In the contemporary era, the escalating demand for energy to power factories, households, and, notably, automobiles has underscored the imperative for renewable energy sources. This essay aims to delve into the advantages and disadvantages of these sustainable energy alternatives in comparison to traditional fossil-based fuels.
On the one hand, renewable energy holds the potential to emerge as our ultimate solution if harnessed effectively. Solar, wind, tidal energy, and other renewable sources stand out prominently, offering far better alternatives to fossil-based fuels. The discernible advantage lies in the marked differences in environmental friendliness and the safeguarding that renewable energy can provide, unlike fossil-based fuels which vent out toxic gasses, which if breathed on a regular basis, could lead to respiratory diseases and more. Moreover, these gases are the primary contributors to the ozone layer’s depletion and global warming. Therefore, renewable energy not only benefits our well-being but also contributes to the health of our planet. Australia is one of the finest examples, embracing wind and solar energy projects, contributing significantly to its electricity generation and concurrently cutting down on air pollution.
On the other hand, renewable energy faces challenges related to reliability, as natural sources like sunlight and wind may not be consistently available. Factors such as precipitation and daylight hours impact successful energy harnessing. For instance, continual rainy or cloudy weather makes electricity production from solar energy close to impossible, and storing it can be costly, highlighting the practical challenges of relying solely on renewables. On the other hand, fossil fuels, like coal, despite environmental concerns, provide a reliable energy source that remains consistently available until fully depleted, exemplifying centuries-long dependence of humanity on such resources.
To conclude, while renewable energy could be the finest alternative to fossil fuel and can be better for our environment and health, it still lacks in the areas of consistency in production, and we cannot yet rely on it solely. However, as technology is evolving, it is possible that the future will offer better alternatives and solutions where we can produce energy without compromise.
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The bar chart and table show information about students from abroad studying in four English-speaking countries in 2004 and 2012. Summarise the information by selecting and reporting the main features, and make comparisons where relevant.
TEXT A. US researchers have found altered sleep patterns among breastfeed infants of mothers who smoke. Julie Mannella from the Monell Chemical Senses Centre in Philadelphia recruited 15 breastfeeding mothers who smoked. Sleep and activity patters in their babies, which were aged between two and six months, were monitored on two occasions over a three-hour period after the children were fed. On both occasions they were allowed to smoke just before they fed their babies. The women were also asked to avoid caffeinated drinks during the study.
TEXT B. Tests on the milk from mothers who had recently smoked confirmed that the babies were receiving a significant increase in nicotine dose, and the team found that the amount of sleep taken during the fallowing three hours by these babies fell from an average of 85 minutes to 53 minutes, a drop of almost 40%. This is probably due to the neuro-stimulatory effects of nicotine, which has been shown to inhibit regions of the brain which are concerned with controlling sleep. It may also, suggests Manella, explain why neonatal nicotine exposure has been linked in the past with long-term behavioural and learning deficits, since these could be the consequence of sleep disturbance. In light of these findings, mothers who smoke might want to consider planning their smoking around their breast feeding. Nicotine levels in milk peak 30-60 minutes after smelting, but take three hours to return to baseline, so this might be feasible.
TEXT C. Cigarette smoke. What is in smoke? Scientific studies show that there can be around 4000 chemicals in cigarette smoke. They can be breathed in by anyone near a smoker. They can also stick to clothes, hair, skin, walls and furniture. Some of these chemicals are: • tar – which has many chemicals in it some of which cause cancer • carbon monoxide – reduces the oxygen in blood – so people can develop heart disease • poisons – including arsenic, ammonia and cyanide.
TEXT D. Passive smoking and respiratory function in very low birth weight children Abstract Aim: To determine if an adverse relationship exists between passive smoking and respiratory function in very low birth weight (VLBW) children at 11years of age. Setting: The Royal Women’s Hospital. Melbourne. Patients: 154 consecutive surviving children of less than 1501 g birth weight born during the 18 months from 1October 2006. Methods: Respiratory function of 120 of the 154 children (77.9%) at 11years of age was measured. Exposure to passive smoking was established by history; no children were known to be actively smoking. The relationships between various respiratory function variables and the estimated number of cigarettes smoked by household members per day were analysed by linear regression Results: Most respiratory function variables reflecting airflow were significantly diminished with increasing exposure to passive smoking. In addition, variables indicative of air-trapping rose significantly with increasing exposure to passive smoking. Conclusions: Passive smoking is associated with adverse respiratory function in surviving VLBW children at 11years of age. Continued exposure to passive smoking, or active smoking, beyond 11years may lead to further deterioration in respiratory function in these children.
Part A. TIME: 15 minutes. Questions 1-7. Choose A, B, C or D. In which text can you find information about 1. how many chemicals are there in cigarette smoke? _____________ 2. which chemical Vs in cigarette smoke cause/s cancer? _____________ 3. when does nicotine levels in breast milk reach at peak? _____________ 4. How does exposure to passive smoking was established in the study? _____________ 5. what happened to respiratory function variables reflecting airflow in the study? _____________ 6. what are the side effects of neonatal nicotine exposure? _____________ 7. what are the poisons in cigarette smoke? _____________ Questions 8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts. 8. How much percentage does the sleep drop in the babies who had significant nicotine dose? ________ 9. How much percentage of children at 11years of age was measured for respiratory function? _______ 10. What was the maximum birth weight of babies who were considered for the study? _____________ 11. Which chemical component in cigarette smoke reduces the oxygen in blood? _____________ 12. Who recruited subjects for the study conducted by Monell Chemical Senses Centre? _____________ 13. Which chemical component in cigarette smoke is responsible for heart disease? _____________ Questions 14-20. Complete each of the sentences, 14-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both. 14. If children are continually exposed to active smoking, it can lead to _________ in respiratory function. 15. Cigarette smoke can be breathed in by anyone near a ___________________ 16. During the study some women were asked to avoid ____________________ 17. ______________________ can also stick to clothes, hair, skin, walls and furniture. 18. Variables indicative of _____________rose significantly with increasing exposure to passive smoking. 19. _____________ of nicotine can inhibit regions of the brain which control sleep. 20. The relationships between respiratory function variables and number of cigarettes smoked per day were analysed by_____________
PART B. Choose the answer (A, B or C) which you think fits best according to the text. B.P.sets: Functioning: The cuff on the arm is inflated until blood flow in the artery is blocked. As the cuff pressure is decreased slowly, the sounds of blood flow starting again can be detected. The cuff pressure at this point marks the high (systolic) pressure of the cycle. When flow is unobstructed and returns to normal, the sounds of blood flow disappear. The cuff pressure at this point marks the low (diastolic) pressure. 1. When should one note the diastolic pressure of patient? A. blood flow is limited to make the sound disappear B. blood flow is normal and the sound disappear C. blood flow is obstructed and the sound disappear
Aspirators: Suction is generated by a pump. This is normally an electrically powered motor, but manually powered versions are also often found. The pump generates a suction that draws air from a bottle. The reduced pressure in this bottle then draws the fluid from the patient via a tube. The fluid remains in the bottle until disposal is possible. A valve prevents fluid from passing into the motor itself. 2. The purpose of bottle in aspirator is to A. deliver suction that draws air B. draw the fluid from the patient C. keep pressure stable if valve prevents fluid
Operating Theatre and Delivery Tables: Where the table has movement, this will be enabled by unlocking a catch or brake to allow positioning. Wheels have brakes on the rim or axle of the wheel, while locks for moving sections will normally be levers on the main table frame. Care should be taken that the user knows which lever applies to the movement required, as injury to the patient or user may otherwise result. The table will be set at the correct height for patient transfer from a trolley then adjusted for best access for the procedure. 3. The email is reminding user that the A. importance of lever for the required movements B. locks of moving wheels are on main table frame C. table should be set at correct height of the patient
Methods of reporting hospital infection: A mass outbreak of a hospital infection, which can result in severe injury or death, must be reported without delay, by telephone, fax or e-mail to the local public health protection authority (usually to the regional hygiene departments). The following cases are subject to the reporting of hospital infections: Severe injury, as a result of hospital infection, A mass outbreak, an infection that led to the death of a patient. 4. The guidelines establish that the healthcare professional should A. report a mass outbreak of hospital infection immediately B. report severe injury, as a result of hospital infection with delay C. report an infection that led to the death of a patient only
Admission and treatment in medical and social care facilities: Hygiene requirements for the admission and treatment of patients at medical inpatient facilities, day care and outpatient care facilities are set out in the operating rules of each healthcare provider, and always take into consideration the nature and scope of activity, and the type of healthcare provided. The receiving healthcare professional at the healthcare facility such as an inpatient facility, day care or social care facility, records anamnesis information that is significant in terms of the potential occurrence of hospital infection, including travel and epidemiological anamnesis, or conducts an examination of the overall health of the individual. 5. This guideline extract says that hygiene requirements are A. determined by the healthcare professional B. implemented by the healthcare provider C. written in the operating rules of the facilities
Treatment of used contagious and surgical linen: The healthcare provider and the laundry contractually agree on a system for classifying and labelling containers according to the content (e.g., in colour or numerical) and the procedure in terms of the quantity, deadlines and handling is documented. Linen is sorted at the place of use but it is not counted. The linen is not to be shaken before placing into the containers in the ward. It is sorted into bags according to the degree of soiling, type of material and colour. 6. The purpose of this email is to A. report on a rise in used contagious and surgical linen in healthcare facility B. explain the background to a change healthcare provider and the laundry contract C. remind staff about procedures for treatment of used contagious and surgical linen _______________________________________________________________________________
PART C. Choose the answer (A, B, C or D) which you think fits best according to the text. PANCREATIC ISLET TRANSPLANTATION Paragraph 1: The pancreas, an organ about the size of a hand, is located behind the lower part of the stomach. It makes insulin and enzymes that help the body digest and use food. Spread all over the pancreas are dusters of cells called the islets of Langerhans. Islets are made up of two types of cells: alpha cells, which make glucagon, a hormone that raises the level of glucose (sugar) in the blood, and beta cells, which make insulin.
