2009年10月30日 星期五

Taiwan NTU EMBA獲世界排名40名佳績

英國金融時報(Financial Times)公布2009年全球EMBA排名調查結果:
本校EMBA獲世界排名40名佳績

英國金融時報(Financial Times)最新公布的2009年全球EMBA (EXECUTIVE MASTER OF BUSINESS ADMINISTRATION)排名調查結果,全台有兩所學校進入排名,本校管理學院比去年更進一步,榮獲世界排名第40名的佳績,居全台之冠。

臺大EMBA自2007年接受英國金融時報全球EMBA評比以來,年年都獲得進步的肯定,顯見本校管理學院在國際管理教育發展上的努力,不論在國際化、學術研究成果或是最讓人關心的學生薪資評比都有明顯的進步,因此才能在今年獲得第40名的佳績。

在國際化方面,本校EMBA自2005年起,每年選派專任教師前往哈佛商學院(HBS)研習,導入國際知名商學院個案教學模式,同時邀請國際知名(MIT、美國達頓商學院等)教授定期來台授課,並與境外夥伴學校交流合班上課。在學術研究成果上,該調查資料顯示管院整體老師的研究成果在商學頂尖40個期刊的發表數量有很好的成績,與近期泰晤士報公布臺大排名第95名,擠進世界百大行列的結果一致。薪資評比部分,校友畢業三年後的平均薪資表現優異,在近百所大學中排名第15名,除此之外,臺大EMBA學生在完成學業後,薪資平均提升58%。

過去十三年來,臺大EMBA為社會培育近1800位的社會菁英,構成高價值的資源網絡,連續兩年,本校管理學院獲得天下『Cheers』雜誌EMBA調查知名度與滿意度全國第一名的殊榮,繼而榮獲《金融時報》的肯定,讓管理學院對於未來深耕高階管理終身教育更具信心,在臺大獲得百大榮譽的同時,相信也值得更多高階經理人作為終身教育的投資首選。

本校在2009年英國金融時報EMBA全球排名之重要指標排名資料
Index 2009年 2008年
Salary today (US$) $202,504 $193,732
Salary increase (%) 58% 65%
Work experience rank 21 11
International board (%) 33% 33%
FT doctoral rank 5 20
FT research rank 66 69
Rank 2009 40 43

2009年10月20日 星期二

Dr. Raymond D. Adams, 97

Dr. Raymond D. Adams, 97; Mass. General neurology chief coauthored textbook
By Bryan Marquard, Globe Staff | October 26, 2008
Nearing the end of his long tenure as chief of neurology at Massachusetts General Hospital, Dr. Raymond D. Adams took time off and traveled to Switzerland. There, in a lakeside villa, he picked up a yellow writing pad and his fountain pen and wrote the first page of what would become his legendary textbook, "Adams and Victor's Principles of Neurology."

And then he wrote another page and another until he had a mountainous draft to give to his colleague and coauthor, Dr. Maurice Victor, who added his own insights.

"He wrote the entire book in longhand, one version that was 1,600 printed pages, and it all came from his personal experience," Dr. Allan Ropper, coauthor of recent editions of the book, said of Dr. Adams.

Chief of neurology at Mass. General for 26 years, Dr. Adams was still offering advice and editorial comments for the ninth edition of his widely-used book when he was in his mid-90s. He died Oct. 18 in Brigham and Women's Hospital of complications from congestive heart failure. Dr. Adams was 97 and had lived in the Chestnut Hill section of Brookline after many years in Milton.

"In American medicine he was viewed as really the consummate clinical neurologist," said Ropper, who is executive vice chairman of neurology at Brigham and Women's and also was the last chief resident to serve under Dr. Adams at Mass. General. "He had a longer and deeper influence on neurology than virtually anyone, but was very eager to share the credit with others. The modesty was quite something to behold."

A few years after he was appointed to head the neurology department in 1951, Dr. Adams used a Joseph P. Kennedy Jr. Foundation grant to help create at MGH Joseph P. Kennedy Jr. Laboratories, which supported children's neurology research.

Years later, he also helped found the Eunice Kennedy Shriver Center on the grounds of the Fernald School in Waltham and was its first director. Dr. Adams was the Bullard professor of neuropathology at Harvard Medical School, and retired in 1977 as chief of neurology at MGH.

His years as head of the department, beginning when he was 41, were a time of great change in the field.

"What Ray Adams did in essence was establish an American style of neurology and broke it away from the dominant European influence of the '20s, '30s, and '40s," Ropper said. "He carved out a much more modern perspective. What he did that really broke the field wide open is that he made maximum use of neuropathology to study diseases. He established neuropathology as the basic science of clinical neurology."

Under the leadership of Dr. Adams, Mass. General became "the place for neurology in the world," said Dr. J. Philip Kistler, director emeritus of the stroke unit at MGH. "It was the place that developed modern thinking about neurology."

The book, meanwhile, went on to reap acclaim from when it was first published in 1977. It "ranks first among textbooks in neurology," a review in the British medical journal The Lancet said of the seventh edition.

"Diving into a new edition of 'Adams and Victor's Principles of Neurology' is like meeting up with an old teacher after several years," began the review, which ended: "One can certainly live without this book, but medical life is far more pleasant with a copy within reach."

In addition to moving the field of neurology forward, Dr. Adams "was extremely loyal," Ropper said. "He was very, very attached to his trainees and looked out for their careers."

"He was intellectually, extraordinarily honest with himself and with others," Kistler said. "You wanted to emulate him and you wanted to strive for the best because of him."

Dr. Adams was born in Portland, Ore., and graduated from the University of Oregon, where he honed his skills as a competitive tennis player. Late into his 60s, he won matches against opponents decades his junior.

In part to impress the family of his girlfriend, Dr. Adams applied to medical school, according to his son-in-law Bud Dudley, a physician in Roanoke, Va.

Dr. Adams ended up at the Duke University School of Medicine and graduated in 1936, just six years after the school was founded. He went to Yale University on a fellowship to study psychology, but grew disenchanted, Dudley said, and moved to Boston. He had worked in the neuropathology laboratories at Boston City Hospital before he was picked to lead the neurology department at Mass. General.

At home in Milton, "he had a carved table, probably eight feet wide and long," said his son, Bill of Chicago. "It was an open table, rather than an ordinary desk, and he sat there writing hour by hour. Behind him was a bay window and he sat on the window seat. He always used a fountain pen, never erased. That mind was obviously a significant one, not only to hold the knowledge, but to modify as he went along."

Dr. Adams's first marriage, to Margaret Elinor Clark, a romance languages scholar, ended in divorce after 33 years. He then married Dr. Maria Salam-Adams, a pediatric neurologist at MGH, who died in 1991.

Though generally reserved, Dr. Adams was very good at telling jokes, said his stepdaughter, Nina Salam of Brookline, and they "would sound all the more funny coming from him, because he was so serious."

"And he loved his dark chocolates, but he was a man of strict habits, even in fun things," she said. "He'd have his cocktail in the evening and have one dark chocolate at the end of the meal. While it was a pleasurable event, there may have been some medicinal reasons, too, from relaxing the arteries with the cocktail to having the dark chocolate, which also could be beneficial."

In addition to his son and stepdaughter, Dr. Adams leaves three daughters, Mary Elinor Dudley of Roanoke, Va., Carol Still of Kalispell, Mont., and Sarah Aldrich of Heber City, Utah; six granddaughters; five grandsons; eight great-granddaughters; and eight great-grandsons.

A service will be announced.

2009年10月15日 星期四

a case of asbestos exposure and bilateral upper lung fibrosis

asbestos exposure 30 years ago in an asbestos-cement factory, work duration of 1 week
temporary worker, non-regular worker in the construction sites, handle the asbestos cement roofing material, including cutting and by-stander in the past


a case of open TB.

姓名: 葉oo (5501011)十日內--檢驗結果

  B4 SPUTUM (EXPECTORATED) No:0004528 ( 98.10.14 14:47登記) (98.10.14 19:59報告)

 
趨勢圖 項目 數值 詳細資料 單位 標準值 說明
AFS+Culture #1 Acid fast bacilli - positive( 3+) *
AFS+Culture #2 *
AFS+Culture #3 *
AFS+Culture #4 *
AFS+Culture #5 *

  B4 SPUTUM (EXPECTORATED) No:0004527 ( 98.10.14 14:47登記) (98.10.14 19:59報告)

 
趨勢圖 項目 數值 詳細資料 單位 標準值 說明
AFS+Culture #1 Acid fast bacilli - positive( 3+) *
AFS+Culture #2 *
AFS+Culture #3 *
AFS+Culture #4 *
AFS+Culture #5 *

  B4 SPUTUM (EXPECTORATED) No:0004526 ( 98.10.14 14:47登記) (98.10.14 19:59報告)

 
趨勢圖 項目 數值 詳細資料 單位 標準值 說明
AFS+Culture #1 Acid fast bacilli - positive(3 +) *
AFS+Culture #2 *
AFS+Culture #3 *
AFS+Culture #4 *
AFS+Culture #5 *

2009年9月23日 星期三

20090923台大醫院植入兒童型迷走神經器新聞稿

what is the mechanism of autonomous [parasympathetic] on seizure control?

臺大醫院 > 最新消息 > 20090923台大醫院植入兒童型迷走神經器新聞稿



公告日期
2009/9/23
標題
20090923台大醫院植入兒童型迷走神經器新聞稿
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台大醫院新聞稿

2009 年 09 月 23 日
台大醫院植入兒童型迷走神經刺激器治療頑固型癲癇病童

台大醫院於今年1月14日針對無法以外科顱內手術或抗癲癇藥物,也無法使用生酮飲食來輔助治療之頑固型癲癇病童,植入兒童型迷走神經刺激器,採用連續24小時,定時經由左側迷走神經傳送微量電刺激到腦幹NTS(孤立束狀核)的部分,抑制病灶處異常放電,術後病童癲癇的情況獲得大幅改善,亞洲國家在此案例之前並無植入兒童型迷走神經刺激器之前例。

迷走神經刺激器,是在胸口皮下植入一個刺激器,將刺激器的神經導線纏繞於左側頸部迷走神經上,植入迷走神經刺激器後,兩週內須定期回診微調刺激器的刺激參數。透過每天定時定量的釋放微量電刺激,利用電刺激方式來改變腦部不同區的血流量,以降低癲癇發作。

本案為頑固型癲癇之4歲病童,因頻繁發作導致神經發展及語言學習退步、認知障礙、和過動行為,且一旦發作病童會跌倒,故需要戴鋼盔預防頭部外傷,走路也退化成必須以推車代步。今年1月即使服用4種抗癲癇藥物,每日癲癇發作仍高達20-40次。藥物劑量增加並未使抽筋減少,反而增加副作用,經MRI等腦部影像及腦波檢查結果,評估病童不適合使用傳統外科手術切除病灶來控制或降低癲癇發作,因此轉至小兒神經外科接受迷走神經刺激器植入手術來改善病症。

患童於98年1月14日植入兒童型的迷走神經刺激器,並於元月底開機使用。開機三個月後,大發作情況消失,但每日仍有7到15次小發作;患童開始可以墊腳尖行走,認知方面增加視線交會的溝通,同時開始聽得懂部分的指令。開機五個月後,白天的發作消失,每週約4次發作;人際關係的互動頗有進展,患者開始會對人笑。六個月後患者不再有癲癇的發作,即便發高燒生病時也未見復發,腦波檢查的結果也發現原本頻繁的癲癇放電波已消失;同時患者的步態漸趨穩定,可以自行走路及跑步;認知方面則進步到會和其他小朋友玩,同時會發出一些聲音,原本過動的他也變得乖巧聽話許多。

2009年9月19日 星期六

who will be the neurologist that take care of P. Lee

it may reflect the weakness of the cerebral blood vessels, chronic hypertension without appropriate control? plus the pulse impact from the Chi-gon?, also probably triggered by the stress, which may be explored with the tool of heart rate variability, autonomic control of brain on the heart?

what about the proportion of contribution of work/job strain on his hemorrhagic stroke?

