opendatalab/WebMainBench huggingface dataset:
# [thechat] London beervolt tonight
    
    
    On Thu, 02 Aug 2001 18:25:45 +0100, <martin.p.burns at uk.pwcglobal.com>
    wrote:
     
    >_OK, as near the bow and on the highest deck as possible while_ >_still remaining within a bar._
    Well yeah, it's great your telling me all this now... after I wandered
    round the bottom deck of the pub chatting to all sundry and getting a
    name for myself. *:)
    
    
    
    >_Here's me:_ >_http://www.easyweb.co.uk/pics/martin.html
    _
    Naah.. the Martin I met was drunker looking than that!
    
    Right.... I had something else to do tonight didn't I?..... oh yeah Mark
    Thomas... right, that'll have to be in a seperate email, cos I'm trying
    to chat to aq in #evolt, make myself a brandy coffee and.. ummm... other
    stuff.
    
    
    G.
    
    P.S. Yes.. I'm drunk right now... yes... this is what I'm like drunk...
    no, you're right, there's not a great deal of difference *:)
    
    -- 
    ----------------------------------------------------------------------------
    WORK: http://spiked.co.uk/
    PLAY: http://polytechnic.co.uk/
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# 浙江诸暨开展文化市场法治宣传教育活动

3月18日，诸暨市文化市场行政执法队工作人员在检查印刷企业教辅教材印刷品内容。

近期，浙江省诸暨市开展以“文化执法、守望成长”为主题的文化市场法治宣传教育系列主题活动，进行文化市场“扫黄打非”“护苗”等法治科普工作，进一步增强群众的法律意识和防范意识。

新华社记者 徐昱 摄

3月18日，诸暨市民在城市广场文化执法主题宣传活动上参加文化市场相关法治知识的互动竞猜游戏。

近期，浙江省诸暨市开展以“文化执法、守望成长”为主题的文化市场法治宣传教育系列主题活动，进行文化市场“扫黄打非”“护苗”等法治科普工作，进一步增强群众的法律意识和防范意识。

新华社记者 徐昱 摄

3月18日，诸暨市文化市场行政执法队工作人员在城市广场发放文化市场相关法治知识宣传册。

近期，浙江省诸暨市开展以“文化执法、守望成长”为主题的文化市场法治宣传教育系列主题活动，进行文化市场“扫黄打非”“护苗”等法治科普工作，进一步增强群众的法律意识和防范意识。

新华社记者 徐昱 摄

3月18日，诸暨市民在城市广场文化执法主题宣传活动上参观文化市场相关法治知识宣传图板。

近期，浙江省诸暨市开展以“文化执法、守望成长”为主题的文化市场法治宣传教育系列主题活动，进行文化市场“扫黄打非”“护苗”等法治科普工作，进一步增强群众的法律意识和防范意识。

新华社记者 徐昱 摄

3月18日，诸暨市文化市场行政执法队工作人员在“1963法润直播间”开展文化市场“扫黄打非”专题直播宣讲。

近期，浙江省诸暨市开展以“文化执法、守望成长”为主题的文化市场法治宣传教育系列主题活动，进行文化市场“扫黄打非”“护苗”等法治科普工作，进一步增强群众的法律意识和防范意识。
# 聚焦重大项目 做强肉牛产业

3月11日至12日，安徽省副省长张曙光在蚌埠市怀远县出席重点市肉牛产业发展工作调度会和国海创联高品质肉牛全产业链发展项目开工动员会，并在怀远县、蒙城县调研肉牛产业发展和当前春季农业生产工作。

会议和调研强调，皖北六市和滁州、六安市是全省肉牛养殖重点区域。要充分发挥自身优势，在肉牛良种引进和培育上狠下功夫，全力完成年度目标任务，为全省多作贡献。要以“双招双引”为抓手，加快推进一批牵动性强、产业链长的重大项目落地，高起点建设优质肉牛种源基地，持续优化养殖结构，提升肉牛品质，着力扩规模、提质量、延链条、创品牌、增效益。要抓好春季农业生产，加强病虫害防控和田间管理，奋力夺取夏季粮油丰收。

据悉，蚌埠市加快推进肉牛振兴，与国海创联实业集团开展深度合作，前不久，怀远县与其签订总投资50亿元的高品质肉牛全产业链发展项目合作协议。此次国海创联肉牛屠宰加工及预制菜产业园、高品质肉牛扩繁育肥示范场2个项目联动开工，总投资11.59 亿元。（通讯员 斯实 记者 许昊杰）
### 《中共中央党校(国家行政学院)学报》2022年第4期

