2008年12月29日 星期一

Taiwan legislator's dual citizenship scandal

The discussion in the following website,  http://www.taiwanus.net/news/press/200812290813551775.htm


revealed that the Taiwan legislator Li Ching-an had not given up her US citizenship according to the state department's record, and was qualified for the US government tax rebate of $900, meaning that she did pay the income tax to the US in 2007. Therefore she has been fully aware that she has effective dual Taiwan-US citizenship all these years! She was also said to be seen passing through the custom entrance for the " US citizen" in LA in 2003 or 2004, according to a caller in a Taiwan talk show.  Her denials that she has lost the US citizenship "automatically" as soon as she was sworn in 14 years ago as the Taiwan government official were blatant lies, and a clear insult of our intelligence.


 


Those KMT government officials who were supposed to investigate and clarify her dual citizenship status long time ago hurriedly denied knowing anything about her dual citizenship.  


 


Li Ching-an, the daughter of the former KMT (Nationalist Party) premier Li Huan, has been lying to all news reporters and Taiwanese people. She received the incomes from Taiwan  government as a public servant, a Taipei city councilman and then a legislator, for 14 years, while secretly maintaining her dual Taiwan-US citizenship which has been illegal according to the Taiwan law. During her tenure as the city councilman, she even harshly criticized 2 Taipei municipal officials who had dual citizenship, to force one to resign and the other to renounce the US citizenship in Thailand. All were done while hiding her own dual citizenship! What an audacity, what a mean, despicable, contemptible behavior!


 


The next question is, of course, what about the permanent US residency status of the current “president”, KMT's Ma Ing-joke? He also claimed that his permanent residency status “automatically expired” or “disappeared”, or evaporated when he did not use it. There is no doubt in people's mind that there is another dishonest man, who is also a self-admitted former campus spy against Taiwanese, sitting in the highest position of Taiwan government. He is currently leading this democratic island nation to become a part of the authoritarian China, despite the opposition by more than 80% of Taiwan residents in repeated polls.  How does the exposure of Ma's deceptions and inconsistencies affect his position, his political decisions, and the stability of this government is to be seen. 


 


The shamelessness of those KMT hypocrites and criminals evolved in large part from their years of superiority feeling and habits of cheating Taiwanese. They have been so confident that whatever they did they could get away with it. “The court is KMT's”, as they proudly claimed. Why should they worry? So far which KMT embezzlers got caught? Who are in jail now?  Well, nearly all of them are enjoying the millions and billions of NT, that they stole from Taiwan , in China . The remainders are hiding in the US , Canada , or somewhere. 


 


After more than 10 years of recent rule by Taiwanese DPP (Democratic Progressive Party), during which democracy, human rights, and law-and-order were promoted, many young voters have become used to the new political climate, the “rule by law”.


 


However, those KMTs still hanged on to their old mind frame, refused to change. They are confident that their structure for the corrupt authoritarian rule, with unfairness and under-the-table dealings, built and perfected since 1940's has not fallen apart. The legal system is still under KMT control, and “Three quarters of legislators are KMT members, what can you do about it?” From the recent events in Taiwan , (e.g. hiding the KMT’s national flags when Chinese officials visited Taiwan , and police beating of the peaceful demonstrators against their visits, etc.) they are correct.


 


After the dual citizenship revelations, Li CA will have to be convicted to 7-8 years in prison and return 114 million NT that she took from the government as her salary and other expenses.


 


What do you guess that she will do next? I will bet that the legal process will be dragged in court for years, and during which, she will flee out of Taiwan with the help of remaining KMT underground secret apparatus.



The fact that many KMTs in the government are still protecting her with various delay tactics of due process shows the basic difference between KMT and DPP. When DPP’s president Chen SB admitted lying to the public, the vast majority of DPP supporters and DPP members were outraged and supported prosecution of Chen.


 


Some Taiwanese who voted for KMT the past year have been keenly alerted to the fact that, what Ma promised during the pre-election campaign has completely been unrealized, and Taiwan, which is an independent state, is taking a very dangerous path of no return to become a region of China.


