OET READING PRACTICE EBOOK

This book contains 24 full OET reading tests. Now

you can easily print it out and use it as a practice
book. As the available OET reading materials in
online are haphazard, I took the initiative to organize
them and make some full tests in a single pdf/book
so that we can easily practice and can print it out. All
the full tests may not be the same as the originial
tests but they resemble original tests and of course
are part of originial tests.
With thanks

Dr. kasfat
DHAKA, BANGLADESH
 FULL TEST 1
Reading Test 1 – Part A Time allowed: 15 minutes

• Complete the following summary using the information in the four texts provided. • You do not need to read each text from
beginning to end to complete the task. You should scan the texts to find the information you need. • Gaps may require 1, 2 or
3 words. • You should write your answers next to the appropriate number in the right-hand column. • Please use correct
spelling in your responses.

TEXT 1

Alcohol Related Brain Impairment (ARBI)

Alcohol is one of the many causes of acquired brain injury. The injury inflicted by alcohol misuse is called alcohol related brain
impairment (ARBI). A person with ARBI might experience problems with memory, cognitive (thinking-related) abilities and
physical coordination.

More than 2,500 Australians are treated for ARBI every year, with approximately 200,000 Australians currently undiagnosed.
Around two million Australians are potentially at risk of developing ARBI due to their drinking habits.

Just how much damage is done depends on a number of factors. These include individual differences, as well as the person’s
age, gender, nutrition and their overall pattern of alcohol consumption. A younger person has a better chance of recovery
because of their greater powers of recuperation. However, the effects of ARBI can be permanent for many sufferers.

Alcohol and brain injury Brain injury can be caused by alcohol because it: • Has a toxic effect on the central nervous system
(CNS) • Results in changes to metabolism, heart functioning and blood supply • Interferes with the absorption of vitamin B1
(thiamine), which is an important brain nutrient • May be associated with poor nutrition • Can cause dehydration, which may
lead to wastage of brain cells • Can lead to falls and accidents that injure the brain.

Treatment A person with suspected ARBI needs to be assessed by a neuropsychologist. Treatment depends on the individual
and the type of brain damage sustained.

TEXT 2

Health benefits of alcohol

Very moderate amounts of alcohol (around half a standard drink a day) may provide health benefits for some middle-aged or
older people by reducing the risk of some types of cardiovascular disease. However, people who do not already drink alcohol
are not encouraged to take up drinking just to get some health benefits.

Recent scientific evidence suggests that the potential for health benefits may have been overestimated in earlier studies.
Possible benefits need to be balanced against the risk of cirrhosis, some cancers and other diseases (which becomes greater
with increased alcohol consumption).

The same benefits do not extend to younger people. Drinking alcohol can affect how the brain develops in people under the
age of 25. Teenagers under 15 years of age are particularly at risk.

TEXT 3

Australian guidelines to reduce health risks from drinking alcohol

Alcohol has a complex role in Australian society. Most Australians drink alcohol, generally for enjoyment, relaxation and
sociability, and do so at levels that cause few adverse effects. However, a substantial proportion of people drink at levels that
increase their risk of alcohol-related harm. For some, alcohol is a cause of significant ill health and hardship. In many countries,
including Australia, alcohol is responsible for a considerable burden of death, disease and injury. Alcohol-related harm to health
is not limited to drinkers but also affects families, bystanders and the broader community.
These 2009 National Health and Medical Research Council (NHMRC) guidelines aim to establish the evidence base for future
policies and community materials on reducing the health risks that arise from drinking alcohol. The guidelines communicate
evidence concerning these risks to the Australian community to allow individuals to make informed decisions regarding the
amount of alcohol that they choose to drink.

Research since the previous edition of the guidelines in 2001 has reinforced earlier evidence on the risks of alcohol-related
harm, including a range of chronic diseases and accidents and injury. The new guidelines take a new approach to developing
population-health guidance, which:

• goes beyond looking at the immediate risk of injury and the cumulative risk of chronic disease, to estimating the overall risk
of alcohol-related harm over a lifetime

• provides advice on lowering the risk of alcohol-related harm, using the level of one death for every 100 people as a guide to
acceptable risk in the context of present-day Australian society

• provides universal guidance applicable to healthy adults aged 18 years and over (Guidelines 1 and 2) and guidance specific to
children and young people (Guideline 3) and to pregnant and breastfeeding women (Guideline 4).

TEXT 4

Risky/high risk alcohol consumption by gender

Summary Task

Most Australians drink alcohol in anounts that lead to few (1) …. , for enjoyment, relaxation, and (2) ….. . Unfortunately though,
a large number of Australians drink amounts of alcohol that increase their risk of (3) …. , and this proportion is increasing. In
2004-05, roughly (4) …. % of adult males and 12% of adult females reported drinking at a risky/high risk level. The increase in
those drinking at a risky/high risk level since 1995 has been greater for (5) ….. than (6) …. .

The proportions of males and females drinking at risky and high risk levels were highest in the middle (7) …. and this proportion
has increased over time. Although drinking moderately may provide some (8) …. for people of middle age or older, such as a
reduced risk of some forms of (9) ….. , more recent research suggests that previous studies may have (10) …. alcohol’s potential
for health benefits. Thus, it is important to weigh these benefits against the risks of alcohol-related diseases, and starting
drinking to receive these benefits is not (11) …. . Drinking alcohol under the age of (12) …. years old can affect mental
development, with a particularly high risk for adolescents under the age of (13) …. .

Damage caused to the brain by alcohol is known as (14) …. Impairment. Some of the common symptoms are problems with
memory, (15) ….. and motor skills. Over two and a half thousand Australians receive treatment for ARBI annually, with around
(16) …. more estimated to be living with the condition undiagnosed, and a further (17) …. at risk of developing ARBI as a result
of risky drinking. Among other factors, alcohol can cause ARBI as it has a (18) ….. on the central nervous system, affects
metabolism, (19) …. and blood supply, and can result in (20) …. , which can contribute to brain cell death. ARBI requires
assessment by a (21) …. . Younger people have better prospects for recovering from ARBI, but the effects are often (22) …. .

The National Health and (23) …. developed new guidelines in 2009 to reduce the health risks of alcohol consumption. The
previous edition of the guidelines was released in (24) … , and new research since that time has strengthened (25) ….. . The
features of the new guidelines include a focus on acute injury, chronic disease and overall risk of (26) …. over a lifetime, and
advice specific to three key groups: Healthy adults, children and young people, and (27) …. women.
Reading Test 1 – Part B Time allowed: 60 minutes There are two reading passages in this test. After each passage you will find a
number of questions or unfinished statements about the passage, each with four suggested answers or ways of finishing.

You must choose the one which you think fits best, i.e. the best answer. For each question, 1-20, indicate on your answer
sheet the letter A, B, C or D against the number of the question.

READING PASSAGE A

Health System Overhaul

Paragraph 1 Improving Australia's health requires both a co-ordinated effort to create environments that make healthy
behaviours easier and a health system that detects conditions early for which there are effective treatments. It must also
provide co-ordinated care by multi-disciplinary teams for patients with the chronic conditions and injuries from which most of
us will suffer and die.

Paragraph 2 The Rudd Government should be rightly proud of starting a discussion about the health system to include a greater
emphasis on prevention. The last major reform was the introduction of Medibank in the 1970s. Since then the ''health'' system
has focused largely on treating illness; little attention has been paid to preventing disease and disability. Less than 2 per cent of
the health budget goes to prevention and there is little in the way of national co-ordination of health promotion actions save
perhaps early detection programs for cancer.

Paragraph 3 The strategy proposed by the National Preventative Health Taskforce in its report released on Tuesday changes
this. For the first time we have a comprehensive framework that aims to improve the health of Australians and to reduce the
huge burden of chronic disease on our health-care system.

Paragraph 4 We know that prevention works - consider the mandatory use of car seatbelts, the banning of tobacco advertising
and increasing alcohol taxation to reduce consumption of these substances. Despite clear evidence of what worked to prevent
death, disease and disability, Australian governments have not developed a comprehensive prevention program. With health
budgets stretched to the limits, an ageing population and increasing costs of treatments and care, isn't it about time for this to
happen?

Paragraph 5 Increases in taxation for both alcohol and tobacco have nothing to do with reforming ''sinners'' and everything to
do with the death and disease they cause. The evidence is overwhelming that increasing price and reducing availability reduces
consumption and related harms for both alcohol and tobacco, particularly for the young and poorer people. Indeed, the
industry's loud protests about price measures show that they know this to be true.

Paragraph 6 Smoking rates have been coming down in Australia over the years but smoking still causes more death and ill
health than any other single factor. Substantially increasing Australia's tobacco prices will encourage people to quit - or not
start. The industry knows very well that stylish packaging attracts people to the product; plain packaging removes this
marketing ploy so that packs are nothing more than functional containers.

Paragraph 7 Other proposals - such as the emphasis on the importance of breastfeeding and the incorporation of health and
physical education throughout the school curriculum - focus on children. Banning smoking in cars carrying children and banning
TV advertising of junk food and soft drinks when high numbers of children are viewing are both moves supported by strong
evidence (does anyone doubt that banning tobacco advertising did not help reduce smoking?), but they have not been pushed
strongly enough at a national level.

Paragraph 8 In some areas the taskforce hasn't gone far enough. Improving nutritional labelling of food is a good start but it did
not recommend the broadly popular mandatory traffic-light labelling of food and beverages - a system that helps people across
the socioeconomic spectrum to make decisions about healthy food. So, the strategy offers a range of innovative, evidence-
based recommendations for action. But will it work?

Paragraph 9 Obviously it needs Federal Government and Council of Australian Government support to have any chance of
success. This could be demonstrated initially by ensuring that the National Prevention Agency proposed in the report is
established as soon as possible - the NPA-lite version hidden in the 2009 budget papers won't do the job. We need an agency
with some resources and the grunt to provide leadership, co-ordinate programs, collect data and translate it into something
useful - an agency that helps Australia focus on health not illness.

Paragraph 10 We also require a massive rethink - by authorities and the public - about what we need the system to do to turn
around our downward spiral into the mire of chronic disease. Our current system of treating symptoms simply isn't working. As
well as raising some of these issues, the strategy offers a couple of other important ideas. This has to be everyone's concern:
government, business and individuals. The other is that every Australian should be given a fair go at health, and that there
should be a special focus on particularly disadvantaged groups.

Paragraph 11 Good health does not happen in hospitals and, on the whole, is not really much due to the actions of health
professionals. It happens when we are not poor, have a good education and live in a safe and healthy environment; when we
eat good food, look after our bodies, don't drink too much or smoke. Our state of health happens because of our everyday lives,
so the structures of everyday life need to support good health.

Paragraph 12 Unfortunately, many of them don't. There have been plenty of disease prevention activities over the years. But
overall, across the nation, they have been not comprehensive, not coordinated well, not sustained and not set into the general
framework of society. This is what the taskforce is urging us and our Government to begin to address.

Paragraph 13 If we are serious about becoming the healthiest nation, we need to embrace the Preventative Taskforce Strategy,
and change the health system and our society to fit - not try to squeeze it into our existing paradigms based on illness.

QUESTIONS Health System Overhaul

1.Which statement does not have a similar meaning to one of the points made in Paragraph 1?

a.) Measures should be put in place to diagnose treatable illnesses earlier. b.) Health professionals of different disciplines
should work together to treat common chronic illnesses. c.) The government should subsidize public health services more
heavily d.) The government should create more regulations and promotion to encourage healthier lifestyles

2.According to the article, which is the most recent revision to the Australian health system?

a.) The introduction of Medicare b.) The establishment of Medibank c.) The Rudd governmentʼs discussion about the health
system d.) The co-ordination of health promotion actions

3. The author believes that not enough attention is paid to preventing diseases. Which statement is not a reason given in the
article for this opinion?

a.) Less than 2% of health funding is spent on preventative measures. b.) Cancer detection is probably the only federally co-
ordinated health promotion campaign. c.) The health system has concentrated mostly on treating illness since 1972. d.) Most of
us will suffer and die from chronic diseases and illnesses.

4. Which statement most closely parallels the authorʼs opinion on the National Preventative Health Taskforce’s report?

a.) It does not focus enough on preventing chronic diseases b.) While framed comprehensively, it burdens the health care
system with additional issues c.) It shifts the focus towards broad and detailed measures to deal with potential chronic diseases
d.) It aims high but fails to convince most important stakeholders as it has no precedent

5. What does the author mean when he says ʻIncreases in taxation for both alcohol and tobacco have nothing to do with
reforming ''sinners''’ in Paragraph 5?

a.) People should be punished for habits that burden the health system b.) People should be punished for their habits, but this
is not the most important reason to increase taxes c.) People should be allowed to continue drinking and smoking as much as
they like d.) The tax increases are not intended to judge and financially punish people who drink and smoke

6.What does the author mean by “the industryʼs loud protests”?

a.) The health industry is upset that tobacco and alcohol are too accessible. b.) The medical industry is upset that the cost of
health services are preventing patients from being treated. c.) The tobacco and alcohol industries are upset by the government
forcing their prices up to prevent diseases. d.) The tobacco and alcohol industries are upset that too many poor and young
people are suffering from chronic diseases.
7. What do you infer “traffic light labeling” to mean?

a.) A government advertising campaign with advertisements stuck to traffic light poles where they can be seen by everyone b.)
A government campaign warning people to be more aware of traffic lights when crossing the street under the influence of
alcohol c.) An automated barcode label scanning system in supermarkets that uses traffic lights to control crowds of customers
d.) Labels on food that highlight the levels of various ingredients according to the colour of traffic lights

8. What does the phrase “fair go” mean in Paragraph 10?

a.) A light touch b.) A chance c.) An education d.) A payment

9. Which of the following statements does not reflect the authorʼs opinion in Paragraph 11?

a.) Doctors and health professionals are largely responsible for the health of their patients. b.) Eating well and not drinking or
smoking plays a big part in peopleʼs health. c.) Health depends to some extent on education and socioeconomic status. d.)
Everyday lifestyle is an important factor that affects health.

10. Which statement best summarizes the entire article?

a.) Ignoring preventative measures has led Australia into a downward spiral of chronic disease but we have the opportunity
now to reverse this trend b.) The Australian health industry now needs to focus more on treating the symptoms of chronic
diseases c.) A new Taskforce has been established to set up initiatives to prevent chronic disease but it has been unsuccessful
and flawed d.) Most health-prevention strategies have been ineffective and Australia now needs to embrace the Prevention
Taskforce Strategy
READING PASSAGE B New AIDS Vaccine Hope
Paragraph 1 For decades, scientists have vigorously searched for a cure for the AIDS virus. Recent research just may have
uncovered a significant key to developing that long-awaited vaccine. Scientists have discovered two key antibodies that seem to
prevent the AIDS virus from mutating and spreading through out the body.

Paragraph 2 The AIDS virus has claimed millions of lives around the world. According to the World Health Organization, 33
million people currently are infected with HIV. While search efforts for an AIDS cure are abundant, several previous stabs at
developing a vaccine proved to be non-effective.

Paragraph 3 The International AIDS Vaccine Initiative, a non-profit organization, is funding the efforts to develop a vaccine and
kicked off their effort in 2006, called Protocol G. Protocol G utilizes blood gathered from HIV patients in developing countries,
to help pinpoint antibodies that could neutralize strains of the AIDS virus. Through this initiative, the Scripps Research Institute
discovered two critical antibodies which naturally fight against the spread of the AIDS virus. During the study, released recently
in the journal Science, researchers not only discovered two vital antibodies, but also discovered a new part of the virus the
antibodies attack. This discovery may lead to a new technique for the creation of a vaccine.

Paragraph 4 For the study, researchers gathered blood from 1,800 HIV patients who had suffered from the virus, without
exhibiting symptoms for at least three years. The participants were mainly from Africa, but also involved HIV patients from
Thailand, Australia, the United States and the United Kingdom.

Paragraph 5 The team pinpointed those who had not exhibited HIV signs, though suffering from the virus for at least three
years, because these patients produce large amounts of natural antibodies in their blood, which fight against almost all strains
of HIV around the world. Dennis Button, a scientist at the Scripps Research Institute, the key player in the new research said,
“We said if we want broadly neutralizing antibodies, we should look for people, infected individuals, who are making them,” He
added, “The key thing about the antibodies we’ve found is that they’re more potent than previous ones and that’s great for a
vaccine.”

Paragraph 6 Once the blood was gathered from the HIV patients, the samples were shipped back to a team with the
Monogram Bioscience laboratories in San Francisco, where researchers studied the samples to determine which antibodies lead
to more resistance to the virus. The team had developed a process that caused the enzyme embedded in the virus to glow
when it entered a cell. If the researchers did not see a glow when performing the process, it was a signal the patient’s natural
antibodies had fought off the virus.

Paragraph 7 Once the samples containing antibodies that fought off the HIV virus were identified, they were shipped to
Theraclone Sciences, in order to isolate the antibodies. Burton said “If you want to make a vaccine that works, it has to protect
against not just one, but most of the strains that are out there.” The team at Theraclone Sciences isolated two antibodies,
which were able to block against three-quarters of the different strains of HIV tested against the antibodies. The two antibodies
were recognized in the blood of an African HIV patient.

Paragraph 8 While the new findings do not create an overnight cure for AIDS, they do help scientists with new options for
treatment and a potential vaccine. The hope is for a vaccine that will encourage a person’s immune system to fight the virus
more vigorously by producing its own antibodies.

New AIDS Vaccine Hope

111.According to Paragraph 1, how do scientists hope their new discovery can help fight AIDS?

a.) By stopping the virus from proliferating inside the patientʼs system b.) By preventing the virus from transmitting from
patient to patient c.) By preventing the patient from suffering secondary illnesses d.) By keeping patients away for longer

12. How many people have HIV?

a.) 30 million Africans b.) 3 million homosexual men c.) 33 million people globally d.) 3,000,000 people

13. Which of the following statements is true?

 a.) Previous viral strains, while abundant, have not been effective when stabbing patients b.) Although patients are abundant,
most have been unaffected by the virus c.) Not many scientists have attempted to create an AIDS vaccine so far d.) Masses of
research has been done into curing AIDS but none has been successful

1 4.Which is the most accurate description of Protocol G?

a.) It is a viral antibody transmitted into the blood of AIDS patients in poor countries via pin prick. b.) It is a procedure for
searching for AIDS-combating antibodies in the blood of AIDS victims. c.) It is a new part of the virus attacked by antibodies
discovered in the study. d.) It is a group made up of The International AIDS Vaccine Initiative and the Scripps Research Institute.

15. According to Paragraph 3, what could be a possible result of the scientistsʼ findings?

a.) A new technique to create vacillation b.) A new viral antibody discovery c.) A new method to build a vaccine d.) A new part
of the virus the antibodies attack

1 6.Which is the most accurate description of the participants in the study?

a.) Scientists from The International AIDS Vaccine Initiative and the Scripps Research Institute b.) Scientists involved in the
Protocol D Project c.) Asymptomatic HIV patients, mostly from the third world d.) HIV positive people with no symptoms from
all over the world

17.Why did the scientists decide to examine blood from these people?

a.) Because the majority of AIDS cases are in these countries b.) Because these people are making AIDS neutralizing antibodies
c.) Because they have large amounts of the virus after at least three years of infection d.) Because their bodies contain enzymes
that glow when the virus enters a cell

18. Which statement best summarizes Denis Burtonʼs opinion about the results of the research?

a.) He thought that the best place to find an HIV vaccine was inside the bodies of HIV patients who are making antibodies. b.)
The key thing is that the potential of previous ones is great for a vaccine. c.) The new antibodies fight HIV more successfully
than prior attempts. d.) A working vaccine must protect against not one, but all types of HIV.

19. Which statement best describes the procedure used in the study?

a.) After the blood was collected, Theraclone identified the antibodies responsible and Monogram Bioscience identified signs of
success in fighting the virus. b.) After the blood was collected, Theraclone identified signs of success in fighting the virus and
Monogram Bioscience identified the antibodies responsible. c.) After the blood was collected, Monogram Bioscience identified
the antibodies responsible, and Theraclone identified signs of success in fighting the virus d.) After the blood was collected,
Monogram Bioscience identified signs of success in fighting the virus, and Theraclone identified the antibodies responsible.

20.Which statement is the most appropriate summary of the article?

a.) Scientists have found a vaccine they hope will encourage a person’s immune system to fight the virus more vigorously by
producing its own antibodies. b.) Scientists have found two antibodies which can fight most strains of HIV and may lead to a
vaccine. c.) Researchers have studied blood samples to determine which antibodies lead to more resistance to the virus. d.)
Scientists have found a new strain of HIV they hope will lead to a new vaccine.

Reading Test 2 - Answers Part A

1. adverse affects 2. sociability 3. alcohol-related harm 4. 15 5. women / females 6. men / males 7. age group 8. health
benefits 9. cardiovascular disease 10. overestimated 11. encouraged 12. 25 13. 15 14. alcohol-related brain 15. cognitive ability
16. 200,000 17. two million 18. toxic effect 19. heart functioning 20. dehydration 21. neuropsychologist 22. permanent 23.
Medical Research Council (capitals needed) 24. 2001 25. earlier research 26. alcohol-related harm 27. pregnant and
breastfeeding

Part B

1. C 2. B 3. C 4. D 5. D 6. C 7. D 8. B 9. A 10. A 11. A 12. C 13. D 14. B 15. C 16. C 17. B 18. D 19. C 20. B
 FULL TEST 2
Reading Test 2 – Part A Time allowed: 15 minutes

TEXT 1

Overweight and obesity in Australia

Introduction

Reports of an ‘obesity epidemic’ appear with increasing frequency and rising concern in Australia. Particular attention is given
to reports of the accelerating rate of obesity among Australian children. Despite this high profile of obesity as a public health
issue, some aspects of the debate rest on limited evidence and/or outdated data, including: out-dated national time trend data
on children and inadequate measures of obesity and overweight. This e-brief provides an overview of the current state of
obesity and overweight in Australia. Information on how overweight and obesity are measured is presented, followed by a brief
discussion on the limitations of these measures. Prevalence data for obesity and overweight in children and adults is then
presented and limitations of this data are discussed. The need for a national nutrition survey and recent developments in this
area are discussed, and finally some links to information and sources are provided.

How obesity is measured

Obesity is most commonly measured using the body mass index (BMI). BMI is a weight-to-height ratio, and is considered to be a
reasonable reflection of body fat for most people. BMI is calculated by dividing body weight in kilograms by the square of
height in metres (kg/m). Among adults, a person with a BMI greater than 25kg/m is considered overweight, while a BMI
greater than 30kg/m is considered obese. The table below shows the BMI cut-off points widely accepted for use among adults
in Australia, and which relate to points where the risks of adverse health outcomes rise sharply.

TEXT 2

Obesity has a range of causes

A range of factors can cause obesity. Factors in childhood and adolescence are particularly influential, since a high proportion
of obese children and adolescents grow up to be obese adults.

Factors known to increase the risk of obesity include:

• Genes – researchers have found that genetics play a part in regulating body weight. However these genes explain only a small
part of the variation in body weight.

• Birth factors – some studies suggest that a person is more likely to become obese later in life if they experienced poor
nutrition in utero, had a low birth weight and weren’t breast fed. However, other studies show that high birth weight is a
stronger risk for becoming overweight.
• Eating more kilojoules than you use – whatever your genetic background, you will deposit fat on your body if you eat more
energy (kilojoules) than you use.

• Inactivity – for most of us, physical activity is no longer a natural part of our daily schedule. Obese people tend to live
sedentary lifestyles.

• Modern living – most modern conveniences, such as cars, computers and home appliances, reduce the need to be physically
active.

• Socioeconomic factors – people with lower levels of education and lower incomes are more likely to be overweight or obese.
This may be because they have less opportunity to eat healthy foods and take part in physical activities.

TEXT 3

10 WAYS TO LOSE FAT

1. Bulk up sandwiches with raw vegetables such as grated carrot, lettuce and cucumber, not high-‐fat cheese or
processed meats.

2. Walk briskly for 15 to 30 minutes every morning, before breakfast. There is some evidence that exercising on an
empty stomach may help deplete fat stores.

3. To cut down on alcohol intake, substitute one glass of water for every second glass of alcohol you would
normally drink.
4. Switch to a non-‐stick frying pan so you don’t have to add butter or oil for cooking.
5. Instead of sour-‐cream or cream in savoury dishes, try substituting plain, low-‐fat yoghurt
6. Stop cooking desserts and try a piece of fresh fruit at the end of a meal instead.
7. Avoid buying foods that are comprised mostly of pastry — pies, sausage rolls, Danish desserts.
8. If you have a choice between wholegrain products and refined, go for the wholegrain. Experts say they will help
you feel fuller, for longer.
9. Talk positively to yourself about your body image and your goals. Believe that it is possible for you to lose weight
and become a healthier, happier person.
10. Enlist support in your efforts to shed kilograms, from your family and friends as well as from your GP. You will
reach your goal sooner with support and professional help.

TEXT 4

Child Obesity Data

Summary Task
An increasing concern in Australia is the existence of an obesity (1) …. , with
particular attention being given to the rising rate of obesity among (2) …. .
Anonline report by Mandy Biggs at the (3) … raises the issues of outdated (4) ….
and limitations in (5) …. Of obesity, and suggests that a (6) …. Is needed.
The body mass index or BMI is the tool (7) …. used to measure obesity. BMI is a
function of the person’s (8) …. divided by their (9) … squared. The commonly
accepted ranges are 20-24.9kg per square metre for (10) …. weight, 25-20kg per
square metre for (11) ….., and over 30kg per square metre for obese, and these
measurements correlate to points where risks of (12) ….. suddenly increase. One
partial, but incomplete cause of obesity is how an individual’s (13) …. regulate
body weight. There are many other (14) …. known to increase the risk of obesity.
Some research has suggested that inadequate (15) …. leads to obesity later in life,
while others studies present (16) …. as having a stronger link with obesity.
Regardless of genetics, your body will (17) … when it has a surplus of energy not
being used. Living a (18) …. with a lack of (14) …. is also strongly correlated with
obesity, and more poorer, less educated individuals are obese, possibly because
they don’t have access to (19) ….. and exercise facilities.
Alarmingly, the proportion of obese children in Australia jumped from (20) ….%
of boys and (21) … % of girls in 1985 to 4.7% and 5.5% respectively in 1995. The
highest percentage of overweight and obesity for boys occurred in the teenage
years, while (22) …. years old was proportionally the most overweight and obese
group of girls. A report commissioned by (23) … recommends 10 practical steps
people can take to reduce their weight. Among the measures are walking briskly
before (24) …. every morning, substituting plain (25) …. for ice cream or cream,
switching to a (26) …. frying pan, and enlisting help from family, friends, and your
(27) …. .
Reading Test 2 – Part B Time allowed: 60 minutes There are two reading passages in this test. After each passage you will find a
number of questions or unfinished statements about the passage, each with four suggested answers or ways of finishing. .

READING PASSAGE A

Celebrex removed from trial due to increased risk

Paragraph 1 The National Institutes of Health (NIH) announced today that it has suspended the use of COX-2 inhibitor celecoxib
(Celebrex, Pfizer, Inc.) for all participants in a large colorectal cancer prevention clinical trial conducted by the National Cancer
Institute (NCI).

Paragraph 2 The study, called the Adenoma Prevention with Celecoxib (APC) trial, was stopped because analysis by an
independent Data Safety and Monitoring Board (DSMB) showed a 2.5-fold increased risk of major fatal and non-fatal
cardiovascular events for participants taking the drug compared to those on a placebo.

Paragraph 3 Additional cardiovascular expertise was added to the safety monitoring committees at the request of the Steering
Committees for this trial after a September 2004 report that the COX-2 inhibitor rofecoxib (Vioxx) caused a two-fold increased
risk of cardiovascular toxicities in a trial to prevent adenomas. The APC is a study of more than 2,000 people who have had a
precancerous growth (adenomatous polyp) removed. They were randomized to take either 200 mg of celecoxib twice a day,
400 mg of celecoxib twice a day, or a placebo for three years. The trial began in early 2000 and is scheduled to be completed by
Spring 2005.

Paragraph 4 Investigators at the 100 sites in the APC trial located primarily in the United States, with a few additional sites in
the United Kingdom, Australia, and Canada, have been instructed to immediately suspend study drug use for all participants on
the trial, although the participants will remain under observation for the planned remainder of the study.

Paragraph 5 "Data from the report on rofecoxib (Vioxx) informed us of the need to focus on specific cardiovascular issues, and
our Institutes brought in the experts to do so, said Elias A. Zerhouni, M.D., NIH Director. "Our overwhelming commitment is to
advance the health and to protect the safety of participants in clinical trials. We are examining the use of these agents in all
NIH-sponsored clinical studies. In addition, we are working closely with our colleagues at FDA to ensure that the public has the
information they need to make informed decisions about the use of this class of drug."

Paragraph 6 "The rigor of our clinical trials system has allowed us to find this problem," said NCI Director Andrew C. von
Eschenbach, M.D. "We have a strong system that provides us with the opportunity to both find ways to effectively treat and
prevent disease and to do so in a way that protects the lives and safety of the participants."

Paragraph 7 However, another ongoing study looking at whether Celebrex can prevent colon cancer has not found any
increased risk of heart attacks in patients taking the drug. This trial, the PreSAP trial, used the same heart measures and the
same safety monitoring board as the APC trial.

Paragraph 8 "Pfizer is taking immediate steps to fully understand the [APC study] results and rapidly communicate new
information to regulators, physicians, and patients around the world," Pfizer CEO Hank McKinnell says in a news release.

Paragraph 9 Because the two studies came up with opposite findings -- and because earlier studies showed no obvious sign of
heart problems linked to Celebrex -- the FDA has not yet decided whether to ban Celebrex, to add additional warnings to the
drug's label, or to wait for more information. But Acting FDA Commissioner Lester Crawford, MD, says the agency won't drag its
feet.

"Paragraph 10 We will evaluate this information and may make statements very soon with regard to Cox-2 drugs in general and
this product in specific," Crawford said today in a joint FDA/National Institutes of Health news conference.

Paragraph 11 NIH sponsors over 40 studies using celecoxib for the prevention and treatment of cancer, dementia and other
diseases. In light of these new findings, NIH Director Zerhouni requested:

* a full review of all NIH-supported studies involving this class of drug. * NIH Institutes to inform the principal investigators
for all of these studies and will ask them to communicate directly with their study participants and explain the risks and benefits
* NIH to ask each investigator to inform us of the their plan to analyze their data in light of the information * the Institutional
Review Boards (IRBs) for all related trials to assess the new information and to conduct a safety review as well
QUESTIONS Celebrex removed from trial due to increased risk

1.The National Cancer Institute…

a.) prevented celecoxib from being used in a trial b.) was responsible for the Adenoma Prevention with Celecoxib (APC) trial c.)
requested that additional cardiovascular expertise be added to the monitoring panel d.) were forced to use a placebo in the
study

2. The NHI has suspended the use of celecoxib in the Adenoma Prevention with Celecoxib (APC) trial because…

a.) Celecoxib dosages administered to the participants were found to be 2.5 times higher than safe recommended levels b.) A
previous report stated that people taking a similar drug were two and a half times more likely to suffer major heart attacks c.)
Celecoxib multiplied the risk of fetal and non-fetal cardiovascular events 2.5 times. d.) Participants were 2.5 times more likely
to suffer serious cardiac arrests when taking a placebo

3. Which of the following statements best describes the future of the trial as a result of this change of plans?

a.) The trial, which was due to finish in 2005, will now be aborted. b.) All participants will now be switched to placebos and the
trial will finish according to schedule. c.) Celecoxib will now be removed from the trial but monitoring will continue. d.)
Participants will be randomly selected to take 200 or 400mg of Celecoxib, or a placebo.

4.Which of the following statements is least similar in meaning to a statement delivered by Dr. Zerhouni?

a.) We will prevent celecoxib from being used in further NHI sponsored trials. b.) Our primary focus is on the welfare of our
trial subjects. c.) We are providing information for the FDA to publicly distribute. d.) We are carefully investigating whether or
not this drug should be used in NIH supported trials.

5. Which of the following statements is most similar in meaning to a statement delivered by Dr. von Eschenbach?

a.) Thanks to data from previous trials, we have managed to avert any serious problems. b.) The National Cancer Institute uses
thorough methods. c.) We apologise for any threat to the safety and lives of our participants. d.) The NHI’s rigorous system is
responsible for allowing us to discover this issue.

6.Three of the statements below are “true” or “not given”, according to the text. Which of the following statements contradicts
the information given in the text about the colon cancer trial?

a.) The observation panel members were identical to the APC trial. b.) The trial did not find out whether Celebrex contributes
to colon cancer or not. c.) The trial did not fail to find risks of cardiovascular events when using celecoxib. d.) Participants were
monitored using the same heart measurements as the APC trial.

7.Which statement most accurately reflects the action currently being taken by the Food and Drug Authority?

a.) They are immediately trying to comprehend the data and distribute it to stakeholders. b.) They are currently trying to
comprehend the data and they will possibly release information in the near future. c.) They are in close collaboration with the
NIH and releasing data jointly at conferences. d.) They have three possible courses of action but at this stage they have not
taken any action.

8.What is the meaning of “drag its feet” in Paragraph 9?

a.) Hide the truth b.) Move slowly c.) Make the process difficult d.) Be forced to do something by someone else

9. What were Dr. Zerhouni’s recommendations a direct response to?

a.) The realisation that celebrex increases risk of cardiac events b.) Data withheld from the NIH by independent investigators c.)
The complete review of NIH sponsored studies where this type of drug is used d.) The fact that the NIH is involved in over 40
studies that use celecoxib

10. Which of the following statements is not a recommendation given by Dr. Zerhouni?
 a.) All studies using celebrex will be reviewed. b.) The NIH should pass on information about risks to trial researchers, who in
turn should pass this information on to test subjects c.) The NIH should require researchers to disclose how they will analyze
trial data d.) Review Boards for every trial should conduct their own safety reviews

READING PASSAGE B

Birth control pill could cause long-term sexual problems

Paragraph 1 In the January issue of The Journal of Sexual Medicine, researchers have published a new investigation measuring
sex hormone binding globulin (SHBG) before and after discontinuation of the oral contraceptive pill. The research concluded
that women who used the oral contraceptive pill may be exposed to long-term problems from low values of "unbound"
testosterone potentially leading to continuing sexual, metabolic, and mental health consequences. Sex hormone binding
globulin (SHBG) is the protein that binds testosterone, rendering it unavailable for a woman's physiologic needs. The study
showed that in women with sexual dysfunction, elevated SHBG in "Oral Contraceptive Discontinued-Users" did not decrease to
values consistent with those of "Never-Users of Oral Contraceptive". Thus, as a consequence of the chronic elevation in sex
hormone binding globulin levels, pill users may be at risk for long-standing health problems, including sexual dysfunction.

Paragraph 2 Oral contraceptives have been the preferred method of birth control because of their ease of use and high rate of
effectiveness. However, in some women oral contraceptives have ironically been associated with women's sexual health
problems and testosterone hormonal problems. Now there are data that oral contraceptive pills may have lasting adverse
effects on the hormone testosterone.

Paragraph 3 The research, in an article entitled: "Impact of Oral Contraceptives on Sex Hormone Binding Globulin and
Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction" published in The Journal of Sexual Medicine,
involved 124 premenopausal women with sexual health complaints for more than 6 months. Three groups of women were
defined: i) 62 "Oral Contraceptive Continued-Users" had been on oral contraceptives for more than 6 months and continued
taking them, ii) 39 "Oral Contraceptive Discontinued-Users" had been on oral contraceptives for more than 6 months and
discontinued them, and iii) 23 "Never-Users of Oral Contraceptives" had never taken oral contraceptives. SHBG values were
compared at baseline (groups i, ii and iii), while on the oral contraceptive (groups i and ii), and well beyond the 7 day half-life of
sex hormone binding globulin at 49-120 (mean 80) days and more than 120 (mean 196) days after discontinuation of oral
contraceptives (group ii).

Paragraph 4 The researchers concluded that SHBG values in the "Oral Contraceptive Continued-Users" were 4 times higher
than those in the "Never-Users of Oral Contraceptives". Despite a decrease in SHBG values after discontinuation of oral
contraceptive pill use, SHBG levels in "Oral Contraceptive Discontinued-Users" remained elevated when compared to
"NeverUsers of Oral Contraceptives". This led to the question of whether prolonged exposure to the synthetic estrogens of oral
contraceptives induces gene imprinting and increased gene expression of SHBG in the liver in some women who have used the
oral contraceptives.
 Paragraph 5 Dr. Claudia Panzer, an endocrinologist in Denver, CO and lead author of the study, noted that "it is important for
physicians prescribing oral contraceptives to point out to their patients potential sexual side effects, such as decreased desire,
arousal, decreased lubrication and increased sexual pain. Also if women present with these complaints, it is crucial to recognize
the link between sexual dysfunction and the oral contraceptive and not to attribute these complaints solely to psychological
causes."

Paragraph 6 "An interesting observation was that the use of oral contraceptives led to changes in the synthesis of SHBG which
were not completely reversible in our time frame of observation. This can lead to lower levels of 'unbound' testosterone, which
is thought to play a major role in female sexual health. It would be important to conduct long-term studies to see if these
increased SHBG changes are permanent," added Dr. Panzer.

Paragraph 7 Dr. Andre Guay, study co-author and Director of the Center for Sexual Function/Endocrinology in Peabody, MA
affirmed that this study is a revelation and that the results have been remarkable. "For years we have known that a subset of
women using oral contraceptive agents suffer from decreased sex drive," states Dr. Guay. "We know that the birth control pill
suppresses both ovulation and also the male hormones that the ovaries make in larger amounts during the middle third of the
menstrual cycle. SHBG binds the testosterone, therefore, these pills decrease a woman's male hormone availability by two
separate mechanisms. No wonder so many women have had symptoms."

Paragraph 8 "This work is the culmination of 7 years of observational research in which we noted in our practice many women
with sexual dysfunction who had used the oral contraceptive but whose sexual and hormonal problems persisted despite
stopping the birth control pill," said Dr. Irwin Goldstein, a urologist and senior author of the research. "There are approximately
100 million women worldwide who currently use oral contraceptives, so it is obvious that more extensive research
investigations are needed. The oral contraceptive has been around for over 40 years, but no one had previously looked at the
long-term effects of SHBG in these women. The larger problem is that there have been limited research efforts in women's
sexual health problems in contrast to investigatory efforts in other areas of women's health or even in male sexual
dysfunction."

Paragraph 9 To better appreciate the scope of the problem, oral contraceptives were introduced in the USA in 1960 and are
currently used for reversible pharmacologic birth control by over 10 million women in the US, including 80% of all American
women born since 1945 and, more specifically, 27% of women ages 15-44 and 53% of women age 20-24 years. By providing a
potent synthetic estrogen (ethinyl estradiol) and a potent synthetic progesterone (for example, norethindrone), highly effective
contraception is achieved by diminishing the levels of FSH and LH, thereby reducing metabolic activity of the ovary including the
suppression of ovulation.

Paragraph 10 Several studies over the last 30 years reported negative effects of oral contraceptives on sexual function,
including diminished sexual interest and arousal, suppression of female initiated sexual activity, decreased frequency of sexual
intercourse and sexual enjoyment. Androgens such as testosterone are important modulators of sexual function. Oral
contraceptives decrease circulating levels of androgens by direct inhibition of androgen production in the ovaries and by a
marked increase in the hepatic synthesis of sexhormone binding globulin, the major binding protein for gonadal steroids in the
circulation. The combination of these two mechanisms leads to low circulating levels of "unbound" or "free" testosterone.

Birth control pill could cause long-term sexual problems

11.Which statement is the most accurate summary of the method of the study?

a.) Levels of SHBG were monitored over a period of time in women who were using the pill b.) Levels of SHBG were measured
in women who were using the pill and women who had stopped using the pill, and these were compared to women who had
never used the pill c.) Levels of SHBG were compared in women who were using the pill, women who had stopped using the
pill, and women who had never used the pill d.) Medical complications were compared between women using the pill and
those who had stopped using the pill

12. is the role of SHBG?

a.) To prevent sexual dysfunction in human females b.) To prevent testosterone from being used in the female body c.) To
prevent women from needing to take traditional contraceptive pills d.) To prevent oncological complications

13. Which group had the highest level of unbound testosterone?

a.) Women with a genetic predisposition for higher testosterone levels b.) Women who had never taken the pill c.) Women
who had previously taken the pill but since stopped d.) Women who were taking the pill during the study

14. Which of the following reasons is given in the study for the popularity of the oral contraceptive pill?

a.) Less interference with sexual routine than other contraceptives b.) High percentage of contraceptive success c.) Favourable
aesthetic effects on womenʼs physiques due to reduced testosterone d.) Low cost

15. Which is the most accurate description of the study discussed in the article?

a.) It involved one hundred and twenty four pre-pubescent girls. b.) It involved 124 premenstrual women who had sexual
health issues for 6 months or more. c.) SHBG levels were monitored at different times in three groups of adult women with
various status regarding contraceptive pill usage. d.) SHBG levels were compared at regular intervals in each of three groups of
women who had different status regarding contraceptive pill usage.

16.Finish the following sentence as accurately as possible. “Levels of SHBG decreased in women who had stopped using the
contraceptive pill….”

a.) due to increased gene expression of SHBG in the livers of these women. b.) in spite of lengthened exposure to artificial
estrogen found in pills. c.) because of psychological factors associated with taking the pill. d.) but their levels remained
elevated compared to women who had never used the pill.

17. Which of the following is an opinion of Dr. Panzer?

a.) SHBG levels remained higher in women who discontinued pill use for the duration of the study b.) The use of oral
contraceptives led to changes in SHBG levels which were not reversible within the timeframe of the study c.) Physicians usually
mention the sexual side effects of the pill to their patients d.) Further studies should determine whether SHBG levels ultimately
return to normal over longer periods

18. Which of the following statements has the same meaning as a statement in the text?

a.) The contraceptive pill was invented in the USA in 1960. b.) The pill has been used by over 100 million women globally. c.)
Dr. Goldstein monitored women with a history of pill use and sexual dysfunction in his clinic for seven years. d.) Lower levels of
unbound testosterone is a result of both higher SHBG and accelerated metabolism in the ovaries.

19.Which of the following is not a negative effect of oral contraceptives mentioned in Paragraph 10?

a.) Having sex less often b.) Less enjoyable sex c.) Less lubrication d.) Sex started less often by women

20.Which of the following statements echoes the opinion of two out of three of the doctors quoted in the article?

a.) The long term effects of the pill should be investigated in longer term studies b.) Doctors should consider the birth control
pill as a possible cause of sexual function, rather than psychological factors alone c.) Most of the facts in the article have been
known for 30 years and are not surprising d.) Comparatively little research has been done into womenʼs sexual health
compared to menʼs sexual health

Reading Test 2 - Answers Part A

1. epidemic 2. Australian Children 3. Australian Parliamentary Library 4. Data 5. Measures / measurements 6. National nutrition
survey 7. Most commonly 8. Weight in kilograms 9. Height in metres 10. Normal 11. Overweight 12. Adverse health outcomes
13. Genes / genetics 14. Factors 15. Nutrition in utero 16. High birth weight 17. Deposit fat 18. Sedentary lifestyle 19. Healthy
foods 20. 1.4 21. 1.2 22. 2-4 23. HCF 24. breakfast 25. Low-fat yoghurt 26. Non-stick 27. GP

Part B 1. A 2. B 3. C 4. A 5. B 6. C 7. D 8. B 9. A 10. A 11. C 12. B 13. B 14. B 15. C 16. D 17. D 18. C 19. C 20. A
 FULL TEST 3
TEXT 1

The Global Burden of Dementia

An expert group, working for Alzheimer’s Disease International, recently estimated that 24.2 million people live with
dementia worldwide (based upon systematic review of prevalence data and expert consensus), with 4.6 million new cases
annually (similar to the annual global incidence of non-fatal stroke.

• Most people with dementia live in Low and Middle Income Countries - 60% in 2001 rising to 71% by 2040.

• Numbers will double every twenty years to over 80 million by 2040.

• Increases to 2040 will be much sharper in developing (300%) than developed regions (100%).

• Growth in Latin America will exceed that in any other world region.

Well designed epidemiological research can generate awareness, inform policy, and encourage service development.
However, such evidence is lacking in many world regions, and patchy in others, with few studies and widely varying
estimates. There is a particular lack of published epidemiological studies in Latin America with two descriptive studies only,
from Brazil and Colombia.

TEXT 2

Some Little Known Facts about Dementia

• A Canadian study found that a lifetime of bilingualism has a marked influence on delaying the onset of dementia by an
average of four years when compared to monolingual patients (at 75.5 years and 71.4 years old, respectively).

• Adult daycare centres provide specialized care for dementia patients, including supervision, recreation, meals, and limited
health care to participants, as well as providing respite for caregivers.

TEXT 3

The Effect of Aging World Populations on Healthcare

Demographic ageing proceeds apace in all world regions, more rapidly than at first anticipated. The proportion of older
people increases as mortality falls and life expectancy increases. Population growth slows as fertility declines to replacement
levels. Latin America, China and India are currently experiencing unprecedentedly rapid demographic ageing.

In the health transition accompanying demographic ageing, non-communicable diseases (NCD) assume a progressively
greater significance in low and middle-income countries. NCDs are already the leading cause of death in all world regions
apart from sub-Saharan Africa. Of the 35 million deaths in 2005 from NCDs, 80% will have been in low and middle-income
countries. This is partly because most of the world's older people live in these regions - 60% now rising to 80% by 2050.
However, changing patterns of risk exposure also contribute.

Latin America exemplifies the third stage of health transition. As life expectancy improves, and high fat diets, cigarette
smoking and sedentary lifestyles become more common, so NCDs have maximum public health salience - more so than in
stage 2 regions (China and India) where risk exposure is not yet so elevated, and in stage 4 regions (Europe) where public
health measures have reduced exposure levels. The INTERHEART cross-national case-control study suggests that risk factors
for myocardial infarction operate equivalently in all world regions, including Latin America and China.
TEXT 4

Agitation in Dementia Patients

Agitation often accompanies dementia and often precedes the diagnosis of common age-related disorders of cognition such
as Alzheimer's disease (AD). More than 80% of people who develop AD eventually become agitated or aggressive.

Evaluation It is important to rule out infection and other environmental causes of agitation, such as disease or other bodily
discomfort, before initiating any intervention. If no such explanation is found, it is important to support caregivers and
educate them about simple strategies such as distraction that may delay the transfer to institutional care (which is often
triggered by the onset of agitation).

Treatment There is no FDA-approved treatment for agitation in dementia. Medical treatment may begin with a
cholinesterase inhibitor, which appears safer than other alternatives although evidence for its efficacy is mixed. If this does
not improve the symptoms, atypical antipsychotics may offer an alternative, although they are effective against agitation
only in the short-term while posing a well-documented risk of cerebrovascular events (e.g. stroke). Other possible
interventions, such as traditional antipsychotics or antidepressants, are less well studied for this condition.

Summary task

Populations all over the world are aging due to increased (1) … and lower birth rates. This shift in population structure
means (2) …. . are now relatively more significant in developing countries, and they are already the leading cause of death in
all regions aside from (3) …. . One such non communicable disease is (4) … , and more than half of all sufferers live in
developing countries.

An expert panel recently commissioned by (5) … to review worldwide prevalence data found that approximately (6) … people
suffer from dementia globally, and a further (7) … patints are diagnosed with the disease every year, making dementia
roughly as common globally as (8) … . (9) … per cent of dementia sufferers in 2001 lived in low and middle income countries,
and growth is expected to (10) … every 20 years, with the highest rate of growth occurring in (11) ... , where there is a
particularly scarce amount of epidemiological research.60% of the world’s older people live in low to middle income
countries, and this will increase to (12) … by (13) …. . Another contributing factor is changing patterns of (14) … . Countries in
the third stage of the (15) … , categorized by higher life expectancy, high fat diets, smoking and (16) …. , are more at risk than
the less developed Stage 2 countries, and Stage 4 countries, where (17) … have mitigated risk exposure.

These changing demographics will place new strains on the healthcare system, and many people suffering from dementia
will require care from family members. In higher income countries, carers are able to enlist the help of (18) …. , who provide
(19) … , recreation and meals for dementia sufferers. Many caregivers finally transfer their family members to (20) …. when
their relatives become aggressive and (21) … . Doctors should first (22)… environmental causes, and if none are found, (23)…
caregivers about useful techniques like (24)… to delay transfer. Interestingly, a (25) … study found that the age of dementia
(26)… was delayed by (27)… in people who speak two languages.
Reading Test 1 - Part B Time allowed: 60 minutes There are two reading passages in this test. After each passage you will
find a number of questions or unfinished statements about the passage, each with four suggested answers or ways of
finishing.

. READING PASSAGE A Swine Flu Found in Birds

Paragraph 1 Last week the H1N1 virus was found in turkeys on farms in Chile. The UN now says poultry farms elsewhere in
the world could also become infected. Scientists are worried that the virus could theoretically mix with more dangerous
strains. It has previously spread from humans to pigs. However, swine flu remains no more severe than seasonal flu.

Paragraph 2 Chilean authorities first reported the incident last week. Two poultry farms are affected near the seaport of
Valparaiso. Juan Lubroth, interim chief veterinary officer of the UN Food and Agriculture Organization (FAO), said: "Once the
sick birds have recovered, safe production and processing can continue. They do not pose a threat to the food chain."

Paragraph 3 Chilean authorities have established a temporary quarantine and have decided to allow the infected birds to
recover rather than culling them. It is thought the incident represents a "spill-over" from infected farm workers to turkeys.
Canada, Argentina and Australia have previously reported spread of the H1N1 swine flu virus from farm workers to pigs.

Paragraph 4 The emergence of a more dangerous strain of flu remains a theoretical risk. Different strains of virus can mix
together in a process called genetic reassortment or recombination. So far there have been no cases of H5N1 bird flu in flocks
in Chile. However, Dr Lubroth said: "In Southeast Asia there is a lot of the (H5N1) virus circulating in poultry. "The
introduction of H1N1 in these populations would be of greater concern."

Paragraph 5 Colin Butter from the UK's Institute of Animal Health agrees. "We hope it is a rare event and we must monitor
closely what happens next," he told BBC News. "However, it is not just about the H5N1 strain. Any further spread of the
H1N1 virus between birds, or from birds to humans would not be good. "It might make the virus harder to control, because it
would be more likely to change."

Paragraph 6 William Karesh, vice president of the Wildlife Conservation Society, who studies the spread of animal diseases,
says he is not surprised by what has happened. "The location is surprising, but it could be that Chile has a better surveillance
system. "However, the only constant is that the situation keeps changing."

Paragraph 7 The United States has counted 522 fatalities through Thursday, and nearly 1,800 people had died worldwide
through August 13, U.S. and global health officials said. In terms of mortality rate, which considers flu deaths in terms of a
nation's population, Brazil ranks seventh, and the United States is 13th, the Brazilian Ministry of Health said in a news
release Wednesday.

Paragraph 8 Argentina, which has reported 386 deaths attributed to H1N1 as of August 13, ranks first per capita, the
Brazilian health officials said, and Mexico, where the flu outbreak was discovered in April, ranks 14th per capita. Brazil,
Argentina, Chile, Mexico and the United States have the most total cases globally, according to the World Health
Organization.

Paragraph 9 The Brazilian Ministry of Health said there have been 6,100 cases of flu in the nation, with 5,206 cases (85.3
percent) confirmed as H1N1, also known as swine flu. The state of Sao Paulo had 223 deaths through Wednesday, the largest
number in the country. In addition, 480 pregnant women have been confirmed with H1N1, of whom 58 died. Swine flu has
been shown to hit young people and pregnant women particularly hard.

Paragraph 10 Many schools in Sao Paulo have delayed the start of the second semester for a couple of weeks, and students
will have to attend classes on weekends to catch up. Schools also have suspended extracurricular activities such as soccer,
volleyball and chess to try to curtail spread of the disease.

Paragraph 11 Flu traditionally has its peak during the winter months, and South America, where it is winter, has had a large
number of cases recently. The World Health Organization said this week that the United States and other heavily populated
Northern Hemisphere countries need to brace for a second wave of H1N1 as their winter approaches.
 Paragraph 12 Officials at the Centres for Disease Control and Prevention and other U.S. health agencies have been preparing
and said this week that up to half of the nation's population may contract the disease and 90,000 could die from it. Seasonal
flu typically kills about 64,000 Americans each year

Paragraph 13 A vaccine against H1N1 is being tested but is not expected to be available until at least mid-October and will
probably require two shots at least one week apart, health officials have said. Since it typically takes a couple of weeks for a
person's immunity to build up after the vaccine, most Americans would not be protected until sometime in November. The
World Health Organization in June declared a Level 6 worldwide pandemic, the organization's highest classification.

QUESTIONS
1. Scientists are worried that the virus could potentially spread…

a.) …from pigs to humans b.) …to chicken and turkey farms elsewhere c.) …to other types of animals d.) …to the seaport of
Valparaiso

2. What does Dr. Lubroth recommend should be done with the sick birds? a.) They should be processed immediately. b.) They
should be killed. c.) They should be allowed to recover. d.) They should be given Tamiflu.

3. What is the meaning of the “spill-over” effect mentioned in the passage?

a.) The virus has spread from Chile to Argentina. b.) The virus has spread from factory workers to birds. c.) Turkey blood has
been spilled during the production process. d.) Turkeys have become infected by eating spilled contaminated pig food.

4. Which possibility is Dr. Lubroth most concerned about?

a.) H5N1 virus spreading to Chile b.) H591 virus spreading to Australia c.) H191 virus spreading to Asia d.) H191 virus
spreading to Canada

5. Which statement best describes the opinion of the representative from the Institute of Animal Health?

a.) He doesnʼt want the virus to spread further because it could lead to genetic reassortment. b.) He thinks H5N1 is no longer
important but he is worried about H1N1. c.) He hopes that BBC News will pay more attention to closely monitoring the virus.
d.) Birds and humans should be under more control otherwise the virus may change.

6. Which statement best describes the opinion of the Vice President of the Wildlife Conservation Society?a.) He is not
surprised that not enough people are studying the spread of animal diseases. b.) He is not surprised that swine flu has been
reported in birds in Chile. c.) He is surprised that the situation is constantly changing. d.) He is surprised that swine flu has
been reported in birds in Chile, but suspects other countries may be unaware of the spread to birds.

7. According to the Brazilian Ministry of Health…

a.) …The United States has counted 522 fatalities. b.) …more people have died in Brazil than in the USA. c.) …more people
have died in the USA than in Brazil. d.) …Brazil is the 13th worst country for swine flu deaths.

8. Which of the following statements is FALSE?

a.) 52 pregnant women have died of Swine Flu in Brazil. b.) Argentina has reported 386 H591 related deaths. c.) Swine flu
was first discovered in Mexico in April. d.) The USA is one of the most severely affected countries annually.

9. Which of the following statements is TRUE?

a.) Young people are less likely to be affected by swine flu than old people and pregnant women. b.) Students in Sao Paulo
have been asked to stop going to weekend classes. c.) Students in Sao Paulo have stopped playing volleyball. d.) Brazil has
had less cases of swine flu this winter than expected.

10. When will most US citizens be protected by the vaccine, and why? a.) Early November, because this is when the vaccine is
available b.) Mid October, because this is when the vaccine is available c.) November, because it takes time to develop
immunity following the vaccine d.) Next June, because there is likely to be a pandemic at this time
READING PASSAGE B Risks and Benefits of Hormone Replacement Therapy
Paragraph 1 Several recent large studies have provoked concern amongst both health professionals and the general public
regarding the safety of hormone replacement therapy (HRT). This article provides a review of the current literature
surrounding the risks and benefits of HRT in postmenopausal women, and how the data can be applied safely in everyday
clinical practice.

Paragraph 2 Worldwide, approximately 47 million women will undergo the menopause every year for the next 20 years.1
The lack of circulating oestrogens which occurs during the transition to menopause presents a variety of symptoms including
hot flushes, night sweats, mood disturbance and vaginal atrophy, and these can be distressing in almost 50% of women.

Paragraph 3 For many years, oestrogen alone or in combination with progestogens, otherwise known as hormone
replacement therapy (HRT), has been the treatment of choice for control of problematic menopausal symptoms and for the
prevention of osteoporosis. However, the use of HRT declined worldwide following the publication of the first data from the
Women’s Health Initiative (WHI) trial in 2002.2

Paragraph 4 The results led to a surge in media interest surrounding HRT usage, with the revelation that there was an
increased risk of breast cancer and, contrary to expectation, coronary heart disease (CHD) in those postmenopausal women
taking oestrogen plus progestogen HRT. Following this, both the Heart and Estrogen/Progestin Replacement Study Follow-up
(HERS II)3,4 and the Million Women Study5 published results which further reduced enthusiasm for HRT use, showing
increased risks of breast cancer5 and venous thromboembolism (VTE),4 and the absence of previously suggested
cardioprotective effects3 in HRT users. The resulting fear of CHD and breast cancer in HRT users left many women with
menopausal symptoms and few effective treatment options.

Paragraph 5 Continued analysis of data relating to these studies has been aimed at understanding whether or not the risks
associated with HRT are, in fact, limited to a subset of women. A recent publication from the International Menopause
Society6 has stated that HRT remains the first-line and most effective treatment for menopausal symptoms. In this article we
examine the evidence that has contributed to common perceptions amongst health professionals and women alike, and
clarify the balance of risk and benefit to be considered by women using HRT.

Paragraph 6 One of the key messages from the WHI in 2002 was that HRT should not be prescribed to prevent age-related
chronic disease, in particular CHD. This was contradictory to previous advice based on observational studies. However, recent
subgroup analysis has shown that in healthy individuals using HRT in the early postmenopausal years (age 50–59 years),
there was no increased CHD risk and HRT may potentially have a cardioprotective effect.8

Paragraph 7 Recent WHI data has suggested that oestrogen-alone HRT in compliant women under 60 years of age delays
the progression of atheromatous disease (as assessed by coronary arterial calcification).9 The Nurses Health Study, a large
observational study within the USA, demonstrated that the increase in stroke risk appeared to be modest in younger women,
with no significant increase if used for less than five years.

Paragraph 8 Hormone replacement therapy is associated with beneficial effects on bone mineral density, prevention of
osteoporosis and improvement in osteoarthritic symptoms. The WHI clearly demonstrated that HRT was effective in the
prevention of all fractures secondary to osteoporosis.11 The downturn in HRT prescribing related to the concern regarding
vascular and breast cancer risks is expected to cause an increase in fracture risk, and it is predicted that in the USA there will
be a possible excess of ≥43,000 fractures per year in the near future.11

Paragraph 9 The WHI results published in 2002 led to a significant decline in patient and clinician confidence in the use of
HRT. Further analysis of the data has prompted a re-evaluation of this initial reaction, and recognition that many women
may have been ‘denied’ treatment. Now is the time to responsibly restore confidence regarding the benefit of HRT in the

treatment of menopausal symptoms when used judiciously. Hormone replacement therapy is undoubtedly effective in the
treatment of vasomotor symptoms, and confers protection against osteoporotic fractures.

Paragraph 10 The oncologic risks are relatively well characterised and patients considering HRT should be made aware of
these. The cardiovascular risk of HRT in younger women without overt vascular disease is less well defined and further work
is required to address this important question. In the interim, decisions regarding HRT use should be made on a case-by-case
basis following informed discussion of the balance of risk and benefit. The lowest dose of hormone necessary to alleviate
menopausal symptoms should be used, and the prescription reviewed on a regular basis.

Risks and Benefits of Hormone Replacement Therapy.

11.Which statement is the closest match to the description of the recent studies in Paragraph 1?

a.) They demand a prompt review of current HRT practices. b.) They have shown that HRT can be used safely in clinical
practice. c.) They have decreased the confidence of doctors and the public in HRT. d.) They have given menopausal women a
new confidence to undergo HRT.

12. Which statement is the closest match to the description of projected menopause figures in Paragraph 2?

a.) 47 international women will enter menopause annually for the next 20 years. b.) All women are likely to go through
menopause if they live long enough. c.) 47 million women globally will enter menopause each year for the next 20 years. d.)
Most women will succumb to menopause if they do not undertake HRT.

13. What cause does the article cite for the symptoms of menopause?

a.) Lack of circulation b.) Age c.) Low progesterone levels d.) Low circulating estrogen levels

14.What has been the effect of the 2002 WHI study?

a.) HRT has become less popular. b.) HRT has increased in popularity as the treatment of choice for problematic menopause
symptoms. c.) There has been an increase in combined estrogen and progesterone therapy. d.) The womenʼs health initiative
has since been established to investigate HRT.

15. Why were many women left with menopausal symptoms and no effective treatment?

a.) They were unable to afford HRT treatments. b.) They were concerned about coronary heart disease and breast cancer.
c.) They were concerned about breast cancer and venous thromboembulism. d.) They were concerned about breast cancer
and the cardioprotective effects.

16, Which of these statements is a TRUE summary of Paragraph 5?

a.) Surveys since WHI have attempted to find out if the WHI results are representative. b.) Results of past surveys are only
valid for a subset of women, whether or not the public is aware of this. c.) The present study aims to show that HRT is safer
than previously believed. d.) Women should ask their doctors to clarify the balance of risks and benefits of HRT.

