【麵包的不同存放、及吃法會不會影響血糖?】
有朋友問我,那麵包?是不是冰過也會增加抗性澱粉?說真的,我直覺是:『會呀!』,但是,因為,我很怕給大家錯誤的資訊。還是查一下文獻好了,發現一篇有趣的文獻,雖然,這篇不是直接在講抗性澱粉,但還是值得分享:
把白麵包做四種不同的處理,再去給10位22-59歲的健康成人吃,然後,去測吃麵包後兩小時的Incremental area under the glucose response curve (IAUC),我就先不在此解釋是是要怎麼測了,大家只要記住,這數值越高,表示吃下的東西,越會讓血糖增加。
以下資訊比較有趣:
第一種麵包:新鮮剛出爐的白麵包 (IAUC 259 mmol min/l)
第二種麵包:把白麵包凍起來後,再解凍 (179 mmol min/l, P<0.05)
第三種麵包:就是直接把白麵包拿去烤 (193 mmol min/l, P<0.01)
第四種麵包:把它先冷凍、解凍再拿去烤 (157 mmol min/l, P<0.01).
p值都是和第一種麵包比的的統計差異。
大家若有興趣可以看一下原文:
https://www.nature.com/articles/1602746
你們會選哪種麵包?
若問我,若眼前只有這四種白麵包可以選,我現在已經很餓了,若有烤麵包機,我會先去烤一下,若不是很餓,那就先凍吧!然後解凍再烤~~呵呵~~(有誰會這樣做?)
突然覺得自己在出心理測驗考題!
但如果眼前的主食,有糙米飯、玉米、或馬鈴薯可以選,我則不會去選白麵包當我的主食。大家應該知道我一向推崇原態食物。
然而,選擇食物還包括感情的因素,如果你回家,剛好老婆或女友(大部分老公、男友不會做這件事)烤一個香噴噴剛出爐的白麵包?你吃嗎?當然要吃呀!!大不了等一下多跑步一會兒,一樣可以消耗血糖的。
其實懂得聰明選擇食物,日積越累,就是儲存健康的本錢,沒有哪種食物一定是罪惡的!
照片這土司當然不是我烤的,我對於烘焙類曾經非常賢慧過的!呵呵~現在很久沒做烘焙了。這是我在楊桃美食網抓的照片,若有作者看到,我要跟他/她謝謝。https://www.ytower.com.tw/recipe/iframe-recipe.asp?seq=G02-1325
同時也有1部Youtube影片,追蹤數超過0的網紅CarDebuts,也在其Youtube影片中提到,? คลิปรถใหม่ 2019-2020 มาแล้วครับ คลิกที่นี่ https://www.youtube.com/channel/UCSebcviE-UeYMxVRNozwqtw/videos 2018 Honda Forza 125 Honda’s segment-lea...
「area under the curve」的推薦目錄:
- 關於area under the curve 在 Facebook 的最佳貼文
- 關於area under the curve 在 外交部 Ministry of Foreign Affairs, ROC(Taiwan) Facebook 的最佳解答
- 關於area under the curve 在 Eddie Tam 譚新強 Facebook 的最讚貼文
- 關於area under the curve 在 CarDebuts Youtube 的最佳貼文
- 關於area under the curve 在 What is Integration? Finding the Area Under a Curve - YouTube 的評價
- 關於area under the curve 在 Finding the Area Under a Curve using Definite Integration 的評價
- 關於area under the curve 在 Area under and between Curves by Integration | ExamSolutions 的評價
- 關於area under the curve 在 Calculus 2 - Finding the Area Under the Curve (1 of 10) 的評價
- 關於area under the curve 在 Area under the Curve (AUC) — area_under_curve • bayestestR 的評價
- 關於area under the curve 在 Calculate the Area under a Curve - Stack Overflow 的評價
- 關於area under the curve 在 Why is the area under a curve the integral? - Math Stack ... 的評價
area under the curve 在 外交部 Ministry of Foreign Affairs, ROC(Taiwan) Facebook 的最佳解答
【台灣防疫成效 #國際政要 都肯定👍👍👍】
第二波移入疫情強勢回流 🌀
看到確診人數增加
相信有在追指揮中心記者會的大家
內心不免七上八下
但只要我們 #謹慎應對 持續落實 #防疫工作
相信還是有機會守住J一波‼️
雖然還是會擔心
但蒐集癖小編決定要再發一篇落落長的文
讓各位看看世界各國的政要大咖
如何讚 #台灣 目前為止的防疫模式 👏👏👏
#我們不害怕雨淋
#因為我們知道大雨之後會有彩虹 🌈
#團結一心 #正向防疫
#台灣加油 💪
As the coronavirus pandemic continues, we'll endeavour to remain prudent in our epidemic prevention measures. We believe we can stem the tide.
To reinstill some confidence, we've collected a series of quotes from politicians and ministers around the world, praising the #TaiwanModel as part of the fight against the #COVID19 #WuhanCoronavirus. Read what they had to say below!
