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.     

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.     

Flood hazard maps in the European context

The implementation of the EU Floods Directive by water authorities across Europe has generated a lack of consistency in the present situation, especially regarding the scales adopted, the hydrological scenarios and the elements represented on flood hazard and risk maps. From the EU-funded project HYTECH, this article presents a general overview of Floods Directive implementation in eight European countries, highlighting the differences between them, with particular attention to flood hazard maps. For the implementation cycle that started at the beginning of 2016, a minimization of such differences is necessary in order to manage flood risk in a better and more integrated way.     

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。     

浅谈企业信用

信用是市场经济的基础,加强信用体制建设是整顿市场经济秩序的治本之策。目前由于我国科学的信用制度还不完善,许多企业应收账款居高不下,使企业的拖欠和亏损问题更为严重,信用环境和市场秩序受到强烈冲击。本文针对当前我国企业信用缺失的现状,分析了信用缺失的原因,并提出了完善的途径和方法,相信通过全社会的努力,信用风险不会再成为困扰社会经济发展的因素,我们的社会将会成为一个诚信法制的社会。     

石油企业财务风险评价神经网络模型的建立

石油企业财务风险评价是石油行业的重要课题.在确立石油企业财务风险评价指标体系的基础上,建立了基于模糊神经网络的石油企业财务风险评价模型.该评价模型分为模糊量化模块和模糊神经网络(FNN)模块,可根据实际问题进行具体调节,具有学习的功能.经过对200多家石油企业的实证分析,结果表明该模型网络预测误差小,是一种可靠、有效的...     

项目投资风险管理体系模型研究

首先分析了项目投资管理、风险管理和信息管理的作用、内容和程序,得出了三者的内在关系;其次提出包括风险管理战略、风险管理程序、风险管理组织、风险管理方法、风险管理制度和风险管理文化的项目投资风险管理体系,分析了其构成要素的功能及设置方案;最后依据构成要素间的逻辑关系构建了项目投资全面风险管理模型.