世界上沒有特異性 100% 的檢驗
#sars #lab
新冠肺炎是一個全新的疾病,因此有一些是事實,有一些是假設的。
特異性是一個「雞生蛋、蛋生雞」的問題,因為 PCR 本身就是確診新冠肺炎的金標準。因此實務上會做短期內系列的 PCR,其中若第一次陽性,第 2 次以後都是陰性的,那麼就稱第一次為假陽性。也可以做 3 個以上不同檢驗單位的 PCR,如果有 1 個陽性,2 個陰性,那麼陽性的那一個檢驗就是假陽性。
有一些人質疑指揮中心假設新冠肺炎 PCR 的特異性為什麼由 4 月 28 日的 99.99% 變成 8 月 22 日的 95%。我認為在指揮中心的模式中,特異性 95% 應該是平均值,99.99%(由於實務上人為採檢及操作上的誤差,不可能達到)應該是最樂觀的假設,亦即假陽性率是假設 0.01-5%。
6-7 月從台灣出境到需要入境者 PCR 普篩國家者是 39673 人,其中有 3 人是陽性的(0.0076%),其 95% 信賴區間 0-0.016% 是在 0.01-5% 的範圍內。亦即這個結果無法排除他們都是假陽性的假設。
經驗科學(包括自然科學、實證醫學)的步驟是重複的假設(理論)→ 觀察或實驗 → 結果跟假設不同 → 修正假設 → 觀察或實驗 → 結果跟假設相同。
“All models are wrong, some are useful” (George Box),因此重點是這個假設是不是合理、有用的。而經驗上及實務上的結果是台灣的防疫成績是世界上最好的。亦即台灣基於這樣的假設所產生的結果是好的,因此這個假設(理論)就是合理、有用的。
Diagnosing COVID-19 infection: the danger of over-reliance on positive test results
https://www.medrxiv.org/content/10.1101/2020.04.26.20080911v3
依據其他病毒 PCR 的 EQA(外部品質測試)結果,平均的假陽性率是 2.3%(0.8-4%)。SARS-CoV 的假陽性率是 2.3-6.9%。
False‐positive reverse transcriptase polymerase chain reaction screening for SARS‐CoV‐2 in the setting of urgent head and neck surgery and otolaryngologic emergencies during the pandemic: Clinical implications
https://onlinelibrary.wiley.com/doi/full/10.1002/hed.26317
假陽性率是 7.1%。
Testing COVID-19 tests faces methodological challenges
https://www.sciencedirect.com/science/article/pii/S0895435620307502
敏感性、特異性並非檢驗本身的特性,而是會隨著目標族群(種族、年齡、性別、共病症、感染的時間、有/無症狀、有/無接觸史、有/無群聚史、醫院/社區/高或低危險群、檢體的採檢等)而變動的不定向飛靶。
QCMD proficiency testing(5 個陽性樣本,每一個有 10 倍稀釋的病毒 2.30–5.30 dPCR log10 RNA copies/mL,其中有一個稀釋樣本是重複的;3 個陰性樣本)發現國際上 365 個不同檢驗單位在 521 個樣本的敏感性是 433/521(83.1%,95% 信賴區間 80-86%),在 1563 個樣本的特異性是 1518/1563(97.1%,96-98%),再現性是 363/365(99.5%,99-100%)。
International external quality assessment for SARS-CoV-2 molecular detection and survey on clinical laboratory preparedness during the COVID-19 pandemic, April/May 2020
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364759/
copies單位 在 陳德政 Facebook 的最佳解答
一本同人誌(Zine)做成這樣,套用購買地方的說法:猴賽雷!
上個月離港那天,趁最後的空檔跑去油麻地的Kubrick書店,在櫃檯旁看見這份Trainspotting同人誌
Trainspotting在香港譯成《迷幻列車》
出版單位是一個頗神秘的組織:電影自學誌 Zinema
https://www.facebook.com/zinemahk/
這是第五期的第三版,共50份
(Vol 5, 3rd Edition, 50 copies)
看了發行時間,2017年四月,應該就是Trainspotting 2上映的時候,趁機做的回顧特輯
售80港幣,二話不說就抓起來結帳
直到今天才拆開,愛不釋手!