《亞太地區》
#紐西蘭 New Zealand 🇳🇿
3/15 ─ 紐西蘭總理阿爾登:「我們將緊密遵循相當接近於台灣的模式,他們(台灣政府)針對公眾集會所建立的因應架構,是相當成功的。我們將以它為根據,來設定我們的標準。」
March 15 - Prime Minister Jacinda Ardern said, in a Q+A interview on Sunday, that officials were looking at tailored criteria for events that may need to be cancelled, such as whether people would be in close proximity to one another.
“We're going to follow, pretty closely, the Taiwanese model. They worked up a framework for mass gatherings that's been quite successful,” she said.
#日本 Japan 🇯🇵
3/12 ─ 日本台灣交流協會代表泉裕泰:「我相信台灣的真知灼見可與世界各國廣泛共享,並對苦於遭受傳染蔓延的其他國家與地區做出巨大的貢獻。」
March 12 - Japan's chief representative in Taiwan, Hiroyasu Izumi, stated that he believes Taiwan's insights can be widely shared with other countries in the world and make great contributions to other countries and regions suffering from the spread of infection.
《亞非地區》
#以色列 Israel 🇮🇱
3/14 ─ 以色列總理尼坦雅胡:「順帶一提,這個方法已經在台灣試過了,可能很成功。以色列是少數國家當中,有這個能力做的。我們將採用這個方法。」
March 14 - Prime Minister Benjamin Netanyahu said it was not an easy choice to make and described the virus as an “invisible enemy that must be located.” He said Israel would follow similar methods used by Taiwan.
3/14 ─ 以色列前總理巴拉克:「以色列可以對抗新冠病毒,但必須像台灣一樣反應快速。」
March 14 - Former prime minister Ehud Barak stated that Israel can fight against the novel coronovirus, but that it must react as swiftly as Taiwan.
《拉美地區》
#尼加拉瓜 Nicaragua🇳🇮
3/11 ─ 尼加拉瓜副總統穆麗優:「我們得知台灣政府及人民實行了成功的防疫模式,我們已向台灣駐尼大使提出請求,期盼台灣與我們分享經驗,因為台灣不僅成功防制傳染,且維持人民秩序免於慌亂,確實值得學習。」
March 11 - La vicepresidenta de Nicaragua, Rosario Murillo, declaró: "Nosotros hemos conocido el Modelo exitoso de contención que puso en práctica el Gobierno y el Pueblo de la República de China(Taiwán), y hemos pedido a su Embajador aquí, que nos presenten ese Modelo exitoso, porque han logrado no solo contener, sino también mantener a la población en un estado que no esté de pánico." (The vice president of Nicaragua, Rosario Murillo, stated, "We are aware of the successful model of prevention that the government and the people of Taiwan have put into practice, and we've asked the Taiwanese ambassador to make a presentation on this successful model, because they've not only managed to contain the virus, but they've kept their population from panicking.")
#聖文森 Saint Vincent and the Grenadines🇻🇨
3/12 ─ 聖文森衛生部長布朗:「台灣因『一個中國』原則不被承認為獨立國家,因此未被納入參與「世界衛生大會」(WHA),台灣距離中國僅為海峽之隔,然而疫情爆發至今卻僅有少數確診病例,我已正式致函何大使尋求台灣的協助以對抗聖國疫情。」
March 12 - "It’s quite remarkable that they’re just 81 miles from mainland China and whereas coronavirus in mainland China has been spiralling out of control...That’s incredible,” Health minister Luke Brown said. Taiwan is not a part of the World Health Assembly as it is not recognised as being an independent country under the One-China policy. Browne said the ambassador has mentioned some of the measures that Taiwan has taken, some of which he believes will work in the Vincentian context while others may not.
#聖露西亞 Saint Lucia🇱🇨
3/11 ─ 聖露西亞衛生部長艾瑟柯:「目前全球正共同對抗來自中國武漢的新型冠狀病毒,聖露西亞政府藉此機會讚許臺灣採取有效率且具成效的防疫措施,並提議與露國緊密合作防疫。」
March 11 - “As the world is fighting the COVID-19 Coronavirus originated from Wuhan, China, the Government of Saint Lucia wishes to take this opportunity to commend Taiwan for its efficient and efficacious measures, and its offer to work closely with Saint Lucia to contain the pandemic,” said Health Minister Mary Isaac.
#貝里斯 Belize🇧🇿
2/4 ─ 貝里斯衛生部長馬林:「貝國政府及衛生部肯定台灣關鍵的公衛措施,包括對隔離案例進行電子監控、口罩及其他物資供應,強化防疫工作。」
Feb. 4 - Minister of Health, Hon. Pablo Marin: “The Government of Belize, and by extension the Ministry of Health, applauds Taiwan’s key public health measures that include electronic monitoring of quarantined cases and the provision of masks and other items to support the prevention efforts.”
#巴拉圭 Paraguay🇵🇾
3/17 ─ 巴拉圭參議員法切提:「儘管與WHO無任何合作關係,台灣仍向前行…台灣也因此能夠成功防堵新冠病毒。」
March 17 - Fernando Silva Facetti, Paraguayan politician: "A PESAR DE LA NULA COOPERACIÓN DE LA @opsoms, #TAIWAN SIGUE ADELANTE... Así es como Taiwán logró contener el brote de #coronavirus" (Despite the lack of cooperation from the WHO, Taiwan continues to progress... This is how Taiwan managed to contain the coronavirus.)
