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。     

Occupational airway diseases in the metalworking industry Part 1: Respiratory infections, pneumonia, chronic bronchitis and emphysema

Occupational airway diseases are now receiving attention in industry, although study is hampered by a lack of readily-available data. The interpretation of the data that is available, and also of the root problems themselves, is itself a difficult problem. This paper has been written as a literature review which it is hoped that other researchers can take either as a starting point or as a refresher.     

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.     

Effects of surrounding brightness on visual search for safety colors

The present article reports the investigation of the effects of surrounding brightness on a visual search for three safety colors: red, orange, and yellow. Images of visual stimuli consisting of an array of colored circles placed on a large visual field (a visual angle of 40°) were displayed on an 80‐in. screen with a DLP projector. Experiment I examined the search efficiency under three levels of background luminance that were equivalent to the three target luminances. The results showed that the search efficiency for the orange target decreased as the number of distractors increased, under each of the background luminance levels, whereas the efficiency scarcely decreased for the red and yellow targets. Although a reduction in background luminance increased the search efficiency for the orange target, it is suggested that the effect of background luminance is smaller than the effect of the target color in search efficiency. Experiment II examined the search efficiency under three conditions of low levels of incident illuminance, which were matched with a linear regression to the luminance of color chips of safety colors measured twilight conditions. The results showed that the search efficiency for the orange target decreased as the number of distractors increased under each of the different illuminance conditions, whereas the efficiency scarcely decreased for red and yellow targets. Furthermore, as illuminance decreased, the search time for the orange target was more greatly impacted than for red or yellow. These results imply that the recognition of orange tends to be influenced by the surrounding brightness. © 2005 Wiley Periodicals, Inc. Col Res Appl, 30, 400–409, 2005; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/col.20152     

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本文通过对在用钻机井架的现场实际测试,建立数据库、测评模型,对实测的数据用计算机技术进行分析,提出了初始弯曲应力;数据正态分布检验——x～2检验;建立回归方程;在给定置信度下测评当前承载能力的技术概念。解决了在用钻机A型井架的安全性评估问题,是一种较为合理、可靠、科学的测评技术和方法。     

智能小区中的网络和布线设计解决方案——智能建筑学术讨论系列文章之七

当前小区信息网络建设中存在多种实施方案。笔者分析比较了常用的几种典型方案的优劣。讨论了目前建设中的一些解决方法，提出了兼顾现状，适度超前的设计实施原则。     

Accidents,often the result of an ‘uncontrolled business process’—a study in the (Dutch) chemical industry

Often companies in the (petro‐) chemical industry claim that all possible countermeasures against potential accidents have been taken and therefore accidents are unforeseeable. In this paper we question this statement by analysing the pre‐warning signals (precursors) preceding a number of industrial accidents. 17 accidents that occurred in the (petro‐) chemical industry have been investigated by exploring FACTS, an accident database containing information about industrial accidents worldwide. This paper will demonstrate that the existence of precursor information could have been used to foresee and even prevent these accidents if a proper control action had been initiated. The accidents are analysed further, according to a control model, which was adapted from that of C. Argyris. It demonstrates the ineffectiveness of several elements of business process control loops and that the so‐called ‘double‐loop learning’ cycle is more important than the ‘single‐loop learning’ cycle if one considers safety improvement. Copyright © 2003 John Wiley & Sons, Ltd.     

隆德县大水沟饮水工程建设与管理措施分析

隆德县在大水沟农村饮水工程建设管理中，科学规划，优化设计方案，完善政策措施，创新管理体制和运行机制，尤其是用水户全过程参与工程建设管理、实行“两部制”水价、实施工程定期检查养护制度、建立工程管理单位目标责任考核制度、执行水费统一管理和提留统筹费等一系列做法．确保了国家投资效益的充分发挥和工程的可持续利用．     

Evaluating Community Safety Programmes and Community Engagement: The Role of Qualitative Methods and Collaborative Approaches to Policy Research

This article explores the role of qualitative and collaborative methods when undertaking evaluation research into local community safety partnerships and neighbourhood strategies. It draws on recent examples of research and evaluation studies of regeneration and community safety programmes in a number of cities and towns in England. The discussion is set against the background of the major changes in policy relating to crime and community safety, particularly the introduction of Crime and Disorder Partnerships and their engagement with local communities. The value of qualitative methods in exploring some key questions is discussed, particularly within a collaborative approach to policy research.     

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。