長賜輪在蘇伊士運河擱淺後,綜合外電報導的省思:極限邊緣的船舶操縱,科學與安全之間給”人的反應”留下多少”餘裕空間?

航行員都知道:在有限水域中的船舶操縱與大洋中的船舶操縱有極大的差別,也因此而產生一些”異常反應”的專有名詞,譬如:淺水效應,岸吸/岸推,船體下坐(Squat),狗頭嗅地(Dog smelling),單俥右旋船在淺水區倒俥時之船頭可能向左,主要的原因都是來自船舶四周的海水,來不及湧入去填補船艉所造成之空穴.

也因為這個緣故,Suez Canal當局對過河船隻有一些船寬,吃水,速度上的限制.基於經濟上的考慮,可以想像這些限制都是在”水工模型”下最大化的尺度界線.(越大的船過河費越貴),然而這些都是理想環境下的科學論證,實際上船舶操縱者的精神狀態,駕駛台的氣氛環境,外界視線,無線電之干擾,Marlboro菸未如預期,住艙走廊上”波斯市場”的氛圍….都在影響著”駕駛台資源管理(BRM)”,而使得船舶之實際Performance遊走在”紅線”邊緣,更糟的是一但越過紅線(Point of non-return),情況就越來越糟,猶如在山脊上騎腳踏車.

這次的重大意外,在檢討”船舶因素”之外,蘇伊士運河當局也應該重新考慮”紅線邊緣的緩衝區”是否應適度放寬,以因應船舶無止境的大型化,因應極端氣候下的異常天氣,因應新世代船員之特性,另外也可考慮在駕駛台放一箱Marlboro,讓有需要的人看自己包包大小量力自取,畢竟比起全球供應鏈上的損失,這都是微不足道的”潤滑油”.不是嗎?

The Suez Canal Authority occasionally brings out updated tables of width and acceptable draft for ships. Currently the permissible limits for suezmax ships are 20.1 m (66 ft) of draught with the beam no wider than 50 m (164.0 ft), or 12.2 m (40 ft) of draught with maximum allowed beam of 77.5 m (254 ft). Due to their design and size, a large number of ports around the world can accommodate suezmax vessels.
17,65 56,96
, a new set is being built for vessels as large as 366 meters in length, 49 meters in beam and 15.2 meters in draft at tropical frvessel.
That would have surpassed the speed limit of about 7.6 knots (8.7 miles an hour) to 8.6 knots that is listed as the maximum speed vessels are “allowed to transit” through the canal, according to the Suez authority’s rules of navigation handbook posted on its website. Captains interviewed for this story said it can pay to increase the speed in the face of a strong wind to maneuver the ship better.
“Speeding up to a certain point is effective,” said Chris Gillard, who was captain of a 300-meter container ship that crossed the Suez monthly for nearly a decade until 2019. “More than that and it becomes counter effective because the bow will get sucked down deep into the water. Then, adding too much power does nothing but exacerbate the problem.”
“You might find yourself positioning the ship in one direction, and you’re actually moving in another direction,” said Kinsey. “There’s a very fine line between having enough speed to maneuver and not having too much speed that the air and hydrodynamics become unstable. Any deviation can get real bad real quick because it’s so tight.”

The accident will be a missed opportunity if the industry doesn’t adapt, he said. “There will be vessels larger than this one that will be going through the Suez,” he said. “The next incident will be worse.”

• The Ever Given's speed was 13.5 knots before it ran aground, The Japan Times reported.
•
• Bloomberg reported the Suez Canal speed limit was between 7.6 knots and 8.6 knots.
The Ever Given didn't have a tugboat escort through the canal, according to Bloomberg. The two ships immediately ahead of it reportedly had escorts, although such escorts were not required.

【踮起腳尖痛，腳踝也會有夾擠問題？】

(這次文章內容稍長，若懶得看文字內容可直接觀看影片)

大家應該對於肩夾擠、髖夾擠這兩個名詞不陌生，但你有聽過腳踝夾擠嗎？夾擠指的是我們的骨頭過度擠壓到周遭的軟組織，可能是肌腱、韌帶或是滑液膜等等，造成疼痛或角度受限。夾擠是一個症候群，並非一個特定的病症，夾擠症候群底這個名詞底下，可能夾到的組織不同，造成的原因歧異度也非常大，造成評估上其實並不是那麼容易。腳踝夾擠雖然沒有像肩夾擠一樣有被正式分類成不同的夾擠類型，但仍能根據症狀呈現的方式跟解剖構造簡單分為前夾擠跟後夾擠，若還要再細分還會分前內側、前外側夾擠，以及後內側、後外側夾擠。

