http://www.zshare.net/audio/9879598fd80705/

Custom has not commonly been regarded as a subject of great moment. The inner workings of our own brains we feel to be uniquely worthy of investigation, but custom, we have a way of thinking, is behaviour at its most commonplace. As a matter of fact, it is the other way around. Traditional custom, taken the world over, is a mass of detailed behaviour more astonishing than what any one person can ever evolve in individual actions, no matter how aberrant. Yet that is a rather trivial aspect of the matter. The fact of first-rate importance is the predominant role that custom plays in experience and in belief, and the very great varieties it may manifest.
No man ever looks at the world with pristine eyes. He sees it edited by a definite set of customs and institutions and ways of thinking. Even in his philosophical probing he cannot go behind these stereotypes; his very concepts of the true and the false will still have reference to his particular traditional customs. John Dewey has said in all seriousness that the part played by custom in shaping the behaviour of the individual, as against any way in which he can affect traditional custom, is as the proportion of the total vocabulary of his mother tongue against those words of his own baby talk that are taken up into the vernacular of his family. When one seriously studies the social orders that have had the opportunity to develop autonomously, the figure becomes no more than an exact and matter-of-fact observation. The life history handed down in his community. From the moment of his birth, the customs into which he is born shape his experience and behaviour. By the time he can talk, he is the little creature of his culture, and by the time he is grown and able to take part in its activities, its habits are his habits, its beliefs his beliefs, its impossibilities his impossibilities. Every child that is born into his group will share them with him, and no child born into one on the opposite side of the globe can ever achieve the thousandth part. There is no social problem it is more incumbent upon us to understand than this of the role of custom. Until we are intelligent as to its laws and varieties, the main complicating facts of human life must remain unintelligible.
The study of custom can be profitable only after certain preliminary propositions have been accepted, and some of these propositions have been violently opposed. In the first place, any scientific study requires that there be no preferential weighting of one or another of the items in the series it selects for its consideration. In all the less controversial fields, like the study of the mature of nebulae, the necessary method of study is to group the relevant material and to take note of all possible variant forms and conditions. In this way, we have learned all that we know of the laws of astronomy, let us say. It is only in the study of man himself that the major social sciences have substituted the study of one local variation, that of Western civilization.
Anthropology was by definition impossible, as long as these distinctions between ourselves and the primitive, ourselves and the barbarian, ourselves and the pagan, held sway over people's minds. It was necessary first to arrive at that degree of sophistication where we no longer set our own belief against our neighbour's superstition. It was necessary to recognize that these institutions which are based on the same premises, let us say the supernatural, must be considered together, our own among the rest.

 

Medical Insight

Self-made Audio Programme 47

download Roy audio material at http://www.zshare.net/audio/97312348967083/

Welcome to Medical Insight March 29th, 2008. I’m Dr. Alex Roy. A 10-year-old girl was seen because of dyspnea and noisy respirations. Approximately 3 weeks earlier, a sharp pain in her chest had developed, associated with shortness of breath, while she was walking home from school, Thereafter, she had dyspnea with exertion. Her respirations became audible on both inspiration and expiration during exercise but were normal at rest and during sleep. Her symptoms did not improve with the use bronchodilators. On examination, mild wheezes, without crackles, were heard bilaterally on tidal and forced breathing. Results of pulmonary-function tests revealed a forced vital capacity (FVC) of 111% of predicted value, a forced expiratory volume in 1 second (FEV1) of 30%, and an FEV1:FVC ratio of 30%. There was a plateau of flow observed on both the inspiratory and expiratory flow-volume loops. When there is a well-defined plateau observed on both the expiratory and inspiratory loops, which indicates limitation of flow in both phases of respiration, the problem is likely to be located in the large airways rather than in the distal airways or pulmonary parenchyma, and one thus needs to consider a fixed-airway obstruction involving the trachea. The differential diagnosis in this case includes

(1) Subglottic stenosis (声门下狭窄)

(2) Hemangioma  (血管瘤)

(3) Complete tracheal ring (完全性气管O型軟骨环型狭窄）

(4) and possibly a foreign body

The patient was taken to the operating room for rigid bronchoscopic evaluation of the airway. Final Diagnosis: Glomus tumor of the trachea.

 

Medical Insight

Self-made Audio Programme 47

download Roy audio material at

http://www.zshare.net/audio/9418162bab4c31/

Welcome to Medical Insight March 19th, 2008. I’m Dr. Alex Roy. Despite optimal and early surgical treatment of non–small-cell lung cancer (NSCLC), many patients die of recurrent disease. Methylation of the promoter region of a gene is a mechanism that influences gene expression. This article  investigated the association between gene methylation and recurrence of the tumor. Methylation of the promoter region of this four genes（p16，CDH13，RASSF1A and APC） is a very bad news to patients with stage I non–small-cell lung cancer, for those patients that even treated with curative intent by means of surgery is still associated with early recurrence.

