrointestinal tract, defective mobilisation of liver vitamin A, increased risk of premature birth, low birth-weight and growth retardation, increased perinatal morbidity and reduced iron transfer to the foetus (23-26). Iron deficiency is the single most common nutritional disorder worldwide and the main cause of anaemia in infancy, childhood and pregnancy (27). It is prevalent in most of the developing world and it is probably the only significant nutritional deficiency found in industrialised countries. The estimate is derived from the sum of basal iron losses, menstrual losses in women of fertile age, body iron accretion for growth and iron needed by foetus, placenta and expansion of the red cell mass in pregnancy, iron losses by milk in nursing women, and needs to maintain minimal iron stores to ensure normal function (14,15,19,28). Basal losses include obligatory losses of iron in the faeces, physiological blood loss and enterocyte desquamation, urine, sweat, and exfoliation of skin cells. Body iron stores, composition of the diet and rate of erythropoiesis influences the proportion of absorbed iron (22). The balance of dietary components that inhibit or enhance iron absorption have a crucial role in determining non-haeme iron absorption (22). However, because haeme-iron is absorbed intact into the enterocyte its absorption is practically not affected by the diet or diet related factors. Zinc Zinc is an essential trace element that is a catalytic component of over 300 enzymes, which also has a role in the structural integrity of proteins and membranes, in the union of hormones to its receptors, and in gene expression (29). Manifestations of zinc deficiency include growth retardation, delayed sexual and skeletal maturation, alteration in cell-mediated immunity, impaired resistance to infections, anorexia, impaired taste, delayed wound healing, behavioural effects, skin lesions and alopecia (29-32). The true prevalence of zinc deficiency at a global level is not known because of the lack of sensitive indicators of zinc status (33). Ithas been estimated using information on the inadequacy of daily zinc intake in developing and industrialised countries. The value is based on the minimal amount of absorbed zinc necessary to replace daily excretion of endogenous zinc and tissue growth, zinc accretion during pregnancy and zinc losses by milk in the case of nursing women (12,14,15,19). Excretion of endogenous zinc by the intestine is the main component of zinc losses, while losses in urine, menses, semen and integument exfoliation contribute to a lesser extent (35). This serves to estimate the required amount of absorbed zinc to compensate for losses. Zinc absorption is inversely related to dietary intake and efficiency of absorption is influenced by the physical and chemical properties of zinc in foods and the interaction of zinc with absorption inhibitors and enhancers (36). Diets have been characterised as of low, intermediate and high zinc bioavailability, based on the composition of the diet (12). For some life stage groupings requirements were corroborated by secondary indicators of zinc depletion and results of the effect of supplementation on biochemical and other laboratory parameters of zinc status, zinc intake and linear growth (12,14). Copper Copper is responsible for structural and catalytic properties of multiple enzymes necessary for normal body functions (37). This metal is required for infant growth, host defence mechanisms, bone strength, red and white cell maturation, iron transport and brain development (38). Other effects described include hypopigmentation of the hair and skin, hypotonia, impaired growth, increased incidence of infections and altered immunity (37 39). In Menkes disease, a genetic form of copper deficiency, symptoms include abnormal spiral twisting of the hair, lax skin and articulations, tortuosity and dilatation of major arteries, varicosities of veins, retinal dystrophy, profound central nervous system damage, and death (38). Some epidemiological studies have shown an association between cardiovascular mortality with low copper intake and/or low serum copper levels (40-43). Acquired deficiency occurs mainly in young infants; however, it has also been diagnosed in children and in adults (38). The true global prevalence of copper deficiency is unknown, but it is associated with common conditions such as low birth weight and child malnutrition. Copper nutrition in infants and in adults has been evaluated using a combination of laboratory indicators (12,14,15). Requirements of children and adolescents were interpolated from the infant and adult data on requirements. Thyroid hormones are necessary for cell growth and differentiation, the maintenance of metabolic rate and overall cellular metabolism (45). Iodine deficiency is frequently observed in populations living in environments where the soil is devoid of iodine due to leaching by the action of glaciation, rain or floods. Iodine deficiency induces enhanced iodine uptake by thyroid cells and an increase size of the thyroid gland (goitre). If these compensatory mechanisms are not enough to produce normal serum levels of thyroid hormones, symptoms and signs of hypothyroidism develop including impaired growth, mental retardation, and reproductive failure (47). Iodine deficiency is recognised as the most important preventable cause of mental retardation in the world today. The iodination of table salt has been introduced worldwide as a public health measure to eradicate iodine deficiency (47). Requirements have been estimated from balance studies, thyroidal radiodine accumulation and turnover, and iodine intake necessary to maintain a normal thyroid size and to provide thyroid iodine stores sufficient for a normal thyroid hormone synthesis (14,15,19). Additional iodine needs during pregnancy were estimated based on the thyroid iodine content of new-born infants, iodine balance studies, and the effect of iodine supplementation on maternal thyroid volume and/or thyroid function (14,19). In addition to its major function as a primary structural constituent of the skeleton, calcium is also important for the regulation of multiple enzymes and hormonal responses, blood clotting, nerve transmission, muscle contraction/relaxation (including normal heart rhythm), vascular contraction and vasodilation, and glandular secretion (13,48-51). Calcium deficiency leads to decrease in bone mineral content and mass that results in a weaker bone structure, leading to increased risk for bone fractures (13,48-51). The Scientific Committee for Food of the European Commission utilised factorial analysis to estimate requirements for calcium (15). This is relevant since most populations in developing countries not consuming dairy products have