濃濃的手感,混搭不同的紙質,採用不同的印刷方式
有漫畫、論文(字體當然小到不行)、一張Trainspotting流行文化地圖(The Pop Culture Map Of Trainspotting),地圖上的座標有Lou Reed、Blur、Pulp、Underworld、足球、Iggy Pop還有1996年Oasis那場驚天動地的Knebworth演唱會
哦,還有一冊煞有介事的Trainspotting時尚考,把眾主角們的穿衣風格徹底分析、考據和過度解讀了一番
最最重要的是,整份Zine超多彩蛋、In-Jokes和重度影迷一看就會說:「對啦!就是要這樣」的巧思
譬如,那間蘇格蘭最糟糕的廁所
#猜火車 #迷幻列車 #Zinema #Trainspotting
copies單位 在 玳瑚師父 Master Dai Hu Facebook 的精選貼文
《玳瑚師父的看見(四)》(English version below)
THE SIGHTINGS OF MASTER DAI HU 4
在十五前,吾常光顧一間叫「翡翠上海小籠包」的中餐館。它的正對面開有一家,在日本赫赫有名的POKKA CAFE。吾,玳瑚師父,是一位懂得吃的人。而真正懂得吃的人,不會侷限於某一種菜色。中餐、西餐、日本餐、義大利餐、韓國餐、泰國餐、越南餐、印度餐等等,吾一律接納。喔!這麼多的美食當前,衣服與地上,沒有半點痕跡,可見吾的內力,著實不淺啊!(一笑)後來爲了吾的客人,有較安靜以及較舒適的環境,吾才開始踏入日本POKKA CAFE。
在這間咖啡屋,吾享用到甚有水準的夏威夷義大利麵,以及吾超愛的奶昔。單單這兩樣飲食,吾已留連忘返。也因爲這樣,專業的助理領班,見吾到來就曉得吾會點什麼。若吾沒見客人時,大多數都是自己,一個人前來用餐。助理領班與其下屬,就乘機過來與吾聊幾句。漸漸的我們就較爲熟路了,她就向吾傾訴有關這裡的經理,名不副實。雖貴爲經理,卻不以身作則的帶領其下的團隊,把這間日式咖啡座給打理好,反而遲到早退,繁忙時不見人影,愛與美眉講黃色笑話,等等。吾聽了問她難道老闆不知嗎?她告知吾日本公司不裁退職員的。吾見她懷才不遇,但卻是一個勤奮有責的好員工。於是吾就運用吾的眼力,望一望那經理一眼,然後跟她說,那經理很快就會被裁退的。事實經吾預言後不久,那經理真被公司給辭退了。
在東北地區的一間組屋單位,吾受邀來此提供問事。欲問事的並不是,女屋主本人,而是她多年的女人。吾落座於她客廳的沙發,一邊與她閒聊,一邊等她的友人回來。等了好一會兒,她的友人終於歸來。這名女屋主是女傭介紹公司的老闆娘,故家中會有幾位在培訓中的女傭。其友人問完後,吾看見女傭群中,有一位較「特別」的女傭,正對著吾微笑。因為她的「特別」,吾就立馬囑咐女老闆,一定要將這位較「特別」的女傭,留在她身邊,勿將她推介出去。女老闆當然問吾為什麼,記得吾當時告訴她說,這位女傭未來會很幫得上妳。若干年後,她命逢劫數時,身文只剩四十元,這位女傭不只陪伴她,沒有離她而去,還自掏腰包買飯給她吃呢!這些是她親口告訴吾的,她感謝吾,也終於明白,為何當初吾囑咐她,一定要將這位較「特別」的女傭,留在她身邊。
每個人的善惡,每個人的動機,每個人的未來走勢,都已「寫」在其臉上。懂得看的人,才是能稱得上察顏觀色的高手。也算是他她心通了。人的臉就好比氣象局,當一個人悲傷欲流淚之時,其臉必是陰天。當一個人要捉狂發怒時,其臉必呈現狂風暴雨、或龍捲風、或落上風、或雷霆萬軍之相。(一笑)當一個人開心快活時,其臉必是晴天,甚至是豔陽高照。當一個人在密運中,其臉必是春天。當一個人事業有成、生意賺錢之時,其臉必是夏天。當一個人滿懷心事時,其臉必是秋天。當一個人困難重重、身體有恙之時,其臉必是冬天。那位POKKA CAFE 的經理,臉色已入秋冬,因此吾狠批他即將被裁退。那位較特別的女傭,臉色呈晴天,因此吾囑咐女老闆,將她留在自己身邊。若你妳有用人之惑,玳瑚師父是你的首選。
......................
I used to frequent a Chinese restaurant named Crystal Jade Shanghai Xiao Long Bao about 15 years ago. Opposite this restaurant was another eatery, Pokka Cafe, a renowned restaurant in Japan. I, Master Dai Hu, am someone who knows how to eat. A person who truly knows how to eat will not restrict himself/herself to one particular cuisine. I accept all types of cuisine: Chinese, Western, Japanese, Italian, Korean, Thai, Vietnamese, Indian, etc. Wow! With such a huge spread of cuisine in front of me, yet there isn't any trace of saliva on my shirt or on the floor, this shows how strong my inner strength is! (laughs) Out of consideration for my clients, that they may have a more serene and comfortable environment, I started to patronise the Pokka Cafe of Japan.
