Prospective audit on the use of the LMA-SupremeTMfor

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信息安全工程师测试题(35个选择题5个简答题)-企事业内部考试IT试卷与试题

12. 网络管理员为了监视和检查网络中的通信问题，会利用Windows系统自带的网络监视器来查看计算机的收发数据包情况，那么网络监视器可以捕获的数据包有。[2分]-----正确答案(正确答案：A) A 本地计算机上发送和接收的单播数据包 B 网络中任何一台计算机收发的数据包 C 本机计算机上的收发的广播数据包 D 与本地计算机在同一网段的所有计算机收发的数据包
姓名：
一、选择题
1. 信息安全最关心的三个属性是什么？[2分]-----正确答案(正确答案：ABE) A Confidentiality B Integrity C Authentication D Authorization E Availability
2. 用哪些技术措施可以有效地防御通过伪造保留IP地址而实施的攻击。[2分]-----正确答案(正确答案：ABC) A 边界路由器上设置ACLs B 入侵检测系统 C 防火墙策略设置 D 数据加密 E无
8. 数字签名是用于保障[2分]-----正确答案(正确答案：D) A 机密性 B 完整性 C 认证性 D 不可否认性
9. 网络攻击者在局域网内进行嗅探，利用的是网卡的特性是[2分]-----正确答案(正确答案：D) A 广播方式 B 组播方式 C 直接方式 D 混杂模式
10. 你是一台Windows系统的管理员，出于安全性的考虑，你希望如果用户连续三次输入错误的密码，就将该用户账号锁定，应该采取（）措施 [2分]-----正确答案(正确答案：A)
13. 对于Winidows系统，以下做法有利于提高计算机的安全性。[2分]-----正确答案(正确答案：BC) A 尽量启用更多的服务 B 重命名Administrator帐户 C 及时下载并安装操作系统漏洞补丁 D 关闭所有的杀毒软件和防火墙

2020考研英语词汇：audit的翻译解析

2020考研英语词汇：audit的翻译解析考研英语有许多题目组成，方便大家及时了解，下面为你精心准备了“2020考研英语词汇：audit的翻译解析”，持续关注本站将可以持续获取的考试资讯!2020考研英语词汇：audit的翻译解析audit是什么意思及用法名词稽核，查帐v.1.及物动词：稽核，旁听2.不及物动词：查账词形变化形容词auditable时态audited，auditing，audits英语解释a methodical examination or review of a condition or situationattend academic courses without getting creditexamine carefully for accuracy with the intent of verificationan inspection of the accounting procedures and recordsby a trained accountant or CPA例句Behind them, the door opened and Mr. Bell, the chief auditor, put his head into the room在他们背后，门开了，审计主任贝尔先生将头伸进屋来。

Therefore, persons outside the business, such as bankers, investors and government officials, attach great importance to the auditor's report.因此,企业外部的人们,如银行家、投资者和政府官员都把审计师的报告放在极其重要的位置。

"Floor levels in a large auditorium may include stalls, private boxes, dress circle, balcony or upper circle, and gallery."大型观众厅的几层楼座包括池座、包厢、花楼、阳台或上层和走廊。

校园是否该向游客开放英语作文

校园是否该向游客开放英语作文Here is an essay on the topic of whether campuses should be open to visitors, written in English with more than 1000 words as requested, without any additional title or superfluous punctuation marks.Campuses are often considered sacred spaces where students can focus on their studies and personal growth away from the distractions of the outside world. However in recent years there has been a growing trend towards opening up these academic enclaves to the general public in the form of campus tours guided by current students or faculty members. This practice raises the question of whether campuses should be more accessible to visitors or maintain their protected status as private institutions of higher learning. There are valid arguments on both sides of this debate that merit careful consideration.Proponents of opening up campuses to the public cite a number of potential benefits. One of the primary arguments is that allowing visitors onto campus can serve as an effective recruitment tool for attracting prospective students. Many high school students and their families are eager to get a firsthand look at the colleges anduniversities they are considering applying to. Campus tours give them the opportunity to experience the atmosphere and amenities of a school, which can be a key factor in their ultimate decision. Exposure to current students and faculty also allows applicants to get a sense of the academic and social culture on campus. This insider perspective can be invaluable when trying to determine if a particular institution is the right fit. Furthermore open campuses can boost enrollment by sparking the interest of students who may not have previously considered that school as an option.In addition to recruitment benefits, proponents argue that open campuses can have a positive impact on the surrounding community. When visitors come to campus, they often patronize local businesses in the area, providing an economic boost. This can be especially beneficial for colleges and universities located in small towns or rural areas where the school may be one of the primary drivers of the local economy. Campus tours and events can also give community members a chance to engage with the intellectual and cultural resources available at the institution, fostering greater town-gown relations.Supporters of open campuses also note the educational value that visitors can derive from experiencing university life firsthand. High school students in particular can gain valuable insights by observing college classrooms, speaking with professors, and getting a feel forcampus life. This exposure can help demystify the transition to higher education and inspire younger students to pursue their own academic ambitions. Lifelong learners in the broader public may also appreciate the opportunity to audit lectures, attend public events, or simply explore the campus grounds.On the other hand, critics of open campuses argue that unrestricted access can compromise the safety and security of students, faculty, and staff. With more people coming and going, there is an increased risk of theft, vandalism, and other disruptive or dangerous behavior. Campuses must then invest significant resources into beefing up security measures, which can be a significant financial burden. There are also concerns that the presence of visitors could distract from the core educational mission of the institution, as professors may have to adjust their teaching styles or limit sensitive discussions in the presence of outsiders.Another potential downside is that open campuses can diminish the sense of community and belonging that students derive from their academic environment. When a campus feels more like a public space than a private sanctuary, it can be harder for individuals to form the meaningful connections and sense of ownership that are crucial for personal growth and academic success. This could be especially problematic for first-year students who are still transitioning to university life.Critics also point out that many of the proposed benefits of open campuses, such as recruitment and community engagement, can be achieved through other means that do not require unfettered access. Virtual campus tours, specialized open house events, and targeted outreach programs can allow prospective students and community members to engage with the institution without disrupting the daily rhythms of campus life.Ultimately, the decision of whether to open up a campus to the general public is a complex one that requires carefully weighing the potential pros and cons. There are valid arguments on both sides, and institutions must consider their unique circumstances, resources, and priorities when determining the appropriate level of access. What may work well for a large urban university may not be the best fit for a small liberal arts college. As with many aspects of higher education, there is no one-size-fits-all solution.That said, on balance, the benefits of open campuses seem to outweigh the drawbacks, provided that institutions implement appropriate security measures and visitor management protocols. The educational and community-building opportunities afforded by campus tours and events are simply too valuable to dismiss, especially in an era of declining college enrollment. With the right safeguards in place, campuses can remain sanctuaries for studentswhile also serving as welcoming gateways to the broader public. By striking this balance, colleges and universities can fulfill their dual missions of fostering academic excellence and enriching their surrounding communities.。

