繼量化寬鬆後,再新現一個名詞,叫量化派A。
FT剛出了一份報道幾有趣,分享下。
如果CPI升5%叫通脹勁的話,睇下英國「派Grade通脹」有幾利害。今年獲派A*及A Grade的比例接近45%,較2019年的25.5%升足廿個百份點。
原因,公開考試取消,變成由老師根據「一籃子」因素決定學生值咩Garde。
調查報道亦發現,私立學校學生獲A及A*比重達七成,公立學校就不足四成。
//Top grades at A-level have reached a record high this year, after exams were cancelled and replaced with teacher assessments for a second year in a row.
On Tuesday, the Joint Council for Qualifications, the exam board body, said the number of A and A* grades given reached 44.8 per cent in England, Wales and Northern Ireland — up from 25.5 per cent in 2019.
Because grades were decided by teachers on the basis of a “basket of evidence”, which demonstrated the maximum potential of each student, this effectively did away with fixed grade boundaries that before the pandemic put limits on the number of top marks that could be awarded.
The decision, which led to a ballooning in top grades, was taken after an outcry in 2020 over a computer-based approach designed to keep results in line with previous years, leading to manifest injustices, particularly in schools in more disadvantaged areas.//
同時也有10部Youtube影片,追蹤數超過2,210的網紅DJ Macky Suson,也在其Youtube影片中提到,Episode 5: CYCLING IN SINGAPORE TOUR WITH GOPRO HERO 9 Health benefits of regular cycling Health benefits of regular cycling Cycling is mainly an aer...
「level of evidence」的推薦目錄:
- 關於level of evidence 在 股榮 Facebook 的精選貼文
- 關於level of evidence 在 3Q 陳柏惟 Facebook 的最佳貼文
- 關於level of evidence 在 鄭宇劭物理治療師 Cheng Yu-Shao Physiotherapist Facebook 的最佳貼文
- 關於level of evidence 在 DJ Macky Suson Youtube 的最佳貼文
- 關於level of evidence 在 DJ Macky Suson Youtube 的最佳貼文
- 關於level of evidence 在 夠維根Go Vegan Youtube 的最讚貼文
- 關於level of evidence 在 What are Levels of Evidence? - YouTube 的評價
level of evidence 在 3Q 陳柏惟 Facebook 的最佳貼文
【三級警戒未來何時解?從研究找依據!】
疫情進入三級警戒至今,本週似有趨穩趨勢,但還難稱真正緩和。不過隨著高強度防疫持續,生計受影響的行業越來越多,也讓人擔心民眾出現「防疫疲乏」的現象,雖然目前還沒到鬆懈的時候,但未來我們有沒有一個「警戒降級」的明確標準,用科學化的方式,及最保險的部署,逐步回復原本的生活?
#修改疫情警戒標準增列查核條件 #訂出解除三級之明確安全標準
根據先前2021/1/21發布的疫情警戒標準,各級警戒的升降依據是病例數與傳播鏈,譬如:『出現感染源不明之本土病例(二級)』、『單周出現3件以上社區群聚事件或1天確診10名以上感染不明的本土病例(三級)』,藉此標準去規定防疫的層級。
和一月時相比,不論國際上或國內,都已經開始進行疫苗施打,而雙北大流行之後,也有更多的數據來反映本土流行的樣態。團隊和我在近期討論過程中,也都會從國際上的實證研究,來參考如何讓大家在安全狀況下解封。我們大致上提出三個建議:
