PICCO技术在老年重型颅脑损伤患者液体管理中的应用研究

目的:研究PICCO技术(脉搏轮廓温度稀释连续心排量)对老年重型颅脑损伤患者的疗效影响。方法:选取2010年10月-2013年12月本院重症医学科收治的38例老年重型颅脑损伤患者,按照随机数字表法将其分为对照组和研究组各19例,患者不同程度合并心肺功能不全、糖尿病、高血压病、营养不良等慢性疾病。对照组给予CVP监测补液,研究组应用PICCO监测血流动力学指标进行液体管理,观察比较两组患者治疗前及治疗后1周GCS评分、呼吸机辅助通气时间、ICU住院时间、急性肺水肿发生率和死亡率及治疗1个月后的恢复情况。结果:两组治疗前的GCS评分比较差异无统计学意义(P>0.05),研究组治疗后1周的GCS评分明显高于对照组,差异有统计学意义(P<0.05)。研究组的呼吸机辅助通气时间、ICU住院时间均明显少于对照组,急性肺水肿发生率及死亡率均明显低于对照组,差异均有统计学意义(P<0.05)。经治疗1个月后,研究组的恢复良好率68.4%明显高于对照组的31.6%,差异有统计学意义(P<0.05)。结论:PICCO监测血流动力学指标进行液体管理能改善老年重型颅脑损伤患者预后,值得临床上推广。     

重症血液净化与集成

重症血液净化学是在重症医学理论指导下,研究机体内环境与重症相关性及变化规律,并运用血液净化技术治疗重症的科学。重症患者病情的复杂多变性,决定了重症血液净化的方式需灵活选用不同血液净化技术,因而表现出集成的特点。其具体形式包括序贯集成和同步集成。本文详细阐述了重症血液净化的集成特征和主要集成技术。     

布地奈德联合异丙托溴铵治疗急性重症哮喘70例临床观察

目的:观察布地奈德联合异丙托溴铵治疗急性重症哮喘患者的临床效果。方法:将140例急性重症哮喘患者分成研究组和对照组。研究组患者采用布地奈德联合异丙托溴铵治疗,对照组患者联合应用氢化可的松、氨茶碱、盐酸普鲁卡因治疗。结果:研究组患者的临床治疗效总有效率和动脉血气状况与对照组患者比较,差异具有统计学意义(P<0.05)。结论:布地奈德联合异丙托溴铵治疗急性重症哮喘患者,疗效安全可靠,值得临床推广应用。     

CBL联合医护一体化教学模式在重症医学科护理人员中的培训效果探析

现阶段,由于对重症医学科的临床教学重视程度较低,且缺少该领域的相关教学,缺乏系统化、规范化的培训体系,致使护理人员缺乏对各个医学领域、疾病之间的内在联系的了解,直接影响危重病症患者的抢救、治疗效果。因此,为重症医学科护理人员提供规范化的培训举措,既有助于发展护理人员的医学事业,又能促进护理学、医学思维增长。基于此,文章探究了案例教学(CBL)、医护一体化联合教学模式在重症医学科护理人员培训中的效果。     

ICU探视行为管理的研究与效果观察

目的:探讨重症监护室(ICU)探视行为管理对策及其效果。方法:选取2014年7-12月本院采用规范ICU探视行为管理的危重症患者223例作为研究组,选取2014年1-6月本院采用常规ICU探视行为管理的危重症患者212例作为对照组,比较两组护理效果。结果:研究组清醒患者偏执症状、焦虑症状、抑郁症状、人际敏感性症状与强迫症状的SCL-90评分均明显低于对照组清醒患者,差异均有统计学意义(P<0.05)。研究组家属满意率与护理服务表扬率明显高于对照组,差异均有统计学意义(P<0.05)。研究组护理服务投诉率明显低于对照组,差异有统计学意义(P<0.05)。结论:规范ICU探视行为管理有助于显著改善危重症患者的心理状态,提高护理满意度与护理质量,值得临床推广应用。     

