Should smoking be banned in all public places, or is it a personal choice that should be respected? IELTS writing task 2- Discussion/Direct essay.
Model answer by Lifestyle Training Centre
Smoking in public places has long been a contentious issue worldwide. Although some view it as a personal choice, I firmly oppose public smoking. This essay will present the arguments supporting my stance.
Smoking in public spaces is a reprehensible act, characterised by its selfish and inconsiderate nature. When individuals smoke in public, they subject non-smokers to the detrimental effects of passive smoking, thereby jeopardizing their health. Children and innocent bystanders, who have no inclination towards smoking, often suffer the consequences of this harmful practice. Passive smoking not only results in long-term respiratory issues but also significantly increases the risk of serious ailments such as cancer. A recent survey conducted in India highlights the grave implications of passive smoking, particularly in children, identifying it as a leading cause of cancer among them and underscoring the urgency of addressing this public health concern.
In addition to causing deleterious health issues to bystanders, public smoking can also influence children and teens to embark on the journey of smoking. By smoking in public, smokers inadvertently promote the notion that smoking is acceptable. This can be seriously harmful to the health and wellbeing of society as a whole. Statistics indicate that children who have parents who smoke are more likely to take up smoking at an early age, thus dragging themselves into a lifestyle of addiction.
To conclude, while smoking may be a personal choice, doing it in public is not justifiable as it causes serious harm to bystanders and can lead to moral degradation, influencing children and teens to start smoking early in life. If one must smoke, it should be done in private, ensuring that others’ health and morals are not jeopardised.
List of vocabulary used
Contentious: causing or likely to cause an argument; controversial.
Reprehensible: deserving censure or condemnation; very bad.
Inconsiderate: thoughtlessly causing hurt or inconvenience to others.
Detrimental: tending to cause harm.
Passive smoking: involuntary inhalation of smoke from other people’s cigarettes, cigars, or pipes.
Jeopardizing: putting (someone or something) into a situation in which there is a danger of loss, harm, or failure.
Innocent bystanders: people who are present at an event or incident but do not take part and are not involved.
Respiratory issues: problems related to the lungs and breathing.
Ailments: an illness, typically a minor one.
Survey: a method of gathering information from individuals, usually by asking questions.
Implications: the possible effects or results of an action or a decision.
Deleterious: causing harm or damage.
Influence: the capacity to have an effect on the character, development, or behavior of someone or something.
Promote: further the progress of (something, especially a cause, venture, or aim); support or actively encourage.
Notion: a conception of or belief about something.
Justifiable: able to be shown to be right or reasonable; defensible.
Moral degradation: decline in ethical standards or moral values.
Ensuring: making certain that something shall occur or be the case.
Jeopardized: put at risk; endangered.
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The graphs below show the number of medals won by the top five countries in the summer and winter Olympics. Summarise the information by selecting and reporting the main features, and make comparisons where relevant.
Model answer by Lifestyle Training Centre
The provided bar charts illustrate the cumulative count of gold, silver, and bronze medals attained by different countries in both the winter and summer Olympics.
Overall, it is evident that Norway emerged as the leading medallist in the winter Olympics, while the United States dominated in the summer Olympics. Conversely, Russia and Canada recorded the lowest medal tallies in the winter events, with Great Britain and France demonstrating comparable performance during the summer Olympics.
Examining the data in more detail, Norway clinched approximately 130 gold, 260 silver, and 370 bronze medals in the winter Olympics. The United States, securing the second position, attained around 105 gold, 220 silver, and 305 bronze in the winter Games, while achieving a remarkable total of around 2500 medals in the summer Olympics. Germany garnered around 90 gold, 180 silver, and 240 bronze medals in the winter Olympics, accumulating a commendable total of approximately 1700 medals in the summer Games.
In contrast, Russia achieved around 70 gold, 130 silver, and 190 bronze medals in the winter Olympics, yet remarkably collected a total of around 1800 medals in the summer Olympics. Canada secured around 70 gold, 135 silver, and 195 bronze medals in the winter Games. Great Britain and France, despite obtaining the lowest medal counts, amassed an aggregate of around 800 and 700 medals, respectively, in the summer Olympics.
Vocabulary used:
Cumulative: Accumulated; total.
Emerged: Became visible or apparent; came out as a result.
Dominated: Exerted control or influence over; was the most successful.
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A ganglion cyst is a collection of synovial fluid in a sac, on or near tendon sheaths and joint capsules. They usually appear on the on the dorsal aspect of hands, fingers and wrists, and can also occur on the feet, ankles and knees. The cyst can range from the size of a pea to the size of a golf ball. The size of a ganglion may increase over time, especially if it near a joint where there are frequent repetitive movements.
About 65% of ganglia of the wrist and hand are dorsal wrist ganglia, followed by the volar wrist ganglion constituting about 20 to 25% of ganglia. Flexor tendon sheath ganglia and mucous cysts arising from the dorsal distal interphalangeal joint make up the remaining 10 to 15%.
Ganglion cysts look and feel like a smooth lump under the skin and the wall of the ganglion is smooth, fibrous, and of variable thickness. The cyst is filled with clear gelatinous, sticky, or mucoid fluid of high viscosity. The fluid in the cyst is sometimes almost pure hyaluronic acid. The cyst is attached to the tendon or joint by a pedicle (stalk).
