2018年医学博士外语真题试卷

The same benefits and drawbacks are found when using CT scanning to detect lung cancer — the three-dimensional imaging, improve detection of disease but creates hundreds of images that increase a radiologist’s workload, which,【C1】________ , can result in missed positive scans.

Researchers at University of Chicago Pritizker School of Medicine presented【C2】________ data on a CAD (computer-aided diagnosis) program they’ve designed that helps radiologist spot lung cancer【C3】________ CT scanning. Their study was【C4】________ by the NIH and the university.

In the study, CAD was applied to 32 low-dose CT scanning with a total of 50 lung nodules, 38 of which were biopsy-confirmed lung cancer that were not found during initial clinical exam.【C5】________ the 38 missed cancers, 15 were the result of interpretation error (identifying an image but【C6】________ it as non cancerous) and 23【C7】________ observational error ( not identifying the cancerous image).

CAD found 32 of the 38 previously missed cancers (84% sensitivity), with false-positive【C8】________ of 1.6 per section.

Although CAD improved detection of lung cancer, it won’t replace radiologists, said Sgmuel G. Armato, PhD, lead author of the study. “The computer is not perfect,” Armato said. “It will miss some cancers and call some things cancer that【C9】________ . The radiologists can identify normal anatomy that the computer may【C10】________ something suspicious. It’s a spell-checker of sorts, or a second opinion.

When Tony Wagner, the Harvard education specialist, describes his job today, he says he’s “a translator between two hostile tribes” — the education world and the business world, the people who teach our kids and the people who give them jobs. Wagner’s argument in his book Creating Innovations: The Making of Young People Who Will Change the World is that our K-12 and college tracks are not consistently “adding the value and teaching the skills that matter most in the marketplace”.

This is dangerous at a time when there is increasingly no such things as a high-wage, middle-skilled job — the thing that sustained the middle class in the last generation. Now, there is only a high-wage, high-skilled job. Every middle-class job today is being pulled up, out or down faster than ever. That is, it either requires more skill or can be done by more people around the world or is being buried — made obsolete — faster than ever. Which is why the goal of education today, argues Wagner, should not be to make every child “college ready” but “innovation ready” — ready to add value to whatever they do.

That is a tall task. I tracked Wagner down and asked him to elaborate.’Today,” he said via e-mail, “because knowledge is available on every Internet - connected device, what you know matters far less than what you can do with what you know. The capacity to innovate — the ability to solve problems creatively or bring new possibilities to life — and skills like critical thinking, communication and collaboration are far more important than academic knowledge. As one executive told me,’We can teach new hires the content. And we will have to because it continues to change, but we can’t teach them how to think — to ask the right questions— and to take initiative.’”

My generation had it easy. We got to “find” a job. But, more than ever, our kids will have to “invent” a job. Sure, the lucky ones will find their first job, but, given the pace of change today, even they will have to reinvent, re-engineer and reimagine that job much more often than their parents if they want to advance in it.

“Finland is one of the most innovative economics in the world,” Wagner said,” and it is the only country where students leave high school ’innovation-ready’. They learn concepts and creativity more than facts, and have a choice of many electives — all with a shorter school day, little homework, and almost no testing. There are a growing number of ’reinvented’ colleges like the Olin College of Engineering, the M.I.T. Media Lab and the ’D-school’ Stanford where students learn to innovate.”

By the end of this century, the average world temperature is expected to increase between one and four degrees, with widespread effects on rainfall, sea levels and animal habitats. But in the Arctic, where the effects of climate change are most intense, the rise in temperature could be twice as much.

Understanding how Arctic warming will affect the people, animals, plants and marine life and economic activity in Canada’s North is important to the country’s future, says Kent Moore, and atmospheric physicist at University of Toronto Mississauga who is participating in a long-term, international study of the marine ecosystem along the Beaufort Sea, from Alaska to the Mackenzie delta.

The study will add to our knowledge of everything from the extent of sea ice in the region to how fish stocks will change, to which areas could become targets for oil and gas exploration, to the impact on the indigenous people who call this part of the country home.

Moore, who has worked in the Arctic for more than 20 years, says his research has already found that thinning sea ice and changes in wind patterns are causing an important change in the marine food chain: phytoplankton (浮游植物) is blooming two to three weeks earlier. Many animals time their annual migration to the Arctic for when food is plentiful, and have not adapted to the earlier bloom. “Animal behavior can evolve over a long time, but these climate changes are happening in the space of a few decades, rather than hundreds of years,” says Moore. “Animals can’t change their behavior that quickly.”