#委內瑞拉 Venezuela🇻🇪
3/13 ─ 委內瑞拉臨時政府代表楊杰斯議員:「感謝情同手足的台灣人民贈交我們防疫所需的口罩及酒精。Taiwan Can Help!」
March 13 - Jesús M. Yánez M., Venezuelan politician: "Gracias a el hermano pueblo de Taiwan nos encontramos entregando tapa boca y kits de alcohol, denunciando la falta de prevención y de medidas acordes contra el COVIDー19 Taiwan Can Help" (Thanks to our brothers and sisters in Taiwan, we find ourselves with face masks and alcohol kits, denouncing the lack of prevention and appropriate measures against COVID-19. Taiwan Can Help.)
3/15 ─ 委內瑞拉駐西班牙大使艾卡利:「台灣及早警覺,並已阻擋了疫情擴散。」
March 15 - Antonio Ecarri B., Ambassador of Venezuela in Spain: "Taiwan se alarmó y frenó su expansión." (Taiwan was alarmed and curbed the spread.)
#阿根廷 Argentina 🇦🇷
3/11 ─ 阿根廷國會議員康帕紐利:「台灣是成功控制疫情的模範。」
March 11 - Marcela Campagnoli, National Deputy in Argentina: "Taiwan es un ejemplo de como lo han controlado." (Taiwan is an example of how to control it.)
3/16 ─ 阿根廷國際關係委員會秘書長桑提巴聶茲:「認為威權政府防疫工作做得比民主國家好,這個想法是錯的。台灣、韓國及新加坡做得非常好,他們都是民主國家。」
March 16 - Francisco de Santibañes, Secretary General of the Argentine Council for International Relations: "Sería un error pensar que los gobiernos autoritarios actuaron mejor que las democracias a la hora de controlar el coronavirus. Corea del Sur, Singapur y Taiwán lo hicieron muy bien y son democracias." (It would be a mistake to think that authoritarian governments act better than democracies in curbing the coronavirus. South Korea, Singapore and Taiwan did it very well and they're democracies.)
#哥倫比亞 Colombia🇨🇴
3/12 ─ 哥倫比亞內科醫師學會前主席希尼爾:「看看台灣,從全球確診統計圖表中漸漸消失,並對照其他亞洲國家防疫進展。他們比其他國家聰明嗎?不,是因為他們比較有組織、守紀律!」
March 12 - Juan Senior, ex-president of the Colombian Association of Internal Medicine: "Miren la evolución de Taiwán, desaparece del panorama y como evoluciona la epidemia en países asiáticos. Son más inteligentes que todos? No, son más organizados y disciplinados!!!" (Look how things have gone in Taiwan, they're out of the picture now and how the epidemic has developed in asian countries. Are they smarter than everyone else? No, they're more organized and more disciplined!!!)
#巴拿馬 Panama 🇵🇦
3/11 ─ 巴拿馬前駐台大使馬締斯:「台灣向世界展現,他們運用2003年抗煞所學到的經驗,準備好對抗新冠疫情。」
March 11 - Dr. Alfredo Martiz, former Ambassador of Panama in Taiwan: "Lo que Taiwán puede enseñar al mundo sobre la lucha contra el coronavirus Análisis: Taiwán aprovechó las lecciones aprendidas durante el brote de SARS de 2003, y esta vez su gobierno y su pueblo estaban preparados" (What Taiwan can teach the world about the fight against the coronavirus. Analysis: Taiwan took the lessons learned during the SARS outbreak of 2003 and this time its government and its people were ready.)
《歐洲》
#捷克 Czech Republic🇨🇿
3/15 ─ 捷克總理巴比斯:「政府決定改變中央危機應變中心的定位及人員調度,仿照如同媒體所報導台灣的因應做法。」 March 15 - Prime Minister Andrej Babis: “The government decided to change the status of the Central Crisis Staff, where the crisis staff will be modeled, as we read in the media and it was in Taiwan.”
#丹麥 Denmark🇩🇰
3/18 ─ 丹麥前總理拉斯穆森:「台灣利用大數據、透明、由中央指揮的防疫作為奏效,值得世界各國學習。現在是時候告訴中國,確有地方可以討論地緣政治的,但不是在世界衛生組織。」 March 18 - In his March 18 piece in Time Magazine, former prime minister of Denmark Anders Fogh Rasmussen, stated "After the first notifications at the end of 2019, Taipei swiftly deployed a combination of measures to identify and contain the virus, including the use of big data to help contain potential cases."