中药灌肠联合西药治疗急性重症胰腺炎临床研究

目的:观察中药灌肠联合西药治疗急性重症胰腺炎的临床疗效。方法:选取2014年8月—2015年8月期间收治的急性重症胰腺炎患者84例作为研究对象,随机分为对照组与研究组,各42例。对照组采用常规西药进行治疗,研究组在对照组基础上联合中药灌肠治疗,观察两组患者临床指标改善情况、淀粉酶变化情况、临床症状缓解时间以及不良反应情况,评价临床疗效。结果:研究组、对照组治疗有效率分别为92.86%、80.95%,两组比较,差异有统计学意义(P<0.05)。治疗后研究组患者白细胞、肌酐、血糖、血尿素氮、淀粉酶以及急性生理与慢性健康(acute physiology and chronic health evaluation,APACHE-Ⅱ)评分水平明显低于对照组,差异有统计学意义(P<0.05)。治疗前、治疗后24 h两组患者淀粉酶水平比较,差异无统计学意义(P>0.05);治疗48 h、72 h后研究组淀粉酶水平明显低于对照组,差异有统计学意义(P<0.05)。研究组患者腹痛缓解时间、体温恢复时间、自主通便时间、住院时间均短于对照组,两组比较,差异有统计学意义(P<0.05)。研究组不良反应发生率为9.52%,对照组不良反应发生率为11.90%,两组比较,差异无统计学意义(P>0.05)。结论:中药灌肠配合西药治疗急性重症胰腺炎效果较好,可明显改善各项临床指标,降低淀粉酶水平,不良反应少,安全性较高。     

脊髓栓系综合征手术中应用神经电生理监测的作用和意义

目的:探讨在脊髓栓系综合征(tethered cord syndrome,TCS)显微手术中应用神经电生理监测的作用以及临床意义。方法:选取2014年1月-2016年12月在本院购买神经电生理监测仪前后被确诊为TCS行显微手术治疗并完成随访的连续患者132例,根据是否应用电生理监测分为试验组(术中应用电生理监测)和参照组(术中未应用电生理监测),各66例。比较两组膀胱功能及下肢运动功能改善情况。结果:术后6个月,试验组膀胱功能改善率为63.6%,高于参照组的37.9%,比较差异有统计学意义(X~2=8.760,P=0.003);试验组术后下肢运动功能改善率为72.7%,高于参照组的65.2%,但比较差异无统计学意义(X~2=0.884,P=0.347)。结论:在TCS显微手术中使用神经电生理监测,能有效提高患者膀胱改善率,有助于防止术中对神经的副损伤,有助于对终丝判定从而获得最大程度的松解,值得临床应用与推广。     

重症颅脑损伤患者急救治疗中临床护理路径的建立与效果

目的:探讨重症颅脑损伤患者急救治疗中临床护理路径的建立方法与效果。方法:选取2016年12月-2018年12月本院急诊收治的102例重症颅脑损伤患者,随机分为对照组和观察组,各51例。对照组按颅脑重症损伤进行常规急救及护理,观察组在对照组基础上实施临床护理路径,对比两组救治结果、并发症情况、救治效率及病情危重程度改善情况。结果:观察组并发症发生率显著低于对照组(P<0.05)。观察组分诊评估时间、建立静脉通道及气管插管时间、急救总时间、住院时间均显著短于对照组(P<0.05)。急救后,观察组APACHEⅡ评分显著低于对照组(P<0.05)。结论:临床护理路径可有效提升重症颅脑损伤患者急救护理质量、急救效果与效率,有利于患者预后改善。     

