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儿童神经源性膀胱管理的最佳证据总结

儿童神经源性膀胱管理的最佳证据总结李珂,贾勤,姚利锋,吴佳云,汪盈盈S u m m a r y o f t h e b e s t e v i d e n c e f o r n e u r o g e n i c b l a d d e rm a n a ge m e n t i n c h i l d r e n L IK e ,J I A Q i n ,Y A OL if e ng ,W UJ i a y u n ,W A N G Y i n g y i n g (S ch o o l o fN u r si n g ,Z h ej i a n g C h i n e s eM e d i c a lU n i v e r s i t y ,Z h e j i a n g 310053C h i n a )A b s t r a c t O b je c t i v e :T o s e a r c ha n d s u mm a r i z e t h eb e s t e v i d e n c e of b l a d d e rm a n ag e m e n t i n chi l d r e nw i t hn e u r o g e n i cb l a d d e r ,s o a s t o p r o v i d e e v i d e n c e -b a s e de v i d e n c ef o rc l i n i c a l p r a c t i c eo f m e d i c a ls t a f f .M e t h o d s :A s ys t e m a t i cs e a r c h w a sc o n d u c t e do n B M JB e s t P r a c t i c e ,C o c h r a n eL i b r a r y ,U p T o D a t e ,J o a n n aB r i g g s I n s t i t u t e ,N a t i o n a lG u i d e l i n eC l e a r i n gh o u s e ,G u i d e l i n e s I n t e r n a t i o n a lN e t w o r k ,S pi n aB i f i d a A s s o c i a t i o n ,N a t i o n a l I n s t i t u t ef o r H e a l t ha n d C l i n i c a lE x c e l l e n c e ,S c o t t i s hI n t e r s c h o o lG u i d e l i n e N e t w o r k ,C a n a d i a n A s s o c i a t i o no fU r o l o g y ,E u r o p e a n A s s o c i a t i o no fU r o l o g y ,E u r o p e a nS o c i e t y o fP e d i a t r i c U r o l o g y,B r i t i s h A s s o c i a t i o no fP e d i a t r i c U r o l o g i s t s ,I n t e r n a t i o n a l C h i l d r e nC o n t i n e n c eS o c i e t y ,P u b M e d ,Y i m a i t o n g ,C h i n aN a t i o n a lK n o w l e d g e I n f r a s t r u c t u r e ,W a n f a n g ,Ch i n a B i o m e d i c a l L i t e r a t u r e D a t a b a s e ,a n do t h e r g u i d e w e b s i t e sa n di n d u s t r y a g e n c y w e b s i t e sf o re v i d e n c eo fb l a d d e r m a n a g e m e n ti n c h i l d r e nw i t hn e u r o g e n i c b l a d d e r ,i n c l u d i n gg u i d e l i n e s ,c l i n i c a l d e c i s i o n s ,b e s t p r a c t i c e s ,s ys t e m a t i c r e v i e w s ,e v i d e n c e s u mm a r i e s ,m e t a -a n a l y s i s a n de x p e r t c o n s e n s u s e s .T h es e a r c h p e r i o d w a sf r o mi n c e p t i o nt o M a y 2022.R e s u l t s :At o t a lo f12a r t i c l e sw e r e i n c l u d e d ,i n c l u d i n g 5g u i d e l i n e s ,1e v i d e n c e s u mm a r y ,4e x p e r t c o n s e n s u s e s ,1c l i n i c a l d e c i s i o n a n d 1s ys t e m a t i c r e v i e w.At o t a l o f 32b e s t p i e c e s o f e v i d e n c e w e r es u mm a r i z e df r o m f i v ea s p e c t s :s c r e e n i n g a n dd i a g n o s i s ,t r e a t m e n t ,p r e v e n t i o na n dt r e a t m e n to fc o m p l i c a t i o n s ,t r a n s i t i o n a lm a n a g e m e n ta n df o l l o w -u p .C o n c l u s i o n :W h e n a p p l y i n g ev i d e n c e ,c l i n i c a l m e d i c a ls t a f fs h o u l d c o m b i n et h ec l i n i c a l e n v i r o n m e n t a n d t h ef a m i l y 'sw i l l i n g n e s st oh e l p c h i l d r e n w i t hb l a d d e r m a n a g e m e n t i nas c i e n t i f i cw a y ,i no r d e rt oi m p r o v et h e q u a l i t y of l i f e o f c h i l d r e n .K e yw o r d s n e u r o g e n i cb l a d d e r ;i l l c h i l d r e n ;b l a d d e rm a n a g e m e n t ;s u mm a r y o f e v i d e n c e 摘要目的:检索和总结神经源性膀胱患儿膀胱管理的最佳证据,为护理人员临床实践提供循证依据㊂方法:计算机检索B M JB e s tP r a c t i c e ㊁C o c h r a n eL i b r a r y ㊁U pT o D a t e ㊁乔安娜布里格斯研究所㊁美国指南网㊁国际指南网㊁美国脊柱裂协会㊁英国国家卫生与临床优化研究所㊁苏格兰校际指南网㊁加拿大泌尿外科协会㊁欧洲泌尿外科学会㊁欧洲小儿泌尿外科学会㊁英国儿童泌尿医师协会㊁国际儿童尿控协会㊁P u b M e d㊁医脉通㊁中国知网㊁万方㊁中国生物医学文献数据库等数据库㊁指南网站及行业机构网站关于神经源性膀胱患儿膀胱管理的证据,包括指南㊁临床决策㊁最佳实践㊁系统评价㊁证据总结㊁M e t a 分析㊁专家共识,检索时限为建库至2022年5月㊂结果:共纳入12篇文献,其中指南5篇,证据总结1篇,专家共识4篇,临床决策1篇,系统评价1篇㊂从筛查与诊断㊁治疗㊁并发症防治㊁过渡期管理㊁随访5个方面共总结了32条最佳证据㊂结论:临床医护人员在应用证据时,应结合临床环境及患儿家庭意愿,以科学的方法帮助患儿进行膀胱管理,提升患儿生活质量㊂关键词神经源性膀胱;患儿;膀胱管理;证据总结d o i :10.12104/j.i s s n .1674-4748.2023.11.003 儿童神经源性膀胱(n e u r o ge n i c b l a d d e r ,N B )是由于先天或后天等因素造成控制排尿功能的中枢神经系统损伤出现的下尿路功能障碍,早期表现为尿失禁异常,进一步发展可致上尿路恶化,最终可发展为肾衰竭,严重影响患儿的生活质量[1]㊂研究显示,该类患儿初期症状不明显,医护人员对其关注度不高,很多患儿直至成年才被重视,导致膀胱管理不理想,并发症发生率和住院率均高[2-3]㊂相关疾病数据显示,N B 患儿平均30d 的再入院次数是普通人群的2.5倍以上,34%是由于泌尿系统并发症入院[4],其中6%的患儿出现复发性泌尿道感染而导致肾衰竭死亡[5],平均医疗支基金项目浙江省科技厅基础公益研究资助项目,编号:G F 18H 170011㊂作者简介李珂,硕士研究生在读,单位:310053,浙江中医药大学护理学院;贾勤(通讯作者)单位:310014,浙江省人民医院杭州医学院附属人民医院;姚利锋㊁吴佳云㊁汪盈盈单位:310053,浙江中医药大学护理学院㊂引用信息李珂,贾勤,姚利锋,等.儿童神经源性膀胱管理的最佳证据总结[J ].全科护理,2023,21(11):1449-1453.出是普通患儿的13倍[6]㊂研究表明,患儿通过积极膀胱管理可以维持正常的肾功能,降低再入院率,减轻医疗负担[7-8]㊂已有研究汇总成人N B 管理的最佳证据[9-11],但儿童处于生长发育阶段,与成人存在差异,儿童N B 管理最佳证据尚不明确㊂本研究对儿童N B 管理相关证据进行总结,以期为护理人员临床实践提供循证依据㊂1 资料与方法1.1 检索策略按照 6S 证据模型,自上而下进行证据检索㊂中文检索式为(神经源性膀胱O R 神经源性下尿路功能障碍O R 神经源性尿失禁)A N D (小儿O R 儿童O R 幼儿O R 患儿);英文检索式为(N e u r o ge n i cb l a d d e r O R N e u r o g e n i cl o w e ru r i n a r y t r a c td ys f u n c t i o n O R N e u r o g e n i cu r i n a r y in c o n t i n e n c e t )A N D (C h i l d O R C h i l d r e n O R p e d i a t r i c )㊂检索B M J B e s t P r a c t i c e㊁C o c h r a n eL i b r a r y ㊁U p T o D a t e ㊁乔安娜布里格斯研究所㊁美国指南网㊁国际指南网㊁美国脊柱裂协会(S B A )㊁英国国家卫生与临床优化研究所(N I C E )㊁苏格兰校际㊃9441㊃全科护理2023年4月第21卷第11期Copyright ©博看网. All Rights Reserved.