sipdroid.docx

合集下载

SIP制作教学讲义ppt课件

產品的開發及量產不是一個人從頭到尾完成的也不是如機械人般的一致性操作，人因差異而完美但產品品質因差異而失敗。所以為了讓品質出現一致性的結果，就必需把人機械化，而機械化的動作就必需要有細膩清楚的規範。
5
SIP資料來源
圖面開發中的改善對策(措施) 量測SOP 治具SOP 客訴 QC檢驗報告(檢驗項目可增加或減少) 包裝SOP
8
13
SIP製作教學
重點一﹕ (球球危機)
字大球大字小球大字大球小
那一個好呢?為什麼?
Байду номын сангаас
怎麼我的球都是小的…
14
SIP製作教學
重點二﹕ (連連看)
範例
15
SIP製作教學
重點三﹕ (量測點線面)
請量測變形度
16
SIP製作教學
重點三﹕ (量測點線面)
17
SIP製作教學
6
SIP製作教學
步驟一身份建立
SIP首重身份的查對，必需確認該版本為最新版否則將會誤導使用人員做出錯誤的判斷。
所謂的身份是指﹕品名、料號、客戶別、圖面版別等…
SIP應有總表可以供使用人員比對SIP的版別是否正確
7
SIP製作教學
步驟二檢驗重點
檢驗重點要以條列式呈現項目編號需和簡圖泡泡球編號視別一致在此步驟應100%的呈現檢驗的規格，
包含﹕
量測尺寸外觀包裝規範要求
8
SIP製作教學
步驟二檢驗重點
在此步驟應100%的呈現檢驗的規格，包含﹕
使用的量測設備(量具、治具等…) 執行的站別注意事項參考文件異常緊急聯絡人

simplicity studio编译工程示例-概述说明以及解释

simplicity studio编译工程示例-概述说明以及解释1.引言1.1 概述Simplicity Studio是一种集成开发环境(IDE)，专门用于开发和调试Silicon Labs公司的嵌入式设备。

它为开发人员提供了一种便捷的工具，使他们可以通过一个用户友好的界面来编写、编译和调试应用程序。

Simplicity Studio具有一系列功能和特点，使它成为一个强大而又灵活的开发平台。

首先，它支持多种不同型号的Silicon Labs芯片，包括各种系列的32位ARM Cortex-M微控制器，蓝牙低能耗芯片以及无线射频设备。

这使得开发人员可以在同一个平台上开发各种类型的项目，而无需切换开发工具。

其次，Simplicity Studio提供了丰富的软件组件和例程库，用于简化开发流程。

这些组件和库覆盖了多个应用领域，包括物联网(IoT)、智能家居、工业自动化和医疗等。

开发人员可以利用这些现成的模块，快速构建出高质量的应用程序。

此外，Simplicity Studio还提供了一整套调试工具，方便开发人员进行代码调试和性能优化。

它支持多种调试接口，包括J-Link、USB DebugAdapter和CMSIS-DAP等。

开发人员可以通过这些接口实现源代码级别的调试，以及对系统资源的监视和分析。

总之，Simplicity Studio是一款功能丰富、易于使用的开发环境，旨在提高开发人员的工作效率和应用程序的质量。

它将硬件和软件开发工具紧密结合在一起，使开发人员能够快速构建出稳定可靠的嵌入式应用。

在下面的文章中，我们将以编译工程示例为例，介绍Simplicity Studio的具体用法和开发流程。

1.2文章结构1.2 文章结构本文将按照以下结构进行详细介绍Simplicity Studio的编译工程示例：2.1 简介Simplicity Studio2.1.1 功能和特点2.1.2 使用场景2.2 编译工程示例2.2.1 创建工程2.2.2 编译和调试3.结论3.1 总结3.2 使用建议在第一个部分中，我们将简要介绍Simplicity Studio的概述，并阐述本文的目的。

ISPD指南ppt课件

ppt课件.
18
第三部分
腹膜炎的初始表现和治疗
如果流出液白细胞总数大于100个/ul，多形核白细胞至少50%，表明存在炎症。
流出液细胞数部分依赖于留腹时间的长短。正常情况下，腹膜有很少的多形核白细胞，因此，即使白细胞的绝对数不到100个/ul，只要多形核白细胞百分比大于50%，就是腹膜炎的有力证据。
ppt课件.
24
第三部分
腹膜炎的初始表现和治疗
二、治疗
抗菌谱必须覆盖G+和G-。工作组推荐中心具体选择经验性治疗药物时要依据既往腹膜炎致病菌的药敏结果（意见）。
G+选择万古霉素和一代头孢，G-选择
氨基糖甙类和三代头孢（证据）。一些中
心，甲氧青霉素的耐药率高，就可能万古
霉素+覆盖G-。 ppt课件.
治疗。
拔管指征：可由于生物膜包裹使得腹膜炎复发。这
时推荐更换腹pp透t课件管. (证据)。
35
第四部分
腹膜炎的后续治疗
链球菌和肠球菌两者痛感强烈链球菌和肠球菌腹膜炎较为严重，最好是
经腹腔给氨苄西林治疗（意见）。
在PD患者中，万古霉素耐药的肠球菌如果
对氨苄青霉素敏感，可以使用氨苄青霉素，
另外，还可以选择利奈唑胺或奎奴普丁
ppt课件.
6
ppt课件.
7
第二部分出口和隧道口感染
ppt课件.
8
第二部分
出口和隧道口感染
从出口处排出脓性分泌物提示存在感染，红斑不一定代表存在感染（证据）。
导管周围有红斑而没有脓性分泌物有时是早期感染的征象，也可能是普通的皮肤反应，特别是置管或导管损伤后。
ppt课件.
9
ppt课件.

CIPD Pres2

Factor Comparison Method
Classification Method Ranking Method
Hay is a Modified Factor Comparison Method
LEVEL
8 5 60 16 45 32 21 12 240 88 60 36 156 120 196
Factor Comparison Method
Classification Method Ranking Method
Hay is a Modified Factor Comparison Method
The Underlying Principle
1
Jobs exist to achieve an end result
7
6
5
4
3
2
1
1. Communication & relationship skills 2. Knowledge, training & experience 3. Analytical skills 4. Planning and organisation skills
6
42 6 42 6 42 27 15 27 15
Different Types of Evaluation Method
Method of Comparison Used
Comparing Job Against Some Scale Comparing Job Against Job
Method of Analysis Used
By considering By considering Job Elements the Entire Job Point Method

dna-sip技术原理

dna-sip技术原理DNA-SIP (Stable Isotope Probing) is a powerful and innovative technique used in environmental microbiology to identify and characterize the functional microbial populations in complex communities. This technique is based on the principle of using stable isotopes to label DNA of microorganisms in order to trace their metabolic activities and interactions in various environments. The application of DNA-SIP has significantly advanced our understanding of microbial ecology, biogeochemical cycling, and the roles of microorganisms in environmental processes.One of the key principles of DNA-SIP is the incorporation of stable isotopes, such as 13C, 15N, or 18O, into the DNA of microorganisms. This labeling allows researchers to track the metabolic activities of specific microbial groups by analyzing the isotopically labeled DNA using molecular biology techniques. By comparing the isotopically labeled DNA with the total DNA from a microbial community, researchers can identify the activemicrobial populations involved in specific metabolic processes, such as carbon or nitrogen cycling, in a given environment.The DNA-SIP technique has been widely used in various environmental studies, including soil, sediment, water, and plant-associated microbial communities. By using stable isotopes to label microbial DNA, researchers can elucidate the functional roles of specific microorganisms in nutrient cycling, pollutant degradation, and other important environmental processes. This information is crucial for understanding and managing ecosystems, as well as for developing biotechnological applications in areas such as bioremediation and bioenergy production.In addition to identifying active microbial populations, DNA-SIP can also provide insights into the interactions and dynamics of microbial communities in complex environments. By analyzing the isotopically labeled DNA, researchers can determine the trophic relationships and metabolic exchanges between different microbial groups. This information is valuable for understanding the stability and resilience ofmicrobial communities, as well as for predicting their responses to environmental changes and disturbances.The development and application of DNA-SIP have revolutionized our ability to study the functionaldiversity and dynamics of microbial communities in diverse environments. By combining stable isotope labeling with molecular biology techniques, researchers can gain unprecedented insights into the metabolic activities, interactions, and ecological functions of microorganisms. This knowledge is essential for addressing global challenges such as climate change, pollution, and sustainable resource management, and for harnessing the potential of microbial communities for biotechnological innovations.In conclusion, DNA-SIP is a groundbreaking technique that has transformed our understanding of microbial ecology and environmental microbiology. By using stable isotopes to label microbial DNA, researchers can identify active microbial populations, elucidate their functional roles, and unravel their interactions in complex environments.This knowledge is essential for advancing our understanding of ecosystem processes, as well as for developing innovative solutions to environmental and societal challenges. The continued advancement of DNA-SIP and its integration with other omics approaches will further expand our knowledge of microbial communities and their contributions to the health and sustainability of our planet.。

