1姜毅--Whats-new-in-GINA-2018
基于决策树的协同进化分类算法研究
基于决策树的协同进化分类算法研究
姜毅;乐庆玲
【期刊名称】《电脑知识与技术》
【年(卷),期】2007(003)013
【摘要】针对当前分类算法还存在的诸如伸缩性不强、可调性差、缺乏全局优化能力等问题,该文提出了一种有效的用于数据挖掘分类任务的方法--基于决策树的协同进化分类算法.实验结果表明该方法获得了更高的预测准确率,产生了更小的规则集.
【总页数】3页(P197-198,252)
【作者】姜毅;乐庆玲
【作者单位】武汉科技大学计算机学院,湖北,武汉,430081;武汉大学信息管理学院,湖北,武汉,430072
【正文语种】中文
【中图分类】TP301.6
【相关文献】
1.基于决策树的协同进化分类算法研究 [J], 姜毅;乐庆玲
2.基于增量式决策树的时间序列分类算法研究 [J], 王树英;王志海
3.基于决策树的协同进化分类算法研究 [J], 姜毅;乐庆玲
4.基于指数的决策树土地利用分类算法研究 [J], 何朝霞
5.区块链框架下基于优化决策树模型的大数据分类算法研究 [J], 杨薇薇;曾凌静
因版权原因,仅展示原文概要,查看原文内容请购买。
儿科专家姜毅教授做客《名医来了》,教你防治儿童呼吸道疾病
儿科专家姜毅教授做客《名医来了》,教你防治儿童呼吸道疾病“名专家的视频公开课,老百姓的健康大管家”。
16日下午3时,由楚天都市报倾力打造的视频直播栏目《名医来了》在武汉大学人民医院闪亮登场。
楚天都市报记者郑晶晶通讯员杜巍巍高婷第九期嘉宾是武汉大学人民医院儿二科主任、主任医师姜毅。
姜主任是不少妈妈心目中的“男神”专家,直播中他妙语连珠,道出了不少为广大家长关心的儿童呼吸系统疾病的知识和一些病症的鉴别方法,近十万网友通过楚天都市报官方微博、楚天都市报头条号、企鹅号及看楚天APP旁听了这节“公开课”。
孩子发烧不可怕,正确处理对待它秋季儿童呼吸系统疾病高发,孩子容易出现感冒、发烧等。
姜毅主任介绍,如果孩子流鼻涕、打喷嚏但不发烧,可能是一般的普通感冒或过敏性鼻炎;如果咳嗽、打喷嚏又发烧,就是出现感染。
姜毅主任表示,不少家长一见孩子发烧就慌,其实,发烧是机体感染细菌病毒后的正常反应,是为了激发其免疫功能,“如果原来的体温在38.5℃以下,这个时候不建议用退烧药,可在家用物理方法降温,并且要观察发烧的伴随症状。
”为何如此,他表示,一般的流感病毒,在温度在38.5℃的时候其活性是最低的。
“孩子通过发烧来杀灭这些病毒的时候,如果家长马上给孩子把温度降下来,不是帮孩子的忙,是帮病毒的忙。
”所以,可以先用物理降温,在家给孩子用温水把四肢擦一下,而且擦浴后要迅速擦干全身,并换上干爽的衣服,以免着凉,不然会加重发烧。
如果体温控制不下来,并有伴随症状时要及时就医,请医生找出原因进行对症处理。
另外,如果孩子有高热惊厥史,或者家族成员中有高热惊厥病史的病人,要使孩子早期退热,必要时要适当用上镇静药。
对于一些家长的“吃点药,捂一捂,出点汗就好了”的做法,姜毅表示,任何治疗都要以孩子舒服为主,孩子在发烧的时候,包得严严实实反而会影响到机体的散热,使体温上升,甚至处于高热状态,长时间下来,极有可能会导致机体多器官、多系统受累。
需要提醒的是,3个月以内的小宝宝,由于免疫系统尚未发育成熟,一旦发烧家长应尽快带孩子就医,遵医嘱治疗,不要盲目用药。
践行人性教育升华人文光辉
践行人性教育升华人文光辉台州市姜毅名师工作室【期刊名称】《体育教学》【年(卷),期】2017(037)012【总页数】2页(P52-53)【作者】台州市姜毅名师工作室【作者单位】【正文语种】中文本刊记者:姜老师领衔的名师工作室的教育理念是什么?是基于怎样的思考提出这样的理念?姜毅:基于人性,改善教师角色意识和行为能力,提升工作成效,服务于孩子。
而人性的基点为健康与尊严。
这里的健康包括健康知识的传授、健康习惯的养成;尊严包括自尊、他尊、尊重自然。
首先,体育与健康课程具有综合性,课程强调着眼人性基点充分发挥体育的育人功能。
在体育与健康学习中要积极渗透德育教育,并融合部分健康行为与生活方式、心理健康与社会适应、疾病预防与安全避险等方面的知识技能。
这就要求我们的教育理念必须将人性作为教育教学工作的基点,将学生对于身心健康和人格尊严的基本诉求放在所有工作的目标首位。
同时,随着课程改革的不断深入,我们欣喜地看到以学生发展为中心、激发学生的运动兴趣、保证每一位学生受益、促进学生健康成长等课程理念已深入人心。
但要将这些理念转化为教师具体的教育教学行动,就要求教师必须改变传统师道尊严的角色定位,及以往发号施令式的操练教学。
转而从学生的身心发展视角审视我们的教育教育学行为,因为只有学生掌握学习方法和学会学习的教学才具有最大效能,也只有学生融入身心和改变身心的教育才具有真正意义。
本刊记者:工作室近期的工作重点是什么?您是通过哪些具体措施来落实这些工作重点?姜毅:工作室当前的工作重点是着手学科教学、着眼人性完善,向教育领域延伸。
尽管体育学科是一门以身体练习为主要手段,以学习体育与健康知识、方法和技能为主要内容的综合实践学科。
但通过体育教学既能够增进学生健康,培养学生终身体育意识和能力,实现学生在体育方面的良好发展。
还能够以体育为载体渗透德育教育,乃至发展学生的多元智能,从而促进学生成为德、智、体全面发展的人。
正是基于这样的全人发展的学科视角,我们一直努力推行促进学生身心全面协调发展的生态化课堂教学。
中医药干预糖耐量低减
中医药干预糖耐量低减
姜燕;余江毅
【期刊名称】《吉林中医药》
【年(卷),期】2009(029)002
【摘要】葡萄糖耐量低减(IGT)是葡萄糖耐量正常与2型糖尿病之间的过渡阶段.葡萄糖耐量低减具有向糖尿病转化的高度危险性,合并大血管疾病的发生率显著增高,早期发现、早期诊断和干预治疗己受到广泛重视.中医认为,IGT的发病机制为脾气虚弱、肝气郁结、肾阴不足,从益气健脾、疏肝解郁、滋阴清热、益气养阴、化瘀祛痰等法入手对IGT进行干预治疗,可以降低糖尿病的发病率及其血管并发症.