前側夾擠的症狀主要出現在腳踝背屈末端角度的時候，脛距關節 (Tibiotalar joint) 前側的組織受到擠壓。腳踝前側的有不少脂肪、滑囊組織，正常情況，這些組織會在腳踝背屈15度過後受到擠壓，但如果在遠端脛骨前側或是距骨頸有增生的骨頭的話，便可能限縮前側的空間，讓組織提早受到壓迫。如果長期在這角度下活動，就可能進一步造成慢性的發炎，或是造成關節囊韌帶的增生。除此之外，如果腳踝曾經扭過傷，造成韌帶或皺襞增厚的話，也是可能造成前側夾擠的原因之一。

雖然這些解剖構造上的變化已有多篇文章有所描述。但造成這些組織增生的原因卻仍不是很清楚。因為運動員有比較高的比例有這樣的問題，有些學者認為前側夾擠可能是因為頻繁地做出大角度的背屈，或是因為運動過程中受到的外力，讓前側軟骨邊緣反覆受到衝擊所造成。也有些學者認為，踝關節的不穩定，造成關節有不正常的微小滑動，也是一個可能造成骨質增生、或是軟組織受到夾擠的的原因。另外在比較早期的文章，一開始學者認為前側的骨質增生可能是來自於頻繁地蹠屈，牽拉到關節囊，進而造成關節處的增生，只是這樣的假設被後來的研究給推翻了。

因為前側夾擠症狀大多是在腳踝背屈的末端角度下出現，上樓梯、跑步、走上坡、爬梯還有深蹲是幾個比較容易會加劇前側疼痛的活動。若未接受妥善治療，在症狀後期可能會因為組織的增生或疼痛，造成更進一步的活動度受限、夾擠和周圍組織的傷害，再回頭限制關節活動度與功能，形成惡性循環。

後側夾擠的症狀主要出現在腳踝蹠屈到末端角度的時候，脛距關節與距跟關節後側的組織受到擠壓。後側夾擠常出現在需要頻繁把腳踝往下壓的人身上，像是芭蕾舞者、需要頻繁跳躍的運動員等等。與前側夾擠雷同，後側夾擠可能是骨質或是軟組織的夾擠，或是兩者同時存在。距骨後外側 (trigonal process) 的骨質增生是比較常被認為導致後側夾擠的原因。除此之外，頻繁的將腳板大幅度的往下踩，可能會導致後側關節囊、後下脛腓韌帶、三角韌帶的後側韌帶發炎，產生疤痕組織，進而造成組織增厚。另外我們的屈足拇長肌的肌腱經過距骨後側的內、外骨突中間的凹槽，也很容易因為過度使用，或是周遭骨質的增生，造成肌腱病變，像是肌腱或腱鞘炎的問題。

與前側夾擠的疼痛大多較為淺層、可觸摸的到相反，後側夾擠的症狀通常較為模糊，比較難有一個特定的單點疼痛，而且位置較深，通常落在阿基里斯腱底下。這也讓後側夾擠不容易和阿基里斯腱或是腓骨長肌的問題做區分。因為症狀出現在腳踝往下踩的時候，走下坡、下樓梯或是穿鞋跟較高的鞋子是幾個容易誘發症狀出現的活動。芭蕾舞者之所以比較容易出現這樣的症狀，被認為是因為需要頻繁的做出踮腳站，承重在前足的關係。

雖然影像檢查出來的骨質、軟組織的病變被認為是可能導致腳踝夾擠的原因之一，但實際上研究還是有提到，我們仍然不能光靠這些影像結果證據就判斷踝關節是否夾擠。影像檢查與我們的症狀表現之間的相關程度有限，仍需要結合其他理學檢查做綜合判斷才行。針對踝關節夾擠的介入，目前比較常見的作法仍是先採取保守治療，若在急性疼痛期，需要先避免會造成疼痛的動作，有必要的話也會使用消炎藥來控制疼痛。在非急性期，甚至是已經是慢性問題的個案，我們則需要著重在踝關節穩定、本體感覺的訓練上，畢竟前面有提到，踝關節不穩、扭傷都是可能造成夾擠的原因之一。與其他肌肉骨骼問題一樣，即使解剖構造上的異常也會被認為是造成踝關節夾擠的原因，但大多數的個案都能在不開刀的情況下有很好的進步。若有類似的狀況，一樣記得先找醫療人員的協助，避免症狀隨著時間越變越嚴重。底下的影片 (6:52) 將跟大家分享幾個簡單的踝關節穩定與本體感覺的訓練。

Impingement syndrome is a common musculoskeletal problem in shoulder and hip joints. But have you ever heard of ankle impingement? Impingement syndrome refers to abnormal contact of bony structures or soft tissue, e.g., tendon, ligament, synovial tissue, resulting in pain and restriction. Through different causes of impingement syndrome, it includes different medical signs or symptoms. Therefore, causes of impingement syndrome differ from person to person, making it more difficult to make a right diagnosis. Although ankle impingement is not officially classified into different types like shoulder impingement, researchers still sort it into anterior and posterior impingement according to anatomical structures are involved. More specifically, it can be classified into anteriomedial, anteriolateral, posteriomedial and posteriolateral impingement.