病後感言 走出生命富有的路 李嗣涔
日前嗣涔因身體不適住院,經臺大醫療團隊悉心診治,順利完成手術,術後恢
復情形良好,並已到校上班。這段期間承蒙社會各界賢達先進及本校師生同仁
校友給予深切的關懷與沛然的祝福,讓嗣涔復原更加迅速,謹以最誠摯的心致
上由衷謝忱!

嗣涔平日雖有做點身體保健,日前或因校務繁忙而疏於休息,於7月13日主持會
議時突感不適,隨即送醫,在被診斷出輕微腦中風後,由臺大醫院腦神經外科
團隊立刻施行手術,術後並悉心照顧,而於7月23日出院,癒後亦頗為良好,已
於8月10日返校上班。臺大醫院醫護同仁的醫術精湛,其明確果決的診斷以及無
微不至的照料,讓嗣涔銘感五內!

在住院期間,來自各界的關心源源不絕,也讓嗣涔備覺溫馨。特別感謝馬英九
總統、蕭萬長副總統、連戰前副總統伉儷、監察院前院長錢復、立法院長王金
平、行政院長劉兆玄、教育部長鄭瑞城、國防部長陳肇敏、國科會主委李羅
權、政務委員曾志朗、張進福、中研院長翁啟惠、前校長虞兆中、孫震、陳維
昭等人,以及各大學校長、各界先進和臺大師生、同仁與校友們,對嗣涔之殷
殷關切。尤其在看到來自各界如雪片般的卡片與電子郵件,當中盡是安慰與鼓
勵時,讓嗣涔充分感受到人情溫暖,也激勵我要盡快恢復健康、重新回到工作
崗位上。除了感謝,在此也要以過來人經驗,期盼各界為民服務之前輩同儕能
在身體健康與社會奉獻之間找到平衡。

嗣涔自2005年接任校長一職以來,為實踐所提出之教育卓越、研究卓越與社會
關懷等三大理念,日夜兢業以對。尤其,近年為執行政府五年五百億計畫,以
及達成進入全球百大的目標,臺大師生同仁齊心致力於校園基礎建設、改善教
學品質與提升研究水準,你們的努力有目共睹,相信成果指日可待。言及此,
嗣涔要特別感謝諸位同仁,因為有你們的協助,讓本校各項業校務不致停頓、
而能持續運作;因為有你們的支持,讓嗣涔得以暫時卸下工作、安心靜養。你
們的合作無間彰顯出臺大是一個大家庭,這個大家庭在面臨危機時展現了支撐
的力量,嗣涔深受感動,更確定這是臺大挺進的強力後盾。所以,嗣涔要再次
叮嚀,請各位同仁在全心推動校務同時,務必不忘維護自身健康;因為,唯有
健康的體魄才有堅強的意志,才能承擔如此繁重的壓力,進而完成不平凡的任
務。

當然,嗣涔還要特別感謝臺大校友們,因有你們熱心回饋,讓母校得以興建館
舍、充實各項教研設施,你們是支持臺大前進不可或缺的助力。《窮得只剩下
錢》作者王陽明牧師在書中指出,人生道路有兩種:生活的路與生命的路;生
活的路追求的是物質滿足,生命的路則是追求平安喜樂;你們不僅工作表現傑
出,成為社會各階層領導人,你們也樂於付出,生命更是富有的。

嗣涔在病榻中,有機會重新審視過往,思索生命的意義,深刻體認到肉體的軟
弱、人生的無常,慶幸有親人日夜陪伴,同仁鼎力支持,臺大醫療團隊專業照
護,以及各界紛至沓來的關愛加持,讓嗣涔能在最短時間內恢復健康,感激之
情,無以言表。謹與各位朋友共勉:活在當下,要為家人珍惜健康,要為社會
奉獻才能,要為人類謀最大幸福。

感謝大家!祝福大家健康、平安、如意!

2009年9月11日 星期五

Aspirin in the primary and secondary prevention of vascular disease

a recent paper published in the Lancet and several correspondence letters which may deserve a look and ask for any practical implication in prevention of stroke

caution about the risk of bleeding, especially the ICH

individualized-medicine

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673609605031.pdf?id=aeaa5a245ca1fddb:-3eff16a0:123aae4eadb:b7b1252705979563

2009年9月9日 星期三

diabetes and shiftwork

canada diabestes association CDA
i can do a great job though i am a person with diabetes

how to use sugar control principle

staying awake all night

type 1 insulin-dependent DM

reasonable accommondation in the workplace suggested by ADA

what occupational cancers under study in 2010

i need to pray and wait for the answer.

agent specific? for example, like IARC, may use for Formaldehyde

site specific? for example, urinary tract system, upper and lower, and questionnaire should be include herbal medicine?

specific questionnaire of bladder cancer symptom, like the EORTC bladder module? kidney module?

2009年9月8日 星期二

20090919 職業傷病診治 meeting

台大醫院職業傷病診治中心
議程\n1. (台大醫院環職部) 朱柏青
醫師-職災創傷後壓力症候群:個案報告與討論 \n2. (長庚
醫院職醫科) 羅錦泉醫師-疑似職業性癌症:個案報告與討
論 \n3. (署新醫院家醫科) 蔡瑞元醫師-臨廠職業衛生服務(
Ⅰ):產業界實例 \n4. (忠孝醫院職醫科) 楊慎絢醫師-臨廠
職業衛生服務(Ⅱ) :職業工會實例 \n\n職醫學分:4.8\n
Where: 台大醫院西址二東一樓健康教育中心
When: 2009年9月19日星期六 下午 01:00-下午 05:00 (GMT+
08:00) 台北

2009年9月7日 星期一

2009 mesothelioma research

is it needed as a IRB proof?

2009年9月6日 星期日

Professor Wang's testmony

produce new knowledge
ministry of education: immunology
biochemistry: protein biosynthesis
God's leading to the field of OEM

2009年9月3日 星期四

laryngeal cancer manuscript in preparation

may invite an ENT specialist Dr. Yang, [is he a specialist in head and neck tumor surgery?]

asbestos is a risk factor for developing laryngeal cancer, which has been recognised as an occupationally caused cancer in several countries, incluing Canada [Ontario], USA [lawsuit system rather than compensation], Deutshland/German, French, UK, EU, South Africa and ILO?

what are the contents of recognition of occupational asbestos-related laryngeal cancer in different countries?



please also search for literature concerning recognition criteria in different countries for asbestos-related laryngeal cancer.
喉癌石綿 ILO、德國、歐盟、英國、法國、南非

評鑑 english revision

IOMIH 評鑑時間為 11/23、11/24 當日所有本所學生務必要來學校

請碩博班同學細心研讀本所教育目標及核心能力

碩士班
教育 目標
培育具備創新研究能力及國際觀的環境職業醫學、職業衛生及健康和環境風險評估與管理的領導人才,以促進全人類的健康福祉。

核心

能力
A. 能夠辨識物理性、化學性、生物性與人因性危害因子對健康的影響。

common sense to identify health hazards

B. 能對職業危害因子提出個人防護設備、工程控制以及行政管理的建議。

provide practical suggestions for risk-reducing practices

C. 搜尋研讀及瞭解環境職業衛生相關科學文獻與法令規範。

research capacity to read and digest literatures and regulations in the field of OEH [occupational and environmental health] issues

D. 能利用科學方法規劃與執行環境職業衛生及風險評估研究,解決環境職業衛生問題,執行風險管理之能力。

scientific approaches for planning and executing research on OEM and health risk assessment for problem solution and risk management





博士班
教育 目標
培育具備獨立創新研究能力及國際觀的環境職業醫學、職業衛生及健康和環境風險評估與管理的領導人才,以促進全人類之健康福祉。

核心

能力
A. 能符合碩士班的核心能力。

B. 能構想、發展及執行原創性研究並應用於環境職業衛生領域。

originality

C. 能應用先進的方法從事環境職業衛生研究,並發展新的研究方法解決環境職業衛生問題。

advanced methods and techniques

develop new research methods

D. 能藉由環境職業衛生相關論文的準備與呈現,證明良好的寫作及口語溝通能力。

good skills and ability in presentation for paper writing and oral communication

go ahead to world sleep medicine conference

it may be a day dream but in real world how should i do for the first step of research on this topic?

EEG, jet lag and HRQOL and fatigue questionnaire for craft servants and pilots?

Local Organizing Committee / Asian Sleep Research Society (ASRS)
Masako Okawa (Chair)
T. Shimizu (Vice Chairs), D. Jeong (Vice Chair / ASRS Vice President)
N. Chen (Vice Chair / ASRS Vice President)
K. Honma (Secretary General / ASRS Secretary General), T. Ohida (Vice Secretary General)
T. Shiomi, S. Miyazaki, K. Hirata, H. N. Mallick (ASRS Chair of Scientific Committee)
K. Kotchabhakdi (ASRS Treasurer)
World Sleep Federation (WSF) Officers
R. Grunstein (President) / M. Okawa (Vice President)
A. I. Pack (Secretary General) / P. Liu (Assistant Secretary) / R. Horne (Treasurer)
D. P. Cardinali (International Program Chair)
T. Porkka-Heiskanen (International Education Chair) / G. Lavigne (Membership Chair)
The 36th Annual Meeting of Japanese Society of Sleep Research
T. Shimizu (Chair, JSSR President)
N.Yamada (Vice Chair)

2009年9月2日 星期三

flu and return to work

當時立即停止感染醫護人員之醫療照護工作,在家自主健康管理----management policy against pandemic flu attack

how many days staying at home?