difficulty meeting the traditional calcium recommendations based on data obtained in industrialised countries. Phosphorus Phosphorus as calcium phosphate (calcium hydroxyappatite) is a structural component of bones it is found in a 1:2 mass ratio relative to calcium (13,15, 48-50). This element plays an important role as a structural component of cell membrane phospholipids; it is essential for energy production and storage, phosphorylation of numerous enzymes, hormones and cell signalling molecules, and to maintain a normal acid-base equilibrium (51,52). Phosphorus deficiency is rare at the population level, although it has been described in small premature infants exclusively receiving human milk, and in patients receiving aluminium hydroxide containing antacids over extended periods of time (13). Requirements of children and adolescents are calculated using a factorial approach based on body accretion in bone and soft tissues, efficiency of absorption and urinary excretion (50). Adult requirements are based on the relationship between serum inorganic phosphorus and dietary intake (50). The Scientific Committee for Food of the European Commission proposed the use of phosphorus intakes that correspond on a molar basis with that for calcium for estimating phosphorus requirements (15). Adult body content is 20-28 g, 60-65% of which is found in the skeleton and 1% in extracellular fluid (15,53). Magnesium is involved in the function of enzymes of carbohydrate, lipid, protein, and nucleic acid metabolisms (15,53). It is essential for the mineralisation and development of the skeleton, and also plays a role in cellular permeability and neuromuscular excitability (15,53). Magnesium deficiency induces increased neuromuscular excitability, and it enhances potassium renal excretion (15,53). Low magnesium intake has been associated with an increased risk of cardiovascular disease (15,53). Balance studies provided the basis for the estimation of magnesium requirement (50). Other criteria utilised to provide Mg recommendation are based on the relationship between magnesium intake and magnesium serum levels or magnesium and potassium content of the muscle, and on studies performed in young children recovering from malnutrition with diets containing different concentrations of this mineral (19). The Scientific Committee for Food of the European Commission provided a recommended intake based on observed acceptable range of intakes (15). Fluoride the essentiality of fluoride for humans has not been proven unequivocally (8,12,50). However, this element has beneficial effects on the prevention of dental caries due to the formation of crystalline hydroxyflurappatite leading to a more acid resistant enamel form (8,12,50). Sodium, Potassium, and Chloride Sodium is the principal cation in the extracellular fluid, while potassium is predominantly an intracellular cation, and chloride is the main extracellular anion (54,55). These electrolytes have important physiological roles in the maintenance of extracellular fluid volume, extra and intracellular osmolarity, regulation of acid base balance, generation of trans-membrane electrochemical gradients, transmission of nerve impulses, and muscle contractions (54,55). In addition to its functions as an electrolyte, chloride is indispensable for gastric hydrochloric acid production (54,55). This deficiency usually is the consequence of excessive losses from the body, commonly occurring during prolonged and/or severe diarrhoea or vomiting, or in hot, humid conditions in which a large amount of sodium is lost in sweat (55). Manifestations of hyponatremia, cerebral oedema and neuromuscular hyperexcitability, are the consequences of changes in extracellular fluid volume (55). Dehydration or metabolic acidosis usually accompanies sodium deficit and these are commonly responsible in part for the clinical findings (55). Signs of sodium deficiency include cramps, weakness, fatigue, nausea, mental apathy, low blood pressure, confusion and seizures (55).
The Veterans Administration had been dispensing research money for several years as a sort of bribe to attract doctors despite the low pay in government service arthritis foundation anti-inflammatory diet buy feldene australia. Moreover arthritis in dogs and exercise generic feldene 20 mg without a prescription, my hypothesis was based on the work of Rose arthritis in dogs natural remedies uk purchase generic feldene, Polezhaev arthritis knee grade 3 order 20mg feldene with amex, Singer rheumatoid arthritis facts purchase 20 mg feldene visa, Sinyukhin arthritis symptoms in back or spine effective 20mg feldene, and Zhir munskii with inescapable logic arthritis relief bracelet reviews order feldene 20mg on-line. And since frogs and salamanders were anatomically similar arthritis pain hot cold therapy cheap feldene online, any difference in their currents of injury should reflect the disparity in their powers of regeneration. Here I was nearly twenty years later, beneficiary of the intervening research, hoping to add to our knowledge of the same phenomenon and perhaps even discover something that would help hu man patients. I worried that my roundabout course might weigh against me, since one of the criteria for grants was whether the investigator had been trained for that particular field. Becker, could you please come to a special research committee meeting in one hour? In place of the long, polished table there was a semicircle of about a dozen chairs, each oc cupied by one of the luminaries from the hospital and medical school. I recognized the chairmen of the departments of biochemistry and phys iology along with the hospital director and chief of research. The spokesman came right to the point: "We have a very grave basic concern over your proposal. This notion that electricity has anything to do with living things was totally discredited some time ago. I will not stand idly by and see this medical school associated with such a charlatanistic, unscientific project. I had the momentary thrill of imagining myself as Galileo or Gior dano Bruno; I thought of walking to the window to see if the stake and fagots were set up on the lawn. Instead I delivered a terse speech to the effect that I still thought my hypothesis was stoutly supported by some very good research and that I was sorry if it flew in the face of dogma. Using a standard technique, Yntema had operated on very young sala mander embryos, cutting out all of the tissues that would have given the Sign of the Miracle 71 rise to the nervous system. The intact embryos furnished the grafts with blood and nourishment, and the procedure resulted in a little "parabiotic" twin, normal except for having no nerves, stuck on the back of each host animal. Yntema then cut off one leg from each of these