The given line diagram projects job opportunities in three different sectors, namely, manufacturing, services, and agriculture, in the United States of America, spanning from 1975 to year 2025. The numbers are portrayed in millions.
Evidently, employment in the services sector demonstrates a marked upward trajectory throughout the given period. In comparison, both the agricultural sector and the manufacturing sector experience a decline in jobs, despite a notable surge in manufacturing sector in the initial half.
Zooming in, the services sector, which had 10 million jobs in 1975, witnesses only a marginal ascent to around 15 million by 1979. However, then on, it skyrockets to nearly 90 million by 2025, marking an astounding upsurge.
The agriculture sector, despite initially holding the top position in employment with 80 million jobs from 1975 to 1977, undergoes a dramatic plunge and decreases to nearly 10 million by 2025. Interestingly, the manufacturing sector, though it had risen from around 10 million in 1975 to a substantial 40 million jobs in 1980, ultimately tumbles close to the initial numbers by 2025.
Text A Reduction: A clinician can achieve a reduction by closed manipulation – in which the displaced bone fragments are pulled into their anatomical position – restoring alignment or by open reduction through a surgical incision. Immobilisation can be achieved by internal or external fixation devices, which are available in many forms. Internal fixation involves the patient undergoing a surgical procedure and includes devices such as intramedullary nails, compression nails, plates and screws. Internal fixation is used in certain pathological fractures, when sufficient reduction cannot be maintained by external fixation, for example, when fractures involve joint surfaces, when it is important to allow early limb or joint movement, or when trying to avoid long periods of immobilisation in bed. External fixation can be achieved through surgical, as well as conservative techniques, and includes slings, cast immobilisation, skin or skeletal traction and external fixator frames.
TEXT B: Rehabilitation: Restoration of the upright position and early mobilization decrease cardiopulmonary and other immobility associated complications, for example. pressure ulcers, constipation. and urinary stasis. Following recovery or once the fracture is stable, the limb can be mobilised and range of movement exercises can begin. Deciding on the right time to begin physiotherapy is difficult. Rehabilitation should not commence too early as this may result in malunion of the bone, however, it should not even begin too late resulting in a perfect union of bone, but muscles are unable to operate the limb. Nurses have a responsibility to know what type of rehabilitation programme patients are undergoing; whether this is fully weight-bearing, partial weight-bearing, touch-toe-bearing or non-weightbearing; and also what mobilisation aids, if any, are being used, so that they are able to continue mobilising patients when physiotherapy services are not available.
Text C The complications associated with fractures can be classified as immediate, early or late. Nurses must observe for complications and take preventive measures.
Mal-union Delayed union Non-union Osteoarthritis Avascular necrosis
Text D: Pain assessment and management: Although pain is a useful sensation in alerting us to disease or injury, it should not be accepted as a normal and inevitable part of recovery from injury or surgery. Assessment of pain is essential to ensure that the correct analgesic for the condition is prescribed and administered, and that it is having the desired effect with minimal side effects. The nurse caring for the patient, who has sustained a fracture should have knowledge of available medications and their actions, side effects and dosages. Pre-emptive analgesia should be provided so that the patient’s pain is sufficiently managed before and during rehabilitation sessions. Non-pharmacological methods of pain control such as positioning, distraction techniques and massage may also benefit patients.
In which text can you find information about: 1. Necessary to take preventive measures 2 To help the patient cope with disability. 3. Minimising the risk of deficit and in detecting early signs of the development. 4 At risk of death from a relatively simple transverse fracture of the tibia, if it is not detected. 5. To restore normal alignment of the bone. 6 To ensure that the reduced position is maintained until the bone union takes place. 7. Internal and external haemorrhage.
Questions 8-14 Answer each of the questions, 8-14, with a word or short phrase from one of the texts.
8. What can be provided for effective pain management? 9. When can it be possible to make the patient ready for movement? 10. What should not be regarded as the unavoidable part of recovery from injury? 11 What is the example given for a non-rigid method of support? 12. What may involve a surgical process? 13 What knowledge shall a nurse have when it comes to effective caring for the patient who is fractured? 14 How can reduction successfully be performed? Questions 15-20Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. 15. Because of a period of immobilisation and the effects of surgery, patients are at a risk of developing ______________ 16. A ______________ may lead to osteoarthritis as a result of an abnormal distribution of load leading to an early degenerative change. 17. There are ______________ that carry the risk of damage to particular arteries. 18. Pain is considered a ______________ which make one aware of the injury. 19. A ______________ is an uncommon but serious complication. 20. Besides the blood loss from the ______________ , the sharp bone ends found in a spiral or comminuted fracture, for example, may damage the surrounding muscle or blood vessels.
PART B. For questions 1-6, choose the answer (A, B or C) which you think fits best according to the text.
1 The following is a model A. Manual calibration B. True gravity calibration C. Wall sphygmomanometer Mercury-gravity Manometer: The mercury-gravity manometer consists of a calibrated cartridge glass tube that is optically clear, easy to clean, and abrasion resistant. The mercury reservoir at the bottom of the tube communicates with a compression cuff through a rubber tube. When air pressure is exerted on the mercury in the reservoir by pumping the pressure bulb, the mercury in the glass tube rises and indicates how much pressure the cuff applies against the artery. The manometer is connected to the wall for ease of accurate visualization.
2 The manual gives information about; A. Indications of emergency treatment. B. How the device can effectively be used? C. Indications for using the Power heart AED G3 Automatic devices like Power heart AED are intended to be used by the personnel who are trained in its operation. The user should be qualified by training in basic life support or other emergency medical response authorized by physicians. The device is indicated for emergency treatment of victims exhibiting symptoms of sudden cardiac arrest, who are unresponsive and not breathing. Post-resuscitation, if the victim is breathing, the AED should be left attached to allow for acquisition and detection of the ECG rhythm. If a shockable ventricular tachyarrhythmia recurs, the device will charge automatically and advise the operator to deliver therapy (G3) or automatically deliver the shock (G3 Automatic). If the patient is a child or an infant up to 8 years of age, or up to 55 lbs (25kg), the device should be used with the Model 9730 Pediatric Attenuated Defibrillation Electrodes. The therapy should not be delayed to determine the exact age or weight of the patient.
