腹腔手术后重症患者心肌损伤的危险因素

目的探讨腹腔手术后重症患者心肌损伤的发生情况及可能的危险因素。方法回顾性分析北京大学人民医院2017年1月至2019年1月腹腔手术后重症患者的一般临床资料及心肌损伤情况,收集并观察基础病史、术中(手术时间、是否急诊手术、术中出血>800 ml和术中低血压等)及术后指标(改良氧合指数、血乳酸、急性肾损伤和术后24 h内使用升压药情况等)。根据术后是否发生心肌损伤,将患者分为心肌损伤组和非心肌损伤组,采用Logistic回归分析腹腔手术后重症患者心肌损伤的危险因素。结果在纳入的803例腹腔手术后重症患者中,心肌损伤发生率为17. 2%(138/803),而急性心肌梗死发生率仅为0. 9%(7/803)。单因素分析显示,慢性肾功能不全病史、手术时间、急诊手术、术中低血压、术后24 h内使用升压药、高APACHEⅡ评分及术后即刻急性肾损伤与术后重症患者心肌损伤相关(P<0. 05)。多因素回归分析显示,急诊手术(OR=3. 14,95%CI:1. 76～5. 60,P<0. 001)、术后24 h内使用升压药(OR=2. 26,95%CI:1. 23～4. 15,P=0. 008)、APACHEⅡ评分(OR=1. 05,95%CI:1. 01～1. 09,P=0. 008)和术后急性肾损伤(OR=3. 18,95%CI:1. 78～5. 69,P <0. 001)与腹腔手术后重症患者发生心肌损伤独立相关。结论重症患者腹腔手术后心肌损伤发生率高,急诊手术、术后24 h内使用升压药、高APACHEⅡ评分和术后急性肾损伤是导致腹腔手术后重症患者发生心肌损伤的独立危险因素。     

Mining fleet management systems: a review of models and algorithms

The objective of this paper is to review and document the mine fleet management systems’ models and algorithms. The purpose is to understand the algorithms behind the fleet management systems and the proposed academic solutions in this area to identify any gaps in the current literature and to open up opportunities to establish research questions that need to be addressed in an integrated simulation and optimisation operational planning research framework. In this paper, we review industrial fleet management systems and the main academic algorithms behind such systems. The fleet management systems are divided into three subsequently related problems to review: shortest path, production optimisation and real-time dispatching. Finally, the limitations of current algorithms for fleet management systems are documented in terms of mining practice feasibility and optimality of the solution on large-scale problems. The results of this literature review enable us to evaluate the logical links between major components of an integrated simulation and optimisation operational planning framework with current theory of fleet management systems.     

Sustainable supply chain management in Indian organisations: an empirical investigation

The present work is an attempt to investigate the adoption of sustainable supply chain management (SSCM) practices amongst manufacturing and process based organisations in India and its impact on organisational performance encompassing all three dimensions of sustainability. SSCM practices conceived in the present study include environmental management practices (EMP), socially inclusive practices for employees (SPE), socially inclusive practices for community (SPC), operations practices (OP) and supply chain integration (SCI) which were treated as exogenous variables. Organisational performance considered in this study includes five dimensions, namely environmental performance (EPR), employee-centred social performance (ESP), community-centred social performance (CSP), operations performance (OPR) and competitiveness, which were regarded as endogenous variables. The analysis was carried out with the help of structural equation modelling considering natural logarithm of manpower as a control variable. Few major findings are mentioned. EMP does not have any significant association with OPR, nor does it result in competitiveness. However, when jointly mediated through both EPR and OPR, EMP leads to competitiveness. SPC has significant negative association with competitiveness, when only direct relationship is considered. However, indirect relationship between SPC and competitiveness shows significant positive association when mediated through CSP. The resultant total effect between SPC and competitiveness turns out to be insignificant. Further, OPR fully mediates the relationship between OP and competitiveness. Managerial implications of the findings are discussed.     