A warmer Arctic is expected to have important effects on human activity in the region, as the Northwest Passage becomes navigable during the summer and resource extraction becomes more feasible. Information gained from the study will help government, industry and communities make decisions about resource management, economic development and environmental protection. Moore says the study—which involves Canadian, American and European researchers and government agencies — will also use a novel technology to gather atmospheric data: remotely piloted drones. “The drones have the capability of a large research aircraft, and they’re easier to deploy,” he says, showing the researchers to gather information on a more regular basis than they would be able to with piloted aircraft.

Skilled clinical history-taking and physical examination remain essential as the basis of the disease diagnosis and management, aided by investigations such as radiological or biochemical tests. Technological advances over the past few decades mean that such investigations now can be refined, or even replaced in some cases, by the measurement of genetic or genomic biomarkers. The molecular characteristics of a disorder or the genetic make-up of an individual can fine tune a diagnosis and inform its management. These new capabilities, often termed ‘stratified (分层的) ’ or ‘personalized’ medicine, are likely to have profound effect on the practice of medicine and service delivery.

Genetic medicine, which uses genetic or genomic biomarkers in this way, has, until recently, been the province of a small minority of specialized physicians who have used it to diagnose or assess risk of inherited disease. Recognition that most disease has a genetic component, the development and application of new genetic tests to identify important disease subsets and the availability of cost-effective interventions mean that genetic medicine must be integrated more widely across healthcare services. In order to optimize benefit equitably across the population, physicians and services need to be ready to change and adapt to new ways of working.

Perhaps the greatest challenge is to ensure the readiness of physicians to use these genomic technologies for maximum effect, so that genetic medicine is incorporated into mainstream specialties. For some clinicians, particularly those involved in clinical research, these advances are already a reality.

However, a sizable majority do not yet recognize the relevance of genetics for their clinical practice, perceiving genetic conditions to be rare and untreatable. Maximizing genomic opportunities also means being aware of their limitations, media portrayals that indicate that genetic information gives clear-cut answers are often unrealistic. Indeed, knowing one’s entire genomic sequence is not the crystal ball of our future that many hope it to be, and physicians will need to be more familiar with what is hype (鼓吹) and what is reality for the integration of genetics into mainstream medicine to be successful.

Finally, both the professional and public should have a realistic view of what is possible. Although the discovery of genetic risk factors in common diseases such as heart disease and cancer has led to important insights about disease mechanisms, the predictive power of individual genetic variants is often very low. Developments in bioinformatics will need to evolve considerably before the identification of a particular combination of genetic variants in an individual will have clinical utility for them.

Misconduct is a word that is always on professors’ minds. Incidents in the news tend to describe the most serious violations of scientific standards, such as plagiarism for fabricating data. But these high-profile infractions (违法) occur relatively rarely. Much more frequent are forms of misconduct that occur as part of the intimate relationship between a faculty member and a student.

Faculty members don’t need to commit egregious acts such as sexual harassment or appropriation of students’ work to fail in their responsibility to their charges. Being generally negligent as teachers and mentors should also be seen as falling down on the job.

What we found most interesting was how respondents had less vehement (强烈的) reactions to a host of questionable behaviors. In particular, they said that faculty members should avoid neglectful teaching and mentoring. These included routinely being late for classes, frequently skipping appointments with advisees, showing favoritism to some students, ignoring those whose interests diverged from their own, belittling colleagues in front of students, providing little or no feedback on students’ theses or dissertations, and take on more graduate advisees than they could handle.

The vast majority of US faculty members have simply not been taught how to teach. And these responses suggest that they are subjecting young scientists-in-training to the same neglect.

To address this systemic issue, we must do a better job of exposing the current and next generations of scientists to the rules of proper mentoring through seminars. For instance, on online modules. The societies of academic disciplines, institutions and individual departments can play a big part here, by developing codes of conduct and clear mechanisms for students to report violations.

The most serious behaviors are relatively easy to spot and address, but “inadequate teaching” can be subjective. Still, if universities establish specific rules for academics to follow, real patterns of abuse will be easier to find. For instance, these rules could stipulate that professors must return substantive feedback on drafts within 15 days, provide more than just negative feedback during a student’s oral defense of their thesis, or be available regularly to answer questions.