Paragraph 2: Islet Functions: Insulin is a hormone that helps the body use glucose energy. If your beta cells do not produce enough insulin, diabetes will develop. In type 1diabetes, the insulin shortage is caused by an autoimmune process in which the body ‘s immune system destroys the beta cells.
Paragraph 3: Islet Transplantation: In an experimental procedure called islet transplantation, islets are taken from a donor pancreas and transferred into another person. Once implanted, the beta cells in these begin to make and release insulin. Researchers hope that; transplantation will help people with type 1 diabetes live without daily injections of insulin.
Paragraph 4. Research Developments: Scientists have made many advances in islet transplantation recent years. Since reporting their findings in the June issue of the New England Journal of Medicine, researchers the University of Alberta in Edmonton, Canada, have continued to use a procedure called the Edmonton protocol to transplant pancreatic islets into people with type 1 diabetes. According to the Immune Tolerance Network (ITN), as of June 2003, about 50 percent of the patients have remained insulin-free up to g 1year after receiving a transplant. Researchers use specialized enzymes to remove islets from the pancreas of a deceased donor. Because the islets are fragile, transplantation occurs soon after they are removed.
Paragraph 5: During the transplant, the surgeon uses ultrasound to guide placement of a small plastic tube (catheter) through the upper abdomen and into the liver. The islets are then injected through the catheter into the liver. The patient will receive a local anesthetic. If a patient cannot tolerate local anesthesia, the surgeon may use general anesthesia and do the transplant through a small incision. Possible risks include bleeding or blood clots. It takes time for the cells to attach to new blood vessels and begin releasing insulin. The doctor will order many tests to check blood glucose levels after the transplant, and insulin may be needed until control is achieved.
Paragraph 6. Transplantation: Benefits, Risks, and Obstacles: The goal of islet transplantation is to infuse enough islets to control the blood glucose level without insulin injections. For an average-size person (70 kg), a typical transplant requires about 1 million islets, extracted from two donor pancreases. Because good control of blood glucose can slow or prevent the progression of complications associated with diabetes, such as nerve or eye damage, a successful transplant may reduce the risk of these complications. But a transplant recipient will need to take immunosuppressive drugs that stop the immune system from rejecting the transplanted islets.
Paragraph 7. Researchers are trying to find new approaches that will allow successful transplantation without the use of immunosuppressant drugs, thus eliminating the side effects that may accompany their long-term use. Rejection is the biggest problem with any transplant. The immune system is programmed to destroy bacteria, viruses, and tissue it recognizes as “foreign,” including transplanted islets. Immunosuppressive drugs are needed to keep the transplanted islets functioning.
Paragraph 8. Immunosuppressive Drugs: The Edmonton protocol uses a combination of immunosuppressive drugs, also called antirejection drugs, including daclixrm (Zenapax), sirolimus (Rapamune), and tacrolimus (Prograf). Dacliximab is given intravenously right after the transplant and then discontinued. Sirolimus and tacrolimus, the two drugs that keep the immune system from destroying the transplanted islets, must be taken for life.
Paragraph 9. These drugs have significant side effects and their long-term effects are still not known. Immediate side effects of immunosuppressive drugs may include mouth sores and gastrointestinal problems, such as stomach upset or diarrhea. Patients may also have increased blood cholesterol levels, decreased white blood cell counts, decreased kidney function, and increased susceptibility to bacterial and viral infections. Taking immunosuppressive, drugs increase the risk of tumors and cancer as well.
Paragraph 10: Researchers do not fully know what long-term effects this procedure may have. Also, although the early results of the Edmonton protocol are very encouraging, more research is needed to answer questions about how long the islets will survive and how often the transplantation procedure will be successful. Before the introduction of the Edmonton Protocol, few islet cell transplants were successful. The new protocol improved greatly on these outcomes, primarily by increasing the number of transplanted cells and modifying the number and dosages of immunosuppressants. Of the 267 transplants performed worldwide “from 1990 to 1999, only 8 percent of the people receiving them were free -of insulin treatments one year after the transplant. The CITR’ s second annual report, published in July 2005, presented data on 138 patients. At six months after patients’ final infusions, 67 percent did not need to take insulin treatments. At one year, 58 percent remained insulin independent. The recipients who still needed insulin treatment after one year experienced an average reduction of 69 percent in their daily insulin needs.
Paragraph 11: A major obstacle to widespread use of islet transplantation will be the shortage of islet cells. The supply available from deceased donors will be enough for only a small percentage of those with type 1diabetes. However, researchers are pursuing avenues for alternative sources such as creating islet cells from other types of cells. New technologies could then be m employed to grow islet cells in the laboratory.
QUESTIONS Q1. The pancreas is A. in the hand B. in the stomach C. above the stomach D. behind the lower part of the stomach Q2. What is the main purpose of insulin? A. Itis a hormone B. to destroy beta cells C. to assist in energy production D. to stimulate the auto immune process Q3. According the article, is islet transplantation common practice? A. Yes, it’s frequently used B. No, it’s still being trialed C. Not stated in the article D. Yes, but only in Canada Q4. What is the Edmonton Protocol? A. A trade agreement B. The journal of Alberta University C. A way to transplant pancreatic islets D. Not stated in the article Q5. What’s the source of the pancreatic islets that are in the transplant operation? A. They are donated by relatives B. They come from people who have recently died C. They are grown in a laboratory D. They come from foetal tissue Q6. Which one of the sentences below is true? A. A local anaesthetic is preferred where possible. B. A general anaesthetic is preferred where possible. C. A general anaesthetic is too risky due to the possibility of blood clots and bleeding. D. An anaesthetic is not necessary if ultrasound is used Q7. How soon after the operation can the patient abandon insulin injections? A. Immediately B. After about two weeks C. When the blood glucose levels are satisfactory D. After the first year Q8. How many islets are required per patient? A. About a million B. 70 kg C. Whatever is available is used D. it depends on the size of the patient
PART C. Choose the answer (A, B, C or D) which you think fits best according to the text. SEASONAL INFLUENZA VACCINATION AND THE HLNL VIRUS
Paragraph 1: As the novel pandemic influenza A (H1N1) virus spread around the world in late spring 2009 with a well-matched pandemic vaccine not immediately available, the question of partial protection afforded by seasonal influenza vaccine arose. Coverage of the seasonal influenza vaccine had reached 30%- 40% in the general population in 2008-09 in the US and Canada, following recent expansion of vaccine recommendations.
Paragraph 2. Unexpected Findings in a Sentinel Surveillance System: The spring 2009 pandemic wave was the perfect opportunity to address the association between seasonal trivalent inactivated influenza vaccine (TIV) and risk of pandemic illness. In an issue of PLoS Medicine, Danuta Skowronski and colleagues report the unexpected results of a series of Canadian epidemiological studies suggesting a counterproductive effect of the vaccine. The findings are based on Canada’s unique near-real-time sentinel system for monitoring influenza vaccine effectiveness. Patients with influenza-like illness who presented to a network of participating physicians were tested for influenza virus by RT-PCR, and information on demographics, clinical outcomes, and vaccine status was collected.
Paragraph 3. In this sentinel system, vaccine effectiveness may be measured by comparing vaccination status among influenza-positive “case” patients with influenza negative “control” patients. This approach has produced accurate measures of vaccine effectiveness for TIV in the past, with estimates of protection in healthy adults higher when the vaccine is well-matched with circulating influenza strains and lower for mismatched seasons. The sentinel system was expanded to continue during April to July 2009, as the H1N1 virus defied influenza seasonality and rapidly became dominant over seasonal influenza viruses in Canada.
Paragraph 4. Additional Analyses and Proposed Biological Mechanisms: The Canadian sentinel study showed that receipt of TIV in the previous season (autumn 2008) appeared to increase the risk of H1N1 illness by 1.03- to 2.74-fold, even after adjustment for the comorbidities of age and geography. The investigators were prudent and conducted multiple sensitivity analyses to attempt to explain their perplexing findings, importantly, TIV remained protective against seasonal influenza viruses circulating in April through May 2009, with an effectiveness estimated at 56%, suggesting that the system had not suddenly become flawed. TIV appeared as a risk factor in people under 50, but not in seniors-although senior estimates were imprecise due to lower rates of pandemic illness in that age group. Interestingly, if vaccine were truly a risk factor in younger adults, seniors may have fared better because their immune response to vaccination is less rigorous.
