I think the issue surrounding H3N2 here, is whether the current state of affairs represent the logical outcome, given contemporary scientific knowledge on influenza virology and epidemiology. I believe that, in the current form, it is probably correct that reinforcement of education in personal hygiene and mask-wearing behavior be done, and citizens be taught of the vulnerable group of people towards these viruses (the extremes of age, those with chronic illness, organ failure and so on.)
I would like to disclaim first, that by profession I am not a microbiologist nor have I undergone any sort of post-graduate training in microbiology. So here, I approach the problem as an amateur, a person with interest in science.
Influenza and H3N2
The influenza A viruses are classified into subtypes according to surface glycoproteins: haemagluttinin, and neuraminidase. Currently, there are 18 H subtypes, and 11 N subtypes, and these are largely found infecting other animals. In the past 100 years, though, there are only three influenza A virus subtypes that occured in human, H1N1, H2N2, and H3N2 (IIRC). Most epidemics occurred when an originally non-human type virus changes enough to settle on the human respiratory tract; the most important element here is that it needs to stick properly to, and stay on the respiratory tract.
The ability to stick properly is dependent on the virus having "receptor binding sites" on the surface and the ability for it to bind to human-type alpha-2,6-linked sialic acid (as opposed to alpha-2,3-linked sialic acid) containing receptors, located on the surface of the upper respiratory tract. Specific mutations in the receptor binding sites are nowadays used to delineate or predict the ability of a virus strain to bind on human upper respiratory tract.
It has been seen that influenza viruses, and especially for strains of subtype A(H3N2), have continual evolutionary changes (which we call "antigenic drift" because it is a continual, slow, and gradual process). It is not difficult to understand why this change is forced upon: the human adaptive immune system is very good at combating an infection if it is known to the system; and moreover, we now use vaccines to make sure that viruses with old antigen won't work anymore. So there is a clear selection pressure on the influenza virus. And for the record, after forty-odd years of history, A(H3N2) is still alive and well.
I honestly do not think that this A(H3N2) is so different from previous ones that infected many of us before - you can probably find some distinct genetic features, and you can also probably see a statistical significant increase in death and infection, even after vaccine failures has been controlled for -- after all, vaccine is only a contributing factor, and the immune system as a whole is more important, but I think the difference is a quantitative one not a qualitative one.
It is notable, though the reason being unclear, strains of A(H3N2) are known to cause increased mortality (compared with other subtypes of flu viruses such as H1N1). The comment quoted in the article saying that the virus targets younger people probably reflects increased admission of young people into ICU, which implies that the virulence (ability to infect and kill) of the virus has been higher than before.
Mortality
I think one should always look at mortality number with the background of those who died in mind. The thing is, who is at risk. For example, while SARS killed 299 in 2003, in the same year, tuberculosis killed 275, and even in 2014, there has been 184 tuberculosis death. So is tuberculosis approximately 92% as severe as SARS in 2003? I don't think so, and I'd assume that you won't believe in that stupid percentage trick as well. YES - tuberculosis is a big problem in Hong Kong but it isn't as much a problem as SARS.
I guess the determinant here is, whether it is something that leads to a lot of death in previously healthy people. If it does, it is a big problem - something should be done immediately to stop its spread. But if it only targets certain group of people, well, then, the problem is easier to tackle, because there aren't as many people who are at risk. And then, another factor plays in - does the infection have a period of time in which the infected person is not quite unwell, but already quite infectious?
Influenza is typically infectious around 1 day before, and up to 4-7 days after initial symptom appear. and to make it better, if you wear a mask in the public area, and keep it off at work, chances are, you probably won't get infected by it.
The bottom line
Influenza A(H3N2), in its current form, had a much lower mortality rate than other dreaded respiratory infections, but obviously is worse off compared with previous years.
There aren't much easy ways of preventing it other than asking people to do their personal hygiene properly and using the vaccine (despite the inefficacy - 20% protection is still way better than no protection). Using the mask is good, but is probably limited to those with reasonable civil education/moral sense, which, lately become a rare occurrence in Hong Kong.
Friday, January 30, 2015
Monday, April 7, 2014
Utilitarian aspect of learning disorders
Looking into the classification of learning disorders we can see a huge inequality between learners who had specific learning disorders. What I am saying is not that people who are dyslexic are put into more difficult situation compared with the "normal" crowd, but rather that people with a less recognized learning disorder such as dyscalculia are essentially labeled as "retarded" or "stupid" in general, whereas people with a more recognized disorder (even though it is less well-defined) such as dyslexia receive a lot of aid (in fact more so that they sometimes fare better than an average student)... when in fact that they both have deficit in one and only one domain of learning. This, sir, is extremely unfair.
I believe that dyslexia receive so much attention because number one, the alleles related to it probably co-segregates with a lot of high-fitness (as in, evolutionarily, intelligent, beautiful, sociable, and so on) alleles -- and parents of these children tended to be well-off, better educated, and at a better position to fight for resources for their children. and number two, dyslexia is interesting to researchers because these children fails only in one aspect of language development, and there are knowledge to be found in this area[1].
I believe that, care for these developmental disorders would improve if we could define a model in which a child can be scored, in different dimensions, normal dimensions, abnormal dimensions. For example, a child with dyslexia would have a perfectly normal (or even superior) performance dimension, whereas his verbal dimension would be two standard deviations lower than the performance dimension. On the other hand, the social and verbal dimension would necessarily be worse in a person with autism, and a person with attention-deficit and hyperactivity disorder would have an attention dimension two standard deviations lower than his average ability in all other dimensions.
With such a classification, we can identify patients whose deficit is in a single dimension which may be readily treatable, and with a central registry, this can enable researchers to recruit subjects with a particular deficit to search for a treatment plan which is best suited to the children in question.
To add to the benefit, the scheme would also allow children whose disability is generalized, in which specific treatment or specific diagnosis is not helpful.
What do you think?
[1] I am sure as hell researchers are more interested in "lesion patients" than a completely debilitated person - just look at the "Broca" patient, the "Wernicke" patient, and so on in the neurology ward, and the stroke patient beside them. You'll see the difference. The lesion patient got interviewed by 100+ medical students and junior doctors whereas the stroke patient struggle to even get somebody speaking to her.
I believe that dyslexia receive so much attention because number one, the alleles related to it probably co-segregates with a lot of high-fitness (as in, evolutionarily, intelligent, beautiful, sociable, and so on) alleles -- and parents of these children tended to be well-off, better educated, and at a better position to fight for resources for their children. and number two, dyslexia is interesting to researchers because these children fails only in one aspect of language development, and there are knowledge to be found in this area[1].
I believe that, care for these developmental disorders would improve if we could define a model in which a child can be scored, in different dimensions, normal dimensions, abnormal dimensions. For example, a child with dyslexia would have a perfectly normal (or even superior) performance dimension, whereas his verbal dimension would be two standard deviations lower than the performance dimension. On the other hand, the social and verbal dimension would necessarily be worse in a person with autism, and a person with attention-deficit and hyperactivity disorder would have an attention dimension two standard deviations lower than his average ability in all other dimensions.
With such a classification, we can identify patients whose deficit is in a single dimension which may be readily treatable, and with a central registry, this can enable researchers to recruit subjects with a particular deficit to search for a treatment plan which is best suited to the children in question.
To add to the benefit, the scheme would also allow children whose disability is generalized, in which specific treatment or specific diagnosis is not helpful.
What do you think?
[1] I am sure as hell researchers are more interested in "lesion patients" than a completely debilitated person - just look at the "Broca" patient, the "Wernicke" patient, and so on in the neurology ward, and the stroke patient beside them. You'll see the difference. The lesion patient got interviewed by 100+ medical students and junior doctors whereas the stroke patient struggle to even get somebody speaking to her.
Sunday, March 30, 2014
Water
So, what is the requirement of water at home?
I come from pathology background -- naturally, I would look at water from a laboratory perspective. What is required for laboratory reagent water? In a laboratory, we are looking at several aspects:
(1) Ionic impurities (e.g. >10 megaohm/cm3)
(2) Organic impurities (e.g. <500 ppb)
(3) Microbiological impurities (e.g. <10 cfu/ml), and
(4) Particulate content (e.g. passing through a 0.22 um absolute screen filter)
The first one is almost an absolute requirement, that laboratory reagent water contain as little undesired ionic contamination as possible, as it will interfere with trace analysis (or if the contamination is severe, non-trace analysis -- that would be gross). The impedence of water is used as a way of measuring ionic contamination. Water has a theoretical maximum impedence of 18.2 megaohms -- and when exposed to air, the highest impedence would drop to around 1 megaohm. Water is purified to remove ionic contaminants mostly by the use of ion-exchange resins. To improve the efficiency, often multiple resins are used in cascade.
The second one refers to the amount of organic compounds dissolved in the water. Organic contaminants can be removed by oxidation by UV light, as well as absorption and adsorption by activated charcoal.
Microbiological impurities are often removed by depth filter, and chlorination of the tap water.