【总页数】3页(P111-113)
【作者】姜燕;余江毅
【作者单位】南京中医药大学,江苏,南京,210029;江苏省中医院,江苏,南京,210029【正文语种】中文
【中图分类】R589.1
【相关文献】
1.糖耐量低减的中医药干预研究现状 [J], 宋晓琴;莫传伟;李小霞
2.中医药干预糖耐量低减的研究进展 [J], 黄文智;梁晓春
3.多囊卵巢综合征患者糖耐量低减的相关因素分析 [J], 张美微; 侯丽辉; 李妍; 王颖; 匡洪影
4.看图对话工具在老年糖耐量低减患者健康教育中的应用 [J], 邓敏婷;陈运香;陆桂
荣;韦世梅
5.60例糖耐量低减居民中医药干预一年的临床观察 [J], 朱蕴华;张晓天;陆灏因版权原因,仅展示原文概要,查看原文内容请购买。
《腹腔镜或机器人辅助胰腺癌根治术中国专家共识(2022_年版)》解读
收稿日期:2023-08-03 录用日期:2023-11-03Received Date: 2023-08-03 Accepted Date: 2023-11-03基金项目:上海市科委科技创新行动计划(20Y11908600)Foundation Item: Science and Technology Inovation Action Plan of Shanghai Science and Technology Commission (20Y11908600)通讯作者:姜翀弋,Email:*********************Corresponding Author: JIANG Chongyi, Email: : *********************引用格式:蔡志伟,姜翀弋. 《腹腔镜或机器人辅助胰腺癌根治术中国专家共识(2022年版)》解读[J]. 机器人外科学杂志(中英文),2024,5(2):299-303.Citation: CAI Z W, JIANG C Y. Interpretation of Chinese expert consensus on laparoscopic or robot-assisted radical pancreatectomy for pancreatic cancer (2022 edition)[J]. Chinese Journal of Robotic Surgery, 2024, 5(2): 299-303.《腹腔镜或机器人辅助胰腺癌根治术中国专家共识(2022年版)》解读蔡志伟,姜翀弋(复旦大学附属华东医院普外科·胆胰疾病诊疗中心 上海 200040)摘 要 《腹腔镜或机器人辅助胰腺癌根治术中国专家共识(2022年版)》是由中国抗癌协会胰腺癌专业委员会微创诊治学组与中华医学会外科学分会胰腺外科学组组织全国部分胰腺外科专家制定,2022年首次发表于 Journal of Pancreatology 。
认知视阈下的英语网络新词生成机制探究
y b e r s p a c e ( 网络空 间 ) , c y b e r h o l i c ( 沉 迷 网络 的 从广义上讲 ,网络语言是指一切与网络相 c , c y b e r c u l u r e ( 网络文化 ) 等新词 , m i c r o 表 示 关的语言 , 一般 由三种类型组成 : 计算机和网络 人 ) 微 型 的 , 因此 , 派 生 出 m i c r o mo n e y( 微 型 货 币) , 技 术 的专业 术 语 、与 网络 文化 现象 相 关 的属 于 c r o p r i c i n g ( 微 型 收费 ) , m o c r o s e r f ( 沉 溺 于 网络 和网络交流中使用的特殊用语 。 而从狭义上讲 , mo
作者简 介 : 姜珊( 1 9 8 1 一) , 女, 硕 士, 黑龙 江科技 大学国际教 育学院讲 师 , 从事语 言学与翻译研 究; 李轶 男( 1 9 8 3 一) 。 女, 硕士 , 黑龙 江科技 大学国际教 育学院助教 , 从 事语 言学研 究。
随着 计 算 机 技 术 的发 展 以及 网络 的 普 及 ,
的人 , 由此 派 生 出 n e w b i e ( 网络 新 手 ) , t e c h i e ( 计 关 系的 网络 词 汇 占总数 的 2 8 . 9 3 %, 与 所要 表 达 渤海大学掌报 哲 学 社 会 科 学 版
认知视阈下的英语网络新词 生成机制探究
姜 珊 李轶 男 ( 黑 龙江科技 大学 国际教育学 院 , 黑 龙江 哈尔滨
1 5 0 0 2 2)
摘
要: 文章从认知的 角度对 英语 网络 新词的生成机制进行探 究。分别从 隐喻 和转喻认 知的角度描 述
了英语 网络新 词的生成方式。从 隐喻 认知 角度主要有 四种 生成方式 : 结构 隐喻 、 方位 隐喻、 本体 隐喻 和 语音隐喻 。 并且分析 了使 英语 网络 新词生成的相似性 的不同特征 。发现 英语 网络新词虽然在构词方式
医院大型医疗设备优化配置及管理
中国卫生产业在人们基本生活水平不断提升的背景下,人们对医院诊疗效率提出了更高的要求,在一定程度上为医院大型医疗设备应用水平提高提供了机遇。
但是由于我国医院大型医疗设备配置管理工作起步较晚,缺乏完善的指导约束规范,导致多数医院出现了大型医疗设备配置不科学、管理效率低等问题,大型医疗设备浪费严重。
再加上在医疗改革不断深化的背景下,我国医疗部门虽然为医院大型医疗设备购置提供了充足的政策支持,但是没有设置严格的配套设备绩效监督审核标准,导致各医院在大型医疗设备购置过程中,大多不会考虑各地区地方差异及人口需求,最终出现无法顺利回收大型医疗设备购置成本的情况。
部分医院甚至以增加服务量的方式诱导患者使用不必要的大型医疗设备,以达到成本回收的目的。
上述错误的管理方式,不仅影响了整体医院诊疗过程的科学有序进行,而且影响了整体医院在社会民众群体中的权威性及公信力。
因此,为了给患者提供更加科学的诊疗服务,结合内部需要理论、健康需求理论、技术效率理论等大型医疗设备配置管理理论,针对现阶段医院内部大型医疗设备配置管理问题,对院内大型医疗设备配置管理路径进行适当分析,就成为医院设备管理部门在常规工作开展过程中面临的重要任务。
1国内医院大型医疗设备配置管理理论1.1内部需要理论为保证医院大型医疗设备配置管理公平性,设备管理人员可以以医院内部疾病发生类型为判断依据,确定大型医疗设备配置服务方法。
1.2健康需求理论健康需求理论主要是以需求为基础,进行大型医疗设备配置规划。
以健康为需求大型医疗设备配置管理方法,可以最大限度降低医院大型医疗设备配置浪费现象。
1.3技术效率理论技术效率理论主要是对医院大型医疗设备技术效率进行分析,数据可靠稳定性较高,且资源配置方法较便捷,成本较低[1]。
2国内医院大型医疗设备配置管理现状2.1缺乏深入的设备配置预测分析由于先进大型医疗设备的应用可以在一定程度上提高治疗价格,受利益驱使,各医院在没有对院内设备需求进行量化分析的情况下就大量购买大型医疗设备,影响了院内大型医疗设备应用效益的充分发挥。
互联网女性形象对青少年身体意象的影响及应对--基于社会比较视角
互联网女性形象对青少年身体意象的影响及应对--基于社会比较视角姜敏敏;杨英新【摘要】互联网媒体中女性形象会影响受众的身体意象。
选择可通达性模型从社会比较角度出发,用同化作用和异化作用解释了这种复杂影响。
对主流审美标准的内化程度、心理亲密性、个性特征、身体质量指数等是影响社会比较结果的中介因素。
加强互联网媒体素养教育,培养自我提升社会比较动机,增强女性的自尊心和自信心,树立正确的价值观和评价标准,可以帮助青少年建立起健康的自我身体意象。
【期刊名称】《广东工业大学学报(社会科学版)》【年(卷),期】2015(000)005【总页数】8页(P79-86)【关键词】社会比较;自我意象;互联网媒体;女性【作者】姜敏敏;杨英新【作者单位】广东工业大学政法学院,广东广州,510090;河北师范大学新闻传播学院,河北石家庄,050024【正文语种】中文【中图分类】G40-052.2身体意象(body image)是个体对于自己体形的主观经验。
身体意象建构为三个成分:知觉成分(perceptual component)、主观成分(subjective component)以及行为成分(behavioral component)。
知觉成分主要指对身体形象大小估计的准确性,主观成分主要指对身体的满意度、关注程度以及认知评价,一般也称为态度成分或情绪成分。
行为成分主要指对一些关注身体外表而引发不舒适感受情境的回避行为。
[1]国际美容整形外科学会(International Society of Aesthetic Plastic Surgery)指出,截止到2013年底,全世界整形手术达到了11 437 040台。
当前整形手术的主流是吸脂手术(约占整形手术的18.8%),其次是隆胸(17%)、去眼袋手术(13.5%)、隆鼻(9.4%)和腹部紧缩术(7.3%)。
[2]澳洲的一项研究表明,身体意象是15~23岁年轻人最关注的,其受关注程度甚至超过了药物、酒精、抑郁和自杀,有40%~70%的青少年都对自己的外表不满意。
小学全科教师的知识结构分析
第8期2019年8月现代教育科学ModernEducationScienceNo 8Aug 2019[收稿日期]2019-03-06[基金项目]浙江省绍兴市“十三五”规划指南课题“名师代际互动研究:基于跨文化学习的视角”(项目编号:135403)。
[作者简介]姜亚洲(1981-),男,博士,绍兴文理学院教师教育学院讲师;研究方向:比较教师教育。
小学全科教师的知识结构分析姜亚洲(绍兴文理学院,浙江绍兴312000) [摘 要]培养小学全科教师是我国应对农村小学教育问题的主要改革举措之一,但全科教师应具备什么样的知识结构并不明晰。
笔者审视相关教师知识结构的论述及国际全科教师培养的发展趋势发现,在舒尔曼对教师知识结构进行分类的基础上,强化学科内容知识和学科教学法知识是培养全科教师的关键。
与此对比,当前我国对全科教师知识结构还存在两个误区,即视全科为全能的任教所有学科、视全科为全知的全科课程统整教学。
在全科教师的培养实践中应该避免这两个误区而落入“缺失范式”陷阱。
[关键词]小学教师;全科教师;知识结构 [中图分类号]G625 1 [文献标识码]A [文章编号]1005-5843(2019)08-0083-05 [DOI]10 13980/j cnki xdjykx 2019 08 015 随着我国社会经济的发展,培养小学全科教师成为应对农村小学教育问题的主要改革举措之一。
2014年,教育部提出要“重点探索全科教师培养模式”;2016年7月11日,国务院发布《关于统筹推进县域内城乡义务教育一体化改革发展的若干意见》,指出要“结合乡村教育实际,定向培养能够承担多门学科教学任务的教师”。
在此背景下,很多师范院校开展了农村小学全科教师定向培养的试验项目。
然而,对毕业生的调查显示,全科教师的培养并不尽如人意[1],其原因概为在培养方案实施之初,全科教师的内涵并不明晰。
在相关讨论中,对全科教师概念仍存在各种不同取向的理解,比如课程取向的视角认为“通过主题化课程开发和整合化课程实施,对学生进行个性化教育的教师”[2];职能取向的视角认为“全科教师是……能独立承担国家规定的小学阶段各门课程的教学工作、从事小学教育教学研究与管理的教师”[3]等。
身高矮小是男孩咳嗽变异性哮喘预后不良的危险因素
身高矮小是男孩咳嗽变异性哮喘预后不良的危险因素
王海;姜毅;张伟
【期刊名称】《中医药信息》
【年(卷),期】2010(027)001
【摘要】目的:研究儿童不同体格发育情况与咳嗽变异性哮喘预后转归的关系.方法:528例CVA患儿中,140例转变为典型哮喘为哮喘组;388例未发生哮喘为对照组.评价体格生长发育情况,并研究其与典型哮喘发作的关系.结果:哮喘组男孩身高低于同组女孩及对照组男孩.体重及BMI指数方面,虽然有组间或组内差异,但均大于平均值.结论:男孩身高矮小是CVA预后不良的重要危险因素.
