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。     

Survey of domestic food purchases and related home handling practices in the Abruzzo region (central Italy): Data collection and analysis through a language-independent classification system

A telephone survey was carried out on 13,486 randomly selected households located in the Abruzzo region (central Italy). Three questionnaires were specifically designed in relation to three different groups of foods (Meat and meat products, Fishery products, Fruit and vegetables). Questions were mainly focused on the amount and number of purchases, type of retailer, and home food handling practices with respect to the week prior to the interview. Data were classified according to a multilingual thesaurus system (LanguaL). Results allowed to estimate domestic purchases (in kg) per capita for different food categories. The category “Red meat/Cattle” accounted for a large part of purchases in the “meat and meat products” group (10.9 kg per capita/year; 32.2% of purchases in the group) while the category “Fish or related organism/Fish” was the most purchased in the “fishery products” group (6.9 kg per capita/year; 63.3%). The aggregation of more detailed characteristics enabled the identification of popular categories of foods, such as “Red meat/Cattle/Divided into pieces” (25% of the “meat and meat products” group). Significant differences (p < 0.05) were found between the four different provinces (L'Aquila, Chieti, Pescara and Teramo) with respect to “Poultry/Chicken” and “Red meat/Cattle” categories. Householders were also asked about post-purchase food handling practices that might be hazardous to food safety. More than 20% of those surveyed stated that they thawed frozen meat at room temperature. The degree of doneness after cooking of different food categories was generally high: over 90% of products purchased in the majority of meat and fish categories were properly cooked. However a noticeable proportion of householders (about 15%) reported medium or rare cooking of “Red meat/Cattle” and “Red meat/Swine”. Differences (p < 0.05) were also found between consumers of different ages, with people over 65 years old being more prone to freeze meat and cook it thoroughly.The survey was carried out in a specific geographic area and on a statistically significant sample of households, thus allowing a collection of data on domestic habits relating to food purchases and home food handling practices. This information should be included in the framework of quantitative microbial risk assessment (QMRA) models as a measure of the actual exposure of consumers to pathogenic microorganism. The LanguaL system also proved to be a practical language-independent method useful not only to identify and describe food items but also to classify them according to specific food safety characteristics.     

管道风险管理方法研究

按照管道风险管理的流程分别对管道风险评价、风险控制和决策支持、效能测试和响应进行了论述。针对目前国内管道行业的情况，提出了进行管道风险评价的有效方法及维护措施。着重介绍了国外管道风险可接受标准的情况，作为国内制定管道风险评价标准的参考。     

信息安全风险评估的模糊多准则决策方法

基于ISO/IEC17799标准建立了一个综合的信息系统风险分析框架,并运用模糊多准则决策(FMCDM)方法计算信息安全风险,根据风险等级矩阵(RLM)对信息资产风险进行级别划分,最终建立评估信息资产相关风险的完整模型。     

Preschool Competency in Context: An Investigation of the Unique Contribution of Child Competencies to Early Academic Success.

The present concurrent study combined developmental and ecological considerations to examine the unique contribution of multiple preschool competencies to an indicator of early academic success. Participants included 195 Head Start children from 32 classrooms representative of a large, urban Head Start program. Dimensional (variable-centered) analyses revealed 3 distinct classroom competency dimensions (i.e., General Classroom Competencies, Specific Approaches to Learning, and Interpersonal Classroom Behavioral Problems). The first 2 of these dimensions were found to be uniquely associated with early academic success. Findings from typological (person-centered) analyses supported the dimensional findings. Typological analyses revealed 7 profiles of classroom competency distinguished by high scores on the dimensions of General Competencies and Approaches to Learning, and these profiles were found to relate differentially to the indicator of early academic success. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

浅谈如何搞好加油站的风险评价

阐述了加油站实施HSE管理，进行加油站风险评价的必要性，介绍了评价方法及其应用范围，评价组织的建立和工作流程及注意事项，指出：进行加油站风险评价，在选择评估方法时应从加油站的生产实际出发，针对不同的区域，采用适当的，可操作的方法；找出身边存在的危害因素，采取适当的措施来控制和化解风险，提高加油站安全管理水平，才能适应加入WTO后所面临的挑战。     

A framework to integrate software behavior into dynamic probabilistic risk assessment

Software plays an increasingly important role in modern safety-critical systems. Although, research has been done to integrate software into the classical probabilistic risk assessment (PRA) framework, current PRA practice overwhelmingly neglects the contribution of software to system risk. Dynamic probabilistic risk assessment (DPRA) is considered to be the next generation of PRA techniques. DPRA is a set of methods and techniques in which simulation models that represent the behavior of the elements of a system are exercised in order to identify risks and vulnerabilities of the system. The fact remains, however, that modeling software for use in the DPRA framework is also quite complex and very little has been done to address the question directly and comprehensively. This paper develops a methodology to integrate software contributions in the DPRA environment. The framework includes a software representation, and an approach to incorporate the software representation into the DPRA environment SimPRA. The software representation is based on multi-level objects and the paper also proposes a framework to simulate the multi-level objects in the simulation-based DPRA environment. This is a new methodology to address the state explosion problem in the DPRA environment. This study is the first systematic effort to integrate software risk contributions into DPRA environments.     

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.     

A goal-striving life event and the onset of hypomanic and depressive episodes and symptoms: Perspective from the Behavioral Approach System (BAS) dysregulation theory.

On the basis of the behavioral approach system (BAS) dysregulation theory of bipolar disorder, this study examined the relation between occurrence of a BAS activation-relevant life event--goal striving--and onset of hypomanic and depressive episodes and symptoms. In particular, the authors examined the relation between preparing for and completing final exams (a goal-striving event) and onset of bipolar spectrum episodes and symptoms in college students with bipolar II disorder or cyclothymia (i.e., "soft" bipolar spectrum conditions). One hundred fifty-nine individuals with either a bipolar spectrum disorder (n=68) or no major affective psychopathology (controls; n=91) were further classified on the basis of whether they were college students (i.e., completed final exams). Consistent with the BAS dysregulation theory, preparing for and completing final exams was associated with an increase in hypomanic but not depressive episodes and symptoms in individuals with a soft bipolar spectrum diagnosis. Furthermore, self-reported BAS sensitivity moderated the presence of certain hypomanic symptoms during final exams. (PsycINFO Database Record (c) 2010 APA, all rights reserved)