17. Which study showed an increased risk of VTE?

a.) The Nurses Health Study b.) The Million Women Study c.) The Womenʼs Health Initiative Study d.) The WISDOM Study

18. Which of the following does the article recommend HRT should NOT be used to treat?

a.) Vasomotor symptoms b.) Atheromatous disease c.) Age-related chronic disease d.) Osteoarthritic symptoms

19. Why were women “denied treatment”? (Paragraph 9)

a.) Due to the decline in patient confidence in HRT b.) Due to the results of studies including the WHI study c.) Due to judicious
use of HRT d.) Due to a re-evaluation of this initial reaction

20. Which statement is NOT a recommendation of the present article?

a.) Further study should be made into oncological risks of HRT b.) Further study should be made into cardio vascular risks of
HRT c.) Doctors should now reassure their patients that HRT can be safe d.) Doctors should prescribe the lowest effective dose
for menopause symptoms
Reading Test 1 – Answers Part A

1. life expectancy 2. 2 3. Sub Saharan Africa 4. dementia 5. Alzheimer’s Disease International 6. 2.4.2 million 7. 4.6 million
8. non-fatal stroke 9. 60 10. double 11. Latin America 12. 80% 13. 2050 14. risk exposure 15. health transition 16.
sedentary lifestyles 17. public health measures 18. adult daycare centres 19. supervision 20. institutional care 21. agitated
22. rule out 23. educate 24. distraction 25. Canadian 26. onset 27. 4 years

Part B

1. B 2. C 3. B 4. A 5. B 6. C 7. D 8. B 9. A 10. A

11. C

12. C

13. D

14. B

15. C

16. D

17. B

18. C

19. A

20. A
 FULL TEST 4
Dengue Fever
Part A Summary Gap Fill Time Limit: 15 minutes Instruction• Complete the following summary using the information in the
texts for this task. • Skim and scan the texts to find the information required. • Gaps may require 1, 2 or 3 words. • Write
your answers in the appropriate space in the column on the right hand side. • Make sure your spelling is correct.

The Increasing Threat of Dengue Fever

Text 1

The dengue mosquito

The dengue mosquito looks like many other mosquitoes so it is difficult for the layperson to identify without the use of a
microscope. As a rule of thumb, if you have mosquitoes biting you indoors during the day in north Queensland, it is likely that
they are dengue mosquitoes. The dengue mosquito(Aedes aegypti) can more readily be identified by its behaviour. Look for
these signs: *It likes to live indoors and bite people indoors *It is hard to catch; it moves very quickly, darting back and forth
*It bites people around the ankles and feet *Its bite is relatively painless The adult mosquito prefers to rest in dark areas
inside and under houses and buildings. Favourite resting spots are under beds, tables and chairs; in wardrobes and closets;
on piles of dirty laundry and shoes; inside open containers; in dark and quiet rooms; and even on dark objects such as
clothing or furniture. The dengue mosquito prefers to bite humans during daylight. It is very cautious when biting, flying
away quickly at the slightest disturbance. An effective way to kill adult mosquitoes is to apply a residual insecticide
(cockroach surface spray) onto the areas where they prefer to rest.

Text 2

Title: Australia’s Dengue Risk Driven by Human Adaption to Climate Change

Background: The reduced rainfall in southeast Australia has placed this region’s urban and rural communities on escalating
water restrictions, with anthropogenic climate change forecasts suggesting that this drying trend will continue. To mitigate
the stress this may place on domestic water supply, governments have encouraged the installation of domestic water tanks
in towns and cities throughout this region. These prospective stable mosquito larval sites create the possibility of the
reintroduction of Aedes aegypti from Queensland, where it remains endemic, back into New South Wales and other
populated centres in Australia, along with the associated emerging and re-emerging dengue risk if the virus was to be
introduced.

Objective: To determine the whether human’s ability to adapt to climate change through the installation of large stable
water storage tanks leads to a more wide spread distribution of Aedes Aegypti.

Principal Findings: The distribution of Aedes aegypti is mediated more by human activity than by climate. Synthesis of this
data with dengue transmission climate limits in Australia derived from historical dengue epidemics suggested that a
proliferation of domestic water tanks in Australia could result in another range expansion of Aedus aegypti which would
present a risk of dengue transmission in most major cities during their warm summer months.

Conclusions/Significance: In the debate of the role climate change will play in the future range of dengue in Australia, we
conclude that the increased risk of an Aedes aegypti range expansion in Australia would be due not directly to climate
change but rather to human adaptation to drier weather by the installation of large domestic water storing containers. The
expansion of this efficient dengue vector presents both an emerging disease risk to Australia. Therefore, if the installation
and maintenance of domestic water storage tanks is not tightly controlled, Aedes aegypti could expand its range again in
urban areas throughout most parts of Australia, presenting a high potential dengue transmission risk during our warm
summers.

Text 3
Symptoms of Dengue Fever

Symptoms are most commonly seen in adults and older children. Young children may show no symptoms. Typical symptoms
may include • sudden onset of fever (lasting three to seven days) • intense headache (especially behind the eyes) • muscle
and joint pain (ankles, knees and elbows) • diarrhoea • fine skin rash as fever subsides

Text 4

Dengue mosquito Breeding sites

The dengue mosquito frequents suburban backyards in search of containers holding water in order to breed • watering cans
• buckets • unsealed rain water tanks • old car tyres • roof gutters • tarpaulins • any vessel which holds water

summery

Due to reduced rainfall in many parts of Australia, governments have encouraged the installation of (1)____. However, a
recent study by Beebe, Cooper, Mottram and (2)____ warn that this could increase the risk of (3)____, especially in summer
time. The scientific name of the dengue mosquito is (4)____. Its appearance is similar to most other mosquitos so a (5)___is
required for identification. In terms of behaviour, the dengue mosquito prefers to (6)____. Its bite is (7)____ and it usually
attacks the (8)____of people. Most bites occur in during (9)____hours. Aedus aegypti is responsible for the spread of dengue
fever and typical symptoms include a rapid (10) ____ which lasts (11) ___to (12)____days. Intense headache, (13)___pain and
diarrhoea may also occur. As the fever subsides, victims may have a (14)__dengue mosquito needs water (15)____ and will
seek out water holding containers in (16)____. Therefore homeowners are encouraged to ensure their backyards do not have
watering cans, (17)___tyres and buckets lying around. In addition, rain water tanks need to be (18)____. While is recent
times, the range of Aedus aegypti has been limited to tropical areas, there is a risk that it could spread further due indirectly
to (19)___. This is because humans have (20) ____to drier weather by installing rain water tanks in their backyards, which in
turn act as breeding sites for Aedus aegypti, leading to the (21) ___ risk of dengue fever in (22)___. Therefore it is essential
that governments strictly monitor the (23)___ and (24) ___of domestic water tanks as they could aid in the spread of Aedus
aegypti to (25)___throughout Australia.
Part B

Text B1 : Animal testing

Paragraph 1 The use of living animals in research and teaching, while first documented around 2000 years ago, became
prominent in the second half of the 19th century as part of the development of the emerging sciences of physiology and
anatomy. In the mid 1900s, the rapid expansion of the pharmaceutical and chemical industries gave rise to an enormous
increase in the use of animals in research. Today it is a multi-billion dollar industry, involving not only the pharmaceutical
and chemical industries, but also university and government bodies. There is, additionally, a sizeable industry providing
support services in relation to animal research, including animal breeding, food supply and cage manufacture, among many
others.

Paragraph 2 The types of research that animals are subjected to include the traditional forms of physiological research,
which typically involves the study of body function and disease, and psychological research, which often entails controlling
the eating, movement or choices of animals in experimental contexts. Other more recent forms of research include
agricultural research directed towards intensive farming methods and increasing the efficiency of animals kept for food or
food products. The genetic engineering of species used in agriculture is common amongst sheep and cattle, for example, in
an attempt to increase the production of wool or milk, or to alter the characteristics of the end product (finer wool, for
instance). Safety testing, or toxicology testing, is another common type of research where medicines, agricultural chemicals
and various other chemical products, such as shampoos and cosmetics, are assessed for safe human use by testing the
products on animals.

Paragraph 3 While accurate global figures for animal testing are extremely difficult to obtain, estimates indicate that
anywhere from 50 to 100 million vertebrates are used in experiments every year (although this figure does not include the
many more invertebrates, such as worms and flies, that are employed). The most commonly used vertebrates are mice,
attractive to researchers for their size, low cost, ease of handling, and fast reproduction rate, as well as the fact that their
genetic makeup is comparable to that of human beings. Other types of vertebrates used in the pursuit of science include fish,
chickens, pigs, monkeys, cats, dogs, sheep and horses.

Paragraph 4 Perhaps one of the most widely-known examples of animals being used for the purposes of scientific research is
Ivan Pavlov’s ‘conditioned reflex’ experiments in the late 19th early 20th centuries. Pavlov and his researchers were
investigating the gastric functions of dogs and the chemical composition of their saliva under changing conditions, when
Pavlov noticed that the animals began salivating before food was delivered. Pavlov’s team then changed the focus of their
experiments and embarked on a series of experiments on conditional reflexes that earned Pavlov the 1904 Nobel Prize in
Physiology and Medicine for his work on the physiology of digestion. What is less well-known about Pavlov’s research is that
these experiments included surgically implanting fistulas in animals’ stomachs, which enabled him to study organs and take
samples of body fluids from animals while they continued to function normally. Also, further work on reflex actions involved
involuntary reactions to extreme stress and pain.

Paragraph 5 Supporters of animal testing argue that virtually every medical achievement in the 20th century relied on the
use of animals in some way and that alternatives to animal testing, such as computer modelling, are inadequate and fail to
model the complex interactions between molecules, cells, tissues, organs, organisms and the environment. Opponents argue
that such testing is cruel to animals and is poor scientific practice, that results are an unreliable indicator of the effects in
humans, and that it is poorly regulated. They also point to the fact that many alternatives to using animals have been
developed, particularly in the area of toxicity testing, and that these developments have occurred most rapidly and
effectively in countries where the use of animals is prohibited.

Paragraph 6 Although animal rights groups have made slow headway, there are signs that the issues they are concerned
about are being heard. Most scientists and governments state, publicly at least, that animal testing should cause as little
suffering to animals as possible, and that animal tests should only be performed where necessary. The ‘three Rs’ of
replacement, reduction and refinement are the guiding principles for the use of animals in research in most countries. They
are designed to minimise the use of animals in scientific research by using other types of research where possible, by
reducing the number of animals used in research, and by refining research techniques to minimise the animals’ pain and
distress.

Part B -Text B1: Questions 1-11

1 According to paragraph 1, research using animals ……

A was non-existent before 1850. B is most common in the medical industry. C generates trade for offshoot industries. D is on
the rise.

2 According to paragraph 1, the use of living animals in research and teaching ……

A has taken place for at least two millennia. B rose to prominence around 2,000 years ago. C emerged in the second half of
the 19th century. D originated in the pharmaceutical and chemical industries.

3 According to paragraph 2, one of the new applications of animal testing is concerned with ……

A combining the traditions of physiological and psychological research. B finding ways to improve farm animals’ productive
capacity. C controlling the eating, movement or choices of animals. D revisiting the age-old study of body function and
disease.

4 According to paragraph 3, global figures for animal testing are ……

A subsiding. B elusive. C confronting. D extreme.

5 According to paragraph 3, which one of the following statements about mice is TRUE?

A They are much more popular with researchers than invertebrates. B They have a genetic make-up which is at odds with
that of humans. C They are very attractive to researchers because of their speed and aptitude. D They pose fewer constraints
than other vertebrates in terms of care and expense.

6 According to paragraph 4, Pavlov’s research ……

A was unethical at the time. B involved hurting animals deliberately. C was conducted solely on dogs. D did not focus on dogs
initially.

7 According to paragraph 4, Pavlov’s groundbreaking research into conditional reflexes ……

A was prompted by the observation that dogs salivated when they were hungry. B came about by accident while he was
investigating something else. C was triggered by his noticing chemical changes in the dogs’ saliva. D led to a larger-scale
investigation of the gastric functions of dogs.

8 According to paragraph 5, animal testing proponents argue that ……

A many of the alternative methods still rely on the use of animals in some way. B it was crucial in the 20th century before
viable alternatives became available. C computer modelling requires improvement before it can replace animal testing. D
medical advancement in the 20th century would have been hindered without it.

9 According to paragraph 5, opponents of animal testing argue that ……

A countries who prohibit it are developing rapidly. B its results are unreliable due to poor regulation. C there are insufficient
rules and restrictions. D it is only justifiable in the area of toxicity testing.

10 The word headway in paragraph 6 could best be replaced by ……

A progress. B improvements. C impact. D developments.

11 Replacement in the three Rs described in paragraph 6 refers to the substitution of ……

A animal species. B research methods. C painful techniques. D animal numbers.

Text B2: Oral health and systemic disease
Paragraph 1 The relationship between oral health and diabetes (Types 1 and 2) is well known and documented. In the last
decade, however, an increasing body of evidence has given support to the existence of an association between oral health
problems, specifically periodontal disease, and other systemic diseases, such as those of the cardiovascular system. Adding
further layers of complexity to the problem is the lack of awareness in much of the population of periodontal disease, relative
to their knowledge of more observable dental problems, as well as the decreasing accessibility and affordability of dental
treatment in Australia. While epidemiological studies have confirmed links between periodontal disease and systemic
diseases, from diabetes to autoimmune conditions, osteoporosis, heart attacks and stroke, in the case of the last two the
findings remain cautious and qualified regarding the mechanics or biological rationale of the relationship.

Paragraph 2 Periodontal diseases, the most severe form of which is periodontitis, are inflammatory bacterial infections that
attack and destroy the attachment tissue and supporting bone of the jaw. Periodontitis occurs when gingivitis is untreated or
treatment is delayed. Bacteria in plaque that has spread below the gum line release toxins which irritate the gums. These
toxins stimulate a chronic inflammatory response in which the body, in essence, turns on itself, and the tissues and bone that
support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth
and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are
destroyed. Often, this destructive process only has very mild symptoms. Eventually, however, teeth can become loose and
may have to be removed.

Paragraph 3 The current interest in the relationship between periodontal disease and systemic disease may best be
attributed to a report by Kimmo Mattila and his colleagues. In 1989, in Finland, they conducted a casecontrol study on
patients who had experienced an acute myocardial infarction and compared them to control subjects selected from the
community. A dental examination was performed on all of the subjects studied, and a dental index was computed. The
dental index used was the sum of scores from the number of carious lesions, missing teeth, and periapical lesions and probing
depth measures to indicate periodontitis and the presence or absence of pericoronitis (a red swelling of the soft tissues that
surround the crown of a tooth which has partially grown in). The researchers reported a highly significant association
between poor dental health, as measured by the dental index, and acute myocardial infarction. The association was
independent of other risk factors for heart attack, such as age, total cholesterol, high-density lipoprotein triglycerides, C
peptide, hypertension, diabetes, and smoking.

Paragraph 4 Since then, researchers have sought to understand the association between oral health, specifically periodontal
disease, and cardiovascular disease (CVD) – the missing link explaining the abnormally high blood levels of some
inflammatory markers or endotoxins and the presence of periodontal pathogens in the atherosclerotic plaques of patients
with periodontal disease. Two biological mechanisms have been suggested. One is that periodontal bacteria may enter the
circulatory system and contribute directly to atheromatous and thrombotic processes. The other is that systemic factors may
alter the immunoflammatory process involved in both periodontal disease and CVD. It has also been suggested that some of
these illnesses may in turn increase the incidence and severity of periodontal disease by modifying the body’s immune
response to the bacteria involved, in a bi-directional relationship.

Paragraph 5 However, not only is ‘the jury out’ on the actual mechanism of the relationship, it also remains impossible to say
whether treating gum disease can reduce the risk of cardiovascular disease and improve health outcomes for those who are
already sufferers. Additional research is needed to evaluate disease pathogenesis. Should the contributing mechanisms be
identified, however, it will confirm the role of oral health in overall well-being, with some implications of this being the
desirability of closer ties between the medical and the dental professions, and improved public health education, not to
mention greater access to preventive and curative dental treatment. In time, periodontal disease may be added to other
preventable risk factors for CVD, such as smoking, high blood cholesterol, obesity and diabetes.

Part B -Text B2: Questions 12-20

12 According to paragraph 1, oral health problems have recently been linked to ……

A periodontal disease. B heart conditions. C diabetes. D economic factors.

13 According to paragraph 1, periodontal disease is unknown to many Australians because ……

A dental treatment is no longer affordable. B the problem has a high degree of complexity. C information on dental
problems is inaccessible. D it is not as prominent as other dental issues.

14 The most suitable heading for paragraph 2 is ……

A ‘Types of periodontal disease’. B ‘The treatment of gingivitis’. C ‘The body’s response to toxins’. D ‘The process of
periodontitis’.

15 According to paragraph 3, the 1989 study in Finland ……

A prompted further interest in the link between oral health and systemic disease. B did not take into account a number of
important risk factors for heart attacks. C concluded that people with oral health problems were likely to have heart attacks.
D was not considered significant when it was first reported but is now.

16 The research study described in paragraph 3 found that the relationship between poor dental health and heart attacks
was ……

A inconclusive. B coincidental. C evident. D inconsequential.

17 According to paragraph 3, the dental index was used to ……

A indicate whether periodontitis was present. B assess the overall oral health of patients. C establish whether pericoronitis
was present. D predict the likelihood of acute myocardial infarction.

18 According to paragraph 4, it has been proposed that ……

A cardiovascular disease could actually exacerbate periodontal disease. B periodontal disease could modify the body’s
immune response. C there is a bi-directional relationship between periodontal disease and bacteria. D systemic factors may
contribute directly to atheromatous and thrombotic processes.

19 According to paragraph 5, if the processes by which gum disease contributes to CVD can be discovered there will be ……

A less need for doctors and dentists to work in conjunction. B a reduced emphasis on other preventable risk factors for CVD. C
a concomitant link between smoking and periodontal disease. D more support for dental care in the public health system.

20 The expression the jury [is] out in paragraph 5 means that a definitive conclusion is ……

A imminent. B impossible. C without empirical basis. D yet to be attained.

Dengue Fever

Answer Sheet 1. domestic water tanks 2. Sweeney 3. dengue transmission 4. Aedes aegypti 5. microscope 6. live indoors
7. relatively painless 8. ankles and feet 9. daylight 10. onset of fever 11. three 12. seven 13. muscle and joint 14. fine skin
rash 15. to breed 16. suburban backyards 17. old car 18. sealed (need change word form from negative to positive) 19.
climate change 20. adapted (need to change the noun adaption to verb form) 21. emerging 22. Australia 23. installation 24.
maintenance 25. urban areas

Text B1: Animal Testing Answer Key

1 C generates trade for offshoot industries.

2 A has taken place for at least two millennia.

3 B finding ways to improve farm animals’ productive capacity.

4 B elusive.

5 D They pose fewer constraints than other vertebrates in terms of care and
expense.

6 B involved hurting animals deliberately.

7 B came about by accident while he was investigating something else.

8 D medical advancement in the 20th century would have been hindered without it.

9 C there are insufficient rules and restrictions.

10 A progress.

11 B research methods.

Reading Sub-test Text B2: Oral health and systemic disease Answer Key Total of 9 questions

12 B heart conditions.

13 D it is not as prominent as other dental issues.

14 D ‘The process of periodontitis’.

15 A prompted further interest in the link between oral health and systemic disease.

16 C evident.

17 B assess the overall oral health of patients.

18 A cardiovascular disease could actually exacerbate periodontal disease.

19 D more support for dental care in the public health system.

20 D yet to be attained.
 FULL TEST 5

Diseases of Affluence
Part A

Time Limit: 15 minutes

Instructions • Complete the summary on the answer page using the information in the four texts below. • Skim and scan the
texts to find the information required. • Write your answers in the appropriate space in the column on the right hand side. •
Make sure your spelling is correct. Diseases of Affluence Source: Public Library of Open Science Authors: Ezzati, M et al 2005

Text 1

Tobacco

Tobacco smoking is also an important risk factor for cardiovascular diseases. Currently, an estimated 930 million of the
world’s 1.1 billion smokers live in the developing world. Tobacco smoking increased among men, followed by women, in
industrialized nations in the last century, and has subsequently declined in some nations such as Canada, the United States,
and the United Kingdom. Descriptive models based on historical patterns in the industrialized world predict a reduction in the
number of male smokers and an increase in the number of female smokers in the developing world over the coming decades.
However, there have been major recent transformations in global tobacco trade, marketing, and regulatory control. As a
result, tobacco consumption among men and women in most nations is primarily determined by opposing industry efforts
and tobacco control measures, and by the socio-cultural context, rather than national income.

Text 2

BMI

The observed rapid BMI increase with national income indicates that preventing obesity, which may be more effective than
reacting after it has occurred, should be a priority during economic growth and urbanization of a nation. Overweight and
obesity are also important because they cause a number of non- cardiovascular outcomes including cancers, diabetes, and
osteoarthritis which cannot be addressed by reducing risk factors such as blood pressure and cholesterol. Current
intervention options for obesity in principle include those that reduce calorie intake and increasing energy expenditure of a
population through urban design which incorporates space for outdoor activities.

Text 3

Background Cardiovascular diseases and their nutritional risk factors—including overweight and obesity, elevated blood
pressure, and cholesterol—are among the leading causes of global mortality and morbidity, and have been predicted to rise
with economic development in countries and societies throughout the world. Methods and Findings We examined age-
standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to
national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total
of over 100 countries and were obtained from systematic reviews of published literature, and from national and international
health agencies. BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually
declined. BMI increased most rapidly until an income of about I$5,000 (international dollars) and peaked at about I$12,500
for females and I$17,000 for males. Cholesterol’s point of inflection and peak were at higher income levels than those of BMI
(about I$8,000 and I$18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of
household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood
pressure was not significantly affected by the economic factors considered. Conclusions When considered together with
evidence on shifts in income–risk relationships within developed countries, the results indicate that cardiovascular disease
risks are expected to systematically shift to low and middle income countries and, together with the persistent burden of
infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of
economic development, accompanied by measures to promote awareness of the causes of high blood pressure and
cholesterol.
Text 4

Health Repercussions of Western Lifestyle

Factors associated with the increase of these illnesses appear to be, paradoxically, things which many people would regard
as lifestyle improvements. They include: -Less strenuous physical exercise, often through increased use of a car -Easy
accessibility in society to large amounts of low-cost food -More food generally, with much less physical exertion expended to
obtain a moderate amount of food -More high fat and high sugar foods in the diet are common in the affluent developed
economies -Higher consumption of meat and dairy products -Higher consumption of grains and white bread -More foods
which are processed, cooked, and commercially provided (rather than seasonal, fresh foods prepared locally at time of
eating)

summary

Diseases of (1)___ is a term used to describe a range of risk factors associated with cardiovascular disease which increase
along with a country’s or society’s (2)____. These risk factors include obesity, high blood pressure and (3)____. Yet the
causes of these conditions are things often regarded as (4) ____ in their lifestyles. For example, the ability to afford a car can
lead to reduced (5)____. This combined with higher consumption of (6)____and (7)___ products, grains and white bread can
have negative health consequences. Foods in affluent countries are also high in (8)___ and (9)___and commercially
processed. A 2005 study by (10)____ analysed data from over (11)____. According to their findings, (12)____and
cholesterol rose markedly before leveling off and finally (13)____in relation to national income. Whereas the economic
factors did not (14)____the average population blood pressure.Based on this information, preventing (15)____ should be a
priority while countries are experiencing (16)____ and (17)____. Methods to reduce obesity include reducing (18)____ and
focussing on (19)___ to ensure that there is (20)____for outside activities. Cigarette smoking is also a significant health
concern for the developing world with approximately (21)____ of the worlds (22)____ smokers from developing nations.
Based on patterns of the industrialised world, the number of male smokers will (23)____ while the number of female smokers
is likely to (24)____. However, future tobacco consumption patterns may not associate directly with (25)____, as efforts to
control its use become widespread. In summary, cardiovascular disease risks are likely to transfer to (26)____ income
countries which when combined with the current problem of (27)____, will lead to further inequalities in (28)____. Therefore
prevention of (29)____ as well as education in the areas of blood pressure and cholesterol must be a (30)____ for developing
nations.
Part B

Reading Passage A

Employment records reveal the detail of asbestos danger Ian Anderson, Melbourne
About a quarter of the people who worked in an asbestos mine in Western Australia between 1943 and the closure of the pit in
1966 are already suffering from diseases related to their exposure to the mineral, or may do in the future. This is the estimate
of researchers who say that the mine's employment records have enabled them to carry out one of the most thorough studies
ever of the long-term health effects of exposure to asbestos fibre.

The team, based at the University of Western Australia and the Sir Charles Gairdner Hospital in Perth, says that it is the only
study in which a well defined group of people has been exposed to a single form of asbestos over a specified period.

Of the 6502 men and 410 women who worked at the mine, almost 2000 have developed or will develop cancer and other
diseases related to asbestos. The Asbestos Diseases Society of Australia, a group formed to help people exposed to asbestos,
claims that 300 former workers have already died of diseases that are asbestos-related.

The people, mostly migrant labourers from Europe, worked in an asbestos mine and mill in Wittenoom, a town in the
Hamersley Range, about 1600 kilometres north of Perth. Wittenoom, once the home for 4000 people, is now virtually deserted.
The state government cut essential services to the town last year. Blue asbestos, or crocidolite, was mined there. The
researchers were able to determine how much asbestos the workers were exposed to by making calculations based on readings
of dust that were taken at various times during the mine's operation. The most extensive exposure to asbestos Occurred in the
mill where ore was ground down and the fibre extracted.

The Australian study was published last month in the Medical Journal of Australia" Other records of exposure to blue asbestos -
such as those from South Afiica - have not been as useful to researchers as the data from Wittenoom, says William Musk, from
the University of Western Australia.

Blue asbestos fibres are very thin, straight and small- about OJ micrometres in diameter. As a result, they are more likely to
enter the lungs than other types of asbestos fibres. They are also the least likely to adhere 'to and be intercepted by the
protective mucus in the airways.

Scientists have associated the, fibres mined at Wittenoorn with three types of disease: malignant mesothelioma, lung cancer
and asbestosis, a scaning of the lung. Most of the workers were at the mine for only short periods - months, rather than years.
The diseases may take up to 40 years to develop.

The records until 1986 show 94 cases of mesothelioma, 141 lung cancers and 356 cases of asbestosis among the Wittenoom
workers. In the general population, mesothelioma, a cancer of the outer covering of the lung, is rare, occurring at the rate of
less than one per million people each year. The scientists say that exposure to asbestos can account for about 40 per cent of
the cases of lung cancer at Wittenoom; the remainder were caused by the effects of smoking.

Over the next 30 years, there will be a sevenfold increase in the number of cases of mesothelioma, according to the
researchers' estimates. There will be as many as 25 cases of the disease a year by the year 2010. The team predicts that
between 1987 and 2020, a total of 692 new cases of mesothelioma will occur. Most will be in the lung (pleural mesothelioma),
but some will be in the abdomen (peritoneal mesothelioma). Cases of lung cancer and asbestos among the workers will reach a
peak by about 2000, with a total of 183 and 482 respectively by the year 2020.

The Asbestos Diseases Society claims that the problem will not be confined to former workers. About 6000 of the 14 000 wives
and children of workers at Wittenoom will also suffer from asbestos-related disease, according to the society. "Forty-one
people in their late 30s or 40s who were children at Wittenoom have died of mesothelioma," according to Robert Vojakovic, the
President of the society. He obtained the statistics from death certificates. The university study only examined the records of
workers.

Last year, after a legal battle lasting 13 years, CSR, the mining company whose subsidiary, Australian Blue Asbestos, operated
the plant, agreed in an out-of-court settlement to pay compensation to former miners and residents of Wittenoom.
 By 5 December, 350 people and their families had received compensation totalling $42 million. The State Government
Insurance Commission will share the costs of compensation based on exposure to asbestos at Wittenoom after 1959. The
payments, part of the largest industrial settlement in Australian history, will range in size between A$30,000 and A$600,000

However, Western Australia has another problem. The red gorges within the Hamersley Range, including the Wittenoom
Gorge, have become a tourist attraction. The millions of asbestos tailings that still litter the area are regarded as a health
hazard, especially to children ~ho might be tempted to play on the piles. Camping is forbidden in the Wittenoom Gorge.

The state government is considering burying the tailings or putting them under the water. Both solutions will be expensive. The
asbestos society is trying to obtain funds from Lang Hancock, the mining magnate who opened the mine in the late 1930s, and
CSR, to help restore Wittencom Gorge, which it says could be made into a major tourist attraction. It also wants the town to be
relocated within the gorge.

Employment records reveal the detail of asbestos danger

1. Of all workers in the Western Australian mine, 25% (a) have died since 1966 of mine- related diseases. (b) have already
got symptoms of mine-related diseases. (c) may suffer from mine-related diseases in the future. (d) have developed mine-
related diseases or may do so.

2. Which of the following is not unique to the West Australian study? (a) The mine kept records of all workers. (b) The effects
of only one form of asbestos were studied. (c) Data were collected during a clear period of time. (d) The group studied was
well defined.

3. The population of Wittenoom is now (a) around 4,000 people. (b) extremely small. (c) around 1,600 people. (d) non-
existent.

4. Which of the following is not typical of blue asbestos fibres? (a) The fibres are so small that they enter the lungs easily. (b)
The fibres easily adhere to protective mucus in the airways .. (c) The fibres are usually not intercepted by mucus in the
airways. (d) The fibres are less than a micro metre in diameter.

5. Of the three types of diseases associated with asbestos fibres at the Wittenoom mines, (a) mesothelioma is the most
frequently occurring type. (b) asbestosis is the most frequently occurring type. (c) asbestosis is the least frequently occurring
type. (d) lung cancer is the least frequently occurring type.

6. The research team predict that by the year 2020 there will be a total of 183 cases of (a) asbestosis. (b) pleural
mesothelioma. (c) lung cancer. (d) peritoneal mesothelioma.

7. Statistics quoted in the article are based on (a) death certificates. (b) mine employment records. (c) research conducted
at a university. (d) all of the above.

8. A 13-year legal battle for compensation of disease victims resulted in (a) an out-of-court settlement involving payment by
two parties. (b) compensation payments to former Wittenoom miners. (c) compensation payments to 350 Wittenoom
residents. (d) an out-of-court settlement involving payment only by CSR.

9. Which of the following statements is most accurate? (a) The high volume of tourist traffic is eroding the red gorge of the
Hamersley Range. (b) Tourists in the Hamersley Range suffer frequently from piles. (c) Camping is forbidden throughout the
gorges of the Hamersley Range. (d) Tourists run a health risk in certain areas of the Hamersley Range.

10. The future of tourism in Wittenoom Gorge depends on (a) solving the problem of how to relocate the town. (b) solving
the problem of how to relocate the gorge. (c) disposing of compensation claims by miners. (d) disposing of trailings left by
asbestos mining.
Reading Passage B The senses of the newborn
Tests for hearing and vision have improved
Shakespeare's description of the infant, "Mewling and puking in the nurse's arms,1 was echoed in the attitudes of doctors
earlier this century. The newborn baby was thought to be either drowsy, asleep, or crying, and to experience the world as a
"great, blooming, buzzing confusion.2 But we have learnt over the past 30 years that the healthy newborn baby can
discriminate between different sensations from the environment and respond selectively. 3Within hours of birth the baby will
look at the mother's face, and given the choice newborn babies prefer to look at a card showing the features of another human
being rather than the same features jumbled up or the features condensed into a large black patch.4 The newborn baby
spends only 11 % of the time awake and alert in the first week of life, a proportion that rises to 21 % in the fourth week. 5This
small fraction of wakefulness hindered the early development of methods of testing senses. When eliciting responses it is
important to record the baby's state of arousal between deep sleep at one extreme and crying at the other - and Prechtl's
group first described five possible behavioural states. 6Brazelton extended this work to include items of higher neurological
function, including visual and auditory responses to a ball and rattle, and his neonatal behavioural assessment scale is a means
of scoring interactive behaviour.7

Why do we need to test the senses of the newborn? We want to ensure that the baby is able to interact with the parents and
with the environment and that there is no impairment to social, emotional, cognitive, and linguistic development. It is often
difficult to prove that early intervention is effective in minimising handicap, but there is evidence - for instance, that deaf
children fitted with hearing aids in the first six months of life

have better speech than those fitted later. 8 And all parents and most therapists agree that they would like to know of any
handicap as early as possible. Finding reliable and practicable methods of testing hearing and vision in newborn babies has
proved difficult. They show behavioural responses to sound, blinking and startling to a sudden clap and "stilling" to interesting
noises, with alteration in their breathing pattern. Every mother recognises these responses, but they cannot be used to detect
deaf babies reliably because of the spontaneous random movements babies make and possible bias on the part of the
observers. The use of a simple rattle to produce head and eye turning has been described, 9but the method has not found
widespread acceptance. Behavioural responses may be recorded by devices incorporating microprocessors such as the auditory
response cradle (which should eliminate observer bias). The sensitivity and specificity of this cradle have varied among trials,10
11 and the sound stimulus has to be very loud (80-85 dB) to result in a behavioural response by the baby, so that moderate
hearing losses are missed.

The electrophysiological response to sound may be detected by audiometry based on evoked responses in the brain stem, and
this is considerably more sensitive. Simpler and more portable brain stem screeners have now been developed. 12 Most
recently newborn babies' hearing has been tested by using otoacoustic emissions, a phenomenon first reported by Kemp in
1978,13 A click stimulus delivered to a normal ear results in an "echo" sound generated by the cochlea, which can be detected
by a miniature microphone. The method is quicker and less invasive than brain stem audiometry and can detect even mild
hearing losses. Stevens and his colleagues tested 346 infants at risk and showed that 20 of the 21 surviving infants who gave
negative results to brain stem audiometry also failed on the otoacoustic test. 14This work also highlighted a major problem -
that of validating methods of testing senses in the newborn baby. This has to be by follow up, checking the outcome with the
testing methods that become possible in the older infant. Steven's group found a poor correlation between distraction testing
of the babies' hearing at 8 months of age and brain stem audiometry in the newborn, a discrepancy confirmed by others. 15We
must now be more cautious in interpreting the results of electrophysiological tests in the newborn. Babies who give negative
results will need retesting several times during the first year. Though the early fitting of hearing aids is desirable, the degree of
hearing impairment needs to be clearly established, particularly as maturation of the auditory pathways may be taking place,
although delayed.

Similar problems and challenges occur in testing vision in newborn babies.16 17 Behavioural responses are familiar to the
mother, with the baby blinking to bring light. Babes turn their heads to a diffuse light but (like turning to sound) this test may
not be reliable, especially in pre term infants. All these responses give a qualitative indication of vision. Optokinetic nystagmus
can be shown when a striped tape or drum is moved in a temporal to nasal direction across the newborn baby's field of vision
and gives a valuable but crude indication that vision is present. Electrophysiological recording of the visual evoked potential to a
flash gives limited useful information because of great individual variations and because it relates as much to general cerebral
function as to visual outcome. 18Visual evoked potentials to patterns may give a measure of visual function but only after the
age of 2 months. The best method of measuring visual acuity is to use the preferential looking technique. This is based on the
observation of Fantz 30 years ago that patterned objects are visually interesting to infants. 19The latest version, called the
acuity card procedure, uses patterned and plain stimuli mounted in pairs on cards, and these can be used successfully even in
the neonatal intensive care unit. 17

Much fascinating and enjoyable research is being done into the ability of babies to discriminate and respond to smell, taste,
and touch. We should also be glad that at long last there is widespread acceptance of fact that newborn babies do experience
real pain and need postoperative analgesia like the rest of us.20 DAVID CURNOCK Consultant Paediatrician City Hospital
Nottingham NG5 IPB

The senses of the newbom

11. Doctors now know (a) that it is natural for a newborn baby to experience the world as a great blooming buzzing
confusion. (b) that babies are much more responsive to visual and auditory cues in their surroundings than was previously
thought. (c) the newborn babies are slow to develop a response to visual and auditory stimulus, since they are awake only 11%
of the time. (d) that babies are less able to discriminate between different features of the environment than was believed in
the first half of this century.

12 According to research referred to in the article, a baby given a choice about what to look at is more likely to choose (a) a
card showing human facial features. (b) a card showing jumbled human features. (c) a card showing a large black patch. (d) a
black and white photograph of the mother.

13 The senses of the 4-week-old baby can only be tested (a) 11 % of the time. (b) when it is crying. (c) 21% of the time. (d)
none of the above.

14. Which of the following statements is true? (a) There is some evidence that early intervention can prevent handicaps. (b)
There is much evidence that early intervention can minimize handicaps. (c) There is some evidence that early intervention can
minimize handicaps. (d) There is no evidence that early intervention can minimize handicaps.

15 Testing hearing in newborn babies is difficult for all of the following reasons, except (a) Newborn babies show behavioural
responses to sound such as blinking and startling.

(b) Deaf babies sometimes make movements by chance when interesting noises are made. (c) Observers may be biased in their
interpretation of babies' responses. (d) The auditory response cradle does not measure moderate hearing losses.

16 Otoacoustic emissions are (a) sounds delivered to the cochlea. (b) 'echo' sounds caused by click stimuli. (c) click stimuli
delivered to a normal ear. (d) sounds generated by a miniature microphone.

17 Compared with the use of otoacoustic emissions, brain stem audiometry (a) is quicker. (b) can detect even mild hearing
loss. (c) is more invasive. (d) is more sensitive.

18 Of the hearing testing methods described in the text (a) brain stem audiometry correlated well with otoacoustic tests. (b)
brain stem audiometry correlated well with distraction testing. (c) otoacoustic tests correlated poorly with brain stem
audiometry. (d) otoacoustic tests correlated well with distraction testing.

19 Which method of testing vision in newbom babies is not listed in the article? Making the baby (a) blink in response to a
bright light. (b) follow the movement of a red woollen ball. (c) choose between looking at either a striped tape or striped
drum. (d) choose between looking at either plain or pattemed cards.

20 Of the publications listed in the footnotes on the page following the reading passage (a) all are from joumals of psychology
or neurology. (b) none deaJ.::with responses or behaviour of infants. (c) most deal with the responses or behaviour of infants.
(d) all deal with the auditory response of infants.
Diseases of Affluence

Answer Sheet 1. affluence 2. economic development 3. cholesterol 4. improvements 5. physical exercise 6. meat 7. dairy 8.
fat 9. sugar 10. Ezatti, M/Ezatti 11. 100 countries 12. BMI 13. Declining (requires word form change to gerund) 14.
Significantly affect (requires change of verb to active form) 15. obesity 16. economic growth 17. urbanisation 18. calorie
intake 19. urban design 20. space 21. 930 million 22. 1.1 billion 23. reduce (verb form of reduction)/decline 24. increase/rise
25. national income 26. low and middle (all 3 words required) 27. infectious diseases 28. global health 29. obesity 30. priority

Asbestos danger Senses of the Newborn

1. d 11. b 2. a 12. a 3. b 13. c 4. b 14. c 5. b 15. a 6. c 16. b 7. d 17. c 8. a 18. a 9. d 19. c 10. d
20. c
 FULL TEST 6
Deep Vein Thrombosis
Part A

Text 1

Economy Class Syndrome

International flights are suspected of contributing to the formation of DVT in susceptible people, although the research
evidence is currently divided. Some airlines prefer to err on the side of caution and offer suggestions to passengers on how to
reduce the risk of DVT. Suggestions include: • Wear loose clothes • Avoid cigarettes and alcohol • Move about the cabin
whenever possible • Don’t sit with your legs crossed • Perform leg and foot stretches and exercises while seated • Consult
with your doctor before travelling

Text 2

Previous research Venous thrombosis was first linked to air travel in 1954, and as air travel has become more and more
common, many case reports and case series have been published since. Several clinical studies have shown an association
between air travel and the risk of venous thrombosis.

English researchers proposed, in a paper published in the Lancet, that flying directly increases a person's risk. The report
found that in a series of individuals who died suddenly at Heathrow Airport, death occurred far more often in the arrival than
in the departure area. Two similar studies reported that the risk of pulmonary embolism in air travelers increased with the
distance traveled.

In terms of absolute risk, two studies found similar results: one performed in New Zealand found a frequency of 1% of venous
thrombosis in 878 individuals who had traveled by air for at least 10 hours. The other was a German study which found
venous thrombotic events in 2.8% of 964 individuals who had traveled for more than 8 hours in an airplane.

In contrast, a Dutch study found no link between DVT and long distance travel of any kind.

Text 3

Symptoms

• Pain and tenderness in the leg

• Pain on extending the foot

• Tenderness in calf (the most important sign)

• Swelling of the lower leg, ankle and foot

• Redness in the leg • Bluish skin discoloration

• Increased warmth in the leg

Text 4

Title: Travel-Related Venous Thrombosis: Results from a Large Population-Based Case Control (2006) Authors: Suzanne C.
Cannegieter1, Carine J. M. Doggen1, Hans C. van Houwelingen2, Frits R. Rosendaal Study Background Recent studies have
indicated an increased risk of venous thrombosis after air travel. Nevertheless, questions on the magnitude of risk, the
underlying mechanism, and modifying factors remain unanswered. Methods We studied the effect of various modes of
transport and duration of travel on the risk of venous thrombosis in a large ongoing case-control study on risk factors for
venous thrombosis in an unselected population. We also assessed the combined effect of travel in relation to body mass
index, height, and oral contraceptive use. Since March 1999, consecutive patients younger than 70 years of age with a first
venous thrombosis have been invited to participate in the study, with their partners serving as matched control individuals.
Information has been collected on acquired and genetic risk factors for venous thrombosis. Results: Of 1,906 patients, 233
had traveled for more than 4 hours in the 8 weeks preceding the event. Traveling in general was found to increase the risk of
venous thrombosis. The risk of flying was similar to the risks of traveling by bus or train. The risk was highest in the first week
after traveling. Travel by bus, or train led to a high relative risk of thrombosis in individuals with factor V Leiden, in those
who had a body mass index of more than 30, those who were more than 190 cm tall , and in those who used oral
contraceptives. For air travel these people shorter than 160 cm had an increased risk of thrombosis after air travel as well.
Conclusions The risk of venous thrombosis after travel is moderately increased for all modes of travel. Subgroups exist in
which the risk is highly increased.

summary

There are various risks associated with flying, one of them being deep vein thrombosis. Research first linked the condition to
air travel in (1)____. Since then many case reports and series have been (2)____. An English study published in the well
known medical journal the (3)____ found that a person’s risk increased directly as a result of (4)____ and that more people
died in the (5) ____area than the (6)_____area. New Zealand and German studies found similar associations between flying
and deep vein thrombosis. This was (7)____ to a Dutch study which did found no association between flying and deep vein
thrombosis. Despite conflicting results, some airlines take a proactive approach and (8) ____ to passengers on how to (9)____
of deep vein thrombosis. Their recommendations include the wearing of loose clothes, avoidance of (10)____and regular
movements around the plane. Sitting with your legs crossed is not (11)____ while regular stretching and (12)____may be
beneficial. Finally before travelling, a (13)____with your doctor is suggested. A recent study by Cannegieter et al, published
in (14)____, investigated the risk factors associated with various (15)____ and (16) ____. Based on a study of (17) ____
patients, the researchers found that travelling by (18)____ had a comparable risk to that of flying. For those still prepared to
take the risk of travelling, common symptoms of deep vein thrombosis include (19) ____ in the leg, often associated with
swelling, redness, increased warmth and bluish (20)____. However, the most significant symptom linked to deep vein
thrombosis is (21)____. According to Cannegieter et al (2006) there are several risk factors among the general population
which may increase the risk of deep vein thrombosis. Bus or train travellers with factor V Leiden who had a (22)_____of more
than 30, were taller than (23)____ or who took (24)____ had a relatively high risk. Whereas air travel led to an
(25)____thrombosis risk for travellers with a height of less than (26) ____.
Part B

Going blind in Australia

Reading passage A

Paragraph 1 Australians are living longer and so face increasing levels of visual impairment. With 85% of the legally blind
over 50 years of age, and the risk of blindness ten times greater for those over the age of 65 than for younger individuals,
what prevents older people from receiving adequate eye care? How can general practitioners help prevent disease and
promote eye health?

Paragraph 2 When we look at the problem of visual impairment and the elderly, there are three main issues. First, most
impaired people retire with relatively "normal" eyesight, with no more than presbyopia, which is common in most people
over 45 years of age. Second, those with visual impairment do have eye disease and are not merely suffering from "old age”.
Third, almost all the major ocular disorders affecting the older population, such as cataract, glaucoma and age-related
macular degeneration (AMD), are progressive and if untreated will cause visual impairment and eventual blindness.

Paragraph 3 For example, cataract accounts for nearly half of all blindness and remains the most prevalent cause of
blindness worldwide. In Australia, we do not know how prevalent cataract is, but it was estimated in 1979 to affect the vision
of 43 persons per thousand over the age of 64 years. Although some risk factors for cataract have been identified, such as
ultraviolet radiation, cigarette smoking and alcohol consumption, there is no proven means of preventing the development
of most age-related or senile cataract.

Paragraph 4 Cataract blindness can be delayed or cured if diagnosis is early and therapy, including surgery, is accessible.
However, a recent survey showed that the rate of intraocular lens insertion was highly variable by State, suggesting there
may be barriers to access to treatment of cataract.

Paragraph 5 AMD is the leading cause of new cases of blindness in those over 65. In the United States, it affects 8-11% of
those aged 65-74, and 20% of those over 75 years. In Australia, the prevalence of AMD is presently unknown but could be
similar to that in the USA. Unlike cataract, the treatment possibilities for AMD are limited.

Paragraph 6 Glaucoma is the third major cause of vision loss in the elderly. This insidious disease is often undetected until
optic nerve damage is far advanced. While risk factors for glaucoma, such as ethnicity and family history, are known, these
associations are poorly understood. With early detection, glaucoma can be controlled medically or surgically.

Paragraph 7 While older people use a large percentage of eye services, many more may not have access to, or may
underutilize, these services. In the United States 33% of the elderly in Baltimore had ocular pathology requiring further
investigation or intervention. In the UK, only half the visually impaired in London were known by their doctors to have visual
problems, and 40% of those visually impaired in the city of Canterbury had never visited an ophthalmologist.

Paragraph 8 The reasons for people underutilising eye care services are, first, that many elderly people believe that poor
vision is inevitable or untreatable. Second, many of the visually impaired have other chronic disease and may neglect their
eyesight. Third, hospital resources and rehabilitation centres in the community are limited and, finally, social factors play a
role.

Paragraph 9 People in lower socioeconomic groups are more likely to delay seeking treatment; they also use fewer
preventive, early intervention and screening services, and fewer rehabilitation and after-care services. The poor use more
health services, but their use is episodic, and often involves hospital casualty departments or general medical services, where
eyes are not routinely examined. In addition, the costs of services are great deterrent for those with lower incomes who are
less likely to have private health insurance.

Paragraph 10 For example, surgery is the most effective means of treatment for cataract, and timely medical care is
required for glaucoma and AMD. However, in December 1991, the proportion of the Australian population covered by private
health insurance was 42%. Less than 38% had supplementary insurance cover. With 46% of category 1 (urgent) patients
waiting for more than 30 days for elective eye surgery in the public system, and 54% of category 2 (semi-urgent) patients
waiting for more than three months, cost appears to be a barrier to appropriate and adequate care.
Paragraph 11 Seddon suggests that the poor may have less knowledge about the warning signs of blindness, as well as
different ideas about blindness and what can be done about it. Two studies conducted in the United States found that
educational level was associated with visual impairment and blindness.

Paragraph 12 With the proportion of Australians aged 65 years and older expected to double from the present 11 % to 21 %
by 2031, the cost to individuals and to society of poor sight will increase significantly if people do not have access to, or do
not use, eye services. To help contain these costs, general practitioners can actively investigate the vision of all their older
patients, refer them earlier, and teach them sell-care practices. In addition, the government, which is responsible to the
taxpayer, must provide everyone with equal access to eye health care services. This may not be achieved merely by
increasing expenditure - funds need to be directed towards prevention and health promotion, as well as treatment. Such
strategies will make good economic sense if they stop older people going blind.

QUESTIONS Going blind in Australia

1 The main idea of the first paragraph (lines 1-5) is that a) 85% of Australians over 50 years old are legally blind b) There
are many reasons for visual impairment in Australia. c) The elderly in Australia need better eye care d) The elderly in
Australia receive sufficient eye care.

2 In paragraph 2 (lines 6-12) the author suggest that a) Many people have poor eyesight at retirement age. b) Sight
problems of the aged are often preventable or treatable. c) Cataract and glaucoma are age-related and often untreatable.
d) Few sight problems of the elderly are potentially damaging.

3 According to the article, cataracts a) May affect about half the population of Australia over age 64. b) May occur in
about 4-5% of Australians over age 64. c) Are directly related to smoking and alcohol consumption in old age. d) Are the
cause of more than 50% of visual impairments.

4 According to the article, age-related macular degeneration (AMD) a) Responds well to early treatment. b) Affects 1 in 5
of people aged 65-74. c) Is a new disease which originated in the USA. d) Causes a significant amount of sight loss in the
elderly.

5 According to the article, the detection of glaucoma a) Generally occurs too late for treatment to be effective. b) Is strongly
associated with ethnic and genetic factors. c) Must occur early to enable effective treatment. d) Generally occurs before
optic nerve damage is very advanced.

6 Statistics in the article indicate that a) Existing eye care services are not fully utilised by the elderly. b) GP's are generally
aware of their patients’ sight difficulties. c) Most of the elderly in the USA receive adequate eye treatment. d) Only 40% of
the visually impaired visit an opthalmologist.

7 According to the article, which of the following statements is NOT true? a) Many elderly people believe that eyesight
problems cannot be treated effectively. b) Elderly people with chronic diseases are more likely to have poor eyesight. c) The
facilities for eye treatments are not always readily available. d) Many elderly people think that deterioration of eyesight is a
product of ageing.

8 In discussing social factors affecting the use of health services, the author points out that a) Wealthier people use health
services more often than poorer people. b) Poorer people use health services more regularly than wealthier people. c)
Poorer people deliberately avoid having their eye sight examined. d) Poorer people have less access to the range of available
eye care services.

9 In Australia, in the year 2031 a) About one tenth of the country's population will be elderly. b) About one third of the
country's population will be elderly. c) The proportion of people over 65 will be twice the present proportion. d) The number
of visually impaired will be twice the present number.

10 The author believes that general practitioners a) Should be more active in investigating patients' possible sight
difficulties. b) Should not be required to deal with sight deterioration. c) Should not refer patients to specialists until the
problems are advanced. d) Should seek assistance from eye specialists in detection of problems.
11 The author suggests that a) Increased government funding will solve the country's eye care problems. b) Government
services should include prevention and health promotion. c) General practitioners should reduce the cost of treating sight
problems in the elderly. d) General practitioners should take full responsibility for treating sight problems.

Reading passage B

"Miracle" jab makes fat mice thin

Paragraph 1 After a four-week course of treatment with a protein called ob, the fat simply falls off, leaving vastly
overweight mice slim, active and sensible eaters. If the protein has the same effect on people, it could be the miracle cure
millions have been waiting for. That, at least, is the theory. But sceptics warn that too little is known about the way the
human version of the ob protein works to be sure that extra doses would help people lose weight.

Paragraph 2 But when the results of the tests were leaked last week, Amgen, the Californian biotechnology company which
owns exclusive rights to develop products based on the protein, saw an overnight jump in its share price.

Paragraph 3 Last December, a team led by Jeffrey Friedman and his colleagues at the Howard Hughes Medical Institute at
the Rockefeller University, New York, discovered a gene which they called ob. In mice, a defect in this gene makes them grow
hugely obese. Humans have an almost identical gene, suggesting that the product of the gene - the ob protein - plays a part
in appetite control. The ob protein is a hormone, which Friedman has dubbed leptin.

Paragraph 4 In April, Amgen, which is based in Thousand Oaks, California, paid the institute $20 million for exclusive rights
to develop products based on the discovery. Amgen will carry out safety tests on the protein in animals next year, and hopes
to begin clinical trials on people within a year.

Paragraph 5 The excitement began last week when the journal Science published the findings of three groups which have
been working on the protein. The results in obese mice with a defective gene that prevents them making the protein were
dramatic. Mary Ann Pelleymounter and her colleagues at Amgen gave obese mice shots of the protein

every day for a month. Those on the highest dose lost an average of 22 percent of their weight.

Paragraph 6 "Before treatment, these mice overate, had lower metabolic rates than normal, lower temperatures, and
raised 20 levels of insulin and glucose in their blood," says Pelleymounter. "The protein brought all of these back to normal
levels," she says.

Paragraph 7 More significantly, in terms of the potential for a human slimming drug, the treatment also worked on normal
mice, which lost what little spare fat they had. They lost between 3 and 5 percent of their body weight, almost all of it in the
form of fat, according to Pelleymounter. This is important because no one has identified a mutation in the human ob gene
that might lead to obesity, suggesting that whatever the cause for obesity, the ob protein might still help people lose weight.

Paragraph 8 Friedman and his team carried out similar experiments. In just one month, their obese mice shed around half
their body fat. In the average obese mouse, fat makes up about 60 percent as much as untreated animals. Their fat is
practically melted away, falling to 28 per cent of their body weight after a month. In normal mice, treatment reduced the
amount of fat from an average of 12.22 percent of body weight to a spare 0.67 percent.

Paragraph 9 Friedman and Pelleymounter believe that the protein, which is produced by fat cells, regulates appetite. "We
think it's something like a circulating hormone to tell the brain there are normal amounts of fat, or too much, in which case
the brain turns down your appetite,” says Pelleymounter.

Paragraph 10 The experiments also show that treated mice have an increased metabolic rate, suggesting that they burn fat
more efficiently. Their appetites decrease - and they are less sluggish, becoming as active as normal mice.

Paragraph 11 The third group of researchers from the Swiss Pharmaceuticals company Hoffman-La Roche, are more
sceptical about how significant the ob protein might be in treating obesity. From their studies, they conclude that the protein
is just one of many factors that control appetite and weight. "This is a very important signal, but it's one of several,” says
Arthur Campfield, who led the team.

Paragraph 12 Campfield doubts whether the ob protein alone will have much effect in overweight humans. His team hopes
to unravel the whole signalling system that regulates weight, and is particularly keen to find the receptor in the brain that
responds to the ob hormone. Hoffman-La Roche, excluded by the Amgen licence to deal from developing products based on
the ob protein itself, hopes to develop pills that interfere with message pathways in appetite control.

Paragraph 13 Stephen Bloom, professor of endocrinology at London's Hammersmith Hospital, agrees. "I think the work with
ob is a major advance, but we've not got the tablet yet. That will come when people have made a pill that stimulates the ob
receptor in the brain so it switches off appetite."

Paragraph 14 Even Pelleymounter at Amgen cautions against overoptimism at this stage. "We don't know whether it would
be true that people would lose weight, but you can predict from mice that it would have some positive effect," she says.
"However, I don't think obese people should hold out for this. They should carry on with their exercises and dieting."

"Miracle" jab makes fat mice thin

12 The first paragraph (lines 1-5) informs the reader that. a) A protein treatment has caused mice to lose weight
dramatically. b) A protein treatment for mice cannot be adapted for use in humans. c) Scientists agree that a new protein
treatment will make people lose weight. d) A scientific method of making obese people slim has been developed.

13 The reader can infer from the second paragraph (lines 6-8) that a) The public is sceptical about the possibility of
developing a scientific slimming method. b) The Californian company, Amgen, is eager to share its new-found technical
knowledge. c) Several companies will be able to develop products based on the results of the research. d) Many people are
confident that a product which guarantees weight loss will sell very well.

14 Friedman and his colleagues found that a genetic defect in the gene called ob a) Causes obesity in mice. b) Causes
obesity in humans and mice. c) Has the same structure in mice and humans. d) Produces a protein called leptin.

15 According to Friedman and his colleagues, the ob protein a) May be transferred from mice to humans. b) May be a
factor in appetite control. c) Is produced by the ob hormone. d) Is mainly found in obese mice.

16 According to the article, the Californian company called Amgen a) Was paid $20 million by the Howard Hughes Institute.
b) Intends to use humans to test new products based on the ob protein. c) Has begun to trial new products based on the ob
protein. d) Is one of several companies trialing products based on the ob protein.

17 A study by Mary Ann Pelleymounter and her colleagues found that a) The ob protein caused subjects in the study to
decrease their metabolic rate. b) The ob protein caused people to lose about twenty percent of their weight. c) A
deficiency in the ob protein had caused obesity· in the subjects. d) A defective ob gene resulted in the production of the ob
protein.

18 According to the Friedman and Polleymounter studies, treatment with ob protein a) May be useful only for people with
a defective ob gene. b) May be useful for anyone who wants to lose weight. c) Is effective only on mice with a defective ob
gene. d) Will not be effective on people who want to lose weight.

19 The evidence gathered in Friedman's and Pelleymounter's studies a) Demonstrates conclusively that the ob protein
controls appetite. b) Proves that the ob protein causes animals to lose 40 percent of their weight. c) Suggests that the ob
protein is a factor in determining appetite. d) Suggests that the normal amount of fat is 0.67 percent of bodyweight.

20 The researchers from Hoffman-La Roche are less confident of the protein's importance because a) It has not been
trialled on humans. b) The trials on mice were inconclusive. c) It does not have a significant role in weight loss. d) It is
not the only factor involved in appetite control.

21 In conclusion, the article suggests that a) A treatment for obesity in humans will be developed from the ob protein. b)
Scientists will soon have more knowledge about the ob receptor in the brain. c) The results of the study of mice will lead to
weight loss pills for humans. d) Despite the results of the study of mice, the benefit for humans is unknown.
Deep Vein Thrombosis

Answer Sheet 1. 1954 2. published 3. Lancet 4. flying 5. arrival 6. departure 7. in contrast 8. offer suggestions 9. reduce the
risk 10. cigarettes and alcohol 11. recommended/advised (necessary to deduce fro the context) 12. exercising/exercises 13.
consultation (necessary to change verb to noun) 14. 2006 15. modes of transport 16. duration of travel 17. 1906 18. bus or
train 19. pain and tenderness 20. skin discoloration 21. tenderness in calf 22. body mass index 23. 190cm 24. oral
contraceptives 25. increased 26. 160cm

Passage A - Going blind in Australia

1 c 2 b 3 b 4 d 5 c 6 a 7 b 8 d 9 c 10 a 11 b

Passage B - "Miracle" jab makes fat mice thin

12 a 13 d 14 a 15 b 16 b 17 c 18 b 19 c 20 d 21 d
 FULL TEST 7
Improving Child Survival Rates
Part A

Improving Child Survival Rates

Text 1 The Consequences of Child Poverty It is estimated that over 10 million children in developing countries die
each year, mainly from preventable causes. In approximately half of these deaths, malnutrition is a contributory
cause. However, the World Health Organization has argued that seven out of ten childhood deaths in such
countries can be attributed to just five main causes. In addition to malnutrition, these causes are pneumonia,
diarrhoea, measles, and malaria. Around the world, three of every four children seen by health services are
suffering from at least one of these conditions. Many of these deaths could be prevented using readily available
medical technologies at comparatively little cost. In 1997, the United Nations Development Programme
estimated that the cost of providing basic health and nutrition for every person on the planet was $13 billion per
year for ten years. To place this sum in perspective, in 2002, United States citizens spent $30 billion on pizza and
Europeans spent $12 billion on dog and cat food.

Text 2 Priority child survival interventions • Newborn care, taking into consideration the life cycle approach and
continuum of care • Infant and young child feeding, including micronutrient supplementation and deworming •
Provision of maternal and childhood immunization and promotion of new vaccines • Prevention of mother-to-
child transmission of HIV • Prevention of malaria using insecticide-treated nets • Management of common
childhood illnesses • Management and care of HIV-exposed or infected children

Text 3 UN Charter on the Rights of the Child Article 24 of the UNCRC states that: Member countries recognize the
right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment
of illness and rehabilitation of health. Member countries shall strive to ensure that no child is deprived of his or
her right to use such health care services. In addition, governments of member countries shall pursue full
implementation of this right and, in particular, shall take appropriate measures to: • diminish infant and child
mortality • ensure provision of medical assistance and health care to all children with emphasis on the
development of primary health care • combat disease and malnutrition, including within the framework of
primary health care through the application of readily available technology and through the provision of
adequate nutritious foods and clean drinking-water, taking into consideration the dangers and risks of
environmental pollution • ensure appropriate pre-natal and post-natal health care for mothers • ensure that all
segments of society, in particular parents and children, are informed, have access to education and knowledge
regarding child health and nutrition, the advantages of breastfeeding, hygiene and environmental sanitation
and the prevention of accidents • develop preventive health care, guidance for parents and family planning
education and services. If these rights were to be fulfilled, child survival rates would rapidly improve.

Text 4 Underlying causes of Poor Health While medical interventions can, in principle, prevent most young
children from dying early, they cannot remove the underlying cause of poor health, which is poor living
conditions suffered by 30% of the world’s children. For example, almost a third of the world’s children live in
squalid housing conditions, with more than five people per room or with mud flooring. Over half a billion
children (27%) have no toilet facilities whatsoever and over 400 million children (19%) are drinking from unsafe
water sources (e.g., rivers, lakes, ponds) or have to walk so far to fetch water that they cannot carry enough to
meet minimum health requirements. The World Health Organization has argued that: “The world’s biggest killer
and the greatest cause of ill health and suffering across the globe is listed almost at the end of the International
Classification of Diseases. It is given code Z59.5— extreme poverty” . Eliminating extreme poverty is the key to
improving global child survival rates, particularly over the long term.

Summary

According to the World Health Organisation (WHO), malnutrition, pneumonia, (1)___, measles and malaria
cause (2)___ percent of childhood deaths in developing countries. In addition over 10 million children are (3)___
to die each year. Through the (4)___ of currently available medical technology, many of these deaths could be
(5)___. However, medical technology cannot (6)___ the underlying cause of poor health which is poor living
conditions. Almost 20% or the world’s children drink from (7)___ water sources such as (8)___. Over 500 million
children do not have (9)___ while (10)___ of the world’s children live in unclean and crowded housing conditions
with more than (11)___ in a single room. These conditions of (12)___must be eliminated if global child survival
rates are to be (13)___ over the (14)___. In recent years, the importance of the link between child rights and
child survival has been put forward by the United Nations. Their charter states that every child has the right to
access (15)___necessary for treating illness and rehabilitating(16)___. The key elements of this charter include
ensuring parents and children have access to (17)___ and (18)___ in the area of child health and nutrition,
breastfeeding, (19)___ and sanitation and accident prevention. The availability of sufficient (20)___ and
(21)___drinking water can also help fight against disease and (22)___. While adhering to the UN charter will
help to improve child survival rates, there are important intervention strategies which should be prioritised.
This includes using (23)___ to help prevent malaria , providing access to (24)____ for mothers and children and
promoting (25)___. Children exposed to or (26)___ HIV also need be managed and cared for. In 1997, the cost of
providing fundamental health and nutrition for the global population was estimated to be (27)___ per year over
ten years. Surely this is affordable when one considers (28)___ spent $30 billion on (29)___ and Europeans
outlayed $12 billion on (30)___ food.
Part B

Passage A

Kaguya Has Two Moms

In Japanese legend, Kaguya was a beautiful princess who came from the moon and was born inside a bamboo stalk. Today,
at the Tokyo University of Agriculture, Kaguya's namesake is a 14-month-old mouse whose conception is every bit as
fantastic: she was created by scientists using two eggs and no sperm. As reported in the journal Nature last week, that makes
Kaguya the first mouse born by parthenogenesis (from the Greek for virgin birth), a reproductive method seen in insects and
reptiles but never before in mammals.