On the audit of internal control evaluation

On the audit of internal control evaluationcriteriaAbstract: Internal control is a modern enterprise macro-control and an important means of micro-management, internal control development situation, will directly influence and even determine the survival and sustainable development, it is necessary to improve the internal control audit. The content of the audit of internal control divided into internal financial accounting control and internal production and management control systems auditing. At this stage, the audit of internal control there are still many problems, in order to effectively audit of internal control, we must establish a relatively scientific audit evaluation criteria.First, the meaning of the internal control audit of internal control audit is an independent, objective assurance and consulting activity, the purpose is to increase the organizational value and improve an organization’s business, it is a through the system, standardized method for evaluating and improving the organization risk management, control andmanagement effectiveness of the process, help the organization achieve its objectives of management activities. internal control audit is set up by the internal audit of institutions and personnel, in accordance with scientific criteria and necessary procedures, the establishment of internal control which and implementation effectiveness and the factors that directly affect their effectiveness, the implementation of audit inspection and evaluation of audit activities. implementation of the internal control audit, you can expose and evaluate all aspects of internal control in all areas and levels of defects and problems, and propose improvement and adjustment, so as to promote business activities in the healthy operation of internal control, improve production efficiency and effectiveness of business activities and enhance the reliability of financial reporting, protection of enterprises of various assets and the safety and integrity of the property, and improving economic accounting quality and management, and business and the development of new planning and provide the scientific basis for management decisions. audit areas of economic oversight, internal control is management areas. With the development of the audit, the two are closely related. the one hand, modern audit is active inthe review process of the reasons for deviation from the target, the final analysis, the review of internal control system; the other hand, strict internal control system determines the quality of accounting information, of audit quality and efficiency of staff. the control system into full play depends on the internal audit, from the essence, the internal control system of internal audit is a special form.Second, the status of the internal control audit (A) the contents of an internal control audit. Internal financial accounting control audit. It includes: authority to authorize the control; segregation of duties control, that is, assets of the custody and accounting separation, economic activities and approved the execution and recording of separation, custody of assets separation of real reconciliation with the accounts; control separate accounting records; practical control; internal audit controls, etc. .2. internal production and management control systems auditing. It includes planning and control, production control, quality control, material inventory control and marketing products control. through the internal accounting control and production management control system to establish and improve the implementation of otheraspects of the review, find out the hidden dangers and abuses the weak link, and then determine the scope of the review, focus and methods. (b) the enterprise control many of the problems the audit that the auditors review the internal control system is redundant, there is not much effect, it is not necessary, do not recognize the impact of enterprise internal control is imperfect, there will be worried about internal control system review of higher risk; Some non-documented internal control within the enterprise system or internal control systems, and not scientific and reasonable, or in practice does not seriously carried out, come out of nowhere, there are chapters that do not follow; some companies the original no longer meet the internal control system development of the situation, non-existent, a mere formality; auditors sense of duty, and lack of in-depth investigation and analysis of audit results obtained there may be major omissions. It is because of the existence of these problems, it is necessary to correctly handle the internal audit , establish a set of national conditions of China, effective audit evaluation criteria. reposted elsewhere in the paper for free download Third, the audit of internal control evaluation criteria (A) the audit of internal control evaluation criteria of an essentialfactor. From the perspective of the organizational structure in the entire management system, organizational structure, management activities, the carrier is also the main carrier of internal control. Appropriate organizational structure should meet the company’s production and management features, firm size, corporate culture and development situation, the external environment, business development, corporate culture and so on. should be fully analyzed on the basis of the above factors, a reasonable set organizational system, the various institutions and positions, to distinguish powers and duties, so that all links in the appropriate agencies and staff. formulate strict rules and regulations and reasonable business processes, so that each employee to do his duty; clearly between the various agencies to contain and promote each other relations, so that each business process is composed of two or more organizations or positions in the mutual coordination and promotion and mutual restraint in the completion of .2. from the point of view of quality of employees of enterprises of all employees is the internal control shapers of the parties concerned, their professionalism, competence and work skills, innovation, etc. determine the effectiveness of internal control. companies operating from itsown characteristics, staff quality, the external environment, consider hiring the staff, professional and moral education and business training, job rotation, etc., clearly establish an effective mechanism to improve the quality of staff, to meet the company’s internal control system. staff is both the main control object is controlled, good corporate culture can be enterprise-specific values, environmental atmosphere as a means of self-restraint to urge the staff, enhance the cohesion, in a relaxed environment, give full play to the enthusiasm and creativity, therefore, positive corporate culture to enhance staff’s initiativ e and their quality is helpful .3. From the information point of view to effective implementation of internal controls, must be accurate, timely and maximize access to and use outside the enterprise and the enterprise from the relevant market, technology, management of information, to in-house vertical and horizontal effective transmission of information. senior management to present their information to the employee responsibilities and performance requirements, each organization and employees understand their position in the information transmission in the entire enterprise should have a bottom-up, top-down and horizontal effective way to pass the information andmechanisms. the only way for the establishment of relevant management and staff, improve the internal control system and corporate culture, and as fully as possible to provide the necessary basis for .4. From a risk management point of view of any company in the business process inevitably exist in both business risk and financial risk, timely forecasts and found that the risk can take steps to avoid risk, avoid or reduce losses, and even the risks into opportunities. enterprises to continue to find the internal control of all aspects of the risk of potential or apparent and to take measures for effective management, which is to control other elements of internal control. Thus, the scientific risk management can contribute to the improvement of internal control system .5. From the perspective of an effective incentive mechanism to reward and punishment mechanism can company’s internal organization, job or even maintain the overall behavior of the same corporate goals. First, the organization and the different positions have different assessment methods, the distinction between job performance rating, given economic and non economic rewards and punishments; s Second, employee participation in goal-setting organizations, detailed objectives at all levels, so that employees play in the work of intelligence, the fullrealization of objectives at all levels; third, to formulate a scientific and rational financial policies, accounting policies and cost policies, according to the actual situation, specific and strict financial policy implementation, promote the business goals; Fourth, the timely, systematic and scientific collection, processing, storage, output and business-related statistical data, particularly to provide scientific oversight, early warning, suspension signal, for the parties to provide the scientific basis for decision-making; Finally, each of the economic activities and management activities, whether ordinary or senior management staff, the powers and responsibilities must be clear, rational authority and responsibilities to be highly consistent with each other rather than separation. (b) learn from foreign experience and improve the evaluation of internal control auditing standard on internal control auditor to evaluate the objective was to determine the audited entity internal control and reliability improvement, in order to determine its dependence, as originally proposed audit program, or modify the conclusions of the original program. to work in the audit of the financial activities of the audited units to prevent and correct self-Cuobi ability to make the audit of internal control risk assessment.our country, should learn from foreign advanced experience, combined with our actual situation, and gradually develop a set of realistic internal control activities of the audit evaluation criteria .1. “Standard Model〞of the evaluation criteria established by supreme audit institutions of evaluation criteria to evaluate the two major areas : First, the internal control system based on the settings related to the situation, make sound or part of the sound, not a sound evaluation; the second is based on the implementation of related internal controls to make effective or partially effective, ineffective evaluation. evaluation of the integrity of the internal control system include the following: First, pay attention to systematic. on the human, financial, material, information and timely control of these elements; various aspects of capital campaign for control of various aspects of production and marketing; the most important thing is to include both the systematic control of business control activities, but also including the management activities of control. Second, the emphasis on science. internal control content must be scientific and rational, in line with the objective laws of science, the right way, rights and responsibilities clear. Again, pay attention to hierarchy. like the same organizational structure, internal control must belayered, vertical horizontal level should be clear, on the lower level have both common principles and requirements of various departments and also to have their own specific measures and methods. Finally, pay attention to coordination. coordination of the internal control objectives required consistent with their overall objectives; different levels of internal control to link up and down the same; the same level of internal control does not conflict with each other and contradictions. evaluation of the effectiveness of internal control system include the following aspects: First, implementation. is essentially to control the quality and experience of the main conditions, can achieve the control performance evaluation. Second, the effectiveness of the assessment. The ultimate goal is to establish internal controls to improve the economic efficiency of enterprises, each of which internal control evaluation criteria should focus on efficiency of , the control point of mutual restraint, mutual promotion, to improve the management, error correction .2 variety of measures. “ideal control model〞evaluation criteria “ideal control mode,〞the standards are based on the experience of audit staff to set and require comprehensive audit staff consider the various factors and accumulatedexperience. Western countries experience a longer period the audit concluded, based on the establishment of a more common mode of the ideal control, as the evaluation of internal control standards in the industry. After a long exploration of the auditors, also developed a set of preliminary typical for our country than the sound, the feasibility of a strong control mode, as the existing internal control evaluation criteria. such as financial processing control system, monetary funds control system, the settlement of internal control systems, production and marketing costs of internal control systems, fixed assets and intangible assets and deferred system of internal controls, investment and financing system of internal controls, internal control systems, computer management. In summary, internal control is to a certain social and economic development stage of the product, with the constant improvement of the socialist market economy, but also shows that the objective to establish and improve internal control systems of urgency. It is based on the internal control system, an important practical significance and role of the highlights of the internal audit activities importance. Therefore, the need for internal control audits, and effective internal control audit, you must create a relatively scientificevaluation criteria.References: [1] Liu Xiufen. On the significance of the internal control audit and the role of [J]. North China Electric Power University: Social Sciences, 2002.[2] Xiaowen Jiang, Rong-qiang. Audit and internal control system of relations [J]. Accounting management, 2004, (5).[3] Chen Fengquan. How to avoid the internal audit risk [J]. China Coal Geology, 2004, (12).[4] Wang Wendi. The evaluation of internal control auditing standard [J]. Audit Research, 2003, (6).[5] Zhou Haoyu. On the audit of internal control evaluation criteria [J]. Audit Research, 2003.Links to free paper download ://eng.。