Particulate content are usually removed in multiple stages: firstly, depth filter consisting of fibers interwoven to trap particulates in a random manner is used; depth filter is a high-capacity, but non-absolute filter. In contrast to depth filter, a screen filter (absolute filter) is used at the end of the water purification process to obtain an absolute cutoff. However, screen filters are low capacity with regard to contaminants, and thus a depth filter in front of it would greatly increase its lifetime.
So, for human consumption, what is the role of water treatment?
Briefly, water from the water service department in Hong Kong is considered potable - i.e. harmful constituents are at a very low level when the water leaves WSD. What is the caveat? It's the route between WSD and your home. What could go wrong?
Plastic pipe can leak organics. Old pipes (if any) could leak heavy metal ions. Bacteria can grow in the water reservoir on the top of the building. Iron oxide fragments can go into the water, etc. Another problem is the presence of chlorine in the water, which cause a change of taste.
To be honest though, none of this is significant to the extent that it is harmful to drink from the tap. And to make it clear, boiling probably does not help (other than perhaps evaporating some volatile organics). And thus, water treatment system at home is probably helpful - Take a chance, make a cup of tea with tap water, and a cup with distilled water from a reputable manufacturer - it WILL taste different. Why? - The organics, the chlorine content, hardness -- all make differences to the taste.
Thus, in my opinion, water treatment at home is mostly aesthetic (taste-enhancement) and psychological (feeling a little bit safer with regard to heavy metal which is essentially non-existent in HK).
For my home, I consider a depth filter, followed by ion exchange resins (to remove cationic [heavy metal] impurities), and activated charcoal filter to be adequate for health. In fact, for well-maintained housing establishments, this shouldn't even be necessary - except charcoal filter perhaps. Charcoal filter enhances the taste of water a lot.
There is probably little need to use elaborate deionization, osmosis or so on for home water.
I come from pathology background -- naturally, I would look at water from a laboratory perspective. What is required for laboratory reagent water? In a laboratory, we are looking at several aspects:
(1) Ionic impurities (e.g. >10 megaohm/cm3)
(2) Organic impurities (e.g. <500 ppb)
(3) Microbiological impurities (e.g. <10 cfu/ml), and
(4) Particulate content (e.g. passing through a 0.22 um absolute screen filter)
The first one is almost an absolute requirement, that laboratory reagent water contain as little undesired ionic contamination as possible, as it will interfere with trace analysis (or if the contamination is severe, non-trace analysis -- that would be gross). The impedence of water is used as a way of measuring ionic contamination. Water has a theoretical maximum impedence of 18.2 megaohms -- and when exposed to air, the highest impedence would drop to around 1 megaohm. Water is purified to remove ionic contaminants mostly by the use of ion-exchange resins. To improve the efficiency, often multiple resins are used in cascade.
The second one refers to the amount of organic compounds dissolved in the water. Organic contaminants can be removed by oxidation by UV light, as well as absorption and adsorption by activated charcoal.
Microbiological impurities are often removed by depth filter, and chlorination of the tap water.
Particulate content are usually removed in multiple stages: firstly, depth filter consisting of fibers interwoven to trap particulates in a random manner is used; depth filter is a high-capacity, but non-absolute filter. In contrast to depth filter, a screen filter (absolute filter) is used at the end of the water purification process to obtain an absolute cutoff. However, screen filters are low capacity with regard to contaminants, and thus a depth filter in front of it would greatly increase its lifetime.
So, for human consumption, what is the role of water treatment?
Briefly, water from the water service department in Hong Kong is considered potable - i.e. harmful constituents are at a very low level when the water leaves WSD. What is the caveat? It's the route between WSD and your home. What could go wrong?
Plastic pipe can leak organics. Old pipes (if any) could leak heavy metal ions. Bacteria can grow in the water reservoir on the top of the building. Iron oxide fragments can go into the water, etc. Another problem is the presence of chlorine in the water, which cause a change of taste.
To be honest though, none of this is significant to the extent that it is harmful to drink from the tap. And to make it clear, boiling probably does not help (other than perhaps evaporating some volatile organics). And thus, water treatment system at home is probably helpful - Take a chance, make a cup of tea with tap water, and a cup with distilled water from a reputable manufacturer - it WILL taste different. Why? - The organics, the chlorine content, hardness -- all make differences to the taste.
Thus, in my opinion, water treatment at home is mostly aesthetic (taste-enhancement) and psychological (feeling a little bit safer with regard to heavy metal which is essentially non-existent in HK).
For my home, I consider a depth filter, followed by ion exchange resins (to remove cationic [heavy metal] impurities), and activated charcoal filter to be adequate for health. In fact, for well-maintained housing establishments, this shouldn't even be necessary - except charcoal filter perhaps. Charcoal filter enhances the taste of water a lot.
There is probably little need to use elaborate deionization, osmosis or so on for home water.
Monday, March 17, 2014
Two types of oil misunderstood: Canola and coconut
Oil Facts:
1. Canola oil is not considered harmful from a toxicological aspect. In fact it's quite healthy!
2. Coconut oil, on the other hand, is not so good for your health.
Information for those who want to read a little bit more:
Canola oil
- Produced from a cultivar of "rapeseed" which is with low erucic acid content (The mustard plant)
- Erucic acid, for those who are unfamiliar with it, is a naturally-occuring omega-9 fatty acid, with a chain length of 22 (denoted as C22:1 omega-9), has not been reported to be associated with human toxicity. It appears to be toxic to mice[1].
- Current cultivars of rapeseed contain only trace quantity of erucic acid (less than 0.1%).
- Other purported toxins in rapeseed includes glucoinolates, which are said to be goitrogens (resulting in a goitre, toxic to the thyroid gland). These are at very low levels in modern rapeseed plants, which contain less than 10 umol/g, compared with broccoli, a common plant containing glucoinolates in the order of 10 mmol/g (dry weight), a 1000x difference. If you can eat broccoli, glucoinolates in canola oil is probably OK.
- It is low in saturated fat, and contain a favorable profile of omega-6 and omega-3 fatty acids.
- It has a fairly high smoke point (204 C), which is about 10 degree higher than cooking (non-extra virgin) olive oil.
Coconut oil
- It contain 91% saturated fat, the highest of all natural oils (excluding those that are hydrogenated). Taking saturated fats *cannot* be very good for your health.
- It does contain a blend of medium chain fatty acids, some of which are good (and some of which are bad) for the heart. One should also note that the famous "heart-killer" BUTTER also contain some 10% of myristic acid, which are said to be a health-promoting component of coconut oil.
- Yes, it's probably healthier than butter, but probably less healthy than even the evil canola oil mentioned above.
Some general facts of oil-making
- Other than cold-pressed oil, most oil produced nowadays include a step of solvent extraction using organic solvents such as hexane, absolute alcohol, and so on. Hexane contamination in oil is usually insignificant. Hexane is probably the least of your worries in your daily diet if you asked me. The air you breath is probably more harmful than the hexane in oil if you live in Hong Kong, given the recent pm2.5 readings.
[1] Chocolate is toxic to dogs. There are a lot of stuff that are toxic to one species and not to other. If you look into your mice biology textbook, you will get to know that they do not digest vegetable fat as well as a lot of other animals.
1. Canola oil is not considered harmful from a toxicological aspect. In fact it's quite healthy!
2. Coconut oil, on the other hand, is not so good for your health.
Information for those who want to read a little bit more:
Canola oil
- Produced from a cultivar of "rapeseed" which is with low erucic acid content (The mustard plant)
- Erucic acid, for those who are unfamiliar with it, is a naturally-occuring omega-9 fatty acid, with a chain length of 22 (denoted as C22:1 omega-9), has not been reported to be associated with human toxicity. It appears to be toxic to mice[1].
- Current cultivars of rapeseed contain only trace quantity of erucic acid (less than 0.1%).
- Other purported toxins in rapeseed includes glucoinolates, which are said to be goitrogens (resulting in a goitre, toxic to the thyroid gland). These are at very low levels in modern rapeseed plants, which contain less than 10 umol/g, compared with broccoli, a common plant containing glucoinolates in the order of 10 mmol/g (dry weight), a 1000x difference. If you can eat broccoli, glucoinolates in canola oil is probably OK.
- It is low in saturated fat, and contain a favorable profile of omega-6 and omega-3 fatty acids.
- It has a fairly high smoke point (204 C), which is about 10 degree higher than cooking (non-extra virgin) olive oil.
Coconut oil
- It contain 91% saturated fat, the highest of all natural oils (excluding those that are hydrogenated). Taking saturated fats *cannot* be very good for your health.
- It does contain a blend of medium chain fatty acids, some of which are good (and some of which are bad) for the heart. One should also note that the famous "heart-killer" BUTTER also contain some 10% of myristic acid, which are said to be a health-promoting component of coconut oil.
- Yes, it's probably healthier than butter, but probably less healthy than even the evil canola oil mentioned above.
