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男性，31岁，行走不慎跌入下水井缘骑跨伤后6小时，会阴区疼痛剧烈，不能坐和行走。伤后不能自行排尿。检查：骨盆挤压分离试验(+)。 最可能出现骨折或脱位的部位是
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For more than a decade, the prevailing view of innovation has been that little guys had the edge. Innovation bubbled up from the bottom, from upstarts and insurgents. Big companies didn’t innovate, and government got in the way. In the dominant innovation narrative, venture-backed start-up companies were cast as the nimble winners and large corporations as the sluggish losers.There was a rich vein of business-school research supporting the notion that innovation comes most naturally from small-scale outsiders. That was the headline point that a generation of business people, venture investors and policy makers took away from Clayton M. Christensen’s 1997 classic, The Innovator’s Dilemma, which examined the process of disruptive change.But a shift in thinking is under way, driven by altered circumstances. In the United States and abroad, the biggest economic and social challenges—and potential business opportunities—are problems in multifaceted fields like the environment, energy and health care that rely on complex systems.Solutions won’t come from the next new gadget or clever software, though such innovations will help. Instead, they must plug into a larger network of change shaped by economics, regulation and policy. Progress, experts say, will depend on people in a wide range of disciplines, and collaboration across the public and private sectors."These days, more than ever, size matters in the innovation game," said John Kao, a former professor at the Harvard business school and an innovation consultant to governments and corporations. In its economic recovery package, the Obama administration is financing programs to generate innovation with technology in health care and energy. The government will spend billions to accelerate the adoption of electronic patient records to help improve care and curb costs, and billions more to spur the installation of so-called smart grids that use sensors and computerized meters to reduce electricity consumption.In other developed nations, where energy costs are higher than in the United States, government and corporate projects to cut fuel use and reduce carbon emissions are further along. But the Obama administration is pushing environmental and energy conservation policy more in the direction of Europe and Japan. The change will bolster demand for more efficient and more environmentally friendly systems for managing commuter traffic, food distribution, electric grids and waterways.These systems are animated by inexpensive sensors and ever-increasing computing power but also require the skills to analyze, model and optimize complex networks, factoring in things as diverse as weather patterns and human behavior. Big companies like General Electric and IBM that employ scientists in many disciplines typically have the skills and scale to tackle such projects. In the author’s opinion, Obama’s approach to the health and energy problem（）
保护胃粘膜，杀灭幽门螺杆菌
Despite decades of scientific research, no one yet knows how much damage human activity is doing to the environment. Humans are thought to be responsible for a whole host of environmental problems, ranging from global warning to ozone depletion. What is not in doubt, however, is the devastating effect humans are having on the animal and plant life of the planet.Currently, an estimated 50,000 species become extinct every year. If this carries on, the impact on all living creatures is likely to be profound, says Dr. Nick Middleton, a geographer at Oxford University. " All species depend in some way on each other to survive. And the danger is that, if you remove one species from this very complex web of interrelationships, you have very little idea about the knock-on effects of other extinctions. "Complicating matters is the fact that there are no obvious solutions to the problem. Unlike global warning and ozone depletion—which, if the political will was there, could be reduced by cutting gas emissions—preserving biodiversity remains an intractable problem.The latest idea is " sustainable management " , which is seen as a practical and economical way of protecting species from extinction. This means humans should be able to use any species of animal or plant for their benefit, provided enough individuals of that species are left alive to ensure its continued existence.For instance, instead of depending on largely ineffective laws against poaching, it gives local people a good economic reason to preserve plants and animals. In Zimbabwe, there is a sustainable management project elephants. Foreign tourists pay large sums of money to kill these animals for sport. This money is then given to the inhabitants of the area where the hunting takes place. In theory, locals will be encouraged to protect elephants, instead of poaching them—or allowing others to poach them—because of the economic benefit involved.This sounds like a sensible strategy, but it remains to be seen whether it will work. With corruption endemic in many developing countries, some observers are skeptical that the money will actually reach the people it is intended for．Others wonder how effective the locals will be at stopping poachers.There are also questions about whether sustainable management is practical when it comes to protecting areas of great-bio-diversity such as the world’s tropical forests. In theory, the principle should be the same as with elephants—allow logging companies to cut down a certain number of trees, but not so many as to completely destroy the forest.Sustainable management of forests requires controls on the number of trees which are cut down, as well as investment in replacing them. But because almost all tropical forests are located in countries which desperately need revenue from logging, there are few regulations to do this. Moreover, unrestricted logging is so much more profitable that wood prices from managed forests would cost up to five times more—an increase that consumers, no matter how " green " , are unlikely to pay.For these reasons, sustainable management of tropical forests is unlikely to become widespread in the near future. This is disheartening news. It’s estimated these forests contain anything from 50 to 90 percent of all animal and plant species on Earth. In one study of a five-square-kilometer area of rain forest in Peru, for instance, scientists counted 1,300 species of butterfly and 600 species of bird. In the entire continental United States, only 400 species of butterfly and 700 species of bird have been recorded.Scientist Professor Norman Myers sees this situation as a gigantic " experiment we’re conducting with our planet " . " We don’t know what the outcome will be. If we make a mess of it, we can’t move to another planet…It’s a case of one planet, one experiment. What damage do we know for sure is human activity doing to the environment（）
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