For the moment, Kaguya's creation is a brilliant piece of science with little or no application to humans. The process by which
she was produced is so technically difficult--not to mention ethically charged--that it is hard to see how it could be attempted
with human subjects. In theory, the technique might be used to create stem cells, but even this scenario is a bit farfetched.
What the experiment offers, however, is a tantalizing glimpse into one of the central mysteries of mammalian biology: Why
do we need genes from both a mother and a father in order to be born?

After all, a queen bee's eggs can create male drones without being fertilized, and whiptail lizards are famous among
biologists and nature-show hosts for not needing males to reproduce. What makes us different?

The answer, most scientists suspect, has to do with a peculiar process called parental or genomic imprinting, which seems to
occur only in mammals. Biologists have discovered subtle changes that are made to about 100 genes and that make a
mammalian DNA molecule distinctly male or female. How does a cell know which form to imprint on its DNA? It checks out
the surrounding microscopic environment to see if it seems more male-like or female-like.

All other things being equal, an embryo must have both a maternal genomic imprint (usually from an egg) and a paternal
genomic imprint (usually from a sperm), or it won't grow properly. If it has two paternal imprints, the placenta grows but not
the embryo. If it has two maternal imprints, the embryo grows but not the supporting placenta. Defects in imprinting in
humans are thought to contribute to such neurodevelopmental ailments as Prader-Willi syndrome and perhaps some forms
of autism. Genes that have lost their imprinting have also shown up in brain tumors.

What a team of researchers led by Tomohiro Kono at the Tokyo University of Agriculture did was create a genetically
modified strain of mice in which the females produce eggs with an imprint that is somewhat father-like. Then, in a key step,
the team extracted immature eggs from the newborn mice of this strain. Why is this important? The immature eggs had the
most paternal imprint of all because they had not yet had time to sense that they were living in a female. By fusing these
father-like eggs with normal, mother eggs, the Japanese researchers were able to create an organism that could develop and
grow.

It wasn't easy. After nearly 600 attempts, only two baby mice (known as pups) survived. One was sacrificed for genetic
analysis. The other, dubbed Kaguya, grew up, mated the usual way and produced two litters. Despite the fact that Kaguya
bore offspring, "we really don't know how healthy she is," says Marisa Bartolomei, an imprinting expert and Howard Hughes
investigator at the University of Pennsylvania.

But scientists now have a better understanding of the biological underpinnings of procreation. "In spite of all the differences
between men and women--our fights, arguments and seeming incompatibility--at the end of the day you still need a set of
male and female genes for the species to go on," Kono says. "I find that fascinating." -With reporting by Toko
Sekiguchi/Tokyo

Title: Kaguya has two Moms

1. What do we know about the legendary Kaguya’s father? He was

a) the moon. b) the king. c) a bamboo stalk. d) a mouse.

2. What is unusual about the conception of Kaguya, the mouse?

a) She was created by scientists. b) No sperm was required. c) She is the first example of a mammal being born this way. d)
All of the above.

3. What use is this process for humans?

a) We will use it to breed more mice. b) We will use it to help infertile couples. c) We will use it to manufacture stem cells.
d)The process is of no immediate value.

4. What do some bees and lizards have in common?

a) Males are largely unnecessary for reproduction. b) They are both dangerous. c) Neither is used by scientists for
experimental purposes. d) They have nothing in common.

5. Which of the following are subject to genomic imprinting?

a) Reptiles. b) Insects. c) Fish. d) Mammals.

6. What do researchers believe could be a factor in Prader-Willi syndrome?

a) Brain tumors. b) Faults in genomic imprinting. c) Neurodevelopmental ailments. d) A defective placenta.

7. Was Kaguya able to have children of her own?

a) Yes, twins. b) Yes, males. c) Yes, females. d) No.

8. Was the first attempt at this experiment successful?

a) Yes. b) No, it took two attempts. c) No, they tried more than 500 times. d) We don’t know.

9. What happened to Kaguya’s sibling?

a) It was dissected by researchers. b) It mated and produced children. c) Its progress is being monitored at the University of
Pennsylvania. d) We don’t know.

10. What will happen to Kaguya now?

a) She will be used to breed a colony of ‘supermice.’ b) She will become Professor Kono’s pet. c) She is expected to die
shortly. d) Kaguya’s fate is not discussed in the article.
Reading Passage B

The evidence in favour of immunisation - a world without smallpox - a world without polio.
1. It is an extraordinary paradox that, despite abundant evidence of the success of immunisation, its necessity is still queried.
In the last 12 months, feature articles in leading Australian newspapers have openly questioned the need for immunisation.
Such articles cause unnecessary concern to parents & and medical practitioners alike and may reduce the numbers of infants
being immunised. The most important issue today is the failure to apply immunisation universally to control or eliminate
disease.

2. How can we produce convincing evidence of the current benefits of immunisation? There are three major methods of
evaluation: challenge studies and epidemiological studies, which were once sufficient to support the common use of vaccines;
and controlled trials, in which both efficacy and safety have been demonstrated to the satisfaction of national control
authorities.

3. Two hundred years ago, Edward Jenner tested the belief that inoculation with cowpox fluid would protect individuals
against smallpox. He subsequently challenged his cowpox vaccinees with smallpox fluid and convincingly confirmed the
belief. Jenner thus started the practice of vaccination and preventive medicine. In 1958, the World Health Organization
began a smallpox eradication campaign (modified in 1967 to deal with those areas when smallpox remained endemic). The
success of this campaign in 1977, both medically and financially, conclusively demonstrated the benefits of well planned and
organised immunisation campaigns.

4. In 1988, the World Health Assembly decided to attempt the global eradication of poliomyelitis. Poliomyelitis has been
eradicated from Australia the United Kingdom, the Americas and many other countries, but the risk of reintroduction by wild
viruses persists. This has been demonstrated twice in 15 years in Holland, where two severe outbreaks of paralytic
poliomyelitis occurred among members of a religious sect who refused vaccination. On both occasions, wild virus was
reintroduced to the United States and Canada by visiting members of this sect. Universal immunisation with poliomyelitis
vaccine is the only way to stop transmission of the virus and achieve complete eradication.

5. What of other vaccine preventable viral diseases, such as measles, mumps and rubella? At an immunisation conference in
Washington, in 1978, Albert Sabin said that eradication of these diseases was achievable with present day vaccines if there
was universal vaccination. He stated that: "The questions are no longer scientific or medical - they are educational, social and
financial. The current evidence for control of these viral diseases is convincing but eradication will take a few more years.
The eradication of hepatitis B, however, may take several generations because of the existence of the carrier state in some
previously infected individuals.

6. What evidence is there for the success of vaccination against the previously common bacterial diseases, diptheria, tetanus
and pertussis. Diptheria and tetanus are types of disease which have responded to vaccination and vaccines have lead to the
almost complete prevention of death in adequately vaccinated individuals. Pertussis is a different type of disease, and the
vaccine does not provide absolute protection. Nevertheless, the epidemiological evidence for efficacy of the pertussis vaccine
is now, overwhelming, and there is no evidence that the modern vaccines are associated with a disorder called neurological
sequelae. However, whole cell pertussis vaccine induces more reactions than diptheria-tetanus vaccines.

7. In the last five years vaccination against Haemophilus influenzae type b (Hib) has been introduced to many countries in the
developed world. In Finland, where the initial efficacy studies were undertaken, there are now no reported cases of invasive
Hib infection. The numbers of reported cases are also falling in Britain and the United States as a consequence of
immunisation. There is no doubt that infant vaccination with Hib vaccines, if conscientiously carried out, could eliminate this
disease from Australia within five years.

8. Despite the available evidence, a vocal minority is attempting to dissuade parents from protecting their young children by
immunisation, objecting that the injection of foreign material is unnatural and, therefore, more dangerous than natural
infection. No medical procedure is entirely without risk, and occasional severe adverse reactions to immunisation do occur.
However, the incidence of death or permanent disability from the infectious diseases of childhood is far in excess of the very
occasional severe reaction to immunisation. What anti-immunisation proponents do not acknowledge is that, in any
infectious disease, the human host is invaded by a foreign and "unnatural" virulent pathogen which produces many toxic
products and destroys or damages many host cells. The result may be irreparable damage to the host or death.
9. Advocates of natural immunisation propose that allowing wild infection to occur in a healthy host engenders stronger
immunity. Not infrequently, quite healthy unimmunised children die from vaccine preventable diseases. Such advocacy is
mischievous and, in view of our knowledge of the efficacy of immunisation, inexcusable.

10. National control authorities will not license the use of any vaccine until extensive safety, immunogenicity and efficacy
studies have been carried out. As an example, the hepatitis A vaccine was demonstrated to have an efficacy of approximately
95% in a controlled trial of about 40000 subjects before it was recently licensed. No comparable data exist to support the use
of any alternative homoeopathic "immunisation" procedures because they have never been subjected to any scientifically
acceptable study. Claims of efficacy for these procedures are only possible because herd immunity resulting from standard
immunisation provides some indirect protection to the unimmunised. Medical practitioners who misguidedly yield to
parental requests to administer such preparations could be charged with malpractice and be liable for damages should the
child subsequently suffer disability from a vaccine preventable disease. The facts speak for themselves. Smallpox has been
eradicated. Poliomyelitis has been eliminated from many countries and could be eradicated by the World Health
Organization campaign. Invasive Haemophilus infection has been eliminated from Finland by the use of Hib vaccines. In
Australia the reductions in mortality cannot fail to impress: 91% reduction from measles

(since immunisation was introduced in 1970); 99% from tetanus and pertussis and 100% from diphtheria and poliomyelitis.
In the United States there has been a 80% - 100% reduction in the incidence of vaccine preventable diseases since
immunisation was introduced.

1. The author of the article thinks that arguments against world immunisation

a. are causing doctors and parents to worry unnecessarily

b. are necessary for the success of immunisation

c. have reduced the numbers of infants and youth being immunised

d. fail to address today's most important issues

2. Two hundred years ago, Edward Jenner

a. proved that injecting people with smallpox would vaccinate them against cowpox

b. injected smallpox into people after inoculating them with a cowpox vaccine

c. mixed cowpox and smallpox vaccines together and tested people

d. changed his vaccine from cowpox to smallpox

3. According to the article, the potential of well planned and organised immunisation campaigns

a. is limited to the World Health Organisation

b. is the responsibility of Edward Jenner

c. was only possible with the eradication of smallpox

d. was successfully demonstrated with the smallpox eradication program

4. Which statement is FALSE?

a. Albert Sabin claims that with world wide immunisation it is possible to eradicate rubella, measles and mumps

b. There is little evidence that Hepatitis B could be eradicated

c. Since some people may be carriers of the Hepatitis B virus, it cannot be eradicated quickly

d. There is convincing evidence that world immunisation of many viral diseases will be effective

5. Evidence for the effectiveness of vaccination against bacterial diseases

a. is not convincing in terms of diptheria and tetanus

b. shows that the vaccine for pertussis causes neurological sequelae

c. indicates that the vaccine for pertussis is also effective

d. none of the above

6. Which statement is TRUE?

a. Initial studies in Finland reported no cases of Hib infection

b. Hib was eliminated from Australia within five years

c. Many people are falling ill in Britain and the United States as a consequence of Hib

d. The vaccination against Hib has been effective in Britain, the United States, Finland and Australia

7. According to the author,

a. immunisation is dangerous because of the injection of foreign material into the body

b. vaccination is completely safe, effective and contains no element of risk

c. a virus is foreign material but a vaccine is a natural product

d. foreign vaccine material is generally less harmful than a foreign virus entering the body

Save Answer

8. Natural ‘immunisation’

a. procedures have a success rate comparable with standard immunisation success rates

b. procedures have been tested extensively and scientifically

c. procedures have appeared to be successful because other people in the community had been immunised

d. procedures should be allowed in the community when requested by parents

9.Which statement is FALSE?

a. No one in Australia now contracts poliomyelitis or diptheria

b. The World Health Campaign may completely eliminate poliomyelitis from the world

c. In the last 25 years in Australia, the number of deaths from measles has dropped by 91%

d. The use of immunisation in the United States has had an enormous effect on the presence of diseases which vaccination
could prevent

10. Where effective campaigns for immunisation are carried out

a. vaccination rates have fallen

b. they are effective in reducing incidence of the disease

c. the diseases have returned soon after

d. medical practitioners are reluctant to vaccinate

Part A Answer Sheet 1. diarrhoea 2. 70 (convert 7 out of 10 into a percentage) 3. estimated 4. use/usage (change
to noun form) 5. prevented 6. remove 7. unsafe 8. rivers, lakes ponds (all required) 9. toilet facilities 10. almost a
third 11. five people 12. extreme poverty 13. improved (change to passive voice) 14. long term 15.
facilities/health care services 16. health 17. education 18. knowledge 19. hygiene 20. nutritious foods 21. clean
22. malnutrition 23. insecticide treated nets 24. immunisation 25. new vaccines 26. infected with (preposition
“with” required) 27. $13 billion 28. US Citizens/Americans 29. pizza 30. dog and cat

PART B

Passage A Answers

1.b) the king

2.d) All of the above.

3. d) The process is of no immediate value.

4.a) Males are largely unnecessary for reproduction.

5.d) Mammals.

6.b) Faults in genomic imprinting.

7. c) Yes, female.

8. c) No, they tried more than 500 times.

9. a) It was dissected by researchers.

10.d) Kaguya’s fate is not discussed in the article

passage B Answers

1.A. are causing doctors and parents to worry unnecessarily

2. smallpox would vaccinate them against cowpox B. injected smallpox into people after inoculating them with a cowpox
vaccine

3. D. was successfully demonstrated with the smallpox eradication program

4.B. There is little evidence that Hepatitis B could be eradicated

5. C. indicates that the vaccine for pertussis is also effective

6. D. The vaccination against Hib has been effective in Britain, the United States, Finland and Australia

7. D. foreign vaccine material is generally less harmful than a foreign virus entering the body

8. C. procedures have appeared to be successful because other people in the community had been immunised

9. A. No one in Australia now contracts

10. B. they are effective in reducing incidence of the disease

 FULL TEST 8
PART A

What’s new?
TEXT 1

Title: Management of migraine in New Zealand General Practice

OBJECTIVES: To determine the proportion of patients who have a diagnosis of migraine in a sample of New Zealand general
practice patients, and to review the prophylactic and acute drug treatments used by these patients.

DESIGN, SETTING AND PARTICIPANTS: A cohort of general practitioners collected data from about 30 consecutive patients
each as part of the BEACH (Bettering the Evaluation and Care of Health) program; this is a continuous national study of
general practice activity in New Zealand. The migraine substudy was conducted in June-July 2005 and December 2005-
January 2006.

MAIN OUTCOME MEASURES: Proportion of patients with a current diagnosis of migraine; frequency of migraine attacks;
current and previous drug treatments; and appropriateness of treatment assessed using published guidelines.

RESULTS: 191 GPs reported that 649 of 5663 patients (11.5%) had been diagnosed with migraine. Prevalence was 14.9% in
females and 6.1% in males. Migraine frequency in these patients was one or fewer attacks per month in 77.1% (476/617),
two per month in 10.5% (65/617), and three or more per month in 12.3% (76/617) (missing data excluded). Only 8.3%
(54/648) of migraine patients were currently taking prophylactic medication. Patients reporting three or more migraines or
two migraines per month were significantly more likely to be taking prophylactic medication (19.7% and 25.0%, respectively)
than those with less frequent migraine attacks (3.8%) (P < 0.0001). Prophylactic medication had been used previously by
15.0% (96/640). The most common prophylactic agents used currently or previously were pizotifen and propranolol; other
appropriate agents were rarely used, and inappropriate use of acute medications accounted for 9% of “prophylactic
treatments”. Four in five migraine patients were currently using acute medication as required for migraine, and 60.6% of
these medications conformed with recommendations of the National Prescribing Service. However, non-recommended drugs
were also used, including opioids (38% of acute medications).

CONCLUSIONS: Migraine is recognised frequently in New Zealand general practice. Use of acute medication often follows
published guidelines. Prophylactic medication appears to be underutilised, especially in patients with frequent migraine. GPs
appear to select from a limited range of therapeutic options for migraine prophylaxis, despite the availability of several other
well documented efficacious agents, and some use inappropriate drugs for migraine prevention

TEXT 2

Table 1: Economic burden of migraine in the USA

US$ million

Cost element Men Women Total

Medical 193 1,033 1,226

Missed workdays 1,240 6,662 7,902

Lost productivity 1,420 4,026 5,446

TEXT 3

Case 1:

“Jane” experienced pressure from employers due to her migraine absences. She had three days off work in the first quarter of
the year, and this was deemed unacceptable and unsustainable by her employers; therefore she has just resigned from her
job and hopes that her future employers will be more understanding.
Case 2:

“Sally’s” employers and colleagues are aware of her migraine symptoms and are alert to any behaviour changes which might
indicate an impending attack. In addition, colleagues have supporters’ contact numbers, should she need to be escorted
during a migraine. As her employers are part of the government ‘Workstep Programme’, she has accessed a number of
allowances and initiatives: her migraines have been classified as a long-term health condition rather than sickness absence,
which permits her a higher absence threshold. She now works flexible hours and has received funding for eye examinations,
prescription glasses, and a laptop to enable her to work from home.

TEXT 4

Research brief on migraines in the US

• Migraine prevalence is about 7% in men and 20% in women

over the ages 20 to 64.

• The average number of migraine attacks per year was 34 for men
and 37 for women.

• Men will need nearly four days in bed every year. Women will
need six.

• The average length of bed rest is five to six hours.

• Only about 1 in 5 sufferers seek help from a doctor.

Summary Answers

In a recent study by Spark, Vale and Mills, which investigated the prevalence of migraines among (1 ..... patients in New
Zealand, it was found that (2) .....out of (3) ..... patients had been diagnosed with migraine. Migraine incidence was different
across genders, with a (4) ..... proportion of men diagnosed compared with women. Similarly, a US report found migraines
occurring in around (5) ..... of men and (6) .....of women within a restricted age range. Concerning interventions, the US
report found that most migraine sufferers in the survey (7) ..... medical advice. Of the patients surveyed by
Spark, Vale and Mills, just over eight per cent were taking (8) ..... at the time of the study. By contrast, the study found that a
large proportion of migraine sufferers used (9) ..... . Given these findings, the authors
note that general practitioners do not utilise (10) ..... effectively, and tend to choose from a (11) ..... of available
therapies.With respect to gender, an economic analysis suggests that the economic (12) ..... of migraines in the US cost
$7,902,000,000 in (13) ..... and $5,446,000,000 in (14) ....., with women accounting for a (15) ..... proportion of costs
compared to men. This is reflected in research from the US which has found that female migraine sufferers spend an average
of six days (16) ..... each year, compared with (17) ..... for men. The case of (18)..... demonstrates that employers may not
tolerate (19) ..... . However the case of (20) ...... illustrates a “best practice” approach to dealing with migraines in the
workplace. This case shows that, ideally, (21) ..... and (22) ..... should be aware of migraine symptoms, and be able to notice
any (23) ..... which might signal that an attack is about to occur. It is also useful if co-workers have a list of (24) ..... .
Being able to work (25) ..... hours and having the capacity to work (26) ..... also make working life more manageable for the
migraine sufferer.
Part B

Passage A

Latin America struggles as cholera spreads

Paragraph 1 Health officials from 10 Latin American countries met in Washington DC this week to search for measures to
control the growing cholera epidemic in their countries. Last week the World Health Organisation (WHO) set up a task force
to combat the spread of the disease which, it predicts, could affect as many as 120 million people – a quarter of Latin
America’s population.

Paragraph 2 Cholera has now reached beyond the western coastal countries of Peru, Colombia, Ecuador, and Chile to the
edge of Brazil. So far, the five cases reported in Brazil are thought to be Peruvians who have crossed the border at an island
in the Amazon called Tabatinga. More than 163,000 cases have been reported to the WHO from Latin America.

Paragraph 3 Despite the large numbers infected, the death rate has so far been relatively low. Figures from Peru show that
out of 158,929 cases of the disease there were 1,130 deaths – fewer than 1 per cent of those affected. The WHO says
communities unprepared for cholera usually suffer a much higher death rate – up to half of those who develop the disease.

Paragraph 4 This is the first widespread outbreak of cholera in the Americas for a century. “Peru has done remarkably well,”
says David Bennett, coordinator for the cholera taskforce at the Pan American Health Organisation (PAHO) in Washington
DC.

Paragraph 5 Cholera is treatable when diagnosed promptly. Jim Tulloch, head of the diarrhoeal diseases program at the
WHO, says Peru has for years been training its doctors to treat diarrhoeal disease and that this has helped to reduce the
death toll.

Paragraph 6 The cholera bacterium produces a toxin which paralyses the gut, stopping it from absorbing liquid. It kills only
because it dehydrates the body rapidly. Nine out of ten patients will recover simply by drinking oral rehydration fluids – a
balance of water, sugar and salt. Intravenous infusions of fluid are necessary for the one in ten who become severely
dehydrated or are unable to keep liquids down. Antibiotics help to reduce the time that people suffer from diarrhoea for and
also make the diarrhoea itself less infectious.

Paragraph 7 No one is belittling the impact of the disease. The WHO says the epidemic is an “unfolding tragedy” worldwide,
with growing numbers of cases in Benin and Zambia as well as those in Latin America. But Tulloch emphasises that the
epidemic must be seen in the context of other deaths caused by diarrhoeal disease. He says that while 2,000 people have died
of cholera worldwide since the end of January, in the same period 800,000 children under 5 years of age have died from
diarrhoea.

Paragraph 8 “The (Latin American) epidemic is much more of a disaster to the economy than to public health,” says Sandy
Cairncross at the London School of Hygiene and Tropical Medicine. Many countries have banned imports of food from Peru,
despite the WHO’s advice that no large cholera outbreak has ever been traced to commercial imports. The WHO estimates
that the epidemic will cost Peru $1 billion this year in losses to exports, tourism and other earnings.

Paragraph 9 Officials say Peru’s poor water supply and overcrowding of the shanty towns that surround the coastal cities
have helped to spread the disease. The cholera bacterium is excreted in the faeces of infected people and thrives in situations
where sewage can mix with supplies of fresh water.

Paragraph 10 Horatio Lores, senior epidemiologist at the Lima office of the PAHO, says, “We have much poverty here, no
sanitation and basic conditions.” Few houses have piped water. Cairncross says that even 10 years ago people were spending
a tenth of their income on water bought from street vendors. Since then real incomes have declined sharply.

Paragraph 11 According to the PAHO, the water and sewerage systems in Lima and Peru’s other coastal cities have not been
properly repaired for years. Levels of chlorine disinfectant in the water supplies have not been checked regularly and the
water pressure is not maintained for 24 hours a day, so wasted water can flow into any pipes that are cracked. Where
populations have grown rapidly, water supplies have become grossly overstretched.
Paragraph 12 “A traditional practice in the dry coastal plains is to use sewage to fertilise fields when water is scarce,” says
Cairncross. “People even smash open sewers or pump water contaminated with raw sewage direct from rivers,” he says.
“Farmers need to grow the kind of crops that have high cash yields and short growing seasons, and these are often
vegetables that are eaten raw.”

Paragraph 13 But while epidemiologists blame poverty and the deteriorating infrastructure for the cholera outbreak, no one
can explain why it should have happened suddenly. The conditions that have fuelled the disease have been worsening for
years. “One assumes that cholera must have been introduced periodically during the last 20 or 30 years,” admits Bennett.
However, Tulloch in Geneva, says, “The precise origin of the epidemic is irrelevant because the level of contamination in the
environment now is very high.”

Paragraph 14 The bacterium that causes cholera, Vibrio Cholerae, has two main forms or “biotypes”: the El Tor biotype is the
cause of the current epidemic and the classical biotype was responsible for outbreaks earlier this century. The WHO says
Latin America’s current epidemic is part of the seventh pandemic, or world epidemic, which began as long ago as 1961.

Paragraph 15 El Tor was endemic in Indonesia before it began to spread. Probably carried by travellers, it reached
Bangladesh in 1963, India a year later and the Soviet Union in the mid-1960’s. In 1970, El Tor reached West Africa, a region
that had been virtually free of cholera until then. The disease remains endemic in this area, where it is difficult to distinguish
from other causes of diarrhoea. Children are most affected.

Paragraph 16 Bennett says that El Tor spreads rapidly before it is detected, because for every one person to suffer severe
diarrhoea there are eight who have no symptoms or only mild disturbance, and so do not seek medical help. In contrast, the
classical biotype causes severe symptoms in half of those infected.

Paragraph 17 “Malnourished people and those who are carrying many intestinal parasites may be more susceptible than
healthy people,” says Cairncross. “It takes 100 billion vibrios in the gut of a healthy person to cause the disease, because
large numbers are immobilised by acid in the stomach. But in someone whose gut is less acidic because of a heavy parasite
burden, it takes only 1 million organisms.”

Paragraph 18 The PAHO believes good surveillance and speedy reporting by countries is more cost effective than border
controls for halting the spread of the disease. The organisation has sent diagnostic equipment to laboratories in countries at
risk and has sent some staff on training courses at the Centers for Disease Control in Atlanta.

Paragraph 19 The existing vaccine against cholera, which is based on killed vibrios, protects only half of those who receive it,
and then only for a few months. The WHO hopes to start a trial in Brazil of an oral vaccine that contains fragments of cholera
toxin as well as killed vibrios. This vaccine was tested in Bangladesh in the mid-1980’s, with partial success.

QUESTIONS

Latin America struggles as cholera spreads

1 So far, the number of people affected by the current cholera epidemic in Latin America is:

a) about 120 million

b) between 160,000 and 120 million

c) between 60,000 and 160,000

d) less than 60,000

2 The number of people who have died from the current epidemic in Peru is:

a) surprisingly high

b) about 1 percent of the population

c) surprisingly low

d) about 50 percent of those affected

3 According to the article, which of the following statements about cholera is FALSE?

a) it usually kills about 50 percent of the people affected by it

b) it has not been seen on such a large scale in that region for more than 100 years

c) the gut of a person affected by it is unable to process liquids

d) 90 percent of those affected do not need to be treated intravenously

4 According to the article, Peru’s water supply…

a) is linked directly to the large number of houses

b) has a constant pressure

c) is chlorinated

d) system is being overhauled

5 The practice of using sewage to fertilise fields…

a) is traditionally carried out throughout the country

b) has been recently introduced

c) has caused the current outbreak of cholera

d) is an old solution to an old problem

6 The current cholera epidemic in Latin America…

a) began in Colombia

b) began in Brazil

c) is part of a world-wide epidemic

d) is of unknown origin

7 El Tor…

a) is NOT the classical biotype of the cholera bacterium

b) was most likely spread by travellers

c) was identified in India after Bangladesh

d) is/was all of the above

8 Which of the following statements about El Tor is TRUE?

a) it was the first cholera bacterium to be detected in West Africa

b) it is not detected as easily as the old biotype

c) it causes severe diarrhoea in all sufferers

d) it has also appeared in isolated cases in Geneva

9 Which of the following is given as THE LEAST USEFUL MEASURE for keeping the disease in check?

a) increased patrols along common borders

b) monitoring areas in which cholera has been detected

c) efficient sharing of information

d) an improved diet

10 From the article, it can be inferred that…

a) WHO is now close to finding an effective preventative vaccine for cholera

b) people are more likely to die from diarrhoeal disease than from cholera

c) up to a quarter of Latin America’s population could die unless trials with a new oral vaccine succeed

d) the outbreak of cholera in any country will affect its economy as much as its public health

Passage B

Trans Fat – Does margarine really lower cholesterol?

Paragraph 1 Butter, as anyone who has not been living in a cave for the past 10 years has probably heard, contains a lot of
saturated fat, which increases the levels of cholesterol in the blood. Margarine, on the other hand, is made from vegetable
oils, which contain cholesterol-lowering polyunsaturated fat. So switching to a diet with only vegetable fats should lower
cholesterol levels, right?

Paragraph 2 “Wrong,” says Margaret A. Flynn, a nutritionist at the University of Missouri. When she performed the
experiment with a group of 71 faculty members – switching in both directions – she found that “basically it made no
difference whether they ate margarine or butter.” The reason, according to a growing group of nutritionists, could be
partially hydrogenated fats. Recent studies suggest that such fats might actually alter cholesterol levels in the blood in all the
wrong ways, lowering the “good” high-density lipoprotein and increasing the “bad” low-density lipoprotein.

Paragraph 3 Partially hydrogenated fats are made by reacting polyunsaturated oils with hydrogen. The addition of hydrogen
turns the oils solid, and some of their polyunsaturated fat is turned into trans monounsaturated fats. Monounsaturated fat is
generally perceived as good, but things are not so simple. “Trans monounsaturates act in the body like saturated fats,” says
Fred A. Kummerow, a food chemist at the University of Illinois at Urbana-Champaign. “Almost all naturally occurring
monounsaturated fat is of the cis variety, which is more like polyunsaturated fat.”

Paragraph 4 Flynn’s study is not the first to raise questions about trans fatty acids. Ten years ago a Canadian government
task force noted the apparent cholesterol-raising effects of trans fats and requested margarine manufacturers to reduce the
amounts – which can easily be done by altering the conditions of the hydrogenation reaction.

Paragraph 5 Last August two Dutch researchers, Ronald P. Mensink and Martijn B. Katan, published a study in the New
England Journal of Medicine that showed eating a diet rich in trans fats increased low-density lipoprotein and decreased
levels of high-density lipoprotein. In an editorial accompanying the study, Scott M. Grundy, a lipid researcher at the
University of Texas Southwestern Medical Centre at Dallas, wrote that the ability of trans fatty acids to increase low-density
lipoprotein “in itself justifies their reduction in the diet.” Grundy called for changes in labelling regulations so that
cholesterol-raising fatty acids, including trans monounsaturates, are grouped together.

Paragraph 6 James I. Cleeman, coordinator of the National Cholesterol Education Program, disagrees. “To raise a red flag is
premature,” he says. “Mensink’s audience is the research community – the public needs useable simplifications.” Cleeman
points out that the subjects in Mensink and Katan’s study ate relatively large amounts of trans fats. He believes more typical
consumption levels should be investigated before any change in recommendations is warranted.

Paragraph 7 Furthermore, Cleeman notes that studies like Flynn’s are hard to interpret because subjects were allowed to eat
as they pleased. Flynns’s study, published this month in the Journal of the American College of Nutrition, found considerable
variability among subjects in their blood lipid profiles. “The only way to study the question properly is in a metabolic ward,”
Cleeman says. “Trans fats are a wonderful example of an issue that’s not ready for prime time.”
Paragraph 8 Edward A. Emken, a specialist on trans fats at the Agricultural Research Service in Peoria, Illinois, also
downplays the concern but for different reasons. Although Mary G. Enig, a nutritional researcher at the University of
Maryland, has estimated American adults consume 19 grams of trans fat per day, Emken thinks that figure is too high.
According to his calculations, eliminating trans fatty acids from the diet will for most people make only a tiny change in
lipoprotein levels. “If you’re hypercholesterolemic, it could be important, but if you’re not, then it is not going to affect risk at
all,” he concludes.

Paragraph 9 Emken, together with Lisa C. Hudgins and Jules Hirsch, has performed a study to be published in the American
Journal of Clinical Nutrition, that finds no association between levels of trans fats in fat tissue in humans and their cholesterol
profiles. To Emken, that suggests trans fats are not a major threat for most people.

Paragraph 10 Nevertheless, trans fats seem destined for more limelight. “How can one defend having cholesterol and
saturated and unsaturated fats listed on food labels but not allow public access to trans information when such fats behave
like saturates?” asks Bruce J. Holub, a biochemist at the University of Guelph in Ontario. “At the very least, one has to ask
whether cholesterol-free claims should be allowed on high-trans products.”

QUESTIONS

Trans Fat – Does margarine really lower cholesterol?

11 M. A. Flynn’s finding is supported by the proposition that…

a) butter lowers high-density lipoprotein while margarine increases low-density lipoprotein

b) butter contains just as much partially hydrogenated fat as margarine

c) trans monounsaturates behave similarly to most naturally-occurring monounsaturates

d) trans monounsaturated fat increases cholesterol level

12 Recent studies suggest that…

a) partially hydrogenated fats decrease high-density lipoprotein

b) partially hydrogenated fats do not increase low-density lipoprotein

c) both a) and b)

d) neither a) nor b)

13 According to the article,

a) eating butter is not as dangerous for cholesterol levels as was previously thought

b) cholesterol levels in humans can be noticeably reduced by cutting out animal fats

c) eating margarine is healthier than eating butter

d) the benefits of using only vegetable fats in the human diet are arguable

14 Research into trans fats…

a) has been going on for at least ten years

b) has been going on for less than ten years

c) has reached an advanced stage

d) has led to popular support for relabelling of butter and margarine

15 As a result of Flynn’s study,

a) a Canadian government task force recommended the reduction of trans fats in margarine
b) a Canadian government task force recommended that the conditions for the hydrogenation reaction should be changed

c) margarine manufacturers in Canada changed their practices

d) none of the above

16 Which of the following statements is FALSE?

a) we do not know what conclusions Flynn drew about lipoproteins

b) Mensink and Katan came to the same conclusion about lipoprotein as Flynn

c) Grundy’s recommendation was supported by Mensink and Katan’s findings

d) None of the above

17 James I. Cleeman DOES NOT…

a) agree with Grundy’s recommendation for relabelling

b) dispute Mensink and Katan’s research into the effects of eating trans fats

c) want Mensink and Katan’s work discussed outside the research community

d) want to wait any longer before warning the public

18 Which statement would Cleeman agree with?

a) Flynn’s study is not very valuable because she is hard to understand

b) Trans fats should now be discussed and debated by interested members of the public

c) Flynn’s study was not sufficiently rigorous

d) Flynn’s subjects should have had more food of a more varied nature

19 It has been estimated that American adults consume 19 grams of trans fats per day. Edward Emken…

a) believes that a reduction in this figure could be achieved quite easily

b) is not very concerned about trans fat intake levels for most people

c) does not think that they should consume so much in trans fats

d) thinks that people should eliminate trans fats from their diets

20 According to Tim Beardsley, the writer of the article,

a) Emken, in a study published in the American Journal of Clinical Nutrition, has challenged other researcher’s claims

b) the levels of trans fats tissue in humans and their cholesterol profiles are not connected

c) the issue of trans fat is likely to receive more, rather than less, attention in the future

d) food products should be labelled with their trans information in addition to the current information

THAT IS THE END OF THE READING TEST

Answer Key Part A

Migraines summary task key Total of 26 questions

1. general practice/GP 2. 649 3. 5663 4. lower/smaller/lesser/low/small/minor 5. 7% 6. 20% 7. did not seek/do not
seek (or contractions) 8. prophylactic medication/preventative medication 9. acute medication 10. prophylactic
medication/preventative medication 11. limited range/narrow range 12. burden/impact 13. (total) missed workdays 14.
(total) lost productivity/productivity loss 15. greater/higher/bigger/larger/high/big/large/major 16. in bed OR off
(work/sick) 17. four (days) 18. Jane 19. (migraine) absences 20. Sally 21. employers OR colleagues 22. employers OR
colleagues 23. behaviour change(s) OR changes in behaviour 24. (supporters’) contact numbers 25. flexible 26. from
home/at home

Part B

Passaget A – Latin America struggles as cholera spreads 1 b paragraphs 1-3… 2 c paragraph 3… 3 a paragraphs 3-6… 4 c
paragraphs 9-11… 5 d paragraph 12… 6 c paragraphs 1-14…7 d paragraphs 14-15… 8 b paragraphs 13-16…9 a paragraph
1810 b paragraph 7-19…

Passage B – Trans Fat… 11 d paragraphs 1-3 …12 a paragraph 2… 13 d paragraphs 1-4…14 a paragraphs 1-5…15 d
paragraphs 4-5 …16 b paragraphs 2-5 …17 a paragraph 6 ,,,18 c paragraphs 6-7 …19 b paragraph 8,,, 20 c paragraphs 9-10

.
 FULL TEST 9
Part A

Time Limit: 15 minutes

Promoting Physical Activity

Text A

Title: Cost-Effectiveness of Interventions to Promote Physical Activity Linda J. Cobiac, Theo Vos, Jan J. Barendregt (2009)
Objective To determine the cost-effectiveness of various intervention strategies aimed at informing the Australian public of
the benefits of physical activity and derive the optimal pathway for implementation. Method Based on evidence of
intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease
treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the
Australian population. Results Intervention to encourage an increase in physical activity participation is highly recommended
in Australia. Potential reductions in costs of treating ischaemic heart disease, stroke, diabetes, breast cancer, and colon
cancer mean that there is a high probability of cost-savings from a health sector perspective. Conclusions: Intervention to
promote physical activity is recommended as a public health measure. Despite substantial variability in the quantity and
quality of evidence on intervention effectiveness, and uncertainty about the long-term sustainability of behavioural changes,
it is highly likely that as a combination of interventions could lead to substantial improvement in population health at a cost
saving to the health sector.

Text B

Intervention strategies GP prescription. Patients are screened opportunistically when visiting their general practice; inactive
patients receive a physical activity prescription from the GP and follow-up phone call(s) from an exercise physiologist. GP
referral to exercise physiologist. Screening questionnaires are mailed to all patients on the GP patient list; inactive patients
are invited to attend a series of counselling sessions with an exercise physiologist at their local general practice. Mass media-
based campaign. A six-week campaign combines physical activity promotion via mass media(television, radio, newspaper,
etc.), distribution of promotional materials, and community events and activities. TravelSmart. An active transport program
targets households with tailored information (e.g., maps of local walking paths, bus timetables) and merchandise (e.g.,
water bottles, key rings) as an incentive and/or reward for reducing use of cars for transport. Pedometers. A community
program encourages use of pedometers as a motivational tool to increase physical activity (e.g., to 10,000 steps per day).
Internet. Participants are recruited via mass media to access physical activity information and advice across the internet via
a Web site and/or email.

Text C

Effects of Physical Inactivity Physical activity occurs during work, transport, domestic, and leisure-time activities. Too little
physical activity increases the risks of ischaemic heart disease, stroke, colon cancer, breast cancer, and type 2 diabetes, as
well as obesity and falls in later life. The World Health Organization recommends at least 30 minutes of regular,
moderateintensity physical activity on most days to reduce the risk of disease and injury. Lack of physical activity is a
problem in many developed countries, and a growing concern for developing countries adopting a progressively
‘‘Westernised’’ lifestyle. Australia is no exception, with only 44% of men and 36% of women achieving sufficient physical
activity for health. This inactivity contributes 7% of Australia’s disease burden and 10% of all deaths, mostly due to
cardiovascular disease and diabetes. It also places a substantial burden on the Australian economy through the costs of
treatment for physical activity–related disease and injury, lost productivity, and diminished quality of life.

Text D

Intervention Target Group Cost (AUS $million)

GP Prescription 35% Population aged 40~79 (14) $250

GP referral to exercise physiologist. 11% Population aged over 60 $190

Mass media-based campaign 100% of population aged 25~60 $160
Internet 2% of population (internet users) aged over 15 $21
Pedometers 13% of population aged over 15 $53
TravelSmart 57 % of population in urban areas over 15 $412

Summary

In Australia and many other (1) ____countries, lack of physical activity in a serious problem. Current figures indicate that
only (2)____ of women and (3)____of men do sufficient physical activity to maintain good health. Insufficient physical
activity (4)____of various (5)____ including heart disease , stroke, diabetes and obesity. In addition, it places a significant
burden on the (6)____ due to the costs of treatment, (7)____and reduced quality of life. To address this situation, a recent
study by Cobaic, Vos and (8)____investigated the (9)____of a range of intervention strategies designed to (10)____the
Australian public of the advantages of regular (11)____. The six intervention strategies selected include GP prescription
which involves screening patients when they visit their (12)____. This is effective for the (13) ___age group and the estimated
cost is (14)____. Another intervention strategy is a mass media-based campaign involving various forms of mass media such
as (15)____. Other aspects of this campaign are promotional material and (16)____. The advantage of this strategy is that it
will reach (17) ____of the 25~60 population. The cheapest intervention strategy was found to be the (18)_____ but it only
reaches (19) ____of the population over 15. (20)_______was found to be an effective strategy for urban areas but it was the
(21)____ in terms of cost at $412 million. From a health sector perspective, the results of the study are encouraging as there
are (22)____in costs for treatment for several major diseases. Therefore intervention to promote physical activity should be
encouraged (23)____variability of evidence regarding the (24)____of intervention as well as (25) ___regarding the long-term
prospects of behavioural changes. Overall improvement in (26)____ while saving costs are major benefits of this strategy.
READING SUBTEST – Passage A

Man's Best Friend Veterinary research provides clues to human diseases

Paragraph 1 Three years ago N. Sydney Moise was making a routine electrocardiogram when her very young patient fell
asleep on the examination table and nearly died. The larger cardiac chambers were misfiring - a condition known as
ventricular arrhythmia - so she jolted them back into step with a defibrillator. Moise is a researcher at the New York State
College of Veterinary Medicine at Cornell University; her patient was a German shepherd.

Paragraph 2 That unfortunate puppy joins a long list of animal models for human disease that has emerged from veterinary
research. The result of Moise's work is a true-breeding line of dogs that can be used to study cardiac arrhythmias, which
afflict millions of people. Most intriguing of all, the model may be able to test the hypothesis that such arrhythmias play a
role in some cases of sudden infant death syndrome (SIDS), the major killer in the U.S. of infants younger than one year.
Through inbreeding, Moise was able to produce puppies predisposed to infantile arrhythmias.

Paragraph 3 "Our hypothesis is that the distribution of nerves in the heart is abnormal," Moise says. "We will first see if the
arrhythmia is exacerbated during sleep. But even if it isn't, this wouldn't negate the importance of the model: cardiac
arrhythmias are a major reason why people die in the U.S." Studying them in animals, she adds, may lead to better diagnosis
and treatment.

Paragraph 4 Indeed, many disease models bred to find cures to the afflictions of animals later find application in humans. A
drug, ivermectin, which was developed to purge heartworms from dogs, is showing promise against the parasites that cause
African river blindness. Another wormer for horses, levamisole, in combination with surgery and conventional chemotherapy
has turned out to increase by a third the survival rate of people with 20 advanced colon cancer. Retroviruses were studied by
veterinarians long before physicians suspected that the organisms might cause human diseases, such as AIDS and leukemia.

Paragraph 5 Data gleaned from animal models are often superior to those from human clinical trials. For one, animals take
their medicine, whereas humans say they do but often don't. "People typically follow veterinarians' prescriptions more
closely than they do their own doctors', " says Fred W. Quimby, director of research animals at Cornell. Animal subjects can
also be kept free of all diseases except those that veterinarians want to study. Human patients are often riddled with
infections.

Paragraph 6 Diseases of the immune system, such as AIDS, produce so many opportunistic infections that the cause and
effect of each symptom cannot always be identified. Physicians would like to know whether AIDS-related dementia is directly
caused by HIV, without the mediation of other organisms. To find out, Quimby says, 30 veterinarians at Cornell and other
institutions are studying changes in the nervous systems of cats infected with the feline analogue to HIV.

Paragraph 7 Animals with exotic syndromes are often donated to veterinary schools, where they found family lines and
serve up genetic material for direct biochemical study. Ronald R Minor of Cornell, Donald F Patterson of the University of
Pennsylvania and their colleagues have studied "stretchy" dogs and cats using this genetic material. The skin of these
animals has only 5 percent of the normal tensile strength. Stretchy skin is rare in humans, as are such other connective tissue
disorders as brittle bone disease and Marfan's syndrome (which may have affected Abraham Lincoln).

Paragraph 8 Normal animals also bring potential medical applications to the attention of veterinarians. This is
demonstrated in the panicked reaction of some pet owners to the Lyme disease epidemic. Veterinarians 40 reassured owners
that their dogs were quite unlikely to pass the parasite directly to humans and in the process learned that the animals make
a splendid model of the disease. Study of dogs with Lyme disease has already produced more sensitive diagnostic tests. "The
next step is to improve the specificity of the test," says Richard H Jacobson, a Cornell immunoparasitologist.

Paragraph 9 Veterinarians are particularly sensitive to the ethical problems of animal modeling - love of animals, after all,
was what brought most of them into the field. But vets point out that their job is not to prolong life but to reduce the
suffering of as many animals as possible. Human medicine, they aver, is in many ways more heartless: "We're allowed to
give suffering animals euthanasia," Quimby says. "Physicians have to keep their patients alive no matter what the cost."

Man's Best Friend

1 Moise's patient three years ago a) was a young child. b) had a heart condition. c) died following defibrillation. d) had
sleeping sickness.
2 Moise bred dogs that a) may help in finding a solution to a major killer of babies. b) study cardiac arrhythmia. c) were
predisposed to Sudden Infant Death Syndrome. d) all of the above.

3 Moise thinks that cardiac arrhythmia a) is less severe dUring sleep. b) only occurs when people are asleep. c) is related to
the nerves in the heart. d) is more likely to occur when people are nervous.

4 Many disease models that were bred to find solutions to animal diseases a) were first studied by physicians. b) have been
used to help humans. c) have shown promise against African river blindness. d) were found to cause AIDS and leukemia in
humans.

5 According to the article, a) ivermectin cures heartworm in humans. b) ivermectin can cause African River blindness. c)
levamisole is used to treat heartworm in dogs. d) levamisole is useful in the treatment of colon cancer.

6 Data from animal models are better because a) their medication intake may be more easily regulated. b) results from
human studies may be distorted by other factors. c) diseases in animals can be more easily controlled. d) all of the above.

7 Opportunistic infections a) cause diseases of the immune system. b) result from diseases of the immune system. c) can be
identified as the cause of AIDS. d) result from changes in the nervous systems of cats.

8 According to the article, animals donated to veterinary schools a) must have exotic syndromes. b) have helped in the
study of "stretchy" skin. c) are sterilised on admission. d) have five per cent of normal tensile strength.

9 Which of the following is true about Lyme disease? a) It is easily passed on to humans b) It causes dogs to have a
panicked reaction. c) It is caused by a parasite. d) It produces sensitive diagnostic tests.

10 According to the article, the most important part of a veterinarian's job is to a) keep animals alive as long as possible. b)
show fondness for their patients. c) lessen the pain of animals. d) prolong the lives of humans.

READING SUBTEST - B PASSAGE

Spicy food eaters are addicted to pain

Paragraph 1 Curry lovers may be physically addicted to their favourite food, claims a scientist who has studied capsaicin, the
"hot" ingredient in chilli. John Prescott of the CSIRO, Australia's national research organisation, says capsaicin does not have
a flavour of its own, but adds to the "flavour impact" of foods. Its effect on the body's chemistry may enhance the
appreciation of hot, spicy flavours.

Paragraph 2 Capsaicin is found in red peppers, chilli peppers and other members of the capsicum group. It causes a
sensation of burning pain in the mouth by triggering the trigeminal nerve, which has branches in the eyes, nose, tongue and
mouth. In the mouth, the ends of these branches are sensitive to temperature and foreign substances such as capsaicin.
Because capsaicin does not activate taste buds, it has no intrinsic flavour.

Paragraph 3 In order to find out why people willingly subject themselves to the pain of a spicy meal, Prescott and his 10
colleagues at the CSIRO Sensory Research Centre in Sydney looked at how different amounts of capsaicin affected the flavour
and intensity of solutions of sucrose and sodium chloride, which stimulate two of the four basic tastes, sweet and salt (the
others are sour and bitter).

Paragraph 4 Prescott's team selected 35 people who all ate spicy food regularly, but who were not brought up in a culture in
which they ate such foods exclusively. The researchers gave 19 people a total of 32 solutions which contained different
amounts of capsaicin and sucrose at either body temperature or room temperature. The other 16 people were asked to taste
and rate 32 solutions of capsaicin mixed with sodium choride, also at body or room temperature. The amount of capsaicin in
both the sweet and salty solutions ranged from zero to 8 parts per million.
Paragraph 5 Prescott's key finding was that capsaicin, in any amount and at body or room temperature, increased the 200
overall intensity, or perceived strength, of the solutions. Capsaicin seems to provide a "big boost" of intensity which salt or
sugar cannot provide alone, says Prescott.

Paragraph 6 He says that the flavour hit may arise because capsaicin triggers the release of endorphins, the body's natural
painkillers. Endorphins can create a sense of pleasure or wellbeing, so when food contains capsaicin, the experience of eating
is more intense and the food seems more highly flavoured, says Prescott.

Paragraph 7 Another finding of the team is that, at both temperatures, the capsaicin decreased the perceived sweetness of
the sucrose solutions. But the amount by which it was reduced did not depend on the amount of capsaicin. "As you increase
the burn, you don't get more suppression of sweetness:” says Prescott. The reason, he suspects, is that the effect is not a
"true suppression". Rather, the pain which is triggered by capsaicin may act to divert the brain's attention from the
processing of information about sweetness.

Paragraph 8 In contrast, the scientists found that capsaicin has no effect on the perception of the saltiness of sodium
chloride. Prescott suggests the reason is that sodium chloride activates taste receptors on the tongue and stimulates the
trigeminal nerve only slightly. The additional stimulation by the capsaicin was not sufficient to distract from the taste.

Paragraph 9 Although it is unlikely that eating too many spicy foods will damage the trigeminal nerve, Prescott warns of
another possible danger. Because people get a definite buzz from capsaicin and because they become used to exposure to
increased levels of the endorphin it stimulates, eating spicy food can be addictive. "The first bite of mild curry leads on to the
vindaloo." He cautions.

QUESTIONS

Spicy food eaters are addicted to pain

11 Capsaicin a) is an optional ingredient in curry and chilli. b) does not make people enjoy hot foods more. c) is not
affected by the body's chemistry. d) has been the subject of an Australian research study.

12 According to the article, capsaicin a) does not stimulate taste buds. b) is not grown in Australia. c) is produced by the
trigeminal nerve. d) affects nerves throughout the body ..

13 Prescott and his team a) conducted experiments on themselves. b) experimented with the effect of capsaicin on sour
tastes. c) experimented with the effect of capsaicin on sweet tastes. d) found spicy meals painful.

14 How many subjects were involved in Prescott's experiment? a) 19 b) 16 c) 35 d) 32

15 In the study, a) nineteen subjects were given capsaicin and salty solutions to taste. b )sixteen subjects were given
capsaicin and salty solutions to taste. C) only nineteen of the subjects were habitual spicy food eaters. D)the subjects were
found to have varying body temperatures.

16 Prescott found that capsaicin's effect is a) increased by adding extra salt or sugar. B) reduced by adding extra salt or
sugar. C) the same at both temperatures tested. D) different when the concentration is changed.

17 The flavour hit occurs when a) highly-flavoured food is eaten b) food containing natural painkillers is eaten. C)
endorphins trigger the release of capsaicin. D) natural painkillers in the body are activated.

18 Which of the following is true? A)Capsaicin makes sugar solutions seem less sweet. B) The perceived sweetness of sugar is
proportional to the amount of capsaicin present. C)Prescott concluded that the brain is distracted from processing
information about sweetness. D)All of the above.

19 Which of the following is true? A) Salty and sweet tastes are affected differently by capsaicin. B)Salt is sensed mainly by
the trigeminal nerve. C) Salty tastes seem to get weaker if you add more capsaicin. D) All of the above.

20 Although spicy foods can be addictive,a) people are not stimulated by eating them. B) they do not affect endorphin
levels. c) most people prefer to eat mild curry. D) they will probably not damage the trigeminal nerve.
Part A

Answer Sheet 1. developed 2. 36% 3. 44% 4. increase the risks 5. diseases/illnesses (not in text, necessary to deduce the word
based on context. It must be plural) 6. Australian economy 7. lost productivity 8. Barendregt 9. cost-effectiveness 10.
inform(necessary to change verb form for grammatical correctness) 11. physical activity 12. general
practice/practitioner/doctor 13. 40~79 14. $250 million (must include million) 15. television, radio, newspaper 16.
community events 17. 100% 18. Internet 19. 2% 20. Travel Smart 21. most expensive/dearest/ (need to deduce meaning) 22.
potential reduction 23. despite 24. effectiveness 25. uncertainty 26. population health

Answer Key

Passage A - Man's Best Friend 1 b 2 a 3 c 4 b 5 d 6 d 7 b 8 b 9 c 10 c

Passage B - Spicy food eaters are addicted to pain 11 d 12 a 13 c 14 c 15 b 16 c 17 d 18 a 19 a 20 d

 FULL TEST 10
Part A

Playground Injuries & Playground Surface Material

Playground Injuries & Playground Surface Material Text 1 Playground Injuries: Fact Sheet Overview Each year in the United
States, emergency departments treat more than 200,000 children ages 14 and younger for playground-related injuries .

Occurrence and Consequences • About 45% of playground-related injuries are severe–fractures, concussions and dislocations
• About 75% of injuries related to playground equipment occur on public playgrounds. Most occur at schools and daycare
centres.

Cost • In 1995, playground-related injuries among children ages 14 and younger cost an estimated $1.2 billion.

Groups at Risk • While all children who use playgrounds are at risk for injury, girls sustain injuries (55%) slightly more often
than boys (45%) . • Children ages 5 to 9 have higher rates of playground injuries than any other age group. Most of these
injuries occur at school .

Risk Factors • On public playgrounds, more injuries occur on climbers than on any other equipment. • On home playgrounds,
swings are responsible for most injuries. • Playgrounds in low-income areas were considered less safe than playgrounds in
high-income areas. For example, playgrounds in low-income areas had significantly more rubbish, rusty play equipment, and
damaged fall surfaces.

Text 2 Safety Surfacing

At its most basic, safety surfacing is a cushion that can absorb some of the impact of falls. While grass may be considered soft
and comfortable, the dirt just beneath grass is actually quite hard and potentially dangerous. In its place, safety experts
recommend surfaces with "give"—most commonly, engineered wood fibre, sand and rubber matting. At proper depths,
safety materials lessen the chances of lifethreatening (mainly head) injuries at your playground.

It's important to note that no surface can guarantee safety, especially against orthopaedic injuries like broken wrists and
ankles. In many cases, these injuries result more from awkward falls than the type of surface material. There is no single best
surface for your playground. Factors like weather, the availability of maintenance staff, and even budgets play a role in that
decision.

Text 3 Injury Reduction through Public Playground Safety Checklist:

• Make sure surfaces around playground equipment such as wood chips, sand, or gravel, are at least 30 cm deep. • Check
that protective surfacing extends at least 2m in all directions from play equipment. For swings, be sure surfacing extends, in
back and front, twice the height of the suspending bar. • Make sure play structures more than 1m high are spaced at least
3m apart. • Make sure spaces that could trap children, such as openings in guardrails or between ladder rungs, measure less
than 12cm or more than 20cm • Check for sharp points or edges in equipment. • Look out for tripping hazards, like exposed
concrete footings, tree stumps, and rocks. • Check playgrounds regularly to see that equipment and surfacing are in good
condition. • Carefully supervise children on playgrounds to make sure they're safe.

Text 4 Source: Public Library of Open Science Authors: Andrew W. Howard, Colin Macarthur, Linda Rothman, Andrew Willan,
Alison K. Macpherson Background: The risk of playground injuries, especially fractures, is prevalent in children, and can result
in emergency room treatment and hospital admissions. Fall height and surface material are major determinants of
playground fall injury risk. However there is limited research comparing different playground surfaces. Methods and
Findings: The risk of arm fracture from playground falls onto granitic sand versus onto engineered wood fibre surfaces was
compared, with an outcome measure of estimated arm fracture rate per 100,000 student-months. Schools were randomly
assigned by computer generated lists to receive either a granitic sand or an engineered wood fibre playground surface
(Fibar), and were not blinded. Injury data, including details of circumstance and diagnosis, were collected at each school by a
prospective surveillance system with confirmation of injury details through a validated telephone interview with parents and
also through collection of medical reports regarding treated injuries. Among all schools, the arm fracture rate was 4.5 per
100,000 student-months for falls into sand compared with 12.9 for falls onto Fibar surfaces. Conclusions: Playground
fractures are a serious health problem created by an environment built specifically for children. Prior investigations have
consistently shown height and surfacing to be important risk factors, but no study has prospectively investigated the effects
of an intervention using injury outcomes. This investigation shows that the risk of a fracture was 4.9 times higher over an
engineered wood fibre playground surface compared with sand. Updating playground safety standards to reflect this
information will reduce the most common and severe injuries seen on modern playgrounds, without limiting children’s access
to healthy outdoor play.

Summary

The most common playground-related injuries are fractures, (1)___ and dislocations, with most injuries occurring in schools
and (2)____. In public playgrounds the equipment with highest number of (3)___was climbers, while in home playgrounds it
was (4)___. The severity of injury is directly related to the surface material in the playground. While grass is often believed
to have a cushioning effect, it is (5)___ because the dirt below is (6)___. As a result, wood fibre, (7)___ and rubber matting
are (8)___by safety experts. A recent study published in the Public Library of Open Science investigated the risk of
(9)___among children. According to the study, the two main determining risk factors are (10)___ and (11)___ . However, the
purpose of the study was to compare two common playground (12)___, granitic sand and engineered wood fibre in regard to
injury prevention. Results indicate that the risk of fracture was much (13)____ in wood fibre surfaced playgrounds than with
(14)___. However, injuries do occur on all surfaces. For example, orthopaedic injuries such as broken (15)___and (16)___are
often the result of (17)___falls. While complete safety can never be guaranteed, the number and severity of injuries can be
(18)___ by adhering to a safety checklist. A (19)___of 30 cm is advised when using wood chips, sand or (20)___. The surface
area covered must (21)___ a minimum of 2m in all directions and play structures which are over 1m in (22)___ must be at
least (23)____apart. Equipment and surfaces should be checked (24)___in order to maintain good condition. Other factors
worth considering are that more injuries occur in the (25)___age group, (26)___have slightly higher chance of injury than
(27)___ and playgrounds in (28)___ were considered more (29)___ than playgrounds in high income areas due to damaged
Part B

Reading passage A

Push-Button Medicine If you can monitor your symptoms electronically, why go to the doctor?
Monday, Aug. 09, 2004 Valeta Young, 81, a retiree from Lodi, Calif., suffers from congestive heart failure and requires almost
constant monitoring. But she doesn't have to drive anywhere to get it. Twice a day she steps onto a special electronic scale,
answers a few yes or no questions via push buttons on a small attached monitor and presses a button that sends the
information to a nurse's station in San Antonio, Texas. "It's almost a direct link to my doctor," says Young, who describes
herself as computer illiterate but says she has no problems using the equipment.

Young is not the only patient who is dealing with her doctor from a distance. Remote monitoring is a rapidly growing field in
medical technology, with more than 25 firms competing to measure remotely — and transmit by phone, Internet or through
the airwaves — everything from patients' heart rates to how often they cough.

Prompted both by the rise in health-care costs and the increasing computerization of health-care equipment, doctors are
using remote monitoring to track a widening variety of chronic diseases. In March, St. Francis University in Pittsburgh, Pa.,
partnered with a company called BodyMedia on a study in which rural diabetes patients use wireless glucose meters and
armband sensors to monitor their disease. And last fall, Yahoo began offering subscribers the ability to chart their asthma
conditions online, using a PDA-size respiratory monitor that measures lung functions in real time and e-mails the data
directly to doctors.

Such home monitoring, says Dr. George Dailey, a physician at the Scripps Clinic in San Diego, "could someday replace less
productive ways that patients track changes in their heart rate, blood sugar, lipid levels, kidney functions and even vision."

Dr. Timothy Moore, executive vice president of Alere Medical, which produces the smart scales that Young and more than
10,000 other patients are using, says that almost any vital sign could, in theory, be monitored from home. But, he warns, that
might not always make good medical sense. He advises against performing electrocardiograms remotely, for example, and
although he acknowledges that remote monitoring of blood-sugar levels and diabetic ulcers on the skin may have real value,
he points out that there are no truly independent studies that establish the value of home testing for diabetes or asthma.

Such studies are needed because the technology is still in its infancy and medical experts are divided about its value. But on
one thing they all agree: you should never rely on any remote testing system without clearing it with your doctor.

Source: TIME Magazine 9th August 2004 Title: Push-Button Medicine

Title: Push-Button

1. Why does Valeta Young need to be under medical supervision? Because

a) she is elderly. b) she doesn’t drive. c) she has a heart condition. d) All of the above.

2. How many times a day does Valeta send information to the medical center?

a) One. b) Two. c) Three. d) Four.

3. Did Valeta Young need intensive computer training to operate the system?

a) Yes. b) No. c) We don’t know. d) She is scheduled to receive training shortly.

4. Which sentence is TRUE?

a) The system is only used to monitor a patient’s weight. b) This area of technology is expanding quickly. c) The system is
lonely used with to monitor patients who have a heart condition. d) There is a competition to decide the best service
provider.

5. Who undertook a survey of diabetic patients living in the countryside?

a) St Francis University b) The BodyMedia Company c) Yahoo d) Both a) and b)

6. Which type of patients use the system to monitor their glucose levels?

a) Diabetic patients. b) Heart attack victims. c) Patients in the Pittsburgh area. d) Yahoo subscribers.

7. When did remote monitoring replace visits to a GP in San Diego?

a) Last year. b) A decade ago. c) Very recently. d) It hasn’t.

8. Why are studies of home testing for diabetes and asthma considered unreliable?

a) A visual survey cannot be undertaken. b) The surveys were not undertaken by impartial observers. c) The medical
requirements have not been met. d) The equipment is not of a sufficiently high standard.

9. Remote monitoring requires further investigation because …

a) … the technology is in the early stages of development and many doctors are not yet convinced it is useful. b) … the
results need to be checked by a GP. c) … too many conditions cannot be diagnosed in this way. d) … independent research is
needed for asthmatics and diabetics.

