基于CREAM方法的海上风机安装人因可靠性评估

采用认知可靠性和差错分析法(Cognitive Reliability and Error Analysis Method,CREAM)对固定式海上风机安装作业的人因可靠性进行评估,并引入结构熵权法和马尔可夫方法对传统CREAM进行改进,实现人因差错概率、平均人为差错时间等人因可靠性指标的定量计算。在充分结合现实条件的情况下,考虑海上风机安装的天气、海浪和操作水平等环境和人为因素的影响,针对固定式海上风机安装作业的要求和特点,结合作业人员可靠性评估结果,从操作素质、组织管理、环境改善等方面提出发展建议。

Enhancing Erectile Function and Alleviating Andropause Symptoms: Clinical Efficacy of a Human Stem Cell Conditioned Medium Cream

Erectile dysfunction (ED) is increasingly prevalent in Japan, exceeding 30%, and increasing with age. Unhealthy lifestyle habits, obesity, insufficient exercise, and smoking have been implicated in its pathogenesis, along with endothelial dysfunction of the corpora cavernosa and impaired blood flow to the penis considered underlying factors. However, the current treatments are limited to Phosphodiesterase-5 (PDE5) inhibitors. ED is the primary symptom of andropathy. This study reports the clinical efficacy of human stem cell-conditioned medium cream for ED treatment. Ten men without underlying diseases suspected of andropause with ED (mean age 43.2 ± 4.4 y, Hb 15.2 ± 0.6 gm/dL, AST/ALT 30.2/37.9 ± 12.4/14.0, eGFR 82.7 ± 12.4 mL/min/1.73 m2) were targeted. The cream was applied twice daily to the genital and scrotal areas. The erectile hardness score (EHS), International Index of Erectile Function-5 (IIEF-5), and Aging Male Symptoms (AMS) scale were used to evaluate the participants before and 30 days after use, and the results were compared using paired t-tests. The post-use qualitative opinions were collected through interviews. Significant improvements were observed compared to baseline in the IIEF-5 (11.8 ± 4.6→17.2 ± 5.1, P < 0.001), and AMS (46.3 ± 6.7→37.6 ± 5.3, P < 0.001) scores post cream use. EHS did not show a statistically significant difference, but a trend towards improvement was observed. Qualitative feedback included increased morning erection, improved maintenance of erection during intercourse, and reduced post work fatigue. Human stem cell-conditioned medium contains endothelial growth factors that potentially contribute to the improvement of ED and andropause by enhancing corporal endothelial function. Future studies should include control groups to further investigate the efficacy of these treatments.

STPA和CREAM方法在飞行冲突调配人因差错研究中的应用

为了研究管制员飞行冲突调配的人因差错问题,进而有效评估管制员解决飞行冲突的可靠性,以保障空中交通的安全运行,提出系统理论过程分析(System Theoretic Process Analysis, STPA)与认知可靠性与失误分析方法(Cognitive Reliability and Error Analysis Method, CREAM)相结合的人因可靠性分析方法。首先,通过STPA方法构建系统控制模型,识别不安全控制行为(Unsafe Control Action, UCA)以及致因因素,找到管制员在调配飞行冲突过程中可能存在的差错行为;其次,基于CREAM扩展法对管制员的差错行为进行定量分析,得到管制员调配飞行冲突的人因失误概率。研究显示:使用该方法能够系统、全面地识别出管制员在调配飞行冲突过程中出现的差错行为,进而计算管制员飞行冲突调配的人因失误概率。实例分析表明该方法可以预测管制员在飞行冲突调配过程中的人因失误概率及可靠性,为管制员人因可靠性分析提供了新思路。