Paragraph 5. Potential Biases and Findings from Other Countries: The Canadian authors provided a full description of their study population and carefully compared vaccine coverage and prevalence of comorbidities in controls with national or province-level age-specific estimates-the best can do short of a randomized study. In parallel, profound bias in observational studies of vaccine effectiveness does exist, as was amply documented in several cohort studies overestimating the mortality benefits of seasonal influenza vaccination in seniors.
Paragraph 6: Given the uncertainty associated with observational studies, we belie would be premature to conclude that TIV increased the risk of 2009 pandemic illness, especially in light of six other contemporaneous observational studies in civilian populations that have produced highly conflicting results. We note the large spread of vaccine effectiveness estimates in those studies; indeed, four of the studies set in the US an Australia did not show any association whereas two Mexican studies suggested a protective effect of 35%-73%.
Paragraph 7. Policy Implications and a Way Forward: The alleged association between seasonal vaccination and 2009 H1N1 remains an open question, given the conflicting evidence from available research. Canadian health authorities debated whether to postpone seasonal vaccination in the autumn of 2009 until after a second pandemic wave had occurred, but decided to follow normal vaccine recommendations instead because of concern about a resurgence of seasonal influenza viruses during the 2009-10 season.
Paragraph 8: This illustrates the difficulty of making policy decisions in the midst of a public health crisis, when officials must rely on limited and possibly biased evidence from observational data, even in the best possible scenario of a well-established sentinel monitoring system already in place. What happens next? Given the timeliness of the Canadian sentinel system, data on the association between seasonal TIV and risk of H1N1 illness during the autumn 2009 pandemic wave will become available very soon, and will be crucial in confirming or refuting the earlier Canadian results.
Paragraph 9: In addition, evidence may be gained from disease patterns during the autumn 2009 pandemic wave in other countries and from immunological studies characterizing the baseline immunological status of vaccinated and unvaccinated populations. Overall, this perplexing experience in Canada teaches us how to best react to disparate and conflicting studies and can aid in preparing for the next public health crisis. QUESTIONS Q1. The question of partial protection against H1N1 arose _ A. before spring 2009 B. 2. during Spring 2009 C. 3. after spring 2009 D. 4. during 2008-09 Q2. According to Danuta Skowronski—- A. the inactivated influenza vaccine may not be having the desired effects. B. Canada’s near-real-time sentinel system is unique. C. the epidemiological studies were counterproductive D. the inactivated influenza vaccine has proven to be ineffective. Q3. The vaccine achieved higher rates of protection in healthy adults when A. it was supported by physicians. B. the sentinel system was expanded. C. used in the right season. D. it was matched with other current influenza strains. Q4. Which one of the following is closest in meaning to the word prudent? A. Anxious B. 2. cautious C. 3. busy D. 4. confused Q5. The Canadian sentinel study demonstrated that _ A. age and geography had no effect on the vaccine ‘s effectiveness. B. vaccinations on senior citizens is less effective than on younger people C. the vaccination was no longer effective. D. the risk of H1N1 seemed to be higher among people who received the TIV vaccination. Q6. Which of the following sentences best summarises the writers’ opinion regarding the uncertainty associated with observational studies? A. More studies are needed to determine whether TIV increased the risk of the 2009 pandemic illness. B. It is too early to tell whether the risk of catching the 2009 pandemic illness increased due to TIV. C. The Australian and Mexican studies prove that there is no association between TIV and increased risk of catching the 2009 pandemic illness. D. Civilian populations are less at risk of catching the 2009 pandemic illness. Q7. Which one of the following is closest in meaning to the word alleged? A. Reported B. 2. likely C. 3. suspected D. 4. possible Q8. Canadian health authorities did not postpone the Autumn 2009 seasonal vaccination because —– A. of a fear seasonal influenza viruses would reappear in the 2009-10 season. B. there was too much conflicting evidence regarding the effectiveness of the vaccine. C. the sentinel monitoring system was well established. D. observational data may have been biased.
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TEXT A. International flights are suspected of contributing to the formation of DVT in susceptible people, although the research evidence is currently divided. Some airlines prefer to err on the side of caution and offer suggestions to passengers on how to reduce the risk of DVT. Suggestions include: • Wear loose clothes • Avoid cigarettes and alcohol • Move about the cabin whenever possible • Don’t sit with your legs crossed • Perform leg and foot stretches and exercises while seated • Consult with your doctor before travelling
TEXT B. Previous research: Venous thrombosis was first linked to air travel in 1954, and as air travel has become more and more common, many case reports and case series have been published since. Several clinical studies have shown an association between air travel and the risk of venous thrombosis. English researchers proposed, in a paper published in the Lancet, that flying directly increases a person’s risk. The report found that in a series of individuals who died suddenly at Heathrow Airport, death occurred far more often in the arrival than in the departure area. Two similar studies reported that the risk of pulmonary embolism in air travellers increased with the distance travelled. In terms of absolute risk, two studies found similar results: one performed in New Zealand found a frequency of 1% of venous thrombosis in 878 individuals who had travelled by air for at least 10 hours. The other was a German study which found venous thrombotic events in 2.8% of 964 individuals who had travelled for more than 8 hours in an airplane. In contrast, a Dutch study found no link between DVT and long-distance travel of any kind.
TEXT C. Symptoms
• Pain and tenderness in the leg • Pain on extending the foot • Tenderness in calf (the most important sign) • Swelling of the lower leg, ankle and foot • Redness in the leg • Bluish skin discoloration • Increased warmth in the leg
TEXT D. Travel-Related Venous Thrombosis: Results from a Large Population¬ Based Case Control
Study Background: Recent studies have indicated an increased risk of venous thrombosis after air travel. Nevertheless, questions on the magnitude of risk, the underlying mechanism, and modifying factors remain unanswered. Methods: We studied the effect of various modes of transport and duration of travel on the risk of venous thrombosis in a large ongoing case-control study on risk factors for venous thrombosis in an unselected population. We also assessed the combined effect of travel in relation to body mass index, height, and oral contraceptive use. Since March 2015, consecutive patients younger than 70 years of age with a first venous thrombosis have been invited to participate in the study, with their partners serving as matched control individuals. Information has been collected on acquired and genetic risk factors for venous thrombosis. – Results: Of 1,906 patients, 233 had travelled for more than 4 hours in the 8 weeks preceding the event. Travelling in general was found to increase the risk of venous thrombosis. The risk of flying was similar to the risks of traveling by bus or train. The risk was highest in the first week after traveling. Travel by bus, or train led to a high relative risk of thrombosis in individuals with factor V Leiden, in those who had a body mass index of more than 30, those who were more than 190 cm tall, and in those who used oral contraceptives. For air travel these people shorter than 160 cm had an increased risk of thrombosis after air travel as well. Conclusions: The risk of venous thrombosis after travel is moderately increased for all modes of travel. Subgroups exist in which the risk is highly increased.
QUESTIONS 1-7. Choose A, B, C or D. In which text can you find -information about 1. what are the symptoms of DVT? 2. how much risk of DVT is there in the first week after traveling? 3. what is the most important sign of DVT? 4. when did DVT was first linked to air travel? — 5. what are the safe practices to reduce the risk of DYT? 6. which exercises reduce the risk of DVT? — 7. what were the conclusions of the Dutch study on DVT? __
QUESTIONS 8-13. Answer each of the questions, 8-13,”with a word or short phrase from one of the texts. 8. What is the type of skin discolouration seen in DVT patients? 9. What type of clothes reduce the risks of DVT? 10. Which type of flights are more suspected of contributing to the formation of DVT? 11. Name the physical activity which was found to increase the risk of DVT in general? 12. Which type of population was the subject for travel related DVT study? 13. Name the body part/s where tenderness was observed as a symptom of DVT?
Questions 14-20. Complete each of the sentences, 14-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both. 14. The risk of flying was similar to the risks of traveling by___________ 15. Recent studies have indicated an increased risk of venous thrombosis after ___________ 16. ___________ of the lower leg, ankle and foot is a symptom of DVT. 17. Several ___________ have shown an association between air travel and the risk of venous thrombosis. 18. ___________in general, was found to increase the risk of venous thrombosis. 19. Venous thrombosis was first linked to air travel in ___________ 20. Some airlines offer ___________ to passengers on how to reduce the risk of DVT.