scPloidy软件包说明书

Package‘scPloidy’October14,2022Type PackageTitle Infer Ploidy of Single CellsVersion0.3.0Description Compute ploidy of single cells(or nuclei)based on single-cell(or single-nucleus)ATAC-seq(Assay for Transposase-Accessible Chromatin using sequencing)data<https:///fumi-github/scPloidy>.BugReports https:///fumi-github/scPloidy/issuesDepends R(>=3.5.0)License MIT+ﬁle LICENSEEncoding UTF-8LazyData trueRoxygenNote7.2.1Imports dplyr,GenomicRanges,magrittr,matrixStats,mixtools,rlang,Rsamtools,utilsSuggests IRanges,knitr,readr,rmarkdown,testthat(>=3.0.0)Conﬁg/testthat/edition3VignetteBuilder knitrNeedsCompilation noAuthor Fumihiko Takeuchi[aut,cre](<https:///0000-0003-3185-5661>) Maintainer Fumihiko Takeuchi<**********************>Repository CRANDate/Publication2022-09-1207:40:02UTCR topics documented:fragmentoverlapcount (2)ploidy (3)SHR_m154211 (3)Index512fragmentoverlapcount fragmentoverlapcount Count Overlap of ATAC-seq FragmentsDescriptionCount Overlap of ATAC-seq FragmentsUsagefragmentoverlapcount(file,targetregions,excluderegions=NULL,targetbarcodes=NULL,Tn5offset=c(1,0))Argumentsfile Filename of theﬁle for ATAC-seq fragments.Theﬁle must be block gzipped(using the bgzip command)and accompanied with the indexﬁle(made us-ing the tabix command).The uncompressedﬁle must be a tab delimitedﬁle,where each row represents one fragment.Theﬁrst four columns are chromo-some name,start position,end position,and barcode(i.e.,name)of the cellincluding the fragment.The remaining columns are ignored.See vignette fordetails.targetregions GRanges object for the regions where overlaps are ually all ofthe autosomes.If there is memory problem,split a chromosome into smallerchunks,for example by10Mb.The function loads each element of targetregionssequentially,and smaller elements require less memory.excluderegions GRanges object for the regions to be excluded.Simple repeats in the genomeshould be listed here,because repeats can cause false overlaps.A fragment isdiscarded if its5’or3’end is located in excluderegions.If NULL,fragmentsare not excluded by this criterion.targetbarcodes Character vector for the barcodes of cells to be analyzed,such as those passingquality control.If NULL,all barcodes in the inputﬁle are analyzed.Tn5offset Numeric vector of length two.The enzyme for ATAC-seq is a homodimer ofTn5.The transposition sites of two Tn5proteins are9bp apart,and the(rep-resentative)site of accessibility is in between.If the start and end position ofyour inputﬁle is taken from BAMﬁle,set the paramater to c(4,-5)to adjustthe offset.Alternatively,values such as c(0,-9)could generate similar results;what matters the most is the difference between the two numbers.The frag-ments.tsv.gzﬁle generated by10x Cell Ranger already adjusts the shift but isrecorded as a BEDﬁle.In this case,use c(1,0)(default value).If unsure,setto"guess",in which case the program returns a guess.ploidy3ValueA tibble with each row corresponding to a cell.For each cell,its barcode,the total count of thefragments nfrag,and the count distinguished by overlap depth are given.ploidy Infer Ploidy from ATAC-seq Fragment OverlapDescriptionInfer Ploidy from ATAC-seq Fragment OverlapUsageploidy(fragmentoverlap,levels,s=100)ArgumentsfragmentoverlapFrequency of fragment overlap in each cell computed by the function fragmentoverlapcount.levels Possible values of ploidy.For example,c(2,4)if the cells can be diploids ortetraploids.The values must be larger than one.s Seed for random numbers used in EM algorithm.ValueA data.frame with each row corresponding to a cell.For each cell,its barcode,ploidy inferred bymoment method,the same with additional K-means clustering,and ploidy inferred by EM algorithmof mixture are given.I recommend using ploidy.moment.SHR_m154211Liver Cells from a RatDescriptionThe dataset includes3572nuclei obtained from the liver of a16weeks old male rat,which was fednormal diet.Overlapping of single-nucleus ATAC-seq fragments was computed with the fragmentoverlapcount function and saved as fragmentoverlap.The cell type of the nuclei are saved in the data.framecells.The data for rat SHR_m154211was taken from the publication cited below.Usagedata(SHR_m154211)FormatAn object of class list of length2.4SHR_m154211SourceTakeuchi et al.(2022)bioRxiv doi:10.1101/2022.07.12.499681Examplesdata(SHR_m154211)fragmentoverlap=SHR_m154211$fragmentoverlapp=ploidy(fragmentoverlap,c(2,4,8))head(p)cells=SHR_m154211$cellstable(cells$celltype,p$ploidy.moment[match(cells$barcode,p$barcode)])Index∗datasetsSHR_m154211,3fragmentoverlapcount,2ploidy,3SHR_m154211,35。

IPDPSSDT计划决策评审汇报胶片模板

市场评估
1 环境分析 2 目标市场和客户分析 3 竞争分析 4 渠道/合作伙伴 5 业务潜力
行为准则：尊重·简单·重用·检查·并行·勇气·反馈·改善·认真·责任
价值观：客户第一 | 阳光沟通 | 团队协作 | 拥抱变化 | 学习成长
市场评估
1、环境分析
描述决定或影响我们产品的细分市场的环境驱动力是什么。会引起变化的趋势是什么（例如规则、社会、行业，经济、技术、业务模式的改变等等）？这些变化发生的速度是怎样的？哪些新的趋势会加大影响或提供新增的业务机会？
概
1、目标产品
产品简要描述
述
简要描述产品的功能、性能方面的特性
优化后的产品目标
简述产品的定位，要做成什么样子，满足哪些功能需求等
行为准则：尊重·简单·重用·检查·并行·勇气·反馈·改善·认真·责任
价值观：客户第一 | 阳光沟通 | 团队协作 | 拥抱变化 | 学习成长
概
2、目标市场：
中国大陆，港澳台地区，国际上哪些国家目标市场份额
价值观：客户第一 | 阳光沟通 | 团队协作 | 拥抱变化 | 学习成长
市场评估
(1)、渠道/合作伙伴确定
1)、计划采用的销售渠道
2)、销售渠道对目标市场的覆盖情况
3)、销售渠道准备的情况 4)、每个销售渠道的销售预期 5)、各销售渠道的激励计划 6)、针对销售和技术支持人员的培训计划
7)、推广的计划
尊重简单重用检查并行勇气反馈改善认真责任6优势劣势机会威胁优势1融合最新的技术及功能2同类功能性能指标强3模块化组合4公司现有品牌在技术上的优势及人力资源上的优势5毛利高劣势1市场容量小2缺少分销经验3没有终端品牌优势机会1现有手机市场高低端产品界线不清楚没有真正的高端23g即将商用推动数据业务及其它多业务的应用发展3全国经济复苏4我们是新的手机终端产品提供商竞争对手可能会忽略我们威胁13g推迟2手机牌照受限3其它公司进入与我们同样的细分市场竞争加剧市场评估价值观

SIPp脚本编写方法基础m

SIPp脚本编写方法基础目录SIPp脚本编写方法入门 (1)1. 脚本格式 (3)1.1.基于XML进行扩展 (3)1.2.DTD扩展语法规则 (3)1.3.脚本结构 (3)1.4.注释 (5)2. 脚本类型 (5)2.1.UAC (5)2.2.UAS (5)2.3.3PCC（三方通话） (6)2.4.OCC（Out-of-call） (6)3. 命令与属性 (6)3.1.常用命令 (6)3.2.常用属性列表 (8)3.3.正则表达式 (10)4. 变量与关键字 (11)4.1.关键字的使用 (11)4.2.变量定义与使用 (13)4.3.鉴权 (15)5. 分支和跳转 (16)5.1.标签 (16)5.2.条件判断 (16)5.3.跳转和循环 (17)5.4.概率分支 (18)6. 文件引用 (19)6.1.外部文件格式 (19)6.2.引用方法 (20)6.3.文件索引 (20)7. 脚本中的命令操作 (21)7.1.内部命令 (21)7.2.外部命令 (21)7.3.媒体命令 (21)8. 附录 (23)修订记录 (24)1.脚本格式1.1.基于XML进行扩展SIPp的测试脚本遵循标准的XML V1.0版本的语法规范，XML即“可扩展标记语言”eXtensible Markup Language 的缩写，W3C组织与1998年发布XML 1.0规范。