Auditing：Engagement Planning

3-5
Engagement Letters
• When a new client is accepted or when an audit engagement continues from year to year, an engagement letter should be prepared. • Acts as a contract between auditor and client. • Serves as a means of reducing the risk of misunderstandings with the client and as a means of avoiding legal liability for claims that the auditors did not perform the work promised • Should include: – Objectives of the engagement – Management’s responsibilities – Auditors’ responsibilities – Any limitations of the engagement
3-8
Considering the Work of Internal Auditors
• Must obtain an understanding of a client’s internal audit department and its work • Audit efficiency can be realized when the two groups work together • Prior to using the work of internal auditors, external auditors should consider internal auditors’ objectivity and competence • Internal auditors should not be delegated tasks that require extensive professional judgment

CCAA《审计学》测试题及解答英文版

CCAA《审计学》测试题及解答英文版CCAA "Auditing" Test Questions and Answers1. What is the purpose of an audit?The purpose of an audit is to provide an independent assessment of an organization's financial statements to ensure they are free from material misstatement.2. What are the main types of audit evidence?The main types of audit evidence include physical examination, confirmation, documentation, observation, analytical procedures, and inquiries.3. What are the key components of the audit process?The key components of the audit process include planning, risk assessment, testing of controls, substantive procedures, and reporting.4. Explain the concept of materiality in auditing.Materiality in auditing refers to the significance of an item or an error in the financial statements that could influence the decisions of users. Auditors consider materiality when planning and performing an audit.5. What is the role of internal controls in an audit?Internal controls are processes implemented by management to provide reasonable assurance regarding the reliability of financial reporting and the effectiveness and efficiency of operations. Auditors assess the effectiveness of internal controls to determine the nature, timing, and extent of audit procedures.6. Describe the difference between a compliance audit and a financial statement audit.A compliance audit focuses on verifying whether an organization is following specific laws, regulations, or policies, while a financial statement audit examines the accuracy and completeness of an organization's financial statements.7. How do auditors assess audit risk?Auditors assess audit risk by considering inherent risk, control risk, and detection risk. The combination of these risks determines the overall risk of material misstatement in the financial statements.8. Explain the concept of independence in auditing.Independence in auditing refers to the auditor's ability to perform an audit without being influenced by relationships or conflicts of interest. It is essential for auditors to maintain independence to ensure the integrity and credibility of the audit process.9. What are the different types of audit reports?The different types of audit reports include unmodified (clean), qualified, adverse, and disclaimer of opinion. The type of report issued by auditors depends on their findings during the audit.10. How do auditors communicate audit findings to stakeholders?Auditors communicate audit findings through the audit report, which includes the auditor's opinion on the financial statements, key audit matters, and any significant issues identified during the audit.Stakeholders use this information to make informed decisions about the organization.These are some of the key concepts and topics related to auditing that are often covered in the CCAA "Auditing" test. Understanding these concepts can help prepare you for the exam and enhance your knowledge of auditing principles and practices.。