twins, and some of them regenerated. The Reversals First I found a good supplier of salamanders and frogs, a Tennessee game warden who ran this business in his spare time. One was the "hot" or measuring electrode, which determined the polarity, positive or nega tive, with regard to a stationary reference electrode. A negative polarity meant there were more electrons where the measuring electrode was placed, while a positive polarity meant there were more at the reference site. A steady preponderance of negative charge at a particular location could mean there was a current flowing toward that spot, continually replenishing the accumulation of electrons. The placement of the refer ence electrode, therefore, was critical, lest I get the voltage right but the polarity, and hence the direction of the current, wrong. Since I postulated that the nerves were somehow related to the current, the cell bodies that sent their nerve fibers into the limb seemed like a good reference point. These cell bodies were in a section of the spinal cord called the brachial enlargement, located just headward from where the arm joined the body. In both frogs and salamanders, therefore, I put the measuring electrode directly on the cut surface of the amputation stump and the reference electrode on the skin over the brachial enlargement. After setting up the equipment, I did some preliminary measure ments on the intact animals. They all had areas of positive charge at the brachial enlargement and a negative charge of about 8 to 10 millivolts at each extremity, suggesting a flow of electrons from the head and trunk out into the limbs and, in the salamanders, the tail. I began the actual experiment by amputating the right forelimbs, between elbow and wrist, from fourteen salamanders and fourteen grass frogs, all under anesthesia. I took no special precautions against bleed ing, since blood clots formed very rapidly. In the wild, both frogs and salamanders get injuries much like the one I was producing?both are favorite foods of the freshwater bass?and heal them without a surgeon. Once the anesthetic wore off and the blood clot formed, I took a voltage reading from each stump. I was surprised to find that the polar ity at the crump reversed to positive right after the injury. By the next day it had climbed to over 20 millivolts, the same in both frogs and salamanders. The Sign of the Miracle 73 I made measurements daily, expecting to see the salamander voltages climb above those of the frogs as the blastemas formed. The salamander potentials changed their sign again, exceeding their nor mal voltage and reaching a peak of more than 30 millivolts negative just when the blastemas were emerging. As the salamander limbs regene rated and the frog stumps healed over with skin and scar tissue, both groups of limbs gradually returned (from opposite directions) to the original baseline of 10 millivolts negative. Already, in my first experiment, I had the best payoff research can give?the excitement of seeing something no one else seen before. Moreover, the opposite polarities indicated a profound difference in the electrical properties of the two animals, which somehow would explain why only the salamander could regenerate. Yntema agreed and urged me to write up a report for publication, but first I jumped ahead with another idea. I took a new group of frogs, amputated one foreleg from each, and every day applied negative current to the stump from a small battery. I dreamed of being the first to get complete regrowth in a normally nonregenerating animal; I could almost see my name on the cover of Scientific American. They refused, so I anesthetized them each day, something they tolerated very poorly. He reported that electrical currents passed through the aquarium water in the Sign of the Miracle 75 which larval salamanders were living speeded up their regeneration. To one group of salamanders I applied 2 microamperes of positive current from batteries connected directly to the stumps for five to ten minutes on each of the first five days after amputation. This treatment seemed to make the blastemas larger but slowed down the whole process somewhat. To another group I applied 3 microamperes of negative current on the fifth to ninth days, when the normal currents were hitting their negative peaks. These failures taught me that, before I applied my findings to other animals, I would have to learn how the current of injury worked. Not knowing any better, I sub mitted my paper to the Journal of Bone and Joint Surgery, the most pres tigious orthopedic journal in the world. The experiment had no immediate practical application, while the journal accepted only clinical reports. Moreover, the publication was very politi cal; normally you had to have an established reputation or come from one of the big orthopedic programs, like Harvard or Columbia, to get into it. Not only was it accepted for publication, but I was invited to present it at the next combined meeting of the Orthopaedic Research Society and the American Academy of Ortho paedic Surgeons, at Miami Beach in January 1961. This invitation was a particular honor, for it meant someone considered my work so signifi cant that practicing physicians, as well as researchers, should hear of it right then and there. My report was well received and soon was published, to the con sternation of the local inquisitors and the delight of Chester Yntema. Although Rose taught at Tulane Medical School in New Orleans, he spent every summer at the Woods Hole Marine Biological Laboratory on Cape Cod, so he and his wife drove to Syracuse from there. My friendship with this fine man and scientist has been fruitful even beyond the expectations I had then, and, when my wife and I had the Roses to dinner, we found our pasts were linked by an odd coincidence. Part 2 the Stimulating Current the basic texture of research consists of dreams into which the threads of reasoning, measurement, and calculation are woven. The new problems branched out like the fingers on those restored limbs: Where did the injury currents come from? It seemed unlikely that they sprang into action only after an amputation; they must have existed before. There must have been a preexisting substratum of direct current activity that re sponded to the injury. I had ideas about how to look for some of the answers, but, to under stand my approach, the reader unfamiliar with electrical terms will need a simplified explanation of several basic concepts that are essential to the rest of the story. Protons, which are one of the two main types of particles in atomic nuclei, are positive; the other particles, the neutrons, are so named because rhey have no charge. Orbiting around the nucleus are electrons, in the same number as the protons 80 the Body