#法國 France🇫🇷
3/5 ─ 前法國衛生部長及外交部長杜斯特:「檢視中央集權與非中央集權國家決策模式的差異十分有意思。台灣雖緊鄰中國卻可能是受武漢肺炎死亡率最低及受影響最輕的國家,其防疫成果完全令人難以置信,是為出色的危機管理。」
March 5 - Former French health and foreign minister Philippe Douste-Blazy said, "Ce qui est très intéressant en regardant les différents pays, c’est la centralisation ou la non-centralisation des décisions. Et on s’aperçoit que par exemple Taiwan est probablement le pays où il y a le moins de létalité et le pays le moins touché alors que c’est extrêmement près de la Chine. Le résultat est absolument invraisemblable. C’est une magnifique gestion de crise." (What is quite interesting with different countries, is centralization vs non-centralization of decisions. And one realizes that, for example, Taiwan is probably the country where the mortality rate is the lowest and the least affected country despite its extreme proximity to China. The result is absolutely implausible. It’s wonderful crisis management.)
3/7 ─ 法國國民議會友臺小組主席瑟賽希尼:「臺灣是處理武漢肺炎疫情的典範。」
March 7 - The chair of the French National Assembly's France-Taiwan Parliamentary Friendship Group, Jean François Cesarini, stated "Taïwan : Exemplaire dans sa gestion de l’épidémie du Coronavirus." (Taiwan: an excellent model for the management of the coronavirus epidemic.)
3/6 ─ 法國國民議會友臺小組副主席拉赫迪耶:「臺灣堪稱處理武漢肺炎危機的典範。」
March 6 - The deputy chair of the French National Assembly's France-Taiwan Parliamentary Friendship Group, Laure de La Raudière, stated "Gestion exemplaire de Taiwan de la crise du Coronavirus." (Taiwan's exemplary management of the coronavirus crisis.)
#義大利 Italy🇮🇹
3/16 ─ 義大利前外交部長德爾其:「台灣可能是第一個向WHO報告新冠病毒人傳人的國家,而且早在中國和WHO承認之前。顯然地,台灣因為北京施壓,被排除在世衛組織之外已有兩年之久。」
March 16 - Former foreign minister, Giulio Terzi: "Taiwan potrebber esser stato primo Paese a comunicare alla OMS che coronavirus COVID19 si stava trasmettendo da uomo a uomo.Molto prima che Cina e OMS lo ammettessero. Ovviamente, per volere Pechino, Taipei subisce esclusione da OMS da due anni." (Taiwan may have been the first country to report to WHO that coronavirus COVID19 was spreading from amongst humans, long before China and WHO admitted it. Obviously, at the behest of Beijing, Taipei has been excluded from WHO for two years.)
3/19 ─ 義大利北聯黨外交事務首席法拉利,轉推蔡總統「台美簽署防疫聯合夥伴關係聲明」推文:「這是向中國,也是向世界傳達的重要訊息。」
March 19: Lega Nord head of foreign affairs in Lombardy, Max Ferrari: "Coronavirus. Importante messaggio alla Cina e al mondo da Taiwan e Usa." (Coronavirus. Important message to China and the world from Taiwan and the USA.)
#歐盟 EU🇪🇺
3/14 ─ 歐洲議會議員暨中國關係代表團團長包瑞翰:「在這次疫情危機中,台灣在拯救生命方面做得很好。為什麼不邀請他們充分參與國際呢? 為什麼WHO不這樣做?因為北京玩弄民族主義政治,犧牲人民的利益。」
March 14 - “Taiwan is doing a great job with saving lives in this corona crisis. Why not acknowledge that and invite them to participate fully in international efforts? Why doesn't WHO do it? Because Beijing is playing nationalist politics at people's expense,” said Reinhard Bütikofer
#英國 UK 🇬🇧
3/13 ─ 英國前衛生大臣杭特表示,政府應採取更積極的行動,包括禁止探視養老院的長者。他認為,英國應該像是泰國和台灣等已控制住疫情的國家一樣,採取行動。
March 13 - Jeremy Hunt, the UK former health secretary: "Countries like Thailand and Taiwan had controlled the outbreak by taking such action. People will be concerned we are not moving sooner on social distancing."
#瑞典 Sweden🇸🇪
2/18 ─ 瑞典國會議員溫和黨主席席德斐:「從長遠來看,世衛組織不願將台灣納入扼止新冠病毒傳播及由該病毒所引起的傳播的任務,是完全站不住腳的,並且從很多面向來看是適得其反,例如從醫學和經濟角度。」
Feb. 18 - Moderate Party MP Margareta Cederfelt pointed out that “WHO’s unwillingness to include Taiwan in its work with limiting the spread of the coronavirus and stopping infections caused by the virus in the long-run, is indefensible and counterproductive seen from several perspectives, for example from a medical and economic perspective.”
#德國 Germany🇩🇪
3/13 ─ 德國自民黨主席國會議員布本多弗:「有一個國家在抗疫上脫穎而出,運用明確的策略及冷靜的態度有效對抗新冠肺炎,這個國家就是臺灣。」
March 13 - Chair of the district association Mühldorf am Inn of the FDP Bavaria Sandra Maria Bubendorfe: "Bei meiner 3. Rede im Deutschen Bundestag zum Thema Zivil und Katastrophenschutz in Deutschland vergangen Freitag, war es mir ein besonderes Bedürfnis Taiwan hervorzuheben, das gezeigt hat wie man mit klaren Strategien und kühlen Kopf auf die Gefahr des Corona Virus antworten kann und damit die Ausbreitung deutlich erschwert und verlangsamt wird." (During my third speech in the German Bundestag on civil and civil protection in Germany last Friday, I felt a need to highlight Taiwan, which showed how to respond to the dangers of the coronavirus with a clear strategy and a cool head, and thus significantly slowed its spread.)