Some general facts of oil-making
- Other than cold-pressed oil, most oil produced nowadays include a step of solvent extraction using organic solvents such as hexane, absolute alcohol, and so on. Hexane contamination in oil is usually insignificant. Hexane is probably the least of your worries in your daily diet if you asked me. The air you breath is probably more harmful than the hexane in oil if you live in Hong Kong, given the recent pm2.5 readings.
[1] Chocolate is toxic to dogs. There are a lot of stuff that are toxic to one species and not to other. If you look into your mice biology textbook, you will get to know that they do not digest vegetable fat as well as a lot of other animals.
Sunday, March 16, 2014
A cancer diagnosed at a late stage
A recent post[1] in "名校 Secrets" surrounds a case of Stage III nasopharyngeal cancer occurring in a middle-aged lady. Following an admittedly flamebait reply, there was a lot of discussion regarding to the role of doctor in the diagnosis of early cancers.
When faced with a diagnosis of "late stage cancer", people would always look back, and try to find a circumstance when he or she mentioned her first symptom to a doctor, and try to blame them for not doing their job -- what they don't realize is that, signs and symptoms of early-stage cancers, with few exceptions, are non-specific, non-sensitive, mimics a thousand other diseases, and in general, not showing up as a "red flag" in most's eyes. And for the matter, most early-stage cancers are NOT symptomatic.
If cancers were so easy to diagnose at a early stage, we wouldn't have a problem of cancer, we won't need thousands of researchers worldwide to combat cancer, and we most certainly do not need a billion-dollar pharmaceutical industry.
[1] https://www.facebook.com/schools.secrets/posts/297387690422653
When faced with a diagnosis of "late stage cancer", people would always look back, and try to find a circumstance when he or she mentioned her first symptom to a doctor, and try to blame them for not doing their job -- what they don't realize is that, signs and symptoms of early-stage cancers, with few exceptions, are non-specific, non-sensitive, mimics a thousand other diseases, and in general, not showing up as a "red flag" in most's eyes. And for the matter, most early-stage cancers are NOT symptomatic.
If cancers were so easy to diagnose at a early stage, we wouldn't have a problem of cancer, we won't need thousands of researchers worldwide to combat cancer, and we most certainly do not need a billion-dollar pharmaceutical industry.
[1] https://www.facebook.com/schools.secrets/posts/297387690422653
Friday, March 14, 2014
Surgical mask, N95 mask...
A response to the following article: http://www.vjmedia.com.hk/articles/2014/03/14/66267
With the current evidence, surgical mask is non-inferior to N95 respirators in preventing influenza infection, the basic reason for its existence in modern healthcare -- preventing droplet-transmitted infections[1]. It should be noted that there are multiple reason behind wearing surgical masks, such as preventing the wearer's droplets from contaminating the operating field, or decreasing the amount of droplets emitted during e.g. sneezing.
On the other hand, while there are a lot of Taiwanese and Japanese people wearing cloth mask. While there are not a lot studies on this matter, Rengasamy et al provided some evidence that it doesn't really work[2]. It's not good enough trapping anything from influenza to tuberculosis.
While we all know that we can buy N95 masks and simple surgical mask, the need for fit-testing for the use of N95 masks are often forgotten: one need to have a tight-fitting N95 masks to enjoy the benefit of a respirator: how is it different from a mask? A major difference lies in that a surgical mask filters aims at filtering only a portion of air taken by the person whereas a respirator aims at filtering all, i.e. practically all gas that you inspire went through the N95 if you are wearing it correctly.
Let me repeat it: you need to do a fit-testing to determine which N95 model fits you the best. If an N95 is not fitting, you are not enjoying any of its benefits. A simple rule is, if it feels easy wearing it, either you are working in the industry, or you are wearing it wrong.
There are some studies suggesting that N95 fit-test is not necessary[3]. However, this has not been published in a peer-reviewed journal, thus, without further studies, it is probably wise to continue doing fit-tests. A rule of thumb for those who may not have access to fit-testing is, 1860 for gentlemen, and 1860s for ladies. Your mileage may vary.
[1] JAMA. 2009 Nov 4;302(17):1865-71
[2] Ann Occup Hyg. 2010 Oct;54(7):789-98.
[3] ICAAC 2009; Oral session K-1918b
With the current evidence, surgical mask is non-inferior to N95 respirators in preventing influenza infection, the basic reason for its existence in modern healthcare -- preventing droplet-transmitted infections[1]. It should be noted that there are multiple reason behind wearing surgical masks, such as preventing the wearer's droplets from contaminating the operating field, or decreasing the amount of droplets emitted during e.g. sneezing.
On the other hand, while there are a lot of Taiwanese and Japanese people wearing cloth mask. While there are not a lot studies on this matter, Rengasamy et al provided some evidence that it doesn't really work[2]. It's not good enough trapping anything from influenza to tuberculosis.
While we all know that we can buy N95 masks and simple surgical mask, the need for fit-testing for the use of N95 masks are often forgotten: one need to have a tight-fitting N95 masks to enjoy the benefit of a respirator: how is it different from a mask? A major difference lies in that a surgical mask filters aims at filtering only a portion of air taken by the person whereas a respirator aims at filtering all, i.e. practically all gas that you inspire went through the N95 if you are wearing it correctly.
Let me repeat it: you need to do a fit-testing to determine which N95 model fits you the best. If an N95 is not fitting, you are not enjoying any of its benefits. A simple rule is, if it feels easy wearing it, either you are working in the industry, or you are wearing it wrong.
There are some studies suggesting that N95 fit-test is not necessary[3]. However, this has not been published in a peer-reviewed journal, thus, without further studies, it is probably wise to continue doing fit-tests. A rule of thumb for those who may not have access to fit-testing is, 1860 for gentlemen, and 1860s for ladies. Your mileage may vary.
[1] JAMA. 2009 Nov 4;302(17):1865-71
[2] Ann Occup Hyg. 2010 Oct;54(7):789-98.
[3] ICAAC 2009; Oral session K-1918b
Thursday, March 13, 2014
Hard disk...
Question
I'm about to purchase a SATA hard drive. I was wondering if, aside from the storage capacity, are there any other factors I should keep in mind? I care above all about reliability. Is a more expensive drive less error-prone than a low-end one?
Answer
Consider reading Pinheiro et al (2007) Failure Trends in a Large Disk Drive Population. Proceedings of the 5th USENIX Conference on File and Storage Technologies, Feb 2007. Just search the title on google.
In general, drives of the same manufacturer are made to the same specification in terms of the disk assembly. It is usually the tolerances that differ. To give an example, if you want a paper circle of 5cm diameter, a circle of 4.5 or 5.5 cm maybe acceptable for one use (e.g. home use for decoration of child's room) but a circle of 5.0cm, add or subtract 1mm, (i.e. within 4.9 - 5.1 cm) would be required if it is a decoration project for a project launch for some big, big company.
For example, the load/unload cycle specification of a home drive may be ~ 300,000 times, the load/unload specification of an enterprise drive would be ~ 600,000 times, doubling the figures. The tighter specification also applies to the drive assembly and the disk manufacturing process - and thus the non-recoverable read error rate would be much smaller for enterprise drives, for example, a typical, current home drive - Caviar Black (from Western Digital) would have a nonrecoverable read error per 10^14 bit read. Compare with a typical harddrive manufactured towards datacenter servers WD RE SAS, which would have a nonrecoverable read error per 10^15 bit read. Whether that 10 times more reliability matters to you, is another matter.
To be honest, how you use the drive, is likely more important than which drive you use. Below is a summary of google's findings:
Mean time between failures is basically not very useful for the typical consumers. The Mean time between failure is usually ideal and theoretical. Let's say we have 500,000 drives with MTBF of 500,000 hours - if you run each and every of them together you will likely to have one of them failing every hour, statistically speaking, if you run them within their specification (temperature, humidity, power supply quality...) With reference to the google study, the realistic useful life of a harddrive would be more like 2 years (in a non-redundant system) or 3 years (in a redundant system) - if you use it 24 hours a day - In a redundant system (e.g. a RAID-[5,6]) you can lose a harddrive without losing data. Particularly, in RAID 6 you can lose a harddrive and still have redundancy during the rebuild process.
Service life
One often see some manufacturer quoting service life such as '5 years' and then offering you a warranty of '3 years'. Translation: "We believe that it should last some 5 years. If it fails within the first three years of use, we'll replace it at our cost, but if you have it failed between 3rd and 5th year, poor you. It certainly won't be the case that we have installed some sort of time bomb to make them unusable by its fifth birthday, but you should get a new harddisk and use instead of this 5-year-old harddrive if your data is any precious."
I'm about to purchase a SATA hard drive. I was wondering if, aside from the storage capacity, are there any other factors I should keep in mind? I care above all about reliability. Is a more expensive drive less error-prone than a low-end one?
Answer
Consider reading Pinheiro et al (2007) Failure Trends in a Large Disk Drive Population. Proceedings of the 5th USENIX Conference on File and Storage Technologies, Feb 2007. Just search the title on google.