IECEx系统操作指南：有关在可爆性环境中使用设备的认证标准的认可的认证机构说明书

INTERNATIONAL ELECTROTECHNICAL COMMISSION SYSTEMFOR CERTIFICATION TO STANDARDS RELATING TO EQUIPMENT FOR USE IN EXPLOSIVE ATMOSPHERES (IECEx SYSTEM)Title: Draft Operational Document Ex OD 501 Assessment Procedures for IECEx acceptance of Certification Bodies (ExCBs) for the purpose of issuing and maintaining IECEx Certificates of Personnel CompetenciesCirculated to: IECEx Management Committee, ExMCINTRODUCTIONDraft Document ExMC/516/CD was prepared by ExMC WG12 during its February 2009 meeting and submitted to ExMC members for comment in March 2009. Comments received from members were collated and circulated as document ExMC/528A/CC.ExMC WG12 held a further 3 day meeting in Singapore during 23 – 25 June 2009 to consider the comments and necessary changes to the document.This document, ExMC/516A/DV incorporates the changes determined during the Singapore WG12 meeting and sets out the proposed Assessment Procedures for acceptance and on-going assessments of Bodies seeking to become ExCBs for the purpose of the IECEx Certificate of Personnel Competency Scheme, OD 501. Refer to ExMC/528A/CC for WG12 responses to comments.This document is issued to ExMC for final approval. Please submit your vote to the IECEx Secretariat by 21st August 2009 using the following voting form.The results of the voting will be reported during ExMC Melbourne 2009 September Meeting. Therefore we seek your assistance for return of the vote by the due date. Main changes to ExMC/516/CD incorporated in this updated version, ExMC/516A/DV include:¾Applications from prospective ExCBs to be endorsed by the IECEx Member Body prior to being accepted by the IECEx Secretariat (Step 1 Sect 1) ¾Review of flowchart to ensure consistency with table.¾Expansion of the assessment process of Step 7 Sect 1 concerning assessment of a CBs documentation, prior to proceeding further with the assessment.¾Expansion of introduction in Section 2 “On-Going Assessments” to require that the ExCB maintains their facilities “relating to assessing demonstration of craftskills”¾ A note added to A6 to clarify cases where CBs have limited experience in this area but yet possess necessary technical capabilityChris AgiusIECEx SecretariatAddress:SAI Global Building 286 Sussex Street Sydney NSW 2000 Australia Contact Details:Tel: +61 2 8206 6940Fax: +61 2 8206 6272e-mail:********************* Draft OD 501Edition 1.0 200x-xx IECExDraft Operational DocumentIECEx Scheme for Certification of Personnel Competencies for Explosive AtmospheresIECEx OD 501Assessment Procedures for IECEx acceptance ofCertification Bodies (ExCBs) for the purpose of issuing and maintaining IECEx Certificates of Personnel CompetenciesINTERNATIONAL ELECTROTECHNICAL COMMISSIONDraft IECEx OPERATIONAL DOCUMENTIECEx Scheme for Certification ofPersonnel Competency for Explosive AtmospheresEx OD 501 Edition 1.0Assessment Procedures for IECEx acceptance ofCertification Bodies (ExCBs) for the purpose of issuing andmaintaining IECEx Certificates of Personnel CompetenciesThis Draft Operational Document, OD 501 sets out the procedures for the assessment and acceptance of Certification Bodies seeking to become ExCBs for the purpose of operating under the IECEx Certificates of Personnel Competencies Scheme, IECEx 05.Document HistoryDate Summary 2009 XX Original Issue (Edition 1)INTRODUCTIONThis document details the assessment procedures established by the IECEx System’s Management Committee, ExMC, for the purpose of ensuring a thorough assessment of candidate ExCBs. The principle aim of these procedures is to instil international confidence in the ExCB’s competence and capabilities for performing assessment and maintaining IECEx Certificates of Personnel Competencies whom seek IECEx Certification.The assessment is to cover the competence, experience and familiarity of ExCB personnel and the organisation with the relevant explosive atmosphere standards, quality management systems, IECEx System and associated rules, ISO/IEC Guide 65, ISO/IEC 17024 and IECEx technical guidance documents. The procedures are also aimed at ensuring a consistent approach to assessments by IECEx assessment teams and therefore establishing confidence in the scheme.This document provides the following Section:Section 1 Initial Assessment and Re-Assessment of ExCBsSection 2 On going Surveillance of ExCBNOTE: A simple change of scope for an existing ExCB is not seen as viable due to the entirely different requirements used for Personnel Certification.The procedures are set out in table form identifying:⎯ Step number⎯ Required action⎯Responsible person or party⎯ Desired outcomeThe steps identified in the table correspond to the steps shown in the flowchart.INTERNATIONAL ELECTROTECHNICAL COMMISSIONDraft IECEx OPERATIONAL DOCUMENTIECEx Scheme for Certification ofPersonnel Competency for Explosive AtmospheresOD 501Assessment Procedures for IECEx acceptance ofCertification Bodies (ExCBs) for the purpose of issuing andmaintaining IECEx Certificates of Personnel Competencies1 INITIAL ASSESSMENT & RE-ASSESSMENTThis Section is to be applied for the initial assessment of ExCBs prior to their acceptance in the IECEx Certificate of Personnel Competency [CoPC] Scheme and re-assessment of existing ExCBs. The term Lead Assessor, as used throughout this document, shall mean the IECEx Assessment Team Leader appointed by the ExMC Secretary and endorsed by ExMC. Steps 1 – 4 are applicable to new applications.IECEx Assessment Flow Chart (Refer to table for details of each stepStep Activity By Whom Desired Outcome Formal Application Submitted to ExMC Secretary1 Application endorsed by Member Body prior tobeing received by ExMC Secretary, in accordancewith IECEx 05ExMC Secretary Candidate ExCB2 Application assessed for completeness andAssessment Team appointed. ExMC Secretary Assessment team proposed byIECEx Secretary3 ExMC Secretary reviews applicationdocumentation for completeness. ExMC Secretarymay request further information from thecandidate. ExMC Secretary to report findings tocandidate ExCBExMC Secretary4 ExMC Secretary forwards Application package toMembers of the appointed Assessment Team ExMC Secretary All relevant informationavailable for team to commencetheir assessmentDocumentation Review Stage5 IECEx Assessment Team commencesassessment. Team Leader, in conjunction withteam members reviews application documentationto satisfy steps 6 to 8. Team Leader may requestadditional information from the Candidate ExCB Team Leader toManageTeam Leader notifies candidateof successful review ofdocumentation and thenprepares to arrange site visit6 Team Leader, in conjunction with team membersdetermines whether the applicant ExCB hasIndependent Accreditation Team Leader orhis designateFormal notification ofaccreditation, with a copy beingsubmitted by the applicant7 Assessment of the accreditation and credentials ofthe accreditation body. For example determining:*Whether the body has Mutual RecognitionAgreements with other bodies*Whether the body has National Governmentrecognition*What Standards or Guides are usedIECEx Assessment Team Leader may obtaininformation directly from accreditation body orcandidate ExCB and circulate to other IECExAssessment team members for review viacorrespondence.Note: ExCB should obtain all necessaryinformation from accreditation body forpresentation to IECEx Assessment Team Leader.The assessment of the documentation shallestablish that the CB has the competence relatedto the particular aspects of hazardous areacompetence they will be issuing. This will includeany facilities provided for demonstration of craftskills”Note:” This may need to provide CV’s of particularpeople used in competency assessment activities.Team Leader *Verification of MRAs*Notification of Governmentrecognition*Use ofIECEx 01, Basic Rules of theIECEx System.ISO/IEC Guide 2,Standardization and relatedactivities - General vocabulary.ISO/IEC 17000 ConformityAssessment – Vocabulary andgeneral principlesISO/IEC 17024 ConformityAssessment – Generalrequirements for bodiesoperating certification ofpersons*Frequency of surveillanceaudits.8 Review of past audit reports, issued by theaccreditation body, by Assessment Team toestablish compliance with the requirements ofIECEx 05, and Documents, ISO/IEC Guide 2,ISO/IEC 17000 and ISO/IEC 17024 relevant. Assessment Teammanaged byTeam LeaderAcceptance by IECExAssessment Team ofinformation and audit reports asevidence of compliance to therequirements of IECEx 05,ISO/IEC Guide 2 and ISO/IEC170249 Notification of results of step 6-8 to candidateExCB Team Leader Letter, Fax or e-mail toCandidate ExCB. Copy toExMC SecretaryOn-site VisitStep ActivityBy Whom Desired Outcome10A minimum of one representative of the IECEx Assessment Team visits candidate to conduct a minimum 1 day site visit for each ExCBapplication. This visit is to verify implementation of certification or auditing proceduresAt least 1 person from IECExAssessment Team Usually Team LeaderVisit notes to be included in assessment file.Team Leader in consultation with his Team shall decide if more than 1 man day visit is necessary.11Results of site visit determined with a final report for submission to the ExMC Secretary prepared in the format as outlined in Annex A. Final report to be reviewed by all members of the assessment teamTeam LeaderTeam Leader to commence arrange for a final assessment report compiling a Report12 Final IECEx Assessment Team Report Reviewed by ExMC Secretary.ExMC SecretaryReview by ExMC Secretary to ensure completeness of information and ready forcirculation to ExMC for voting. 13ExMC Secretary prepares Report for voting and submits to ExMC Members for formal voting, via correspondence or at the next ExMC meeting. ExMC SecretaryExMC Document issued forvoting, with a copy submitted to candidate ExCBFinal Approval of ExCB by ExMC14 Assessment of report considered by ExMCmembers with members returning the completed voting form to the ExMC Secretary as soon as possible and by due date ExMC MembersMajority acceptance voteapproves application (re Clause 12.2 of IECEx 01)15 If voting is acceptable then ExMC Secretary notifies applicant of their acceptance ExMC Secretary ExMC Letter to accepted ExCB 16 Appointment recorded at next ExMC meeting ExMC Secretary to arrange Recorded in Minutes 17Where review in step 12 is unsatisfactory, ExMC Secretary refers the matter to the IECExAssessment Team Leader seeking additional information or revised reportExMC SecretaryAn acceptable report for circulation to ExMC18Where a positive vote, in accordance with IECEx 01 is not achieved the application is then referred to the next ExMC meeting for discussionExMC Secretary to arrange Findings recorded in the minutes19If at the conclusion of the “Document Review Stage’, the Assessment Team are not satisfied with the information presented, the Team Leader shall inform the candidate ExCB and ExMC Secretary of the Assessment team’s views. In order for the assessment to proceed, the IECEx Assessment Team may be required to conduct a full on site assessment in accordance with IECEx 05 and Technical Guidance Documents, ISO/IEC Guide 2, ISO/IEC 17000 and ISO/IEC 17024 as applicable.Team Leader to manageAssessment report by Team Leader20 Where non-conformances are identified during the assessment process the candidate ExCB implements corrective action if they wish to proceed with their applicationCandidate ExCBImplementation of corrective actions21Assessment team assesses corrective action. This may be performed by either the full team or a partial team or even one member of the team Team Leader to manage Report on assessment of corrective actions22Notification of results of step 5 to candidate ExCB and IECEx ChairmanTeam LeaderLetter, Fax or e-mail toChairman of Assessing Panel2 ON GOING ASSESSMENTSThis Section applies to ExCBs that have been accepted into the IECEx CoPC Scheme for the scope of issuing of IECEx Certification of Personnel Competencies to provide cross-industry competencies needed for work associated with equipment for hazardous areas. The purpose of on-going assessments is to satisfy the International Ex community that ExCBs maintain their facilities relating to assessing demonstration of craft skills and capabilities that enabled their entry into the Scheme.2.1 Surveillance of ExCBs with National Accreditation acceptable by ExMC2.1.1 ScopeThis section covers ExCBs that maintain national accreditation found to be acceptable by the original IECEx Assessment Team, and by way of ExMC voting on the initial assessment report, the ExMC. The procedures detailed below are general and ALL ExCBs are reminded of their obligations to notify the IECEx Secretariat of any changes within their organisation that may impact on their ability to deliver IECEx Certification Services in accordance with IECEx Rules and Operational Documents and in the spirit of a timely and professional service delivery.2.1.2 ProceduresEach year, prior to the anniversary date of acceptance into the IECEx System, ExCBs shall submit to the ExMC Secretary a report containing the following information:a) Any changes in the organisationDescription of changes in the organisation of the ExCB, its staff, facilities, quality system, operating procedures, or other similar changes, that relate to the ExCB’s operation under IECEx05.ANDb) Annual audit reportCopy of a National Accreditation Body’s audit report issued during the preceding 12 months. This report should show:⎯Site that was audited by the accreditation body⎯Date and duration of the audit⎯ Audit scope⎯ISO/IEC Guides, Standards and IECEx Technical Guidance Documents used during the audit⎯ Observation notes⎯Details of any non-conformances raised⎯Copy of any audit report summaryORc) Report by the ExCB based on its own internal audit(s) carried out during the preceding 12months. A standardised report format should be used for this purpose. Once every two years, the report, prepared by the ExCB shall be endorsed by the National Accreditation Body.Item a) is mandatory and either b) or c) is applicable.2.1.3 ReviewThe ExMC Secretary shall review the information to ensure:⎯Site assessed aligns with the site previously approved by ExMC;⎯All Clauses of ISO/IEC Guide 2, ISO/IEC 17000 and ISO/IEC 17024, as applicable, have been covered;⎯Ensure that Technical Guidance Documents have been used (where available);⎯Any Non-Conformances are identified;Where major Non-Conformances have been identified the ExMC Secretary in consultation with the IECEx Assessor Panel Chairman shall propose appropriate action to be taken, with the IECEx Officers to decide on such action and report at the next ExMC meeting. Where the ExCB does not agree with the course of action, the matter may be referred to the IECEx Board of Appeals, if requested by the ExCB. During the period of referral to the Board of Appeal, the ExMC Chairman in consultation with the other IECEx Officers shall decide on the status of the ExCB in question. In extreme circumstances the status of temporary suspension may be considered. The ExMC is to decide on the final action to be taken.The Secretary will retain a copy of the report, for a minimum of 10 years, for record keeping purposes.2.1.4 Re-assessmentOn the 5th anniversary of the acceptance of the ExCB, or re-assessment of an ExCB, a re-assessment in accordance with the assessment procedure detailed in Section 1 shall be performed by an IECEx Assessment Team appointed by ExMC.2.2 Surveillance of ExCBs without National Accreditation acceptable by ExMC2.2.1 ScopeThis section covers ExCBs that do not have national accreditation but who have been accepted in to the IECEx System by way of a full on-site assessment, by the IECEx Assessment Team.audit2.2.2 On-siteExCBs shall arrange to have one member of the original IECEx assessment team conduct an annual on-site audit. The assessor shall be appointed by the IECEx Assessment Team Leader responsible for the original assessment. The ExCB shall agree to bear the costs associated with this on-site audit.The appointed assessor shall carry out an assessment for compliance with ISO/IEC Guide 2, ISO/IEC 17000 & ISO/IEC 17024 and IECEx System Rules. The Team Leader will then issue a report.Where the original assessment team is no longer available a new assessment team shall be appointed by the ExMC.These reports shall be forwarded to the ExMC Secretary who shall review them for completeness and any non-conformances. Where non-conformances have not been identified the reports shall be retained, for a minimum of 10 years, for record keeping purposes, by the ExMC Secretary.2.2.3 Non-conformancesWhere Non-Conformances have been identified the reports shall be referred to the ExMC Secretary who shall consult with IECEx Officers who shall propose appropriate action to be taken and report at the next ExMC meeting. Where the ExCB does not agree with the course of action, proposed, the matter may be referred to the ExMC or IECEx Board of Appeal. During the period of referral to ExMC, the ExMC Chairman in consultation with the other IECEx Officers shall decide on the status of the ExCB in question. In extreme circumstances the status of temporary suspension may be considered. The ExMC will then decide on the final action to be taken.anniversary2.2.4 FifthOn the 5th anniversary of the acceptance of the ExCB, or re-assessment of an ExCB, a reassessment in accordance with the assessment procedure detailed in Section 1 shall be performed by an IECEx assessment team appointed by the ExMC.Annex AIECEx ASSESSMENT REPORT FORMFor ExCB(IECEx Certification Body –for Certification of Personnel Competencies Scheme) Type of Assessment:⎯Initial Assessment for Candidate ExCB⎯Surveillance Assessment for existing ExCBA.1 OBJECT AND FIELD OF APPLICATION..........................................................................................................................................................................................................................................................................................................................................................................................A.1.1 Country:..............................................................................................................................A.1.2 Name of Candidate ExCB............................................................................................................................................................................................................................................................A.1.3 Members Of The Assessment Team..........................................................................................................................................................................................................................................................................................................................................................................................A.1.4 Place And Date Of Assessment......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ReferencesA.1.5 AssessmentDocument:i) IECEx 05ii) IECEx Operational Document OD 503iii) IECEx Operational Document OD 501, OD 502 & OD 504iv) ISO/IEC 17000 & ISO/IEC 17024v) ExCB application documents datedOfApplicationA.1.6 ScopeIndicate whether this is an extension of scope for an already accepted ExCB (include detailsof existing acceptance)Category StandardCompetencyGeneral Requirements ISO/IEC 17024 .....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................(List all Standards within scope of application or acceptance within IECEx)A.1.7 Candidate ExCB Persons InterviewedName Position ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................A.1.8 Legal Entity Of The Candidate ExCB..........................................................................................................................................................................................................................................................................................................................................................................................A.1.9 Any Associated Testing OrganizationsNames of Organization Address ..........................................................................................................................................................................................................................................................................................................................................................................................A.1.10 Associated Certification Functions..........................................................................................................................................................................................................................................................................................................................................................................................A.1.11 National Marks And Certificates........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................A.1.12 Financial Support..........................................................................................................................................................................................................................................................................................................................................................................................A.1.13 History....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................A.1.14 Standards Accepted................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................A.1.15 National Differences in addition to IEC Standards..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................A.2 ORGANISATIONA.2.1 Names, Titles And Experience Of The Senior ExecutivesName Title Experience ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................A.2.2 Name, Title And Experience of The Quality Management RepresentativeName Title Experience ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................。