指南网㊁加拿大泌尿外科协会(C U A )㊁欧洲泌尿外科学会(E A U )㊁欧洲小儿泌尿外科学会(E S P U )㊁英国儿童泌尿医师协会(B A P U )㊁国际儿童尿控协会(I C C S )㊁P u b M e d㊁医脉通㊁中国知网㊁万方㊁中国生物医学文献数据库等数据库㊁指南网站及行业机构网站㊂1.2 文献的纳入与排除标准纳入标准:①研究类型为临床实践指南㊁专家共识㊁临床决策㊁系统评价㊁证据总结,研究语种为中文或英文;②研究主题为神经源性膀胱管理,研究人群全部或部分是儿童(年龄0~18岁)㊂排除标准:①翻译㊁重复收录或无法获取全文;②文献类型为综述㊁会议摘要等;③文献质量评价低的文献㊂1.3 文献的质量评价标准(方法) 研究指南采用A G R E E Ⅱ(2017版)[12]进行质量评价;系统评价㊁类实验研究和专家共识采用澳大利亚J o a n n a B r i g gs I n s t i t u t e (J B I )循证卫生保健中心的标准(2016版)[13]进行评价;证据总结采用证据总结质量评价工具(C r i t i c a l A p pr a i s a l f o r S u m m a r i e s o f E v i d e n c e ,C A S E )进行质量评价[14];临床决策来源于U pT o D a t e ,为 6S 证据金字塔中的顶层,证据质量高,直接纳入;1篇指南[15]缺乏方法学介绍,故同专家共识标准进行评价㊂1.4 文献质量评价过程所有筛选及评价均由2名完成‘循证护理学“课程学习的护理研究生独立完成,意见分歧时,邀请第3名评价者参与评价㊂当不同来源的证据结论相冲突,按照高质量证据优先㊁最新发表权威文献优先㊁国内指南优先的原则㊂本研究采用2014版J B I 循证卫生保健中心证据预分级系统[16]将证据等级划分为1~5级,并根据研究F AM E 结构,依据证据的可行性㊁适宜性㊁临床意义和有效性划分为A 级推荐(强推荐)和B 级推荐(弱推荐)㊂2 结果2.1 纳入文献基本情况本研究共纳入12篇文献,其中指南5篇[15,17-20],证据总结1篇[21],临床决策1篇[22],系统评价1篇[23],专家共识4篇[24-28](其中1篇专家共识分为两部分)㊂纳入文献基本情况见表1㊂2.2 纳入文献的质量评价结果表1 纳入文献的一般特征纳入文献发表/更新时间(年)文献来源文献类型研究主题文建国等[15]2015年知网指南小儿神经源性膀胱诊断和治疗S B A [19]2018年S p i n a B i f i d aA s s o c i a t i o n 指南脊柱裂患儿护理N I C E [20]2012年N I C E 指南神经系统疾病中的尿失禁C U A [17]2021年梅斯医学指南儿童膀胱功能障碍的治疗E A U /E S P U [18]2020年医脉通指南儿童神经源性膀胱S a ge r 等[21]2022年P u b M e d 证据总结儿童神经源性膀胱功能异常功能障碍管理修波[28]2021年知网专家共识脊柱裂诊治B A P U [25]2016年医脉通专家共识儿童神经源性膀胱的管理I C C S [24,26]2012年P u b M e d 专家共识神经源性膀胱的评估㊁随访及治疗B o w e r 等[27]2017年P u b M e d 专家共识终生泌尿系统管理需求的儿童从儿科到成人医疗过渡B a s k i n 等[22]2021年U p T o D a t e 临床决策脊柱裂的泌尿系统并发症的评估与治疗E k e 等[23]2021年P u b M e d系统评价改善患有神经性疾病的儿童和青少年的尿失禁状况2.2.1 指南的质量评价(见表2)表2 指南的方法学质量评价纳入文献各领域标准化百分比(%)范围和目的参与人员指南开发的严格性指南呈现的清晰性指南的适用性指南编撰的独立性ȡ60%领域数(个)ȡ30%领域数(个)推荐级别E A U /E S P U [18]83.3360.1158.3372.9270.8340.0046B S B A [19]100.00 100.00 100.00 100.00 100.00 100.00 66A N I C E [20]100.00 100.00 73.1591.6795.84100.00 66A C U A [17]94.4480.5575.9375.0070.8345.8356B2.2.2 系统评价的质量评价结果本研究共纳入1篇[23]系统评价,来源于P u b M e d ㊂所有条目的评价结果均为是㊂2.2.3 专家共识的质量评价结果文建国等[15,24-28]的所有条目评价结果均为是㊂2.2.4 证据总结的质量评价结果本研究纳入1篇[21]证据总结,所有条目的评价结果均为是研究整体质量较好㊂2.3 证据描述及汇总采用澳大利亚J B I 循证卫生保健中心证据推荐级别系统(2014),对纳入的证据进㊃0541㊃C H I N E S EG E N E R A LP R A C T I C E N U R S I N G A pr i l 2023V o l .21N o .11Copyright ©博看网. All Rights Reserved.行级别划分㊂根据研究设计类型的不同,将证据等级划分为1~5级,并根据研究设计的严谨性与可靠性,将推荐等级划分为A 级推荐与B 级推荐㊂见表3㊂表3 神经源性膀胱患儿膀胱管理的证据总结证据类别证据内容证据来源推荐级别筛查与诊断1.建议对患儿病史进行全面的评估,重点了解神经系统相关情况L e v e l 5A2.评估患儿膀胱功能障碍症状,包括尿潴留㊁尿失禁㊁频次㊁尿量等L e v e l 5A 3.尽早行泌尿系超声㊁膀胱尿道造影㊁肾脏二巯丁二酸(D M S A )㊁肾功能等检查作为基线评估L e v e l 5A 4.尿动力学检查是患儿诊断㊁治疗效果评价及随访的主要手段,开放性脊柱裂患儿建议手术后2~3个月内进行检查,闭合性脊柱裂出生后立刻进行L e v e l 5A 5.建议根据患儿尿动力学和尿道括约肌功能进行N B 分型L e v e l 5B 治疗6.膀胱管理的目标是保护患儿肾功能,最大限度提高其排尿独立自主性,达到青少年有效控尿时间4h ,婴幼儿不小于1hL e v e l 5A 7.N B 患儿应由儿科㊁泌尿外科㊁骨科㊁康复科及护理等多学科协同合作管理治疗L e v e l 5A 8.积极治疗原发的神经系统疾病,依据尿动力学分类制订治疗方案L e v e l 5A 9.确保安全的膀胱储存压力和低压下充足的膀胱排空是膀胱管理的重点L e v e l 5A 10.早期开始抗胆碱能药物联合清洁间歇导尿治疗可以有效降低膀胱压力,预防上尿路损害L e v e l 1A 11.建立患儿泌尿自我护理方案,由专业护士培训患儿及家长学会并坚持长期甚至终身规范的清洁间歇导尿,其既是患儿膀胱排空的首选方法,也是膀胱训练的一种重要方式L e v e l 5A 12.膀胱收缩无力患儿可按压下腹部(C r e d e s 动作)或屏气增加负压(V a l s a v a 动作)辅助膀胱排空L e v e l 2B 13.注射A 型肉毒毒素适用于膀胱活动亢进患儿,但其疗效不能长期维持,必须重复治疗L e v e l 3B 14.行为训练方式主要有延迟排尿和定时排尿两种,应考虑其适应证及禁忌证应用L e v e l 2B 15.盆底肌训练(K e ge l 运动)和生物反馈治疗适用于较大儿童压力性尿失禁治疗L e v e l 2B 并发症防治16.提示存在泌尿道感染(U T I )的症状包括实施清洁间歇导尿时疼痛㊁肉眼血尿㊁背/腹痛㊁嗜睡㊁发热或呕吐L e v e l 5A 17.怀疑U T I 患儿均应行血㊁尿常规检查㊁尿细菌培养和药物敏感试验等,以确定是否并发U T I 及指导抗生素的使用L e v e l 5A 18.无症状菌尿无需治疗,出现尿液浑浊或异味时,增加液体摄入量,并将清洁间歇导尿(C I C )频率增至每次1~2h ,共12hL e v e l 1A 19.出现复发性U T I 时应全面评估感染原因,必要时行泌尿系超声及尿动力学检查辅助评估L e v e l 5A 过渡期管理20.N B 患儿过渡期管理目的是让患儿及家属在参与成人医疗系统内实现最大的独立性和舒适性,其主要目标是保持患儿随访依从性,避免发生可预防的并发症[18,24]L e v e l 5A 21.建议指定一名专科护士为过渡协调员支持过渡计划,为患儿家庭提供信息咨询L e v e l 5A 22.定期与患儿及家庭讨论过渡计划,包括膀胱管理方案㊁教育和就业㊁医疗保险及支持性生活(住房和交通)㊁治疗决策等,及时调整以促进患儿自我管理L e v e l 5A 23.向成人医疗过渡年龄没有严格限制,可根据患儿生理㊁心理㊁环境及经济因素选择适当时机进行过渡L e v e l 5A 24.过渡前应评估患儿神经认知㊁过渡准备度㊁自我管理能力㊁心理㊁社会支持等㊂推荐使用过渡期准备度评估问卷(T r a n s i t i o n R e a d i n e s sA s s e s s m e n tQ u e s t i o n n a i r e ,T R A Q )㊁青少年自我管理和独立量表(A d o l e s c e n t /Y o u n g A d u l t S e l f -M a n a g e m e n t a n d I n d e p e n d e n c e ,A M I S )L e v e l 5A25.儿科与成人医疗团队对接应提供患儿转诊文件,内容包括全面病史㊁各项检查结果㊁治疗及多学科医疗团队信息L e v e l 5A 随访26.患儿应终生定期随访,随访内容包括神经系统检查㊁脊柱核磁共振成像(M R I )㊁D M S A ㊁泌尿系超声㊁尿动力学㊁尿常规及肾功能等L e v e l 5A 27.随访内容和频率取决其临床表现及膀胱功能情况L e v e l 5B28.出现复发性泌尿系感染㊁骨科或神经系统体征㊁治疗方案变化㊁青春期发育时应增加随访频率L e v e l 5A 29.稳定性N B 患儿只需进行泌尿系超声及导尿日记随访,频率为1岁前每隔3个月随访1次,2岁时每隔6个月随访1次,之后每年随访1次L e v e l 5B 30.尿动力学检查应根据临床参数进行风险分层选择性随访L e v e l 3B 31.D M S A 是肾瘢痕检查的金标准,出现复发性U T I ㊁尿动力学及泌尿系超声异常时应进行D M S A 随访L e v e l 5A 32.护理人员向患儿家庭强调标准化随访方案,宣教随访的重要性L e v e l 5A㊃1541㊃全科护理2023年4月第21卷第11期Copyright ©博看网. All Rights Reserved.3证据描述第1条~第5条证据总结了关于N B患儿的筛查与诊断内容㊂N B患儿由于该疾病初期症状不明显,出现尿失禁时,家属可能认为因患儿年龄较小的正常现象,容易忽视疾病的严重性[29]㊂若不早期进行膀胱管理,长期发展易导致多种长期并发症,如泌尿系统感染㊁膀胱输尿管反流等㊂因此,早期筛查确定有较大风险发展为泌尿系统损害的患儿亚群,对改善临床结局尤为重要[30]㊂相较于成年人,儿童N B临床表现与神经病变的平面及程度相关性较低,尿动力学表现分类更能反映病变的特点㊂E A U/E S P U指南[18]根据患儿逼尿肌和括约肌活跃程度进行分型,文建国等[15]根据膀胱尿道功能障碍情况进行分型,临床医务人员可根据个体情况进行分析,指导治疗决策㊂第6条~第15条证据总结了N B患儿非手术治疗方案㊂E A U/E S P U认为N B患儿都应被看作潜在高压的膀胱,早期干预对上尿路进行保护具有重要的意义㊂C I C为国际儿童失禁协会推荐排空膀胱的首选方法[24]㊂早期行C I C可以降低膀胱过度扩张的风险,且患儿及家庭成员的依从性和适应性更好,建议所有患儿应出生后尽早行C I C[22]㊂目前对于儿童C I C的执行频次㊁时间及导尿管的选择,国内外尚未有统一的标准㊂临床护理人员可根据患儿喜好㊁成本㊁便携性及使用难易程度选择导尿管的类型,但如果是脊柱裂导致N B患儿乳胶过敏率较高,应避免使用所有乳胶产品[31]㊂此外,行为训练㊁盆底肌训练及生物反馈治疗也是N B患儿膀胱功能训练的方法,但这些证据质量较低,未来还需要多中心大样本进行试验性研究㊂第16条~第19条证据总结了N B并发症的防治㊂U T I是实施C I C的患儿常见的并发症,复发性U T I可导致肾脏瘢痕形成,最终发展成肾衰竭[32]㊂N B患儿尿标本中检测细菌的发生率可高达76%[33],但大多都无症状,无需治疗㊂若出现复发性U T I时,临床护理人员应重视评估原因,U T I诱发因素包括对治疗方案不依从㊁便秘㊁膀胱动力学变化(可能由脊髓栓系导致)或治疗方案的调整需求等㊂第20条~第25条证据总结了患儿向成人医疗过渡管理㊂该证据主要来源于一篇美国脊柱裂协会指南[19]和B o w e r等[27]专家共识㊂该指南及专家共识方法学质量评价较好,纳入证据质量较高㊂但目前我国对于儿童向成人医疗过渡体系尚不完善,临床工作人员应用证据时应基于我国医疗背景,考虑证据的适宜性应用㊂第26条~第32条证据总结了随访的内容及时间㊂N B患儿膀胱功能会随着生长发育㊁治疗效果㊁依从性变化等改变,护理人员应向患儿家庭强调标准化随访方案的重要性,随访内容及频率取决于患儿的临床表现及膀胱功能情况[21]㊂值得一提的是,尿动力学检查作为一项有创的操作,国外对其作为常规随访内容有了不同的看法㊂一项对215例N B患儿7年追踪调查显示,只有24%的患儿出现尿动力学检查的指征[34]㊂因此,B A P U提出在进行初次诊断后尿动力学应该根据临床参数进行风险分层选择性随访[25]㊂4结论本研究总结了国内外N B患儿膀胱管理的最佳证据,为医护人员临床实践提供循证依据㊂但本研究只纳入了中英文文献,大多数来源于国外,且大部分文献属于描述性研究,证据等级不高㊂由于不同地域医疗服务系统之间有一定的文化差异,建议在证据转化与应用时,充分考虑证据的可行性㊁适用性,结合患儿的临床表现制订个性化的管理方案,改善患儿生活质量㊂今后尚需在循证方法的指导下,开展高质量家庭参与的干预性研究,为制订适宜我国国情的N B患儿膀胱管理提供依据㊂参考文献:[1] M O U S S A M,P A P A T S O R I S A G,C H A K R A M A,e ta l.P e r s p e c t i v e so nu r o l o g i c a l c a r e i ns p i n ab i f i d a p a t i e n t s[J].I n t r a c t a b l e&R a r eD i s e a s e sR e s e a r c h,2021,10(1):1-10.