【总页数】3页(P76-78)
【作者】王海;姜毅;张伟
【作者单位】黑龙汀中医药大学附属第一医院,黑龙江,哈尔滨,150040;黑龙汀中医药大学附属第一医院,黑龙江,哈尔滨,150040;黑龙汀中医药大学附属第一医院,黑龙江,哈尔滨,150040
【正文语种】中文
【中图分类】R725.6
【相关文献】
1.结肠型与非结肠型克罗恩病的预后及预后不良相关危险因素分析
2.咳嗽变异性哮喘预后转归危险因素的随访研究
3.急性脑卒中患者营养不良、卒中后并发症及不
良预后的危险因素分析4.自身免疫性脑炎患者的预后及导致其预后不良的危险因素分析5.胃癌肝转移不良预后的独立危险因素研究进展
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MedDRA User Portfolio document 用户说明手册
A large, international user base (with varied linguistic and cultural differences) led to the creation of MedDRA – the Medical Dictionary for Regulatory Activities (MedDRA) terminology. MedDRA, developed by the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH), is continuously enhanced to meet the evolving needs of its users, who include regulators and industry worldwide. ICH has created a governance structure to nurture and protect the integrity of MedDRA. The ICH MedDRA Management Committee, appointed by the ICH Assembly, has overall responsibility for the direction of MedDRA, and oversees all the activities of the MedDRA Maintenance and Support Services Organization.
2.2.1 Commercial, Non-profit / Non-Commercial, and Regulatory Level Subscription ............................................................................................. 6 2.2.2 System Developer Subscription .....................................................7 2.3 MedDRA TERMINOLOGY AND DOCUMENTATION ..............................8 2.3.1 Terminology....................................................................................8 2.3.2 Documentation ...............................................................................8 2.4 MedDRA RELEASES...............................................................................9 2.5 MedDRA UPDATES AND CHANGES......................................................9 2.6 HELP DESK SUPPORT...........................................................................9 2.7 USER GROUP MEMBERSHIP ..............................................................10 2.8 THE MedDRA WEBSITE .......................................................................10 2.9 MedDRA DESKTOP AND WEB-BASED BROWSER ............................11 2.10 MedDRA TERMINOLOGY DOWNLOAD INSTRUCTION....................12 2.11 MAINTENANCE RIGHTS.....................................................................12 Appendix A. MedDRA TERMINOLOGY AND DOCUMENTATION .................14
研究者发起的临床研究质量管理体系建设
·专家论坛·研究者发起的临床研究质量管理体系建设张卿1 高源1 黄轶刚2 张长青2 张力1(1. 同济大学附属同济医院临床研究中心 上海 200065;2. 上海交通大学医学院附属第六人民医院骨科 上海 200233)摘 要 我国研究者发起的临床研究(investigator-initiated trial, IIT )数量持续增加,同时其研究质量问题也逐渐凸显。
如何建设和优化医疗卫生机构IIT 质量管理体系,提升研究质量,成为医疗卫生机构管理者关注的焦点之一。
本文梳理国际/我国质量管理标准,结合IIT 质量管理实践,提出应将质量管理的基本原则、要求和方法应用于医疗卫生机构IIT 质量管理体系建设。
医疗卫生机构管理者须根据IIT 的特点建设与IIT 相适宜的质量管理体系,以保障受试者的权益和安全,确保研究数据的真实性和可靠性。
关键词 研究者发起的临床研究 质量管理体系 质量管理标准中图分类号:R197; R951 文献标志码:C 文章编号:1006-1533(2024)05-0009-05引用本文 张卿, 高源, 黄轶刚, 等. 研究者发起的临床研究质量管理体系建设[J]. 上海医药, 2024, 45(5): 9-13; 76.The construction of quality management system for investigator-initiated trialsZHANG Qing 1, GAO Yuan 1, HUANG Yigang 2, ZHANG Changqing 2, ZHANG Li 1(1. Clinical Research Center, Tongji Hospital, Tongji University, Shanghai 200065, China; 2. Department of Orthopedics,Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China)ABSTRACT The number of investigator-initiated trial (IIT) has increased continuously in our country and meanwhile the quality of their studies is gradually becoming prominent. How to construct and optimize quality management system (QMS) of IIT and improve IIT quality has become one of the focuses of managers in the medical and health institutions. This article sorts out international and domestic quality management standards including principles, requirements and methods, analyzes the application in the IIT-QMS construction, and proposes applicability, reference significance and specificity of the quality management standards for IIT-QMS construction. These standards would guide medical and health institutions to construct the effective QMS in order to ensure the rights and safety of subjects and the authenticity and reliability of research data.KEY WORDS investigator-initiated trial; quality management system; quality management standards基金项目:上海市卫生健康委员会卫生健康政策研究课题(2023HP40);上海申康医院发展中心“临床三年行动计划”项目(SHDC2022CRS048、SHDC2023CRS030);上海申康医院发展中心管理研究项目(2023SKMR -30);上海市科学技术委员会“科技创新行动计划”软科学研究项目(23692113100)作者简介:张卿,博士,副研究员。
境外教师教育课程改革的范式变迁对我国教育硕士课程改革的启示
境外教师教育课程改革的范式变迁对我国教育硕士课程改革的
启示
姜勇;柳佳炜
【期刊名称】《学位与研究生教育》
【年(卷),期】2018(0)6
【摘要】高质量的教师教育课程有助于培养高素质的教师.哈贝马斯对人类认识的三种旨趣的分析为理解境外教师教育课程的三次重要变迁提供了适切的视角."知识关注"阶段的教师教育课程关注教师应具备的核心素养,包括必要的知识、关键的能力与必备的品格."实践关注"阶段的教师教育课程注重的是教师日常的教育生活中的鲜活、动态、丰富、智慧的实践."精神关注"阶段的教师教育课程则关心的是教师的内在精神和内心世界的洗礼与升华,或者说内在心灵的成长.这对新时期我国教育硕士课程改革走向"精神关注",关注教育硕士生的心灵转向的课程改革提供了新的思考方向和路径选择.
【总页数】7页(P44-50)
【作者】姜勇;柳佳炜
【作者单位】华东师范大学教育学部上海200062;华东师范大学教育学部上海200062
【正文语种】中文
【相关文献】
1.国外课程地图发展及对教师教育课程改革启示
2.国外幼儿教师教育课程改革及其启示——以瑞典和土耳其为例
3.“整合连贯型”教师教育模式对“现代教育技术”课程改革的启示
4.发达国家教师教育课程设置对我国高职教师教育课程改革的启
示*5.台湾高校服务学习对大陆特教教师教育课程改革的启示
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生姜多糖的提纯工艺、结构及其功能活性研究进展
付琳,王一红,蔺子晗,等. 生姜多糖的提纯工艺、结构及其功能活性研究进展[J]. 食品工业科技,2024,45(1):335−342. doi:10.13386/j.issn1002-0306.2022120239FU Lin, WANG Yihong, LIN Zihan, et al. Progress in Purification Technology, Structure and Functional Activity of Ginger Polysaccharide[J]. Science and Technology of Food Industry, 2024, 45(1): 335−342. (in Chinese with English abstract). doi:10.13386/j.issn1002-0306.2022120239· 专题综述 ·生姜多糖的提纯工艺、结构及其功能活性研究进展付 琳,王一红,蔺子晗,王思璎,王 漫,龙丹凤*(兰州大学公共卫生学院,甘肃兰州 730030)摘 要:生姜作为我国丰富的草本植物资源,从古至今,在食品、药品中扮演着重要角色,也被称为药食同源植物,具有良好的医用和营养价值。
生姜多糖是生姜中重要的生物活性物质之一,国内外研究发现其具有多种功能活性。
本文系统回顾并比较了生姜多糖的提取工艺和纯化方法,总结了生姜多糖的结构表征。
同时对生姜多糖的抗氧化、调节免疫、抗肿瘤等功能活性进行了归纳分析,以期为后续生姜多糖的深入研究和产业应用提供参考。
关键词:生姜多糖,药食同源,提取,纯化,结构表征,功能活性本文网刊:中图分类号:TS255.3 文献标识码:A 文章编号:1002−0306(2024)01−0335−08DOI: 10.13386/j.issn1002-0306.2022120239Progress in Purification Technology, Structure and FunctionalActivity of Ginger PolysaccharideFU Lin ,WANG Yihong ,LIN Zihan ,WANG Siying ,WANG Man ,LONG Danfeng *(School of Public Health, Lanzhou University, Lanzhou 730030, China )Abstract :Ginger, as a rich herb resource in China, has played an important role in food and medicine since ancient times. It is also known as a medicinal and edible homologous plant that possesses unique medical and nutritional values. Ginger polysaccharide is considered one of the most important bio-active components in ginger, which have attracted many attentions for various of bioactivities. In this review, the methods of extraction and purification of polysaccharide, as well as structural characteristics are discussed, what’s more, functional properties including antioxidant, immunity regulatory, anti-tumor and their influencing factors are reviewed. It is expected to provide valuable reference for further research and industrial application of ginger polysaccharide.Key words :ginger polysaccharide ;homology of medicine and food ;extract ;purification ;structural characteristics ;functional activity生姜(Zingiber officinale Roscoe )为姜科、姜属多年生草本宿根植物[1],是具有悠久历史的香辛调味料,并兼具广泛的药理作用,属于药食同源资源。
姜老师PPT定稿-J
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全球卫生概述
复旦大学公共卫生学院 姜庆五 教授
内容提要
01 瘟疫与人类文明 02 全球卫生的定义 03 当今全球卫生的关注点 04 全球卫生的倡导者与组织者
➢进入新世纪,人口、技术与社会发生的剧烈变化,使一些传染病的 传播途径发生重大改变。每隔10年左右,就会有一种新的、不同型 式的流感出现,形成全球传播,形成一种大规模传播(pandemic)。
➢流行性感冒每年都在全世界暴发,这些流感能够给 高龄和慢性心、肺病人带来严重影响乃至死亡。此 外,人传播的禽流感也是目前十分令人关注的全球 性健康问题,已经成为全球性的健康问题。
the more fundamental social
aspirations of its evolving
市场分化
institutions. BRIEF HISTORY OF GLOBAL HEALTH
TO PUT IT SIMPLY: THE WORLD
HAS CHANGED AROUND US
影响全球卫生的相关因素
1、人口的流动与商业的交往 2、新现疾病的不断出现 3、生态环境破坏的加剧 4、气候等自然环境的变化影响 5、病原的变异 6、社会的发展与人口的迁移
内容提要
01 瘟疫与人类文明 02 全球卫生的定义 03 当今全球卫生的关注点 04 全球卫生的倡导者与组织者
全球卫生(Global Health)是指跨越国家边界的、需动用多国的公 共卫生力量来解决的健康问题。全球卫生是一个医学、环境和社会科学 的交叉科学。
1918年流感大流行
Co-experience user experience as interaction
Co-experience:user experience as interactionKATJA BATTARBEE*and ILPO KOSKINENUniversity of Art and Design Helsinki,School of Design,Industrial Design,Ha meentie135C,00560Helsinki,Finland(Received 26January 2004;in final form 10May 2004)User experience is becoming a key term in the world of interactive productdesign.The term itself lacks proper theoretical definition and is used in manydifferent,even contradictory,ways.This paper reviews various existingapproaches to understanding user experience and describes three mainapproaches and their differences.A missing perspective is noted in all three:their focus is on only the individual having the experience and neglects thekinds of experiences that are created together with others.To address this,anew elaboration called co-experience is presented.It builds on an existingapproach but borrows from symbolic interactionism to create a moreinclusive interactionist framework for thinking about user experiences.Datafrom a study on mobile multimedia messaging are used to illustrate anddiscuss the framework.Keywords :User experience;Social interaction;Mobile communication;Multimedia messaging1.IntroductionUsability experts know that while usability is important,it is not enough on its own to guarantee a product’s success with customers.While helping people take advantage of a product’s functionality,usability also needs to pave the road for ability techniques can be used to improve a given solution,but they do not reveal whether a different solution might deliver better and more enjoyable experiences.Consequently,designers have begun to apply hedonistic psychology (Jordan 2000,Hassenzahl 2003)and to design for user experience.For example,Jordan takes a hedonistic perspective by proposing that pleasure with products is the sum of sociopleasure,ideopleasure,physiopleasure and psychopleasure.He defines pleasure with products as ‘the emotional,hedonic and practical benefits associated with products’(Jordan 2000,p.12).Hassenzahl (2003)shows that satisfaction,a part of usability,is the sum of pragmatic and hedonic quality.However,as Desmet (2002)notes,the problem *Corresponding author.Email:kbattar@uiah.fiCoDesign ,Vol.1,No.1,March 2005,5–18CoDesign ISSN 1571-0882Print/ISSN 1743-3755online #2005Taylor &Francis Ltd /journals DOI:10.1080/157108804123312899176K.Battarbee and I.Koskinenwith focusing on pleasure is that it ignores the unpleasant emotional experiences related to product use.Perhaps to overcome this deficiency,user experience has become the new buzzword in design(for example,see Shedroff2001,Garrett2003,Kuniavsky2003).User experience is subjective and holistic.It has both utilitarian and emotional aspects,which change over time(Rhea1992).In this paper,we deal with what we see as a major problem in the