1. 根據實證證據,納入疫苗接種率考量
2. 確保流行熱區疫調、匡列、檢驗作為足夠
3. 各項限制分別逐步開放
我們先來討論疫苗接種率,根據《自然醫學》(Nature Medicine)6月10日刊登的論文[1]指出,在177個以色列社區中,疫苗施打率每增加20%,未施打疫苗族群的陽性檢驗率就會下降一半,這篇研究由於使用以色列四大健保之一的資料,涵蓋百萬人以上,因此有相當的證據力,可以讓我們看出,疫苗接種率在還沒達到理論上的「群體免疫閾值」以前,和保護力就有一定的正向關係。打疫苗不僅保護自己,並可間接保護沒打疫苗的他人。
這篇研究的附件中,更動各種參數,保護力都相對穩定。但要注意若僅算「高齡族群(>66歲)施打率」,則對未打疫苗族群的保護力就很弱,這可能是因為高齡族群本身活動力就低,較不會「主動產生」傳播鏈。
當然,根據由美國、南韓、德國三國數據的實際分析,疫苗先打高齡者,可以拯救最多生命[2],英國研究也顯示,先打60歲以上高齡族群,可以讓武漢肺炎造成的死亡降低96%、住院降低80%、加護病房入住也降低65%[3]。顯示台灣先打高齡族群的政策當然正確。
但要疫苗要涵蓋到一定比率中壯年人口(若把55~65歲加進來就有效),才能有效抑制輕症與無症狀傳播。也就是說,在解封過程中,需考量中壯年人口施打疫苗比率來「漸進放寬」管制措施。
但在疫苗接種以外,同一篇文章作者也提到,以色列的封鎖等NPI政策,與疫苗是相輔相成,此因素無法被獨立排除。我們也看到,能夠妥善進行疫調、擴大往外匡列、搭配對高風險群大量篩檢的地方,在圍堵疫情上表現都不錯。例如指揮中心進駐苗栗後,成功控制大量移工感染疫情,近幾日確診個案都早已被隔離,這才能確保社區的安全。而社區的安全性,也可以用抗原快篩陽性率、抗體陽性率、背景病毒量幾種方式去推估,已確保疫情已被侷限住。
最後,解封過程中,一定要小心謹慎,現行三級警戒不少限制,譬如停課、展覽館、社團交接、公祭、群聚人數限制、餐廳需外帶......等等規定,也應該研擬「風險區分」來分開開放。
根據英國研究,第一次封鎖令的對國民行為的影響,以及減少死亡的效應,遠高於第二次封鎖令,很可能有「防疫疲勞」的現象[4]。顯示解了又封,國民遵守的程度就沒這麼好。因此,我希望把「關鍵人口疫苗接種率」(例如65歲以上50%)、「青壯人口(18~65歲)疫苗接種率」(例如20%)、縣市疫調匡列與篩檢能量(能否確實掌握多層對象,外圈的篩檢陽性率)都納入「解封標準」,訂定更嚴格、更安心、更透明的標準,讓社會大眾了解,穩定民心,並得以達到社會共識。
在這次解封以後,今年都不用再倒退,才能讓經濟振興、產業輔導轉型等後續政策順利推展,這有賴與大眾的溝通和討論,重建國人信心,而不只是頒布命令而已。
期待台灣經此一役,能成為一個真正的公衛國家!
1.Milman, O., Yelin, I., Aharony, N., Katz, R., Herzel, E., Ben-Tov, A., ... & Kishony, R. (2021). Community-level evidence for SARS-CoV-2 vaccine protection of unvaccinated individuals. Nature Medicine, 1-3.
2.Goldstein, J. R., Cassidy, T., & Wachter, K. W. (2021). Vaccinating the oldest against COVID-19 saves both the most lives and most years of life. Proceedings of the National Academy of Sciences, 118(11).
3.Cook, T. M., & Roberts, J. V. (2021). Impact of vaccination by priority group on UK deaths, hospital admissions and intensive care admissions from COVID‐19. Anaesthesia, 76(5), 608-616.
4.Davies, N. G., Barnard, R. C., Jarvis, C. I., Russell, T. W., Semple, M. G., Jit, M., & Edmunds, W. J. (2021). Association of tiered restrictions and a second lockdown with COVID-19 deaths and hospital admissions in England: a modelling study. The lancet infectious diseases, 21(4), 482-492.
