Text A: Bed bugs have feasted on sleeping humans for thousands of years. After World War II, they were eradicated from most developed nations with the use of DDT. This pesticide has since been banned because it’s so toxic to the environment. Spurred perhaps by increases in international travel, bed bugs are becoming a problem once again. The risk of encountering bed bugs increases if you spend time in places with high turnovers of night-time guests – such as hotels, hospitals or homeless shelters. Bed bugs are reddish brown, oval and flat, about the size of an apple seed. During the day, they hide in the cracks and crevices of beds, box springs, headboards and bed frames. It’s a daunting task to eliminate bed bugs from your home. Professional help is recommended.
Symptoms: It can be difficult to distinguish bed bug bites from other insect bites. In general, the sites of bed bug bites usually are:
• red, often with a darker red spot in the middle
• itchy
• arranged in a rough line or in a cluster
• located on the face, neck and arms

Text B Reactions to bed bug bites in humans
Skin reactions are commonly associated with bed bugs, which result from the saliva injected during feeding. Some individuals, however, do not react to their bite, whereas others note a great deal of discomfort often with loss of sleep from the persistent biting. Reactions to the bites may be delayed, up to 9 days before lesions appear.
Common allergic reactions include the development of large wheals, often >1-2 cm, which are accompanied by itching and inflammation. The wheals usually subside to red spots but can last for several days. Bullous eruptions have been reported in association with multiple bed bug bites and anaphylaxis may occur in patients with severe allergies. In India, iron deficiency in infants has been associated with severe infestations. It has been suggested that allergens from bed bugs may be associated with asthmatic reactions.

Text C Bed bug-detecting canines
The bed bug, Cimex lectularius L., like other bed bug species, is difficult to visually locate because it is cryptic. Detector dogs are useful for locating bed bugs because they use olfaction (smell) rather than vision. Dogs were trained to detect the bed bug (as few as one adult male or female bug) and viable bed bug eggs (as few as five, collected 5-6 days after feeding) by using a modified food and verbal reward system. Their efficacy was tested with adult bed bugs and viable bed bug eggs placed in vented polyvinyl chloride containers. Dogs were able to discriminate bed bugs from the insects Camponotus floridanus (Buckley), Blattella germanica L., and Reticulitermes flavipes (Kollar), with a 97.5% positive indication rate (correct indication of bed bugs when present) and 0% false positives (incorrect indication of bed bugs when not present). Dogs also were able to discriminate live bed bugs and viable bed bug eggs from dead bed bugs, cast skins, and feces, with a 95% positive indication rate and a 3% false positive rate on bed bug feces. In a controlled experiment in hotel rooms, dogs were 98% accurate in locating live bed bugs. A pseudoscent prepared from pentane extraction of bed bugs was recognized by trained dogs as bed bug scent (100% indication). The pseudoscent could be used to facilitate detector dog training and quality assurance programs. If trained properly, dogs can be used effectively to locate live bed bugs and viable bed bug eggs.

Text D. Bed bugs as vectors of human disease
Transmission of more than 40 human diseases has been attributed to bed bugs, but there is little evidence that such transmission has ever occurred. Older scientific literature postulated that bed bugs may be vectors of plague, yellow fever, tuberculosis, relapsing fever, leprosy, filariasis, kala azar (leishmaniasis), cancer, smallpox, and Chagas disease (Trypanosoma cruzi). Recently, the possibility of human immunodeficiency virus and hepatitis B virus transmission by bed bugs has been investigated. Human immunodeficiency virus can be detected in bed bugs up to 8 days after ingestion of highly concentrated virus in experimental blood meals. However, no viral replication has been observed within the insects and no virus has been detected in bed bug feces. Mechanical transmission of human immunodeficiency virus has not been demonstrated using an artificial system of feeding bed bugs through membranes.

Questions 1-7. For each question, 1-7, decide which text (A, B, C or D) the information comes from. You may use any letter more than once. In which text can you find information about

1. normal allergic reactions to bed bugs?
2. signs that bed bugs may spread diseases?
3. dogs can be trained to detect bed bug eggs?
4. bed bugs showed no viral replication?
5. bed bug bites may be seen in a cluster?
6. places where bed bugs are found?
7. what is used to facilitate quality assurance programs?