In general, drives of the same manufacturer are made to the same specification in terms of the disk assembly. It is usually the tolerances that differ. To give an example, if you want a paper circle of 5cm diameter, a circle of 4.5 or 5.5 cm maybe acceptable for one use (e.g. home use for decoration of child's room) but a circle of 5.0cm, add or subtract 1mm, (i.e. within 4.9 - 5.1 cm) would be required if it is a decoration project for a project launch for some big, big company.
For example, the load/unload cycle specification of a home drive may be ~ 300,000 times, the load/unload specification of an enterprise drive would be ~ 600,000 times, doubling the figures. The tighter specification also applies to the drive assembly and the disk manufacturing process - and thus the non-recoverable read error rate would be much smaller for enterprise drives, for example, a typical, current home drive - Caviar Black (from Western Digital) would have a nonrecoverable read error per 10^14 bit read. Compare with a typical harddrive manufactured towards datacenter servers WD RE SAS, which would have a nonrecoverable read error per 10^15 bit read. Whether that 10 times more reliability matters to you, is another matter.
To be honest, how you use the drive, is likely more important than which drive you use. Below is a summary of google's findings:
- 6-7% of the drives fail within first year of use. Within which, more than half of these failing drive will fail within 6 month. These drives tends to be utilized highly during these periods.
- Failure of the drive follow a double peak model. The first peak is within 3 months, and the second peak is around 3 years.
- After the first year, there is in general a 8% failure rate of harddrive annually.
- The effect of temperature is twofold: [1] The lowest failure rate is seen at disks run around 40 degree C. [2] As the drive ages, the failure rate rises expoentially with temperature at third year. To interpret this statement, running the drive at ~35C would achieve the best compromise of longevity and early failures, and if your harddrive can be replaced every 2 years, running the drives as hot as 45C in general would in fact decrease the failure rate, but past the second year there will be an exponential increase if you run it at 45C.
- If you use SMART reporting software (a nice one is Crystal Disk Info URL: http://crystalmark.info/software/CrystalDiskInfo/index-e.html ), if you see one scan error, 10% will fail within days, and 30% of the drive will fail within 6 months. Thus, backup and discard the drive accordingly after you see the first one. If you see a reallocation event, 10% will fail within ~4 months. Note, however that only 60% of all harddrive failures would be predicted by SMART system.
Mean time between failures is basically not very useful for the typical consumers. The Mean time between failure is usually ideal and theoretical. Let's say we have 500,000 drives with MTBF of 500,000 hours - if you run each and every of them together you will likely to have one of them failing every hour, statistically speaking, if you run them within their specification (temperature, humidity, power supply quality...) With reference to the google study, the realistic useful life of a harddrive would be more like 2 years (in a non-redundant system) or 3 years (in a redundant system) - if you use it 24 hours a day - In a redundant system (e.g. a RAID-[5,6]) you can lose a harddrive without losing data. Particularly, in RAID 6 you can lose a harddrive and still have redundancy during the rebuild process.
Service life
One often see some manufacturer quoting service life such as '5 years' and then offering you a warranty of '3 years'. Translation: "We believe that it should last some 5 years. If it fails within the first three years of use, we'll replace it at our cost, but if you have it failed between 3rd and 5th year, poor you. It certainly won't be the case that we have installed some sort of time bomb to make them unusable by its fifth birthday, but you should get a new harddisk and use instead of this 5-year-old harddrive if your data is any precious."
Saturday, March 8, 2014
Allocation of resources: you can't put all bucks in one bucket.
"Selfishness is the greatest curse of the human race." -- William E. Gladstone, four-time prime minister of the U.K.With the great increase in the life expectancy in our population, and the advances in medical technology, we are seeing more and more people becoming chronically debilitated, rather than dying from the outset; and with the advances in pharmaceutical industry, we are more able than ever in prolonging life, as well as improving quality of life in patients who would have otherwise died or suffer an ailment that would be worse than dying.
These wonder drugs, however, do not come without a steep price. The question then, is how much is the society willing to pay for these patients? If there is a cap as to how much we're going to pay, would it be based on a "per capita" basis, "per diagnosis" basis, or "per quality-adjusted life-year gained" basis? What is the price of a quality-adjusted life-year?
Taking the most extreme example, given a dose of loratadine (less than $1 hkd/day), and I can be free of my allergic rhinitis symptoms. This facilitates my performance at work, and I guess perhaps I can proudly say that taxpayers funding me the treatment (in the form of a prescription under HA) is probably fair.
On the other hand, a patient with terminal cancer may have his or her life extended by three months by the use of multiple targeted therapy, which can cost more than $10,000 a month per drug. Is that good use of taxpayer money? I shall leave that to the readers to judge. The question for those who answered "yes" is that, what is the opportunity cost for others in giving this patient his/her much-needed targeted therapy drugs?
I think the current approach of using a drug formulary to limit the spending is probably wise. On a side note, none of the psychiatric drugs used currently are "self-financed items". Many are under "special drug" label, but no, patients do not need to pay using these drugs.
Postscriptum. this is a response to "在香港做人，還是仆街到底比較好", Accessed 8 March 2014, URL:http://dadazim.com/journal/2012/03/pk-in-hks/
Psychiatric disorder: Bipolar disorder
I guess a blog named pathological mind would not be complete without a touch on psychiatric disorders, and thus, perhaps the topic for today would be bipolar disorder. I decided not to cover treatment though, for I, admittedly, are not so updated with respect to the advances of treatment in the area.
Abbreviations:
MDD: Major depressive disorder (i.e. depression)
Bipolar disorder (or manic-depressive illness) is often a severe, chronic illness chracterised by periods of depression and elation. Manic and depressed phase are both associated with significant morbidity and mortality. Bipolar disorder is usually divided into two forms, I and II. The diagnosis of bipolar I disorder requires a manic episode.
A manic episode is characterized by seven features, which I remember by the mnemonic "fidgets" -
The individual may also have experienced depressive episode or mixed episodes of manic and depressive symptoms in the past.
The diagnosis of a bipolar II disorder requires at least 2 prior major depressive episode and a hypomanic episode. Once an individual is diagnosed of a bipolar I or bipolar II disorder, the diagnosis during subsequent mood episodes continues to be bipolar disorder, with the most recent episode being described as depressed, hypomanic or manic.
Clinical features
Patients with bipolar disorders common experience several major depressive episode prior to their first manic or hypomanic episode. Early in the illness episodes of depression or mania are separated by relatively long periods of normal behavior, but without treatment subsequent episodes become increasingly frequent.
Untreated manic or depressive episodes typically last several months. Treatment results in shortening in length and decrease in severity.
Rapid cycling form of bipolar disorder affects 10-15% of the patients and is characterized by increased frequency of episodes to 2-4 times per year. This form is associated with a poor prognosis and is less responsive to treatment.
Psychotic symptoms may develop during any manic episode, but once present subsequent manic episodes are more likely to be accompanied by psychotic features. Approximately 20-30% of patients with bipolar disorder, and 15-20% of patients with bipolar II disorder (patients who experience hypomanic episodes with depressive episodes) do not experience total recovery between episodes.
Prevalence and heritability
The prevalence of bipolar disorderis about 1.5% and 3% of the general populaton. The lifetime prevalence is approximately 0.8% for bipolar I disorder, 0.5% for bipolar II disorder. The prevalence of these disorders are the same for male and female.
Bipolar disorders cluster in families. For bipolar I disorder, the risk among first degree relative is 6-7% for bipolar I disorder, 2-5% for bipolar II disorder and 25-35% for MDD. Concordance rate for the monozygotic twins is 75% for bipolar disorder and 50% for major depressive disorder, suggestive of nonheritable as well as heritable factors in disease expression.
In contrast, first degree relatives of patients suffering from bipolar II disorder is at significantly increased risk of developing bipolar II disorder and MDD but not bipolar I disorder.
Twin, adoption and family studies indicate that genetic factors substantially contribute to the liability for developing bipolar disorder and major depressive disorder. The earlier age of onset appears to be associated with increased transmissibility of both bipolar disorder and MDD.
Taken at face value, adult twin and adoption studies indicate that familial transmission of bipolar disorder is largely a result of genetic factors and that genetic factors are more important in the development of bipolar disorder than in depressive disorder.
The heritability of bipolar disorder is estimated to be 60-70% whereas that of adult MDD is about 40%.
Complications
Bipolar disorder, like MDD, carries an increased risk of suicide and accidental death. Suicide are more common during depressed or mixed manic/depressive episodes, and while intoxicated.
Accidental injury or death are more common in manic state because of poor judgement and increased risk-taking behavior. In the elderly, mania is associated with increased medical morbidity due to malnutrition and exhaustion states from increased activity and decreased sleep.
Mania, hypomania and cyclothymia are all associated with occupational, scholastic and social impairment. The risks of comorbidities such as alcoholic abuse are markedly increased.
Patients with mixed manic/depressive episode appear to have the highest psychosocial morbidity.