 


This Li CA scandal might further hurt the power of KMT’s holds on the voters for the next legislatorial and local elections. To what degree will the damage to the KMT be, and whether Taiwan will be saved from becoming a subordinate of China, is dependent on the wisdom of the Taiwan voters. The future of Taiwan will be decided by the elections in various levels over the next couple of years.


 


Will the ideal for law-and-order, human rights, the fairness, and the real democracy prevail over the vote-buying and bribery with the KMT's huge illegal party assets? This is the question that will decide the fate of 23 million people in Taiwan.  


 


 


2008年12月15日 星期一

Reminiscence-1

Watching the TV news of snow storm in the Northeast, I feel relieved that we had left Chicago eight or nine years ago. At my age, I would certainly like to avoid shoveling snow or driving in icy weather. When we were young and vigorous, we could live in any place. I still remember how I answered Dr. Lloyd Old when I saw him in early 1970’ s while looking for a job. He asked me where did I want to live and work. I said if the work fit, I could go to Alaska . He nodded understandingly. It was such a long time ago that I do not remember when and how I got to visit him. It could be upon the suggestion of Dr. Cooperband who taught me the lymphocyte culture technique.


Reminiscing the days in Chicago , I thought of a funny exchange at my hospital in 1980’ s that still makes me laugh. There was a very smart, quick-witted and humorous chief resident, Dan Fisher, at our Columbus Hospital in Chicago . The Northwestern University Medical Center (NUMC) was trying to include this catholic hospital as one of its teaching hospitals. The house staff, the chief of medicine, and I, from NUMC, were assigned there to draw salaries. But eventually the negotiations failed. I was not interested in those administrative matters and never had any idea of how, why, and the potential consequences to us later.


The medical director and the chief of medical department of Columbus Hospital was Dr. Erl Dordal, a professor of clinical medicine in gastroenterology. He is highly intelligent, sharp as a needle, and can be very humorous. Sometimes his comments can be so funny that I could not stop giggling. He can grab complicated situation in an instant and seems to be able to think many steps ahead of you and then back to you within a fraction of a second. He was very nice and protective of his men.


At that time, almost weekly, the chief resident would arrange a drug company to host noon conferences with outside speakers to talk on some subjects. The drug rep would provide simple lunch and small gift items to attract residents to attend. The conference would go on while we munch on those lunches with drinks. The topics discussed were on various clinical issues and usually very useful. They were not necessarily related to the company’s products, but the company would distribute drug brochures.


One day, after the conference, three of us met in the hall way. Dr. Dordal did not attend the conference, and asked Dan:


“Noon conference?” the director asked softly with an inquisitive look. He did not want to be involved in those company-related matters, I supposed, but still wanted to be kept informed.


Dan answered, “Yes, by so-and-so company”.


He asked, “What was it?”.


Instantaneously, Dan replied:


“Pizza and penlight”.


I burst out laughing and Dr. Dordal broke up grinning. Every time I recalled this episode, I could not help laughing and also admired Dan’s fast and humorous response.


I wonder where Dan is working now. And Dr. Dordal, who must be over 80 years old, from a web search, seems to be associated with the University of Chicago . I wish I could call them and say hi.


 


2008年11月15日 星期六

嚴重急性呼吸道症候群 SARS (Part-10) image studies

 


上接: 嚴重急性呼吸道症候群 SARS Part-9




嚴重急性呼吸道症候群 SARS (Part-10)


 


十四、SARS影像


 


Case 1 A 34-year-old presented with 3-day history of fever, chills and malaise


Fig. 1, on admission showed ill-defined air space opacification in periphery of right lower zone


 



 


Figure 2 - CXR 3 days later showed progression of air space opacification in right lower zone and a new finding of similar changes in left mid and lower zones after initial treatment



 


Figure 3 - CXR another 3 days showed marked resolution of the consolidative changes in both lungs after treatment



Case 2: A 46-year-old health care worker presented with 2-day history of fever, chills and myalgia


Figure 1 - CXR on admission was normal



Figure 2 - CXR after 3 days showed ill-defined consolidation in periphery of left lower zone



Figure 3 - CXR after another 4 days showed progressive multi-focal consolidation in mid and lower zones of both lungs



 


Case 3: 52-year-old symptomatic female from Virginia
Boca Raton, Florida, USA Courtesy of Dr. Michael E. Katz M D


Fig 1: 15 MARCH 2003 (On presentation to A&E)



Fig 2: 4 days after admission



Fig 3: Another day later



Case 4: SARS Chest X-Ray: (day 5 after onset of symptoms)  Multi-focal confluent areas of air-space opacities in both lungs



Case 5: 6-year-old girl presented with fever, running nose and cough. CXR on admission showed focal air-space consolidation in left upper zone.



