|Exam Name||:||Communication Server 1000 to Rls. 6.0 Upgrades for Technicians|
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|Updated On||:||February 22, 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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newsMicrosoft-Nortel See Unified Communications good points
The Alliance lately won three new shoppers as well, including Indiana institution, U.ok.-based mostly Worcestershire health assistance and Communications technology services, and an IT and telephony issuer known as 4ward.
Microsoft and Nortel formed the imaginative Communications Alliance in July of last year with the purpose of delivering unified communications options to companies. below the Alliance, the companies initiated joint analysis and building efforts. They additionally created consumer demonstration centers and engaged in joint earnings and advertising and marketing.
in the Alliance's preliminary press unencumber, Jeff Raikes, Microsoft's enterprise Division president, stated that the joint unified communications solution would allow a "single identification across electronic mail, voice mail, voice over internet protocol (VoIP) call processing, quick messaging and video."
The Alliance's important product is referred to as Nortel Converged office, a unified communications gadget that integrates Nortel's VoIP telephony equipment with Microsoft's server technology.
The main accessories of Converged office include:
there's also a Nortel utility middle component that supports not obligatory capabilities, including internet integration, interactive voice response and make contact with core services.
Unified communications gets defined in a variety of ways, however in response to the IEEE, it usually encompasses "unified messaging, collaboration and interplay programs." These programs also usually allow real-time and close real-time communications. moreover, combined media (voice, email, fax, and many others.) can also be accessed from a single application, independent of the entry machine.
competitors within the unified communications space is thick with massive names. In March of this year, IBM and Cisco, announced a collaborative effort on unified messaging client expertise referred to as Unified Communications and Collaboration (UC2). UC2 is based on open technologies, akin to Eclipse development atmosphere and the Open capabilities Gateway Initiative framework. Citrix methods and Nokia, amongst others, have expressed support for the UC2 platform.
below the IBM-Cisco unified communications partnership, Cisco plans to sell IBM's Lotus Sametime collaboration answer and IBM plans to promote Cisco's Unified Communications supervisor, Cisco cohesion and Cisco Unified MeetingPlace products. The whole unified communications answer is designed and delivered by way of IBM global know-how functions.
Kurt Mackie is senior news producer for the 1105 enterprise Computing community.
big apple — Jan. 17, 2007 — today, Microsoft Corp. CEO Steve Ballmer and Nortel* CEO and President Mike Zafirovski introduced a joint highway map to deliver their shared vision for unified communications. The street map is the outcome of an alliance between Microsoft and Nortel announced in July 2006, and comprises three new joint options to dramatically improve company communications by using breaking down the barriers between voice, email, speedy messaging, multimedia conferencing and different types of communication.
speakme at an event at Studio 8H in Rockefeller core to more than one hundred consumers together with newshounds and analysts, Ballmer and Zafirovski outlined how corporations can improve worker productivity and effectiveness and reduce the fees and complexity of communications. They additionally introduced 11 new implementation functions from Nortel and the outlet of more than 20 joint demonstration centers where purchasers can adventure the technology firsthand.
in exactly six months for the reason that the alliance become formed, both organizations have signed agreements with dozens of customers, and have developed a pipeline of hundreds of possibilities who are looking to recognize the benefits of unified communications.
“we are executing forcefully on the imaginative and prescient of this alliance and have made significant progress,” Zafirovski said. “We accomplished the planning levels and at the moment are providing unified communications solutions to groups worldwide. Our intention is to close the gap between the contraptions we use to speak and the company applications we use to run our groups, giving employees the vigour to make use of advice extra straight away and simply.”
“The normal worker gets more than 50 messages each day1 on as much as seven distinct instruments or applications,” Ballmer delivered. “software can and may support address the continued problem of managing communications and this challenge is the riding concept in the back of our alliance with Nortel. collectively, we will evolve VoIP and unified communications to integrate all the ways we contact each and every other in an easy atmosphere, using a single identity throughout telephones, PCs and different gadgets.”
New options to improve Communications and Collaboration
Microsoft and Nortel shaped the creative Communications Alliance to help groups transform enterprise communications by rushing up the transition to voice over cyber web protocol (VOIP) and unified communications. providing on the vision they outlined in July, Microsoft and Nortel today added three new options:
UC integrated branch. This new product from the alliance will contain Nortel and Microsoft® know-how on a single piece of hardware that grants reasonably-priced, terrific and simple-to-installation VoIP and unified communications in far flung offices. The UC integrated branch is planned to be available within the fourth quarter of 2007.