Abbreviations:
MDD: Major depressive disorder (i.e. depression)
Bipolar disorder (or manic-depressive illness) is often a severe, chronic illness chracterised by periods of depression and elation. Manic and depressed phase are both associated with significant morbidity and mortality. Bipolar disorder is usually divided into two forms, I and II. The diagnosis of bipolar I disorder requires a manic episode.
A manic episode is characterized by seven features, which I remember by the mnemonic "fidgets" -
- Flight of ideas (the subject feeling that thoughts are going too fast),
- Increased goal-related activity,
- Distractibility,
- Grandiosity (thinking that one is of a great status, etc.)
- Excessive pleasurable activity,
- Talkative,
- Sleep disturbance
The individual may also have experienced depressive episode or mixed episodes of manic and depressive symptoms in the past.
The diagnosis of a bipolar II disorder requires at least 2 prior major depressive episode and a hypomanic episode. Once an individual is diagnosed of a bipolar I or bipolar II disorder, the diagnosis during subsequent mood episodes continues to be bipolar disorder, with the most recent episode being described as depressed, hypomanic or manic.
Clinical features
Patients with bipolar disorders common experience several major depressive episode prior to their first manic or hypomanic episode. Early in the illness episodes of depression or mania are separated by relatively long periods of normal behavior, but without treatment subsequent episodes become increasingly frequent.
Untreated manic or depressive episodes typically last several months. Treatment results in shortening in length and decrease in severity.
Rapid cycling form of bipolar disorder affects 10-15% of the patients and is characterized by increased frequency of episodes to 2-4 times per year. This form is associated with a poor prognosis and is less responsive to treatment.
Psychotic symptoms may develop during any manic episode, but once present subsequent manic episodes are more likely to be accompanied by psychotic features. Approximately 20-30% of patients with bipolar disorder, and 15-20% of patients with bipolar II disorder (patients who experience hypomanic episodes with depressive episodes) do not experience total recovery between episodes.
Prevalence and heritability
The prevalence of bipolar disorderis about 1.5% and 3% of the general populaton. The lifetime prevalence is approximately 0.8% for bipolar I disorder, 0.5% for bipolar II disorder. The prevalence of these disorders are the same for male and female.
Bipolar disorders cluster in families. For bipolar I disorder, the risk among first degree relative is 6-7% for bipolar I disorder, 2-5% for bipolar II disorder and 25-35% for MDD. Concordance rate for the monozygotic twins is 75% for bipolar disorder and 50% for major depressive disorder, suggestive of nonheritable as well as heritable factors in disease expression.
In contrast, first degree relatives of patients suffering from bipolar II disorder is at significantly increased risk of developing bipolar II disorder and MDD but not bipolar I disorder.
Twin, adoption and family studies indicate that genetic factors substantially contribute to the liability for developing bipolar disorder and major depressive disorder. The earlier age of onset appears to be associated with increased transmissibility of both bipolar disorder and MDD.
Taken at face value, adult twin and adoption studies indicate that familial transmission of bipolar disorder is largely a result of genetic factors and that genetic factors are more important in the development of bipolar disorder than in depressive disorder.
The heritability of bipolar disorder is estimated to be 60-70% whereas that of adult MDD is about 40%.
Complications
Bipolar disorder, like MDD, carries an increased risk of suicide and accidental death. Suicide are more common during depressed or mixed manic/depressive episodes, and while intoxicated.
Accidental injury or death are more common in manic state because of poor judgement and increased risk-taking behavior. In the elderly, mania is associated with increased medical morbidity due to malnutrition and exhaustion states from increased activity and decreased sleep.
Mania, hypomania and cyclothymia are all associated with occupational, scholastic and social impairment. The risks of comorbidities such as alcoholic abuse are markedly increased.
Patients with mixed manic/depressive episode appear to have the highest psychosocial morbidity.
Patient behavior - sense of entitlement
Whereas doctors working in the private sector generally enjoyed great respect from their patients -- as a professional whom their patient consults, doctors working in the public sector generally do not
enjoy such status. The trouble? Wages are being paid by the taxpayers, and this often create a sense of entitlement among the citizens.
Given the amount of work, it is not surprising that most doctors staying in the public sectors are enthusiastic towards patient care and are eager to help their patients. However, it should be borne in mind that we doctors are also human beings and have our families and life outside work.
Consider these three questions:
Unfortunately, for the doctor, their answers to these three question needs to be "yes". However, I wouldn't be expecting a doctor to stay smiling when faced with personal attacks.
enjoy such status. The trouble? Wages are being paid by the taxpayers, and this often create a sense of entitlement among the citizens.
Given the amount of work, it is not surprising that most doctors staying in the public sectors are enthusiastic towards patient care and are eager to help their patients. However, it should be borne in mind that we doctors are also human beings and have our families and life outside work.
Consider these three questions:
- If you are rude, can you expect the doctors to stay professional in their judgement?
- If you are swearing, can you expect others to be caring for you?
- If you are attacking their colleagues, can you expect them to uphold their professional standards and give their best to treat you?
Unfortunately, for the doctor, their answers to these three question needs to be "yes". However, I wouldn't be expecting a doctor to stay smiling when faced with personal attacks.
"Disorders", "diagnostic labels", and why getting it diagnosed.
More and more people are being diagnosed to have a psychiatric disorders. The keyword here is "disorder". We shall look at how a "disorder" is defined - in essence, in most psychiatric guidelines or manuals, a condition can only be said as an disorder when it causes impaired function in social, occupational, or educational aspects of life.
And when we evaluate the requirements for social, occupational, and educational aspects of life - we can see that over the past 20 years, these requirements have been a monotonous increasing function.
It is perhaps thus to nobody's surprise that we have more such "disorders" diagnosed, especially in Hong Kong. In other countries, and in other cities, if you are not the kind to live in cities, you can move elsewhere, and work a easier life. Not so much in Hong Kong -- there's nowhere to go. Perhaps jumping from height or into the sea, but that's it. It is so unacceptable socially that a person from Hong Kong would go elsewhere to live a lowly life that people would choose to die over going elsewhere.
Definition is one thing, and then we have several groups with vested interest in giving a "diagnosis" to patients: parents, and perhaps patients. Nowadays, instead of "laziness" and "stupidity", people are increasingly referring their child as being inflicted by developmental delay (which is otherwise known as "stupidity" in my days, especially when they are not formally "mentally retarded"), attention-deficit hyperactivity disorder (which is known as "lazy and distracted"), and so on, so forth.
It has become a trend such that all child are bright and beautiful, and only afflicted by a disorder and is therefore so naughty that you teacher cannot work with them. And it's your fault by not coping well with their illness, or by discriminating them based on their ailment.
Honestly, I don't believe in the notion that this generation of children is facing a "psychiatric epidemic". In my humble opinion, they are facing a "diagnosis epidemic".
And when we evaluate the requirements for social, occupational, and educational aspects of life - we can see that over the past 20 years, these requirements have been a monotonous increasing function.
It is perhaps thus to nobody's surprise that we have more such "disorders" diagnosed, especially in Hong Kong. In other countries, and in other cities, if you are not the kind to live in cities, you can move elsewhere, and work a easier life. Not so much in Hong Kong -- there's nowhere to go. Perhaps jumping from height or into the sea, but that's it. It is so unacceptable socially that a person from Hong Kong would go elsewhere to live a lowly life that people would choose to die over going elsewhere.
Definition is one thing, and then we have several groups with vested interest in giving a "diagnosis" to patients: parents, and perhaps patients. Nowadays, instead of "laziness" and "stupidity", people are increasingly referring their child as being inflicted by developmental delay (which is otherwise known as "stupidity" in my days, especially when they are not formally "mentally retarded"), attention-deficit hyperactivity disorder (which is known as "lazy and distracted"), and so on, so forth.
It has become a trend such that all child are bright and beautiful, and only afflicted by a disorder and is therefore so naughty that you teacher cannot work with them. And it's your fault by not coping well with their illness, or by discriminating them based on their ailment.
Honestly, I don't believe in the notion that this generation of children is facing a "psychiatric epidemic". In my humble opinion, they are facing a "diagnosis epidemic".
People see doctor, people die.
IT is sad that every two or three weeks, we're seeing episodes and episodes of people suffering because the waiting time for special out-patient departments are long. Don't be mistaken - I agree that it is indeed long, what I wanted to say though, is that these high counts of mortality is probably less related to the long waiting time. I believe, however, this is due to patient behavior, as opposed to negligent doctors, failing standards, or poor medical system.
It is, again, a recurring theme that wherever there are poor outcomes, people ask for somebody to take up the responsbility, typically a scapegoat in my humble opinion. People tends to blame the establishment, such as the hospital management, the lengthy waiting time, the lack of medical manpower, or sometimes, it could even be targeting those doctors who are not willing to work too many hours overtime. However, it is very much less common that we see people blaming the patient.