#荷蘭 The Netherlands🇳🇱
3/18 ─ 荷蘭前中央銀行主席維林克:「臺灣防疫預警作為,是這個擁有約2400萬居民,且每年接受約300萬中國旅客往訪的國家,迄今得以有效控制疫情的關鍵作為。」
March 18 - The former head of the Dutch central bank stated that with its 24 million strong population and 3 million annual tourists from China, Taiwan has unrolled effective key measures to curb the spread of the epidemic.
3/18 ─ 荷蘭50 Plus黨眾議員兼主席克羅及民主論壇黨眾議員兼主席伯德特:「台灣是成功例子」 無黨籍眾議員哈加:「台灣大量檢測與居家隔離,成功控制疫情,為何荷蘭不學習?」
March 18 - The leaders of the 50PLUS party and the Forum for Democracy, Henk Krol and Thierry Beaudet, stated that Taiwan has provided a successful model. Independent Dutch MP Wybren van Haga stated that Taiwan has been testing on a large scale and enforcing home quarantines, successful measures in curbing the epidemic and asked why the Netherlands wasn't learning from their example.
#瑞士 Switzerland 🇨🇭
3/10 ─ 瑞士國會下議員瓦爾德:「臺灣對抗新冠病毒具特別成效。」 March 10 - Swiss National Councillor Nicolas Walder said Taiwan's response to the novel coronavirus has been particularly effective.
#葡萄牙 Portugal🇵🇹
3/15 ─ 葡萄牙前人民黨黨揆暨資深媒體評論家波塔斯:「台灣承襲2003年對抗SARS經驗,成功壓抑疫情曲線峰值,值得葡國作為借鏡。」
March 15 - Former Deputy Prime Minister of Portugal and media personality Paulo Portas stated that Taiwan's experience in fighting SARS in 2003 allowed it to be successful in flattening the curve, providing a model Portugal can learn from.
3/18 ─ 葡萄牙國會友臺小組歐利維拉:「台灣病例出現雖早,卻在努力下獲得很好的控制,台灣防疫措施值得肯定及學習。」
March 18 - Chair of the Portugal-Taiwan Parliamentary Friendship Group Paulo Rios de Oliveira stated that although cases in Taiwan started to appear quite early on, they've controlled it very well with a lot of effort. Taiwan's epidemic control measures should be praised and studied.
#西班牙 Spain🇪🇸
3/13 ─ 西班牙前國會議員瓦紐費瑞:「這些措施證明台灣公衛模式有效,包括世界上最先進的醫衛系統、自2003年抗煞以來所累積的廣泛防疫經驗等。」
March 13 - Francisco Vañó Ferre, a former member of the Spanish Parliament: "Estas y otras medidas prueban la eficacia del modelo sanitario de Taiwán, que cuenta con uno de los más avanzados sistemas de salud del mundo y con amplia experiencia en la lucha contra enfermedades contagiosas tras haber sufrido la epidemia del SARS en 2003." (These and other measures prove the efficacy of the health model of Taiwan, which has one of the most advanced health systems in the world and a wealth of experience in the fight against contagious diseases, after having suffered from the SARS epidemic in 2003.)
#匈牙利 Hungary🇭🇺
3/15 ─ 匈牙利醫師學會:「在中國其他省份和其他亞洲國家,例如台灣和新加坡等,已經能夠預防感染的傳播。」
March 15 - The Hungarian Medical Chamber stated “In other provinces of China and other Asian countries (eg Taiwan, Hong Kong and Singapore) have been able to prevent the spread of the infection.”
北美:
#美國 US🇺🇸
2/5 ─ 美國前衛生部長派司:「台灣已經證明其防疫行動極為負責且透明,特別是在醫學和科學領域。最近有幸到訪台灣,台灣協助研發疫苗或以其他方式協助拯救生命,並促進人類對抗病毒的能力及情報,此刻尤顯出色。」
Feb. 5 – US former secretary of health and human services Tom Price: "Taiwan has shown itself to be extremely responsible and transparent in its actions, especially in the area of medicine and science. Having had the privilege of visiting recently, the capacity of Taiwan to help formulate a vaccine or assist in other ways to help save lives and advance human engagement and intelligence at this time is remarkable."
#加拿大 Canada🇨🇦
3/6 ─ 加拿大前國務部長契爾格:「將台灣排除在世衛組織之外,會讓新冠病毒對其國民和世界其他地區變得更加危險。」
March 6 - Canadian former secretary of state David Kilgour: “Excluding Taiwan from contact with WHO makes COVID-19 more dangerous for its nationals and the rest of the world.”
area under the curve 在 Eddie Tam 譚新強 Facebook 的最讚貼文
譚新強:大流行40%至70%感染率預測 是從HIT計算出來的
本來今周值得討論的事情極多,包括沙特阿拉伯與俄羅斯油價戰、美國10年債息首次歷史性跌穿1厘、美國道指跌至11年來首次熊市,和美國大選的選情幻變。但最值得關注的仍然是COVID-19疫情的急速蔓延,世衛終於正式宣布這次為一場Global Pandemic(全球大流行病)!