[2]何梦,张潍平,孙宁,等.脊髓脊膜膨出并发神经源性膀胱的诊疗现状及进展[J].中华小儿外科杂志,2017,38(12):947-951. 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All Rights Reserved.[8] H O B B SK T,K R I S C H A K M,T E J WA N I R,e t a l.T h e i m p o r t a n c eo f e a r l y d i a g n o s i s a n dm a n a g e m e n t o f p e d i a t r i c n e u r o g e n i c b l a d d e rd y s f u n c t i o n[J].Re s e a r c ha n d R e p o r t s i n U r o l o g y,2021,13:647-657.[9]周美玲,张荀芳,何炼英,等.卒中后患者神经源性膀胱管理的最佳证据总结[J].解放军护理杂志,2021,38(5):67-70. [10]叶丽,黄厚强,郭声敏,等.脑卒中后神经源性膀胱管理的最佳证据总结[J].护理学报,2021,28(10):40-44.[11]胡英杰,陈玲,陈晓敏,等.神经源性膀胱上尿路损害风险管理的最佳证据总结[J].护理研究,2019,33(14):2367-2373. 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[19]S p i n aB i f i d aA s s o c i a t i o n.G u i d e l i n e s f o r t h eC a r eo fP e o p l ew i t hS p i n aB i f i d a[E B/O L].(2018-11-15)[2022-05-10].h t t p://w w w.s p i n a b i f i d a a s s o c i a t i o n.o r g/g u i d e l i n e s/.[20] N a t i o n a l I n s t i t u t ef o r H e a l t h a n d C l i n i c a l E x c e l l e n c e.U r i n a r yi n c o n t i n e n c e i nn e u r o l o g i c a l d i s e a s e:a s s e s s m e n t a n dm a n a g e m e n t[E B/O L].(2019-01-15)[2022-05-10].h t t p s://w w w.n i c e.o r g.u k/g u i d a n c e/c g148.[21]S A G E RC,B A R R O S O U,B A S T O S JM N,e t a l.M a n a g e m e n t o fn e u r o g e n i c b l a d d e r d y s f u n c t i o n i n c h i l d r e n u p d a t e a n dr e c o mm e n d a t i o n so n m e d i c a lt r e a t m e n t[J].I n t B r a zJ U r o l, 2022,48(1):31-51.[22] B A S K I NLS.M y e l o m e n i n g o c e l e(s p i n a b i f i d a):U r i n a r y t r a c tc o m p l i c a t i o n s.[E B/O L].(2022-01-25)[2022-05-20].h t t p s://w w w.u p t o d a t e.c o m/c o n t e n t s/z h-H a n s/m y e l o m e n i n g o c e l e-s p i n a-b i f i d a-u r i n a r y-t r ac t-c o m p l i c a t i o n s c s i=5178f1f2-5789-4f c c-86e4-66427982b683&s o u r c e=c o n t e n t S h a r e.[23] E K E H,HU N T H,B A L L S,e t a l.I m p r o v i n g c o n t i n e n c ei nc h i ld re na n d y o u n g p e o p l e w i t h n e u r o d i s a b i l i t y:a s y s t e m a t i cr e v i e wa n ds u r v e y[J].H e a l t hT e c h n o lA s s e s s,2021,25(73):1-258.[24] R A W A S H D E H YF,A U S T I N P,S I G G A A R D C,e ta l.I n t e r n a t i o n a lC h i l d r e n'sC o n t i n e n c e S o c i e t y's r e c o mm e n d a t i o n s f o r t h e r a p e u t i ci n t e r v e n t i o n i n c o n g e n i t a l n e u r o p a t h i c b l a d d e r a n d b o w e ld y s f u n c t i o ni n c h i l d re n[J].N e u r o u r o l o g y a n d U r o d y n a m i c s,2012,31(5):615-620.[25] L E EB,F E A T H E R S T O N E N,N A G A P P A N P,e t a l.B r i t i s hA s s o c i a t i o no f P a e d i a t r i cU r o l o g i s t sc o n s e n s u ss t a t e m e n to nt h em a n a g e m e n t o f t h en e u r o p a t h i cb l a d d e r[J].J o u r n a lo fP e d i a t r i cU r o l o g y,2016,12(2):76-87.[26] B A U E RSB,A U S T I N PF,R A W A S H D E H Y F,e ta l.I n t e r n a t i o n a lC h i l d r e n's C o n t i n e n c e S o c i e t y's r e c o mm e n d a t i o n sf o ri n i t i a ld i a g n o s t i ce v a l u a t i o n a n df o l l o w-u p i n c o ng e n i t a ln e u r o p a thi cb l a d d e r a n db o w e l d y s f u nc t i o n i nc h i ld re n[J].N e u r o u r o l o g y a n dU r o d y n a m i c s,2012,31(5):610-614.[27] B OW E R W F,C H R I S T I E D,D E G E N N A R O M,e t a l.T h et r a n s i t i o no f y o u n g a d u l t s w i t hl i f e l o n g u r o l o g i c a ln e e d sf r o mp e d i a t r i c t oa d u l t s e r v i c e s:a n i n t e r n a t i o n a l c h i l d r e n'sc o n t i n e n c es o c i e t yp o s i t i o ns t a t e m e n t[J].N e u r o u r o l o g y a n d U r o d y n a m i c s, 2017,36(3):811-819.[28]修波.脊柱裂诊治专家共识[J].中国修复重建外科杂志,2021,35(11):1361-1367.[29]徐莲花,张芳.神经源性膀胱患儿家属照顾负担影响因素的路径分析[J].护理研究,2022,36(13):2429-2432.[30] L E H K,C A R D O N A-G R A U D,C H I A N G G.E v a l u a t i o na n dl o n g-t e r m m a n a g e m e n t o f n e u r o g e n i c b l a d d e r i n s p i n a l d y s r a p h i s m[J].N e oR e v i e w s,2019,20(12):e711-e724.[31] A U S I L IE,T A B A C C O F,F O C A R E L L IB,e ta l.P r e v a l e n c eo fl a t e x a l l e r g y i n s p i n a b i f i d a:g e n e t i c a n d e n v i r o n m e n t a lr i s kf a c t o r s[J].E u r o p e a n R e v i e w f o r M e d i c a la n d P h a r m a c o l og i c a lS c i e n c e s,2007,11(3):149-153.[32] MA R I A N IF,A U S I L I E,Z O N A M,e t a l.T h e i m p a c t o f c o n s t a n ta n t ib i o t ic p r o p h y l a x i si nc h i ld re naf f e c t e db y s p i n a ld y s r a p h i s mp e r f o r m i n g c l e a ni n t e r m i t t e n tc a t h e t e r i z a t i o n:a2-y e a r m o n o c e n t r i c r e t r o s p e c t i v e a n a l y s i s[J].C h i l d'sN e r v o u sS y s t e m,2022,38(3): 605-610.[33] F O R S T E RCS,S H A I K H N,H O B E R M A N A,e ta l.U r o p a t h o g e n sa n d p y u r i ai nc h i l d r e n w i t hn e u r o g e n i cb l a d d e r s[J].P e d i a t r ic s,2018,141(5):e20173006.[34] W I L S O NSN,K O N G N Y U Y M,J O S E P H D B,e ta l.U r o d y n a m i cu t i l i z a t i o n i n t h e a d u l t s p i n a b i f i d a p a t i e n t:a n i n s t i t u t i o n a l r e v i e w[J].J o u r n a lo fP e d i a t r i cR e h a b i l i t a t i o n M e d i c i n e,2021,14(4): 655-659.(收稿日期:2022-09-30;修回日期:2023-04-04)(本文编辑卫竹翠)㊃3541㊃全科护理2023年4月第21卷第11期Copyright©博看网. All Rights Reserved.。