Electric inside the nucleus. Although an electron is 1,836 times less massive than a proton, the electron carries an equal but opposite (negative) charge. When electrons move away from an area, it becomes positively charged, and the area to which they move becomes negative. A flow of electrons is called a current, and is measured in amperes, units named for an early-nineteenth-century French physicist, Andre Marie Ampere. A direct current is a more or less even flow, as opposed to the instantaneous discharge of static electricity as sparks or lightning, or the back-and-forth flow of alternating current which powers most of our appliances. Besides the amount of charge being moved, a current has another characteristic important for our narrative?its electromotive force. In high school most of us learned that a current flows only when a source of electrons (negatively charged material) is connected to a mate rial having fewer free electrons (positively charged in relation to the source) by a conductor, through which the electrons can flow. The force of this latent current is also measured in volts by temporarily completing the circuit with a recording device, as I did in my experiment. The potential can continue to build until a violent burst of current equalizes the charges; this is what happens when lightning strikes. In this case they must be continuously fed by a direct current flowing from positive to negative, the opposite of the normal direction. As Volta found, such a flow is generated inside a battery by the electrical interaction of two metals. Like charge, magnetism is a dimly understood intrinsic property of matter that manifests itself in two polarities. Any flow of electrons sets up a combined electric and magnetic field around the current, which in turn affects other electrons nearby. Just as a current produces a magnetic field, a magnetic field, when it moves in relation to a conductor, induces a current. Any varying magnetic field, like that around household appliances, generates a cur rent in nearby conductors. A field is represented by lines of force, another abstraction, to indicate its direction and shape. Both kinds of fields de cline with distance, but their influence is technically infinite: Every time you use your toaster, the fields around it perturb charged particles in the farthest galaxies ever so slightly. It exists in a spectrum of wave lengths that includes cosmic rays, gamma rays, X rays, ultraviolet radia tion, visible light, infrared radiation, microwaves, and radio waves. Together, electromagnetic fields and energies interact in many complex ways that have given rise to much of the natural world, not to mention the whole technology of electronics. Physicists have been trying for generations to solve the fundamental mysteries of elec tromagnetism, and no one, not even Einstein, has yet succeeded. A major evaluation of American medicine, financed by the Carnegie Foundation and published in 1910 by the re spected educator Abraham Flexner, had denounced the clinical use of electric shocks and currents, which had been applied, often over enthusiastically, to many diseases since the mid-1700s. Its legitimate proponents had no scientific way to defend it, so the reforms in medical education that followed the Flexner report drove all mention of it from the classroom and clinic, just as the last remnants of belief in vital elec tricity were being purged from biology by the discovery of acetylcholine. Meanwhile, the work of Faraday, Edison, Marconi, and others liter ally electrified the world. As the uses of electricity multiplied, no one found any obvious effects on living creatures except for the shock and heating caused by large currents. To be sure, no one looked very hard, for fear of discouraging a growth industry, but the magic of electricity seemed to lie precisely in the way it worked its wonders unseen and unfelt by the folks clustered around the radio or playing cards under the light bulb. By the 1920s, no scientist intent on a respectable career dared suggest that life was in any sense electrical. One line of inquiry began just after the turn of the century when it was learned that hydras were electrically polarized. He claimed to have influenced the development of frog eggs not only with currents but also with magnetic fields, a conclusion that was really risque for that time. He edited the Yale Journal of Biology and Medicine, where most of his reports appeared; few other journals would touch them. Burr and his co-workers found electric fields around, and electric potentials on the surfaces of, organisms as diverse as worms, hydras, salamanders, humans, other mammals, and even slime molds. They measured changes in these potentials and correlated them to growth, regeneration, tumor formation, drug effects, hypnosis, and sleep. Burr claimed to have measured field changes resulting from ovulation, but others got contradictory results. He hooked up his voltmeters to trees for years at a time and found that their fields varied in response not only to light and moisture, but to storms, sunspots, and the phases of the moon as well. Burr and Lund were handicapped by their instruments as well as the research climate. The two scientists could refine their observations only enough to find a simple dipolar dis tribution of potentials, the head of most animals being negative and the tail positive. Burr and Lund advanced similar theories of an electrodynamic field, called by Burr the field of life or L-field, which held the shape of an organism just as a mold determines the shape of a gelatin dessert. His later writings were marred by a son of bioelectric determin ism and a tendency to confuse "law and order" in nature with that 84 the Body Electric odious euphemism as preached by Presidents. As a result, he began to suggest his simple readings as a foolproof way to evaluate job applicants, soldiers, mental patients, and suspected criminals or dissidents. Biological knowledge at that time gave them no theoretical framework to explain where their fields came from. They had no inkling that currents might flow in specific tissues or in the fluids outside cells. They suggested that all these little intracellular currents somehow added up to the whole field. Burr wrote that "electrical energy is a fundamental attribute of protoplasm and is an expression or measure of the presence of an electrodynamic field in the organism. After all, you can disagree with a theory, but you should respect the data enough to check them. When a direct current was fed in the proper direction through a section of a worm, normal polarity disappeared and a head formed at each end. At higher voltages, even intact worms completely reorganized, with the head becoming a tail and vice versa. Still, their work was