Unified Messaging. To simplify customer deployments, native session initiation protocol (SIP) interoperability between the Nortel communique Server one thousand and Microsoft trade Server 2007 Unified Messaging is planned to be available within the 2d quarter of 2007. The solution contains Nortel knowledgeable functions for design, deployment and guide.
Conferencing. This new solution will prolong the rich characteristic set of Nortel Multimedia Conferencing to Microsoft workplace Communicator 2007, delivering a single, common customer adventure consistent across applications equivalent to voice, immediate messaging, presence, and audio- and videoconferencing. The on-premise answer is planned to be obtainable in the fourth quarter of 2007.
In 2007, the businesses additionally plan to prolong their existing unified communications solution — a unified desktop and delicate phone for VoIP, e mail, speedy messaging and presence — to the Nortel verbal exchange Server 2100, a carrier-grade commercial enterprise telephony product aiding up to 200,000 users on a single system.
in addition, Nortel and Microsoft introduced a highway map for 2008 and past for moving company communications onto a software platform designed to power a better-excellent person journey and reduce total charge of possession. The road map outlines a few key applications and expertise developments including a unified communications contact middle, Nortel function server, expanded hosted UC solutions, mobility and client options, and utility-mindful networking enhancements.
“imaginitive communications and collaboration applied sciences are important to thoroughly enabling Royal Dutch Shell’s international work drive, and key to working at properly quartile in our business. We accept as true with in and help the vision Nortel and Microsoft have outlined,” spoke of Johan Krebbers, community IT architect at Royal Dutch Shell, who joined Ballmer and Zafirovski onstage for these days’s event. “Over the next a number of years, we plan emigrate our network to a utility-based mostly communications device built on applied sciences represented through the Nortel and Microsoft alliance.”
Experiencing VoIP and Unified Communications solutions
The corporations announced that they've outfitted greater than 20 joint demonstration centers in North the us, Europe and Asia, with greater than 100 additional facilities scheduled to open by means of midyear.
In a related announcement, Nortel brought 11 core integration functions to help valued clientele construct, install and aid joint unified communications solutions, including conclusion-to-conclusion challenge management. Nortel already has more than 2,200 VoIP specialists to deliver these features and should add more as deployment ramps up. This group is supported by the 10,000-potent Nortel global features team and a large ecosystem of features partners.
Nortel is a diagnosed leader in supplying communications capabilities that enhance the human experience, ignite and vigor international commerce, and comfortable and give protection to the realm’s most crucial suggestions. Our next-generation applied sciences, for both service providers and organisations, span entry and core networks, support multimedia and business-important functions, and assist get rid of nowadays’s obstacles to effectivity, velocity and performance via simplifying networks and connecting americans with counsel. Nortel does company in more than a hundred and fifty nations.
founded in 1975, Microsoft (Nasdaq “MSFT”) is the international leader in utility, features and solutions that support people and groups realize their full talents.
note to editors: in case you have an interest in viewing additional info on Microsoft, please discuss with the Microsoft web page at http://www.microsoft.com/presspass on Microsoft’s company tips pages. net links, mobile numbers and titles had been suitable at time of publication, however may additionally when you consider that have modified. For extra counsel, journalists and analysts can also contact Microsoft’s quick Response group or other appropriate contacts listed at http://www.microsoft.com/presspass/contactpr.mspx .
resourceful Communications Alliance customer support
BT international capabilities is the division of BT neighborhood that provides networked IT functions international that enable multinational, multisite companies to thrive and develop in the digital networked economic climate
“The Nortel and Microsoft alliance has the knowledge to accelerate and simplify the attention of unified communications for a major part of our consumer base. BT leads through instance, and we are already the use of exchange Server 2007 Unified Messaging with our Nortel telephony device. From this journey and from our position as a number one company of networked IT functions, we consider that the native, requirements-based SIP interoperability that Microsoft and Nortel announced today should simplify deployments and cut back total charge of possession.”