1.2.DTD扩展语法规则SIPp的执行目录中，存在一个sipp.dtd文件。

该文件为标准的xml扩展语法规则，在该文件中，对send、recv、pause等元素增加了定义，包括其属性列表等内容，可作为脚本文件格式的校验。

1.3.脚本结构一个标准的SIPp脚本，文件起始应为通用的xml前导区和DTD文件定义区如图所示：接下来使用<scenario>和</scenario>包括的部分，即为脚本的正文部分。

sipp脚本正文部分，包含如下几个区域：1.初始化区在初始化区域中，通常用来进行全局变量的定义和赋值等操作，在脚本未进行逻辑流程前，预先完成初始化动作。

SIP作业指导书

SIP作业指导书SIP作业指导书课程：SIP（软件工程实践）指导教师：XXX一、作业目的：本次作业的目的是让学生能够通过实际项目实践来熟悉和运用软件工程的基本概念和方法，培养学生团队合作和项目管理的能力，并锻炼学生的问题分析和解决能力。

二、作业要求：1. 学生们将分为若干个小组，每个小组3-5人。

2. 每个小组要选择一个软件项目，项目类型不限，但需在指导教师的审批范围内。

3. 每个小组需要按照软件工程的基本步骤进行项目开发，包括需求分析、系统设计、编码、测试和部署等阶段。

4. 每个阶段开发完毕后，小组需要提交相应的文档和代码，并向指导教师进行汇报。

5. 项目开发过程中，小组成员需要积极合作，充分发挥每个成员的潜力，相互协助解决问题。

6. 作业完成后，每个小组需要进行项目总结和经验分享。

三、作业分数评定：1. 项目策划、需求分析和系统设计：占总分的30%。

2. 代码实现和测试：占总分的40%。

3. 汇报和演示：占总分的20%。

4. 小组合作和项目进展情况：占总分的10%。

四、提交截止日期：作业的提交截止日期将在课程中确定，请同学们密切关注课程公告和指导教师的通知。

五、补充说明：1. 小组成员之间可以通过各种方式进行沟通和交流，包括在线聊天工具、电子邮件等，但不得泄露个人信息。

2. 作业中所需的文档和代码请按照指导教师的要求进行命名和格式要求。

3. 如遇到问题，请及时向指导教师进行咨询和求助，但不得直接向其他学生求助或索取他人的代码。

以上为SIP作业的指导书，请同学们按照要求完成作业，并在规定的时间内提交。

希望本次作业能够帮助各位同学提升软件工程实践能力，感谢大家的合作与努力！。

IDEXX 4Dx

Screening for vector-borne disease IDEXX 4Dx® Plus Test clinical reference guideWith the IDEXX 4Dx ® Plus T est, a positive result can also be an indication of ticks and and the pathogens they carry. Know more with every resultdetect antibodies to these pathogens When you use the IDEXX 4Dx Plus T est as a screening tool, you maycarried by these ticks Anaplasmaphagocytophilum Borrelia burgdorferi (Lyme disease)Ehrlichia ewingiiEhrlichia canis Anaplasma platysBabesia spp.Rocky Mountain spotted feverEhrlichia chaffeensis TularemiaRocky Mountain spotted fever STARIBartonella spp.Babesia spp.Ehrlichia canis Brown dog tickRhipicephalus sanguineusAmerican dog tickDermacentor variabilisBlack-legged tick (deer tick)Ixodes scapularis Ixodes pacificusLone star tickAmblyomma americanumRocky Mountain spotted fever TularemiaGeographic tickdistribution as of 20213that may also transmit other pathogens and infections to dogs and peopleLyme diseasebacterium Borrelia burgdorferi cases that have mild to severe disease.* S erology is typically used to diagnose Lyme disease. B. burgdorferi Did you know?•D ogs testing positive for antibodies to the C 6 peptide had 43% increased risk of having chronic kidney disease (CKD) compared to seronegative dogs.4• T he C 6 peptide used in the IDEXX 4Dx ® Plus Test and Lyme Quant C 6® Antibody Test does not cross-react with the antibody response to commercially available Lyme vaccines.5 • D ogs with seroreactivity to both B. burgdorferi and Anaplasma phagocytophilum may have two times the risk of developing clinical illness than singularly infected dogs.2Borrelia burgdorferiPrimary vectorsIxodes scapularis or Ixodes pacificus Black-legged tick (deer tick)Pathology• Localizes in tissues of infected dogs • Synovitis (may be subclinical) • Lyme nephritisClinical presentationChronic infection with clinical signs that may present acutely:• Fever, anorexia• Polyarthritis, lameness• Rapidly progressive renal failure • Neurologic syndromesLaboratory abnormalities• Elevated C 6 antibody level ≥ 30 U/mL • May have proteinuria• M ay have IDEXX SDMA ® T est result > 14 µg/dLCKD monitoring• Chemistry panel with SDMA – R ecommended to evaluate forthe development of protein-losing kidney disease• Urinalysis with Reflex UPC – R ecommended to evaluate forproteinuria • CBC with blood film evaluation – R ecommended as part of aminimum databaseHeartworm diseaseDirofilaria immitis, the causative agent of heartworm disease, is transmitted when mosquitoes infected with D. immitis larvae feed on (or bite) a healthy dog. Heartworm disease has subtle or mild clinical signs in the early stages, making preventive measures so much more important—especially as advanced infection may result in death.Did you know?•D espite availability of monthly preventives, prevalence rates of canine heartworm have remained consistent nationwide.7•T he American Heartworm Society (AHS) and the Companion Animal Parasite Council (CAPC) recommend testing all dogs for both antigen and microfilariae annually.7,8•F or more information and current recommendations on treating canine heartworm disease, goto or . Dirofilaria immitisPrimary vectorMosquitoPathologyInfective larvae (L3) mature to adult worms in the heart and pulmonary arteriesClinical presentation Asymptomatic at first, later developing:• Mild, persistent cough• Lethargy• Exercise intolerance• Reduced appetite• Weight lossLaboratory abnormalities that may be seen • Eosinophilia• Azotemia• Increased liver enzymes• ProteinuriaAnaplasmaphagocytophilumAnaplasma platysPrimary vectorsIxodes scapularis Ixodes pacificusBlack-legged tick (deer tick)Rhipicephalus sanguineus (brown dog tick)PathologyInfects neutrophilsInfects plateletsClinical presentationCan present acutely:• F ever • Anorexia • Lethargy• Polyarthritis, lameness • Neurologic signsUsually minimal clinical signs, but some dogs may have:• F ever • Uveitis• Petechiae and ecchymoses • EpistaxisLaboratory abnormalities• Thrombocytopenia• Anemia• Lymphopenia• Increased liver enzymesOther findings may be seen:• Decreased albumin • Increased globulin• Increased ALP and ALT • Proteinuria• Decreased Urine SG • Increased UPC NotePrevious infection may not prevent reinfection and persistent infections are possible.9,10Canine anaplasmosisCanine granulocytic anaplasmosis is caused by the bacterium Anaplasma phagocytophilum (transmitted by the black-legged tick [deer tick]). Anaplasma platys (transmitted by the brown dog tick) is the cause of infectious cyclic thrombocytopenia.Did you know?•M any mammalian species, including humans, are susceptible to A. phagocytophilum infection. •D ogs coinfected with Anaplasma and other bacterial pathogens may have more complex disease presentations and respond more slowly to therapy.• A .platys infects canine platelets and is frequently seen as a coinfection with Ehrlichia canis .Canine ehrlichiosisCanine ehrlichiosis is caused by the bacteria Ehrlichia canis (transmitted by the brown dog tick) and Ehrlichia ewingii (transmitted by the lone star tick). Canine Ehrlichia infections may progress to the subclinical phase or may become chronic infections.Ehrlichia canisEhrlichia ewingiiPrimary vectorRhipicephalus sanguineus (Brown dog tick)Amblyomma americanum (Lone star tick)PathologyInfects monocytes Infects granulocytesClinical presentation• Fever, anorexia, lethargy • Bleeding disorders • Polyarthritis, lameness • Lymphadenomegaly • Neurologic signs• Fever, anorexia, lethargy • Polyarthritis, lameness • Neurologic signsLaboratory abnormalitiesNotePrevious infection may not prevent reinfection, and persistent infections are possible.12,14Did you know?