also ignored, except by Meryl Rose, who suggested that a gradation of elec trical charge from front to back controlled the gradient of growth inhib itors and stimulators. He suggested that the growth compounds were charged molecules that were moved to different places in the body by the electric field, depending on the amount and sign of their charge and their molecular weight. The first recorded use of currents on the nervous system was by Giovanni Aldini, a nephew of Galvani and an ardent champion of vi talism. Using the batteries of his archenemy Volta, Aldini claimed re markable success in relieving asthma. Modern studies of nerves and current began in 1902, when French researcher Stephane Leduc reported putting animals to sleep by passing fairly strong alternating currents through their heads. Electronarcosis?induction of sleep by passing small currents across the head from temple to temple?is widely used by legitimate therapists in France and the Soviet Union. In the second and third decades of this century there was a flurry of interest in galvanotaxis, the idea that direct currents guided the growth of cells, especially neurons. Ingvar found that the fibers growing out of nerve cell bodies would align themselves with a nearby flow of current and that the fibers growing toward the negative electrode were different from those growing toward the positive one. Paul Weiss soon "explained" this heretical observation as an artifact caused by stretching of the cell culture substrate due to contact with the elec trodes. Even after Marsh and Beams proved Weiss wrong in 1946, it took many more years for the scientific community to accept the fact that neuron fibers do orient themselves along a current flow. Today the possible use of electricity to guide nerve growth is one of the most excit ing prospects in regeneration research (see Chapter 11). The Bernstein hypothesis, unable to account for these facts, has turned out to be deficient in several other respects. To begin with, ac cording to the theory, an impulse should travel with equal ease in either direction along the nerve fiber. If the nerve is stimulated in the middle, an impulse should travel in both directions to opposite ends. Instead, impulses travel only in one direction; in experiments they can be made to travel "upstream," but only with great difficulty. No im pulses have ever been found to be related to regrowth, and neu rotransmitters such as acetylcholine have been ruled out as growth stimulators. This stimulates stretch recep tors (nerve cells in the tendon), which fire a signal to the spinal cord saying, "The patellar tendon has suddenly been stretched. In everyday life, the reflex keeps you from falling in a heap if an outside force suddenly bends your knees. However, no one can walk on reflexes alone, as victims of cerebral palsy know all too well. Even more troublesome are the higher processes, such as sight?in which somehow we interpret a con stantly changing scene made of innumerable bits of visual data?or the speech patterns, symbol recognition, and grammar of our languages. Heading the list of riddles is the "mind-brain problem" of con sciousness, with its recognition, "I am real; I think; I am something special. The story goes that Otto Loewi had wrestled with the problem of the synapse for a long time without result, when one night he had a dream in which the entire frog-heart experiment was reveiled to him. This time he remembered the procedure, went to his lab in the morning, did the experiment, and solved the problem. How do you convert simple digital messages into these complex 88 the Body Electric phenomena? Latter-day mechanists have simply postulated brain cir cuitry so intricate that we will probably never figure it out, but some scientists have said there must be other factors. Even as Loewi was finishing his work on acetylcholine, others began to find evidence that currents flowed in the nerves. Berger at first thought there was only one wave from the whole brain, but it soon became clear that the waves differed, depending on where the electrodes were put.
While Speech Pathology Office/Treatment spaces and the Assistive Technology Room may be located close to the clinic entry for patient convenience rheumatoid arthritis in fingers pictures discount generic feldene canada, the Voice Treatment and Special Procedure Rooms should be more remote arthritis pain quality order feldene 20 mg with mastercard, with direct or very convenient access to key Support Area spaces arthritis in back of hip buy feldene 20mg with mastercard, including the Soiled Utility and Clean Supply Rooms arthritis in fingers at young age purchase cheap feldene online. Sound attenuation considerations are also a consideration for location of the Voice Treatment Room traumatic arthritis in the knee generic 20mg feldene visa, in particular arthritis in dogs prognosis order cheap feldene on line. Locating Office/Treatment spaces along the facility exterior wall with controlled natural daylight and windows is recommended; however arthritis medication anti-inflammatory discount 20 mg feldene otc, equipment and privacy needs are an additional consideration arthritis pain vs bone cancer pain cheap feldene online american express. Refer to Figure 40 which illustrates the functional relationships between key Speech Pathology spaces as well as patient/staff flow between them. Functional Requirements There are specific functional and technical requirements associated with Speech Pathology. Wayfinding to the Service incorporating both intuitive visual cues and clear, visible, barrier-free signage. The service must be individually identified in facility signage, Figure 40: Speech-Language particularly if it is not collocated with Audiology. Pathology Functional Relationships Page 2-42 Audiology and Speech Pathology Design Guide November 2017. Sufficient, waiting and seating, immediately adjacent to the clinic, configured so that the receptionists have direct visualization of patients and family members. Noise mitigation, a calming environment, connection to daylight/natural light, and proximity to toilet rooms and vending are also important considerations. The size of the waiting area should have sufficient aisle space for movement of wheelchairs and scooters. Wheelchairs and scooters must be accommodated in both the public and corridor areas, as well as in the patient care rooms themselves. Wide door widths, smooth transitions (avoid thresholds); flooring materials which facilitate movement, mounting heights of devices, and assistive devices such as handrails, grab bars, and adjustable height furnishings are all considerations. Speech privacy must be maintained and sound transmission from the patient care spaces to the corridor and adjacent rooms? spaces must be