To deal with faculty members who consistently fall short, universities should establish teaching-integrity committees, similar to the research-integrity committees that handle issues of scientific misconduct. These could receive reports from students and decide what action to take, either by following a due process laid out in the faculty manual, or simply by adopting the same process as that of other committees, such as for tenure applications.

Is the profession of medicine in retreat? I’m reminded of this with September welcoming a new influx (流入) of medical students. A handful of them may be some of the wide-eyed enthusiasts who attended a meeting at the Royal Society of Medicine (RSM) earlier this year about why they should choose a career in medicine. Choose medicine, I said, because it is a profession that allows you to pursue many different paths, catering for the diverse personalities that constitute any medical school’s intake.

But I’m beginning to wonder if I misled them? Not just on the opportunities that will open up to them and only be limited by their own ambition and abilities. No, I’m questioning something more fundamental; the perception of medicine as a profession.

Doctors have traditionally embellished (润色) their day jobs with roles, for example, on medical committees, college councils, and faculties for conferences, meetings and training courses. Journal editors and associate editors are prime examples of doctors taking on an additional responsibility to their full-time role.

The advantages of these outside interests and positions have been considerable for individuals and for the organizations that employ them. The organizations gain greater influence, open themselves up to new ideas and alternative strategies, and can gain a competitive advantage. Doctors have considered that these additional responsibilities are an important differentiator between medicine as a profession and medicine as a factory job.

Yet times are changing. Clock-watching has become common place, with the European a Working Time Directive being the most obvious examples. More troublesome for many senior doctors is the issue of job planning, which is beginning to limit the additional roles and responsibilities that doctors can undertake. Organizations are becoming more corporate and less enlightened.

Most doctors will find a way round this new regime, but short-term petty-minded bosses are beginning to view doctors as factory workers. Their limited vision considers doctors to be dangerously independent, malfunctioning cogs (无足轻重的成员) in their wobbly health care machine, a species to be controlled and beaten into the shape of appropriate widget (装饰品) .

Medicine was never meant to be governed by such runnel vision, was it? Ultimately it will be the less enlightened organizations who will fail. These organizations will perceive little value in doctors spreading their wings and will treat them like factory workers, clocking on and off and filling in timesheets.

Doctors in these organizations will begin to wonder whether medicine is any longer a profession when its practitioners are forced to cower (畏缩) before number crunches and bean counters.

Scientists have a duty to talk to the public. Why? Because social policies need to be decided on the basis of rational grounds and facts. These include important issue ranging from climate change, to the goals of the space program, to the protection of endangered species, to the use of embryonic stem cells or animals in biomedical research. Both the public and policy makers need to understand not only the scientific justification for our work but also, in some cases, why we deem our studies to be morally justifiable.

The time is ripe for a more open, public and honest debate about the role of scientific experimentation in animals. What follows are some of my thoughts on this topic. I hope this perspective encourages other scientists to join the discussion and prompts opponents of animal research to create an atmosphere where civil discourse can take place, free of the threats, harassment and intimidation (恐吓) that are increasingly directed at biomedical scientists and their families.

Criticism to the use of animals in biomedical research rests on varied scientific and ethical arguments. One extreme view holds that information gathered from animal research cannot, even in principle, be used to improve human health. It is often accompanied by catchy slogan such as “If society funds mouse models of cancer, we will find more cures for cancer in mice”. It is argued that the physiology of animals and humans are too different to allow results from animal research to be extrapolated (推断) to humans.

Such a blanket statement is falsified by numerous cases where experimentation on animals has demonstrably contributed to medical breakthroughs. The experiments on cardiovascular and pulmonary function in animals that began with Harvey and continued with the Oxford physiologists established the understanding of what the heart and lungs do and how they do it, on which the modem practice of internal medicine rests. Modern medical practice is inconceivable in the absence of the insights gained from these experiments. Anticoagulants were first isolated in dogs; insulin was discovered in dogs and purified in rabbits; lung surfactants were first extracted and studied in dogs; rabbits were used in the development of in vitro fertilization; mice in the development of efficient breast cancer drugs and so on.

For the sake of completeness, it must be noted that the other extreme — the notion that all medical advances are a result of animal research — is false as well. Important medical advances, such as sanitation and the discovery of aspirin, were conducted without the use of animals.