目录

习近平新时代中国特色社会主义思想研究

中国特色社会主义政治经济学视角下的中国式现代化道路

张素峰

坚持人民至上的观念认知、制度支撑及运行机制

陈家刚;陈凌宇

论发展全过程人民民主与新时代民生建设

杨渊浩;程竹汝

中共党史

中华优秀传统文化与马克思主义中国化的三次飞跃

张卫波

中共党史学“三大体系”建设的历史性契机

宋学勤;马骋

专题·社会治理

新发展阶段社会建设与构建新发展格局

杨典;向静林

基本公共服务均等化的政策逻辑与深化:共同富裕视角

袁威

老少边穷地区公共文化服务软治理路径建构研究

熊皇;宫慧颖 ;许艳艳

专题·构建新发展格局

全球价值链视角下的发展格局:结构、循环与效应分析

刘志彪

新发展格局下区域协调发展的战略骨架与路径构想

孙久文;蒋治

新发展阶段我国经济增长动能转换及路径优化——基于需求侧与供给侧双轮驱动框架

张红凤;李晓婷;蒲存秀

专题·中国国际传播能力建设

智能传播时代如何塑造中国国际形象——以2022年北京冬奥会国际传播为视角

史小今;吴金希

国际战略视域下的中国国际传播能力建设评估体系研究

刘佳

政治学与公共管理

论中国式治理现代化个性

宋世明

不同培养方式对领导干部发展影响效能的比较

萧鸣政;张睿超

法学

环境法独立性阐释与环境法典编纂

张璐

我国行政诉讼功能模式的演进、局限及其转型

邓刚宏
# File:Bukit Timah Railway Station, Singapore (1).jpg

## Summary

Description |  **English:** The Bukit Timah Railway Station in Singapore - general view.  
---|---  
Date |  10 June 2011  
Source |  Own work  
Author |  EquatorialSky2  
  
## File history

Click on a date/time to view the file as it appeared at that time. 

Date/Time| Thumbnail| Dimensions| User| Comment  
---|---|---|---|---  
current| 07:16, 12 June 2011| | 4,000 × 3,000 (3.44 MB)| EquatorialSky2  
  
## File usage

The following pages on the English Wikipedia use this file (pages on other projects are not listed):

  * 2011 in Malaysia
  * Bukit Timah
  * Bukit Timah railway station
  * User:Lemongirl942/Bukit Timah



## Global file usage

The following other wikis use this file: 

  * Usage on ms.wikipedia.org 
    * 2011 di Malaysia
  * Usage on www.wikidata.org 
    * Q4986974
  * Usage on zh.wikipedia.org 
    * 武吉知马站



## Metadata

This file contains additional information, probably added from the digital camera or scanner used to create or digitize it. 

If the file has been modified from its original state, some details may not fully reflect the modified file.

Camera manufacturer| Canon  
---|---  
Camera model| Canon IXUS 115 HS  
Exposure time| 1/125 sec (0.008)  
F-number| f/3.2  
ISO speed rating| 100  
Date and time of data generation| 09:32, 11 June 2011  
Lens focal length| 7.015 mm  
Orientation| Normal  
Horizontal resolution| 180 dpi  
Vertical resolution| 180 dpi  
File change date and time| 09:32, 11 June 2011  
Y and C positioning| Co-sited  
Exif version| 2.3  
Date and time of digitizing| 09:32, 11 June 2011  
Image compression mode| 3  
Shutter speed| 6.96875  
APEX aperture| 3.34375  
Exposure bias| 0.33333333333333  
Maximum land aperture| 3.34375 APEX (f/3.19)  
Metering mode| Pattern  
Flash| Flash did not fire, compulsory flash suppression  
Color space| sRGB  
Focal plane X resolution| 16,393.442622951  
Focal plane Y resolution| 16,393.442622951  
Focal plane resolution unit| inches  
Sensing method| One-chip color area sensor  
Custom image processing| Normal process  
Exposure mode| Manual exposure  
White balance| Auto white balance  
Digital zoom ratio| 1  
Scene capture type| Standard
# The Link Between Childhood TBIs and ADHD

As if there weren’t enough reasons to ensure your child gets the best treatment after a traumatic brain injury, new research suggests there may be a link between childhood TBIs and attention deficit hyperactivity disorder. Researchers also note that symptoms of ADHD may not appears for up to a decade after the original head injury.