level of evidence 在 鄭宇劭物理治療師 Cheng Yu-Shao Physiotherapist Facebook 的最佳貼文
【雷可貼布-運動生物力學貼布】
重點
1.歷史悠久的運動貼布
2.大師都會用的臨床貼紮
3.台灣蠻常缺貨的貼布,臨床人員都難買到
介紹:
雷可貼布(Leukotape)是常運用在肌肉骨骼及運動傷害的強力貼布,而且歷史應該有超過40年以上,由BSN這家醫材行提供。最有名的應用此貼布的大師是Jenny McConnell為澳洲的物理治療師同時也是資深研究員和BJSM的編委會,發表超多篇關於慢性肌肉損傷相關的臨床期刊。而最有名的我想就是針對前測膝蓋痛的貼紮法McConnell taping技術(1984)。另外在臨床上也蠻常運用紐西蘭物理治療師Brian Mulligan,Brian最有名的臨床技術就是動態關節鬆動術(Mobilisation with Movement,MWM),然後貼紮方法的概念也就跟徒手技術一樣,將關節擺位到舒服的位置,並且由操作者施予貼布方向,也是我目前常用的臨床技術。
如果有興趣的治療師或防護員可以看下列兩位大師的網站,都有提供一些影片或期刊資源。
https://www.mcconnell-institute.com
https://bmulligan.com
臨床學習與紀錄:
在學校就有聽到曉昀老師介紹雷可貼布,而最早接觸是在實習階段,那時候是由目前台中照揚物理治療所 許其揚所長將雷可貼布與其他不同性質的貼布運用在臨床個案上,印象最深刻的針對脛骨骨折合併韌帶損傷術後病人,除了徒手儀器與運動外,最後都會藉由貼布來調整生物力學結構。而後來由於2017年參與世大運的關係,也有機會聽到不同老師來講解。
在實際運用上我最常運用的貼法
1.脛骨旋轉貼法(膝蓋彎曲角度受限)(圖234)
2.遠端腓骨貼法(腳踝扭傷或腳踝不穩定)
3.足弓支撐貼法(過度外翻導致跟腱問題)
4.上背減壓貼法
5.水泡貼法(足部蠻常應用,常走路可以貼)
後記:
雷可貼布與動態貼布一樣,都是根據生物力學與人體動作原理來進行貼紮。而貼布需要注意的是關節擺的位置和貼布需要導引的動作或放鬆的組織。下面附上看到的一篇期刊是關於髕骨股骨疼痛的保守治療臨床準則,裡面也有將貼紮列入被動處置之一。當然有人會問說需不需要上課?我自己覺得可以先看影片學習,因為現在開這門課很少,我自己在學習上,針對不管近端或遠端腓骨貼法是最簡單且實用。最後雷可貼布最近在台灣缺貨,不知道有沒有治療師大神知道哪裡可以取得。
期刊:Barton CJ, Lack S, Hemmings S, et al The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning British Journal of Sports Medicine 2015;49:923-934.
#physiotherapy #sportphysio #physicaltherapy #physicaltherapist #taping #leukotape #sport #sporttape @ Taipei, Taiwan
level of evidence 在 DJ Macky Suson Youtube 的最佳貼文
Episode 5: CYCLING IN SINGAPORE TOUR WITH GOPRO HERO 9 Health benefits of regular cycling
Health benefits of regular cycling
Cycling is mainly an aerobic activity, which means that your heart, blood vessels and lungs all get a workout. You will breathe deeper, perspire and experience increased body temperature, which will improve your overall fitness level.
The health benefits of regular cycling include:
increased cardiovascular fitness
increased muscle strength and flexibility
improved joint mobility
decreased stress levels
improved posture and coordination
strengthened bones
decreased body fat levels
prevention or management of disease
reduced anxiety and depression.
Back to top
Cycling and specific health issues
Cycling can improve both physical and mental health, and can reduce the chances of experiencing many health problems.
Obesity and weight control
Cycling is a good way to control or reduce weight, as it raises your metabolic rate, builds muscle and burns body fat. If you’re trying to lose weight, cycling must be combined with a healthy eating plan. Cycling is a comfortable form of exercise and you can change the time and intensity – it can be built up slowly and varied to suit you.
Research suggests you should be burning at least 8,400 kilojoules (about 2,000 calories) a week through exercise. Steady cycling burns about 1,200 kilojoules (about 300 calories) per hour.
If you cycle twice a day, the kilojoules burnt soon add up. British research shows that a half-hour bike ride every day will burn nearly five kilograms of fat over a year.
Cardiovascular disease and cycling
Cardiovascular diseases include stroke, high blood pressure and heart attack. Regular cycling stimulates and improves your heart, lungs and circulation, reducing your risk of cardiovascular diseases.
Cycling strengthens your heart muscles, lowers resting pulse and reduces blood fat levels. Research also shows that people who cycle to work have two to three times less exposure to pollution than car commuters, so their lung function is improved. A Danish study conducted over 14 years with 30,000 people aged 20 to 93 years found that regular cycling protected people from heart disease.
Cancer and cycling
Many researchers have studied the relationship between exercise and cancer, especially colon and breast cancer. Research has shown that if you cycle, the chance of bowel cancer is reduced. Some evidence suggests that regular cycling reduces the risk of breast cancer.
Diabetes and cycling
The rate of type 2 diabetes is increasing and is a serious public health concern. Lack of physical activity is thought to be a major reason why people develop this condition. Large-scale research in Finland found that people who cycled for more than 30 minutes per day had a 40 per cent lower risk of developing diabetes.