When patients visit their doctor, we call it consultation, and we charge the consultation fee. What this mean is that the doctors are consulted, and to spell it out clearly, if the patients do not visit their doctors, the doctors could do nothing. I think it could be said that our patient population in general has been educated to come to the emergency department whenever their condition changes for the worse.
In this case[1], the gentlemen went to general out-patient clinics for depressed mood. Apparently, what the medical officer did was to refer him for psychiatric evaluation, which, in my books, it means that this patient does not have severe psychiatric disturbances, and there were no signs or symptoms that are suggestive of him being at risk of harming himself or others. Subsequently, he has been evaluated (probably by psychiatric advanced practice nurses -- who are extremely familiar with psychiatric conditions) and was given an appointment ten-eleven months down the road.
What he did was that he killed himself three days after receiving the appointment. At this point it is important to stress on that we doctors works with uncertainty, and are definitely not fortune-tellers who can see the future through a ball of crystal. And for the matter, if any medical graduate could see the future, it's probably better to win a mark-six ticket every now and then instead of working 60+ hours in the hospital every week.
What is the lesson learnt? If you have got a patient at home, and you see his or her condition changing for the worse, bring them to the emergency department -- this, is the raison d'etre of emergency department.
[1] http://www.vjmedia.com.hk/articles/2014/03/07/65639
It is, again, a recurring theme that wherever there are poor outcomes, people ask for somebody to take up the responsbility, typically a scapegoat in my humble opinion. People tends to blame the establishment, such as the hospital management, the lengthy waiting time, the lack of medical manpower, or sometimes, it could even be targeting those doctors who are not willing to work too many hours overtime. However, it is very much less common that we see people blaming the patient.
When patients visit their doctor, we call it consultation, and we charge the consultation fee. What this mean is that the doctors are consulted, and to spell it out clearly, if the patients do not visit their doctors, the doctors could do nothing. I think it could be said that our patient population in general has been educated to come to the emergency department whenever their condition changes for the worse.
In this case[1], the gentlemen went to general out-patient clinics for depressed mood. Apparently, what the medical officer did was to refer him for psychiatric evaluation, which, in my books, it means that this patient does not have severe psychiatric disturbances, and there were no signs or symptoms that are suggestive of him being at risk of harming himself or others. Subsequently, he has been evaluated (probably by psychiatric advanced practice nurses -- who are extremely familiar with psychiatric conditions) and was given an appointment ten-eleven months down the road.
What he did was that he killed himself three days after receiving the appointment. At this point it is important to stress on that we doctors works with uncertainty, and are definitely not fortune-tellers who can see the future through a ball of crystal. And for the matter, if any medical graduate could see the future, it's probably better to win a mark-six ticket every now and then instead of working 60+ hours in the hospital every week.
What is the lesson learnt? If you have got a patient at home, and you see his or her condition changing for the worse, bring them to the emergency department -- this, is the raison d'etre of emergency department.
[1] http://www.vjmedia.com.hk/articles/2014/03/07/65639
Saturday, August 3, 2013
My issues with science teachers
Perhaps 20 years ago, we had "degree teachers" who were among the best students of their time, having read a degree from the two prestigious universities in Hong Kong, The University of Hong Kong, and The Chinese University of Hong Kong. The implications then were that they are well-versed in their matriculation and undergraduate studies, and they know the knowledge by heart, most of the time adequate to explain issues inside and outside the then-british curriculum to students.
For me, secondary science education was a great introduction to science and certainly what led me into clinical medicine and research. For those who believe in that you don't need much more than the curricular knowledge to teach science, I would give two simple phenomenon that I encourage your kids to ask their science teachers:
(1) Why is metallic mercury a liquid at room temperature and pressure, and
(2) Why does a mirror reflect light of most visible wavelength
The phenomenon in both questions are simple, and taught at perhaps primary school or junior forms, however, the ability to explain these to matriculation students (who, presumably, had the prerequisites) are certainly not found in most teachers I have personally met. If one has not heard of the answer before, it's readily derivable from basic principles in relativity and quantum mechanics taught at A-level Physics and Chemistry.
What this example illustrate, is that you need science teachers who knew much more than the mere curricular knowledge to teach, and to inspire students so that we won't miss a potential scientist in the future. If there should be a reason as to why we had less and less locally schooled scientists in the past 10 years, it probably had to do with the ability of teachers these days.
For me, secondary science education was a great introduction to science and certainly what led me into clinical medicine and research. For those who believe in that you don't need much more than the curricular knowledge to teach science, I would give two simple phenomenon that I encourage your kids to ask their science teachers:
(1) Why is metallic mercury a liquid at room temperature and pressure, and
(2) Why does a mirror reflect light of most visible wavelength
The phenomenon in both questions are simple, and taught at perhaps primary school or junior forms, however, the ability to explain these to matriculation students (who, presumably, had the prerequisites) are certainly not found in most teachers I have personally met. If one has not heard of the answer before, it's readily derivable from basic principles in relativity and quantum mechanics taught at A-level Physics and Chemistry.
What this example illustrate, is that you need science teachers who knew much more than the mere curricular knowledge to teach, and to inspire students so that we won't miss a potential scientist in the future. If there should be a reason as to why we had less and less locally schooled scientists in the past 10 years, it probably had to do with the ability of teachers these days.
Monday, October 29, 2012
On the CUHK student
There are quite a bit of noise in the society as to whether this gentlemen should be punished. And there is an interesting standpoint that I would like to comment on...
"Freedom of Speech"
It has been said that the best way to test one's support to the freedom of X is when X is used against the person.
When your social group is called "ugly", "with speech bypassing the brain", or perhaps attributed as a species like C. familiaris, by a certain person that your very social group is supporting, it is rather difficult not to be at least angry.
It is true that such hateful speech, no matter how bad it is, is probably not illegal in Hong Kong. And there shouldn't be legal punishment for that.
However, given that he is receiving scholarship from taxpayer's money, a privilege, removing such privilege may not be exactly wrong -- you can't take the money from us and slap us on our face at the same time, right? Remember - we are only suggesting that we take away his privilege that we granted him in the first place for his scholarly results and personality. when we find out that we're wrong, it's time to act!
"Freedom of Speech"
It has been said that the best way to test one's support to the freedom of X is when X is used against the person.
When your social group is called "ugly", "with speech bypassing the brain", or perhaps attributed as a species like C. familiaris, by a certain person that your very social group is supporting, it is rather difficult not to be at least angry.
It is true that such hateful speech, no matter how bad it is, is probably not illegal in Hong Kong. And there shouldn't be legal punishment for that.
However, given that he is receiving scholarship from taxpayer's money, a privilege, removing such privilege may not be exactly wrong -- you can't take the money from us and slap us on our face at the same time, right? Remember - we are only suggesting that we take away his privilege that we granted him in the first place for his scholarly results and personality. when we find out that we're wrong, it's time to act!
Monday, June 4, 2012
My stand on Inclusive Education
What's inclusive education?
Quoting Wikipedia, Inclusive education is "an approach to educating students with special educational needs. Under the inclusion model, students with special needs spend most or all of their time with non-disabled students."
The notion is that, by allowing students with special educational needs to participate in classroom with other students who are not disabled, these students with SEN will fare better.
What is the issue?
There exists quite a number of premises that must be fulfilled before inclusive education would be beneficial.
(1) Teachers must be educated such that they know how to handle students with special education needs.
We are talking about a really wide range of knowledge that a teacher needed before they can conduct a lesson with these students with SEN. There are a thousand and one disabilities out there and these requires knowledge and input from speech, occupational and physio-therapists. And we are talking about three-to-five years of tertiary education here.
And then, the ability to deal with difficult case adequately is strongly correlated with center experience (in almost all sort of fields). Do you know why liver transplant in Hong Kong is only done in QMH? Do you know why we need to segregate hospitals into different levels of "trauma center" in the US? It has all to do with the center experience and center volume.
The more you do, the better you can do it. There's a reason why people are called "specialists".
(2) The classroom (i.e. teachers AND other fellow students) must extend to adapt to the need of the students who may be unable to receive traditional instruction without interrupting the class.
In the past, special education schools opened because people find that the traditional classroom was too rigid to adapt to the need of the students with SEN, and for the matter, there has been little change in the classroom situation.
and so on, and so forth.
Without these premises fulfilled, the situation of "inclusive education" in Hong Kong is more like dumping all those special students into schools of poorer academic performance, whether you like it or not...
Quoting Wikipedia, Inclusive education is "an approach to educating students with special educational needs. Under the inclusion model, students with special needs spend most or all of their time with non-disabled students."
The notion is that, by allowing students with special educational needs to participate in classroom with other students who are not disabled, these students with SEN will fare better.
What is the issue?
There exists quite a number of premises that must be fulfilled before inclusive education would be beneficial.
(1) Teachers must be educated such that they know how to handle students with special education needs.
We are talking about a really wide range of knowledge that a teacher needed before they can conduct a lesson with these students with SEN. There are a thousand and one disabilities out there and these requires knowledge and input from speech, occupational and physio-therapists. And we are talking about three-to-five years of tertiary education here.