3. Pick the correct statement; A. Data suggests that NAFLD is more common than any other diseases. B. NAFLD is more prevalent in Middle East. C. NAFLD is more prevalent in Africa. Prevalence of NAFLD – In Contrast to Other Diseases: The meta-analysis estimated that the overall global prevalence of NAFLD diagnosed by imaging I around 25.24% (95% CI, 22.10-28.65). The ubiquity rate of NAFLD in the Middle East can be reported as follows: (31.79% [95% CI, 13.48- 58.23]) and South America (30.45% [95% CI, 22.74-39.440]), whereas the lowest prevalence rate is reported from Africa (13.48% [5.69- 28.69]).
4 The manual talks about; A. Critical Illness & Treatment Of Delirium B. Delirium In Critical Care C. Impact Of Delirium On ICU Patient Delirium: The study of disease transmission of Delirium in sick patients is currently perceived as a general well-being issue, influencing the mechanically ventilated grown-up ICU patients up to 80%, and costing $4 to $16 billion every year in the United States alone. Effect of Delirium, as a sign of intense cerebrum brokenness, is a free critical indicator of negative clinical results in ICU patients that includes expanded mortality, healing facility LOS, expense of consideration, and long-haul psychological weakness reliable with a dementia-like state. Patients with long-haul presentation to high-measurements sedatives or medications may create physiologic reliance, and unexpected suspension may bring about medication withdrawal side effects. This session likewise incorporates Impact of Delirium on ICU Patient Outcomes, Epidemiology of insanity in ICU patients, Preventing, Detecting, and Treatment because of Alcohol and drug Withdrawal. Critical illness and appraisal of incoherence, Risk element of wooziness.
5 As per the report, what is correct? A. Talk about 2050 neonates. B. Major reason for admission into hospital was related to CMV. C. Gestational age is taken as an important factor for the study conducted. A Report; Two hundred and sixty-one neonates born at the hospital were admitted to the neonatal ICU during the study period. Two patients were excluded because they had received transfusions of blood products before urine collection (0.76%), two because the consent was not obtained (0.76%), one because the urine sample was lost (0.38%), two died before collection (0.76%) and four were lost because they were discharged early, before urine collection (1.5%). The study population comprised 145 male NB (58%) and 105 female NB (42%). The principal causes of admission to the ICU were prematurity (111 cases, 44.4%), respiratory dysfunction (64 cases, 25.6%), sepsis (31 cases, 12.4%) and hypoglycemia (21 cases, 8.4%). The mean weight of the newborn population studied was 2,412±900 g and mean gestational age was 35.7±3.7 weeks.
6. From the given manual, it is clear that; A. The device will analyze ECG and can make shock deliverance simple. B. Non-committed shock is possible through the device. C. The device automatically shifts from one phase to other phase of operations as per the rhythmic changes. After the AED advises a shock, it continues to monitor the ECG rhythm of the patient. If the ECG rhythm changes to a non-shockable rhythm before the actual shock is delivered, the AED will advise that the rhythm has changed and issue the prompt “RHYTHM CHANGED. SHOCK CANCELLED.” The AED will override the charge and continue ECG analysis. Synchronized Shock:- The AED is designed to automatically attempt to synchronize shock delivery on the R-wave, if one is present. If delivery cannot be synchronized within one second, a nonsynchronized shock will be delivered.
PART C. TEXT 1. OPIOID-INDUCED CONSTIPATION The human opioid system is highly complex and includes three main endogenous opioid receptors (µ, κ and δ receptors), as well as a number of endogenous opioid peptides such as endorphins, enkephalins, and dynorphins, which activate these receptors. Opioid receptors are widely distributed in the brain and spinal cord, as well as in a variety of peripheral tissues such as the gut, airways, blood vessels, and heart. When activated, the opioid receptors located in the brain and spinal cord mediate the analgesic effects of the opioids. Unfortunately, activation of opioid receptors in the gut can significantly impair intestinal activity and lead to OIC.
Mu-opioid receptors, and to a lesser extent κ-opioid receptors, are expressed extensively throughout the gastrointestinal tract and enteric nervous system. When opioid receptors are stimulated they may alter or more precisely decrease peristalsis, inhibit intestinal transit, increase intestinal fluid absorption and decrease intestinal secretions. All of these effects combine to cause significant constipation. A clinical syndrome of opioid-induced bowel dysfunction may occur with chronic opioid use that is characterized by abdominal pain, hard stools, fecal impaction, anorexia, nausea and vomiting.
A 2009 study by Bell et al., examined the prevalence, severity and impact of OIC in 322 patients taking daily opioids. The investigators found that 81% of the patients in their study reported OIC and that the majority of patients with OIC reported at least a moderate negative impact on quality of life and activities of daily living. One third of patients with OIC missed the doses, decreased dosage or stopped using opioids completely in order to improve their bowel function. A second study by Bell found that the patients with OIC were more likely to take time off from work and were less productive in both their work and home environments. With continued opioid use, patients often become adept at dealing with the analgesic effects of the opioids. The mechanism of opioid tolerance is likely related to down-regulation (decreased numbers) or desensitization of µ-opioid receptors in the CNS. Binding of opioids to the µ receptor activates numerous downstream intracellular pathways. Activated G-protein-dependent signaling pathways appear involved in receptor desensitization while G-proteinin dependent signaling pathways appear to facilitate µ receptor endocytosis and subsequent downregulation of receptors. Fortunately, tolerance to the respiratory depressant effects of the opioids also develops in parallel to the tolerance seen with the analgesic effects. Interestingly, however, tolerance does not occur to the constipating effect of the opioids. Opioid-induced constipation and opioid bowel dysfunction presents with a myriad of symptoms. Diagnosis of OIC should begin with a detailed patient history that includes frequency of bowel movements, the consistency of stool, and the presence of straining, pain, nausea and vomiting. A physical examination should also be conducted including the bowel sounds, and abdominal palpation for firmness, distention and the presence of pain. The possibility of fecal impaction should also be assessed in patients with persistent and severe constipation. A number of nonpharmacologic and pharmacologic options are available with respect to effective elimination of this condition. Although current treatment recommendations support the prophylactic use of various bowel regimens in patients receiving opioid therapy, definitive studies showing the superiority of one treatment regimen over another are currently lacking.