有创呼吸机辅助通气联合吗啡治疗重症急性左心衰竭的效果分析

目的:研究重症急性左心衰竭患者应用有创呼吸机辅助通气联合吗啡治疗的临床效果。方法:选取本院2015年1月-2017年1月就诊的重症急性左心衰竭患者92例作为研究对象,按照随机数字表法将其分为对照组和研究组,各46例。对照组在临床治疗中单独应用有创呼吸机方案,研究组应用有创呼吸机辅助通气联合吗啡方案,观察比较两组治疗前后的生命体征指标水平、急性生理与慢性健康(APACHEⅡ)评分、血浆脑钠肽(BNP)水平、临床疗效和28 d生存情况。结果:治疗后,研究组pH、动脉氧分压(PaO_2)和动脉血氧饱和度(SaO_2)指标水平均明显高于对照组,心率(HR)、BNP指标水平和APACHEⅡ评分均明显低于对照组,差异均有统计学意义(P<0.05)。研究组临床总有效率为95.65%、28 d生存率为93.48%,均明显高于对照组的76.09%和78.26%,差异均有统计学意义(x~2=7.256、4.390,P=0.001、0.001)。结论:重症急性左心衰竭患者采取有创呼吸机辅助通气联合吗啡方案治疗,能够在短时间内缓解患者临床症状表现,稳定患者生命体征情况,达到预期抢救效果,对于保证患者生命安全、提高生存质量均具有重要作用。     

CITE查房模式在重症临床思维培养中的应用

随着重症医学的快速发展,重症临床思维的特殊性和专业性愈发凸显。如何让年轻医生快速、准确掌握重症临床思维是重症临床教学的重点和难点之一。北京协和医院重症医学团队探索出的CITE临床查房模式,将训练重症临床思维融入至日常床旁查房中,可快速培养年轻医生的重症临床思维能力,实现高质量医疗服务的延续和统一。     

Modified Critical Temperatures for Steel Design Based on Simple Calculation Models in Eurocode 3

Critical temperature is defined as the temperature at which failure is expected to occur in a structural steel member given a uniform temperature distribution and load level. Determination of the critical temperature is a simple but efficient way for structural fire design. This paper proposed a new model which incorporated the buckling, load levels and non-dimensional slenderness to calculate the critical temperature of steel member under fire based on the simple calculation models in Eurocode 3. To advance the application of this new model, design charts for determining the critical temperatures were developed. The design charts showed that the critical temperature decreases with increasing load level, and increases as the buckling curve varies from “a₀” to “d”. It is also recommended to use higher grade steel in both normal and fire situations. The accuracy of this model was ascertained by comparing with the test results in available literature. The new model gave an average prediction-to-test ratio of 0.980 with a standard deviation of 0.077, indicating conservative and less scattered predictions. The percentage of over-prediction (i.e., prediction-to-test ratio >1.0) was less than 5.8% when the nominal yield strength of steel rather than its test strength was used for predictions. In general, reasonable agreements were obtained between the test results and the predictions.     

A method of reducing drag and fluctuating side force on bluff bodies

Measurements have been made of the forces imposed on typical two-dimensional bluff bodies with a small circular cylinder (here called a “rod”) placed upstream on the stagnation line. In most cases, the interaction was beneficial in that the drag of the overall system was lower with the rod than without it. Fluctuating side forces due to vortex shedding from the main body were also reduced for most rod positions and diameters.Three two-dimensional bluff bodies were investigated: a flat plate, a square and a circular cylinder. Reynolds numbers were in the range of 1 × 10⁴ to 7 × 10⁴.The measured overall drag coefficient at various rod spacing showed a discontinuous “jump” at some critical “jump” spacing. This change corresponded to the elimination of the usual single stagnation point on the bluff body centre line and the appearance of two stagnation points symmetrically placed, close to the lateral edges of the body.Significant drag reductions were obtained for all bluff body shapes when a front rod was located near the “jump” spacing. The fluctuating side force on the circular cylinder was reduced by the rod at high Re. On the square cylinder, the reduction in fluctuating side force was large (up to 90%) for any Re and rod size investigated.     

Learning by Doing: Employer Expectations of Planning Studio Education

Planning education is often criticised for being “too theoretical” and subsequently producing graduates who lack the requisite technical skills for the job market—who, in other words, are not “work ready.” It is assumed that employers will prefer graduates with technical and procedural know-how. This article reports on an employer workshop to evaluate the urban planning studio courses at the University of Queensland in Australia. The results were surprising. The attending employers agreed that procedural planning skills can be learned “on the job” while the university environment is an opportunity to develop critical and spatial thinking.     