Symptoms of anterior ankle impingement are generally induced by compression of anterior margin of tibiotalar joint in terminal dorsiflexion. There are adipose and synovial tissues in the anterior joint space. Normally, these tissues are compressed after 15 degree of dorsiflexion in healthy individuals. However, if there is osteophyte at anterior distal tibia or talus neck, it will take up the space and limit ankle movement, causing early compression. This will result in chronic inflammation, synovitis, and capsuloligamentous hypertrophy. Apart from this, ankle sprain, thickened anterior tibiofibular ligament and synovial plica are also possible causative factors.

Even though structural pathologies are well described in much research, their exact etiologies are still less understood. Research showed that athletes are tend to affected by anterior impingement, and it led to hypothesis that pathologies are caused by repetitive impact injury to anterior chondral margin from hyper-dorsiflexion or direct impact during sports. Chronic ankle instability has also been hypothesized to be the causative factor of anterior impingement, because abnormal repetitive micromotion may develop bony and soft tissue lesions. In addition, early research hypothesized anterior osteophyte is caused by traction to the anterior capsule during repetitive plantar flexion, but this theory was disproved by later anatomic studies.

Anterior impingement symptom typically presents as anterior ankle pain during terminal dorsiflexion. Climbing stairs, running, walking up hills, ascending ladders and deep squat are common aggravating activities. If anterior impingement doesn’t get treated well, in the later stage, joint mobility may be further restricted due to mechanical block or pain, resulting in vicious circle.

Posterior ankle impingement symptom typically occurs in terminal plantarflexion, due to compression of tissues posterior to the tibiotalar and talocalcaneal joint. Posterior impingement tend to occur in athletes who need to plantarflex frequently, like ballet dancers, etc. Similarly, posterior impingement can result from compression of bony or soft tissue in isolation or in combination. Trigonal process of posterior talus is the most common cause of posterior impingement. Besides this, repetitive hyper-plantarflexion may cause posterior capsule, inferior tibiofibular ligament, and posterior fiber of deltoid ligament inflammation, scarring, and thickening. Lastly, tendinitis and tenosynovitis are easily found in flexor hallucis longus tendon, running between the medial and lateral posterior process of the talus. This probably results from overuse or irritation from surrounding abnormal bony tissue. The tissues mentioned above are all possible causative factors to the posterior ankle impingement.

In contrast to patients with anterior impingement pain that are accessible to palpation, posterior impingement pain is less specific, deep to the Achilles tendon. This makes it difficult to differentiate from Achilles tendon or peroneal tendon pathology. Since posterior impingement symptom is usually irritated by repetitive plantarflexion, walking downstairs, downhill running, and wearing high-heeled shoes are some common exacerbated activities to posterior impingement syndrome. Ballet dancers are commonly affected by posterior impingement syndrome due to weight bearing on forefoot in plantarflexion position over and over again.

Though osseous or soft tissues abnormality in radiography is seen to be one of the causes of ankle impingement, it doesn’t mean that we can simply blame patient’s symptom on these structural pathology. In fact, there is a limited correlation between medical image findings and our symptom. We should integrate patient’s history, physical examination, imaging studies, etc., for accurate diagnosis. Conservative treatment remains first option to manage ankle impingement. In acute stage, patient should avoid from doing provocative activities. If it is necessary, NSAIDs can be used for pain management. In chronic stage, clinicians should focus on ankle stability and proprioception training because ankle instability and sprain are both causative factors of ankle impingement. Just like other musculoskeletal disease, even though structural abnormality is thought to be a possible cause of ankle impingement, most ankle impingement cases still respond well to conservative treatment. If you have any similar medical problem, please find medical professions for help. The video below will show you some simple ways to train our ankle stability and proprioception.