As we’ve noted on the blog in the past, head injuries have been linked to an increased risk of mental problems, like depression or anxiety. But according to this new study, children who suffer head injuries may be more likely to develop ADHD down the road. The study claims that roughly 1 in 5 children who’ve suffered a TBI will develop ADHD within a few years, although it may take much longer in some cases.

“Children with a history of TBI, even those with less severe injuries, have an increased risk for the development of new-onset attention problems, potentially many years after injury,” said Megan Narad, PhD, lead author and postdoctoral fellow at Cincinnati Children’s Hospital Medical Center. “While previous studies suggest kids with a history of TBI are at risk for developing attention problems, they only followed kids two to three years after injury. Our study is unique in that we followed children 7 to 10 years after their injury.”

## TBI and ADHD

For the study, researchers followed 187 children with no prior history of ADHD who were hospitalized due to TBI or other trauma, like fractures or broken bones. Children in the study were between 3 and 7 years old at the time of hospitalization, and parents were responsible for completing behavioral assessments at the time of the injury and every six months going forward.

Out of 187 children, 48 eventually met the criteria for secondary ADHD, which is more than 25 percent of the group. According to researchers, that represented a more than four-fold increase in eventual ADHD risk compared to a child who did not suffer a TBI. Even if kids appear to no longer be dealing with symptoms of their head injuries, risk of secondary acquired ADHD may still exist.

“I think this is important to point out, as these kids are often perceived as being recovered from their injury, when in fact they may be at greater risk for SADHD,” Dr. Narad said. 

Dr. Narad hopes the findings will encourage parents and doctors to be more diligent about monitoring children after a TBI and ensuring the child fully recovers before resuming physical activities.

If your child has suffered head injuries in the past, talk to your doctor or a nuerospecialist about ways to manage the head injury and the role behavioral therapy may play in the equation. For more information, reach out to Dr. Chang’s office today.
| |  Fútbol: Máximos goleadores de la Liga francesa  
---  
|  A continuación ofrecemos la tabla de goleadores de la Liga francesa de fútbol tras los encuentros disputados el sábado: Con 12 goles -- Andre-Pierre Gignac (Toulouse) Con 11 goles -- Guillaume Hoarau (París St Germain) Fernando Cavenaghi (Girondins Burdeos) Con 10 goles -- Karim Benzema (Olympique Lyon) Con 9 goles -- Michel Fernandes Bastos (Lille) Con 7 goles -- Steve Savidan (Caen). Fin  
---
### 開箱分享-時尚女性【BEIBAOBAO】東京時尚真皮手提肩背包(古銅咖)

  
  


【BEIBAOBAO】東京時尚真皮手提肩背包(古銅咖)  
  


時尚是一種生活態度，東森購物提供最流行的女性包款、精品,包包與服飾配件，始終秉持為女性打造多樣風格的初衷，引領妳跟隨時尚的腳步，綻放屬於自我的迷人魅力，後背包，肩背包，手提包，斜背包，皮夾，皮件，手拿包，時尚，零錢包，側背包，時尚女包，帆布包，真皮包，簡約素雅，流行時尚質感....   
  


小妹對於包包的基本要求就是外觀與質感，如果沒有好的質感，不管是哪一個名牌我都不會喜歡，但是如果質感是精品等級，我就會非常感到興趣，不會盲目的追求品牌，因為那樣就像是拿著充滿LOGO的包包一樣，只是在炫耀缺乏設計感，我對於這樣的包包不感興趣，每天形影不離的包包，甚至比妳穿什麼衣服還重要，它可是吸引別人目光的重要配件。  
  


買包包總有一款最適合你，下面這幾款時尚包包大概是近來最火的人氣美包了，很多女明星都愛不釋手，街拍中經常有看到，你也來試試吧，成為搶鏡女王不在話下哦!! 看到這些美麗的包包你有沒有心動呢?喜歡立馬購入吧!!  


