急性生理学和慢性健康状况评分系统Ⅱ在ICU中的临床应用

目的应用急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)评价外科重症监护病房(ICU)患者的病情及预后,并验证在ICU中的应用价值。方法对97例危重患者的资料用APACHEⅡ进行评分及预测病死率。结果 97例患者评分5～44分,平均(18.8±8.1)分,存活组75例评分(16.5±6.4)分,死亡组22例评分(26.8±8.3)分(P<0.05)。结论评估ICU患者病情程度、预后、控制医疗质量及合理利用ICU资源可应用APACHEⅡ评分系统。     

影响重症加强护理病房老年脓毒症合并急性肾损伤患者预后的高危因素

目的探讨影响重症加强护理病房(ICU)老年脓毒症合并急性肾损伤患者预后的高危因素。方法选取2020年2月至2022年3月宜兴市中医医院收治的ICU老年脓毒症合并急性肾损伤患者128例作为研究对象,按照28d后生存情况分为生存组(n=94)及死亡组(n=34),采用单因素及多因素Logistic回归分析探讨影响ICU老年脓毒症合并急性肾损伤患者预后的高危因素。结果死亡组与生存组性别、感染类型、吸烟饮酒、是否需要机械通气治疗、脓毒症分级、血管活性药物使用情况、序贯器官衰竭(SOFA)评分比较,差异无统计学意义(P>0.05)。死亡组与生存组相比年龄、急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分较高,急性肾损伤分级较高,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、APACHEⅡ评分、急性肾损伤分级可作为影响ICU老年脓毒症合并急性肾损伤患者预后的高危因素。结论年龄、APACHEⅡ评分、急性肾损伤分级可作为影响ICU老年脓毒症合并急性肾损伤患者预后的高危因素。     

中西医结合治疗慢性阻塞性肺疾病急性加重期患者疗效分析

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者行中西医结合治疗的临床疗效。方法采用前瞻性研究方法,收集我院2010年1月至2013年1月收治的120例AECOPD患者资料,将患者随机分为对照组(行西药常规治疗)和观察组(西药常规治疗基础上加用中药汤剂)。分析比较两组患者的临床疗效和实验室指标的差异。结果观察组患者总有效率为88.3%,对照组为61.7%,两组比较差异有统计学意义(P<0.05);观察组患者治疗前后血氧分压(Pa O2)、二氧化碳分压(Pa CO2)缓解情况明显优于对照组,差异有统计学意义(P<0.05)。结论中西医结合治疗AECOPD患者疗效确切,能明显提高患者的生活质量,是一种安全有效的治疗方法。     

雾化吸入布地奈德混悬液治疗慢性阻塞性肺疾病急性加重期的效果观察

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者选择雾化吸入布地奈德混悬液治疗后的临床效果。方法选取我院2011年1月至2013年6月AECOPD患者150例。通过随机数表法将其分为A1组(观察组75例)与A2组(对照组75例)。A2组患者选择常规治疗+甲泼尼松龙治疗;A1组患者选择常规治疗+布地奈德混悬液(雾化吸入)治疗;比较两组患者治疗7 d后在相关指标方面表现的差异性。结果两组AECOPD患者完成7 d治疗后,与治疗前比较,在动脉血氧分压(Pa O2)以及动脉血二氧化碳分压(Pa CO2)等指标差异有统计学意义(P<0.05)。结论针对AECOPD患者选择雾化吸入布地奈德混悬液治疗,表现出较高的有效性及安全性。     