Tom CraigPresident, IP NetworkingBT global services
With operations in eleven international locations in the Asia-Pacific vicinity and the financial facilities of ny and London, CLSA is without doubt one of the main monetary powerhouses international. Hong Kong-primarily based CLSA is an award-successful company that gives capabilities in brokerage, funding banking and private equity.
“We had to connect our regional places of work and headquarters, with more than 1,000 employees, with a device that superior our potential to execute trades and provide reporting information. The ingenious Communications Alliance is delivering a unified communications equipment that brings the vigor of Nortel’s IP telephony at the side of the collaboration of Microsoft office are living Communications Server to deliver a solution superior to anything else on the market. it is going to permit us to meet the wants of our clients, meet our regulatory necessities throughout many countries and simplify communications for our personnel. since the imaginative Communications Alliance makes it possible for us to leverage our existing infrastructure, it's the most cost-efficient answer accessible.”
T. RajahChief counsel OfficerCLSA
Fred Weber Inc.
Fred Weber Inc. is the St. Louis enviornment’s chief in heavy and dual carriageway development. primarily based in Maryland Heights, Mo., this $300 million-a-yr, worker-owned enterprise makes a speciality of full-carrier concrete and asphalt paving initiatives and is the region’s greatest materials corporation. The enterprise’s work philosophies nowadays are the same as those of founder Fred Weber seventy eight years in the past. of those, “The deserve to normally think and alter business practices to more advantageous serve valued clientele” led Fred Weber Inc. to leverage the Nortel and Microsoft relationship.
“At Fred Weber, our wants are different than other corporations. Our company exists past 4 partitions and a normal office complicated. This creates a important want for beneficial and respectable integrated communications. Orchestrating 1,200 personnel across our 25 building and substances places in addition to our a lot of subsidiary companies may also be a logistical nightmare. The resourceful Communications Alliance solution provided with the aid of Nortel and Microsoft helps resolve this issue, and allows for us to spend more time with our consumers and reply in actual time to their needs.”
Phillip HagemannChief advice OfficerFred Weber Inc.
overseas SOS is the area’s main company of clinical counsel, foreign healthcare and safety functions. With operations in sixty five international locations and a 4,500-effective work drive, overseas SOS helps companies and organizations control the health and safety dangers their travelers, expatriates and international work force face.
“presenting tremendous services to our clients globally requires beneficial communication internally and externally. engaging Nortel and Microsoft’s resourceful Communications Alliance relationship gives us the opportunity to put into effect a blended technology answer that permits us to raise our core company of offering healthcare and security functions all over.”
Todd SchofieldChief expertise OfficerInternational SOS
Thomas faculty, a private faculty in Waterville, Maine, is committed to profession practicing with a practice of teaching college students in enterprise, know-how and training. With greater than 950 undergraduate and graduate college students, and a school of sixty six, Thomas is adopting cutting-part Microsoft and Nortel tips expertise beneath the aegis of the imaginitive Communications Alliance.
“whereas we are a small faculty, we have the goal of implementing unified communications capabilities to serve our students and college on par with universities that have higher enrollments and larger budgets. we now have used the Nortel telephony infrastructure for two many years and at the moment are using Microsoft office reside Communications Server, so the imaginative Communications Alliance unified communications suite is a herbal extension. The plan is to set up the innovative Communications Alliance solution to integrate communications, increase online coursework, and supply a custom, campuswide immediate messaging skill and a collaborative electronic blackboard ability. The web influence is that we are a 113-year-old establishment that's getting ready our college students for success of their personal and knowledgeable lives, and for management and repair in their communities.”
Chris RhodaVice President of counsel ServicesThomas college
Nortel CEO and President Mike Zafirovski (left) and Microsoft CEO Steve Ballmer (right) discussing the businesses’ shared imaginative and prescient for unified communications. manhattan, new york. Jan. 17, 2007
newsMicrosoft and Nortel existing Alliance Roadmap Six months after announcing a telecommunications alliance, Microsoft and Nortel this week presented some early effects of their efforts and outlined a roadmap for future initiatives.
both groups first introduced their collaboration last summer.
The road map contains three new joint options “to dramatically improve enterprise communications by using breaking down the barriers between voice, e mail, quick messaging, multimedia conferencing and different styles of communique,” in keeping with a press release by the two establishments.
additionally blanketed in the announcement are 11 new implementation functions from Nortel and the hole of greater than 20 joint demonstration facilities where shoppers can adventure the expertise, the commentary persevered.
furthermore, both companies stated they've signed agreements with dozens of shoppers, and have developed a “pipeline of a whole bunch of possibilities who wish to recognise the merits of unified communications.”