  
  
  
  
**商品訊息描述** : 

  *   
  


  * 品 牌：BEIBAOBAO揹包包   
商品尺寸：約寬13 cm*長32cm,高23 cm (以實品尺寸為主)   
商品重量：800公克(以實品重量為主)   
背包方式: 側肩背 手提 二用 揹帶長度可調整   
主要材質：全牛皮   
有無夾層: 有   
商品顏色:經典黑 天使白 古銅咖 共三色 (因網頁顏色表現有所差異.以實品顏色為主.並每次出廠紋路也不盡相同.以實品紋路為主) 

  


內政部役政署副署長梁國輝帶領役政署各級長官於昨（九）日到宜蘭縣參訪水利署第一河川局及衛生福利部宜蘭教養院的替代役男，對服勤替代役弟兄的高素質、高服務品質效率及役男守法守紀表示高度肯定，期許再接再厲服務人群。  
  
副署長梁國輝實地了解服役的替代役弟兄平時服勤環境及生活管理情形，表達關心慰問，以激勵士氣。  
  
梁副署長表示：替代役制度實施，已為各機關、單位及社福團體注入活力及助力，期許役男平時除了從事輔助性的行政工作外，更要積極參與各項服務及社會福利事務，秉持愛心來服務人群，以志工精神作為楷模，服勤期間積極做到「主動、禮貌、迅速、經濟與創新」，培養責任感，並備具嚴明的紀律及個人自我要求砥礪，體現替代役的四大信念「愛心、服務、責任、創新」。
# Python 随机模块（Random Module）

**Python 有一个可用于制作随机数的内建模块。**

**`random` 模块有一组如下的方法：**

方法 | 描述  
---|---  
seed() | 初始化随机数生成器。  
getstate() | 返回随机数生成器的当前内部状态。  
setstate() | 恢复随机数生成器的内部状态。  
getrandbits() | 返回表示随机位的数字。  
randrange() | 返回给定范围之间的随机数。  
randint() | 返回给定范围之间的随机数。  
choice() | 返回给定序列中的随机元素。  
choices() | 返回一个列表，其中包含给定序列中的随机选择。  
shuffle() | 接受一个序列，并以随机顺序返回此序列。  
sample() | 返回序列的给定样本。  
random() | 返回 0 与 1 之间的浮点数。  
uniform() | 返回两个给定参数之间的随机浮点数。  
triangular() | 返回两个给定参数之间的随机浮点数，您还可以设置模式参数以指定其他两个参数之间的中点。  
betavariate() | 基于 Beta 分布（用于统计学）返回 0 到 1 之间的随机浮点数。  
expovariate() | 基于指数分布（用于统计学），返回 0 到 1 之间的随机浮点数，如果参数为负，则返回 0 到 -1 之间的随机浮点数。  
gammavariate() | 基于 Gamma 分布（用于统计学）返回 0 到 1 之间的随机浮点数。  
gauss() | 基于高斯分布（用于概率论）返回 0 到 1 之间的随机浮点数。  
lognormvariate() | 基于对数正态分布（用于概率论）返回 0 到 1 之间的随机浮点数。  
normalvariate() | 基于正态分布（用于概率论）返回 0 到 1 之间的随机浮点数。  
vonmisesvariate() | 基于 von Mises 分布（用于定向统计学）返回 0 到 1 之间的随机浮点数。  
paretovariate() | 基于 Pareto 分布（用于概率论）返回 0 到 1 之间的随机浮点数。  
weibullvariate() | 基于 Weibull 分布（用于统计学）返回 0 到 1 之间的随机浮点数。
Project: public project 

Summary: |  Two models, two forecasts, 620 rows (estimated), 4,623 rows (actual) as of 2019-12-07   
---|---  
Owner: |  project_owner1  
Model Owners: |  model_owner1  
Time Interval Type  | Week  
Visibility |  Public  
Description: | description  
Home: | http://example.com/  
Core data: | http://example.com/  
Truth Data:  |  2017-01-17-truths.csv (7 rows)  
Analysis: | Visualizations, Aggregate scores, Score data  
  
## Models (2) 

  * Test ForecastModel1 (public)
  * Test ForecastModel2 (public)



## Locations (11)

`HHS Region 1`, `HHS Region 10`, `HHS Region 2`, `HHS Region 3`, `HHS Region 4`, `HHS Region 5`, `HHS Region 6`, `HHS Region 7`, `HHS Region 8`, `HHS Region 9`, `US National`