user experience literature,which is its implicit individualistic bias.We refer to the mostly missing social quality of experience with the term‘co-experience’,and propose an interactionist perspective for studying co-experience.We show that with this concept,we are able to pay attention to things that are not addressed by existing theories of user experience.We illustrate this perspective by showing how people communicate emotions with each other via mobile multimedia technology.2.Three approaches to user experienceCurrently there are three main approaches to applying and interpreting user experience in design.These are the measuring approach,the empathic approach,and the pragmatist approach.The role of emotional experiences is important in all three,although,as they stem from different disciplines,they treat emotions differently.The measuring approach is mainly used in development and testing.It builds on the notion that experiences can be measured via emotional reactions.Thus,the approach is narrow—the definition only includes those aspects of user experience that can be measured and,through measuring,understood and improved.There are several alternative orientations within the approach.Thefirst builds on the idea that people experience things as reactions in their bodies.People’s bodies react to situations chemically and electrically,and experience this reaction in terms of emotions.As these reactions are oftenfleeting and sometimes difficult to verbalise,tools for monitoring such reactions,such as facial expressions or changes in galvanic skin response,can be recorded in order to understand when and where people get frustrated(Picard1997).A second orientation is based on subjective reports(e.g.Jordan2000).For instance,Desmet(2002) has developed a testing tool to elicit emotional responses to products such as cars.His tool,PrEmo,uses animated cartoon characters to describe14different emotional responses.By selecting all that apply,the user creates an emotional profile.Universal evaluation criteria for user experience do not exist,though some have been proposed for interaction design(Alben1996).Rather,the‘soft and emotional experiences’need to be translated into‘experience goals’relevant to each project and included in the testing of products and prototypes(Teague and Whitney2002).The empathic approach also claims that experience is emotional in nature but that the kinds of experiences that products elicit should be connected to the needs,dreams and motivations of individuals(Dandavate et al.1996,Black1998).Designing for user experience begins with creating a rich,empathic understanding of the users’desired experiences and only then designing concepts and products to support them.The term ‘design empathy’has been in use since the late1990s to describe the role of the designer/ researcher(Leonard and Rayport1997,Segal and Fulton Suri1997,Koskinen et al. 2003).Design empathy makes use not only of the emotions of the users,but also those of the designers.In order to become not merely informed but also inspired,designers must both observe and feel for the users(Ma kela and Fulton Suri2001,Kankainen2002).The methods used in empathic approaches aim to provide an understanding of users’experiences with qualitative methods;they also assist users in constructing,for designers,Co-experience:user experience as interaction7 descriptions of their experiences,dreams,expectations and life context(Dandavate et al. 1996).Typically,these methods combine visual and textual data,self-documentation and projective tasks,several of which are used in parallel.This approach aims to inspire designers rather than produce testable hypotheses through measurement and conceptual elaboration.The pragmatist approach borrows much of its perspective from pragmatist philosophy (see Dewey1934).Recently,Forlizzi and Ford(2000)presented a model of user experience in interaction.This model is theoretical in nature,and shows that experiences are momentary constructions that grow from the interaction between people and their environment.In their terminology,experiencefluctuates between the states of cognition, subconsciousness and storytelling,depending on our actions and encounters in the world. Experience is something that happens all the time:subconscious experiences arefluent, automatic and fully learned;cognitive experiences require effort,focus and concentration. Some of these experiences form meaningful chunks and become demarcated as‘an experience’—something meaningful that has a beginning and an end.Through stories, they may be elaborated into‘meta-experiences’that are names for collections of individual experiences.Even more recently,Wright et al.(2003)focused on what is common to all experience,describing four strands—the compositional,sensory, emotional and spatio-temporal strands—which together form experience.They also describe sense-making processes such as anticipating,interpreting and recounting. These three approaches propose divergent methodologies for studying user experience, but imply different things.The measuring approach focuses on emotional responses,the empathic approach on user-centred concept design,while the pragmatic approach links action to meaning.The measuring approach is useful in development and evaluation,but is more difficult to apply at the fuzzy front end of design(Cagan and Vogel2002).The pragmatist approach concentrates on the embodied nature of experience and interaction. Thefirst two approaches,the measuring and the empathic,share one main problem. Both see emotions as driving forces of human conduct,an assumption contested by more situated views of interaction(Blumer1986,p.7;about plans,see Dourish2002,pp.70–73).Of user experience approaches,only the pragmatist perspective really accounts for the situated unity of action,emotion and thought in the individual in a theoretical way. The pragmatist perspective is broader than the others in its scope;in fact,other models can be seen as its special cases.However,all these approaches are individualistic,thus missing a crucially important aspect of human experience.People as individuals depend on others for all that makes them truly human.Experiencing happens in the same social context—therefore,it is necessary to account for this context and its effect on experience.3.Co-experience:elaborating the pragmatist perspectiveWe use the term‘co-experience’to describe experiences with products in terms of how the meanings of individual experiences emerge and change as they become part of social interaction.To explore co-experience more deeply,we expand the pragmatist model of user experience in interaction(Forlizzi and Ford2000)and address the mention of meaning in more detail by building on three classic principles of symbolic interactionism. First,people act towards things through the meanings they have for them.Second, meanings arise from interaction with one’s fellows.Third,meanings are handled in,and modified through,an interpretive process used by the person in dealing with things he encounters(Blumer1986,pp.2–6).These are the classic statements of symbolic interactionism,a sociological tradition that builds on the pragmatist philosophy of John8K.Battarbee and I.KoskinenDewey,William James,and George Herbert Mead(see Joas1997).This perspective adds social interaction to the pragmatist model,maintaining that people come to define situations through an interpretive process in which they take into account the non-symbolic gestures and interpretations of others.The improved interactionist model for co-experience uses these meanings to explain how experiences migrate between the different levels of Forlizzi and Ford’s model(for an elaboration,see Forlizzi and Battarbee2004)—from the centre of attention to the periphery or into stories and acts of personalisation and back again.Such migrations happen in at least three general ways..Lifting up experiences.Often subconscious experience migrates to become‘an experience’through a social process.People constantly lift things from the stream of events in everyday life and communicate them to others.For example,a person may describe something that has happened to them,evaluating it as meaningful enough to be told to others..Reciprocating experiences.Quite often,once it has been lifted up in this way,recipients acknowledge and respond to experience.For example,they may reciprocate by telling about their own,similar experiences,or simply offer a sympathetic response(Mauss 1980,Licoppe and Heurtin2001,Koskinen et al.2002,Ch.7,Taylor and Harper 2002).In doing so,they show that the experience(as well as the person sharing it)is meaningful for them.This can be shown in various ways,for example,by appreciating the experience,or by taking sides with it.Experiences can be maintained,supported and elaborated socially.Memories of relevant experiences may be retold in this way as well..Rejecting and ignoring experiences.Finally,experiences brought to the attention of others may also be rejected or downgraded by others.For example,something that is important for one person may be too familiar,uninteresting or even offensive for others.They may indicate this in various ways to soften the rejection,for example through humor or teasing,or with varying degrees of topic change,direct response or inaction.Similarly,people often elaborate‘meta-experiences’together(see Forlizzi and Ford 2000).In this paper we do not focus specifically on meta-experience for two reasons. First,the pragmatist model of Forlizzi and Ford already accounts for it.When people compare experiences,often collected over several years,they come tofind similarities and differences,and classify them in stories.Ultimately,some stories may become key symbols of their identities(see Orr’s1996analysis of technicians’‘war stories’).Also, stories provide one of the main mechanisms for reconstructing memories(Neisser1981, Orr1996).Second,we see storytelling as just another form of social interaction.It is significant when sharing experiences verbally,but not necessarily the dominant form for digital media.Although storytelling has well-studied forms and traits,it nevertheless is included in the more general approach of symbolic interactionism,thus making it a special case of the more general argument for all social interaction.The following example(figure1)illustrates the strength of this framework.Thefigure is a mobile multimedia message(MMS):a photo,audio and text message sent from one mobile phone to another during a pilot study in Finland in2002(the pilot study and further details of the messaging are described in