• D ogs coinfected with E. canis and A. platys were found to have more severe anemia and thrombocytopenia than dogs with either single infection.11• I n a study of healthy dogs with antibodies to E. canis , 39% were thrombocytopenic.12• C hronic E. canis infections, if left untreated, can lead to bone marrow dysfunction or kidney disease.• D ogs with Ehrlichia antibodies in E. canis endemic areas had a 112% increased risk of developing chronic kidney disease (CKD).13CKD monitoring• Chemistry panel with SDMA - R ecommended to evaluate forsecondary kidney disease.• Urinalysis with UPC - R ecommended to evaluatefor proteinuria • CBC with blood film - R ecommended as part of aminimum database• Anemia• Thrombocytopenia • Hyperglobulinemia • ProteinuriaOther clinical findings may include:• Decreased albumin • Increased globulin• Mild increased ALT and ALP • Increased SDMA • Creatinine• Decreased urine specific gravity, proteinuria • Increased urine protein:creatinine (UPC) ratio.Serology and PCR for sick patients For dogs presenting with clinical signs consistent with a vector-borne disease, usingserology and PCR together improves your ability to make an accurate diagnosis.Serology Polymerase chain reaction (PCR)Measures Antibody response of host Nucleic acid (DNA) from pathogenBenefits Useful for screening as well as diagnosisof infection Specifically identifies pathogens indicating active infectionLimitations Clinical signs may precede a measurableantibody response A negative PCR result does not necessarily rule out infectionDogs with ehrlichiosis and anaplasmosis may present with clinical signs at different times after infection. Which sick dog are you dealing with? Benefits and limitations of each diagnostic methodrecrudescence presents presents presentsWhen to use the IDEXX vector-borne disease RealPCR™ panels• S ick patients with clinical signsand/or laboratory abnormalitiesconsistent with a vector-borne illness• P atients with subclinical infectionsbased on history, physicalexamination, serology, and clinicallaboratory findings“No single test is sufficientfor diagnosing an infectious disease in a sick patient.”Edward Breitschwerdt, DVM, DACVIM*Professor, Internal MedicineCollege of Veterinary Medicine,North Carolina State University* D r. Breitschwerdt has a business relationship with IDEXX pursuant to which he receives compensation from IDEXX from time to time. The views expressed in this guide are solely those of Dr. Breitschwerdt.References1. G eneral guidelines: Parasite testing and protection guided by veterinarians [dog].Companion Animal Parasite Council website. /guidelines /general-guidelines. Updated July 29, 2020. Accessed November 17. 2021. 2. B eall MJ, Chandrashekar R, Eberts MD, et al. Serological and molecular prevalenceof Borrelia burgdorferi , Anaplasma phagocytophilum , and Ehrlichia species in dogs from Minnesota. Vector-Borne Zoonotic Dis . 2008;8(4):455–464. doi:10.1089/vbz.2007.0236 3. R egions where ticks live [maps]. Centers for Disease Control and Prevention website./ticks/geographic_distribution.html. November 17, 2021. 4. D rake C, Coyne M, McCrann DJ, Buch J, Mack R. Risk of development of chronickidney disease after exposure to Borrelia burgdorferi and Anaplasma spp. T op Companion Anim Med. 2020;42:100491. doi:10.1016/j.tcam.2020.100491 5. O ’Connor TP , Esty KJ, Hanscom JL, Shields P , Philipp MT . Dogs vaccinatedwith common Lyme disease vaccines do not respond to IR 6, the conserved immunodominant region of the VlsE surface protein of Borrelia burgdorferi.Clin Diagn Lab Immunol. 2004;11(3):458–462. doi:10.1128/CDLI.11.3.458-462.2004 6. S traubinger RK. PCR-based quantification of Borrelia burgdorferi organisms in caninetissues over a 500-day postinfection period. J Clin Microbiol. 2000;38(6):2191–2199. doi:10.1128/JCM.38.6.2191-2199.2000 7. C APC prevalence maps: heartworm [dog]. Companion Animal Parasite Councilwebsite. /maps/#/2021/all-year/heartworm-canine/dog/united-states. Accessed November 17, 2021.8. A merican Heartworm Society. Current canine guidelines for the prevention, diagnosis,and management of heartworm infection in dogs . 2020. Accessed November 17, 2021. https:///images/pdf/AHS_Canine_Guidelines_11_ 13_20.pdf?1605556516 9. E genvall A, Lilliehöök I, Bjöersdorff A, et al. Detection of granulocytic Ehrlichia speciesDNA by PCR in persistently infected dogs. Vet Rec . 2000;146(7):186–190. doi:10.1136/vr.146.7.186 10. B reitschwerdt EB, Hegarty BC, Qurollo BA, et al. Intravascular persistence ofAnaplasma platys , Ehrlichia chaffeensis , and Ehrlichia ewingii DNA in the blood of a dog and two family members. Parasit Vectors . 2014;7:298. doi:10.1186/1756-3305-7-298 11. G aunt S, Beall M, Stillman B, et al. Experimental infection and co-infection of dogs withAnaplasma platys and Ehrlichia canis : hematologic, serologic and molecular findings. Parasit Vectors . 2010;3(1):33. doi:10.1186/1756-3305-3-33 12. H egarty BC, de Paiva Diniz PP , Bradley JM, Lorentzen L, Breitschwerdt E. Clinicalrelevance of annual screening using a commercial enzyme-linked immunosorbentassay (SNAP 3Dx) for canine ehrlichiosis. J Am Anim Hosp Assoc. 2009;45(3):118–124. doi:10.5326/0450118 13. B urton W, Drake C, Ogeer J, et al. Association between exposure to Ehrlichia spp.and risk of developing chronic kidney disease in dogs. J Am Anim Hosp Assoc . 2020;56(3):159–164. doi:10.5326/JAAHA-MS-7012 14. S tarkey LA, Barrett AW, Beall MJ, et al. Persistent Ehrlichia ewingii infection indogs after natural tick infestation. J Vet Intern Med . 2015;29(2):552–555. doi:10.1111/jvim.12567 15. S nellgrove AN, Krapiunaya I, Ford SL, et al. Vector competence of Rhipicephalussanguineus sensu stricto for Anaplasma platys . Ticks Tick Borne Dis. 2020;11(6):101517. doi:10.1016/j.ttbdis.2020.101517Depend on the most accurate and comprehensive screenSNAP 4Dx Plus T estReference-laboratory quality in the palm of your hand, for superior diagnostic accuracy at the pointof care.Lab 4Dx Plus T estAvailable from IDEXX Reference Laboratories as a stand-alone test or as part of a more comprehensiveparasite screen with the Fecal Dx Antigen Panel with Lab 4Dx Plus Test-Canine.SNAP ® technology uses a proprietary three-step process to deliver dependable sensitivity and specificity.Available in-clinic or from IDEXX Reference LaboratoriesStrengthen the bonds.IDEXX Laboratories, Inc.One IDEXX DriveWestbrook, Maine 04092United StatesAmerican dog tick (Dermacentor variabilis) photographer: Susan E. Ellis, USDA-APHIS-PPQ. Black-legged tick (Ixodes scapularis), lone star tick (Amblyomma americanum), and brown dog tick (Rhipicephalus sanguineus) photographer: James L. Occi.© 2022 IDEXX Laboratories, Inc. All rights reserved. • 09-69074-13All ®/TM marks are owned by IDEXX Laboratories, Inc. or its affiliates in the United States and/or other countries. The IDEXX Privacy Policy is available at .。