## Targets (7)

Name | Description | Unit | Point Value Type | Date? |  Step Ahead?  |  Predictions  | BinLwrs  
---|---|---|---|---|---|---|---  
1 wk ahead  | One- to four-week ahead forecasts will be defined as the weighted ILINet percentage for the target week. | percent | Float |  1 step  |  BL|NM|PT|SA  | 131  
2 wk ahead  | One- to four-week ahead forecasts will be defined as the weighted ILINet percentage for the target week. | percent | Float |  2 steps  |  BL|NM|PT|SA  | 131  
3 wk ahead  | One- to four-week ahead forecasts will be defined as the weighted ILINet percentage for the target week. | percent | Float |  3 steps  |  BL|NM|PT|SA  | 131  
4 wk ahead  | One- to four-week ahead forecasts will be defined as the weighted ILINet percentage for the target week. | percent | Float |  4 steps  |  BL|NM|PT|SA  | 131  
Season onset  | The onset of the season is defined as the MMWR surveillance week (http://wwwn.cdc.gov/nndss/script/downloads.aspx) when the percentage of visits for influenza-like illness (ILI) reported through ILINet reaches or exceeds the baseline value for three consecutive weeks (updated 2016-2017 ILINet baseline values for the US and each HHS region will be available at http://www.cdc.gov/flu/weekly/overview.htm the week of October 10, 2016). Forecasted 'onset' week values should be for the first week of that three week period. | week | Text |  BC|BI|SC  | 0  
Season peak percentage  | The intensity will be defined as the highest numeric value that the weighted ILINet percentage reaches during the 2016-2017 influenza season. | percent | Float |  BL|NM|PT|SA  | 131  
Season peak week  | The peak week will be defined as the MMWR surveillance week that the weighted ILINet percentage is the highest for the 2016-2017 influenza season. | week | Text |  BC|BI|SC  | 0  
  
## Time zeros (3)

Time Zero  |  Data Version Date  | # Forecasts | Starts Season  
---|---|---|---  
2017-01-01 |  (No data version date) | 1  
2017-01-17 |  (No data version date) | 1  
2017-01-24 |  (No data version date) | 0
# History of the Poplar Grove Airport

**A Proud Heritage**

The Airport in 1986

In 1947, Richard Thomas took his first airplane ride. That ride started a lifelong love of aviation and led to his founding of Belvidere Airport in 1972. Today, the airport continues to prosper under the ownership of Richard’s son Steve and wife Tina Thomas.

The airport, renamed Poplar Grove Airport in 1994, is located in northern Illinois near Rockford, 75 miles northwest of Chicago and only an hour drive from O’Hare International Airport. Over the last seven years the airport has experienced significant growth. The airplane population has grown from 45 based aircraft in 1994 to over 350 today, and is expected to reach 400 by 2005. Our strong customer focus and dedication to aviation were recognized when we were voted the Best Privately Owned General Aviation Airport in Illinois three times in the last ten years.

**A Dynamic Future**

The Airport in 1999

When fire destroyed our original maintenance facility in 1996, the decision was made to rebuild with an eye toward the future. Today, a modern 20,000+ square foot facility houses our maintenance shops, administrative offices, parts department and flight training’s ground school classroom.

Our location and the services we offer have driven airport development. We are located in one of our country’s most densely pilot-populated areas with over 18,000 pilots, over 8,000 registered aircraft and general population totals of 15,000,000 within a two-hour drive of Poplar Grove. We have developed 180 acres of land adjacent to our primary runway into a Residential Airpark/Fly-In Community, Bel Air Estates, with 140 single family lots and 46 luxury condominiums.

The future is bright at Poplar Grove Airport. Phase II of the airport development is being planned and will include an additional 150+ lots (most with airport access). In 1996, the Poplar Grove Vintage Wings & Wheels Museum was established to educate youth and preserve history. The museum compliments our area and airport as an intellectual asset.

Poplar Grove Airport is more than just an airport, it’s an aviation oriented community. Through conscious effort and design, Poplar Grove Airport has developed as a friendly, fun, neighborhood airport. The addition of Bel Air Estates has allowed many aviation enthusiasts to truly call Poplar Grove Airport “home.”

