【 週五，跟著霍華看產業趨勢 | Follow Howard C. for business 】

在接軌下個世代的路上，台灣究竟扮演著什麼樣的角色? 看似穩定成長的台灣，其實在整體經濟發展是不平均的，以工業、製造業為主的台灣，在數位、產品行銷、組織轉型的人才相對缺乏，為了因應接下來的挑戰，我們必須先行做好準備，一起來看看麥肯錫怎麼說吧！
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On the way for connecting next generation, what is the role of TAIWAN? What kind of position that we are? TAIWAN seems develop sustainably in the economic growth, but we are disequilibrium in this business environment. Actually Taiwan is focusing on manufacturing, as a result, we are lack of talent in digital, product marketing and organizational transformation. In order to face the challenge, we need to prepare our mindset and knowledge first, so now , let's take a look from Mckinsey :)

#HCC #BusinessTime #FutureTrend

The Taiwan story is one of the greatest economic stories in the world. Today it’s the 22nd largest economy globally. It’s one of the largest exporters in the world as well. And it controls the fifth largest foreign exchange reserves.

It’s been a remarkable story, and yet today, Taiwan is falling behind. If you look at labor productivity, Taiwan lags behind the US, Japan and other similar economies. Even high tech, Taiwan’s leading sector, lags behind other major economies in terms of labor productivity.

In this short video, Albert Chang, Managing Partner of McKinsey Taiwan, explains why he believes Taiwan needs nothing less than a digital revolution to revitalize its economy.

台灣是舉世矚目的經濟奇蹟，全球第22大經濟體, 也是全世界最大的出口國之一。坐擁全球第五大外匯存底，令人稱羨的成績得來不易，然而目前卻呈現落後狀。以勞動生產力為例台灣落後於美國、日本和其他類似經濟體. 甚至高科技這個領先產業，相較於其他經濟體，台灣高科技產業的勞動生產力也呈現落後。

加護病房查房日誌20180321
大家有沒有聽過? Dialysis disequilibrium syndrome(DDS)?洗腎不平衡症候群?這是在洗腎的時候，可能因為滲透壓的不平衡，導致的一種情況，可能會seizure等症狀。
今天老師要跟大家分享如何預防DDS。
首先甚麼樣的族群呢?是每個洗腎的人都要嗎?
建議是要針對高風險的人，特別是第一次洗腎，BUN特別高，或在洗腎時會出現一些神經方面的問題。
最重要的預防監測指標為限制在治療時的BUN下降，建議是數天內慢慢地下降比較好。
那要怎麼做呢?
1. 洗腎的時候，在剛開始的前兩個小時，盡量用相對低血流速，150 to 250 mL/min，搭配小的surface area dialyzer (0.9 to 1.2 m2)。
2. 病人應該連續三到四天重複洗腎，不過要依照病人臨床的反應進行調整，如果病人沒有任何DDS的症狀，血流速可以每次治療時提50 mL/min，最高300 to 400 mL/min，而且洗腎的時間可以慢慢增加30分鐘，最高到四小時或更多，依照適當移出的溶質情況而定。
3. 若病人有明顯體液過多情況，可以用ultrafiltration治療，這個可以減少移出尿素的量，而且對血漿的滲透壓改變不大。
4. 若病人有顯著的增加BUN或神經學症狀，應該讓病人住院期間洗腎，比較安全。
以上是uptodate的說法，也有醫師會用在透析時注射mannitol (1 gm/kg/次透析)，最近老師還遇到使用D50W注射，這些也都可以。
看看大家對於這樣的做法，有沒有甚麼經驗，或是甚麼病人會使用mannitol?歡迎大家在底下留言分享喔。
圖片來源: http://www.netdoctor.co.uk/…/liver-kidney-a…/a3034/dialysis/
#腎臟透析

New Renaissance can reform global nations peacefully and digitally

Your esteemed institution will dominate think tank industry with my 4 plans that surely will attract more donation and create New Renaissance to reform China, North Korea and global nations peacefully and create $30 trillion dollars new revenue annual. 4 plans and the new management science will speed global development with prosperity, peace and health for new civilization.

I would like to introduce new management science and technology before the 4 plans that everyone will have equal opportunity to contribute in community and play a role in decision making with direct democracy in order to regulate perceived disequilibrium in human civilization. New management science of direct democracy will not put cat and fish together that is the only way we can keep financial discipline and transparency. Direct democracy is not campaign in every 4 years. It is new life in ICT century. The new management system can sell itself due to the benefit is huge that will create New Renaissance for peace, health and prosperity.