ispd guidelines 预防腹膜炎

Peritoneal Dialysis International, Vol. 31, pp. 614–630doi: 10.3747/pdi.2011.000570896-8608/11 $3.00 + .00Copyright © 2011 International Society for Peritoneal DialysisISPD POSITION STATEMENT ON REDUCING THE RISKS OF PERITONEALDIALYSIS–RELATED INFECTIONSBeth Piraino,1 Judith Bernardini,1 Edwina Brown,2 Ana Figueiredo,3David W. Johnson,4 Wai-Choong Lye,5 Valerie Price,6 Santhanam Ramalakshmi,7 and Cheuk-Chun Szeto 8University of Pittsburgh School of Medicine,1 Pittsburgh, Pennsylvania, USA; Imperial College Healthcare NHS Trust,2 London, UK; Faculdade de Enfermagem,3 Nutriccao e Fisioterapia, Pontificia Universidade Catolicado Rio Grande do Sul, Brazil; Princess Alexandra Hospital and School of Medicine,4University of Queensland, Brisbane, Australia; Mount Elizabeth Medical Centre,5 Singapore; Saint JohnRegional Hospital,6 Horizon Health Network, St. John, New Brunswick, Canada;Sri Ramachandra University No 1,7 Ramachandra Nagar, Porur, Chennai,India; and Department of Medicine and Therapeutics,8 Prince ofWales Hospital, The Chinese University of Hong Kong,Hong Kong SAR, PR ChinaSPECIAL ARTICLEF or a peritoneal dialysis (PD) program to be successful, close attention must be paid to preventing PD-related infections (defined as exit-site infections, tunnel infec-tions, and peritonitis). The variation in peritonitis rates in recently published studies (1–20) is astonishing: from a low of 0.06 episodes per year in a Taiwanese program to a high of 1.66 episodes per year at risk in an Israeli pediatric program (Table 1). Those rates mean that an individual patient, on average, may expect to have peritonitis as rarely as once every 17 years in one cen-ter, or as frequently as once every 7 months in another. Even at centers within a single country, there is often a marked variation in the peritonitis rate. For example, the Scottish registry has centers with rates that range from 0.43 episodes to 0.89 episodes per year (1), the LondonThames centers vary from 0.14 episodes to 1.0 episodes per year (9), and the Austrian Study Group centers range from 0.07 episodes to 0.60 episodes per year (10). Ex-planations for such marked variations are lacking, but are likely related at least in part to differences in patient training and in infection-prevention protocols. Varia-tions in the accuracy with which peritonitis episodes are recorded may also contribute in part to the differences in reported rates.Studies on preventing PD-related infections are lim-ited both in number and in quality, and guidelines are therefore not yet appropriate. The present position paper is a compilation of the opinions of experts in the field, combined with the available evidence. It is intended to provide support to PD programs developing approachesto reduce PD-related infections to very low levels atall centers. Suggestions for which there is published research are labeled “evidence”; suggestions for which only case reports, limited observational studies, or theexperience of the work group are available are labeled“opinion.” We hope that this review of the problems willstimulate further research into this important topic.Specific guidelines for treating peritonitis were updated and published in 2010 (21), as were guidelines for PD Correspondence to: B. Piraino, Suite 200, 3504 Fifth A venue, Pittsburgh, Pennsylvania 15213 USA.Piraino@ Received 11 May 2011; accepted 17 May 2011Perit Dial Int 2011; 31(6):614-630 epub ahead of print: 31 Aug 2011 doi:10.3747/pdi.2011.00057KEY WORDS: Peritonitis; exit-site infections; tunnel in-fections; prevention of peritonitis; automated peritoneal dialysis; continuous ambulatory peritoneal dialysis. by guest on July 22, 2014/Downloaded fromPDI NovEMBER 2011 - voL. 31, No. 6 ISPD: REDUCING THE RISKS OF PD-RELATED INFECTIONScatheter insertion and management (22). The present position paper is directed specifically at the prevention of PD-related infections, and it is intended primarily for adult programs; however, many of the principles are likely to be applicable to pediatric programs as well.MONITORING PERITONITIS • Every program should monitor infection rates at least quarterly (23–26). (Opinion)• A team approach for continuous quality improvement (CQI) is the key to a successful PD program (25–26). (Opinion)The PD CQI team generally includes nephrologists, nurses, social workers, and dietitians. Regular meetings of the team should be held to examine all PD-related infections, identifying the root cause of each episode. If a pattern of infections develops, the team needs to investigate and to plan interventions such as retrain-ing, equipment changes, application of new protocols for exit-site care, or management of contamination (to mention just a few examples). Tracking not only the overall rates of each type of PD-related infection, but also the rates by organism will aid the team in identify-ing problems and trends. The organisms causing theperitonitis episodes can provide important clues to thepossible causality (Table 2). Peritonitis episodes caused by Staphylococcus aureus and Pseudomonas aeruginosa are often secondary to exit-site and tunnel infections with the same organisms; peritonitis episodes caused by coagulase-negative staphylococci are generally re-lated to contamination at the time of connection or tocontamination of tubing (27), and they indicate a needto re-examine training methods. The CQI team identifies problems, develops solutions, and evaluates results in an iterative fashion.Calculation of peritonitis rates should be standard-ized and should be clearly defined in any publication on peritonitis. Most observers would start to calculate the time at risk for peritonitis as the first day of training;TABLE 1Peritonitis Rates Around the WorldPatient population (n ) Episodes per Country Reference Year Adults Children Centers year at risk (n )Scotland Kavanaugh (1) 2004 1205a 0.62Japan Hoshii (2) 2006 130 0.17Canada Mujais (3) 2006 26 0.43United States Mujais (3) 2006 35a 0.37Japan Nakamoto (4) 2006 139 0.22Portugal Rodrigues (5) 2006 312 0.39Canada Fang (6) 2008 312 0.33China Fang (6) 2008 496 0.20Taiwan Tzen–Wen (7) 2008 100 0.06Turkey Akman (8) 2009 132 0.77United Kingdom Davenport (9) 2009 1904 pt–yrs a 0.82 CAPD 0.66 APD Austria Kipriva–Altfart (10) 2009 332 0.24Brazil Mores (11) 2009 680a 0.74Canada Nessim (12) 2009 4247a 0.36Spain Perez Fontan (13) 2009 641 0.38United States Qamar (14) 2009 137a 0.24Netherlands Ruger (15) 2009 205a 0.60France Castrale (16) 2010 1631b 0.36Israel Cleper (17) 2010 29 1.66Australia/New Zealand Fahim (18) 2010 4675a 0.62Australia Jarvis (19) 2010 4675a 0.60Qatar Shigidi (20) 2010 241 0.24CAPD = continuous ambulatory peritoneal dialysis; APD = automated peritoneal dialysis.a Registry data.b Elderly patients.by guest on July 22, 2014/Downloaded fromPIRAINO et al. NovEMBER 2011 - voL. 31, No. 6 PDIsome might consider the date of catheter insertion to be the starting point. The former is probably preferable, because the latter might lead to falsely low rates, espe-cially in centers that place the catheter many weeks or even months before the start of training.The rate is calculated by totaling all the peritonitis episodes that occurred during the entire time on PD (“at risk”) for all patients in the program during the period in question. That total is then divided by the time at risk in years. “Time at risk” is the sum of all days that each patient was on PD during the time in question. The days at risk are then converted to years at risk.Peritonitis episodes that occur while the patient is hospitalized and not doing self-dialysis might be exclud-ed, but the work group feels that including all episodes while the patient is on PD is the best approach. The stop points for time at risk are generally successful transplan-tation (even though the catheter may be left in place for a period of time) and transfer to hemodialysis. Time spentduring a period of temporary transfer to hemodialysisshould not be included in the time at risk.As shown in Table 1, low peritonitis rates are achiev-able. We believe that a rate of 0.36 episodes per patient per year can be reached by most programs. However, overall rates as low as 0.06 – 0.24 episodes per year at risk or 1 episode every 50 – 200 months have been reported,and so those are the goals that dialysis programs should strive to achieve (2,4,6,7,10,14,20).Yearly, each program should also examine the propor-tion of patients who are peritonitis-free. A minimum of 80% of patients should be peritonitis-free in any givenyear. Often, a small number of patients experience most of the peritonitis episodes. Those patients require close scrutiny, with the development of approaches to lower the infection risk in such patients. That effort may require more intensive training, home visits, or the training of a family member. The dialysis center personnel should closely examine the organisms causing the peritonitis and determine whether the peritonitis is relapsing,repeat, or recurrent (as discussed later in this position paper). A program may also find it helpful to calculatea median rate for all the individual patient rates. In a successful program, the median rate will be zero, with most patients having no peritonitis episodes in a given year.It is very important to examine organisms not just as a percentage of the total but also as an absolute rate (episodes per year). Only in this way can the results of a center be compared, organism-by-organism, with the results in the literature. To evaluate problem areas in aprogram, the rates of infection by organism should beexamined and followed on a regular basis because of theimportant information provided.For example, at one center, 30% of all peritonitis is caused by S. aureus, similar to the proportion reported at another center. However, if the first center has an overall peritonitis rate of 0.2 episodes per year, the S. aureus rate is then 0.06 episodes per year. That rate can then be compared to the rate at the second center whose overall peritonitis rate is 0.60 episodes per year, for a S. aureus peritonitis rate of 0.18 episodes per year. The second center therefore has a rate of S. aureus peritonitis that is 3 times the rate at the first center, despite a similar proportion of S. aureus episodes at the two centers.In addition to examining rates by organism at multiple centers, publications on PD-related infections should also present the organism-specific data as rates, and not just as proportions or percentages of the total peritonitis rate. Table 3 