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糖尿病患者足溃疡减压指南(2023年更新版)——《国际糖尿病足工作组:糖尿病相关的足病预防与管理指南(2023)》的一部分

感染、炎症、修复 2024年第1期25卷 1-22页

作者： Sicco A.Bus David G.armstrong Ryan T.Crews Catherine Gooday Gustav Jarl Klaus Kirketerp-Moller Vijay Viswanathan Peter A.Lazzarini on behalf of the International Working Group on the Diabetic Foot 陈燕刘斌张晓诗邓武权(译) 王爱萍许樟荣(审校) Amsterdam UMC University of AmsterdamDepartment of Rehabilitation MedicineAmsterdamthe Netherlands Amsterdam Movement Sciences program Rehabilitation&DevelopmentAmsterdamthe Netherlands Southwestern Academic Limb Salvage Alliance(SALSA) Department of SurgeryKeck School of Medicine of University of Southern California(USC)Los AngelesCaliforniaUSA Dr.William M.Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research(CLEAR)at Rosalind Franklin University North ChicagoIllinoisUSA Elsie Bertram Diabetes Centre Norfolk and Norwich University HospitalsNorwichUK Department of Prosthetics and Orthotics Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden University Health Care Research Center Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden Copenhagen Wound Healing Center Bispebjerg University HospitalCopenhagenDenmark Steno Diabetes Center CopenhagenDenmark MV Hospital for Diabetes ChennaiIndia School of Public Health and Social Work Queensland University of TechnologyBrisbaneAustralia Allied Health Research Collaborative The Prince Charles HospitalBrisbaneAustralia 不详重庆大学附属中心医院重庆400014 东部战区空军医院糖尿病足中心江苏南京210002 战略支援部队特色医学中心北京100101

减轻组织的机械性压力在治愈糖尿病相关的足溃疡所需的多种干预措施中最为重要。本文是2023年国际糖尿病足工作组(IWGDF)发布的减压治疗促进糖尿病相关的足溃疡愈合的循证指南,也是对2019年IWGDF指南的更新。我们遵循推荐、评估、发展... 详细信息

减轻组织的机械性压力在治愈糖尿病相关的足溃疡所需的多种干预措施中最为重要。本文是2023年国际糖尿病足工作组(IWGDF)发布的减压治疗促进糖尿病相关的足溃疡愈合的循证指南,也是对2019年IWGDF指南的更新。我们遵循推荐、评估、发展和评价分级(GRADE)方法学,以患者-干预-比较-结局(patient-intervention-control-outcome,PICO)模式设计临床问题和重要结果,进行系统评价和Meta分析,制定评判表汇总,为每个问题编写推荐和理由。每项推荐都是基于系统综述中发现的证据,在无证据情况下则采用专家意见,以及对判断项目的GRADE等级总结进行仔细权衡,包括可预期和不可预期的影响、证据的确定性、患者价值、所需资源、成本效益、公平性、可行性和可接受性。为了治愈糖尿病患者神经性前足底或中足底溃疡,要使用不可拆卸的齐膝高减压装置作为首选减压干预措施。如果患者存在对不可拆卸减压装置的禁忌证或不能耐受,考虑使用可拆卸齐膝(或踝)高减压装置作为减压干预措施的第二选择。如果无可用的减压装置,考虑使用合适的鞋具结合毡制泡沫作为减压干预措施的第三选择。如果这种非手术减压治疗不能治愈前足底溃疡,可以考虑跟腱延长术、跖骨头切除术、关节置换术或跖骨截骨术。为了治疗继发于屈趾畸形的神经性足底或小趾远端溃疡,可行趾屈肌腱切开术。为了促进后足、非足底或并发感染或缺血的溃疡的愈合,提出了进一步的推荐。所有推荐都已在减压临床路径中进行了总结,以帮助促进本指南在临床实践中的实施。这些减压推荐将帮助医务人员为糖尿病相关的足溃疡患者提供最佳的治疗和预后,降低患者感染、住院和截肢的风险。