參考資料：
https://pubmed.ncbi.nlm.nih.gov/27608626/
https://link.springer.com/article/10.1007/s00247-019-04459-5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065672/

#腳踝夾擠 #踝關節不穩 #腳踝扭傷 #本體感覺訓練 #物理治療 #ankleimingement #ankleinstability #anklesprain #proprioception #physiotherapy #hunterptworkout

｜Ze and Zir｜
　
今年受邀參與韓國 Asia Culture Center 的展覽《Solidarity as Spore》，主題為各種形式的愛（Love: in all its forms and inclusivity) 。2019年，台灣成為亞洲第一個同性婚姻合法化的國家，同一年，Ze 與 Zir 在 2019 年正式收錄於牛津英語辭典，將特指單一性別的 He or she 取代成中性的代名詞。作品也類比成華文的「也」，取下「他」或者「她」的性別部首符號，作為這次創作的核心理念。
　
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二元社會性別是所有性別問題的根源，當人們選擇成為伴侶、選擇衣著、選擇以一種特定形象生活時，捨棄掉性別的標籤就可以超脫目前所有的問題，我們不需要透過刻板印象來建立自我價值，自己可以隨意建立個人識別象徵而不需要參考模範，滿足任何有限的想像空間。
　
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作品呈現三幅動態視覺系列稿，同時在垂直並排的三面螢幕重複播放，它們各自擁有不同的主題。打破性別刻板印象，沒有男孩應該要做什麼，女孩應該要做什麼，呈現更自由的性別氣質與性向。女人不用一定要穿高跟鞋，男人也可以喜歡化妝。
　
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最後，一個彩色的玻璃球穿梭在各個畫面中，打破界線劃破三個螢幕的彩色玻璃球，劃破時間與空間。
　
｜Sydney Sie / Zen Yun Zon,
｜Ze and Zir, 2020. Three-channel
｜video, color, silent, 2 min.
｜Commissioned by Asia Culture
｜Center; courtesy of the artist.
｜Special Thanks: 親愛的 Aaron Nieh (✾♛‿♛) 聶永真 Aaron Nieh / Elise Chen
　
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If there were no genders, it should not cause any troubles to say “ze has loved cars since childhood”, “ze dreams to become a ballet dancer”, or “ze loves zir deeply and wants to spend zir life with zir”.
　
Gender binary is the source of all gender troubles. If people could choose to become partners, how to dress and how to present themselves in life without gender labels, then we no longer need to establish self-value by conforming to gender stereotypes. An individual could build a personal image freely without referring to gender roles and instead according to their unlimited imagination.
　
Taiwan became the first country in Asia to legalize same-sex marriage in 2019. In the same year, the Oxford English Dictionary update included gender-neutral third-person pronouns Ze and Zir. With a similar spirit, we experiment with removing the radicals of Chinese characters “他(he)”/“她(she)”, reinventing the character “也” as the potential gender-neutral pronoun and using it as the core concept of this creative project.
　
The work consists of three moving posters, which will be displayed in loop on three aligned, vertical screens, each with a different theme. We incorporate elements of gender stereotypes in these images while seeking to break the traditional gender framework through a visual dynamic, as well as to discover more freedom in gender expression. There is no “should”; women don’t need to wear heels and men can enjoy putting on makeup.
　
Lastly, a colorful glass ball travels through the images on the screens, metaphorically crossing the boundaries of time and space.
　
————————————————
● Solidarity as Spore
● Dates: May 14–October 25, 2020 (opening May 13)
● Venue: Asia Culture Center (https://new.acc.go.kr), Gwangju, South Korea
● Organized by: Asia Culture Institute (​http://aci-k.kr​) and Asia Culture Canter
● Artistic director: Kim Sung Won
● Contributing curators: Bojana Piškur, Vali Mahlouji, Museo de la Solidaridad
Salvador Allende, Sulki and Min, Goto Tetsuya, Kim Seong Hee, and Seo Dongjin
● Overarching theme: history of Non-Aligned Movement and its relevance to the
contemporary artistic practice in Asia
　
Section Participants
● Bae Minkee (Seoul, South Korea)
● Gideon Jamie (Singapore)
● So Hashizume (Tokyo, Japan)
● Saki Ho (Hong Kong, China)
● Hong Eunjoo (Seoul, South Korea)
● Sueh Li (Kuala Lumpur, Malaysia)
● Scarlett Xin Meng (Shanghai, China)
● Rikako Nagashima (Tokyo, Japan)
● Nguyen Giang (Ho Chi Minh City, Vietnam)
● Januar Rianto (Jakarta, Indonesia)
● Shin In-ah (Seoul, South Korea)
● Sydney Sie and Zen Yun Zon (Taipei, Taiwan)
● Yui Takada (Tokyo, Japan)

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