Nothing is difinite. Perhaps we might hope someone will do what he has promised , but we should not think others "must " do it.
12/22/2006
About Doctors
技工和醫師都是按表操課的行業，雖然臺醫大眾頭目不斷放炮說和病人溝通是一種藝術...，所以醫學是一種藝術云云。但是君不見現今實證醫學所要求的證據化，標準化之理想就是將行醫變成看﹝或背﹞操作手冊修東西。這種夢想其實也很合理，畢竟大家寧願給專業原廠修電腦也不要給很會嘴砲的學生修。
醫學，特別是臨床醫學，特別是在緊急狀況下，絕對不鼓勵大家思考，不鼓勵大家發揮創意。所以醫學教育很大的目標就是在把學生壓榨到其壓力極限下時還能讓他背出該背的東西來。這種訓練方式從古到今都和訓練技工一樣，包括師徒制，不領錢的實習，填鴨﹝不用理解﹞的教育，還有在國家介入後發明的證照制度。差別就在醫師養成時間久，課本厚，門檻高，學費貴，預期薪水高而已。這其實就是因為修的東西比較貴，就像修飛機的比修腳踏車訓練久，薪水高。不過基本上修理和設計飛機所要研讀的原理雖然一樣，但工作內容卻是不同的。
至於comfort這種東西，其實是一種弔詭，看似存在又似不存在，我們有很多種方式去討論它，不過我現在不想討論。不過我們很粗俗的講，comfort這種東西在某個層面上就是醫生販賣的產品之一，基本上來找你看病，你的目的就是讓病人：1.不要死 2.比較爽大部分所謂的病都是這樣。
所以俊哥說的技工，並不是歧視，而是指一種強調實用思維的範疇。身為一個人，受大學教育，又有一點自尊心。通常不會想從事最高目標是成為機器人的行業，但是又很不幸被騙進來了，所以只好安慰自己跟病患交流很有趣又很有挑戰性，薪水其實沒那麼少云云。其實已經失去獨立批判思考能力了。如果大家仔細想想，醫學教育就是一種泯滅人性，而不是發揚人性光輝的教育。當頭目們宣揚什麼當醫生就是一種福氣啦這種從美國抄過來的話時，各位可以和"Arbeit macht frei"比較看看。這兩者之前有著微妙的族系類同，最簡單的一個就是，在某種意義上，你走進這個門，就再也出不來了。
9 crimes-Damien Rice
Title: 9 Crimes (feat. Lisa Hannigan)
*Lisa Hannigan*
Leave me out with the waste
This is not what I do
It's the wrong kind of place
To be thinking of you
It's the wrong time
For somebody new
It's a small crime
And I've got no excuse
Is that alright with you?
Give my gun away when it's loaded
Is that alright with you?
If you don't shoot it how am I supposed to hold it
Is that alright with you?
Give my gun away when it's loaded
Is that alright with you?
with you.
*Damien Rice*
Leave me out with the waste
This is not what I do
It's the wrong kind of place
To be cheating on you
It's the wrong time
She's pulling me through
It's a small crime
And I've got no excuse
Is that alright with you?
Give my gun away when it's loaded
(Is that alright with you?)
Is that alright with you?
If you don't shoot it how am I supposed to hold it
(Is that alright with you?)
Is that alright?
Give my gun away when it's loaded
(Is that alright with you?)
Is that alright?
Is that alright with you?
Is that alright with you?
Give my gun away when it's loaded
(Is that alright with you?)
Is that alright with you?
If you don't shoot it how am I supposed to hold it
(Is that alright with you?)
Is that alright with you?
Give my gun away when it's loaded
(Is that alright with you?)
Is that alright?
Is that alright with you?
Is that alright with you?
(Give my gun away when it's loaded)
Is that alright with you?
(If you don't shoot it how am I supposed to hold it)
Is that alright with you?
(Give my gun away when it's loaded)
Is that alright?
Is that alright?
Is that alright with you?
No...
Elephant by Damien Rice
Elephant by Damien Rice
homemade MV
This has got to die
This has got to stop
This has got to lie down
With someone else on top
You can keep me pinned
It's easier to tease
But you can't paint an elephant
Quite as good as she
And she may cry like a baby
And she may drive me crazy
'Cause I am lately lonely
So why d'you have to lie?
I take it I'm your crutch
The pillow in your pillow case
It's easier to touch
And when you think you've sinned
Do you fall upon your knees?
And do you sit within your picture?
Do you still forget the breeze?
And she may rise, if I sing you down
And she may wisely cling to the ground
'Cause I'm lately horny
So why would she take me horny?
What's the point of this song? Or even singing?
You've already gone, why am I clinging?
Well I could throw it out, and I could live without
And I could do it all for you
I could be strong
Tell me if you want me to lie
'Cause this has got to die
This has got to stop
This has got to lie down, down
With someone else on top
You can both keep me pinned
'Cause it's easier to tease
But you can't make me happy
Quite as good as me
Well you know that's a lie
homemade MV
This has got to die
This has got to stop
This has got to lie down
With someone else on top
You can keep me pinned
It's easier to tease
But you can't paint an elephant
Quite as good as she
And she may cry like a baby
And she may drive me crazy
'Cause I am lately lonely
So why d'you have to lie?