关键词：糖尿病足溃疡减压减压装置指南国际糖尿病足工作组

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Measurement and quantification of caking in excipients and food products with emphasis on the non-homogeneous interaction with ambient moisture

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Particuology 2021年第3期19卷 75-83页

作者： Katrina Brockbank Brian armstrong Jamie Clayton Freeman Technology Ltd 1 Miller CourtSevern DriveTewkesburyGloucestershireGL208DNUK

Whilst caking occurs via several different mechanisms,absorption and migration of moisture is frequently the most dominant mechanism within the food and pharmaceutical *** understanding the propensity to cake is important for minimising down-stream process issues,however most characterisation techniques assume that moisture induced caking occurs homogenously through the sample resulting in a uniformly caked powder *** this study,the effect of moisture induced caking on powder flowability was investigated using powder *** materials,including skimmed milk powder(SMP)and sulphated methyl ester(SME)were stored for several days under controlled humidity *** flow energies,a measure of the resistance to flow,were measured at 24 h intervals using an FT4 Powder *** the energy is measured as a function of the bed height,variations in the powder bed are also *** results demonstrated that caking does not always occur uniformly,instead a caked region(or crust)forms at the air-powder interface and then progresses through the powder ***,the strength of this caked region was shown to increase over several days before stabilising.

关键词： Powder Caking Crust formation Powder rheometry Relative humidity

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Detrital zircon U-Pb geochronology and geochemistry of the Riachuelos and Palma Sola beach sediments,Veracruz State,Gulf of Mexico:a new insight on palaeoenvironment

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Journal of Palaeogeography 2020年第4期9卷 495-521页

作者： John S.armstrong-Altrin Unidad de Procesos Oceánicos y Costeros Instituto de Ciencias del Mar y LimnologíaUniversidad Nacional Autónoma de MéxicoCiudad UniversitariaCiudad de México 04510México

Zircons are abundant in the beach *** this study,surface microtexture,mineralogy,bulk sediment geochemistry,trace element composition and U−Pb isotopic geochronology of detrital zircons collected from the Riachuelos and Palma Sola beach areas,southwestern Gulf of Mexico were performed to infer the sediment provenance and *** zircon microtexture was categorized as mechanically-and/or chemically-induced *** weathering index values for the Riachuelos(~72−77)and Palma Sola(~71−74)beach sediments indicated moderate weathering of both of the two source *** major and trace element data of bulk sediments suggested passive margin settings for the two *** trace elemental ratios and chondrite-normalized rare earth element(REE)patterns of bulk sediments revealed that the sediments were likely sourced by felsic and intermediate igneous *** the zircon Th/U ratios(mostly more than 0.2)and zircon REE patterns(with negative Eu and positive Ce anomalies)suggested a magmatic origin for both of the beach sediments from these two *** distinct zircon age peaks respectively belonging to the Paleozoic and the Cenozoic were identified both in the Riachuelos and Palma Sola beach *** geochronology comparison research between the Riachuelos−Palma Sola beach sediments and potential source areas in SW Gulf of Mexico revealed that the source terrane supplied the Paleozoic zircons of this study was identified as the Mesa Central Province(MCP),and the Cenozoic zircons were transported from the nearby Eastern Alkaline Province(EAP).Moreover,although the Precambrian zircons were very few in the studied sediments,their geochronology and geochemistry results still could infer that they were contributed by the source terranes of Grenvillian igneous suites in the Oaxaca and the Chiapas Massif Complexes.

关键词： Detrital zircon Beach sediment U-Pb dating Zircon grain morphology Microtexture Mineralogy Geochemistry Geochronology Gulf of Mexico

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Development of starch-based films reinforced with cellulosic nanocrystals and essential oil to extend the shelf life of red grapes

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Food Bioscience 2022年第3期47卷 403-412页

作者： Sneh Punia Bangar William Scott Whiteside Fatih Ozogul Kyle D.Dunno George armstrong Cavender Paul Dawson Department of Food Nutrition and Packaging SciencesClemson UniversitySC 29634USA Department of Seafood Processing Technology Faculty of FisheriesCukurova UniversityBalcaliAdana01330Turkey Department of Packaging Science Rochester Institute of TechnologyRochesterNYUSA