PART B. Choose the answer (A, B or C) Flowmeter: A flowmeter is an instrument used to measure the flow rate of a liquid or a gas. In healthcare facilities, gas flowmeters are used to deliver oxygen at a controlled rate either directly to patients or through medical devices. Oxygen flowmeters are used on oxygen tanks and oxygen concentrators to measure the amount of oxygen reaching the patient or user. Sometimes bottles are fitted to humidify the oxygen by bubbling it through water. 1. The purpose of bottles that are fitted with flowmeter is to A. humidify the oxygen tanks by bubbling it through water B. humidify the oxygen reaching the patient or user C. dehumidify the gas in the flowmeter
Pulse Oximeters: Non-invasive monitors: The coloured substance in blood, haemoglobin, is carrier of oxygen and the absorption of light by haemoglobin varies with the amount of oxygenation. Two different kinds of light (one visible, one invisible) are directed through the skin from one side of a probe, and the amount transmitted is measured on the other side. The machine converts the ratio of transmission of the two kinds of light into a % oxygenation. Pulse oximeter probes can be mounted on the finger or ear lobe. 2. What does these notes tell us about pulse oximeters? A. levels vary with amount of oxygenation B. converts percent of light into a % oxygenation C. probes can be mounted either on finger or earlobe
Measuring Patient Weight: Measuring patient weight is an important part of monitoring health as well as calculating drug and radiation doses. It is therefore vital that scales continue to operate accurately. They can be used for all ages of patient and therefore vary in the range of weights that are measured. They can be arranged for patients to stand on, or can be set up for weighing wheelchair bound patients. For infants, the patient can be suspended in a sling below the scale or placed in a weighing cot on top of the scale. 3. These notes are reminding staff that the A. importance of precise reading of scales to monitor health of patient B. infants should stand in a weighing cot on top of the scale C. wheelchair bound patients should be suspended in a set up
Breast Examination: Detection of changes in the breast depends on routine medical check-ups, especially by an oncologist, regular breast scanning and mammography, and women’s self-examination. If early detected, a tumor is usually small, and the smaller it is, the less probability of metastases. Early detection considerably improves prognosis in women with breast cancer: Mammography enables detection of breast cancer at least one year ahead of its manifestations. The smallest clinically palpable tumor is about 1cm in size. 4. The purpose of these notes about mammography is to A. help maximise awareness about its efficiency B. give guidance on early detection and prognosis C. decrease probability of metastases
Catheterisation: Regardless of the instrumental examination carried out in the urinary tract, it is obligatory to maintain perfectly sterile conditions, to apply analgesic and sedative drugs in order to alleviate patient’s suffering, and to use gel substances that facilitate the introduction of the instrument into the urinary tract. While introducing instruments into the bladder, it is necessary to remember about overcoming the resistance of the urethral sphincter gently. 5. What must all staff involved in the catheterization process do? A. maintain perfect aseptic conditions B. use non lubricant substances C. inhibit analgesic and sedative drugs
Ophthalmoscopy: Direct ophthalmoscopy is the most common method of examining the eye fundus. It provides a 15x magnified upright image of the retina. Ophthalmoscopy is much easier through a dilated pupil. Tropicamide 1% drops (0.5% for children) are recommended. The pupil mydriasis starts 10 to 20 minutes after installation and lasts for 6-8 hours. There is a small risk of angle closure glaucoma caused by mydriasis in eyes with shallow anterior chambers, particularly in elderly patients. 6. The guidelines establish that the healthcare professional should A. recommend 1% drops of Tropicamide for elderly patients B. recommend 5% drops of Tropicamide for children C. recommend 10% drops of Tropicamide for elderly patients
PART C. TEXT 1. Choose the answer (A, B, C or D) Is ADHD a valid diagnosis in adults?
Paragraph 1: Attention deficit hyperactivity disorder (ADHD) is well established in childhood, with 3.6% of children in the United Kingdom being affected. Most regions have child and adolescent mental health or paediatric services for ADHD. Follow-up studies of children with ADHD find that 15% still have the full diagnosis at 25 years, and a further 50% are in partial remission, with some symptoms associated with clinical and psychosocial impairments persisting.
Paragraph 2: ADHD is a clinical syndrome defined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, by high levels of hyperactive, impulsive, and inattentive behaviours in early childhood that persist over time, pervade across situations, and lead to notable impairments. ADHD is thought to result from complex interactions between genetic and environmental factors.
Paragraph 3: Proof of validity. Using the Washington University diagnostic criteria, the National Institute for Health and Clinical Excellence (NICE) reviewed the validity of the system used to diagnose ADHD in children and adults.
Paragraph 4: Symptoms of ADHD are reliably identifiable. The symptoms used to define ADHD are found to cluster together in both clinical and population samples. Studies in such samples also separate ADHD symptoms from conduct problems and neuro developmental traits. Twin studies show a distinct pattern of genetic and environmental influences on ADHD compared with conduct problems, and overlapping genetic influences between ADHD and neuro developmental disorders such as autism and specific reading difficulties. Disorders that commonly, but not invariably, occur in adults with ADHD include antisocial personality, substance misuse, and depression.
Paragraph 5: Symptoms of ADHD are continuously distributed throughout the population. As with anxiety and depression, most people have symptoms of ADHD at some time. The disorder is diagnosed by the severity and persistence of symptoms, which are associated with high levels of impairment and risk for developing co-occurring disorders. ADHD should not be diagnosed to justify the use of stimulant drugs to enhance performance in the absence of a wider range of impairments- indicating a mental health disorder.
Paragraph 6: ADHD symptoms have been tracked from childhood through adolescence into adult life. They are relatively stable over time with a variable outcome in which around two thirds show persistence of symptoms associated with impairments. Current evidence defines the syndrome as being associated with academic difficulties, impaired family relationships, social difficulties, and conduct problems. Cross sectional and longitudinal follow-up studies of adults with ADHD have reported increased rates of antisocial behaviour, drug misuse, mood and anxiety disorders, unemployment, poor work performance, lower educational performance, traffic violations, crashes, and criminal convictions.
Paragraph 7: Several genetic, environmental, and neurobiological variables distinguish ADHD from non-ADHD cases at group level, but are not sufficiently sensitive or specific to diagnose the syndrome. A family history of ADHD is the strongest predictor-. parents of children with ADHD and off spring of adults with ADHD are at higher risk for the disorder. Heritability is around 76%, and genetic associations, have been identified. Consistently reported associations include structural and functional brain changes, and environmental factors (such as maternal stress during pregnancy and severe early deprivation).
Paragraph 8: The effects of stimulants and atomoxetine on ADHD symptoms in adults are similar to those seen in children. Improvements in ADHD symptoms and measures of global function are greater in most studies than are reported in drug trials of depression. The longest controlled trial of stimulants in adults showed improvements in these response measures over six months. Stimulants may enhance cognitive ability in some people who do not have ADHD, although we are not aware of any placebo-controlled trials of the effects of stimulants on work or study related performance in healthy populations. This should not, however, detract from their specific use to reduce symptoms and associated impairments in adults with ADHD.
Paragraph 9: Psychological treatments in the form of psychoeducation, cognitive behavioural therapy, supportive coaching, or help with organising daily activities are thought to be effective. Further research is needed because the evidence base is not strong enough to recommend the routine use of these treatments in clinical practice. Paragraph 10: Conclusions. ADHD is an established childhood syndrome that often (in around 65% of cases) persists into adult life. NICE guidelines are a milestone in the development of effective clinical services for adults with ADHD. Recognition of ADHD in primary care and referral to secondary or tertiary care specialists will reduce the psychiatric and psychosocial morbidity associated with ADHD in adults.
QUESTIONS Q1. The article reports what proportion of diagnosed children present with ADHD in adulthood? a. Half b. 3.6% c. A quarter d. 15%
Q2. According to the article _ _ a. ADHD is triggered by genetic factors b. ADHD is the result of environmental factors c. both A and B. d. neither A nor B.
Q3. According to the article symptoms _ a. vary across clinical and population samples. b. varies across situational factors. c. need to pervade across time and situations for a diagnosis to be made. d. are not reliably identifiable.
Q4. Which co-occurring disorders does ADHD frequently present with? a. Antisocial personality disorder. b. Substance misuse. c. Depression. d. All of the above.
Q5. According to the article, which one of the following statements about ADHD is FALSE? a. The use of stimulants is justified in the absence of a wider range of impairments. b. Symptoms of ADHD are evenly prevalent throughout the population. c. The criteria for diagnosis measure the severity and persistence of symptoms. d. High levels of impairment and risk for developing co-occurring disorders are related with ADHD.
Q6. Which heading would best describe paragraph 6? a. Symptoms associated with impairments. b. ADHD and outcomes in adulthood. c. Further definition of the syndrome. d. none of the above
Q7. The strongest predictor of ADHD is _ a. Diagnostic and Statistical Manual of Mental Disorders, fourth edition. b. Social and academic impairment. c. Heritability. d. Family environment.
Q8. The effectiveness of atomoxetine on ADHD symptoms is _ a. less than described in drug trials of depression. b. greater when measured over six months. c. reduced in adults with ADHD. d. known to improve measures of global functioning.
PART C. TEXT 2. Choose the answer (A, B, C or D) Risks and Benefits of Hormone Replacement Therapy
Paragraph 1: Several recent large studies have provoked concern amongst both health professionals and the general public regarding the safety of hormone replacement therapy (HRT). This article provides a review of the current literature surrounding the risks and benefits of HRT in postmenopausal women, and how the data can be applied safely in everyday clinical practice.
Paragraph 2: Worldwide, approximately 47 million women will undergo the menopause every year for the next 20 years. The lack of circulating oestrogens which occurs during the transition to menopause presents a variety of symptoms including hot flushes, night sweats, mood disturbance and vaginal atrophy, and these can be distressing in almost 50% of women.
Paragraph 3: For many years, oestrogen alone or in combination with progestogens, otherwise known as hormone replacement therapy (HRT), has been the treatment of choice for control of problematic menopausal symptoms and for the prevention of osteoporosis. However, the use of HRT declined worldwide following the publication of the first data from the Women’s Health Initiative (WHI) trial in 2002.
Paragraph 4: The results led to a surge in media interest surrounding HRT usage, with the revelation that there was an increased risk of breast cancer and, contrary to expectation, coronary heart disease (CHD) in those postmenopausal women taking oestrogen plus progestogen HRT. Following this, both the Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II) and the Million Women Study published results which further reduced enthusiasm for HRT use, showing increased risks of breast cancers and venous thromboembolism (VTE), and the absence of previously suggested cardioprotective effects in HRT users. The resulting fear of CHD and breast cancer in HRT users left many women with menopausal symptoms and few effective treatment options.