Case 6: 24 year old symptomatic female. Frontal view shows vague para spinal opacity in the left lower zone. HRCT showed Consolidation in the posterior basal segment of the LLL



Case 7: 29 year old symptomatic female with normal radiographic appearance. HRCT showed the consolidation of the medial basal segment of the RLL.



 


 


Case 8: (day 3 after onset of symptoms)
Peripheral ill-defined consolidation in the lateral basal segment of left lower lobe



Case 9: (day 2 after onset of symptoms)
Peripheral ground-glass opacification in middle lobe



Case 10: (day 3 after onset of symptoms)
Ground-glass opacification in perihilar region of right upper lobe



Case 11: (day 3 after onset of symptoms)
Ill-defined consolidation with air-bronchogram in apical segment of right lower lobe



Case 12: (day 5 after onset of symptoms)
Multi-focal peripheral consolidation in posterior basal segments of both lower lobes and an area of ground-glass opacification in left lingular segment



Case 13: (day 5 after onset of symptoms)
Patchy, multi-focal, ground-glass opacification and consolidation in both upper lobes



Case 14: (day 4 after onset of symptoms)
Multiple confluent areas of consolidation in the middle lower and both lower lobes



安教養機構感染控制措施

安教養機構感染控制措施


 


 


安養機構及智能教育機構


        患有慢性疾病、失能、失智、老人


        群聚的生活


        抵抗力較弱


        應加強機構內的感染控制、環境安全


 


機構式的感染管制



  1. 有感染管制的政策

  2. 有經過感染控制訓練之人員執行

  3. 有感染管制的監測系統

  4. 對醫院員工之健康有定期檢查,或依流行病情況,有每天持續監測之機制。


 


工作人員


    注意本身健康狀態


    定期健康檢查


    若有呼吸道的症狀,應報告主管或自動請假


    勤洗手


    適時戴口罩


 


機構護士/病服員


    著便服進機構


     更換制服,佩掛名牌


     戴上口罩


     洗手


 


執行平時護理措施


    應遵守無菌技術,


    丟棄針頭


    丟棄鼻胃管


    丟棄導尿管及尿袋


    丟棄抽痰管


 


醫療廢棄物的處理原則:
分類處理


    一般性廢棄物:


    紙類、鐵罐、塑膠、保麗龍、廚餘等,


    應該依照主管單位的環保法規執行;


    感染性廢棄物:


    胃管、尿管、傷口敷料、抽痰管等,


    以雙層塑膠袋包裝後,放入硬紙盒子中,


    再依環保局的規定,以專用垃圾袋丟棄


 


更換尿布


        更換後的尿布,應該丟入有蓋的垃圾桶內,或


        放入垃圾袋後放置於戶外有蓋的垃圾桶中。


 


處理排泄物、分泌物或嘔吐物


    戴手套,倒消毒水。


    抽痰機使用前,先將5~6﹪的漂白水稀釋100倍後,倒入抽痰瓶中;使用後,抽痰瓶中液體直接倒入馬桶沖掉,再將瓶子清潔後,備用。


    更換抽痰瓶後,清洗抽痰瓶。


    處理後脫去手套,並洗手。


 


環境清潔


        機構內清潔工每日執行的清潔工作包括擦拭地面、傢俱、浴室、洗手枱等。


        定期清洗窗戶、圍簾、窗簾。


        每半年清潔環境:整體消毒、除蟲、水質檢驗、水塔清洗等。


    病服員擦拭床、床墊及拆洗被褥


        住民離開機構後,所使用的床及相關設備應做終期消毒。


 


 


教學---要講效率、要能落實


v     教學的方法:演講、個別指導。


v     演講、上課,能提供原則。


v     演講後,多半需要個別指導。


v     學習的意願?有活到老,學到老的精神?


v     教育就是不斷的重複!


v     每一位醫護人員都應該熟悉感染管制!