Questions 8-15. Answer each of the questions, 8-15, with a word or short phrase from one of the texts.

8. How much was the false positive indication rate of bed bugs by detector dogs?
9. What was used to eliminate bed bugs from developed countries?
10. What is the usual symptom exhibited by bed bug infestation?
11. What was detector dogs’ positive indication rate for distinguishing live and dead bed bugs?_______
12. What caused serious infestations of bed bugs in newborns?
13. What is the reason for reappearance of bed bugs in developed countries?
14. How many diseases are said to be spread by bed bug being vectors?
15. What are responsible for asthma symptoms caused by bed bugs?
Questions 16-20. Complete each of the sentences, 16-20, with a word or short phrase from one of the texts.
16. The usage of ___________ is prohibited as it is proven to be very harmful to our surroundings.
17. The presence of______________ is not detected in ordure of the bed bugs.
18. To locate bed bugs, detector dogs use olfactory senses despite their________________.
19. Numerous bed bug bites are found to produce________________.
20._________________ is made from the pentane extraction of bed bugs.

END OF PART A

PART B Choose the answer (A, B or C)

1. According to the extract, every physicians must
A. declare modifications regarding requirement of seasonal influenza immunization.
B. provide help to get proper immunization against the seasonal influenza virus.
C. get a flu vaccination from an appropriate place that offer a valid substantiation.
The seasonal influenza immunization: In an effort to protect our patients, visitors, and colleagues, we are announcing an important change regarding the requirement of seasonal influenza immunizations for all employees, physicians, active volunteers, vendors, contracted staff, and students. As health care providers, it is our responsibility and obligation to protect our patients, visitors, and colleagues—as well as ourselves and our family members—by being immunized against the seasonal influenza virus. As we have done in the past, seasonal influenza immunizations will be provided free of charge to all employees, physicians, contracted staff and active volunteers. Participation in this year’s seasonal influenza immunization program is required. All employees, physicians, contracted staff, active volunteers and students will be required to do one of the following:
• Receive a flu vaccination through RH Occupational Health Office.
• Provide proof of immunization if you received a vaccination outside of RH’s planned immunization program— from another health care provider or local pharmacy, for example.

2. The policy document tells us that tolerance for risk is greater for permanently implanted medical devices
A. in pediatric patients with a limited life expectancy.
B. such as pacemaker pulse generators.
C. in a healthy pediatric population.
Risk Assessment of Medical Devices: The risk assessment should consider the proposed clinical use of the device, including the anatomical location, duration of exposure, and intended use population. For example, for pediatric patients with a limited life expectancy, the tolerance for risk associated with a permanently implanted medical device may be higher than the tolerance for risk from the same device in an otherwise healthy pediatric population. The potential exposure duration should also consider which material components of the device have direct or indirect contact with tissue, and whether exposure would be a one-time exposure, a constant exposure over time, or an intermittent exposure over time that could have a cumulative effect. For example, pacemaker pulse generators commonly contain internal electronic components made from chemicals that could be toxic to the body, but appropriate bench testing can demonstrate that the pulse generator is hermetically sealed and will limit exposure of those chemicals to the surrounding tissues.

3. What is being described in this section of the guidelines?
A. changes in procedures.
B. best practice procedures.
C. exceptions to the procedures.
Patient Admission: If the patient medically requires hospital inpatient services and the physician believes that the patient will need to stay in the hospital at least 2 midnights, the physician should order inpatient admission. If the patient does not medically require inpatient hospital services or the physician does not expect the patient to stay past 2 midnights, the physician should order observation or outpatient services. The certification must be signed and documented in the medical record prior to patient discharge. Hospitals may choose to have physicians record these elements of the certification either on a specific form or throughout the medical record such as in the orders, history and physical, or physician progress notes.
Guidelines:
• Excellent patient care should continue to be the top priority.
• Document the diagnosis, medical rationale, plan of care and anticipated discharge.
• Sign the admission order and certification (if appropriate) prior to discharge.