 

http://www.zshare.net/audio/941634060ac899/

We must conclude from the work of those who have studied the origin of life, that given a planet only approximately like our own, life is almost certain to start. Of all the planets in our solar system, we ware now pretty certain the Earth is the only one on which life can survive. Mars is too dry and poor in oxygen, Venus far too hot, and so is Mercury, and the outer planets have temperatures near absolute zero and hydrogen-dominated atmospheres. But other suns, start as the astronomers call them, are bound to have planets like our own, and as is the number of stars in the universe is so vast, this possibility becomes virtual certainty. There are one hundred thousand million starts in our own Milky Way alone, and then there are exist is now estimated at about 300 million million.
Although perhaps only 1 per cent of the life that has started somewhere will develop into highly complex and intelligent patterns, so vast is the number of planets, that intelligent life is bound to be a natural part of the universe.
If then we are so certain that other intelligent life exists in the universe, why have we had no visitors from outer space yet? First of all, they may have come to this planet of ours thousands or millions of years ago, and found our then prevailing primitive state completely uninteresting to their own advanced knowledge. Professor Ronald Bracewell, a leading American radio astronomer, argued in Nature that such a superior civilization, on a visit to our own solar system, may have left an automatic messenger behind to await the possible awakening of an advanced civilization. Such a messenger, receiving our radio and television signals, might well re-transmit them back to its home-planet, although what impression any other civilization would thus get from us is best left unsaid.
But here we come up against the most difficult of all obstacles to contact with people on other planets -- the astronomical distances which separate us. As a reasonable guess, they might, on an average, be 100 light years away. Radio waves also travel at the speed of light, and assuming such an automatic messenger picked up our first broadcasts of the 1920's, the message to its home planet is barely halfway there. Similarly, our own present primitive chemical rockets, though good enough to orbit men, have no chance of transporting us to the nearest other star, four light years away, let alone distances of tens or hundreds of light years.
Fortunately, there is a 'uniquely rational way for us to communicate with other intelligent beings, as Walter Sullivan has put it in his excellent book, We Are not Alone. This depends on the precise radio frequency of the 21-cm wavelength. It is the natural frequency of emission of the hydrogen atoms in space and was discovered by us in 1951; it must be known to any kind of radio astronomer in the universe.
Once the existence of this wave-length had been discovered, it was not long before its use as the uniquely recognizable broadcasting frequency for interstellar communication was suggested. Without something of this kind, searching for intelligences on other planets would be like trying to meet a friend in London without a pre-arranged rendezvous and absurdly wandering the streets in the hope of a chance encounter.

 

http://www.zshare.net/audio/9320800e1f2749/

An earthquake comes like a thief in the night, without warning. It was necessary, therefore, to invent instruments that neither slumbered nor slept. Some devices were quite simple. One, for instance, consisted of rods of various lengths and thicknesses with would stand up end like ninepins. When a shock came, it shook the rigid table upon which these stood. If it were gentle, only the more unstable rods fell. If it were severe, they all fell. Thus the rods, by falling, and by the direction in which they fell, recorded for the severe, they all fell. Thus the rods, by falling, and by the direction in which they fell, recorded for the slumbering scientist the strength of a shock that was too weak to waken him, and the direction from which it came.
But instruments far more delicate than that were needed if any really serious advance was to be made. The ideal to be aimed at was to devise an instrument that could record with a pen on paper, the movements of the ground or of the table as the quake passed by. While I write my pen moves, but the paper keeps still. With practice, no doubt, I could in time learn to write by holding the pen still while the paper moved. That sounds a silly suggestion, but that was precisely the idea adopted in some of the early instruments (seismometers) for recording earthquake waves. But when table, penholder and paper are all moving, how is it possible to write legibly? The key to a solution of that problem lay in an everyday observation. Why does a person standing in a bus or train tend to fall when a sudden start is made? It is because his feet move on , but his head stays still. A simple experiment will help us a little further. Tie a heavy weight at the end of a long piece of string. With the hand to and fro and around but not up and string so that the weight nearly touches the ground. Now move the hand to and fro and around but not up and down. It will be found that the weight a piece of string. With the hand held high in the air, hold the string so that the weight nearly touches the ground. Now move the hand to and fro and around but not up and down. It will be found that ten weight moves but slightly or not at all. Imagine an earthquake shock shaking the floor, the paper, you and your hand. In the midst of all this movement, the weight and the pen would be still. But as the paper moved from side to side under the pen point, its movement would be recorded in ink upon its surface. It was upon this principle that the first instruments were made, but while the drum was being shaken, the line that the pen was drawing wriggled from side to side. The apparatus thus described, however, records only the horizontal component of the wave movement, which is, in fact, much more complicated. If we could actually see the path described by a particle, such as a sand grain in the rock, it would be more like that of a bluebottle path described by a particle, such as a sand grain in the rock, it would be more like that of a bluebottle buzzing round the room; it would be up and down, to and fro and from side to side. Instruments have been devised and can be so placed that all three elements can be recorded in different graphs.
When the instrument is situated at more than 700 miles from the earthquake centre, the graphic record shows three waves arriving one after at short intervals. The first records the arrival of longitudinal vibrations. The second marks the arrival of transverse vibrations which travel more slowly and arrive several minutes after the first. These two have travelled through the earth. It was from the study of these that so much was learnt about the interior of the earth. The third, or main. The third, or main wave, is the slowest and has travelled round the earth through the surface rocks.