The overall strategy to prevent OIC and to start with the onset of opioid therapy, include adequate fluid and fiber intake, and increased physical activity. A recent study showed that patients with post- operative constipation, who received bowel massage by nurses had reduced symptoms of constipation, increased stool output and improved quality of life with no significant adverse side effects. However, in another study, it is showed that while abdominal massage was useful for decreasing the severity of constipation symptoms, it did not lead to curtailing down of laxative. Bowel “diaries” which track the frequency of bowel movements might also be helpful for determining the severity of the OIC that is occurring. While helpful, nonpharmacologic interventions are seldom successful alone for the management of OIC.
Senior nurses should be ideally situated to identify patients at high risk for OIC and ruling out other causes of chronic constipation. A detailed patient history should be obtained, which will include physical activity, and a review of all medications the patient is currently taking. A thorough patient examination should be conducted and accompanying signs and symptoms such nausea, vomiting or abdominal pain/distention should be noted. Nurses should monitor patient bowel habits as well as the quantity and quality of stools.
7. In the first paragraph, the writer talks about; A. OIC in general B. Types of OIC receptors C. How OIC occurs? D. Distribution of opioid receptors. 8. As per paragraph two, activation of opioid receptors will; A. Lead to intestinal movement B. Cause hard stools C. Lead to constipation D. Cause abdominal pain 9. What do we learn about OIC in the third paragraph? A. Research conducted by Bell B. Impact of OIC on life C. How OIC will affect? D. Cessation of opioid pain therapy 10 What do we learn from the fourth paragraph? A. Opioid acceptance behaviour among patients B. Ability to deal with the analgesic effects C. Resilience and OIC D. Opioid Tolerance and OIC 11. What is not right as per the information given in the fifth paragraph? A. A large number of symptoms arises that lead to OIC. B. Detection of bowel sounds, presence of nausea are common. C. Patients suffering from the disease will vomit, feel abdominal pain. D. None of the above 12. In paragraph six, the writer gives information on; A. How OIC can easily be avoided? B. Nonpharmacologic management of OIC. C. Steps to be taken to deal with OIC. D. How OIC can be prevented? 13. Pick the incorrect statement related to the study performed as explained by the writer; A. Only nonpharmacologic interventions can be effective. B. Bowel massage is effective in eliminating many of the problems associated with OIC. C. Stool output can be improved. D. Use of laxative can certainly be decreased. 14 In the final paragraph, the writer talks about; A. Importance of taking patient`s history. B. Identifying risks. C. Role of the advanced practice nurse in OIC. D. Treatment procedure.
PART C. TEXT 2: VACCINATION
Vaccination as a deliberate attempt to protect human beings against disease has a long history and more widespread use of vaccines could prevent about 1.6 million deaths a year among children less than five years of age. Over the next few years a new generation of vaccines will become available that could save the lives of up to 10 million individuals: e.g., vaccines against diarrhoeal diseases, hepatitis C, malaria, acquired immunodeficiency syndrome (AIDS), sexually transmitted and other diseases. Current development efforts seek combination vaccines that protect against multiple pathogens, with a goal of combining all the antigens recommended for routine immunization into a single multivalent product.
Combining multiple related or unrelated antigens into a single vaccine is not a new concept and the first combination vaccine licensed in the United States of America was trivalent influenza in 1945. Diphtheria, Pertussis, Tetanus (DPT) vaccine although developed in 1943, was not licensed till 1948. Efforts to overcome the interference seen with simultaneous administration of three live vaccines delayed the licensing of trivalent Oral Polio Vaccine (OPV) till 1963. Measles, Mumps,Rubella (MMR) was licensed in 1971 and quadrivalent meningococcal vaccine in 1978.
Combining multiple antigens into one injection requires demonstration that the combination will not materially reduce the safety or immunogenicity of the component vaccines. Combination vaccine trials should be prospective, randomised, double blinded and should have control (comparison) groups.Identifying the control groups could be problematic when multicomponent vaccine is evaluated. Other factors like sequence of administration of certain antigens may play an important role in immunogenicity.
The interaction can enhance the immune response to individual components as it occurs in whole cell pertussis vaccine, when combined with diphtheria toxoid. Usually, a combination of vaccines results in no effect or a depression of immune response to one or more vaccine component. It is an immunologic phenomenon relevant to combination vaccines, antibody responses to hapten polysaccharide vaccine (e.g. H influenzae b) presented on a carrier protein (e.g. tetanus toxoid,diphtheria toxoid) are inhibited by prior immunization with the specific carrier.Combination live vaccines can interfere immunologically with each other, e.g., one vaccine may stimulate interferon production that may inhibit replication of another virus.
Interest in combining DPT/IPV was generated when enhanced potency IPV became available, thus eliminating the necessity of frozen shipments for OPV. In addition, administration of IPV would eliminate the risk of vaccine-associated polio. Antibody responses to pertussis and poliovirus components may be substantially reduced in combination than when given alone. However, poliovirus seroconversion rates and absolute antibody levels remained high in combined vaccines. Various studies have compared DPT combinations with unconjugated Polyribose phosphate (PRP) or conjugated PRP Hib vaccine. A number of studies have evaluated these combination vaccines and results are variable. In general, the groups with lower antibody responses still attained levels considered protective. One study evaluated the effect of booster dose of DPT/Hepatitis B/Hib given to subjects, who received DPT/Hepatitis B/ Hib for the primary series. The group hadhigh antibody response and mean levels were higher in the group primed with DPT/Hepatitis B/Hib, especially with PRP (Hib).
DTaP/HB combination vaccine retains the immunogenicity and safety profiles of the separate components and delivers good antibody concentrations at a variety of schedules. A comparison of combination vaccine at 2, 4, 6 months versus the currently recommended schedules-HB at birth, 1 & 6 months and DPT at 6, 10 & 14 weeks, found similar or higher antibody responses for combined vaccine for every component, which was significantly lower. However, the mean HB antibody levels were high and 98% of subjects had levels greater than 10mIU/mL, which are considered protective. A study comparing combination vaccine and separate vaccines given at 2, 4, 6 and booster between 12 and 15 months of age has shown that the antibody response to Hib, were 72% and 76% at 6 months, increasing to 92% and 93% after booster dose with combination and separate vaccines respectively.