4. The purpose of these instructions is to explain
A. how to wear respirators effectively
B. how to use respirators appropriately
C. necessity of wearing proper respirators
Respirators: Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker. Workers who occasionally wear filtering face-piece respirators on a voluntarily basis must be aware of the following information. This information is intended for employees who are not required to wear respirators for protection from recognized airborne hazards. Employees who perceive exposures to any airborne contaminants, particularly outside of a chemical fume hood, should request an exposure evaluation before selecting a respirator.

5. The extract informs us that your
A. input will help evaluate the current HOCC program and its future program review.
B. participation ensure that patients’ needs are met exclusively by physicians.
C. support and elaborate retrospect will help in fulfilling targets of

HOCC program review.
Hospital On-Call Coverage Program Review: We are requesting your assistance with the detailed review of the Hospital On-Call Coverage (HOCC) Program; your input will help evaluate the current HOCC program and assist to identify future directions. With your participation, we can ensure that the HOCC program meets the needs of patients, participating physicians and other health care stakeholders. The HOCC Program review has three primary objectives:
 To identify and examine the effectiveness of key elements of the program already in place at hospitals. These elements include eligibility criteria, compensation structures, process metrics, resource requirements, and others.
 To develop recommendations for improving the organization and delivery of on-call services based on evidence and best practices identified through the data and information collection processes.
 To explore specific issues: Participation of doctors, use of regional call networks, and coverage for long-term care, sexual assault centres, chronic care facilities and palliative care programs.

6. What point does the extract make about processing of medical devices?
A. could significantly affect the biocompatibility of the medical devices.
B. includes passivating surface of medical devices by acid bath or other method.
C. uses resin supplier to remove all processing solvents from medical devices.
Identification of Potential Risks: An assessment of potential biocompatibility risk should include not only chemical toxicity, but also physical characteristics that might contribute to an unwanted tissue response. These characteristics can include surface properties, forces on surrounding tissue, geometry, and presence of particulates, among others. In addition, changes in manufacturing and processing parameters can also have an impact on biocompatibility. For example, the original processing for an implanted device might include placing the device in an acid bath to facilitate passivation of the implant surface. If this passivation process is changed to eliminate the acid bath in favor of a different method of passivating the surface, removal of the acid bath might unintentionally lead to a smaller reduction in pyrogenic material, which could result in pyrogenic reactions (fever) following implantation of the device. Another common change that might impact biocompatibility is a change in resin supplier. For example, if the new resin supplier does not remove all processing solvents (some of which may be known toxic compounds, such as formaldehyde), the final manufactured device could cause unexpected toxicities that were not seen with devices manufactured from the original resin.

PART C. TEXT 1. MEASURING LIFE. Choose the answer (A, B, C or D).

Somewhere out in the future there’s a final moment with our name on it: life’s only certainty is death. It’s coming, and the only mystery about mortality’s last call is: when? But if your doctor could tell you, would you want to hear how long you are likely to live? American researchers now believe that they are able to determine a person’s “natural” life span from a simple blood test. They have identified the ability of a common gene to influence the ageing process, and the form it takes in any given individual can they say, indicate medical vulnerability and predict when the person may die. The news has created much excitement but it also has raised concerns about the ethical dilemmas involved if science is able to read our lifelines and forecast our susceptibility to deadly diseases. It’s a development that revives the eternal question: should a doctor tell?

Apo E, as it’s known, is not a new discovery but, hitherto, scientists believed that its only function was to remove cholesterol from the bloodstream. Only lately as they have been able to study the ever increasing numbers of elderly, has the gene’s relationship with longevity become apparent. It apparently operates as a kind of caretaker gene, maintaining the system’s cells and keeping them running smoothly, and its efficiency can determine the rate at which the body holds up or wears out. “Apo E is one of those genes that we suspect controls life span because it affects people’s susceptibility to diseases of ageing”, says Dr Jan Vigh; a molecular geneticist at Beth Israel Hospital, in Boston. The gene has three variants, known as E2, E3, E4, and we all inherit one of them from each of our parents. More than half of us are born with two E3s, but it is the distribution of the other two forms that has proved so compelling to scientists that they have been analyzing data on the elderly.