The cause of them is not known, however it is thought they may be caused by tiny tears in the covering of a tendon or joint. Ganglion cysts are benign and appear in isolation. Around 30 to 50 per cent of ganglion cysts resolve spontaneously without medical intervention, though this can take many years.
Ganglia constitute about 60% of all chronic soft-tissue swellings affecting the hand and wrist. They usually develop spontaneously in adults aged 20 to 50, with a female: male preponderance of 3:1.People who have wear-and-tear arthritis in the finger joints closest to their fingernails are at higher risk of developing ganglion cysts near those joints. Joints or tendons that have been injured in the past are more likely to develop ganglion cysts.
TEXT 2: Diagnosing a ganglion cyst
Ganglia are evident on examination even if they cannot be seen by the naked eye. It is important that cysts are examined by a doctor because there is another type of ganglion on the dorsal wrist that occurs in people with rheumatoid arthritis. A doctor can easily differentiate between them because a rheumatoid cyst is soft and irregular in appearance. Also, a person with rheumatoid arthritis will also have proliferative rheumatoid extensor tenosynovitis.
Most ganglion cysts do not cause symptoms, but the main symptoms people experience are a noticeable swelling or lump. The lump is able to change its size, including going away completely only to return. The lump is usually soft and immobile. In some cases, the lump is painful and aching, particularly those at the base of fingers. The ache and pain is made worse by moving any nearby joints. The affected tendon may cause a sensation of muscular weakness. The back of the hands and wrists are most commonly affected.
A medical examination is generally all that is needed to confirm diagnosis but other tests could include: Aspirating some of the fluid with a syringe An ultrasound to determine if the ganglion is solid or fluid filled X-ray and/or magnetic resonance imaging may be needed if the cyst cannot be seen.
TEXT 3 Passive treatment options for a ganglion cyst
If a cyst is not causing any problems, a passive “watch and wait” approach is recommended. This means the cyst is monitored and action only taken if it increases to a point where it causes symptoms. However, even if there are no symptoms some people prefer treatment for cosmetic reasons.
Temporarily immobilising the joints around a cyst may both slow down the rate at which the cyst grows and reduce the size of the cyst. This may release the pressure on nerves, relieving pain. If a person knows what activity is the likely cause such as starting to play an instrument or using a new piece of equipment, it may be helpful to stop or modify this activity.
Simple over the counter pain relievers and/or anti-inflammatory medications may be required to alleviate pain. In some cases, modifying shoes or how they are laced can relieve the pain associated with ganglion cysts on ankles or feet.
A traditional old home remedy for a ganglion cyst consisted hitting the cyst with the Bible. Thumping a cyst with any heavy object is not recommended because the force of the blow can damage surrounding structures in the hand or foot.
TEXT 4
Another self-help approach is to try and “pop” the cyst by puncturing it with a needle. This is unlikely to be effective and can lead to infection.
Some people advocate herbal remedies that have anti-inflammatory properties such as turmeric and ginger. The true cause of ganglion cysts is not known but they are a bulge in the lining of a structure. This means it is unlikely to be part of the inflammatory process
Active treatment options for ganglion cysts.
If a cyst is causing problems, a needle aspiration performed by a qualified doctor. This simple procedure is carried out in the GP surgery or hospital outpatients department. It involves drawing the liquid contents of the cysts out of the sac via the syringe.
Needle aspiration is usually the first active treatment option offered for ganglion cysts as it is less invasive than surgery. However, nonsurgical treatment fails in about 40 to 70% of patients, necessitating surgical excision.
The cyst may be surgically removed using either open or keyhole approaches.
In open surgery the surgeon makes a medium-sized cut, usually about 5cm (2in) long, over the site of the affected joint or tendon. The sac is removed at the pedicle to reduce recurrence.
Keyhole surgery is often used if the ganglion cyst is near, or in a joint. Smaller incisions are made and a tiny camera called an arthroscope is used by the surgeon to look inside the joint and then pass instruments through the incision to remove the cyst. Excision can be done via arthroscopic or standard open surgery. Recurrence rates after surgical excision are about 5 to 15%.
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 The ratio of ganglion cysts between sexes? ___________________
2 The primary dynamic way of removing ganglion cysts? ________________
3 The investigations that may be done to confirm someone has a ganglion cyst? ___________________
4 How keeping the affected area immobile for a time can reduce the effect of a ganglion cyst? _____________
5 Another type of ganglion cyst that can develop at the wrist? ____________
6 The role the bible used to play in managing ganglion cysts? _____________
7 The contents of a ganglion cyst? ___________________
Questions 8-14 Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.
8 Where ganglion cysts are usually seen? ___________________
9 What percentage of ganglion cysts come back after a surgical excision? ___________________
10 Are ganglion cysts more common in men or women? ___________________
11 What can changing shoes achieve for people with ganglion cysts in lower limbs? ___________________ 12 What are the two main complaints people with a ganglion cyst have? ___________________
13 What type of cysts develop from the fingers? ___________________
14 What is often the first invasive treatment option offered for ganglion cysts? ___________________
Questions 15-20 Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.
15 An______________ shows if the ganglion is solid or not.
16 ___________ganglia and mucous cysts in the DIP joints account for a small number of all ganglion cysts.
17 No one really knows why ganglion cysts develop but there is a____ in the membrane around a structure 18 A surgeon can look into a ganglion cyst around a joint with an arthroscope and then_________ through an additional small cut in the skin to get rid of the cyst.