大流行沒有一個非常正式的定義,理論上最重要因素為某傳染病的廣泛性和宗數,但就跟某病症的嚴重性和死亡率沒甚關係。世衛有頗大的主動決定權,雖不少世界各地的醫學專家已呼籲了好幾周,但明顯世衛一直拖泥帶水,不太願意作出正式宣布。直至近日全球COVID-19確診宗數急升超過12萬,波及超過100個國家,尤其意大利疫情實在已到失控地步,醫療系統崩潰,歐洲其他國家個案亦以幾何級數上升,美國確診個案也升至1000宗以上,世衛才無可奈何地作此大流行宣布。
世衛拖延宣布 或有兩大原因
我相信世衛拖延有兩個主要原因。第一肯定出自對全球經濟考慮,根據IMF估計,大流行的標籤可導致全球GDP增長降低1%,亦即全球衰退的機會大大上升(一般定義為低於3%)。例如很多企業和機構,或將借此提出"Force Majeure"(不可抗力條款),提前取消大量商業合約。
拖延的第二個原因是宣布大流行,亦即等如承認人類跟COVID-19的這場戰爭已「失敗」,將無法消滅此病毒。世衛總幹事譚德塞提到多國的"alarming inactions"(驚人的不行動),有些缺乏資源,有些則缺乏決心!沒點名,但請各位對號入座吧!
當一個疫症到了大流行階段,理論上全球處理方法應有所改變,從containment(圍堵)轉向所謂mitigation(紓緩)。意思是可能各種國際旅遊限制(international travel bans)已對控制疫情無效,但就對經濟有極大傷害,所以應考慮逐步解封。更重要和更有效的應對手段變為"social distancing"(社交隔離)和提升個人衛生。
但理論歸理論,這做法或者合理和具科學理據,但現實歸現實,政治上,在大流行宣布後,誰敢不加強邊境控制,反而大膽放鬆旅遊限制?美國總統特朗普在周三晚就馬上宣布針對英國以外歐洲的30日旅遊禁令!但他亦有提到隨着中國和韓國的疫情改善,將考慮放鬆旅遊限制,但尚未宣布細節。中國疫情終於算得上受控,但近日又見一些從外國輸入個案,辛苦得來的成果,怎會輕易冒險放鬆旅遊限制!
大流行的另一意思是全球人類的一個頗高比例將受到感染。在2009年的H1N1流感,受感染比例約11%至21%,1918年的西班牙流感(亦是H1N1豬流感),受感染比例更可能高達27%。2009年那次的全球總死亡人數約15萬至60萬;1918年那一次,正值第一次世界大戰,當年醫療比現代當然差很多,所以雖只是流感,但死亡率估計高達10%,總死亡人數可能高達5000萬!特朗普自稱不認識任何死於流感的人,可能忘記了他的祖父,正是死於1918年的大流感!
周三,德國總理默克爾向國民說,COVID-19或將感染到60%至70%的德國人,大家必須阻慢疫情,爭取時間為此作好免疫和醫療系統準備。她本身是一位量子化學博士,懂和相信科學,所以有勇氣成為第一個主要國家元首說出這句話!她說這個驚人預測已成為頂尖專家的共識,即包括我多次提過的世衛顧問Ira Longini、哈佛教授Marc Lipsitch和Imperial College教授Neil Ferguson等。
他們預測,全球40%至70%人口將在今年內受到感染。如這個非常驚人的預期成真,即是最高感染人數高達55億,如按現在確診死亡率(CFR)約3.7%來計算,死亡人數可超過2億人!如果感染人數那麼多,一切mitigation手段都必徒然,肯定全球醫療系統將快速崩潰,死亡率必飈升,輕易高至10%以上(意大利已經是7%),即總死亡人數更可超過5億!即使CFR跌至懷疑較低的感染死亡率(IFR),譬如約1%,總死亡人數也已將是非常嚴重的3000萬至5000萬!
倘2億人感染死亡成真 醫療系統崩潰
我明白這些專家的出發點應該是「好意」的,警告全球政府作出最積極準備。但如此驚人的預測,其實他們也必定有責任舉出證據,解釋他們的假設,和這是否他們的唯一結論,或只是一個worst case scenario(最壞情境),概率又多少呢?
失望地,他們似乎完全沒有對公眾交代過任何證據,令到全球人民和各國政府更加迷惘和惶恐。如果他們的講法是對的,一切的旅遊限制,甚至社交隔離措施,到最後都是沒有用的。那麼即使不是坐着等被感染,不如索性繼續外出旅遊,跟朋友聚會,再過正常生活(多渴望)?