Section4).The story behind this MMS is how Thomas,a father,lifts up a significant experience:the toddler Mikey’s evening tantrum.Jani,a friend,reciprocates by saying that his experiences in babysitting Mikeyhave been similar,and Thomas should consider getting him a soccer ball of his own.Jani’s comment could be taken as a rejection,suggesting a disinterest in Mikey and his temper.In a subsequent reply (shown in the figure)Thomas reinstated the importance of the event,and furthermore,turned it into an opportunity to tease Jani.His reply contained a good audio sample of the howling and a picture of the boy,red in the face and tears streaming down his cheeks,and suggested similarities between Mikey and Jani.However,Jani’s softened rejection was successful:there were no more reports on Mikey crying after that.As this example shows,people may use technology to share meaningful experiences,to sympathise with them,to suggest that they are not particularly significant,or even to reject denial of their significance.These experiences would not occur to a user alone;identities,roles and emotions are resources for interpreting and continuing interaction (Blumer 1986).For instance,in the example of figure 1,Thomas and Jani do more than share an experience:they actively interpret it,relate to it,reinterpret it and,in so doing,constitute a line of action and come to define their mutual relationship for a brief moment.The other recipients of the MMS remain more or less neutral bystanders.The interactionist perspective on co-experience claims that experience is a social phenomenon and needs to be understood as such.Also,it claims that bodily and psychological responses to external phenomena do not necessarily lead to predictable emotional reactions,because of an interpretive social process in between (see Shott 1979).Thus,relying solely on emotion as an index of experience leads us astray.For these same reasons,empathising with individuals does not explain co-experience.Empathy is necessary,but the focus must first be on interaction.When people act together,they come to create unpredictable situations where they must respond to each other’s actions creatively.In the lifecycle of an experience (cf.Rhea 1992),we need to pay attention to co-experience,not just to individual aspects of experience.This is the crux of the symbolic interactionist perspective on user experience.4.Data and methodsWe illustrate our argument with data from Mobile Multimedia,a multimedia messaging pilot study organised with Radiolinja,a Finnish telecommunications operator.In Mobile Multimedia several groups of friends exchanged multimedia messages with each other for about five weeks in the summer of 2002.Each participant was given an MMS phone (either a Nokia 7650with an integrated camera or a SonyEricsson T68i with a plug-in camera);the service was free of charge (see Koskinen 2003).Out of the Mobile Multimedia pilot,three mixed-gender groups of 7,11and 7members were selected fora Figure 1.A little boy’s bad mood.Co-experience:user experience as interaction 910K.Battarbee and I.Koskinendetailed study to explore in more detail gender difference,terminal types and the city–countryside axis.The qualitative study focused on the messaging of these groups. During the pilot,the three groups sent over4000messages which were analysed quantitatively;two samples of the messages were also analysed qualitatively.The messages are published here with permission;the names of people and places have been changed.The data reveal how people themselves construct messages,and how others respond to them.Even though there is no access to what people did when they received the messages,we can see their virtual responses:exactly the same content of text,image and audio as was received by the participant(see Battarbee2003,Koskinen2003, Kurvinen2003and references therein).The study of co-experience is the study of social interaction between several people who lift up something from their experience to the centre of social interaction for at least a turn or more.Since the focus is on how people give meanings to things,and how they understand them,the study setting needs to be naturalistic,i.e.to happen in the real world rather than in a controlled setting such as a laboratory(Glaser and Strauss1967, Blumer1986).Designers need to explore how interaction proceeds and aim to describe its forms before trying to explain it in terms of such structural issues as roles or identities. Rather,inference proceeds inductively(Seale1999).Roles and identities may be made relevant in interaction,but they are resources people can use rather than features that explain co-experience.In this paper,we aim to indicate the value of the concept by showing that experience has features that cannot be studied adequately with existing concepts of user experience.Here,we aim to illustrate co-experience as a sensitising concept(Blumer1968),rather than trying to provide a comprehensive analysis of the varieties of co-experience.5.Lifting up experiences into the focus of social interactionFrom the symbolic interactionist standpoint proposed in this paper,the key feature of experience is symbolisation:what people select from experience to be shared with others. People communicate with each other for a variety of reasons,ranging from practical to emotional.In so doing,they place the things they communicate at the focal point of shared attention.In presenting things as‘an experience’,they invite others to join in. However,these communications remain open to negotiation,something that may or may not be picked up by others and made into something more meaningful than merely the scenic background of experience.As an example of an ordinary message that illustrates this argument,we may take the simple pleasures of eating,drinking and socialising(seefigure2).This message is part of a sequence of holiday reports between two groups of friend:the‘land lovers’and the ‘sailors’.Susse and her friends choose to describe their evening sentiments with a multimedia puzzle.The audio explains the picture and the text suggests that the key element is in fact still missing and remains to be imagined:the smell of hot pizza. Susse may have tried to convey a realistic sense of what the experience of hot pizza is, but she is also acknowledging that it is impossible,with the smell(and the pizza itself) missing.However,she seems to trust that with the names of the ingredients,the‘sailors’will get the idea—and share their sentiments as she has shared theirs.Sometimes experiences belong to larger themes and can be called scalable(Forlizzi and Battarbee2004).For example,an eagerly waited holiday trip to Paris is a complex experience that may last for weeks and contain many larger and smaller,sometimes contradictory,elements.Documenting such experiences requires more than one message,as in the case of the following monologue.Markku and his friends are driving to a weekend rock festival.Their first message (figure 3)describes the mood inside the van.The second message (figure 4)reports that they are still on their way,but something unexpected has happened—they were caught in a speed trap and fined.When experiencing strong emotions,the process of symbolisation requires more effort.The description of the experience has to take into account the responses of others,such as anger,fear,disappointment,ridicule or sympathy,and explore which interpretations are desirable and which are to be avoided.What is offered here for common attention is laughing at the experience and making fun of it,with only a side reference to the actual event and the emotional experience of being caught by the police and receiving a fine.In principle,almost any detail of ordinary life can be meaningful enough to send.In MMSs,people document food,drink,children,pets and spouses (see Koskinen et al.Figure 2.A pleasantevening.Figure 3.Driving to the rockfestival.Figure 4.Reporting on the speeding ticket incident.Co-experience:user experience as interaction 1112K.Battarbee and I.Koskinen2002,Lehtonen et al.2003).In addition,people report events such as rock festival trips and events in summer homes as well as moods,socially significant things and emotionally relevant experiences.The reason for sending an image and audio is its topic rather than its artistic quality.The literature on experience tends to emphasise and focus on experiences that are emotionally strong and that stand out as memorable.However,the content in the Mobile Multimedia project focuses predominantly on small,everyday and mundane matters,suggesting that in social interaction,the strength of emotions does not correlate with the emotional satisfaction of the experience of communicating and sharing them.6.Reciprocating experience in social interactionPeople do not merely compose Multimedia messages,they also acknowledge them in replies.In responding,recipients pick up the gist of the message andfit their response to it.Typically,they show that they either share the experience or empathise with the sender on a more general level,as is suggested in theories of gift-exchange(Mauss1980)applied to mobile communications(Licoppe and Heurtin2001,Taylor and Harper2002).Parents share pictures of their babies,expecting others to mirror their delight,but even in more ordinary cases,the expected response is a positive,reinforcing one.Of course,recipients may not always produce a proper response,and this may prompt problems in subsequent interactions.For example,the sender may become embarrassed or hurt,and may even lose face(Gross and Stone1964,Goffman1967,pp.5–45).Between the need to maintain social interaction and support others,and the need to look out for personal gain and be selfish,the more likely people are to meet again,the more they will try to keep the interaction going and help everyone maintain face.This,among socially connected people,results in an in-built tendency to reciprocate experiences in human interaction—and in Multimedia messaging.Most responses follow this logic.Sometimes people start with a parody,as infigure5. Replies to such messages(figure6)are usually not explicit congratulations.Risto, however,makes a point of saying how much he enjoyed it.However,to really mean this, he needs to respond with a similarly overdone picture,a reflection of thefirst one.Pleased with his message,Risto reuses the picture and shares it with other friends as well,this time with a new text(figure7).The response to Risto’s message does not merely share the holiday mood,but also copies the response format almost perfectly(figure8).People may also align with negative