19 A ganglion cyst on a tendon on can lead to a cause a feeling of___________________ weakness.
20 Needle aspiration involves pulling the__________ of the cysts out of the sac with a needle and syringe.
PART B
TEXT 1 What Nurses Need to Know About Celiac Disease and Gluten Sensitivity
Gluten is the group name for two proteins, gliadin and glutenin, which are primarily derived from wheat, barley, rye and triticale. These proteins are responsible for the bonding of particles, giving food its shape. When gluten is consumed, those with an allergy experience an immune response which attacks the small intestine. Once the villi of the small intestine are damaged, nutrients cannot be properly absorbed. While some people may be asymptomatic throughout their lifetime, many experience at least some symptoms.
Recent research shows there is no evidence to support an increased risk of celiac disease when infants are introduced to gluten at an early age (less than 4 months). However, delayed introduction (more than 7 months) to gluten may be associated with an increased risk.
Question 1) What does the article say about the causes of celiac disease?
a) It can provoke damage to the small intestine
b) It could be linked to children’s diets
c) Normally, children don’t suffer from celiac disease
TEXT 2 Aspirin Guidelines
Aspirin should be taken with, or straight after, a meal or snack. This helps to reduce the risk of any stomach irritation. Gastro-resistant tablets (also called enteric-coated or EC tablets) can be taken before food as these have a special coating which will help to protect the stomach from irritation. Gastro-resistant tablets should be swallowed whole, they must not be crushed or chewed. If the patient is using indigestion remedies, aspirin in this form must not be taken for at least two hours before and the two hours after they are used. This is because the antacid in the remedy can affect the way the coating on these tablets works. Melt-in-the-mouth (orodispersible) tablets should be placed on the tongue and allowed to dissolve.
Question 2) What do these guidelines say about when to take aspirin?
a) Aspirin taken close to meal times can irritate the stomach lining
b) Some types of aspirin have special indications
c) It can be taken in combination with indigestion remedies
TEXT 3 Assessing the Need for a Peripheral Intravenous Cannula
Many cannulas are left in without orders for intravenous fluids or medications. Some patients end up with two, three, or even more concurrent cannulas, despite only needing one in most cases. They are often left in ‘just in case’ they might be needed. But any catheter leads directly to the bloodstream and can be a source of infection. The need for the cannula must be constantly reassessed.
When a cannula is inserted, a flashback of blood in the chamber confirms it is in the vein. Flushing the cannula with 0.9% saline before and after intravenous medications reduces admixture of medicines and decreases the risk of blockage.
Question 3) What does this article say about the use of cannulas?
a) Cannula usage should be reviewed regularly
b) In most cases, concurrent cannula use is justified
c) Cannulas can be left in place so long as they are flushed with a 0.9% saline solution
TEXT 4 Description of the ‘SecurAcath’ Device
SecurAcath’ is a single-use device to secure percutaneous catheters in position on the skin. It is intended for use in adults and children who need a central venous
catheter which is a long, thin, flexible tube that is inserted into a vein through the skin.
‘SecurAcath’ has two parts, a base and cover. The base is made up of two foldable metal legs and two securement feet. The feet are placed under the skin at the catheter insertion site and unfolded to make a subcutaneous anchor. The cover then attaches to the catheter shaft and holds it in place when it is clipped onto the base. The device stays in place as long as the catheter is needed and can be lifted off the skin to allow cleaning of the insertion site.
Question 4) How should the ‘SecurAcath’ device be used?
a) The feet can be repositioned in order to clip them to the base
b) It should be correctly assembled before attaching the cover
c) The flexible tube should be inserted into a vein first
TEXT 5 Assessment of Colorectal Polyps During Colonoscopy
Colorectal polyps are small growths on the inner lining of the colon. Polyps are not usually cancerous, most are hyperplastic polyps with a low risk of cancer. However, some (known as adenomatous polyps) will eventually turn into cancer if left untreated. Detecting and removing adenomas during colonoscopy has been shown to decrease the later development of colorectal cancers. However, removal of any polyps by polypectomy may have adverse effects such as bleeding and perforation of the bowel.
It can take three weeks for a person to get the examination results for polyps that were removed during colonoscopy, and they may feel anxious during this waiting period. Using virtual chromoendoscopy technologies may allow real-time differentiation of adenomas and hyperplastic colorectal polyps during colonoscopy, which could lead to quicker results. Question
5) What does the article tell us about colonoscopies?
a) Colonoscopy and polypectomy procedures are thought to be risk-free
b) Virtual chromoendoscopy technology could speed up the process
c) Most hyperplastic polyps become cancerous if left untreated
TEXT 6 Osteomyelitis After Traumatic Knee Injury
A 56-year-old woman was admitted to a hospital for the treatment of osteomyelitis following a traumatic knee injury. She received the antibiotic Gentamicin in accordance with the hospital’s usual protocol. Kinetics, blood drug levels, and renal function were monitored, and dosage recommendations were made. However, a permanent vestibulopathy (or balance disorder) resulted from the antibiotic.
During the case investigation, the patient testified that she experienced “roaring” in her ears while hospitalized. (The roaring is a form of tinnitus) She further testified that she was not ambulatory; she was restricted to bed rest. No staff member inquired about unusual ear symptoms or told her to report such symptoms. Consequently, a lawsuit was brought against the hospital, specifically against the pharmacists.