Bel Air Estates
*   * 


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# 云南腾冲：山乡秋收正当时 尽显金色浪漫

俯瞰梯田（10月22日摄）。新华网发（龚祖金 摄）

近日，云南省腾冲市五合乡的万亩水稻陆续成熟。层层叠叠的梯田上呈现出“大地染金”的壮丽景观，稻田与不远处的村庄遥相呼应，构成一幅绝美的田园丰收图，勾勒出秋日浪漫。（完）（腾冲市融媒体中心 龚祖金 黄蓉）

俯瞰梯田（10月22日摄）。新华网发（龚祖金 摄）

忙着收获的农户（10月22日摄）。新华网发（龚祖金 摄）

宛如一幅绝美的田园画（10月22日摄）。新华网发（龚祖金 摄）

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忙着收获的农户（10月22日摄）。新华网发（龚祖金 摄）

宛如一幅绝美的田园画（10月22日摄）。新华网发（龚祖金 摄）

忙着收获的农户（10月22日摄）。新华网发（龚祖金 摄）

宛如一幅绝美的田园画（10月22日摄）。新华网发（龚祖金 摄）
# 探索农业技术的可能性

不断发展的农业技术已成为当今农场运营中提高产量的关键。随着农民面临越来越多的新型高科技工具选择，他们需要合作伙伴帮助他们找到最合适的系统，并学习如何从技术投资中获得最高的回报。  
  
在全新视频系列中，WinField 技术专家探讨了农业技术的进步，以及农民如何从当今的新工具中挖掘出最大的利润潜力。观看这些发人深省的片段，了解更多关于农业技术带来的激动人心的机遇：

  * **_农业与数字革命_**
  * 与 WinField 技术领袖 Teddy Bekele、Kevin Eye 和 Joel Wipperfurth 一起深入探讨当前的数字革命，他们将重点介绍新技术如何通过改变游戏规则的见解改变现代农业。
    * **_数据驱动的决策_**
    * Teddy Bekele 和 Joel Wipperfurth 讨论了数据在决策中应发挥的核心作用，展示了 WinField 如何将业界最广泛的数据集之一直接传送到农场门口。
      * **_利用农业技术优化产量潜力_**
      * Kevin Eye 和 Joel Wipperfurth 详细介绍了农学家如何使用 R7 等新技术® 工具，用于根据田地情况平衡投入与产量潜力。
        * **_农业的未来在于农业科技_**
        * 与 Teddy Bekele 和 Joel Wipperfurth 一起仔细研究如何通过增加对农业技术的投资来做出更好、更高效的商业决策。  
  
访问 WinField YouTube 频道 了解有关新兴农业技术主题的更多更新和信息。



### 不断发展的农业技术已成为当今农场运营中提高产量的关键。随着农民面临越来越多的新型高科技工具选择，他们需要合作伙伴帮助他们找到最合适的系统，并学习如何从技术投资中获得最高的回报。
呼吸机操作技术

1． 患者的教育

与IPPV不同，NPPV更强调患者的主动合作和舒适感，对患者的教育可以消除恐惧,争取配合,提高依从性和安全性。教育的内容包括：讲述治疗的目的(缓解症状、帮助康复)，指导患者有规律地放松呼吸,注意咳痰和可能出现的不良反应(漏气等), 有不适时及时通知医务人员，以及面罩连接和拆除方法，特别是在紧急情况下(如咳嗽、咳痰或呕吐时)拆除面罩的方法，等54。

2． 呼吸机与患者的连接

连接的舒适性、密封性和稳定性对疗效和患者的耐受性影响很大。因此，除应准备好不同大小的鼻罩和口鼻面罩供患者试用，还应注意保持合适的松紧度，尽量减少漏气及避免面部皮肤破溃。目前常用4条或3条固定带进行固定，与4点固定相比,3点固定符合力学原理,压力分布最均匀,密闭性和舒适性更好，佩带方便55。在吸氧或者低的气道压(如4cmH2O的CPAP)状态下将面罩连接稳固舒适后，再连接呼吸机管道或增加气道压。否则高的气道压使连接过程中漏气，导致患者明显的不适。

3． 通气模式的选择与参数调节

常用于NPPV模式有以下几种：压力控制通气（PCV）、持续气道正压（CPAP）、双水平正压通气（BiPAP）、压力支持通气（PSV）及比例辅助通气（PAV），其中以BiPAP模式最为常用16-24。

如何为患者设定个体化的合理治疗参数十分重要。压力和潮气量过低导致治疗失败，但过高也将导致漏气和不耐受的可能性增加。一般采取适应性调节方式：呼气相压力（EPAP）从2～4cmH2O开始，逐渐上调压力水平，以尽量保证患者每一次吸气动作都能触发呼吸机送气；吸气相压力（IPAP）从4～8cmH2O开始，待患者耐受后再逐渐上调，直至达到满意的通气水平，或患者可能耐受的最高通气支持水平54。

