http://www.zshare.net/audio/11220305e534a439/
Economy is one powerful motive for camping, since after the initial outlay upon equipment, or through hiring it, the total expense can be far less than the cost of hotels. But, contrary to a popular assumption, it is far from being the only one, or even the greatest. The man who manoeuvres carelessly into his twenty pounds' worth of space at one of Europe's myriad permanent sites may find himself bumping a Bentley. More likely, Ford Escort will be hub to hub with Renault or Mercedes, but rarely with bicycles made for two.
That the equipment of modern camping becomes yearly more sophisticated is an entertaining paradox for the cynic, a brighter promise for the hopeful traveler who has sworn to get away from it all. It also provides-and some student sociologist might care to base his thesis upon the phenomenon -- an escape of another kind. The modern traveller is often a man who dislikes the Splendid 5-star hotel , not because he cannot afford, or shuns their material comforts. but because he is afford of them. Affluent he may be, but he is by no means sure what to tip the doorman or the chambermaid. Master in his own house, he has little idea of when to say No to manager.
From all such fears camping releases him. Granted, a snobbery of camping itself, based upon equipment and techniques, already exists; but it is of a kind that, if he meets it, he can readily understand and deal with. There is no superior 'they' in the shape of managements and hotel hierarchies to darken his holiday days.
To such motives, yet another must be added. The contemporary phenomenon of car worship is to be explained not least by the sense of independence and freedom that ownership entails. To this pleasure camping gives an exquisite refinement.
From one's own front door to home or foreign hills or sands and back again, everything is to hand. Not only are the means of arriving at the holiday paradise entirely within one's own command and keeping, but the means of escape from holiday hel (if the beach proves too crowded, the local weather too inclement)
Idealists have objected to the package tour, that the traveller abroad thereby denies himself the opportunity of getting to know the people of the country visited. Insularity and self-containment, it is argued, go hand in hand. The opinion does not survive experience of a popular Continental camping place. Holiday hotels tend to cater for one nationality of visitors especially, sometimes exclusively. Camping sites, by contrast, are highly cosmopolitan. Granted, a preponderance of Germans is a characteristic that seems common to most Mediterranean sites; but as yet there is no overwhelmingly specialized patronage. Notices forbidding the open-air drying of clothes, or the use of water points for car washing, or those inviting 'our camping friends' to a dance or a boat trip are printed not only in French or Italian or Spanish, but also in English, German and Dutch. At meal times the odour of sauerkraut vies with that of garlic. The Frenchman's breakfast coffee competes with the Englishman's bacon and eggs.
Whether the remarkable growth of organized camping means the eventual death of the more independent kind is hard to say. Municipalities naturally want to secure the campers' site fees and other custom. Police are wary of itinerants who cannot be traced to a recognized camp boundary or to four walls. But most probably it will all depend upon campers themselves: how many heath fires they cause; how much litter they leave; in short, whether or not they wholly alienate landowners and those who live in the countryside. Only good scouting is likely to preserve the freedoms so dear to the heart of the eternal Boy Scout.

 

Medical Insight

Self-made Audio Programme 51

download Roy audio material at

http://www.zshare.net/audio/11071045890944a6/

Welcome to Medical Insight , today is April 17, 2008. I’m Dr. Alex Roy. Nearly all serious illnesses and deaths from malaria are caused by P. falciparum（恶性疟）. Travelers to areas where malaria is endemic often contract the disease, mostly because of lack of compliance with preventive measures such as the avoidance of night-biting anopheline mosquitoes（按蚊） and use of chemoprophylaxis. Many drugs are available for the treatment of uncomplicated malaria. However, control in areas where malaria is endemic is limited by drug resistance, the toxic effects of some agents, and the relatively high cost and limited availability of newer drugs. The most important new class of anti-malarial agents is the Artemisinins 青蒿素 ，which are natural products developed in China beginning in the 1960s. And it is at least as effective against severe malaria as quinine, with fewer side effects. The drug is available in the United States only by special request from the Centers for Disease Control. A key advantage of Artemisinins is rapid action against all of the erythrocytic stages of the parasite, including transmissible gametocytes, resulting in a rapid clinical benefit and decreased transmission of malaria. In addition, there is currently limited, if any, resistance to Artemisinins in malaria parasites. This article described the life cycle of P. falciparum, and the clinical efficacy of Artesunate 青蒿琥酯 in the treatment of malaria.