mitigated. Non-porous, easily cleanable flooring (such as Welded Seam Sheet Flooring with backing) is recommended for the Special Procedure and Voice Treatment Rooms. Good overall general lighting is required throughout, and carefully designed lighting to help reduce patient stress in specific locations should be a consideration. Enclosed modular storage systems, built-in or modular casework, and equipment rails all serve to facilitate clean/uncluttered procedure/treatment environments. Design criteria for healthcare facilities are to address: Page 2-43 Audiology and Speech Pathology Design Guide November 2017 Light/Lighting: natural light and illumination Views and access to nature Wayfinding User control of the environment Privacy and confidentiality Security (patients, staff, and visitors) Surfaces, finishes, architectural details Cultural responsiveness the Joint Commission defines additional requirements in their various publications, such as Environment of Care Essentials for Healthcare (The Joint Commission, 2017). These include, but are not limited to , those related to infection prevention and control, life safety measures, and reduction of clutter. Provisions for assistive listening devices in public spaces, handrails in corridors, and direct visualization of patients and visitors in waiting areas are relevant design and planning tools for this service. Additional design strategies which have been documented to mitigate stress include various positive distractions: Views to the exterior: the use of large expanses of glass to allow natural light in, and should include landscaping or natural vistas where possible. Access to exterior courtyards: provisions for exterior seating, fountains, sculpture gardens, or well landscaped settings to provide a level of comfort for the patient. Lighting design: the use of adequate lighting is essential to the comfort of the healthcare environment. While significant for reading and the performance of caregiver tasks, proper lighting levels (and types of lighting) are a factor in affording levels of emotional and psychological comfort for the patient. Privacy curtains are not needed since patients do not disrobe for any of the care. Requirements in this Design Guide shall not be construed as authorization to disregard or violate applicable local codes and regulations. The law protects all conversations between patients and admission interviewers, caregivers, nurses, physicians, and families. Penalties differ per violation versus maximum penalty according to these four categories and vary between $100 and up to $1,500,000. Location of Spaces A key consideration for the location and layout of the Audiology and Speech Pathology Clinic is noise mitigation. Noise-sensitive spaces should be located away from noisy areas since the acoustical performance of rooms depends on the function of adjacent spaces. In order to avoid the necessity of enhanced exterior building construction, including expensive window systems in high noise level areas, locate noise-sensitive spaces in the interior of the building away from windows or on the side of the building shielded from the transportation noise. This minimum width is also recommended in order to accommodate clear passage in front of the Audiometric Examination Suites (refer to Figure 16 and Figure 57). In non-patient areas and outpatient clinical spaces without gurneys, corridors may be a minimum of 6 0? (1830 mm) in clear width. The recommended finished interior height of a prefabricated Audiometric Exam Suite/Booth is 8 0? (2440 mm) minimum clear (refer to Figure 41); this is greater than the height of a standard prefabricated sound suite/booth (approximately 6 6? (1980 mm)). The taller interior dimension is recommended in order to reduce the sense of confinement inside the booth. However, additional consideration must be given to ensure there is adequate space above the prefabricated booth to accommodate mechanical, lighting, and fire protections systems; the overall height of the prefabricated Page 2-48 Audiology and Speech Pathology Design Guide November 2017 system is approximately 19? (480 mm) greater than the interior dimension. Careful coordination with vendor equipment drawings and specific requirements is required, particularly for renovation projects. Refer to Paragraph 8 Acoustics and the Room Templates for recommended noise reduction criteria and discussion. Walls Partitions shall be designed based on the sound transmission criteria established in the Room Data Sheets for specific rooms. Refer to Paragraph 8 Acoustics for additional discussion of sound attenuation considerations, and Section 2. Specialty doors include the Audiometric Examination Suites doors, which Page 2-49 Audiology and Speech Pathology Design Guide November 2017 are pre-manufactured, insulated steel components of the sound suite/booth assembly. Alternative door materials such as hollow metal or high-impact doors fully clad in solid vinyl guard sheets may be considered in order to achieve specific fire ratings or to increase durability provided that other criteria established in this Design Guide are met. Assistive Technology Room 2 Doors indicated on room templates are a single leaf; additional width may be accommodated with a second inactive leaf. Audiometric Examination Suite Doors Room templates for the Audiometric Sound Suites are developed based on a two-door configuration on each side of the double-wall assembly (one interior/in-swinging and one outer/out-swinging) on both the control side and exam side in order to maximize flexibility. A single-leaf 44? (1120 mm) wide door is preferred; however, an uneven pair (such as 36? (910 mm) plus 12? (300 mm) or 24? (610 mm) leaf) may be utilized in lieu of a single leaf in order to minimize the weight of the door, or to achieve a larger opening width. Doors shall swing clear (180 degrees or 90 degrees where applicable) against the sound booth outer and interior walls; maintaining the required corridor widths in front of booths is a significant planning consideration (refer to Figure 16). For specific door sound attenuation criteria, please refer to the Room Data Sheets and Paragraph 8 Acoustics of this guide. Casework For planning and utilization concerns, casework systems with modular components will provide flexibility and durability. Casework systems shall incorporate components dimensioned for Page 2-50 Audiology and Speech Pathology Design Guide November 2017 ease of multiple re-use applications. Countertops for all clinical and clinical support areas shall be solid impervious resin material which offers long-term durability, and resists chipping and staining from medical agents expected to be used in clinical environments. For areas where strong chemicals are used, such as soiled utility