利多卡因治疗慢性阻塞性肺疾病急性加重期效果观察

目的探讨利多卡因对慢性阻塞性肺疾病急性加重期(AECOPD)患者的治疗效果。方法选择在我院治疗的慢性阻塞性肺疾病急性加重期患者166例,将其分为试验组92例与对照组74例。对照组予以常规治疗,试验组在常规治疗的基础上雾化吸入利多卡因,观察两组患者的临床治疗效果。结果两组患者治疗后基本生命体征和动脉血气较治疗前均有所改善,试验组患者雾化吸入利多卡因1h后,PaO2和氧合指数较同时期对照组升高更快,差异有统计学意义(P<0.05);两组患者治疗后第4天,咳嗽、咳痰和喘息症状均有所缓解,试验组患者咳嗽和喘息症状缓解率高于对照组,差异有统计学意义(P<0.05)。结论在治疗AECOPD中,雾化吸入利多卡因可早期改善氧合,缓解患者咳嗽和喘息症状具有良好的效果。     

无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效

目的探讨无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的临床疗效。方法收集46例慢性阻塞性肺疾病合并呼吸衰竭患者资料,将患者随机分为对照组和观察组,各23例。对照组患者给予低流量氧疗、支气管舒张药物、抗感染等常规治疗,观察组患者在对照组常规治疗基础上行NIPPV治疗。比较两组患者的肺功能指标、动脉血气指标、气管插管率、病死率。结果治疗前,两组患者的肺功能比较差异无统计学意义(P>0.05);治疗后,两组患者肺功能较治疗前均明显改善,观察组明显优于对照组;观察组患者的气管插管率及病死率均明显低于对照组;观察组患者有效率为82.6%,明显优于对照组的65.2%,差异均有统计学意义(均P<0.05)。结论 NIPPV能明显改善COPD合并呼吸衰竭患者的呼吸情况及预后。     

抗菌药物在慢性阻塞性肺疾病急性加重期患者中的应用

目的：探讨74例慢性阻塞性肺疾病（COPD）患者在急性加重期使用抗菌药物治疗的情况。方法回顾分析广东省佛山市三水区人民医院2009年5月至2013年12月收诊的74例Ⅱ、Ⅲ级慢性阻塞性肺疾病急性加重期（AECOPD）患者,统计和分析使用抗菌药物治疗的情况。结果74例AECOPD患者中,年发病率2次以上有（70±15）例次;有73例（98.6%）使用了抗菌药物,治疗总有效率为93.2（69/74）;共使用20种抗菌药物,有9种DUI＞1,占45.0%,其他11种DUI≤1,占55.0%。结论 AECOPD患者使用抗菌药物进行治疗的方案基本合理,但部分仍需继续完善,有必要对其使用抗菌药物情况进行分析,提高抗菌药物的合理使用率,降低治疗费用。     

万托林联合布地奈德雾化吸入治疗AECOPD疗效观察

目的观察万托林联合布地奈德雾化吸入治疗慢性阻塞性肺疾病急性加重期(AECOPD)疗效。方法选择我院在2012年1月~2013年6月收治的60例AECOPD患者,按照就诊时间顺序随机分为四组,每组15例,A组患者给予鼻导管低流量吸氧、营养支持、纠正酸碱失衡、止咳化痰药物依照病原学和病情而定。B组在A组上加用5ml生理盐水+2.5ml万托林雾化吸入;C组在A组上加用5ml生理盐水+2ml布地奈德雾化吸入;D组在A组上加用3ml生理盐水+2ml布地奈德+2.5ml万托林雾化吸入;各组治疗疗程均为7~10d,每次15~20min,3~4次/d。结果 A组患者治疗后总有效率为60.00%;B组患者治疗后总有效率为73.33%;C组患者治疗后总有效率为80.00%;D组患者治疗后总有效率为93.33%。结论单用布地奈德或万托林来对AECOPD进行雾化吸入,治疗效果不显著,而将两种药物联合使用,则临床疗效更为显著,无不良反应和并发症发生,值得在临床上大量推广应用。     