4． 监测、停用及撤离

通过密切的综合临床监测,判断疗效,发现治疗过程中的问题和可能出现的不良反应,及时处理和调整,是提高患者的耐受性和疗效的重要因素,也是避免因NPPV 治疗无效而延误插管的重要措施。监测应包括的内容如表2所示14,54。

表 2 NPPV治疗AECOPD时的监测内容  
---  
一般生命体征 |  一般状态、神志等  
呼吸系统 |  呼吸困难的程度、呼吸频率、胸腹活动度、辅助呼吸肌活动、呼吸音、人机协调性等  
循环系统 |  心率、血压等  
通气参数 |  潮气量、压力、频率、吸气时间、漏气量等  
血气和血氧饱和度 |  SpO2、pH、PaCO2、PaO2等  
不良反应 |  胃肠胀气、误吸、罩压迫、口鼻咽干燥、鼻面部皮肤压伤、排痰障碍、不耐受、恐惧(幽闭症)、气压伤等  
  
应特别注意对临床表现、SpO2和血气指标三方面进行监测。如果NPPV有效，在应用NPPV1-2小时后患者的呼吸困难、呼吸频率、心率以及精神状态均有改善14，否则，提示肺泡通气量不足，这可能与呼吸机参数设置（吸气压力、潮气量）过低、管路或面罩漏气等有关，应注意观察分析并及时调整。SpO2是观察NPPV后氧合变化比较简便易行的方法，特别是对于AECOPD患者，更强调控制性氧疗，在NPPV治疗初期应持续监测SpO2以指导调节吸入氧浓度/流量，使SpO2维持在90%左右14。此外，在NPPV1-2小时后进行血气分析是判断NPPV疗效比较确切的指标28,29,38。若血气指标无明显改善，需进一步调整参数或检查漏气情况，4-6小时后再次复查血气指标，若仍无改善，则须考虑停止NPPV并改用IPPV14。

在NPPV初期应鼓励患者尽量持续使用NPPV,直至病情改善11。若在应用NPPV过程中出现下列情况，即认为NPPV失败：①病情明显恶化，呼吸困难和血气指标无明显改善；②出现新的症状或并发症，如气胸、误吸、痰液严重潴留且排除障碍等；③患者严重不耐受；④血流动力学不稳定；⑤意识状态恶化。

对于NPPV有效者何时停机尚无统一标准，临床状况改善，并且病情稳定即可考虑逐渐撤离NPPV。总的来说，NPPV较IPPV使用更为灵活，可根据病情间断使用，也可采用逐渐降低压力支持和/或逐渐延长NPPV停用时间的方法撤离。

1． 常见不良反应及防治方法

1) 严重胃肠胀气：主要是因为气道压力高(＞25cmH2O时有可能超过食道贲门的压力)或张口呼吸、反复咽气引起。有明显胃肠胀气者，可考虑采取以下措施56：避免碳酸饮料摄入，避免吸气正压(IPAP)＞ 25cmH2O，放置胃管持续引流，间断应用NPPV。

2) 误吸：口咽部分泌物或呕吐物误吸可以引起肺部感染、呼吸衰竭加重等严重的后果。应注意患者体位、防治胃肠胀气等。

3) 口鼻咽干燥：多见于使用鼻罩又有经口漏气时,寒冷季节尤为明显。避免漏气(能够明显降低通过口咽部的气流量)和间歇喝水通常能够缓解症状，也可使用加温湿化器。然而,由于水蒸汽冷凝的作用,会有较多的水在面罩和管道内沉积;也有患者诉闷热不适。因此应该根据每个患者的具体情况而选用。

4) 面罩压迫和鼻面部皮肤损伤：轻度的面罩压迫感比较常见57。合理地调整面罩的位置﹑选用适合患者脸型的硅胶或气垫面罩以及调整固定带的张力(能避免漏气的最低张力)可以减轻面罩的压迫症状。鼻梁皮肤损伤比较少见，主要是因为长时间压迫引起。间歇松开面罩或轮换使用不同类型的面罩，避免长期压迫同一位置，可以避免此并发症。此外，我国自行研制的硅胶面膜型面罩具有良好的防漏气性,比较适合国人面型55,58。

5) 排痰障碍：NPPV易致痰液粘稠使痰液排出困难，往往与患者通气需求较大，或伴有较大漏气量，使总的通气量过大而不能充分湿化有关。应保证足够的液体量，少量多次饮水，应用功能较强的主动加温湿化器，间歇让患者主动咳嗽(将呼吸机与面罩的连接暂时断开)，保证痰液引流通畅。此外，还可进行胸部物理治疗以辅助患者排痰。NPPV不应影响患者的正常饮水、咳痰、进食等。