Shaping the discourse of worker health in the UK construction industry

The UK construction industry is in poor health, statistics show rates of occupational illness significantly higher than for workers in any other industry. Recently, the scope of occupational health management on large sites has increased as public health has become included within the organizational remit. Concerns have been raised around the consequences of this development, its close relationships to Corporate Social Responsibility, and how this is now shaping the wider discourse. To explore this phenomenon, a critical discourse analysis of UK “construction worker health” has been carried out, using the public-facing data of ten large UK contractors. Findings show that “public” has now overtaken “occupational”, the latter restricted to legal compliance presented as corporate citizenship, the former championed as evidence of benevolent organizational values. Yet public health concerns are limited to those of lifestyle and individual responsibility, whilst more complex issues around the social determinants of health as associated with work are missing from the discourse, separating organizations from the impacts of their work on their workers. A contemporary mapping of “construction worker health” is developed for consideration by industry and academics to support future health initiatives and research.     

Developing a risk assessment model for PPP projects in China — A fuzzy synthetic evaluation approach

Earlier research works on PPP showed that an objective, reliable, and practical risk assessment model for PPP projects is essential to the successful implementation of PPP projects. However, actual empirical research studies in this research area are rather limited. This paper reports the second stage of a funded research study, which aims to develop a fuzzy synthetic evaluation model for assessing the risk level of a particular critical risk group (CRG) and the overall risk level associated with PPP projects in China. At the first research stage, thirty-four risk factors were identified through a comprehensive literature review and 3 new risk factors were proposed during a two-round Delphi questionnaire survey. The most critical 17 risk factors were selected through the calculation of normalized values. The correlation of these 17 critical risk factors (CRFs) was further analyzed via factor analysis and 6 CRGs were formulated, namely: (1) Macroeconomic Risk; (2) Construction and Operation Risk; (3) Government Maturity Risk; (4) Market Environment Risk; (5) Economic Viability Risk; and (6) Government Intervention. On the basis of the research works conducted at the first research stage, the weightings for each of the 17 critical risk factors (CRFs) and 6 CRGs were determined through the two-round Delphi questionnaire survey. A set of knowledge-based fuzzy inference rules was then established to set up the membership function for the 17 CRFs and 6 CRGs. The empirical research findings showed that the overall risk level of PPP highway projects is between “moderate risk” and “high risk”. Hence it could be construed that investment in PPP highway projects in China may be considered as risky. In fact, the Delphi survey respondents perceived that “Government Intervention” is the most CRG; with “Government Maturity Risk” being the second; “Economic Viability Risk” the third; “Market Environment Risk” the fourth; “Construction and Operation Risk” the fifth; and “Macroeconomic Risk” the last. These findings revealed that government intervention and corruption may be the major hurdles to the success of PPP highway projects in China. These may be caused by inadequate law and supervision system and poor public decision-making process. Although the fuzzy synthetic evaluation model was primarily developed for PPP projects in general, the research method could be replicated in a specific type of PPP project, such as water treatment projects and hospital projects, to produce similar models for inter-type comparisons. By doing so, it provides an opportunity for practitioners to assess the risk level of different types of PPP projects based on objective evidence rather than subjective judgment. The most CRG for different types of PPP projects could be identified and both precautionary and remedial actions could be taken as soon as possible. Such an extension would provide a deeper understanding of managing different types of PPP projects.     

广州城市快速轨道交通的规划与实践

根据快速轨道交通的特点,提出了广州城市快速轨道交通规划编制的层级体系,阐述了广州线网规划编制由“战备型”—“客流疏导型”—“规划引导型”—“内优外拓型”演变的规划理念和各阶段线网架构的特点;归纳并提出了广州快速轨道交通控制性规划编制的基本原则、目标与深度及主要规划成果;针对广州“客流疏导型”和“规划引导型”轨道交通线路的特点,阐述了轨道交通的交通衔接规划编制的基本理念、规划目标以及规划实践;提出了开展轨道交通线网施工期间交通影响评估与交通组织的目的、基本原则与主要工作内容;面向2010年亚运会的召开,提出了广州城市快速轨道交通的发展战略。     

Care and cleanliness of the environment in public places: a survey of Kibbutzim in Israel

It is argued that the problems of environmental pollution, and those of the inadequacy of formal social control mechanisms in contemporary societies are the unintended dysfunctional consequences of two separate but interrelated clusters of change processes. Consequently, solutions to the former require a thorough study of the latter in their relation to behaviour of individuals vis a vis the physical environment in public places.