蟾酥注射液治疗鲍曼不动杆菌重症肺炎的临床疗效

目的探讨蟾酥注射液治疗鲍曼不动杆菌引起的重症肺炎的临床疗效。方法选取2020年10月至2021年10月河北省第八人民医院收治的60例鲍曼不动杆菌重症肺炎患者作为研究对象,按随机数字表法分为对照组和观察组,各30例。对照组采用西医常规治疗,观察组加用蟾酥注射液进行治疗,两组均治疗7 d。比较两组患者感染指标(白细胞计数、C反应蛋白、降钙素原),临床疗效,预后指标(28d生存率、ICU时间、感染控制窗出现时间),疾病严重程度评分(急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分),不良反应发生情况。结果治疗后,两组白细胞计数、C反应蛋白、降钙素原较治疗前明显降低(P<0.05),且观察组白细胞计数、C反应蛋白、降钙素原明显低于对照组(P<0.05)。观察组治疗有效率高于对照组,差异有统计学意义(P<0.05)。观察组28d生存率明显高于对照组(P<0.05),ICU时间和感染控制窗出现时间较对照组明显缩短(P<0.05)。治疗后,两组APACHEⅡ评分和SOFA评分均较治疗前明显降低(P<0.05),且观察组APACHEⅡ评分和SOFA评分明显低于对照组(P<0.05)。所有患者治疗期间未出现严重不良反应,无死亡病例。结论鲍曼不动杆菌重症肺炎患者在常规西医治疗的基础上联合应用蟾酥注射液治疗,有利于提高临床治疗效果,缩短感染控制窗时间,改善患者预后,且安全性较好。     

参麦注射液联用三代头孢类抗生素治疗慢性阻塞性肺疾病急性加重期疗效观察

目的探讨对于慢性阻塞性肺疾病急性加重期患者采用参麦注射液联用三代头孢类抗生素的治疗效果。方法选取2011年6月至2012年6月收治的86例慢性阻塞性肺疾病急性加重期的住院患者,将其随机分为两组,治疗组患者(43例)给予参麦注射液联合用三代头孢类抗生素静脉滴注治疗,对照组患者(43例)给予单纯抗生素静脉滴注治疗,对两组患者治疗的总有效率进行评价,分析其治疗的效果。结果治疗组总有效率88.4%,对照组总有效率79.1%,差异具有统计学意义(P<0.05)。结论参麦注射液联用三代头孢类抗生素治疗慢性阻塞性肺疾病急性加重期患者的临床疗效更为显著,其治疗总有效率高,值得在临床推广应用。     

Forecasting the price of gold

This article seeks to evaluate the appropriateness of a variety of existing forecasting techniques (17 methods) at providing accurate and statistically significant forecasts for gold price. We report the results from the nine most competitive techniques. Special consideration is given to the ability of these techniques to provide forecasts which outperforms the random walk (RW) as we noticed that certain multivariate models (which included prices of silver, platinum, palladium and rhodium, besides gold) were also unable to outperform the RW in this case. Interestingly, the results show that none of the forecasting techniques are able to outperform the RW at horizons of 1 and 9 steps ahead, and on average, the exponential smoothing model is seen providing the best forecasts in terms of the lowest root mean squared error over the 24-month forecasting horizons. Moreover, we find that the univariate models used in this article are able to outperform the Bayesian autoregression and Bayesian vector autoregressive models, with exponential smoothing reporting statistically significant results in comparison with the former models, and classical autoregressive and the vector autoregressive models in most cases.     

Planned adaptation in risk regulation: An initial survey of US environmental, health, and safety regulation

In principle, we want regulatory programs to be based on current realities, as reflected for example in the best knowledge of relevant experts. That would imply that old rules now on the books should be consistent with today's knowledge base, not just what was known when a rule or standard was originally set. This paper reports on a survey of US programs, examining how often existing rules are actually updated in light of better knowledge, and identifies five programs that attempt to make policy routinely adaptive. These programs exhibit what we term Planned Adaptation: they both revise rules when relevant new knowledge appears, and take steps to produce such improved knowledge. While Planned Adaptation is rare, it is used in several nationally prominent programs, including air pollution, airplane safety, and drug safety. Planned Adaptation is a policy tool that deserves more attention.     

