板金液压柔性技术及其产品设计

板金液压柔性成形具有诸多的优点,受到了汽车、航空航天等领域设计和研究者的普遍重视。文章主要介绍了板金液压柔性成形技术的内涵和外延,针对所提出的无模液压柔性成形技术和复合液压柔性成形技术,从不同的工艺方法入手,基于所研制的液压柔性成形设备,介绍了相关的飞机等领域产品特点以及设计要点,并对其中的关键工艺参数进行了描述。     

Use and non‐use of VDTs—organization of terminal work: Research findings from Swedish cross‐site studies in the field of office automation

A group of users in Copenhagen were asked to evaluate how important a number of user interface characteristics were for them. The results show high importance of efficient daily use and of possibilities for exploratory learning while tutorial materials were of less importance. Users also were asked to evaluate four usability aspects of a number of popular programs. Results show that the quality pleasant to work with has the largest impact on evaluations of overall user‐friendliness while users seem able to view usability independently from the number of features in an application.     

Wetland change mapping for the U.S. mid-Atlantic region using an outlier detection technique

Although the impacts of wetland loss are often felt at regional scales, effective planning and management require a comparative assessment of local needs, costs, and benefits. Satellite remote sensing can provide spatially explicit, synoptic land cover change information to support such an assessment. However, a common challenge in conventional remote sensing change detection is the difficulty of obtaining phenologically and radiometrically comparable data from the start and end of the time period of interest. An alternative approach is to use a prior land cover classification as a surrogate for historic satellite data and to examine the self-consistency of class spectral reflectances in recent imagery. We produced a 30-meter resolution wetland change probability map for the U.S. mid-Atlantic region by applying an outlier detection technique to a base classification provided by the National Wetlands Inventory (NWI). Outlier-resistant measures – the median and median absolute deviation – were used to represent spectral reflectance characteristics of wetland class populations, and formed the basis for the calculation of a pixel change likelihood index. The individual scene index values were merged into a consistent region-wide map and converted to pixel change probability using a logistic regression calibrated through interpretation of historic and recent aerial photography. The accuracy of a regional change/no-change map produced from the change probabilities was estimated at 89.6%, with a Kappa of 0.779. The change probabilities identify areas for closer inspection of change cause, impact, and mitigation potential. With additional work to resolve confusion resulting from natural spatial heterogeneity and variations in land use, automated updating of NWI maps and estimates of areal rates of wetland change may be possible. We also discuss extensions of the technique to address specific applications such as monitoring marsh degradation due to sea level rise and mapping of invasive species.     

Diamorphine-bupivacaine mixture compared with plain bupivacaine for analgesia

We have studied the efficacy of two extradural infusions (10 ml h-1) in 50 patients in active labour. Patients in the diamorphine group (n = 25) received 0.0625% plain bupivacaine 6.25 mg h-1 mixed with 0.005% diamorphine 0.5 mg h-1 and those in the control group (n = 25) received 0.125% plain bupivacaine 12.5 mg h-1. Both groups received intermittent "top-ups" of 0.25% bupivacaine 10 ml when indicated. Although median pain scores during the infusion were similar in both groups, patients in the diamorphine group indicated greater satisfaction with the infusion (88% very satisfied, compared with 52% in the control group (P < 0.02)). There were no differences in the incidence of hypotension, instrumental vaginal delivery, number of "top-ups", duration of the second stage or extent of motor block. However, patients in the diamorphine group had a high incidence of pruritus (44%, compared with 0% in the control group (P < 0.01)).     

Lichtenstein herniotomy

All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and accounts for an unacceptable number of failures. Total reinforcement of the inguinal floor with a sheet of suitable biomaterial and employment of a "tension-free" technique is a more effective approach. Since June 1984, 3250 primary inguinal hernias have been repaired at the Lichtenstein Hernia Institute by the open tension-free technique using Marlex mesh. All operations were performed under local anesthesia. Patients were discharged from the hospital within two or four hours after the operation. The patients were followed from one to 8 years by physician examination. The follow-up rate was 87%. There were four recurrences. The causes of recurrence and how to avoid them are discussed.     

Long‐term effects of angiotensin II blockade with irbesartan on inflammatory markers in hemodialysis patients: A randomized double blind placebo controlled trial (SAFIR study)