An Improved CREAM Model Based on DS Evidence Theory and DEMATEL

Cognitive Reliability and Error Analysis Method(CREAM)is widely used in human reliability analysis(HRA).It defines nine common performance conditions(CPCs),which represent the factors thatmay affect human reliability and are used to modify the cognitive failure probability(CFP).However,the levels of CPCs are usually determined by domain experts,whichmay be subjective and uncertain.What’smore,the classicCREAMassumes that the CPCs are independent,which is unrealistic.Ignoring the dependence among CPCs will result in repeated calculations of the influence of the CPCs on CFP and lead to unreasonable reliability evaluation.To address the issue of uncertain information modeling and processing,this paper introduces evidence theory to evaluate the CPC levels in specific scenarios.To address the issue of dependence modeling,the Decision-Making Trial and Evaluation Laboratory(DEMATEL)method is used to process the dependence among CPCs and calculate the relative weights of each CPC,thus modifying the multiplier of the CPCs.The detailed process of the proposed method is illustrated in this paper and the CFP estimated by the proposed method is more reasonable.

基于CREAM和AHP的残疾人驾驶员人因可靠性分析

依据我国残疾人驾驶机动车辆现状,提出一种基于AHP的残疾人驾驶车辆人因可靠性分析方法。根据残疾人应对道路交通突发事件时需要执行的任务,改进CPC因子;针对人因可靠性分析法存在的片面性问题,采用层次分析法建立CPC因子网络层次结构,计算其权重,对残疾人驾驶员执行应对道路交通突发事件的任务的人因失误概率进行预测。研究结果表明,从方法的科学性性和可行性角度分析,改进后的CREAM方法研究该问题更具优势。

人因可靠性评价的改进加权BN-CREAM模型

传统认知可靠性与失误分析方法 (cognitive reliability and error analysis method,CREAM)存在诸多缺陷,导致适用面较窄,但仍具有较大的开发潜力。为提高方法评价的精度和扩展其适用性,提出一种改进加权的贝叶斯网络(Bayesian network,BN)与CREAM方法相结合的模型。该模型首先使用灰色关联法与决策实验室分析法获取在场景下因子的权重,再利用贝叶斯网络推理得到调整后的共同绩效条件因子节点概率分布;然后将加权后的因子进行抽样仿真,得到在该场景下人所处控制模式的概率分布。选用1 800 W定制种子电源的案例,通过分析评估结果,再对比其他方法,验证了模型的有效性和可行性。改进后模型的适用性更广,输出结果更客观,为人因可靠性评价指标体系的构建提供参考。

基于CREAM的管线打开作业人因失误事故研究

为提升管线打开作业的人因可靠性,深入探讨管线打开作业人因失误事故发生的根原因,基于认知可靠性和失误分析方法(CREAM),建立了管线打开作业人因失误模型,将失误模式划分为疏忽、擅自、错误、违反,建立了涵盖环境、人、信息、组织、危险源、技术6个方面的前因分类表和后果—前因追溯表,追溯分析人因失误的根原因,并运用扩展法对人因失误的发生概率进行定量预测。将模型应用于管线打开作业人因失误事故实例分析,结果显示:追溯到事故发生的根原因与员工个性缺陷、管理问题、安全意识欠缺等方面相关;获得3个人因失误事件的人因失误概率值分别为0.006、0.04、0.006;并提出了有针对性的建议、措施。

改进贝叶斯网络模型在起重作业人机交互差错风险分析中的应用

为量化分析起重作业人机交互差错风险,根据安全工效学原理及安全技术规范将起重作业人、机、环相关影响因素作为根节点,按照事故致因层次关联关系确定子节点,构建起重作业人机交互差错的3层级贝叶斯网络模型(Bayesian Network, BN);基于模糊集理论,采用认知可靠性与失误分析方法(Cognitive Reliability and Error Analysis Method, CREAM),厘定贝叶斯网络父节点失效概率以及中间节点条件概率;利用逆向推理仿真技术分析起重作业人机交互差错发生的因果链,探究起重伤害事故发生的人机交互差错风险。结果表明:起重作业人机交互差错最可能致因链为起重设备安全检查不到位→管理人员失误→人员操作失误→起重伤害事故发生;单因素失效条件下,起重作业人机交互差错风险概率呈线性增长趋势;在多因素失效条件下,一级节点因素失效概率愈大则人机交互差错效应愈显著,且呈现非线性增长态势。

