2016年医学博士外语真题试卷

Humans are the only species known to have consciousness, awareness that we have brains and bodies【C1】___adaptability that we can affect the course our lives take, that we can make choices【C2】that vastly affect the quality of our lives—biologically, intellectually, environmentally, and spiritually. As humans, we have the ability to mold our【C3】beings to become what or who we wish to become. While some of us may,【C4】, have genetic and biological imperatives that may require medication or training to overcome, or at least to modulate, the vast majority of us do, in fact, hold our emotional【C5】___in our hands.

All that【C6】___, until the last decade, scientists believed that the human brain and its connections were formed during gestation and infancy and remained【C7】unchanged through childhood. They believed that humans had a given number of neurons in a specific brain structure, and【C8】the number might vary among people, once you were done with childhood development, you were set in this【C9】. Your connections were already made, and the learning and growing period of your brain was over. In the last decade, however, researchers have found【C10】___evidence that this is not so, and that something called neuroplasticity continues throughout our lives.

Parents are on a journey of discovery with each child whose temperament, biology, and sleep habits result in a unique sleep-wake pattern. It can be frustrating when children’s sleep habits do not conform to the household schedule. Helping the child develop good sleep habits in childhood takes time and parental attention, but it will have beneficial results throughout life. An understanding of the changing patterns of the typical sleep-wake cycle in children will help alleviate any unfounded concerns. Maintaining a sleep diary for each child will provide the parents with baseline information in assessing the nature and severity of childhood sleep problems. Observant patents will come to recognize unusual sleep disruptions or those that persist or intensify.

Developmental changes throughout childhood bring differences in the sleep-wake cycle and in the type and frequency of parasomnias that may interrupt sleep. Medical consultation to rule out illness, infection of injury is prudent if the child’s sleep problems prevent adequate sleep and result in an ongoing sleep deficit. As reported by News-Medical in Child Health News, children’s sleep problems should be taken seriously as they may be a “’marker’ for predicting later risk of early adolescent substance use. In the same article University of Michigan psychiatry professor Kirk Brower, who has studied “the interplay of alcohol and sleep in adults” stressed that “The finding does not mean there’s a cause-and-effect relationship. “

Consultation with a child psychologist may be helpful if frightening dreams intensify and become more frequent as this may indicate a particular problem or life circumstance that needs to be changed or one that the child may need extra help working through.

Most childhood sleep disturbance will diminish over time as the brain matures and a regular sleep-wake cycle is established. Parental guidance is crucial to the development of healthy sleep habits in children.

The United States and England each has a major—and unique—health-care challenge, according to a study comparing the health of senior citizens in the two countries. The study, conducted by researchers from RAND Corporation in the United States and Institute for Fiscal Studies in the United Kingdom, found that disease and health disorder incidence was higher among U. S. senior citizens, but mortality rates were higher among English senior citizens.

Americans aged 65 and older have almost twice the rate of diabetes found among their English counterparts and more than double the rate of cancer. Nevertheless, death rate among Americans 65 and older is lower.

“Americans are a sicker group of people who tend to live longer, ” says James Smith, a study co-author. He attributes the U. S. health problems to lifestyle factors, including poor eating habits and inadequate exercise. Americans tend to eat much larger servings of food, for example, “There is what I call an American plate. When we go to a restaurant, it’s a plate I can’t even eat any more. It’s a plate with so much food on if it’s not even appealing to me. “

Smith also says that English adults are generally much more physically active than Americans. Biking and walking are much common in everyday life in England. He observes that “there is a lot of walking in London, and there is a lot of bicycle riding. I don’t see people in downtown Los Angeles on their bicycles”.

On the other hand, England’s problem is that doctors fail to diagnose serious conditions early enough. American doctors tend to screen patients for cancer, diabetes, and other illnesses more frequently. Smith notes “American medicine is much more aggressive. It leads to high costs, but it has benefits, too”.

Less meat and dairy in our diets could help reduce agricultural greenhouse gases by as much as 80% by 2055, according to a recent study by the Potsdam Institute for Climate Impact Research (PIK). The researchers created global land-use model to project likely outcomes given different scenarios involving consumer dietary trends and changes in agriculture production methods. The models take into consideration population growth, the world economy, and other factors.

The researchers found that, if meat and dairy consumption patterns remain constant of increase, the associated global agricultural omissions will increase significantly. On the other hand, a 25% reduction over the next 40 years would help bring levels to where they were around 1995.

Methane and nitrous oxide in particular could be reduced if less meat and dairy is produced and consumed. These gases are caused largely by livestock waste and synthetic fertilizers. Around two-thirds of nitrous-oxide emissions come from agriculture—and most of that as a result of either raising animals or producing the feed used to raise them. Consumers’ food choices, combined with what one PIK researcher terms “technical mitigation options on the producers side” could make an enormous impact on these emissions.

While not nearly as much methane or nitrous oxide is released into the atmosphere as carbon dioxide, both are significantly more potent and they form substantial pieces of the greenhouse gas pie. Both of these gases trap heat and radiation in the atmosphere much more effectively than does carbon dioxide. The U. S. Environmental Protection Agency cites methane as being “21 times more effective at trapping heat in the atmosphere than carbon dioxide over a 100-year time period. ” Nitrous oxide is more than 300 times more effective than CO₂.

While the PIK study doesn’t detail exactly which consumer choices and eating habits can help reverse the trend, it seems clear that less is more when it comes to consuming meat and dairy products.