Paragraph 5: Continued analysis of data relating to these studies has been aimed at understanding whether or not the risks associated with HRT are, in fact, limited to a subset of women. A recent publication from the International Menopause Society has stated that HRT remains the first-line and most effective treatment for menopausal symptoms. In this article we examine the evidence that has contributed to common perceptions amongst health professionals and women alike, and clarify the balance of risk and benefit to be considered by women using HRT.
Paragraph 6: One of the key messages from the WHI in 2002 was that HRT should not be prescribed to prevent age-related chronic disease, in particular CHD. This was contradictory to previous advice based on observational studies. However, recent subgroup analysis has shown that in healthy individuals using HRT in the early postmenopausal years (age 50-59 years), there was no increased CHD risk and HRT may potentially have a cardioprotective effect.
Paragraph 7: Recent WHI data has suggested that oestrogen-alone HRT in compliant women under 60 years of age delays the progression of atheromatous disease (as assessed by coronary arterial calcification). The Nurses’ Health Study, a large observational study within the USA, demonstrated that the increase in stroke risk appeared to be modest in younger women, with no significant increase if used for less than five years.
Paragraph 8: Hormone replacement therapy is associated with beneficial effects on bone mineral density, prevention of osteoporosis and improvement in osteoarthritic symptoms. The WHI clearly demonstrated that HRT was effective in the prevention of all fractures secondary to osteoporosis. The downturn in HRT prescribing related to the concern regarding vascular and breast cancer risks is expected to cause an increase in fracture risk, and it is predicted that in the USA there will be a possible excess of 243,000 fractures per year in the near future.
Paragraph 9: The WHI results published in 2002 led to a significant decline in patient and clinician confidence in the use of HRT. Further analysis of the data has prompted a re-evaluation of this initial reaction, and recognition that many women may have been ‘denied’ treatment. Now is the time to responsibly restore confidence regarding the benefit of HRT in the treatment of menopausal symptoms when used judiciously. Hormone replacement therapy is undoubtedly effective in the treatment of vasomotor symptoms, and confers protection against osteoporotic fractures.
Paragraph 10: The oncologic risks are relatively well characterised and p9-tients considering HRT should be made aware of these. The cardiovascular risk of HRT in younger women without overt vascular disease is less well defined and further work is required to address this important question. In the interim, decisions regarding HRT use should be made on a case-by-case basis following informed discussion of the balance of risk and benefit. The lowest dose of hormone necessary to alleviate menopausal symptoms should be used, and the prescription reviewed on a regular basis.
QUESTIONS Q1. Which statement is the closest match to the description of the recent studies in Paragraph? a. They demand a prompt review of current HRT practices. b. They have shown that HRT can be used safely in clinical practice. c. They have decreased the confidence of doctors and the public in HRT. d. They have given menopausal women a new confidence to undergo HRT.
Q2. Which statement is the closest match to the description of projected menopause figures in Paragraph 2? a. 47 international women will enter menopause annually for the next 20 years. b. All women are likely to go through menopause if they live long enough. c. 47 million women globally will enter menopause each year for the next 20 years. d. Most women will succumb to menopause if they do not undertake HRT.
Q3. What cause does the article cite for the symptoms of menopause? a. Lack of circulation b. Age c. Low progesterone levels d. Low circulating estrogen levels Q4. What has been the effect of the 2002 WHI study? a. HRT has become less popular. b. HRT has increased in popularity as the treatment of choice for problematic menopause symptoms. c. There has been an increase in combined estrogen and progesterone therapy. d. The women ‘s health initiative has since been established to investigate HRT.
Q5. Why were many women left with menopausal symptoms and no effective treatment? a. They were unable to afford HRT treatments. b. They were concerned about coronary heart disease and breast cancer. c. They were concerned about breast cancer and venous thromboembolism. d. They were concerned about breast cancer and the cardioprotective effects.
Q6. Which of these statements is a TRUE summary of Paragraph S? a. Surveys since WHI have attempted to find out if the WHI results are representative b. Results of past surveys are only valid for a subset of women, whether or not the public is aware of this. c. The present study aims to show that HRT is safer than previously believed. d. Women should ask their doctors to clarify the balance of risks and benefits of HRT
Q7. Which study showed an increased risk of VTE? a. The Nurses’ Health Study b. The Million Women Study c. The Women’s Health Initiative Study d. The WISDOM Study
Q8. Which of the following does the article recommend HRT should NOT be used to treat’? a. Vasomotor symptoms b. Atheromatous disease c. Age-related chronic disease d. Osteoarthritic symptoms
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Read the case notes and complete the writing task which follows Notes Name: Phillip Satchell Age: 73 Marital status: Wife deceased (2007) Family: Two sons in their 40’s in Darwin. First attended community centre: March 2007 Last visit to community centre: Feb 2011 Diagnosis: Multiple sclerosis, Type 2 diabetes, chronic L & R leg ulcers Social/Medical Background: Current: lives alone in public housing in Orange Future: will move to equivalent housing in Maroubra to Î access for MS treatment. Income: aged pension Poor compliance with oral diabetic agents and diabetic diet MS currently stable but frequent relapses 2-3/12 Staphylococcus Aureus infections in leg ulcers; pus ++ Lonely and isolated, but nil mental illness; good relations with sons but rarely see them. They run a pet shop business. Nursing management and progress: Medications: IV antibiotics twice daily and metformin for diabetes three times per day. Twice daily dressings to L & R legs Monitored blood sugar levels, medication compliance and provided education re diabetes. Constantly monitored for signs of MS relapse Discharge plan
Switch to oral antibiotics but continue same diabetic medications and dressings. Please refer to Prince of Wales Diabetic Clinic (medication review + Î education). Via your doctors, facilitate referral to neurologist for MS follow up. Support to link with community services to Î coping and social network. Writing task Using the information in the case notes, write a referral letter to the Community Nurse, Community Health Centre, Maroubra, outlining relevant information and requesting continued community care. In your answer: Expand the relevant notes into complete sentences Do not use note form Use letter format The body of the letter should be approximately 180-200 words.
Sample answer by Lifestyle Training Centre
Community Nurse, Community Health Centre, Maroubra
February 2011
Dear Nurse, Re: Mr Phillip Satchell, aged 73 years.
I am writing to refer Mr Satchell, who requires on going care, particularly for multiple sclerosis, following his relocation to Maroubra. He has been undergoing treatment for MS, Type 2 diabetes, and chronic L & R leg ulcers with us since March 2007.
Though Mr Satchell’s MS is presently stable, it often worsens. He is regularly monitored for signs of MS relapse and now requires finer medical access in Maroubra to treat his condition. With the help of your doctors, kindly refer him to a neurologist for his MS follow up.
Mr Satchell has been suffering from leg ulcers along with Staphylococcus Aureus infections, which happens up two three times a year. Both his legs need to be dressed twice daily. As his medical compliance is poor, he was educated on diabetes and its diet.
Mr Satchell is a widower and his two sons, who live in Darwin, rarely visit him. As he is lonely and isolated, kindly connect him with community services, and help him to increase his social network. He has no mental illness.
Based on the above, please provide Mr Satchell care and assistance on his arrival to Maroubra. His IV antibiotics, twice daily, needs to be switched to oral. He also needs to continue taking metformin for diabetes, three times per day. Kindly refer him to Prince of Wales Diabetic Clinic for medication review and further education. If you have further queries, please do not hesitate to contact me.
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Aging infrastructure poses risks to public safety. What problems can arise from outdated infrastructure, and what measures can governments take to invest in infrastructure renewal and ensure the safety of their citizens?
Sample essay by Lifestyle Training Centre
Antiquated social and economic infrastructure within a nation can undeniably compromise its overall wellbeing, particularly in the context of safety. This essay will expound upon specific instances of these challenges and suggest practical remedies that can be set in motion to bolster them, thereby fostering the upliftment of society and its populace.
Outdated infrastructure can impede a nation in various ways, primarily by constraining its potential for growth if not modernised. This holds true across sectors such as transportation, healthcare, and construction. However, among the multitude of infrastructural aspects, one of the most disregarded necessities in many countries, particularly in developing or underdeveloped nations, is the implementation of road safety protocols and mechanisms. This issue is conspicuous exceptionally in the case of railways, contributing to a myriad of accidents on a daily basis. For instance, over the past year in India alone, it was reported that there were 1,550 railway crossing accidents, resulting in the tragic loss of at least 1,807 lives. This is a substantial and concerning number.
To mitigate the potential threats to a nation arising from faulty or outdated infrastructures, governments should promptly undertake initiatives. Citizens must have access to modernised facilities, especially in critical areas such as medical care and transportation. For instance, addressing railway crossings, notorious for causing injuries, delays, and fatalities, the government should consider constructing overpasses or underpasses. This solution not only eliminates the need for manual gate operators and saves time, but more importantly, prevents numerous accidents and loss of lives. Implementing such improvements is a surefire way to propel a nation forward.
In conclusion, the failure to keep pace with the modernisation of infrastructure within a nation can undoubtedly impede its potential for growth and, most importantly, compromise the safety of its populace. While various areas require attention, prioritising the enhancement of road and transportation infrastructure, especially at railway crossings, would propel a nation forward and ensure the safety of its people.