2023年度内审员考试题库英文版

2023年度内审员考试题库英文版2023 Internal Auditor Exam Question BankHello and welcome to the 2023 Internal Auditor Exam Question Bank! In this document, you will find a comprehensive collection of questions that may appear on the exam. These questions cover a wide range of topics related to internal auditing, including risk assessment, control activities, audit evidence, and more.Please use this question bank as a study tool to help you prepare for the exam. Make sure to challenge yourself with a variety of questions to test your knowledge and understanding of internal auditing principles. Good luck with your exam preparation!1. What is the purpose of risk assessment in internal auditing?2. Explain the difference between preventive and detective control activities.3. How does an internal auditor gather audit evidence during an audit engagement?4. Describe the importance of independence in the internal audit function.5. Discuss the role of internal auditors in evaluating the effectiveness of internal controls.6. How can internal auditors contribute to the improvement of an organization's risk management processes?7. What are the key steps in the internal audit process?8. Explain the concept of materiality in the context of internal auditing.9. How do internal auditors ensure the confidentiality of audit information?10. Describe the relationship between internal audit and external audit functions.These are just a few examples of the types of questions you may encounter on the exam. Remember to study diligently and practice answering different types of questions to ensure you are fully prepared. Good luck with your exam preparation!。

法考英语试题及答案

法考英语试题及答案一、选择题（每题2分，共20分）1. Which of the following is not a basic principle of the rule of law?A. Equality before the lawB. Legal supremacyC. Arbitrary powerD. Legal certainty2. The legal system of China is based on:A. The ConstitutionB. The Criminal LawC. The Civil LawD. The Administrative Law3. In the context of legal proceedings, which of the following is a fundamental right of the defendant?A. The right to remain silentB. The right to a fair trialC. The right to appealD. All of the above4. According to the principle of "innocent until proven guilty," the burden of proof lies with:A. The defendantB. The prosecutionC. The judgeD. The jury5. What is the term for the legal process of formally charging a person with a crime?A. ConvictionB. IndictmentC. SentencingD. Appeal二、填空题（每题1分，共10分）6. The ________ is the highest legislative body in China.7. The ________ is the basic law of the People's Republic of China.8. A legal contract is valid when it meets the requirements of ________, capacity, and form.9. The principle of ________ means that the law applies toall individuals equally.10. The ________ is the process of formally accusing someone of a crime in a court of law.三、简答题（每题5分，共20分）11. Explain the concept of "due process of law."12. What are the key elements of a valid contract?13. Describe the role of a public prosecutor in the criminal justice system.14. Discuss the importance of the presumption of innocence ina criminal trial.四、案例分析题（每题15分，共30分）15. Case Study: A man is accused of theft. He is arrested and detained without being informed of his rights. Discuss the potential legal issues with the arrest and detention process.16. Case Study: A company enters into a contract with a supplier, but the supplier fails to deliver the goods as agreed. Analyze the possible legal remedies available to the company.五、论述题（每题30分，共30分）17. Discuss the significance of the rule of law in a democratic society, including its impact on individual rights and the functioning of the government.答案：一、选择题1. C2. A3. D4. B5. B二、填空题6. National People's Congress7. Constitution8. legality9. equality10. prosecution三、简答题11. Due process of law refers to the legal procedures that must be followed in legal proceedings to ensure fairness and justice.12. Key elements of a valid contract include offer, acceptance, consideration, and mutual assent.13. The role of a public prosecutor includes investigating crimes, bringing charges against suspects, and presenting evidence in court.14. The presumption of innocence is crucial in a criminaltrial as it places the burden of proof on the prosecution and ensures that the accused is treated fairly.四、案例分析题15. The arrest and detention without informing the suspect of his rights may violate the principle of due process and the suspect's right to be informed of the charges against him. 16. Legal remedies for the company may include seeking specific performance, claiming damages, or rescinding the contract.五、论述题17. The rule of law is essential in a democratic society as it ensures that all individuals and institutions are subject to and equal before the law. It protects individual rights by providing a framework for resolving disputes and governs the actions of the government, preventing abuse of power and promoting accountability.。