People with one or – more rarely – two E2s tend to survive the longest, while those with E4s die considerably earlier than the rest. Studies in Canada, France, Sweden and Finland found that E2 carriers were about four times more likely to reach their 100th birthday than those born with an E4. The E2 is, it seems, an excellent caretaker. By comparison, E4 does sloppy work and its inadequacies at cell upkeep make those who have it vulnerable to illness and early death. Doctors now accept that the presence of the Apo E4 gene signals a risk of heart disease and Alzheimer’s. American studies show that middle aged women with an E4 are twice as likely to develop coronary heart disease as those who don’t, while E4 men have a 50 per cent higher risk than other men. Among men under 40 who require surgery for clogged heart arteries, the incidence of two E4s is 16 times higher than among others in their age group And Dr Alan Roses, the Duke University neurologist who first made the link between Apo E and Alzheimer’s, says those with two E4s have about six times the normal risk of developing the disease, while people born with two E2s may be protected from it.

More than 4 million Americans are afflicted by this devastating brain disorder and nearly two-thirds of them have at least one Apo E4 gene, compared with only 15 percent in the general population. So, Apo E may be a critical marker for life span and vulnerability to grave diseases, and evidence of its presence is in the records of millions of blood tests conducted for other reasons. But is it ethical or wise for doctors to use that information to tell people something they may not want to know and which, in any case, alerts them to threats that may be unavoidable? “We consulted bioethicists and got a variety of opinions,” says Dr Norman Relkin, the New York neurologist who gathered other concerned doctors to discuss the issue at a conference in Chicago. After two days, they called for more research to establish the nature and the risks of the Apo E family but many researchers seem opposed to confronting people with alarming news about conditions that cannot be fought, based on blood samples given for other purposes.

“Have you done them a service?” asks Dr Lindsay Farrer, an Alzheimer ‘s researcher at Boston University Medical Centre. “What good does it do to tell someone about being at risk from a dreaded disease that can neither be prevented nor effectively treated?” Dr Rudolph Tanzi, an Alzheimer’s specialist at Massachusetts General Hospital, agrees but, because his own family has a history of early heart problems, he was unable to resist having his own Apo E analyzed. He is an E3, in the same wide, neutral middle ground as most of humanity. The problems raised by Apo E are varied and complex. Some doctors worry about possible discrimination from employers and insurance companies if people are routinely told they may have a predisposition to serious illness and premature death.
Because blows to the head seem to increase the risk of getting Alzheimer’s among people with the E4 gene, should boxers and other athletes, and children wanting to play contact sports, be tested for their Apo classification? “Already!”, says Dr Relkin, pregnant women are asking for their fetuses to be screened so they can consider abortion if their babies show two E4s.

Duke University’s Dr Roes is working with a major drug company to try to define what gives Apo E2 its ability to improve the body’s defenses, so that its protection can be duplicated in the laboratory. “The hope is that we shall be able to make a drug that does what Apo E2 does,” he says. Meanwhile, for millions of people around the world, their destiny -how they will live, when they will die is perhaps already foretold in a dusty medical file.