Packaging material has an important role in extending the shelf-life of *** study investigated the effectiveness of cellulose nanocrystals(CNCs)derived from Kudzu(Pueraria montana)vine to reinforce to starch-based *** addition,the essential oil was incorporated into these nanocomposite films to evaluate further improvement in film properties and *** packaging materials,including the pearl millet starch(PMS),PMS reinforced with Kudzu CNCs,and PMS reinforced with Kudzu CNCs stabilized pickering emulsion containing clove bud oil(CBO),was used to develop biodegradable nanocomposite *** films were investigated for their thermal,morphological,mechanical,and barrier *** addition,the films were used as packaging material to improve the shelf life of the grapes for 15 days at 5℃.PMS films reinforced with Kudzu CNCs stabilized pickering emulsion of CBO were most effective in extending the shelf life of red grapes up to 15 days at 5℃ by maintaining the weight,firmness,and soluble solids in grapes for a longer duration during *** study suggests that PMS+Kudzu CNCs+EO films have the potential for commercial packaging of fruits during short storage periods without adversely affecting their quality and sensory attributes.

关键词： Packaging material Nanocomposites Cellulose nanocrystals Red grapes Shelf life

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Optical domain digital-to-analog converter for visible light communications using LED arrays [Invited]

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Photonics Research 2013年第2期1卷 92-95页

作者： Jean armstrong Department of Electrical and Computer Systems Engineering Monash UniversityClaytonVictoria 3800Australia

In this paper,we describe a new type of digital-to-analog converter(DAC)for optical wireless *** occurs in the optical rather than the electrical *** overall intensity of the light transmitted by an array of light-emitting diodes(LEDs)is varied by changing the number of LEDs that are switched on.A number of different structures are described,and their compatibility with light dimming and overall energy efficiency are *** linearity of the new DAC depends on the geometry of the system and on the variability in light output between individual LEDs.

关键词： switched digital light

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HM-EH-RT:hybrid multimodal energy harvesting from rotational and translational motions

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International Journal of Smart and Nano Materials 2013年第4期4卷 257-285页

作者： miles Larkin Yonas Tadesse Department of Mechanical Engineering Erik Jonsson School of Engineering and Computer ScienceThe University of Texas at DallasRichardsonTX 75080USA

This paper presents a novel hybrid multimodal energy harvesting device consisting of an unbalanced rotary disk that supports two transduction methods,piezoelectric and *** device generates electrical energy from oscillatory motion either orthogonal or parallel to the rotary axis to power electronic *** models for the electromagnetic and piezoelectric systems were developed to describe the mechanical and electrical behavior of the *** these models,numerical simulations were performed to predict power generation *** device was fabricated,and several components were optimized *** energy harvester was then experimentally characterized using a modal shaker in several different *** device generates a maximum RMS power output of 120 mW from the electromagnetic system at 5 Hz and 0.8 g,and 4.23 mW from the piezoelectric system at 20.2 Hz and 0.4 g excitation *** device is 180 mm in diameter and 45 mm thick including the rotor *** size optimization will produce an energy harvester capable of being used as a wearable device to power mobile electronics for multiple applications.

关键词： energy harvesting piezoelectric electromagnetic wearable device multimodal

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Capturing, protecting and restoring plant diversity in the UK: RBG Kew and the Millennium Seed Bank

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Plant Diversity 2019年第2期41卷 124-131页

作者： Ted Chapman Stephanie miles Clare Trivedi Royal Botanic Gardens Kew

Ex situ seed banking is a practical and cost-effective means of preserving wild plant diversity and a crucial complement to the in situ conservation and restoration of species and habitats. As pressures on the natural environment have grown, so has the call for seed banks to provide scientifically-robust,practical solutions to seed-related problems in nature conservation, from single-species recovery and reintroduction to the restoration of complex, dynamic communities at the largest scales. In this paper, we discuss how the Royal Botanic Gardens, Kew and its Millennium Seed Bank have responded to this call in the United Kingdom. We demonstrate that banked seed collections can provide a range of otherwiseunavailable, high quality, known-origin, genetically-diverse biological materials. The data, expertise and specialist facilities that accompany these collections are also valuable, helping overcome constraints to the collection, production and effective use of native seed. Challenges remain-to ensure ex situ collections protect the species and genetic diversity that will enable plants to adapt to a changing environment, and to find new ways for seed banks to mobilise their resources at a landscape scale.