 

Medical Insight

Self-made Audio Programme 46

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http://www.zshare.net/audio/920988688e6b13/

Welcome to Medical Insight March 19th, 2008. I’m Dr. Alex Roy. Although sporadic ovulation continues until menopause, fecundity declines as the final menses approaches. Women of older reproductive age are more likely than younger women to have adverse consequences when they do conceive. In the United States, pregnancy related mortality ratios among women 40 years of

age or older are five times those of women between 25 and 29 years of age. These and other data underscore the importance of effective contraception for women of older reproductive age. Healthy, lean women of older reproductive age who are nonsmokers, can safely use combination estrogen–progestin contraceptives. Benefits include effective contraception and reductions in irregular bleeding and vasomotor symptoms associated with the perimenopausal transition. Epidemiologic data also suggest potential long-term benefits, including reductions in the risks of fractures among postmenopausal women and of ovarian, endometrial, and colorectal cancer. However, for women of older reproductive age who are obese, smoke cigarettes, or have hypertension, diabetes, or migraine headaches, the cardiovascular risks associated with combination oral contraceptives are considered to outweigh the benefits. This review focuses on hormonal contraception, primarily the use of combination estrogen–progestin contraceptives, in women of older reproductive age.

 

http://www.zshare.net/audio/9207927c9cee09/

Two main techniques have been used for training elephants, which we may respectively the tough and the gentle. The former method simply consists of setting an elephant to work and beating him until he does what is expected of him. Apart from moral considerations this is a stupid method of training, for it produces a resentful animal who at a later stage may well turn man-killer. The gentle method requires more patience in the early stages, but produces a cheerful, good-tempered elephant who will give many years of loyal service.
The first essential in elephant training is to assign to the animal a single mahout who will be entirely responsible for the job. Elephants like to have one master just as dogs do, and are capable of a considerable degree of personal affection. There are even stories of half-trained elephant calves who have refused to feed and pined to death when by some unavoidable circumstance they have been deprived of their own trainer. Such extreme cases must probably be taken with a grain of salt, but they do underline the general principle that the relationship between elephant and mahout is the key to successful training.
The most economical age to capture an elephant for training is between fifteen and twenty years, for it is then almost ready to undertake heavy work and can begin to earn its keep straight away. But animals of this age do not easily become subservient to man, and a very time man, and a very firm hand must be employed in the early stages. The captive elephant, still roped to a tree, plunges and screams every time a man approaches, and for several days will probably refuse all food through anger and fear. Sometimes a tame elephant is tethered nearby to give the wild one confidence, and in most cases the captive gradually quietens down and begins to accept its food. The next stage is to get the elephant to the training establishment, a ticklish business which is achieved with the aid of two tame elephants roped to the captive on either side.
When several elephants are being trained at one time, it is customary for the new arrival to be placed between the stalls of two captives whose training is already well advanced. It is then left completely undisturbed with plenty of food and water so that it can absorb the atmosphere of its new home and see that nothing particularly alarming is happening to its companions. When it is eating normally, its own training begins. The trainer stands in front of the elephant holding a long stick with a sharp metal point. Two assistants, mounted on tame elephants, control the captive from either side, while others rub their hands over his skin to the accompaniment of a monotonous and soothing chant. This is supposed to induce pleasurable sensations in the elephant, and its effects are reinforced by the use of endearing epithets. The elephant is not son', or 'ho! my father', or 'my mother', according to the age and sex of the captive. The elephant is not immediately susceptible to such blandishments, however, and usually lashes fiercely with its trunk in all directions. These movements are controlled by the trainer with the metal-pointed stick, and the trunk eventually becomes so sore that the elephant curls it up and seldom afterwards uses it for offensive purposes.