既然所謂專家不解釋,唯有靠自己做些研究,在這裏跟大家分享,但我確不是專家,所以不可擔保分析的準確性,請見諒。
上周我已解釋過R0和R的概念,R0是病毒本身的基本傳染度,R是在採取各種隔離措施後的較低傳染度。我現在將介紹傳染病學上的另一概念——Herd Immunity(群體免疫),當一個population(群組)內的某一比例的人得到免疫力,身體產生了抗體,可以是經過感染,也可以是經過vaccination(注射疫苗),剩下來的人口,即使沒有個人免疫力,亦會享受到間接免疫的保護。基本上,這就是我上周提過的pox party(疫症派對)概念。道理很簡單,就是當很大比例的人已有免疫力,病毒就不能再經他們傳給更多其他人,所以疫情就將熄滅。這就是上周刊出感染曲線有自然頂峰的原因。
這個關鍵的人口比例稱為Herd Immunity Threshold(HIT,群體免疫臨界點),原來是可以用很簡單的方程式計算出來的:
HIT=1-1/R0
HIT就是這個需要受感染而達到群體免疫效果的人口比例臨界點。R0當然就是我們的老朋友:Basic Reproduction Number,病毒基本傳染度,即平均每個病人將傳染給多少個其他人。流感(influenza)的R0約為1.3至1.8,COVID-19是全新病毒,數據尚未很準確,估計R0約為1.4至3.9。
以流感為例,如用R0=1.3:
HIT=1-1/1.3=23%
以COVID-19為例,如用R0=3:
HIT=1-1/3=66%
雖然專家沒有解釋,明顯他們的COVID-19的HIT為40%至70%。全球感染率預測,是來自這個基本方程式的,但可能加上其他的一些假設。流感的計算結果,也符合HIN1和西班牙大流感的經驗。
但我仍有多個重要的疑問。首先這基本方程式用的是R0而並非R,那麼隔離措施,到底是有效還是無效呢?如果有效,如有能力把原來R0=3降至較低的R=1.3,那麼COVID-19的HIT也可降至如流感的23%,已可最少挽救數千萬條人命!還是如我上周的附圖顯示,即使能用隔離措施把感染曲線壓扁,但其實兩條曲線的"area under the curve"(曲線下面積)仍然差不多,較低的R只能把整個過程拖長,和減低頂峰發病期對醫療系統的壓力?理論上,如隔離措施百分百有效,密不透風,當然可把原來的一個群組分割為多個隔絕的群組,壓低R必定有效,這就是中國針對湖北的手段,亦見成效。但這種極端的封關措施在多少地方可以執行?意大利正在嘗試,但恐怕為時已晚。况且即使湖北也不是完全密封,也有很多案例流出,亦不可能永遠封關下去,當重開時,從外再傳入的機會也極高。
我的第二個疑問是這個高達70%感染率預測,需時多久,有沒有把夏天的可能消滅病毒效果,計算在內?假設R0為較低的1.6,另假設serial interval(平均每代傳染需時)為專家估計的4.6天,約今年6至7月初夏,或已將達到40%的HIT。
我見過不少專家如美國NIH的Anthony Fauci醫生,當被問到天氣回暖會否加速消滅COVID-19的病毒時,他的答案是按過去流感病毒的經驗,較高溫度和濕度,似乎對遏抑病毒傳播有幫助,但因為此病毒是全新的,所以不能肯定。
無藥根治 夏天回暖成唯一希望
此答案聽似合理,但其實並不科學化。如果不知道,為何不馬上做實驗,在實驗室內模擬夏天環境,包括溫度、濕度,甚至陽光時間和角度等,培植病毒,或在試管內,或把病毒打進動物身上,然後放進一個群組內,不就加速解答這個超重要的疑問嗎?因為請記住,到現時為止,我們沒有任何免疫針和已經驗證有效的藥物,所以如萬一containment真的控制不了疫情,那麼夏天的消減病毒功能,可說是我們的唯一希望!