rooms, seamless stainless steel counters with integral backsplash should be used. Plastic laminate veneer material shall only be used for vertical and non-clinical horizontal applications. Acoustics General Properly functioning Audiology and Speech Pathology spaces require appropriate acoustical design of interior room acoustics, and acoustical isolation measures to control sound transmission, background noise, and vibration. For spaces used for speech communication, well-controlled reverberation characteristics are recommended to achieve sound clarity and good speech intelligibility. Proper design and installation of partitions (including walls, floors, ceilings, and roofs) as well as building components (such as windows and doors) are required to control sound transmission into and out of spaces. For specific room sound attenuation criteria, please refer to the Room Data Sheets. Acoustical criteria for key Audiology and Speech Pathology spaces are established based on the functions and acoustical sensitivities of each room. A space not found in the Room Data Sheets shall be treated comparably to the space to which it is most similar (for example, the Telehealth Room should be treated the same as the Audiology Rehabilitation/Counseling Room). Partition intersection and termination details which control sound transmission and meet the criteria shall be implemented. The acoustical isolation criteria in the Room Data Sheets are based on the assumption that typical healthcare spaces are located above and below the noise-sensitive Audiology and Speech Pathology spaces. It is also assumed that noise-sensitive spaces are not being located such that the room entrance doors connect to a main lobby or corridor with a lot of Page 2-51 Audiology and Speech Pathology Design Guide November 2017 people activity. To ensure that the acoustical design goals for the Audiology and Speech Pathology spaces are achieved, post construction testing should be performed. Audiology Numerous diagnostic tests performed in Audiology are highly sensitive to reverberation and interference from sound transmission, background noise, as well as electromagnetic sources. The rationale for acoustical criteria developed for key Audiology rooms is briefly described in the following paragraphs. The exam side/booth shall comply with the same requirements as Audiometric Examination Suite 1. This audiometric testing configuration may be preferred over Audiometric Examination Suite 1 for retrofitting in existing buildings or where more flexibility is desired. The Hearing Aid Analyzer/Real Ear Measurement System, which measures the performance of hearing aid devices in the Programming/Fitting Room, is sensitive to interference from external and background noise. Consideration for sound transmission at the door is addressed in the Room Data Sheet as well. Speech-Language Pathology the basis for determining the acoustical criteria for the Speech-Language Pathology spaces is similar to those for the Audiology spaces. However, since speech therapy and diagnostics involve the generation of sound, the resulting acoustical criteria for the Speech Pathology spaces incorporates more consideration for controlling patient speech transmission out of the spaces. The louder the speech levels generated, the higher the acoustical performances required for the partitions to control the speech transmission to other spaces and maintain speech privacy. The acoustical criteria for partitions, ceilings, and doors in these rooms are identified in the Room Data sheets. Interior Finishes Extensive criteria are addressed in the above-referenced documents for the selection of surface and furnishing material products, (such as non-flammable/flame spread characteristics, resilience/impact resistance, durability, reduce user fatigue, joints/seams/assembly, safe and efficient for use in occupied patient settings, supports clinical needs, acoustic properties, non Page 2-53 Audiology and Speech Pathology Design Guide November 2017 toxic, minimize reflectivity and glare, patient and staff safety, etc. These are all applicable for the design of Audiology and Speech Pathology facilities; however, there are several key considerations: Patient mobility Selection of wall, flooring, and ceiling materials shall meet the noise reduction and sound attenuation requirements specified for the key functional spaces in this department. However, sound attenuation characteristics of materials such as carpet tile and acoustical wall treatment panels must be balanced with considerations for infection control and the movement of wheeled traffic, including gurneys, stretchers, mobile equipment/supply carts, and motorized wheelchairs/scooters. Carpet tile (with anti-microbial and other properties suitable for the healthcare environment) may be used in spaces such as the Audiometric Sound Suites, Programming Fitting, Rehab/Counseling, Speech Pathology Office/Treatment, Cochlear Implant Mapping, Group Rooms, Staff Offices, and Conference Rooms to help achieve sound attenuation criteria. Carpet tile may also be considered for use in public spaces including the Waiting Room/Area and Audiology patient corridor areas, but careful evaluation of the selected product is required: ?different types of and brands of carpet may have significantly different levels of resistance to wheeled devices. Installation of a mock-up to test flooring materials in relationship to wheeled equipment and devices used in a facility is recommended. Carpet should not be automatically discounted as inappropriate due to this challenge as it has major advantages over hard-surface flooring in terms of noise reduction, acoustics, and residential appearance, all of which are important in creating a comfortable, attractive living environment for patients? (Facility Guidelines Institute, 2014). Where sound absorptive wall treatment is called for in the Room Data Sheets, materials shall be non-porous, soil resistant, and washable. Flooring material selection for the Hearing Aid Lab must also consider slip resistance. Patients needing Audiology and Speech Pathology services may have multiple disabilities that affect both cognitive skills and mobility; patients may be disoriented, either because of their disability or due to certain diagnostics/treatments in the clinic. All floor transitions shall be flush to avoid tripping hazards and to facilitate the movement of wheeled traffic. Minimizing color contrast in flooring patterns and between walls and floors may reduce falling risk, particularly for visually impaired patients. Handrails in the patient corridor areas are required to assist mobility-impaired patients. Telehealth Room (Remote Clinician Consultation) and Telehealth Exam Room Special considerations for the interior environment and