Effect of Soursop Puree and Gum Arabic on the Sensory Properties of Non-Dairy Coconut Milk-Based Ice Cream

Coconut (Cocos nucifera) milk-based ice cream is one of the innovative non-dairy milk products gaining popularity among consumers. The objective was to develop coconut milk-based ice cream incorporated with soursop (Annona muricata) fruit puree and gum Arabic from Acacia senegal var. kerensis, conduct a sensory evaluation using descriptive tests by trained panelists (n = 9) then evaluate for consumer acceptability by semi trained panelists (n = 30). A seven-point hedonic scale for colour, taste, flavour, texture and overall acceptability was used. The data obtained was subjected to analysis of variance (ANOVA) and the means were separated to determine their significance differences. Principal Component Analysis (PCA) was done for factor reduction to make it easy for the multi-dimensional descriptive data to be interpreted. PCA results indicated that unit increase in soursop and gum Arabic in the ice cream led to 83.1% increase in starchy taste, 78.3% increase in consistency and 73.6% decrease in coconut aroma. For consumer acceptability test, the obtained results showed that, soursop puree addition at successive levels led to a statistically significant effect (p < 0.05) on colour, flavour, texture, taste and overall acceptability while of gum Arabic incorporation was not significant (p > 0.05) for all attributes. The effect due to interaction between gum Arabic and soursop puree at the different levels however was significant for colour, flavour and texture but not significant for taste and overall acceptability. Our results therefore point to a potential application of soursop fruit and gum Arabic as alternative ingredients in the manufacture of a non-dairy ice cream with desirable sensory properties that would expand the variety of options consumers can choose from.

Textural and functional analysis of sorghum flour cookies as ice cream inclusions

Flour serves as one of the primary ingredients of cookies,which affects dough properties,physical changes during baking,and post-baking cookie properties.Two gluten-free cookie formulations were developed with the goal of use as inclusions in frozen desserts.Blonde and chocolate cookies were made with sorghum flour or all-purpose wheat flour and then evaluated for physical and chemical properties.To determine functionality in a frozen state,texture analysis was conducted on cookies at−30℃,−17°C,and 20℃,replicating various ice cream storage temperatures.To simulate the process effect of incorporating the product into a frozen dessert,cookies were crumbled mechanically,and the crumbles were separated based on size.When evaluating cookies,no significant differences(P<0.05)were observed in width(W),thickness(T),spread,and W/T ratio for flour source within formula.Blonde cookies had lower moisture contents than chocolate cookies;further,blonde cookies made from sorghum flour had less moisture than those made with wheat flour.As the cookie temperature decreased from 20℃to−17℃,cookie hardness increased,with flour type having no effect.Within formula,cookies had similar instrumental color parameters.However,blonde cookies made from sorghum flour produced more smaller-sized pieces than those made from wheat flour.The results of this study demonstrate that sorghum flour cookies have desirable properties for use as inclusions in ice cream and other frozen desserts.

基于CREAM追溯法的变电运行人因失效分析

文章以GREAM追溯法为基础对人为因素给电力系统造成的影响进行研究分析,构建变电站运行人为故障模型,创建真正适用于变电运行人因失效事故分析的方法,以期为电力系统中变电运行安全保障体系的整体构建提供理论支持。