Question 6) What went wrong in the treatment of the 56-year-old woman?
a) The woman was infected by vestibulopathy while in hospital
b) The correct dosage was not balanced
c) Staff members failed to take note of the woman’s symptoms
PART C TEXT 1
Many adult hospital inpatients need intravenous (IV) fluid therapy to prevent or correct problems with their fluid and/or electrolyte status. Deciding on the optimal amount and composition of IV fluids to be administered and the best rate at which to give them can be a difficult and complex task, and decisions must be based on careful assessment of the patient’s individual needs.
Errors in prescribing IV fluids and electrolytes are particularly likely in emergency departments, acute admission units, and general medical and surgical wards rather than in operating theatres and critical care units. Surveys have shown that many staff who prescribe IV fluids know neither the likely fluid and electrolyte needs of individual patients, nor the specific composition of the many choices of IV fluids available to them. Standards of recording and monitoring IV fluid and electrolyte therapy may also be poor in these settings. IV fluid management in hospital is often delegated to the most junior medical staff who frequently lack the relevant experience and may have received little or no specific training on the subject.
The ‘National Confidential Enquiry into Perioperative Deaths’ report in 1999 highlighted that a significant number of hospitalised patients were dying as a result of infusion of too much or too little fluid. The report recommended that fluid prescribing should be given the same status as drug prescribing. Although mismanagement of fluid therapy is rarely reported as being responsible for patient harm, it is likely that as many as one in five patients on IV fluids and electrolytes suffer complications or morbidity due to their inappropriate administration.
There is also considerable debate about the best IV fluids to use (particularly for more seriously ill or injured patients), resulting in wide variation in clinical practice. Many reasons underlie the ongoing debate, but most revolve around difficulties in interpretation of both trial evidence and clinical experience. For example, many accepted practices of IV fluid prescribing were developed for historical reasons rather than through clinical trials. Trials cannot easily be included in meta-analyses because they examine varied outcome measures in heterogeneous groups, comparing not only different types of fluid with different electrolyte content, but also different volumes and rates of administration. In addition, most trials have been undertaken in operating theatres and critical care units rather than admission units or general and elderly care settings. Hence, there is a clear need for guidance on IV fluid therapy for general areas of hospital practice, covering both the prescription and monitoring of IV fluid and electrolyte therapy, and the training and educational needs of all hospital staff involved in IV fluid management.
The aim of these guidelines is to help prescribers understand the physiological principles that underpin fluid prescribing the pathophysiological changes that affect fluid balance in disease states and the indications for IV fluid therapy. In developing the guidelines, it was necessary to limit the scope by excluding patient groups with more specialised fluid prescribing needs. It is important to emphasise that the recommendations do not apply to patients under 16 years, pregnant women, and those with severe liver or renal disease, diabetes or burns. They also do not apply to patients needing inotropes and those on intensive monitoring, and so they have less relevance to intensive care settings and patients during surgical anaesthesia. Patients with traumatic brain injury (including patients needing neurosurgery) are also excluded. The scope of the guidelines does not cover the practical aspects of administration (as opposed to the prescription) of IV fluids. It is hoped that these guidelines will lead to better fluid prescribing in hospitalised patients, reduce morbidity and mortality, and lead to better patient outcomes.
The guidelines will assume that prescribers will use a drug’s summary of product characteristics to inform decisions made with individual patients. All patients continuing to receive IV fluids need regular monitoring. This should initially include at least daily reassessments of clinical fluid status, laboratory values (urea, creatinine and electrolytes) and fluid balance charts, along with weight measurement twice weekly. It is important to remember that patients receiving IV fluid therapy to address replacement or redistribution problems may need more frequent monitoring. Additional monitoring of urinary sodium may be helpful in patients with high-volume gastrointestinal losses. Patients on longer-term IV fluid therapy whose condition is stable may be monitored less frequently, although decisions to reduce monitoring frequency should be detailed in their IV fluid management plan. Clear incidents of fluid mismanagement (for example, unnecessarily prolonged dehydration or inadvertent fluid overload due to IV fluid therapy) should be reported through standard critical incident reporting to encourage improved training and practice (see Consequences of fluid mismanagement to be reported as critical incidents).