And then, the ability to deal with difficult case adequately is strongly correlated with center experience (in almost all sort of fields). Do you know why liver transplant in Hong Kong is only done in QMH? Do you know why we need to segregate hospitals into different levels of "trauma center" in the US? It has all to do with the center experience and center volume.
The more you do, the better you can do it. There's a reason why people are called "specialists".
(2) The classroom (i.e. teachers AND other fellow students) must extend to adapt to the need of the students who may be unable to receive traditional instruction without interrupting the class.
In the past, special education schools opened because people find that the traditional classroom was too rigid to adapt to the need of the students with SEN, and for the matter, there has been little change in the classroom situation.
and so on, and so forth.
Without these premises fulfilled, the situation of "inclusive education" in Hong Kong is more like dumping all those special students into schools of poorer academic performance, whether you like it or not...
Sunday, June 3, 2012
On the June 4th Incident...
It is almost time, and many colleague of mine had discussed with me on the possibility of exchanging a day of compensatory leave on the June 4th. They were trying to attend the June-4th memorial held in the Victoria Park (or something).
I have talked briefly on the trouble of democracy earlier on in this blog.
Whereas I do have my admiration towards those who protested in the Tiananmen square in 1989, for their bravery and pursuit of their dream (of a democratic China), these memorials have been transformed into more of a political tool of the pan-democratic band than a memorial of the martyrs.
What I had even more trouble with is the churches that organized memorials for the June-4th event. If anything, they should hold memorials for the mass killings of:
(1) Egyptians firstborn sons (Exodus 11-12),
(2) Canaanites (Numbers 21; Deuteronomy 20), and perhaps also
(3) Amalekites (1 Samuel 15)
And then perhaps, for the Catholics, they could also consider holding memorials for
(1) People who died in the Crusade,
(2) Those who are butchered by the Canon laws because of holding a religious belief rather than Catholic, and
(3) The slaughtering of the Ancient Pagans, the Saxons who refused to convert, those who refused Church taxes all across europe in the middle ages, the so-called Heretics, Witches and so on...
I mean, these churchman holding memorials for the June-4th incident is just.. hilarious.
I have talked briefly on the trouble of democracy earlier on in this blog.
Whereas I do have my admiration towards those who protested in the Tiananmen square in 1989, for their bravery and pursuit of their dream (of a democratic China), these memorials have been transformed into more of a political tool of the pan-democratic band than a memorial of the martyrs.
What I had even more trouble with is the churches that organized memorials for the June-4th event. If anything, they should hold memorials for the mass killings of:
(1) Egyptians firstborn sons (Exodus 11-12),
(2) Canaanites (Numbers 21; Deuteronomy 20), and perhaps also
(3) Amalekites (1 Samuel 15)
And then perhaps, for the Catholics, they could also consider holding memorials for
(1) People who died in the Crusade,
(2) Those who are butchered by the Canon laws because of holding a religious belief rather than Catholic, and
(3) The slaughtering of the Ancient Pagans, the Saxons who refused to convert, those who refused Church taxes all across europe in the middle ages, the so-called Heretics, Witches and so on...
I mean, these churchman holding memorials for the June-4th incident is just.. hilarious.
Sunday, May 13, 2012
Placebo’s guide – getting into medical school
There
are no grades that I’ll talk about (you can see for yourselves in the JUPAS
website I suppose); there are few
examples of what would bring a person into medical school (there are enough
medical doctors around you and it’s easy to ask); what this piece deals with is
how you get there after you have got all the requisites – good academic results, reference
letters and the much needed luck. Accept this, and read on.
Medical
schools in Hong Kong are basically a place for
really bright students[1]. For those who are less able to get good grades at public examinations, alternatives include
entrance to medical schools in Taiwan,
the United Kingdom and Australia.
Medical
school isn’t exactly something one should consider if you are asking for money.
Yes – really good surgeons do make a million a week – but how many of those are
there? You are much better off doing MT jobs and hope for the best. You will
work less hours, have better quality of life earlier and hopefully retire
earlier. There are certainly jobs in the medical sectors that would provide you
with decent hours, but those would
usually require either a period of damnation
which may be quite long (some 8 years perhaps for physicians to rise to the
level where you need not be on-site during on-call period) or an unreasonable curriculum that you will
need to finish (e.g. anatomic and cytopathology).
Who do they want as medical students?
It all
stems from one thing – a medical school wants to train safe doctors. The idea is, you could at least expect a safe doctor
taking care of you when you’re in the hospital – thus, we need doctors (thus medical students) who understand
their limits, work as a team and listen to others.
Accept
it – medical school is all about vocational training. There is no ‘university’
part involved unless you are part of the academic staff in the university – and
even then, not until you receive your fellowship.
You are
going to get interviews, and you are going to be asked on why you want to be a medical doctor (once you’re in you will graduate unless you quit) and why you should be offered a place in the
medical school.
So why do you want to be a doctor?
It is
very natural to ask this question, am I not correct, monsieur? Let’s look at some sample answers:
1. My mother told me to do so.
2. I am living in a public housing
estate and all I want to do is to get some decent salary to raise my four
younger brothers.
3. It is my dream to become a
doctor.
4. My father is a doctor, and I am
to inherit his practice.
And so
on, and so forth. These may as well be the real underlying reasons for many
doctors out there, but of course, as a reasonably
good student you know that there are many ways of presenting the same idea. I
am not trying to give standard
answers here, but the idea is that you want to help other people out, and medicine is one direct way of helping these folks.
[1] No,
the luminance is not required for passing the examinations after you get into the medical school.
Friday, May 11, 2012
Childhood education - our future?
Irrelevant introduction
There are a total of four pillars in the Trafalgar square. Alongside Lord Nelson, are four pillars with the statues of King George IV, Sir Charles Napier and Sir Henry Havelock. Yes- we are missing one of them. At the current moment, it showcases a sculpture called "Powerless Structures, Fig. 101".
An excerpt of the caption thus reads:
Childhood educators
Childhood education is important[1]. The thing is, whether you believe in the critical period hypothesis or not, the golden rule in language acquisition is still the earlier the better. The problem[2] with childhood education in Hong Kong is the utter neglect of it by the government.
Face it, the average parent in Hong Kong is not that sort of well-educated parent we are seeing in the advertisements (e.g. of HSBC) - look at the statistics - the average boy in Hong Kong doing HKCEE (although it is now historical, this represents what we have in the society for at least a decade-worth of men) would not pass all the three core subjects (Chinese, English and Mathematics).
And then we need kindergarten[3], and some of us may believe in the supposition that these quasi-educators in the kindergartens are better qualified than these apparently academically not-so-competent dads and moms. And perhaps we are wrong - at least for our generation. The minimum qualification, back in the years when the now-working generation were kindergarten pupils, for kindergarten teachers is that of finishing Form 3. The requirement has since changed to five passes in HKCEE (and still not requiring a pass in mathematics).
I suppose our children deserve better education. It is time we actually examine what is going on in the kindergartens rather than trying the best of our luck in applying for the best kindergartens judged by their associations with the international primary schools...
Recommendations?
In the form of replying a specialty consultation, may I suggest:
(1) Raising the salary for all education posts such as kindergarten, primary and secondary teachers to improve the competitiveness in the job market.
(2) Mandatory language assessment for all childhood educators (to the likings of LPAT in primary and secondary teachers) - our children are looking at them for INPUTS during their critical (or early if you insist) years.
I am not asking for much - a pass in CAE or CPE would be quite sufficient - and mind you, we had that passed in our matriculation years.
[1] If you believe that a citation here would be useful, go here. I believe in the contrary.
[2] If there were no problems then I wouldn't have written this.
[3] To be honest, this is probably not the reason for the existence of kindergartens, and even with the universal tertiary education in taiwan, things are much better looking either.
There are a total of four pillars in the Trafalgar square. Alongside Lord Nelson, are four pillars with the statues of King George IV, Sir Charles Napier and Sir Henry Havelock. Yes- we are missing one of them. At the current moment, it showcases a sculpture called "Powerless Structures, Fig. 101".
 |
| Powerless Structures, Fig.101 by Loz Flowers |
"... the work references the traditional monuments in the square, but, with its golden shine, it celebrates generations to come... We wanted to create a public sculpture which, rather than dealing with topics of victory or defeat, honours the every battles of growing up."This shows how these Englishman see the importance of our future generations - they raise the depiction of our future generations to the status of historical heroes.
Childhood educators
Childhood education is important[1]. The thing is, whether you believe in the critical period hypothesis or not, the golden rule in language acquisition is still the earlier the better. The problem[2] with childhood education in Hong Kong is the utter neglect of it by the government.
Face it, the average parent in Hong Kong is not that sort of well-educated parent we are seeing in the advertisements (e.g. of HSBC) - look at the statistics - the average boy in Hong Kong doing HKCEE (although it is now historical, this represents what we have in the society for at least a decade-worth of men) would not pass all the three core subjects (Chinese, English and Mathematics).