基于组合赋权的压裂作业人因失误概率研究

压裂作业强度大,环境恶劣,长时间枯燥的作业容易诱发人因失误,造成事故,分析压裂现场人因可靠性对于提升压裂作业的安全和效率具有重要意义。在考虑压裂现场情境因素影响基础上,提出了一种组合赋权模糊人因可靠性分析方法,用以评估压裂现场人因失误概率。首先,通过对压裂现场的调研分析,结合压裂作业情境环境特点,基于认知可靠性与失误分析方法(CREAM)建立了适用于评估压裂作业的一级共同绩效条件CPC 8个,二级CPC因子评估指标36个。其次,根据实际工况中各CPC对人的绩效可靠性的影响程度不同,提出以差异系数法确定线性组合系数,基于序关系法与熵权法对各项评估指标进行主客观线性组合赋权。最后,利用本文方法分析四川某页岩气压裂作业现场人因失误概率,结果表明,较一般模糊CREAM方法,在不同情境环境下,随着情境环境水平的下降,组合赋权模糊CREAM方法对CPC评价数据敏感度更高,人因失误概率增加,并且变化速率加快,这与现场实际工况一致,为压裂现场的人因可靠性分析和人因失误概率量化结果优化提供了参考。

妇安消疹洗液三联法治疗神经性皮炎的疗效

目的观察妇安消疹洗液三联法治疗神经性皮炎的疗效。方法选取2019年1月—2020年12月十堰市太和医院皮肤病中心收治的神经性皮炎患者166例,按照年龄排序以随机数字表法分为观察组和对照组,各83例。对照组在皮损处涂抹糠酸莫米松乳膏治疗,观察组在对照组基础上在皮损处涂抹妇安消疹洗液与白及多糖乳膏治疗,1周为1个疗程,2组均连续治疗3周。比较2组疗效,治疗前后血清组胺、白介素-5(IL-5)水平、湿疹面积及严重度指数(EASI)、皮肤病生活质量指数(DLQI),不良反应及随访3个月后复发率。结果观察组总有效率为89.16%,高于对照组的66.26%(χ^(2)=14.299,P=0.003)。治疗3周后,2组血清组胺、IL-5水平低于治疗前,且观察组低于对照组(P<0.01);2组EASI评分低于治疗前,DLQI评分高于治疗前,且观察组降低或升高幅度大于对照组(P<0.01)。2组治疗期间均无明显不良反应发生;随访3个月后,观察组复发率为4.82%(4/83),对照组复发率为8.43%(7/83),2组比较差异无统计学意义(χ^(2)=5.725,P=0.221)。结论妇安消疹洗液、白及多糖乳膏配合糠酸莫米松乳膏治疗神经性皮炎效果显著,可有效降低炎性反应,改善患者临床症状及生活质量,且不良反应少,复发率低。

国医大师张大宁教授以膏方辨治阴虚型慢性肾脏病经验总结

慢性肾脏病逐渐成为临床最常见的慢性疾病之一,严重影响了人民群众的身体健康,国医大师张大宁教授作为中医肾脏病的奠基人,在长期的临床实践中,最早提出了“肾虚血瘀论”并首创“补肾活血法”,同时将补肾活血法融入膏方之中来治疗阴虚型慢性肾脏病。文章总结了张大宁教授利用膏方治疗慢性肾脏病的经验,供读者参考。