Questions 7-14
7) What does the first paragraph tell us about intravenous (IV) fluid therapy? a) Most patients receive a standard composition of fluids b) Electrolyte status should be kept at the optimal level c) It is not easy to decide on the correct volume and speed of delivery of fluids d) It is difficult to correct problems 8) What have surveys shown about intravenous (IV) fluid therapy? a) There is often a lack of information about correct dosage b) Sometimes, staff mixed up electrolyte fluids with standard IV fluids c) Intravenous (IV) fluid therapy should be delegated to junior medical staff d) Mistakes made in operating theatres were often fatal 9) What did the 1999 report highlight? a) A small number of patients died because they were prescribed the wrong medication b) Around 20% of patients experience problems due to incorrect IV fluid therapy c) Some hospitals fail to report deaths due to mismanaged procedures d) Not all Perioperative deaths could be linked to IV fluid therapy 10) What does the fourth paragraph tell us about IV fluid therapy? a) Seriously ill patients generally need more fluids that injured patients b) There are historical reasons to prolong the use of IV fluid therapy c) The best IV fluids are more expensive d) Not everyone agrees on the most suitable fluids to use 11) Why is it difficult to perform meta-analyses of trials? a) There are not enough qualified analysts b) Trials usually don’t take place in different healthcare settings c) The volume of data is too great to analyse d) More hospital staff need training before the trials take place 12) What do we learn about the scope of the guidelines in the fifth paragraph? a) The guidelines are not appropriate for all types of patients b) Patients needing inotropes and those on intensive monitoring were included for historical reasons c) Pathophysiological patients were excluded because they cannot be given IV fluid therapy d) The guidelines only apply to men (that is to say, adult male patients) 13) According the sixth paragraph, how often should clinical fluid status be reassessed? a) Twice a day or more frequently b) Once every 24 hours c) Twice a week d) Never – routine reassessment can be monitored by machine 14) What should be done in the case of fluid mismanagement? a) Additional monitoring should be carried out b) Rehydration should be prolonged c) Information about occurrences should be conveyed to the appropriate authorities d) The person or persons involved should be criticised
PART C TEXT 2
A CT scan is a specialised X-ray test. It can give quite clear pictures of the inside of your body. In particular, it can give good pictures of soft tissues of the body which do not show on ordinary X-ray pictures. CT stands for computerised tomography. It is sometimes called a CAT scan. CAT stands for Computerised Axial Tomography. The CT scanner looks like a giant thick ring. Within the wall of the scanner there is an X-ray source. Opposite the X-ray source, on the other side of the ring, are X-ray detectors. You lie on a couch which slides into the centre of the ring until the part of the body to be scanned is within the ring. The X-ray machine within the ring rotates around your body. As it rotates around, the X-ray machine emits thin beams of X-rays through your body, which are detected by the X-ray detectors.
The detectors detect the strength of the X-ray beam that has passed through your body. The denser the tissue, the less X-rays pass through. The X-ray detectors feed this information into a computer. Different types of tissue with different densities show up as a picture on the computer monitor, in different colours or shades of grey. So, in effect, a picture is created by the computer of a slice (cross-section) of a thin section of your body.
As the couch moves slowly through the ring, the X-ray beam passes through the next section of your body. So, several cross-sectional pictures of the part of your body being investigated are made by the computer. Newer scanners can even produce 3-dimensional pictures from the data received from the various slices of the part of the body being scanned.
A CT scan can be performed on any section of the head or body. It can give clear pictures of bones. It also gives clear pictures of soft tissues, which an ordinary X-ray test cannot show, such as muscles, organs, large blood vessels, the brain and nerves. The most commonly performed CT scan is of the brain to determine the cause of a stroke, or to assess serious head injuries.
Usually, very little preparation is necessary. It depends on which part of your body is to be scanned. You will be given instructions by the CT department according to the scan to be done. As a general rule, you will need to remove any metal objects from your body, such as jewellery, hair clips, etc. It is best not to wear clothes with metal zips or studs. You may be asked not to eat or drink for a few hours before your scan, depending on the part of your body to be scanned.
The CT scan itself is painless. You cannot see or feel X-rays. You will be asked to stay as still as possible, as otherwise the scan pictures may be blurred. Conventional CT scans can take between 5-30 minutes, depending on which part of the body is being scanned. More modern CT scans (helical CT scans) take less than a minute and also use less radiation.
As the scan uses X-rays, other people should not be in the same room. The operator controls the movement of the couch and scanner from behind a screen or in a separate control room so that they are protected from repeated exposure to X-rays. However, communication is usually possible via an intercom, and you will be observed at all times on a monitor. Some people feel a little anxious or claustrophobic in the scanner room when they are on their own. You can return to your normal activities as soon as the scan is over. The pictures from the scan are studied by an X-ray doctor (radiologist) who sends a report to the doctor who requested the scan.
CT scans use X-rays, which are a type of radiation. Exposure to large doses of radiation is linked to developing cancer or leukaemia – often many years later. The dose of X-ray radiation needed for a CT scan is much more than for a single X-ray picture but is still generally quite a low dose. The risk of harm from the dose of radiation used in CT scanning is thought to be very small but it is not totally without risk. As a rule, the higher the dose of radiation, the greater the risk. So, for example, the larger the part of the body scanned, the greater the radiation dose. And, repeat CT scans over time cause an overall increase of dose. Various studies have aimed to estimate the risk of developing cancer or leukaemia following a CT scan. In general, the risk is small. In many situations, the benefit of a CT scan greatly outweighs the risk.
Questions 15-22 15) What advantage does a CT scan give over a standard X-ray? a) It emits less radiation b) It can take pictures of bones and soft tissues c) It is quieter and uses less electricity d) The patient can lie down during the scan 16) What can be seen on a CT scan result? a) Tissue thicknesses and densities can be shown using different colours b) The computer displays the date, time and patient’s name on the result c) When this article was written, CT scans could only show shades of grey on the results d) Cross-dimensional attributes are shown on the results in colour or shades of grey 17) What does the third paragraph tell us about the CT scans? a) Usually, more than one picture is obtained b) 3-dimensional pictures provide more information that standard cross-sectional pictures c) The CT ring can be programmed to move the coach slowly d) Images and scans can be stored on computers for up to a year 18) What type of scan is carried out most frequently? a) Scans of the head and neck b) Scans of the chest and upper body c) Whole body scans d) Scans of the head only 19) What should you wear for your CT scan? a) Clothing that is free of any metal b) A standard hospital gown c) There are usually no restrictions on clothing d) Some scans require an absence of clothing 20) What can influence the clarity of CT images? a) Temperature b) Movement c) Radiation levels d) Levels of pain or discomfort 21) What does the article say about the number of people in the CT room? a) A Only the operator will be with you in the CT room b) You can ask for one or two people to stay with you during the scan c) You can only be accompanied if you feel anxious or claustrophobic d) You will be alone in the CT room 22) What does the last paragraph say about the levels of risk? a) Generally, the risks are not as significant as the potential advantages b) Some people have developed cancer or leukaemia after a CT scan c) CT scanners pose a lower risk than standard X-ray machines d) There is a high risk of cancer if you have a large body
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Below is a map of the city of Brandfield. City planners have decided to build a new shopping mall for the area, and two sites, S1 and S2 have been proposed. Summarize the information by selecting and reporting the main features and make comparisons where relevant.