From Microsoft's standpoint, it's all a part of the enterprise's lengthy-term play to merge every kind of communications and messaging right into a single framework. A 12 months in the past, the business introduced that it changed into merging its alternate Server neighborhood with its precise-Time Collaboration (RTC) community, and that it had begun to consider of both technologies comprising a "platform."
the brand new neighborhood changed into named the Unified Communications community (UCG) and resides in Microsoft's enterprise Division. The idea for the brand new group emanated from a vision of adding continuity to a myriad of communications instruments, technologies and modes -- from electronic mail and speedy messaging to Voice over internet Protocol (VoIP), audio/video and web conferencing -- in a unified manner.
The three new joint options introduced by using the alliance this week are named Unified Communications built-in branch, Unified Messaging, and Conferencing.
When it's accessible within the fourth quarter, UC integrated branch will contain Nortel and Microsoft technology on a single piece of hardware that provides VoIP and unified communications in faraway workplaces.
Coming a bit earlier within the 2nd quarter, Unified Messaging will intention to simplify client deployments, native session initiation protocol (SIP) interoperability between the Nortel communication Server 1000 and Microsoft change Server 2007. The answer includes Nortel skilled capabilities for design, deployment and guide.
also coming within the fourth quarter, Conferencing will extend Nortel Multimedia Conferencing to Microsoft office Communicator 2007. It goals to provide a single customer adventure consistent throughout applications reminiscent of voice, rapid messaging, presence, and audio- and videoconferencing.
This yr, the organizations additionally plan to prolong their latest unified communications solution — a unified computer and soft cell for VoIP, electronic mail, instant messaging and presence — to the Nortel communication Server 2100, a service-grade enterprise telephony product assisting up to 200,000 users on a single gadget, in response to company statements.
As for the highway map, the two companies have fitted more than 20 joint demonstration centers in North the united states, Europe and Asia, with greater than one hundred extra facilities scheduled to open by way of midyear.
Nortel has also brought eleven core integration functions to help consumers construct, install and assist joint unified communications solutions, including conclusion-to-end assignment management. Nortel claims it has already trained greater than 2,200 VoIP consultants to carry these services and may add extra as deployment ramps up.
Stuart J. Johnston has coated technology, notably Microsoft, given that February 1988 for InfoWorld, Computerworld, suggestions Week, and computing device World, as well as for enterprise Developer, XML & net features, and .internet magazines.
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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.
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.
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.
THE 50 STATES<@VM>THE 50 STATES: Maryland to WyomingWhat's up in your agency?For governments east of the Mississippi, call 301-650-2145 or e-mail firstname.lastname@example.org. For those west, call 301-650-2238 or e-mail email@example.com.
VIRTUAL KNOWLEDGE. The state Legislature has sponsored an online library system that gives registered users access to 53 databases of information. Students, teachers and other Alabama residents can access thousands of full-length articles and definitions, as well as links to numerous Web sites, from the Alabama Virtual Library.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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!
Submit Your Papers Online
You can now have your paper processed and reviewed faster by sending it to us through our new, web-based Rapid Review System.
Submitting your manuscript online will mean that the time and expense of sending papers through the mail can be eliminated. Moreover, because our reviewers will also be working online, the entire review process will be significantly faster.
You can submit manuscripts electronically via http://www.rapidreview.com. There are links to this site from the Anesthesia & Analgesia website (http://www.anesthesia-analgesia.org), and the IARS website (http://www.iars.org).