真理来源于质疑英语作文

真理来源于质疑英语作文Possible English Version:The source of truth is often questioned, as different people may have different perspectives and interpretations. However, questioning is also a vital process for seeking and verifying truth. In this essay, I will discuss my views on the source of truth and the role of questioning in discovering and validating it.First of all, I believe that truth is not an absolute and fixed entity, but a dynamic and evolving concept thatis subject to revision and refinement. Truth can be based on facts, evidence, logic, and consensus, but it can also be influenced by bias, prejudice, ignorance, or manipulation. Therefore, we need to be open-minded, critical, and collaborative in our pursuit of truth, and be willing to adjust our beliefs and opinions when new information or perspectives emerge.Secondly, I think that questioning is an essential tool for exploring truth, as it allows us to challenge assumptions, test hypotheses, and expose fallacies.Questioning can take many forms, such as asking why, how, what if, or what else. Questioning can also involve listening, observing, researching, and reflecting. Through questioning, we can deepen our understanding, broaden our perspectives, and strengthen our reasoning.Thirdly, I acknowledge that questioning can be difficult and risky, especially when it challenges authority, tradition, or consensus. Questioning can provoke resistance, ridicule, or even repression from those who benefit fromthe status quo or the dominant ideology. Therefore, questioning requires courage, integrity, and empathy, aswell as a supportive and diverse community that values inquiry and pluralism.Fourthly, I recognize that questioning can also be misused or abused, especially when it serves narrow interests, spreads misinformation, or undermines trust in legitimate sources of knowledge. Questioning can become a tool of propaganda, conspiracy theory, or pseudoscience, which distort reality and harm society. Therefore, questioning needs to be based on reliable sources, soundmethods, and ethical principles that respect human rights and dignity.In conclusion, the source of truth comes from various channels, including our senses, reason, intuition, experience, and communication with others. However, the reliability and validity of these sources depend on how we question, verify, and integrate them into a coherent and comprehensive understanding of reality. Therefore, we need to cultivate a questioning mindset that values curiosity, skepticism, and humility, and apply it to all aspects of our lives, from personal beliefs to public policies. Only by doing so can we approach closer to the truth and make informed decisions that benefit ourselves and others.中文翻译：真理的来源常常受到质疑，因为不同的人可能有不同的观点和解释。

西宁2024年05版小学三年级下册Y卷英语下册试卷

西宁2024年05版小学三年级下册英语下册试卷考试时间：100分钟（总分:100）B卷考试人：_________题号一二三四五总分得分一、综合题(共计100题)1、填空题：The _____ (向日葵) is tall and bright.2、填空题：In spring, the ________ (花朵) bloom and the ________ (树叶) grow green.3、听力题：Mercury is the closest planet to the ______.4、听力题：Photosynthesis requires sunlight, water, and ________ dioxide.5、听力题：An emulsion is a mixture of two ______ liquids.6、听力题：In chemical terms, a "reactant" is a substance that undergoes a _____ in a chemical reaction.7、What is the name of the famous detective created by Arthur Conan Doyle?A. Hercule PoirotB. Sherlock HolmesC. Miss MarpleD. Sam Spade答案: B8、听力题：The _____ (bridge) is long.9、听力题：The girl sings very ________.10、填空题:My favorite thing to do is ________.11、How many stars are estimated to be in the Milky Way galaxy?A. 100 millionB. 200 billionC. 400 billionD. 1 trillion12、听力题：My favorite fruit is ______ (watermelon).13、听力题：A mixture of metals is called an ______.14、填空题：We have a ______ (精彩的) plan for the weekend.15、听力题：They are playing ________ in the park.16、填空题：What is your favorite __________ (玩具类型)?17、填空题：________ (树木) can live for many years.18、填空题：I enjoy collecting ______ (自然) items like shells and rocks.19、What do we call the person who repairs cars?A. PlumberB. ElectricianC. MechanicD. Carpenter答案: C. Mechanic20、听力题：The chemical bond formed by the transfer of electrons is called an __________ bond.21、填空题：A _____ (果蔬) plate is healthy and colorful.22、听力题：A mixture can be separated by _______ methods.23、What is the primary color of the sun?a. Greenb. Bluec. Yellowd. Red答案:C24、听力题：Many countries have _______ that connect them.25、Which planet is closest to the sun?A. EarthB. MercuryC. VenusD. Mars答案：B26、填空题：The invention of the radio transformed _____ communication.27、填空题：I enjoy building ______ (模型) of historic landmarks.28、听力题：I see a ___ (star/moon) shining.29、填空题：My ________ (玩具名称) has a cool design.30、听力题：The _______ has green leaves.31、填空题：The _______ (Scientific Revolution) changed the way people viewed the natural world.32、听力题：We are ___ to school. (walking)33、What is the name of the famous British rock band that included John Lennon?A. The WhoB. The Rolling StonesC. The BeatlesD. Pink Floyd答案: C. The BeatlesI enjoy riding my __________ on a sunny day. (自行车)35、What is the main ingredient in peanut butter?A. AlmondsB. PeanutsC. WalnutsD. Cashews答案:B36、听力题：The bunny hops around the _____ yard.37、填空题：A _____ (温室) helps plants grow in winter.38、填空题：The _____ (lettuce) grows quickly in cool weather.39、What is the name of the fairy in Peter Pan?A. CinderellaB. Tinker BellC. Snow WhiteD. Ariel答案:B. Tinker Bell40、听力填空题：I think staying positive is crucial. A positive mindset helps us overcome challenges and encourages others. I try to maintain a positive attitude by __________.41、听力题：An alloy is a mixture of two or more ________.42、听力题：The _______ of sound can change depending on the source of the sound.43、听力题：The chemical formula for aluminum oxide is _______.44、听力题：A ______ is a study of how substances interact.45、听力题：A cactus can survive in ______ conditions.An ion is an atom that has lost or gained ______.47、听力题：The sun is ___ (shining).48、听力题：The Earth's tilt affects the changing of the ______.49、What color is an orange?A. BlueB. GreenC. YellowD. Orange答案：D50、What do we call a person who plays music?A. ArtistB. MusicianC. PainterD. Dancer答案:B51、填空题：The ________ was a famous market in ancient Rome.52、听力题：A wheel helps reduce ______.53、What shape has four equal sides?A. RectangleB. TriangleC. SquareD. Circle答案:C54、选择题：What do you call the study of living things?A. BiologyB. ChemistryC. PhysicsD. Geography55、填空题：The __________ is a large forest area in the Pacific Northwest. (雨林)A solute is a substance that is ______ in a solvent.57、ic Ocean was crossed by explorers like _____. 填空题：The Paci58、听力填空题：I love going to the library to find new __________.59、What is the name of the famous bridge in San Francisco?A. Brooklyn BridgeB. Golden Gate BridgeC. London BridgeD. Sydney Harbour Bridge答案: B. Golden Gate Bridge60、What do we call the act of preparing food?A. CookingB. BakingC. GrillingD. Boiling答案:A61、填空题：A ____(habitat) is where an animal or plant lives.62、填空题：My favorite ________ is purple.63、听力题：The Earth's surface is home to a wide variety of ______.64、听力题：A _______ is a reaction that produces a pungent aroma.65、What do you call a person who studies the effects of chemicals on living organisms?A. ChemistB. ToxicologistC. PharmacologistD. All of the above答案: D66、听力题：My sister is very good at ____ (languages).67、 (79) River is important for trade in Europe. 填空题：The ____68、填空题：We saw many __________ (旅游者) at the famous landmark.69、听力题：I like to run in the _____ (公园).70、What do we call the seasonal change when trees lose their leaves?A. SpringB. SummerC. AutumnD. Winter答案: C71、听力题：We have a ______ of books at home. (shelf)72、填空题：A _____ (bouquet) of flowers makes a lovely gift.73、选择题：What do we call the animal that is often kept as a pet and purrs?A. DogB. CatC. RabbitD. Hamster74、What type of animal is a frog?A. MammalB. ReptileC. AmphibianD. Fish答案:C75、听力题：In a neutralization reaction, an acid and a base react to form _____ and water.76、填空题：The ______ (金色的蟾蜍) is often found near water.77、What is 14 7?a. 5b. 6c. 7d. 8答案:b78、填空题：Let’s build a __________ (名词) with our __________ (玩具名)!79、填空题：I enjoy creating art with my toy ________ (玩具名称).80、听力题：The main purpose of a catalyst is to speed up a _____.81、填空题：The ________ (植物特性分析) reveals traits.82、填空题：The _____ (marigold) deters pests in gardens.83、Which fruit is red and often mistaken for a vegetable?A. OrangeB. AppleC. TomatoD. Banana答案:C84、What do you call a place where you can see stars and planets?A. MuseumB. ObservatoryC. AquariumD. Library答案: B85、听力题：The dog is barking ________.86、What is the process of turning a solid into a liquid?A. FreezingB. MeltingC. EvaporationD. Condensation答案: B87、听力题：__________ are important for environmental sustainability.88、What is the opposite of "big"?A. LargeB. SmallC. TallD. Heavy89、填空题：My sister loves to plant _____ in pots.90、What is the name of the famous painting by Leonardo da Vinci?A. The ScreamB. The Starry NightC. Mona LisaD. Last Supper答案: C91、听力题：The cat curls up next to its _____ owner.92、填空题：A _____ (78) is an area with many trees and animals.93、填空题：My uncle is a __________. (作家)94、听力题：She is _____ (running) in the park.95、听力题：A beaker is a common piece of ______ glassware.96、What is the name of the famous ancient city in Greece?A. AthensB. MycenaeC. DelphiD. All of the above97、填空题：My puppy loves to bark at ______ (邮递员).98、填空题：The garden has many _______ that blossom beautifully all year round.99、填空题：________ (植物资源保护) is vital for sustainability.100、填空题：My pet _____ loves to cuddle.。

俞敏洪说：背完这100个句子,你已经背过7000个单词!!!

16.机械计时器的发展促使人们寻求更精确的日晷，以便校准机械计时器。
17. Anthropology is a science in that anthropologists use a rigorous set of methods and techniques to document observations that can be checked by others.
【四六级推荐】俞敏洪说：背完这100个句子，你已经背过7000个单词！！！（此贴无敌了，正犯愁英语不好但又不知每天该做些什么吗？赶紧收藏吧...校内超火精品日志，超过90000人分享~！！！） 2009-09-20 19:36 | (分类:道❤知識)
这个真的很不错，每天背诵一句也不累，第二天在复习前面的一句，这样就想滚雪球一样，背的越来越多。正所谓熟读唐诗三百首，不会作诗也会吟。更何况这只有100句呢。想学好英语的，一定不要错过。
23.在大量的实验中，某一事件发生的几率等于它不发生的几率。
24. Most substance contract when they freeze so that the density of a substance’s solid is higher than the density of its liquid.
22. The chief foods eaten in any country depend largely on what grows best in its climate and soil.
22.一个国家的主要食物是什么，大体取决于什么作物在其天气和土壤条件下生长得最好。
23. Over a very large number of trials, the probability of an event’s occurring is equal to the probability that it will not occur.