Model answer by Lifestyle Training Centre
The given map delineates the layout of the city of Brandfield, including the location of two proposed sites (S1 and S2) for the construction of a new shopping mall.
Overall, the layout includes a golf course and park, a housing estate, a city centre, an industrial estate, a river, roads, and a railway.
S2, one of the proposed sites for the new shopping mall, lies in the north-east of the city, bordered by the railway and the road which span across to the north-west and north-east of the city, respectively. This road bifurcates at the south-west of the city centre which is at the middle, redirecting towards the north-east and intersecting with the industrial estate.
The other proposed site, S1, is positioned to the north of the city, adjacent to the housing estates. A river traverses the locale from the south-east to the north, dividing the area in half and serving as a central geographical feature. To the south-west to the north-west, a golf course and park provide ample green space for recreation and leisure.
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TEXT 1:Tobacco Smoking Statistics from the Australian Institute of Health and Welfare
Tobacco smoking is the single most important preventable cause of ill health and death in Australia. Tobacco smoke contains over 7,000 chemicals, of which over 70, cause cancer. Lung cancer, chronic obstructive airways disease and coronary heart disease are the 3 main diseases linked to tobacco smoking.
Smoking-related diseases killed 14,900 Australians in the financial year 2004–05. This equals 40 preventable deaths every day. Smoking resulted in over 750,000 days spent in hospital and cost $670 million in hospital costs in the financial year 2004–05.
Smoking kills more men than women – 9,700 men compared to 5,200 women. Cancer is the number one cause of tobacco-related death in men (57 per cent) and women (51 per cent), with lung cancer accounting for around 75 per cent and 72 per cent of cancers for men and women respectively. Lung cancer currently causes the most cancer deaths in Australia and this is due mainly to smoking.
The trend for tobacco smoking is dropping with 12% of people aged 14 and older smoking daily in 2016, which is a 24% reduction since 1991. The number of young people who start smoking is also reducing. In 2010, the average age when 14–24 year-olds smoked their first full cigarette was 14.2, but it was 16.3 in 2016. In 1995, 31% of adults smoked in a home where there were dependent children. In 2016, this was down to just 2.8%.
TEXT 2 Why do people smoke?
Cigarettes contain nicotine which does not cause the health issues linked to cigarette smoking but is highly addictive. In small amounts, nicotine causes pleasant feelings which makes the smoker want more. It does not take long before the time between cigarettes gets less, because the smoker is keen to get the pleasant feelings they had before. When a person becomes addicted to nicotine they soon start to have bad
feelings like being irritated and edgy when they are ready for another boost of nicotine.
Most smokers started when they were teens and those who have friends and/or parents who smoke are more likely to start smoking than those who don’t.
The tobacco industry spends billions of dollars each year to create and market their products that show smoking as exciting, glamorous, and safe. Tobacco use is also shown in video games, online, and on TV. Movies showing smokers are another big influence and studies show that young people who repeatedly see smoking in movies are more likely to start smoking.
Widespread advertising, price breaks, and other promotions for cigarettes have been big influences in the past but now many governments are bringing in a lot of ways to reduce the number of people who smoke.
In Australia, the government:
•does not allow cigarette advertising
•has had cigarettes moved to covered cupboards so they cannot be seen in places like dairies, petrol stations and supermarkets
•has gradually increased the amount of tax added to a packet of cigarettes
TEXT 3 Stopping smoking is not easy
Common symptoms people have when they stop smoking include:
•Cravings for nicotine which may be strong at first but they
usually only last a few minutes
• restlessness and trouble concentrating or sleeping
• irritability, anger, anxiety, depression
• increase in appetite and weight gain
Less common symptoms include:
• cold symptoms such as coughing, sore throat and sneezing
• constipation
• dizziness or light-headedness
• mouth ulcers.
The benefits of quitting smoking are:
• immediate health benefits
• a dramatic reduction the risk of smoking-related diseases
Statistics include:
• Quitting before 30 years of age reduces the risk of lung cancer by 90 per cent
• After 15 years of being a non-smoker, the risk of stroke is reduced to that of a person who has never smoked
• Within two to five years of quitting, there is a large drop in the risk of heart attack and stroke
TEXT 4. Different support to stop smoking in Australia
• ‘Cold turkey’ is giving up smoking suddenly, without using medications.
• The prescription medications, bupropion (Zyban) and varenicline (Champix) which reduce withdrawal symptoms from nicotine.
• Nicotine replacement therapy including patches, gum and lozenges.
• QuitCoach is an online tool developed to assist in quitting smoking.
• Quitline is a telephone service available to smokers who want to quit.
• Acupuncture involves treatment by applying needles or surgical staples to different parts of the body.
