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。     

Time and cost securing in complex large-scale projects

Meeting time and cost objectives in complex projects involves specific problems and risks. An attempt is made to analyse the components of total cost increase of a project caused by time delay. An outline is given as to how these considerations can be used to estimate cost increases in investors' decision situations as well as to ascertain fair contractual penalties and claims for compensation and for the evaluation of justified project acceleration costs.     

Student acceptance of unique meals

Students (N = 167) from the 4th, 8th, and 11th grades sorted meals, listed on individual cards, according to whether they would or would not eat them. Students were told to either consider eating the meals at home or at school. Forty-two different meals were selected from a pool of unique meals created by students in a previous study. The meals differed in head component, the presence or absence of vegetables, and the number of different foodstuffs. On average, approximately half of the meals were deemed acceptable, but older students accepted more meals than younger ones, boys accepted more meals than girls, and meals to be consumed at home were accepted more than those to be consumed at school. In addition, students tended to accept meals comprised of a small number of foodstuffs that did not contain vegetables. The also chose more meat-based meals over those containing fish or soup. These results suggest that students have rather unique food preferences that do not correspond well with nutritional standards. In order to address this problem we recommended that students be given more good choices in the school cafeteria through the introduction of a two-meal system and salad bars.     

Peer-assisted learning interventions with elementary school students: A meta-analytic review.

A meta-analytic review of group comparison design studies evaluating peer-assisted learning (PAL) interventions with elementary school students produced positive effect sizes (ESs) indicating increases in achievement (unweighted mean ES = 0.59, SD = 0.90; weighted ES, d = 0.33, p     

服务器虚拟化带来的信息安全风险以及影响策略

服务器虚拟化大大提高了服务器的资源利用率,对客户来说是十分有利的。但是,也带来了一些诸如破坏正常的网络架构、可能致使系统服务器超载等信息安全风险,需要采取一定的影响策略予以解决。能采取的影响策略有:安装兼容性杀毒软件、不间断地进行服务器硬件的容量分析等。     

Forest harvesting in rural properties: Risks and worsening to the worker’s health under the ergonomics approach

Through an ergonomic approach, this study aimed to evaluate whether workers involved in forest harvesting activities in rural properties are subject to the development of work-related diseases, as well as their consequences. A cross-sectional study with 267 forest workers in rural properties in the Brazilian Central region was used. The following evaluations were performed for each of the activities (felling, delimbing, tracing, manual extraction and manual loading): physical workload evaluation; biomechanical evaluation; risk of repetitive strain injuries/work-related musculoskeletal disorders; environmental noise and vibration factors, where relevant, and thermal overload through the Wetbulb Globe Temperature index. The results showed that in general the physical workload was very high, exceeding the cardiovascular load limits and adding to the need for work reorganization. All activities exposed workers to serious and imminent risks of developing injuries to the spine and lower limbs. Likewise, in general the risk of the appearance of RSI/WMSDs was very high for all activities evaluated. Such results are due to the combination of organizational work factors and factors of the work environment such as exposure to bad weather, uneven terrain, lifting and handling loads above tolerable limits, excessive noise and thermal overload. All of this allows to conclude that ergonomic risks and workers’ health hazards in forest harvesting in rural properties are latent and very worrying, and that these workers are exposed to a form of labor exploitation that invariably leads to physical and emotional exhaustion and therefore to their decreased labor capacity and useful working life.     

Human error identification in human reliability assessment. Part 2: Detailed comparison of techniques

This is the second part of a two-part review of human error identification (HEI) approaches in human reliability assessment (HRA). Part 1 reviewed the probabilistic risk assessment (PRA) context in which HRA occurs, and then detailed 12 HEI techniques which have evolved in the field of HRA. Part 2 attempts to compare the way these techniques perform against a range of criteria relevant to HEI theoretical and empirical validity, and practical usefulness in applied HRA. It is hoped that these comparisons will help assessors in the selection of techniques for practical applications. The comparisons also point to research and development needs in the area of applied HEI.     

赋权学生:混合式学习模式的应有之意——以通识类课程社会学的教学实践为例

工业化时代的传统教学模式已滞后于后福特主义生产模式对劳动者的需要。混合式学习模式在最近二十年发展起来,具有知识载体的多元化、知识获取的易得性,以及知识形式的丰富性等显著特征。在社会学的课程实践中,运用混合式学习模式,将赋权学生的教学理念融入课前、课中和课后三个阶段,精心的教学设计激发学生的主体意识,取得较好的教学效果。     

扎赉诺尔褐煤制取高炉喷吹料和中热值煤气研究 (Ⅰ)煤气、焦油产率及性质

本文是在10kg／h固体热载体干馏实验装置上用扎赉诺尔褐煤制取高炉喷吹料和中热值煤气的研究结果。在干馏温度450℃～650℃范围制得煤气110Nm3/t～400Nm3/t，煤气热值为14．7MJ／Nm3～17．5MJ／Nm3，属中热值煤气。可供民用，也可用于补充钢铁企业燃气不足，平衡能源。得低温焦油2％～9％，可加工成化工产品和燃料油。半焦可用于高炉喷吹。     

浅谈俄罗斯银行信息安全体系的建立

本文主要从俄罗斯银行信息安全管理体系（ISMS）建立准则,ISMS成熟度等级,与信息安全体系相关的法律法规三个方面来介绍俄罗斯银行信息安全体系的建立。