10. Which of the sentences below is correct?

a) The article supports remote monitoring. b) The article is against remote monitoring. c) The article gives a fairly balanced
view of the advantages and disadvantages of remote monitoring, d) The article recommends remote monitoring for patients
with a heart condition like Valeta Young,
Reading Passage B

Title: The Semiprivate Checkup

Tired of waiting two hours to see the doctor for 10 minutes? Try making your appointments en masse

Kim Strong, 41 and eight months pregnant, lies down on four armless chairs shoved together in the far corner of a
conference room at Montefiore Medical Center's Comprehensive Family Care facility in the Bronx, N.Y. She lifts up her T shirt,
lowers her pants and watches obstetrician Liza Kunz squirt gel on her big, full belly. As the doctor slides a fetal heart monitor
across her skin, Strong isn't the only one listening carefully for the reassuring sound of a baby's heartbeat. Gathered in the
room with her are four equally pregnant women. They all arrived as a group to have their obstetrics checkup together.

For American patients used to thinking of a doctor's appointment as a private, one-on-one affair, the idea of a roomful of
strangers discussing something as intimate as the progress of their pregnancy may seem strange. But look at it this way:
Would you rather wait an hour or two to see your doctor for 10 minutes or meet at a prearranged time and see the doctor--
along with up to 25 other patients--for two hours?

More and more doctors and their patients are opting for the latter. Patients enjoy the support and encouragement of people
who are in the same boat they are, and get to ask the questions that often slip their mind in the rush of a short appointment.
Doctors appreciate the efficiency of giving better information and care to many more patients a day, up to three times their
previous number.

"This is an important part of the future of medicine," says health psychologist Ed Noffsinger, who introduced shared
appointments to California's giant Kaiser Permanente system in 1996, and is now a full-time consultant in the field. "Most
doctors are still using a system that was developed in an era of acute care, when we didn't even have antibiotics. It's a
mistake to believe that same model is the best way of looking after people."

The idea Noffsinger has been championing is rapidly catching on across the country, from rural Tennessee to South Central
Los Angeles. The VA Medical Center in Bay Pines, Fla., introduced group appointments in the summer of 2002 as a way to
combat a backlog of 17,000 patients waiting to be inducted into its primary-care system. Today that waiting list hovers at
about 100, and the group model is being extended to Veterans Health Administration centers around the country.
Endocrinologist David Shewmon started group appointments in his Wooster, Ohio, practice last January and has reduced the
wait time for a follow-up appointment from six months to about a week. In Kalamazoo, Mich., internist Ed Millermaier can
get you in for a shared physical next week, but if you want an individual appointment, there's a four-month wait.

Group appointments allow doctors to see more patients a day--and, in many cases, make more money--and advocates argue
that these physicians also provide superior care. A Kaiser study by pioneer John Scott, who introduced groups to Colorado in
1991, randomly allocated elderly patients to group or individual care and found that after two years, those who attended the
groups regularly had 18% fewer emergency-room visits and a 12% decrease in hospital admissions, were more likely to get
flu and pneumonia shots, and cost Kaiser about $50 a patient less each month.

Groups come in many shapes and sizes. Most appointments last 90 minutes to 2 1/2 hours and involve half a dozen to 25
participants. Patients are urged to maintain confidentiality; many doctors require privacy waivers. Physical examinations
may be conducted in the presence of the entire group or in private exam rooms before group discussions. Of course, shared
visits are not appropriate for every patient. They don't work very well with the acutely ill, the demented or the hearing
impaired. Nor are they well suited to one-time consultations.

Insurance payments can also get complicated. There is no American Medical Association--generated billing code for services
provided entirely in a group setting, which means that for now that model is best suited to so-called capitated systems, in
which doctors are paid a flat salary. Doctors conducting one-on-one exams followed by a group discussion can bill for
individual visits, but Noffsinger, for one, is concerned that insurers could reduce those payments once they realize doctors can
triple the number of patients they see. "The insurers have more to gain than anybody," he insists. "Their patients are serviced
faster and better."

The shared sessions help doctors as well. "Somebody who has had three children," says Kunz, "can tell me more about how
to solve a pregnancy ache or pain than any reading I can do."
Now read the text and select the best answer for each of the questions below.

1. Lisa Kunz is

a) An 8 month pregnant woman b) An obstetrician in Montefiore c) A Health Psychologist d) An obstetrician in New York

2. Under the new system of doctor’s appointments a woman

a) has to wait a long time to see the doctor. b) has a short appointment with the doctor. c) sees the doctor in company with
several other women. d) sees the doctor individually

3. Which of the following statements is NOT true? This new system of appointments is becoming more popular because

a) doctors want to earn a lot more money. b) people who have the same medical condition sympathize with one another. c)
people have more time to think of the questions they want to ask. d) doctors can attend to many more patients than they
used to.

4. In a medical centre in Florida, the waiting list for doctors’ appointments

a) is about the same as in 2002 b) has decreased dramatically since 2002

c) has increased since 2002 d) has decreased slightly since 2002

5. The traditional type of consultation

a) was developed when acute care was necessary. b) was developed before antibiotics were available. c) is no longer the
most appropriate method, d) All of the above.

6. David Shewmon

a) is a full time consultant in shared appointments b) introduced group appointments in the summer of 2002 c) started group
appointments the previous January d) introduced group appointments to Colorado.

7. In one study, patients who attended group appointments regularly

a) went to hospital less than those who attended traditional consultations. b) went to hospital more than those who
attended traditional consultations. c) were more likely to get ‘flu or pneumonia. d) cost the system more.

8. Group consultations

a) work especially well for deaf patients. b) are effective for every kind of patient. c) are not suitable for patients suffering
from mental deterioration. d) encourage patients to give out information about each other.

9. In a capitated system,

a) doctors are paid according to the number of patients they see. b) doctors are paid a set salary. c) doctors only see patients
individually. d) patients don’t pay medical insurance.

10. Ed Noffsinger is afraid that insurance companies

a) will not benefit from the group consultation system. b) have reduce the amounts patients pay for medical insurance.

c) will have to pay for three as many patients as previously. d) may reduce the amounts paid to doctors.
Part A

Answer Sheet 1. concussions 2. daycare centres 3. injuries 4. swings 5. potentially dangerous 6. quite hard 7. sand 8.
recommended (use passive form) 9. playground injuries 10. fall height 11. surface material 12. surfaces 13. higher 14. sand
15. wrists 16. ankles 17. awkward 18. reduce (change noun to verb) 19. depth (change adjective to noun) 20. gravel 21.
extend(change verb to standard form following the modal verb must) 22. height (change adjective to noun) 23. 3 m 24.
regularly 25. 5 to 9 26. girls 27. boys 28. low-income areas 29. dangerous (use opposite of safe) 30. Rusty

Part B

Passage A

Title: Push-Button Medicine ANSWERS

1. c) she has a heart condition

2.b) Two.

3. b) No.

4 b) This area of technology is expanding quickly.

5 d) Both a) and b)

6. a) Diabetic patients.

7. d) It hasn’t.

8. The surveys were not undertaken by impartial observers.

9 a) … the technology is in the early stages of development and many doctors are not yet convinced it is useful.

10. a) The article supports remote monitoring,

Passage B

ANSWERS

1. d 2. c 3. a 4. b 5. d 6. c 7. a 8. c 9. b 10. d
 FULL TEST 11
Part A

Rabies
Part A Time Limit: 15 minutes
Rabies: A Neglected Tropical Disease
Text A Title: The Feasibility of Canine Rabies Elimination in Africa Lembo et al Background
Canine rabies causes many thousands of human deaths every year in Africa, and continues to
increase throughout much of the continent. Methodology/Principal Findings There are four
common reasons given for the lack of effective canine rabies control in Africa: (a) a low
priority given for disease control as a result of lack of awareness of the rabies burden; (b)
epidemiological constraints such as uncertainties about the required levels of vaccination
coverage (c) operational constraints including accessibility of dogs for vaccination and
insufficient knowledge of dog population sizes for planning of vaccination campaigns; and (d)
limited resources for implementation of rabies surveillance and control. We address each of
these issues in turn, presenting data from field studies and modelling approaches used in
Tanzania, including burden of disease evaluations, detailed epidemiological studies,
operational data from vaccination campaigns in different demographic and ecological
settings, and economic analyses of the cost-effectiveness of dog vaccination for human rabies
prevention. Conclusions/Significance We conclude that there are no insurmountable problems
to canine rabies control in most of Africa; that elimination of canine rabies is
epidemiologically and practically feasible through mass vaccination of domestic dogs; and
that domestic dog vaccination provides a cost-effective approach to the prevention and
elimination of human rabies deaths.
Text B Description of Rabies and current situation • Rabies is a viral zoonosis caused by
negative-stranded RNA viruses from the Lyssavirus genus. • Although rabies can infect and
be transmitted by a wide range of mammals but the vast majority of human cases result from
the bites of rabid domestic dogs • Recent successes have been demonstrated in many parts of
South America, where canine rabies has been brought under control through large-scale dog
vaccination campaigns. • In contrast, in Africa and Asia the incidence of dog rabies and
human rabies deaths continue to escalate, and new outbreaks have been occurring in areas
previously free of the disease.
Text C
Economic Burden The major component of the economic burden of rabies relates to high costs
of medication, which impacts both government and household budgets. Many countries
spend millions of dollars importing supplies of tissue-culture vaccine. At the household level,
costs of medication arise directly from anti-rabies vaccines and from patient costs associated
with travel including multiple hospital visits, medical fees and income losses. Total costs have
been estimated conservatively at $40 US per treatment in Africa and $49 US in Asia
accounting respectively for 5.8% and 3.9% of annual per capita gross national income.
Text D Vaccination Coverage Domestic dogs are the sole population responsible for rabies
maintenance and main source of infection for humans throughout most of Africa and Asia
and therefore control of dog rabies should eliminate the disease. Studies indicate the
elimination of rabies through domestic dog vaccination is cost effective.
Technology Considerable progress has been made in the development of simple and
inexpensive techniques for sample preservation and rapid diagnosis such as the use of light
microscopes which are widely available. The technique is simple and can be performed by a
range of operators if appropriate training is provided.
Summary
Rabies Rabies is a viral disease that is transmitted by (1)…..of mammals. However the
majority of human cases occur from (2)….by domestic dogs infected with the virus.
Elimination of canine rabies has been achieved in many parts of the world, but it still kills
many thousands of people in (3)….. Common arguments given for (4)….control of rabies in
Africa include(5)…..given for disease control; uncertainties about the necessary levels of (6)….;
limited resources and (7)….constraints. One major obstacle in overcoming the spread of
rabies in Africa is the economic costs required for effective control of the virus. The (8)….
medication affects both (9) …. and (10)…… budgets. For families, there are additional costs
such as (11)….visits, loss of income and (12)….. Cost per treatment is estimated at (13)….in
Africa and (14)….in Asia. This represents a significant proportion of a families income. Recent
advancement in technology may also aid in fast and accurate diagnosis of the condition.
Equipment such as (15)…. are now (16)…. and as long as (17)… is available, the technique can
be performed by a range of users. Vaccination of (18).... is another important component in
addressing the issue. This is because they are the primary (19)…. Among the human
population in (20)….and (21)….. Fortunately studies suggest that the rabies virus can be
eliminated through vaccination and that it is (22)…. In recent years, vaccination campaigns
against canine rabies in South America have been very (23)….. Therefore, in conclusion, the
(24) …. of the domestic dog population is the best way to avoid and reduce the number of
(25)….
 Part B

Passage A

Stem-Cell Rebels
Katie Zucker, 16, has sky blue eyes, wild curly hair and a dazzling smile. She is a champion equestrian and an A student. Her
parents are doting, her friends devoted. So what's not to envy? Well, there's the small rectangular box attached to her belt
that pumps insulin through a tube into her hip. To test her blood, she pricks her finger seven times a day. "It's scary," she
says. "If your blood sugar goes too low, you could go into a coma." Sometimes at school her eyes swell, and she can't see the
blackboard. She knows that her diabetes can result in kidney failure, amputation and blindness. But mostly, she says, "I try to
think it won't affect me too much in the future."

If there's any hope for a cure for Zucker and more than 1 million other Americans with Type 1 diabetes, the most debilitating
form of the disease, it may lie in a revolutionary new field of research based on manipulating human embryonic stem cells.
These building blocks of life, when isolated in a microscopic cluster of cells, can morph into any kind of tissue. (So-called adult
stem cells, which can be harvested without sacrificing embryos, can turn into only a few tissue types.) One day, scientists
hope, the entire genetic makeup of a patient like Zucker could be transferred into a cloned human egg that can produce the
insulin-producing cells her body lacks.

But some religious groups believe the clumps of 100 to 200 cells from which embryonic stem cells are taken represent a
potential human life as worthy of protection as any child's. Three years ago, President George W. Bush, under pressure from
both sides, adopted a compromise that ended up choking off most federal research funds to the field. He said at the time that
although the research offered "great promise" in saving lives, it could lead to "growing human beings for spare body parts."

Today a brush-fire challenge to Bush's stem-cell policy is spreading across the U.S., fueled by the frustration of such families
as Zucker's who have allied themselves with patient activists for other diseases, major universities, several state legislatures
and members of Congress. Last month 206 U.S. Representatives wrote to the President, calling on him to fund stem-cell
research on spare embryos from a pool of some 400,000 stored in the freezers of in vitro fertilization clinics. These embryos,
only a few days old and smaller than the head of a pin, will probably be discarded unless they are donated to science.
Embryonic stem cells, the letter noted, can be used to treat "diseases that affect more than 100 million Americans, such as
cancer, heart disease, diabetes, Parkinson's, Alzheimer's, multiple sclerosis, spinal cord injury ..." The signatories included
two dozen pro-life Republicans.

Given the emotional nature of the debate, the Bush White House is unlikely to make any sudden moves before the November
election. But in a startling rebellion against the federal biomedical establishment, several states are moving forcefully into
the vacuum. California and New Jersey have passed laws specifically authorizing the cloning of human eggs to create stem
cells (so-called therapeutic cloning), and the legislatures of seven other states, including Illinois and New York, are
considering similar bills. This week New Jersey Governor James McGreevey, in a nod to the state's pharmaceutical industry,
will inaugurate a $50 million stem-cell institute to befunded with state and private money. In California, activists last month
submitted 1.1 million signatures--nearly twice as many as necessary--to launch a November ballot measure that would
underwrite stem-cell research with $3 billion in state bonds over 10 years. The California funds would dwarf federal grants,
which have stalled at about $17 million a year for human embryonic research since Bush restricted funding to a few dozen
pre-existing stem-cell lines. Only 19 of those turned out to be available. Says Stanford Nobel prizewinner Paul Berg:
"California is paving the way for a revolt in a lot of other states."

Meanwhile, universities are maneuvering for position, fearing that they could lose their brightest scientists to programs
overseas. It was only six years ago that a biologist at the University of Wisconsin in Madison, James Thomson, isolated the
first human stem cells from in vitro embryos. But in February, South Korean researchers stunned the scientific world by
successfully harvesting stem cells from cloned human embryos--considered the most promising avenue for treating disease. A
prestigious American investigator moved to Britain, where the research is encouraged. Now Stanford and Harvard hope to
raise at least $100 million each for new stem-cell institutes. The universities of Wisconsin and Minnesota are expanding their
labs, and in March an anonymous donor gave $25 million to the University of Texas to boost its Houston program.

Billions of dollars are at stake in the race for medical cures. California boasts half of the nation's biomedical research capacity
and one-third of its biotech companies. The bond initiative, if it passes, would pay to build 12 to 15 new stem-cell research
centers, a massive magnet for scientific talent. "California will be the center of stemcell research for the world," predicts Palo
Alto real estate developer Robert Klein, cochairman of the initiative campaign. Klein, who has contributed $1.4 million of his
money toward the effort, touts the economic benefits, forecasting $70 million in tax revenues from new jobs even before any
cures are discovered. And if cures are found, the profits would accrue to California companies, along with substantial savings
on the state's $114 billion annual health-care bill.

Finances, however, have little to do with Klein's passion for the measure. Like Janet and Jerry Zucker, Katie's parents and the
initiative's other chief organizers, Klein is the father of a diabetic, Jordan, 13. In addition, his mother, 84, has Alzheimer's.
Distraught at the federal cutoff of stem-cell research, Klein and the Zuckers, who are Los Angeles film producers, were
brought together last year by the Juvenile Diabetes Research Foundation, one of the nation's most forceful disease-advocacy
groups. They hired a clutch of sophisticated lawyers and political consultants to draft the measure and conduct polls. They
enlisted allies from Alzheimer's, cystic fibrosis, Parkinson's and other disease-advocacy groups and spent $2.5 million
gathering signatures for the initiative. Ten Nobel prizewinners have endorsed the measure, including David Baltimore,
president of the California Institute of Technology, and Berg, who created the first recombinant DNA molecule. Behind the
scenes, Silicon Valley venture capitalists are backing what is expected to be a $20 million campaign.

It will certainly be a celebrity-studded crusade. Last Saturday, the Zuckers and other Hollywood notables were hosts of a
Beverly Hills tribute to Nancy Reagan that raised $2 million for stem-cell research. The former First Lady, who took up the
cause after her husband developed Alzheimer's, had earlier written to President Bush in favor of federal funding. But this is
the first time Mrs. Reagan has spoken out publicly on the issue. Proponents of the California initiative hope that advocacy by
an icon of the conservative movement will help neutralize resistance to the November bond measure.

Opponents have barely begun to organize. "We're not Hollywood producers," says Richard Doerflinger, spokesman for the
U.S. Conference of Catholic Bishops. "We don't have the money they do." Nonetheless, he says, pro-life groups will explain to
voters that embryonic stem-cell cloning is "unpromising for cures" and offers "a gateway to all kinds of possible genetic
engineering in humans." Although the California measure would initially limit research to embryos less than 12 days old,
Doerflinger contends it could lead to "the exploitation of women as 'fetus farms.'" Such arguments have persuaded eight
states, including Iowa, Michigan and Kansas, to restrict therapeutic-cloning research. More dramatically, the U.S. House
passed legislation last year that would make cloning human cells a crime punishable by up to 10 years in prison. The bill
stalled in the Senate, in part because of opposition from Utah Republican Orrin Hatch, who is antiabortion yet favors stem-
cell research.

The initiative's backers plan to run a grass-roots operation urging the 5 million Californians who are members of disease-
advocacy groups to e-mail friends and neighbors. A December poll commissioned by organizers showed that 85% of probable
voters have a relative or close friend with one of five illnesses most likely to be a target of the research. The possibility of
curing such afflictions as Alzheimer's and diabetes will be the focus of a multimillion-dollar statewide television campaign.
"This is not a wedge issue," contends state senator Deborah Ortiz, who was attacked by Catholic Church officials, with little
effect, for authoring the law to encourage stem-cell inquiry. "Ours will be a heartwarming message: that millions of people
might be cured of diseases."

Whatever happens in California is likely to reverberate nationally. Already, breakthroughs in stem-cell science, published
almost weekly in medical journals, are ratcheting up the stakes. If the initiative passes in the nation's largest state, "it will
put tremendous pressure on the White House to re-evaluate its policy," predicts Daniel Perry, head of the Washington-based
Coalition for the Advancement of Medical Research. If it doesn't, scientists claim, the work will move to such research-
friendly countries as Israel, Singapore and even China.

No one is more aware of the issues than Katie Zucker. A couple of years ago, she visited Congress with her parents to lobby
for stem-cell research, and she plans to help generate support for the initiative. "I have dreams and goals in life," she says,
fingering her insulin pump. "What keeps me going is that people are working so hard to find a cure.

Now read the text and select the best answer for each of the questions below.
1. What may diabetic patients suffer from?

a) kidney failure b) blindness c) amputation d) all of the above

2. Excluding America, how many people suffer from Type 1 diabetes worldwide?

a) about one million b) under three million c) about four million d) about five million

3. How do scientists hope to be able to help diabetics in the future?

a) By fewer insulin injections b) By creating insulin-producing cells which can be transferred to the body c) By growing spare
body parts d) By isolating the cells

4. What was the result of presidential disapproval of embryonic stem cell research?

a) Human beings will no longer be cloned for body parts b) The majority of research grants in this field were terminated c)
The president was re-elected d) There were no significant changes

5. What is the main source of fetal stem cells proposed for use in research?

a) Willing donors b) Anonymous donors c) In-vitro fertilization clinics d) The House of Representatives

6. How many signatures are needed to initiate a Californian ballot on state funding for embryonic research?

a) 1.1 million b) About half a million c) 17 million d) We don’t know

7. Which of the following is NOT mentioned as possibly benefiting from embryonic stem cell research?

a) Multiple Sclerosis b) Parkinson’s Disease c) Cancer d) Gluten allergy

8. Why is Nancy Reagan’s support so important to those in favour of embryonic stem cell research?

a) She was married to a former president b) Her husband suffered from Alzheimer’s c) She is associated with more traditional
attitudes which could have been expected to oppose the research. d) She has personally raised $2 million.

9. What are the fears of opponents of this type of research?

a) That it could result in female exploitation b) The fetal ‘right to life’ would not be respected c) Both ‘a’ and ‘b’ d) Neither ‘a’
nor ‘b’

10. What is the likely result of continued official disapproval for this type of research?

a) No further research will be done b) Scientists will work illegally c) An election may be necessary d) Scientists will move to
countries where their work is valued
Passage B

Surviving Cancer
New targeted therapies are turning malignancies into chronic--but manageable--conditions

Two years ago, Louise Jacobs was idly playing with a necklace when she felt a couple of tiny lumps around her collarbone.
She thought they were calcium deposits. She was wrong. Jacobs had advanced lung cancer that had already spread to her
lymph nodes. Because the tumors had infiltrated healthy tissue, surgery was not an option. "It was devastating," says the
teacher, 56, from Atlanta. "I never smoked, my husband never smoked, and nobody in my immediate family had ever had
cancer."

Jacobs immediately started the only treatment doctors had to offer--attacking the tumors with intensive chemotherapy and
radiation to try to kill the malignant growths. For seven weeks, her body was bombarded with radiation twice a day and
poisoned with toxic chemotherapy drugs once a week.

One year later, Jacobs got the bad news that cancer was starting to grow again in her lungs. This time, however, the doctors
had something else to offer. Two new anticancer drugs that target cancer cells more precisely and with less toxicity had been
approved by the FDA. (Two more have since been approved.) Jacobs' doctors at the M.D. Anderson Cancer Center in Houston
enrolled her in a clinical trial for a combination of two of those agents, Tarceva and Avastin, last August. "The difference is
like night and day," says Jacobs. "I take a pill every day, and every three weeks I go in for an infusion, which takes about 30
minutes." After nearly a year on the experimental cocktail, she has seen her primary lung cancer shrink more than 50%.

Jacobs is part of an exciting vanguard--the first wave of cancer patients who are benefiting from a more targeted,
molecular-based assault on the disease. Old-fashioned chemotherapy and radiation treatments were blunt weapons that
killed healthy cells along with malignant ones; the treatments were far too toxic for most patients to endure. By comparison,
the new-generation drugs are precision-guided missiles that zero in on tumors with a minimum of collateral damage. Used in
combination with advanced techniques for classifying tumors by their molecular signatures and screening patients by their
DNA, the drugs are transforming cancer from a deadly disease into a chronic condition that can be managed indefinitely. The
FDA, responsible for approving new drugs, acknowledged the trend earlier this year when it issued new guidelines for
evaluating this type of molecular and genetic data. "The bench and bedside have merged," says Dr. Roy Herbst of M.D.
Anderson Cancer Center. "We are truly in the molecular-targeted era."

After years of feeling that they were losing the war on cancer, doctors and researchers gathered at the American Society of
Clinical Oncology meeting in New Orleans reported last week that they finally have a deep enough understanding of the
molecular underpinnings of cancer to offer patients new hope. "The paradigm is changing," says Dr. David Sidransky, a
cancer specialist at Johns Hopkins Medical Institution. "New targeted drugs are coming, and we have to figure out how to
use them."

IDENTIFYING MUTATIONS

The detective work required to combat cancer effectively starts with the malignant cell itself. A tumor is essentially an
accumulation of mutations. It grows uncontrollably because its DNA, laboring under the weight of layer upon layer of genetic
errors, has become unstable and unable to repair itself. By studying those mutations, scientists can learn quite a bit about
how a particular cancer cell became malignant and the molecular pathways it uses to get the nutrients it needs to fuel
growth. One or several of those mutations may turn out to be the tumor's Achilles' heel--a weakness that makes it vulnerable
to a particular drug.

At the meeting in New Orleans, two groups of scientists, one based at Massachusetts General Hospital (MGH) and another
at the Dana-Farber Cancer Institute, reported on their search for such a weakness among a small group of lung-cancer
patients taking gefitinib (trade name: Iressa), a recently approved drug that blocks a key protein known as the epidermal
growth factor. Cancer cells need epidermal growth factor to continue dividing; design a drug that blocks its action, and you
can slow or even prevent further growth.

In the MGH trial, doctors studied 16 cancer patients who were treated with Iressa. Nine saw their tumors shrink, but the
drug had little effect on the rest. It turns out that eight of the nine patients who benefited from gefitinib had mutations in the
receptor that binds to the cancer's epidermal growth factor; none of the patients who didn't respond had the mutations.
Growth factors tend to fit into receptors on a cell's surface like keys into locks. Somehow, the changes in the eight patients
made their receptor locks a better fit for the gefitinib key.

In the Dana-Farber study, researchers looked at a larger number of patients in the U.S. and Japan and found a similar
pattern with a different set of mutations in the same receptor. "Knowing that those drugs will work brings us closer to being
able to screen patients and target the right drugs to them," says Dr. Thomas Lynch, who led the MGH study. His group is
analyzing still more lung-cancer patients, and if the results hold up, doctors may soon be able to identify these super-
responding patients as soon as their cancers are diagnosed. That will allow physicians to bypass chemotherapy and start
these patients on gefitinib as their first line of treatment.

TRACKING CHANGES

Cancer cells are not static creatures. As a tumor develops, it begins to change genetically and physically, and scientists are
trying to identify those changes through the various compounds a cancer cell secretes as it ages. As they are released in the
blood or urine, those compounds offer doctors a window onto the disease, allowing them to see what the cancer cells are
doing without having to biopsy the tumor. "A tumor that was removed three years ago and has spread is probably not the
same tumor anymore," notes Howard McLeod, a professor of oncology at Washington University in St. Louis, Mo. "For a
tumor to have survived a first-line therapy, something changed to give it an advantage. For it to survive second-line therapy,
something else changed. And for it to survive long enough to spread to other sites, then something more is different."

The better that researchers know a cancer, the better their chances of defeating it. Those odds also improve if doctors have
more than one way to fight it. As they fill in the details--at the molecular level--of the world in which tumors thrive, doctors
are becoming convinced that a one-drug-one-cancer approach is not sufficient. Just as AIDS physicians currently use a multi-
drug approach to attack HIV at different stages of its life cycle, so too are cancer doctors beginning to surround tumor cells
with combinations of agents that can weaken a growing cancer by chipping away at its life-support systems.

Already it is clear that the nature of those support systems is more important than where in the body the cancer originated.
"The source of the cancer becomes less of an issue over time than trying to understand the signaling pathways the cell is
using," says Dr. James Abbruzzese of M.D. Anderson Cancer Center. In coming years, doctors will think not of breast cancers
and colon cancers but rather of growth-factor cancers and signaling cancers.

MATCHING PATIENTS

After a doctor identifies a cancer and chooses a combination of drugs to combat it, there is still no guarantee that the drugs
will work. That's because no two patients are alike. Subtle differences in their genetic code often determine how well a
cancer drug will be tolerated and how quickly it will be broken down in the body. Some people produce enzymes that can
neutralize the more toxic side effects of anticancer drugs, while others either lack such agents or have genes that produce the
opposite effect, making them more sensitive to the drug's adverse effects. Researchers at MGH, for example, found that
changes in the gene coding for an enzyme involved in DNA repair can mean the difference between breast-cancer patients
who can tolerate chemotherapy and those with a twofold greater chance of experiencing a toxic reaction.

When it works, the new paradigm can achieve dramatic results. Most of the newly approved drugs work in only 10% to 30%
of patients, but in those patients, tumors routinely shrink to less than half their size. The number of new drugs that have
been approved is small, their cost is high (at least $20,000 per cycle), and progress is slow. The five-year survival rate for all
cancers is 63%, up from 51% in 1975, according to the American Cancer Society. But most of that improvement is attributed
to the effectiveness of antismoking campaigns, not to better drugs. Thanks to patients like Louise Jacobs, who is helping to
make new, smarter treatments part of standard cancer care, that may soon change.

Now read the text and select the best answer for each of the questions below.

1. Louise Jacob’s tumors weren’t removed surgically because:

a) the cancer had already infected healthy tissue. b) she was a smoker. c) chemotherapy is a better approach for this type of
cancer. d) they were calcium deposits.

2. For many weeks was the initial treatment effective?

a) One b) Two c) Seven d) Fifty-two

3. What is the major advantage of a molecular-based treatment over chemotherapy and radiation treatments? It is…

a) more specific b) cheaper c) more toxic d) none of the above

4. Your Achilles’ heel is…

a) your best feature b) your most vulnerable point c) part of your foot d) a new anti-cancer drug

5. When lung cancer patients at the Massachusetts General Hospital were treated with Iressa, how many of them improved?

a) All of them b) None of them c) More than half d) Less than 50%

6. In what way is current thinking on cancer therapy and treatment for HIV AIDS similar?

a) More than one method of treatment is used. b) Both involve attacking thriving tumors. c) Both areas are under-funded. d)
All of the above.

7. What factors determine how successful the newtherapies will be?

a) Genetic factors b) Enzyme production c) Both a & b d) Neither a nor b

8. The number of cancer victims who die within five years of contracting the disease is…

a) increasing. b) decreasing. c) stable. d) unknown.

9. Have the efforts of US anti-smoking campaigners been effective in reducing cancer deaths?

a) Yes b) No c) We don’t know d) Only in certain states

10. The overall tone of the article is …

a) cautiously optimistic about the new cancer treatments available. b) entirely pessimistic. c) damaging to doctors. d) very
likely to worry cancer victims.
Part A
Answer Sheet
1. A wide range 2. the bite 3. Africa 4. lack of effective/ineffective 5. a low priority 6. vaccination coverage 7.
operational 8. high cost of 9. government 10. household 11. multiple hospital 12. medical fees 13. $ 40 US 14.$ 49 US
15. light microscopes 16. Widely available 17. Appropriate training 18. Domestic dogs 19. source of infection 20.
Africa 21. Asia 22. cost effective 23. successful 24. mass vaccination 25. Human rabies deaths

Part B

Passage A

ANSWERS

1.: a) the cancer had already infected healthy tissue. 2. For many weeks was the initial treatment effective?

2. d) Fifty-two (ONE YEAR)

3. a) more specific

4. b) your most vulnerable point

5. c) More than half (NINE OUT OF SIXTEEN) d) Less than 50%

6. a) More than one method of treatment is used

7. c) Both a & b

8. b) decreasing.

9. a) Yes

10. a) cautiously optimistic about the new cancer treatments available.

Passage B

ANSWERS:

1. d) all of the above

2.c) about four million

3. b) By creating insulin-producing cells which can be transferred to the body

4 b) The majority of research grants in this field were terminated

5. c) In-vitro fertilization clinics

6 b) About half a million

7. d) Gluten allergy

8. c) She is associated with more traditional attitudes which could have been expected to oppose the research.

9 c) Both ‘a’ and ‘b’

10. d) Scientists will move to countries where their work is valued

 FULL TEST 12
Snake Bite in South Asia
Part A Time Limit: 15 minutes

Snake Bite in South Asia

Text 1

Background

There are more snake bites in the South Asia region than any where else in the world. This is due to its high population
density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control
programs. However, since ancient times, snakes have been worshipped and feared, in South Asia. Cobras appear in many
tales and myths and are regarded as sacred by both Hindus and Buddhists. Unfortunately, snakes remain a painful reality in
the daily life of millions of villagers in this region. Indeed, although antivenom is produced in sufficient quantities by several
public and private manufacturers, most snake bite victims don’t have access to quality care, and in many countries, both
morbidity and mortality due to snake bites are high.

Text 2

First aid

Most experts agree that snake bite victims should be transported as quickly as possible to a medical centre where they can
be clinically evaluated by qualified medical staff, and where antivenoms are available. In fact, time of transport was shown
to be a crucial determinant of snake bite mortality in eastern Nepal, and studies in southern India confirmed that delayed
antivenom administration was associated with an increased risk of complications. The bite victim should be reassured, the
bitten limb immobilized with a makeshift splint or sling, and the patient transported. Walking is contraindicated, because
muscular contractions promote venom absorption. These traditional measures are strongly contraindicated as they are
ineffective and in most cases deleterious. For example, tourniquets cannot be safely left on for long without risking severe
local damage including ischemia, necrosis, and gangrene

Text 3 Table 1. Characteristics of snake bite victims in South Asia

Characteristic Detail

Age

The mean age of snake bite victims is around 30 years. Three-quarters of the victims are in the 10- to 40-year age group,
broadly in agreement with demography.

Gender

There is a clear preponderance of males among snake bite victims. A 2:1 male to female ratio is frequently observed.

Occupation

Farmers account for more than half of the victims. Students and housewives are also frequently bitten.

Time of Bite

The time of bite depends on the relative abundance of diurnal and nocturnal snakes. Krait bites generally occur at night,
whereas viper and cobra bites mostly occur during daytime.

Site of bite
60%–80% of bites occur on the foot, ankle, or leg. Bites on the head and trunk are mostly due to nocturnal species biting
sleeping people.

Delay between bite and treatment

The bite-to-treatment delay varies greatly, ranging from 30 minutes to 15 days. Most studies show that at least 60% of
victims reach a health centre within six hours but very few in less than one hour.

First aid methods

In eight out of 15 studies, more than 50% of snake bite victims used inappropriate and harmful first aid methods.
Tourniquets are used by up to 98% of patients, and cannot be left on for too long without risking severe local damage
including ischemia, necrosis, and gangrene

Mortality

Mortality rates are highly variable, ranging from 0.5% to 58%. Most fatalities occur before reaching treatment centres.

Text 4

Control and Prevention In practice, strategies to control snake populations and to prevent snake bites are nonexistent in
South Asian countries. Many bites could be avoided by educating the population at risk. Sleeping on a cot (rather than on the
floor) and under bed nets decreases the risk of nocturnal bites in Nepal. Rubbish and firewood, which attract snakes, can be
removed from the vicinity of human dwellings. Attempts can be made to prevent the proliferation of rodents in the domestic
and peridomestic area. Thatched roofs, and mud and straw walls are favoured hiding places for snakes and should be
checked frequently. Many bites occur when people walking barefoot or wearing only sandals accidentally step on a snake.
Using a torch/ flashlight while walking on footpaths at night, and wearing boots and long trousers during agricultural
activities, could significantly reduce the incidence of bites.

Summary

Snake bite is one of the most neglected public health issues in poor rural communities living in South East Asia. Yet this
creature has been both (1)____ and (2)____since the earliest of times. To Hindus and (3)____, it is considered to be (4)____.
Despite being revered, however, there are (5)____ in the South Asia region than anywhere else in the world. There are many
reasons for this situation including (6) ____, extensive agricultural activities, lack of snake bite control programs and the fact
that many of the snakes are (7)____. According to recent studies on the characteristics of victims, (8) ____are twice as likely
to be bitten as (9)____ and the average age of those bitten by a snake is (10)____. While (11)_____ and (12)____ are
commonly bitten, over 50% or the victims are farmers. The (13) ____ is dependent on the species, and Cobra bites usually
occur during the (14)____ while (15) ____are more frequent at night. (16)____ of bites occur on the foot, ankle or leg.
Regarding treatment, it (17)____by most experts that snake bite victims require urgent transportation to a medical centre for
clinical(18)_______ by experienced medical staff. This fact is supported by research in (19) ____which confirmed that there is
an increased risk of complication if antivenom administration (20) _____. Unfortunately most studies also show that
(21)____ snake bite victims reach a health centre in less than one hour. To make matters worse, over half of snake bite
victims received (22)____ and (23)____ first aid, such as tourniquets which if left on for (24)____can cause severe local
damage. The number of snake bites could be reduced if prevention strategies were implemented. For example, many bites
occur when people walk (25)____ and step on a snake (26)____. Protective clothing such as boots and long pants should be
worn when doing (27) ____The removal of (28) ____and (29)____ from the surroundings of human dwellings can also help
reduce snake populations.
Part B

Reading Passage A

AIDS deaths blamed on immune therapy

1 THE DEATHS of three patients during trials of an experimental immune therapy for people with AIDS have renewed
controversy over experiments carried out by the French scientist Daniel Zagury. The affair has also highlighted shortcomings
in the system of checks and controls over clinical research.

2 The French health minister, Bruno Durieux, recently announced that an inquiry had cleared Zagury and his team at the
Pierre and Marie Curie University in Paris of alleged irregularities in the way they conducted tests of a potential vaccine and
an experimental immune therapy in patients at the Saint-Antoine Hospital (This Week, 13 April). But Durieux made no
mention of three deaths which the inquiry had reported.

3 Following revelations about the circumstances in which the patients died, Durieux has now announced a new assessment
of the tests, to be undertaken by ANRS, the national agency for AIDS research.

4 Last July, Zagury and his colleagues reported in a letter to The Lancet (vol 336, p 179) a trial on patients with AIDS or AIDS-
related complex. The patients received a preparation based on proteins from HIV that was designed to boost their immune
systems.

5 The preparation was made from samples of the patients' own white blood cells, purified and cultured in the laboratory.
The researchers had infected the white blood cells with a genetically engineered form of the vaccinia virus that had genes
from HIV inserted into its DNA. The vaccinia, or cowpox, virus, had first been inactivated with formaldehyde, said the
researchers. Last week, the Chicago Tribune and Le Monde alleged that at least two of the deaths were caused by vaccinia
disease, a rare complication of infection with vaccinia virus. Vaccinia is harmless in healthy people and has been used in its
live form as the vaccine against smallpox worldwide. But in people whose immune systems are suppressed, the virus can
occasionally spread rapidly in the body and kill.

6 A Paris dermatologist, Jean-Claude Guillaume, said that when he warned Zagury's team that he was convinced one of
their patients had contracted vaccinia disease "the response was that this was not possible" because the vaccinia had been
inactivated. Shortly before his death, the patient had consulted Guillaume about large, rubbery lesions across his abdomen.

7 Guillaume consulted a colleague, Jean-Claude Roujeau, about the rare disease. Roujeau told the Chicago Tribune that his
tests on the tissue samples taken from two patients before they died had detected vaccinia virus in their skin cells.

8 The Saint-Antoine team's postmortem tests did not reveal vaccinia. Odile Picard, who is in charge of administering the
treatment, says there were three possible causes of death - vaccinia disease, herpes or a toxic reaction to the procedure used
to prepare white blood cells before injecting them into patients. Zagury, however, insisted that "nothing allows us to affirm it
[was vaccinia]. It could have been herpes or Kaposi's sarcoma". The tests are continuing, he says.

9 Luc Montagnier, co-discoverer of HIV, called for an immediate halt to the experiments. He says that intravenous injections
could lead to generalised vaccinia disease. His team at the Pasteur Institute has already shown in laboratory tests that
vaccinia virus maybe dangerous if the immune system is unable to resist it.

10 The findings at the Pasteur Institute were apparently unknown to Zagury's team, which works with Montagnier's
rival,the researcher Robert Gallo. Gallo's collaboration with Zagury has been suspended by the National Institutes of Health
in the US because of alleged irregularities.

11 Zagury and his team have also denied charges that they covered up the deaths, which are not mentioned in their report
in The Lancet. "They were not covered up," Picard said. "They were accepted [into the trial] on compassionate grounds."

12 The Lancet report concerns 28 patients. 14 who were treated and 14 controls who were not able to receive the
treatment. Picard says that five other patients were also treated with the preparation but were not compared with the
controls. Their T4 cell counts had fallen too low to be comparable with the control group, so they were excluded from the
study and not mentioned in its report.
13 AIDS patients are particularly vulnerable to infection. Furthermore, the French ethics council had specified that
volunteers should be chosen because "their state was so advanced it excluded treatment with AZT". At least some of the
patients were being treated with AZT at the same time as immune therapy.

14 The council had also asked to be informed of the results of the trials case by case, but had not been told of the deaths.
The geneticist Andre Boue, a member of the council, said: "The ethics council does not have judicial powers; we are not the
fraud squad."

15 The director of the AIDS research agency ANRS. Jean-Paul Levy, is concerned that all the controversy may lead to a crisis
of public confidence but laid the blame firmly at the door of the media where "excessive praise is followed by excessive
rejection ".

16 Levy, who had still heard nothing, "even informally" from the health ministry the day after Durieux told parliament that
ANRS would assess immune therapy trials, said he wanted to study the problems "in depth, but not in the atmosphere of a
tribunal".

17 ANRS has a panel of experts in therapeutic trials, which, says Levy, "might seek international contacts to obtain a broad
consensus" on the issues involved. The research agency's role is to carry out a purely scientific evaluation, not to assess
whether there was a breach of ethical guidelines, according to Levy.

18 "If the government called on us to examine this case, we could act very quickly," said Philippe Lucas of the ethics council.

AIDS deaths blamed on immune therapy

1 Which of the following is FALSE? a. Zagury's experiments have been controversial before. b. An inquiry found obvious
irregularities in Zagury's work. c. ANRS is to re-evaluate Zagury's tests. d. Zagury's intention had been to increase patients'
immune systems with proteins.

2 The preparation which the patients received a. had been accidentally infected with a form of the vaccinia virus. b. was
made from white blood cells which had been manufactured in the laboratory. c. had been stored in formaldehyde. d.
contained laboratory-treated white blood cells which had been taken from them.

3 According to the article. vaccinia a. is potentially lethal for all humans. b. has been used to fight both cowpox and
smallpox all around the world. c. can be dangerous in people who have abnormal immune systems. d. in none of the above.

4 Jean-Claude Guillaume a. was also a member of Zagury's team. b. examined one of the patients who had been referred
to him by Zagury's team. c. informed the Chicago Tribune about the results of the tests on the tissue samples. d. was/did
none of the above.

5 Which of the following people does NOT work with Zagury? a. Odile Picard. b. Luc Montaignier. c. Robert Gallo. d.
None of the above works with Zagury.

6 It is FALSE that findings at the Pasteur Institute a. were ignored by Zagury's team. b. did not lead to intervention by the
National Institutes of Health. c. showed that intravenous injections were not good for patients with weaker d. immune
systems. e. led to Zagury's team keeping quiet about the patients who had died.

7 How many people were injected with the preparation in the trial? a. Fourteen b. Nineteen c. Twenty eight d. Thirty three

8 Which of the following statements best describes the initial condition of the people who took part in the trial? a. Fewer
than half of them had AIDS b. Half of them had AIDS c. Most of them had AIDS d. AIl of them had AIDS

9 The French ethics council a. is against the use of AZT b. wanted to remain ignorant of the deaths c. is willing to evaluate
the trial d. may prosecute Zagury's team

10 According to Jean-Paul Levy a. over-reaction in the media has led to a crisis in public confidence. b. the health ministry
told him about the deaths the day after parliament had been informed. c. the ANRS did not want to conduct their
assessment in a public arena. d. ANRS may prosecute Zagury's team if they find there was a breach of ethical guidelines.
Reading Passage B

Insulin is still a hard act to swallow

1 Research groups around the world are optimistic that they are making progress towards developing the drug insulin in a
form that can be taken by mouth. Many diabetics must inject themselves every day with insulin to help control the level of
sugar in their blood. For decades, scientists have been looking for an effective way to give people insulin by mouth instead.

2 Insulin is an essential hormone for getting glucose from the bloodstream into body cells, and most people produce it
naturally in the pancreas. People with diabetes mellitus produce either not enough insulin or none at all. The hormone
cannot normally be taken by mouth because insulin molecules are destroyed by digestive enzymes in the gut. Thus many
diabetics must inject them-selves with insulin daily.

3 Researchers have therefore been aiming to package the hormone in some way so that it can survive intact in the gut and
cross the gut wall into the bloodstream.

4 The current experiments are all at an early stage. Even if they do lead to an effective treatment, it may not be suitable for
every diabetic. Those most likely to benefit are people who find injections difficult, such as blind people and younger children.

5 This month a team in Ohio is applying for permission to test its oral insulin on people. The tablet is a gelatin capsule which
contains insulin and a drug similar to aspirin and sodium bicarbonate. The gelatin has a coating of waterproof plastic that
becomes permeable in the gut.

6 Murray Saffran, who is leading the research at the Medical College of Ohio in Toledo, says the plastic based on a polymer
whose structure contains certain nitrogen-nitrogen bonds known as azo bonds. In the gut, bacteria break down the azo
bonds, and the plastic becomes permeable to water. Water enters the capsule and causes a reaction between the aspirin-like
drug and the sodium bicarbonate, giving off carbon dioxide and rupturing the capsule.

7 The researchers believe the aspirin-like drug may also help the insulin to be absorbed. The insulin is absorbed directly from
the gut into the vein carrying blood to the liver.

8 Saffran and his colleagues have so far carried out trials of the capsule in rats and most recently - diabetic dogs. The
researchers found that the level of glucose in the animals' blood fell, on average, from more than 400 to 120 milligrams per
decilitre after receiving the capsule. At the same time, the insulin levels in their blood rose, showing they had absorbed the
hormone.

9 Another group has already started testing a different insulin capsule in humans, having first performed animal trials.
Hanoch Bar-On and his colleagues at the Hadassah Hospital in Jerusalem have patented their capsule, which is coated so that
it is not destroyed by the stomach acid. Bar-On says the capsule contains insulin and "other ingredients" which help to
enhance the hormone's absorption in the gut and to inhibit the enzymes that destroy it.

10 So far, the trial in Jerusalem has been small, involving only eight health volunteers. In future, Bar-on wants to extend the
trials to diabetics, but he stresses the need for more research before he can do so.

11 The success of the tests so far has been limited, but encouraging, says Bar-On: in three of the eight, the level of sugar in
their blood fell after they took the capsule from 100 milligrams per decilitre to between 80 and 85. At the same time, the
insulin level in their blood was seen to rise to a peak then tail off. For the remaining five people, there was no significant
effect from the capsule.

12 A third project is led by Y ough Cho at Murdoch University in Perth, Australia, together with Cortecs, a company in Isle
Worth near London. Cho has devised a combination of insulin and fatty molecules, encapsulated in gelatin. The fatty
molecules, which occur naturally in the gut as a product of the digestion of fat, are easily absorbed from the gut and carried
to the liver. Insulin attached to these molecules can enter the bloodstream.

13 Cho gave three diabetic men this preparation, in liquid form. In each of the men there was a "substantial reduction" in
the level of blood sugar. Their insulin levels were also seen to peak and tail off. The team has published this work in The
Lancet (vol ii 1989, P 1518), and clinical trails of the capsule are due to start soon at Guy's Hospital, in London.
 14 There are, however, several problems with oral insulin. First, it is relatively inefficient: several times as much insulin is
needed to achieve the same drop in blood sugar that a specific amount could achieve if injected. This suggests that a
significant amount of insulin is still being destroyed in the gut. Also, the amount of insulin that will be absorbed is
unpredictable and can be disrupted, for example, by illness.

Insulin is still a hard act to swallow

11 According to the article.

a) it is no longer desirable that diabetics should inject themselves with insulin b) a large number of diabetics no longer
want to inject themselves with insulin c) a viable oral form of insulin has been developed d) a viable oral form of insulin
may soon be developed

12 The major problem with an oral form of insulin has been

a) producing it in sufficient quantities outside the pancreas b) delivering it undamaged into the bloodstream c) preventing
it from attacking digestive enzymes in the gut d) its previous inability to cross the gut wall into the bloodstream

13 The capsule which is to be tested in Ohio

a) will also be tested on blind people and younger children b) contains a combination of insulin, aspirin and sodium
bicarbonate c) has protection which enables it to overcome the previous problems d) none of the above

14 The reaction between the capsule and water in the gut

a) is likely to destroy the insulin b) causes the insulin and the aspirin-like drug to be taken into the bloodstream c) produces
carbon dioxide as a by-product d) allows the insulin and the sodium bicarbonate to I?ass into the bloodstream

15 Research at the Medical College of Ohio in Toledo

a) has shown signs of being successful b) has been carried out on diabetic rats and dogs c) has shown an increase in blood
level in the animals tested d) all of the above

16 In tests carried out at the Hadassah Hospital in Jerusalem

a) Saffran's capsule has had similar results with humans b) Saffran's capsule has not had similar results with humans c) the
researchers have used a capsule which is almost identical to Saffran's d) the capsule being used contains substances to
protect the insulin from attacking in the stomach

17 Which of the following statements is TRUE?

a) Bar-On has used healthy diabetic volunteers exclusively in his trials b) Bar-On is ready to extend his trials c) Bar-On has
not been discouraged by results to date d) Less than 50% of Bar-On's subjects experienced minimal change of insulin level in
the blood

18 In the Australian project a) fatty molecules. similar to those found naturally-occurring in the body. are used to cost the
insulin-gelatin combination b) the artificially-introduced fatty molecules solidify in the gut c) fatty molecules carry the
insulin d) the gelatin enters the bloodstream with the insulin

19 We know a) the sex of Cho's test subjects b) in what form the preparation was administered c) whether the level of
insulin in the subjects increased or not d) all of the above

20 Which of the following is NOT given as a problem with an oral form of insulin? a) it is difficult to work out how much
insulin needs to be administered b) there are many people who are unable to swallow capsules successfully c) the rate of
insulin absorption may be affected by the general health of the diabetic d) patients would need to be given substantially
more insulin than they currently use
Part A

Answer Sheet 1. worshipped 2. feared 3. Buddhists 4. sacred 5. more snake bites 6. high population density 7. venomous 8.
males (must be plural) 9. females (must be plural) 10. 30(years) 11. students 12. housewives 13. time of bite 14. daytime/day
15. Krait bites 16. 60 to 80% 17. is agreed (use passive verb form) 18. evaluation (change adjective to noun) 19. Southern
India 20. Is/was delayed (use passive verb form) 21. very few 22. inappropriate 23. harmful 24. too long 25. barefoot 26.
accidentally 27. agricultural activities 28. rubbish 29. Firewood

Part B

ANSWER KEY – Passage A ANSWER KEY – Passage B

AIDS death Insulin _____________________________ _____________________________ 1. b - paras 1-4 11. d - para 1
2. d - para 5 12. b - paras 1-3 3. c - paras 5-6 13. c - paras 4-6 4. 4. d - paras 7-8 14. c - para 6 5. b - paras 9-11
15. a - para 7 6. a - paras 11-13 16. d - para 8 7. b - para 13 17. c - paras 9-10 8. d - para 14 18. c - para 11 9. c
- paras 14-19 19. d - para 12 10. c - paras 16-18 20. b - para 13
 FULL TEST 13
Part A

Vitamin C
Text 1
The Recommended Dietary Allowance
The Food and Nutrition Board at the Institute of Medicine recommends Vitamin C be consumed every day in the following
amounts:

Infants and Children

• 0 - 6 months: 40 milligrams/day (mg/day) • 7 - 12 months: 50 mg/day • 1 - 3 years: 15 mg/day • 4 - 8 years: 25 mg/day • 9

- 13 years: 45 mg/day

Adolescents

• Girls 14 - 18 years: 65 mg/day • Boys 14 - 18 years: 75 mg/day

Adults

• Men age 19 and older: 90 mg/day • Women age 19 year and older: 75 mg/day

Women who are pregnant or breastfeeding and those who smoke need higher amounts. All fruits and vegetables contain
some amount of vitamin C. Foods that tend to be the highest sources of vitamin C include green peppers, citrus fruits and
strawberries.

Text 2
Toxicity
A number of possible problems with very large doses of vitamin C have been suggested, including genetic mutations and
birth defects. However, these alleged adverse health effects have not been confirmed, and there is no reliable scientific
evidence that large amounts of vitamin C (up to 10 grams/day in adults) are toxic or detrimental to health. With the latest
RDA published in 2000, a tolerable upper intake level (UL) for vitamin C was set for the first time. A UL of 2 grams daily was
recommended in order to prevent most adults from experiencing diarrhoea. Such symptoms are not generally serious,
especially if they resolve with temporary discontinuation or reduction of high-dose vitamin C supplementation.

Text 3
Research Review
We sought to discover whether vitamin C in doses of 200 mg or more daily reduces the incidence, duration, or severity of the
common cold when used either as continuous prophylaxis or after the onset of cold symptoms. Literature from 1940 to 2004
was methodically screened.

• Studies of marathon runners, skiers, and soldiers exposed to significant cold and/or physical stress experienced 50%
reduction in common cold incidence.

• Duration of cold that occurred during prophylaxis was significantly reduced in both children and adults. For children this
represented an average reduction of 14% in symptom days, while in adults the reduction was 8%.
• Incidence of the common cold showed no change in several community studies where prophylactic doses as high as 2 g
daily were used.

Implications of the Review

• The clinical significance of the minor reduction in duration of common cold episodes experienced during prophylaxis is
questionable, although the consistency of these findings points to a genuine biological effect.

• In special circumstances, where people used prophylaxis prior to extreme physical exertion and/or exposure to significant
cold stress, the collective evidence indicates that vitamin C supplementation may have a considerable beneficial effect

Text 4
Function of Vitamin C
Vitamin C is required for the growth and repair of tissues in all parts of your body. It is necessary to form collagen, an
important protein used to make skin, scar tissue, tendons, ligaments, and blood vessels. Vitamin C is essential for the healing
of wounds, and for the repair and maintenance of cartilage, bones, and teeth. Vitamin C is one of many antioxidants.
Antioxidants are nutrients that block some of the damage caused by free radicals, which are by-products that result when
our bodies transform food into energy. The build up of these by-products over time is largely responsible for the ageing
process and can contribute to the development of various health conditions such as cancer, heart disease, and a host of
inflammatory condition like arthritis. Antioxidants also help reduce the damage to the body caused by toxic chemicals and
pollutants such as cigarette smoke. Vitamin C, also known as ascorbic acid, is a water-soluble vitamin. Unlike most mammals
and other animals, humans do not have the ability to make their own vitamin C. Therefore, we must obtain vitamin C
through our diet.

Summary

Vitamin C is an essential nutrient for humans in its function as a vitamin. However, unlike in most(1)___, the human body can
not (2)___vitamin C by itself. As a result, vitamin C must be (3)___ through our daily dietary intake. Vitamin C can be found
in all (4)___ and (5)___ but the (6)___ of this essential vitamin are green peppers, (7)___ and strawberries. The human body
(8)___vitamin C for tissue growth and (9)___ and it is an important element in the (10)___ of wounds as well as the (11)___
of teeth, cartilage and bones. Vitamin C is also an (12)___. Therefore, it can act as a block against damage caused by free
radicals. It is this quality which has some experts claiming that it has an anti-ageing effect and can lessen the effects of a
variety of (13)__ including cancer and heart disease as well as arthritis which is an (14)___. However the role of vitamin C in
the prevention and treatment of the common cold is controversial. A recent study by (15)___ reported mixed results in the
ability of vitamin C to fight this most common of ailments. Positive results included significant reduction in the (16)____ in
adults and children when vitamin C was used as a (17)___. A 50% reduction in cold incidence was also reported by (18)___ ,
skiers and soldiers who had been exposed to conditions of (19)___ or significant cold. In contrast, the frequency of the
common cold (20) ___ in several community studies in which the subjects were given (21)___ prophylactic doses as high as 2
grams. Despite this mixed evidence, the Food and Nutrition Board at the Institute of Medicine recommends (22)___ vitamin C
every day in amounts ranging from (23)___ for babies between zero and 6 months, 65 to 75 mg per day for (24) ___ boys and
girls to 90mg per day for (25)___ aged 19 and over. In addition, (26)___ are required for pregnant women and smokers. To
date there is no (27)___that Vitamin C in large amounts is toxic, despite (28)__that very large doses can cause birth defects
and genetic mutations. An upper intake limit of (29)___ per day is recommended to prevent mild symptoms such as (30)___.
Part B

Passage A

The Bird Flu

A growing number of avian influenza (bird flu) cases are turning up among bird populations around the world. While the flu
has yet to have a large scale impact on human lives, the World Health Organization (WHO) and the United States Center for
Disease Control (CDC) warns that it is not a matter of if we will be affected, but when. The first step you can take is to
educate yourself and stay informed. What follows are questions and answers that will help you take this first step.

What is the bird flu (avian influenza)? The bird flu is an infection caused by avian (bird) influenza (flu) virus. These flu virus
occur naturally among birds. Wild birds worldwide carry the virus in their intestines, but usually do not get sick from it.
However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks,
and turkeys, very sick and kill them.

How does the bird flu virus differ from seasonal flu viruses that infect humans? Of the few bird flu viruses that have crossed
the species barrier to infect humans, the most recent virus that you are hearing about in the news has caused the largest
number of reported cases of severe disease and death in humans. In Asia, more than half of the people infected with the virus
have died. Most cases have occurred in previously healthy children and young adults. However, it is possible that the only
cases currently being reported are those in the most severely ill people and that the full range of illness caused by the current
bird flu virus has not yet been defined. Unlike seasonal influenza, in which infection usually causes only mild respiratory
symptoms in most people, bird flu infection may follow an unusually aggressive clinical course, with rapid deterioration and
high fatality.

How does the bird flu spread among birds? Infected birds shed influenza virus in their saliva, nasal secretions, and feces.
Susceptible birds become infected when they have contact with contaminated excretions or with surfaces that are
contaminated with excretions or secretions. Domesticated birds may become infected with avian influenza virus through
direct contact with infected waterfowl or other infected poultry or through contact with surfaces (such as dirt or cages) or
materials (such as water or feed) that have been contaminated with the virus.

Do bird flu viruses infect humans? Bird flu viruses do not usually infect humans, but more than 100 confirmed cases of human
infection with bird flu viruses have occurred since 1997.

What would make the bird flu a ‘pandemic flu’? A ‘pandemic flu’ is defined as a global outbreak of disease that occurs when
a new virus appears in the human population and then spreads easily from person to person. Three conditions must be met
for a pandemic to start: 1) a new virus subtype must emerge; 2) it must infect humans and cause serious illness; and 3) it
must spread easily and continue without interruption among humans. The current bird flu in Asia

Source: http;//www.browardhealth.org Title: Pandemic Flu

and Europe meets the first two conditions: it is a new virus for humans and it has infected more than 100 humans.

How do people become infected with bird flu viruses? Most cases of the bird flu infection in humans have resulted from direct
or close contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with
secretions and excretions from infected birds. The spread of bird flu viruses from an ill person to another person has been
reported very rarely, and transmission has not been observed to continue beyond one person. During an outbreak of bird flu
among poultry, there is a possible risk to people who have direct or close contact with infected birds or with surfaces that
have been contaminated with secretions and excretions from infected birds.

What are the symptoms of avian influenza in humans? Symptoms of the bird flu in humans have ranged from typical human
flu-like symptoms (fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases
(such as acute respiratory distress syndrome), and other severe and life-threatening complications. The symptoms of the bird
flu may depend on type of virus causing the infection.

How is avian influenza detected in humans? A laboratory test is needed to confirm bird flu in humans. How is avian influenza
in humans treated? Studies done in laboratories suggest that the prescription medicines approved for human flu viruses
should work in treating bird infection in humans. However, flu viruses can become resistant to these drugs, so these
medications may not always work. Additional studies are needed to determine the effectiveness of these medicines.

Does a seasonal flu vaccine protect me from avian influenza? No. Seasonal flu vaccines do not provide protection against the
bird flu. However, it is always a good idea to obtain a vaccine for your well-being.

Should I wear a surgical mask to prevent exposure to the bird flu? Currently, wearing a mask is not recommended for routine
use (e.g., in public) for preventing flu virus exposure. Is there a risk for becoming infected with avian influenza by eating
chicken, turkey, or duck? There is no evidence that properly cooked poultry or eggs can be a source of infection for bird flu
viruses. For more information about bird flu and food safety issues, visit the WHO’s website at: www.who.org. The U.S.
government carefully controls domestic and imported food products, and in 2004 issued a ban on importation of poultry from
countries affected by bird flu viruses.

What can I do to help reduce the risk for infection from wild birds in the United States? As a general rule, the public should
observe wildlife, including wild birds, from a distance. This protects you from possible exposure to pathogens and minimizes
disturbance to the animal. Avoid touching wildlife. If there is contact with wildlife do not rub eyes, eat, drink, or smoke
before washing hands with soap and water. Do not pick up diseased or dead wildlife. Contact the Department of Agriculture
and Consumer Services for issues related to poultry flocks or the Fish and Wildlife Conservation Commission for issues
relating to wild birds.

Is there a vaccine to protect humans from the bird flu virus? There currently is no commercially available vaccine to protect
humans against the bird flu virus that is currently being detected in Asia and Europe. However, vaccine development efforts
are taking place. Research studies to test a vaccine that will protect humans against the current bird flu virus began in April
2005, and a series of clinical trials is under way. For more information about the avian influenza vaccine development
process, visit the National Institute of Health’s website: www.nih.gov.

Does CDC recommend travel restrictions to areas with known bird flu outbreaks? CDC does not recommend any travel
restrictions to affected countries at this time. However, CDC currently advises that travelers to countries with known
outbreaks of avian influenza avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to
be contaminated with feces from poultry or other animals. For more information, visit www.cdc.gov/travel/.

Is there a risk to importing pet birds that come from countries experiencing outbreaks of the bird flu ? The U.S. government
has determined that there is a risk to importing pet birds from countries experiencing outbreaks of the avian influenza. CDC
and the U.S. Department of Agriculture (USDA) have both taken action to ban the importation of birds from areas where
avian influenza has been documented.

Can a person become infected with the bird flu virus by cleaning a bird feeder? There is no evidence of the avian influenza
having caused disease in birds or people in the United States . At the present time, the risk of becoming infected with the
virus from bird feeders is low. Generally, perching birds are the type of birds commonly at feeders. While there are
documented cases of avian influenza causing death in such birds (e.g., house sparrow, Eurasian tree-sparrow, house finch),
most of the wild birds that are traditionally associated with bird flu viruses are waterfowl and shore birds.