The greenhouse effect: Damages,costs and abatement

The buildup of so-called greenhouse gases in the atmosphere — CO₂ in particular-appears to be having an adverse impact on the global climate. This paper briefly reviews current expectations with regard to physical and biological effects, their potential costs to society, and likely costs of abatement. For a worst case scenario it is impossible to assess, in economic terms, the full range of possible non-linear synergistic effects. In the most favorable (although not necessarily likely) case (of slow-paced climate change), however, it seems likely that the impacts are within the affordable range, at least in the industrialized countries of the world. In the third world the notion of affordability is of doubtful relevance, making the problem of quantitative evaluation almost impossible. We tentatively assess the lower limit of quantifiable climate-induced damages at $30 to $35 per ton of CO₂ equivalent, worldwide, with the major damages being concentrated in regions most adversely affected by sea-level rise. The non-quantifiable environmental damages are also significant and should by no means be disregarded.The costs and benefits of (1) reducing CFC use and (2) reducing fossil fuel consumption, as a means of abatement, are considered in some detail. This strategy has remarkably high indirect benefits in terms of reduced air pollution damage and even direct cost savings to consumers. The indirect benefits of reduced air pollution and its associated health and environmental effects from fossil-fuel combustion in the industrialized countries range from $20 to $60 per ton of CO₂ eliminated. In addition, there is good evidence that modest (e.g. 25%) reductions in CO₂ emissions may be achievable by the U.S. (and, by implication, for other countries) by a combination of increased energy efficiency and restructuring that would permit simultaneous direct economic benefits (savings) to energy consumers of the order of $50 per ton of CO₂ saved. A higher level of overall emissions reduction — possibly approaching 50% — could probably be achieved, at little or not net cost, by taking advantage of these savings.We suggest the use of taxes on fossil fuel extraction (or a carbon tax) as a reasonable way of inducing the structural changes that would be required to achieve significant reduction in energy use and CO₂ emissions. To minimize the economic burden (and create a political constituency in support of the approach) we suggest the substitution of resource-based taxes in general for other types of taxes (on labor, income, real estate, or trade) that are now the main sources of government revenue. While it is conceded that it would be difficult to calculate the optimal tax on extractive resources, we do not think this is a necessary prerequisite to policy-making. In fact, we note that the existing tax system has never been optimized according to theoretical principles, and is far from optimal by any reasonable criteria.During the academic year 1989–90 Dr. Ayres was at the International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria.During the summer of 1989 Mr. Walter was a member of the Young Scientists' Summer Program at IIASA.     

SCIENCE AND INDUSTRY: TRACING THE FLOW OF BASIC RESEARCH THROUGH MANUFACTURING AND TRADE

This paper describes flows of basic research through the US economy during the late 20th century. In addition, the paper studies the effect of the flows on scientific papers in industries and fields. This article differs from others in its use of measures of science rather than technology. Together, its results present a picture of the structure of basic research flows in a modern, science-intensive economy. Basic research flows are large within petrochemicals and drugs, and within software and communications. Flows of chemistry, physics, and engineering are common throughout all industries – biology and medicine are almost confined to petrochemicals and drugs; and computer science is nearly as restricted to software and communications. In general, basic research flows are more concentrated within scientific fields than within industries. Our findings concerning the production of scientific papers indicate that the effect of a 1% change in academic R&D spillovers significantly exceeds that of industrial spillovers. In addition, within-field effects exceed effects between-fields, while within- and between-industry effects are roughly equal. It follows that scientific fields limit basic research flows more than industries do, perhaps because large firms implicitly span a range of industries.     