某地区儿童误食有害物的临床原因分析及文献复习

•182 •中国实用医药 2019年5 月第 14 卷第 15 期ChinaPracMe(i，M a v2019，V〇l. 14，N o. 15某地区儿童误食有害物的临床原因分析及文献复习赵■彦昌韦克金谢金荣余健全张栋武【摘要】目的了解分析本地区患儿误食有害物原因，为儿童误食有害物防控提供询证依据。

方法回顾性分析因误食有害物就诊的58例儿童的临床资料，对儿童误食原因等信息进行归纳分析，并采用多因素L ogistic回归分析误食有害物儿童的独立危险因素。

结果58例儿童误食的有害物中，纽扣电池(36.2%)、硬币（24.1%)和玩具部件（17.2%)占前3位，家长首饰（13.8%)及其他有毒物(8.6%)分列其后。

58例误食有害物儿童年龄1~7岁，平均年龄(2.8 ± 1.5)岁；男36例，女22例，男女比为1.64 :1，男性多于女性；家长文化程度：父母双方均高中及以上丨7例，双方均初中及以下41例，家长文化程度偏低；单亲家庭39例，双亲家庭19例，单亲家庭占比较大；家庭环境：农村40例，城镇1S例，农村：城镇为2.22 : 1，农村占比大；留守35例，非留守23例，留守：非留守为1.52 :1，留守儿童占比较大。

多因素L ogistic回归分析显示：儿童年龄<7岁（0尺=1.341，95%C/ : 0.872, 9.746)、单亲家庭(0/f=1.742,95%C/:1.287,丨1.476)、家长文化水平偏低(0/?=1.547,95%C/: 1.527, 10.647)是儿童误食有害物的独立危险因素(P<〇.〇5)。

结论留守儿童、单亲家庭儿童、家长文化水平较低儿童是导致儿童误食有害物的外在因素，加强对幼儿的看护教育，能够有效降低儿童误食。

【关键词】误食有害物；因素；文献复习D0I ：10.14163/ki.l l-5547/r.2019.19.103Clinical cause analysis and literature review of children' s accidental eating of harmful substances in acertain area ZHAO Yan-chang,WEI Ke-jin,XIE Jin-rong,et al.Foshan Gaoming District Peopled Hospital,Foshan528500, China【Abstract 】Objective To understand and analyze the causes of c h ild re n's accidental eating ofharmful substances,and to provide evidence for the prevention and control of children s accidental eatingharmful substances.Methods A retrospective analysis was made on the clinical data of58 children treated foraccidental eating harmful substances.The information about the causes of accidental eating harmful substanceswas summarized and analyzed.Multivariate logistic regression was used to analyze the independent risk factors ofchildren1s accidental eating of harmful substances.Results Among 58 cases of accidental harmful substanceseaten by children,button batteries (36.2%), coins (24.1%) and toy parts (17.2%) accounted for the top 3, followedby parent jewellery (13.8%) and other toxicants (8.6%). 58 children with accidental eating harmful substancesaged 1to 7 years,with average of(2.8 士 1.5)years.There were 36 males and 22 females,with a male-to-fem aleratio of 1.64 ：1and more males than females.Parents'educational level:17 parents were both high school andabove, 41 parents were both junior high school and below,parents'educational level was low; 39 single-parentfamilies, 19 double-parent families,single-parent families account for a larger proportion;family environment:40 cases in rural areas, 18 cases in urban areas,rural areas:urhan areas as2.22 ：1,mral areas account for a largeproportion; 35 cases of left-hehind, 23 cases of non-left-hehind,left-hehind children account for 1.52 ：1,left-hehind children account for a relatively large proportion.Multivariate Logistic regression analysis showed thatchildren^age<7 years old(OR= 1.341,95%Cl:0.872,9.746), single parent family(OR= 1.742, 95%CI: 1.287,11.476), parents'low educational level(OR = 1.547, 95%Cl: 1.527, 10.647) were independent risk factors forrhildren's accidental eating harmful substances (P<0.05). Conclusion The low level of education of left-hehindchildren,single-parent fam ilies and parents is an external factor that causes of children^accidental eatingharmful substances.Strengthening the nursing education for young children can effectively reduce children'saccidental eating.【Key words 】Accidental eating of harmful suhstances;Factors;Literature review•有害物误食所导致的儿童安全问题已经成为当今社会重要的公共社会问题，文献报道显示：因食入有害物导致的伤害是影响儿童健康成长的第二大危险因素；由于儿童对于各基金项目：佛山市卫生科技基金项目（项冃编号：20180413)作者单位：528500佛山市高明区人民医院种能够见到或拿到的物品均具有好奇的天性，且儿童缺乏对有害物基本的辨识能力，再加上儿童往往通过舔舐外物来认识外物，因此，儿童天生的好奇习惯及其监管的缺失导致了儿童对有害物的误食u'2]。

真言与美言的辩证关系英语作文

真言与美言的辩证关系英语作文The Dialectical Relationship between Truthful Speech and Pleasant Words.In the intricate tapestry of human communication, the threads of truthful speech and pleasant words play pivotal roles. While both have their unique value and significance, their interplay and dialectical relationship offer profound insights into the dynamics of effective communication. This essay delves into the nuances of this relationship, examining how truth and pleasantries can complement each other in fostering harmonious and meaningful exchanges.Truthful speech, at its core, is the unvarnished expression of facts, ideas, and opinions, free from embellishment or distortion. It is the backbone of any meaningful conversation, as it serves to inform, educate, and challenge the beliefs and perspectives of others. Truth speaking is essential in fostering trust and establishing reliable relationships, as it creates a foundation oftransparency and mutual understanding. In professional settings, it is crucial for maintaining ethical standards and ensuring the efficient flow of information. However, the rawness of truth can sometimes lead to conflict and discomfort, as it may clash with individuals' preconceptions or egocentric interests.On the other hand, pleasant words are the lubricants of conversation, smoothing over rough edges and fostering positive interactions. They are the subtle touches that make a conversation flow more smoothly, the complimentsthat brighten someone's mood, and the encouraging wordsthat boost someone's morale. Pleasant words are often employed in social settings to foster warmth and camaraderie, creating an atmosphere conducive to deeper connections. They are also powerful tools in conflict resolution, as they can diffuse tense situations and open doors to productive dialogue. However, the excessive use of pleasantries can sometimes lead to a dilution of truth and sincerity, resulting in a superficial and disconnected communication.The dialectical relationship between truthful speech and pleasant words lies in their complementary nature. While truth speaking provides the substantive foundation of a conversation, pleasant words add the necessary emotional layer that makes the exchange richer and more meaningful. A balance between the two is crucial for effective communication. Too much truth can be jarring and abrasive, while too much pleasantry can lead to a lack of substance and sincerity.In everyday interactions, we often find ourselves navigating this delicate balance. For instance, when offering feedback to a friend, it is essential to strike a balance between being honest about their shortcomings and expressing our thoughts in a way that does not hurt their feelings. Similarly, in professional settings, we must ensure that our communication is rooted in truth while maintaining a professional tone and respecting the sensitivities of our colleagues.The art of mastering this dialectical relationship lies in developing a keen understanding of when and how to usetruthful speech and pleasant words effectively. It requires empathy, understanding, and the ability to read the subtleties of a conversation. It is about finding the right balance between being direct and honest while also being sensitive and compassionate.In conclusion, the dialectical relationship between truthful speech and pleasant words is an intricate and multifaceted one. It is about finding the harmonious blend of honesty and pleasantries that foster meaningful, enriching, and harmonious conversations. It is about understanding that while truth is the backbone of communication, pleasantries are the glue that binds people together. It is about learning to speak the truth with love and compassion, and to offer pleasant words with sincerity and genuineness. Only then can we create truly meaningful and enriching exchanges that lead to deeper understanding and stronger relationships.。

Cyagen Biosciences Neural Stem Cell Growth Medium产

Material Safety Data SheetRevision Date: 03-Feb-2012Product codeProduct name GUXNX-90011 Neural Stem Cell Growth Medium Company/Undertaking IdentificationCyagen Biosciences Inc.574 East Weddell Dr, Suite 6Sunnyvale, CA 94089, U.S.A.Tel: 800-921-8931Hazardous/Non-hazardous ComponentsThe product contains no substances which at their given concentration, are considered to be hazardous to health. We recommend handling all chemicals with caution.Ensure adequate ventilation, especially in confined areas Engineering measuresPersonal protective equipmentRespiratory protectionHand protectionIn case of insufficient ventilation wear suitable respiratory equipment Protective gloves Safety glasses with side-shields Eye protectionLightweight protective clothing.Skin and body protectionHandle in accordance with good industrial hygiene and safety practice Prevent product from entering drains.Hygiene measuresEnvironmental exposurecontrolsGeneral InformationLiquidForm Important Health Safety and Environmental Information °C No data available °C No data available °C No data available °C No data availableNo information available No data availableBoiling point/range Melting point/range Flash point Autoignition temperature Oxidizing propertiesWater solubility°F No data available°F No data available°F No data available°F No data availableStable. No information available No information available StabilityMaterials to avoidHazardous decompositionproductsPolymerizationHazardous polymerisation does not occur.Acute toxicity Principle Routes of Exposure/Potential Health effectsNo information available No information available No information available May be harmful if swallowed.EyeSkinInhalation Ingestion Specific effectsNo information available No information available No information availableCarcinogenic effectsMutagenic effectsReproductive toxicitySensitization No information available No information availableTarget Orcia Effects No information available. No information available. Inherently biodegradable. Does not bioaccumulate.Ecotoxicity effectsMobilityBiodegradationBioaccumulationDispose of in accordance with local regulationsIATANot classified as dangerous in the meaning of transport regulations No information available No information available No information availableNo information availableProper shipping nameHazard ClassSubsidiary ClassPacking group UN-NoInternational Inventories U.S. Federal ReciulationsSARA 313This product is not regulated by SARA. Clean Air Act, Section 112 Hazardous Air Pollutants (HAPs) (see 40 CIFIR 61)This product does not contains HAPs. U.S. State ReaulationsCalifornia Proposition 65This product does not contain chemicals listed under Proposition 65 WHMIS hazard class:Non-controlledThis product has been classified according to the hazard criteria of the CPR and the MSDS contains all of the information required by the CPRThis material is sold for research and development purposes only. It is not for any human or animal therapeutic or clinical diagnostic use. It is not intended for food, drug, household, agricultural, or cosmetic use. An individual technically qualified to handle potentially hazardous chemicals must supervise the use of this material.The above information was acquired by diligent search and/or investigation and the recommendations are based on prudent application of professional judgment. The information shall not be taken as being all inclusive and is to be used only as a guide. All materials and mixtures may be present unknown hazards and should be used with caution. Since Cyagen Biosciences Inc. cannot control the actual methods, volumes, or conditions of use, the Company shall not be held liable for any damages or losses resulting from the handling or from contact with the product as described herein. THE INFORMATION IN THIS MSDS DOES NOT CONSTITUTE A WARRANTY, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR ANY PARTCULAR PURPOSE.End of Safety Data Sheet。