Bone injuries, arthritis and cycling
Cycling improves strength, balance and coordination. It may also help to prevent falls and fractures. Riding a bike is an ideal form of exercise if you have osteoarthritis, because it is a low-impact exercise that places little stress on joints.
Cycling does not specifically help osteoporosis (bone-thinning disease) because it is not a weight-bearing exercise.
Mental illness and cycling
Mental health conditions such as depression, stress and anxiety can be reduced by regular bike riding. This is due to the effects of the exercise itself and because of the enjoyment that riding a bike can bring.
level of evidence 在 DJ Macky Suson Youtube 的最佳貼文
Health benefits of regular cycling
Cycling is mainly an aerobic activity, which means that your heart, blood vessels and lungs all get a workout. You will breathe deeper, perspire and experience increased body temperature, which will improve your overall fitness level.
The health benefits of regular cycling include:
increased cardiovascular fitness
increased muscle strength and flexibility
improved joint mobility
decreased stress levels
improved posture and coordination
strengthened bones
decreased body fat levels
prevention or management of disease
reduced anxiety and depression.
Back to top
Cycling and specific health issues
Cycling can improve both physical and mental health, and can reduce the chances of experiencing many health problems.
Obesity and weight control
Cycling is a good way to control or reduce weight, as it raises your metabolic rate, builds muscle and burns body fat. If you’re trying to lose weight, cycling must be combined with a healthy eating plan. Cycling is a comfortable form of exercise and you can change the time and intensity – it can be built up slowly and varied to suit you.
Research suggests you should be burning at least 8,400 kilojoules (about 2,000 calories) a week through exercise. Steady cycling burns about 1,200 kilojoules (about 300 calories) per hour.
If you cycle twice a day, the kilojoules burnt soon add up. British research shows that a half-hour bike ride every day will burn nearly five kilograms of fat over a year.
Cardiovascular disease and cycling
Cardiovascular diseases include stroke, high blood pressure and heart attack. Regular cycling stimulates and improves your heart, lungs and circulation, reducing your risk of cardiovascular diseases.
Cycling strengthens your heart muscles, lowers resting pulse and reduces blood fat levels. Research also shows that people who cycle to work have two to three times less exposure to pollution than car commuters, so their lung function is improved. A Danish study conducted over 14 years with 30,000 people aged 20 to 93 years found that regular cycling protected people from heart disease.
Cancer and cycling
Many researchers have studied the relationship between exercise and cancer, especially colon and breast cancer. Research has shown that if you cycle, the chance of bowel cancer is reduced. Some evidence suggests that regular cycling reduces the risk of breast cancer.
Diabetes and cycling
The rate of type 2 diabetes is increasing and is a serious public health concern. Lack of physical activity is thought to be a major reason why people develop this condition. Large-scale research in Finland found that people who cycled for more than 30 minutes per day had a 40 per cent lower risk of developing diabetes.
Bone injuries, arthritis and cycling
Cycling improves strength, balance and coordination. It may also help to prevent falls and fractures. Riding a bike is an ideal form of exercise if you have osteoarthritis, because it is a low-impact exercise that places little stress on joints.
Cycling does not specifically help osteoporosis (bone-thinning disease) because it is not a weight-bearing exercise.
Mental illness and cycling
Mental health conditions such as depression, stress and anxiety can be reduced by regular bike riding. This is due to the effects of the exercise itself and because of the enjoyment that riding a bike can bring.
level of evidence 在 夠維根Go Vegan Youtube 的最讚貼文
FB粉絲專頁:https://www.facebook.com/GoVeganTW
提倡一種新的生活態度,透過動畫宣導"動物權利"!
感謝【台灣素食營養學會】整理資料、提供贊助
【台灣素食營養學會 官網】http://www.twvns.org/
-------------------------------------------------
【補充資料】
豆腐補鈣,鹽滷、石膏哪種好 http://goo.gl/MWcs7w
今天的鈣夠了嗎 http://goo.gl/xGUOe7
蔬食鈣高尚 https://goo.gl/Mz2fkB
素食者是否該喝牛奶 http://goo.gl/NSDmQN
1. 喝牛奶增加死亡率、骨折率 (瑞典研究):
Michaëlsson K, Wolk A, Langenskiöld S, Basu S, Warensjö Lemming E, Melhus H, Byberg L. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ. 2014 Oct 28;349:g6015.