shows an example of rates by organism.TABLE 2 Causes of Peritonitis 1 C ontamination, most likely skin or environmental o rganisms Contamination at the time of connection Contamination from tubing Hole in exchange tubing or catheter L oss of cap on end of tubing or failure to close clamp with leaking Product defects 2 C atheter related, most often staphylococcal species or Pseudomonas aeruginosa B iofilm on internal portion of the catheter (relapsing, repeat peritonitis) Exit-site and tunnel infection 3 B owel-source enteric organisms including gram-negative rods, Candida, and anaerobes Diverticulitis Cholecystitis Ischemic bowel ColitisPerforated stomach or intestine Colonoscopy, especially with polypectomy C onstipation with transmural migration of organisms into peritoneum 4 Bacteremia, often Streptococcus or Staphylococcus Transient from dental procedures Infection of intravascular device 5 G ynecologic source, often Streptococcus, Candida, some gram-negative rods Peritoneal vaginal leak Vaginal delivery Hysteroscopy by guest on July 22, 2014/Downloaded fromPDI NovEMBER 2011 - voL. 31, No. 6 ISPD: REDUCING THE RISKS OF PD-RELATED INFECTIONSthe potential benefit against the risk of vancomycin usehastening the emergence of resistant organisms.In patients participating in the U.S. National CAPDRegistry, catheter survival was superior for double-cuffcatheters compared with single-cuff catheters; double-cuff catheters were also less likely to result in catheter removal for exit-site infection (32). This benefit was not confirmed in a single-center randomized trial with a much smaller number of patients (33); however, a recent study from Canada found that double-cuff catheters were associated with lower rates of S. aureus peritonitis (12). A large multicenter randomized controlled trial (RCT) would be helpful to resolve this question.A downward-directed tunnel may decrease the risk of catheter-related peritonitis (34); however, randomized trials have not confirmed a benefit for the swan-neck configuration in reducing PD-related infections (29,30), nor has burying the catheter proved effective in reducing the risk of infection (35). Outcomes for infectious and mechanical complications are equivalent in cathetertypes using downward and lateral tunnel-tract and exit-site configurations (30).Every effort should be made to avoid trauma and hematoma during catheter placement. The exit siteshould be round, and the tissue should fit snugly around the catheter. Sutures at the exit site increase the risk of infection and are contraindicated. Some programs obtain nose cultures before placement of the catheter, and they treat positive S. aureus nasal carriage with a 5-day course of intranasal mupirocin. No data on the effectiveness ofthat approach are available. Once the catheter is placed,and until healing is complete, dressing changes should be done by a dialysis nurse using sterile technique. The exit site should be kept dry until well healed, which precludes showers or tub baths for that period, which can take up to 2 weeks or more.TRAINING PROGRAMS• Training methods influence the risk of PD infections (36–46). (Evidence)• Whenever possible, a nurse should provide the training, according to the 2006 ISPD guidelines/recommendations for PD patient training (Figure 1, Table 4), using the principles of adult education (38). (Opinion)• Each PD program should consult the ISPD guidelines/recommendations to prepare the trainer and to devel-op a specific curriculum for PD training. (Opinion)Each PD program should ensure that the trainer of the PD patients is well prepared and has the specifictheoretical and clinical skills to present a well-plannedCATHETER PLACEMENT TO PREVENT CATHETER INFECTIONS AND THE RELATED PERITONITIS EPISODES • No particular catheter has been definitively shown to be better than the standard silicone Tenckhoff catheter for the prevention of peritonitis (28–30). (Evidence)• Prophylactic antibiotics administered at the time of i nsertion decrease the infection risk (31). (Evidence)The topic of peritoneal access has been covered in a recent position paper (22) from the International Soci-ety for Peritoneal Dialysis (ISPD). Ideally, the patient should see the surgeon or training nurse (or both) before c atheter placement, with the ideal location for the exit site being determined. In addition, the patient shouldbe free from constipation. Proper skin preparation and careful cleansing of the area where the catheter is to beplaced is essential, and if there is an excess of hair, it may need to be removed. A single dose of intravenous (IV) antibiotic given at the time of catheter placement decreases the risk of subsequent infection. A first-generation cephalosporin has been most frequently used in that context. However, a randomized trial found that vancomycin (1 g IV, single dose) at the time of catheter placement is superior to cephalosporin (1 g IV, single dose) in preventing early peritonitis (31). The odds ratio of peritonitis without any antibiotic was 11.6, and for cefazolin (compared with vancomycin), it was 6.45. Eachprogram must therefore consider using vancomycin for prophylaxis for catheter placement, carefully weighing TABLE 3 Example of Rates by Organism Episodes per Organism year at risk Peritonitis Coagulase negative Staphylococcus 0.05 S. aureus peritonitis 0.03 Other gram-positive organisms 0.04 Pseudomonas aeruginosa 0.03 Other gram-negative organisms 0.10 Multiple organisms 0.02 Fungal 0.01 No growth/no culture 0.06 TOTAL 0.34Catheter infections (exit site, tunnel) S. aureus 0.05 P. aeruginosa 0.03 All others 0.12TOTAL 0.20 by guest on July 22, 2014/Downloaded fromPIRAINO et al. NovEMBER 2011 - voL. 31, No. 6 PDIcurriculum for the patient. The center should not assume that a nurse who knows how to do PD is prepared to train patients to do PD. When the learner is a patient with a chronic disease such as end-stage renal disease, that learner has special needs that require specific teaching techniques (42). Nurse education should include theories of adult education and the specifics for teaching adult patients on PD. A full discussion of adult learning is be-yond the scope of this position paper, but is described in some detail in the ISPD guidelines/recommendations for PD patient training at (38).Ideally, a senior mentor should train new PD nurses. That approach may require that new nurses be sent to train at a more experienced center. The old adage of “see one, do one, teach one” is not an appropriate foundation for the education of nurses in the principles of teaching PD. A structured nurse training program with subsequent continuing education is important to enhance the skills and the knowledge base of the trainers. A structured ap-proach can translate into high-quality patient training and good outcomes.Unfortunately, few if any studies have considered the nurse:patient ratio that leads to the best outcomes. Overburdening the nurse with excessive numbers of patients will result in shortened training times and dif-ficulty in scheduling retraining as needed. Ideally the PD nurse should be focused solely on home dialysis and should have no in-center hemodialysis responsibilities.The work group feels that, although the practice has notbeen adequately studied, the assignment of one nurseto fully train a particular patient rather than a differentnurse on different days should be adhered to, if possible.One-on-one training is ideal, although it may not alwaysbe feasible.Interestingly, the experience of the PD nurse may beless important than the training protocol (40). A retro-spective study paradoxically found that, compared withpatients trained by newer, less experienced nurses, thepatients trained by nurses with more experience hada shorter time to peritonitis. The authors speculatedthat nurses who had practiced PD for many years mayhave been more resistant to the institution of a pro-tocol using adult learning techniques that the centerhad i mplemented. Another explanation might be thatthe nurses with more experience had been assignedto train patients who were perceived to be more dif-ficult to train. The work group members feel that allnurses need continuous education to update and hone teaching skills.The center should have a clearly developed curricu-lum for PD training modeled after the ISPD guidelines/recommendations for PD patient training (38). This cur-riculum should include a daily plan for training content and handouts such as those that can be downloaded from the relevant article posted on the ISPD website. Hand hygiene must be emphasized. Training in the proper washing and drying of the hands, and use of hand dis-infectant, especially where the water supply is not to be trusted, are critical parts of the training (further detail provided later in this paper). At the end of training, the patient should be tested to ensure that learning of the objectives has occurred.Very few randomized trials have compared training protocols and curricula for PD patients. The length of patient training for PD is variable around the world (47). The length of training has never been shown to correlate with peritonitis rates. A trial that randomized centers to an enhanced training program using adult learning principles or to the center’s standard approach found that peritonitis rates were lower with the enhanced train-ing: 0.33 episodes per year (1 episode in 36.7 months) compared with 0.43 episodes per year (1 episode in 28.2 months) respectively (37). However, the details of the training curricula were not described, and the baseline peritonitis rates differed in the two groups. In children, peritonitis rates were lower in programs with longer training dedicated to theory and technical skills (39). No randomized trials have compared different training schedules that cover the same content and curriculum.TABLE 4 Suggestions for Retraining Frequency After hospitalizationAfter peritonitis or catheter infection After change in dexterity, vision, or mental acuity Three months after initial training and routinely thereafter(once yearly at minimum)Figure 1 — Center approach to peritoneal dialysis (PD) training. by guest on July 22, 2014/Downloaded fromPDI NovEMBER 2011 - voL. 31, No. 6ISPD: REDUCING THE RISKS OF PD-RELATED INFECTIONSAll patients must be taught what contamination is and what the proper response to contamination is. Each center should have a appropriate protocol to handle contamination (48). The protocol should detail the responses to specific occurrences such as fluid