At this cafe, I enjoyed their high-quality Hawaiian spaghetti dish and my favourite milk tea. These two dishes always have me going back for more. As such, the professional assistant captain would straightaway know my order when she saw me. When I was not meeting clients, I would dine there alone. The assistant captain and her staff would seize the chance and come over to chat. Soon, we got on more familiar terms. She then told me about the restaurant manager whom she said was not living up to his title. Despite being a manager, he did not set a good example. He failed to lead his staff and mange the restaurant well. Instead, he would come to work late, leave early, and often disappeared during the restaurant’s peak period. He also enjoyed telling dirty jokes to young pretty female staff, etc. After listening to her, I asked if the boss knew about it. She replied that it was not the culture of a Japanese company to dismiss its employees. I saw that she was not recognised for her contribution despite being a responsible and hardworking staff. Therefore I use the prowess of my sight and took a glance at the restaurant manager. Thereafter, I told the staff that the manager would soon be made redundant. The truth is, not long after my prediction, the restaurant manager indeed got the sack from the company.
I was invited to a flat unit situated in the North-eastern part of our country, to provide divination service. The session was not meant for the lady owner of the house, but for a lady friend whom she had known for many years. I was seated on the sofa, and chatting with the lady owner while waiting for her friend to arrive. We waited for some time before her friend finally came. The lady owner was the boss of a maid agency, and that explained the many maids undergoing training in her house.
When the session with her friend ended, I spotted one particularly “extraordinary” maid among the group smiling slightly at me. Because of her "extraordinariness", I immediately advised the lady owner to keep this maid by her side always and not refer her to others. Naturally, she asked me why. I remembered telling her, " This maid would be of help to you in time to come." Many years later, misfortune struck and this lady boss was left with only $40 in her possession. This maid not only stayed with her but also bought meals for the lady boss with her own money. The lady boss recounted this incident to me and was grateful for my advice. She finally understood the reason for my advice to keep this “extraordinary” maid by her side.
Our every deed, virtuous or non-virtuous, our every motive and future development, are all clearly “written” on our faces. One who knows how to read these signs can be regarded as an accomplished face reading expert. This ability is also known as having the penetrating knowledge of the mind. A human's face is like a weather station. When a person is grieving, the face shows a gloomy day. When a person is enraged, the face is stormy with hurricanes or roaring with thunder. (laughs) When When he is happy and joyful, the face will show a clear day, with even the sun riding high in the sky. When he is in a romance, the face will show signs of Spring. When he is successful in his career and his business raking in the profits, it is summer time on the face. When he is pensive and worrisome, the face becomes autumn-like. And when he is fraught with challenges and stricken by ailments, the face will manifest the winter season. The face of the Pokka Cafe’s manager was showing auras of Autumn and Winter. That was why I boldly predicted that he would lose his job soon. On the other hand, the face of the “extraordinary” maid was showing a clear day. Hence I advised the lady boss to hold on to her. Should you have doubts on who to employ, I, Master Dai Hu, am your first choice for advice!
*********************
【開放預購】PRE-ORDER OPEN
《向善向上 2》Towards Kindness, Towards Betterment 2
心可造天堂,心可造地獄。
改命必從心起,改運必先行動。
30則真人真事的度眾故事 30 real-life deliverance stories of Master Dai Hu
全彩色的漫畫 Comics in full colour illustration
中英文翻譯 In both English & Mandarin
192頁 192 pages
此書將於2018年11月底印刷完畢,目前開放預購,預計12月15日之前以Smartpac寄出 (本地郵寄),屆時也會在台灣金石堂書局同步上架。價格大眾化,包涵全球運送,無需再付郵資。
歡迎大家踴躍支持,人手一冊,也可將此書贈送給鄉親父老、親朋好友,帶領他們向善向上,迎接更美好的未來!
https://booklaunch.io/masterdaihu/towardskindness2
.
The mind can create Heaven. It can also create Hell.
Transformation of your destiny begins from your mind.
Transformation of your luck begins from taking action.
My new book should reach the shores of Singapore in 1st week of December 2018. Pre-order is now open and the books are estimated to be mailed out through Smartpac, by 15 December. At the same time, it will be on the shelves of Taiwan KingStone bookshops.
The economical price includes global delivery (Smartpac mailing for Singapore addressees, registered mail for overseas mailing).
Looking forward to your enthusiastic support! May everybody has a copy and gift copies of this virtuous book to your family and friends and together, embrace a beautiful future!
https://booklaunch.io/masterdaihu/towardskindness
copies單位 在 CLC Library - We get pretty excited when copies of Lab... - Facebook 的推薦與評價
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