To find out more about Rapid Review, go to http://www.rapidreview.com and click on “About Rapid Review.”© 2003 International Anesthesia Research Society Source
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Autodesk [2 Certification Exam(s) ]
Avaya [96 Certification Exam(s) ]
AXELOS [1 Certification Exam(s) ]
Axis [1 Certification Exam(s) ]
Banking [1 Certification Exam(s) ]
BEA [5 Certification Exam(s) ]
BICSI [2 Certification Exam(s) ]
BlackBerry [17 Certification Exam(s) ]
BlueCoat [2 Certification Exam(s) ]
Brocade [4 Certification Exam(s) ]
Business-Objects [11 Certification Exam(s) ]
Business-Tests [4 Certification Exam(s) ]
CA-Technologies [21 Certification Exam(s) ]
Certification-Board [10 Certification Exam(s) ]
Certiport [3 Certification Exam(s) ]
CheckPoint [41 Certification Exam(s) ]
CIDQ [1 Certification Exam(s) ]
CIPS [4 Certification Exam(s) ]
Cisco [318 Certification Exam(s) ]
Citrix [48 Certification Exam(s) ]
CIW [18 Certification Exam(s) ]
Cloudera [10 Certification Exam(s) ]
Cognos [19 Certification Exam(s) ]
College-Board [2 Certification Exam(s) ]
CompTIA [76 Certification Exam(s) ]
ComputerAssociates [6 Certification Exam(s) ]
Consultant [2 Certification Exam(s) ]
Counselor [4 Certification Exam(s) ]
CPP-Institue [2 Certification Exam(s) ]
CPP-Institute [1 Certification Exam(s) ]
CSP [1 Certification Exam(s) ]
CWNA [1 Certification Exam(s) ]
CWNP [13 Certification Exam(s) ]
Dassault [2 Certification Exam(s) ]
DELL [9 Certification Exam(s) ]
DMI [1 Certification Exam(s) ]
DRI [1 Certification Exam(s) ]
ECCouncil [21 Certification Exam(s) ]
ECDL [1 Certification Exam(s) ]
EMC [129 Certification Exam(s) ]
Enterasys [13 Certification Exam(s) ]
Ericsson [5 Certification Exam(s) ]
ESPA [1 Certification Exam(s) ]
Esri [2 Certification Exam(s) ]
ExamExpress [15 Certification Exam(s) ]
Exin [40 Certification Exam(s) ]
ExtremeNetworks [3 Certification Exam(s) ]
F5-Networks [20 Certification Exam(s) ]
FCTC [2 Certification Exam(s) ]
Filemaker [9 Certification Exam(s) ]
Financial [36 Certification Exam(s) ]
Food [4 Certification Exam(s) ]
Fortinet [13 Certification Exam(s) ]
Foundry [6 Certification Exam(s) ]
FSMTB [1 Certification Exam(s) ]
Fujitsu [2 Certification Exam(s) ]
GAQM [9 Certification Exam(s) ]
Genesys [4 Certification Exam(s) ]
GIAC [15 Certification Exam(s) ]
Google [4 Certification Exam(s) ]
GuidanceSoftware [2 Certification Exam(s) ]
H3C [1 Certification Exam(s) ]
HDI [9 Certification Exam(s) ]
Healthcare [3 Certification Exam(s) ]
HIPAA [2 Certification Exam(s) ]
Hitachi [30 Certification Exam(s) ]
Hortonworks [4 Certification Exam(s) ]
Hospitality [2 Certification Exam(s) ]
HP [750 Certification Exam(s) ]
HR [4 Certification Exam(s) ]
HRCI [1 Certification Exam(s) ]
Huawei [21 Certification Exam(s) ]
Hyperion [10 Certification Exam(s) ]
IAAP [1 Certification Exam(s) ]
IAHCSMM [1 Certification Exam(s) ]
IBM [1532 Certification Exam(s) ]
IBQH [1 Certification Exam(s) ]
ICAI [1 Certification Exam(s) ]
ICDL [6 Certification Exam(s) ]
IEEE [1 Certification Exam(s) ]
IELTS [1 Certification Exam(s) ]
IFPUG [1 Certification Exam(s) ]
IIA [3 Certification Exam(s) ]
IIBA [2 Certification Exam(s) ]
IISFA [1 Certification Exam(s) ]
Intel [2 Certification Exam(s) ]
IQN [1 Certification Exam(s) ]
IRS [1 Certification Exam(s) ]
ISA [1 Certification Exam(s) ]
ISACA [4 Certification Exam(s) ]