A survey of all 332 kibbutzim in Israel, conducted in 1973, assessed the level of “active care” (i.e. landscaping, lawns, trees, etc.) and “cleanliness” (i.e. absence of litter, refuse, etc.) found in eleven different locations in each kibbutz. Although kibbutzim are generally considered rural settlements, the data showed a typically urban reliance on “the authorities” to take care of the appearance of public places. Further analysis indicated that at least three variables are systematically related to this normative pattern: residential instability, age of settlement, and population size. Other background variables considered and analyzed were not found to be statistically related to active care and cleanliness.     

“They say this is a home”: the challenge of “home” in residential care settings for old and young

In this article, we want to bolster a critical discussion of how the “home” is used in research on residential care, and additionally make sense of young and old residents’ feelings of resistance, through the lens of a critical geography of home. We illustrate how the home ideal might be provocative and frustrating for the residents, although previous studies point out that the ideal is used by staff and in policy to reassure residents of a sense of belonging and mastery. Examples from interviews with young unaccompanied boys as well as older residents living in residential care have been used and the analysis resulted in two themes: “Residents’ conflicting experiences of space” (shared space, restricted space and regulated space, and “Residents’ feelings of homelessness” (transitional space and encroached space). How the residents themselves understand the space that is called their home and why their home can stir ambivalent or negative feelings of isolation, exclusion, and homelessness, is relevant in order to avoid romanticizing home. Residents’ understanding of home can be different from the staff, a reminder that home is a much more complex notion than the rosy ideal.

     

Getting ‘Out There’ and Impacting: The Problem of Housing and Urban Research and its Anarchist Alternative

Housing and Urban Researchers (HURs) are under intensifying pressures to impact on society. Although this orientation towards research impact sits well with “policy oriented” HURs, it has sat less well with some “critical” HURs. It would nevertheless be wrong to paint critical HURs as unconcerned with research impact. Debates about research impact led to the emergence of “critical” Housing and Urban Research (HUR) in the first place. Critical HURs simply seek to ensure that their research impacts in different ways. In fact, this is the problem. Policy and critically oriented HURs both presume social science to be an appropriate vehicle for impacting social change. Yet, such presumptions were questioned in my 'Fallacy paper', which was philosophically hostile to the idea of social scientific HUR which it sought to dethrone. However, it stopped short of outlining an alternative to it. This paper addresses this lacuna by suggesting an anarchist approach to impacting social change that is equally suspicious of social scientific HUR but, unlike the 'Fallacy paper', conciliatory towards it.     

Laboratory evaluation of incorporating waste ceramic materials into Portland cement and asphaltic concrete

Laboratory tests were conducted to evaluate the feasibility of incorporating fired ware scrap, a waste ceramic material from automobile manufacturing, into pavement material. In this study, crushed fired ware scraps were added into Portland cement concrete (PCC) and hot-mix asphalt (HMA) to replace fine aggregates.The results of this study indicated that the fired ware scraps can be potentially used in the Portland cement concrete and HMA mixture. The compressive strength of PCC was improved by adding crushed scrap. However, due to the high water absorption of the crushed scrap, crushed scrap content is recommended to be less than 10% and a water reduction additive is recommended to provide adequate workability. For HMA, the test results indicated that adding a certain amount (up to 15% by weight) of ground scrap improved the binder’s total resistance to deformation. The dynamic modulus, flow number and indirect tensile strength of the HMA mixture were all improved by adding “filler” made of ground scrap. 2.5% “filler” content was recommended for a dense-graded HMA surface mixture.