2023年化学期末考试题目与解答(英文)

2023年化学期末考试题目与解答(英文) 2023 Chemistry Final Exam Questions and Answers1. Define the term "molecule" and provide an example.3. Describe the process of chemical bonding.4. Discuss the concept of chemical equilibrium.Chemical equilibrium is a state in a chemical reaction where the forward and reverse reactions occur at the same rate, resulting in no net change in the concentrations of reactants and products.5. Explain the difference between an exothermic and endothermic reaction.An exothermic reaction releases heat to its surroundings, while an endothermic reaction absorbs heat from its surroundings.6. Define the term "pH" and its significance in chemistry.pH is a measure of the acidity or alkalinity of a solution, indicating the concentration of hydrogen ions present. It is important in chemistry as it affects the properties and behavior of substances in a solution.7. Discuss the role of catalysts in chemical reactions.Catalysts are substances that increase the rate of a chemical reaction without being consumed in the process. They work by providing an alternative pathway with lower activation energy for the reaction to occur.8. Describe the properties and uses of the following elements: carbon, oxygen, and hydrogen.9. Explain the concept of oxidation and reduction in chemical reactions.Oxidation is the loss of electrons by a substance, while reduction is the gain of electrons. Together, they make up redox reactions where electrons are transferred between reactants.10. Discuss the environmental impact of chemical processes and the importance of green chemistry.Chemical processes can have negative effects on the environment through pollution and waste generation. Green chemistry aims to design chemical products and processes that minimize their impact on human health and the environment.These are just a few examples of the topics that may be covered in the 2023 Chemistry Final Exam. Make sure to review your notes, textbooks, and practice problems to prepare thoroughly for the exam.。

petronas substance misuse policy

petronas substance misuse policy题目：Petronas Substance Misuse Policy: Promoting a Safe and Healthy WorkplaceIntroduction:Petronas, as one of the world's leading oil and gas companies, recognizes the importance of maintaining a safe and healthy workplace. The company's Substance Misuse Policy is designed to safeguard its employees' well-being and create a productive working environment. This article will provide a comprehensive overview of the policy, discussing its objectives, key provisions, implementation strategies, and the positive impact it has on employees and the organization.Body:1. Objectives of Petronas Substance Misuse Policy (250 words)The primary objectives of the Petronas Substance Misuse Policy are:a. Ensuring the safety and well-being of employees by preventing and addressing substance misuse in the workplace.b. Promoting a healthy work environment that supports employee well-being and productivity.c. Complying with legal requirements and ethical standards related to substance misuse.d. Providing support and assistance to employees struggling with substance misuse issues.e. Reducing the potential risks and liabilities associated with substance misuse within the organization.2. Key Provisions of Petronas Substance Misuse Policy (500 words)The policy includes several essential provisions aimed at achieving its objectives:a. Prohibition of Substance Misuse: Petronas strictly prohibits the unauthorized use or possession of illicit drugs, alcohol, and other controlled substances during working hours, on company premises, or while performing job duties.b. Drug and Alcohol Testing: The policy mandates drug and alcohol testing for employees in safety-sensitive positions, as well as for those suspected of substance misuse. Random testing may also be conducted to deter substance misuse.c. Employee Education and Awareness: Petronas is committed to raising awareness about substance misuse through regular employee training programs and informational campaigns. Employees are educated on the potential risks, consequences, and available resources for substance misuse.d. Confidentiality and Non-Discrimination: The policy ensures that employee information related to substance misuse is treated confidentially and that individuals seeking assistance are protected from discrimination or retaliation.e. Support and Rehabilitation: Petronas provides confidential support and assistance to employees struggling with substance misuse. Rehabilitation programs, counseling services, and employee assistance programs are available to encourage recovery and provide guidance.f. Disciplinary Actions: Violations of the Substance Misuse Policy may result in disciplinary actions, including warnings, suspensions, and termination, depending on the severity of the infraction.3. Implementation Strategies (500 words)To effectively implement the Substance Misuse Policy, Petronas employs several strategies:a. Policy Communication: The policy is communicated to all employees through various channels, including orientation programs, employee handbooks, intranet resources, and regular reminders.b. Training and Education: Training sessions are conducted to ensure employees understand the policy's provisions, their responsibilities, and the potential consequences of substance misuse. These programs also offer guidance on identifying signs of substance misuse in colleagues and providing appropriate support.c. Testing Procedures: Petronas establishes clear guidelines and protocols for drug and alcohol testing, ensuring transparency, fairness, and accuracy in the testing process. These procedures may be conducted by trained professionals or authorized third-party agencies.d. Employee Assistance Programs: The company offersconfidential counseling services and employee assistance programs to support individuals struggling with substance misuse. These programs aim to provide guidance, promote awareness, and help employees achieve recovery and healthier lifestyles.e. Monitoring and Evaluation: Periodic evaluation is conducted to assess the effectiveness of the Substance Misuse Policy. Feedback from employees and relevant stakeholders is taken into consideration, and necessary amendments are made to ensure continual improvement.f. Collaboration with External Partners: Petronas collaborates with external organizations, such as healthcare providers and community support groups, to enhance the effectiveness of its substance misuse prevention efforts. This collaboration ensures comprehensive support and access to additional resources for employees in need.4. Impact on Employees and the Organization (250 words)The implementation of the Substance Misuse Policy has had significant benefits for both employees and the organization:a. Employee Well-being: The policy promotes a safe and healthy working environment, safeguarding employees' physical and mental well-being. It provides support for individuals struggling with substance misuse, facilitating their recovery and overall wellness.b. Increased Productivity: By reducing substance misuse-related incidents, the policy enhances employees' focus, concentration, and overall productivity. It helps maintain a workforce that is more engaged and driven towards achieving organizational goals.c. Risk Mitigation: The policy minimizes the potential risks and liabilities associated with substance misuse, such as accidents, injuries, legal repercussions, reputational damage, and increased insurance costs. This proactive approach protects the organization's financial stability and reputation.d. Compliance and Ethical Standards: The policy ensures compliance with legal requirements related to substance misuse while promoting ethical standards within the organization. This strengthens Petronas' reputation as a responsible corporate citizen.e. Positive Organizational Culture: The Substance Misuse Policy fosters a culture of safety, well-being, and accountability within the organization. It sends a clear message that substance misuse is unacceptable and supports a workplace where employees can thrive.Conclusion (100 words)Petronas' Substance Misuse Policy serves as a vital framework for maintaining a safe, healthy, and productive workplace. By establishing clear guidelines, providing support resources, and emphasizing prohibition and prevention, Petronas demonstrates its commitment to employee well-being and organizational excellence.。

影响英语单词拼写的因素及解决方法

影响英语单词拼写的因素及解决方法拼写虽然属于英语学习中较低层次的问题，掌握起来却并不容易，即使以英语为母语的、受过良好教育的人士也常常犯错。

英语单词的拼写之所以非常复杂，主要有以下两个原因：第一，英语的来源非常复杂，其基础是日耳曼语族的盎格鲁―萨克森语，但在中世纪和文艺复兴时期，教会和知识分子都普遍使用拉丁语，诺曼征服之后数百年，拉丁语族中的法语又成了宫廷的语言，在殖民扩张和全球化过程中，由于英语的显赫地位，许多语言的词汇都被吸纳进来，更强化了英语的多元性。

第二，与法语不同，英国历史上一直没有统一英语用法的官方努力，导致中古英语拼写的混乱局面对现代英语的拼写产生了消极影响。

尽管如此，借助词汇学的知识，我们仍能找出英语单词拼写中一些具备普遍性的规则。

本文希望通过讨论影响英语单词拼写的因素，对英语学习者有所帮助。

1、外来语的影响对英语拼写影响较大的三种语言是希腊语（多数词汇通过拉丁语间接进入英语）、拉丁语（英语80%的词汇直接或间接来源于拉丁语）和法语。

1）希腊语：英语中保留了一些典型的希腊语拼法，如发音为/k/的ch组合（chemistry、orchestra等等，因为ch在希腊语中是一个字母，h表示是送气音）、词首的rh组合（rhyme、rhetoric等等，因为希腊语中与英语r对应的字母在词首必须有送气音标志）、ps组合（psychology、psychiatrist等等，因为ps在希腊语中是一个字母）、mn组合（mnemonic等等）。

此外，部分英语词汇的词尾单复数均遵循希腊语规则，如on→a（phenomenon / phenomena、criterion / criteria）、is→es（crisis / crises、thesis / theses ）的变化。

2）拉丁语：拉丁语对英语拼写的影响非常巨大，我们在3―6条还要涉及到，这里主要介绍对英语词尾的影响。

以―us（如alumnus）、―a（如alga）、―um（如referendum、datum）等结尾的很多英语词汇都源于拉丁语，因而在变复数时遵循拉丁语的规则：us→i（alumni）、a→ae（algae）、um→a （referenda、data）等等。

线申请加拿大的旅游签证

2014年2月24日在线申请了加拿大的旅游签证，电子申请很方便的一点是签证材料只要提供电子版就可以了，而且相比签证中心能省个百十块钱。

最终给到了我的护照有效期的前一天，一共三年半吧，还不错。

分享一点这次网签的经验给大家。

首先，懂一点英语，有过签证经历的十分推荐在线申请；其次，手机或相机拍照上传文件方便快捷者，推荐。

第三；有美国签证并且去过美国的，十分推荐。

第四，100加币按照汇率也比大使馆收的590元低，还有交给签证服务中心的服务费为169元，比直接递交219元少了一些吧，当然，这都是小钱，如果一家人一起申请，可以便宜很多了。