We are so blessed and so lucky to live in ICT era that systematically reform is a matter of finger tips. Human thought and information can transfer so fast and so massive that can perform direct democracy easily with ICT platform. It can start with housing and facility management industry that global residents in housing communities can perform direct democracy to form a global trend of new politics and new management science. We can create equal opportunity in different agendas with ICT platform that will liberate global productivity and lift efficiency to create new revenue $30 trillion dollars in New Renaissance.

Most communities, cities and nations will enjoy the new infrastructure of cloud conference in ICT platform for new management system that can stop human ordeals in politics, finance, education, ecology and economy. New generation will live in prosperity, peace and health with new management science. China reformed in 1980’s with global synergy platform to lift economy tremendously. New Renaissance with new management science will reform global nations in economy, education, politics, ecology and other different agendas that we can cross barrier of time and space to explore new worlds. If we adopt the new management system of direct democracy, we shall live peacefully in New Renaissance that people will not snipe at police any more.

Your institution can lead global think tanks, communities, governments, and enterprises in New Renaissance. It not only will reform management system but also will increase 40% productivity globally that equal to lift $30 trillion dollars revenue annual plus to save resources wasted in mismanagement. Direct democracy is green management for global sustainable development.

ICT sponsors will donate $30 million dollars to the institution annual that can promote New Renaissance and create $3 trillion dollars revenue annual for ICT industry. ICT can fabricate new platform of cloud conference for direct democracy that can apply in housing and facility management industry globally before it can lift to city level, national level and UN level eventually.

A housing community is a small nation. Nation will change when communities change. Residents in housing communities will enjoy surfing new management system to solve unrest and create pleasant environment. New Renaissance will start in housing communities and lift to higher levels accordingly. It will be a project that sells itself and build 200 ICT platforms globally. Each platform will be at the size of Facebook.

Since we can trade stocks directly in NASDAQ, why can’t we use civil power directly in cloud government and cloud conference? Initially we can operate both cloud conference and reality conference synchronously like Dow Jones operating both cloud trading and floor trading. NASDAQ has never operated floor trading since establishment. Literally politics is like the stock exchange. We can trade without brokers in stock exchange as well as in politics.

Everyone has access to information that information can spread massively and quickly without limit of time and space. Global development is the task of how to apply with synergy ICT platform for human activities especially for the public affairs that can lift efficiency, productivity and revenue with new management system to achieve prosperity, peace and health globally.

I am glad to learn we pursue the same goal and we might choose the same approach when we find polluted air in China and India can spread to Japan, America and Europe at the speed of hundreds miles per hour along jet stream in 6 miles height. Particles in polluted air can damage human health as well as catalyze extreme weather globally. We can benefit or hurt consequently with all events happening on the Earth.

What if African will pollute air and water seriously like China and India have done? How soon the Earth will become uninhabitable? Our knowledge and experience convince us the global is a holistic life body. Development should prevent from damaging the holistic life body. We had to protect the holistic life body by all means with new ethics and new code of conduct for sustainable development. The best way to achieve the goal is to operate new management system on ICT platform globally that all people can contribute and play a role in decision making. Everyone can watch, report and maintain the health of the holistic life body in every corner of the Earth without limit of time and space.

New management system and ICT platforms rely on consistent electric power supply. We need to develop green energy as electric power industry is major factor of pollution and global warming. Most energy in nuclear power plant has been applied to heat up sea water and vaporize into the sky that can rise up temperature seriously. Green energy and green management undoubtedly are strong pillars to support sustainable development for the holistic life body.

With continuous high growth rate, Africa has become new engine to pull global economy. Walmart is landing in Lagos. Major manufacturing facilities moved to Africa like Japan Panasonic. Chinese companies have operated in Nigeria since 1980’s. I met chiefs of CCECC in 1982 when they started water bore hole contracts in Lagos and looked for railroads contracts.

Plan 1 is to construct river flow power plants combining irrigation canals in Nigeria with water flushing out of existing hydro generators to rotate river mills for additional 30,000 MW that equals to 20 nuclear power plants. It can irrigate farms for 30 million tons rice annual to improve food shortage and inconsistent power supply not mentioning to create huge employment. Plan 1 is a project of one stone for many birds.

A river generator can be installed in every 7 meters along irrigation canal with minimum water flow at 5 tons per second. 1 KM canal with slight slope at 0.3% can install 140 units of river flow generators at 15 KVA through 150 KVA each depending on water flow. 1 KM canal can equip 2 MW through 20 MW that 1,000 KM canal can install 2,000 MW through 20,000 MW.

In 1920’s Japanese engineer Yoichi Hatta built Wusanto Reservoir in Taiwan with irrigation canal 7,400 Km for rice farm of 145,000 hectares that could reap 3 times annual. Land, water and good weather are available in Nigeria that can develop farms of millions hectares with irrigation canals and river power plants. One hectare farm will produce rice 18 tons for 3 reaps annual.