关键词： Seed banking Ex situ conservation Botanic garden Species-reintroduction Ecological restoration Native seed production

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Shared decision-making in stroke:an evolving approach to improved patient care

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Stroke & Vascular Neurology 2017年第2期2卷 84-87页

作者： Melissa J armstrong Department of Neurology University of Florida College of MedicineGainesvilleFloridaUSA

Shared decision-making(SDM)occurs when patients,families and clinicians consider patients’values and preferences alongside the best medical evidence and partner to make the best decision for a given patient in a specific *** is increasingly promoted within Western contexts and is also being explored outside such settings,including in *** and tools to promote SDM can improve patients’knowledge/understanding,participation in the decision-making process,satisfaction and trust in the healthcare *** has also proposed long-term benefits to patients,clinicians,organisations and healthcare *** successfully perform SDM,clinicians must know their patients’values and goals and the evidence underlying different diagnostic and treatment *** is relevant for decisions throughout stroke care,from thrombolysis to goals of care,diagnostic assessments,rehabilitation strategies,and secondary stroke *** physician,patient,family,cultural and system barriers to SDM *** to overcome these barriers and facilitate SDM include clinician motivation,patient participation,adequate time and tools to support the process,such as decision *** research about SDM in stroke care is lacking,decision aids are available for select decisions,such as anticoagulation for stroke prevention in atrial *** research is needed regarding both cultural aspects of successful SDM and application of SDM to stroke-specific contexts.

关键词： prevention overcome outside

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Composite Vernacular Constructions

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Built Heritage 2019年第4期3卷 26-40页

作者： miles Lewis University of Melbourne MelbourneAustralia

Vernacular building is the building for ordinary people,constrained by the practicalities of environmental conditions and physical materials,and influenced by traditional culture,but not mediated by professional architects and *** of earth and timber,such as wattle and daub,are found in the vernacular in almost every part of the world,but are a source of great confusion to archaeologists and *** are misled by the remains,in which the earth may have survived but the timber usually does *** such as Lehmwickel are never recognised in archaeological *** is no common system of naming or classification,and English speakers regularly describe any combination of earth and timber in walling as‘wattle and daub’.Many of these techniques have been changed by the impact of modern technology,notably pole and pug construction(which is often confused with wattle and daub,though it is quite different in principle);this is essentially a 19^(th) century development because it relies upon plentiful and cheap *** purpose of this paper is to establish a common terminology in English,and where possible in other relevant languages,so that misinterpretations are avoided and scholarship can proceed on an orderly basis.

关键词： mixed construction wattle and daub lath and pug Lehmwickel pole and pug nails

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Emerging Powers and Leadership Norms

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Fudan Journal of the Humanities and Social Sciences 2020年第1期13卷 7-27页

作者： miles Kahler School of International Service American University4400 Massachusetts Avenue NWWashingtonDC 20016-8071USA Council on Foreign Relations New YorkNYUSA

Leadership is a notoriously ambiguous term in international politics,one with meanings that range from disguised hegemony or domination on the one hand to purely consensual coalition-building and the provision of focal points for collective action on the *** term usually has positive normative content(leadership is viewed as necessary for global governance to succeed),but the form that leadership takes-the mix of instruments that are deployed,whether a single leader is necessary or collective leadership is possible-varies over time and across *** global leadership by the USA is called into question,the leadership norms advanced by emerging powers represent different formulas that may ultimately be transferred to the global *** in South America,Germany in Europe,India in South Asia,and China in East Asia demonstrate specific types of leadership that may coincide or clash as their roles in global governance grow in importance.

关键词： Leadership Leaders Norms Regional Emerging powers

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