大醫院新流感獲控制 請病友及家屬安心

98 年 08 月 20 日
本院在14日開始有4位醫護人員及住院病友出現類流感症狀,經篩檢,確實為A型流感。當時立即停止感染醫護人員之醫療照護工作,在家自主健康管理,所有接觸過同仁、臨床病患及家屬皆已立即做預防性的投藥,情況已獲控制,請各位病友及家屬安心。

在此之前,本院已加強全院各單位同仁健康監測,每日測量體溫;醫療區醫療人員ㄧ律戴上外科口罩,落實勤洗手,保持個人衛生,預防流感傳染,若有呼吸道症狀則應全時間戴外科口罩。發燒或有呼吸道症狀同仁則依行政院衛生署規定給予休養,若為A型流感檢驗陽性,則強制休假。

本院並已加強環境清潔消毒,同時呼籲病人家屬及訪客新流感流行期間,減少不必要的探病,避免散播疾病,勤洗手,落實呼吸道衛生與咳嗽禮儀,有急性發燒、呼吸道症狀者戴上一般口罩,不應探病。

2009年8月17日 星期一

a new research proposal on young stroke and environmental facotors and interaction with genetics, hemorrhagic strokes attributable fraction from HTN

i need to write an new stroke-related proposal within 1-2 weeks and gather related references on the issue of prevention oriented research on ICH in relatively young patients, less than 60 years.

deadline is 2009/08/22. hopefully i may consult neurologists at UOEH for karoshi and work-related strokes in Asian countries


premature stroke, hemorrhagic type

SAH, ICH, AVM, venous malformation, small vessel diseases

secondary ICH
primary ICH [due to hypertension]

OOO=李痛湖? ooo=李洞湖?

lacune: definition based on dictionary
google dictionary

the similaries and differences between ischemic lacunar stroke and hemorrhagic stroke affecting hypertensive-prone areas

read the book of Caplan's stroke 2000 carefully with focus on the pathophysiology and mechanism






lacune

腔隙
由A組分析結果得知,有症狀的病灶中47.6%是腔隙(lacune );而且這些腔隙位於豆狀
核(12.7 % ),內囊(12.7 % ),和大腦皮質 ...
www.ceps.com.tw - 相關搜尋
陷窩
... cell divisions)的方式進行;在肥大軟骨細胞同一陷窩(lacune)內,存在兩種不同
命運的子細胞,通常軟骨細胞是不會產生 ...
www.51daifu.com - 相關搜尋

在英文 > 中文(繁體)字典中找到。
lacuna /ləˈkjuːnə/ DJ /lə'kjunə/ KK /-ˈkuː-/ DJ American English /-'ku-/ KK American English
a place where sth is missing in a piece of writing or in an idea, a theory, etc. (文章、思想、理論等中的)缺漏,脫漏,空白,闕如 noun formal
Irregular: -nae plural /-niː/ DJ /-ni/ KK; lacunas plural
英文字典

lacuna
If you say that there is a lacuna in something such as a document or a person's argument, you mean that it does not deal with an important issue and is therefore not effective or convincing.
更多英文字典結果 »
相關語言

下列語言也有「lacuna」這一個字: Italiano, Portuguese
網頁翻譯

lacuna

腔隙
lacuna 腔隙 lag phase 停滯期 lagoon 舄湖 lamella1片層板2瓣鰓瓣 lamellibranch 瓣
www.xwyx.cn - 相關搜尋
闕文
闕文lacuna 闕中glabella 闞surnamepeep 汔near 汜streamwhichreturnsafterbranching
www.88cf88.com - 相關搜尋
缺失
lacuna 缺失. hiatus 間斷. continuity 連續. discontinuity 不連續. conformity 整合
www.uua.cn - 相關搜尋
地層缺失
lacuna 地層缺失 lacustrine deposits 湖沉積 lacustrine formation 湖積建造
www.yesed.com - 相關搜尋
骨窩
骨窩 骨單元 lacuna lacunae osteon 骨膜periosteum 骨質疏鬆症 骨化 osteoporosis
www.poledu.cn - 相關搜尋
網路上的定義

a blank gap or missing part
wordnetweb.princeton.edu/perl/webwn
coffer: an ornamental sunken panel in a ceiling or dome
wordnetweb.princeton.edu/perl/webwn
In music, a lacuna is an intentional, extended passage in a musical work during which no notes are played. A lacuna acts as "negative music" to induce a state of serenity (or tension) in the listener through its contrast to "normal" music consisting of sounded notes. ...
en.wikipedia.org/wiki/Lacuna_(music)

2009年8月16日 星期日

trouble from upgrade to window 7?

http://docs.google.com/View?id=dch5rvd7_1798wx9b5dd5

2009年8月14日 星期五

PVC玩具 有損孩童性發育?

PVC玩具 有損孩童性發育
在莫拉克颱風來襲前一天,消基會與標檢局公布40件市售食品玩具安全檢驗報告,抽檢項目包括標示、材料、耐燃、重金屬含量、塑化劑含量等,有十件不符合規定,不合格率達四分之一。

其中有兩件的塑化劑(又稱可塑劑)含量超標,一件為「恐龍蛋」,被檢出鄰苯二甲酸二異壬酯(DINP)11.6%,另一件「畫板」檢出鄰苯二甲酸雙-2-乙基己酯(DEHP)28%,以國家標準0.1%換算,分別達標準值的116倍及280倍。

消基會秘書長吳家誠表示,玩具製作過程中添加塑化劑,可便於塑造各種動物或玩偶形狀,幾乎玩具都有塑化劑。塑化劑會影響孩童的性器官發育、影響性徵表現,長期累積體內過量,會罹患胸腺癌、乳癌及氣喘。孩童將玩具放入嘴巴咬時,易有屑屑咬出,可能咬一口就過量。

然而,市面上玩具那麼多,政府也無法保證每一樣玩具的塑化劑含量都符合標準,而我們又沒有實驗設備檢驗塑化劑,怎麼辦?還好,塑化劑幾乎都添加在PVC產品中,因為其與PVC塑膠相容性最高,跟其他泛用塑膠(如PE)卻不見得相容,因此如果不買標示3號PVC塑膠的玩具,就可避免掉絕大部份的塑化劑危機了。當然,只標示「塑膠」,卻沒有指明是什麼塑膠的玩具,就千萬不要買,因為可能就是PVC製品。

資料來源:

「中國玩具可塑劑超標 影響兒童性徵」,自由時報,2009.08.07

http://www.libertytimes.com.tw/2009/new/aug/7/today-life7.htm

timing?

be patient, forebearance for God's sake? 給神的憤怒留地步?
在指望中要喜樂,在患難中要忍耐,在禱告上要堅定持續

堅定持續的禱告

  患難常常對我們是有益處的,所以也不要怕,在艱苦的環境裡,在環境的壓力裡,要學習會禱告。這個禱告要有目標,要堅定持續。所以你若找不到事,你要禱告,並且要堅定持續地禱告。

怎麼禱告呢?
「主啊,我這麼久還沒有找到事,我現在很痛苦,我現在開始覺得自己沒有什麼價值,主啊……」我告訴你,這就是沒有目標的禱告。
要為神的經綸禱告
你要不斷的地在裡面有動力,為著一個更高的事,更高超的事,更超越的事禱告。
主耶穌也曾說過,「不要憂慮,說,我們要吃什麼,喝什麼,披戴什麼……但你們要先尋求祂的國和祂的義,這一切就都要加給你們了。」(太六31~33)
你若為著神的國和神的義而禱告,神就會把你的需用都供應給你。

<< 路 加 福 音 12:49 >>
聖經 Chinese Bible: Union (Traditional)
我 來 要 把 火 丟 在 地 上 , 倘 若 已 經 著 起 來 , 不 也 是 我 所 願 意 的 麼 ?

圣经 Chinese Bible: Union (Simplified)
我 来 要 把 火 丢 在 地 上 , 倘 若 已 经 着 起 来 , 不 也 是 我 所 愿 意 的 麽 ?

聖經 Chinese Bible: NCV (Traditional)
將引起紛爭(太10:34~36)“我來要把火投在地上,如果燒了起來,那是我所願意的。

圣经 Chinese Bible: NCV (Simplified)
将引起纷争(太10:34-36)“我来要把火投在地上,如果烧了起来,那是我所愿意的。
ΚΑΤΑ ΛΟΥΚΑΝ 12:49 Greek NT: Westcott/Hort with Diacritics
Πῦρ ἦλθον βαλεῖν ἐπὶ τὴν γῆν, καὶ τί θέλω εἰ ἤδη ἀνήφθη.

Luke 12:49 King James Bible
I am come to send fire on the earth; and what will I, if it be already kindled?

2009年8月13日 星期四

台大醫院遠距醫療中心

how to have heart rate variability analysis real on time?

公告日期
2009/8/10
標題
20090810台大醫院遠距醫療中心成立新聞稿
本文


台大醫院新聞稿
98 年 08 月 10 日

即時照護網路化 方便好安心
台大醫院遠距照護中心成立記者會

隨著無線網路與視訊傳播的高度發展,結合網路與醫療,藉由遠端監測系統,即時發現陣發性或突發性症狀,提升健康照護品質,是台大醫院發展遠距照護的目的。

由病房推動出院準備服務到遠距照護,台大醫院規劃 24 小時全年無休的出院病人遠距照護平台,結合電子病歷應用、遠距照護資訊網路與居家遠距生理監測系統,病友可依病情需要將各項檢查資料,如血壓、血糖、心跳、心電圖等 8-15 項數據每天上傳到資料庫,每週與個案管理師視訊溝通,諮詢檢測結果以及因應方式。

台大醫院遠距照護中心收案除了慢性病患與癌末安寧病患的照護外,並由醫療團隊篩選狹心症、心肌梗塞、心律不整、猝死、中風、經心導管或開心手術等心血管重症為主要收案考量,因為此類病友曾經歷生死關頭,對於自身的健康照護有較深一層的體會。遠距醫療團隊 24 小時監控各項生理數據,病友如有疑問,也可以隨時詢問個案管理師,讓出院病友回家後,還能獲得持續性的照護與諮詢,減少疾病復發或嚴重併發症。

藉由遠距醫療的發展,醫療的提供必須打破區域限制,發展到唾手可得、 24 小時無間隙的方便性,才是真正高品質的醫療服務,台大醫院的心血管疾病遠距醫療計劃已能涵蓋海外的生理訊號量測與監測,目前在大陸的台商也能加入遠距照護醫療網絡,如此讓病友可以在大陸得到跟台北一樣持續性的醫療照護。

個案介紹

吳小姐是一位約50歲的上班族,因心血管阻塞引起心臟衰竭,在 97 年初就常常感覺胸悶、嚴重手腳麻痺與冰冷,爬 2 層樓梯就開始會喘、不舒服,晚上也不敢睡覺,因為擔心ㄧ覺不醒、心臟不跳、手腳麻痺導致中風。經由參加遠距醫療照護模式一年多來,現在胸悶、手腳麻痺等不適症狀及擔心程度均已改善許多,還可以ㄧ口氣爬到 9 樓。

吳小姐年輕時即因為嚴重心肌梗塞及心因性休克做過心臟血管繞道手術,約 6 年前再次覺得會喘及胸悶不適,經心導管檢查,發現心臟血管左主動脈有嚴重阻塞情形,持續門診追蹤治療, 4 年前曾經醫師建議,需進行心臟移植手術評估。

吳小姐在 95年開始在本院心臟衰竭門診追蹤調藥,並於 97 年由醫療團隊邀請加入遠距照護,不舒服時隨時可以利用網路視訊系統與個案管理師溝通,定時上傳心電圖、血氧、血糖、血壓、心跳、體溫、體重等數值至資料庫,由個案管理師做初期監控,還會根據傳輸的數值與情況隨時跟醫師報告病情,或是安排提前門診追蹤調藥。

遠距醫療照護除了可以隨時監測病患端測量之數值,還可協助醫護人員資料檢閱、管理與分析,及時協助做緊急處置,藉以提供個人化及互動性的照護服務、提昇病患的生活品質及滿意度、讓病患可以更安心,達到即時、遠端醫療照護之目標以及醫療與病患雙贏的局面。

2009年8月11日 星期二

2005 cancer and its management

2005 cancer and its management
book reading for 1. general concepts concerning cancer biology for illustrating occupational cancer, 2. treatment and its adverse effects in cognitive function, especially radiotherapy?