Introduction: Low‐grade chronic inflammation is common in hemodialysis (HD) patients. Previous studies suggest an anti‐inflammatory effect of angiotensin II receptor blocker (ARB) treatment. The aim of this study was to compare the effect of ARB vs. placebo on plasma concentrations of inflammatory markers in HD patients. Methods: Adult HD patients were randomized for double‐blind treatment with the ARB irbesartan 150–300 mg/day or placebo. At baseline, 1 week, 3, 6, 9, and 12 months plasma high sensitivity C‐reactive protein (hsCRP), interleukin (IL)?1β, IL‐6, IL‐8, IL‐18, and transforming growth factor‐β (TGF‐β) were measured using Luminex and enzyme‐linked immunosorbent assay (ELISA) technology. Findings: Eighty‐two patients were randomized (placebo/ARB: 41/41). The groups did not differ in initial levels of any of the inflammatory markers (placebo/ARB median(range)): hsCRP 3.3(0.2–23.4)/2.7(0.2–29.6) μg/mL; IL‐1β 1.1(0.0–45.9)/1.1(0.0‐7.2) pg/mL; IL‐6 10(1–90)/12(1–84) pg/mL; IL‐8 31(9–134)/34(5–192) pg/mL; IL‐18 364(188–1343)/377(213–832) pg/mL; TGF‐β 3.2(0.8–13.9)/3.6(1.3–3.8) ng/mL. Overall, there was no significant difference in hsCRP, IL‐6, IL‐8, and TGF‐β between placebo and ARB‐treated patients during the study period, and hsCRP, IL‐6, IL‐8, and TGF‐β were relatively stable during the study period (P ≥ 0.18 in all tests for parallel curves, equal levels, and constant levels). The IL‐1β level was slightly different in the two groups over time, but not significantly (P = 0.09 in test for parallel curves) and it was also relatively stable during the study period (P ≥ 0.49 in tests for equal levels and constant level). IL‐18 was the only inflammatory marker which was not constant during the study period (P = 0.001 in test for constant level), but there was no significant difference between placebo and ARB‐treated (P ≥ 0.51 in tests for parallel curves and equal levels). Discussion: Inflammatory biomarkers were neither acutely, nor in the long‐term significantly affected by the ARB irbesartan. Our findings suggest that ARB treatment in HD patients does not offer protective anti‐inflammatory effects.     

The use of social media in impact assessment: experiences among national infrastructure developers in Denmark

Social media plays an increasingly prominent role in the interaction between impact assessments and society. Impact assessment is thus becoming part of social networks that are claimed to be able to improve interaction between actors in impact assessment processes. By investigating the use of social media in impact assessment and planning processes of national linear infrastructure development, we explore how social media impinge on participatory practices and how the potential of social media is realized in the current use related to public participation processes. The study focuses on experiences among national developers working in road, rail, electricity, gas, and metro infrastructures in Denmark. The article shows that the current use of social media in public participatory practices is limited to branding and on-way communication and that the increasing use of social media in linear infrastructure planning gives rise to a variety of concerns among developers that are related to especially organizational cultures, perception of the target groups, and prioritization of resources.     

Critical care medicine: opportunities and strategies for improvement

BACKGROUND: Like other areas of health care, critical care faces increasing pressure to improve the quality while reducing the cost of care. Strategies drawn from the literature and the authors' experiences are presented. STRATEGIES AND OPPORTUNITIES FOR IMPROVEMENTS: Ten process- or structure-related areas are targeted as strategically important focuses of improvement: (1) restructuring administrative lines to better suit key processes; (2) physician leadership in critical care units; (3) management training for critical care managers; (4) triage; (5) multidisciplinary critical care; (6) standardization of care; (7) developing alternatives to critical care units; (8) timeliness of care delivery; (9) appropriate use of critical care resources; and (10) tracking quality improvement. TIMELINESS OF CARE DELIVERY: Whatever the root cause(s) of unnecessary delays, the result is inefficient use of critical care resources-and ultimately either a need for more resources or longer wait times. Innovations designed to reduce wait times and waste, such as the establishment of a microchemistry stat laboratory, may prove valuable. APPROPRIATE USE OF CRITICAL CARE RESOURCES: Possible strategies for the appropriate use of critical care resources include better selection of well-informed patients who undergo procedures. Reduction in variation among physicians and organizations in providing therapies will also likely lead to a reduction in some high-risk procedures offering little or no benefit, and therefore a reduction in need for critical care services. Better preparation of patients and families should also make end-of-life decisions easier when questions of "futility" arise. Better information on outcomes and cost-effectiveness and consensus on withdrawal of critical care treatments represent two additional strategies.     

Intradermal and subcutaneous leiomyosarcoma: a clinicopathological and immunohistochemical study of 41 cases

Superficial leiomyosarcomas are rare tumours. The lesions confined to the dermis, contrary to those involving the subcutis, have been reported to carry a favourable prognosis. A retrospective study of 41 consecutive cases of surgically treated intradermal and subcutaneous leiomyosarcomas was undertaken in order to determine the prognostic factors that may influence the survival of these patients. Seven tumours were predominantly intradermal and 34 involved the subcutaneous tissue. Fifty-four percent of the tumours were located in the lower extremities. All cases stained positively for smooth muscle antigen and 66% for desmin. The tumours were classified with regard to tumour grade I (low grade, 3%), II (intermediate, 12%), IIIA (high grade, 46%) and IIIB (high grade, 39%). In all patients, follow-up information was available. Mean follow-up time was 5 years. The patients with intradermal tumours were all alive without signs of recurrence, whereas 14 of those with leiomyosarcomas involving the subcutis have died with pulmonary metastases. Our study confirms that "pure" intradermal leiomyosarcomas independent of tumour grade behave in a benign fashion, probably due to small tumour size. Tumour size > or = 5 cm, deep localization with fascia involvement, and high malignancy grade (IIIB) were found to deteriorate survival based on a univariate analysis. However, in a multivariate analysis only tumour size was found to be an independent prognostic factor.