• Hypnotherapy has not been shown to increase the likelihood of quitting in the long term, although counselling or other treatments that may be offered with it can be helpful to some smokers
E-Cigarettes/ Vaping are increasingly being used instead of traditional cigarettes. However, there is limited evidence available on their quality, safety, efficacy for smoking cessation or harm reduction, and the risks they pose to population health.
In March 2015, the Chief Executive Officer (CEO) of Australia’s National Health and Medical Research Council (NHMRC) issued a statement stating that: “there is currently insufficient evidence to conclude whether e-cigarettes can benefit smokers in quitting, or about the extent of their potential harms. It is recommended that health authorities act to minimise harm until evidence of safety, quality and efficacy can be produced”.
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 E-cigarettes and their role in stopping smoking? __________________
2 Statistics about smoking in Australia? __________________
3 The benefits of quitting smoking? __________________
4 The different support to stop smoking in Australia? _____________
5 The addictive features of nicotine? __________________
6 The 3 main diseases linked to tobacco smoking? __________________
7 The common symptoms people have when they stop smoking? __________________
Questions 8-14 Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.
8 What bad feelings might a person have when they are ready for another boost of nicotine? ________
9 What therapy includes patches, gum and lozenges? __________________
10 How old is a person if their risk of lung cancer reduces by 90 per cent if they stop smoking? _______
11 What percentage of adults smoked in a home where there were dependent children in 2016?
12 Who does not allow cigarette advertising? __________________
13 Who should act to minimise harm until evidence of safety, quality and efficacy of e-cigarettes can be produced__________________
14 Young people are more likely to start smoking if they see what repeatedly? __________________
Questions 15-20 Complete each of the sentences, 15-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.
15 12% of people aged 14 and older smoked daily in 2016, which is a___________reduction since 1991
16 Common symptoms of nicotine withdrawal include_________________and depression
17 Cigarettes contain nicotine which does not cause the___linked to cigarette smoking but is highly addictive. 18 Smoking kills more_________________
19 The prescription medications, bupropion (Zyban) and varenicline (Champix) which reduce__from nicotine. 20 The Government in Australia has_________________the amount of tax added to a packet of cigarettes.
PART B
TEXT 1 The MIST Therapy system for the promotion of wound healing
The MIST Therapy system shows potential to enhance the healing of chronic, ‘hard-to-heal’, complex wounds, compared with standard methods of wound management. If this potential is substantiated, then MIST could offer advantages to both patients and the hospitals.
However, comparative research has yet to be carried out. Further investigation is necessary to reduce uncertainty about the outcomes of patients with chronic, ‘hard-to-heal’, complex wounds treated by the MIST Therapy system compared with those treated by standard methods of wound care. This research should define the types and chronicity of wounds being treated and the details of other treatments being used. It should report healing rates, durations of treatment (including debridement) needed to achieve healing, and quality of life measures (including quality of life if wounds heal only partially).
Question 1) Why should further research be carried out on the MIST Therapy system?
a) To investigate the range of wounds that this system can help to treat
b) To make sure that it offers improvements over the usual treatment option
c) To discover if this system can avoid deleterious outcomes for chronic wounds
TEXT 2 Assessing Risk and Prevention
Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 45% of people older than 80 falling at least once a year. The human cost of falling includes distress, pain, injury, loss of confidence, loss of independence and mortality. Falling also affects the family members and carers of people who fall.
All people aged 65 or older are covered by all guideline recommendations as they have the highest risk of falling. According to the guideline recommendations, all
people 65 or older who are admitted to hospital should be considered for a multifactorial assessment for their risk of falling during their hospital stay.
Question 2) What does the article tell us about the risk of falling?
a) People over 65 need extra facilities to help them avoid falls
b) More people over 65 fall in hospital environments compared with other places
c) Only a minority of people over 65 fall at least once a year
TEXT 3 Dealing With Hazmat
One of the most challenging aspects of providing emergency medical care is attending to patients who have been contaminated with hazardous materials. HAZMAT is a term used to describe incidents involving hazardous materials or specialized teams who deal with these incidents. Hazardous materials are defined as substances that have the potential to harm a person or the environment upon contact. These can be gases, liquids, or solids and include radioactive and chemical materials.
The potential for exposure to hazardous materials in the United States is significant. More than 60,000 chemicals are produced annually in the United States, of which the US Department of Transportation considers approximately 2000 hazardous. More than 4 billion tons of chemicals are transported yearly by surface, air, or water routes.
Question 3) According to this article, what is HAZMAT?
a) Liquid, gaseous or solid materials that are bad for the environment
b) Events where harmful substances are released and the groups that deal with the aftermath
c) Toxic chemicals that are transported by water, land or air.
TEXT 4 How Does Blood Clot?
Within seconds of a blood vessel cut, the damaged tissue causes platelets to become ‘sticky’ and gather together around the cut. These ‘activated’ platelets and the damaged tissue release chemicals which react with other chemicals and proteins in the plasma, called clotting factors. A complex series of reactions involving these clotting factors then occurs rapidly. Each reaction triggers the next reaction and this process is known as a cascade.
The final chemical reaction is to convert a clotting agent called fibrinogen into thin strands of a solid protein called fibrin. The strands of fibrin form a meshwork and trap blood cells which form into a solid clot.