the e-book is available online

http://www3.interscience.wiley.com/cgi-bin/bookhome/116838389

the outlines


Cancer and its Management (Fifth Edition)
Published Online: 12 Nov 2007
Author(s): Robert Souhami, Jeffrey Tobias
Print ISBN: 9781405126366 Online ISBN: 9780470994887
DOI: 10.1002/9780470994887
Copyright © 2005 by Blackwell Science Ltd

Recommend to Your Librarian
How to get Online Access
Save Title to My Profile
Purchase a Print Copy

Book Home
Product Information | For Authors


Frontmatter (p i-x)
Robert Souhami, Jeffrey Tobias
Summary | Full Text: PDF (Size: 92K)
Chapter 1:
The Modern Management of Cancer: An Introductory Note (p 1-5)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 143K)
Chapter 2:
Epidemiology, Cure, Treatment Trials and Screening (p 6-22)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 233K)
Chapter 3:
Biology of Cancer (p 23-41)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 1268K)
Chapter 4:
Staging of Tumours (p 42-56)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 482K)
Chapter 5:
Radiotherapy (p 57-75)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 240K)
Chapter 6:
Systemic Treatment for Cancer (p 76-107)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 299K)
Chapter 7:
Supportive Care and Symptom Relief (p 108-122)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 228K)
Chapter 8:
Medical Problems and Radiotherapy Emergencies (p 123-139)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 246K)
Chapter 9:
Paraneoplastic Syndromes (p 140-149)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 153K)
Chapter 10:
Cancer of the Head and Neck (p 150-173)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 437K)
Chapter 11:
Brain and Spinal Cord (p 174-194)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 374K)
Chapter 12:
Tumours of the Lung and Mediastinum (p 195-215)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 375K)
Chapter 13:
Breast Cancer (p 216-235)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 357K)
Chapter 14:
Cancer of the Oesophagus and Stomach (p 236-252)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 392K)
Chapter 15:
Cancer of the Liver, Biliary Tract and Pancreas (p 253-269)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 291K)
Chapter 16:
Tumours of the Small and Large Bowel (p 270-282)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 237K)
Chapter 17:
Gynaecological Cancer (p 283-308)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 332K)
Chapter 18:
Genitourinary Cancer (p 309-334)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 383K)
Chapter 19:
Testicular Cancer (p 335-349)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 304K)
Chapter 20:
Thyroid and Adrenal Cancer (p 350-363)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 297K)
Chapter 21:
Cancer from an Unknown Primary Site (p 364-368)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 133K)
Chapter 22:
Skin Cancer (p 369-385)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 270K)
Chapter 23:
Bone and Soft-Tissue Sarcomas (p 386-404)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 374K)
Chapter 24:
Paediatric Malignancies (p 405-425)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 279K)
Chapter 25:
Hodgkin's Disease (p 426-442)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 298K)
Chapter 26:
Non-Hodgkin's Lymphomas (p 443-468)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 337K)
Chapter 27:
Myeloma and other Paraproteinaemias (p 469-481)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 252K)
Chapter 28:
Leukaemia (p 482-498)
Robert Souhami, Jeffrey Tobias
Summary | References | Full Text: PDF (Size: 216K)

Appendix: Useful Addresses (p 499-507)
Robert Souhami, Jeffrey Tobias
Summary | Full Text: PDF (Size: 129K)

Index (p 509-533)
Robert Souhami, Jeffrey Tobias
Summary | Full Text: PDF (Size: 230K)

2009年8月10日 星期一

the badness of being single: no end to his toil, a miserable business

there was a man all alone; he had neither son nor brother. there was no end to his toil

for whol am i toiling, he asked, and why am i depriving myself of enjouyment? this too is meaningless-- a miserable business

ecclesiastes 4:8


the best solution is that" two are better than one because they have a good return for their work: if one falls down, his friend can help him up! Also, if two lie down together \, they will keep ward...
a cord of three strands is not quickly broken.

lukas at DEOM office

2009年8月8日 星期六

[醫療] 醫界發現兩種神經蛋白有利追蹤頭痛

gustav [ 站內寄信 / PM ]
[Medical] Two Kinds of Neuroproteins That Help Track Cephalalgia Have Been Identified
July 27, 2009 08:48PM

發表文章數: 619
[Medical] Two Kinds of Neuroproteins That Help Track Cephalalgia Have Been Identified (Chinese Version)

China Times E-paper (2009/07/26) Migraine and cluster headache are two of the most commonplace headache classifications. Their diagnosis depends on patient's first personal report presently, but in this way the precise location or status of pain is difficult to specify. NTU and Taipei Veterans General Hospital find in a new study that it can take phlebotomy test alone targeting two neuroproteins in the brain to specify the pain grade, bringing great enhancement to follow-up treatment. Along with the finding, it is also discovered that one of the headache-related neuroprotein, Orexin A, increases appetite, which explains the phenomenon that people with higher BMI (body mass index) suffer from headache more frequently.

According to Chair of Department of Neurology, Taipei Veterans General Hospital, Shuu-Jiun WANG, the activation of trigeminal vascular system in the brain is commonly regarded as the pathogenic mechanism for sick headache and cluster headache. Stick to this premise, the research team hypothesizes that the system activator Nociceptin and the system inhibitor Orexin A these two kinds of neuroproteins are related to the pain degree of migraine and cluster headache. The experiments show that the concentration of Nociceptin in the adult headache group is far lower than the control group, and the children groups perform little specific significance; on the contrary, Orexin A concentration in both the adult and the children headache groups is higher than the control groups, though the difference in the children groups is not strong as well, which is believed to be related with the immature pain mechanism of the children.

S.-J. WANG says, both the conventional inferences and animal experiments support that Nociceptin strengthens the pain response and Orexin A prohibits the pain. But the present study results in an opposite outcome, suggesting that Nociceptin and Orexin A together “balance” the brain. The patient, for instance, whose headache intensifies needs less Nociceptin and more Orexin A.


Reference:
China Times E-paper 2009/07/26


[醫療] 醫界發現兩種神經蛋白有利追蹤頭痛
[醫療] 醫界發現兩種神經蛋白有利追蹤頭痛 (英文版)

《中時電子報》(2009/07/26) 偏頭痛及叢發性頭痛是兩種最常見的頭痛,目前臨床診斷都靠患者主觀描述,但患者確切的疼痛位置總無法清楚指出。臺大與台北榮總最新研究發現,只要透過抽血檢測腦內兩種神經蛋白質,即可瞭解患者頭痛程度,對追蹤治療效果有幫助。該研究還發現,由於下視丘素會增加食慾,故BMI(身體質量指數)愈高者,愈容易頭痛。

北榮神經內科主任王署君表示,腦內三叉神經血管系統活化與否,是醫界公認的偏頭痛與叢發性頭痛致病機轉,故研究團隊推測,可活化該系統的致痛素(Nociceptin),以及抑制該系統的下視丘素(Orexin A)兩種神經蛋白質,應與偏頭痛與叢發性頭痛的程度有關。經由實驗發現,致痛素在成人頭痛組的濃度竟遠低於對照組,兒童組的差異性則不具統計意義;至於下視丘素則在成人與兒童組中的濃度,均高於對照組,但兒童組的差異程度也不明顯,推測應與兒童的疼痛機制尚未發展完全有關。

王署君說,一般推論及動物實驗都顯示,致痛素會增加動物疼痛反應,下視丘素則有止痛效果,但此次研究結果卻正好相反,顯示致痛素與下視丘素在人類大腦中可能扮演「平衡」的角色,亦即當患者頭痛程度愈強烈時,大腦就愈不需要分泌致痛素,相對下視丘素濃度就愈高。


資訊來源:
中時電子報 2009/07/26

2009年8月5日 星期三

one size fits nobody

2009/8/6 8:30 am - 12 (noon)

one size does not fit all.

busy hand video shown with a visual analogue scale (VAS) rating for HAL (hand activity level)

mono-task

rate the HAL; rate the force, peak hand force (90%, 90th percentile)

training for scoring based on VAS
a worker on a production line



fuzzy on the face for protect privacy (personal identity)

7 score out of 10 may be my choice but the answer is 9

variation exists in human life

how many exertions to write "ERGO"

illustrate individual differences

2009年8月4日 星期二

terms used in the class given by professor Amstrong

2009/8/5 am

biomechanics
mechanic stress [tranismission of forces through the body]
deformation of tissues (strain) third law of Newton: sitting for a long time may hurt low back soft tissues.
shoulder ligaments keep the shoulders , stretch of the ligaments--> perception of the brain
how to relax

standard time by standard methods to perform a job

WMSD work-related musculoskeletal disorders
callus resulted from mechanical stress

callus /ˈkæləs/ DJ /'kæləs/ KK
an area of thick hard skin on a hand or foot, usually caused by rubbing 胼胝,老繭(手、足上的硬皮) noun
英文字典

callus
A callus is an unwanted area of thick skin, usually on the palms of your hands or the soles of your feet, which has been caused by something rubbing against it.

trip

verb
to catch your foot on sth and fall or almost fall 絆;絆倒 V often VN + adv./prep. ~ (over/up) ~ (over/on sth)
She tripped and fell. 她絆了一下摔倒了。
Someone will trip over that cable. 有人會讓那條電纜絆倒的。
Be careful you don't trip up on the step. 你小心別在台階上絆倒了。
to catch sb's foot and make them fall or almost fall 將…絆倒;使跌倒 VN
As I passed, he stuck out a leg and tried to trip me up. 我經過時,他伸出腿來想把我絆倒。
Variant: trip sb up British English
to walk, run or dance with quick light steps 腳步輕快地走(或跑、跳舞) V VN + adv./prep. literary
She said goodbye and tripped off along the road. 她說了聲再見就連蹦帶跳地沿路走了。
to release a switch, etc. or to operate sth by doing so 觸發(開關);(鬆開開關)開動 VN
to trip a switch 打開開關
Any intruders will trip the alarm. 任何非法入室者都會觸響報警器。
to be under the influence of a drug that makes you hallucinate (服用毒品後)產生幻覺 V informal

symptoms are subjective and apparently only to the workers
causes: both are caused or aggravated
repeated and sustained exertions
forceful exertions

localized fatigue
tired
what dose fatigue mean? reduced performance over time
remain attention
retention as Y-axis, time as X-axis
fatigue defined in the dictionary

fatigue /fəˈtiːɡ/ DJ /fə'tig/ KK
noun
a feeling of being extremely tired, usually because of hard work or exercise 疲勞;勞累 uncountable

台灣地區勞工人體計測資料庫

an accident report of a bricklayer

pulley
Belt pulley 皮帶輪. Belt stretching device 傳動帶拉緊裝置. Belt tension 傳動帶
bricklayer /ˈbrɪkleɪə(r)/ DJ /'brɪkˈleɚ/ KK
a person whose job is to build walls, etc. with bricks 砌磚工;瓦工 noun
Variant: brickie British English, informal
Derivative: bricklaying noun, uncountable
physical and mental fatigue 身體和精神的疲勞
Driver fatigue was to blame for the accident. 這個事故是駕駛員疲勞所致。
I was dropping with fatigue and could not keep my eyes open. 我快要累倒了,眼睛也睜不開了。
a feeling of not wanting to do a particular activity any longer because you have done too much of it 厭倦 uncountable
battle fatigue 戰鬥疲勞
weakness in metal or wood caused by repeated bending or stretching (金屬或木材的)疲勞 uncountable
The wing of the plane showed signs of metal fatigue. 機翼顯示出金屬疲勞的跡象。
loose clothes worn by soldiers (士兵穿的)工作服 plural
Alternate: fatigues
duties, such as cleaning and cooking, that soldiers have to do, especially as a punishment 士兵雜役(尤指作為懲罰,如做打掃、幫廚) plural especially American English
Alternate: fatigues
英文字典

fatigue
Fatigue is a feeling of extreme physical or mental tiredness.
You can say that people are suffering from a particular kind of fatigue when they have been doing something for a long time and feel they can no longer continue to do it.
Fatigues are clothes that soldiers wear when they are fighting or when they are doing routine jobs.