15. In the first paragraph, writer says that; A. Combination vaccines are the new phase of development. B. Vaccines implemented have changed lives of people across the globe. C. Vaccines provide effective protection from a large number of pathogens c. D. Use of vaccines have led to curtailing down of deaths in millions. 16. In paragraph 2, the writer says A. Combination vaccines came into being in 1940s. B. DPT was the first combined vaccine to be used. C. OPV was not introduced before 1963. D. MMR is an example of effective combined vaccine. 17. Paragraph three talks about; A. Immunogenicity of the prepared vaccines. B. Importance of conducting trails. C. Facts that have direct impact on immunogenicity. D. Challenges in the development of combined vaccines. 18 In paragraph four, the writer has described; A. Immunological interference B. Antigen role C. Induction of interferon D. B and C 19. Immunologic phenomena relevant to combination vaccines gives an idea about; A. Induction of interferon B. Carrier induced epitope expression C. Antigen competition D. Immunological interference 20 As per paragraph five, what is more relevant? A. DPT/Conjugate (Hib) will often be not more effective. B. Combined vaccines often produce different results. C. DPT/IPV came into being only after potency IPV became available. D. DPT/Hepatitis B and DPT/Hepatitis B/Hib have more potential to produce same results 21. In paragraph 6, the writer says; A. Taking vaccines at an early age is important. B. Various combinations bring in various results. C. Combinations with DTaP is proven to be more effective D. Separate vaccine shall be given as needed 22 In final paragraph, writer has directly or indirectly implied that; A. Vaccines for newborn and children less than 3 years old are known to be more powerful. B. Combined vaccines may not be as effective as separate vaccines. C. Separate vaccines are more effective than combined vaccines. D. Combined vaccine helps with retaining immunogenicity.
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5: Gestational age is taken as an important factor for the study conducted.
6: The device will analyze ECG and can make shock deliverance simple.
Reading test – part C – answer key
Text 1 – Answer key 7 – 14
7: How OIC occurs? 8: Lead to intestinal movement 9: Impact of OIC on life 10: Opioid Tolerance and OIC 11: None of the above 12: Nonpharmacologic management of OIC. 13: Use of laxative can certainly be decreased. 14: Role of the advanced practice nurse in OIC.
Text 2 – Answer key 15 – 22
15: Vaccines implemented have changed lives of people across the globe.
16: MMR is an example of effective combined vaccine.
17: Immunogenicity of the prepared vaccines.
18: Antigen role
19: Antigen competition
20: Combined vaccines often produce different results.
21 : Various combinations bring in various results.
22: Combined vaccine helps with retaining immunogenicity.
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The provided line graph denotes the percentage of the total number of people living in four different cities, namely: Philippines, Malaysia, Thailand, and Indonesia from the year 1970 to 2040.
Overall, it is observed that the population trend projects an upward trajectory for all the cities throughout the given period. While Malaysia culminates at the top in terms of numbers, Thailand has the lowest population.
Despite initially having the lowest population percentage (less than 15%) among the cities in 1970, Indonesia demonstrates a remarkable upward trend, culminating at around 65% by 2040. Similarly, Malaysia exhibits a parallel trend, starting at 30% in 1970 and reaching approximately 85% by 2040.
Philippines, unlike the other three given cities, experiences drastic fluctuations in population. Starting just above 30% in the year 1970, it undergoes sharp population growth, reaching close to 50%. However, from 1990 to 2010, it plummets to around 43%. Subsequently, the percentage recovers and rises, reaching almost 55% by 2040.
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TEXT A: The temporomandibular joint (TMJ) is one of the most frequently used joints of the human body. It is used when speaking, chewing, yawning, swallowing and other activities during the day and even in sleep. The frequency of movement is assessed as about 1500-2000 times a day. The term ‘temporomandibular disorder’ (TMD) stands for a number of disorders related to the masticatory muscles or the TMJs and related structures. In the greatest number of cases, the cause of temporomandibular disorder is a disturbance of function in the form of increased muscular tonus and myofascial trigger points. It is essential to start treatment at the stage of mere dysfunction, i.e., at the stage when the changes are still reversible, in order to prevent irreversible structural changes. According to epidemiological statistics, 70% of the randomized population suffers from at least one symptom or sign of TMD, but only one fourth of this number is aware of it and only 5% seeks medical treatment.
TEXT B: Symptoms: Dull aching pain, which varies in strength from mild to severe, is the most common symptom associated with TMJ disorders. The pain is usually felt in the jaw, but can also be felt in the surrounding areas, including the face, ear, and even the teeth. The pain may also radiate to the neck or shoulders, and is usually made worse by chewing and moving your jaw. Other signs and symptoms associated with TMJ disorders include: • jaw tenderness; • jaw clicking, or popping, when you open and close your mouth or chew; • a grating sensation when chewing; • an uncomfortable or uneven bite; and • jaw locking (an inability to open or close the mouth completely). TMJ disorders can be temporary or chronic, but only a small proportion of people develop significant, long-term problems. Women tend to be affected by TMJ disorders more often than men.
TEXTC: Diagnosis and treatment: A dentist can help identify the source of the pain with a thorough exam and appropriate X-rays. However, for some types of pain, the cause is not easily diagnosed. The pain may be related to the facial muscles, the jaw or the TM joint. Some TMJ problems result from arthritis, dislocation or injury. All of these conditions can cause pain and dysfunction. Muscles that move the joints are also subject to injury and disease. Injuries to the jaw, head or neck might cause some TMJ problems. Other factors relating to the way the upper and lower teeth fit together (the bite) may cause some types of TM disorders. Stress and teeth grinding are also considered as possible factors. There are several treatments for TMJ disorders. They may include stress-reducing exercises, wearing a mouth protector to prevent teeth grinding, orthodontic treatment, medication or surgery. Treatment may involve a series of steps beginning with the most conservative options. In many cases, only minor, non-invasive treatment may be needed to help reduce symptoms.