I take it I'm your crutch
The pillow in your pillow case
It's easier to touch
And when you think you've sinned
Do you fall upon your knees?
And do you sit within your picture?
Do you still forget the breeze?
And she may rise, if I sing you down
And she may wisely cling to the ground
'Cause I'm lately horny
So why would she take me horny?
What's the point of this song? Or even singing?
You've already gone, why am I clinging?
Well I could throw it out, and I could live without
And I could do it all for you
I could be strong
Tell me if you want me to lie
'Cause this has got to die
This has got to stop
This has got to lie down, down
With someone else on top
You can both keep me pinned
'Cause it's easier to tease
But you can't make me happy
Quite as good as me
Well you know that's a lie
12/20/2006
2006/12/14
Wanted!
Life is a STRUGGLE. And who can totally handle it?
Please tell me if you just know someone who can do it.
Sincerely thank you.
Johnson Tsai 2006.12.14
What the hell? What is going on with me?
EVERING around me seems to be outcontroling...
Everytime I say something wrong I feel I am so weak.
Maybe I do NOT have the ability to live on this world.
Why am I here? Can you tell me ?
12/13/2006
12/06/2006
Endotoxins
Endotoxins are potentially toxic, natural compounds found inside pathogens such as bacteria. Classically, an "endotoxin" is a toxin, which unlike an "exotoxin", is not secreted in soluble form by live bacteria, but is a structural component in the bacteria which is released mainly when bacteria are lysed.
The prototypical examples of endotoxin are lipopolysaccharide (LPS) or lipo-oligo-saccharide (LOS) found in the outer membrane of various Gram-negative bacteria. The term LPS is often used exchangeably with endotoxin, owing to its historical discovery. In the 1800s it became understood that bacteria could secrete toxins into their environment, which became broadly known as "exotoxin". The term endotoxin came from the discovery that portions of Gram-negative bacteria itself can cause toxicity, hence the name endotoxin. Studies of endotoxin over the next 50 years revealed that the effects of "endotoxin" was in fact due to lipopolysaccharide. There are, however, endotoxins other than LPS. For example, delta endotoxin of Bacillus thuringiensis makes crystal-like inclusion bodies next to the endospore inside the bacteria. It is toxic to larvae of insects feeding on plants, but is harmless to humans (as we do not possess the enzymes and receptors necessary for its processing followed by toxicity). The only gram positive bacteria that produces endotoxin is Listeria monocytogenes.
LPS consist of a polysaccharide (sugar) chain and a lipid moiety, known as lipid A, which is responsible for the toxic effects. The polysaccharide chain is highly variable amongst different bacteria. Endotoxins are approximately 10 kDa in size but can form large aggregates up to 1000 kDa. Humans are able to produce antibodies to endotoxins after exposure but these are generally directed at the polysaccharide chain and do not protect against a wide variety of endotoxins. Injection of a small amount of endotoxin in human volunteers produced fever, a lowering of the blood pressure, and activation of inflammation and coagulation. Endotoxins are in large part responsible for the dramatic clinical manifestations of infections with pathogenic Gram-negative bacteria, such as Neisseria meningitidis, the pathogen that causes fulminant meningitis.
In humans, LPS binds to the lipid binding protein (LBP) in the serum which transfers it to CD14 on the cell membrane, which in turn transfers it to another non-anchored protein, MD2, which associates with Toll-like receptor-4 (TLR4). CD14 and TLR4 are present in several immune system cells (including macrophages and dendritic cells), triggering the signaling cascade for macrophage/endothelial cells to secrete pro-inflammatory cytokines and Nitric oxide that lead to "endotoxic shock". Other than TLR4, components of gram negative cell wall may also activate other pathways which may contribute to the overall endotoxic effect.
Endotoxins are frequent contaminants in plasmid DNA prepared from bactera, and must be removed from the DNA to avoid unwanted inflammatory responses prior to in vivo applications such as gene therapy.
In pharmaceutical production, it is necessary to remove all traces of endotoxin from drug product containers as even small amounts of endotoxin will cause illness, but not disease, in humans. A depyrogenation oven is used for this purpose. Temperatures of approximately 400 degrees celsius are required to break down this substance. A defined endotoxin reduction rate is a correlation between time and temperature. Based on primary packaging material as syringes or vials a glass temperature of 250°C and a holding time of 30min is typical to achieve 3log reduction on endotoxin levels.
A very sensitive assay for detecting presence of endotoxin is the Limulus Amebocyte Lysate assay, utilizing blood from the Horseshoe crab. Very low levels of LPS can cause coagulation of the limulus lysate due to a powerful amplification through an enzymatic cascade.
張學友 我等到花兒也謝了 很好聽！
每個人都在問我到底還在等什麼
等到春夏秋冬都過了難道還不夠
其實是因為我的心有一個缺口
等待拿走的人把它還給我
每個人都在說這種愛情沒有結果
我也知道妳永遠都不能夠愛我
其實我只是希望妳有時想一想我
妳卻已經漸漸漸漸什麼都不說
我睡不著的時候 會不會有人陪著我
我難過的時候 會不會有人安慰我
我想說話的時候 會不會有人瞭解我
我忘不了妳的時候 妳會不會來疼我
妳知不知道 妳知不知道
我等到花兒也謝了
妳知不知道 妳知不知道
我等到花兒也謝了
訂閱：
文章 (Atom)