http://www.zshare.net/audio/895885574ec6b7/

Waves are the children of the struggle between ocean and atmosphere, the ongoing signatures of infinity. Rays from the sun excite and energize the atmosphere of the earth, awakening it to flow, to movement, to rhythm, to life. The wind then speaks the message of the sun to the sea and the sea transmits it on through waves -- an ancient, exquisite, powerful message.
These ocean waves are among the earth's most complicated natural phenomena. The basic features include a crest (the highest point of the wave), a trough (the lowest point), a height (the vertical distance from the trough to the crest), a wave length (the horizontal distance between two wave crests), and a period (which is the time it takes a wave crest to travel one wave length).
Although an ocean wave gives the impression of a wall of water moving in your direction, in actuality waves move through the water leaving the water about where it was. If the water was moving with the wave, the ocean and everything on it would be racing in to the shore with obviously catastrophic results.
An ocean wave passing through deep water causes a particle on the surface to move in a roughly circular orbit, drawing the particle first towards the advancing wave, then up into the wave, then forward with it and then -- as the wave leaves the particles behind -- back to its starting point again.
From both maturity to death, a wave is subject to the same laws as any other 'living' thing. For a time it assumes a miraculous individuality that, in the end, is reabsorbed into the great ocean of life.
The undulating waves of the open sea are generated by three natural causes: wind, earth movements or tremors, and the gravitational pull of the moon and the sun. Once waves have been generated, gravity is the force that drives them in a continual attempt to restore the ocean surface to a flat plain.

 

Medical Insight

Self-made Audio Programme 45

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http://www.zshare.net/audio/89572500345bf2/

Welcome to Medical Insight March 15th, 2008. I’m Dr. Alex Roy.

An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting. She also reported increasing shortness of breath and fatigue. She had a history of congestive heart failure, mitral regurgitation, hypertension, atrial fibrillation, hypothyroidism, peptic ulcer disease, and depression. During the year before presentation, abdominal distention had developed, according to the medical records, ascites had been found. The patient had been treated for presumed congestive heart failure. On physical examination, the patient appeared to have a long-term illness, but she was in no acute distress. A prominent systolic C-V wave was visible in the neck veins. A diastolic murmur was audible at the left upper sternal border. Abdominal paracentesis yielded 2 liters of red, hazy serous fluid. In this unusual case, the patient’s slowly progressive symptoms were attributed to her known chronic coexisting conditions and, thus, the diagnostic evaluation was delayed. This case underscores the need to pursue further evaluation when a salient finding(in this case a diastolic murmur)appears incongruous with the presumed diagnosis. Final Diagnosis: Severe pulmonary hypertension (Eisenmenger’s syndrome) caused by Patent Ductus Arteriosus(PDA).

 

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I have known very few writers, but those I have known, and whom I respected,confess at once that they have little idea where they are going when they first set pen to paper. They have a character, perhaps two, they are in that condition of eager discomfort which passes for inspiration, all admit radical changes of destination once the journey has begun; one, to my certain knowledge, spent nine months on a novel about Kashmir, then reset the whole thing in the Scottish Highlands. I never heard of anyone making a 'skeleton', as we were taught at school. In the breaking and remaking, in the timing, interweaving, beginning afresh, the writer comes to discern things in his material which were not consciously in his mind when he began. This organic process, often leading to moments of extraordinary self-discovery, is of an indescribable fascination. A blurred image appears, he adds a brushstroke and another, and it is gone; but something was there, and he will not rest till he has captured it. Sometimes the yeast within a writer outlives a book he has written. I have heard of writers who read nothing but their own books, like adolescents they stand before the mirror,and still cannot fathom the exact outline of the vision before them. For the same reason, writers talk interminably about their own books, winkling out hidden meanings, super-imposing new ones, begging response from those around them. Of course a writer doing this is misunderstood: he might as well try to explain a crime or a love affair. He is also, incidentally, an unforgivable bore.This temptation to cover the distance between himself and the reader, to study his image in the sight of those who do not know him, can be his undoing: he has begun to write to please. A young English writer made the pertinent observation a year or two back that the talent goes into the first draft, and the art into the drafts that follow. For this reason also the writer, like any other artist, has no resting place, no crowd or movement in which he may take comfort, no judgment from outside which can replace the judgment from within. A writer makes order out of the anarchy of his heart; he submits himself to a more ruthless discipline than any critic dreamed of, and when he flirts with fame, he is taking time off from living with himself, from the search for what his world contains at its inmost point. 