"6 sigma approach", borrowed from management science 六標準差
control program ANSI designated Z365 committee

allowance

allowance /əˈlaʊəns/ DJ /ə'lauəns/ KK
noun
an amount of money that is given to sb regularly or for a particular purpose 津貼;補貼;補助
an allowance of $20 a day 每天 20 元補貼
a clothing/living/travel allowance 服裝/生活/交通補貼
Do you get an allowance for clothing? 你有服裝補貼嗎?
the amount of sth that is allowed in a particular situation 限額;定量
a baggage allowance of 20 kilos 行李限重 20 公斤
an amount of money that can be earned or received before you start paying tax 免稅額 British English
personal tax allowances 個人所得免稅額

大專院校研究人才延攬方案

公告主旨  環境衛生研究所蔡詩偉老師研究室誠徵專任研究助理(大專院校研究人才延攬方案)  
公告單位  公共衛生學院--環境衛生研究所  
公告時間  2009/8/4 下午 03:18:15 
公告內容 
※工作地點:台北市徐州路17號(臺大環衛所蔡詩偉老師研究室)
※徵求條件:
(1) 具碩士學位(外國學歷亦可)之本國人。大學畢業亦可。
(2) 具有擔任行政助理能力者或具公共衛生相關背景為佳。
※工作內容:協助計畫進行或行政助理事項
※工作薪資:
依據教育部「大專校院研究人才延攬方案經費審查作業要點」辦理,碩士畢業工作酬金每月28,000元,保險費公提部分2,870元,勞退公提部分1,728元。大學畢業工作酬金每月22,000元,保險費公提部分2,258元,勞退公提部分1,368元。享年終獎金。
※聘期:自起聘日起一年
※申請方式:
意者請將履歷(含學經歷、自傳、畢業證明文件等)以電子檔案方式e-mail至shihweitsai@ntu.edu.tw,信件主旨請註明「應徵專任助理」。隨到隨審,額滿為止,資格符合者電話通知面談,不合者恕不另行通知。
※聯絡人:蔡詩偉
※聯絡電話:(02)3366-8097 
聯 絡 人  蔡詩偉 
聯絡電話  02-33668097 
電子郵件  shihweitsai@ntu.edu.tw 
公告對象  教職員、學生、校友、其他 
 


 

Sabbath

God need to rest one day after 6-days work and feel delighted.

Rest-year sabbatical
For more details on this topic, see Sabbatical.
From the Biblical Sabbatical Year came the modern concept of sabbatical, a prolonged, often one-year, hiatus in the career of an individual (not usually tied to a seven-year period). Such a period is often taken in order to fulfill some goal such as writing a book or traveling extensively for research. Some universities and other institutional employers of scientists, physicians, or academics offer paid sabbatical as an employee benefit, called "sabbatical leave"; some companies offer unpaid sabbatical for people wanting to take career breaks.


Sabbath
From Wikipedia, the free encyclopedia
Look up sabbath in Wiktionary, the free dictionary.
Wikiquote has a collection of quotations related to: Sabbath
Contents [hide]
1 Biblical tradition
1.1 Sabbath as day
1.2 Sabbath as week
1.3 Annual Sabbaths
1.4 Seventh-year Sabbatical
2 Jewish tradition
2.1 Weekly Sabbath
2.2 Weekend Sabbath
3 Christian tradition
3.1 First-day Sabbath
3.2 Seventh-day Sabbath
3.3 Monthly Sabbath
3.4 Annual Sabbath
3.5 Millennial Sabbath
4 Other religious traditions
4.1 Babylonian rest days
4.2 Buddhist rest day
4.3 Sabbath as Saturday
4.4 Islamic rest day
4.5 Wiccan sabbat
4.6 Bahá'í weekend
4.7 Unification Sabbath
5 Secular traditions
5.1 Rest day in seven-day weeks
5.2 Rest day in other weeks
5.3 Work day in seven-day weeks
5.4 Annual rest days
5.5 Rest-year sabbatical
For other uses, see Sabbath (disambiguation).
Sabbath or a sabbath is generally a weekly day of rest and/or time of worship that is observed in Abrahamic religions and other faiths. Many viewpoints and definitions have arisen over the millennia. The term has been used to describe a similar weekly observance in any of several other traditions; the new moon; any of seven annual festivals in Judaism and some Christian traditions; any of eight annual festivals in Wicca (usually "sabbat"); an annual secular holiday; and a year of rest in religious or secular usage, originally every seventh year.
[edit]Biblical tradition

[edit]Sabbath as day
For more details on this topic, see Biblical Sabbath.
The term "Sabbath" derives from the Hebrew shabbat (שבת), "to cease", which was first used in the Biblical account of the seventh day of Creation (Genesis 2:2-3). Observation and remembrance of Sabbath is one of the Ten Commandments (the fourth in the original Jewish, the Eastern Orthodox, and most Protestant traditions, the third in Roman Catholic and Lutheran traditions). Most people who observe Biblical Sabbath regard it as having been instituted as a "perpetual covenant [for] the people of Israel" (Exodus 31:13-17), a sign in respect for the day during which God rested after having completed the Creation in six days (Exodus 20:8-11); Isaiah extends the term to include even corrupted rest-day traditions (Isaiah 1:13). Sabbath desecration was originally officially punishable by death (Exodus 31:15).

[edit]Sabbath as week
For more details on this topic, see Seven-day week.
By synecdoche (naming a part for the whole), the term "Sabbath" also came to mean simply a "se'nnight" or seven-day week in Jewish sources by the time of the Septuagint, namely, the interval between two Sabbaths. Jesus's parable of the Pharisee and the Publican describes the Pharisee as fasting "twice a week" (Greek dis tou sabbatou, literally, "twice of the Sabbath").
[edit]Annual Sabbaths
For more details on this topic, see High Sabbaths.
Seven annual Biblical festivals, called by the name miqra ("called assembly") in Hebrew and "High Sabbath" in English, serve as supplemental testimonies to the plan of Shabbat. These are recorded in the books of Exodus and Deuteronomy and do not necessarily occur on Shabbat. They are observed by Jews and a minority of Christians. Three of them occur in spring: the first and seventh days of Pesach (Passover), and Shavuot (Pentecost). Four occur in fall, in the seventh month, and are also called shabbaton: Rosh Hashanah (Trumpets); Yom Kippur, the "Sabbath of Sabbaths" (Atonement); and the first and eighth days of Sukkoth (Tabernacles).
[edit]Seventh-year Sabbatical
For more details on this topic, see Shmita.
The year of Shmita (Hebrew שמיטה, literally, "release"), also called the Sabbatical Year, is the seventh year of the seven-year agricultural cycle mandated by the Torah for the Land of Israel. During Shmita, the land is to be left to lie fallow and all agricultural activity—including plowing, planting, pruning, and harvesting—is forbidden by Torah law. In traditional interpretation, other cultivation techniques—such as watering, fertilizing, weeding, spraying, trimming, and mowing—may be performed as preventative measures only, not to improve the growth of trees or plants; additionally, any fruits which grow of their own accord are deemed ownerless and may be picked by anyone, and a variety of laws apply to the sale, consumption, and disposal of Shmita produce. A second aspect of Shmita concerns debts and loans: when the year ends, personal debts are considered nullified and forgiven. In similar fashion, the Torah required a slave who had worked for six years to go free in the seventh year.

2009年8月3日 星期一

anthropometry and ergonomics

anthropometry ·其它相關字
[]
《名》 1.人體測量學.2.人體測量法.

Newton law of motion
third law (law of reaction): for every action there is an equal and opposite reaction

static equilibrium

movement: rotation

one-body segment model
two-body segment model
upper segment above the eblow: Me= clockwise 2.7 Nm ; Ms=10.6 Nm counterclockwise

2009年8月1日 星期六

pray for the timing of study on occupationally caused leukemia/lymphoma

available at http://epaper.ntuh.gov.tw/health/200908/health.html#hot2

認識白血病

白血病就是血癌。常見到連續劇中的女主角因白血病而顯得虛弱蒼白異常,痛的很厲害,咳血,這些都是一些容易誤導觀眾的錯誤觀念,因當病情進展至這些狀況時,都已是相當嚴重而需住院緊急處置了,病人是很難還在院外”趴趴走”。

白血病是一種骨髓惡性疾病,骨髓無法產生正常的血球,取而代之是一些毫無功能的不成熟血球。不成熟的血球又稱為芽細胞(leukemic blast),這些血球不會變成成熟有用的血球,因此白血病在臨床上常常表現出白血球過高的現象,正常人白血球數目在一萬個以下,而白血病患者則可高達數萬,甚至數十萬,大量不成熟白血球會排擠正常血球的生存空間,使得正常血液細胞無法發揮功能。


白血病的分類

白血病依臨床疾病惡化速度及細胞成熟度分為急性及慢性。急性白血病的血液細胞分化程度較差、較不成熟,因此芽細胞增加的速度較快,相對地在短時間內容易出現較嚴重的臨床症狀;慢性白血病的血液細胞分化程度較好、成熟度較高,因此芽細胞的增加速度比較慢,在初期可能不會有明顯症狀出現。白血病又可依細胞的來源區分為淋巴性白血病及骨髓性白血病。


為什麼會得白血病

白血病的原因目前仍不清楚,它發生於每一個年齡層,從初生嬰兒到八、九十歲老人都有可能,研究上發現可能與放射線照射、化學毒物,尤其是苯類有機溶劑,以及某些化學治療藥物、病毒感染有關。


白血病有哪些症狀

正常血液細胞在骨髓製造、分化成熟後進入人體血管內,每種細胞在體內各自扮演不同角色:白血球協助身體對抗感染;紅血球負責攜帶氧氣供給身體組織,並從組織帶走二氧化碳回到肺臟,以進行氣體交換;血小板則幫助血液形成血塊來控制出血。正常情況下,血液細胞會依身體的需要有規則且受控制地分化、生長,幫助我們保持健康;而白血病則是不受控制地產出過多不正常細胞,導致無法發揮正常血液細胞的功能。因此臨床上常見的症狀諸如原本健康的人卻因感冒久久無法痊癒,或不明原因發燒、容易出血(例如:牙齦出血、皮膚淤青或出現小紅點)、體重減輕、年輕女性月經量變多等現象,病人會覺得近來容易疲倦,看起來臉色蒼白,抽血檢查發現貧血,血小板缺乏,而白血球數目異常增高,血球分類檢驗中出現異常的白血球。急性白血病症狀的出現和病情進展都相當快,因此病人容易因身體感到不適而就醫,而慢性白血病在初期則可能不會出現任何症狀,所以病人往往是在接受健康檢查時才被診斷出慢性白血病。在診斷期間,醫師除詢問相關的病史和進行身體檢查外,還會特別注意病人的肝、脾和頸部、腋下及鼠蹊部淋巴結是否有腫大情形,同時需進行骨髓穿刺(骨髓切片)檢查,並在顯微鏡下觀察血球的變化,以確定診斷。