Pandemic Flu
Now read the text and select the best answer for each of the questions below.

1. Which of the following statements is NOT true?

a) Wild birds carry the virus in their intestines. b) Avian influenza is very contagious among birds. c) Avian flu can make
domestic birds very ill and may be fatal. d) Wild birds often die from Avian flu.

2. Which of the following statements is NOT true?

a) 50% of the people in Asia infected with bird flu have died. b) Healthy people have been infected. c) Bird flu causes mild
respiratory symptoms in most people. d) It’s likely that we don’t yet know the full range of illnesses caused by the bird flu
virus.

3. How does a bird become infected?

a) Contact with the saliva, nasal secretions or faeces of an infected bird. b) Contact with surfaces that have been
contaminated by excretions or secretions from infected birds. c) Direct contact with an infected bird. d) Any of the above.

4. How many confirmed cases of human infection with bird flu viruses have occurred since 1997.

a) 100+ b) 50 c) Over a thousand. d) 25

5. Is the current outbreak a ‘pandemic?’

a) Yes b) No c) The information is not given in the text.

6. Which of the following statements is NOT true? Bird flu can be transmitted…

a) …from bird to bird. b) … from bird to human. c) … from one person to another person. d) … from one person to another
person and beyond.

7. Which of these are typical symptoms of bird flu in humans?

a) fever, cough, sore throat and muscle aches. b) Vomiting and diarrhoea. c) Insomnia d) Swollen limbs and earache.

8. If you have had a seasonal flu vaccine this year, are you also protected against bird flu?

a) Yes b) No c) Yes, if the virus doesn’t mutate. d) The information is not given in the text.

9. Do I need to wear a surgical mask if I plan to feed the ducks at the park?

a) Yes. b) No. c) No, but I should avoid touching the birds. d) Yes, if I am over 65 years of age.

10. Which of the birds listed below are perching birds?

a) house finches b) waterfowl c) turkeys d) ducks

Passage B

To Walk Again
1.Yang is just one individual hit by an epidemic of spinal injuries in China that is a direct consequence of the nation's
economic development. Over the past decade, the rate of spinal cord injuries has increased roughly tenfold, largely due to
the car crashes that have become common as the burgeoning middle class has take to the wheel, plus numerous accidents in
the nation's booming construction and mining industries-which have terrible safety records.

2. "With 60,000 new cases per year, China now has more patients with spinal cord injuries than anywhere else in the world",
says Wise Young of Rutgers University in New Jersey. "This means that new therapies can be tested more quickly and
cheaply." To seize this opportunity-and hopefully in the long run to help patients like Yang-the Hong Kong-born neurologist
has set up the China SCI Network, encompassing 22 centres across the country, with the aim of conducting clinical trials that
meet the highest international standards.

3. That will be a tough task, however, as China has a poor record for conducting rigorous clinical research. What's more, in
the past few years some Chinese surgeons have become notorious for charging paralysed patients-both Chinese and "medical
tourists" from abroad-thousands of dollars for experimental cell transplants that have not yet been shown to work. As New
Scientist learned on a visit to one of China SCI's showcase centres in Kunming, capital of Yunnan province in south-west
China, they include some of the surgeons in Young's own network.
4. In August 2008, Young aims to begin a trial of the therapy involving 44 patients, half of them paralysed during the
previous year, the rest with older spinal injuries. But before it can begin, there is a huge amount of work to do .. For example,
the participating centres are now observing patients who will eventually take part in the trial, recording information about
their ability to feel and moveessential for assessing the therapy's potential benefits. At the same time, 20 patients at the
Hong Kong University of Science and Technology are taking lithium alone. And in the coming months, further small studies
will begin involving lithium alone, stem cell transplants, or both. Young is also negotiating with pharmaceutical firms to add
a third component: drugs known to block molecules in the spinal cord that inhibit nerve growth.

5. The participating centres must also meet Good Clinical Practice (GCP) international guidelines, which stipulate how clinical
trials should be run, including procedures for informed consent and ethical review. This is no small task , as Chinese doctors
have until recently paid scant attention to such niceties. So over the past two years, Young has concentrated on training
China SCI's staff

6. Efforts to get the network's centres certified for GCP with the state Food and Drug Administration have been hampered by
scandals involving the ag1~ncy. In July, its former head, Zheng Xiaoyu was executed for corruption. For now, seven of the
centres, seven of the centres hold GCP status, and Young believes the rest will follow by next summer. "Regardless of the
result of the clinical trial, it will be a significant achievement i~we could demonstrate that it can be run in China", he says.

7. The Kunming Centre, which New Scientist visited in late July, already has its GCP certification. There is an optimistic
atmosphere, as patients with some mobility exercise in the ring-shaped corridor, while others in the rooms that lead from it
practise fine movements with their fingers. Between rehabilitation sessions they are wheeled by their carers into the
picturesque garden, which has lawns, a pond and a path that winds over bridges towards a pagoda.

8.Even here, however, the murkier side of Chinese medicine is not far beneath the surface. Shen, the head nurse, would only
let me speak to Yang and one other patient. But later that evening the families of others sought me out at my hotel. They
were anxious to learn more about the therapies their loved ones had received, for which they had paid a small fortune.

9. In today's China, patients must often pay for medical care out of their own pockets, and unlike in other countries with
largely private sector healthcare, medical insurance is not widely available.

10. Young adds that his priority is to ensure that China SCI's trials are conducted properly, not to police the activities of its
members outside of these trials. "As long as they don't throw it in my face, I am not going to invest1gate", he says.

11. Some observers-both western and Chinese-are troubled by Young's pragmatic attitude. "offering unproven therapies
outside the network's tnals could harm its reputation and credibility, "says Timothy Caulfied of the Health Law Institute at
the University of Alberta in Alberta, Canada. And Qiu Renzing, a bioethicist at eh Institute of Philosophy of the Chinese
Academy of Social Sciences in Beijing, is openly critical: " How could a doctor turn a blind eye to practices which e~QI.Qit
patients with devastating conditions?".

12. Yang, for one, does not feel exploited. "I will stand up one day" he says hopefully. But it is hard to tell whether the cell
transplants he received have really made a difference, since people with spinal injuries sometimes improve spontaneously
over time. If a miracle treatment for spinal injuries is to emerge from China, it will need to be backed up by hard evidence,
not a series of glowing testimonies from carefully chosen patients.

1. Which of the following is NOT one of the critical factors to China's increasingly high rate of spinal injuries:

a) poor occupational health and safety procedures for workers in the construction and mining industries b) an epidemic c) the
Chinese middle class driving more and more cars d) the increasing rate of car accidents

2. Which of the following is the strongest criticism of Chinese surgeons

a) Chinese research teams traditionally keep poor records b) Chinese research is traditionally too rigorous c) Young wants to
hold international clinical trials d. Chinese surgeons have been criticised for charging exorbitant fees for treating spinal injury
patients, using methods which have not been properly trialled

3. All of the following statements are true of Young EXCEPT:

a) He was born in Hong Kong but now lives in the USA b) He set up the China SCI Network c) He treats mood disorders with
the drug, Lithium, and hopes that this treatment will help repair damaged spinal cords"~ d) He is currently trialling a
treatment for spinal cord injuries involving lithium and stem cells

4. Doctors in China

a) have traditionally not given patients a lot of information before asking their permission to begin treatment J b) have
traditionally not needed to be nice to their patients c) have not carried out their work in an ethical way d) in Young's project
have been receiving basic medical training for the past two years

5. The article suggests that

a) Attempts to get the network's centres certified for GCP with the State Food and Drug Administration have resulted in the
former head being put to death b) Young is not very optimistic that all of the centres will be certified before the trial begins c.
Even in the Kunming centre, which has achieved GCP certification, there are signs that all is not above board d. Young is more
interested in demonstrating success in having all of the participating centres certified for GCP than achieving good results in
the trial

6. According to the writer

a) Chinese people often have to pay for their own health care b) Chinese people don't mind paying for experimental methods
c) Health insurance in China is very expensive d) China's medical system is in the public sector

7. Young's statement "Unless they throw it in my face, I am not going to investigate" suggests that

a) he is not going to investigate the doctors in his network b) he will only investigate breaches of protocol outside of the trials
that the doctors themselves confess to him c) unless they physically attack him, he will not investigate the activities of the
doctors in the network d) he is more interested in ensuring that the SCI's trials are conducted properly than investigating the
activities of the doctors outside of the trials

8) In the context of this article, to "turn a blind eye to practises which exploitpatients" means

a) to refuse to acknowledge unethical practices b) to refuse to ensure that the patients on the trials are treated ethically

c) to pretend not to know about unethical practices that are carried out by the doctors outside of his trials d) to knowingly
exploit patients

9. Both Western and Chinese observers of the trails

a) are worried that the trials are unethical b) believe that Young should investigate any ethics breaches of his doctors outside
of the trial c) believe that any unethical activities performed by the doctors out side of the trials could negatively affect their
standing d) believe that the trials exploit patients with devastating conditions

10. The main idea of the article is:

a) There are no miracle cures to be found in China at this time b) China may one day find a miracle cure for spinal injuries but
ethical questions are being raised as to how they are going about their medical research in this area c) There are more people
in China with spinal cord injuries than anywhere else in the world d) A steep rise in paralysis cases is partly due to accidents in
the mining industry
Part A

Answer Sheet 1. Mammals 2. make 3. obtained (change verb to passive form) 4. fruits 5. vegetables 6. highest sources 7.
citrus fruits 8. requires (change verb to active form) 9. repair 10. healing 11. repair and maintenance 12. antioxidant (change
to singular form) 13. health conditions 14. inflammatory condition (change to singular form) 15. Douglas R & Hemila H/
Douglas & Hemila 16. duration of cold 17. prophylaxis 18. marathon runners 19. physical stress 20. showed no change 21.
daily 22. consuming/the consumption of (change verb to noun form) 23. 40 mg/day 24. adolescents 25. men 26. higher
amounts 27. reliable scientific evidence (all words required) 28. suggestions (change verb to noun) 29. 2 grams 30. Diarrhea

Part B

Passage A

ANSWERS

1. D 2. C 3. D 4. A 5. B 6. D 7. A 8. B 9. C 10. A

Passage B
ANSWERS:

1b 2d 3 c4a 5c 6a 7d 8c 9c 10b
 FULL TEST 14
PART A - READING 1

BEING HEALTHY
Results

During the 18-month American study,

• 46% reported at least one injury/illness, and

• 32% reported at least one injury that was attributed to exercise.

• Lower-body musculoskeletal injuries (21%) were the most commonly reported

injury followed by

• cold/flu/respiratory infections (18%) and

• back pain/injury (10%).

• Knee injuries comprised one-third of the lower-body musculoskeletal injuries.

• Only 7% of the injuries were attributed to exercise alone, and

• 59% of the injuries did not involve exercise.

BMI (p<0.01) but not exercise (p>0.41) was significantly associated with time to first injury and injuries over time.
Participants with higher BMIs were injured earlier or had increased odds of injury over time than participants with lower
BMIs. Due to the linear dose-response relationship between BMI and injury/illness, any weight loss and reduction in BMI was
associated with a decrease risk of injury/illness and delay in time to injury/illness.

PART A - READING 2

BEING HEALTHY

When a pharmaceutical company first markets a drug, it is usually under a

patent that only allows the pharmaceutical company that developed the drug

to sell it. This allows the company to recoup the cost of developing that

particular drug. It will frequently cost millions of dollars to develop and test a

new drug before it is approved for use. After the patent on a drug expires, any

pharmaceutical company can manufacture and sell that drug. Since the drug

has already been tested and approved, the cost of simply manufacturing the

drug will be a fraction of the original cost of testing and developing that

particular drug.

PART A - READING 3
PART A - READING 4

BEING HEALTHY

Abstract: Zhong, Z.., (2005) Health determinants in Urban China, for Institute of the Study of Labor

(IZA) Paper No 1835

This paper identifies health determinants in urban China applying Grossman model.

Using wave of China Health and Nutrition Survey in 2000, we find that education has

important positive effect on health, and cost of health care services has significantly

negative impact. However, effects of wage rate and household income are

insignificant. We also find that region is an important determinant of health. The body

weight is also important, but unlike findings in developed countries, under-weight

instead of over-weight is a better predictor for poor health. Our results suggest that

the male has better health than the female does, and married couples have better

health in urban China.

Part A Reading: Being Healthy question sheet

The cost of being healthy is rising. Reading 2 explains that when a pharmaceutical company ……..a drug, it is usually under
………] only allowing the developing [……..] company to […….] the drug. This enables the [……..] to get back the cost of [………..]
a particular drug. Once the [……..] has expired any pharmaceutical company is permitted to [………] and sell that particular
drug. An 18-month long study in the [……..] studied the influence of exercise and body mass index on injuries and illnesses in
overweight and obese [……….] . Of those studied [……] % reported at least one injury or illness during the study period with
[……….] injuries comprising one third of the lower-body musculoskeletal injuries. Only 7% of injuries were attributed to
[……….. alone and [……..] % of those injuries did not [………] any exercise.

The first chart in Reading 3 gives the 2006 percentages for US Health Care Expenditures and [……..] seven developed nations
with the USA’s own position. In 2006, health expenditure in the US occupied nearly […….] % of GDP compared to [……..] % for
Japan and just over [………] % for the UK.

The second chart gives historical and [………] US health care expenditures as a percentage of GDP. Zhao Zhong, a Chinese
researcher, looked at what factors influenced one’s health. His study found that [……….] has a positive effect on health and
the […….] of health care services – had a [……..] impact. Effects of [………] rate and [……..] income are insignificant.
Whereabouts one lived in China was also found to be an important [……….] of health. One’s body weight was also important
however being [………] weight was a predictor for […………..] health. His study revealed that males in China have better health
than females as do …………..]

.
Part B

Reading Passage A

ARTHRITIS - A Holistic Approach Can Help

Paragraph 1 Mosby's Medical and Nursing Dictionary defines arthritis as any inflammatory condition of the joints,
characterized by pain and swelling. The name derives from the Greek word "arthron" which means joint and "itis" which means
inflammation. In its various forms arthritis afflicts millions throughout the world from juveniles to the elderly.

Paragraph 2 A 2003-2005 National Health Interview Survey in the United States of America reported 21.6% of adults have self
reported, doctor diagnosed arthritis. In Australia it is estimated that by 2020 one in every five Australians will have arthritis.
To date, despite the expenditure of an enormous amount of money on research and the considerable efforts of scientists
throughout the world, a cure for arthritis has proved elusive.

Paragraph 3 Medical treatments range from simple pain relievers like Paracetamol, which eases pain and if taken as
recommended has few side effects, to powerful non-steroidal anti-inflammatory drugs and corticosteroids. Such drugs can
provide effective relief from the pain, joint stiffness and inflammation but do not result in a permanent cure. Unlike
Paracetamol, these medications taken long term can have serious side effects and they must be regularly and carefully
monitored. There may also be contraindications relating to other medical conditions, use during pregnancy or lactation and
adverse reactions as a result of allergies.

Paragraph 4 Surgical interventions such as hip and other joint replacements are usually performed to relieve severe pain and
loss of function where other non-surgical treatments are unable to bring sufficient relief. Such procedures can be highly
effective in enhancing mobility in the majority of cases. The need for hip replacement surgery is becoming increasing common
among the elderly as

longevity increases. For example the 2007 Spring Issue Joint News reports "over the last ten years, hip replacement surgery has
increased in Australia by 94.1%”.

Paragraph 5 Other non-pharmacological treatments such as physiotherapy, acupuncture, therapeutic massage and aqua
aerobics can help to relieve some symptoms. There are also a number of nutritional supplements that may relieve the
inflammation, pain and slow degeneration of effected joints. Such supplements are advertised widely and available from
chemists, health food outlets, and many supermarkets. However even "natural" products can have side effects or conflict with
other medication so always check first with your doctor or pharmacist.

Paragraph 6 In relation of dietary supplements, a number of studies conclude that Fish Oils containing omega-3 fatty acids can
help reduce inflammation associated with osteoarthritis and rheumatoid arthritis. Research published in a reputable medical
journal also suggests a glucosamine dietary supplement can slow down the deterioration of joints associated with
osteoarthritis. As a result selected hospitals are conducting clinical research trials to determine the validity of the research.

Paragraph 7 While there is no "miracle food" that cures arthritis, general dietary advice recommends a healthy balanced diet
rich in foods that contain calcium to reduce the risk of osteoporosis. A wide range of fresh fruit and vegetables, plenty of fluids,
preferably water and fresh fruit juices rather than carbonated drinks are recommended. The intake of alcohol should
preferably be kept to low level.

Paragraph 8 Dieticians also advise arthritis sufferers to eat fatty fish such as herring, tuna, mackerel, salmon or sardines at least
twice a week. There is also anecdotal evidence from people with arthritis that certain foods impact negatively on their
condition. Keeping a food diary over a period of a month or more could help individuals identify any particular foods that
appear to regularly provoke their arthritic symptoms.

Paragraph 9 It is universally acknowledged that exercise programs which improve the fitness of the heart and lungs, correct
poor posture, build muscular strength, increase joint flexibility and improve balance are beneficial to people of all ages and can
reduce the pain and stiffness associated with arthritis. The ancient Chinese martial art of Tai Chi, in an appropriately modified
style, is a form of exercise which achieves all this and also enhances both mental and physical relaxation.
 Paragraph 10 Dr Paul Lam, a family physician who lives in Sydney Australia began to have signs of arthritis after graduating
from medical school. He took up Tai Chi and found it improved his arthritis and enabled him to enjoy his chosen and busy
lifestyle. He is now a highly respected Tai Chi teacher and practitioner and has created a number of Tai Chi programs to improve
people's health and well being. Arthritis Foundations and organisations in the Britain, America and Australia, New Zealand
support his work. He has travelled the world to train instructors in the Tai Chi for Arthritis Program and produced books, videos
and DVDs.

Paragraph 11 The Sun style Tai Chi movements are fluid, gentle and slow and help reduce the pain and stiffness associated with
arthritic conditions. The movements incorporate breathing techniques and place an emphasis on posture and on the
importance of weight transference which is an essential component of good balance. To ensure smoothness and harmony
they require a mental as well as a physical commitment. People who practice these movements regularly, either individually in
their homes or with a group in a park or community hall, report many benefits.

Paragraph 12 In many countries there are government funded and other support organizations whose purpose is not only to
fund raise for

further medical research into a cure for arthritis but also equally to provide comprehensive advice and assistance for people
living with arthritis. This can include running education programs and seminars to provide the public with reliable and well
researched information and also to providing aids to help in everyday living. These aids range from simple devices to assist in
opening jars and cans and to larger equipment to assist with mobility.

Paragraph 13 Ultimately, to live as full a life as possible with an arthritic condition, you need to gain a full understanding of
your condition. This can be achieved by working with a medical care team who shares their knowledge, is supportive and
recognizes the contributions you can make. The best outcomes require a close partnership between you, your doctor and any
health professionals or practitioners involved in your treatment

Paragraph 14 A degree of self management has proved effective in managing arthritic conditions. This can be achieved in a
number of ways. Keep up to date and enquire about the latest research results. Learn about and choose foods that will ensure
you have a healthy well balanced diet. Always take medicines as directed and do not try any new “natural” supplement or
medication without first consulting with your doctor or pharmacist. Undertake an exercise regime such as Tai Chi that is
suitable to you and that you can enjoy in the company of others.

Paragraph 15 Until such time as a cure for all forms of arthritis becomes a reality, a holistic approach to the control of arthritis
incorporating many of the treatments, therapies and concepts outlined in this article, will help you discover that living with
arthritis does not mean you cannot have an enjoyable and fulfilling life.

QUESTIONS: Arthritis
1. Which of the following statements is correct? a) More adults in Australia have arthritis than in the US b) More adults in the
US have arthritis than in Australia c) Over 20 % of Australians have arthritis d) 4 in every hundred people have arthritis

2. According to the article a cure for arthritis is: a) Much too expensive to justify b) A major focus for Australian scientists c)
Hard to find d) Likely within 2 - 3 years

3. Which of the following statements is not reflected in the article? a) Paracetamol has few side effects b) Some powerful
drugs can provide a permanent cure c) Pregnancy and lactation contraindicate the use of certain drugs d) Powerful non-
steroidal anti- inflammatory drugs can provide effective relief from pain, joint stiffness and inflammation.

4. Which of the following statements is correct? a) In the US hip replacement surgery has increased by 94.1% in the last
decade b) Such surgery is unsuitable for the elderly c) Hip replacement surgery usually improves mobility d) Hip replacement
surgery is not expensive and is easily accessible

5. According to the article which one of the following statements is false? a) Glucosamine dietary supplement is clinically
proven b) Natural products can have side effects c) A number of nutritional supplements may relieve the inflammation, pain
and slow degeneration of effected joints. d) Omega-3 fatty acids can help reduce inflammation
6. In paragraph 8 the expression anecdotal evidence can best be described as: a) A personal observation b) Scientific
investigation c) An old wives tale d) None of the above

7. Which of the following statements appear in the article relating to diet? a) Alcohol in moderation is beneficial b) Carbonated
drinks are recommended c) Arthritis sufferers indicate that some foods adversely affect their condition d) Fatty fish such as
herring, tuna, mackerel and sword fish must be eaten twice weekly

8. In which paragraph can you find a description a style of Tai Chi which is useful for sufferers of arthritis? a) Paragraph 9 b)
Paragraph 10 c) Paragraph 11 d) Paragraph 12

9. Which of the following is correct from the article’s point of view? a) The major purpose of Government funded and other
support organisations is to raise money for further medical research b) Seminars and education programs are run to provide
the public with consistent and thoroughly researched information c) Simple devices can assist in opening jars and can d) For
optimum results a close relationship between you and medical professionals is essential

10. The article makes the following suggestions a) Self management is ineffective in managing arthritic conditions b) Having
arthritis does not mean a fulfilling life is impossible c) There may be a cure for arthritis soon d) Have a spirit of adventure and
try anything new

Reading passage B

Balding, Wrinkled, and Stoned

The '60s are gone, but for some baby boomers, the drugs
aren't. A guide to the cost of a 40-year high
1. Few people know the perils of drug abuse better than a 55-year-old former schoolteacher whose job it used to be to teach
that very topic--which is why it's particularly ironic that she's a cocaine addict today. More than 30 years ago, Gwen-who
prefers to keep it to one name when discussing her addiction--spent her days teaching in the Virginia school system and
drafting the schools' drug-and-alcoholabuse curriculum. She spent her nights researching the subject firsthand.

2. "I started using alcohol and pot in college," she says. "Then I turned to sniffing cocaine and freebasing. By the time I began
teaching, I was spending big-time money. My body knew that I got out of school at 3:30 every day, and then I'd have to go out
and get my drugs."

3. Today Gwen spends most of her time far from Virginia, living in New York City and attending regular sobriety meetings in the
Odyssey House ElderCare treatment program in East Harlem. It's not how she envisioned her retirement. "I never thought the
drug-abuse classes I taught applied to me," she says. "But here I am."

4. She's hardly alone. Of the more than 75 million baby boomers who came of age in the 1960s and '70s, millions experimented
with drugs during their impressionable teenage years, and millions went on to enter middle age--and are now headed into their
senior years--with decades-long addictions. Hard numbers are not easy to come by, but older addicts are clearly a growth
sector in the drug-recovery industry. There are an estimated 1.7 million Americans over age 50 addicted to drugs, according to
the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the Department of Health and Human
Services. By 2020 SAMHSA expects the number to reach 4.4 million. Already an ongoing federal study has found that the
number of older Americans seeking help for heroin or cocaine abuse roughly quadrupled from 1992 to 2002. Odyssey House,
which was founded to treat younger addicts, now has a separate division, with both inpatient and outpatient facilities, to deal
specifically with older users.
5. What makes the problem especially hard for seniors is that the wages of drug abuse are cumulative. A lifetime of recreational
chemistry also means a lifetime of neglect of overall health--as a recent morning meeting at Odyssey House illustrated. There
were too many canes in evidence for a group so comparatively young--the legacy of joints wrecked by years of undertreated
diabetes--and too many bad hearts and bum livers and vascular systems fighting hypertension. "This is the first generation to
have

Source: TIME Magazine 15th Jan 2006 Title: Balding, Wrinkled, and Stoned

a high incidence of using recreational drugs," says SAMHSA epidemiologist Joseph Gfroerer. "All this puts them at risk for
problems."

6. But why did those baby boomers stay aboard the drug carousel when so many millions more climbed off? And what exactly
have 40 years of experimental pharmacology done to them? It would not have been possible--much less ethical--to recruit
subjects when the 1960s drug circus got started, send them off for four decades of substance abuse and bring them back for
study. But now that the ad hoc longitudinal experiment those aging boomers have been conducting on themselves is reaching
its endgame, addiction experts are pouncing on what the doctors and psychiatrists treating the abusers are learning. What they
uncover may help not only the surviving victims of the early drug years but younger users as well.

7. Of all the drugs the boomers have used, perhaps the four most notorious have been marijuana, hallucinogens, cocaine and
heroin. Researchers have devoted enormous effort to studying those drugs' long-term effects. The results have been decidedly
mixed.

8. MARIJUANA The so-called demon weed turned out to be a lot less devilish than advertised. The popular image of the goofy,
smoky slacker notwithstanding, a 2003 study in the Journal of the International Neuropsychological Society found that even
among regular users, there is no proof that pot causes irreversible cognitive damage. Memory does get cloudy, and learning
new information does get harder, but those effects fade if the user does kick the habit. The drug may also diminish libido and
fertility. (So much for its promised free-love properties.) And as with any intoxicating chemical, pot use can become chronic and
compulsive, crowding out room for much else. "If you came to our adolescent program and saw the 16-year-old kids whose
lives have become unmanageable as a result of pot use, you'd understand it's addictive," says psychologist Peter Provet,
president of Odyssey House. "But a lot of people who use pot don't become addicts."

9. Scientists haven't settled on whether repeated chestfuls of unfiltered marijuana smoke increase the risk of pulmonary
disease and cancers of the mouth, throat and lungs. Although a recent study out of UCLA says no, practitioners in the field
disagree. "There's certainly strong if not definitive evidence that long-term smokers take in a lot of particulates and
carcinogens," says Dr. Robert Raicht, medical director of Odyssey House.

10. HALLUCINOGENS Things are trickier when it comes to LSD and its hallucinogenic kin, but reports suggest that most '60s trips
ended relatively benignly. The most rigorous studies of hallucinogens have been conducted not on boomers, who used the
drugs intermittently and furtively, but on Native American populations for whom consumption of the hallucinogen peyote is
part of their cultural and religious fabric. In November researchers from the McLean psychiatric hospital outside Boston
released a five-year study that found no cognitive or psychological problems among Native American regular users, some of
whom even performed better on psychological tests than those with minimal substance use. It's certainly too much to say that
every peyote user emerges undamaged by the drug, and the lead researcher on the study, Dr. John Halpern, takes care to stress
that his findings apply only to the Native American groups he studied.

Source: TIME Magazine 15th Jan 2006 Title: Balding, Wrinkled, and Stoned

11. LSD and mescaline, which are often whipped up in unpoliced labs in uncontrolled ways, present different problems. The
condition that the experts call HPPD (hallucinogen persisting perception disorder) and that users call flashbacks is a very real
problem. But Halpern says it is relatively rare, striking mostly people who use LSD specifically. But there are other risks too.
Some trips have ended catastrophically, with suicides or fatal accidents. In other cases, the disaster was not physical but
emotional. "There were a lot of people who decompensated into major mental illness," says Dr. Charles Grob, a professor of
psychiatry at UCLA's school of medicine. "But you could make the case that these were people who were vulnerable to begin
with."
12. COCAINE The coke party started late for most boomers--not until the 1980s--but when it hit, it hit hard. Even cocaine
apologists admit that the drug is dangerously addictive and sometimes lethal. Coke-triggered strokes and heart attacks--both of
which can occur in people with no known cardiovascular disease--are the real deal, caused by the sudden elevation of blood
pressure and spasms of vessels. "The damage can be done suddenly and acutely," says Raicht, "or slowly and chronically."

13. Whether periodic cocaine use develops into disabling addiction can be something of a crapshoot. "There's a tendency for
most people who have any kind of stake in conventional life to modulate their use and not let it get out of hand," says Craig
Reinarman, a sociologist at the University of California at Santa Cruz and a co-author of two books on cocaine. For most people,
he says, the breaking point for cocaine use is about an eighth of an ounce a week. But that's just a very general rule, and for
many people, the threshold can be lower. And when it comes to crack--crystallized and smoked instead of snorted--addiction,
often from the first use, is much harder to avoid.

14. HEROIN Easily the most lethal of the gang of four, heroin frequently hooks users for the rest of their lives, unless it simply
kills them first. One long-term study, published in May 2001 in the Archives of General Psychiatry, followed 581 male heroin
users from 1962 to 1997. Nearly half the subjects were dead by the time the study ended. Of those still alive, many were self-
medicating with multiple other illicit drugs or alcohol and 67% smoked cigarettes. Not surprisingly, heroin users suffer from a
wide range of medical ills, including hypertension, liver and pulmonary diseases and HIV. But the most common cause of death
from heroin is overdose, with 22% of the subjects in the long-term study dying that way. Some of the health problems
associated with heroin come from the impurities it is cut with. Overdoses often spring from an uncut batch that is unexpectedly
pure.

15. The ultimate impact of any of those drugs, of course, depends on the users. No one has yet been able to tease out the
precise mix of genetics, temperament and environment that makes one person a recreational user and another a lifelong
addict, but clearly there is no single cause. "There are inherited components, hormonal components, psychosocial variables
such as poverty," says Provet. And then, of course, there is mere opportunity--something the '60s provided in abundance.

16. "That was the era," says Evelyn, 56, an Odyssey House graduate and an addiction counselor there. "If the drugs hadn't been
so available, I wouldn't have been apt to go looking for them."

Source: TIME Magazine 15th Jan 2006 Title: Balding, Wrinkled, and Stoned

17. As drug users mature, geriatric biology and life circumstances tend to tighten the drugs' hold. Reduced body mass, slower
metabolism and less efficient kidneys and liver mean that the same quantity of drug hits harder and stays in the body longer.
Older users who think they're keeping their doses fixed are thus, in effect, steadily increasing them. What's more, the loss of a
spouse or job or merely the boredom of retirement could tip the nonuser into experimentation and the borderline user into
fullblown addiction. Moses, 57, never touched heroin until 2001, when his wife died. But when he picked it up, he got hooked
fast. "I missed my wife. I was lonely," he says. "I didn't want to live, but I didn't have the nerve to put a gun to my head."

18. For the seniors who do get clean--and the millions more who will need to in the years to come--there are a few factors that
drive recovery. Seeing peers die of addiction certainly scares some straight. So too do late-life worries about the legacy one is
going to leave. "You get to a point when you think about having a dignified end," says Jon Roberts, another Odyssey House
veteran who is now a counselor. "You think about family reunification, about giving back through community service, about
having spent your life as more than an addict."

19. It's rare for teenagers of any generation to think that far ahead, never mind the cohort that reached adolescence at the
height of the drug boom. It may be impossible to slow the demographic conveyor belt that's going to dump so many of them
into the senior population with a habit they picked up during their summers of love. But it's not too late for them to shake it off,
achieving the peace in the last chapters of their lives that the drugs promised them in the first.

Discuss: • In your opinion, how should society deal with older people who have a long-term drug problem? • Which of the
drugs mentioned in the article do you consider to be the most / least damaging to the individual and to society? • Have you any
personal experience of having to treat drug addicts?
Balding, Wrinkled, and Stoned
1. Which word could best be substituted for envisioned in paragraph three? a) imagined b) planned c) discussed d) discovered

2. Which statement is NOT true? a) Gwen prefers to remain anonymous b) .Gwen currently lives in New York City. c) 75 million
people experimented with drugs in the 1960’s and 1970’s. d) Many people who experiment with drugs when younger become
addicted and remain addicts as they approach retirement age.

3. The Substance Abuse and Mental Health Services Administration (SAMHSA) expects the number of addicts over the age of
50 to rise over the next few years. a) This statement is true. b) This statement is false. c) This information is not given in the
text.

4. Already an ongoing federal study has found that the number of older Americans seeking help for heroin or cocaine abuse
roughly quadrupled from 1992 to 2002. Which statement below most accurately paraphrases this statement from paragraph
four. a) The number of US citizens who abuse drugs such as cocaine and heroin has increased significantly. b) A federal study
discovered that the number of older Americans looking for assistance for cocaine / heroin related problems had increased x4
In the decade prior to 2002. This study is still continuing. c) There were four times more drug abuse cases in the USA involving
older citizens in 2002 than in 1992. d) A number of federal studies of older Americans in the 1992 - 2002 period found that the
number of addicts had increased four-fold.

5. What does the author mention as evidence that longterm recreational drug use can lead to poor health. a) Blood pressure
was tested at the meeting at Odyssey House and found to be far too high. b) The complexion of many older drug users
indicates liver problems. c) At the meeting at Odyssey House many of the people attending needed walking sticks to assist
with mobility. d) All of the above.

6. Which statement is true. a) It would have been impractical and unethical to recruit people for research into the long term
effects of drug abuse. b) Marijuana, ecstasy, cocaine and heroin were the most popular drugs for baby-boomers. c) Addiction
experts are uninterested in the work of health professionals treating drug users. d) Research results have been very one-sided.

7. Research is currently inconclusive on the effects of long-term marijuana use on a) the brain b) sex and fertility c) the lungs d)
all of the above

8. Research at a Boston hospital found that using hallucinogens a) has a beneficial effect for most people b) has a negative
effect for most people c) causes no cognitive or psychological problems among most of the Native American regular users
studied d) causes an improvement in test scores if used only occasionally.

9. Cocaine is known to be a) highly addictive and can sometimes result in death b) a hallucinogen c) a cause of low blood
pressure d) all of the above

10. What is the most common cause of death for heroin users? a) HIV / AIDS b) hypertension c) lung cancer d) An overdose
Part A Reading: Being Healthy Answers:

The cost of being healthy is rising. Reading 2 explains that when a pharmaceutical company [markets] a drug, it is usually
under [patent] only allowing the developing [pharmaceutical] company to [sell] the drug. This enables the [company] to get
back the cost of [developing] a particular drug. Once the [patent] has expired any pharmaceutical company is permitted to
[manufacture] and sell that particular drug. An 18-month long study in the [USA] studied the influence of exercise and body
mass index on injuries and illnesses in overweight and obese [adults] . Of those studied [46] % reported at least one injury or
illness during the study period with [knee] injuries comprising one third of the lower-body musculoskeletal injuries. Only 7%
of injuries were attributed to [exercise] alone and [59] % of those injuries did not [involve] any exercise. The first chart in
Reading 3 gives the 2006 percentages for US Health Care Expenditures and [compared] seven developed nations with the
USA’s own position. In 2006, health expenditure in the US occupied nearly [16] % of GDP compared to [8] % for Japan and
just over [8] % for the UK. The second chart gives historical and [projected] US health care expenditures as a percentage of
GDP. Zhao Zhong, a Chinese researcher, looked at what factors influenced one’s health. His study found that [education] has
a positive effect on health and the [cost] of health care services – had a [negative] impact. Effects of [wage] rate and
[household] income are insignificant. Whereabouts one lived in China was also found to be an important [determinant] of
health. One’s body weight was also important however being [under] weight was a predictor for [poor] health. His study
revealed that males in China have better health than females as do [married [couples]

PART B

Reading passage A Answers:

Question 1 (Para 2) a) Incorrect b) Correct: …….in the United States of America reported 21.6% of adults have self reported,
doctor diagnosed arthritis. In Australia it is estimated that by 2020 one in every five Australians will have arthritis. c) Incorrect
d) Incorrect

Question 2 (para 2) a) Incorrect b) Incorrect c) Correct: …..a cure for arthritis has proved elusive. Elusive is synonym for hard to
find d) Incorrect

Question 3 (para 3) a) Incorrect b) Correct: …powerful non-steroidal anti-inflammatory drugs and corticosteroids. Such drugs
can provide effective relief from the pain, joint stiffness and inflammation but do not result in a permanent cure. I c) Incorrect
d) Incorrect

Question 4: (para 4) a) Incorrect b) Incorrect c) Correct: ….such procedures can be highly effective in enhancing mobility in the
majority of cases d) Incorrect

Question 5 (para 5/6) a) Correct: False …not proven yet b) Incorrect: True c) Incorrect: True d) Incorrect: True

Question 6 (para 8) a) Correct: Key word: There is also anecdotal evidence from people with arthritis b) Incorrect c) Incorrect
d) Incorrect

Question 7 (para 8) a) Incorrect b) Incorrect c) Correct: There is also anecdotal evidence from people with arthritis that certain
foods impact negatively on their condition. d) Incorrect

Question 8 a) Incorrect: b) Incorrect c) Correct d) Incorrect

Question 9 (para 13) a) Incorrect b) Incorrect c) Incorrect d) Correct: The best outcomes require a close partnership between
you, your doctor and any health professionals or practitioners involved in your treatment

Question 10 (para 15) a) Incorrect b) Correct: living with arthritis does not mean you cannot have an enjoyable and fulfilling
life. c) Incorrect d) Incorrect

Reading Passage B

ANSWERS

1.A 2. C 3. A 4. B 5. C 6. A 7. D 8. C 9. A 10. D
 FULL TEST 15
OET Reading Practice Test - Part A:

TEXT 1

Incidence and Prevalence in an Emergency Department Population, 1995

Abstract

Objective. —To determine the incidence, 1-year prevalence, and cumulative prevalence of domestic violence (DV) among
female emergency department (ED) patients.

Design. —Descriptive written survey.

Setting. —Two teaching EDs, two hospital walk-in clinics, and one private hospital ED in Denver, Colo.

Participants. —Of 833 women presenting during 30 randomly selected 4-hour time blocks, 648 (78%) agreed to participate.
Most respondents were young (median age, 34 years) and unemployed (62%); half (49%) had annual household incomes less
than $10000.

Main Outcome Measures. —Domestic violence was defined as an assault, threat, or intimidation by a male partner. Acute DV
(incidence) and past DV exposure (1-year prevalence and cumulative prevalence) were determined.

Results. —The incidence of acute DV among the 418 women with a current male partner was 11.7% (95% confidence interval
[CI], 8.7% to 15.2%). Only 11 (23%) of these 47 women subjected to acute DV presented for care because of trauma, and only
six (13%) either told staff about DV or were asked about DV by ED professionals. Among 230 women without current
partners, 13 (5.6%) reported an episode of DV within the previous 30 days. For the entire sample, the cumulative lifetime
prevalence of DV exposure was 54.2% (95% CI, 50.2% to 58.1%). Women exposed to acute or prior DV were more likely than
unexposed women to have made suicide attempts (26% vs 8%; P<.001) and to report excessive ethanol use (24% vs 13%;
P=.001).

Conclusions. —The incidence of acute DV is not as common among women visiting an ED as previously reported, although the
cumulative prevalence of DV is strikingly high. Women who have experienced DV are seldom identified by ED professionals.
TEXT 3

Case 1 Justine, an 18-year-old woman presented to her family physician for an initial obstetric examination, accompanied by
her 27-year-old boyfriend. Initial history revealed that she was at 16 weeks of gestation and living in a mobile home with her
partner. She was strongly considering giving up the baby for adoption because of "financial and other" reasons. Answers to
screening violence history questions indicated that her present partner had "slapped her around" on several occasions. On
further questioning the patient stated that she was not happy in this relationship and in fact did not feel safe. However, she
stated that she "had no place else to go" and expressed optimism about the future because her partner had begun to attend
church and stated that he wanted to be a good father.

Case 2 Martin, a 45-year-old man presented to his physician with a complaint of worsening depression. The patient had been
taking antidepressant medications for many years, was receiving ongoing psychotherapy from a clinical social worker and
attending Alcoholics Anonymous meetings. The patient complained of insomnia, loss of appetite and thoughts of guilt and
suicide since his spouse had "kicked him out." Further discussion revealed that during an argument, he verbally threatened to
harm her. She called the police, had him removed from the home and told him she would soon be filing for divorce. A
positive outcome is possible for this couple because of the confluence of several helpful events and interventions. The patient
had previously received treatment for alcoholism, had not resumed drinking and was under care for depression. Furthermore,
his wife was receiving retirement benefits and was not financially dependent on him. Perhaps most significantly, she called
the police during the first violent episode rather than excuse her husband's actions and allow a pattern of threats and
intimidation to become established. She also received a prompt response and support from the police and the courts.

TEXT 4

Violence Runs in Couples

An important but unanticipated finding was that violence runs in couples.

54% of respondents who reported that they had been assaulted, also admitted that they had assaulted their partners.

94.4% report being neither perpetrators nor victims of violence.

2.5% report both assaulting and being assaulted.

2.1% report being assaulted but not committing assault.

1.0% report assaulting their partner but not being assaulted.

SUMMARY TASK

Statistics of crime in Australia (2004), reveal that the most common form of domestic violence is damage to 1)
_________________ at 2) _____%. Another common form of controlling behavior is limiting a partner’s 3) _________ with
relatives and friends. A 1995 study on domestic violence (DV) against women examined the 4) ____________ of DV among
patients presenting at an 5) ___________ A total of 6) _____ female patients agreed to participate in the study. Their
average age was 7) ____, most were 8) ________ and about half came from from low 9) _______ households. At the time of
this study, 10) ________ of these women had a male partner. 11) _____ of the women had presented at hospital due to
trauma. 12) _____ o the women reported an incident of DV within the last 13) _____ days. The women reported being either
assaulted, 14) ___________ or intimidated by their partner. The case of Justine illustrates this. She presented at 15) ______
for an obstetric examination. She was considering having her baby 16) ________ due to financial reasons and the fact that
she had been 17) _______ by her partner. She reported feeling unsafe in the relationship. However she still felt 18)
_________________ about their future together. The case of Martin shows that a positive outcome is possible in some
cases, if the victim 19) _______ excuse their violent partner’s actions. Martin was suffering from 20) _____________ and was
on 21) __________. He had also been 22) _________ for alcoholism. During an argument, he had 23) _______________ his
wife, who sought help from 24) __________ and 25) _____________.

Research from the ABS shows surprisingly that 26) ____ of those who reported assault, also 27) ______________ their
partners. The results of the earlier study indicated that DV was 28) _________ than previously thought, with 29) ____ of
thevictims saying they were neither victims nor 30) ________________ of DV. But worryingly, the 1995 study found that
victims of DV were not often 31) ___________ by medical professionals.
Part B

Reading passage A

INFLUENZA
As the novel pandemic influenza A (H1N1) virus spread around the world in late spring 2009 with a well-matched pandemic
vaccine not immediately available, the question of partial protection afforded by seasonal influenza vaccine arose. Coverage
of the seasonal influenza vaccine had reached 30%– 40% in the general population in 2008–09 in the US and Canada,
following recent expansion of vaccine recommendations.

Unexpected Findings in a Sentinel Surveillance System

The spring 2009 pandemic wave was the perfect opportunity to address the association between seasonal trivalent
inactivated influenza vaccine (TIV) and risk of pandemic illness. In an issue of PLoS Medicine, Danuta Skowronski and
colleagues report the unexpected results of a series of Canadian epidemiological studies suggesting a counterproductive
effect of the vaccine. The findings are based on Canada's unique near-real-time sentinel system for monitoring influenza
vaccine effectiveness. Patients with influenza-like illness who presented to a network of participating physicians were tested
for influenza virus by RT-PCR, and information on demographics, clinical outcomes, and vaccine status was collected. In this
sentinel system, vaccine effectiveness may be measured by comparing vaccination status among influenza-positive “case”
patients with influenzanegative “control” patients. This approach has produced accurate measures of vaccine effectiveness
for TIV in the past, with estimates of protection in healthy adults higher when the vaccine is well-matched with circulating
influenza strains and lower for mismatched seasons. The sentinel system was expanded to continue during April to July 2009,
as the H1N1 virus defied influenza seasonality and rapidly became dominant over seasonal influenza viruses in Canada.

Additional Analyses and Proposed Biological Mechanisms

The Canadian sentinel study showed that receipt of TIV in the previous season (autumn 2008) appeared to increase the risk
of H1N1 illness by 1.03- to 2.74-fold, even after adjustment for the comorbidities of age and geography. The investigators
were prudent and conducted multiple sensitivity analyses to attempt to explain their perplexing findings. Importantly, TIV
remained protective against seasonal influenza viruses circulating in April through May 2009, with an effectiveness
estimated at 56%, suggesting that the system had not suddenly become flawed. TIV appeared as a risk factor in people under
50, but not in seniors—although senior estimates were imprecise due to lower rates of pandemic illness in that age group.
Interestingly, if vaccine were truly a risk factor in younger adults, seniors may have fared better because their immune
response to vaccination is less rigorous.

Potential Biases and Findings from Other Countries

The Canadian authors provided a full description of their study population and carefully compared vaccine coverage and
prevalence of comorbidities in controls with national or province-level age-specific estimates—the best one can do short of a
randomized study. In parallel, profound bias in observational studies of vaccine effectiveness does exist, as was amply
documented in several cohort studies overestimating the mortality benefits of seasonal influenza vaccination in seniors.

Given the uncertainty associated with observational studies, we believe it would be premature to conclude that TIV
increased the risk of 2009 pandemic illness, especially in light of six other contemporaneous observational studies in civilian
populations that have produced highly conflicting results. We note the large spread of vaccine effectiveness estimates in
those studies; indeed, four of the studies set in the US and Australia did not show any association whereas two Mexican
studies suggested a protective effect of 35%–73%.

Policy Implications and a Way Forward

The alleged association between seasonal vaccination and 2009 H1N1 illness remains an open question, given the conflicting
evidence from available research. Canadian health authorities debated whether to postpone seasonal vaccination in the
autumn of 2009 until after a second pandemic wave had occurred, but decided to follow normal vaccine recommendations
instead because of concern about a resurgence of seasonal influenza viruses during the 2009–10 season. This illustrates the
difficulty of making policy decisions in the midst of a public health crisis, when officials must rely on limited and possibly
biased evidence from observational data, even in the best possible scenario of a well-established sentinel monitoring system
already in place.
What happens next? Given the timeliness of the Canadian sentinel system, data on the association between seasonal TIV and
risk of H1N1 illness during the autumn 2009 pandemic wave will become available very soon, and will be crucial in confirming
or refuting the earlier Canadian results. In addition, evidence may be gained from disease patterns during the autumn 2009
pandemic wave in other countries and from immunological studies characterizing the baseline immunological status of
vaccinated and unvaccinated populations. Overall, this perplexing experience in Canada teaches us how to best react to
disparate and conflicting studies and can aid in preparing for the next public health crisis.

Part B : Multiple Choice Questions !

1. The question of partial protection against H1N1 arose… a. before spring 2009 b. during Spring 2009 c. after spring 2009 d.
during 2008-09

2. According to Danuta Skowronski…. a. the inactivated influenza vaccine may not be having the desired effects. b. Canada’s
near-real-time sentinel system is unique. c. the epidemiological studies were counterproductive d. the inactivated influenza
vaccine has proven to be ineffective.

3. The vaccine achieved higher rates of protection in healthy adults when…. a. it was supported by physicians. b. the sentinel
system was expanded. c. used in the right season. d. it was matched with other current influenza strains.

4. Which one of the following is closest in meaning to the word prudent? a. anxious b. cautious c. busy d. confused

5. The Canadian sentinel study demonstrated that….. a. age and geography had no effect on the vaccine’s effectiveness. b.
vaccinations on senior citizens is less effective than on younger people. c. the vaccination was no longer effective. d. the risk
of H1N1 seemed to be higher among people who received the TIV vaccination.

6. Which of the following sentences best summarises the writers’ opinion regarding the uncertainty associated with
observational studies? a. More studies are needed to determine whether TIV increased the risk of the 2009 pandemic illness.
b. It is too early to tell whether the risk of catching the 2009 pandemic illness increased due to TIV. c. The Australian and
Mexican studies prove that there is no association between TIV and increased risk of catching the 2009 pandemic illness. d.
Civilian populations are less at risk of catching the 2009 pandemic illness.

7. Which one of the following is closest in meaning to the word alleged? a. reported b. likely c. suspected d. possible

8. Canadian health authorities did not postpone the Autumn 2009 seasonal vaccination because… a. of a fear seasonal
influenza viruses would reappear in the 2009-10 season. b. there was too much conflicting evidence regarding the
effectiveness of the vaccine. c. the sentinel monitoring system was well established. d. observational data may have been
biased.

9. What would make the most suitable alternative title for the article? a. Current research on H1N1 and other influenza
strains b. Errors in Canadian health policy c. Possible link between influenza vaccination and increased risk of H1N1 illness. d.
Unreliable H1N1 and influenza vaccination research

Readind Passage B

in cycle of poverty Title: High birthrate threatens to trap Africa

High birthrate threatens to trap Africa in cycle of poverty

World’s poorest nations predicted to triple in size. By Xan Rice

There are 27.7 million people in Uganda. But by 2025 the population will almost double to 56 million, close to that of Britain,
which has a similar land mass. In 44 years its population will have grown by nearly as much as China's.

"You look at these numbers and think 'that's impossible'," said Carl Haub, senior demographer at the US-based Population
Reference Bureau, whose latest global projections show Uganda as the fastest-growing country in the world. Midway
through the 21st century, if current birthrates persist, Uganda will be the world's 12th most populous country with 130
million people - more than Russia or Japan.

Startling as they are, the projections are feasible, and a glance at some of the variables shows why. A typical Ugandan
woman gives birth to seven children - an extraordinarily high fertility rate that has remained largely unchanged for more
than 30 years. Half the population is under 15, and will soon move into childbearing age. Only one in five married women has
access to contraception.

Taken together, the factors point to a population explosion that has demographers and family planning experts warning that
efforts to cut poverty are doomed unless urgent measures are taken.

And not just in Uganda. Across much of sub-Saharan Africa the population is expanding so quickly that the planet's
demographic map is changing.

In the rest of world, including developing nations in Asia and South America, fertility rates have steadily declined to an
average of 2.3 children to each mother. Most will experience only modest population growth in coming decades. Some
countries, particularly in eastern Europe, will see their numbers decline.

But by 2050 Chad, Mali, Guinea Bissau, Liberia, Niger, Burundi and Malawi - all among the poorest nations in the world - are
projected to triple in size. Nigeria will have become the world's fourth-biggest country. The Democratic Republic of Congo
and Ethiopia will have vaulted into the top 10 for the first time. Nearly one in four of the world's population will come from
Africa - up from one in seven today.

"What's happening is alarming and depressing," said Jotham Musinguzi, director of the population secretariat in Uganda's
ministry of finance, pointing out the clear correlation between high fertility levels and poverty. "Are we really going to be
able to give these extra people jobs, homes, healthcare and education?"

Development may not be the only casualty of the population boom. With increased competition for scarce resources such as
land, conflict is likely to increase. Consequences will be felt far beyond Africa: pressure to migrate abroad - already great -
can only grow, experts say.

It is not yet a lost cause. Experience has shown that with strong political will population growth can be tackled in Africa.
Southern Africa's population is expected to remain stable thanks to sustained efforts to cut fertility rates, although Aids-
related deaths are also a factor. In 1978 Uganda's neighbour Kenya had the world's highest fertility rate - more than eight
children per mother. The government made family planning a national priority and by the mid-1990s the figure had dropped
to below five.

But a number of African leaders, including Uganda's president, Yoweri Museveni, believe that their countries are
underpopulated, and that a bigger internal market and workforce will boost their economic prospects. In a speech to MPs in
July Mr. Museveni said: "I am not one of those worried about the 'population explosion'. This is a great resource."

Studies across Africa have shown that the desire for large families remains powerful. In Nigeria a recent survey revealed that
only 4% of women with two children said they wanted no more. Part of the reason is cultural, with bigger families seen as a
sign of security. It is also because of fears of high levels of infant mortality.

Stigmas about birth control are another factor. Reproductive health experts say that a lack of information and of availability
of female contraceptives plays a major role. In Ethiopia only 8% of married women use contraceptives. In Uganda more than
a third of all women say they would like to stop - or at least stall - having children.

For that, donors must share the blame, said Steven Sinding, director-general of the International Planned Parenthood
Federation. He said the world had declared premature victory in the battle to cut fertility rates. Curbing population growth is
not one of the UN's Millennium Development Goals, which aim to halve poverty by 2015, and barely features in the
Commission for Africa report championed by Tony Blair.

"In sub-Saharan Africa population remains a very serious problem," said Mr. Sinding. "Yet donors have completely shifted
their focus to HIV/Aids and nobody is talking about it any more."
Elly Mugumya, head of the Family Planning Association of Uganda, agreed. Cost is not the problem in Uganda, he explained:
a three-month supply of birth-control pills costs about 25 cents; condoms are free for the men. The problem is access - in most
parts of Uganda clinics simply do not exist.

QUESTIONS

1. “World’s poorest nations predicted to triple in size.” means

a) the population of the poorest countries is expected to increase significantly. b) there are three times as many poor
countries in the world as rich countries. c) the world’s least rich countries have said they will add to the number of people
they have currently.

2. What is the current population of Uganda?

a) 56 million b) the same as Britain c) 27.7 million

3. Which of the following statements is true?

a) Britain and Uganda are about the same size. b) Uganda is roughly the same size as China. c) Uganda currently has a
higher population than Russia.

4. Which if the following statements is NOT true?

a) About 50% of the Ugandan population is under 15 years of age. b) It is not unusual for a Ugandan woman to have seven
children. c) The high fertility rate in Uganda is a new phenomenon.

5. How many married women in Uganda can obtain contraception?

a) five per cent b) Twenty per cent c) the information is not stated in the article.

6. Which of the statements below is true?

a) In the developing nations of Asia and South America the population is expected to shrink. b) Nigeria is currently the
fourth largest country in the world. c) The populations of many sub-Saharan African nations is growing rapidly and this
increase is expected to continue.

7. What are the likely consequences of Uganda’s population growth?

a) Increasing poverty and less development b) Disagreements over insufficient materials and an increase in migration. c) ‘a’
and ‘b’

8. By how many did the number of children per mother decrease between 1978 and 1995 in Kenya?

a) three b) five c) eight

9. Which of the statements below is false?

a) Many Africans perceive large families as beneficial. b) It can be difficult for African women to obtain information about
contraception. c) The Ugandan president is keen to reduce his country’s population.

10. What percentage of Ethiopian married women do not use contraceptives?

a) 4% b) 8% c) 92%

11. The United Nations hopes to decrease ….. by 2015.

a) population growth b) poverty c) HIV/Aids

Part A Answers:

1) Property 2) 20% 3) Contact 4) Prevalence / incidence 5) ED (Emergency Departments) 6) 648 7) 34 8) Unemployed 9)

Income 10) 418 11) 11 12) 13 13) 30 14) Threatened 15) Her GP / a GP / .. doctor 16) Adopted 17) Assaulted / slapped / hit /
abused 18) Optimistic 19) Does not 20) Depression 21) Anti-depressant 22) Treated 23) Threatened (to hit) 24) The police 25)
Courts 26) 54 27) Assaulted 28) Lower / less 29) 94.4% 30) Perpetrator 31) Identified

Part B

Passage A

Answer Key 1. b 2. a 3. d 4. b 5. d 6. b 7. c 8.a 9. c

Question 1 a) Incorrect b) Correct: during is a synonym for as c) Incorrect d) Incorrect Question 2 a) Correct:
counterproductive can mean not achieving what you want b) Incorrect: the system is unique but it has nothing to do with
Danuta Skowronski c) Incorrect: it is not the studies that were counterproductive d) Incorrect: This is a suggestion not a fact
Question 3 a) Incorrect: This is not stated b) Incorrect: This is not stated c) Incorrect: This is not stated d) Correct: Refer
highlighted text. Question 4 a) Incorrect b) Correct: The meaning can be deduced by the fact that they conducted several
tests so were therefore cautious c) Incorrect d) Incorrect Question 5 a) Incorrect: no connection b) Incorrect: not mentioned
c) Incorrect : it had a limited effect d) Correct: Refer highlighted text Question 6 a) Incorrect: More studies not mentioned b)
Correct: Premature to conclude means too early to tell c) Incorrect: Nothing was proven d) Incorrect Question 7 a) Incorrect b)
Incorrect c) Correct: The meaning can be deduced by the overall discussion in the article d) Incorrect Question 8 a) Correct:
See highlighted text b) Incorrect: This is a true fact but not the answer to the question c) Incorrect: This is also a true fact but
not the answer to the question d) Incorrect: This is also a true fact but not the answer to the question Question 9 a) Incorrect:
Too general b) Incorrect: This opinionis not stated in the article c) Correct: This issue is raised several times in the text
including in questions 2 & 5 d) Incorrect: The research results have been inconsistent bit not unreliable.

Passage B

ANSWERS:

1. A

2. C

3. A

4. C

5. B (ONE IN FIVE)

6. C (SEE BELOW)

7. C

8. A

9. C

10. C

11. B
 FULL TEST 16
PART A

TEXT 1

Abstract

Perinatal outcomes after assisted reproductive technology treatme~nt in Australia and New Zealand:

single versus double embryo transfer

Objective:

To compare the perinatal outcomes of babies conceived by single embryo transfer (SET) with those conceived by double

embryo transfer (DET).

Design, setting and participants:

A retrospective population-based study of embryo transfer

cycles in Australia and New Zealand between 2002 and 2006,

using data from the Australia and New Zealand Assisted

Reproduction Database.

Main outcome measures:

Proportion of SET procedures; comparison of SET and DET procedures with respect to multiple births, low birthweight

(LBW), preterrn birth and fetal death.

Results:

proportion of SET procedures has increased from 28.4% in

2002 to 32.0%, in 2003, 40.5% in 2004, 48.2% in 2005 and

56.9% in 2006. The multiple birth rate for all babies conceived

by SET (4.0%) was 10 times lower than for those conceived by

DET (39.1 %) (P < 0.01 ). The average birthweight for all liveborn

babies conceived by SET (3290 g) was higher than for those

conceivHd by DET (2934 g) (P < 0.01 ). The preterm birth rate of

all DET-conceived babies (30.3%) was higher than for SETconceivE~d babies (12.3%) (adjusted odds ratio [AOR],

3.19 [95% Cl, 3.01-3.38]). All babies conceived by DET were

more likely to be stillborn than those conceived by SET (AOR,

1.49 [95% Cl, 1.21-1.82]). Singletons conceived by DET were

more likely to be born preterm than singletons conceived by

SET (AOR, 1.13 [95% Cl, 1.05-1.22]). Liveborn singletons

conceived by DET were 15% more likely to have LBW than

liveborn singletons conceived by SET (AOR, 1.15 [95% Cl,

1.05-1.26]). There was no significant difference in fetal death

rate between DET-and SET-conceived singletons.

Conclusion:

The increase in proportion of SET procedures has resulted in a

lower rate of multiple births and in better perinatal outcomes in

Australian and New Zealand assisted reproduction programs.

TEXT 2

Abstract

Oocyte freezing: timely reproductive insurance?

 Cryopreservation of unfertilised oocytes for later use in initiating pregnancy is now a viable technology, with
acceptable pregnancy rates (over 20% per thaw cycle).
 Oocyte cryopreservation used as a form of insurance against "social" (age-related) infertility can improve the
lifetime chance of pregnancy in women who defer pregnancy into their late 30s or early 40s.
 Use of oocytes harvested and frozen from women aged under 35 years may more than double the chance of
pregnancy for a 41year-old woman.
 The disadvantages of oocyte freezing for social infertility reasons include cost, the usual risks associated with in-
vitro fertilisation, and the lack of a guarantee of eventual pregnancy.

TEXT 3

Sperm removal and dead or dying patients: a dilemma for emergency departments and intensive care units

Abstract

An unexpected consequence of the increase in the use of fertility treatment is that emergency department and intensive care
doctors are receiving requests from wives (actual or de facto) of dying or recently deceased men for sperm removal.

Legislation in all states and territories regulates removal of

sperm from a dying man and, provided that lawful consent is obtained, a doctor can harvest sperm.

In several states, including Victoria, harvested sperm cannot be used in a fertilisation procedure without the man's consent,
and debate surrounds the issue of consent and how it can be proved.

Recent Victorian Law Reform Commission recommendations attempt to streamline the law to make a man's consent the
cornerstone of decision making for both harvesting and subsequent use of sperm.
TEXT 4

Infertility Treatment Act or forced sterilisation program?

To THE EDITOR: Before starting chemotherapy, many young men with cancer arrange to have their sperm stored to allow
them the chance to father a child later. However, hundreds of these Australian cancer survivors have been informed that
their stored sperm sample~s were to be destroyed by government order.

Summary

A letter to the editor outlines the conflict resulting from the legislation regarding the 1. ___ _ . Many young men with 2. __ _
_arrange to remove and store their sperm before starting chemotherapy. However the Government has ordered the
destruction of these stored sperm samples. A.3………. by Middleton and Buist throws light on the 4…….. of men wives of dying
or.5. __ _ men requesting emergency or ICV doctors to remove sperm from their husbands. All states and territories in
Australia permit such 6. ___ _ _from a dying man with 7……... However several states, including Victoria, don't allow the use
of such 8……. without the man's.9….. .Recent recommendation from the Victorian Law Reform Commission have tried to
streamline the law regarding such sperm removal.Molloy et al. reported on 10…… oocytes questioning if it was a 11. __ _
They.reported that cryopreservative of 12……….. is a 13,,,,,,, technology resulting in a pregnancy rate of 14. ……_ per thaw
cycle. A study by Wang, Sulican Healy and Black, comparing the 15…..of births through 16. ___ _ found that SET procedures
in Australia and New Zealand increased from 28.4% to 17…... between 2002 and 18. ……. However, the multiple birth rate
achieved by SET was much 19……. than that conceived by double embryo transfer (DET). 20…….conceived by DET were more
likely to be stillborn compared to 21 ….born through SET. The 22….. concluded that SET procedures 23. __ _ a.24…... of
multiple births, and improved 25. _____ _ 26…… improves the27…... of.28…… among 29…… in their 30…... or 31…….. Oocytes
from .women. below 35 could 32….. the 33….. chances for a 34…… woman. The disadvantages of oocyte freezing are cost, the
usual risks of IVF, and the lack of 35….. of pregnancy.
PART B

READING PASSAGE A

Death on the Nile

1. The 1995 autopsy of Tutankhamun , carried out by Carter and Douglas Derry of the Egyptian University in Cairo, found a
slightly built young man around 165 centimetres tall. From his bones and teeth, Derry put his age at death at just 18. But
there were no clues as to what killed him.