infused after the contamination and open compared with closed clamping of exchange tubing (36). Patients need to come to the center for a tubing change if the end of the tubing is contaminated. Prophylactic antibiotics should be pre-scribed if dialysis solution was infused after contamina-tion or if the catheter administration set was open and exposed to bacteria for an extended period of time. After a known break in technique, many nephrologists give a 2-day course of antibiotics; others provide a single dose of intraperitoneal antibiotic. There is no standard regi-men. Generally, a culture of the effluent is not obtained after an episode of contamination. However, if culturing is done and is positive, consideration might be given to extending therapy. After contamination, a positive culture in the presence of clear fluid and no symptoms should not be considered peritonitis; however, if left untreated, the patient might develop peritonitis. The goal of managing contamination is always to prevent the development of peritonitis.According to learning specialists, retraining plays an important role in reducing mistakes (41,43,44). Task repetition causes the brain to learn both the cognitive and the physical steps of the procedures. A psychological mechanism called “false memory” is readily illustrated by patients who perform an exchange in front of the nurse, but who are not aware of mistakes being made and who say that they were taught to perform the exchange that way (41). Memory is in a labile state after early exposure to new information; memory is enhanced by returning to the learning context and cues for correct performance (43,44).After a period of time, patients may alter the procedure they were taught during training. A study of compliance with the exchange procedure done at 6 months after the start of PD found that most patients had begun to take shortcuts or had simply veered off the prescribed steps that they had been carefully taught at the start of PD (46). Half the patients did not wash their hands according to procedure, nearly half did not check the bag for leaks, and 10% forgot to wear their mask or cap. Not wearing a mask or cap was associated with subsequent peritonitis risk in that study. However, other studies have not shown that using a mask reduces peritonitis risk (49,50). An Italian study of patient knowledge about PD (assessed using a questionnaire and a review of patient behavior during a home visit) found that, after a mean of 33 months on PD, 34% of patients did not answer the questions accurately, and 23% did not follow the correct exchange procedures (41). Noncompliance with exchange protocols was sig-nificantly associated with a higher peritonitis rate. These studies suggest a need for periodic retraining.Retraining seems to be helpful in reducing peritonitisrisk, but data are limited (41,45). Russo and colleagues (41) found retraining to be important for younger pa-tients (<55 years of age), patients with a lower educa-tion level, and patients in the early or late phase of PD therapy (<18 or >36 months). An observational study of120 dialysis centers in Italy found that retraining andhome visits correlated with lower peritonitis rates (45).How often a patient should be retrained or how soonafter initiation is unknown and requires study. Table 4shows our suggestions.A patient’s learning about the signs of peritonitis in training may be long forgotten if the patient does not develop their first peritonitis for several years and ifthere is no reinforcement of information on peritonitisgiven earlier. Retraining therefore needs to include notjust technique but also recognition of this important complication. The patient needs to be reminded that haziness of the effluent might be peritonitis even in the absence of pain, and that they should take that hazinessas an indication to call the dialysis unit.In the absence of definitive studies, each PD programmust decide when and how often to routinely retrain pa-tients. Retraining should include observation of dialysis exchange procedures, handwashing technique, recogni-tion of signs and symptoms of peritonitis, recognitionof contamination and the appropriate response to it,and exit-site care. Retraining is an opportunity to pre-vent future infections, with observation to identify thee mergence of problems such as poor vision, forgetful-ness, or shortcuts.Home visits by the PD nurse may be very useful in de-tecting problems with exchange technique, adherence to protocols, and other environmental and behavioral issuesthat increase the risk of infection and are best dealt with proactively. It has long been accepted that the locationfor exchanges must be clean, with avoidance of animalhair, dust-laden air, and fans or drafts. Home visits in-dicated that retraining was necessary in approximatelyone half of a center’s patients, who were not following protocols (41).CONNECTION METHODS• Spiking of dialysis bags is a procedure that poses ahigh risk for contamination of the system. “Flush be-fore fill” reduces the risk of contamination (51–58). (Evidence)by guest on July 22, 2014/Downloaded fromPIRAINO et al.NovEMBER 2011 - voL. 31, No. 6PDI• Data on peritonitis rates in automated PD (APD) and continuous ambulatory PD (CAPD) are conflicting (12,59–62). (Evidence)• The decision on modality (APD vs CAPD) should not be based on peritonitis risk. (Opinion)Data to show that spiking leads to peritonitis are abundant. Furthermore, for both CAPD and APD, flushing with dialysate before filling the abdomen has been shown to decrease the risk of peritonitis from contamination. Therefore, for CAPD, a double-bag system should be used. Manual spiking should be avoided as much as p ossible; if spiking is required, assist devices may be used. A systematic review concluded that of all catheter-related interventions designed to prevent peritonitis in PD, only disconnect (twin-bag and Y-set) systems have been proved to be effective (compared with conventional spike systems) (58). Close attention must therefore be paid to the connection methodology. For programs that switch vendors and, therefore, connection method, careful at-tention should be paid to subsequent infection rates. Peritonitis rates on APD and CAPD are probably similar (12,59,60). The literature describing the relative risks of peritonitis with continuous cycling PD (CCPD) and CAPD is conflicting, but the disparate results may reflect the fact that the cycler connection methodology varies from study to study and sometimes is not even mentioned in the paper (59). Several studies have shown that, compared with CAPD patients, CCPD patients have significantly lower peritonitis rates (61,62); however, use of a cycler that requires spiking may lead to high rates of peritonitis caused by contamination if an assist device is not used. The work group recommends either the use of an assist device, if available, for all spiking procedures or conver-sion to a system that does not require spiking. Some cyclers require a cassette; if the cassette is reused, the risk of peritonitis cause by water-borne organisms is high (63,64). Cassettes should not be reused. More research is needed comparing peritonitis risk in dry day, CCPD, and CAPD patients. Patients on nightly PD (cycler at night with a dry day) may have a decreased risk of infection compared with those on CCPD (cycler at night plus a day fill), perhaps because the empty abdomen for part of the day enhances immune function (65). This issue also requires further study.EXIT-SITE CARE TO PREVENT PERITONITIS• Prevention of catheter infections (and thus perito-nitis) is the primary goal of exit-site care. Antibiotic protocols against S. aureus are effective in reducing the risk of S. aureus catheter infections (66–81). (Evidence)• All PD patients should use topical antibiotic eitherat the catheter exit site or intranasally or both(66,70,71,73–76,78,82). (Evidence)• Topical antibiotic ointments (as opposed to antibiotic creams) should not be used at the exit site of polyure-thane catheters (82). (Evidence)Routine exit-site care by the patient begins when theexit site is well healed; such care is part of the patient’s training. Water and antibacterial soap are recommendedby many centers. Use of an antiseptic to clean the exitsite is preferred in some programs, but the agent must benon-cytotoxic. The concentration of the cleansing agentsmust be carefully considered (83–87). For example, povi-done iodine is cytotoxic at concentrations greater than0.001%; hydrogen peroxide, at greater than 0.003%; sodium hypochlorite, at greater than 0.24%; and chlor-hexidine, at greater than 0.005% (83,84).Excellent hand hygiene is most important before any examination of the patient’s exit site by the patient,family members, and members of the health care team.The U.S. Centers for Disease Control and Prevention recommends 70% alcohol-based hand rubs as the most effective hand cleansing agent (88). The quantity ap-plied to the hands should take at least 15 seconds ofhand rubbing to dry. Handwashing for 15 seconds with antimicrobial soap (4% chlorhexidine) is the next most effective method for hand cleansing. Visibly dirty hands require handwashing with soap. Polished nails doublethe risk of bacterial contamination on hands, and ar-tificial nails create a risk of bacterial contaminationthat is increased by a factor of 7 (88). Patients, healthcare givers, and patient helpers should all be aware ofproper hand hygiene protocols. If the water the patientuses is thought to have a high bacterial count, then theuse of alcohol hand hygiene is preferred to simply usingtap water.A number of protocols for the prevention of S. aureusPD-related infections have been examined. Prophylaxisusing daily application of mupirocin cream or ointmentto the skin around the exit site has been effective in reducing S. aureus exit-site infection and peritonitis ina number of reports (70,75,76,78,80,89). An observa-tional study in 740 incident PD patients showed that useof topical mupirocin was associated with a significant reduction in exit-site infection (0.168 vs 0.156 episodesper patient–year) and peritonitis (0.443 vs 0.339 epi-sodes per patient–year) (80). In a meta-analysis of ten studies (three RCTs and seven historical cohort studies)of mupirocin prophylaxis to prevent S. aureus infection,PD patients using prophylaxis had a 63% reduction in therisk of S. aureus infection—peritonitis being reduced by66% and exit-site infection by 62% (66). A more recentby guest on July 22, 2014/Downloaded from。