如何治療白血病

大多數急性白血病需要立刻給予化學藥物治療,醫師會依據病人的白血病類型、年齡、症狀以及健康狀況來擬定合適的治療計劃。化學藥物主要是由靜脈注射給予,透過藥物來殺死血液中的癌細胞。急性白血病的治療可分為兩大階段,第一階段先達到「緩解」狀態,再進行第二階段的「鞏固治療」。所謂「緩解」,是指在接受化學治療後,暫時從血液及骨髓檢查中已觀察不到不正常的細胞,但為預防疾病復發,需安排第二階段的「鞏固治療」,目的是為了徹底殺死殘存的不正常細胞,以達到根治的目的。如果病情條件需要,病人的年齡適合,及有合適的捐髓者,則會考慮作幹細胞移植治療,治療過程中,病人和家屬都可以隨時和醫生討論治療的相關問題。


化學治療的副作用

化學藥物會影響正在生長分裂的細胞,癌細胞比健康的細胞較常進行分裂,因此較容易被化學治療藥物所影響,但化學藥物雖然可殺死不正常細胞,健康的細胞相對也會被破壞,因此相關的副作用是無法完全避免的。化療副作用包括噁心、嘔吐、掉頭髮、口腔黏膜破皮、抑制骨髓造血功能血球降低等,大部分的副作用在化療停止後的恢復期會逐漸改善。由於骨髓抑制會導致貧血、白血球及血小板降低,病人容易出現感染及出血等症狀,因此需注意個人衛生習慣,限制訪客,並密切注意病人的血球數,必要時進行輸血治療,以及投予抗生素,小心的照顧以度過骨髓恢復期。另化學藥物可能會影響病人的生殖能力,孕齡女性的月經週期會變得不規則或提早停經,因此有些病人會選擇在化學治療前先將他們的精子或卵子冷凍保存。化學治療副作用與化學藥物種類有關,每個人的反應也都不盡相同,臨床有藥物可改善,在心理上應先瞭解治療的副作用,以勇敢的面對並度過難關。


幹細胞移植

白血病除化學治療外,另一可行的方法即是安排幹細胞移植。移植是將患者體內不正常的白血球細胞先以高劑量的化學治療或放射線治療破壞,然後再以健康的幹細胞取代之。健康的幹細胞可以是來自捐贈者,或患者在接受高劑量的治療之前,事先將病人本身的幹細胞收集、儲存備用。患者接受移植直到被植入的幹細胞開始製造足夠的正常血球前,必需小心避免感染、出血及其它副作用導致的危險性,因此需住院數週。捐贈者的骨髓可能在病人身上發生移植物反宿主疾病(俗稱的排斥反應)。移植後可能發生的併發症很多,每個人的病情亦各有不同,宜與主治醫師就移植時機與方式等,詳細討論後再決定是否進行移植。


結語

當被告知罹患白血病時,震驚、沮喪、焦慮、擔憂、難以接受等情緒反應均可能出現,病患及家屬內心均承受莫大的壓力,在辛苦的治療過程中,雖在醫院內有醫護人員的協助,但朋友和親屬的支持更顯得重要。透過與相同遭遇之病友及家屬間的鼓勵與分享,更能夠使病患及家屬勇於面對治療。本院血液腫瘤團隊成立「台灣髓緣之友協會」,志工成員為病患或其家屬所組成,每週定期探訪住院病友,互相關懷並給予情緒支持,一起分享學習治療及對副作用的調適,增加對疾病的適應性,以減輕內心的壓力。每個病人即使患有相同種類的白血病,但因狀況都不盡相同,治療計畫勢必有所差異,醫師通常會以多面向的角度與病人和家屬溝通討論相治療計畫,而家屬和朋友的參與是必要的,當擁有足夠的資訊和支持時,他們才有勇氣與能力去面對並克服種種的挑戰。

護理部護理長 羅淑玲

information technology of internet medical care

i pray for contact with Dr. 呂, the professor of the institute of electronics, NTU, for knowing the information technology of internet medical care, for the potential technology support of research on overtime work, shift work, and heart rate variability.

available at http://epaper.ntuh.gov.tw/health/200908/teams.html

不打烊的照顧-遠距醫療照護團隊

臺大醫院為了打造一個出院病人遠距照護平台,結合電子病歷應用、遠距照護資訊網路與遠距生理監測系統,由遠距醫療團隊監控各項生理數據,而病友如有疑問,也可以隨時詢問個案管理師,讓出院病友不管是回家或是到護理之家,都能獲得持續性的照護與諮詢,減少疾病復發或嚴重併發症,提升生活品質。為了能更精確追蹤病情的變化,臺大醫院現階段遠距醫療照護計畫,主要針對心血管疾病與高血壓、糖尿病、膽固醇、肥胖症及代謝症候群等慢性病以及癌症末期的安寧照護三類住院病友,經過醫師與個案管理師評估病友情況及意願後,加入臺大醫院遠距照護網。


因遠距醫療計畫需要投入人力資源及相關儀器設備,所以加入臺大醫院遠距照護網的病友,必須自行負擔一部分費用,這些費用包括請廠商安裝生理訊號測量儀器及網路通訊儀器的費用及管理費。病友即可每天將各項檢查資料,如血壓、血糖、心跳等8-15項數據(視病情需要)上傳到資料庫,每週與個案管理師視訊溝通,諮詢檢測結果以及因應方式,也可以查詢門診的最新抽血報告。


資料庫系統如果顯示異常的生理資訊,個案管理師會聯絡負責的醫師,討論適合處理方式或是藥物使用,隨時掌握病友健康狀況,病友即使在家也能得到醫學中心級的居家照護。
主治醫師 何奕倫 

戴奧辛被稱為『世紀之毒』?, what is its acutal meaning?

戴奧辛對人體疾病的影響

available at http://epaper.ntuh.gov.tw/health/200908/project.html#hot2


多氯聯苯與其相關化學物質之的環境問題概述

自20世紀中葉開始,環境污染物逐漸被發現其普及性及其對人體健康之影響。多氯聯苯、多氯夫喃與戴奧辛類之化合物乃全世界各水體、土壤、底泥、空氣、等環境中到處可以測得到的污染物質,並為農業、工業、焚化、與交通等現代國家無可避免的過程中常見的副產物。這些化合物在動物研究中明顯地被發現有致癌性、免疫毒性、生殖系統毒性、致畸性、皮膚毒性、肝毒性、神經毒性、與對內分泌系統之毒性。由於其普遍性、環境留存性、與多樣的毒性,這些化合物已成為公共衛生與環境醫學之重要化合物,而受到相當的關切。戴奧辛且被稱為『世紀之毒』。



圖一、戴奧辛


圖二、多氯夫喃


圖三、多氯聯苯
多氯夫喃與戴奧辛在結構上相似,其毒性亦相似。多氯聯苯乃是一族相互類似的化合物,以二個相連的苯環(聯苯)為基本構造(見右圖)。苯環上的氫,可以由不同數目的氯來取代。而依氯取代數目及位置的不同,多氯聯苯共有209個可能的化合物。工業上所使用的則為這些化合物的不同百分比的混合物。多氯聯苯與戴奧辛在結構上相似,而其毒性亦有一部份與戴奧辛相似。根據氯取代數目及位置的不同,多氯夫喃與戴奧辛各有135及75個可能的化合物。


多氯聯苯、多氯夫喃與戴奧辛類之化合物中只有多氯聯苯曾被大量用於工業上,並曾被大量地製造。多氯聯苯的生產始於1920年代,主要以液態存在,其溶點、沸點及可燃燒度隨其含氯原子的多少而成正比,可耐強酸、強鹼及其他化學物質之侵蝕,因此穩定度極高,並有極佳的絕緣性,工業用途大。其最大的用途列於下: 電力公司的變壓器與電容器、水力與熱轉換液的製造、馬達或引擎、油漆、塑膠、印刷油墨、塑化劑、黏著劑、潤滑添加劑。


雖然多氯聯苯的使用早在1920年代,直到1966年,在使用了40年之後,才有學者發現在環境中有多氯聯苯的存在。然而仔細一查,發現在環境之中,包括河底的污泥、各種水流或水體、土壤等,無處沒有多氯聯苯的存在。這時才引起人們的警覺。這個強有力的環境污染者已潛伏在地球的每一個角落,無所不在了。在北歐的生物學者將歷年來野生博物館內所收集的鳥類羽毛作分析,結果,竟發現早在1944年,鳥類羽毛中就有多氯聯苯的存在。這個發現,顯示出人類對環境中毒物,具有很低的敏感度,竟在動物已受污染的20年之後,才發現有多氯聯苯污染的問題存在。今日,多氯聯苯已為學者列為與鉛、戴奧辛、石綿合稱的四大環境污染物之一,而它在世界上各種環境分佈的普遍性,以及污染的總量,更是其他三者所無法比擬的。


不但如此,因為戴奧辛類、多氯夫喃與多氯聯苯均有很高的脂溶性,這一些化合物在環境中較易與脂肪含量較多的生物結合。因此,隨著生物食物鏈的層次愈高,生物體內的戴奧辛類、多氯夫喃與多氯聯苯濃度也愈高。人類體內最大的戴奧辛類、多氯夫喃與多氯聯苯來源為食用水生動物,如魚類、貝類等。食用愈多魚類的人,其體內的戴奧辛類、多氯夫喃與多氯聯苯濃度也愈高。因這些化合物可以隨著生物食物鏈進入人體,美國、加拿大、挪威、以色列、日本、台灣等國家均有一般人口中人體血液戴奧辛類、多氯夫喃與多氯聯苯濃度的報告。台灣的一般人口血清中戴奧辛類平均濃度為20 ppt毒性當量;多氯聯苯的平均濃度約為1到3ppb。而在美國五大湖區等工業污染較嚴重的區域,根據吃魚量的大小,血中多氯聯苯的平均濃度可以到達10ppb以上。而現在最令學者擔心的是:這種濃度的多氯聯苯會不會在人體中引起影響健康的作用?若會的話,作用多嚴重?多氯聯苯∕夫喃∕戴奧辛等物質已知在動物研究中有致癌性、免疫毒性、生殖系統毒性、致畸性、皮膚毒性、肝毒性、神經毒性、與對內分泌系統之毒性。因此,最令人擔心的是,這種濃度的戴奧辛類物質及多氯聯苯會不會在人體中引起這些健康效應?