2. The next study didn't happen until 1968 Ronald Harrison, an anatomist at the University of Liverpool, UK, X-rayed the
qggy_u_sjng_a portable scanner squeezed intot he \fomb: He also took-a-sl<lnsample, from which his colleague Robert
Connolly determined Tutankhamun's blood group. As to Tutankhamun's death, Harrison found that the 111ummy's sternum
and much of his ribcage were missing, as well as,strangely, his heart-the one organ that ancient Egyptian embalmers always
returned to the body: He also noticed a thinning_ of the bone at the back of the skull, which he said(,colJtQ .. .h!aYe.JJeen-
caused-by~a haemorrhage resulting from a blow to the head. This throwaway comment triggered years of speculation that
Tutankhamun metaviolent end, possibly murde-r

3. In 2005, Tutankhamun's body was scanned using _3D X-ray ;computed tomograph (CT) scans. Three consultants, including
Frank Ruhli, head of the Swiss Mummy Project at the University of Zurich, discussed the scans. Together, they confirmed
what many had Sl,JS(?e.c_ted-that there was no sign of a blow to the head. They also made a surprise discovery, a broken
leg.

4. Some team members, including Ruhli, believed the break happened when the pharaoh was still alive, perhaps triggering
fatal bleeding or infection. Others were convinced that it occurred after death, possibly during the embalming process. Yet
the 2005 National Geographic documentary film, King Tut's Final Secrets put aside this um:!eitQ.inty, and was unequivocal:
Tut,ankhamun died of complications following a broken leg.

5. Like most theories of Tutankhamun's death, however, this one didn't last long. In another project, this time gversee,n,_by
Albert Zink of the EURAC Institute for Mummies and the Iceman in Balzano, Italy, and Carsten Pusch of the University of
Tubingen, Germany, the CT scans were analysed in more detail. They also took DNA samples from Tutankhamun's leg bones
to check for genes from disease-causing organisms and to compare his DNA with that of 11 other royal mummies in the hope
of a producing a family tree

6. The results, published early last year, down played the significance of the ~ 1 1" ··' broken leg. This time, the headline
conclusion was th~! .. (J deformed and sickly youth who died of malaria (The'Journa/ of the American Medical Association,
vol 303, p638). ~I

7. However, there are two main reasons for scepticism. The first is the condition of the DNA Although DNA has~n recovered
from mammoth and Neanderthal remains that are tens of thousands of years old, it is not expected to last as long in a warm
environment.

8. The second concern is contamination. The team used the polymerase chain reaction to amplify the DNA in their samples-
and this technique is known to be susceptible to picking up traces of modern material. Barne$.iS also sceptical about the
malaria diagnosis. He says that the test theteam used is only 75 per cent successful on living patients, and question whether
it could detect the pathogen in a 3000 year old mummy. "How likely is it that enough malaria DNA would end up deep in the
bone?" he says

9. As doubts grow over Tutankhamun's "official" cause of death, some researchers are building up a different story. Connolly,
who has digitally enhanced the 1968 X-rays, ~<2_0UIJ.!.§...~he idea of Tutankhamun as a weakling. Instead, he sees him as
an active young man who was killed in an accident.

10. Connolly believes that Tutankhamun died in an accident some distance from home, which meant that by the time the
embalmers got the body, it was already decaying. He speculates that the embalmers cut the chest away to remove the
decomposing organs as quickly as possible. This also provides a possible explanation for Tutankhamun's missing heart: it
putrefied. What's more, when DerrYand Carter unwrapped Tutankhamun, they found that the mummy appeared charred.
This was most likely due to a heat-producing reaction in the resin that the embalmers poured over the body, Connolly says.

11. Unsurprisingly, Connolly's theory has also been met with scepticism. Ruhli says he is open to the idea but "very cautious",
arguing that a fatal accident would have damaged other parts of the skeleton such as the backbone or arms.

12. Far from solving the case, the latest studies illustrate the difficulty researchers face when extracting information from
such battered remains. Working on ancient Egyptian mummies is always "a minefield" Ruhil says, because the aggressive
embalming process makes it almost illl_p_()s_sibJeJo tell the condition a body was in when the ern.~alm_~_~sg_()t hold

Death on the Nile

1. According to paragraph 2, what was considered most surprising about Tutankhamen's body during the autopsy was that
a) his sternum was missing b) his ribcage was missing c) his heart was missing d) There was thinning of the bone at the base
of his skull

2. The 1968 autopsy a) found that Tutankhamun was murdered b) found that Tutankhamun met a violent end c) found
evidence of a haemorrhage resulting from a blow to the head d) led to speculation that Tutankhamun may in fact have been
murdered

3. The 2005 study a) found that Tutankhamun had died of complications following a broken leg b) found that the broken leg
had occurred during the embalming process c) involved the use of a high tech method using CT scans d) found that the break
happened when the pharaoh was alive

4. Which of the following is incorrect: Zink's project

a) stressed the significance of the broken leg b) aimed in part to produce Tutankhamun's family tree c) involved the taking of
DNA samples d) compared Tutankhamun's DNA with that of other royal mummies

5) According to Barnes, DNA samples taken in Zink's study

a) are thousands of years old b) could probably not reliably show evidence of malaria c) were only 75% successful d) were
taken using an unreliable method

6) The following sentence, "The team announced that Tutankhamun's mother was his father's sister, making him the product
of incest" would be best inserted into

a) paragraph 1 b) paragraph 6 c) paragraph 2 d) paragraph 5

7). The word 'scepticism' in paragraph 7means a) seriousness b) investigation c) further study d) doubt

8. The sentence, "Working on Egyptian mummies is always a minefield" (paragraph 11) means that

a) There are a lot of hidden problems when the bodies of Egyptian mummies are studied

b) The study of Egyptian mummies is controversial c) Egyptology can produce shocking results d) Egyptian mummies are very
fragile

9) The word, 'unequivocal' in paragraph 4 means

a) not equivalent b) completely clear in meaning c) final d) shocking

1 0) The most suitable alternative title for the article would be:

a) The unreliability of autopsies b) A cause for scepticism c) The negative effects of embalming d) Establishing cause of death
-an ancient problem
PASSAGE B

Pacemaker may avert seizures

Scientists in the US have developed a treatment for epilepsy that they say could help millions of people. Researchers at the
Massachusetts Institute of Technology (MIT) hope to try out the neurological pacemaker, which detects and treats seizures
before they happen, this summer.

"Unlike so many other illnesses where we can easily measure what's going on, epilepsy has been difficult to understand,"
said Professor John Guttag of MIT, who is supervising the project. "It's one of the main reasons there has been so much of a
stigma attached to the condition. For centuries epileptics were even thought to be possessed by the devil."

The new procedure is based on an existing treatment known as vagus nerve stimulation (VNS). A small electrical device
planted in the body sends regular electrical pulses to the brain, usually one every five minutes throughout the day. Experts at
MIT say they have developed a method of analyzing the brain's activity that can be used alongside VNS to prevent seizures
from occurring.

By using electrodes attached to a cap, the system can monitor neurological activity and determine when an episode is likely.
A message is then sent to the VNS implant, which transmits a specific shock to prevent the incident, rather than the scatter-
gun of electric shocks currently used. Researchers say this will dramatically reduce the number of pulses sent to the brain and
will control epilepsy more effectively.

Ari Shoeb, the MIT researcher who developed the system, and Steven Schacter, an expert in VNS, say they are preparing to
test the procedure on a handful of patients over the next few months. Tests using existing data have encouraged them to
think that success could lead to much wider adoption of VNS as a treatment for neurological problems.

About 456,000 people have epilepsy in Britain, a third of whom cannot be treated with medication. Even those who can use
medical controls are often plagued with unpleasant side effects. Nerve stimulation has proved a successful alternative, with
about two-thirds of all patients experiencing significant improvements in their condition.

Although VNS therapies involve a surgical procedure, the success rates are high, and non-invasive diagnosis could not only
revolutionize the way that epilepsy is treated, but also be applicable to other neurological disorders. There are some
similarities to deep-brain stimulation techniques that are being developed to help stop the symptoms of Parkinson's disease
or severe depression, but these involve placing electrodes directly into the brain.

Experts say that if the new analytical technique is successful, it could provide similar relief without being so surgically
invasive. "All research has to be welcomed because we're still trying to understand exactly what is happening in epileptic
seizures," said Margaret Thomas, a spokeswoman for the National Society for Epilepsy in the UK. "Vagus nerve stimulation
works for some people, but not everyone - but we are looking forward to the results of any clinical trials."

The team behind the new system say they are still some way from reaching the public, and each device will need to be
tailored to the individual patient. "At the moment we have developed a diagnostic tool," said Prof Guttag. "But there will be
some serious development work to make it small and portable - not in the sense of needing a scientific breakthrough, but lots
of hard engineering."

Title: Pacemaker May Avert Seizures

1. Another word for a seizure is

a) heart attack b) stroke c) electroencephalogram d) fit

2. This new treatment for epilepsy was developed in

a) Australia b) The USA c) The UK d) Germany

3. Which one of the statements below is not true?

a) This new treatment for epilepsy will help millions of people. b) MIT stands for Massachusetts Institute of Technology. c)
Researchers hope to test a neurological pacemaker. d) The pacemaker is meant to discover and treat seizures before they
occur.

4. Which previous research lay the foundation for the new treatment?

a) Attaching stigmas to the condition. b) Possession by the devil. c) Vagus Nerve Stimulation. d) The information is not given
in the text.

5. The new system has a ….. than the previous system

a) a wider focus

6. The new system will be tested on

a) a small number of people. b) a large number of people. c) 456,000 people d) no one.

7. Approximately how many British epilepsy sufferers cannot be treated with medication? About…

a) 456,000 b) 152,000 c) 304,000 d) Two thirds

8. Nerve stimulation is an alternative to medication. It is successful in

a) one third of cases. b) the majority of cases. c) all cases d) 456,000 cases

9. Who is Margaret Thomas?

a) An epilepsy sufferer b) An MIT researcher. c) Professor Guttag’s assistant. d) A spokeswoman for the National Society for
Epilepsy.

10. The overall tone of the article is

a) cautiously optimistic. b) pessimistic. c) depressing. d) happy b) narrower focus

READING PART A ANSWERS

Fertility Issues

1. Infertility treatment Act 2. Cancer

3. Study

4. Increasing practice/ requests

5. (recently) deaceased/ dead

6. Removal (of sperm)

7. Lawful consent

8. Harvested sperm 9. Consent

10. The freezing of

11. Timely reproductive insurance

12. Unfertilised oocytes

13. Viable technology

14. Over 20%

15. Perinatal outcomes 16. Assissted reproductive technology I SET and DET

17. 56.9%

18. 2006

19. Lower

20. (all) babies

21. Those/ babies

22. Study 23. Resulted in

24. Lower rate

25. Perinatal outcomes

26. Oocyte preservation

27. Lifetime chance

28. Pregnancy

29. Women

30. Late 30s

31. Early 40s

32. (more than) double

33. Pregnancy

34. 41 years old

35. Guarantee

PART B

PASSAGE A answer key: 1.C 2.D 3.C 4.A 5.B 6.B 7.D 8.A 9.B 10.D
PASSAGE B ANSWERS 1D 2B 3A - it could help 4C 5B 6A - a handful is a small number 7A - one third of the total
number 8B - two thirds is a majority 9D 10A
 FULL TEST 17
OET: Reading Part A

Text 1

Title: Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis.

Objective To summarise the benefits and harms of treatments for women with gestational diabetes mellitus.

Design Systematic review and meta-analysis of randomised controlled trials.

Review methods Included studies were randomised controlled trials of specific treatment for gestational diabetes compared
with usual care or "intensified" compared with "less intensified" specific treatment.

Results Five randomised controlled trials matched the inclusion criteria for specific versus usual treatment. All studies used a
twostep approach with a 50 g glucose challenge test or screening for risk factors, or both, and a subsequent 75 g or 100 g
oral glucose tolerance test. Meta-analyses did not show significant differences for most single end points judged to be of
direct clinical importance. In women specifically treated for gestational diabetes, shoulder dystocia was significantly less
common (odds ratio 0.40, 95% confidence interval 0.21 to 0.75), and one randomised controlled trial reported a significant
reduction of pre-eclampsia (2.5 v 5.5%, P=0.02). For the surrogate end point of large for gestational age infants, the odds
ratio was 0.48 (0.38 to 0.62). In the 13 randomised controlled trials of different intensities of specific treatments, meta-
analysis showed a significant reduction of shoulder dystocia in women with more intensive treatment (0.31, 0.14 to 0.70).

Conclusions Treatment for gestational diabetes, consisting of treatment to lower blood glucose concentration alone or with
special obstetric care, seems to lower the risk for some perinatal complications. Decisions regarding treatment should take
into account that the evidence of benefit is derived from trials for which women were selected with a twostep strategy
(glucose challenge test/screening for risk factors and oral glucose tolerance test)..
Text 3

Complications of diabetes.

Complications include increased risk of heart disease, Peripheral Vascular Disease (PVD) and stroke, blindness, kidney
failure, limb amputation and erectile dysfunction in men.

Diabetes and heart disease/stroke/PVD. Diabetes is also often associated with high blood pressure and high blood fats
(cholesterol and triglycerides) and increases the risk of heart attack and stroke/PVD. Close to 80% of people with diabetes
will die from a heart attack or stroke.

Diabetes and eye disease. Retinopathy is a major long-term complication of diabetes. It affects about 1 in 4 people with
diabetes. The development of retinopathy is strongly related to the length of time diabetes has been present and the degree
of blood glucose control. Regular eye checks and treatment can help prevent retinopathy.

Diabetes and kidney disease. Diabetes is the fastest growing cause of kidney failure. It is the leading cause of end stage
renal disease (ESRD). About 30% of people with diabetes will develop kidney disease. Diabetes and lower limbs. Neuropathy
or peripheral nerve disease and blood vessel damage may lead to leg ulcers and serious foot problems from which limb
amputation may result.
Text 4

Statistics

• Diabetes is the sixth highest cause of death by disease in Australia • People with diabetes are twice as likely to have high
blood pressure and also are more likely to have elevated blood fats e.g. cholesterol, triglycerides • They are twice as likely to
have cardiovascular disease, e.g. heart disease and stroke • One in four Australian adults has either diabetes or impaired
glucose metabolism

People with diabetes in 2005

• 15% were hospitalised with coronary heart disease • 38,700 Australians were hospitalised for eye complications caused by
diabetes • 90% undergoing a lower limb amputation had a history of ulceration • 3,400 had amputations (65 a day) • 11%
of people with diabetes have had a heart attack • 23% died from kidney disease

Summary Task 1

The goal of the research by Horvath & Koch, (2010) was to determine the 1) .............................. of treatments for women
with gestational diabetes 2) ...................... using a 3) ......................... review and meta-analysis of randomised controlled
trials. The study compared standard treatment or "intensified" with 4) .............................. specific treatment.

The resulting data was collected from 5) ........................... trials matched the inclusion criteria for specific versus standard
treatment. Overall, the meta-analysis reported a 6) ....................,,,...... of shoulder dystocia in women with more intensive
treatment. However, the Meta-analyses did not show 7) ...................... for most single end points considered being of direct
clinical importance. In summary, treatment to 8) .................... concentration alone or with special 9)................. seems to
lower the risk for some 10) ...........................

In Australia the most prevalent form of diabetes is 11) ............................ while the most common chronic childhood disease
is 12) .................... which is increasing at approximately 13) ................... per year. In the former type symptoms are often
unobserved as the disease 14) ………………..….. yet in the latter type symptoms including excessive thirst and urination,
unexplained weight loss tend to have an 15) ………………… onset. Complications from diabetes show a concurrence with high
blood pressure and 16) …………………. (cholesterol and triglycerides). Another long-term complication of diabetes is 17)
…………………… which is strongly related to the duration of the patient’s diabetic condition and the degree of 18) …………………..
About 19) ……………….. of all diabetics will suffer this complication while eight in ten diabetics will suffer a fatal
20)………………………. or stroke

Statistically diabetes is the 21) ………………….… of death by disease in Australia and people diagnosed with diabetes are 22)
………………….. to have cardiovascular disease. A total of 38,700 Australians were hospitalised for eye complications and a
total number of 23) ………….. underwent a 24) ………………. , or 65 people a day, in 2005. Nationally, 25 % of all Australian
adults have been diagnosed with either diabetes or 25) ………………….

OET: Reading Part A

Management of Diabetes

Total 25 questions answers

1) benefits and harms 2) mellitus 3) systematic 4) less intensified 5) five randomised controlled 6) significant reduction 7)
significant differences 8) lower blood glucose 9) obstetric care 10) perinatal complications 11) Type 2 diabetes 12) Type 1
diabetes 13) 3% 14) develops gradually 15) abrupt 16) high blood fats 17) retinopathy 18) blood glucose control 19) one in
four / 1 in 4 / 25% 20) heart attack 21) sixth highest cause 22) twice as likely 23) 3,400 24) lower limb amputation 25)
impaired glucose metabolism
PART B

Reading Passage A >Aspirin's New Benefits

1. Aspirin may be one of the most familiar drugs in the world today particularly given its power to heal
goes far beyond the everyday ache or pain. 2. Just one example of this has been supported by studies of
people who have been regularly taking anti-inflammatory medications such as Aspirin, for conditions
such as cardiovascular disease or arthritis because it has been shown that by taking aspirin they are less
likely to develop Alzheimer's Disease. 3. There are two theories about why this happens. One theory is
that these drugs reduce inflammation within the brain. And the other is that they inhibit the body's
metabolism of proteins, particularly the protein called amyloid, which is known to contribute to the
development of Alzheimer's. 4. Yet another way that aspirin can help is that it reduces the risk of strokes
in the elderly, which can seriously and permanently affect memory. 5. Aspirin can also help prevent
diabetes related heart disease. Researchers have found evidence of diabetics being prone to an
increased production of thromboxane a substance that encourages blood vessels to constrict and
platelets to clump together. Due, in part, to this effect, diabetes are 2 to 4 times more likely than non-
diabetics to die from complications of cardiovascular disease. Aspirin helps prevent diabetes related
heart disease by blocking the synthesis of thromboxane. 6. In the case of cancer studies carried out over
the past 10 years these studies suggest that by taking aspirin on a regular basis this can slow down, and
in some cases, even prevent the development of pre-cancerous polyps in the colon, stomach and
oesophagus. A landmark study at the University of Melbourne found a 40% lower rate of Colorectal
cancer among regular aspirin users. And at the Harvard Medical School a long-term Nurses Health Study
(which involved nearly 90,000 female nurses) has revealed a 30% reduction in colorectal cancer among
those women who used aspirin consistently for 10 to 19 years, and a 44% reduction after 20 years of
consistent aspirin use. 7. Similarly, aspirin has been shown to lower heart attack and death rates in
those with cardiovascular disease. For this reason, it is now common practice for doctors to prescribe
daily doses of 100 to 150 milligrams to patients judged to be at high risk. 8. Aspirin can also help during
a heart attack. It's currently considered best practice to administer half a 300 m tablet of aspirin,
without delay, to any patient with chest pains suspected to be related to a heart attack. The reason for
this is that the faster help can come for the structures of a patient's blood platelets during a heart attack
the more the heart muscle can save a patient from any potential damage. 9. In such cases soluble aspirin
starts to act almost immediately: enteric coated aspirin tablets, which are designed to produce less
gastrointestinal irritation, will not start to dissolve until they reach the small intestines. 10.Research
suggests that by taking aspirin along with other drugs a patient who has been

diagnosed as suffering from a hearing loss which is associated with common antibiotics called
aminoglycosides such a hearing loss can be curtailed. 11. At the same time, researchers located at the
World Health Organisation (WHO) consider that in some cases these drugs can make a significant
contribution towards preventing deafness. It is said that they can combine with iron in the body to form
free radicals - unstable molecules that can damage cells, including the thousands of tiny hair cells in the
inner ear. Once these hair cells are damaged the inner ear loses its ability to detect sounds, thus leading
to permanent hearing loss. 12.From all of the above it can be seen that aspirin has a wide range of
health applications and it is for this reason it is often described as being a wonder drug.
Reading Passage B “Snapshots” revolutionise cervical screening
13.Doctors in north London last week began work with a specially designed camera which takes perfect
photographs every time of the cervix. The new technique, dubbed cervicography, could revolutionise
the exiting system of examining women who have abnormal changes in their cervix that, if untreated,
could develop into cancer. “It is designed to be completely foolproof. All you need to do is a load the
film and press a button”, says Peter Greenhouse of the Royal Northern Hospital. 14.The camera will
make it possible to extend a highly useful technique; called colposcopy is available only in specialised
centres. 15.The first step in screening for cancer of the cervix is a smear test. The doctor gently scrapes
a few cells from the cervix and places them on a glass slide. After staining the cells, a trained technician
examines them under the microscope to see if any are abnormal. If this test comes up positive, the
woman’s doctor may send her to a centre that does colposcopy. The doctor paints the cervix with a
dilute solution of acetic acid, and then examines the cervix through binocular microscope called a
colposcope. 16.The acetic acid makes any abnormal cells turn white, allowing the colposcopist to sample
the abnormal areas for microscopic analysis and definitive diagnosis. If is often possible to vaporise
abnormal cells with a laser. 17.Unfortunately, facilities for colposcopy are sparse. Women with minor
abnormalities can sometimes wait as long as nine months. Cervicography could help to improve matters.
18.The new camera could not be simpler to operate. You look through it at the cervix, moving the
camera forward or back until the cervix is in focus. When the image is sharp, you press a button on the
handle. A data back, a device on the back of the camera, prints a new number on each frame. 19.On the
front of the lens is a halogen light source, so that you can see what you are doing. A ring flash
eliminates any shadows from the photograph. The depth of field is almost 5 centimetres, ensuing that
the entire cervix and much of the surrounding tissue is in focus. The result should be a perfect
photograph each time. 20.The advantage of cervicography is that it takes no special expertise to
produce the photographs. Health workers in family planning clinics, for example, could send batches of
photographs to specialist centres for interpretation. The outcome would be more efficient use of highly
trained staff. Greenhouse says “it would only take about half a minute to assess and write up a report
on each photographs. It’s like having a top colposocopist looking over your shoulder”. 21.Albert Singer,
head of the Royal Northern’s colposcopy clinic, said that the most important application of
cervicography there would be to speed up the rate at which women could be seen. Early consultation
and counselling would be possible, allaying the anxiety that a long wait for colposcopy generates.

22.How does cervicography compare to the standard smear test? Doctors in the US studied 3000
patients attending for their routine annual smear. All the women had cervicography as well. Fifty-four
of the photographs were classified as abnormal compared with only 12 of the smears. 23.A British study
was also encouraging. Mike Campion, until recently also at the Royal Northern, examined 200 women
attending a clinic for genitourinary medicine. He found that cervicography picked up 98 per cent of
abnormalities, as judged by colposcopists. The conventional smear test failed to detect 58 per cent of
these. 24.One disadvantage of cervicography is that the colposcopist is likely to call the woman in for
examination if her cervix looks at all suspicious. In Campion’s study, 16 per cent of women fell into this
category. But as Campion has said, “a 16 per cent false-positive rate is preferable to a 58 per cent false-
negative rate.” 25.Cervicography may never completely replace smear tests because some women
develop abnormalities in the endocervical canal, which connects the womb with the vagina. This area is
difficult to view on colposcopy and cervicography, as well as difficult to sample for a smear test.
Aspirins Benefits

QUESTIONS
1. Which of the following statements best summarises what the writer meant when he wrote:
‘(aspirin’s) power to heal goes far beyond the everyday ache or pain?’

a) Aspirin helps to cure aches and pains b) There are many uses for aspirin c) There are many more
important uses for aspirin than just curing an ache or a pain d) None of these

2. The writer claims that aspirin:

a) Cures Alzheimer's Disease b) Contributes to the development of Alzheimer's Disease c) Inhibits the
development of Alzheimer's Disease d) May inhibit the development of Alzheimer's Disease

3. Which of the following statements is true?

a) Diabetics are more likely to die from cardiovascular disease than are non-diabetics b) Diabetics are 4-
6 times more likely to die from cardiovascular disease than are non-diabetics c) Diabetics causes
cardiovascular disease d) Cardiovascular disease occurs only in diabetic sufferers.

4. Research carried out at the Harvard Medical School showed:

a) A 40% reduction in colorectal cancer among patients who had taken aspirin regularly for 10–19 years
b) A 30% reduction in colorectal cancer after 20 years of consistent aspirin usage c) A 30% reduction in
colorectal cancer over a period of 10-19 years d) A 30% reduction in colorectal cancer in women who
had taken aspirin regularly over a period of 10-19 years

5. The reason a doctor may prescribe aspirin for a patient with suspected chest pains related to a heart
attack is:

a) A patient's heart will not be damaged b) To help prevent damage to a patient's heart c) To help
decrease the possibility of damage to a patient's heart d) To save a patient from dying from a heart
attack

6. The prescribing of soluble aspirin for the treatment of suspected heart attacks is because they are
considered to be better than enteric coated aspirin because

a) They dissolve more quickly than do enteric coated aspirin b) They work almost immediately c) They
cause less gastro-intestinal irritation d) They are easier for a patient to swallow

7. Researchers located at the World Health Organisation (WHO) have discovered that:

a) Aspirin prevents deafness b) In some cases aspirin may help to prevent deafness c) Aspirin cures
deafness d) None of these

8. Which of the following statements best summarises the passage?

a) There are some very good reasons why medical practitioners should, and do, prescribe the taking of
aspirin for a number of medical conditions b) Aspirin cures a range of illnesses such as diabetes, heart
attacks and deafness c) Research has proved that aspirin is a wonder drug d) The long-term taking of
aspirin helps to alleviate many diseases

Aspirin’s New Benefits LESSON 1 READING 1 – REASONS for the ANSWERS

*ANSWERS
1. Which of the following statements best summarises what the writer meant when he wrote:
‘(aspirin’s) power to heal goes far beyond the everyday ache or pain?’

*c) There are many more important uses for aspirin than just curing an ache or a pain

1ST AND 2ND P/GRAPHS …”its power goes far beyond the everyday ache or pain…” THEN THE 2ND P/G
GIVES EXAMPLES SUCH AS C/VASCULAR DISEASE

2. The writer claims that aspirin:

*d) May inhibit the development of Alzheimer's Disease

P/G 2 …”by taking aspirin they are less likely to develop Alzheimer’s Disease…” The words less likely
mean that it is not certain that Alzheimer’s is inhibited by taking aspirin.

3. Which of the following statements is true?

*a) Diabetics are more likely to die from cardiovascular disease than are non-diabetics

THE 3RD AND 4TH LINES IN P/G 5

4. Research carried out at the Harvard Medical School showed:

*d) A 30% reduction in colorectal cancer in women who had taken aspirin regularly over a period of 10-
19 years.

P/G 6 LINES 5 AND 6 The answer is NOT (B) because that refers to 44% of women.

5. The reason a doctor may prescribe aspirin for a patient with suspected chest pains related to a heart
attack is:

*c) To help decrease the possibility of damage to a patient's heart

P/G 8 “…It is currently considered best practice (FOR A DOCTOR) to administer half a 300 mg tablet of
aspirin, without delay, to any patient with chest pains suspected to be related to a heart attack (these
words are also in the question) …the more a heart muscle can save a patient from any potential
damage.” [“potential” is a synonym for “the possibility of damage” written in (C) ]

6. The prescribing of soluble aspirin for the treatment of suspected heart attacks is because they are
considered to be better than enteric coated aspirin because L1_1_R REASONS.doc

Victoria University 2 of 4 OCCUPATIONAL ENGLISH TEST PREPARATION ONLINE

*b) They work almost immediately

P/G 9 1ST LINE Yes, answer (A) is also correct but (B) is MORE correct so it’s the BEST answer.
7. Researchers located at the World Health Organisation (WHO) have discovered that:

*b) In some cases aspirin may help to prevent deafness

P/G 11 2ND LINE …”in some cases these drugs can make ( = may help make) a significant contribution
towards preventing deafness…”

8. Which of the following statements best summarises the passage?

*a) There are some very good reasons why medical practitioners should, and do, prescribe the taking of
aspirin for a number of medical conditions

P/G 13 …”From all of the above…” THIS IS A CONCLUDING PARAGRAPH SO IT TELLS US THAT THE WHOLE
ARTICLE IS 8 (A) ALSO THE MEANING OF 8(a) IS THROUGHOUT THE WHOLE ARTICLE

L1_1_R REASONS.doc

Victoria University 3 of 4 OCCUPATIONAL ENGLISH TEST PREPARATION ONLINE Cervical Screening

CERVICAL SCREENING ANSWERS
1. Cervicography is a new technique which will

*c) transform the present system of cervical screening

P/G 1 LINES 3 and 4 …”… could revolutionise the existing system of examining women who have
abnormal changes…” PLEASE NOTE THE SYNONYMS “transform” = “revolutionise”

2. The smear test can include all of the following steps except

*a) painting the cervix with acetic acid

2 (A) IS THE ANSWER BECAUSE PAINTING THE CERVIX WITH ACETIC ACID IS PART OF THE COLOPOSCOPY
NOT THE SMEAR TEST SO WE WANT THE FALSE ANSWER

3. The colposcope is used to

*b) locate abnormal cells in the cervix

P/G 4 LINE 2 (THIS LINE IS ABOUT THE PERSON [THE COLOPOSCOPIST] LOOKING THROUGH A
COLOPOSCOPE TO LOCATE ABNORMAL CELLS). 4. Which of the following features on the camera does
not improve the photographic image?

*a) the databack

P/G 6 LINES 3 and 4 …”the databack …prints a new number on each frame.”

5. Which of the following statements is not true?

*a) Health workers are able to interpret photographs quickly.

P/G 8 LINES 2 and 3…”Health workers …could SEND batches of photographs to specialist centres for
interpretation.”

6. According to recent studies, cervicography

*c) detects more abnormalities than the smear test

P/G 10 LINES 3 and 4 AND P/G 11 LINES 2, 3 and4

7. The British study team favoured cervicography over smear tests even though L1_1_R REASONS.doc

Victoria University 4 of 4 OCCUPATIONAL ENGLISH TEST PREPARATION ONLINE

*b) women without abnormalities would be referred to colposcopists

P/G 12

8. According to the article, cervicography will

*d) allow patients quicker access to colposcopy.

P/G 5 ( [a] and [c] are wrong – read paragraph 13.)

 FULL TEST 18
OET: Reading Part A

Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community
randomised trial.

Reading Sub-test

TIME LIMIT: 15 MINUTES

• Complete the following summary using the information in the four texts provided.

• You do not need to read each text from beginning to end to complete the task. You should scan the texts to find the
information you need.

• Gaps may require 1, 2 or 3 words.

• You should write your answers next to the appropriate number in the right-hand column.

• Please use correct spelling in your responses.

OET: Reading Part A

Text 1

Title: Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children:
community randomised trial. Baqui, Black, El Arifeen, & Yunus 2002.

Objective: To evaluate the effect on morbidity and mortality of providing daily zinc for 14 days to children with diarrhoea
using a cluster randomised comparison trial design.

Participants: 8070 children aged 3-59 months contributed 11 881 child years of observation during a two year period.

Intervention: Children with diarrhoea in the intervention clusters were treated with zinc (20 mg per day for 14 days); all
children with diarrhoea were treated with oral rehydration therapy.

Main outcome measures: Duration of episode of diarrhoea, incidence of diarrhoea and acute lower respiratory infections,
admission to hospital for diarrhoea or acute lower respiratory infections, and child mortality.

Results: About 40% (399/1007) of diarrhoeal episodes were treated with zinc in the first four months of the trial; the rate
rose to 67% (350/526) in month 5 and to >80% (364/434) in month 7 and was sustained at that level. Children from the
intervention cluster received zinc for about seven days on average during each episode of diarrhoea. They had a shorter
duration (hazard ratio 0.76, 95% confidence interval 0.65 to 0.90) and lower incidence of diarrhoea (rate ratio 0.85, 0.76 to
0.96) than children in the comparison group. Incidence of acute lower respiratory infection was reduced in the intervention
group but not in the comparison group. Admission to hospital of children with diarrhoea was lower in the intervention group
than in the comparison group (0.76, 0.59 to 0.98). Admission for acute lower respiratory infection was lower in the
intervention group, but this was not statistically significant (0.81, 0.53 to 1.23). The rate of non-injury deaths in the
intervention clusters was considerably lower (0.49, 0.25 to 0.94).

Conclusions: The lower rates of child morbidity and mortality with zinc treatment represent substantial benefits from a
simple and inexpensive intervention that can be incorporated in existing efforts to control diarrhoeal disease.
Text 2

Common types of infectious gastroenteritis in Australia.

• Rotavirus is the leading single cause of severe diarrhoea among infants and young children. By the age of five, nearly every
child in the world has been infected with rotavirus at least once. There are seven species of this virus, referred to as A, B, C, D,
E, F and G. Rotavirus A, the most common, causes more than 90% of infections in humans. Rotavirus is transmitted by the
faecal-oral route usually infant to infant. It infects cells that line the small intestine and produces an enterotoxin, which
induces gastroenteritis, leading to severe diarrhoea and sometimes death through dehydration. A vaccine is available with
recommended doses to be administered between ages 6 and 12 weeks, and vaccination should not be initiated for infants
aged >12 weeks. Subsequent doses should be administered at 4--10 week intervals, with all doses administered by age 32
weeks

• Campylobacter infection – the bacteria are found in animal faeces. Infection is caused by, for example, consuming
contaminated food or water, eating undercooked meat (especially chicken), and not washing your hands after handling
infected animals.

• Cryptosporidium infection – parasites are found in the bowels of humans and animals. Infection is caused by, for example,
swimming in a contaminated pool and accidentally swallowing water, or through contact with infected animals. An infected
person may spread the parasites to food or surfaces if they don’t wash their hands after going to the toilet.

• Giardiasis – parasite infection of the bowel. Infection is caused by, for example, drinking contaminated water, handling
infected animals or changing the nappy of an infected baby and not washing your hands afterwards.

• Salmonellosis – bacteria are found in animal faeces. Infection is caused by eating contaminated food or handling infected
animals. An infected person may also spread the bacteria to other people or surfaces by not washing their hands properly.

• Shigellosis – bacteria are found in faeces. An infected person may spread the bacteria to food or surfaces if they don’t wash
their hands after going to the toilet.

• Viral gastroenteritis – viruses are found in human faeces. Infection is caused by person-to-person contact such as touching
contaminated hands, faeces or vomit, or by drinking contaminated water or food.

Text 3

Figure 2: Percentage of pediatric hospitalizations from infectious gastroenteritis from each age group, in children aged less
than 5 years, Queensland, 1 July 2001 to 30 June 2006, by year of age and Indigenous status
Text 4

Pre- rotavirus vaccine immunisation checklist

Before an infant is immunised, the doctor or nurse should be told if any of the following apply:

• Is outside the recommended age range for the first and third dose • Is unwell on the day of immunisation (temperature
over 38.5C) • Has had a severe reaction to any vaccine • Is allergic to anything • Is taking steroids of any sort other than
inhaled asthma sprays or steroid creams (for example cortisone or prednisone) • Has received a recent blood transfusion or
blood products, including immunoglobulins • Has a disease or is having treatment which causes low immunity (for example,
leukaemia, cancer, HIV/AIDS, radiotherapy or chemotherapy) • Lives with someone who has a disease or is having treatment
which causes low immunity (for example, leukaemia, cancer, HIV/AIDS, radiotherapy or chemotherapy)

Summary Task 2: Gastroenteritis

The aim of the Bangladeshi study was to report on the effectiveness of administering 1)…………… to children with diarrhea
over a 2) ………….. period. The researchers studied outcomes for length and incidence of diarrhea, acute lower 3)………………. ,
hospitalisations for diarrhoea, and child 4) …………………. Participants in the intervention group received a supplement for
about 5) ……………. on average during each episode of diarrhoea. They had a 6) …………….. duration and lower occurrence of
diarrhoea than children in the comparison group. In addition, admission to hospital of children with diarrhoea was 7)
…………… in the intervention group. In contrast, the occurrence of acute 8) ………………….…. was reduced in the intervention
group but not in the comparison group and although hospitalization was lower this was not 9) ………………… Finally, the
study indicates there are substantial benefits from a simple and 10) ………………… intervention in the form of zinc treatment to
control diarrhoeal disease.

There are a range of infectious gastroenteritis in Australia, of which 11) ………………… is the most common in children and
infants, with species A accounting for 12) ……… of all reported cases. Looking at pediatric hospitalizations from infectious
gastroenteritis children less than 2 years old, children of 13) ………………. status are disproportionately represented among the
Australian population. Both 14) ………….…. and 15) ……………… are parasitic infections of the bowel often caused by drinking or
swallowing contaminated water and the parasites may be spread if the host doesn’t wash their hands hygienically. 16)
…………..……… , 17) ……….…………… , and 18) ……………………. are all bacterial infections transmitted when an infant comes into
contact with in animal faeces. Whereas 19) ……………………….. is a viral infection found in human faeces and transmitted by
person-to-person contact such as touching contaminated hands, faeces or vomit. In the most common cause of severe
diarrhoea among infants, 20) ……………….. is produced when cells lining the small intestine are infected, inducing
gastroenteritis, and leading to acute diarrhoea and if mismanaged causing death through dehydration.

The rotavirus vaccine is promoted in Australia to lower the incidence of severe gastroenteritis. However doctors and
community nurses are not recommended to vaccinate infants when the infant has a temperature over 21) ……………, or has
had any 22) ………………… to any prior vaccination. Similarly, infants should not be vaccinated if they are co-habiting or in close
contact with someone who has a disease or is having treatment likely to cause 23) …………………., such as leukaemia, cancer,
HIV/AIDS, radiotherapy or chemotherapy. Vaccination is recommended to begin before 24) …………. weeks with all doses
administered by age 25) …………. Weeks.

Answers Test 2: Gastroenteritis

1) zinc / daily zinc 2) two year / 2 year 3) respiratory infections 4) mortality 5) seven days 6) shorter 7) lower 8) lower
respiratory infection 9) statistically significant 10) inexpensive 11) rotavirus 12) 90% 13) indigenous 14) Giardiasis /
Cryptosporidium infection (either is correct) 15) Cryptosporidium infection / Giardiasis (either is correct) 16) Campylobacter
infection / Salmonellosis / Shigellosis (any order) 17) Campylobacter infection / Salmonellosis / Shigellosis (any order) 18)
Campylobacter infection / Salmonellosis / Shigellosis (any order) 19) viral gastroenteritis 20) enterotoxin 21) 38.5 C 22)
severe reaction 23) low immunity 24) 12 25) 32
PART B

Reading Passage A
Drug for diabetics goes on sale in Ireland
1. Hospital consultants in the Republic of Ireland can now prescribe a new drug for patients suffering
form a major complication of diabetes mellitus. Wyeth Laboratories, which makes tolrestat, claims that
the drug hits the progressive degeneration of nervous tissue which can make diabetic people seriously
ill. 2. Until the discovery of insulin in 1922, two-thirds of diabetics eventually entered a coma, because
they had too much sugar in their blood, and died. Now patients can control their blood sugar, and their
life expectancy has improved dramatically, but they have become exposed to long-term complications of
the disease. Many diabetics find that the sensory nerves in their limbs degenerate - a condition known
as diabetic peripheral neuropathy. 3. Peripheral neuropathy causes painful tingling and hypersensitivity
in the lower limbs. Patients lose their reflexes, making the limbs vulnerable to damage. In extreme
cases, a limb may have to be amputated. According to Michael Dvornik, a researcher at Wyeth who has
worked since 1967 on substances related to tolrestat, diabetic neuropathy is responsible for half of the
amputations carried out in the U. S. 4. Since the 1950s, researchers have known that diabetics have
large amounts of sorbitol, an alcohol produced by the breakdown of glucose, in their red blood cells.

Physiologists have found that this high level of sorbitol in the blood cells is associated with high levels of
the substance in the nerve cells and damage to the nervous tissue, although researchers disagree about
how the damage happens. 5. Studies on rats show that, in vitro sorbitol passes more slowly than glucose
through the cell membrane, disrupting normal osmosis. However, James Crabbe, a microbiologist at the
University of Reading, who has done extensive research on diabetic neuropathy, says there is little
evidence about how sorbitol affects nervous tissue in humans. 6. Tolrestat reduces the level of sorbitol
in the red blood cells. The drug belongs to a class of chemicals known as aldose reductase inhibitors,
first synthesised by Dvornik, and his colleagues at Wyeth in 1967. Some research has demonstrated that
ARIs appear to stop the degeneration of nervous tissue and allow new tissue to grow. 7. For example, a
team in Canada studied an aldose reductase inhibitor called sorbinil. Anders Sima, a pathologist at the
University of Manitoba in Winnipeg, and his colleagues from other centres in Canada found a 3.8
increase in the average number of nerve fibres that regenerated in a group of patients who took sorbinil
for a year. The researchers also found that patients' nerves functioned better after treatment with the
drug (The New England Journal of Medicine, Vol 319pg.548). But several other clinical trials of sorbinil
failed to find any significant improvement in nervous function in patients, according to Crabbe.

8. Like all other aldose reductase inhibitors, sorbinil failed to reach the market because it had serious
side effects. Now, however, the National Drug Advisory Board in Dublin has

authorised tolrestat following Wyeth's clinical trials. The NDAB is the first authority in the world to
license the drug. 9. Last month, tolrestat became available to patients in hospital in Ireland in a two year
surveillance programme, which is standard practice for a drug that contains a "novel ingredient". If this
limited programme is successful, tolrestat could then become available to general practitioners. Wyeth,
a British subsidiary of the pharmaceuticals company Wyeth-Ayerst in Philadelphia has applied for
product licences in several other countries, including Britain and Italy. 10. Patients in Britain, the U.S.
and Europe have participated in clinical trials of the drug for the manufacturers. Another study, led by
Philip Raskin at the Department of Internal Medicine in the University of Texas Health Science Centre at
Dallas, has assessed the drug in 23 patients with diabetes. 11. Raskin and his colleagues found that the
level of sorbitol in red blood cells fell, on average, by 57 per cent in diabetic patients who received 100
milligrams of tohestat twice daily for two weeks (ClinicalP harn~acologya nd Therapeutics, Vol 38, pg.
625). 12. So far, doctors have observed two occasional side effects of treatment with tolrestat. Some
patients developed mild dizziness, and the levels of certain liver enzymes rose in 2 per cent of the
patients. Such patients stopped receiving the drug immediately, and their liver enzymes returned to
normal levels. 13. In Dublin, Allene Scott, the director of the NDAB, says that there is no evidence yet
that either side effect is serious, but stresses the need for the two-year monitoring programme. "Time
alone will tell just how effective it (tolrestat) is", she says. "But certainly it is one of the few things that
will help diabetic patients suffering from these complications". 14. However, Crabbe is guarded about
the benefits of the drug. He says "There is no evidence that the lowering of sorbitol in diabetic
peripheral neuropathy is relevant in humans.. . . I feel there are a lot of unanswered questions".

Reading Passage B
Brain Disease Drives Cows Wild
1. Vets at the Ministry of Agriculture have identified a new disease in cows that is causing dairy farmers
some consternation. The fatal disease, which they have called bovine spongiform encephalopathy,
causes degeneration of the brain. Afflicted cows eventually become uncoordinated and difficult to
handle. The first case was reported in 1985. Now there are 92 suspected cases in 53 herds, mostly in the
south of England. So far 21 cases in 18 herds have been confirmed. All are Friesian/Holstein dairy
animals. 2. Gerald Wells and his colleagues at the Central Veterinary Laboratory in Weybridge, Surrey,
describe the symptoms and pathology in the current issue of The Veterinary Record (vol. 12 1, p. 4 19).
3. No one yet knows the cause of the disease but there are some similarities with a group of
neurological diseases caused by the so called "unconventional slow viruses". This group of progressive
diseases includes scrapie in sheep and goats, chronic wasting disease in mule deer and transmissible
mink encephalopathy. In humans kuru and Creutzfeldt-Jakob disease, both fatal neurological diseases,
come into the same category. The precise nature of the agents causing this group of diseases is a matter
of intense debate but all are infectious (New Scientist, 29 January, p. 32 and 15 May 1986, p 41). 4. Like
scrapie and the other diseases, bovine spongiform encephalopathy is insidious and progressive. A
farmer is unlikely to suspect that a cow has the disease until it has almost run its course. Previously
healthy animals become highly sensitive to normal stimuli, they grow apprehensive and their
movements uncoordinated. In the final stages the cows may be frenzied and unpredictable and have to
be slaughtered. 5. At autopsy, Wells and his colleagues found that some areas of the brain were full of
holes, giving it a spongy appearance. The pattern of holes shows some similarity with that in the other
unconventional encephalopathies. In all these diseases an important diagnostic feature is the presence
of proteinaceous fibrils seen in brain extracts in the electron microscope. No one knows for certain what
the fibrils are – whether they are the agents of the disease, a type of subviral particle, as some
researchers suggest, or are a product of the disease. The veterinary researchers analysed the brain
tissue from cows that died from the disease and found similar fibrils. Brain tissue from healthy cows did
not contain fibrils. 6. At the moment researchers at the Central Veterinary Laboratory are keeping an
open mind on the cause of the disease. If it is not a scrapie-like agent it might be something to do with
the genetics of Friesian cows. Another suggestion is that contaminated food might be to blame. "It is too
early to come to conclusions," said a spokesman at the Ministry of Agriculture. "It might be caused by
toxic products, or food, or it might be genetic." 7. According to Richard Kimberlin, of the AFRC/MRC
Neuropathogenesis Unit in Edinburgh: "The similarities are enough to make us think that it's in the
scrapie family, but without evidence of transmission it's impossible to say anything more certain".
Scientists at the Neuropathogenesis Unit will look for evidence of transmission in experiments on mice,
while Wells and his

colleagues try to transmit the disease in cows. It will take at least two years of experiments before
transmission can be proved. 8. What is certain is that the number of reported cases is increasing rapidly.
Not all reports will turn out to be bovine spongiform encephalopathy. Farmers and vets might just be
getting better at recognising symptoms. In the past farmers probably got rid of nutty middle-aged cows
without thinking too much about it. 9. If the disease turns out to be transmissible then it might spread
to other breeds of cows. Many countries ban the import of sheep from areas where scrapie occurs. 10.
In the US, consumer rights groups won a ban on the purchase of meat from scrapie flocks because no
one could rule out absolutely the possibility of transmission to humans. If bovine spongiform
encephalopathy turns out to be infectious, it could cause problems out of proportion to the number of
cases.

Vacuoles in the brain prevent the passage of nerve impulses (left). Fibrils in brain tissue resemble those
that are diagnostic of scrapie.

Diabetes Drugs QUESTIONS

1. After the discovery of insulin all of the following happened except

a) deaths among diabetic patients reduced slightly. b) diabetic patients were able to control their blood
sugar levels. c) diabetes was found to have long-term effects on surviving patients. d) diabetic peripheral
neuropathy was revealed as a problem.

2. As a result of peripheral neuropathy

a) Wyeth was asked to research into a drug to cure it. b) diabetics feel no pain in their limbs. c) diabetics
are particularly affected in lower limbs. d) half the diabetics in the US need to have a limb amputated.

3. Researchers disagree

a) that high levels of sorbitol in the blood cells are connected with damage to nervous tissue. b) that
diabetics have high levels of sorbitol in their blood cells. c) how high levels of sorbitol in the blood and
nerve cells cause damage. d) hew sorbitol is produced in the red blood cells.

4. Studies on rats show that

a) sorbitol levels should be lowered in humans too. b) sorbitol behaves differently from glucose. c)
sorbitol causes damage to the nervous tissue in humans in the same way. d) tolrestat would be a
suitable drug to use.

5. Clinical trials of sorbinil were

a) successful in 3.8% of patients. b) carried out by Crabbe. c) promising in some cases. d) all of the
above.

6. Tolrestat has been licensed in Ireland

a) as a result of clinical trials by Wyeth. b) because it contains a ‘novel ingredient’. c) because the NDAB
wanted to be the first in the world with the drug. d) because other countries were unwilling to take the
risk.

7. From last month tolrestat may be used by

a) general practitioners in Ireland. b) hospitals in Ireland. c) patients in Britain and Italy. d) Wyeth-Ayerst
in Philadelphia.

8. Raskin found that the level of sorbitol in red blood cells fell

a) in 57 per cent of diabetic patients. b) in diabetic patients taking 100 milligrams of tolrestat daily. c) in
23 per cent of diabetic patients taking tolrestat twice daily. d) by an average of 57 per cent in 23 diabetic
patients taking tolrestat.

9. Which statement is not true regarding the side effects of tolrestat

a) They have not yet been found to be serious. b) All patients experienced side effects, even if minor. c)
Levels of liver enzymes went up in a small number of patients. d) Some patients experienced dizziness.

10. Crabbe feels that, as far as diabetic peripheral neuropathy is concerned,

a) patients must be discouraged from using tolrestat. b) the monitoring programme will give useful
information. c) more proof is needed that sorbitol levels need reducing. d) none of the above.

Drug for Diabetes Goes On Sale in Ireland *ANSWERS

1. After the discovery of insulin all of the following happened except

*a) deaths among diabetic patients reduced slightly.

THIS IS NOT MENTIONED, ALL THE OTHERS B, C, D ARE MENTIONED IN P/G 2

2. As a result of peripheral neuropathy

*c) diabetics are particularly affected in lower limbs. (Please note, the word “diabetics” is an adjective –
e.g. “he is a diabetic [patient]”)

ALL OF P/G 3 (The answer is not (d) because the last sentence in the text refers to half of ALL
amputations in the U.S., not only diabetics.

3. Researchers disagree

*c) how high levels of sorbitol in the blood and nerve cells cause damage.
P/G 4 …”although researchers disagree about how the damage happens.” The researchers agree with a,
b and d “Since the 1950s, researchers have known that diabetics have large amounts of sorbitol…in their
red blood cells.”

4. Studies on rats show that

*b) sorbitol behaves differently from glucose.

P/G 5 LINES 1 AND 2 In the 6th paragraph Tolrestat is mentioned but there is no mention DIRECTLY that
Tolrestat would be a suitable drug to use as in (d).

5. Clinical trials of sorbinil were

*c) promising in some cases.

THE WHOLE OF P/G 7. BE CAREFUL, 7(A) 3.8% REFERS TO NERVE FIBRES NOT PATIENTS

6. Tolrestat has been licensed in Ireland

*a) as a result of clinical trials by Wyeth.

P/G 8 LINE 3

7. From last month tolrestat may be used by

L1_2_R REASONS for answers.doc

Victoria University Page 2 of 4 OCCUPATIONAL ENGLISH TEST PREPARATION ONLINE *b) hospitals in
Ireland.

P/G 9 LINE 1

8. Raskin found that the level of sorbitol in red blood cells fell

*d) by an average of 57 per cent in 23 diabetic patients taking tolrestat.

LAST LINE P/G 10 AND ALL OF P/G 11

9. Which statement is not true regarding the side effects of tolrestat

*b) All patients experienced side effects, even if minor.

P/G 12 9(b) IS NOT MENTIONED (The key word in 9(b) is ALL patients. In paragraph 10 there is only
mention of SOME patients.)

10. Crabbe feels that, as far as diabetic peripheral neuropathy is concerned,

*d) none of the above.

A B C ARE NOT MENTIONED (It could be INFERRED that answer c is correct but Crabbe says there is “no
evidence” regarding reducing sorbitol levels, he doesn’t DIRECTLY mention more proof being needed.)
Brain Diseases Drive Cows Wild *ANSWERS

11. Bovine spongiform encephalopathy is a disease which is currently found in

*d) Friesian/Holstein dairy cows.

P/G 1 LAST LINE

12. According to the article, when bovine spongiform encephalopathy is confirmed in cows, which of the
following symptoms do they NOT exhibit?

*a) chronic wasting

“chronic wasting” is NOT MENTIONED. All the other answers, b, c and d are mentioned in Paragraph 4.
The use of SYNONYMS in this question is typical of the OET Reading Test. “ungainly action” in (b) =
“movements uncoordinated” in p/g 4, “frenzied and unpredictable” = “frantic and agitated behaviour”.

13. Bovine spongifonn encephalopathy is similar to other neurological diseases caused by

‘unconventional slow viruses’ in that it

*b) develops inconspicuously

P/G 4 LINES 1 AND 2 …”is insidious and progressive…” = SYNONYMS FOR “develops inconspicuously”.
The answer is not (d) as “A farmer is unlikely to suspect… until it [the disease] has almost run its course.”
= almost finished

14. Pathology tests conducted on brains of cows which died of bovine spongiform encephalopathy show
the presence of

*c) fibrils which are also found in other animals infected with unconventional encephalopathies

P/G 5 LINES 3 – 4 The answer is not (a) or (b) because “No one knows for certain … whether they are the
agents (the cause) of the disease…or are a product of the disease.” (d) is wrong (the last line of the same
paragraph.)

15. Which of the following is not being considered as a cause of bovine spongiform encephalopathy?

*c) parasite-produced vacuoles in the brain

NOT MENTIONED

16. Bovine spongiform encephalopathy in cows appears similar to scrapie in sheep and goats because
L1_2_R REASONS for answers.doc

*b) the fibrils in diseased brains are similar

P/G 5 LINES 2 – 4 a, c and d are not mentioned. So b is the best answer as it’s linked to paragraph 3
which mentions that bovine spongiform encephalopathy is similar to scrapie which sheep and goats.
Then, in paragraph 5 in line 2 the sentence begins “In all these disease…is the presence of …fibrils…”

17. Vets in Surrey are conducting experiments which will attempt to.

*d) infect healthy cows with bovine spongiform encephalopathy.

P/G 7 LINES 5 – 6 “Wells and his colleagues (from Surrey [see paragraph2])…”

18. The purchase of meat from scrapie infected flocks is banned in some countries because

*a) the disease may then be transmitted to humans

P/G 10 LINES 1 – 2 – “…no one could rule out absolutely the possibility of transmission to humans.” rule
out = exclude, therefore the disease may then be transmitted…

19. So far scientists and vets know that bovine spongiform encephalopathy is definitely

*a) confined to Friesian/Holstein herds

P/G ONE LAST LINE. The key word in the last question stem is DEFINITELY. Scientists don not know b, c
or d definitely. This answer is in the FIRST PARAGRAPH so be careful, the answers are not always in
order / one after the other.
 FULL TEST 19
Glaucoma

TIME LIMIT: 15 MINUTES

OET: Reading Part A

Text 1

Description

Glaucoma is the name given to a group of eye diseases in which the optic nerve at the back of the eye is slowly destroyed. In
most people this damage is due to an increased pressure inside the eye - a result of blockage of the circulation of aqueous, or
its drainage. In other patients the damage may be caused by poor blood supply to the vital optic nerve fibers, a weakness in
the structure of the nerve, and/or a problem in the health of the nerve fibres themselves. Over 146,000 Australians have been
diagnosed with glaucoma. While it is more common as people age, it can occur at any age. Glaucoma is also far less common
in the indigenous population.

Symptoms

Chronic (primary open-angle) glaucoma is the commonest type. It has no symptoms until eye sight is lost at a later stage.

Prognosis

Damage progresses very slowly and destroys vision gradually, starting with the side vision. One eye covers for the other, and
the person remains unaware of any problem until a majority of nerve fibres have been damaged, and a large part of vision
has been destroyed. This damage is irreversible.

Treatment

Although there is no cure for glaucoma it can usually be controlled and further loss of sight either prevented or at least
slowed down. Treatments include: Eyedrops - these are the most common form of treatment and must be used regularly.
Laser (laser trabeculoplasty) - this is performed when eye drops do not stop deterioration in the field of vision. Surgery
(trabeculectomy) - this is performed usually after eye drops and laser have failed to control the eye pressure. A new channel
for the fluid to leave the eye is created. Treatment can save remaining vision but it does not improve eye sight.
Text 3

Other forms of Glaucoma.

Low-tension or normal tension glaucoma. Occasionally optic nerve damage can occur in people with so-called normal eye
pressure.

Acute (angle-closure) glaucoma. Acute glaucoma is when the pressure inside the eye rapidly increases due to the iris
blocking the drain. An attack of acute glaucoma is often severe. People suffer pain, nausea, blurred vision and redness of the
eye.

Congenital glaucoma. This is a rare form of glaucoma caused by an abnormal drainage system. It can exist at birth or
develop later.

Secondary glaucomas. These glaucomas can develop as a result of other disorders of the eye such as injuries, cataracts,
eye inflammation. The use of steroids (cortisone) has a tendency to raise eye pressure and therefore pressures should be
checked frequently when steroids are used.
Text 4

Overview of Glaucoma Facts

Glaucoma Facts

Glaucoma is the leading cause of irreversible blindness world wide.

One in 10 Australians over 80 will develop glaucoma.

First degree relatives of glaucoma patients have an 8-fold increased risk of developing the disease. At present, 50% of
people with glaucoma in Australia are undiagnosed.

Australian health care cost of glaucoma in 2005 was $342 million.

The total annual cost of glaucoma in 2005 was $1.9 billion.

The total cost is expected to increase to $4.3 billion by 2025.

The dynamic model of the economic impact of glaucoma enables cost-effectiveness comparison of various interventions
to inform policy development.

Summary Task

According to the article by Robertson, the primary cause of glaucoma is 1) ……………....... inside the eye, followed by 2)
…………..….. to the vital optic nerve fibers. More than 3) …………… Australians are currently living with Glaucoma, however the
4) ……………… population is less likely to suffer. Primary open-angle glaucoma has no real 5) …..…..….. until the onset of
blindness.

Deterioration of eyesight starts with 6) ………… and the sufferer may not be conscious of glaucoma progression until a 7)
………… of optic nerves have been destroyed. The most common form of treatment is/are 8) ………………. although when this
treatment and the use of lasers fails to stop deterioration 9) ……………. , also know as 10) …………………..can be preformed.

A Study looking at non-genetic predictors of glaucoma found 11) ………………….. and 12) ………………. were significantly
correlated with glaucoma. Noticeably, the results show pressures more than 13) …………….. and thicknesses greater than 14)
…………… were negatively correlated with the onset of glaucoma. Combined, the two factors had a predictive value of 15)
…………… Turning to types other than non-chronic glaucoma, 16) …………….…… can occur with normal eye pressure. Regarded
as a birth defect 17) …………..…….. may be present at birth or develop later. In older age, when the drain is blocked by the iris,
the eye’s internal 18) …………..….. rapidly increases and this is referred to as 19) …..………. Similarly the use of steroids, such as
20) …..………., can affect the internal balance of the eye.

Glaucoma is a major cause of 21) ……………….. globally, with immediate family members of glaucoma sufferers having an 22)
…………….. risk of future diagnosis. Yet in the Australian community 23) ………. of potential sufferers are undiagnosed. The
associated health care cost was 24) ……………….. in 2005 and the total social and economic costs were calculated to be 25)
………… in the same year.

Concussions Summary Task Key

Total 25 questions

1) increased pressure 2) damage 3) 146,000 4) indigenous 5) symptoms 6) the side vision 7) majority 8) Eyedrops
9)Surgery 10) trabeculectomy 11) Intraocular pressure / Central corneal thickness (either correct) 12) Intraocular pressure /
Central corneal thickness (either correct) 13) 22 mmHg 14) 588 microns 15) .49 16) Low-tension glaucoma / Normal
tension glaucoma 17) glaucoma / Congenital glaucoma 18) pressure 19) Acute glaucoma 20) cortisone 21) blindness 22) 8
fold / 8 times / eight fold 23) 50% / half 24) $342 million 25) $1.9 billion
PART B

READING PASSAGE A Time Limit: 20~25 Minutes

Breast Cancer and the Elderly

Paragraph 1

Breast cancer is one of the highest-profile diseases in women in developed countries. Although the risk for women younger
than 30 years is minimal, this risk increases with age. One-third of all breast cancer patients in Sweden, for example, are 70
years or older at diagnosis. Despite these statistics, few breast cancer trials take these older women into account.
Considering that nowadays a 70-year-old woman can expect to live for at least another 12–16 years, this is a serious gap in
clinical knowledge, not least because in older women breast cancer is more likely to be present with other diseases, and
doctors need to know whether cancer treatment will affect or increase the risk for these diseases.

Paragraph 2

In 1992, guidelines were issued to the Uppsala/Örebro region in Sweden (with a population of 1.9 million) that all women
with breast cancer should be able to receive equal treatment. At the same time, a breast cancer register was set up to record
details about patients in the region, to ensure that the guidelines were being followed. Sonja Eaker and colleagues set out to
assess data from the register to see whether women of all ages were receiving equal cancer treatment.

Paragraph 3

They compared the 5-year relative survival for 9,059 women with breast cancer aged 50–84 years. They divided them into
two age groups: 50–69 years, and 70–84 years. They also categorized the women according to the stage of breast cancer.
They looked at differences between the proliferative ability of breast cancer cells, estrogen receptor status, the number of
lymph nodes examined, and lymph node involvement. The researchers also compared types of treatment—i.e., surgical,
oncological (radiotherapy, chemotherapy, or hormonal)—and the type of clinic the patients were treated in.

Paragraph 4

They found that women aged 70–84 years had up to a 13% lower chance of surviving breast cancer than those aged 50–69
years. Records for older women tended to have less information on their disease, and these women were more likely to have
unknown proliferation and estrogen receptor status. Older women were less likely to have their cancer detected by
mammography screening and to have the stage of disease identified, and they had larger tumours. They also had fewer
lymph nodes examined, and had radiotherapy and chemotherapy less often than younger patients.

Paragraph

5 Current guidelines are vague about the use of chemotherapy in older women, since studies have included only a few older
women so far, but this did not explain why these women received radiotherapy less often. Older women were also less likely
to be offered breast-conserving surgery, but they were more likely to be given hormone treatment such as tamoxifen even if
the tumours did not show signs of hormone sensitivity. The researchers suggest that this could be because since
chemotherapy tends to be not recommended for older women, perhaps clinicians believed that tamoxifen could be an
alternative.