TEXT D: ABSTRACT: Effectiveness of specific physiotherapy in treatment of TMD. The aim of this study was to evaluate the effect of individual specific physiotherapy in the treatment of temporomandibular disorders, its immediate effect and its effect after two months. The research sample was comprised of 23 subjects, 17 women and 6 men, with an average age of 36.5 years. They complained of pain, sound phenomena and restricted mandibular movements. The patients were first examined by a stomatologist who recommended physiotherapy. The effect of treatment was assessed according to the intensity of pain, the occurrence of reflex changes in soft tissues in the region of the masticatory muscles and digastricus muscle, the range of mouth opening and the intensity of sounds produced by mandibular movements. It was found that after treatment pain was significantly reduced (p<0.001) at the temporomandibular joint (from 4.2 points to 0.7 point on the VAS [Visual Analogue Scale]). There were also fewer reflex changes in the muscles and fascias. The range of mouth opening increased significantly (from 37.3 mm to 41.3 mm, p<0.001) and the intensity of sounds was reduced from 100% to 43% (p<0.001). This state was maintained two months later: intensity of pain (p<0.001), mouth opening (p<0.003) and reduction of sound phenomena (p<0.001). Pain was ameliorated, the intensity of sounds reduced, and the range of movement significantly improved after specific physiotherapy.
For each question, 1-7, decide which text (A, B, C or D) the information comes from. 1 frequently found symptom regarding TMJ disorders? 2 improvements noted after treatment? 3 right time to begin the treatment? 4 ratio of patients to the ones who get medical care? 5 gender-wise prevalence of TMJ disorders? 6 how to reduce the symptoms? 7 role of physiotherapy in the treatment?
Questions 8-14. Answer each of the questions, 8-14, with a word or short phrase from one of the texts
8 Which healthcare professional normally does the diagnosis of TMJ disorders? 9 What is the very common symptom exhibited by TMJ disorders? 10 What does ‘VAS’ stand for based on the information given in the texts? 11 What was the average age of the subjects in the research study? 12 What is the term for the inability to open or close the mouth completely? 13 What type of treatment was offered to the subjects in the research study? 14 Where does a patient suffering from TMJ disorders normally sense the pain?
Questions 15-20. Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. 15 TMJ is one among the more regularly used in our body. 16 Apart from the pain and sound phenomena, the subjects also complained about . 17 An oral guard is used to avoid . 18 Small, may be required to reduce symptoms of TMJ in most cases. 19 TMJ disorders can be or non-permanent. 20 The aching caused by TMJ disorders may also emanate to the .
PART B. For questions 1-6, choose the answer (A, B or C) which you think fits best according to the text.
1. According to the extract, the nursing facilities require more physicians, who A. increase the demand of quality long-term care. B. lead the clinical decision-making for patients after care. C. can offer care on-site to nursing facility residents. Nursing Facility Care: Nationwide, nursing facility care is changing to include not only long-term care of frail residents but also complicated and resource-intensive post-hospital care. The population of people receiving care in nursing facilities is more medically complex as patients are discharged ‘sicker and quicker’ from the hospital to skilled nursing facilities and the hospitals focus on decreasing readmission rates. However, the majority of patients are still long term stay patients who themselves have increased in medical complexity and acuity. Both of these imperatives have resulted in an increased need for highly trained and committed health care practitioners willing to provide care on-site to nursing facility residents. Physician involvement in nursing facilities is essential to the delivery of quality long-term care. Attending physicians should lead the clinical decision-making for patients under their care. They can provide a high level of knowledge, skill, and experience needed in caring for a medically complex population in a climate of high public expectations and stringent regulatory requirements
2. Material-mediated pyrogenicity is not assessed using A. traditional non biocompatibility extraction method. B. pyrogenicity test equivalent validated method. C. material-mediated pyrogenicity testing. Pyrogenicity: Implants as well as sterile devices having direct or indirect contact with the cardiovascular system, the lymphatic system, or cerebrospinal fluid and devices labeled as “non-pyrogenic,” should meet pyrogen limit specifications. Pyrogenicity information is used to help protect patients from the risk of febrile reaction. There are two sources of pyrogens that should be considered when addressing pyrogenicity. The first, material – mediated pyrogens, are chemicals that can leach from a medical device during device use. Pyrogens from bacterial endotoxins can also produce a febrile reaction similar to that mediated by some materials. Material-mediated pyrogenicity testing is not needed if chemical characterization of the device extract and previous information indicate that all patient- contacting components have been adequately assessed for pyrogenicity. Otherwise, we recommend that you assess material-mediated pyrogenicity using traditional biocompatibility extraction methods, using a pyrogenicity test or an equivalent validated method.
3. What is the purpose of the Staffing Reallocation Plan? A. reallocate RNs from home unit to another unit to provide needed patient care. B. balance patient census and care needs with RN competencies and availability. C. flex RNs who match patient census with patient care needs according to their specialty. Staffing Reallocation Plan: The Staffing Reallocation policy was revised to ensure a consistent system-wide approach that correlates patient census and patient care needs with RN competencies and availability. The newly standardized process may include reallocating RNs from their home unit to another like unit to provide needed patient care. The policy was reviewed and vetted by nurses at all levels of the organization. A standard icon was created in scheduling and productivity system to easily identify RNs who sign- up for additional shifts to support patient care needs. This allows the nursing division to utilize the most cost-effective staffing resources at the appropriate time for the specific patients requiring care. The Clinical Administrators work collaboratively with the Staffing Resources Office and nursing leadership to reallocate and/or flex RN staff matching patient census with patient care needs and the specialty RNs needed to provide care.
4. If a patient request for an assisted death, nurses must A. explore the reasons and understand them to seem helpful B. ensure every opportunity to relieve suffering is offered C. talk to their superior and team for a formal request Assisted Death: Every question from a patient about assisted death signifies that the patient is, or is worried about, suffering and is an opening for a dialogue with that individual. It is important for us, as nurses, to explore the reasons for the request in order to understand what supports might be helpful, and whether the patient has unmet needs. Whether or not, a nurse is prepared to be involved in any way in assisting someone to die, they remain a part of the team caring for the patient. Nurses should advocate for their patients, including the pursuit of aggressive symptom management strategies, to ensure every opportunity to relieve suffering is offered. Nurses should also understand the process for medical assistance in dying, and their professional role in the process. Any nurse could be asked by a patient or family member about assisted death. For some, it might be an exploration of options, or simple information seeking. For others, their questions may indicate intent to pursue an assisted death. Please talk to your supervisor and team if a patient would like to proceed with a formal request.