 

 

Gluttony（暴食），

Greed（贪婪），

Sloth（懒惰），

Pride（傲慢），

Lust（淫欲），

Envy（嫉妒），

Wrath（暴怒）

are seven deadly sins in the Bible.

 

 

 

Medical Insight

Self-made Audio Programme 44

download Roy audio material at

http://www.zshare.net/audio/882973021ce90c/

Welcome to Medical Insight March 11th, 2008. I’m Dr. Alex Roy.

 Pulmonary embolism ranges from asymptomatic, incidentally discovered emboli to massive embolism causing immediate death. Acute pulmonary embolism may occur rapidly and unpredictably, and may be difficult to diagnose. It usually originates from the deep veins of the legs, most commonly the calf veins. These venous thrombi originate predominantly in venous valve pockets and at other sites of presumed venous stasis. If a clot propagates to the knee vein or above, or if it originates above the knee, the risk of embolism increases. Thromboemboli travel through the right side of the heart to reach the lungs. Untreated pulmonary embolism is associated with high mortality. Suspected pulmonary embolism demands prompt diagnostic testing and assessment of risk factors and clinical probability, with empirical clinical assessment and a validated clinical prediction score when possible. Clinical assessment, together with D-dimer testing, may sometimes circumvent the need for imaging. Otherwise, there should be a low threshold for diagnostic imaging. Treatment of acute pulmonary

embolism has been shown to reduce mortality, and appropriate primary prophylaxis is usually effective. Risk stratification of patients with this disease is necessary to optimize decision making with regard to the use of thrombolytic therapy.This review focuses on the pathogenesis, diagnosis, and treatment of acute pulmonary embolism of thrombotic origin.

 

http://www.zshare.net/audio/8566093d7e7280/

Contamination of water supplies is usually due to poor sanitation close to water sources, sewage disposal into the sources themselves, leakage of sewage into distribution systems or contamination with industrial or farm waste. Even if a piped water supply is safe at its source, it is not always safe by the time it reaches the tap. Intermittent tap-water supplies should be regarded as particularly suspect.
Travellers on short trips to areas with water supplies of uncertain quality should avoid drinking tap-water, or untreated water from any other source. It is best to hot drinks, bottled or canned drinks of well-known brand names -- international standards of water treatment are usually followed at bottling plants. Carbonated drinks are acidic, and slightly safer. Make sure that all bottles are opened in your presence, and that their rims are clean and dry.
Boiling is always a good way of treating water. Some hotels supply boiled water on request and this can be used for drinking, or for brushing teeth. Portable boiling elements that can boil small quantities of water are useful when the right voltage of electricity is available. Refuse politely any cold drink from an unknown source.
Ice is only as safe as the water from which it is made, and should not be put in drinks unless it is known to be safe. Drink can be cooled by placing them on ice rather than adding ice to them.
Alcohol may be a medical disinfectant, but should not be relied upon to sterilize water. Ethanol is more effective at a concentration of 50-70 per cent; below 20 per cent, its bactericidal action is negligible. Spirits labelled 95 proof contain only about 47 per cent alcohol. Beware of methylated alcohol, which is very poisonous, and should never be added to drinking water.
If no other safe supply can be obtained, tap water that is too hot to touch can be left to cool and is generally safe to drink. Those planning a trip to remote areas, or intending to live in countries where drinking water is not readily available, should know about the various possible methods for making water safe.

 

Medical Insight

Self-made Audio Programme 43

download Roy audio material at http://www.zshare.net/audio/8511994cdd2d77/

Welcome to Medical Insight March 5th, 2008. I’m Dr. Alex Roy.

A 17-year-old girl was transferred to a hospital because of chest pain and hemoptysis. A diagnosis of membranous glomerulonephritis with the nephritic syndrome had been made 3 months earlier. Since then she had persistent pain in the back and abdomen. Ultrasonography of the kidney disclosed a small perinephric hematoma. During the 2 weeks before admission, she began to have pain in the chest, radiating to the neck and shoulder, which was exacerbated by coughing and deep inspiration. The pain worsened, cough and hemoptysis developed, along with fever, tachycardia, and tachypnea. CT angiography showed emboli in both pulmonary arteries, and echocardiography showed acute right heart strain.

1) The first question the physicians needed to address in the immediate management of this young patient’s illness with a large pulmonary embolus was whether she should receive thrombolytic therapy or have a caval filter placed, in addition to receiving standard anticoagulation treatment.

2) A second issue is the presence of the nephrotic syndrome, and whether that should affect the treatment decisions.

3) Finally, how should her renal disease be managed?