And then we need kindergarten[3], and some of us may believe in the supposition that these quasi-educators in the kindergartens are better qualified than these apparently academically not-so-competent dads and moms. And perhaps we are wrong - at least for our generation. The minimum qualification, back in the years when the now-working generation were kindergarten pupils, for kindergarten teachers is that of finishing Form 3. The requirement has since changed to five passes in HKCEE (and still not requiring a pass in mathematics).
I suppose our children deserve better education. It is time we actually examine what is going on in the kindergartens rather than trying the best of our luck in applying for the best kindergartens judged by their associations with the international primary schools...
Recommendations?
In the form of replying a specialty consultation, may I suggest:
(1) Raising the salary for all education posts such as kindergarten, primary and secondary teachers to improve the competitiveness in the job market.
(2) Mandatory language assessment for all childhood educators (to the likings of LPAT in primary and secondary teachers) - our children are looking at them for INPUTS during their critical (or early if you insist) years.
I am not asking for much - a pass in CAE or CPE would be quite sufficient - and mind you, we had that passed in our matriculation years.
[1] If you believe that a citation here would be useful, go here. I believe in the contrary.
[2] If there were no problems then I wouldn't have written this.
[3] To be honest, this is probably not the reason for the existence of kindergartens, and even with the universal tertiary education in taiwan, things are much better looking either.
Thursday, May 3, 2012
English as medium of instruction - II
In the classroom
It is no secret that the English competence of an average HK secondary school student is inadequate to learn the curriculum in English. However, to satisfy parental demands of using English as the medium of instruction, schools has been silently allowing teachers who were supposed to teach in English, to use Cantonese to supplement teaching - this supplementation could sometimes be a whole session conducted in Cantonese.
In fact, this (using Cantonese to conduct a lesson teaching material in a textbook written in English) certainly improved the understanding of students despite being rather unsound pedagogically. The problem with it though, is that, should we still label these as "EMI" schools? "EMI" subjects?
The situation of the pseudo-EMI teaching in secondary school has not been studied thoroughly, the obvious reason being that teachers will usually revert to teaching in English when being observed. What comes to rescue, though, is studies conducted among university students in Hong Kong.
Braine and McNaught had a fairly well-written literature review of the pseudo-EMI teaching in Hong Kong in their paper entitled "Adaptation of the ‘Writing Across Curriculum’ Model to the Hong Kong Context" [1]. In essence, in the university, students pressure the lecturers to use Cantonese by simply not responding to lecturers who still teach with English.
We can see that the outcome associated with teaching in English in these students whose competence do not enable them or facilitate them to learn in English is that - they will simply NOT learn the subject, and the outcome associated with teaching in Cantonese in these students would be that their English couldn't improve. The issue lies on:
(1) Are we doing an adequate job in placing students into correct MOI group?
... are we trying to put too many students in EMI schools?
... could this be due to parental demands?
(2) Is it possible to setup a category so that English textbooks are taught in lessons conducted in Cantonese?
(3) What is wrong with the current English education in HK?
[1] http://www.cuhk.edu.hk/clear/download/paper/BMcN_Lui.pdf
It is no secret that the English competence of an average HK secondary school student is inadequate to learn the curriculum in English. However, to satisfy parental demands of using English as the medium of instruction, schools has been silently allowing teachers who were supposed to teach in English, to use Cantonese to supplement teaching - this supplementation could sometimes be a whole session conducted in Cantonese.
In fact, this (using Cantonese to conduct a lesson teaching material in a textbook written in English) certainly improved the understanding of students despite being rather unsound pedagogically. The problem with it though, is that, should we still label these as "EMI" schools? "EMI" subjects?
The situation of the pseudo-EMI teaching in secondary school has not been studied thoroughly, the obvious reason being that teachers will usually revert to teaching in English when being observed. What comes to rescue, though, is studies conducted among university students in Hong Kong.
Braine and McNaught had a fairly well-written literature review of the pseudo-EMI teaching in Hong Kong in their paper entitled "Adaptation of the ‘Writing Across Curriculum’ Model to the Hong Kong Context" [1]. In essence, in the university, students pressure the lecturers to use Cantonese by simply not responding to lecturers who still teach with English.
We can see that the outcome associated with teaching in English in these students whose competence do not enable them or facilitate them to learn in English is that - they will simply NOT learn the subject, and the outcome associated with teaching in Cantonese in these students would be that their English couldn't improve. The issue lies on:
(1) Are we doing an adequate job in placing students into correct MOI group?
... are we trying to put too many students in EMI schools?
... could this be due to parental demands?
(2) Is it possible to setup a category so that English textbooks are taught in lessons conducted in Cantonese?
(3) What is wrong with the current English education in HK?
[1] http://www.cuhk.edu.hk/clear/download/paper/BMcN_Lui.pdf
Wednesday, May 2, 2012
English as medium of instruction - I
There is a recent posting on the medium of instruction in discuss.com.hk.The matter surrounding the discussion was that whether Chinese should be employed during teaching of a subject (other than English) in a school where the "medium of instruction" is English.
a short history of MOI in Hong Kong
a large proportion of this historical account was derived from [1].
It all started in 1978 - when universal education in Hong Kong was in its first year of life. It was the year that all Hong Kong children, regardless of their socioeconomic background, were granted 9 years of free education.
The curriculum then, was terribly difficult even for students nowadays. The 1953 Joint primary 6 examination was famous and it was well-circulated on the internet. A copy was donated by a retired teacher to a museum in Hong Kong (三棟屋博物館).
The questions were as follows:
This is terribly difficult even for junior secondary school students nowadays. Given such examination paper, one can imagine how elitist the education then was. The less prestigious schools were then harbouring a lot of students from lower socio-economic status who basically had completely inadequate English competency to study the curriculum in English.
And expectedly, the Education Commission sought help from UK. The panel of experts then recommended that:
With failure of the policy, a mandatory scheme was then introduced to categorize STUDENTS, first, into Group I-III (Ability to learn in I - both EMI and CMI schools, II - CMI schools only, III - EMI schools only) and then those school that couldn't get enough of EMI-capable students are forced to use Chinese as the medium of instruction.
[1] http://www.fed.cuhk.edu.hk/~hkier/content/document/OP/Op64.pdf
a short history of MOI in Hong Kong
a large proportion of this historical account was derived from [1].
It all started in 1978 - when universal education in Hong Kong was in its first year of life. It was the year that all Hong Kong children, regardless of their socioeconomic background, were granted 9 years of free education.
The curriculum then, was terribly difficult even for students nowadays. The 1953 Joint primary 6 examination was famous and it was well-circulated on the internet. A copy was donated by a retired teacher to a museum in Hong Kong (三棟屋博物館).
The questions were as follows:
一至四題任答三題
(一)斯巴達和雅典是怎樣的國家，試分述之。
(二)試述法國革命的起因。
(三)分答下列二題：
(甲)季候風地帶包括哪些地區？氣候和雨量的情形怎樣？
(乙)沙漠的成因怎樣？
(四)試把中國和美國的農作方式作一比較。
五至八題任答三題
(五)香港政府的立法機關和司法機關及行政機關其組織與職權是怎樣的？
(六)香港政府何以要設華民政務司署？這個機關辦些什麼事情？
(七)政府為什麼要對人民徵稅？是不是隨意徵收？須經什麼機關通過才能實行？人民對政府估定的稅額不同意時有什麼補救方法？
(八)聯合國何時成立？會址設於何處？為實現「天下一家」的最高理想，聯合國應做些什麼事情？
九至十一題任答二題
(九)試以圖及文字解釋潮汐的原因。
(十)維他命有哪幾種？每種有什麼功用？各種維他命在食物中之含量如何？
(十一)普通蚊與瘧蚊有什麼區別，瘧蚊怎樣傳染瘧疾？
This is terribly difficult even for junior secondary school students nowadays. Given such examination paper, one can imagine how elitist the education then was. The less prestigious schools were then harbouring a lot of students from lower socio-economic status who basically had completely inadequate English competency to study the curriculum in English.
And expectedly, the Education Commission sought help from UK. The panel of experts then recommended that:
...is for the Government to impose Cantonese as the medium of instruction in FI-III of all secondary schools...and also
...to leave alone the small number of school which have been genuinely successful in using English as a medium of instruction...The idea then was to introduce English progressively throughout junior secondary education. Then, a policy called "positive discrimination" evolved. It was a policy such that schools teaching in Chinese could brand themselves as such. The problem that follow was of course - very few school followed this recommendation. The reason was simple - you need good input to make good output, and better students tends to go to schools that teach in English.
With failure of the policy, a mandatory scheme was then introduced to categorize STUDENTS, first, into Group I-III (Ability to learn in I - both EMI and CMI schools, II - CMI schools only, III - EMI schools only) and then those school that couldn't get enough of EMI-capable students are forced to use Chinese as the medium of instruction.
[1] http://www.fed.cuhk.edu.hk/~hkier/content/document/OP/Op64.pdf
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