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[b] If clutch contact face is scored or worn, the flywheel may be refaced. [c] If clutch contact face is cracked, the flywheel must be replaced. NOTE: Do not remove more than 0.508 mm (0.020 in.) material from the flywheel. Maintain all of the radii when resurfacing. 2. Inspect the ring gear. [a] Check ring gear for excessively worn or damaged gear teeth. [b] If damaged gear teeth are detected, replace the ring gear. Refer to Section 1.15.3. 3. Inspect crankshaft and flywheel contact surface. [a] Check the butt end of the crankshaft and flywheel contact surface for fretting, brinelling, or burrs. See Figure 1-212. [b] Lightly stone the contact surface to remove any fretting, brinelling, or burrs. Figure 1-212 1.14.3 Crankshaft and Flywheel Mating Surfaces Installation of Flywheel Install the flywheel as follows: 1. Install two flywheel guide studs, J 36235, into two of the tapped holes in the crankshaft at the 3 and 9 o’clock position. 2. Attach the flywheel lifting tool and, using a chain hoist, position the flywheel in the flywheel housing. Align the flywheel bolt holes with the crankshaft bolt holes. All information subject to change without notice. (Rev. 2004) 6SE50 0403 Copyright © 2004 DETROIT DIESEL CORPORATION From Bulletin 2-50-04 1-261 1.14 FLYWHEEL NOTICE: A new scuff plate must be used whenever the flywheel is removed. Failure to replace the scuff plate may cause the flywheel bolts to loosen, even when torqued correctly. 3. Using a new scuff plate, install two bolts with International Compound #2® (or equivalent) through the plate 180 from each other. 4. Install the flywheel lock, J 36375–A. See Figure 1-195. 5. Remove the flywheel lifting tool and guide studs. 6. Apply International Compound #2® (or equivalent) to the threads and to the bolt head contact area (underside) of the remaining bolts. The bolt threads must be completely filled with International Compound #2® (or equivalent). Any excess must be wiped off. See Figure 1-213.
New flanged multi-point socket head bolts have been released to prevent the MBE 900 pilot bearing from walking out of the flywheel housing. The new bolts will replace two flywheel bolts, located 180 degrees from one another. KIT CONTENTS The MBE 900 Pilot Bearing Bolt Service Kit P/N: A9269900105, consists of the following parts, listed in Table 1: Part No. A9269900005 18SP666 Table 1 Qty. 2 1 Description Flanged Multi-point Socket Head Bolts Installation Instructions MBE 900 Pilot Bearing Retaining Bolt Service Kit (P/N: A9269900105) INSTALLATION PROCEDURE Use the following procedure to install the new flanged multi-point socket bolts: 1. Shut off engine and apply the parking brake, chock the wheels, disconnect vehicle battery power, and perform any other applicable safety steps. 2. Remove the transmission. 3. Remove clutch from flywheel. 4. Pull the crankshaft position sensor out of the flywheel housing about 8 mm (0.32 in.). 5. Remove the end cover from the flywheel housing and install the engine barring tool (J-46392). Tighten the bolts on the barring device to 25 N·m (18 lb·ft). Insert the locking pin to block the device and prevent it from rotating. 6. Using J-46385, the flywheel and main pulley socket tool, remove two flywheel multi-point socket head bolts from the flywheel, 180 degrees apart. See Figure 1.
Emergency Department Visits for Chest Pain and Abdominal Pain: United States, 1999–2008 Farida A. Bhuiya, M.P.H.; Stephen R. Pitts, M.D., M.P.H., F.A.C.E.P.; and Linda F. McCaig, M.P.H., Division of Health Care Statistics Key findings Data from the National Hospital Ambulatory Medical Care Survey: 1999–2008 • The number of noninjury emergency department (ED) visits in which abdominal pain was the primary reason for the visit increased 31.8%. • The percentage of ED visits for which chest pain was the primary reason decreased 10.0%. • Use of advanced medical imaging increased strongly for ED visits related to abdominal pain (122.6%) and chest pain (367.6%). Chest and abdominal pain are the most common reasons that persons aged 15 years and over visit the emergency department (ED) (1). Because EDs provide both emergency and nonemergency care (2,3), visits for these symptoms may vary in their acuity. Advanced medical imaging is often ordered to assist in both diagnosing and ruling out serious illness associated with these symptoms (4,5). This report describes trends in visits for chest and abdominal pain in adults and the seriousness of illness and use of imaging in these visits. All data shown are for persons aged 18 and over whose visit was not injury related. Keywords: National Hospital Ambulatory Medical Care Survey • advanced medical imaging • reason for visit Are ED visits for chest or abdominal pain increasing?
