The performances of ceramic inserts in cutting nickel-based alloy were investigated. A new cutting test-bed was devised and used to deburr. The burr height on the working surface with notch wear in deburring cutting w...The performances of ceramic inserts in cutting nickel-based alloy were investigated. A new cutting test-bed was devised and used to deburr. The burr height on the working surface with notch wear in deburring cutting was compared with that in normal cutting. The impact force, impact pressure, and impact frequency of the saw-tooth-shaped chip edge on rake face and cutting edge at different speeds were calculated, and the influence of chip edge on notch wear formation was analyzed. A new tool design for reducing notch wear was presented, which is flexible and can deburr effectively.展开更多
Manufacture is facing more furiously competition in the new century. It tends to be globalized. Rapid response and technology innovation have become the key factor to the success of manufacture enterprise. At present,...Manufacture is facing more furiously competition in the new century. It tends to be globalized. Rapid response and technology innovation have become the key factor to the success of manufacture enterprise. At present, internet-based manufacturing develops rapidly. With the development of engineering material and machining techniques, better cutting properties of metal cutting tools are required. The world is paying more attention to the study of indexable carbide inserts with three-dimensional complex grooves which can affect cutting properties directly and chip-controlling. So the variety and specification of indexable insert develop quickly and the application of insert with three-dimensional complex chip-former becomes wider and wider. Because milling is an interrupted cutting, the process of milling is complicated and the failure of the milling inserts is severe. It is important to choose suitable milling inserts groove for particular machining conditions before actual machining, it will extend tool life and raise productivity. Optimization and choice of inserts with complex groove via internet may serve for manufacture enterprises all over the world. The milling inserts with three-dimensional complex grooves are optimized and chosen via Internet in this paper. The face-milling process is studied, with the mathematics models of cutting force for different shape of cutting edges established, the cutting forces predicted and stress-fields of different insert grooves analyzed by FEM, according to the predictable results and the most suitable insert groove for particular machining conditions are optimized and chosen. The complex groove optimization and choice are based on a client/server model, with the client and server being on different machines across the internet. Communication between the client and server uses the TCP/IP. The result of optimization and choice will be sent to the users via Internet. Manufacturers all over the world can get the desired insert groove without paying for expensive experiments. Thus, the cost and lead time of products are reduced.展开更多
目的检索、评价和总结住院患儿鼻胃管置管的最佳证据,为临床护理提供依据。方法系统检索BMJ、UpToDate、Cochrane Library、JBI循证卫生保健中心数据库、PubMed、Ovid、Web of Science、中国生物医学文献数据库、中国知网、万方数据库...目的检索、评价和总结住院患儿鼻胃管置管的最佳证据,为临床护理提供依据。方法系统检索BMJ、UpToDate、Cochrane Library、JBI循证卫生保健中心数据库、PubMed、Ovid、Web of Science、中国生物医学文献数据库、中国知网、万方数据库、医脉通中英文数据库以及美国肠外肠内营养学会网站、欧洲肠外肠内营养学会网站中住院患儿鼻胃管置管的相关证据,包括临床决策、最佳实践、指南、专家共识、证据总结和系统评价。检索时限为各数据库建库至2024年12月。对文献进行质量评价、证据提取和汇总。结果共纳入10篇文献,包括指南2篇、专家共识3篇、证据总结4篇和系统评价1篇。形成置管人员、置管前准备、胃管选择、胃管留置、胃管末端位置确认、胃管固定、胃管更换、上报失误8个方面共23个条目的最佳证据。结论本研究汇总了住院患儿鼻胃管置管的最佳证据,可为临床医护人员准确置管提供循证依据,减少置管并发症,提高置管成功率。展开更多
目的对比经外周静脉穿刺置入中心静脉导管(Peripherally Inserted Central Catheter,PICC)带量采购前后的临床使用情况及患者治疗费用,为优化临床决策、完善医用耗材带量采购政策提供参考。方法通过关键知情人访谈收集PICC带量采购前后...目的对比经外周静脉穿刺置入中心静脉导管(Peripherally Inserted Central Catheter,PICC)带量采购前后的临床使用情况及患者治疗费用,为优化临床决策、完善医用耗材带量采购政策提供参考。方法通过关键知情人访谈收集PICC带量采购前后的临床使用情况,基于文献回顾、关键知情人访谈等构建PICC整体费用模型,采用Kruskal-Wallis检验对患者整体治疗费用进行分析。结果通过护士访谈,带量后的PICC实际平均留置时间相较于带量前平均留置时间缩短10.77%、穿刺时间增加14.21%、置管后导致的并发症或不良反应发生率相对带量前均有不同程度的上升;PICC带量采购前后患者的住院费用、卫材费差异均有统计学意义(P<0.05)。带量采购后的PICC单价和均次置管总费用明显下降,但均次并发症费用呈上升趋势,差异均有统计学意义(P<0.05)。结论带量采购后,PICC的质量及临床使用情况并不十分理想。建议各医疗主体加强对医用耗材带量采购前、中、后的质量评估体系建设和临床使用监测,系统分析患者治疗费用,逐步建立针对医用耗材带量采购的质量和整体费用评价标准,进一步完善医用耗材带量采购体系。展开更多
经外周静脉置入中心静脉导管（peripherally inserted central catheters,PICC）是一种经肘前外周静脉穿刺置入上腔静脉处的深静脉置管技术。PICC因具有操作简单、安全、成功率高等优点而被广泛应用于临床,但是PICC也存在一些并发症如...经外周静脉置入中心静脉导管（peripherally inserted central catheters,PICC）是一种经肘前外周静脉穿刺置入上腔静脉处的深静脉置管技术。PICC因具有操作简单、安全、成功率高等优点而被广泛应用于临床,但是PICC也存在一些并发症如感染、静脉炎、导管堵塞、导管异位、静脉栓塞等。穿刺点发生渗液也是一种并发症,渗液发生后需要频繁更换贴膜,不仅增加了护士的工作量,也加重了患者的经济负担,有的患者无法耐受因此带来的种种不便而提前拔管。展开更多
文摘The performances of ceramic inserts in cutting nickel-based alloy were investigated. A new cutting test-bed was devised and used to deburr. The burr height on the working surface with notch wear in deburring cutting was compared with that in normal cutting. The impact force, impact pressure, and impact frequency of the saw-tooth-shaped chip edge on rake face and cutting edge at different speeds were calculated, and the influence of chip edge on notch wear formation was analyzed. A new tool design for reducing notch wear was presented, which is flexible and can deburr effectively.