 

 

Medical Insight

Self-made Audio Programme 50

download Roy audio material at

http://www.zshare.net/audio/106901932f9eec76/

Welcome to Medical Insight , today is April 17, 2008. I’m Dr. Alex Roy. A 45-year-old man with end-stage liver disease was admitted to the hospital for orthotopic liver transplantation. At the age of 18 years, a diagnosis of non-A, non-B hepatitis was made after a 1-month episode of jaundice; the source of exposure was thought to be tattoos. Six years before admission, the episodes of jaundice became more frequent and severe, and chronic pruritus developed. Serologic testing disclosed antibodies to hepatitis C virus (HCV) and hepatitis B virus (HBV) core and surface antigens. The patient began drinking heavily during this time. A diagnosis of hepatic cirrhosis was made. During the 4 months before admission, lactulose was administered for encephalopathy, and multiple therapeutic paracenteses were performed. On the 4th hospital day of the current admission, orthotopic liver transplantation was performed. Nine days later, fever and headache developed, followed by confusion, slurred speech, photophobia, and neck stiffness. This case discussed the Differential Diagnosis of Confusion in Liver-Transplant Recipients. The spectrum of causes is broad, and the diagnosis is urgent in those Immunocompromised Host. Final diagnosis: Cryptococcal Meningitis.

http://www.zshare.net/audio/106100189410a1c6/

A gifted American psychologist has said, 'Worry is a spasm of the emotion; the mind catches hold of something and will not let it go.' It is useless to argue with the mind in this condition. The stronger the will, the more futile the task. One can only gently insinuate something else into its convulsive grasp. And if this something else is rightly chosen, if it really attended by the illumination of another field of interest, gradually, and often quite swiftly, the old undue grip relaxes and the process of recuperation and repair begins.
The cultivation of a hobby and new forms of interest is therefore a policy of the first importance to a public man. But this is not a business that can be undertaken in a day or swiftly improvised by a mere command of the will. The growth of alternative mental interests is a long process. The seeds must by carefully chosen; they must fall on good ground; they must be sedulously tended, if the vivifying fruits are to be at hand when needed.
To be really happy and really safe, one ought to have at least two or three hobbies, and they must all be real. It is no use starting late in life to say: 'I will take an interest in this or that.' Such an attempt only aggravates the strain of mental effort. A man may acquire great knowledge of topics unconnected with his daily work, and yet get hardly any benefit or relief. It is no use doing what you like; you have got to like what you do. Broadly speaking, human beings may be divided into three classes: those who are toiled to death, those who are worried to hard week's sweat and effort, the chance of playing a game of football on Saturday afternoon. It is no use inviting the politician or the professional business man, who has been working or worrying about serious things for six days, to work or worry about trifling things at the weekend.
As for the unfortunate people who can command everything they want, who can gratify every caprice and lay their hands on almost every object of desire -- for them a new pleasure, a new excitement if only an additional satiation. In vain they rush frantically round from place to place, trying to escape from avenging boredom by mere clatter and motion. For them discipline in one form or another is the most hopeful path.
It may also be said that rational, industrious, useful human being are divided into two classes: first, one. Of these the former are the majority. They have their compensations. The long hours in the office or the factory bring with them as their reward, not only the means of sustenance, but a keen appetite for pleasure even in its simplest and most modest forms. But Fortune's favoured children belong to the second class. Their life is a natural harmony. For them the working hours are never long enough. Each day is a holiday, and ordinary holidays, when they come, are grudged as enforced interruptions in an absorbing vocation. Yet to both classes, the need of an alternative outlook, of a change of atmosphere, of a diversion of effort, is essential. Indeed, it may well be that those work is their pleasure are those who most need the means of banishing it at intervals from their minds.

Medical Insight

Self-made Audio Programme 49

download Roy audio material at 

http://www.zshare.net/audio/103124857ba2cca4/

Welcome to Medical Insight , today is April 10, 2008. I’m Dr. Alex Roy. Mechanical ventilation is a critical component of modern intensive care medicine, The combination of complete diaphragm inactivity and mechanical ventilation (for more than 18 hours) elicits disuse atrophy of myofibers in animals. These investigators hypothesized that the same may also occur in the human diaphragm. In this study, changes in the cross-sectional area and biochemical composition of biopsy specimens from brain-dead patients with inactive diaphragms at the time of organ donation were compared with similar measurements from patients undergoing thoracic surgery. As compared with diaphragm-biopsy specimens from controls, specimens from case subjects showed decreased cross-sectional areas of slow-twitch and fast-twitch fibers of 57% and 53%, respectively, decreased glutathione concentration of 23%, and increased active caspase-3 expression of 100%. The combination of 18 to 69 hours of complete diaphragmatic inactivity and mechanical ventilation results in marked atrophy of human diaphragm myofibers. These findings are consistent with increased diaphragmatic proteolysis during inactivity. In an editorial, Gary. Sieck from Mayo Clinic, in Rochester, Minnesota, writes that regardless of the underlying cause, the results reported by Levine et al. certainly argue against the use of controlled mechanical ventilation as a protective, fatigue-reversing intervention for patients requiring ventilatory assistance in intensive care settings. Whether patients undergoing shorter-term procedures (e.g., surgical anesthesia) should also be considered at risk of ventilator-induced diaphragmatic dysfunction remains to be explored, but it is likely that alternative ventilatory strategies will be necessary, especially for patients with decreased reserve capacity at baseline.