除了一般人口每日不知不覺的暴露之外,多氯聯苯等物質更因為有多次引起某些特定人群的嚴重中毒事件而惡名昭彰。其中較顯著的急性暴露者則以1968年日本九卅福岡的中毒事件稱為Yusho(日文油症);及1979年台灣台中、彰化一帶的中毒事件稱為油症(Yu-cheng),皆引起廣泛的注意。這兩次的意外中毒事件的起因,皆是由於米糠油的製造過程包括了使用間接加熱方式以去除米糠油之異色的步驟,而多氯聯苯自管路中洩漏出來,進入製造成的米糠油之中。食用這些污染米糠油者就中毒,因此稱為油症。1968年日本九卅福岡的油症中毒事件共有一千八百人受害。而於1979年台灣多氯聯苯米糠油中毒事件,中毒而報告至省衛生處的受害者達兩千人之眾,中毒者發生極端疲勞、皮膚產生許多黑頭的青春痘、手足酸痳無力、走路不穩,並有神經炎、肝功能與血液中免疫機能異常的現象。長期追蹤之結果,亦發現在中毒後8年之內患者因慢性肝病及肝硬化死亡者增加為一般人之三倍;而在中毒後9-24年之間女性因紅斑性狼瘡而死亡者為一般人之近20倍之多。且中毒女性在60歲以上者,有記憶力較一般女性為差的現象。不單在直接中毒者,中毒婦女懷孕所生下的小孩有皮膚褐色素沈澱、發育遲緩、體重過輕、身高過短、與畸形等現象,並有些胎死腹中,這些小孩,被稱為『可樂兒』。不是他們比其他的小孩更愛喝可樂,而是對他們皮膚顏色的形容!


台灣多氯聯苯米糠油中毒事件的元凶,一般相信為一種多氯聯苯混合物Kanechlor 500所引起。Kanechlor 500內約含有54%重量的氯。又由於經過反覆地加熱過程,米糠油之內亦含有少量的多氯夫喃。由於多氯夫喃的毒性比多氯聯苯為強,即使是少量的多氯呋喃,亦被認為提供了污染米糠油造成的人類毒性與症狀的重要成分。因此,一向所說的多氯聯苯米糠油中毒,事實上應是多氯聯苯∕多氯呋喃米糠油中毒才正確。


台灣油症暴露患者在中毒之後四年內有廿四人死亡,其中半數死於肝癌、肝硬化及其他肝病,日本學者也報告廿年後的追蹤研究提及肝癌死亡率較一般民眾為高。台灣為B型肝炎盛行之地區,B型肝炎是人類發生肝癌、肝硬化之重要因素之一。多氯聯苯中毒對肝癌之誘發機轉中所佔的角色近年來為流行病、癌症、環境醫學諸多學者所揣測。在台灣多氯聯苯患者會不會有較多的肝癌罹患率,目前仍無研究資料,此將是公共衛生、環境衛生一個十分重要,亟待解答的問題。


研究者估計:在日本油症病人,平均每人約吸收了633mg的PCBs及3.4mg的PCDFs。而在台灣的油症病人,平均每人約吸收了973mg的PCBs及3.84mg的PCDFs。國內的患者因此暴露量比日本要高。在日本油症病人中毒五年後,血中PCBs濃度為1-30ppb,而在台灣的油症病人中毒一年後,血中PCBs濃度為3-1156ppb。而且國內患者所食之PCBs所含的氯成分比較高。這些高氯的多氯聯苯一般來說,比日本中毒者所食之低氯的多氯聯苯,更不易排除而易積存在體內。如在職業上暴露於多氯聯苯混合物Arochor1254者,其血中之半衰期就比暴露於Arochor1242者之血中半衰期為長。因此國內患者極可能會比日本患者積存更久的多氯聯苯。油症中毒乃一生的中毒,因為油症女性中,即使在中毒事件十三年之後,其體內毒物濃度,仍比正常未受暴露者高出五十倍至一百八十倍之多。因此其一生之健康均受到影響。


多氯聯苯及類似的化學物質,都是極親油脂性,而不易由人體內排出,其體內的半衰期可以達到七或八年之久。所以十多年前中毒的人,其體內仍留有相當高濃度的多氯聯苯及多氯夫喃。由於不同的多氯聯苯∕夫喃化合物在人體的吸收、代謝與滯留各異,在人血中與脂肪中的多氯聯苯∕夫喃的成分,已與剛中毒時有別。我們的研究顯示,中毒者在1992年血清中的多氯聯苯的濃度,為未中毒者濃度的七倍以上;而多氯夫喃濃度則為未中毒者的五十倍至二百倍之高。因此,雖然已經是中毒的十多年之後,中毒者仍會受到體內所含的化學毒物的慢性影響。所以繼續健康檢查與追蹤仍有其事實上的必要性。


日本福岡地區學者於1986年重新體認追蹤研究PCBs中毒患者的重要性,而成立了新的油症患者醫學檢查資料系統,並發現在PCBs中毒患者在中毒十八年後仍有皮膚、指甲、黏膜等的色素沉著。然而福岡地區患者比長崎地區患者多指甲、結膜等之色素沉著,而長崎地區患者比福岡地區患者多口唇黏膜之色素沉著。至於血中多氯聯苯濃度,福岡地區患者平均在4.39ppb,而長崎地區患者平均為6.79ppb,顯示兩地中毒者對多氯聯苯之代謝,似有不同。且在血中留存的成份,可能今日亦有相當的不同。


臺灣大學醫學院的油症研究小組於多年來長期地追蹤這批攝食PCBs污染之米糠油病患,以提供其檢查,並求早期發現疾病與早期治療。長期追蹤在1979年台灣發生的米糠油中毒事件(稱為油症事件)的中毒者的健康效應。對其健康及疾病的發生上,至今已發現中毒者在肝臟疾病尤其是肝硬化的死亡率是對照組的三倍左右,且生存者肝病患的機會比未中毒高兩倍。而男性即使在中毒事件十六年之後,其體內毒物濃度,仍比正常未受暴露者高出四十倍以上,且其肝臟中之cytochrome P450 1A2代謝酵素,亦因此而大幅昇高,昇高到吸菸者昇幅的10倍以上。這樣的酵素變化,可以作為一個有效的環境污染物暴露的生物指標。最近更發現,中毒者女性死於系統性紅斑性狼瘡的機會,在中毒之後九年開始增大,而可以高至正常人之20倍。在60歲以上之中毒者進行智力之評估,並發現他們在記憶力與學習能能力方面較差,而此項影響在女性更形嚴重。中年以上之女性中毒者,亦比對照組易發生糖尿病。


由於人類對此類化學物質之排出十分的慢(半衰期約八年),即使一生,均未能將體內污染物質降至一般人的濃度。而最新的研究發現,即使在中毒25年之後,仍可能發現正常人很少發的疾病;可以說中毒者其一生之健康均會受到影響,故其長期之追蹤,具有十分重要的意義。在中毒者之中,其甲狀腺腫大、皮膚病、女性貧血、及男性關節炎與椎間盤問題均比對照組為高。在中毒女性中,死產與月經問題均比對照組高出許多。而在正常的結婚婦女間,即使正常的結婚生活,在無避孕措施之下,發生不孕之機會亦為未暴露者之兩倍多。由於多氯聯苯與多氯夫喃為環境中之內分泌干擾物質,中毒者與對照組之子代性別作一比較,發現在中毒男性中,中毒之後10年內所生的小孩,女性機率高出男性許多。


油症中毒不只對中毒者本身是嚴重的傷害,對於中毒女性所產下的小孩,亦即在胎盤內暴露於多氯聯苯的油症兒,發現有智力發展的遲緩現象,此智力的發展遲緩問題,甚至在女性中毒後七至十二年所生的小孩仍會發生,而男孩受到的影響比女孩較為嚴重。油症兒身高與身體肌肉發育有減慢的現象,牙齒發育之異常並比正常兒高出數倍。對油症兒在中毒事件十二年之後的體內毒物濃度研究,發現其濃度仍比正常未受暴露者高出將近十倍。油症兒之罹患中耳炎的機會,比其對照組高上將近十倍左右,且其罹患的可能性,與油症兒血清中的多氯聯苯的相關性,反而不及與血清中的多氯夫喃的相關性為高。因此,顯示此一重要的環境毒性物質,的確有增加感染性的可能。若考量多氯聯苯與多氯夫喃可能為環境中之內分泌干擾物質,則其對生殖系統作用如何?油症中毒之女性所生的男孩,在到達生殖系統成熟的年齡時(即他們母親中毒發生的16至20年之後),其精子正常型態比例增加50%、精子活動力下降40%、可活動之精虫其擺動速率下降20%、與卵子結合能力下降10%。中毒第二代的小孩,其行為亦有異常的現象,尤其在身體不適、注意力不集中、不良行為、攻擊性行為等,中毒者小孩均比對照組為高。此發現提供所有流行病學者與環境研究者一個警訊,環境毒性物質可能影響到人類的行為,且可以傳給第二代。


我們必須知道,多氯聯苯類的化學物質並不只在油症的中毒者身上才有,而在每一個人體內都有一些。由於多氯聯苯類化學物質的環境穩定性,以及其親脂肪性,在環境中可以造成生物濃縮的現象。即此類物質在水中的濃度,比不上在水中生存的浮游生物的濃度,而食用浮游生物的魚體內濃度,比浮游生物更高。因此食物鏈的上層生物的濃度,可比最下層的生物高上百萬倍。這種生物濃縮,使得在高污染區的人類有效地攝取了多氯聯苯等毒物。人類體內這些毒物最大的來源之一,即為水產生物。


人類雖已是食物鏈的最高層次,然而吃母乳的小孩,更自母乳中有效地得到相當量的多氯聯苯類化學物質。人體之中的分佈,集中於脂肪多的構造中。環境學者查出在工業化國家正常的母奶中,所含的多氯聯苯量為動物致毒劑量的十分之一,而所含的多氯夫喃為動物致毒量的百分之一。而哺育母乳,可能帶給嬰兒類似動物實驗所造成的各種毒性。


多氯聯苯雖於1970年代在許多歐美國家中禁止生產,在1986年在我國禁用,然而目前全世界仍有超過一百萬噸之多氯聯苯分散各地,其中57%仍在反覆使用中、或已停止使用而尚未掩埋,27%已被掩埋起來,16%則污染於各地的土壤、湖泊、河川、海洋及空氣。所以,我們現在所面對的問題,仍只是所有人類曾經製造的多氯聯苯的一小部份而已。引起多氯聯苯污染的來源,主要是工業上使用而殘留的多氯聯苯大量或廣泛的排放、或丟棄之結果。對於多氯聯苯,至今常使用的廢棄方法包括:掩埋、焚燒、倒入海中或河湖等其他水體中等方法。然而這一些方法都有其缺失,而較安全的高溫氣化的方法則其花費十分昂貴,因此對已存在的多氯聯苯之廢棄,是今日環境學者必須仔細考慮、討論,以決定其方式的。而在決定之時,對處置多氯聯苯所可能引起的影響,必須作好環境影響評估,不可輕率從事。最使學者以及知情的一般民眾擔心的,則是那些仍在反覆使用中、或已停止使用而尚未掩埋的多氯聯苯。而至於多氯夫喃及戴奧辛等化合物,為許多工業、焚化過程可能的副產物。如何以最妥善的方法來處理這些隱伏的環境危機,仍是人類面臨的最大挑戰之一。

環境及職業醫學科部教授 郭育良  TOP

a case of over-work or stress related stroke during work?

it may be needed to have the prior data of BP /PR, even HR variability, also the post-stroke data to refutate the hypothesis of work-related stroke in this case study.