0.03%他克莫司软膏联合多磺酸粘多糖乳膏治疗面部单纯糠疹的效果观察

目的:观察探讨0.03%他克莫司软膏联合多磺酸粘多糖乳膏治疗面部单纯糠疹的美学效果。方法:选取2019年11月-2022年1月门诊收治的105例面部单纯糠疹患儿为观察对象,通过随机数字法随机分为联合组(n=53)和对照组(n=52),对照组给予多磺酸粘多糖乳膏治疗,联合组在对照组基础上加用0.03%他克莫司软膏治疗,比较两组治疗后的临床疗效、症状体征评分、皮肤生理功能指标[角质层含水量(Water content of stratum corneum,WCSC)、皮肤油脂(Skin sebum,SC)、经表皮水分流失(Transepidermal water loss,TEWL)]、复发情况、不良反应及美学效果满意度。结果:治疗4周后,联合组总有效率为88.68%,对照组为71.15%,差异有统计学意义(P<0.05)。治疗前两组患儿各项症状体征评分差异均无统计学意义(P>0.05);治疗4周后,两组患儿鳞屑、瘙痒、色素减退、皮损面积及皮损数量评分均较治疗前显著降低(P<0.05),且联合组各症状体征评分明显低于对照组(P<0.05);治疗前两组患儿皮肤生理功能指标差异均无统计学意义(P>0.05);治疗4周后,两组患儿WCSC和SC均显著升高(P<0.05),TEWL均显著降低(P<0.05),且联合组改善优于对照组(P<0.05);结束治疗随访4周,联合组患儿复发率(14.89%)低于对照组(27.03%),差异无统计学意义(P>0.05);治疗期间,两组患儿均未出现明显不良反应;联合组患儿美学效果总满意度(96.23%)显著高于对照组(82.69%)(P<0.05)。结论:0.03%他克莫司软膏联合多磺酸粘多糖乳膏治疗面部单纯糠疹疗效显著,可有效改善患儿皮损症状和皮肤生理功能,能有效预防复发,提高美学效果,且安全性好,值得临床推广应用。

止疼膏1号外敷治疗肺癌癌痛患者的临床观察

目的 观察止疼膏1号外敷痛点及穴位治疗肺癌癌痛患者的临床疗效。方法 选取2022年1月—2022年12月期间山东省昌乐人民医院收治的80例肺癌患者作为研究对象,按随机数字表法分为对照组和观察组,每组各40例。对照组仅采用规范的三阶梯止痛方案,观察组在接受三阶梯止痛方案治疗的基础上,采用止疼膏1号外敷痛点及穴位。治疗2周后,观察比较两组患者临床疗效、不良反应情况,治疗前后疼痛程度[数字疼痛分级法(Numberical rating scale, NRS)]、生活质量[肺癌治疗功能评价系统(Functional Assessment of Cancer Therapy-Lungcancer, FACT-L)]评分。结果 治疗后观察组总有效率87.50%(35/40)高于对照组67.50%(27/40),差异有统计学意义(P<0.05)。治疗后两组患者NRS评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组NRS评分均较对照组同期明显降低,差异有统计学意义(P<0.05)。治疗后两组患者FACT-L评分均较治疗前升高,差异有统计学意义(P<0.05);且观察组FACT-L评分明显高于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论 止疼膏1号外敷治疗具有协同止痛作用,能够有效减轻肺癌癌痛患者的疼痛程度,提高肺癌患者的生活质量。

响应面优化法制备“腾药”乳膏及其镇痛作用研究

目的:将“腾药”熥剂制备为“腾药”乳膏,并对比研究“腾药”熥剂和“腾药”乳膏的镇痛作用,为“腾药”熥剂的开发利用提供参考。方法:通过单因素筛选和Box-Behnken响应面法,筛选出“腾药”乳膏基质的最佳处方工艺,以乳膏的外观均匀性、离心稳定性、涂布延展性、耐寒稳定性、耐热稳定性5个方面作为评价指标对制备的“腾药”乳膏进行综合评价;运用醋酸扭体法、甲醛致痛模型、热板法对比研究“腾药”熥剂和“腾药”乳膏的镇痛作用。结果:最佳“腾药”乳膏处方为载药量0.29 g,硬脂酸用量0.91 g,单硬脂酸甘油酯用量0.50 g。“腾药”乳膏与“腾药”熥剂在醋酸扭体法中疼痛抑制率分别为28.77%、28.74%;甲醛致痛模型实验中“腾药”乳膏第I相、第Ⅱ相小鼠平均累计舔足时间分别为28.83 s、36.00 s;“腾药”熥剂第I相、第Ⅱ相小鼠平均累计舔足时间分别为30.17 s、38.25 s;热板法实验中“腾药”乳膏痛阈提高百分率为90.54%,“腾药”熥剂痛阈提高百分率为69.87%。结论:“腾药”乳膏制备工艺可行,其镇痛效果与“腾药”熥剂相当。