Dr Joan Meagher, General Practitioner, Bannockburn Community Health Centre, 2 Pope Street Bannockburn Victoria 3331.
1/10/2009
Dear Dr Meagher, Re: Mr John McIntyre, aged 68 years.
I am writing to refer Mr McIntyre, who needs sympathetic care and monitoring following his relocation to Lake Retirement Village at Bannockburn in a week. He suffers from Hypertension, Congestive cardiac failure, and Chronic obstructive airways disease.
Since September 2001, Mr. McIntyre is consistently monitored by our Community Nurse to ensure medication compliance. His prescribed medications include diuretics, antihypertensives, vasodilators, and bronchodilators. A detailed description of his medical history can be found in his casebook, which is currently in his possession.
Mr. McIntyre has been engaging in excessive alcohol consumption and has been smoking 40 cigarettes per day for the past 30 and 35 years, respectively. He believes that he will be able to curtail these habits following the relocation.
Mr. McIntyre is married and resides in his own home with his wife. He has three children and a grandchild, managing expenses from a small savings account and aged pension. Despite advice from his wife and children to modify his lifestyle, Mr. McIntyre does not yield.
Considering the provided information, I kindly request that you assume responsibility for Mr. McIntyre’s care. Please ensure that he receives sympathetic care and continuous monitoring. Kindly encourage him to cease smoking and drinking. Additionally, please monitor his medication compliance and diet closely, and motivate him to engage in regular exercise. If you have further queries, please do not hesitate to contact me.
Your sincerely, Registered nurse.
Case notes:
MR JOHN McINTYRE – 68 year old Born: 1941 This 68 year old married man has been getting monitored at the Community Health Centre, Richmond. He and his wife are moving to The Lake Retirement Village Bannockburn 11/2001 – First attended Community Health Centre, Richmond 10/2009 – Last attended the Centre DIAGNOSIS: Hypertension, Congestive cardiac failure, Chronic obstructive airways disease (COAD) SOCIAL HISTORY: Married, Three children; one grandchild, Lives in own home with his wife Wife has no control over his lifestyle or medication. He resents his children’s advice about the need to change his lifestyle. Now moving to a self-contained Unit at The Lake Retirement Village (Anticipate this will happen in one week’s time). Apart from a small amount of savings, Mr. and Mrs. McIntyre plan to live on the Aged Pension. Has been excessively drinking alcohol for past 30 years. Has been excessively smoking (40/day) for the past 35 years. Claims he will stop smoking once he moves to the new Unit. He will try and cut down on the drinking NURSING MANAGEMENT AND PROGRESS Medications include diuretics, antihypertensive, vasodilators and bronthodilators Has received regular monitoring by Community Nurse to achieve medication compliance Further details in patient’s personal casebook (with the patient)
DISCHARGE PLAN: Establish contact with a sympathetic medical practitioner Monitor medication compliance and diet, Encourage patient to stop smoking Encourage patient to stop drinking, Encourage patient to take moderate regular exercise WRITING TASK: Mr. McIntyre needs to be monitored by a sympathetic GP so that his present regime continues in his new home. Using the information in the above case notes, write a letter referring the patient into the care of Dr Joan Meagher, General Practitioner, Bannockburn Community Health Centre, 2 Pope Street Bannockburn Victoria 3331. You must use full sentences in your letter – not notes / bullet points. Write no more than 25 lines about 180 to 200 words.
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In this era of technology and numerous knowledge acquisition avenues, it is argued by some that educating children at home is preferable to sending them to traditional classrooms. While others disagree with this notion, this essay will examine both options and present my personal perspective on the matter.
On the one hand, homeschooling presents numerous benefits. Firstly, children have the opportunity to spend more time with their parents, fostering a lasting and deeper bond through quality time together. Secondly, homeschooling enables parents to significantly reduce the cost of education by minimising expenses on transportation, uniforms, tuition fees, and other associated costs. Finally, parents can ensure that their kids receive the best education by providing resources without constraints. Additionally, homeschooling offers a sense of safety as children are rarely exposed to unwanted associations, including strangers.
On the other hand, some prefer traditional schooling, citing multiple valid reasons. Fundamentally, it becomes nearly impossible for employed parents to attend to their children during working hours unless they are willing to incur expenses on home tutors or babysitters. Secondly, children, when exposed to other students and diverse environments, have the opportunity to acquire more knowledge and experience than if they were solely engaged in independent learning.
Personally, I endorse traditional schooling as I believe not every parent may possess the necessary qualifications to effectively teach their children, especially considering that schools today offer a multifaceted mode of education, requiring highly educated and talented teachers to provide proper guidance.
To conclude, while homeschooling offers a sense of safety, strengthens the bond between children and parents, and reduces expenses, traditional classrooms guarantee high-quality education, exposure to diverse environments, and are particularly suitable for parents with full-time jobs. The decision between homeschooling and traditional schooling ultimately rests on individual circumstances, available resources, and personal preferences.
Sample answer 2 by Lifestyle Training Centre
In the contemporary age characterised by technological advancements and diverse avenues for knowledge acquisition, a contentious debate revolves around the preference for homeschooling over traditional classrooms. Some contend that educating children at home is a superior choice, while others vehemently disagree. This essay aims to delve into the merits and drawbacks of both options, ultimately providing insights into my personal perspective on this educational discourse.
On one hand, homeschooling is praised for its potential to foster stronger bonds within families, reduce educational costs, and provide a safe and controlled learning environment. The personalised attention and flexible schedule afforded by homeschooling can cater to individual learning styles, allowing children to progress at their own pace. Additionally, the sense of security and limited exposure to potentially negative influences are often seen as significant advantages.
On the other hand, traditional schooling offers its own set of advantages. The exposure to diverse environments and interactions with peers can contribute to a more comprehensive social education. Furthermore, the structured curriculum and professional guidance provided by qualified teachers in traditional classrooms are considered essential for a well-rounded education.
In my opinion, for working parents, the logistical challenges of homeschooling may make traditional schooling a more practical option. However, the choice between homeschooling and traditional schooling is not one-size-fits-all. It depends on the unique needs and circumstances of each family.
To conclude, while homeschooling can be beneficial for some in terms of flexibility and individualised attention, traditional schooling ensures a standardised and well-rounded education. A balanced approach, considering the strengths of both methods, might be the most optimal solution for certain families. Ultimately, the decision should be made based on a careful evaluation of the child’s learning style, the family’s lifestyle, and the available resources.
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Name : Joel Silbersher Age 12 Admitted : 10 September 2008 Discharged : 13 September 2008 Reason for admission: Dehydration, weak rapid pulse, orthostatic hypotension, acetone breath, tachycardia, weakness, fatigue, N & V. abdominal cramps Diagnosis: Diabetic ketoacidosis History: IDDM Type 1; Joel was staying with his friends in Ballarat for the weekend; Insulin injections (Self-administered) neglected, increased sweet and fatty food intake; Stress levels were high; embarrassed by condition. Nursing Notes: IV fluids, IV insulin administration, blood glucose monitoring; electrolyte replacement; K+ replacement. Pt. condition improved gradually with above, maintained consciousness; glucose added to IV when blood glucose normalized.Pt. commenced on low-fat, low-sugar diet
Discharge Plan: Pt. and family educated re prevention of future episodes, carry medical ID (indicating diabetic, name of GP, type and dose of insulin) at all times, tell friends and family how to respond in case of hypoglycemia; need for complying with dose and self- medication emphasized; diet plans given, exercise options outlined.
Writing Task: Using the information in the case notes, write a letter of referral to historical GP, Dr. Harry Coleman, St. Kilda Health Clinic, 35 Carlisle St, St Kilda 3182. DO NOT use note form in the letter. Expand the relevant case notes into full sentences. The letter should be approximately 200 words long.
Sample letter by Lifestyle Training Centre
Dr Harry Coleman, St Kilda Health Clinic, 35 Carlisle St, St Kilda 3182.
13 September 2008
Dear Dr Coleman, Re: Joel Silbersher, aged 12 years.
I am writing to refer Joel, who requires education on prevention of Diabetic ketoacidosis, following his discharge today as he is recuperating from an episode.
Joel, diagnosed with type 1 Insulin-Dependent Diabetes Mellitus, experienced a distressing incident over the weekend at a friend’s place. He consumed high-sugar and fatty foods, neglecting to self-administer his insulin injection. Consequently, Joel was admitted to the hospital, presenting symptoms such as dehydration, a weak rapid pulse, orthostatic hypotension, acetone breath, tachycardia, weakness, fatigue, nausea and vomiting, and abdominal cramps. The diagnosis confirmed Diabetic Ketoacidosis.
During hospitalisation, Joel received IV fluids and IV insulin. Continuous monitoring of his blood glucose levels was conducted, and electrolytes as well as potassium were replenished. To normalise his blood glucose levels, IV glucose was administered.
Joel is presently conscious and recuperating effectively; however, he is coping with stress and embarrassment following the recent episode. He was initiated on a low-fat and low-sugar diet.
In light of the above, it’s crucial to educate Joel and his family on preventing future episodes and ensuring prompt assistance in case of hypoglycaemia. Joel is advised to consistently carry a medical ID containing details about his condition, insulin dosage, and his GP’s name. Strict adherence to self-medication, dietary plans, and exercise is essential for effective management of his condition. If there are any further questions or concerns, please feel free to reach out to me.