IAD配置模板

5.
sip send-capability fax pri 0 transfer g711a
sip send-capability fax pri 1 t38 redundancy 2 传真的配置
6.
sisip digitmap 1[358]XXXXXXXXX
4. TERMINAL(config)#advanced
sip soft-parameter auth-username name 鉴权方式为 name
sip soft-parameter new-service-mode local 服务类型为local sip soft-parameter priv-val user on privacy值
sip digitmap 400XXXXXXX
sip digitmap 800XXXXXXX
sip digitmap 100XX
sip digitmap 12580
sip digitmap 110
sip digitmap 119
sip digitmap 120
sip digitmap 122
sip digitmap 0596[2-8]XXXXXX
sip digitmap 0597[2-8]XXXXXX
sip digitmap 0598[2-8]XXXXXX
sip digitmap 0599[2-8]XXXXXX
sip digitmap 123XX
由于IAD初始IP地址获取方式为DHCP方式，所以电脑连接上IAD后将自动获取到IP地址，在连接到IAD的话机上拨打*127听语音播报IP地址，*125 不能查看号码，只有在连接softco的环境下才可用。

Piboserod_SDS_MedChemExpress

Inhibitors, Agonists, Screening LibrariesSafety Data Sheet Revision Date:Aug.-23-2017Print Date:Aug.-23-20171. PRODUCT AND COMPANY IDENTIFICATION1.1 Product identifierProduct name :PiboserodCatalog No. :HY-15574CAS No. :152811-62-61.2 Relevant identified uses of the substance or mixture and uses advised againstIdentified uses :Laboratory chemicals, manufacture of substances.1.3 Details of the supplier of the safety data sheetCompany:MedChemExpress USATel:609-228-6898Fax:609-228-5909E-mail:sales@1.4 Emergency telephone numberEmergency Phone #:609-228-68982. HAZARDS IDENTIFICATION2.1 Classification of the substance or mixtureNot a hazardous substance or mixture.2.2 GHS Label elements, including precautionary statementsNot a hazardous substance or mixture.2.3 Other hazardsNone.3. COMPOSITION/INFORMATION ON INGREDIENTS3.1 SubstancesSynonyms:SB–207266Formula:C22H31N3O2Molecular Weight:369.50CAS No. :152811-62-64. FIRST AID MEASURES4.1 Description of first aid measuresEye contactRemove any contact lenses, locate eye-wash station, and flush eyes immediately with large amounts of water. Separate eyelids with fingers to ensure adequate flushing. Promptly call a physician.Skin contactRinse skin thoroughly with large amounts of water. Remove contaminated clothing and shoes and call a physician.InhalationImmediately relocate self or casualty to fresh air. If breathing is difficult, give cardiopulmonary resuscitation (CPR). Avoid mouth-to-mouth resuscitation.IngestionWash out mouth with water; Do NOT induce vomiting; call a physician.4.2 Most important symptoms and effects, both acute and delayedThe most important known symptoms and effects are described in the labelling (see section 2.2).4.3 Indication of any immediate medical attention and special treatment neededTreat symptomatically.5. FIRE FIGHTING MEASURES5.1 Extinguishing mediaSuitable extinguishing mediaUse water spray, dry chemical, foam, and carbon dioxide fire extinguisher.5.2 Special hazards arising from the substance or mixtureDuring combustion, may emit irritant fumes.5.3 Advice for firefightersWear self-contained breathing apparatus and protective clothing.6. ACCIDENTAL RELEASE MEASURES6.1 Personal precautions, protective equipment and emergency proceduresUse full personal protective equipment. Avoid breathing vapors, mist, dust or gas. Ensure adequate ventilation. Evacuate personnel to safe areas.Refer to protective measures listed in sections 8.6.2 Environmental precautionsTry to prevent further leakage or spillage. Keep the product away from drains or water courses.6.3 Methods and materials for containment and cleaning upAbsorb solutions with finely-powdered liquid-binding material (diatomite, universal binders); Decontaminate surfaces and equipment by scrubbing with alcohol; Dispose of contaminated material according to Section 13.7. HANDLING AND STORAGE7.1 Precautions for safe handlingAvoid inhalation, contact with eyes and skin. Avoid dust and aerosol formation. Use only in areas with appropriate exhaust ventilation.7.2 Conditions for safe storage, including any incompatibilitiesKeep container tightly sealed in cool, well-ventilated area. Keep away from direct sunlight and sources of ignition.Recommended storage temperature:Powder-20°C 3 years4°C 2 yearsIn solvent-80°C 6 months-20°C 1 monthShipping at room temperature if less than 2 weeks.7.3 Specific end use(s)No data available.8. EXPOSURE CONTROLS/PERSONAL PROTECTION8.1 Control parametersComponents with workplace control parametersThis product contains no substances with occupational exposure limit values.8.2 Exposure controlsEngineering controlsEnsure adequate ventilation. Provide accessible safety shower and eye wash station.Personal protective equipmentEye protection Safety goggles with side-shields.Hand protection Protective gloves.Skin and body protection Impervious clothing.Respiratory protection Suitable respirator.Environmental exposure controls Keep the product away from drains, water courses or the soil. Cleanspillages in a safe way as soon as possible.9. PHYSICAL AND CHEMICAL PROPERTIES9.1 Information on basic physical and chemical propertiesAppearance White to off-white (Solid)Odor No data availableOdor threshold No data availablepH No data availableMelting/freezing point No data availableBoiling point/range No data availableFlash point No data availableEvaporation rate No data availableFlammability (solid, gas)No data availableUpper/lower flammability or explosive limits No data availableVapor pressure No data availableVapor density No data availableRelative density No data availableWater Solubility No data availablePartition coefficient No data availableAuto-ignition temperature No data availableDecomposition temperature No data availableViscosity No data availableExplosive properties No data availableOxidizing properties No data available9.2 Other safety informationNo data available.10. STABILITY AND REACTIVITY10.1 ReactivityNo data available.10.2 Chemical stabilityStable under recommended storage conditions.10.3 Possibility of hazardous reactionsNo data available.10.4 Conditions to avoidNo data available.10.5 Incompatible materialsStrong acids/alkalis, strong oxidising/reducing agents.10.6 Hazardous decomposition productsUnder fire conditions, may decompose and emit toxic fumes.Other decomposition products - no data available.11.TOXICOLOGICAL INFORMATION11.1 Information on toxicological effectsAcute toxicityClassified based on available data. For more details, see section 2Skin corrosion/irritationClassified based on available data. For more details, see section 2Serious eye damage/irritationClassified based on available data. For more details, see section 2Respiratory or skin sensitizationClassified based on available data. For more details, see section 2Germ cell mutagenicityClassified based on available data. For more details, see section 2CarcinogenicityIARC: No component of this product present at a level equal to or greater than 0.1% is identified as probable, possible or confirmed human carcinogen by IARC.ACGIH: No component of this product present at a level equal to or greater than 0.1% is identified as a potential or confirmed carcinogen by ACGIH.NTP: No component of this product present at a level equal to or greater than 0.1% is identified as a anticipated or confirmed carcinogen by NTP.OSHA: No component of this product present at a level equal to or greater than 0.1% is identified as a potential or confirmed carcinogen by OSHA.Reproductive toxicityClassified based on available data. For more details, see section 2Specific target organ toxicity - single exposureClassified based on available data. For more details, see section 2Specific target organ toxicity - repeated exposureClassified based on available data. For more details, see section 2Aspiration hazardClassified based on available data. For more details, see section 212. ECOLOGICAL INFORMATION12.1 ToxicityNo data available.12.2 Persistence and degradabilityNo data available.12.3 Bioaccumlative potentialNo data available.12.4 Mobility in soilNo data available.12.5 Results of PBT and vPvB assessmentPBT/vPvB assessment unavailable as chemical safety assessment not required or not conducted.12.6 Other adverse effectsNo data available.13. DISPOSAL CONSIDERATIONS13.1 Waste treatment methodsProductDispose substance in accordance with prevailing country, federal, state and local regulations.Contaminated packagingConduct recycling or disposal in accordance with prevailing country, federal, state and local regulations.14. TRANSPORT INFORMATIONDOT (US)This substance is considered to be non-hazardous for transport.IMDGThis substance is considered to be non-hazardous for transport.IATAThis substance is considered to be non-hazardous for transport.15. REGULATORY INFORMATIONSARA 302 Components:No chemicals in this material are subject to the reporting requirements of SARA Title III, Section 302.SARA 313 Components:This material does not contain any chemical components with known CAS numbers that exceed the threshold (De Minimis) reporting levels established by SARA Title III, Section 313.SARA 311/312 Hazards:No SARA Hazards.Massachusetts Right To Know Components:No components are subject to the Massachusetts Right to Know Act.Pennsylvania Right To Know Components:No components are subject to the Pennsylvania Right to Know Act.New Jersey Right To Know Components:No components are subject to the New Jersey Right to Know Act.California Prop. 65 Components:This product does not contain any chemicals known to State of California to cause cancer, birth defects, or anyother reproductive harm.16. OTHER INFORMATIONCopyright 2017 MedChemExpress. The above information is correct to the best of our present knowledge but does not purport to be all inclusive and should be used only as a guide. The product is for research use only and for experienced personnel. It must only be handled by suitably qualified experienced scientists in appropriately equipped and authorized facilities. The burden of safe use of this material rests entirely with the user. MedChemExpress disclaims all liability for any damage resulting from handling or from contact with this product.Caution: Product has not been fully validated for medical applications. For research use only.Tel: 609-228-6898 Fax: 609-228-5909 E-mail: tech@Address: 1 Deer Park Dr, Suite Q, Monmouth Junction, NJ 08852, USA。