Plan 1 can change Nigeria and Africa and benefit the global ecologically. USA and China compete in Nigeria and Africa very hard. China promoted railroads construction with loan at $6 billion dollars. IMF offered direct loan to governors at $3.2 billion dollars. I heard GE tried to involve in the railroads construction. Japan plans to invest $30 billion dollars in Africa. Employment, sufficient food and consistent power supply can support Nigeria to lead Africa nations to join the New Renaissance for global peace and sustainable development.

Dangote is an aggressive entrepreneur who might join us for Plan 1. He ranks 25 richest people and is nephew of my friend, Alh. Abdul Dantata. When I was in Nigeria, Abdul gave me his driver Alh. Uba who used to buy ice bars for young Aliko Dangote. Dongote cement can benefit since Plan 1 will need huge cement for river power plants and irrigation canal.

Dangote will donate generously if we can initiate Plan 1 with him and Nigeria president Buhari who is lack of convincing economy policy that a hot pot of food on fire becomes popular target of thieves. Buhari can use Nigerian agric bond to attract investors and complete Plan 1 if he can apply leverage properly. Global donors will support green energy industry in Nigeria if Buhari can show his determination. Good plan, advanced management and talent people will create hope and confidence for a nation and the world.

Plan 1 will attract $1 billion dollars donation and create annual revenue $10 trillion dollars in Africa. The core value of Plan 1 is by all means to prevent Africa from pollution and global warming like China and India. Eventually Plan 1 will attract investors to build river flow power plants with 700,000 MW globally that equal to 400 nuclear power plants. Irrigation canal will boom agric and housing communities synchronously that can develop new cities to attract investors and migrants for new economy in Nigeria and Africa.

European nations will collaborate to construct river power plants with irrigation canal for agric in Africa and in the Middle East to improve economy, ecology and peace. It can reduce refugees flooding into Europe like fleeces. Hopefully it will stop casualty drowned in the Mediterranean Sea.

Big waves attract great surfers. Great surfers can't attract big waves. Good leader can see the trend and keep right direction for delicate surf. I can see 4 trends are going to surge into big waves where we can approach for delicate surfs. New Renaissance will surge with ICT that can promote new platforms for communities, governments and public companies globally. The institution will rank as the 1st think tank in the world if leaders can find new trends of big waves and lead all teams to surf delicately.

Plan 2 is to reform China peacefully with 2 tactics that will turn China into a positive power for regional peace as well as free market for global enterprises. China market is still inaccessible to Facebook, media industry and many other sectors who are looking for tickets to China. They might join us if they learn our plan can benefit them hugely. Apple and Google have been tumbling in China from time to time. Donors from ICT industry and different sectors will donate $3 billion dollars for Plan 2 that will create $10 trillion dollars revenue annual.

Plan 2-1 is to reform China peacefully with platform of cloud conference in housing community management with direct democracy. It will support liberal leadership to emerge in China and open gate wider for global enterprises duly. How can we reform China into democracy when there is only one communist party? No matter one party or no party, residents in housing communities can use cloud conference to perform direct democracy that will create internal climate for liberal leadership.

Plan 2-2 is to mobilize people in global nations to carry out judiciary project in local courts and subvert the apex policy of China i.e. to occupy Taiwan. China has been lying that Taiwan is part of China and there is only one China. Most nations have tolerated Chinese lies for some benefit but lies can’t last forever when global people feel it is enough. Lie can’t never become the truth.

There are extreme groups against China in most nations. They can have suits in courts to win the verdict that Taiwan is not part of China and there are two China in the world. There is nothing wrong to have two China since there are two Congo and two Korea in UN. Nigeria is the only nation considers two China and accept Taiwan to register in the name of the Republic of China in Nigeria. The verdict surely will discredit leadership in Beijing and bring stronger impact than the South China Sea Arbitration has done. It will split leadership in Beijing and support emergence of liberal leadership.

Justice of speech is as important as freedom of speech. It is new trend in ICT century that human can solve global conflicts with judiciary power and public opinions instead of wars. Verdict of Plan 2-2 will become huge external power to shake dictatorship in Beijing that can collaborate with internal pressure from direct democracy in housing communities of Plan 2-1. Plan 2 will catalyze emergence of liberal leadership and lead China to join New Renaissance.

Plan 2 will reform China and North Korea with direct democracy and judiciary power peacefully that will attract $3 billion donation and create $10 trillion dollars revenue annual. Taiwan people can donate $1 billion dollars referring to Taiwan people donated $252 million dollars in 2011 for Japan tsunami.