重组人干扰素α-2b乳膏治疗小儿传染性软疣的临床效果

目的 探讨重组人干扰素α-2b乳膏治疗小儿传染性软疣的临床效果。方法 选取2022年3月至2023年3月在滨州市中心医院皮肤科就诊的84例传染性软疣患儿作为研究对象,按照奇偶分组法分为参照组(42例)与试验组(42例)。参照组采用夹疣治疗,试验组采用重组人干扰素α-2b乳膏治疗。比较两组治疗效果及复发情况。结果 试验组总有效率高于参照组,复发率低于参照组(P <0.05)。结论 重组人干扰素α-2b乳膏治疗小儿传染性软疣的临床效果较好,复发率较低,值得临床推广应用。

甲硝唑片和保妇康凝胶联合普罗雌烯乳膏治疗老年性阴道炎的效果及对炎性因子水平的影响

目的分析甲硝唑片和保妇康凝胶联合普罗雌烯乳膏治疗老年性阴道炎的效果及对炎性因子的影响。方法选取2022年1月—2023年8月靖江市人民医院门诊接诊的86例老年性阴道炎患者为研究对象,以随机数表法分为观察组和对照组,各43例。观察组患者实施甲硝唑片和保妇康凝胶联合普罗雌烯乳膏治疗,对照组患者实施甲硝唑片及保妇康凝胶治疗,对比两组患者治疗总有效率、炎性因子水平、生活质量。结果观察组治疗总有效率为97.67%,高于对照组的81.40%,差异有统计学意义(χ^(2)=4.468,P<0.05)。干预后,观察组白细胞介素-6、肿瘤坏死因子-α、C反应蛋白分别为(48.27±12.84)ng/L、(72.63±2.42)ng/L、(30.26±8.34)mg/L,均低于对照组,差异有统计学意义(t=2.875、14.853、11.212,P均<0.05)。结论给予门诊老年性阴道炎患者甲硝唑片和保妇康凝胶联合普罗雌烯乳膏治疗效果更优,可显著改善患者症状,降低炎性因子水平。

降脂膏联合瑞舒伐他汀钙片治疗颈动脉易损斑块痰瘀互结证

目的探讨降脂膏联合瑞舒伐他汀钙片治疗颈动脉易损斑块痰瘀互结证临床疗效。方法按照随机数字表法将120例颈动脉易损斑块痰瘀互结证患者分成对照组与观察组,各60例。对照组采用瑞舒伐他汀钙片治疗,观察组在对照组基础上联合降脂膏治疗。观察2组治疗前后眩晕、头痛、耳鸣、肢体疼痛或麻木、胸胀中医证候积分、颈动脉超声相关指标IMT值、颈动脉斑块面积、颈总动脉收缩期Vmax、舒张期Vmin、颈总动脉RI、血清学指标肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、hs-CRP、血脂水平、凝血指标凝血酶原时间(PT)、D-二聚体、凝血酶原国际标准化比(INR)水平变化,比较2组治疗总有效率及安全性。结果观察组治疗后各项中医证候积分、IMT值、颈动脉斑块面积、颈总动脉RI、TNF-α、IL-6、hs-CRP、TG、TC、LDL-C、PT、D-二聚体、INR水平均低于对照组(P<0.05),颈总动脉收缩期Vmax、舒张期Vmin、HDL-C水平及治疗总有效率均高于对照组(P<0.05);2组治疗期间均无明显不良反应发生。结论降脂膏联合瑞舒伐他汀钙片能够显著缓解颈动脉易损斑块痰瘀互结证症状,降低血脂指标、血液高凝态、炎症因子,改善颈动脉血流速度。