5. The policy document tells us that the potential toxicity of a component is evaluated by A. testing the component exclusively. B. testing the exposure separately. C. adequate assessment of the material. Inclusion of Multiple Components: For devices that include components with different lengths of contact, we recommend that any extract-based biocompatibility testing be conducted separately. If the components are combined into a single test article, this will dilute the amount of component materials being presented to the test system and may not accurately identify potentially toxic agents that would have been found if the components were tested separately. For example, we recommend testing implants separately from delivery systems or other kit components. For devices or device components that contain multiple materials with differing surface areas or differing exposure to the body, if one or more materials is new, it may also be necessary to test the new material components separately as well, to further understand the potential toxicity of this component. For example, for a catheter-based delivery system that contains a new balloon material, tests of the delivery system separate from the balloon may be necessary to ensure adequate assessment of each of the materials.
6. What is being described in this extract? A. detailed information about medical records. B. purpose of medical records in patient care. C. how to avoid errors in medical records Medical records: Medical records is a broad term, encompassing a range of data and information storage mediums containing patient information. Whether paper based or electronic, the term “medical records” applies to clinical notes, investigations, letters from other doctors and healthcare providers, photographs and video footage. However, information exchanges (such as correspondence, email and file notes of discussions) between a medical practitioner and their medical indemnity insurer or solicitor should not be stored in the medical record. For this reason, it is recommended that you keep a separate medico-legal file in which to store these documents. Medical records are an integral part of good quality patient care. The primary purpose of the medical record is to facilitate patient care and allow you or another practitioner to continue the management of the patient. Clinical observations, decision making and treatment recommendations or plans should be recorded contemporaneously. This reduces the possibility of an error occurring and is an important risk management tool.
PART C. TEXT 1: GOOD LOOKS
Paragraph 1: Attempts to find out what makes a person physically attractive date back at least to the Ancient Greeks. Plato wrote that the ideal face should have a width two-thirds of its length, and that a nose should be no longer than the distance between the eyes. His theory of ‘golden proportions’, while not necessarily accepted by researchers today, nevertheless represented an attempt to define a fundamental preference for symmetry that scientists say is a highly evolved trait seen in both humans and animals. Human babies, for example, spend more time staring at pictures of symmetric faces than they do at photos of asymmetric ones. In the bird kingdom, female swallows prefer males with longer and more symmetric tails, while female zebra finches mate with males with symmetrically colored leg bands.
Paragraph 2: The rationale behind symmetry preference in both humans and animals is that symmetric individuals have a higher mate-value. Scientists also believe that symmetry is equated with a strong immune system. Thus, beauty is indicative of more robust genes, improving the likelihood that an individual’s offspring will survive_ This evolutionary theory is supported by research showing that standards of attractiveness are similar across cultures. John Manning of the University of Liverpool does not agree entirely, however, and cautions against such over- generalization, especially by Western scientists. Darwin thought that there were few universals of physical beauty because there was much variance in appearance and preference across human groups,’ he says.
Paragraph 3: Research overwhelmingly shows that beauty matters. It pervades society, it affects how people choose partners, and it influences how people are seen and how they see others. One of the chief beneficiaries of this focus on physical attractiveness is the cosmetic medicine and cosmetic surgery industry. Once only for the rich and privileged, cosmetic procedures nowadays are mainstream and affordable. For a fraction of the cost and time required even a decade ago, practitioners these days can remove wrinkles and blemishes, straighten teeth and noses, and sculpt bodies into works of art.
Paragraph 4: In most countries, due to the range of procedures available and of practitioners performing them, from plastic surgeons to cosmetic doctors and dermatologists, statistics for cosmetic surgery are either not collected or not reliable. In the United States, however, statistics released by the American Society for Aesthetic Plastic Surgery show that nearly 11.7 million cosmetic surgical and nonsurgical procedures were performed in 2007. The Aesthetic Society, which has been collecting multi-specialty procedural statistics since 1997, says the overall number of cosmetic procedures in the US has increased 457% since the collection of the statistics first began.
Paragraph 5: It is important to bear in mind that there are potential pitfalls, both physical and emotional, associated with this growing cultural phenomenon. While people have the right to maximize their attractiveness, there is the danger that, for some, cosmetic medicine may become an unhealthy obsession or be mistaken as the answer to life’s problems. Studies spanning four decades have reported that most people undergoing cosmetic interventions are satisfied with the result; however, there is a particular subgroup of people who appear to respond poorly to cosmetic procedures. These are people with the psychiatric condition known as ‘body dysmorphic disorder’ (BDD), which is characterized by a preoccupation with an objectively absent or minimal deformity that causes clinically significant distress or impairment in social, occupational, or other areas of functioning.
Paragraph 6: While few methodologically robust studies have been done, some clinicians and researchers have attempted to evaluate whether improvement in psychosocial wellbeing following cosmetic enhancement can be objectively verified at all. Overall, studies suggest that those patients who were pleased with the outcome showed improvements in ‘self worth’, ‘self esteem ‘, ‘distress and shyness’ and ‘quality of life’. What does appear to be an important factor in assessments of satisfaction is the patient’s expectation of the outcome of the procedure. Research suggests that the more extensive ‘type change’ procedures (e.g., rhinoplasty, breast augmentation) appear to require greater psychological adjustment by the patient than ‘restorative ‘ procedures (e.g., facelift, botulinum toxin A injection).
Paragraph 7: Given the range of possible reactions to cosmetic procedures, it is important for the practitioner to evaluate the patient ‘s motivations for surgery before the procedure is undertaken. First, the individual’s attitude towards the cosmetic problem, and the distress and disability associated with it, should be assessed. Patients should be advised of what the cosmetic outcome is likely to be and fully informed of potential side effects and complications. It is also useful to review past cosmetic interventions, including the number of previous procedures and their cosmetic and psychosocial outcome as perceived by the patient as well as family and friends. The cosmetic specialist should probably be most concerned about people who have had numerous procedures performed by many practitioners, and particularly those who report the outcome of such procedures to have been unsatisfactory.