Survey of domestic food purchases and related home handling practices in the Abruzzo region (central Italy): Data collection and analysis through a language-independent classification system

A telephone survey was carried out on 13,486 randomly selected households located in the Abruzzo region (central Italy). Three questionnaires were specifically designed in relation to three different groups of foods (Meat and meat products, Fishery products, Fruit and vegetables). Questions were mainly focused on the amount and number of purchases, type of retailer, and home food handling practices with respect to the week prior to the interview. Data were classified according to a multilingual thesaurus system (LanguaL). Results allowed to estimate domestic purchases (in kg) per capita for different food categories. The category “Red meat/Cattle” accounted for a large part of purchases in the “meat and meat products” group (10.9 kg per capita/year; 32.2% of purchases in the group) while the category “Fish or related organism/Fish” was the most purchased in the “fishery products” group (6.9 kg per capita/year; 63.3%). The aggregation of more detailed characteristics enabled the identification of popular categories of foods, such as “Red meat/Cattle/Divided into pieces” (25% of the “meat and meat products” group). Significant differences (p < 0.05) were found between the four different provinces (L'Aquila, Chieti, Pescara and Teramo) with respect to “Poultry/Chicken” and “Red meat/Cattle” categories. Householders were also asked about post-purchase food handling practices that might be hazardous to food safety. More than 20% of those surveyed stated that they thawed frozen meat at room temperature. The degree of doneness after cooking of different food categories was generally high: over 90% of products purchased in the majority of meat and fish categories were properly cooked. However a noticeable proportion of householders (about 15%) reported medium or rare cooking of “Red meat/Cattle” and “Red meat/Swine”. Differences (p < 0.05) were also found between consumers of different ages, with people over 65 years old being more prone to freeze meat and cook it thoroughly.The survey was carried out in a specific geographic area and on a statistically significant sample of households, thus allowing a collection of data on domestic habits relating to food purchases and home food handling practices. This information should be included in the framework of quantitative microbial risk assessment (QMRA) models as a measure of the actual exposure of consumers to pathogenic microorganism. The LanguaL system also proved to be a practical language-independent method useful not only to identify and describe food items but also to classify them according to specific food safety characteristics.     

地勘单位转制后税务风险识别与控制

结合“减税降费”的政策背景,以陕西省某转制地勘单位为例,引入风险控制相关理论并应用层次分析法,构建了税务风险评估指标体系,对转制地勘单位面临的税务风险进行了识别、分析、评估。研究结果表明:针对不同的税收类型,应着重关注不同方面的风险,排序前6位的风险依次为企业所得税扣除类风险、增值税决策环节风险、增值税销售环节风险、房产税计税依据风险、企业所得税税收优惠类风险、增值税采购环节风险;并对上述风险的控制机制进行了分析,从企业管控、政策优化两方面分别提出了相关对策和建议。     

首钢1号高炉增产节焦生产实践

对首钢1号高炉焦炭质量恶化后增产节焦的生产经验进行了总结分析。认为提高入炉原燃料质量，综合优化高炉基本制度，合理控制稳定的操作炉型是保证炉况长期顺稳、实现效益最大化的有效手段。     

AD HOC网络管理综述

由于AD HOC网络自身的特点，其网络管理很多方面与固定网络不同，如移动性管理和体系结构管理等。讨论了AD HOC网络管理的各个方面，并列举了各个方面的设计思路和已有的相关算法的简介。     

钱塘江景观与文化关系初析

我国进入经济高速发展期后,人们在防洪抗旱得到安全保障、开发资源和治理江道等对河流的基本需求得到满足后,逐渐重视河流的景观和生态功能.从分析研究钱塘江下游河流景观特征、地理水文及人类活动对形成丰富多彩的景观的作用,以及一些以钱塘江为吟颂对象的诗词出发,初步探讨钱塘江景观多样性对人的性格、文学家风格的影响,最后从景观角度探讨河流治理的一些原则.     

企业质量管理体系运行的思考

质量管理永远是企业生命的源泉,质量管理体系是一个复杂的系统工程,企业只有不断完善质量体系,进行质量管理创新,保持质量管理体系的长期有效的进行,才能在市场竞争中保持领先。     

Lake Chivero: A management case study

Lake Chivero in Zimbabwe was shown to be hypereutrophic. Historical data showed that the eutrophication process had been arrested in the late 1970s. However, a combination of poor planning, multiplicity of jurisdiction, mismatch between rate of urbanization and waste management investment, recent changes in the local climate and a permissive, immature political system that called for no public accountability resulted in environmental management breakdown leading to hypereutrophication of the lake. The case of Lake Chivero is presented as an example of a wider global issue regarding the status of environmental management in competition with other priorities in emerging democracies.