ISC2 [6 Certification Exam(s) ]
ISEB [24 Certification Exam(s) ]
Isilon [4 Certification Exam(s) ]
ISM [6 Certification Exam(s) ]
iSQI [7 Certification Exam(s) ]
ITEC [1 Certification Exam(s) ]
Juniper [64 Certification Exam(s) ]
LEED [1 Certification Exam(s) ]
Legato [5 Certification Exam(s) ]
Liferay [1 Certification Exam(s) ]
Logical-Operations [1 Certification Exam(s) ]
Lotus [66 Certification Exam(s) ]
LPI [24 Certification Exam(s) ]
LSI [3 Certification Exam(s) ]
Magento [3 Certification Exam(s) ]
Maintenance [2 Certification Exam(s) ]
McAfee [8 Certification Exam(s) ]
McData [3 Certification Exam(s) ]
Medical [69 Certification Exam(s) ]
Microsoft [374 Certification Exam(s) ]
Mile2 [3 Certification Exam(s) ]
Military [1 Certification Exam(s) ]
Misc [1 Certification Exam(s) ]
Motorola [7 Certification Exam(s) ]
mySQL [4 Certification Exam(s) ]
NBSTSA [1 Certification Exam(s) ]
NCEES [2 Certification Exam(s) ]
NCIDQ [1 Certification Exam(s) ]
NCLEX [2 Certification Exam(s) ]
Network-General [12 Certification Exam(s) ]
NetworkAppliance [39 Certification Exam(s) ]
NI [1 Certification Exam(s) ]
NIELIT [1 Certification Exam(s) ]
Nokia [6 Certification Exam(s) ]
Nortel [130 Certification Exam(s) ]
Novell [37 Certification Exam(s) ]
OMG [10 Certification Exam(s) ]
Oracle [279 Certification Exam(s) ]
P&C [2 Certification Exam(s) ]
Palo-Alto [4 Certification Exam(s) ]
PARCC [1 Certification Exam(s) ]
PayPal [1 Certification Exam(s) ]
Pegasystems [12 Certification Exam(s) ]
PEOPLECERT [4 Certification Exam(s) ]
PMI [15 Certification Exam(s) ]
Polycom [2 Certification Exam(s) ]
PostgreSQL-CE [1 Certification Exam(s) ]
Prince2 [6 Certification Exam(s) ]
PRMIA [1 Certification Exam(s) ]
PsychCorp [1 Certification Exam(s) ]
PTCB [2 Certification Exam(s) ]
QAI [1 Certification Exam(s) ]
QlikView [1 Certification Exam(s) ]
Quality-Assurance [7 Certification Exam(s) ]
RACC [1 Certification Exam(s) ]
Real-Estate [1 Certification Exam(s) ]
RedHat [8 Certification Exam(s) ]
RES [5 Certification Exam(s) ]
Riverbed [8 Certification Exam(s) ]
RSA [15 Certification Exam(s) ]
Sair [8 Certification Exam(s) ]
Salesforce [5 Certification Exam(s) ]
SANS [1 Certification Exam(s) ]
SAP [98 Certification Exam(s) ]
SASInstitute [15 Certification Exam(s) ]
SAT [1 Certification Exam(s) ]
SCO [10 Certification Exam(s) ]
SCP [6 Certification Exam(s) ]
SDI [3 Certification Exam(s) ]
See-Beyond [1 Certification Exam(s) ]
Siemens [1 Certification Exam(s) ]
Snia [7 Certification Exam(s) ]
SOA [15 Certification Exam(s) ]
Social-Work-Board [4 Certification Exam(s) ]
SpringSource [1 Certification Exam(s) ]
SUN [63 Certification Exam(s) ]
SUSE [1 Certification Exam(s) ]
Sybase [17 Certification Exam(s) ]
Symantec [134 Certification Exam(s) ]
Teacher-Certification [4 Certification Exam(s) ]
The-Open-Group [8 Certification Exam(s) ]
TIA [3 Certification Exam(s) ]
Tibco [18 Certification Exam(s) ]
Trainers [3 Certification Exam(s) ]
Trend [1 Certification Exam(s) ]
TruSecure [1 Certification Exam(s) ]
USMLE [1 Certification Exam(s) ]
VCE [6 Certification Exam(s) ]
Veeam [2 Certification Exam(s) ]
Veritas [33 Certification Exam(s) ]
Vmware [58 Certification Exam(s) ]
Wonderlic [2 Certification Exam(s) ]
Worldatwork [2 Certification Exam(s) ]
XML-Master [3 Certification Exam(s) ]
Zend [6 Certification Exam(s) ]
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