2. 青少年喝奶量與老年時的骨折率:
Feskanich D, Bischoff-Ferrari HA, Frazier AL, Willett WC. Milk consumption during teenage years and risk of hip fractures in older adults. JAMA Pediatr. 2014 Jan;168(1):54-60. doi: 10.1001/jamapediatrics.2013.3821.
3. 其他喝牛奶與骨折的研究:
Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR. Calcium intake and risk of fracture: systematic review. BMJ. 2015 Sep 29;351:h4580. doi:10.1136/bmj.h4580. Review.
Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Kanis JA, Orav EJ, Staehelin HB, Kiel DP, Burckhardt P, Henschkowski J, Spiegelman D, Li R, Wong JB, Feskanich D, Willett WC. Milk intake and risk of hip fracture in men and women: a meta-analysis of prospective cohort studies. J Bone Miner Res. 2011 Apr;26(4):833-9.
4. D-半乳糖:
Hao L, Huang H, Gao J, Marshall C, Chen Y, Xiao M. The influence of gender, age and treatment time on brain oxidative stress and memory impairment induced by dgalactose in mice. Neurosci Lett 2014;571C:459.
Cui X, Wang L, Zuo P, Han Z, Fang Z, Li W, et al. D-galactose caused life shortening in Drosophila melanogaster and Musca domestica is associated with oxidative stress. Biogerontology 2004;5:31725.
5. IGF-1相關:
Cao Y, Nimptsch K, Shui IM, Platz EA, Wu K, Pollak MN, Kenfield SA, Stampfer MJ, Giovannucci EL. Prediagnostic plasma IGFBP-1, IGF-1 and risk of prostate cancer. Int J Cancer. 2015 May 15;136(10):2418-26. doi: 10.1002/ijc.29295. Epub
2014 Nov 10.
Ma J, Giovannucci E, Pollak M, Chan JM, Gaziano JM, Willett WC, Stampfer MJ. Milk intake, circulating levels of insulin-like growth factor-I, and risk of colorectal cancer in men. J Natl Cancer Inst 2001; 93:1330–6.
Qin LQ, He K, Xu JY. Milk consumption and circulating insulin-like growth factor-I level: a systematic literature review. Int J Food Sci Nutr 2009;60(Suppl 7):330–40.
Allen NE, Appleby PN, Davey GK, Key TJ. Hormones and diet: low insulin-like growth factor-I but normal bioavailable androgens in vegan men. Br J Cancer 2000;83:95–7.
6. 攝護腺癌:
Aune D, Navarro Rosenblatt DA, Chan DS, Vieira AR, Vieira R, Greenwood DC, Vatten LJ, Norat T. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr. 2015 Jan;101(1):87-117.
7. 牛乳與便秘:
Andiran F, Dayi S, Mete E. Cows milk consumption in constipation and anal fissure in infants and young children. J Paediatr Child Health. 2003 Jul;39(5):329-31.
Irastorza I, Ibañez B, Delgado-Sanzonetti L, Maruri N, Vitoria JC. Cow's-milk-free diet as a therapeutic option in childhood chronic constipation. J Pediatr Gastroenterol Nutr. 2010 Aug;51(2):171-6.
Carroccio A, Mansueto P, Morfino G, D'Alcamo A, Di Paola V, Iacono G, Soresi M, Scerrino G, Maresi E, Gulotta G, Rini G, Bonventre S. Oligo-antigenic diet in the treatment of chronic anal fissures. Evidence for a relationship between food hypersensitivity and anal fissures. Am J Gastroenterol. 2013 May;108(5):825-32.
Dehghani SM, Ahmadpour B, Haghighat M, Kashef S, Imanieh MH, Soleimani M. The Role of Cow's Milk Allergy in Pediatric Chronic Constipation: A Randomized Clinical Trial. Iran J Pediatr. 2012 Dec;22(4):468-74.
8. 牛乳與青春痘:
Melnik BC. Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Nestle Nutr Workshop Ser Pediatr Program. 2011;67:131-45.
9. 鈣質吸收率:
Weaver CM, Plawecki KL. Dietary calcium: adequacy of a vegetarian diet. Am J Clin Nutr. 1994 May;59(5 Suppl):1238S-1241S. Review.
Weaver CM, Proulx WR, Heaney R. Choices for achieving adequate dietary calcium with a vegetarian diet. Am J Clin Nutr. 1999 Sep;70(3 Suppl):543S-548S. Review.
10.溫室氣體排放:
http://www.fao.org/agriculture/lead/themes0/climate/emissions/en/
level of evidence 在 What are Levels of Evidence? - YouTube 的推薦與評價
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