7. In the first paragraph, babies are mentioned because they A. prefer faces with symmetric features. B. have highly evolved symmetric traits. C. react negatively to asymmetric images. D. display the same preferences as birds. 8. In the second paragraph, the phrase ‘is equated with’ indicates that symmetry and immunity are A. linked to each other. B. equal to each other. C. dependent on each other. D. opposite to each other. 9. Which one of the following statements according to John Manning’s opinion, is NOT supported by information given in second paragraph? A. Western scientists take a Darwinist approach to attractiveness. B. Darwin’s theories go against some current views of attractiveness. C. Western scientists tend to take a simplistic view of attractiveness. D. there is no definitive basis for symmetry’s role in attractiveness. 10. Scientists believe that humans and animals are instinctively attracted by symmetry in potential partners A. because they want a good-looking mate. B. in the interests of survival of the species. C. to strengthen their own immune systems. D. because symmetrical bodies are noticeable. 11. The cosmetic surgery industry is popular because A. society is preoccupied with beauty. B. it is considered an art form. C. so many people feel unattractive. D. it promotes wealth and glamour. 12. Aside from the United States, country-specific statistics on cosmetic surgery are unreliable because______ A. the United States dominates the market. B. of the number of different professions involved. C. there are too many instances to count. D. of the rapid increase in demand. 13. In the fifth paragraph, the phrase ‘potential pitfalls’ refers to A. life’s problems. B. maximum attractiveness. C. unhealthy obsessions. D. dangerous outcomes. 14. Based on the seventh paragraph, the doctor should tell patients about A. the different attitudes of patients to cosmetic surgery. B. how distress influences the outcome of surgery. C. what the result might be and what could go wrong. D. the success rate of his/her previous procedures.
PART C. TEXT 2: RABBIT CALICIVIRUS DISEASE David Lord’s family arrived in western New South Wales in 1870. The first rabbit plague came 10 years later. In the 1940s rabbits would flock in thousands to waterholes, kicking up storms of dust. In the 1950s they disappeared, and were thought to be gone. But they came back. Last year Mr. Lord’s property, 40 kilometers west of Broken Hill, had 25,000 warrens and about a million rabbits. Then in early November he found a dead one near his home, and felt pretty sure his problem was solved. Within a week, 600,000 more were dead. Few carcasses were seen above ground but the stench was overpowering as the rabbits just crawled into their burrows and died. The killer is rabbit calicivirus disease (RCD. Transmitted primarily by rabbits themselves, the naturally occurring virus scythes through populations of the European rabbit yet is not known to infect any other species. Proponents of the virus as a biological control say it could save up to $1 billion a year in lost primary production and degraded land, as well as priceless native flora and fauna.
Mr. Lord born in the 1950s, when another imported disease, myxomatosis, killed 99 per cent of the country’s rabbits-calls it “the best thing to happen to inland Australia in 40 years.” But it wasn’t meant to happen now. The virus was not due for release for another two years. Its escape from a South Australian testing station in October severely embarrassed the government and the CSIRO and threatened a nine-year program of testing and hearings to win public support. As the virus is now out, scientists and farmers want to ensure its effectiveness with a controlled release in the next two months. Autumn is believed to be the best time for release as young rabbits, whose underdeveloped immune system makes them less susceptible to the disease, are less common. Yet while the Minister for Primary Industry, John Anderson, said this week that he favored early release, he doubted bureaucratic and legislative approvals could be granted in time. In Western Australia a defense coalition against RCD, including animal rights groups and the fledgling rabbit farming industry, is demanding a public inquiry into the disease. Any virus is hard to sell.
“We recognized years ago that virus-dread, as we call it, would need to be managed,” says Nicholas Newland, the coordinator of the RCD program. Although the CSIRO never guaranteed it could contain the virus on Wardang Island, it had taken great precautions to ensure an escape never happened. The calicivirus – so called because under a microscope its surface resembles a set of inverted chalices –was found in China in 1984. It reached Europe two years later, killing about 64 million farmed rabbits in two months in Italy alone. Scientists here watched with interest. Rabbits had developed some immunity to myxomatosis, and no other control had been as successful. The rabbit count was steadily increasing, to about one-fifth of pre-myxomatosis numbers. In 1991 quarantine authorities allowed the CSIRO to import the virus. At the Animal Health Laboratory in Geelong. scientists injected 28 species with a virus dose 1000 times greater than one lethal to a rabbit. None of these species which included dogs, cats, native mammals and birds, were infected.
Testing moved to Wardang Island in 1994. A direct flight transported the virus, packed into containers so secure that a plane crash would not destroy them. In a scene from science fiction, the quarantine station had an electric fence, double fenced pens and high security shacks that required researchers to change cloths three times before leaving. Rabbits wore radio collar so scientists would know instantly if one had died. Yet the virus escaped-from the shacks to rabbits elsewhere on the island, then across a four-kilometer strait. Researchers blame an insect, perhaps a fly. Once on the mainland, the virus jumped 380 kilometers almost overnight, probably through insects floating on air currents. By Christmas it covered one-third of South Australia. In the Flinders Ranges, where 95 per cent of rabbits are thought to have died, flora such as the bullock bush and mulga tree showed new shoots for the first time in decades, says Ron Sinclair of the Animal and Plant Control Commission. Since Christmas, perhaps because of a hot summer and poor conditions for insects, the spread has slowed.
The first sign of the virus in Victoria appeared only recently with dead rabbits near Castlemaine, Maryborough and Marong. Again, insects on air currents may be responsible. The untimely escape has forced authorities to concertina an approval process of years into months. In December, two American scientists wrote to Australia’s Biological Control Authority and he then Prime Minister, warning that the calicivirus could jump species barriers. Dr. Alvin Smith, professor of veterinary medicine at Oregon State University, wrote that if the virus mutated-and it was far too early to be sure that it wouldn’t or it could endanger livestock and even humans. Australian scientists say there is no evidence the rabbit calicivirus can jump species. Only one virus-feline panleukopaenia, or cat flu-has been documented to have increased its host range (to dogs), says Tony Robinson, a senior CSIRO virologist. He says that after 10 years of contact with diseased rabbits in Europe, no human has been infected.