喉罩的类型与型号选择新进展

喉罩的类型与型号选择新进展2019-10-18喉罩（Laryngeal Mask Airway，LMA）由英国⿇醉医⽣Archie Brain于1981年发明，是⼀种介于⽓管导管与⾯罩之间的通⽓⼯具，具有操作简便、放置成功率⾼、术后并发症少、对⽓道刺激⼩、⼼⾎管反应弱、可以保留⾃主呼吸维持⿇醉等优点，⽬前⼴泛⽤于国内外全⿇⼿术的⽓道管理、急症⽓道的处理和困难⽓道的插管[1]，由于喉罩的种类甚多，型号多样，如何根据⼿术选⽤⼀款最适合患者的喉罩，故很有必要对其类型和型号进⾏⼀个全⾯的介绍。

⼀、喉罩的类型喉罩的类型较多，本⽂根据喉罩的发展历史，可以将喉罩分为第⼀代喉罩、第⼆代喉罩、第三代喉罩和⽆套囊喉罩。

1. 第⼀代喉罩即标准型喉罩。

临床上主要有LMA-Classic，LMA-Flexible，LMA-Unique和LMA-Ambu AuraOnce。

LMA-Classic主要⽤于择期⾏四肢、体表、短⼩的⼿术，可保留⾃主呼吸或短时间的机械通⽓，也可以⽤于紧急⽓道，但其具有密封性差、可调整性差、防误吸能⼒差等缺点。

⽬前有8种型号可供选择。

LMA-Flexible主要⽤于⽿⿐喉科、头颈外科和⼝腔科⼿术的⿇醉。

LMA-Flexible的通⽓管长度增加使其对⼿术野的影响⼩，通⽓管⼝径较细，减少⼝腔内⼿术空间的占⽤，钢丝加强型通⽓管不易成⾓和堵塞，但其具有通⽓阻⼒较⾼、根据通⽓管位置不易判断通⽓罩的位置、不适⽤于困难⽓道、防误吸能⼒差等缺点。