Paragraph 6

The researchers admit that one drawback of their study is that there was little information on the other diseases that older
women had, which might explain why they were offered treatment less often than younger patients. However, the fact
remains that in Sweden, women older than 70 years are offered mammography screening much less often than younger
women— despite accounting for one-third of all breast cancer cases in the country— and those older than 74 years are not
screened at all. Eaker and co-workers' findings indicate that older women are urgently in need of better treatment for breast
cancer and guidelines that are more appropriate to their age group. Developed countries, faced with an increasingly aging
population, cannot afford to neglect the elderly.
Multiple Choice Questions

1. The main idea presented in paragraph one is that…… a. only older women need to be concerned about breast cancer. b.
breast cancer trials seldom consider older women. c. breast cancer is more common than other diseases in older woman. d.
older woman do not take part in breast cancer trials.

2. Regarding cancer treatment, it can be concluded that…. a. doctors know cancer treatment will increase the risk of disease
in elderly patients. b. cancer treatments may be a risk for all elderly people c. it is unknown whether or not cancer treatments
will affect the treatment of other diseases in elderly people. d. older woman are less likely to have other diseases

3. 1992 Guidelines issued to the Uppsala/Orebro region in Sweden stated that… a. Sweden has a population of 1.9 million. b.
women with breast cancer need to register their condition to ensure they receive equal treatment. c. identical breast cancer
treatment should be available to women of all ages. d. all women with breast cancer should have access to equivalent
breast cancer treatment.

4. Which of the following was not part of Sonja Eaker and her colleagues research? a. Comparing ability of breast cancer
cells to increase in number. b. Grouping woman according to their survival rate. c. Identifying differences in treatment
methods. d. Splitting the groups based on age.

5. Findings by the researchers indicate that……. a. older women are less likely to have chemotherapy recommended. b. older
women prefer hormone treatment to breast-conversing surgery. c. older women have fewer lymph nodes. d. older women
respond better to chemotherapy than to hormone treatment.

6. The word vague is paragraph 5 means…… a. uncertain b. unclear c. unknown d. doubtful

7. One limitation of the study is that….. a. older women are treated less often than younger women. b. older women have a
lower incidence of breast cancer. c. younger women are treated more often than older women. d. there is a lack of
information on other diseases which older women have.

8. Which of the following statements best represents the view expressed by the writer at the end of the article? a. Due to
ageing population in developed countries, the needs of the elderly must not be ignored. b. Older women need more
appropriate treatment to suit their age. c. Developed countries have neglected the elderly for too long. d. It is too expensive
treat the elderly.

Answer Key 1. b 2.c 3. d 4. b 5. a 6. b 7. d 8.a

Question 1 a) Incorrect: incorrect assumption b) Correct: see highlighted text c) Incorrect: it is present with other diseases, not
more common d) Incorrect: usually they do not take part but not always Question

2 a) Incorrect: Doctors don’t know this. b) Incorrect: It affects other treatments not people c) Correct: see highlighted text d)
Incorrect: Question

3 a) Incorrect: The statement itself is true, but it has nothing to do with the guidelines b) Incorrect: Not given, note that
register is used as a verb here to confuse the test taker c) Incorrect: identical is not a synonym for equal d) Correct: equivalent
is a synonym for equal. Question

4 a) Incorrect: Mentioned..proliferate is synonym for increase b) Correct: They were not grouped based on survival rate(and if
they did not survive they could be grouped!!) c) Incorrect: mentioned d) Incorrect: mentioned Question

5 a) Correct: See highlighted test b) Incorrect: older women’s preference is not mentioned c) Incorrect: fewer lymph nodes
examined d) Incorrect: possibly true but not mentioned or indicated by the researchers Question

6 a) Incorrect b) Correct: Check your dictionary and thesaurus if you got this wrong! c) Incorrect d) Incorrect Question

7 a) Incorrect: This information is true but is not related to their study b) Incorrect: Not mentioned c) Incorrect: This
information is also true but is not related to their study d) Correct: see highlighted text Question

8 a) Correct: See highlighted text b) Incorrect: This the research findings not the writer’s opinion c) Incorrect: Could be true
but not mentioned d) Incorrect: Trick question connecting the word afford & expensive
 READING PASSAGE B Time Limit: 20~25 Minutes

The Mental Health Risks of Adolescent Cannabis Use Author: Wayne Hall Source: Public Library of Science

Paragraph 1

Since the early 1970s, when cannabis first began to be widely used, the proportion of young people who have used cannabis
has steeply increased and the age of first use has declined. Most cannabis users now start in the mid-to-late teens, an
important period of psychosocial transition when misadventures can have large adverse effects on a young person’s life
chances. Dependence is an underappreciated risk of cannabis use. There has been an increase in the numbers of adults
requesting help to stop using cannabis in many developed countries, including Australia and the Netherlands. Regular
cannabis users develop tolerance to many of the effects of delta-9tetrahydrocannabinol, and those seeking help to stop often
report withdrawal symptoms. Withdrawal symptoms have been reported by 80% of male and 60% of female adolescents
seeking treatment for cannabis dependence.

Paragraph 2

In epidemiological studies in the early 1980s and 1990s, it was found that 4% of the United States population had met
diagnostic criteria for cannabis abuse or dependence at some time in their lives and this risk is much higher for daily users
and persons who start using at an early age. Only a minority of cannabis-dependent people in surveys report seeking
treatment, but among those who do, fewer than half succeed in remaining abstinent for as long as a year. Those who use
cannabis more often than weekly in adolescence are more likely to develop dependence, use other illicit drugs, and develop
psychotic symptoms and psychosis.

Paragraph 3

Surveys of adolescents in the United States over the past 30 years have consistently shown that almost all adolescents who
had tried cocaine and heroin had first used alcohol, tobacco, and cannabis, in that order; that regular cannabis users are the
most likely to use heroin and cocaine; and that the earlier the age of first cannabis use, the more likely a young person is to
use other illicit drugs. One explanation for this pattern is that cannabis users obtain the drug from the same black market as
other illicit drugs, thereby providing more opportunities to use these drug.

Paragraph 4

In most developed countries, the debate about cannabis policy is often simplified to a choice between two options: to legalize
cannabis because its use is harmless, or to continue to prohibit its use because it is harmful. As a consequence, evidence that
cannabis use causes harm to adolescents is embraced by supporters of cannabis prohibition and is dismissed as “flawed” by
proponents of cannabis legalisation

Paragraph 5

A major challenge in providing credible health education to young people about the risks of cannabis use is in presenting the
information in a persuasive way that accurately reflects the remaining uncertainties about these risks. The question of how
best to provide this information to young people requires research on their views about these issues and the type of
information they find most persuasive. It is clear from US experience that it is worth trying to change adolescent views about
the health risks of cannabis; a sustained decline in cannabis use during the 1980s was preceded by increases in the perceived
risks of cannabis use among young people.
Paragraph 6

Cannabis users can become dependent on cannabis. The risk (around 10%) is lower than that for alcohol, nicotine, and
opiates, but the earlier the age a young person begins to use cannabis, the higher the risk. Regular users of cannabis are
more likely to use heroin, cocaine, or other drugs, but the reasons for this remain unclear. Some of the relationship is
attributable to the fact that young people who become regular cannabis users are more likely to use other illicit drugs for
other reasons, and that they are in social environments that provide more opportunities to use these drugs.

Paragraph 7

It is also possible that regular cannabis use produces changes in brain function that make the use of other drugs more
attractive. The most likely explanation of the association between cannabis and the use of other illicit drugs probably
involves a combination of these factors. As a rule of thumb, adolescents who use cannabis more than weekly probably
increase their risk of experiencing psychotic symptoms and developing psychosis if they are vulnerable—if they have a family
member with a psychosis or other mental disorder, or have already had unusual psychological experiences after using
cannabis. This vulnerability may prove to be genetically mediated.

Part B : Multiple Choice Questions

1. In paragraph 1, which of the following statements does not match the information on cannabis use? a. The use of
cannabis by teenagers has been increasing over the past 40 years. b. Cannabis use has adverse effects on young people. c.
Withdrawal symptoms are more common in males. d. People try cannabis for the first time at a younger age than previously.

2. Epidemiological studies in the 1980s & 1990s have found that…. a. 4% of the US population currently suffer from
cannabis abuse or dependence. b. starting cannabis use at a young age increases the risk of dependence or abuse. c. only a
minority of surveys researched treatment options for cannabis dependent people. d. people who start cannabis use at a
young age have high risk of becoming daily users.

3. The main point of paragraph 3 is that… a. alcohol, tobacco and cannabis can lead to the use of heroin and cocaine. b. most
adolescents who have used cocaine or heroin first try alcohol, followed by tobacco and then cannabis. c. there is a clear link
between habitual cannabis use and the use of heroin and cannabis. d. the black market is the main source of illicit drugs.

4. Which of the following would be the most appropriate heading for paragraph 4? a. Opinion on an effective cannabis
policy is divided. b. Cannabis use is harmful to adolescents and should be prohibited. c. Cannabis use is a serious problem in a
majority of developed countries. d. Cannabis use should be legalised.

5. The word closest in meaning credible in paragraph 5 is… a. believable b. possible c. high quality d. inexpensive

6. Cannabis use in the US declined during the 1980s because… a. parents were able to explain the health risks of cannabis
use. b. there was good health education regarding the health risks associated with cannabis use available at that time. c.
cannabis had increased in price d. young people had became more worried about its effect on their health

7. The word relationship in paragraph 6 refers to the connection between… a. legal drugs such as alcohol and nicotine and
illegal drugs such as cannabis, cocaine and heroin. b. cannabis use and dependency. c. the use of hard drugs such as heroin
and cocaine and cannabis use. d. regular users and their partners.

8. Which of the following statements best matches the information in the last paragraph? a. Regular cannabis use produces
changes in brain function. b. Regular adolescent cannabis users with a genetic predisposition to mental disorders have an
increased risk of encountering psychosis. c. Regular adolescent users of cannabis are vulnerable to psychosis. d. Occasional
use of cannabis can make other drugs more appealing.

Answer Key 1. b 2.b 3. c 4. a 5. a 6. d 7. c 8.b

Question 1 a) Incorrect: Mentioned b) Correct: not mentioned (note: misadventures can have an adverse effect, but nothing is
mentioned directly about cannabis) c) Incorrect: Mentioned d) Incorrect: Mentioned
Question 2 a) Incorrect: Not currently, at some time in their lives. b) Correct: risk (of abuse/dependence) is much higher for
persons who start using at an early age c) Incorrect: play on word order d) Incorrect: Not mentioned

Question 3 a) Incorrect: This is not stated and is logically incorrect. b) Incorrect: The statement itself is correct, but it is not
the main idea. c) Correct: this sentence best summarises the main idea. d) Incorrect: This is probably true, but it is not stated,
nor is it the main idea.

Question 4 a) Correct: Yes: debate about cannabis policy is often simplified to a choice between two options (therefore
opinion is divided) b) Incorrect: This is only one side of the debate. c) Incorrect: This is not mentioned d) Incorrect: This is the
other side of the debate.

Question 5 a) Correct b) Incorrect c) Incorrect d) Incorrect

Question 6 a) Incorrect: Parents not mentioned b) Incorrect: Education not mentioned c) Incorrect: No mention of price d)
Correct: preceded by increases in the perceived risks of cannabis use among young people.

Question 7 a) Incorrect: Not mentioned b) Incorrect: Not mentioned c) Correct: See highlighted text d) Incorrect: Partners not
mentioned!

Question 8 a) Incorrect: Incomplete information b) Correct: Meaning is the same, note use of synonyms i.e encountering for
experiencing c) Incorrect: Only certain users, see B d) Incorrect: Not occasional use, regular use
 FULL TEST 20
Reading: Part A – Text booklet Instructions TIME LIMIT: 15

Text A1

Radiation is all around us

Although doctors do worry about exposing people repeatedly to X-rays, and there’s no doubt that too much exposure to this
form of radiation can be harmful, it’s important to keep the risks of X-rays in perspective. We’re constantly being exposed to
natural radiation from the environment around us – from the earth, through cosmic rays from outer space, even from the
food we eat.

The dose from chest X-rays is very small

The dose of radiation you receive each time you have a chest X-ray is very small, especially given this background of natural
radiation. It’s certainly many thousands of times smaller than the dose of radiation needed to cause skin burns or radiation
sickness. The only risk that needs to be considered is the risk of causing cancer but this is also very small.

X-rays compared with other risks

This means that even if you had chest X-rays taken every week, the increased risk wouldn’t be very much. And these risks
have to be put into the perspective not just of the benefits of doctors being able to keep an eye on your lungs but also of
other risks we choose to expose ourselves to, such as from sports, driving or smoking (which is very risky indeed).

Text A2

Which types of diagnostic imaging procedures use radiation?

● In X-ray procedures, X-rays pass through the body to form pictures on a computer or television monitor, which are viewed
by a radiologist. If you have an X-ray, it will be performed with a standard X-ray machine or with a more sophisticated X-ray
machine called a computerised tomography machine.

● In nuclear medicine procedures, a small amount of radioactive material is inhaled, injected, or swallowed by the patient. If
you have a nuclear medicine procedure, a special camera will be used to detect energy given off by the radioactive material
in your body and form a picture of your organs and their level of function on a computer monitor. A nuclear medicine
physician views these pictures. The radioactive material typically disappears from your body within a few hours or days.

Text A3

Risk of cancer from diagnostic X-rays

BACKGROUND

Diagnostic X-rays are the largest man-made source of radiation exposure to the general population, contributing about 14%
of the total annual exposure worldwide from all sources. Although diagnostic X-rays provide great benefits, that their use
involves some small risk of developing cancer is generally accepted. Our aim was to estimate the extent of this risk on the
basis of the annual number of diagnostic X-rays undertaken in the UK and in 14 other developed countries.

METHODS

We combined data on the frequency of diagnostic X-ray use, estimated radiation doses from X-rays to individual body
organs, and risk models, based mainly on the Japanese atomic bomb survivors, with population-based cancer incidence rates
and mortality rates for all causes of death, using life table methods.

FINDINGS

Our results indicate that in the UK about 0.6% of the cumulative risk of cancer to age 75 years could be attributable to
diagnostic X-rays. This percentage is equivalent to about 700 cases of cancer per year. In 13 other developed countries,
estimates of the attributable risk ranged from 0.6% to 1.8%, whereas in Japan, which had the highest estimated annual
exposure frequency in the world, it was more than 3%.

INTERPRETATION

We provide detailed estimates of the cancer risk from diagnostic X-rays. The calculations involved a number of assumptions
and so are inevitably subject to considerable uncertainty. The possibility that we have overestimated the risks cannot be
ruled out, but that we have underestimated them substantially seems unlikely.

Text A4

Question

I am pregnant. What are the risks to my baby from dental, mammogram, chest, extremity, head, or computerized
tomography exams that don’t directly expose my abdomen?

Answer

The risks to the baby are minimal, if any, when X-rays are taken of areas other than the abdomen. This is because the X-ray
beam is focused only on the area of interest to minimize doses to other areas of the body. When you receive a diagnostic X-
ray study of your head, teeth, chest, arms, or legs at a qualified facility, the X-ray exposure is not to your baby. The “scatter”
radiation that might reach the baby would be extremely small and would not represent an increased risk for birth defects or
miscarriage.

Summary Answers

Exposure to radiation from medical procedures

Two types of procedure using radiation for diagnostic imaging are described in the texts: X-ray procedures and ....(1)....
procedures. In the former, the ....(2).... is created by passing X-rays through the body using either a standard machine or a
more ....(3).... one called a ....(4).... machine; in the latter, it is generated using a camera that detects ....(5).... emitted from
....(6).... material introduced into the body. This material can be breathed in, taken orally or ....(7).... and may remain in the
body for up to a few ....(8).....

The environment always has naturally occurring radiation – from the earth, the food people eat, and rays from ....(9).....
Diagnostic X-rays make up about ....(10).... of the total annual ....(11).... exposure to radiation for humans, and are the
biggest ....(12).... source for the ....(13).... population. Nevertheless, the amount of radiation in one X-ray procedure of a
person’s chest is still tiny in comparison to the background of natural radiation.

The texts stress the safety and benefits of X-rays. Any risks are compared with those that people take voluntarily, perhaps
when they ....(14).... or, in particular, ....(15)..... Even in pregnancy, it is only ....(16).... exposure of a woman’s ....(17).... to X-
rays that is seen as carrying some risk. Any so-called ....(18).... radiation from X-rays of other areas of the body will not make
....(19).... any more likely.

However, there is a minor risk of X-rays causing cancer. Researchers sought to estimate the extent of this using data from a
total of ....(20).... developed countries. The study considered radiation exposure for each country based on the ....(21).... of
use of diagnostic X-rays and on the doses needed to take X-rays of different body ....(22)..... This was combined with the rate
of incidence of ....(23).... and overall ....(24).... rates for each country. While the findings are somewhat uncertain due to
several ....(25).... made in the calculations, they indicate that over 3% of the risk of cancer could be attributed to X-rays in
....(26)..... This was approximately five times greater than the same risk in ....(27).....

Answer key Total of 27 questions

1 nuclear medicine 2 (X(-)ray/x(-)ray/X ray/x ray) image/picture 3 sophisticated OR advanced OR complex 4

computerised/computerized tomography NOT CT 5 (the) energy 6 (a/some) radioactive 7 injected 8 (hours or) days 9
(outer/deep) space OR the cosmos 10 14% OR fourteen percent/per cent 11 world(-)wide OR global 12 man(-)made 13
general 14 play/do/participate in sports OR drive OR play/do sports, drive 15 smoke (cigarettes) OR if/when they smoke 16
direct 17 abdomen 18 (“)scatter(”) 19 birth defects/abnormalities OR a birth defect/abnormality OR (a) miscarriage OR
defects/abnormalities or miscarriage OR miscarriage or defects/abnormalities 20 15 OR fifteen 21 frequency 22 organs 23
cancer 24 death OR mortality 25 assumptions 26 Japan 27 (the) UK OR (the) United Kingdom OR GB OR (Great) Britain

PART B

READING PASSAGE A

Alzheimer Disease
Paragraph 1
Physicians now commonly advise older adults to engage in mentally stimulating activity as a way of
reducing their risk of dementia. Indeed, the recommendation is often followed by the
acknowledgment that evidence of benefit is still lacking, but “it can’t hurt.” What could possibly be the
problem with older adults spending their time doing crossword puzzles and anagrams, completing
puzzles, or testing their reaction time on a computer? In certain respects, there is no problem.
Patients will probably improve at the targeted skills, and may feel good—particularly if the activity is
both challenging and successfully completed.
Paragraph 2
But can it hurt? Possibly. There are two ways that encouraging mental activity programs might do
more harm than good. First, they can falsely raise expectations. Second, individuals who do develop
dementia might be blamed for their condition. When heavy smokers get lung cancer, they are
sometimes seen as having contributed to their own fates. People with Alzheimer disease might
similarly be viewed as having brought it on themselves through failure to exercise their brains.

Paragraph 3
There is some evidence to support the idea that mental exercise can improve one’s chances of
escaping Alzheimer disease. Having more years of education has been shown to be related to a
lower prevalence of Alzheimer disease. Typically, the risk of Alzheimer disease is two to four times
higher in those who have fewer years of education, as compared to those who have more years of
education. Other epidemiological studies, although with less consistency, have suggested that those
who engage in more leisure activities have a lower prevalence and incidence of Alzheimer disease.
Additionally, longitudinal studies have found that older adults without dementia who participate in
more intellectually challenging daily activities show less decline over time on various tests of
cognitive performance.
Paragraph 4
However, both education and leisure activities are imperfect measures of mental exercise. For
instance, leisure activities represent a combination of influences. Not only is there mental activation,
but there may also be broader health effects, including stress reduction and improved vascular
health— both of which may contribute to reducing dementia risk. It could also be that a third factor,
such as intelligence, leads to greater levels of education and more engagement in cognitively
stimulating activities, and independently, to lower risk of dementia. Research in Scotland, for
example, showed that IQ test scores at age 11 were predictive of future dementia risk .
Paragraph 5

The concept of cognitive reserve is often used to explain why education and mental stimulation are
beneficial. The term cognitive reserve is sometimes taken to refer directly to brain size or to synaptic
density in the cortex. At other times, cognitive reserve is defined as the ability to compensate for acquired
brain pathology. Taken together, the evidence is very suggestive that having greater cognitive reserve is
related to a reduced risk of Alzheimer disease. But the evidence that mental exercise can increase
cognitive reserve and keep dementia at bay is weaker. In addition, people with greater cognitive reserve
may choose mentally stimulating leisure activities and jobs, which makes is difficult to precisely determine
whether mentally stimulating activities alone can reduce dementia risk.

Paragraph 6

Cognitive training has demonstrable effects on performance, on views of self, and on brain function—but
the results are very specific to the skills that are trained, and it is as yet entirely unknown whether there is
any effect on when or whether an individual develops Alzheimer disease. Further, the types of skills
taught by practicing mental puzzles may be less helpful in everyday life than more straightforward
techniques, such as concentrating, or taking notes, or putting objects in the same place each time so that
they won’t be lost.

Paragraph 7

So far, there is little evidence that mental practice will help prevent the development of dementia. There is
better evidence that good brain health is determined by multiple factors, that brain development early in
life matters, and that genetic influences are of great importance in accounting for individual differences in
cognitive reserve and in explaining who develops Alzheimer disease and who does not. At least half of
the explanation for individual differences in susceptibility to Alzheimer disease is genetic, although the
genes involved have not yet been completely discovered. The balance of the explanation lies in
environmental influences and behavioral health practices, alone or in interaction with genetic factors.
However, at this stage, there is no convincing evidence that memory practice and other cognitively
stimulating activities are sufficient to prevent Alzheimer disease; it is not just a case of “use it or lose it.”
Part B : Multiple Choice Questions

1. According to paragraph 1, which of the following statements matches the opinion of most doctors?

a. Mentally stimulating activities are of little use b. The risk of dementia can be reduced by doing mentally stimulating
activities c. The benefits of mentally stimulating activities are not yet proven d. Mentally stimulating activities do more harm
than good

2. In paragraph 2, the author expresses the opinion that …….

a. Mentally stimulating activities may offer false hope b. Dementia sufferers often blame themselves for their condition c.
Alzheimer’s disease may be caused lack of mental exercise d. Mentally stimulating activities do more harm than good

3. In paragraph 3, which of the following does not match the information on research into Alzheimer disease?

a. People with less education have a higher risk of Alzheimer disease b. Cognitive performance can be enhanced by regularly
doing activities which are mentally challenging c. Having more education reduces the risk of Alzheimer disease d. Regular
involvement in leisure activities may reduce the risk of Alzheimer disease

4. According to paragraph 4, which of the following statements is false?

a. The impact of education and leisure is difficult to measure b. Better vascular health and reduced stress can decrease the
risk of dementia c. People with higher IQ scores may be less likely to suffer from dementia d. Cognitively stimulating activities
reduce dementia risk

5. Which of the following is closest in meaning to the expression: keep dementia at bay?
a. delay the onset of dementia b. cure dementia c. reduce the severity of dementia d. treat dementia

6. Which of the following phrases best summarises the main idea presented in paragraph 6?

a. The effect cognitive training has on Alzheimer disease is limited b. Doing mental puzzles may not be as beneficial as
concentrating in everyday life c. Cognitive training improves brain performance d. The effect cognitive training has on
Alzheimer disease is indefinite

7. According to paragraph 7, which of the following is correct regarding the development of dementia?

a. Genetic factors are the most significant b. Environmental factors interact with behavioural factors in determining
susceptibility to Alzheimer disease c. Good brain health can reduce the risk of developing Alzheimer disease d. None of the
above

8. Which of the following would be the best alternative title for the essay?

a. New developments in Alzheimer research b. Benefits of education in fighting Alzheimer disease c. Doubts regarding
mental exercise as a preventive measure for Alzheimer disease d. The importance of cognitive training in preventing early
onset of Alzheimer disease

Answer Key

1. c 2. a 3. b 4. d 5. a 6. d 7.a 8.
Question 1 a) Incorrect: No, they believe it may help b) Incorrect: This is their advice, but they
acknowledge there is no evidence c) Correct: See highlight d) Incorrect: No, (this is the author’s opinion in
paragraph 2)

Question 2 a) Correct: synonym: (may offer false hope= can falsely raise expectations) b) Incorrect: Not
mentioned c) Incorrect: No, some people may believe this, but not the author d) Incorrect: No, they might
i.e it is possible

Question 3 a) Incorrect: Matches b) Correct: Does not match: will not enhance, just stop the decline c)
Incorrect: Matches d) Correct: Matches

Question 4 a) Incorrect: True b) Incorrect: True c) Incorrect : True d) Correct: False: could reduce, not
reduce…(degrees of certainty)

Question 5 a) Correct b) Incorrect c) Incorrect d) Incorrect

Question 6 a) Incorrect: Not mentioned b) Incorrect: True: but a detail c) Incorrect: True, but not the main
idea d) Correct: synonym: unclear=unknown

Question 7 a) Correct: see highlight b) incorrect: c) Incorrect: could be true but not mentioned d) Incorrect:

Question 8 a) Incorrect: no new developments mentioned b) Incorrect: not the main focus c) Correct: Best
summary d) Incorrect: opposite is true
READING PASSAGE B Time Limit: 20~25 Minutes

Task 2: The Mental Health Risks of Adolescent Cannabis Use Author:

Wayne Hall Source: Public Library of Science
Paragraph 1 Since the early 1970s, when cannabis first began to be widely used, the proportion of young people who have
used cannabis has steeply increased and the age of first use has declined. Most cannabis users now start in the mid-to-late
teens, an important period of psychosocial transition when misadventures can have large adverse effects on a young
person’s life chances. Dependence is an underappreciated risk of cannabis use. There has been an increase in the numbers of
adults requesting help to stop using cannabis in many developed countries, including Australia and the Netherlands. Regular
cannabis users develop tolerance to many of the effects of delta-9tetrahydrocannabinol, and those seeking help to stop often
report withdrawal symptoms. Withdrawal symptoms have been reported by 80% of male and 60% of female adolescents
seeking treatment for cannabis dependence.

Paragraph 2 In epidemiological studies in the early 1980s and 1990s, it was found that 4% of the United States population
had met diagnostic criteria for cannabis abuse or dependence at some time in their lives and this risk is much higher for daily
users and persons who start using at an early age. Only a minority of cannabis-dependent people in surveys report seeking
treatment, but among those who do, fewer than half succeed in remaining abstinent for as long as a year. Those who use
cannabis more often than weekly in adolescence are more likely to develop dependence, use other illicit drugs, and develop
psychotic symptoms and psychosis.

Paragraph 3 Surveys of adolescents in the United States over the past 30 years have consistently shown that almost all
adolescents who had tried cocaine and heroin had first used alcohol, tobacco, and cannabis, in that order; that regular
cannabis users are the most likely to use heroin and cocaine; and that the earlier the age of first cannabis use, the more likely
a young person is to use other illicit drugs. One explanation for this pattern is that cannabis users obtain the drug from the
same black market as other illicit drugs, thereby providing more opportunities to use these drug.

Paragraph 4 In most developed countries, the debate about cannabis policy is often simplified to a choice between two
options: to legalize cannabis because its use is harmless, or to continue to prohibit its use because it is harmful. As a
consequence, evidence that cannabis use causes harm to adolescents is embraced by supporters of cannabis prohibition and
is dismissed as “flawed” by proponents of cannabis legalisation.

Paragraph 5 A major challenge in providing credible health education to young people about the risks of cannabis use is in
presenting the information in a persuasive way that accurately reflects the remaining uncertainties about these risks. The
question of how best to provide this information to young people requires research on their views about these issues and the
type of information they find most persuasive. It is clear from US experience that it is worth trying to change adolescent
views about the health risks of cannabis; a sustained decline in cannabis use during the 1980s was preceded by increases in
the perceived risks of cannabis use among young people.

Paragraph 6 Cannabis users can become dependent on cannabis. The risk (around 10%) is lower than that for alcohol,
nicotine, and opiates, but the earlier the age a young person begins to use cannabis, the higher the risk. Regular users of
cannabis are more likely to use heroin, cocaine, or other drugs, but the reasons for this remain unclear. Some of the
relationship is attributable to the fact that young people who become regular cannabis users are more likely to use other
illicit drugs for other reasons, and that they are in social environments that provide more opportunities to use these drugs.

Paragraph 7 It is also possible that regular cannabis use produces changes in brain function that make the use of other drugs
more attractive. The most likely explanation of the association between cannabis and the use of other illicit drugs probably
involves a combination of these factors. As a rule of thumb, adolescents who use cannabis more than weekly probably
increase their risk of experiencing psychotic symptoms and developing psychosis if they are vulnerable—if they have a family
member with a psychosis or other mental disorder, or have already had unusual psychological experiences after using
cannabis. This vulnerability may prove to be genetically mediated.
Part B : Multiple Choice Questions
1. In paragraph 1, which of the following statements does not match the information on cannabis use? a. The use of
cannabis by teenagers has been increasing over the past 40 years. b. Cannabis use has adverse effects on young people. c.
Withdrawal symptoms are more common in males. d. People try cannabis for the first time at a younger age than previously.
2. Epidemiological studies in the 1980s & 1990s have found that…. a. 4% of the US population currently suffer from cannabis
abuse or dependence. b. starting cannabis use at a young age increases the risk of dependence or abuse. c. only a minority of
surveys researched treatment options for cannabis dependent people. d. people who start cannabis use at a young age have
high risk of becoming daily users.

3. The main point of paragraph 3 is that… a. alcohol, tobacco and cannabis can lead to the use of heroin and cocaine. b. most
adolescents who have used cocaine or heroin first try alcohol, followed by tobacco and then cannabis. c. there is a clear link
between habitual cannabis use and the use of heroin and cannabis. d. the black market is the main source of illicit drugs.

4. Which of the following would be the most appropriate heading for paragraph 4? a. Opinion on an effective cannabis
policy is divided. b. Cannabis use is harmful to adolescents and should be prohibited. c. Cannabis use is a serious problem in a
majority of developed countries. d. Cannabis use should be legalised.

5. The word closest in meaning credible in paragraph 5 is… a. believable b. possible c. high quality d. inexpensive

6. Cannabis use in the US declined during the 1980s because… a. parents were able to explain the health risks of cannabis
use. b. there was good health education regarding the health risks associated with cannabis use available at that time. c.
cannabis had increased in price d. young people had became more worried about its effect on their health

7. The word relationship in paragraph 6 refers to the connection between… a. legal drugs such as alcohol and nicotine and
illegal drugs such as cannabis, cocaine and heroin. b. cannabis use and dependency. c. the use of hard drugs such as heroin
and cocaine and cannabis use. d. regular users and their partners.

8. Which of the following statements best matches the information in the last paragraph? a. Regular cannabis use produces
changes in brain function. b. Regular adolescent cannabis users with a genetic predisposition to mental disorders have an
increased risk of encountering psychosis. c. Regular adolescent users of cannabis are vulnerable to psychosis. d. Occasional
use of cannabis can make other drugs more appealing.

Answer Key 1. b 2.b 3. c 4. a 5. a 6. d 7. c 8.b

Question 1 a) Incorrect: Mentioned b) Correct: not mentioned (note: misadventures can have an adverse effect, but nothing
is mentioned directly about cannabis) c) Incorrect: Mentioned d) Incorrect: Mentioned

Question 2 a) Incorrect: Not currently, at some time in their lives. b) Correct: risk (of abuse/dependence) is much higher for
persons who start using at an early age c) Incorrect: play on word order d) Incorrect: Not mentioned

Question 3 a) Incorrect: This is not stated and is logically incorrect. b) Incorrect: The statement itself is correct, but it is not
the main idea. c) Correct: this sentence best summarises the main idea. d) Incorrect: This is probably true, but it is not stated,
nor is it the main idea.

Question 4 a) Correct: Yes: debate about cannabis policy is often simplified to a choice between two options (therefore
opinion is divided) b) Incorrect: This is only one side of the debate. c) Incorrect: This is not mentioned d) Incorrect: This is the
other side of the debate.

Question 5 a) Correct b) Incorrect c) Incorrect d) Incorrect

Question 6 a) Incorrect: Parents not mentioned b) Incorrect: Education not mentioned c) Incorrect: No mention of price d)
Correct: preceded by increases in the perceived risks of cannabis use among young people.

Question 7 a) Incorrect: Not mentioned b) Incorrect: Not mentioned c) Correct: See highlighted text d) Incorrect: Partners not
mentioned!

Question 8 a) Incorrect: Incomplete information b) Correct: Meaning is the same, note use of synonyms i.eencountering for
experiencing c) Incorrect: Only certain users, see B d) Incorrect: Not occasional use, regular use.
FULL TEST 21
PART B

READING PASSAGE A

Pancreatic Islet Transplantation

The pancreas, an organ about the size of a hand, is located behind the lower part of the stomach. It makes insulin and
enzymes that help the body digest and use food. Spread all over the pancreas are clusters of cells called the islets of
Langerhans. Islets are made up of two types of cells: alpha cells, which make glucagon, a hormone that raises the level of
glucose (sugar) in the blood, and beta cells, which make insulin. Islet Functions Insulin is a hormone that helps the body use
glucose for energy. If your beta cells do not produce enough insulin, diabetes will develop. In type 1 diabetes, the insulin
shortage is caused by an autoimmune process in which the body's immune system destroys the beta cells. Islet
Transplantation In an experimental procedure called islet transplantation, islets are taken from a donor pancreas and
transferred into another person. Once implanted, the beta cells in these islets begin to make and release insulin. Researchers
hope that islet transplantation will help people with type 1 diabetes live without daily injections of insulin.

Research Developments Scientists have made many advances in islet transplantation in recent years. Since reporting their
findings in the June 2000 issue of the New England Journal of Medicine, researchers at the University of Alberta in Edmonton,
Canada, have continued to use a procedure called the Edmonton protocol to transplant pancreatic islets into people with
type 1 diabetes. According to the Immune Tolerance Network (ITN), as of June 2003, about 50 percent of the patients have
remained insulin-free up to 1 year after receiving a transplant. Researchers use specialized enzymes to remove islets from the
pancreas of a deceased donor. Because the islets are fragile, transplantation occurs soon after they are removed. During the
transplant, the surgeon uses ultrasound to guide placement of a small plastic tube (catheter) through the upper abdomen
and into the liver. The islets are then injected through the catheter into the liver. The patient will receive a local anesthetic. If
a patient cannot tolerate local anesthesia, the surgeon may use general anesthesia and do the transplant through a small
incision. Possible risks include bleeding or blood clots.

It takes time for the cells to attach to new blood vessels and begin releasing insulin. The doctor will order many tests to check
blood glucose levels after the transplant, and insulin may be needed until control is achieved.

Transplantation: Benefits, Risks, and Obstacles The goal of islet transplantation is to infuse enough islets to control the blood
glucose level without insulin injections. For an average-size person (70 kg), a typical transplant requires about 1 million islets,
extracted from two donor pancreases. Because good control of blood glucose can slow or prevent the progression of
complications associated with diabetes, such as nerve or eye damage, a successful transplant may reduce the risk of these
complications. But a transplant recipient will need to take immunosuppressive drugs that stop the immune system from
rejecting the transplanted islets. Researchers are trying to find new approaches that will allow successful transplantation
without the use of immunosuppressive drugs, thus eliminating the side effects that may accompany their long-term use.
Rejection is the biggest problem with any transplant. The immune system is programmed to destroy bacteria, viruses, and
tissue it recognizes as "foreign," including transplanted islets. Immunosuppressive drugs are needed to keep the transplanted
islets functioning.

Immunosuppressive Drugs The Edmonton protocol uses a combination of immunosuppressive drugs, also called antirejection
drugs, including dacliximab (Zenapax), sirolimus (Rapamune), and tacrolimus (Prograf). Dacliximab is given intravenously
right after the transplant and then discontinued. Sirolimus and tacrolimus, the two main drugs that keep the immune system
from destroying the transplanted islets, must be taken for life.

These drugs have significant side effects and their long-term effects are still not known. Immediate side effects of
immunosuppressive drugs may include mouth sores and gastrointestinal problems, such as stomach upset or diarrhea.
Patients may also have increased blood cholesterol levels, decreased white blood cell counts, decreased kidney function, and
increased susceptibility to bacterial and viral infections. Taking immunosuppressive drugs increases the risk of tumors and
cancer as well.

Researchers do not fully know what long-term effects this procedure may have. Also, although the early results of the
Edmonton protocol are very encouraging, more research is needed to answer questions about how long the islets will survive
and how often the transplantation procedure will be successful. Before the introduction of the Edmonton Protocol, few islet
cell transplants were successful. The new protocol improved greatly on these outcomes, primarily by increasing the number
of transplanted cells and modifying the number and dosages of immunosuppressants. Of the 267 transplants performed
worldwide from 1990 to 1999, only 8 percent of the people receiving them were free of insulin treatments one year after the
transplant. The CITR's second annual report, published in July 2005, presented data on 138 patients. At six months after
patients' final infusions, 67 percent did not need to take insulin treatments. At one year, 58 percent remained insulin
independent. The recipients who still needed insulin treatment after one year experienced an average reduction of 69
percent in their daily insulin needs.

A major obstacle to widespread use of islet transplantation will be the shortage of islet cells. The supply available from
deceased donors will be enough for only a small percentage of those with type 1 diabetes. However, researchers are pursuing
avenues for alternative sources, such as creating islet cells from other types of cells. New technologies could then be
employed to grow islet cells in the laboratory.

Title: Pancreatic Islet Transplantation Read the text and select the best answer for each of the questions below.

1. The pancreas is

a) in the hand b) in the stomach c) above the stomach d) behind the lower part of the stomach

2. What is the main purpose of insulin?

a) It is a hormone b) to destroy beta cells c) to assist in energy production d) to stimulate the auto immune process

3. According the article, is islet transplantation common practice?

a) Yes, it’s frequently used b) No, it’s still being trialled c) Not stated in the article d) Yes, but only in Canada

Pancreatic Islet Transplantation

4. What is the Edmonton Protocol?

a) A trade agreement b) The journal of Alberta University c) A way to transplant pancreatic islets d) Not stated in the article

5. What’s the source of the pancreatic islets that are used in the transplant operation?

a) They are donated by relatives b) They come from people who have recently died c) They are grown in a laboratory d) They
come from foetal tissue

6. Which one of the sentences below is true?

a) A local anaesthetic is preferred where possible b) A general anaesthetic is preferred where possible c) A general
anaesthetic is too risky due to the possibility of blood clots and bleeding. d) An anaesthetic is not necessary if ultrasound is
used 7. How soon after the operation can the patient abandon insulin injections?

a) Immediately b) After about two weeks c) When the blood glucose levels are satisfactory d) After the first year

8. How many islets are required per patient?

a) About a million b) 70 kg c) Whatever is available is used d) it depends on the size of the patient

9. Immediately after the operation the patient must take

a) insulin b) immunosuppressive drugs c) both a and b d) nothing

10. Patients on immunosuppressive drugs may experience

a) mouth sores b) gastro-intestinal problems c) increased cholesterol levels and decreased kidney function d) All of the above

11. Twelve months after the operation, how many more patients were still independent of insulin after the introduction of
the Edmonton Protocol compared with before its introduction? a) 8% b) 50% c) 58% d) 67%

ANS:1. D 2. C 3. B 4. C 5. B 6. A 7. C 8. D 9. B (Insulin MAY be needed until control is achieved) 10. D 11. B (58% - 8% = 50%)
READING PASSAGE B

SUICIDE RATES MASK MEN AT RISK

Occurrences are falling, but researches are worried about a continuing rise among young to middle-aged men. Health editor
Adam Cresswell reports. Paragraph 1 As the manager of the national suicide counselling service Mensline Australia, Terry
Melvin is used to being confronted with tense, life-or-death situations. Such as recently when a man rang the service to talk:
when the conversation started he already had a gun in this mouth. Sadly, this scenario is hardly a one-off. Mensline
Australia fields an average of two calls per day from men with suicidal plans or thoughts and occasionally the men ring when
they are in a position to enact them. Paragraph 2 Melvin explains that in these cases, the operators may attempt to contact
the police and have the call traced. More than once, police have as a result been able to rush to the scene in the nick of time
and stop the caller taking the drastic last step - one that invariably causes untold and long-lasting grief to partners, friend
and families. Melvin has also noticed something that is worrying some suicide researchers – a shift in the age of the men who
are now most likely to kill themselves. Paragraph 3 But first, a step back. Suicide rates were in the headlines in the last 1990s,
when the numbers were rising fast. But now that curve has levelled off, and the latest official figures – published by the
Australian Bureau of Statistics in March – confirmed that the rate is now gently declining overall. There were 2008 deaths
from suicide registered in 2004, the year to which the latest figures relate – a 5.2 per cent decrease on the figures recorded
the previous year, when there were 2213 recorded suicides. The annual suicide toll rose over 2000 and 2001, but the latest
figures mean it has been falling now for the subsequent three years. Some think this plateau or gentle decline has created a
creeping complacency about suicide in Australia, an idea that it is something we no longer need to worry so much about.
Paragraph 4 But many suicide experts say that idea is a big mistake. “Five men kill themselves every day in Australia,” says
John Macdonald, president of the Australasian Men’s Health Forum and professor of primary health care at the University of
Western Sydney. “If there were five whales being washed up on a Sydney beach every day, we would be really concerned.
You don’t have to be ‘crazy’ to kill yourself.” Nearly 80 percent of suicides are by men. What is puzzling or concerning some
suicide experts, including Macdonald, is that although the overall number of suicides has levelled off, this has camouflaged
the fact that the rate is continuing to rise among men aged 25-44. Paragraph 5 There are a couple of theories as to why this
should be so, but one in particular is troubling. The peak group for suicide used to be boys in late adolescence and young men
in their early 20s. With the peak now being seen in men aged 25-44, some suggest this means it is the same group of people
– those born roughly in the 1960s and 1970s – who are continuing to kill themselves in the greatest numbers. Put another
way, what this theory suggests is that the peak suicide group today is roughly the same group of people who were the peak
group a few years ago, when they were teenagers – it’s just that now they are a bit older and are showing up in the statistics
in a later age bracket. “We have wondered about this for the past four or fives years,” say Michael Dudley, chairman of
Suicide Prevention Australia and senior lecturer in psychiatry at the University of NSW. “As the suicide figures emerge, you
see this wave effect, and that’s supporting this suggestion that there’s a group of high-risk people moving through.”
Paragraph 6 Melvin agrees that is one of the theories, and says it fits in the pattern of calls to Mensline Australia. The
services averages about 3800 calls from around the country every month, the bulk of which he says are from men aged
between 29 and 49. “They are often men who are going through some sort of life change, and often it’s the period of time
when the family and relationships issue rears its head - 45 per cent of our callers are going through separation or family
breakdown,” he says. “We know that particular group are at high risk for self-harm and suicide.” Paragraph 7 Of course, it
takes two to separate as much as to tango, but the evidence is that marital and family break-up hits men much harder than it
does women. Women are better at maintaining the all-important extended family and social networks that are crucial in
helping individuals cope with trying circumstances, and are much better at using these net-works to seek advice, share their
concerns or simply find a shoulder to cry on. Paragraph 8 But there’s another factor too: for men, much more than for
women, a relationship break-up usually means more than losing a partner. It often means losing any children too, at least
between access visits. Dudley thinks this is something that may be exacerbating other aspects of rapid social change which
he says have already resulted in a “loss of anchorage” for many men as their traditional roles and community supports are
eroded. “Men are often separated from their partners as well as from their children, which is frequently commented on by
men’s consumer groups, who have been very troubled by this and angry>” Dudley says. “I don’t think we know how much
that contributes to the total problem.” Paragraph 9 But this theory that there is something peculiar about men born in the
1960s and ‘70s that puts them at a higher risk of suicide remains just that, a theory. And John Macdonald for one is not yet
convinced. He says another – probably more plausible- explanation for the shift in the ages of those most of risk is not that
it’s the same group of people who are now a bit older, but that there are two distinct problems youth suicide and adult
suicide, and we have simply managed to tackle the first more effectively than the second. Paragraph 10 As a result, youth
suicide rates have gone down, leaving suicides among the older age groups more noticeable. “It’s much more easy to get
national sympathy for youth suicide.” He says. “ It’s interesting speculation (to suggest a cohort effect)…but that could also
be a sign that there are changes in society that are making men aged 25-44 commit suicide for frequently.” Paragraph 11 A
national forum to discuss some of these issues was held by SPA, Mensline Australia and its parent body, the Victoria-based
Crises Support Services, in Sydney in May. The outcome of that meeting – a 25 page “Blueprint for the future” – was
launched last weekend to coincide with Suicide Awareness Day. The document aims to create a “national vision” for tacking
male suicide, and boldly sets a goal of removing suicide as a health risk for men within one generation. Paragraph 12 Dudley
concedes changing ingrained notions of what it means to be a man - which for some men makes it difficult for them to
confront their emotional needs, let alone discuss then with others – are not straightforward. But there are already specific
measures in train. We have undertaken to sit down with workplace groups like the construction industry and talk with them
about how we engage not only apprentices, but also managers, to have a workforce that’s observant not only to
occupational health and safety matters, but also provides a safer environment for people overall.” The idea, he says is to
encourage workplaces “where it’s okay to get help, where people are not black-marked for getting help. We have to change
the way blokes and their needs are seen. Men have emotions too- men can cry, and men have stuff they need to process. It’s
important not only for them individually, but it’s likely to lead to better productivity and less time off.” Source: The Weekend
Australian

OET reading style questions Suicide rates mask men at risk

1. The scenario described in the last sentence of paragraph 1 a) happened only once b) happens occasionally c) is common d)
is rare

2. Which of the following statements is true a) The number of people who committed suicide started to decrease at the end
of the 1990s b) There were more deaths in 2001 than in 2000 c) There were more deaths in 2000 than in 2001 d) Since 2001
the suicide rate has remained stable

3. We can infer from John Macdonald’s words in paragraph 4 that a) Whales dieing on Sydney’s beaches is a regular
occurrence b) Most of the people who kill themselves are crazy c) People should be more concerned about the suicide
problem d) In Australia 5 people kill themselves everyday

4. In paragraph 5 the suicide statistics indicate that a) Men born in the 1960s & 1970s have the highest rate of suicide b) The
age group most likely to commit suicide is young people in their twenties c) Teenagers are least likely to commit suicide d)
Older people are more likely to commit suicide

5. We can infer from the article that a) Family breakdown is a major cause of suicide among men b) Men are less likely to
find support than women c) Men often lose more than women if a relationship breaks-up d) all of the above

6. John Macdonald a) accepts the proposed theory is true b) has a different theory to explain the suicide rate
c) committed suicide last year d) none of the above

7. We can understand from paragraph 12 that a) the suicide problem relates to men’s inability to express their
feelings b) suicide is related to workplace conditions c) men need to cry more often d) it will take more than
one generation to solve the problem

ANSWERS:

Question 1 a) Incorrect: b) Correct: Sadly, this scenario is hardly a one-off c) Incorrect: d) Incorrect

Question 2 a) Incorrect: b) Correct: The annual suicide toll rose over 2000 and 2001 c) Incorrect d) Incorrect

Question 3 a) Incorrect: b) Incorrect: c) Correct: Logical inference d) Incorrect:

Question 4 a) Correct: those born roughly in the 1960s and 1970s – who are continuing to kill themselves in the greatest
numbers b) Incorrect: c) Incorrect d) Incorrect:

Question 5 a) Incorrect: True: 45 per cent of our callers are going through separation or family breakdown,” he says. “We
know that particular group are at high risk for self-harm and suicide.” b) Incorrect: True: Women are better at maintaining
the all-important extended family and social networks that are crucial in helping individuals cope with trying circumstances
c) Incorrect True: for men, much more than for women, a relationship break-up usually means more than losing a partner. It
often means losing any children too d) Correct: All of the above

Question 6 a) Incorrect b) Correct: And John Macdonald for one is not yet convinced. He says another – probably more
plausible- explanation for the shift c) Incorrect: d) Incorrect

Question 7 a) Correct: for some men makes it difficult for them to confront their emotional needs, let alone discuss then with
others – are not straightforward b) Incorrect c) Incorrect d) Incorrect:
FULL TEST 22
PART B

READING PASSAGE A

Skin cancer medicine in primary care: towards an agenda for quality health outcomes
The recent report of a patient who attended a skin cancer clinic in New South Wales in 2002,and apparently failed to have a
melanoma diagnosed, and then sued his attending practitioner, sends a chill through every doctor who has ever assessed a
pigmented skin lesion.1 Although settled out of court, this case highlights the clinical challenges of screening for and
diagnosing skin cancer, and throws into sharp relief the issue of quality and safety in skin cancer clinics in Australia.

In the Newcastle Herald in July 2005, Emeritus Professor Bill McCarthy of the Sydney Melanoma Unit is quoted as saying “I
want to make it clear that I believe some clinics are very careful and do good work”. However, he also expressed concern that
quality across the clinics was patchy:

Obviously some people have seen an entrepreneurial opportunity and some clinics have been put together by non-medical
people who have simply advertised for doctors to work for them. The staff of some clinics do not have any specialised
training: they may have just qualified or they may be overseas practitioners. Some fancy themselves as surgeons and maybe
some were in other countries but they may not meet Australian standards. There is no quality control and no accreditation
scheme. There are some who have come to me for advice. They might tell me they are going to work in a skin cancer clinic in
a country town, for example. They sit in on my clinics for a day and, while that isn’t training, it’s better than nothing.1

Skin cancer is by far the most common cancer in Australia. The most common and important skin cancers are basal cell
carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma. In 2002, there were estimated to be 374 000
cases of BCC plus SCC.2 The agestandardised incidence of BCC alone in men was 1150/100 000; more than 10 times that of
prostate cancer, the next most common cancer.2 Most BCCs and SCCs occur in older Australians, causing considerable
morbidity, but little mortality. In 2000–2001, they were also the most expensive cancer to treat, costing $264 million,
followed by breast cancer at $241 million.3 Melanoma is the most common cancer among those aged 15–44 years, and the
second most common cause of cancer death in that age group, and it accounts for 3% of all cancer deaths in all ages (1199
deaths in 2001).2

Skin cancers are the most common cancers managed by general practitioners, with more than 800 000 patient encounters
each year.3 While historically GPs have managed most skin cancers,4 in recent years, with the rapid growth of “skin cancer
clinics”, there has been a dramatic change. Little is known about these clinics; some include large “corporate” chains and
others comprise smaller independent operators. Anecdotally, most doctors working in these clinics seem to be GPs, or at least
non-specialist doctors, from a variety of backgrounds.

Some concerns have been raised about the type and quality of work performed within these clinics from other sectors of the
profession.5 The pros and cons of “the fragmentation of general practice”, typified by skin cancer clinics, travel medicine
clinics, women’s health clinics and others have been considered previously.6

Currently, in Australia, there are:

no barriers to working in skin cancer medicine in primary care; limited training opportunities for generalist doctors wanting
to do this work (and no formal award courses); no opportunities for skin cancer clinics to be accredited against defined
standards; and no quality framework to support this work.

In August this year, the Skin Cancer Society of Australia was formed to provide one mechanism to redress some of these
deficiencies (http://www.skincancersociety.com.au).

Two of us (A D, P B) have worked in the skin cancer field for over 20 years, and A D has provided formal training for 15 years.
When one of us (D W) decided to start working in this field at the beginning of 2005, there was no barrier to taking a position
in a skin cancer clinic, and no formal assessment of competency. There was also no barrier to accessing the Medicare Benefits
Schedule (MBS) item numbers that relate specifically to the management of skin cancer, including some that relate to fairly
significant plastic surgical procedures. There were no easily accessible training opportunities, or postgraduate awards for
general practitioners in skin cancer medicine. Furthermore, as skin cancer clinics are demonstrably not general practices, they
cannot be accredited through the mechanisms that apply to Australian general practice. It is unclear whether the concerns
expressed by other sectors of the profession5 lie in the age-old debate “GPs versus specialists”, or whether it is “skin cancer
clinic doctors versus the rest”. Perhaps it is some of both. Certainly, there is real concern among mainstream general
practice6 that skin cancer clinics are an expression (or the cause of) fragmentation, and there is real concern from
dermatologists and plastic surgeons about encroachment on their domains of practice.

Without doubt, some dermatologists believe that they are the doctors best placed to diagnose and manage patients with
skin cancer. However, there are hardly enough dermatologists to cope with current demand for their general services, let
alone enough to manage the majority of skin cancers in Australia. Furthermore, some plastic surgeons believe that patients
receiving surgical treatment for skin cancer should be treated exclusively by them, but the geographic distribution of
dermatologists and plastic surgeons in Australia precludes their managing most patients. The perception may exist among
some GPs that skin cancer doctors are taking a lucrative (procedural) aspect of their practice away. At least some of this
debate seems to be vested in professional selfinterest, rather than a dispassionate consideration of what is best for the
patient.

Most patients with skin cancer can be competently diagnosed and treated by appropriately trained, non-specialist primary
care physicians, whether they are working in skin cancer clinics or in mainstream general practice.7,8 We also believe that
consultants, such as dermatologists and plastic surgeons, have a crucial role to play in helping manage the more complex
cases, as well as providing training. However, much more needs to be done if we are to collectively ensure that patients enjoy
maximal health outcomes, and that doctors are well trained and supported.

Multiple Choice Questions

1. There is concern about quality and safety in skin cancer clinics because: a) some doctors employed lack the required skills
b) Australian standards are difficult to meet c) they are in country towns d) Doctors rarely attend training

2. Which of the following statements is not true? a) Prostate cancer is less common than skin cancer b) People often die from
BCCs & SCCs c) Melanoma is a common cancer for people aged between 15~44 d) The older the person the greater the risk of
BCCs

3. Which of the following is not mentioned as a problem in Australia a) Lack of education & training b) Lack of patients c)
Lack of recognised guidelines for the clinics d) Ease at which doctors can choose to work in this area e) B & D

4. Dermatologists and plastic surgeons view skin cancer clinics as a threat to their business. True or False

5. In the paragraph beginning with Without doubt the author’s view is a) Dermatologists can provide better treatment for
skin cancer patients b) Only plastic surgeons should provide surgery c) GPs earn a lot of money from skin cancer patients d)
That some practitioners are more concerned about theier professional reputation instead of patient benefit.

6. Put the section headings in the correct place in the article a) Where does the divide lie? b) The problem c) Skin cancer in
Australia d) Skin cancer in general practice: emergence of new models of care

ANSWERS

Question 1 a) Correct: The staff of some clinics do not have any specialised training: b) Incorrect: c) Incorrect: d) Incorrect

Question 2 a) Incorrect: True b) Correct: Untrue: Most BCCs and SCCs occur in older Australians, causing considerable
morbidity, but little mortality. c) Incorrect: True d) Incorrect: True

Question 3 a) Incorrect: Mentioned b) Correct: Not Mentioned c) Incorrect: Mentioned d) Incorrect: Mentioned

Question 4: a) False: The perception may exist among some GPs that skin cancer doctors are taking a lucrative (procedural)
aspect of their practice away.

Question 5 a) Incorrect b) Incorrect: c) Incorrect: d) Correct: At least some of this debate seems to be vested in professional
self-interest, rather than a dispassionate consideration of what is best for the patient.

Question 6 Put the section headings in the correct place in the article a) Where does the divide lie? : 4 b) The problem: 3 c)
Skin cancer in Australia : 1 d) Skin cancer in general practice: emergence of new models of care: 2
READING PASSAGE B

What’s Sex Got To Do With It.

1. What are listed as symptoms of clinical depression in the first paragraph?

a) Moodiness and melancholy b) Loss of appetite and insomnia c) Discolouration of the skin d) a & b

2. According to the article, why is diagnosing mental illness difficult? Because

a) patients are often wrongly labeled b) diagnosis relies on experience, careful study of the patient and, perhaps, good
intuition. c) medical texts can be inaccurate with regard to diagnosis of mental disorders. d) patients may choose to deceive
their doctor.

3. Which of the statements below is NOT true. Medical texts report that

a) women are more prone to depression and anxiety disorders than men. b) Men are more likely to suffer from alcohol
abuse and violence. c) the number of women suffering from depression is double that of men. d) Women are often depressed
because the men in their lives are impulsive and violent.

4. Based on the examples given in the text which of the following would probably be considered emotionally unsettling?

a) A kettle b) A detached limb c) A fire hydrant d) A cup of tea.

5. What did MRI scans discover about how men and women remembered emotive pictures?

a)Women linked the picture with an emotion and stored them together. Men stored the emotional content and the factual
information separately. b) Women have a superior memory. c) Men suppressed the emotions connected to the pictures;
women were more easily upset by the pictures d) Women were 15% more likely to remember the pictures than the men in
the study were.

6. Which one of the statements below is true?

a) Hormonal differences explain why more boys than girls are autistic. b) Estrogen and progesterone in the womb result in
women become more emotionally integrated in later life. c) It’s possible that a sudden increase in hormones may cause an
increase in female depression rates. d) Estrogen and progesterone levels rise sharply in older women.

7. If a boy and a girl both have an emotional problem, who is more likely to want to discuss it? a) The girl because of her
hormone levels. b) The girl because of her upbringing. c) The boy because of his hormone levels. d) The boy because of his
upbringing.

8. What is premenstrual dysphoric disorder?

a) A severe type of premenstrual syndrome. b) A type of premenstrual disorder caused by exposure to petrol fumes. c) A
psychosomatic condition. d) An easily cured condition frequently mentioned in medical literature as an example of PMS.

9. Which of these scientists is working with the World Health Organization?

a) Turhan Canli b) Dr Nada Stotland c) Paula Caplan d) Ron Kessler

10. Which statement best describes the WHO study mentioned?

a) Superficial b) Extensive c) Gender-based d) Doubtful

 What’s Sex Got To Do With It?
Your gender can determine a lot-including, perhaps, your mental health By JEFFREY KLUGER

If you have been moody and sad, unable to eat or sleep, chances are you suffer from clinical depression--unless, of course,
it's just a bout of the blues. If you have a nasty habit of getting into brawls, chances are you are an antisocial personality--
unless, of course, you are just a bit of a hothead. What determines whether you are sick or well? Often as not, it's whether
you are male or female.

Diagnosing mental disorders has always been a tricky business, with doctors often relying on little more than observation,
experience and the occasional hunch. Once the labels are applied, however, they stick, and medical texts tend to accept the
results as truth--reporting, say, that two times as many women suffer from depression as men or that twice as many men
suffer from alcoholism. Similarly, women are said to be more prone to anxiety disorders, while men may lean toward
conditions stemming from impulsiveness and violence.

Is there something about our psychic makeup that makes one gender more vulnerable to some disorders than others? Or
does it have more to do with societal roles? And if environment is the determining factor, will the illnesses that beset each
sex change as society evolves?

Researchers seeking to answer those questions come up against a confounding mess of variables--everything from changing
hormone levels to a patient's willingness to admit that a problem exists. But last summer a researcher at Stanford University
tried to wave away some of the fog. Turhan Canli showed nearly 100 photographs--some of emotionally neutral objects like a
fire hydrant, others of emotionally unsettling things like a severed hand--to 12 men and 12 women. Three weeks later he
showed the subjects the same images and found that the women were 15% more likely to have accurately remembered the
emotionally charged pictures than the men were. Brain scans produced by functional magnetic resonance imaging suggested
why: the women stored both memory and the emotion linked with it in the same parts of the brain. The men used the
identical brain regions but tucked away the emotion and the memory into different spots within them.

If women are better integrated emotional organisms, that difference may begin in the womb, when estrogen and
progesterone help shape the function and structure of the brain. "The hormones are very physiologic," says Dr. Nada
Stotland, professor of psychiatry at Rush Medical College in Chicago. "They have very measurable effects." Similar hormonal
surges later in life may have an equally profound impact, triggering higher rates of depression among women between
puberty (when estrogen starts to rise and fluctuate) and menopause (when the hormone is turned down low). Other--though
less clear--physical differences may explain why boys are more likely than girls to develop such early-onset illnesses as
autism.

But while biology is important, nobody discounts environment. Girls are taught early that the best way to manage feelings is
to dredge them up and air them out. Boys are taught the value of suck-it-up silence. "Later in life," says psychologist Paula
Caplan of Brown University, "women are thus more likely to come forward and ask for help."

Even the apparent connection between hormones and depression may be more environmentally linked than it appears. One
study revealed that pubescent girls are more depressed in school systems in which seventhgraders attend the same school as
ninthgraders, as opposed to K8 systems, in which students in Grade 7 remain near the top of the social ladder longer. "The
problem may simply be that the girls become depressed when they encounter older boys at an earlier age," says Ron Kessler,
professor of health-care policy at Harvard Medical School. In other cases, there is doubt whether a mental condition exists at
all. Caplan believes that premenstrual dysphoric disorder--essentially high-octane PMS--doesn't belong in the medical
literature. Eliminate the condition, and many women instantly get well.

None of these matters are close to being completely sorted out, but science is trying. Kessler is working with the World
Health Organization to study 200,000 men and women in 28 countries, focusing particularly on the issue of gender and
depression. Along with researchers from the National Institute of Mental Health, Kessler is taking surveys and saliva samples
of 10,000 U.S. adolescents, hoping to correlate mental health and hormone levels. Will you find their results convincing? That
also may depend on your gender.

ANSWERS

1. D 2. B 3. D 4. B 5. A 6. C 7. B 8. A 9. D 10. B
FULL TEST 23
PART B
READING PASSAGE A

With Help From Friends

The kid who puts tacks on classmates' chairs and turns his math tests into paper planes may have a problem, but chances are
someone will act quickly to find out what it is. Maybe it's one of the attention disorders so commonly diagnosed these days;
perhaps there's trouble at home. The point is that disruptive children don't go unnoticed. But what of the child in the same
classroom who never acts up and whose reports are full of ticks in the right boxes? Though easy to teach compared to the
troublemaker, some children like this might also be crying out for help, if only they could summon the nerve. Thanks to a new
Australian program, help might find them first.