experiences,as in the following example in which two young women share a mood.First,Maria lets Liisa know that she is experiencing something‘typical’,which seems neither exciting nor fun.Liisa sympathises,and reciprocates the experience,sharing her own interpretation of what a‘typical’experience is like(figures9and10).This example demonstrates the power of the visual in pared to emotions, moods are lower intensity and last longer.Because moods are not focused on any particular object,objects do not describe moods very well.Here,the focus is on the face. The MMS phones were often used for literal self-documentation—taking a picture of one’s own face at arm’s length—although collaboration was also frequent.Through this exchange,Liisa and Maria indicate that they know each other and have shared similar experiences before:how else could they talk about‘this’being‘typical’? The closeness is also expressed by the framing of the picture.Whether Liisa’s response is sincere or a parody is hard to say.Maybe the interpretation is intentionally left for the recipient to decide,and to remain open for future interactions.Figures 5–8.A staged picture prompts stagedresponses.Figures 9,10.Exchanging pictures of mood.Co-experience:user experience as interaction 1314K.Battarbee and I.Koskinen7.Rejecting and ignoring experiences in social interactionFor a number of reasons,experiences that are offered to the common awareness may also be rejected,downplayed or made fun of.A certain banality is almost built into MMS use, which focuses on mundane experiences rather than,say,key rituals of life or experiences withfine art.Banality may go overboard and lose the recipient’s interest;sometimes,the report may stretch the bounds of what is morally acceptable,for example by being sexually explicit(see Kurvinen2003).Recipients,then,may have many different reasons to interrupt or redirect the messaging,even when it may be difficult to do so without insulting the sender.How can they accomplish such actions without causing the sender to lose face? Thefirst thing to notice is that rejection may be active or passive—communication always offers multiple alternative possibilities for interpretation,and choosing one option may negate others.In the following sequence,Thomas offers a significant experience (getting engaged/married)for others to respond to(figures11–13).Predictably,he receives several congratulations and pictures of happy faces.However,Jani did not notice the engagement message until25hours later,and takes a different course of action.In his response,he teases Thomas indirectly for losing his freedom,proclaiming that he himself has no intention of getting‘snatched’,and thus inverts the value of Thomas’s experience. In response,Thomas defends his case by returning the tease and peppering it with an insult.The communication between Thomas and Jani is a clever play on the possibilities of multimedia,as the joke is largely a visual play on the theme ofhands. Array Figures11–13.Two teases.Generally,a positive experience like that sent by Thomas calls for an aligning response. Responses rejecting the intended value of such messages normally incorporate accounts and disclaimers that soften the impact of the rejection.Typical examples of such accounts and disclaimers are humour,excuses,justifications and hedges(Scott and Lyman1968, Hewitt and Stokes1975).With these devices,the communication channel is kept open despite the interactional problems posed by the rejection.This was also the case in the messaging aroundfigure1,in which Jani indirectly indicated to Thomas that Mikey’s tantrums were no longer a welcome topic.By advising Thomas to buy a ball for Mikey, Jani softened the message by suggesting that maybe Mikey had good reason to be upset, i.e.not having a soccer ball of his own.However,the tactic failed,and Thomas countered by comparing Jani with the baby—humorously,of course,but the comparison still turned his reply into a tease.No matter how nice,such rejections may still insult the original sender—or at least give them an opportunity to behave as if they were insulted.8.Conclusions and discussionIn this paper,we have introduced the notion of co-experience and present it as an elaboration of Forlizzi and Ford’s(2000)model of user experience in interaction.Our claim is based on a simple observation:people create,elaborate and evaluate experiences together with other people,and products may be involved as the subject,object or means of these interactions.Social processes are particularly significant in explaining how experiences migrate from subconscious into something more meaningful,or lose that status.The concept of co-experience builds on the understanding that experiences are individual,but they are not only that.Social interaction is to the experiences of the individual the same as a sudden jolt is to a jar of nitroglycerine:it makes things happen. We claim that neglecting co-experience in user experience leads to a limited under-standing of user experience—and a similarly limited understanding of design possibilities. The concept of co-experience enriches design in several ways..Co-experience extends the previous understanding of user experience by showing that user experiences are created together and are thus different from the user experiences people have alone..It suggests an interactionist methodology for studying user experience.It is important to see what the content is,what people do,or,in the case of the Mobile Multimedia project,what is in their messages.This alone,however,is not enough to make sense of co-experience.It is also necessary to study the interactions between people with and without technologies,and to put the messages into context..Co-experience opens new possibilities in design for user experience by focusing on the role of technology in human action(parallel ideas can be found in the concept of embodied interaction,see Dourish2001).Co-experience focuses on how people make distinctions and meanings,carry on conversations,share stories and do things together.By understanding these interactions,opportunities for co-experience can be designed into the interactions of products and services.To put this into design terms:user experiences can only be understood in context.New technologies are adopted in social interactions where the norms for behavior(and product use)are gradually developed and accepted.These rules are never absolute or complete.For example,instead of merely responding to a suggestion,people may turn their response into a mock tease.There is therefore little point in creating an interface。
Endress + Hauser Promass 300流量计传感器说明书
E v a l u a t i o nC e r t i f i c a t e Issuing Aut horit y NM i Certin B.V.22 December 2016C. Oost ermanHead C ert ificat ion BoardNM i Certin B.V. Hugo de Groot plein 1 3314 EG Dordrecht The Net herlandsT +31 78 6332332 cert in@nmi.nlwww.nmi.nl This document is iss ued under t he provis ion t hatno liability is accept ed and that the applicants hall indemnify third-part y liabilit y.R eproduction of t he completedocument only is permitt ed.Number TC10822 revision 0Project number: 16200475Page 1 of 1Issued by NM i C ert in B.V.In accordance w it h Aspect s of t he Volunt aryOIM L R117-Producer Endress + Hauser Flow t ec AGKägenst rasse 7C H-4153 ReinachS w it zerlandM easuring inst rument A flow transm itt er (calculat ing/indicat ing device for Endress + HauserC oriolis meters), int ended t o be used as a part of a measuring inst rument.Brand : Endress + Hauser Flow t ec AGDesignat ion : Promass 300S oft w are versions : see paragraph 1.2 of t he descript ionAccuracy class : 0,3Environment classes : M3 / E2Temperat ure range ambient: -40 °C +55 °CFurt her propert ies and t est result s are described in t he annexes:Descript ion TC10822 revision 0;Document at ion folder TC10822-1.R emarks An overview of t he performed t est s is given in Annex 2 appert aining t ot his Evaluat ion Cert ificat e.Number TC10822 revision 0Project number 16200475Page 1 of 51General inform ation on the flow transm itterAll propert ies of t his flow t ransmit t er, w het her ment ioned or not, shall not be in conflictw it h t he Legislat ion.This Evaluat ion Cert ificat e is t he posit ive result of t he applied volunt ary, modular approach, for a component of a measuring inst rument, as described in WELM EC guide 8.8.The complet e measuring inst rument must be covered by an EC-t ype examinat ion C ert ificat e or an EU-t ype examinat ion C ert ificat e.This Evaluat ion Cert ificat e is valid for t he Endress + Hauser flow t ransmit t er, as described in paragraph 1.1 of t he descript ion and may only be used in combinat ion w it h Coriolismeasurement sensors manufact ured by Endress + Hauser Flow t ec AG:- That are covered by an Evaluat ion Cert ificate;- Direct ly ment ioned in t he EU-t ype examinat ion cert ificat e of t he measuring syst em.1.1Essential PartsDescript ion Docum ent at ionRem arksnum berPow er Supply100 240 V AC / 50/60 Hz 10822/0-02; 10822/0-0324 V DC 10822/0-04; 10822/0-05100 240 V AC / 50/60 Hz;10822/0-06; 10822/0-0724 V DCA m plif ierFor Exi Hart10822/0-08; 10822/0-09 Zone 1 st andardFor Exi Hart10822/0-10; 10822/0-11 Zone 1 IIC 200 °CFor M odbus and Hart10822/0-12; 10822/0-13 Zone 2For Exd M odbus and Hart10822/0-14; 10822/0-15 Zone 1 st andardFor Exd M odbus and Hart10822/0-16; 10822/0-17 Zone 1 IIC 200 °CCPU M odemFor Exi hart devices 10822/0-18; 10822/0-19 I/O 1 = Exi current out put + HartFor Non-Ex Hart devices 10822/0-20; 10822/0-21 I/O 1 = C urrent out put + HartFor M odbus devices 10822/0-22; 10822/0-23 I/O 1 = M odbusI/O M odulesM ult i I/O module Non-Ex 10822/0-24; 10822/0-25 Frequency, pulse, st at us in/out,current in/outM ult i I/O module Ex 10822/0-26; 10822/0-27Double pulse 10822/0-28; 10822/0-29 Double pulse channel, phaseshift edDisplayDisplay module 10822/0-30; 10822/0-31 Int egrat ed in flow t ransmit t er orremot e (ext ernal) moduleNumber TC10822 revision 0Project number 16200475Page 2 of 5Descript ion Docum ent at ionRem arksnum berTerm inal boardsTerminal board 10822/0-32; 10822/0-33 For Ex devicesTerminal board 10822/0-34; 10822/0-35 For Non-Ex devicesTerminal board 10822/0-36 Used at remot e display moduleBack planeFor Ex devices 10822/0-37; 10822/0-38For non Ex devices 10822/0-39; 10822/0-40- Input s (sensor side)From t he connect ed C oriolis sensor t he Promass 300 receives:Tw o pick-of f signals; analogue mV signals from w hich t he mass flow and densit y aredeterminedOne t w o-w ire Pt-1000 t emperat ure t ransmit t er for t he measurement of t he t ubet emperat ureOne t w o-w ire Pt-1000 t emperat ure t ransmit t er for t he measurement of t he carriert ube t emperat ure.Please not e t hat t hese t emperat ures shall not be used for Cust ody Transfer relat edpurposes, but only for t he correct ion given above.