6) 恐惧(幽闭症):部分患者对带面罩,尤其是口鼻面罩有恐惧心理,导致紧张或不接受NPPV治疗。合适的教育和解释通常能减轻或消除恐惧。观察其他患者成功地应用NPPV治疗,有利于提高患者的信心和接受性。

7) 气压伤：对于合并肺大疱患者应警惕。以维持基本通气为目标，不应过分追求通气状况的改善而提高气道压力。

推荐意见：对AECOPD患者首选双水平正压通气（BiPAP）。[C]

推荐意见：在AECOPD应用NPPV治疗初期应密切监测生命体征和血气，根据患者治疗反应调整治疗方案，4-6小时仍无改善，则考虑改用有创正压通气。[D]
# Weight Loss Pearland

Finding a program for weight loss in Pearland can help you shed those pounds easier. Even if you’re already eating healthy and losing weight, adding a program of regular exercise can help. Adding exercise to a nutritional program can make the difference between success and failure. While you can’t out exercise a bad diet, exercise has its own benefits to add to your program. It builds muscle tissue. Muscle tissue requires more calories to maintain. The more you have, the more calories your body burns 24/7. As you’re building those muscles, you’ll also be igniting a calorie burning fire.

## Exercise does more than just help you shed those pounds.

It’s tough being overweight. You lose a lot of your self-esteem. You start to feel less than you really are. When you workout as part of your weight loss program, you’ll be amazed at how much it boosts your confidence. It improves your posture and makes you walk taller, giving you an air of confidence. They say that if you “act like” so shall “you be.” That’s certainly true when it comes to posture and looking confident. You start to feel more confident. If you don’t believe “acting like” works try smiling big and laughing right now. You’ll feel your mood change almost instantly.

## You’ll boost your energy level when you add exercise.

There’s no doubt about it. When you workout regularly, you’ll have energy to spare. The body is amazing. The more you do, the more you’re capable of doing. Think about it. Have you ever laid around all binge-watching television or NetFlix? You feel exhausted at the end of the day. The reverse is often true. If you’ve been physically active, you often have energy to spare after an eight hour day. Imagine how active you’ll be, burning even more calories, when you workout regularly.

## Exercise not only helps you lose weight by building muscles.

Exercise also helps you maintain your muscle mass. Your body doesn’t discriminate when it needs calories. It burns both fat and muscle tissue. However, studies show that when you do strength training while eating a lower calorie diet, it burns more fat tissue than muscle tissue. You need as much muscle mass as possible to keep your metabolism high. Exercise helps maintain it.

Circuit training, HIIT and strength training are super calorie burners. They not only burn calories while you’re doing them, they have an after burn that increases your metabolism for hours afterward.

Regular exercise can help keep you younger looking. It stimulates the body to create antioxidants that protect the cells from damage and ultimately death. Cell damage and death cause aging.

When you workout regularly, you’ll also boost your stem cell production. Stem cells are necessary to keep your body functioning and looking younger.

Working out burns off the hormones of stress, like cortisone. Cortisol is linked to the accumulation of abdominal fat.
#  光明日报副总编辑陆先高在第五届“政法系统新媒体应用案例”推选活动颁奖仪式暨研讨交流会上致辞 

光明日报副总编辑陆先高致辞。

**光明网讯** 6月14日，第五届“政法系统新媒体应用案例”推选活动颁奖仪式暨研讨交流会在京举行。会上，“优秀新媒体案例奖”和“最具影响力新媒体奖”揭晓，并为获奖单位代表颁奖；光明舆情发布《2017年政法系统新媒体应用蓝皮书》以及“政法大数据舆情分析系统”“政法新媒体监测系统”。

本次活动由光明日报社、公安部宣传局、最高人民检察院新闻办、最高人民法院新闻局、中央网信办移动网络管理局指导，光明网主办，新浪微博、今日头条、清博大数据提供数据支持。光明日报副总编辑陆先高、公安部宣传局副局长王志勇、最高人民检察院新闻办网宣处处长殷毅、最高人民法院新闻局网络处处长朱世亮等先后致辞，光明网总裁、总编辑杨谷，中央网信办移动网络管理局微传播处处长张琳等出席。**（光明网记者 李政葳、陈畅/文 李伯玺、李运恒/图）**