⽬前有6种型号可供选择。

LMA-Unique是⼀次性使⽤的普通喉罩，罩囊由PVC材料制成，主要⽤于急救复苏和有传染病的患者，其优缺点与LMA-Classic相同，共有7种型号可供选择。

LMA-Ambu AuraOnce是Ambu公司于2004年上市的⼀次性单管喉罩，它的通⽓管被预塑成⼀定⾓度以便于置⼊喉罩，通⽓道末端⽆栅栏。

Ambu AuraOnce喉罩⼀次置⼊成功率与Classic喉罩相当[2]，置⼊时间短，⼝咽部漏⽓压⾼，可⽤于保留⾃主呼吸[3]和机械通⽓[4]的⿇醉。

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Prospective audit on the use of the LMA-Supreme TM for airway management of adult patients undergoing elective orthopaedic surgery in prone positionV.Sharma1,C.Verghese1*and P.J.McKenna21Department of Anaesthesia,Royal Berkshire NHS Foundation Trust,Reading RG15AN,UK2Royal Berkshire NHS Foundation Trust,Reading,UK*Corresponding author.E-mail:chandy.verghese@Key points†SLMA can be used as an airway managementdevice for patients under-going orthopaedic surgery in the prone position.†Insertion of the SLMA in the anaesthetized,pronepatient was successful in184of205patients at the ﬁrst attempt.†Minor airway problems were rectiﬁed in proneposition without turningpatients supine.†Regurgitation of gastric contents through LMAdrainage tube observed in four of205patients.There were no cases of clinicallyrelevant aspiration.Background.The LMA-Supreme TM(SLMA)is a single-use,latex-free,supraglottic airway device with a drain tube which allows immediate assessment of correct positioning of the device at insertion and throughout the procedure and provides access to gastric contents.The anatomically shaped airway tube facilitates easy insertion in anaesthetized patients in the supine,lateral,and prone positions.We present a prospective audit in205 consecutive adult patients presenting for elective spine surgery in the prone position. Patients positioned themselves in the prone position,on a Montreal or Wilson mattress to optimize patient comfort in this position.Anaesthesia was then induced,and an appropriate-sized SLMA was inserted.Methods.Prospective,descriptive audit of SLMA insertion in205consecutive adult patients, anaesthetized in the prone position for elective orthopaedic surgery with spontaneous (n¼6)or positive pressure ventilation(PPV)(n¼199).Results.First-pass success was achieved in184insertions.Forty-two SLMA insertions were performed by anaesthesia trainees withﬁrst-pass success achieved in38insertions.All problems encountered during insertion were minor,and no patient had to be turned to the supine position for an airway problem.Problems during insertion were independent of patients’BMI.There were no failures of SLMA insertion or of maintenance of PPV during surgery.Conclusions.The results suggest that the SLMA is a useful device for airway management in patients anaesthetized in the prone position and for subsequent airway management with PPV,with or without neuromuscular block.Keywords:anaesthesia,general;laryngeal mask;orthopaedic surgery;prone position Accepted for publication:9April2010The limitation of use of the laryngeal mask airway(LMA)for surgery in the prone position appears to be based on opinion rather than on available,published data.1The use of the Lar-yngeal Mask Airway-Classic TM(CLMA)in fasted patients in the prone position,with the head turned to either side, using recommended insertion techniques(the indexﬁnger or the‘thumb insertion’technique)has been previously described.23The CLMA has also been used for anaesthesia in the prone position for minor surgery.4The introduction of the re-usable LMAs with gastric access, the LMA-Proseal TM(PLMA)in20005and the single-use LMA-Supreme TM(SLMA)in2007,6has provided additional features to ensure successful use in a wider range of appli-cations than the CLMA.The SLMA has an anatomically shaped airway tube,a drain tube(DT),a modiﬁed inﬂatable cuff,an integral bite block,and aﬁxation tab(FT).6The airway and DT project from a manifold at the proximal end of the device.The anatomically shapedﬁrm airway tube, elliptical in cross-section,facilitates easy insertion and mini-mizes accidental rotation of the SLMA.The DT helps in immediate diagnosis of incorrect device placement and acts as a conduit for access to gastric contents.The DT runs along the posterior surface of the cuff and has an open end facing the oesophagus.The DT serves as a continu-ous clinical monitor during positive pressure ventilation(PPV), indicating whether the SLMA is correctly positioned.Malposi-tion of the SLMA during PPV results in a poor airway seal and an audible and immediately detectable leak of delivered gases through the DT,hence minimizing the possibility of gastric insufﬂation.6Twoﬁn-shaped structures extend on either side of the DT and prevent the epiglottis from occlud-ing the airway.An integral bite block and FT further aid easy insertion andﬁxation of the SLMA.A distance of1.5–2cm between the FT and the patient’s upper lip indicatesBritish Journal of Anaesthesia105(2):228–32(2010)Advance Access publication10June2010.doi:10.1093/bja/aeq118&The Author[2010].Published by Oxford University Press on behalf of the British Journal of Anaesthesia.All rights reserved. For Permissions,please email:journals.permissions@ by weibin chou on February 28, 2013 / Downloaded fromappropriate size of the SLMA,otherwise a different size may be chosen.A modiﬁed and enhanced inﬂatable cuff is designed to provide a superior anatomicalﬁt into the pharynx.The cuff has a conventionally placed inﬂation line terminating in a pilot balloon and a one-way valve for inﬂation and deﬂation of the mask.6Brimacombe and colleagues7in a retrospective audit described their experience with the insertion and mainten-ance of anaesthesia with the PLMA in245healthy adults in the prone position.More recently,Lopez and colleagues8 reported that the SLMA is easy to insert and suitable to manage the patient’s airway in the prone position.Insertion and removal of LMA devices causes less physiological conse-quences than those associated with a tracheal tube(TT),and thus offer an attractive alternative to the TT for airway man-agement in fasted patients undergoing surgery with PPV in the supine and prone positions.The CLMA,PLMA,and SLMA,unlike the TT,also provide a minimally invasive airway during the recovery phase after general anaesthesia.9 This prospective audit describes airway management after induction of anaesthesia and prone insertion of the SLMA TM in205consecutive adult patients for elective orthopaedic surgery on the spine.MethodsThe aim of this audit was to evaluate the safety,efﬁcacy,and complication rate associated with the use of SLMA TM in the prone position.The use of the PLMA TM and the SLMA TM for airway management after induction of anaesthesia in the prone position is an accepted practice at our institution. Our Local Research Ethics Committee advised us against the need for ethical approval and written informed consent since this was an audit of current practice against local stan-dards(i.e.the use of supraglottic airway devices by experi-enced users in adequately fasted adult patients for elective surgery)set at our institution.All adult patients meeting pre-operative fasting guidelines for elective surgery,ASA physical status I–III,presenting for elective orthopaedic surgery in the prone position were prospectively audited from Decem-ber2008to November2009,using the logbook of The Royal College of Anaesthetists(rca logbook v6and v7). Patients with documented gastro-oesophageal reﬂux disease and BMI up to55kg m22were included,in accord-ance with the current practice.Non-fasted,pregnant,paedia-tric(,16yr of age),and patients with BMI.55kg m22were considered ineligible for this audit.All patients received a detailed explanation of the posi-tioning procedure before induction of general anaesthesia. Patients were offered the option of having general anaesthe-sia induced in the supine position and subsequent position-ing to the prone position.After adopting the prone position,patients were requested to position their arms on either side,on a board,in a position that was most comfor-table.Care was taken to minimize damage to the brachial plexus and ulnar nerves,and patients’arms were reposi-tioned,as indicated,before induction of general anaesthesia.The patient was asked to indicate the most acceptable pos-ition of his/her face on the pillows(facing left,right,or central).Pillows were added or removed to maximize patient comfort in the prone position on the Montreal or Wilson mattress.In those who preferred to lie with the head in the neutral position,the forehead was supported on a donut head pad(Central Medical Supplies:Critical Care model number40204,40211)with care to prevent pressure on the orbit.Patients who agreed to induction of anaesthesia in the prone position but subsequently experienced difﬁculty in positioning themselves were anaesthetized in a position most comfortable to them(left or right lateral or supine pos-ition)and then turned to the prone position.Patient monitoring was instituted before induction of general anaesthesia,in accordance with recommendations of the Association of Anaesthetists of Great Britain and Ireland(AAGBI):three-lead ECG,peripheral pulse oximetry (S pO2),and non-invasive arterial pressure monitoring.These were monitored in all patients,using the Datex-Ohmeda Aestiva/5system(Datex Ohmeda,Helsinki,Finland).After appropriate positioning and establishment of monitoring, venous access was secured on the dorsum of the non-dominant hand.Additional venous access,as clinically indi-cated,was established after induction of anaesthesia. Patient’s lungs were preoxygenated via a face mask.After preoxygenation,anaesthesia was induced using midazolam 2mg(all patients),followed by fentanyl1–3m g kg21and propofol(2–3mg kg21).Jaw relaxation was assessed clini-cally,and additional doses of propofol were administered at the anaesthetist’s discretion to optimize jaw relaxation. Once acceptable jaw relaxation was obtained,the selected SLMA(size3–5)was inserted.This was achieved with the face facing to the left or right or by simply raising the head (central position),which caused the lower jaw to fall,allow-ing insertion of the tightly deﬂated SLMA TM.9The number of attempts for successful insertion was recorded(removal of the device from the mouth of the patient was recorded as an attempt),the manipulations required to achieve an acceptable airway,and reinsertions with either the initially chosen SLMA TM or one of a different size were recorded.The need to exchange the initial airway device for one with a larger or smaller size was determined by the distance of the FT from the upper alveolar margin.6The cuff was inﬂated to a volume required to allow PPV without a leak around it.Leaks through the DT conﬁrmed that the SLMA had not been inserted to the correct depth,and were cor-rected.Following veriﬁcation of the correct sizing of the SLMA(distance from the FT to the upper alveolar margin), PPV was established using volume-controlled ventilation (tidal volumes of5–8ml kg21)via the ventilator.The pressure–volume curves generated on the monitor were dis-played throughout the procedure.Discrepancies between inspired and expired tidal volumes(leak volume)and sudden increases in peak inspiratory pressures(PIP)were monitored,and manoeuvres required to correct these were recorded.Anaesthesia was maintained with oxygen/air and sevoﬂurane or desﬂurane(minimum alveolar concentrationProspective audit on the use of the SLMA BJA229 by weibin chou on February 28, 2013 / Downloaded from.1).Neuromuscular blockers were used if the pressure–volume curves revealed an obstructive pattern during PPV, despite adequate level of anaesthesia(minimum alveolar concentration.1).Patients undergoing minimally invasive surgery(facet joint injection,rhizolysis,etc.)lasting,20 min,in the prone position,were allowed to breathe spon-taneously,at the discretion of the anaesthetist.The duration of surgery(time of insertion of the SLMA to discharge to the recovery ward)was plications of airway maintenance and methods used to resolve these were recorded in the appropriate spaces provided in the logbook.Postoperative complications such as sore throat and difﬁculty in speaking and swallowing were entered in the logbook as free text.Data were recorded using the Royal College of Anaesthetists logbook