按照我的研究,曾有人做過針對SARS的夏天模擬實驗,亦證明較高溫度和濕度,確對壓抑SARS病毒有效。但暫時仍未發現類似針對COVID-19的研究,或者最少尚未完成和對公眾宣布結果。疫情非常嚴重,時間非常寶貴,實在刻不容緩,我確對醫學界有點失望。
除此,近日很多專家都告訴我們,在12至18個月內,將可成功研發出有效疫苗,如屬實,當然是天大喜訊。當然遠水不能救近火,即使如期成功,對今年疫情亦沒有幫助;但大家都應該有準備COVID-19將成為endemic,可能每年會捲土重來的風土病(但將不停出現基因變異),所以如明年已有疫苗,進度已算神速!但這些專家也沒有告訴我們為何有此信心。從前我已指出過,感染人類的7種冠狀病毒,包括SARS,到現時為止仍沒有任何疫苗,亦沒有特別的抗病毒藥!當年SARS也是頭等大事,應不乏人和資源去研究疫苗和藥物,但到現在仍未成功。是否因為SARS在2004年後沒有再出現案例,所以沒有人再研究下去,有可能但不肯定。為何其他冠狀病毒,包括導致傷風的兩種,亦沒有疫苗,但流感就有?是否冠狀病毒有些特別結構和特徵,令到發展疫苗和藥物特別困難?如果是的話,為何又有信心在一至一年半內,即可研發出COVID-19的疫苗?此病毒較簡單?現在有迫切性、資源充分、研發技術突飛猛進,加快過程(希望是)?還是專家也沒有把握,在總統和公眾壓力下,信口開河,忽悠大家(希望不是)?我渴望他們用科學解釋一下希望的來源。
除此,我當然也失望仍未看到以隨機測試統計學來計算出來的感染率和IFR。最接近的應該是韓國的數據,他們不斷進行大量接近隨機測試,應該超過20萬人次,確診人數近8000,死亡人數67,CFR約0.8%,接近全球最低。既可能韓國醫療系統比意大利好,中間年齡較低,但明顯亦跟大量測試,擴大CFR分母有關。所以最少這給我們一點希望,神秘的IFR,理論上應可以低於0.8%,如韓國的真正宗數比確診多一倍,那麼IFR就只有0.4%。雖仍遠高於流感的0.03%至0.1%,但總比現在CFR的3.7%好得多。
我們極需要準確一點的IFR估計,因為即使不幸中招,也可安心一點。
中環資產投資行政總裁
[譚新強 中環新譚]
area under the curve 在 CarDebuts Youtube 的最佳貼文
? คลิปรถใหม่ 2019-2020 มาแล้วครับ คลิกที่นี่ https://www.youtube.com/channel/UCSebcviE-UeYMxVRNozwqtw/videos
2018 Honda Forza 125
Honda’s segment-leading sports/GT Forza 125 scooter maintains its rapid upward trajectory, receiving a thorough-going restyle, plus electrically adjustable screen, LED indicators, new instrumentation, two all-new colour options. increased underseat storage space and an optional 45-litre Smart Key-linked top box that improve still further its all-round premium appeal.
Honda’s Forza 125 was designed specifically for discerning European scooter customers who demand the maximum out of their ride in every respect – style, presence, performance and specification. And right from its introduction in 2015 it has met and exceeded all expectations, evolving year on year with owner feedback and selling over 30,000 units to date.
Straight out of the crate the Forza 125 hit the ground rolling, deftly mixing traffic-busting agility – thanks to its compact dimensions – with ample ability for longer-range highway commute thanks to its engine performance, wind protection and comfort. It combines the comfort of a ‘GT’ (Grand Touring) scooter with a sports-oriented attitude and handling ability, while offering plenty of storage, a host of premium details plus Honda’s engineering innovation and high build quality.
Classy and agile, and expanding on its obvious success, the Forza 125 is not standing still: for 2018, maintaining a steep development curve, it has been redrawn with fresh new lines and several significant rider-focused upgrades.
- Adjustable electric screen controlled from the left handlebar
- Revised dash offers a mix of analogue and digital information
- LED indicators complement the LED headlight and taillight
- The Smart Key also now operates an optional 45-litre top box
- Refreshed design lines further enhance the premium feel
The Forza 125’s fully-refreshed look flows back from the new electric screen, which adjusts smoothly through 140mm and is designed to provide wind protection (with airflow directed around and over the rider’s head) and reduce wind noise. Stability and comfort at higher speeds – and for long distances – can be instantly exchanged for a greater sense of freedom with the screen in its lower position by simply pushing a switch on the left handlebar to move it to any point in the 140mm range.
Handlebar width remains 754mm as does mirror height of 1125mm, the perfect dimensions for slipping through streets clogged with cars – one of the Forza 125’s incremental development steps already in place from 2017 was to raise its own mirror height to avoid issues with car mirrors. Seat height is unchanged at 780mm; there’s plenty of room for two and the sit-in riding position cups the rider securely. The front and rear indicators are now LED, matching the headlight and taillight.
Two full-face helmets can be stored under the seat, which now offers increased storage space of 53.5 litres, up from 48 litres. It’s also possible to partition the storage area to house a helmet and/or rain gear and A4 sized bags. The front left inner fairing pocket is lockable, and its internal space can be arranged for the rider’s convenience, to hold a phone and water bottle, for instance. It also houses a 12V-1A charging socket.
The Forza 125’s Smart Key – as well as controlling the main ignition switch knob and compartment locking – also now manages the optional 45L removable top box, a first on a Honda scooter. With the Smart Key in the rider’s pocket the box automatically locks when the rider walks away. It can also be locked from the key. The top box switch is on its bottom surface, and to maintain the internal volume of the box the actuator mechanism is located in the rear body of the machine.
Revised instruments present analogue speedometer and rev-counter dials flanking a digital display that can switch between 3 modes (controlled by a switch on the left handlebar); odometer, range remaining and current fuel consumption; trip meter, average fuel consumption and timer; or ambient temperature thermometer and battery sensor.
The Forza’s sharp design lines and distinctive contemporary presence have played a big part in its success since launch in 2015. Now for the 2018 model, the design has been substantially re-worked. While the bold design lines remain instantly recognizable as a Forza 125, every panel has been revised to give the machine a slightly smoother, more mature appearance, with a more rounded, ‘stubby’ feel to the front end and slightly softer design lines throughout. Further heightening the new look, black signature points around the nose, front and side cowls give an added sense of sportiness.

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