 


每個人都有其專長!


向別人討教不是羞恥!


多欣賞大自然,身段放低點,多學習!


2008年11月13日 星期四

嚴重急性呼吸道症候群 SARS (Part-9) Sterilization

上接: 嚴重急性呼吸道症候群 SARS Part-8




嚴重急性呼吸道症候群 SARS (Part-9)


 


十四、SARS時的消毒


 


 


SARS病患住院消毒處置感管師張淑美提供)


 


一、病患方面


(一)可重覆使用物品:床單、衣物包布類


1.以雙層袋(外層印有當心感染標誌黃色垃圾袋,內層為布袋)收集至八分滿由護理人員紮緊後,放於污物間的布類物品運輸車中待送至洗衣房。


2.洗衣房工作人員處理該包布類,則戴口罩、手套、穿布類隔離衣後即進行以下操作:除去外層黃色感染性塑膠袋,並將內層污衣袋直接置入高溫、高壓蒸氣滅菌鍋中滅菌(1202Kg/cm240分鐘,抽真空烘乾40分鐘)後,再與一般布類物品一起依非感染性布類物品清洗方式清洗。


 (二)不可重覆使用物品:口罩、衛生紙、便盆、尿壺,則依醫院感染性廢棄物處理。


(三)排泄物:以5.25 %次氯酸鈉溶液(漂白水)稀釋110 浸泡於馬桶內30分鐘後在沖入下水道。


 


二、   醫護人員


(一)可重覆使用物品:布類隔離衣物,同病患之床單衣物處置。病患專用一套血壓計、聽診器。而每次聽診器使用前需以75% 酒精擦拭後再使用。血壓計、聽診器:於病患出院後以75%酒精擦拭消毒。


(二)不可重覆使用物品:丟棄式隔離衣、頭套、腳套、護目鏡、口罩、手套等依醫院感染性廢棄物處理。


三、環境部分


(一)病房


1.   常規性環境消毒:每天以5.25 %次氯酸鈉溶液(漂白水)稀 110以噴霧及擦拭方式消毒床頭(床需移出以進行硬體部分擦拭)、床欄杆、桌面、椅子、地板、牆面板及盥洗室洗臉台、馬桶、地面等。之後再以清水擦拭以上各設備一次。


2.   終期環境消毒:(1)以5.25 %次氯酸鈉溶液(漂白水)稀釋110噴霧及擦拭方式消毒床頭(床需移出以進行硬體部分擦拭)、床欄杆、桌面、椅子、地板、牆面板及盥洗室洗臉台、馬桶、地面等。之後再以清水擦拭以上各設備一次。(2)紫外線燈照射消毒至少2小時以上。


(二)運送病患電梯(32號):以5.25 %次氯酸鈉溶液(漂白水)稀釋110噴霧及擦拭方式消毒地面、牆板、扶手、按鈕等處,之後再以清水擦拭以上各設備一次。


(三)急診帷幕處、急診手術室(暫時放置病患地點):比照病房終期消毒處理。


 


    清潔人員擦拭消毒各設備後需立即更換抹布再進行清水擦拭作業。使用完之抹布、拖把以110濃度漂白水浸泡30分鐘後清洗晾乾。


 


 






























環境消毒(隔離病房、血液、體液)



名稱



濃度



比例



 隔離病房地面、床、桌等



0.2%


(2000PPM)



1CC漂白水:30CC清水



傳染病床單


、衣物等



0.5%


(5000PPM)



1CC漂白水:10 CC清水



 血液、體液


 及污物品



1%


(10000 PPM)



1CC漂白水:5CC清水




 


 


 


 


 


 


 


 






























一般環境清潔



名稱



濃度



比例



地面



0.01%-0.05%


(100-500PPM)



1CC漂白水:100-200CC清水



浴廁



0.1%


(1000 PPM)