先来介绍一下个人情况，选择加拿大签证在线申请，是因为2012年去过美国，有美国的B 2签证，所以符合材料简化的要求，只需要提供以下材料，很方便：1，填写完整的“临时居民访问签证申请(IMM5257）”。

每位申请人及每名随行子女均需一份单独的申请表格。

2，申请人及每位年满18周岁及以上的随行家庭成员完整填写“家庭信息表”（IMM5645）。

3，申请人及每位随行的家庭成员每人需递交两张相同的在最近六个月内拍摄的彩色或黑白照片，背景为纯白色或浅色。

相片外框大小为35毫米X 45毫米。

4，申请人及每位随行的家庭成员的有效护照。

每本护照须包含除最后一页外的至少一整页空白页、且护照必须在行程前至少六个月有效。

5，一份陈述你此次申请访加目的的说明或邀请函。

6，如果在职，使用印有公司抬头信笺、由雇主签字的准假信原件，并包含以下信息：申请人的姓名、职位、目前收入及起聘日期；以及注明的雇主全称和地址，以及电话号码。

7，签证费100加币。

在线申请前，先把IMM5257和IMM5645填写好（不用签名，直接电子版就可以）、自己的照片、美国签证页和盖章页、学历证书、行程说明、在职证明等用相机拍好，存成JPG 等照片格式保存好，文件名必须用英文命名。

说到这个，当时上传的时候老提示出错，后来才发现原来是他们的网站不认中文名字的文件。

儿童肺含铁血黄素沉着症的研究进展

儿童肺含铁血黄素沉着症的研究进展发布时间：2021-03-22T14:11:43.623Z 来源：《医师在线》2020年10月19期作者：张恒山练红英李根[导读]张恒山练红英李根通讯作者（广东省儿童医院；广东广州511400）摘要：肺含铁血黄素沉着症（Idiopathic Pulmonary Hemosiderosis， IＰＨ）是一组好发于儿童的肺间质疾病，其典型表现为反复咯血、缺铁性贫血、胸部影像学示弥漫性肺部浸润。

下面从中医和西医两方面对IＰＨ的病因病机、鉴别诊断、诊治进展和预后管理进行相关综述。

关键词：特发性肺含铁血黄素沉着症；儿童；中西医；综述肺含铁血黄素沉着症（IＰＨ）是一组反复发作的肺泡毛细血管出血性疾病，其特征是大量含铁血黄素积累于肺内，多见于儿童[1]。

肺含铁血黄素沉着可分为原发性和继发性。

原发性可分为四个亚型，其中最具代表性的就是特发性肺含铁血黄素沉着症。

IPH典型临床三联征为反复缺铁性贫血、咯血、弥漫性肺浸润，国外研究显示，在确诊的IPH患儿中最常见的临床表现就是贫血（约64%）和呼吸困难（约68%），而出现咯血的患儿只有50%[2]。

因本病临床较少见，症状不典型，而且是排他性诊断，因而极易误诊[3]。

为了提高临床对本病的认知，提高诊治水平，现将近年来中西医对IPH诊断与治疗的研究进展综述如下。

1 西医对IPH的认识及治疗1．1 流行病学根据研究统计，本病在国外的发病率约为 0.24/100 万-1.23/100 万，男女患病率大致相同，多数患儿年龄在7岁以下[4-5]。

北京儿童医院2001年至2011年十年间有登记的儿童间质性肺疾病的349例病例中，IPH占113例（32.3%），为常见的间质性肺疾病之一[6]。

1．2．病因病机目前IPH病因仍然不明，存在多种假说：自身免疫方面、遗传基因、过敏机制、环境因素等[1]。

最新的研究多倾向于认为IPH和免疫功能紊乱相关。

自身免疫方面：自身免疫紊乱，抗原-抗体复合物沉积在肺泡内，增加肺小管出血风险，可能是最重要的发病机制之一。

化学在艺术品保护中的应用英语

化学在艺术品保护中的应用英语Chemistry in the Conservation of Art.Chemistry, a branch of science dealing with the composition, structure, properties, and reactions of matter, finds itself at the forefront of numerous scientific disciplines, including the preservation and conservation of art. Art, whether it be paintings, sculptures, or even ancient artifacts, requires careful handling and preservation techniques to ensure its longevity and to maintain its original beauty and value. Chemistry plays a pivotal role in this endeavor, providing a range of tools and techniques to address the unique challenges posed bythe conservation of art.The first and foremost application of chemistry in art conservation is the cleaning and restoration of artifacts. Over time, artifacts can accumulate dirt, grime, and even harmful pollutants that can damage their surfaces and alter their colors. Chemical cleaners and solvents can be used togently remove these contaminants, revealing the original beauty of the artifact. For instance, the use of solvents like acetone or ethanol can effectively remove oil and grease stains from paintings, while specialized cleaning agents can be used to remove dust and dirt from sculpturesor ancient artifacts.Chemistry also plays a crucial role in thestabilization and preservation of artworks. Artifacts that are made of organic materials, such as wood or paper, are particularly susceptible to decay and damage caused by humidity, temperature fluctuations, and pests. Chemical treatments can be used to stabilize these materials, making them more resistant to these environmental factors. For instance, the application of water-repellent chemicals can help prevent the absorption of moisture by wooden artifacts, while the use of insecticides can protect them from pests.In addition to cleaning and stabilization, chemistry also finds application in the restoration of damaged artworks. When an artifact is damaged, it may require complex repairs that go beyond simple cleaning. In suchcases, chemical materials and adhesives can be used torepair cracks, holes, or tears. For instance, epoxy resinsor polyester resins can be used to fill in cracks or gapsin wooden or stone artifacts, while adhesives like cyanoacrylate glue can be used to bond broken pieces together.Moreover, chemistry is essential in the analysis and authentication of artworks. The identification of materials, techniques, and even the origin of an artifact oftenrequires the use of chemical tests and analytical methods. For instance, the analysis of pigments and binders in paintings can help identify the period and style of an artwork, while the use of spectroscopic techniques like X-ray diffraction or infrared spectroscopy can reveal the composition and structure of materials used in sculpturesor jewelry.Finally, chemistry is also at the forefront ofinnovative conservation techniques that aim to preserve artworks in a more sustainable and environmentally friendly manner. For instance, the development of new materials andadhesives that are non-toxic and biodegradable is an ongoing research area in art conservation. Additionally, the use of digital technologies in conjunction with chemical analysis and restoration techniques is enabling conservationists to create virtual replicas of damaged artworks, thus preserving their original beauty and value while also allowing for their public display and access.In conclusion, chemistry plays a crucial role in the conservation of art, providing a range of tools and techniques to address the unique challenges posed by the preservation of cultural heritage. From cleaning and stabilization to restoration and authentication, chemistry is essential in ensuring that artworks are preserved for future generations to enjoy and appreciate.。

在学校中如何长高英语作文

Growing taller is a common concern among students, and its a topic that can be approached from various angles. Heres a composition on how to potentially increase height while at school:Title: Enhancing Height Growth at SchoolGrowing up, we often hear that our height is determined by factors beyond our control, such as genetics. However, there are certain practices that can be incorporated into our daily school life to potentially influence our height positively. Here are some strategies that students can adopt:1. Balanced DietA wellrounded diet is fundamental to overall health and growth. Schools should provide a variety of foods rich in vitamins and minerals that are essential for bone growth and development. Students should ensure they consume plenty of fruits, vegetables, whole grains, lean proteins, and dairy products.2. Regular ExercisePhysical activity is crucial for promoting growth hormones. Schools should encourage students to participate in sports and physical education classes. Activities like basketball, swimming, and yoga can help stretch the body and strengthen muscles, which may contribute to height increase.3. Adequate SleepSleep is the time when the body grows and repairs itself. Students should aim for at least 810 hours of sleep per night. Schools can support this by creating a conducive environment for rest and relaxation during study hours and afterschool activities.4. Posture ImprovementMaintaining good posture can make a significant difference in how tall one appears. Schools can integrate posture exercises into their physical education curriculum to help students stand and sit straight, which can help stretch the spine and potentially add to their height.5. Avoiding Harmful SubstancesThe use of tobacco, alcohol, and drugs can stunt growth. Schools should educate students about the harmful effects of these substances and promote a healthy lifestyle.6. Regular Health CheckupsSchools should facilitate regular health checkups to monitor students growth and development. Early detection of any growthrelated issues can allow for timely intervention.7. Positive Mental AttitudeStress can have adverse effects on growth. Schools should provide a supportive environment where students feel comfortable expressing their concerns and seeking help. Encouraging a positive mental attitude can also contribute to overall wellbeing.8. HydrationDrinking plenty of water is essential for maintaining healthy bodily functions, including growth. Schools should ensure that students have access to clean drinking water throughout the day.In conclusion, while genetics play a significant role in determining height, adopting healthy habits at school can potentially influence a students growth positively. By focusing on diet, exercise, sleep, posture, avoiding harmful substances, regular health checkups, maintaining a positive mental attitude, and staying hydrated, students can maximize their growth potential during their school years.。

参考：DIY网申加拿大学签

DIY网申加拿大学签Study Permit （非SDS）经历分享大家好，我是2015 Fall 即将入学University of Waterloo上Software Engineering 本科专业的新生。

由于是拿托福成绩申请的大学，不能走SDS的快速通道，只好普签SP。

在网上Research 了一段时间后，发现网申是一条速度又快，要求材料又少的方法，遂决定网申。

但是最后发现要求的材料真的比纸签少很多，但是速度并没有想象中的那么快。

鉴于网上关于网申SP的经验贴和资料很少，我在网申SP时经常对流程有困惑，相信大家也都会有。

在摸爬滚打几十天后，我终于如愿以偿拿到了VISA，果断决定把自己在申请过程中的宝贵经验分享出来造福以后DIY网申普签的同学们。

免责声明：以下信息仅供参考，因此被拒签，本人概不负责0.0 哈哈。

Timeline：4/6: 预体检4/10: submit application5/8: mycic更新状态：Review of Medical Results: Passed5/27 mycic更新Message：Original Passport Request (激动！当天去签证中心提交了护照）6/1 护照状态：Dispatched from Canada Visa Office to Visa Application Center，当天在mycic 收到Introduction Letter（过签信）6/2 去签证中心取到了护照，上面贴着热乎乎的VISA材料准备：1. 先去体检。

CIC网站上有认证体检中心列表，找个离家里近的，提前一天打了个电话预约，第二天就去了（准备1700大洋），最后拿到了一份体检信息表（重要）。

2. 在cic网站填个questionnaire，然后生成了一个码和材料checklist，然后注册一个GCKey 账号，然后登录Mycic把生成的码输入，application就附在账号里了。