文摘Manufacture is facing more furiously competition in the new century. It tends to be globalized. Rapid response and technology innovation have become the key factor to the success of manufacture enterprise. At present, internet-based manufacturing develops rapidly. With the development of engineering material and machining techniques, better cutting properties of metal cutting tools are required. The world is paying more attention to the study of indexable carbide inserts with three-dimensional complex grooves which can affect cutting properties directly and chip-controlling. So the variety and specification of indexable insert develop quickly and the application of insert with three-dimensional complex chip-former becomes wider and wider. Because milling is an interrupted cutting, the process of milling is complicated and the failure of the milling inserts is severe. It is important to choose suitable milling inserts groove for particular machining conditions before actual machining, it will extend tool life and raise productivity. Optimization and choice of inserts with complex groove via internet may serve for manufacture enterprises all over the world. The milling inserts with three-dimensional complex grooves are optimized and chosen via Internet in this paper. The face-milling process is studied, with the mathematics models of cutting force for different shape of cutting edges established, the cutting forces predicted and stress-fields of different insert grooves analyzed by FEM, according to the predictable results and the most suitable insert groove for particular machining conditions are optimized and chosen. The complex groove optimization and choice are based on a client/server model, with the client and server being on different machines across the internet. Communication between the client and server uses the TCP/IP. The result of optimization and choice will be sent to the users via Internet. Manufacturers all over the world can get the desired insert groove without paying for expensive experiments. Thus, the cost and lead time of products are reduced.
文摘目的检索、评价和总结住院患儿鼻胃管置管的最佳证据,为临床护理提供依据。方法系统检索BMJ、UpToDate、Cochrane Library、JBI循证卫生保健中心数据库、PubMed、Ovid、Web of Science、中国生物医学文献数据库、中国知网、万方数据库、医脉通中英文数据库以及美国肠外肠内营养学会网站、欧洲肠外肠内营养学会网站中住院患儿鼻胃管置管的相关证据,包括临床决策、最佳实践、指南、专家共识、证据总结和系统评价。检索时限为各数据库建库至2024年12月。对文献进行质量评价、证据提取和汇总。结果共纳入10篇文献,包括指南2篇、专家共识3篇、证据总结4篇和系统评价1篇。形成置管人员、置管前准备、胃管选择、胃管留置、胃管末端位置确认、胃管固定、胃管更换、上报失误8个方面共23个条目的最佳证据。结论本研究汇总了住院患儿鼻胃管置管的最佳证据,可为临床医护人员准确置管提供循证依据,减少置管并发症,提高置管成功率。
文摘目的对比经外周静脉穿刺置入中心静脉导管(Peripherally Inserted Central Catheter,PICC)带量采购前后的临床使用情况及患者治疗费用,为优化临床决策、完善医用耗材带量采购政策提供参考。方法通过关键知情人访谈收集PICC带量采购前后的临床使用情况,基于文献回顾、关键知情人访谈等构建PICC整体费用模型,采用Kruskal-Wallis检验对患者整体治疗费用进行分析。结果通过护士访谈,带量后的PICC实际平均留置时间相较于带量前平均留置时间缩短10.77%、穿刺时间增加14.21%、置管后导致的并发症或不良反应发生率相对带量前均有不同程度的上升;PICC带量采购前后患者的住院费用、卫材费差异均有统计学意义(P<0.05)。带量采购后的PICC单价和均次置管总费用明显下降,但均次并发症费用呈上升趋势,差异均有统计学意义(P<0.05)。结论带量采购后,PICC的质量及临床使用情况并不十分理想。建议各医疗主体加强对医用耗材带量采购前、中、后的质量评估体系建设和临床使用监测,系统分析患者治疗费用,逐步建立针对医用耗材带量采购的质量和整体费用评价标准,进一步完善医用耗材带量采购体系。
文摘经外周静脉置入中心静脉导管（peripherally inserted central catheters,PICC）是一种经肘前外周静脉穿刺置入上腔静脉处的深静脉置管技术。PICC因具有操作简单、安全、成功率高等优点而被广泛应用于临床,但是PICC也存在一些并发症如感染、静脉炎、导管堵塞、导管异位、静脉栓塞等。穿刺点发生渗液也是一种并发症,渗液发生后需要频繁更换贴膜,不仅增加了护士的工作量,也加重了患者的经济负担,有的患者无法耐受因此带来的种种不便而提前拔管。