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TEXT A Tobacco: Tobacco smoking is also an important risk factor for cardiovascular diseases. Currently, an estimated 967 million of the world’s 7.6 billion smokers liv in the developing world. Tobacco smoking increased among men, followed by women, in industrialized nations in the last century, and has subsequently declined in some nations such as Canada, the United States, and the United Kingdom. Descriptive models based on historical patterns in the industrialized world predict a reduction in the number of male smokers and an increase in the number of female smokers in the developing world over the coming decades. However, there have been major recent transformations in global tobacco trade, marketing, and regulatory control. As a result, tobacco consumption among men and women in most nations is primarily determined by opposing industry efforts and tobacco control measures, and by the socio¬ cultural context, rather than national income.
TEXT B. BMI: The observed rapid BMI increase with national income indicates that preventing obesity, which may be more effective than reacting after it has occurred, should be a priority during economic growth and urbanization of a nation. Overweight and obesity are also important because they cause a number of non- cardiovascular outcomes including cancers, diabetes, and osteoarthritis which cannot be addressed by reducing risk factors such as blood pressure and cholesterol. Current _intervention options for obesity in principle include those that reduce calorie intake and increasing energy expenditure of a population through urban design which incorporates space for outdoor activities.
TEXT C. Current Research (WHO, 2018) Background: Cardiovascular diseases and their nutritional risk factors-including overweight and obesity, elevated blood pressure, and cholesterol-are among the leading causes of global mortality” and morbidity, and have been predicted to rise with economic development in countries and societies throughout the world. Methods and Findings: We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from national and international health agencies. BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. BMI increased most rapidly until an income of about 1$ 5,000 (international dollars) and peaked at about 1$ 12,500 for females and I$ 17,000 for males. Cholesterol’s point of inflection and peak were at higher income levels than those of BMI (about 1$ 8,000 and 1$ 18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not significantly affected by the economic factors considered. Conclusions: When considered together with evidence on shifts in income–risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low- and middle-income countries and, together with the persistent burden of infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of economic development, accompanied by measures to promote awareness of the causes of high blood pressure and cholesterol.
TEXT D. Health Repercussions of Western Lifestyle Factors associated with the increase of these illnesses appear to be, paradoxically, things which many people would regard as lifestyle improvements. They include: • Less strenuous physical exercise, often through increased use of a car • Easy accessibility in society to large amounts of low-cost food • More food generally, with much less physical exertion expended to obtain a moderate amount of food • More high fat and high sugar foods in the diet are common in the affluent developed economies • Higher consumption of meat and dairy products -Higher consumption of grains and white bread • More foods which are processed, cooked, and commercially provided (rather than seasonal, fresh foods prepared locally at time of eating)
QUESTIONS 1-7. For 1-7, decide which text (A, B, C or D): in which text can you find information about 1. from where did the data for the research were collected? 2. name one important risk factor for cardiovascular diseases? 3. what does the observed rapid BMI increase with national income indicate? 4. which types of foods are common in the affluent developed economies? 5. what can cause a number of non- cardiovascular outcomes? — 6. what was the influence of economic factors on the mean population blood pressure? _ 7. how many smokers are there in the developing world?
QUESTIONS 8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts. 8. Who conducted the current research on diseases of affluence? 9. How many countries contributed the data for the research? 10. What is the efficient way to minimize diseases of affluence? 11. What is the basis of description models that predicts number of smokers? 12. What is the estimated population of the world? 13. Where did tobacco smokers increase in the last century?
QUESTIONS 14-20. Complete each of the sentences, 14-20, with a word or short phrase. 14. Cholesterol is one among the leading causes of _____________________ and morbidity. 15. Current intervention option for ____________________ in principle include reducing calorie intake. 16. Overweight and obesity can cause _____________________ outcomes including cancers, diabetes, and osteoarthritis. 17. Preventing obesity should be apriority during economic growth and __________________ of a nation. 18. There have been major recent transformations in global ________________________ marketing, and regulatory control. 19. There was an inverse relationship between BMl/cholesterol and the food share of __________________ 20. Factors of these illnesses -are things which many people would regard as ______________________
PART B. Choose the answer (A, B or C).
Ultrasound Machines: Diagnostic ultrasound machines are used to give images of structures within the body. The diagnostic machine probes, which produce the ultrasound, come in a variety of sizes and styles, each type being produced for a particular special use. Some require a large trolley for all the parts of the unit, while the smallest come in a small box with only an audio loudspeaker as output. They may be found in cardiology, maternity, outpatients and radiology departments and will often have a printer attached for recording images. Unlike X-rays, ultrasound poses no danger to the human body.
1. The manual informs us that the ultrasound machines A. are used to give images of structures with the body. B. have a printer attached for recording images. C. poses negligible danger to the human body.
X-Ray Machines: X-rays are high energy electromagnetic waves. The transformer produces a high voltage that directs electrons onto a target in the machine head. X-rays are produced by the target and are directed into beams by a collimator towards the human body. Soft body tissue absorbs less X-rays, i.e., passes more of the radiation, whereas bone and other solids prevent most of the X-rays from going through. Users must ensure proper radiation safety protocols and supervision are in place.
2. The guidelines establish that the healthcare professional should A. must ensure proper safety protocols. B. evaluate the radiation absorbed by bones and tissues. C. respect the wishes of the patient above all else. Biomedical waste: Biomedical waste is all waste tissue and body fluids, including clinical items contaminated with these. It is covered under the rules framed by the Central Pollution Control Board. Hospital management must take steps to segregate, manage and safely dispose of this waste. Equipment users must be aware of the systems that exist for this and follow local procedures. Most importantly, users must keep biomedical waste separate from other waste.
3. The purpose of this email is to A. inform biomedical waste rules are framed by the Central Pollution Control Board. B. inform users must beware of the systems that exist and follow local procedures. C. inform users must keep biomedical waste separate from other waste.
Hygienic requirements for cleaning: All healthcare and social care facilities are wet cleaned daily and even more frequently if necessary. According to the nature of the operation, the floor must be suitable for this method of cleaning. In operating theatres using invasive procedures, cleaning is carried out both pre- and post-surgery for each patient. Intensive care units and the rooms for collecting biological material are cleaned three times a day. The frequency of cleaning in other workplaces corresponds to the nature of the operation. In the event of cleaning by a subject other than the healthcare or social care facility provider, the designated worker must proceed according to the contract and the disinfecting or cleaning rules.
4. The manual informs us that the intensive care units A. are cleaned thrice a day B. are wet cleaned more frequently C. frequency of cleaning corresponds to nature of operation
Decontamination: Decontamination procedures include mechanical cleaning, which removes impurities and reduces the presence of microorganisms. In the event of contamination by biological material, it is necessary to include mechanical cleaning before the disinfection process. Detergents with a disinfectant effect are applied manually or by washing and cleaning machines, pressure guns, ultrasonic devices, etc. All tools and equipment must be kept clean. Cleaning machines and other equipment are used in accordance with the manufacturer’s instructions, including checks of the cleaning process.
5. The notice is giving information about A. cleaning process before disinfection process B. cleaning process before decontamination process C. cleaning process after disinfection process
Physical disinfection • Boiling under atmospheric pressure for at least 30 minutes. • Boiling in pressurized containers for at least 20 minutes. • Disinfection in equipment at a temperature determined by parameter A. The equipment must guarantee to reduce living microorganisms on the disinfected object at a given temperature to a predetermined level suitable for further use.
6. What must all staff involved in the physical disinfection process do? A. Boil under atmospheric pressure for at least 20 minutes B. Boil under atmospheric pressure for at least 30 minutes C. Boil in pressurized containers for at least 30 minutes
PART C. TEXT 1. Choose the answer (A, B, C or D) BREAST CANCER AND THE ELDERLY
Paragraph 1: Breast cancer is one of the highest-profile diseases in women in developed countries. Although the risk for women younger than 30 years is minimal, this risk increases with age. One-third of all breast cancer patients in Sweden, for example, are 70 years or older at diagnosis. Despite these statistics, few breast cancer trials take these older women into account. Considering that · nowadays a 70-year-old woman can expect to live for at least another 12-16 years, this is a serious gap in clinical knowledge, not least because in older women breast cancer is more likely to be present with other diseases, and doctors need to know whether cancer treatment will affect or increase the risk for these diseases.
Paragraph 2: In 1992, guidelines were issued to the Uppsala/Orebro region in Sweden (with a population of 1.9 million) that all women with breast cancer should be able to receive equal treatment. At the same time, a breast cancer register was set up to record details about patients in the region, to ensure that the guidelines were being followed. Sonja Eaker and colleagues set out to assess data from the register to see whether women of all ages were receiving equal cancer treatment.
Paragraph 3: They compared the 5-year relative survival for 9,059 women with breast cancer aged 50-84 years. They divided them into two age groups: 50-69 years, and 70-84 years. They also categorized the women according to the stage of breast cancer. They looked at differences between the proliferative ability of breast cancer cells, estrogen receptor status, the number of lymph nodes examined, and lymph node involvement. The researchers also compared types of treatment-Le., surgical, oncological (radiotherapy, chemotherapy, or hormonal)-and the type of clinic the patients were treated 1n.