v6and v7and trans-ferred to a spreadsheet program(Microsoft Ofﬁce Excel& 2003;Microsoft Corporation,Redmond,WA,USA). ResultsAll patients provided verbal consent to being awake and con-scious during positioning in the prone position before general anaesthesia,and there were no exclusions from this audit. One patient,who consented to prone positioning,was unable to comfortably position herself in the prone position, and in order to minimize discomfort,she accepted our sugges-tion that anaesthesia be induced in the left lateral position.Patient characteristics are presented in Table1.Seventy-nine patients were classiﬁed as obese(BMI≥30kg m22). Within this group,53patients were obese class I(BMI30–34.99kg m22),20patients were obese class II(BMI35–39.99kg m22),and six patients had a BMI≥40kg m22.Surgi-cal procedures included microdiscectomy,multiple level spinal decompression,and spinal fusion procedures.One hundred and ninety-nine patients underwent PPV,and neuro-muscular blocking drugs were used in27patients.The mean (range)duration of surgery was102(15–300)min.Some prob-lems were encountered during insertion of the SLMA and maintenance of anaesthesia with the SLMA in the prone pos-ition(Table2).Repositioning(manual adjustment without removal from the oral cavity)of SLMA TM required in13patients was achieved easily.Regurgitation of gastric contents(an infrequent but potentially serious complication),all via the DT(n¼4),was observed and patients were followed up for clinical evidence of aspiration(auscultation of lungs,dyspnoea,and hypoxaemia).None of these patients had clini-cal evidence of aspiration,and there were no long-term com-plications documented during follow-up visits.Five patients required a change of the initial SLMA.In four of these patients, a different sized SLMA solved the problem,while one patient required a change to PLMA due to unavailability of an appropriate-sized replacement SLMA.Difﬁcult insertion of SLMA(greater than two attempts at insertion)occurred in two patients.No patient required rotation back into the supine position due to a complication during airway manage-ment.We did not experience an increase in the incidence of problems with insertion of SLMA(repositioning of SLMA n¼6, multiple attempts at insertion n¼1,regurgitation of gastric contents n¼1)in obese patients.Forty-two prone insertions of SLMA were performed by anaesthesia trainees.First-pass success was achieved in38 insertions(ﬁrst-pass success rate90.5%).There was no incidence of failure to insert the SLMA and establish and maintain PPV with the SLMA in the prone position.DiscussionIn this prospective audit,we found that the SLMA TM provided an acceptable,alternative means of inducing anaesthesia and maintaining an unimpeded airway in the prone position. Complications encountered during insertion were minor and easily resolved.Traditional airway management for patients undergoing surgical procedures with general anaesthesia in the prone position is to induce anaesthesia in the supine position and secure the airway with a cuffed TT.After correct TT placement and secureﬁxation of the TT,the anaesthetized patient is then turned into the prone position.Positioning of the anaesthe-tized patient from the supine to prone requires meticulous attention to airway maintenance during turning(to prevent accidental extubation of the TT).Additional care is taken to ensure unimpeded ventilation of the lungs,minimize obstruc-tion of venous return,and to ensure that upper and lower limbs are suitably arranged to prevent injury to peripheral nerves.A variety of measures such asﬁrm pillows placed below the chest and pelvis,the Montreal mattress,and the Wilson mattress are currently used to achieve these objec-tives.Despite meticulous attention to placing the patient in the prone position which is perceived acceptable,the chosen prone position may not be optimal for all patients initially anaesthetized in the supine position.Accidental displacement of the TT may occur during repositioning from the supine to prone position,during perioperative head and neck manipu-lation and lengthy surgical procedures.Replacement of an accidentally displaced TT in the prone position is very difﬁcult and may require cessation of surgery and the turning of the patient into either the lateral or supine position to enable reinsertion of the TT.The CLMA,PLMA,and the SLMA are easily inserted in the prone position,unlike the TT,and offer an easily replaceable and secure airway device in the prone position.4710The PLMA and SLMA offer the additional advantages of higherTable1Patient characteristics presented as median(inter-quartile range)or nMale(n594)Female(n5111)Age(yr)51(41–65)57(47–64)ASA grade(I/II/III)45/29/2034/63/14Weight(kg)85(77–98)75(65–83)Height(cm)177(173–182)160(155–165)Body mass index(kg m22)27(25–32)28(25–31)BJA Sharma et al. 230 by weibin chou on February 28, 2013 / Downloaded fromglottic seal pressures than the CLMA and provide a separate conduit for passive passage of gastric contents and allow the passage of a lubricated gastric tube via the DT to access liquid and gaseous gastric contents.The advantages of a higher glottic seal pressure,easy access to liquid gastric con-tents,6ease of insertion in the supine lateral and prone pos-itions,its efﬁcacy for PPV and as a reliable and non-invasive airway during the recovery phase from general anaesthesia support its use in this form of surgery.The relativelyﬁrm,anatomically shaped airway tube of the SLMA makes it a more suitable choice of device to insert in the prone position.The major advantages,apart from those mentioned above,are easy reinsertion in the prone position,a clear airway provided during the recovery phase from anaesthesia, and minimizing the sequelae commonly accompanying tra-cheal intubation and accidental tracheal extubation.This audit has distinct features.It is the largest audit of SLMA insertion in adult patients undergoing elective orthopaedic surgery in the prone position.Previous studies in the prone position have featured the use of CLMA or PLMA.4710–12This audit included obese patients and our results show that the SLMA TM can be inserted in this cohort of patients without an increase in the incidence of compli-cations of airway management.Our results highlight that duration of surgery,use of PPV,and neuromuscular blocking drugs are not contraindications for the use of SLMA for surgi-cal procedures in the prone position.Problems encountered during insertion of SLMA in the prone position were minor and were not inﬂuenced by the BMI of patients and the experience of the anaesthetist.This audit has some limitations.We used pillows as our head and neck support system in patients who indicated that the head and neck turned either to the left or right was their preferred choice,in the prone position.There have been case reports of serious consequences following occlusion of carotid or vertebral arteries with excessive head rotation for prolonged periods.13Newer head support systems such as Prone View w(unavailable at our hospital at the time of the audit)may prevent the occur-rence of complications associated with excessive head rotation.The longest duration of surgery in our audit was plex spinal surgeries may involve considerably longer periods of anaesthesia in the prone position,but pro-longed duration of surgery is not a contraindication for the use of SLMA,provided adequate measures have been taken to maintain the neck in a neutral position.This audit has been undertaken by very experienced users of the LMA in all its forms.One of the authors has experience of inducing anaesthesia and inserting PLMA and SLMA in the prone pos-ition in more than500patients.The safety of this tech-nique,especially for long duration surgery,will need further evaluation in a large cohort of patients.There are instances when intense surgical stimulation may lead to laryngospasm;however,these can be addressed by increas-ing the depth of anaesthesia,administration of neuromus-cular blocking agents,or both.Despite the low incidence of complications with the use of SLMA,we do not advocate that the use of TT for surgery in the prone position should be abandoned.We note that the incidence of problems encountered did not increase when insertion of SLMA was performed by trainee anaesthetists under adequate supervision.Ng and col-leagues4postulated that insertion of PLMA TM in the prone pos-ition can be learned and practiced within 10supervised cases.Lopez and colleagues8in their study of prone insertion of SLMA in40adult patients achieved success rates of92.5% (37/40)and7.5%(3/40)at theﬁrst and second attempts, respectively,and concluded that the use of SLMA in the prone position by experienced users is feasible.Our results reinforce theirﬁndings which may encourage experienced users and trainee anaesthetists that with appropriate supervi-sion and experience;this technique can be safely used for elective surgical procedures in the prone position.We do not encourage anaesthesia trainees to practice this technique without adequate supervision and experience.In conclusion,ourﬁndings suggest that the SLMA is a useful alternative to tracheal intubation for surgery in fasted patient in the prone position,as it is easily inserted in the anaesthetized patient in the prone position and could be easily re-inserted in the prone position.In addition,it is a useful airway management technique to acquire for airway management experts,to rescue the ‘lost airway’,in patients undergoing surgery in the prone position,including those requiring PPV.Further studies in a large cohort of patients and comparison of SLMA with similar airway devices such as CLMA and PLMA for use in surgical procedures in the prone position will be required to establish the relative safety of SLMA in this clinical situation.Table2Problems encountered during insertion of SLMA TM in the prone positionProblem CommentRepositioning of SLMA(n¼13)Only one attempt at repositioning.SLMA repositioned easily Regurgitation of gastric contents through the DT(n¼4)No clinical evidence of aspirationLaryngospasm(n¼1)Neuromuscular blocking drug given.No further problems Change of SLMA(n¼6)Change of size inﬁve patients,change to PLMA in one patient More than two attempts at insertion(n¼2)Success with careful head positioning Prospective audit on the use of the SLMA BJA231 by weibin chou on February 28, 2013 / Downloaded fromConﬂict of interestC.V.receives an annual honorarium from The LMA Company, Jersey,Channel Islands.References1Elias ryngeal mask airway and radiotherapy in the prone position.Anaesthesia1992;47:10052Ngan Kee ryngeal mask airway for radiotherapy in the prone position.Anaesthesia1992;47:446–73Milligan ryngeal mask in the prone position.Anaesthesia 1994;49:4494Ng A,Raitt DG,Smith G.Induction of anaesthesia and insertion ofa laryngeal mask airway in the prone position for minor surgery.Anesth Analg2002;94:1194–85Brain AIJ,Verghese C,Strube PJ.The LMA‘Proseal’:a laryngeal mask with an oesophageal vent.Br J Anaesth2000;84:650–4 6Verghese C,Ramaswamy B.LMA-Supreme—a new single-use LMA with gastric access:a report on its clinical efﬁcacy.Br J Anaesth2008;101:405–107Brimacombe JR,Wenzel V,Keller C.The ProSeal laryngeal mask airway in prone patients:a retrospective audit of245patients.Anaesth Intensive Care2007;35:222–58Lopez AM,Valero R,Brimacombe J.Insertion and use of LMA Supreme TM in the prone position.Anaesthesia2010;65:154–7 9Vaughan RS.Airway management in the recovery room.Anaes-thesia1997;52:617–810Osborn IP,Cohen J,Soper RJ,Roth ryngeal mask airway—a novel method of airway protection during ERCP:comparison with endotracheal intubation.Gastrointest Endosc2002;56: 122–811McCaughey W,Bhanumurthy ryngeal mask placement in the prone position.Anaesthesia1993;48:1104–512Herrick MJ,Kennedy DJ.Airway obstruction and the laryngeal mask airway in paediatric radiotherapy.Anaesthesia 1992;47:91013Edgcombe H,Carter K,Yarrow S.Anaesthesia in the prone pos-ition.Br J Anaesth2008;100:165–8314The LMA-Supreme TM.Instruction Manual.Maidenhead:Intravent Orthoﬁx Ltd,2007BJA Sharma et al.232 by weibin chou on February 28, 2013 / Downloaded from。