Diagnostic Laparoscopy for Chronic Abdominal Pain Richmond University Hospital, July 2012 David A Vivas, MD www.downstatesurgery.org Case Presentation HPI • 25 y/o female with no significant PMH who was seen in clinic c/o intermittent, moderate to severe, dull abdominal pain, located in epigastric area and right abdomen for the last 3 years. Patient denied any other symptoms (N/V, weight loss) • PMH: None • PSH: None www.downstatesurgery.org Case Presentation • Work up: • EGD: No pathologic findings • RUQ US: No gallstones or other biliary or liver pathology • Pelvic US: No GYN pathology www.downstatesurgery.org Case Presentation • Work up: • CT scan abdomen and pelvis with PO/IV contrast: • Probable diverticulum in the ascending colon • Otherwise unremarkable www.downstatesurgery.org Case Presentation • Work up: • Colonoscopy: • 0.5 cm sessile, friable mass in the distal ascending colon • Mass was removed with cold technique • Area was tattooed with India ink and sent to pathology • Rest of the study was unremarkable for any pathology
Starting mid-2008, Roche introduces a new global packaging design for prescription medicines. This will meet requirements and expectations of health authorities, medical professionals and patients worldwide. The new packaging allows quick and easy identification of the medicine and dosage strength. one product colour specific dosage colour icon of pharmaceutical form dosage colour is repeated How was the design selected? Roche sought feedback from medical professionals and health authorities and reviewed possible design options with more than 700 doctors, pharmacists, nurses and patients worldwide. There was clear support for the selected new design and respondents particularly highlighted that it was easy to recognise. What are the new features? The new packaging design includes d • istinct product and dosage colours for quick identification c • olour banding visible from three sides p • lunger rods and flip-off caps in dosage colours The design is in line with recent regulatory labelling guidelines and industry best practices. There will be no changes in pack dimensions and text. How will the design be implemented? The new packs will be phased in for Roche prescription medicines between mid-2008 and 2010 (approx.). C • ellCept, Copegus, Pegasys and Xeloda will be the first medicines to feature the new packaging design (some country-specific exceptions) T • he remaining medicines will change over the coming months Packs in the old design will not be replaced and can be used until expiry. Please contact your local Roche Office for country-specific details. F. Hoffmann-La Roche Ltd 4070 Basel Switzerland www.roche.com © 2008
Zero gravity recliners gives your body a Zero Gravity Position where your legs are elevated above your heart, putting the back in a correct resting position where your spine makes an S curve and reduces all the pressure on your back. This position reduces the pressure on your spine by 15% as compared to lying horizontally. Since all our body parts are co-dependent, this zero gravity posture is beneficial to other areas as well: Lung capacity is expanded to ease breathing and boost oxygen levels in the blood, while circulation improves to minimize stress on the heart, which in turn leaves you with less muscle fatigue and a completely relaxed feeling overall. It's no wonder that Zero Gravity recliners are recommended by many physicians and health care professionals, and is the closest thing you'll find here on earth to the weightless conditions of outer space. For More Details Visit Our Website URL: http://www.backrxspinecare.com
Pensez à recycler Think recycling Publication no 2013-05-01 de la série Regards sur le monde : avis d’experts This report contains the results of a research project led by the academic outreach program of the Canadian Security Intelligence Service (CSIS) to explore the future of the Al-Qaeda phenomenon. It consists of alternative future scenarios developed during a workshop, as well as four original papers written by individual specialists at the request of CSIS. The report is not an analytical document and does not represent any formal assessment or position of CSIS or the Government of Canada. All components of the project were held under Chatham House rule; therefore, the identity of the authors and the participants is not disclosed. www.csis-scrs.gc.ca Published April 2013 Printed in Canada © Her Majesty the Queen in Right of Canada Photo credit: istockphoto.com World Watch: Expert Notes series publication No. 2013-05-01 Le présent rapport contient les conclusions d’un projet d’étude mené dans le cadre du programme de liaison recherche du Service canadien du renseignement de sécurité (SCRS) pour examiner l’avenir du phénomène al-Qaïda. Il présente des scénarios envisagés lors d’un atelier, ainsi que quatre études originales rédigées par différents spécialistes à la demande du SCRS. Le présent rapport n’est pas un document analytique et ne représente pas la position officielle du SCRS ou du gouvernement du Canada. Tout le projet s’est déroulé conformément à la règle de Chatham House; les auteurs ne sont donc pas cités et les noms des participants ne sont pas révélés. www.scrs-csis.gc.ca Publié en avril 2013 Imprimé au Canada © Sa Majesté la Reine du chef du Canada Crédit photo : istockphoto.com Ce document est imprimé avec de l’encre sans danger pour l’environement
Philippines’ is one of those places that are known for its islands and it is home to worlds largest islands and there are more than 7000 islands. The country is located at the edge of Asia and is split into three geographical zones. Luzon is the largest of all the zones while Visayans is the best of all zones. Then there is the Mindanao zone known for its forests.