The prevalence of anxiety among children in many developed nations seems to be rising. Whatever the causes (and the
decline of the extended family, overemphasis on achievement and a general speeding up of life are all possibilities), it's
estimated that between 15 and 20% of kids feel anxiety that diminishes the quality of their lives. Put simply, these children
spend too much time worrying, ruining what should be their most carefree years.

Instead of looking forward to a school camp, for example, they fret about what might go wrong, like being served food they
don't like or having to shower in front of others. While these scenarios might cross the minds of most kids, anxious ones
would rather skip the camp than risk embarrassment. Some extremely anxious children worry incessantly about things
beyond their control, such as earthquakes, nuclear war and sars, inflating in their minds the danger to themselves and their
families. Worse, sufferers feel compelled to conceal their fears from everyone and often grow into depressed teens. "Anxious
children are too rarely brought to us," says clinical psychologist Dr. Paula Barrett, director of Pathways Health and Research
Centre in Brisbane, "so we've started going to them."

This is done with a Barrett-designed program called friends, which is used widely in Australian hospitals and clinics to treat
anxious children and depressed adolescents. But it's as a course presented in both primary and secondary schools and aimed
at preventing anxiety that friends (a mnemonic for Feeling worried? - Relax - Inner thought - Explore plans - Nice work,
reward - Don't forget to practice - Stay calm) is taking off. By helping young people to accept their feelings as legitimate and
showing them techniques of positive thinking and problem solving, the program "builds their emotional resilience," claims
Barrett, who is also associate professor of psychology at Griffith University. In Australia, some 40,000 students - mainly in
private schools - have done friends, which has also reached children in New Zealand, South Africa, the U.S. and Europe.
Canadian schools are soon to begin a large trial of the program, which will be translated later this year into Chinese and
Russian. "Dr. Barrett's work in childhood anxiety can only be described as ground-breaking," says Dr. Deborah Beidel,
professor of psychology at the Maryland Center for Anxiety Disorders, a leading specialist facility in the U.S.

As both a preventive and a treatment tool, friends is helping to control childhood distress. For evidence, there are the
favorable results of numerous trials - and there are children like Maddison, who was eight when her Dad left home to live
with one of her Mum's friends. Previously outgoing, she became increasingly withdrawn and diffident as she struggled with
feelings of guilt and confusion. Steered toward Barrett by the family's G.P., Maddison thrived in the friends program. One
afternoon last week she sat doing her homework at a desk at Pathways, where her mother, Vikki, works at the front desk.
Now 11, Maddison explained how she'd just auditioned at a big dance school. It had been nerve-racking, she said, having to
perform ballet and a jazz routine in front of the examiners and other kids; she'd even had to sing Happy Birthday. She didn't
make it into the school, but the point for her was that she'd tried, and driving home afterward Vikki choked up when
Maddison told her, "You know, I'm so proud of myself."

In the '90s, as Barrett was drawing on work by American psychologist Phillip Kendall to design friends, researchers were fine-
tuning their theories on the types of children most prone to anxiety. They now believe that 1 in 5 is born, as Barrett describes
it, "physiologically sensitive to stress and certain stimuli." A test for this sees threemonth-old babies held by their mothers
and exposed to a sudden noise. The heart rate of the sensitive child rises higher and more quickly than the average child's,
and remains elevated for longer.

But of every five sensitive kids (who tend to be smart and artistic), three won't develop problems with anxiety. Their secret,
explains Barrett, is certain "protective factors." Top of these is parenting style: the sensitive child whose parents are
encouraging and optimistic generally rises above his predisposition toward anxiety. On the other hand, a child with the
double whammy of physiological sensitivity and negative parents whose favored approach to problems is to avoid them "is
going to be a bit of a mess," says Barrett. Sensitive kids "desperately need the parent who says, �Yes, there are some
dangerous things, but we can learn to cope with them and generally the world is a pretty good place.'" In the past few years,
researchers have become convinced that other things can help prevent children from lapsing into anxiety, including a school
environment that is welcoming and puts participation above achievement, and a network of good friends.

Barrett first read psychologist Kendall's work while researching her Master's thesis on childhood fears in 1992. She was
fascinated, and later wrote to him seeking permission to develop it. Kendall had challenged the prevailing notion that
children weren't capable of thinking about how they think, and that it was therefore pointless to try to treat their anxiety
with cognitive behavioral therapy; the only solution, it was believed, was to help the parents manage the child's behavior.
Barrett agreed CBT directed at the child could work, and thought Kendall's "Coping Cat" program could be built on by
encouraging greater parental and sibling involvement in the treatment. She also began treating anxious kids in groups,
convinced the interaction would boost their confidence.

Her latest contribution is the prevention program. There are two friends courses in schools, one aimed at children aged 10-12,
the other at 15- and 16-year-olds. Run by teachers in 10 sessions over as many weeks, they introduce children to "thought
terminators" to fight negative thinking and six-step plans to beat problems that may seem insurmountable.

Apart from draining joy from young lives, untreated childhood anxiety tends to morph into adolescent depression, a strong
risk factor for suicide. Living with fear wears down the will to live, and constantly avoiding unpleasant things - while it offers
shortterm relief - eventually makes the sufferer feel isolated and useless. Katherine, 18, of Brisbane, recalls a childhood spent
in her "own little world," not feeling close to either parent, hung up on doing everything perfectly and racked by the fear of
getting into trouble. By her final year of high school, she was so filled with despair that she resolved to kill herself. "I had it
all planned out," she says. But with just days to spare, Katherine's concerned ancient history teacher steered her toward
Barrett. "When I was talking to Paula and doing the program, nothing else mattered," says Katherine. "Compared to how I
was, I'm 500% better." friends isn't a panacea. Katherine's treatment included antidepressant drugs, which Barrett says are
an important aid to treatment when the anxiety or depression is severe. She dismisses any suggestion that treating
childhood anxiety - even with cognitive behavior therapy alone - is an example of medicalizing normal human variation.
Some kids are always going to be scared of the dark or socially awkward, and friends doesn't expect to change that. The
beauty of presenting the program in schools, Barrett argues, is that it keeps nonanxious kids non-anxious, leads the
somewhat anxious toward normality, and helps teachers to identify those whose anxiety may need one-on-one clinical
attention. This last group's anxiety isn't part of the normal range of variation, she stresses: "Internally, they are suffering."

The saddest news on anxiety is that it is showing up in younger and younger children, and Barrett is now working on a
friends course aimed at pre-schoolers. Even the child playing quietly with her blocks may be thinking thoughts no one would
have imagined.

Title: With Help from Friends

Now read the text and select the best answer for each of the questions below.

1. In developing nations it is estimated that between 15% and 20% of children…

a) … suffer from attention disorders b) … have trouble at home c) … spend a lot of time worrying d) … never cause disruption
in the classroom

2. Some children worry continually about …

a) …earthquakes and nuclear war b) … growing up to be depressed c) … having to eat food they don’t like d) … danger from
their family

3. Dr Paula Barrett is …

a) … a professor at an Australian university b) … a psychologist c) … director of research d) … all of the above

4. Thousands of children have done friends in …

a) … Brisbane b) … Australia c) … Russia and China d) … Canada

5. Maddison was a child who…

a) … worked at pathways b) … entered a dance school by succeeding in her audition c) … was very conceited d) … felt guilty
because her father left home

6. Dr Barrett …

a) … developed the ideas for ‘Friends’ entirely by herself b) … stole the program for ‘Friends’ from an American psychologist
c) … built up the ideas of an American psychologist to design ‘Friends’ d) … made friends with as many psychologists as
possible

7. The proportion of children who will develop problems with anxiety is …

a) … completely unknown b) … three out of five c) … two out of five d) … about one out of five

8. A factor NOT working against the development of excessive anxiety is…

a) … psychological sensitivity b) … parents with a positive attitude to life c) … schools which emphasize cooperation rather
than competition d) …a group of supportive friends

9. According to Phillip Kendall …

a) …children cannot recognize their own state of mind b) … the best way to treat childhood anxiety is to help parents
manage a child’s behaviour c) … children are able to recognize problems in the way they think d) … children learn by copying
each other

10. Children who suffer from anxiety should be treated because …

a) … they are very unhappy b) … they can become depressed teenagers c) … they might eventually try to commit suicide d) …
all of the above

11. A ‘panacea’ is …

a) … a cure for everything b) … an anti-depressant drug c) … a pain killer d) … an aid to treatment

12. The ‘Friends’ program consists of …

a) … 10 programs in 12 weeks b) … 15 programs in 16 weeks c) … 6 programs d) … 10 programs in 10 weeks

ANSWERS

1. C 2. A 3. D 4. B 5. D 6. C 7. D 8. A 9. C 10. D 11. A 12. D

READING PASSAGE B

Venus and Mars collide

1. We have learned a great deal about the biology that underpins sex differences. For years, the accepted view was that all
embryos start out the same-the default sex being female. Then during the first trimester, in individuals that have inherited a
Y chromosome, a gene called sry, for sex determining region Y, switches on the development of the testes. These start
pumping out testosterone and by the time a baby boy is born, the "default" female brain has become masculine.

2. We now know that's_.n..o.Lquitahow__iLw.orks. It turns out there are "pro-female" as well as "pro-male" genes, and that
sexual differentiation is governed by a delicate balance between the two. In 2006, for example, Pietro Parma at the
University of Pavia in Italy, and colleagues, reported that a gene called r-spondin1 promotes the development of the ovaries,
and that without it individuals who are genetically female grow up physically and psychologically male, although they have
ambiguous external genitalia and are sterile (Nature Genetics, vol 38, p1304).

3. Biologists have also revised their views on the role of sex hormones. Testosterone in men and oestrogen in women were
always thought to account for most of the biological differences between the sexes. Testosterone in men and oestrogen in
women were always thought to account for most of the biological differences between the sexes. While that remains the
mainstream view, it is now clear that the effects of hormones and genes can interact, with implications for the wiring of the
brain and, ultimately, for behaviour. Moreover, the contribution of genes can in turn be modified by experience: a child's
early environment can induce chemical modifications of DNA-so-called epigenetic changes-that without altering the actual
sequence of a gene changes whether it is active or quiescent in a particular tissue.

4. The identification of all these sex-determining factors and their complex interactions has an important corollary, which is
that sex determination is not over by birth, as was once thought. Both nature and nurture play a role in shaping the
differences between men and women, nowhere more so than in the brain, which is constantly remoulded throughout our
lives. Many now believe that there are critical periods when the sex of a child's brain-and everything that accompanies it,
including such things as the J!19ivt<:Jua.l's attit~,Jdes to~ love_ocfoo_d: is particularl(,[Il_alleable.j By the time we reach
adulthood there are numerous differences in structure between the brains of men and women, as revealed by brain -imaging
studies. These could explain why males and females show such different vulnerabilities to mental illness and learning
difficulties, but as yet neuros_c;Jentists know little about how the structural differences translated into behaviour.

5. That said, over the years psychologists have developed a good picture of which human behaviours show sex differences.
What has emeqJed is a hierarchy of traits within which, Pfaff, a professor of neurobiology from Rockerfeller University in
New York, noted there is one rather obvious pattern. "The further you go from reproductive behaviour, the less impressive
the sex differences". So, not surprisingly, at the top of the table are gender identity and sexual orientation, which both have
a direct bearing on an individual's chances of reproducing. Put simply, the vast majority of people who think of themselves as
male are men, while those who consider themselves female overwhelmingly tend to be women. Likewise, most people who
prefer their sexual partners to be women are men (and vice versa).

6. Last year, Jay Giedd and Judith Roporport of the US National Institute of Mental Health in Bethesda, Maryland, compared
the extent of psychological differences between men and women with obvious physical onE~s such as height. They found that
most of the effects of sex on behaviour are only around half the size of those on height (Neuron, vol 67,p728). Nevertheless,
they found real and measurable differences in behaviour between the sexes. In regard to play behaviour, for example, boys
are on average more likely than girls to engage in rough-and-tumble play, or to choose a truck over a doll, but tht:!re enough
exceptions to that rule that it is not possible to predict a child's sex from his or her play preferences alone. The areas where
differences between men and women are about half that of height include aggression, empathy, assertiveness, and cognitive
skills, such as the ability to mentally rotate an object. Further down the list come verbal fluency and mathematical
attainment, which show far less variation between the sexes than we are often led to believe. And at the bottom of the chart
are a bunch of traits commonly thought to be biased by sex but which in practice show no di~~fl:iJ:>:~_difference between
men and women. These include computational\skills, overall verbal ability and leadership potential.
Venus and Mars collide

1. According to the article, which of the following is INCORRECT

a) the biology that underpins sex differences is simply a matter of the sry gene being switched on in those who have a y
chromosome, which stimulates testes development and the masculine brain forms b) There are pro-female and pro-male
genes which help to determine whether a person is male or female c) The absence of the gene r-spondin1 results in sterility
and external genital organs which are androgynous in appearance d) Oestrogen and testosterone have long been considered
to be behind most of the biological differences between men and women

2. Which of the following paragraphs would the following sentence be best inserted into: "But things get more contentious
when we start considering traits such as empathy and assertiveness"

a) paragraph 2 b) paragraph 4 c) paragraph 5 d) paragraph 6

3. The word, 'malleable' in paragraph 4 means

a) vulnerable b) partially informed c) unclear d) easily shaped

4) A suitable sub-heading for paragraph 4 could be

a) The brain b) Nature, nurture and the brain c) Sex determining factors d) Different vulnerabilities

5). Sex hormones

a) are no longer thought to account for many of the sex differences in males and females b) consist of testosterone in males
and oestrogen in females c) have effects which can interact with the effects of genes, affecting the brain and behaviour d)
can interact with genes

6. The statement, "The further you go from reproductive behaviour, the less impressive the sex differences" in paragraph 5
means

a) People are not impressed by sex differences which are not related to reproduction b) The less related to reproduction a
particular behaviour is, the less likely it is to display gender differences c) Reproduction is the only important sex difference d)
Sex differences are not very impressive or easily reproduced

7) The word, 'discernible' in paragraph 6 means

a) relevant b) significant c) gender-based d) obvious

8) Which of the following best sums up the view of the writer:

a) The differences between the sexes is the result of a number of factors including the interplay between genetics and the
environment b) The brain is the most important source of sex differences c) Sexual differentiation is still a matter of debate d)
The brains of men and women are different

ANSWERS:

1a 2c 3d 4b 5c 6b 7d 8a
FULL TEST 24
PAET B
READING PASSAGE A

The impending influenza pandemic: lessons from SARS for hospital practice
Routine infection control strategies are likely to have the most benefit

There is increasing concern regarding the possibility of another influenza pandemic arising from genetic mutation or
reassortment of the avian influenza strain H5N1. Governments have stockpiled billions of dollars worth of antiviral agents,
even though efficacy may be limited. Vaccines are being developed for a disease that does not yet exist. Many birds have
been destroyed in the hope of preventing a possible future mutation and spread of disease to humans. Meanwhile, since the
1918 influenza pandemic, the seasonal winter flu has killed more people than the number who died in the pandemic.

The recent SARS epidemic was a wake-up call regarding the risk of major epidemics. While important differences exist
between SARS and pandemic influenza, the experience of controlling SARS provides some lessons on how to prepare for
major outbreaks. It is possible that the next global infectious disease threat will not be influenza. Improving general infection
control procedures and preparedness has the potential to improve routine health care on a daily basis as well as improve our
ability to manage the next pandemic.

The SARS epidemic was not predicted. It took time to recognise that there was an epidemic and then to identify the virus.
Cooperation among affected countries led to a coordinated effort to improve infection control procedures and limit spread of
the disease. The epidemic was controlled largely with basic epidemiological principles of outbreak management and basic
infection-control strategies.

Hospital infection control

Infection control in hospitals is likely to have the most benefit in controlling a pandemic. The following points need to be
considered.

Overcrowding: Several of the hospitals affected in the SARS outbreak were suffering from chronic overcrowding (common to
all Western countries). Patients were accommodated in beds less than one metre apart and routine infection-control
procedures such as hand washing and changing gowns between patients were not possible. Overcrowding in emergency
departments, and hospitals generally, inevitably increases the risk of infectious disease outbreaks. A separation of at least
one metre should be maintained between patients and staff wherever possible.

Separation of patients should be routine for all patients with undifferentiated, potentially infectious, illnesses. The easiest
way to enforce separation of patients and encourage hand washing and other basic infection-control behaviour is to
physically separate the patients in single rooms.

Hand washing: Many studies have shown that hand washing protocols are not followed. This is partly related to ward layout,
but also involves training and use of innovative solutions, such as staff having small antiseptic lotion bottles around their
neck. It does need concerted effort and a culture change.

Masks should be used routinely when dealing with patients who have undifferentiated, potentially infectious, respiratory
illnesses or any infection that can be spread by droplets or aerosolisation (eg, measles, SARS). It is unclear whether
highperformance masks (eg, N95) are needed or whether fit-testing is required, but it is probably more important to wear
some type of mask routinely rather than a highperformance mask intermittently. Experience suggests that known high-risk
patients represent a lesser threat than an unrecognised patient presenting with what is thought to be a common condition.

Both patients and staff should wear masks.

Personal protective equipment should be simple, such as disposable gowns, gloves, masks and eye protection. Expensive and
complicated equipment, if used at all, should be limited to high-risk procedures (eg, airway procedures), as it is difficult to use
properly.

Design flaws are present in many hospitals. Examples include turbulent ventilation across patient areas and flow of
aerosolised gases between treatment areas. Negative pressure rooms are frequently in short supply, if they exist at all, and
would be insufficient in a pandemic. Therefore, other strategies are needed, such as physically separating patients, using
curtains as separators, and cohorting infected patients as required.

The benefits of good infection control were demonstrated during the SARS epidemic, with reduced staff sickness rates and
fewer common infections such as gastroenteritis. A recent study has shown that in-hospital infection rates with
multiresistant organisms are also reduced by good basic infection control. Improving day-to-day infection control will also
ensure staff familiarity with basic infectious disease principles and allow rapid implementation in a pandemic.

It is prudent to ensure that all first-line staff are fully vaccinated for common diseases, and risk assessment should be
undertaken regarding other vaccination for staff.

Other lessons from SARS

Epidemiological skills: Many of the hospitals and communities affected by the SARS epidemic did not have the ability to
rapidly deploy skilled staff for epidemiological study of the epidemic as it unfolded. This led to delays in contact tracing and
control of the outbreak.

Epidemiological skills need to be readily available, either directly through the hospital, or through a regional or national
facility.

Agreed isolation procedures: During the SARS outbreak, there was little consensus on how to quarantine and cohort
potentially affected people — both in hospitals and in

the community. Planning and capability to perform these functions should be researched now. Additionally, planning for
surge capacity should be part of routine health care planning.

Coordination and oversight: A poorly integrated public health system meant policies and protocols could vary even in
neighbouring communities. Governments scrambled to set up expert committees composed of individuals with varied
backgrounds and no history of working together. The absence of legislation empowering governments to compel health
authorities and hospitals to comply with directives led to confusion and often incomplete compliance.

An agreed regional approach for an infectious disease outbreak is essential; there are many authoritative guidelines. Equally,
the dangers of a profusion of lengthy guidelines must be avoided. Materials must be made available to front-line staff, and
should be concise, applicable and accessible.

If a major infectious disease outbreak occurs, antivirals and vaccines are unlikely to be effective initially, as it will be a new
disease or mutation (whether avian flu or not). Improving routine infection control procedures within hospitals is likely to
have a much greater effect on limiting a new outbreak within hospitals, as well as providing benefits on a daily basis to
patients and staff.

Strategies to limit an infectious disease outbreak from any likely cause

Strictly follow routine precautions in hospitals:

• Hand washing (alcohol/non-alcohol based lotions preferable to soap and water)

• Wearing of masks, gowns, gloves, goggles

• Maintaining one metre distance between patients and staff where possible

• Placing patients with undifferentiated infectious disease in single rooms.

Avoid overuse of complicated or expensive approaches, as they cannot be used routinely (eg, negative pressure rooms,
isolation suits).

Limit exposure to procedures that produce aerosolisation (eg, intubation, nebulisation).

Avoid hospital overcrowding, especially in emergency departments.

Have a planned approach for isolation and cohorting of large groups of potentially affected people.
Develop epidemiological and disease surveillance skills.

Ensure staff are up to date in regular staff vaccination schedule.

Ensure health system has a sustained surge capacity. Author detailsPeter A Cameron, MB BS, FACEM, Head, Pre-hospital and
Emergency Trauma Group1Michael Schull, MD, MSc, FRCPC, Scientist,2 Staff Physician3Matthew Cooke, PhD, FCEM,
FRCS(Edin), Professor of Emergency Medicine4

OET reading style questions

Influenza pandemic

1. Which of the following is true to lessen the impact of pandemics? a) Make vaccines before the pandemic occurs b) Good
preparation c) Prepare anti-viral agents in advance d) None of the above

2. Which of the following statements is false? a) Crowded hospitals are uncommon during pandemics b) Staff should remain
I metre apart from each other c) Normal medical procedures were not possible d) B & C

3. Hand washing procedures may not be followed due to a) Lack of soap b) Cultural attitudes c) Hospital design d)
Communication breakdown

4. High performance masks a) Are still subject to some uncertainty b) are too expensive c) are a necessity to prevent
infections d) should be worn intermittently

5. Which of the following is not mentioned as a design flaw in hospitals? a) Negative pressure rooms are have low ceilings b)
Poorly designed hospitals are not uncommon c) Air flow is unstable in some areas d) A & C

6. Which of the following statements are true? (There may be more than one answer) a) governments lacked power to deal
with situation b) guidelines should not be ambiguous c) The method of control must be planned in advance

Influenza Pandemic Answer Sheet

Question 1 a) Incorrect b) Correct: Improving general infection control procedures and preparedness has the potential to
improve routine health care on a daily basis as well as improve our ability to manage the next pandemic c) Incorrect: d)
Incorrect

Question 2 a) Incorrect: True: overcrowding (common to all Western countries) b) Correct:: False: A separation of at least
one metre should be maintained between patients and staff wherever possible. c) Incorrect: True: and routine infection-
control procedures such as hand washing and changing gowns between patients were not possible d) Incorrect: True

Question 3 a) Incorrect: b) Incorrect: c) Correct: This is partly related to ward layout d) Incorrect:

Question 4: a) Correct: It is unclear whether high-performance masks (eg, N95) are needed or whether fit-testing is required
b) Incorrect c) Incorrect d) Incorrect

Question 5 a) Correct: Not Mentioned: Negative pressure rooms are frequently in short supply, if they exist at all, and would
be insufficient in a pandemic. b) Incorrect: Mentioned Design flaws are present in many hospitals. c) Incorrect: Mentioned:
turbulent ventilation across patient areas d) Incorrect

Question 6 a) Correct: The absence of legislation empowering governments to compel health authorities and hospitals to
comply with directives led to confusion and often incomplete compliance. b) Incorrect c) Correct: An agreed regional
approach for an infectious disease outbreak is essential
READING PASSAGE B

Medical staff working the night shift: can naps help?

Napping at night may benefit both health professionals and their patients Delivering medical care is a 24-hour business that
inevitably involves working the night shift. However, night shift requires the health professional to work when the body’s
clock (circadian system) demands sleep. Added to this is the problem of “sleep debt”, arising from both prolonged prior
wakefulness on the first night shift and cumulative sleep debt after several nights’ work and repeated unsatisfactory daytime
sleeps. A further aggravation, particularly for trainee medical staff in teaching hospitals, has been the demand for excessive
work hours across the working week. As has been dramatically shown in recent well controlled studies, the net result of this
assault on the sleep of health professionals can be impaired patient safety, and the health and safety of health professionals
themselves. The good news is that health organisations and regulators are beginning to treat the matter seriously. In
Australia, the United States and Europe, work hours of medical staff have recently been shortened by government
regulation, and bodies such as the Australian Medical Association and professional colleges are advising their members on
strategies to improve their sleep health and thus work safety. A recent publication prepared by the Royal College of
Physicians (London) (RCP), Working the night shift: preparation, survival and recovery. A guide for junior doctors, is an
excellent example. One proposed countermeasure for excessive sleepiness is the use of strategically placed naps both before
and during the night shift. But does napping either before or during the night shift reduce sleepiness and improve
performance, and, if so, how practical is it? There are two important, independent mechanisms of sleep and sleepiness that
hold the key to these questions. Probably the more potent mechanism impairing night-shift alertness is the circadian system.
For most individuals, even those working permanent night shift, the circadian system is in sleep mode during the night. This
causes slowed reactions, increased feelings of fatigue, impaired concentration, and increased sleep propensity. The second
important mechanism affecting night-time alertness is homeostatic sleep drive. This increases in intensity the longer we are
awake and, like appetite which is sated by eating, homeostatic sleep drive is reduced by sleeping. If the first night shift starts
at midnight following a normal wake time at about 8 am, about 16 hours of wake sleep debt has already been accrued and
the rest of the night shift will be performed under intense homeostatic, in addition to circadian, sleep drive. Performance
decrements during this night period can be similar to those measured in the daytime with a blood alcohol concentration of
0.05%–0.10%. Day sleep in the home environment is likely to be shorter and less effective than night sleep so, even though
second and subsequent night shifts may follow fewer wakeful hours (8– 10 hours), homeostatic sleep drive is likely to remain
elevated during night shifts because of incomplete repayment of the previous sleep debt. To a limited extent, it is possible to
“bank” sleep (or pay off residual sleep debt) before the first night shift, potentially reducing subsequent night-time
homeostatic sleep drive and improving alertness and work safety. A long (1–2 hours) nap in the afternoon, as recommended
in the RCP report, is best. Afternoon sleep is more efficient than early evening sleep as it uses the natural afternoon “dip” in
circadian physiology and avoids the risk of post-sleep grogginess or sleep inertia impinging on the start of night duty.
Between subsequent night shifts, the aim should be to maximise daytime sleep length (at least 7 hours) and efficiency by
including the afternoon sleepy period (1–4 pm). What about napping during a night shift to improve alertness and reduce
errors and accidents? Brief afternoon naps of 10–30 minutes (so-called power naps) improve alertness and performance. We
compared afternoon naps of 5, 10, 20, and 30 minutes of total sleep. The 10 minute sleep (about a 15 minute nap
opportunity) produced improvements over the 3 hour post-nap period in all eight alertness and performance measures,
without any of the post-nap impairment of sleep inertia that followed the 20 and 30 minute naps. Whether these results
would be replicated at, say, 3 am in a night-shift environment, with considerably greater homeostatic and circadian sleep
drive, is now being tested. Only a few studies have measured the effects of night-shift napping. Long naps of about 2 hours
appear as effective at about 3 am as at 3 pm. However, 1–2 hour naps were followed by sleep inertia, during which alertness
was impaired for up to an hour. Longer naps, although beneficial once sleep inertia has been dissipated, may be used
reluctantly by medical staff wishing to maintain continuity of patient care. Briefer naps (18–26 minutes) have also improved
performance in night-shift environments. Therefore, the picture emerging from night-shift napping studies is similar to that
from the afternoon studies. Very brief naps (10–15 minutes of sleep) may improve alertness immediately without the
negative effects of sleep inertia. How long this improvement lasts and what is the optimal nap length on the night shift
remains to be determined. In the meantime, as recommended in the recent RCP guide, health professionals who work night
shift should, for the sake of their own health and safety and that of their patients, consider the benefits of night-shift
napping. Optimal benefit and a higher take-up rate are likely for sleep lengths of 10–15 minutes.
OET reading style questions Medical staff & the night shift

1. Which of the following is not mentioned a cause of sleep debt? a) Regular lack of sleep during the day b) Staying awake for
a long period before the first night shift c) Poor health among health professionals d) A build up of sleep debt during the
night shift period

2. Which of the following statements is not mentioned? a) Lack of sleep among health professionals can affect the safe
treatment of patients b) Lack of sleep among health professionals can affect the health of health professionals c) Long hours
are very common for trainee medical staff d) Most health professionals don’t get adequate sleep

3. According to the article which of the following statement is false? a) people who work the night shift during sleep mode
may have increased appetite b) people who work the night shift during sleep mode may feel exhausted c) people who work
the night shift during sleep mode may be unable to keep their mind on the job d) people who work the night shift during
sleep mode may respond slowly to certain situations

4. Which of the following statements is true? a) It is beneficial to sleep between 1~4PM b) If you sleep in the early evening
you will be fully alert at work c) Do not sleep more than 7 hours during the day before your night shift d) All of the above

5. Recent studies have shown that a) Long 2 hour naps are more beneficial at night b) Short naps are equally effective at
night as they are during the day c) Short daytime naps are less beneficial than longer daytime naps d) none of the above

6. Overall the purpose of the article is to explain that a) Health professionals don’t get enough sleep b) Both
short and long naps during night shift will improve work performance and patient treatment c) Short naps during night
shift may be the best way to improve work performance and patient treatment d) Tired health professionals are less
efficient than alert health professionals. Understanding meaning from context Use you’re the online dictionary

Answer Sheet

Question 1 a) Incorrect: Mentioned: repeated unsatisfactory daytime sleeps b) Incorrect: Mentioned: prolonged prior
wakefulness on the first night shift c) Correct: Not mentioned d) Incorrect: Mentioned: cumulative sleep debt after several
nights’ work

Question 2 a) Incorrect: Mentioned the net result of this assault on the sleep of health professionals can be impaired patient
safety, b) Incorrect: Mentioned ….and the health and safety of health professionals themselves. c) Incorrect: Mentioned… A
further aggravation, particularly for trainee medical staff in teaching hospitals, has been the demand for excessive work
hours across the working week d) Correct: Not Mentioned

Question 3 a) Correct: False b) Incorrect: True: increased feelings of fatigue, and increased sleep propensity. c) Incorrect:
True: impaired concentration d) Incorrect: True: slowed reactions

Question 4 a) Correct: True Between subsequent night shifts, the aim should be to maximise daytime sleep length…..by
including the afternoon sleepy period (1–4 pm). b) Incorrect: c) Incorrect d) Incorrect

Question 5 a) Incorrect:.. of equal benefit b) Correct: Therefore, the picture emerging from night-shift napping studies is
similar to that from the afternoon studies c) Incorrect d) Incorrect:

Question 6 a) Incorrect b) Incorrect: c) Correct: Optimal benefit and a higher take-up rate are likely for sleep lengths of 10–
15 minutes. d) Incorrect:
 SOME OTHER TESTS
1
Doctors behaving badly?
It is in doctors’ and the drug industry’s best interests that their interactions be openly declared There is no such thing as a
free lunch. Pharmaceutical companies lavish meals, five-star travel, cash and gifts on doctors for one reason: to encourage
them to prescribe their drugs. The standard retort from the medical profession is that doctors have sufficient clinical
objectivity — and personal integrity — not to be so crudely swayed. Perhaps so.

The interaction between doctors and the pharmaceutical industry was recently catapulted into the public domain by a piece
of investigative journalism published in The Australian, detailing the wining and dining of doctors by the pharmaceutical
giant, Roche, at an educational meeting in Sydney. What surprised many observers was not the revelations regarding the
extent of hospitality provided by pharmaceutical companies to doctors, but the response of the Australian Medical
Association (AMA). The AMA’s public stance was that pharmaceutical industry sponsorship of accommodation and
restaurant meals is perfectly acceptable, that drug company sponsorship serves to “oil the wheels” of medical education, and
that industry-sponsored events provide valuable opportunities for doctors “to critically question the companies’ products”
and that “no patient harm comes from this practice”. A review of the literature, however, suggests that this is not true.

The Australian Competition and Consumer Commission (ACCC) had a differing view. Following the recent release of the
ACCC’s revised guidelines for disclosure of industry support, the Chairman of the ACCC noted that “Consumers should be able
to have confidence that decisions made by their doctors are made solely having regard to their best interest without any
potential for influence by benefits or perks”. Stated in these terms, the issue is not so much the pharmaceutical industry
itself, but the prevention, assessment and management of conflict of interest and, more fundamentally, the importance of
public trust in doctors.

The moral core of medicine and the therapeutic relationship has always been expressed in terms of the possession and
expression of values such as honesty, integrity, benevolence, respect, compassion, courage and trustworthiness. Trust, which
in relation to health care may denote faith, commitment, respect, belief and confidence, has been the focus of extensive
academic exploration by a broad range of writers.All have pointed to the centrality of trust in therapeutic relationships, the
“non-legal” expression of trust, the specific and contextual nature of trust and the manner in which trust can be threatened,
diminished or destroyed by actions or behaviour including professional incompetence, abuses of power, boundary violations,
experience of harm or the lack of care or respect, deception and manifest conflicts of interest.Of those things that may
damage trust in doctors, much of the attention in recent years has been on recognising and managing conflict of interest.

What then constitutes a conflict of interest and how may we avoid it occurring? Although medical codes of ethics and
statements of medical professionalism often give the impression that doctors have a single higher duty to care for the sick, in
reality, the relationships that doctors have with their patients are determined by multiple interests, many of which may
influence care or decision making. Doctors may hold patient care as their highest professional ideal, but they may also be
concerned with community welfare, participation in research, career advancement, student teaching, continued
employment, public or professional recognition, and the obligations they have to their care for themselves and their families.

While it is inevitable that doctors will have multiple interests, true conflicts of interest (a set of conditions in which
professional judgement concerning a primary interest, such as a patient’s welfare, is unduly influenced by a secondary
interest, such as financial gain) are neither inevitable nor common.But distinguishing where there are no conflicts between
these interests from where there is a genuine conflict of interest is sometimes difficult, as any assessment of behaviour must
take into account the ethical standards of the profession, the nature of the relationship in question, and the values of the
community within which it occurs.

What makes this assessment even more difficult is that standards of doctors’ behaviour may change as a consequence of
deeper sociocultural changes, and according to changes in professional interests, and changes in public or patient needs and
expectations. This means that the only way to establish that a conflict of interest exists is to have all the relevant facts
available for scrutiny by the participants in the relationship, and by the community or an independent third party. This is only
possible if there is a genuine commitment to disclosure and transparency in all areas of medical practice.
Unfortunately, a review of the history of medicine suggests that the medical profession has, until recently, generally been
reluctant to be exposed to public scrutiny, either out of fear of legal or social repercussions that may result from such
disclosure, or on the grounds that that there is no need for it or no public desire for it. Although such concerns may be
understandable, for the most part they are unfounded. Transparency and honest disclosure may actually reduce loss of trust,
formal and informal complaints and litigation, and it is the culture of secrecy and sense of moral superiority that sometimes
runs through the health professions, rather than “unnecessary” exposure to a disinterested public, that threatens public trust
and undermines the doctor–patient or researcher–patient relationship. In this regard, it is of note that a recent randomised
trial in the United States of disclosing doctors’ financial incentives to patients found that patients’ trust in their doctors was
unharmed, and their loyalty to their doctor’s practice was strengthened.

. Doctors occupy a unique position of trust in society. They should act solely in the best interests of the patient — as many
do. But drug companies spend billions of dollars on promotions because they work. The medical profession cannot have it
both ways. If doctors want to be seen to be beyond influence, the remedy is simple. Be willing to say thanks, but no.

questions
1. There is no such thing as a free lunch means: a) The price of food is increasing b) The buyer of the lunch expects you to buy
their lunch next time c) Nothing is cheap nowadays d) The buyer of the lunch has an underlying motivation

2. According to the AMA, which of the following is false? a) Patient care is not compromised by pharmaceutical industry
sponsorship b) Pharmaceutical industry sponsorship helps educate the doctors c) Pharmaceutical industry sponsorship allows
doctors to analyse products d) Pharmaceutical industry sponsorship can harm patient care

3. The view of the ACCC can be best summarised as: a) Doctors receive too many perks b) The pharmaceutical industry is a
big issue c) Accepting of benefits by doctors puts there credibility at risk d) There is a lack of public trust in doctors

4. Patients trust in doctors is affected by a) Professional ability b) Conflict of interest c) Misuse of power d) All of the above

5. According to the article true conflicts of interest a) Are unavoidable b) Are very common c) Are difficult to judge d) Are
illegal

6. The medical profession may be against public scrutiny a) for legal reasons b) for historical reasons c)
despite high public demand d) because they are secretive

7. The recent study in the US a) indicates US doctors often receive financial incentives b) provides evidence to
support transparency c) found disclosing of financial benefits to doctors negatively affects patient/doctor trust d)
none of the above .

1. oil the wheels 2. perks 3. incompetence 4. transparency in business 5. litigation 6. undermine something 7. moral
superiority

Question 1 a) Incorrect: b) Incorrect: c) Incorrect: d) Correct: Choose answer based on the context

Question 2 a) Incorrect: True: …no patient harm comes from this practice b) Incorrect: True: ……drug company sponsorship
serves to “oil the wheels” of medical education c) Incorrect: True: ….. industry-sponsored events provide valuable
opportunities for doctors “to critically question the companies’ products” d) Correct: False

Question 3 a) Incorrect: b) Incorrect: c) Correct: Summary of viewpoint d) Incorrect:

Question 4 a) Incorrect: True: Professional incompetence b) Incorrect: True: deceptions and manifest conflicts of interest c)
Incorrect True: Abuses of power d) Correct: Best choice

Question 5 a) Incorrect: not inevitable b) Incorrect: not common c) Correct: But distinguishing where there are no conflicts
between these interests from where there is a genuine conflict of interest is sometimes difficult d) Incorrect: Not mentioned

Question 6 a) Correct: out of fear of legal or social repercussions b) Incorrect: c) Incorrect: d) Incorrect Question 7 a)
Incorrect b) Correct: Transparency and honest disclosure may actually reduce loss of trust c) Incorrect d) Incorrect:
 2
Home care Vs Hospital Care
Improvements in technology and greater acceptability have narrowed the gap between care in the hospital and care in the
home. More patients with more diagnoses are receiving a greater diversity of hospital-type treatments at home than ever.
However, the schism that once existed between hospital and home for treatment has opened up within the “hospital in the
home” (HITH) movement over whether the concept works at all.

In the early days, anecdotes suggested better outcomes at home, the only plausible mechanism being avoiding the risks of
hospital. Then, it was easy to consider the high rate of adverse events in hospital and believe that HITH must reduce these.
Because hospital-related adverse events are more common in older patients,1 it seemed plausible that older patients may
have more to gain from HITH. However, the wide variety of adverse events hinted at difficulties in capturing the difference. It
seemed even more obvious that replacing care in hospital with care at home must be cheaper. But critics thundered that
HITH offered inferior care at greater cost.2 Both sides spoke without fear of contradiction because evidence was absent. But
now there is evidence, and the debate has been reignited: Is HITH a true advance on in-hospital treatment with reduced
complications, better health outcomes and greater patient satisfaction? Is it even cost-saving, or just a waste of money?

On one side sits the Cochrane review, Hospital at home versus in-patient hospital care.3 This meta-analysis of 22 randomised
controlled trials (RCTs) clearly concluded that there is no difference in outcomes and no cost savings! However, the review
grudgingly accepts that patient satisfaction is greater with HITH than with hospital. The Cochrane process carefully sifted the
trials to determine methodological rigour — whether the patients were adequately randomised, etc. Unfortunately, this
sifting process did not include a criterion as to whether the basic experiment succeeded. One may assume that a review
entitled Hospital at home versus in-patient hospital care would include only trials where patients in the control arm received
their treatment in hospital, while those in the other arm received treatment entirely or almost entirely at home as a
substitute for in-hospital care, with a curative intent. Studies of intensive palliative care at home should properly be called
“hospice in the home”.

Unfortunately, in one large study included in the Cochrane review, there was no statistically or clinically significant
substitution for care in hospital by care at home. The study recruited older medical patients and the control group stayed in
hospital 13.20 days while the group randomised to “HITH” was discharged 0.36 days earlier from hospital and then received
an additional 9.04 days of “HITH” care at home.4 If the patients in the treatment group were not discharged from hospital
earlier than the control group, that study does not meet the Cochrane review’s own definition of HITH, namely “treatment . .
. that otherwise would require hospital in-patient care”, and should clearly have been excluded.

Clouding by a study that did not meet HITH criteria was not the only impediment to discovering whether there was an
improvement in health outcomes. Where outcomes were assessed, this was almost always done after discharge, often 3 or
more months later. To be fair though, no one knew exactly what the difference in outcomes was, and so what “instrument”
to use, at what time (during or after the admission) and how frequently to look for it, and in what patient group.

On the other side, and providing the first inkling that there may be a difference, but that we had been looking at the wrong
time, was an article published in this Journal. An RCT of 100 emergency department patients found a 20% decrease in the
incidence of confusion in HITH.5 Three subsequent studies have now confirmed this. A trial (not an RCT) of surgical patients
found less postoperative cognitive dysfunction at 7 days after day surgery compared with inpatient surgery.6 A United States
multicentre trial (not an RCT) and an Australian single-centre RCT both showed significant decreases in delirium using the
Confusion Assessment Method during the admission (to either hospital or HITH) for medical patients in HITH compared with
hospitalised patients.7,8 The manifestation of this phenomenon in both medical and surgical patients demonstrates that the
underlying diagnosis is not important, but the substitution of HITH care for in-hospital care is critical. Delirium is the “canary
in the coalmine” of aged care — a transient early warning of increased mortality, nursing home placement and impaired
physical and cognitive function. So, if delirium is reduced by HITH keeping patients out of hospital, you would expect to find
reduced mortality and placement, and improved function, though a very large study or meta-analysis might be needed,
because these events are less common than delirium.
The problems with the financial analyses are similar, but simpler. Services where HITH is not a substitute for in-hospital care,
but merely add-on care, are bound to be more expensive, no matter how sophisticated the economic analysis.4 Where HITH
substitutes for in-hospital care, and the service works at reasonable capacity, HITH is cheaper than hospital.11

All the pieces are in place, though more evidence is needed to achieve statistical significance. The evidence clearly leads
towards a conclusion that HITH offers better health outcomes and a reduction in costs.

OET reading style questions Home Care Vs Hospital Care

1. According to paragraph 2 which statement is not true? a) In the past, the advantages of HITH were based on research b)
HITH had perceived advantages for older patients c) There is debate over the cost & standard of care with HITH d) The
comparisons between hospital care and HITH are not easy to analyse

2. According to Cochrane’s research a) Randomised trials do not provide cost savings b) Patient’s were not happy with
hospital treatment c) There is no difference between hospital and HITH d) Patient’s prefer to be treated at home

3. In Paragraph 4, Cochrane’s study was criticised because a) the experiment was not successful b) it only studied older
patients c) the HITH group had received some in hospital care d) the patients were not randomised

4. There is evidence which suggests a) Delirium should be treated at home b) HITH reduces the onset of delirium regardless
of the illness c) The US trial was more rigorous d) Delirium is dependent on the original illness

5. According to the article it can be concluded that a) HITH care is cheaper and has superior results than hospital care b) HITH
is not a good substitute for hospital care c) HITH will become very popular in the future d) The research is complete

Match the word and definition 1. schism 2. anecdote 3. plausible 4. to reignite 5. grudgingly 6. impediment 7. inkling 8.
delirium 9. Canary in a coal mine

a) doing something reluctantly b) a division usually on the grounds of differing beliefs or practices c) a short personal
account of an incident or event d) a vague idea or suspicion about a fact, event, or person e) A warning sign f) something that
hinders progress in some way g) believable and appearing likely to be true h) a state marked by extreme restlessness,
confusion, and sometimes hallucinations i) to start something again

Home Care Vs Hospital Care Answer Sheet

Question 1 a) Correct: Not True: In the early days, anecdotes suggested better outcomes at home b) Incorrect: True: .
Because hospital-related adverse events are more common in older patients,1 it seemed plausible that older patients may
have more to gain from HITH. c) Incorrect: True: But critics thundered that HITH offered inferior care at greater cost.2 Both
sides spoke without fear of contradiction because evidence was absent. But now there is evidence, and the debate has been
reignited d) Incorrect: True: However, the wide variety of adverse events hinted at difficulties in capturing the difference.

Question 2 a) Incorrect b) Incorrect c) Incorrect: d) Correct: However, the review grudgingly accepts that patient satisfaction
is greater with HITH than with hospital.

Question 3 a) Incorrect b) Incorrect c) Correct: study does not meet the Cochrane review’s own definition of HITH, namely
“treatment . . . that otherwise would require hospital in-patient care”, and should clearly have been excluded. d) Incorrect

Question 4: a) Incorrect b) Correct: The manifestation of this phenomenon in both medical and surgical patients
demonstrates that the underlying diagnosis is not important, but the substitution of HITH care for in-hospital care is critical.
c) Incorrect: d) Incorrect

Question 5 a) Correct: The evidence clearly leads towards a conclusion that HITH offers better health outcomes and a
reduction in costs. b) Incorrect: c) Incorrect: d) Incorrect: Vocabulary Answers 1. b 2. c 3. g 4. i 5. a 6. f 7. d 8. h 9. E
 3
INSURANCE REFORM PACKAGE IGNORES THE NEEDS OF THE MAJORITY
The federal Government’s private health insurance reform package is a mixed bag of policy tricks. The reform package, due
to be introduced in April next year will only deepen the divide between Australia’s private health insurance haves and have-
nots.

The centrepiece of the Government’s taxpayer-funded plan is the concept of “broader health cover”, which will allow
insurers to offer cover for services which they could not in the past. This means policy holders for the first time could be
covered for treatment they receive outside hospitals. For example, receiving dialysis or chemotherapy at home, or
recuperating in a hotel, will be covered by private insurance. The premise is that this will take pressure off the public hospital
system because more treatment will be undertaken outside the hospital setting. But it is only the 43 per cent of consumers
with private health insurance who will benefit from these changes, making it unlikely that the policy will make public
hospital waiting lists disappear.

The concept of “broader health cover” will also include access to preventative care treatments for policy holders.
Preventative care encourages people to stay well rather than just treating illness when it develops. It can involve getting
regular check-ups and making positive lifestyle changes, such as regular exercise and an appropriate balanced diet.

Consumer organisation Choice welcomes the preventative health care measures included in the reforms. Public health
specialists around the world have been calling for them for years. Yet in the government’s overhaul of the private health
sector, only those with private cover will benefit. The majority of Australians will get left behind.

Despite the bells and whistles included in the new package, private health insurance is just not an option for many
Australians. They simply cannot afford it. Private health insurance can cost the average cash-strapped family between 3 and
4 per cent of their annual income. For single parent families, the picture is bleaker. Australian Bureau of Statistics figures
show that 54 per cent of this group receive government benefits, leaving them with far less discretionary spending power.
For this group, affording private health insurance is pier in the sky. Future premium increases will squeeze out most
struggling families, particularly those on lower incomes.

A worrying precedent has already been set. Over the last five years, premiums have increased by 40.9 per cent. That’s a rise
equivalent to double the rate of inflation each year since 2001. Given the rising cost of premiums, it is no wonder that
consumers on higher incomes are more likely to take out private cover.

While Choice supports consumers’ right to choose between the private and the public sector, Australia prides itself on being
an egalitarian nation. The idea of a fair go still forms the foundation of our society. Yet here we have a situation where all
taxpayers are funding a system which mainly benefits those on higher incomes who can afford to pay for better services. All
taxpayers fund the 30 percent private health insurance rebate at a cost of $3 billion a year. Yet the 57 per cent of people
without insurance are being left out in the cold. In addition, taxpayers are also footing the bill for the marketing of private
health insurance.

In his last speech, Treasurer Peter Costello said that the Government would spend $55million over the next four years “to
increase consumer awareness of the incentives and benefits associated with private health insurance”.

The industry should be thrilled to have its marketing campaign underwritten by Australian taxpayers. This money, together
with the $3 billion rebate, would be better spent on reinvigorating the public health care system, rather than propping up the
private sector.

So, what is the solution? How the public system is funded is critical. The current commonwealth/state funding model of
public hospitals is inefficient and wastes resources. The health system is also being crippled by workforce shortages,
especially in rural areas. Australia is in dire need of not just doctors and nurses, but also allied health professionals such as
physiotherapists, dieticians and podiatrists.

Underpinning the success of these measures is a government willing to engage consumers in a health care debate.
Governments in Canada and the UK have successfully involved consumers in designing their healthcare systems. Australia
can learn some important lessons from this egalitarian approach. Healthcare reform is not just about redistributing the
current health care dollar. It is about finding a lasting solution that goes beyond election cycles and political expediency. It
requires a government with the courage to undertake reforms bases on asses not income.

Viola Korczak is health policy officer at the consumer organisation Choice.

OET reading style questions

1. Based on paragraph 1 & 2 which statement is true? a) Opinions about the governments private health insurance reform
package are divided b) the governments private health insurance reform package was introduced in April c) Will help both
people with private health insurance and those without it d) None of the above

2. The insurance policy is criticised because a) The majority of the people will not gain from new system b) people who
receive treatment at home will not be covered by insurance c) It will not reduce the wait lists at public and private hospitals
d) It should have been introduced a long time ago

3. The expression discretionary spending power means a) Unrestricted spending power b) limited spending power c) freedom
to spend money based on individual needs d) all of the above

4. Which of the following statements is true a) Hospital fees have increased more than 40% in recent years b) The rate of
inflation has doubled every year for the past 5 years c) In recent years the price of health insurance has been increasing
twice as fast as inflation d) All of the above

5. Which of the following statistics is true a) 70% of tax payers money is spent on health b) Over a 12 month period the
health insurance rebate costs tax payers 3 billion dollars c) 30% of tax payers’ money is spent on health d) 57% of people
do not receive adequate treatment for colds

6. Which of the following is not mentioned as a problem in the health system a) lack of qualified staff b)
inefficiency c) wastefulness d) lack of rural hospitals

Understanding meaning from context: Try to work out the meaning of the following expressions from the article. Use a
dictionary and the internet to find out the meaning. 1. mixed bag of policy tricks 2. deepen the divide 3. Despite the bells and
whistles of the package 4. cash strapped family 5. a bleak picture 6. affording health insurance is pie in the sky 7. squeeze out
8. egalitarian nation 9. to foot the bill 10. to be left out in the cold

Insurance Reform Answer Sheet

Question 1 a) Incorrect: Untrue b) Incorrect: Untrue c) Incorrect: Untrue d) Correct

Question 2 a) Correct: Yet in the government’s overhaul of the private health sector, only those with private cover will
benefit. The majority of Australians will get left behind. b) Incorrect c) Incorrect: …..a cure for arthritis has proved elusive.
Elusive is synonym for hard to find d) Incorrect

Question 3 a) Incorrect b) Incorrect c) Correct (best choice) d) Incorrect

Question 4: a) Incorrect b) Incorrect c) Correct: …. Over the last five years, premiums have increased by 40.9 per cent. That’s
a rise equivalent to double the rate of inflation each year since 2001 d) Incorrect

Question 5 a) Incorrect b) Correct: All taxpayers fund the 30 percent private health insurance rebate at a cost of $3 billion a
year. c) Incorrect: d) Incorrect:

Question 6 a) Incorrect: Mentioned: The health system is also being crippled by workforce shortages, especially in rural
areas. Australia is in dire need of not just doctors and nurses, but also allied health professionals such as physiotherapists,
dieticians and podiatrists. b) Incorrect: Mentioned: The current commonwealth/state funding model of public hospitals is
inefficient and wastes resources. c) Incorrect Mentioned: The current commonwealth/state funding model of public hospitals
is inefficient and wastes resources. d) Correct: Not mentioned
 4
Do box jellyfish sleep at night?
A novel tagging technique has uncovered some surprising information about jellyfish
behaviour
If you spend any time at all in tropical Australia, especially in the water, you will know about
box jellyfish. You will also know that they have a major effect on the way people use the
water, that they are capable of killing humans within minutes, and that vinegar is the first aid
treatment of choice.1 But did you know that they “sleep”? We certainly didn’t!
About 12 months ago, we came up with a novel idea to try to track box jellyfish (Chironex
fleckeri) using small ultrasonic transmitters (about 4 cm long and 12 mm in diameter). Using
these for tracking marine animals is not new, but tracking jellyfish with them — that’s
certainly never been done before. Normally, when tracking marine organisms (such as fish),
you open the body cavity, insert the transmitter, suture the wound and let the fish go.
With jellyfish, it’s not that simple.
Firstly, jellyfish don’t have a body cavity (they only have two cell layers, an ectoderm and an
endoderm, with a non-cellular layer, the mesoglea, between these). Secondly, suturing
jellyfish is not easy. In fact, it’s impossible! After many failed attempts to attach transmitters,
we finally struck upon a simple but effective method. We glued them on using histoacryl, a
superglue used by surgeons. All you need to do is catch a box jellyfish without getting stung
(an art in itself!), glue a transmitter to it release it, and follow it with an underwater
directional microphone. You can then work out where they go and how active they are.
In the last jellyfish season, we managed to track several tagged box jellyfish and came up
with some staggering results. It seems that these jellyfish show marked diurnal behaviour.
During daylight hours (from about 0600 to 1500), they moved in straight-line distances of
about 212 m an hour. However, from about 1500 to 0600, they moved an average of less than
10 m an hour. During these periods of “inactivity”, the jellyfish lie motionless on the sea floor,
with no bell pulsation occurring and with tentacles completely relaxed and in contact with the
sea floor Shining lights on the jellyfish while they are inactive on the sea floor, or causing
vibrations close by on the seabed, causes the animals to rise from the sea floor, swim around
for a short period, and then fall back into an inactive state on the sand.
If you have any interest in animal biology, this type of action in a lower invertebrate should
immediately raise the question of “Why?”. We believe it is related to the way the jellyfish
collect food. The box jellyfish is an active visual hunter of vertebrates. It has four sets of six
eyes, some of which are image-forming with lenses and retinas, lying around the four facets
of the bell (body) of the animal. Box jellyfish are also extremely active, with metabolic rates
at least an order of magnitude greater than those of any other jellyfish we know of.
So, at night — when vision is limited and you cannot see your prey or your predators (turtles
for box jellyfish) — rather than burn a lot of energy swimming around, it makes a lot of sense
to become inactive, decrease your energy used in locomotion and divert it to growth (these
animals can grow at 2–3 mm across the bell per day). A really simple strategy, but one we
had not thought box jellyfish used.
OET reading style questions
Do box jellyfish sleep at night
1. Which of the following is not true about Box Jelly fish a) Vinegar is the best remedy b) Box
jelly fish live in tropical regions c) Influence people’s swimming behaviour d) Vinegar is the
best way to kill them
2. It was difficult to attach a tracking machine because a) Lack of a body cavity b) it was the
first time to do this c) It is hard to put in stiches d) All of the above
3. Box jelly fish a) Are more active during the day b) Are active mostly active at night c) Shine
brightly on the sea floor d) Vibrate their body when they swim
4. Box jelly fish sleep at night because a) it is safer b) it requires minimal energy c) they can’t
find food to eat d) all of the above
Question 1 a) Incorrect: True: vinegar is the first aid treatment of choice b) Correct: Not true
c) Incorrect: True If you spend any time at all in tropical Australia, especially in the water, you
will know about box jellyfish d) Incorrect: True …they have a major effect on the way people
use the water
Question 2 a) Incorrect: True: jellyfish don’t have a body cavity b) Incorrect True: tracking
jellyfish with them — that’s certainly never been done before. c) Incorrect: True: suturing
jellyfish is not easy d) Correct: All of the above
Question 3 a) Correct: It seems that these jellyfish show marked diurnal behaviour During
daylight hours (from about 0600 to 1500), they moved in straight-line distances of about 212
m an hour. However, from about 1500 to 0600, they moved an average of less than 10 m an
hour b) Incorrect: c) Incorrect: d) Incorrect:
Question 4: a) Incorrect::True: cannot see your …your predators b) Incorrect: True: rather
than burn a lot of energy swimming around, it makes a lot of sense to become inactive,
decrease your energy used in locomotion and divert it to growth c) Incorrect: True: you cannot
see your prey d) Correct: All of the above
 5
OBESITY IS THE BIGGEST PUBLIC HEALTH HURDLE OF THE CENTURY -
Like many nations, Australia is in the throes of an unprecedented epidemic of obesity and type 2 diabetes – an epidemic in
acceleration mode.

Over the last week, more than 2500 scientists have been in Sydney for the 10th International Congress of Obesity. The
theme of the congress was “From Science to Action”. Its aim has been to produce workable strategies to counter the obesity
pandemic and to deliver to communities and governments the leadership that only a meeting of this significance and
magnitude can offer.

Obesity is the single most important challenge for public health in the 21st century. More than 1.5 billion adults worldwide
and 10 per cent of children are now overweight or obese. Yes the world’s waistline in bulging – some cynics call the
phenomenon “Globesity”. Professor Phillip James, chairman of the International Obesity Task Force, warned the congress
that it is sweeping the world with terrifying rapidity.

Obesity is the driving force behind type 2 diabetes, which causes significant cardiovascular complications, kidney failure,
blindness and amputations. This is leading to decreased life expectancy from type 2 diabetes, cardiovascular disease and
some forms of cancer.

The selection of Sydney as the host city for the conference was made eight years ago, but in the meantime Australia has
assumed the not-so-welcome honour as the nation with one of the fastest-growing rates of obesity in the world. The 2000
AusDiab study, undertaken by the International Diabetes Institute, showed that more than 60 per cent of our adult
population is overweight or obese, along with 20 per cent of our children. It is a tripling in numbers over the last 20 years.

The Pharmaceutical Benefits Scheme subsidised the obesity-related conditions diabetes and heart disease by more than $2
billion last year, and the costs are still rising. This is replicated in many nations and this “diabesity” pandemic is now set to
bankrupt health budgets all over the world.

Eemerging from the conference was some important new scientific research.

In the last decade, fat has moved from being viewed as inert “blubber” to probably the most active endocrine (hormonal)
organ in the human body. It makes a vast range of chemical substances vital to body function – from control of appetite,
energy balance, our immunity and blood clotting, to regulation of insulin and other hormonal actions. Fat in the abdominal
cavity, the “Aussie beer gut” makes chemicals that cause type 2 diabetes and heart disease.

On the public health side, VicHealth CEO Robert Moodie, noted that there was a role for government regulation and, without
it, we will not be able to curb the epidemic. He said that the contemporary environment promotes obesity. The obesity
diabetes epidemic will continue unless we accept that many years of health promotion aimed at individuals seem to have
had virtually no effect.

Our own state and local governments may have inadvertently contributed to this epidemic by allowing developers to create
urban social problems. New developments lack proper attention to sidewalks, bike paths, public transport corridors, playing
fields and friendly exercise areas that are essential to maintain a healthy lifestyle.

We can rejoice that obesity has implanted itself firmly on government radars. Tackling obesity and its consequences has
been taken to a new political level. Our federal and state governments have recognised the need for action to tackle obesity
and diabetes through the Better Health Initiative. Federal Health Minister Tony Abbot and John Howard have been powerful
advocates of action – with certain reservations such as in the area of banning TV advertising.

We don’t have the luxury of time to deal with the epidemic – it’s as big a threat as global warming and bird flu. Solutions
are urgently needed, and involve more basic issues than more exercise and correcting diet.
The way ahead for us to address this “globesity” crisis is not for obesity researchers, scientists, health professionals and
politicians to live in their silos with pet beliefs on issues of taxing junk foods and banning TV advertising. What is needed is a
bigpicture approach, and to acknowledge our lives and the environment have changed in the last 20 or 30 years.

Just three weeks ago, Professor Phillip James and I wrote an editorial for the Medical Journal of Australia (2006;185:187-8)
which outlined some key legislative and regulatory measures that are required to turn the epidemic around, particularly in
relation to childhood obesity. We need urban planning to help people exercise more, physical activity reintroduced into
curricula, nutrition education in schools, production and availability of cheap healthy foods, and responsible labelling and
advertising.

At the congress, a major topic was the call by many for bans on marketing and TV advertising to children. While this seems
sensible, the evidence that it translates into reduced obesity rates is not yet available. Certainly stronger guidelines are
needed, and we may need to implement guidelines for food labelling. Currently, labels cannot be understood by consumers –
and health claims are often misleading.

Looking at the big picture, the prevention of obesity and type 2 diabetes requires co-ordinated policy and legislative
changes, with greater attention on our urban environment, transportation infrastructure, and workplace opportunities for
education and exercise. Governments – local, state and federal should commit to optimising opportunities for exercise in a
safe environment. A multidisciplinary, politically driven, co-ordinated approach in health, finance, education, sports and
agriculture can contribute to reversing the underlying causes of the obesity epidemic. This may well be the single and most
important challenge for public health in the 21st century. It is a battle than we can and must win.

OET reading style questions

1. According to the article, in Australia a) There are more overweight children than adults b) Australia has the fastest growth
rate of obesity c) In the past 2 decades Australia’s rate of obesity has increased 3 fold. d) None of the above

2. According to Robert Moodie a) Government regulation will not help lessen the epidemic b) Modern lifestyle encourages
obesity c) Health promotion is a good way to reduce obesity d) Obesity is a bigger problem than diabetes

3. Which of the following statements are true a) New suburbs do not encourage people to develop a healthy routine b)
Australians have too much time to enjoy luxury foods c) John Howard and Tony Abbot support prohibiting TV advertisements
d) obesity is a greater danger than bird flu & global warming

4. Professor Philip James believes a) Advertisements must be labelled b) Make healthy food more affordable c) Physical
education reduces academic levels d) Education is necessary to encourage people to exercise

5. According to the article it can be concluded that a) Lack of exercise is the number one cause of obesity b) Modern lifestyle
is not as healthy as a traditional lifestyle c) Obesity and type 2 diabetes can only be reduced if governments are involved in
the process d) None of the above

Answer Sheet

Question 1 a) Incorrect b) Incorrect c) Correct: It is a tripling in numbers over the last 20 years. d) Incorrect

Question 2 a) Incorrect b) Correct: He said that the contemporary environment promotes obesity. c) Incorrect d) Incorrect

Question 3 a) Correct: New developments lack proper attention to sidewalks, bike paths, public transport corridors, playing
fields and friendly exercise areas that are essential to maintain a healthy lifestyle. b) Incorrect c) Incorrect d) Incorrect
Question 4 a) Incorrect b) Correct: availability of cheap healthy foods c) Incorrect d) Incorrect

Question 5 a) Incorrect b) Incorrect: c) Correct: Looking at the big picture, the prevention of obesity and type 2 diabetes
requiresco-ordinated policy and legislative changes, with greater attention on our urban environment, transportation
infrastructure, and workplace opportunities for education and exercise. d) Incorrect:

THANK YOU