Valuing Mangrove-Fishery Linkages – A Case Study of Campeche, Mexico

This paper explores the value of mangrove systems as a breeding and nursery habitat for off-shore fisheries, focusing on mangrove-shrimp production linkages in Campeche State, Mexico. We develop an open access fishery model to account explicitly for the effect of mangrove area on carrying capacity and thus production. From the long-run equilibrium conditions of the model we are able to establish the key parameters determining the comparative static effects of a change in mangrove area on this equilibrium. We then estimate empirically the effects of changes in mangrove area in the Laguna de Terminos on the production and value of shrimp harvests in Campeche over 1980–90. Our findings suggest that mangroves are an important and essential input into the Campeche shrimp fishery, but that the low levels of deforestation between 1980 and 1990 mean that the resulting losses to the shrimp fishery are still comparatively small. Over-exploitation of the fishery due to open access conditions remains the more pervasive threat, and without better management any long-run benefits of protecting mangrove habitat are likely to be dissipated.     

An Economic Analysis and Simulation of Woodfuel Management in the Sahel

This paper presents an economic framework and a computationalmethodology for assessing the evolution of woodfuel supply costsand the spatial distribution of biomass in a Sahelian woodlandsetting. Spatial data on standing stock and the costs oftransport to market are used to construct a supply curve for fuelto a fuel-consuming location. Given an exogenously specifieddemand, the model simulates, period by period, the extraction,regeneration, and transport of wood fuels. The model is appliedto evaluate the benefits and ecological impacts of scenarios forwoodland management around the city of N'Djamena, Chad.     

Evidence on the impact of R&D and ICT investments on innovation and productivity in Italian firms

Both research and development (R&D) and information and communication technology (ICT) investment have been identified as sources of relative innovation underperformance in Europe vis-à-vis the USA. In this article, we investigate the R&D and ICT investment at the firm level in an effort to assess their relative importance and to what extent they are complements or substitutes. We use data on a large unbalanced panel data sample of Italian manufacturing firms constructed from four consecutive waves of a survey of manufacturing firms, to estimate a version of the CDM model of R&D, innovation, and productivity [Crépon–Duguet–Mairesse 1998. Research, innovation and productivity: An econometric analysis at the firm level. Economics of Innovation and New Technology 7, no. 2: 115–58] that has been modified to include ICT investment and R&D as the two main inputs into innovation and productivity. We find that R&D and ICT are both strongly associated with innovation and productivity, with R&D being more important for innovation, and ICT investment being more important for productivity. For the median firm, rates of return to both investments are so high that they suggest considerably underinvestment in both these activities. We explore the possible complementarity between R&D and ICT in innovation and production, but find none, although we do find complementarity between R&D and worker skill in innovation.     

Zvi Griliches's contributions to the economics of technology and growth*

Zvi Griliches's contributions to the economics of technology and growth are identified. Included is a discussion of his contributions on: the determinants of differences in speed of adoption of innovations; the use of patents to measure technology; the private and social returns to R&D; and spillover effects from R&D. Griliches's own evaluation of his research contribution is compared to the evaluation of others in the field, using as evidence citation counts of his works collected from the online Web of Science. Griliches's most important contribution is his 1957 Econometrica hybrid corn paper that is a foundation of the economics of technological innovation. Remarkably, the trend in annual citations to the paper has continued to increase for over 40 years. Finally, we summarize Griliches's most recent views on the practice of economics and on the most important unanswered questions in the economics of technology and growth.     

新员工主动社会化行为与组织承诺关系研究——以社会资本为中介变量

为了探索新员工主动社会化行为影响组织承诺的过程,本文对来自企业的401个有效样本进行了实证分析。本研究运用层级回归的方法,控制了人口统计变量的影响后,发现员工的搜寻信息和搜寻绩效反馈行为对组织承诺有直接的正面影响,同时,通过员工社会资本对员工组织承诺产生了间接的正面影响。社会资本在员工搜寻信息和搜寻绩效反馈行为影响组织承诺的机制中起部分中介作用。员工的关系构建行为对组织承诺没有显著影响,但对员工社会资本存在显著的正面影响。