Text 1: Questions 7-14

7. Researchers have identified
A. a way to monitor a person’s life span from a blood test.
B. a gene which could affect the process of ageing in humans.
C. the mystery about mortality’s last call.
D. a way to predict the vulnerability of an individual.
8. The discovery of being able to estimate the life span of a person
A. has generated apprehension about people’s predisposition to deadly diseases.
B. has initiated an ethical puzzle involved in being able to predict disease.
C. has rekindled debate about a perpetual dilemma for doctors.
D. has been instrumental in forecasting deadly diseases.
9. Apo E functions within a person’s system as
A. a cholesterol gene controller.
B. a maintainer of the gene’s relationship with longevity.
C. a gene which monitors and determines the ageing process.
D. the gene which inhibits the rate at which the body degenerates.
10. Scientists have been in a position to study the Apo E phenomenon because
A. of the steadily ageing population in North America.
B. Apo E has been known about for many years.
C. diseases which affect the elderly have increased.
D. they knew that its only function is to remove the cholesterol from the blood.
11. A molecular geneticist in Boston has found that
A. we all inherit Apo E2, E3 or E4 from either parent.
B. the greater number of us inherit three variants of Apo E from both parents.
C. the majority of us will inherit two Apo E3s from both parents.
D. more than half of us inherit either two Apo E2s or two Apo E4s from both parents.
12. Middle aged women with an Apo E4 gene
A. are at greater risk of being vulnerable to illnesses.
B. have a 50% higher risk factor than men.
C. experience a higher incidence of Alzheimer’s disease.
D. are more likely to develop heart disease.
13. Which statement is not true? The neurologist who made initial connection with Apo E and Alzheimer’ s believes people with
A. 2 E4s are more likely to develop the disease.
B. 2 E4s are more likely to be protected by it.
C. 2 E4s are six times more at risk of vulnerability to Alzheimer’s than others.
D. 2 E2s are less in 15% of general population who have the disease.
14. Neurologists and bioethicists who met at a conference in Chicago
A. were mildly in favor of telling people alarming news about their condition.
B. agreed that there was sufficient information to establish risks of Apo E gene.
C. agreed that it was insufficient to determine extent of risks using Apo E information.
D. were not in favor of giving bad news based on blood samples only.

PART C. TEXT 2. E.Coli Outbreak. Choose the answer (A, B, C or D).

An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause. The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit. The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals. Infections have so far only been linked to Spanish cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected. The European Union says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

The ECDCP says the bacteria’s impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection. However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 people at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized. Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water or food — especially raw vegetables and undercooked meat. It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a life- threatening kidney failure.

The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics. In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure. The ECDPC says the outbreak is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across Western Europe but so far, the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to Germany. The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.
Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. “Personal hygiene messages are important,” it says. With exports of Spanish vegetables “paralyzed” according to officials, weekly losses of about €200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain’s fruit and vegetable market, last year worth €8.6 billion. Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain. Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain’s prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: “In the absence of proof, we’re not ruling out using all necessary measures to make sure there’s compensation for the (economic) damage,” she wrote. “From the first day, the government launched a diplomatic offensive to prevent the linking of this health crisis with our products.” While Germany accounts for much of Spain’s vegetable export market, the country does export further afield to countries including Russia and the United States. There is also the risk of so- called “secondary clusters” of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

Text 2: Questions 15-22

15. hat is the meaning of the word ‘fallout’ in the first paragraph?
A. What effects the infection will have on the infected people.
B. What the causes of the infection are.
C. What effects the breakout will have.
D. What the causes of eating too many cucumbers are.
16. The source of the E. Coli outbreak is thought to be caused by
A. cucumbers exported from Germany.
B. infected cattle.
C. contaminated food or water and contact with animals.
D. cucumbers exported from Spain to Germany.
17. Which one of the following statements is not true?
A. Cucumbers from Almeria and Malaga are thought to be infected.
B. Tomatoes and lettuce from Spain may be affected.
C. A suspect batch of cucumbers sold in Denmark or the Netherlands is under investigation.
D. A suspect batch of cucumbers imported to Germany is under investigation.
18. What do the statistics published on May 27 show?
A. That women are less likely to be infected.
B. That children are more likely to be infected.
C. That adults are more likely to be infected.
D. That men are more likely to be infected.
19. Which of the following statements is correct?
A. A Hospital in Hamburg reported 276 cases of E.coli.
B. 700 cases have been reported worldwide.
C. Sweden has reported the most cases of E. coli.
D. 85 people are at risk of renal failure in a hospital in Hamburg.
20. How is E. coli transmitted?
A. From person to person.
B. Through contaminated water or food.
C. Through eating the kidney’s of animal products.
D. From young children to older adults.
21. Why is this strain of E.Coli so deadly?
A. It is particularly virulent and resistant to antibiotics.
B. It leads to haemolytic-uremic syndrome.
C. It is a bacteria linked to contaminated cucumbers.
D. Because 30% of people with E.Coli have died.
22. Which of the following is not true? Infections have been reported in people who
A. live in Australia and Spain.
B. have returned from traveling in Germany.
C. live in Austria, Britain, Denmark, France, Netherlands, Sweden and Switzerland.
D. have eaten cucumbers which were from Spain and packaged in Germany.

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