Today this dangerous situation has been largely alleviated. Henry, a 77-year-old pensioner from East London, still lives alone and happily practices golf swings in his back garden safe in the knowledge that his body is able to cope with the extra exertion.

What has altered Henry’s life is not some wonder drug but a simple change in the way his illness is managed. Every day Henry hooks himself up to monitoring devices whose results have helped him to understand it and overcome its more debilitating effects. “Telehealth has given me confidence in myself because I know my own body now, ” he says. He adjusts what he does according to what his daily readings tell him about his condition.

Henry is just one of a growing number of pioneering patients who are trusting their futures to telehealth. Large trials are under way around the world to evaluate the idea. With elderly populations and the incidence of age-related illnesses growing telehealth promises to give people the independence they need to remain in their own homes. It could also reduce the burden of healthcare costs.

The disorder that makes Henry’s life so difficult is chronic obstructive pulmonary disease (COPD), a condition that affects some 800, 000 people in England. The airways in his lungs have narrowed, leaving him with severe shortness of breath and blood oxygen levels that can fall dangerously low.

With his new equipment, Henry can keep a close eye on how his body is doing. He received for measuring his blood oxygen level and pulse rate, a blood pressure monitor and a set of speaking scales. Each connects wirelessly to a unit which collates the readings and sends them to a team of medical specialists, who watch for suspicious changes. If the readings look bad, they call him to discuss appropriate action. Henry too can see the readings on his television, where they are displayed with the help of a special set-top box.

Whether a day is good or bad depends largely on Henry’s blood oxygen level. Before joining the telehealth program, he could only guess at that. Now he knows if the reading is low, he can take action. When the reading is high, he can go about his business confident that his oxygen level will see him through. “Telehealth is a good thing for me, ” says Henry. “I know that on the other end of the telephone there’s a little angel and if anything goes wrong it shows up on the television and she’s on the phone within five minutes. “

When it comes to health, which is more important, nature or nurture? You may well think your genes are a more important predictor of health and ill health. Not so fast. In fact, it transpires that our everyday environment outweighs our genetics, big time, when it comes to measuring our risk of disease. The genome is out—welcome the exposome.

“The exposome represents everything a person is exposed to in the environment, that’s not in the genes, ” says Stephen Rappaport, environmental health scientist at the University of California, Berkeley. That includes stress, diet, lifestyle choices, recreational and medicinal drug use and infections, to name a few. “The big difference is that the exposome changes throughout life as our bodies, diets and lifestyles change, ” he says.

While our understanding of the human genome has been growing at an exponential rate over the last decade, it is not as helpful as we hoped in predicting diseases. “Genes only contribute 10 percent to the overall disease burden, ” says Rappaport.

“Knowing genetic risk factors can prove absolutely futile , ” says Jeremy Nicholson at Imperial College London. He points to work by Nina Paynter at the Brigham and Women’s Hospital in Boston, who investigated the effect of 101 genetic markers implicated in heart disease. After following over 19, 000 women for 12 years, she found these markers were not able to predict anything about the incidence of heart disease in this group.

On the other hand, the impact of environmental influences is still largely a mystery. “ There’s an imbalance between our ability to investigate the genome and the environment, ” says Chris Wild, director of the International Agency for Research on Cancer, who came up with the idea of the exposome.

In reality, most diseases are probably caused by a combination of the two, which is where the exposome comes in. “The idea is to have a comprehensive analysis of a person’s full exposure history, ” says Wild. He hopes a better understanding of exposures will shed a brighter light on disease risk factors.

There are likely to be critical periods of exposure in development. For example, the time from birth to 3 years of age is thought to be particularly important. “We know that this is the time when brain connections are made, and that if you are obese by this age, you’ll have problems as an adult, ” says Nicholson.

Publishing in scientific journals is the most common and powerful means to disseminate new research findings. Visibility and credibility in the scientific world require publishing in journals that are included in global indexing databases such as those of the Institute for Scientific Information (ISI). Most scientists in developing countries remain at the periphery of this critical communication process, exacerbating the low international recognition and impact of their accomplishments. For science to become maximally influential and productive across the globe, this needs to change.

The economy of electronic publication, open access, and property rights fuel current academic and policy debates about scientific publishing in the industrialized world. The concerns in the developing world (with few ISI-indexed journals) focus on more fundamental questions, such as sustaining local research activity and achieving the appropriate global reach of its science activities.

The essence of the African situation is captured by R. J. W. Tijssen’s analysis of publications by African authors, which was based not only on data from ISI indexing databases, but also on publications not indexed in this system. Surprisingly, half of the South African citations in the indexed ISI literature are to articles in nonindexed, locally published journals. Also, several nonindexed local journals are cited in the ISI system at about the same rate as are indexed journals. The share of indexed articles with at least one author with an Africa address remains steady at about 1%. About half of the ISI-indexed papers with at least one author with an African address have non-African partners outside of the continent. These figures vary, country by country, sometimes in surprising ways. For example, 85% of the papers published from Mali or Gabon involve collaborations on other continents, versus 39% and 29%, respectively, for South Africa and Egypt, the continent’s leading research producers. Thus, much of the African research system is now highly dependent on collaborations.

How can the global reach and potential impact of scientific research in Africa and other developing countries be optimized? Of primary importance is boosting the quality and quantity of work that is locally published, through measures including review of submissions by peers research opportunities. A proliferation of journals, short-lived publications, print-only journals, and poor distribution constitutes a picture that must change. A nationally organized project can probably make the biggest difference, with investment by government and research-support agencies, as well as wide participation by local and regional scientific communities.