Nevertheless, the debate has bothered Hugh Wirth. “Two lots of scientists are arguing, so the jury is still out,” says the head of the RSPCA. Yet conservation groups such as the Wildlife Preservation Society favor release. “Calicivirus is a blessing. to all who care for Australia’s plants and animals,” society president Vincent Serventy has written. One thing is sure: the virus will not eradicate all rabbits. “We made that mistake with myxomatosis – apathy crept in,” says lan Lobban, spokesman on rabbit control for the Victorian Farmers’ Federation. In Canberra, CSIRO scientists have already begun to try to engineer a new strain of myxomatosis that causes rabbit sterility. In Europe the rabbit poses a different problem. Worried about the animal’s decline because of calicivirus, Spain is stocking a national park with inoculated rabbits to ensure prey for species such as the lynx and imperial eagle. In its birthplace, the rabbit is struggling. Here it is not wanted, and has thrived. The effects of the Australian and Spanish programs are opposite but the intent is the same: to help to balance an unbalanced world.
15. Australian farmers like David Lord consider the release of the virus to be A. a dangerous mistake. B. an embarrassing incident. C. a fortunate accident. D. a bureaucratic error. 16. Scientists prefer to release the virus in autumn because A. there are fewer young rabbits in autumn. B. rabbits have weaker immune systems in autumn. C. young rabbits catch the disease more easily in autumn. D. rabbits are more plentiful in autumn. 17. Official early release of the virus is unlikely because A. the Minster for Primary Industry supports it. B. rabbit farmers disagree with animal rights groups. C. the general public refuses to pay for the program. D. groups opposing RCD are demanding an inquiry. 18. The number of rabbits in Australia prior to the release of RCD was A. 20% more than in the period before myxomatosis. B. 20% less than in the period before myxomatosis. C. remaining stable. D. seems to be rising. 19. How did the virus enter Australia? A. carried by insects. B. brought by dogs and cats. C. imported by scientists. D. found in European rabbits. 20. From the article, we can infer that the virus was being tested on Wardang Island for what reason? A. to prevent its uncontrolled spread. B. to eliminate rabbits from the island. C. to protect the researcher. D. to keep the tests a secret. 21. Because of the escape of the virus, authorities are trying to: A. delay the approval process for several months. B. modify the approval process. C. speed up the approval process. D. extend the approval process. 22. Which of the following was not a concern of the American scientists who contacted the Biological Control Authority? A. that humans could catch the disease. B. that sheep and cattle could die. C. that insufficient research had been done before the release. D. that the virus had already mutated.
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The given map delineates the geographical, population, and infrastructural disparities in a locale between the year 1950 and the present day.
Overall, there is a discernible expansion in the population, residential area, business district, airport, government building, and major roadways between these two timeframes.
The population of the city dramatically augmented from 20,000 in 1950 to 200,000 at present. Moreover, the residential area now covers a substantial portion with the expanded business district in the heart, demarcated by a seizable lake, which originally was a small river. Notably, there is now a dam at the south east corner and a new bridge, complementing the existing one that spans the city from south to north.
Further developments include the addition of a major road, spanning from southwest to southeast and interconnecting existing ones. The airport is now tripled in size, and in addition to the one they had adjacent to the centre bridge, a new government building now stands at the south of the city.
The provided sketch meticulously illustrates the historical setting from 1980 and the present state of a specific area, presumably a park.
In general, substantial transformations have shaped the area, with the removal of fences and gates symbolizing the park’s newfound accessibility to the public. The addition of a playground and a barbecue facility has added an appealing dimension to the park, albeit at the cost of its previous centerpiece— a vibrant display of flowers, lost to the developments.
Firstly, a significant change is the introduction of a playground situated at the southeast corner, replacing the once abundant floral landscape. Additionally, the southwest region, formerly adorned with flowers, now features a bush.
Notably, the pond area remains relatively unchanged, except for the incorporation of an extra bench, bringing the total to four. Furthermore, in the northeast corner, a barbecue facility has been established next to the existing trees, equipped with tables and chairs. The centrally located pathway, dividing the park into four quadrants, facilitates easy access to each of these newly added amenities.
The presented diagram delineates the current infrastructure alongside proposed modifications for a specific locale.
Overall, it is evident that the proposed plan encompasses various alterations, incorporating the introduction of an industrial estate, interconnected roadways, a roundabout, and a highway.
A salient modification in the proposed plan involves the complete replacement of the existing airfield with an industrial estate. Furthermore, the town center in the proposed plan is intricately connected to a highway, significantly enhancing accessibility. While the build-up area adjacent to the ring road is slightly reduced in size, the gas station remains totally untouched.
In addition, the industrial estate in the new rendition is seamlessly linked to the railway via a road. There is also a new road from the town center, namely A4, which connects to the railway in the south, and A2, another road. Notably, a newly introduced roundabout at the heart of the location serves to augment mobility.
In IELTS Writing Task 1, maps are visual prompts that depict the layout or design of a location, such as a city, building, or site. Candidates are tasked with describing the key features, changes, and spatial relationships within the map. The goal is to convey a clear understanding of the geographic details presented. This may include explaining the locations of different structures, roads, landmarks, or transformations over time. The language used should be precise, and the response should effectively communicate the information found in the map. Describing the overall layout, specific locations, and any notable changes are crucial elements for a successful response in IELTS Writing Task 1 involving maps.
5. IELTS task 1 Map: The maps show the change of Pentland from 1980 to 2007. Summarise the information by selecting and reporting the main features, and make comparisons where relevant.
6. IELTS writing task 1 Map. University sports centre:
12. IELTS writing task 1 Map.Cinema: The diagrams below show changes of a cinema from 1980 until now. Summarize the information by selecting and reporting the main features, and make comparisons where relevant.
20. IELTS writing task 1 Map: Sawry district: The diagrams below show changes that have taken place in the Sawry District neighbourhood since 1920. Summarise the information by selecting and reporting the main features and make comparisons where relevant.
21. IELTS writing task 1 Map: Brandfield Below is a map of the city of Brandfield. City planners have decided to build a new shopping mall for the area, and two sites, S1 and S2 have been proposed. Summarize the information by selecting and reporting the main features and make comparisons where relevant.
22. IELTS writing task 1 Map. Birshire: The maps below show the center of a small town called Birshire as it is now, and plans for its development. Summarize the information by selecting and reporting the main features, and make comparisons where relevant.
23. IELTS writing task 1 Map: The diagrams below show the changes that has taken place in a village park.
24. IELTS writing task 1 Map: Foster Road between SE 84th and 85th Avenue, before and after installation of wider sidewalks, a new crossing, bicycle lanes and street trees.