- Out put s (sensor side)The Promass 300vibrat ing mot ion. The frequency of t he vibrat ion is aut omat ically adjust ed t o t heresonant f requency of t he measurement t ubes. This out put is referred t o as: drive current out put- Input/Out put (elect ronic calculat or/indicat ing device)The Promass 300 is equipped w it h t he follow ing C ust ody Transfer out put s: Double, 90° or 180° phase shif t ed pulse-out put for t he t ransmission of volume- ormass-informat ion. Phase shif t is select able4 20 mA out put for t he t ransmission of densit y. This out put can also be used forinput/out put via Hart prot ocol.Ot her informat ion can also be t ransmit t ed via t his out put (for example flow rat e), but t his informat ion is not W&M approved.4 20 mA input for t he t ransmission of product t emperat ure. The (ext ernal)t emperat ure is used for aut omat ic correct ion of t he t emperat ure influence on t heconnect ed measurement sensor and overrides bot h int ernal t w o-w ire Pt-1000t emperat ure sensors.4 20 mA input for t he t ransmission of product pressure. The pressure is used foraut omat ic correct ion of t he pressure influence on t he connect ed measurement sensor.S t at us input or st at us out put (depending on version)M odbus R S485 serial prot ocol. Dat a t ransmission is saf e guarded w it h C R C checksumover t he dat a package.Number TC10822 revision 0Project number 16200475Page 3 of 51.2Essential Characteristics-S oft w are t ype P;R isk C lass C;Ext ensions T and I-5 apply.- S oft w are-versionsVersion num bers Checksum01.00.02 0xE87F (M odbus)0x321F (Hart)The soft w are version and checksum can be verified on screen:S oft w are version, menus Diagnost ics Device Info Firmw are VersionC hecksum, menus Operat ion C ust ody Transfer ChecksumNot e t he s oft w are version includes t he soft w are of all modules ment ioned inparagraph 1.1.- C ust ody Transf er paramet ersThe C ust ody Transfer paramet ers and t he mandat ory set t ings are ment ioned in Annex 1.For securing t he Weight s and M easures paramet ers:Go t o menu S et up Advanced set up C ust.t rans. act.Login w it h aut horized user login and passw ord and complet e all ot her set t ings (dat eand t ime)S et dipsw it ch number 2 t o ON. Only t he Weight s and M easures paramet ers aresecured against changing.Aft er exit ing t he menu syst em, t he lock symbol () is show n on t he display and t hebot t om row show s t he Weight s and M easures count er.Alt ernat ive met hod is t o set dipsw itch number 1 to ON; t his secures all paramet ersagainst changing. The lock symbol () is show n on t he display.S ecurit y disabled S ecurit y enabled (paramet ers prot ect ed) - The flow t ransmit t er may only be used in combinat ion w it h an approved flow comput er[1] as t he display may not be used as a primary indicat ion.[1]The flow comput er must have an Evaluat ion or Part s Cert ificat e issued by a recognised Not ifiedBody under Annex M I-005 (M ID 2004/22/EC) or Annex VII (M ID 2014/32/EU).Number TC10822 revision 0 Project number 16200475 Page 4 of 51.3 Essential Shapes- Inscript ions of the Promass 300AtTC10822 is placed on t he housing(s) of the Promass 300; Ident ificat ion of t he measurementsensor; Serial number;In case of a remot e version: t he serial number of t he measurement sensor is inscribed on t he Promass 300 and/or t he serial number of t he Promass 300 is inscribed on t he measurement sensor. - S t at us of t he deviceIn case an elect ronic calculat or/indicat ing device is connect ed t o t he Promass 300, theis sent t o t he connect ed device in one of t he follow ing ways:-channels, t hus enabling t he flow comput er t o det ect a pulse failure and consequent ly generat e an alarm. Ifnecessary, an ext ra elect rical board is added t o prevent t his act ion short -circuit ing t hePromass 300.The current out put is set t o failure current (minimum or maximum value is possible), t hus enabling t he flow comput er t o det ect the failure.The Promass' pulse out put is set t o maximum pulse rat e for one channel and t o no pulses for t he ot her pulse channel. This w ill t rigger t he pulse securit y checking of t he connect ed elect ronic calculat or/ indicating device.The M odbus.In all cases t he st at us of t he device must be configured so, t hat t he alarm conditions- S ealing.S ee chapt er 2.- C ablingAll cables shall be shielded and t he shielding shall be connect ed on bot h sides.1.4 Conditional Part s- Key-boardThe keyboard consist s of a t hree keys of w hich t heir funct ion depends on t he menu and select ed it em. The keyboard is part of the LC D display. If t he display is not present , t he keyboard is also not present. - HousingInside t he met al housing t he Promass, t he essent ial and t he condit ional part s are mount ed. Access can be obt ained t hrough t w o sealable lids.S ee document at ion number 10822/0-01 for t he assembly of t he part s inside the housing. compact , explosion proof , direct ly mount ed on t he measurement sensor.Opt ionally t he display is mount ed in a separat e housing. The communicat ion w it h t he display is via M odbus.1.5 Conditional Shapes- Blinding of Promass displayIf an elect ronic calculat or/indicat ing device (flow comput er) is connect ed t o t he Promass 300, t he display (w hen present ) of t he Promass 300 may be blinded. The display is st ill pres ent and funct ioning, it is not possible t o read t he display.Number TC10822 revision 0Project number 16200475Page 5 of 52SealsAft er set t ing t he securit y sw it ch in t he secured posit ion, all lids are sealed against opening.3Conditions for Approval- Verify t he paramet ers set t ings ment ioned in Annex 1 for correct set t ing and w here applicable if t he set t ing is in accordance w it h t he calibrat ion dat a.- Ot her part ies may use t his Evaluat ion Cert ificat e only w it h t he w rit t en permission of Endress + Hauser Flow t ec AG, Kägenst rasse 7, CH-4153 R einach, S w it zerland.4Test ReportsAn overview of t he performed t est s is given in Annex 2 appert aining t o t his Evaluat ionC ert ificat e.Number TC10822 revision 0Project number 16200475Page 1 of 2M andat ory paramet er set t ings:General set t ings for all paramet ers (w here applicable):M ass unit: t, kg or gM ass flow unit: M et rical (for example kg/min)Volume unit: m3; dm3; cm3; L or mlVolume flow unit: M et rical (for example m3/h)Densit y unit: M et rical (for example kg/m3)Temperat ure unit: °C or KPressure unit: M et rical unitS imulat ion modes: S hall be disabledM enu Sub M enu Sub subm enuParam eter Value- DisplayLanguage Local language (preferred); EnglishOperat ionLocking S t at us C T act.; CT act.-def.par. S et up M ediumselect ionLiquidC urr.out put0/4 mA value S ee not e (1)20 mA valuePFS out put Assign pulse M ass flow or Volume flowValue perpulseS ee not e (2)Pulse w idt h S ee not e (3)Low flow cut off AssignvariableM ass flow or volume flow On value S ee not e (4)Off value S ee not e (5)Part ial pipe det AssignvariableDensit y Low value S ee not e (6) High valueAdvanced set up Tot aliser n Operat ionmodeS ee not e (7)Failure mode Act ual valueExpert S yst em Diagn.handlingAlarm delay 0Process param. Flow damping In accordance w it h t hecalibrat ion dat aDensit ydampingTemp.DampingNumber TC10822 revision 0Project number 16200475Page 2 of 2M enu Sub M enu Sub subm enuParam eter ValueExpert S ensor S ensor adjust. Inst all direct. C orrect inst allat ion direct ionshall be select ed.Variable adjust M ass flowoffsetS ee not e (8)M ass flowfact orS ee not e (9)Volume flowoffsetS ee not e (8)Volume flowfact orS ee not e (9) Densit y offset S ee not e (10) Densit y fact or S ee not e (10)C alibrat ion C al.Fact or According calibrat ion dat aNominaldiamet erC orrect sizeAccording calibrat ion dat aNot es t o t he mandat ory paramet er sett ings:(1)The sett ings in t he flow comput er shall mat ch t he set t ings in t he flow t ransmit t er.(2)The sett ings shall be such t hat t he maximum pulse frequency of 5000 Hz is not exceeded.(3)The value shall be such t hat t he pulses can st ill be processed by t he conn ect ed flow comput er.(4)Value at w hich t he low flow cut of f is enabled (pulse out put st opped)(5)Value at w hich t he low flow cut of f is disabled (pulsed st art ed). Is given as a percent age inrespect of t he On value.act ual value = On value x (1 + Off value/100).If t he act ual flow rat e is higher t han 20% of t he minimum flow rat e of t he (complet e)measuring syst em, pulses must be generat ed by t he flow t ransmit t er.(6)Values shall be explained during conformit y assessment(7)At leas t one of t he t ot alisers must be in accordance w it h t he calibrat ion dat a.(8)If t he mass or volume flow offset is not zero t he value shall be explained during t he conformit yasses sment for t he impact on t he meas urement performance. These paramet ers are notint ended for a correct ion of t he zero flow rate.(9)If t he mass/volume flow f act or is not 1 t he act ual value shall be explained during t heconformit y assessment for t he impact on t he measurement perf ormance.(10)If t he densit y off set and densit y fact or are not 0 resp. 1, t he act ual value s hall be explainedduring t he conformit y assessment.Number TC10822 revision 0Project number 16200475Page 1 of 1Performed t est s on t he flow transmit t er:TEST Part TYPE TEST REPORT TEST HOUSE REM A RKSC limat e , vibrat ion and EM C t est s according OIM L R117-2 Flowt ransmit t erPromass 300 NM i-16200475-01 NM i C ert in B.V.S oft w are Evaluat ion Flowt ransmit t erPromass 300 NM i-16200475-02 NM i C ert in B.V.。
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武汉大学人武汉大学人民医院 民医院武汉大学人民医院 姜毅 武汉大学人民医院 姜毅 姜毅
姜毅
更新要点
1、哮喘的评估(表2-2,第29页):明确哮喘急性发作是 “独立”危险因素的概念,即使患者症状很少时也会增加急性发作风险。 这些因素是在调整了症状控制对于急性发作的风险后进行分析确定的。 2、新增了对支气管舒张剂反应的可逆性升高是成年以及儿童急性发作的独立风险因素。发展成为持续性气流受限的新增风险因素 为:早产、出生体重低以及婴儿期体重增长过多。
有上述风险因素的 一项或多项,即可 增加哮喘急性发作 的风险,即使症状 控制良好的患者
其他哮喘急性发作主要独立风险因素
• 曾有过气管插管或因哮喘在ICU治疗 • 过去12个月内≥1次严重哮喘发作 • • • •
发展为固定气流受限的风险因素
早产、出生时低体重儿、婴儿期体重过度增长 缺乏ICS治疗 暴露、吸烟;有害化学物质;职业暴露 低初始FEV1,慢性粘液高分泌状态;痰液或血液嗜酸性粒细胞增多
50%
45%
40% 35% 30% 25% 20% 15% 10% 5%
0%
MDI Diskus HandiHaler Turbuhaler
Respir Med. 2011 Jun;105(6):930-8. © Global Initiative for Asthma
吸入装置不正确的吸入技术与哮喘控制相关
© Global Initiative for Asthma
支气管舒张剂反应性是区别易控制与难控制哮喘 的关键变量
J Allergy Clin Immunol. 2016 Oct;138(4):1030-1041.