Paragraph 4: They found that women aged ·70-84 years had up to a 13% lower chance of surviving breast cancer than those aged 50-69 years. Records for older women tended to have less information on their disease, and these women were more likely to have unknown proliferation and estrogen receptor status. Older women were less likely to have their cancer detected by mammography screening and to have the stage of disease identified, and they had larger tumours. They also had fewer lymph nodes examined, and had radiotherapy and chemotherapy less often than younger patients.
Paragraph 5: Current guidelines are vague about the use of chemotherapy in older women, since studies have included only a few older women so far, but this did not explain why these women received radiotherapy less often. Older women were also less likely to be offered breast-conserving surgery, but they were more likely to be given hormone treatment such as tamoxifen even if the tumours did not show signs of hormone sensitivity. The researchers suggest that this could be because since chemotherapy tends to be not recommended for older women, perhaps clinicians believed that tamoxifen could be an alternative.
Paragraph 6: The researchers admit that one drawback of their study is that there was little information on the other diseases that older women had, which might explain why they were offered treatment less often than younger patients. However, the fact remains that in Sweden, women older than 70 years are offered mammography screening much less often than younger women- despite accounting for one-third of all breast cancer cases in the country- and those older than 74 years are not screened at all. Eaker and co-workers’ findings indicate that older women are urgently in need of better treatment for breast cancer and guidelines that are more appropriate to their age group. Developed countries, faced with an increasingly aging population, cannot afford to neglect the elderly.
Q1. The main idea presented in paragraph one is that. ….. a. only older women need to be concerned about breast cancer. b. breast cancer trials seldom consider older women. c. breast cancer is more common than other diseases in older woman. d. older women do not take part in breast cancer trials. Q2. Regarding cancer treatment, it can be concluded that. … a. doctors know cancer treatment will increase the risk of disease in elderly patients. b. cancer treatments may be a risk for all elderly people c. it is unknown whether or not cancer treatments will affect the treatment of other diseases in elderly people. d. older women are less likely to have other diseases Q3. 1992 Guidelines issued to the Uppsala/Orebro region in Sweden stated that. a. Sweden has a population of 1.9 million. b. women with breast cancer need to register their condition to ensure they receive equal treatment. c. identical breast cancer treatment should be available to women of all ages. d. all women with breast cancer should have access to equivalent breast cancer treatment. Q4. Which of the following was not part of Sonja Eaker and her colleagues research? a. Comparing ability of breast cancer cells to increase in number. b. Grouping woman according to their survival rate. c. Identifying differences in treatment methods. d. Splitting the groups based on age. QS. Findings by the researchers indicate that ……. a. older women are less likely to have chemotherapy recommended. b. older women prefer hormone treatment to breast-conversing surgery. c. older women have fewer lymph nodes. d. older women respond better to chemotherapy than to hormone treatment. Q6. The word vague is paragraph 5 means …… a. uncertain b. unclear c. unknown d. doubtful Q7. One limitation of the study is that ….. a. older women are treated less often than younger women. b. older women have a lower incidence of breast cancer. c. younger women are treated more often than older women. d. there is a lack of information on other diseases which older women have. Q8. Which of the following statements best represents the view expressed by the writer at the end of the article? a. Due to ageing population in developed countries, the needs of the elderly must not be ignored. b. Older women need more appropriate treatment to suit their age. c. Developed countries have neglected the elderly for too long. d. It is too expensive treat the elderly.
PART C. TEXT 2. Choose the answer (A, B, C or D) PARENTS, KIDS & VEGIES
Paragraph 1: Most parents have waged epic battles with their kids over eating vegies. But if they don’t clean their plate of the last brussels sprout, does it really matter? Vegetables are behind some of the greatest battles between parents and children. Most parents have dinnertime horror stories involving small bits of vegetable and lots of screaming, and while these stories can be entertaining, the research showing how few vegies our kids are eating is not.
Paragraph 2: The 2009 Australian Institute of Health and Welfare national report card found that a whopping 78 per cent of 4–8-year-olds, 86 per cent of 9-13 year¬ olds and 95 per cent of 14–16-year-olds are not eating the recommended daily servings of vegetables. Take out potatoes, which most kids eat as chips, and the percentage of kids not getting the nutrition they need jumps to 97, 98 and 100 per cent respectively. Other research has made similar findings.
Paragraph 3: But Australian children are hardly going to starve if they don’t eat vegetables and it’s not easy for parents to keep cooking meals that are left on the plate or worse, tipped on the floor. Does it really matter if our kids don’t eat their greens? Professor Louise Baur, paediatrician and director of weight management services at The Children’s Hospital at Westmead, says we all need to eat a wide variety of foods – including vegetables – and children are no different. Research shows vegetable consumption can help prevent chronic diseases such as heart disease, type 2 diabetes and a range of cancers.
Paragraph 4: According to Australia’s dietary guidelines, children aged between four and seven should be eating two to four serves of vegetables daily. Eight- to 11-year-olds should be eating an extra serve; teenagers should have between four to six serves every day. One serve of vegetables is one cup of raw salad vegetables, one medium potato or half a cup of cooked vegetables or legumes.
Paragraph 5: In the short-term, children who don’t eat vegetables can end up with dental issues, constipation (especially if they skip on fruit as well) and on rare. occasions nutritional deficiencies, Baur says. But perhaps more importantly, we tend to develop our eating habits in childhood, so if you’re not eating vegetables and other healthy foods as a child then you are less likely to do so as an adult.
Paragraph 6: Excess weight is also a problem; between 6-8 per cent of school age children in Australia are obese and at least another 17 per cent are overweight. You won’t automatically put on weight if you don’t eat vegetables, Baur says, but children who don’t eat vegetables are often eating foods that are high in saturated f ats, sugar and salt. Children who are overweight are more likely to become overweight or obese adults, who are then at greater risk of chronic diseases.
Paragraph 7: And while the most hardened young vegie hater might enjoy an apple, banana or piece of watermelon, Baur says fruit doesn’t contain the iron and other minerals found in vegetables, and it also contains more sugars. While fruit is an important part of a healthy diet, the dietary guidelines suggest kids under 12 only need one to two serves a day. So, we know that kids need their vegies, but getting them to eat a mouthful, let alone several cups can be a challenge.
Paragraph 8: Nutritionist Dr Rosemary Stanton suggests nutrition should be a whole family affair; you can boost your child’s vegetable intake by eating your evening meal together at the dinner table, preferably with the television off. “Vegetables have traditionally been eaten mainly at dinner and with many families no longer having a family meal, many kids get themselves something to eat – often instant noodles, pizza or some kind of pasta dish (rarely with vegies),” Stanton says.
Paragraph 9: Children are also more likely to eat and enjoy vegetables, and other healthy foods, if they find them interesting, says Stanton. “Several studies show that when kids grow vegies or attend a school with a kitchen garden, they tend to eat more vegies … For those in flats, there are community gardens in some areas, or if they have a balcony lettuce, herbs, cherry tomatoes etc …can all be grown in pots.” ·
Paragraph 10: You can also pique your child’s interest in vegetables by including them in a range of tasks, such as grocery shopping, going to markets or by getting them to help prepare meals. Small children can toss a salad (you can rewash any salad leaves that end up on the floor), and older children can take on more difficult tasks, for example peeling and cutting vegetables. But perhaps the most important thing parents can do is model healthy eating. Research has shown children’s eating patterns are affected by the family’s eating behaviour. Lisa Renn, spokesperson for the Dietitians Association Australia, encourages parents to be persistent.
Paragraph 11: She says there are many easy and crafty ways to get vegies off your children’s plates and into their mouths: • grate extra vegetables and add them to a favourite pasta sauce • make green mash, add spinach or rocket when mashing potato • serve vegie sticks with dips (think avocado, pumpkin or sweet potato) and other snacks • add extra vegetables or legumes to your next soup or stew • make muffins using vegetables – com, pumpkin and sweet potato all work well.
Paragraph 12: She also suggests the scattergun approach: offering a wide variety of vegetables (the more different colours the better) in small amounts throughout the day, not just at dinner time. There’s no denying these suggestions require time, effort and creative ‘marketing’. Ultimately, says Renn, “you do what you can do, get them in where you can, be as inventive as possible and be persistent”.
QUESTIONS Q1. According to the passage what is the reason behind the battle between parents & children? a. over eating of vegies b. not cleaning c. vegetables d. not eating vegies Q2. Who stand first is avoiding vegies from daily servings? a. 4-8 years b. Teen years c. 14-16 years d. Kids Q3. Why do parents feel discomfort in cooking vegetables? a. Children won’t eat them b. Vegetables will be in plates/ floors c. Children will starve d. b and c. Q4. Who cannot be eliminated according to Prof. Louise? a. diabetic patients b. children c. children prone to cancer d. a and c QS. Along with a potato how munch vegetables should be taken in a day? a. a cup b. a cup of cooked veggies c. none of the above d. a and b Q6. Which has the less possibility to occur with eating les veggies? a. Dental issues b. Constipation c. Deficiency d. None Q7. What will automatically happen when you are not eating vegetables? a. put on weight b. reduce in weight c. occurrence of obese d. nothing will happen Q8. Who needs 2 serves of vegetables a day according to the passage? a. 4-7 years b. 8-11years c. Below 12 years d. A and c
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