公告日期 2009/7/23
標題 國立臺灣大學李嗣涔校長出院新聞稿
本文 台大醫院新聞稿

98年7月23日
經過臺大醫院一週的觀察治療,臺大李校長於7月23日(四)出院。李校長表示,由於日前身體不適住院,經臺大醫療團隊悉心診治,順利完成手術,術後恢復亦頗良好。

李校長並且以最誠摯的心對各界的關懷表示由衷的感謝。除了住院期間醫療團隊悉心照護外,亦承蒙馬總統、蕭副總統、連前副總統伉儷、行政院劉院長、立法院王院長、司法院賴院長、監察院前錢院長、教育部鄭部長、國防部陳部長、國科會李主委、曾政務委員、張政務委員、各大學校長、各界賢達先進及校內師生同仁深切的關懷與沛然的祝福,使得復元更為迅速。

李校長也強調,在住院期間更加體會健康之重要,期盼各界為民服務之前輩同儕能在身體健康與社會奉獻之間找到平衡。

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由 劉宣昕 在 2009/7/23 下午 06:15 所建立
上次修改日期 2009/7/25 上午 11:27 ,修改者 劉宣昕

2009年7月21日 星期二

neurocysticercosis

i saw a 30+ female patient from india, who suffered from headache, and visited my clinic for help. She has past history of neurocysticercosis when she was a PhD student, which may get infected from food eaten outside in the market?
The first presentation is headache and seizure, generalized tonic and clonic convulsion.



She received antibiotic treatment at the clinic for 1 year and totally recovered.


news video available at http://abcnews.go.com/Health/PainManagement/Story?id=6309464&page=1



It's Not a Tumor, It's a Brain Worm
Doctor Surprised to Find a Worm Living Inside a Woman's Brain

By LAUREN COX
ABC News Medical Unit
Nov. 24, 2008—

Late last summer, Rosemary Alvarez of Phoenix thought she had a brain tumor. But on the operating table her doctor discovered something even more unsightly -- a parasitic worm eating her brain.

Alvarez, 37, was first referred to the Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix with balance problems, difficulty swallowing and numbness in her left arm.

An MRI scan revealed a foreign growth at her brain stem that looked just like a brain tumor to Dr. Peter Nakaji, a neurosurgeon at the Barrow Neurological Institute.

"Ones like this that are down in the brain stem are hard to pick out," said Nakaji. "And she was deteriorating rather quickly, so she needed it out."

Yet at a key moment during the operation to remove the fingernail-sized tumor, Nakaji, instead, found a parasite living in her brain, a tapeworm called Taenia solium, to be precise.

"I was actually quite pleased," said Nakaji. "As neurosurgeons, we see a lot of bad things and have to deliver a lot of bad news."

When Alvarez awoke, she heard the good news that she was tumor-free and she would make a full recovery. But she also heard the disturbing news of how the worm got there in the first place.

Nakaji said someone, somewhere, had served her food that was tainted with the feces of a person infected with the pork tapeworm parasite.

"It wasn't that she had poor hygiene, she was just a victim," said Nakaji.

Pork Tapeworms a Small, But Growing Trend

"We've got a lot more of cases of this in the United States now," said Raymond Kuhn, professor of biology and an expert on parasites at Wake Forest University in Winston-Salem, N.C. "Upwards of 20 percent of neurology offices in California have seen it."

The pork tapeworm has plagued people for thousands of years. The parasite, known as cysticercosis, lives in pork tissue, and is likely the reason why Jewish and Muslim dietary laws ban pork.

Kuhn said whether you get a tapeworm in the intestine, or a worm burrowing into your brain can depend on how you consumed the parasite.

How Humans Get Worms

Eat the parasite in tainted meat and you'll end up eating the larvae, called cysts. Kuhn said in that case, a person can only end up with a tapeworm.

"You can eat cysts all day long and it won't get into your brain," said Kuhn. Instead, the larvae go through the stomach and mature in the intestine.

"When it gets down into their small intestine, it latches on, and then it starts growing like an alien," said Kuhn.

Once there, the tapeworm starts feeding and gets to work. A single tapeworm will release 50,000 eggs a day, most of which usually end up in the toilet.

"They can see these little packets pass in their feces," said Kuhn. "And ... sometimes people eat the eggs from feces by accident."

Kuhn said it is then feces-tainted food, and not undercooked pork, that leads to worms burrowing into the brain.

Unlike the cysts, the eggs are able to pass from the stomach into the bloodstream. From there, the eggs may travel and lodge in various parts of the body -- including the muscle, the brain or under the skin -- before maturing into cysts themselves.

According to Kuhn, who has traveled to study this parasite, cysticercosis is a big problem in some parts of Latin America and Mexico where health codes are hard to enforce and people may frequently eat undercooked pork.

As people travel across the border with Mexico for vacation and work, Kuhn said so does the tapeworm. One person infected with a parasite, who also has bad hand washing habits, can infect many others with eggs.

"These eggs can live for three months in formaldehyde," said Kuhn. "You got to think, sometimes, a person is slapping lettuce on your sandwich with a few extra add-ons there."

Getitng the Worms Out

Dr. Christopher Madden, an assistant professor in the University of Texas Southwestern department of neurological surgery in Dallas, has operated on a number of these cysts himself. He said not every worm needs to be surgically removed; those whose location is not an immediate threat to the patient's health can be treated with medications that cause the worms to die.

But when the cysts are in problematic locations, as was the case for Alvarez, an operation is necessary. Fortunately, the long-term prognosis for most patients is positive.

"Most patients we see actually do very well with medicines and/or surgery to take out a large cyst," Madden said.

Alvarez is not alone in accidentally eating tainted food, but Nakaji rarely sees cases so severe that people require surgery. Nakaji said he only removed six or seven worms in neurosurgery this year.

"But lodging in the brain stem is bad luck," he said.

Nakaji said other parts of the brain have more "room" or tissue to expand around a growing cyst. However the brain stem, which is crucial to life, is only the width of a finger or two.

"She could have recovered," said Nakaji. "But if the compression lasted for long enough, she could have been left permanently disabled or dead."

Copyright © 2009 ABC News Internet Ventures

2009年2月19日 星期四

warfarin dose

Volume 360:753-764 February 19, 2009 Number 8
Estimation of the Warfarin Dose with Clinical and Pharmacogenetic Data
The International Warfarin Pharmacogenetics Consortium


ABSTRACT

Background Genetic variability among patients plays an important role in determining the dose of warfarin that should be used when oral anticoagulation is initiated, but practical methods of using genetic information have not been evaluated in a diverse and large population. We developed and used an algorithm for estimating the appropriate warfarin dose that is based on both clinical and genetic data from a broad population base.

Methods Clinical and genetic data from 4043 patients were used to create a dose algorithm that was based on clinical variables only and an algorithm in which genetic information was added to the clinical variables. In a validation cohort of 1009 subjects, we evaluated the potential clinical value of each algorithm by calculating the percentage of patients whose predicted dose of warfarin was within 20% of the actual stable therapeutic dose; we also evaluated other clinically relevant indicators.

Results In the validation cohort, the pharmacogenetic algorithm accurately identified larger proportions of patients who required 21 mg of warfarin or less per week and of those who required 49 mg or more per week to achieve the target international normalized ratio than did the clinical algorithm (49.4% vs. 33.3%, P<0.001, among patients requiring 21 mg per week; and 24.8% vs. 7.2%, P<0.001, among those requiring 49 mg per week).

Conclusions The use of a pharmacogenetic algorithm for estimating the appropriate initial dose of warfarin produces recommendations that are significantly closer to the required stable therapeutic dose than those derived from a clinical algorithm or a fixed-dose approach. The greatest benefits were observed in the 46.2% of the population that required 21 mg or less of warfarin per week or 49 mg or more per week for therapeutic anticoagulation.



Source Information


Address reprint requests to the International Warfarin Pharmacogenetics Consortium at 300 Pasteur Dr., Ln. 301, Mailstop 5120, Stanford, CA 94305, or at iwpc@pharmgkb.org.


中研院研究》抗凝血劑 依基因精準抓劑量

【聯合報╱記者楊正敏/台北報導】
2009.02.20 02:19 am


中研院發展抗凝血劑劑量公式,李明達博士拿著基因鑑定套件,很快就驗出結果。
記者趙文彬/攝影
未來使用口服抗凝血劑「華法林」時,不必再為劑量頭痛了。中央研究院國家基因體鑑定中心參與的一項國際鉅型研究計畫,發展出「華法林」劑量公式,可依病人的基因型,精確算出藥量,減少藥物不良反應,有效預防心臟病或中風。

這項研究是由國科會基因體國家型計畫經費支持,中研院、長庚醫院等單位參與,研究成果獲刊登於醫學界權威期刊「新英格蘭醫學」,昨天全球同步發表。

中研院生醫所所長陳垣崇說,未來會在台灣進行「華法林」劑量公式的大型臨床試驗,從臨床治療上驗證公式的準確性,預計最快一年半後可以完成,屆時就能應用於臨床治療。

中研院基因體鑑定中心研究助技師李明達指出,華法林是目前世界上最被廣泛使用的口服抗凝血劑,可以用來預防深部靜脈栓塞、肺栓塞、缺血性冠狀動脈症狀。在台灣保守估算,每年約有三萬人,使用超過一千萬顆華法林。

他指出,華法林劑量很難掌控,且每個人的差異很大,劑量過多可能造成中風;過少會造成血栓塞。醫師多半只能按照病人的年紀、身高體重及經驗等判斷。

二○○五年陳垣崇帶領的團隊發現人體VKORC1基因上的基因型差異,影響人體對「華法林」劑量的需求,不知是否能運用在所有種族的人身上。

因此九國廿一個團隊展開合作研究,觀察五千七百位固定服「華法林」藥物的不同種族病患的醫療效果,先鑑定患者的基因型,再加上身高、體重、年齡等,發展出計算公式,可以精確預測適當劑量。

李明達說,中研院發展出快速基因型鑑定的套件,用現有的設備就能在三點五小時檢出患者的基因型。未來劑量公式也將網頁化,只要填進相關資訊與基因型,五秒內就能算出劑量。他指出,有這套公式,不僅能減少劑量不準造成的不良反應,更能提升治療品質,患者不必為了調藥到往返醫院,往個人化醫療再邁進一步。

【2009/02/20 聯合報】@ http://udn.com/

2009年2月12日 星期四

mononeuritis multiplex

Most systemic diseases associated with mononeuritis multiplex, including vasculitides, connective-tissue disease, cryoglobulinemia, sarcoidosis, diabetes, amyloidosis, neoplasms, and infections, cause nerve damage by affecting the vasa nervorum.

http://content.nejm.org/cgi/content/full/360/7/711

Livedoid Vasculopathy

Livedoid vasculopathy is a segmental, hyalinizing vasculopathy that involves small and medium-sized blood vessels in the lower legs. It can present with livedo changes in the skin, focal purpura, and painful, irregularly shaped lesions around the malleoli. It can be an isolated or a primary condition or can be associated with a variety of hypercoagulable risk factors, including antiphospholipid antibodies, as well as most other serologic and genetic risk factors for either venous or arterial thromboses, and connective-tissue diseases.20 Our patient's cutaneous findings could be explained by livedoid vasculopathy occurring in the setting of a connective-tissue disorder, the most likely of which would be SLE.

2009年2月3日 星期二

case of HACE

delayed neurological progress was noted in the case of HACE but dramatic clinical improvement ensued with a successful community discharge and return to work. Based on this case, optimism is warranted even with the most severe neurological presentation; long-term prediction of outcome should be delayed for at least 3 to 4 months.