1CC漂白水:60 CC清水



行政單位



    清水



 




 


 


 


 


 


 


 


 


 


感管師邱月璧提供:


 


漂白水的正確使用方法為何? http://www.osa.nchu.edu.tw/health/hygiene/new/newsars2.htm
A:目前市售的家用漂白水,其成分多半為「次氯酸鈉」,濃度約為 12 %。以下為建議稀釋倍率:


1. 如果是清洗手部及一般器物,通常使用稀釋到濃度為 0.01 0.05 之漂白水。


2. 清洗大型客車車箱或其他公共場合,可使用 1 漂白水擦拭表面。


3. 清洗嘔吐物,則需使用 5 之漂白水。


實際使用時,稀釋倍數可視污染程度加以調整。台灣市售的漂白水濃度,不同廠牌可能濃度也有高低差異,請注意。清潔用具使用後,先清潔,再以 0.05 漂白水泡 30 分鐘後晾乾。用漂白水擦拭過後的地方,30分鐘後要再用清水擦一遍。


剩餘漂白水可回收保存,不要任意棄置,放置2 小時後,待氯揮發後再傾倒,以免流入河川,有害河川生態亦不可直接倒入馬桶。若以一般容器盛裝,要記得註明「漂白水」字樣,避免日後誤食或誤用。使用漂白水的時候,切記不能和家中清潔用的鹽酸混合在一起,因為這樣會產生對人體有害的氯氣。請民眾千萬小心。(資料來源:台大醫院感染控制小組文件)


 


 













Q9:家裡怎麼消毒,消毒什麼?http://ww3.ymsh.tp.edu.tw/pre_epi/sars/teachbook/book9.htm



答:目前市售的家用漂白水,其成分多半為「次氯酸鈉」。



  1. 清洗手部及一般器物等最常用的是稀釋濃度為0.01%漂白水。
    [
    調配方式] 漂白水(成分為次氯酸鈉,濃度約12%) 10㏄的漂白水加入12000 ㏄(12L )的水

  2. 大型客車車箱內部或其他場合有可能受分泌物污染,故稀釋濃度要高一點,因此大型客車車箱內部或其他場合清潔,以1 %漂白水沖洗車箱及擦拭之,其他場合比照進行。
    [
    調配方式] 漂白水(成分為次氯酸鈉,濃度約12%)1000㏄(1L )的漂白水加入1200012L ) ㏄的水

  3. 嘔吐物以5 %漂白水清洗之。
    [
    調配方式] 漂白水(成分為次氯酸鈉,濃度約12%)500㏄的漂白水加入1200 ㏄的水


 


感管師林明瀅提供:


 


常用漂白水濃度為5.25%~6%1000ppm(0.1%)以上(1:50)屬於高程度消毒劑,100ppm(1:500)為低程度消毒劑。因其有腐蝕作用,不適用於次重要醫療物品的消毒。雖對肝炎病毒有效,但不可用於內視鏡之消毒。稀釋溶液不穩定,須在使用前才泡製。


如有血跡、糞便、體液等污染,應即時以0.5~0.6%次氯酸鈉溶液(6%漂白水稀釋10)拖洗。


 


病室浴室每日洗澡池均須以0.5~0.6%次氯酸鈉溶液(6%漂白水稀釋10)刷洗。


 


SARS病房之清潔


一、清潔工作人員穿戴全套個人防護裝備進入隔離區內,先清潔和處理前室(或隔離室外走廊)的垃圾,再進入隔離病室內使用隔離室專用清潔用具進行環境清潔和垃圾處理。


()隔離室環境清潔程序請參見「嚴重急性呼吸道症候群之醫院感染控制指引」


()每一病床使用專用的清潔用具,病人單位每天以0.1%次氯酸鈉溶液(6%漂白水稀釋50)清潔,包括地板、門把、電話、桌面等表面。清潔用具使用後先清潔再以0.1%次氯酸鈉溶液泡20分鐘以上晾乾。


()病人出院或轉出後,空調至少繼續運轉2小時後才能作終期清潔。


 


 


 

(continued to:  嚴重急性呼吸道症候群 SARS Part-10  )