© Global Initiative for Asthma
出生时婴儿状态会影响儿童期肺功能
孕龄不足者儿童期FEV1,FEV1/FVC,FEF75均减低;小于胎龄时FEV1减 低,FEV/FVC增高;出生时体重高者FEV1增高,但是FEV1/FVC和FEF减低
Respir Med. 2011 Jun;105(6):930-8. © Global Initiative for Asthma
在哮喘易控制组与难控制组中的季节波动状况
J Allergy Clin Immunol. 2016 Oct;138(4):1030-1041.
© Global Initiative for Asthma
是
这些症状是典型的哮喘症状吗?
否
病史/急性发作支持哮喘诊断吗?
临床紧急情况, 不像其他诊断 是 否
详细的病史/哮喘急性发作
进一步了解病史和检查以改变诊断
确定改变诊断吗?
结果支持哮喘诊断吗?
否 是
检查肺活量/PEF
重复上述流程或安排其 他检查
确定哮喘诊断吗?
否
否 是
ICS和按需SABA经验性治疗 评估治疗反应 1-3个月内进行诊断性检查
3、FENO指导治疗:
(1 ) 新的荟萃分析中,使用了相当接近基于当前指南治疗的控制治疗策略,从而可提供与临床相关的对比。在儿童和年轻人的 研究中,研究显示FENO指导的治疗与基于当前指南的治疗相比,可显著减少急性发作次数和急性发作频率。在成人患者中,FENO 指导的治疗与基于当前指南的治疗相比无显著差异。 (2)FENO可以支持开始ICS治疗,但目前不能安全地被推荐来决定不用ICS治疗。根据目前的证据,GINA推荐使用低剂量ICS 治疗大多数哮喘患者,即使是那些症状较少的患者,来降低严重急性加重的风险。 (3)最有可能从FENO指导的治疗中获益的人群以及监测的最佳频率目前仍需要进一步的研究阐明。
GINA updated 2014.
© Global Initiative for Asthma
哮喘预后不良的风险因素
哮喘症状未控制是急性发作重要的危险因素。 即使症状少的患者中,其他潜在的哮喘急性发作独立风险因素
• • • • • • • • • • 过量使用SABA(若>1ⅹ200-剂量 罐/月,死亡风险增加) 不充分的ICS治疗;未处方ICS; 依从性不好;不正确的吸入技术 低FEV1,尤其当<60%预测值时 对支气管舒张剂可逆性高 重要的心理和社会经济学问题 暴露:吸烟;如果是过敏性哮喘暴露于过敏原 并发症:肥胖、慢性鼻窦炎、确诊的食物过敏 痰或血中嗜酸性粒细胞增多 FENO增高(成人过敏性哮喘服用ICS者) 怀孕
den Dekker HT, Sonnenschein-van der Voort AM, de Jongste JC,et al. Early growth characteristics and the risk of reduced lung function and asthma: A meta-analysis of 25,000 children. J Allergy Clin Immunol. 2016 Apr;137(4):1026-35.
进行哮喘诊断的标准
2.确切的可变性呼气气流受限
肺功能可变性(以下一个或者多个检查)以及 气流受限 支气管舒张试验阳性 变异性越大,过度变异发生次数越多,诊断越明确 当FEV1 低的时候,诊断过程中至少发生一次,确定FEV1/FVC降低(正常:成人〉 0.75-0.8,儿童〉0.9) 成人:200-400 mcg 沙丁胺醇给药10-15分钟后FEV1〉12 % 以上,且FEV1增加绝 对值〉200 ml, ; 儿童:FEV1〉12 % 以上 成人:PEF日内变异率或昼夜波动率〉10 % 儿童:PEF日内变异率或昼夜波动率〉13 % 排除呼吸道感染后,成人抗炎治疗4周后,FEV1〉12 % ,且FEV1增加绝对值〉 200 ml(或者PEF〉20 %) 成人:FEV1降低〉10% ,且FEV1降低绝对值〉200 ml 儿童:FEV1降低〉12% ,或者PEF〉15 % 给予标准剂量乙酰甲胆碱或组胺后,FEV1降低≥2 0%;给予标准剂量蒸馏水或高渗 盐水,FEV1降低≥15% 成人:排除呼吸道感染后,不同门诊之间,FEV1〉12 % ,且FEV1增加绝对值〉 200 ml 儿童:不同门诊之间FEV1降低〉12% ,或者PEF〉15 %(可以包括呼吸道感染)
• 日间哮喘症状>2次/周? • 夜间因哮喘憋醒? • 使用缓解药次数>2次/周 • 哮喘引起的活动受限 是□否 是□否 是□否 是□否 控制
哮喘症状控制水平
部分控制 未控制
□ □ □ □
无
存在 1-2项
存在 3-4项
B. 哮喘预后不良的风险因素(未来风险)
在诊断时和之后定期评估风险因素,尤其对经历过哮喘急性发作患者。 在开始治疗时、控制药治疗3-6个月测定FEV1,记录患者最佳肺功能,之后定期进行风险评估。
© Global Initiative for Asthma
哮喘的定义和诊断
© Global Initiative for Asthma
哮喘定义
2017版 • 什么是哮喘? 2018版 • 哮喘是一种异质性疾病,通常以慢性气道炎症 为特征。其定义包含随时间不断变化的呼吸道 症状病史,如喘息,气短,胸闷和咳嗽,强度 亦可发生变化,同时具有可变性呼气气流受限。
4、阶梯治疗3-4(第47页):内容更新后,纳入了3项FDA 关于 LABA在成人、青少年和儿童中安全性研究的结果,研究对ICS
联合LABA和同等剂量的ICS进行了比较。 5、阶梯治疗5(第48页):重度嗜酸性粒细胞型哮喘的2型-靶向生物制剂中新增了Benralizumab(单克隆抗-IL5α 受体),明 确了获批可应用2型靶向生物制剂的年龄范围 。 6、对婴儿来说,长期咳嗽以及非感冒症状咳嗽,与后期家长报告的医师诊断哮喘呈现相关性,并独立于婴儿喘息之外。(103 页) 7、过敏原免疫治疗(第52页):新增的内容,指出可能只在特定的提取物和治疗方案中才有效果。 8、过敏性鼻炎的治疗(第66页):鼻用皮质类固醇治疗与在未同时使用ICS的患者中的哮喘改善相关。 9、新增了围经期哮喘(月经性哮喘)的章节(第69页)。
© Global Initiative for Asthma
两周以上PEF变异率 抗炎治疗4周后肺功能明显改善 运动激发试验阳性 支气管激发试验阳性 (通常只在成人进行) 不同门诊之间肺功能过度变异(不可靠)
指南定义的哮喘典型症状
下列特征为哮喘典型症状,如果存在,增加哮喘诊断的可能性:
超过1个症状(喘息,气短,胸闷和咳嗽),尤其在成人患者 夜间或早晨症状常常加重 症状表现和强度随时间变化 症状是由病毒感染(感冒),锻炼,接触过敏原,天气变化,大笑,或刺激物 如汽车废气,烟雾或强烈的气味触发
下列特征提示哮喘引起的呼吸道症状可能性低:
无其他呼吸道症状的单独咳嗽 长期咳痰 气短伴有头晕,头昏目眩或外周刺痛(感觉异常) 胸痛 运动性呼吸困难伴吸气噪音
GINA updated 2018.
© Global Initiative for Asthma
哮喘初始诊断流程
患者存在呼吸道症状
所以,所有的哮喘患者都应该有书面行动计划。
强调其异质性特征,不断变化的症状及可变性呼气气 流受限是哮喘定义的核心要素
GINA updated 2018.
© Global Initiative for Asthma
哮喘诊断(6岁以上)
诊断特点 1. 变化的呼吸道症状病史
喘息,气短,胸闷和咳嗽 不同文化背景或者不同年龄的患者描述不同, 例如:儿童更多地描述为很难呼吸 一般超过一种呼吸道症状(成人,很少哮喘只有咳嗽一种症状) 症状会随着时间改变,症状的严重程度也会改变 症状在夜间或者醒来时更重 症状经常由于运动、大笑、过敏源或者冷空气诱发 症状通常由于病毒感染出现或者加重
•
哮喘的症状包括喘息、气短、胸闷和咳嗽。
其发生、频率和严重程度随时间而变化。这些 症状伴随着可变性呼气气流受限,即由于支气 管狭窄(气道狭窄)、气道壁增厚和粘液增多 导致的呼气困难。气流受限有时也见于非哮喘 人群,但在哮喘人群中更加明显。哮喘的不同 表型具有不同疾病进程。