问题 单项选择题 案例分析题

女性,50岁,近2月来反复发生夜间呼吸困难,加重2天入院。查体:心率150次/分,血压24/14.7kPa,呼吸急促,双肺散在哮鸣音,双肺底细湿啰音

此患者最需进行鉴别的是()

A.是慢性支气管还是支气管哮喘

B.是肺气肿还是左心衰竭

C.是心源性哮喘还是支气管哮喘

D.是肺炎还是肺癌

E.是肺心病还是ARDS

答案

参考答案:C

单项选择题

The landscape of the Giant’s Causeway, lurking below the gaunt sea wall where the land ends, must have struck wonder into the hearts of the ancient Irish, who subsequently felt inspired and created legends about its builder: the giant Finn McCool. The Causeway Coast has an unparalleled display of geological formations representing volcanic activity during the Early Tertiary Period some 5060 million years ago. Its Tertiary lavas of the Antrim Plateau, covering some 3,800 sq km, represent the largest remaining lava plateau in Europe.
The Causeway is a mass of basalt columns packed tightly together. The tops of the columns form stepping stones that lead from the cliff foot and disappear under the sea. Altogether there are 40, 000 of these stone columns, mostly hexagonal, but some are quadrangular, pentagonal, heptagonal and octagonal. The tallest ate about 40 feet high, and the solidified lava in the cliffs is 90 feet thick in places.
A fine circular walk will take you down to the Giant’s Causeway, past amphitheatres of stone columns and formations with fanciful names like the Honeycomb, the Wishing Well, and the Giant’s Granny, past a wooden staircase to Benbane Head, and back along the cliff-top. Further down the coast, the stunning Carrick-a-rede rope bridge spans a gaping chasm between the coast and a small island used by fishermen. The eighty-foot drop can be crossed via the swinging bridge—and is not for the faint-hearted!
The Giant’s Causeway and Causeway Coast site was inscribed as a World Heritage Site by UNESCO in 1986. The site is of outstanding universal value and meets the criteria set in the World Heritage Convention. Namely, it is an outstanding example representing major stages of the earth’s history including the record of life: significant on-going geological processes in landform developments, and significant geomorphic and physiographic features; moreover, it also contains superlative natural phenomena and areas of exceptional natural beauty and aesthetic importance.
Moyle District Council’s Causeway Visitor Centre is open daily all year round and located on the cliff top 1 km from the site. The Centre is the ideal starting point for walks along the coastal and cliff-top paths, providing all excellent range of visitor services. A 12-minute audio-visual presentation, with commentary available in 5 European languages, enables visitors to further explore the origins of the Giant s Causeway through local folklore and scientific theory, and highlights the many other attractions of the Causeway Coast and Glens of Antrim area.

From the last paragraph, we can infer that this piece of writing is most probably ______.

A.a developmental design

B.a text on geography

C.a record of local folklore

D.a tourism advertisement

问答题

2003年,光明乳业与联华进行合作,针对其30家门店保鲜牛奶产品以及达到酸奶的缺货率、新鲜程度、库存积压率和按时到货率的情况进行了调研。调研结果显示,除产品的按时到货率基本满意外,光明乳业的产品在缺货率、新鲜度以及自身库存积压率方面都不太理想。
对此,光明乳业的相关负责人认为以下三个原因。一是由于保险产品配送的特殊性,光明乳业每日与联华的订单数量达几千张,双方的工作量都比较大,造成订单的采集成本比较高。二是订单下达完全依靠业务员的经验或者感觉来判断,会有一些误差;并且不能将这种人的经验转化为公司的财富;另外,人员的流动造成公司短期内的业务情况异常,销量有一定的流失。三是光明乳业让业务员通过手持设备(PDA)进行订单输入,这种数据交换的方式具有很高的时效性和销售准确率,但每天只能导入一次订单,不能实现二次配送,难以满足零售商的需求。
于是,一些新的供应链管理模式被提上日程。对于被认为是经销商或零售商实现负现金流强势工具的供应商管理库存(VMI),光明乳业并没有简单排斥,深入分析之后,发现它是增加销售量、提高服务水平、降低成本、保持竞争力和加强与客户联系的有效手段。因此,完善这种VMI模式,形成自身有效的客户反映系统,便形成了光明乳业寻求突破的光明大道。在这种情况下,2003年光明乳业决定与联华联手开展VMI项目,以提高订单精度和效率,实现无间断供货,最终实现电子化订单、网上对账及支持。
为了很好地完成项目,光明乳业与联华商量之后,制定了VMI项目的目标。通过实施VMI,光明乳业希望能够根据客户分销中心(DC)或零售终端(POs)的销售情况进行有效的客户需求预测,达到减少库存不足以提高客户服务水平和库存周转率,减少库存水平(客户和供应商),以便减少供应链成本的目的,进而优化物流配送,加强与零售商之间的战略伙伴关系.提高供应链管理水平和客户忠诚度。同时,光明乳业希望能根据客户实际销售情况,变“推动供应”为“拉动供应”,提高订单的效率和精度,减少采集成本。
对于经销商或零售商来说,实施VMI的阻力在于说服供应商。对于供应商来说,主要困难在于关键问题的解决。根据光明乳业设计的系统构架,由联华的各家超市将每日库存和销售数据信息以及送货单信息传递到联华总部,然后经由联华总部传递到光明乳业的后台——VMI系统中。这些信息经过VMI系统处理后,会给出一个产品的预测信息,然后把信息给联华发送过去。之后,联华根据这个信息制定订单并返回到光明乳业公司,最终,光明乳业ERP的后台会产生一个物流的配送单,实现不间断地送货。
然而,这个看似简单的系统,实施起来难度却非常大,其中订单的预测是VMI系统的关键因素,也是光明乳业面临的最大难题。为了保证订单的准确性,光明乳业绞尽脑汁,摸索出一套行之有效的预测思路。
首先,光明乳业通过对联华的一些历史数据进行初步分析,比如进行回归分析等。对一些因素进行考虑,如节假日、温度、天气、促销等不确定的因素,系统管理人员将这些因素转化成参数,由业务员提供个人经验值,完成VMI预测系统的销售影响因素的初始系数设定。接下来,对历史数据及各种信息,比如VMI门店信息、天气、促销、团购、库存预警、发货策略等进行处理。
最后,通过对光明乳业VMI这个多元化的信息反馈系统,确保任何影响销售的因素及时被记录并交由系统作进一步处理。主要分四个方面:一是对各种信息如门店信息、天气信息、团购信息等进行基础性维护;二是通过光明的0M0系统完成促销计划的提前导入,以计划的准确性及信息转换的便捷性,完善促销信息;三是采集产品的缺货率、新鲜度、即时库存、精品促销活动等更多的信息,并立即运用起来;四是与联华形成互动联系,二次要货计划由网上VMI系统实现,而一些突发信息比如停电、修路等可以通过光明VMI热线来实现,形成门店主动反馈。
问题:
(1)VMI系统的关键因素是什么光明乳业是如何解决这个关键问题的
(2)建立VMI系统对光明乳业产生哪些积极的作用