finishes in telehealth rooms are discussed in the Telemedicine Room Design Program Guide (California Telemedicine and eHealth Center, 2011). As with other spaces in the Audiology and Speech Pathology Clinic, sound absorptive materials are an important consideration for telehealth. Rooms that echo make conversation between the patient and remote clinician difficult. Noise transmission from external sources, such as adjacent spaces and mechanical noise will also interfere with effective communication. While the remote clinician consultation Telehealth Room may utilize carpet tile, the Telehealth Exam Room may require use of an impervious flooring material; room function and specific activities are to be verified for selection of appropriate materials. Facilities may consider signage with the site location in the background to help orient the participants. Light neutral or blue shades to provide contrast with flesh tones are recommended in lieu of white or dark walls. Patient seating/side chairs in waiting and treatment spaces: Shall not have casters Upholstery fabrics, if provided, shall be specified in accordance with applicable building codes and standards, and address infection control/safety measures (such as anti microbial properties, special coatings, moisture resistant backings) Provide accommodations for bariatric patients and family members Task seating for staff may be selected based on local requirements. Clear, visible and barrier free signage, as well as visual cues via the ceiling design and floor pattern are elements that will facilitate wayfinding for individuals who may be disabled or disoriented. Depending on the size of the service and facility plan, the Audiology and Speech Clinic may have a dedicated entrance. Medical equipment for each service shall be identified with descriptions, quantities, and alternate manufacturers provided for all items, when available. Note that, although graphic representations/images of room contents are exhibited in this Design Guide to assist with room planning and visualization of minimum sizes and component parts, no implied preference for a particular manufacturer is intended. Audiology Specialized equipment associated with Audiology requiring significant coordination includes the following items: General audiology equipment Audiometers, analyzers, diagnostic sets, and other small countertop devices for audiologic testing (such as Figure 43 and Figure 44). Figure 43: Diagnostic Audiometer these often have multiple components including computers and speakers which require space and electrical/network connectivity. The hearing aid Figure 44: Tympanometer test box is an additional component of the system which requires desk space. This equipment requires extensive coordination with other building systems, including structural, mechanical, electrical, and fire protection. Refer to Audiometric Examination Suite descriptions in Section Figure 45: Hearing Aid Analyzer/Real 2. Refer to discussions related to coordination with applicable building systems in Section 2. An isolation Figure 46: Hearing Aid Analyzer /Real transformer must be accommodated in a separate facility Ear Measurement System-Example 2 electrical closet (refer to Figure 26 and Figure 122). Provisions for dust collection and noise mitigation are crucial (refer to Figure 47). This equipment produces vibrations, so location in the department and sound attenuation are a consideration. This equipment has electrical requirements and may be attached to a vacuum/suction device depending on model selected. The air caloric irrigator (refer to Figure 49) is used for stimulating the horizontal semi canal by pumping warmed or cooled room air into the external ear canal. The irrigator is typically placed on a mobile cart; the water irrigator requires a plumbing connection at a sink/faucet. Speech-Language Pathology Specialized equipment associated with Speech-Language Pathology requiring significant coordination includes the Figure 49: Air Caloric Irrigator following items: Computerized Speech Lab ?Equipment used for voice and speech analysis is typically located on a table or countertop and is connected to a non-network computer and monitor (refer to Figure 51). If utilized, this is located on a countertop and is usually connected to the Speech Lab computer. They are sometimes placed on mounts that occupy additional floor or counter space (refer to Figure 53). Additional features shall include an adjustable headrest, arm rests which raise to facilitate patient access/transfer, and solid footrest (avoid an open metal bar, Figure 53: Speech Therapy Device which is a tripping hazard). A chair-mounted exam light is an optional accessory, which may be included based on local requirements; it is typically needed for the Cerumen Management Room. Since the chair is heavy and requires an electrical outlet nearby, the planner shall coordinate in advance its physical placement relative to other fixed elements in the room. Recommended clearances for working space around the chair as well as the recommended location of the floor outlets are indicated on the applicable room templates. A surface mounted floor outlet is preferred to avoid the tripping hazard of a cord running to an electrical outlet on the wall. The head section of the table must be adjustable to a minimum of 30 degrees; height adjustability facilitates patient transfers from wheelchairs. Extra (bariatric) width is recommended to support flexible positioning and patient recovery. Alternative exam/procedure tables are acceptable in lieu of the Hi-Lo Table as long as the various treatment positions can be achieved. To achieve acceptable vibration levels for sensitive Audiology and Speech Pathology functions, building structures should be designed to minimize footfall vibration. Significant equipment identified in this Design Guide requiring structural design and analyses for load carrying capacity are: Slabs shall be depressed to accommodate prefabricated Audiometric Examination Suites while maintaining load carrying capacity requirements. The minimum slab depression depth shall be coordinated with vendor requirements (approximately 6 1/8? (160 mm)) plus additional allowance for adjacent flooring material. The overall dimensions of the slab depression shall be established based on project requirements and the overall size of the prefabricated sound suite, providing for no less than a minimum clear dimension of 4? (100 mm) between the outer wall of the sound suite and inside edge of the slab depression. Page 2-60 Audiology and Speech Pathology Design Guide November 2017 Slab Thickness and Equipment Anchoring Slab thickness and anchoring of equipment into the slab are a consideration for the Rotary Chair.
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