 

http://www.zshare.net/audio/1004905557878214/

In man's early days. competition with other creatures must have been critical. But this phase of our development is now finished. Indeed, we lack practice and experience nowadays in dealing with primitive conditions. I am sure that, without modern weapons, I would make a very poor show of disputing the ownership of a cave with a bear, and in this I do not think that I stand alone. The last creature to compete with man was the mosquito. But even the mosquito has been subdued by attention to drainage and by chemical sprays.
Competition between our selves, person against person, community against community, still persists, however; and it is as fierce as it ever was. But the competition of man against man is not the simple process envisioned in biology. It is not a simple competition for a fixed amount of food determined by the physical environment, because the environment that determines our evolution is no longer essentially physical. Our environment is chiefly conditoned by the things we believe. Morocco and California are bits of the Earth in very similar latitudes, both on the west coasts of continents with similar climates, and probably with rather similar natural resources. Yet their present development is wholly different, not so much because of different people, but because of the different thoughts that exist in the minds of their inhabitants.This is the point I wish to emphasize. The most important factor in our environment is the state of our own minds.
It is well known that where the whites has invaded a primitive culture, the most destructive effects have come not from physical weapons but from ideas. Ideas are dangerous. The Holy Office knew this full well when it caused heretics to be burned in days gone by. Indeed, the concept of free speech only exists in our modern society because when you are inside a community, you are conditioned by the conventions of the community to such a degree that it is very difficult to conceive of anything really destructive. It is only someone looking on from outside that can inject the dangerous thoughts. I do not doubt that it would be possible to inject ideas into the modern world that would utterly destroy us. I would like to give you an example, but fortunately I cannot do so. Perhaps it will suffice to mention the unclear bomb. Of making the effect on a reasonably advanced technological society, one that still does not possess the bomb, of making it aware of the possibility, of supplying sufficient details to enable the thing to be constructed. Twenty or thirty pages of information handed to any of the major world powers around the year 1925 would have been sufficient to change the course of world history. It is a strange thought, but I believe a correct one, that twenty or thirty pages of ideas and information would be capable of turning the present-day world upside down, or even destroying it. I have often tried to conceive of what those pages might contain, but of course outside the particular patterns that our brains are conditioned to, or, to be more accurate, we can think only a very little way outside, and then only if we are very original.

 

Medical Insight

Self-made Audio Programme 48

download Roy audio material at

http://www.zshare.net/audio/10029090c2229ae2/

Welcome to Medical Insight , today is April 4, 2008. I’m Dr. Alex Roy. A 79-year-old man with a 5-month history of fatigue and 20-pound weight loss presented to his local physician. The patient also reported intermittent episodes of high temperature, night sweats, and chills. He was treated with a short course of Ciprofloxacin环丙沙星, followed by a course of Levofloxacin, for a presumed sinus infection, without any improvement in his symptoms. The patient’s medical history was significant for coronary artery disease, gastroesophageal reflux disease, hypothyroidism, and transitional-cell cancer of the bladder, which had been diagnosed 4 years earlier and was currently in remission缓解期. Two weeks after completion of antimicrobial therapy. The intermittent fever, fatigue, and night sweats persisted. An evaluation for fever of unknown origin (FUO) was undertaken. CT of the abdomen and pelvis is recommended in patients with FUO, and the most common finding is an abscess or lymphadenopathy. In this patient, the CT study revealed an infrequent cause of FUO —a likely infected aneurysm of the infra-renal aorta. Infected aneurysms of the aorta are rare but potentially catastrophic. Urgent surgical intervention is warranted for the aneurysm. A day after surgery, additional history was obtained (he had received intravesical BCG for his bladder cancer 11 months before admission). This led to the final diagnosis: M. Tuberculosis Infected Aneurysm.