化学物质英语名称

English names provide a consistent and relevant way to identify chemical substances, regulations of the language spoon by the user
English names allow for easy comparison and communication among different scientific disciplines that deal with chemical abstracts
02
Common English names of inorganic
chemical substances
Metallic element
Aluminum (Al)
A silver white metal that is ductile and malleable, Al is the most abundant metal in the Earth's rust and is widely used in the manufacturing of alloys, all as in aircraft and coverage cans
Alcohols
Compounds containing a hydroxide group (- OH) attached to a hydrocarbon Examples include methanol (CH3OH), ethanol (C2H5OH), and propanol (C3H7OH)
Compounds that ionize in water to form hydroxide ions (OH -) Examples include sodium hydroxide (NaOH) and potassium hydroxide (KOH)

怀疑真理的英语作文带翻译

In the realm of philosophical inquiry, the concept of truth has always been a subject of intense debate. The essay that follows explores the skepticism towards truth, questioning its absoluteness and examining different perspectives on what constitutes truth.Title: Questioning the Absoluteness of TruthIn the vast expanse of human thought, the idea of truth has been a beacon, guiding us through the labyrinth of knowledge and understanding. However, the nature of truth is not as straightforward as it may seem. This essay delves into the skepticism surrounding the concept of truth, challenging its perceived absoluteness and exploring the various dimensions that contribute to our understanding of what is true.IntroductionThe quest for truth has been a fundamental pursuit in human history. Philosophers, scientists, and thinkers from all walks of life have sought to uncover the ultimate truths of the universe. Yet, the very notion of truth is subject to interpretation and is often influenced by cultural, social, and individual perspectives.The Relativity of TruthOne of the primary arguments against the absoluteness of truth is its relativity. Truth is not a fixed entity but rather a construct that is shaped by the context in which it is perceived. What is considered true in one culture may be seen as false in another, highlighting the subjective nature of truth.Cultural InfluencesCultural factors play a significant role in shaping our understanding of truth. Different societies have their own set of values, beliefs, and norms that influence what is accepted as true. This cultural relativism suggests that truth is not universal but varies from one society to another.The Role of PerceptionPerception is another critical factor in our apprehension of truth. Our senses and cognitive processes filter and interpret the world around us, which can lead to different interpretations of the same event or phenomenon. This subjective experience of reality further complicates the concept of an absolute truth.The Evolution of KnowledgeThe evolution of human knowledge also casts doubt on the absoluteness of truth. As our understanding of the world expands and our technologies advance, previously accepted truths are often revised or even discarded. This continuous evolution implies that our current understanding of truth is likely to change in the future.ConclusionIn conclusion, the skepticism towards the absoluteness of truth is wellfounded. Truth isnot an unchanging absolute but a fluid concept that is influenced by cultural, perceptual, and epistemological factors. Recognizing the complexity and relativity of truth encourages a more nuanced and openminded approach to understanding the world around us.Translation:在哲学探究的领域中，真理的概念一直是激烈辩论的主题。

《大学英语精读》份练习标准答案汇集

I will give this book to____________ wants to have it.A.whomeverB.whoeverC.whateverD.wherever标准答案：B您的答案：题目分数：1.0此题得分：0.02．第3题The higher the standard of living,____________.A.the greater is the amount of paper is usedB.the greater amount of paper is usedC.the amount of paper is used is greaterD.the greater the amount of paper is used标准答案：D您的答案：题目分数：1.0此题得分：0.03．第4题I doubt____________he will lend you the book.A.whetherB.whenC.thatD.which标准答案：A您的答案：题目分数：1.0此题得分：0.04．第5题Students in his class cannot understand ____________.A.what does the sentence meanB.what means this sentenceC.what this sentence meansD.what is the meaning of the sentence标准答案：C题目分数：1.0此题得分：0.05．第6题I didn't remember his name____________after I had greeted him.A.whenB.asC.untilD.while标准答案：C您的答案：题目分数：1.0此题得分：0.06．第7题________the door than somebody started knocking on it.A.I had closed no soonerB.No sooner had I closedC.I had no sooner closedD.No sooner I close标准答案：B您的答案：题目分数：1.0此题得分：0.07．第8题The instruments of the older factory____________.A.is as good or better than the new oneB.are as good or better than the new oneC.is as good as or better than those of the new oneD.are as good as or better than those of the new one标准答案：D您的答案：题目分数：1.0此题得分：0.08．第9题The village ____________my mother grew up in is not far from the city.A.whatB.whereC.whichD.wherever标准答案：C您的答案：题目分数：1.0此题得分：0.09．第10题I have no idea_________ they have kept in touch with me by E-mail since last year.A.whatB.howC.thatD.when标准答案：C您的答案：题目分数：1.0此题得分：0.010．第11题Mrs. Lee will move into her new house next Monday, ____________it will be completely furnished.A.by that timeB.by the timeC.by which timeD.by some time标准答案：C您的答案：题目分数：1.0此题得分：0.011．第23题The crime was discovered till 48 hours later, ____________gave the criminal plenty of time to getaway.A.whichB.thatC.soD.what标准答案：A您的答案：题目分数：1.0此题得分：0.012．第24题The time will come ____________ man can fly he likes in the universe.A.how ... whereB.when ... whereverC.where ... whereD.Bwhat ... which标准答案：B您的答案：题目分数：1.0此题得分：0.013．第25题Never hesitate to ask about ____________.A.that you don' t understandB.what you don' t understandC.which you don' t understandD.what don' t you understand标准答案：B您的答案：题目分数：1.0此题得分：0.014．第37题We must do well____________the boss assigns us to do.A.thatB.whateverC.whicheverD.those标准答案：B您的答案：题目分数：1.0此题得分：0.015．第38题You can't imagine____________ when they received these gifts.A.how they were excitedB.how excited they wereC.how excited they haveD.they were how excited标准答案：B您的答案：题目分数：1.0此题得分：0.016．第39题Do you know ____________?A.when does the party startB.whether the party startsC.what time the party startsD.if the party starts标准答案：C您的答案：题目分数：1.0此题得分：0.017．第40题______ is a fact that English is accepted as an international language.A.WhatB.ThisC.ThatD.It标准答案：D您的答案：题目分数：1.0此题得分：0.018．第41题The water gives up energy and becomes cooler____________the ice receives energy and melts.A.whenB.whileC.forD.because标准答案：B您的答案：题目分数：1.0此题得分：0.019．第42题Young ___________John was, he was able to swim across the channel within minutes.A.asB.soC.thoughD.although标准答案：A您的答案：题目分数：1.0此题得分：0.020．第43题Most of the stones are____________ a man and weigh about two and a half tons each.A.more highB.much more highC.higher moreD.higher than标准答案：D您的答案：题目分数：1.0此题得分：0.021．第1题1.we ________ copper ａnd silver _________ good conductors.2. here patience is __________. 3 . the company _______ the children in the mountain area ______ a lot of books. 4. these_______ are very common now. 5. these english words ___________ ｆrom greek. 6. the stormcaused untold ___________ the farmer' s production. 7. the region continues to ______________serious pollution. 8. how do _________ you iron into steel? 9. climate change could haveserious__________ for africa. 10. the harmful substances ________ into the environment.标准答案：【参考答案】：1.refer to… as 2.essential 3.supplied ,with 4.phenomena 5.derive6.damage to7.suffer from8.convert9.consequences 10.released题目分数：1.0此题得分：0.022．第36题1.The city' s road system is ___________ handling the current volume of traffic. 2 If thecorporation wants to increase its __________,it must reduce operating expense. 3 The constructionof the bridge ___________ due to the snowstorm. 4 Some of them did not get a chance to see the Olympic flame because of the ___________ changes, but we, indeed, feel their passion for Chinaand the Olympics. 5 In general most workers were in favor of a(n) _____________ scheme offeringfinancial rewards. 6 A college-level course of study intended to provide students with generalacademic knowledge _______________ occupational training. 7 The __________ workers' attention isnow turning towards the recovery of bodies from the rubble and providing food, shelter and drinking water for the survivors. 8 He hides behind door or creeps under a table to ________ from his enemies. 9 He sometimes employs students to ___________ samples of their products. 10 This year' s Asian oil demand ___________ will amount to 582,000 more barrels of oil a day.标准答案：【参考答案】：1.incapable of 2.profit 3.has been suspended 4.route 5.incentive 6.ratherthan 7.rescue 8.escape 9.distribute 10.in total您的答案：题目分数：1.0此题得分：0.023．第12题到了巴黎的时候，我迷了路。

女性如何爱护健康英语作文

Maintaining good health is essential for everyone,and women are no exception. Here are several key points that women can follow to take care of their health:1.Balanced Diet:Eating a wellbalanced diet is crucial.Women should include a variety of fruits,vegetables,lean proteins,whole grains,and healthy fats in their daily meals to ensure they get all the necessary nutrients.2.Regular Exercise:Engaging in regular physical activity can help women maintain a healthy weight,reduce the risk of chronic diseases,and improve mental health.Aim for at least150minutes of moderate aerobic activity or75minutes of vigorous activity each week,along with strength training exercises at least twice a week.3.Adequate Sleep:Getting enough sleep is vital for overall health.Most adults need between7to9hours of sleep per night.Good sleep habits can help improve concentration,mood,and immune function.4.Hydration:Drinking plenty of water throughout the day helps to maintain hydration, which is important for all bodily functions.Aim for at least eight8ounce glasses of water daily.5.Regular Checkups:Women should have regular health checkups,including screenings for breast cancer and cervical cancer.Early detection can significantly improve treatment outcomes.6.Mental Health:Taking care of mental health is just as important as physical health. Engaging in activities that reduce stress,such as meditation,yoga,or hobbies,can contribute to a healthy mind.7.Avoiding Harmful Substances:Smoking and excessive alcohol consumption can lead to numerous health problems.Women should avoid or limit their intake of these substances to maintain good health.8.Preventive Care:Staying uptodate with vaccinations and taking preventive measures against diseases can help keep women healthy.9.Healthy Relationships:Having strong social connections and maintaining healthy relationships can contribute to emotional wellbeing.10.Personal Hygiene:Practicing good personal hygiene,such as regular bathing,dental care,and staying clean,can prevent infections and promote a healthy lifestyle.11.Sun Protection:Protecting the skin from harmful UV rays by using sunscreen and wearing protective clothing can prevent skin cancer and premature aging.12.Mindful Living:Being mindful of ones body and its needs,listening to its signals,and making conscious choices can lead to a healthier lifestyle.By incorporating these practices into daily life,women can significantly improve their health and wellbeing.Its important to remember that consistency is key,and making small,sustainable changes can lead to big improvements over time.。