Question 4) According to this article, what is a cascade?
a) A series of events
b) The process that occurs when platelets become sticky
c) The reaction that precedes the formation of fibrin
TEXT 5 At the onset of a migraine attack, the patient should be given a full dose of painkiller. For an adult this means 900 mg aspirin (usually three 300 mg tablets) or 1000 mg of paracetamol (usually two 500 mg tablets). This dose can be repeated every four hours if necessary. Soluble tablets have the advantage of being absorbed more quickly than solid tablets.
Codeine and medicines containing codeine, such as co-codamol, are not recommended for the treatment of migraine. This is because codeine can make feeling sick (nausea) and being sick (vomiting) worse, which can aggravate the migraine. They are also more likely than paracetamol or aspirin to cause a condition called medication-overuse headache if they are used frequently.
Question 5) What do we learn about migraine treatment from this article?
a) Paracetamol doses should not exceed 1000mg
b) Aspirin can cause nausea and/or vomiting
c) Codeine can provoke conditions other than migraine
TEXT 6 Not all patients can independently move or position themselves in bed and their immobility may be due to a wide range of factors. Positioning patients in good body alignment and changing position regularly are essential aspects of nursing practice. It is vital to provide meticulous care to patients who must remain in bed. Healthcare givers’ measures should ensure to preserve the joints, bones and skeletal muscles and must be carried out for all patients who require bed rest.
Positions in which patients are placed, methods of moving and turning should all be based on the principles of maintaining the musculoskeletal system in proper alignment. In addition, the health care provider must also use good body mechanics when moving and turning patients to preserve his or her own musculoskeletal system from injury.
Question 6) What information does the article give us about positioning patients?
a) Healthcare givers should position immobile patients in accordance with the doctor’s instructions
b) Positioning patients is a fundamental part of a nurse’s job
c) Improper musculoskeletal manipulation can lead to immobility
PART C TEXT 1
Once the preserve of hippies and activists, veganism has now hit the mainstream. Forgoing meat, dairy and eggs is more popular than ever. While it’s positive that people are taking a more ethically-conscious approach to food shopping, what nutrients could vegetarians and vegans put themselves at risk of losing out on? And how can you approach animal-free consumption in a healthy way?
Generally, people choose to be vegetarian or vegan for ethical reasons or because they want to improve their health. A vegan diet is usually low in saturated fats and rich in fruit and vegetables. ‘Meat-free Monday’ is a UK campaign, launched by Paul McCartney in 2009, to encourage people to reduce their environmental impact and improve their health by having at least one meat-free day each week. More and more people are realising this is far more manageable than they first thought. When you stop thinking a meal needs meat to be complete, vegetarian options start to look a lot more appealing.
If you’ve decided to give up meat and have vowed to eat more vegetables, that’s a good first step. But vegetarians and vegans do have to be careful they’re not missing out on nutrients most easily found in meat and dairy sources. Protein is one of them. Protein builds and repairs tissues and is a building block of bone, muscles, skin and blood. It isn’t stored in your body, so you need to make sure you’re getting enough from your diet.
Unfortunately for vegetarians, meat is a rich source of this macronutrient. “Whilst many plant-based foods contain protein too, they may not contain protein in the correct balance that the body needs. Therefore, vegetarians need to make sure they eat a combination of foods to achieve the right protein balance,” says Dr Jan Sambrook, a doctor who specialises in nutrition. Luckily, you can also find protein in grains, pulses and dairy products. “If you eat any two of these, the protein will balance,” reveals Sambrook. “This doesn’t necessarily need to be within a single meal, as was previously thought. Examples of protein-balanced meals include cereal with milk, or baked potato with beans and cheese.”
A balanced vegetarian or vegan diet generally gives you plenty of vitamins. But if you’re not sure, there are some foods to look out for when it comes to specific nutrients. “Vitamin A is found in eggs and dairy products. A different form of the vitamin, called beta carotene, is found in dark green leafy vegetables and in coloured fruits and vegetables such as mango, carrots and red peppers,” explains Sambrook. Vitamin D, ‘the sunshine vitamin’, is also really important. It helps your body absorb calcium and is also needed for our muscles to work properly. More recently, vitamin D deficiency has been associated with numerous conditions, from heart disease, to dementia and multiple sclerosis. “Vitamin D is mainly made in our skin by the action of sunlight. However, it is also found in dairy products, mushrooms and in fortified cereals and margarine,” says Sambrook. “Oily fish and eggs are also among the top dietary sources of vitamin D, so if you’re adopting a vegan diet you’re less likely to be getting enough.”
Most of the minerals we need are found in a wide variety of foods and anyone eating a balanced diet can obtain enough of them. However, vegetarians and vegans must make sure they’re getting enough calcium and iron. Recently, the National Osteoporosis Society (NOS) warned that the popularity of ‘clean eating’ and other diets where major foods groups are cut out is setting young people up for a future of weak bones. “Without urgent action being taken to encourage young adults to incorporate all food groups into their diets and avoid particular ‘clean eating’ regimes, we are facing a future where broken bones will become just the norm,” said Susan Lanham-New, a nutrition professor and clinical advisor to the NOS.
Vegans, who normally don’t consume dairy products, may find it challenging to obtain calcium in their diet. “Calcium is, however, also present in leafy green vegetables, dried figs, almonds, oranges, sesame seeds, seaweed and some types of bean,” reveals Sambrook. She explains that if non-dairy calcium is eaten with a source of vitamin D, this will help the body absorb it.
You need iron in order for your blood to carry oxygen around your body. If you don’t get enough, you become anaemic. Whether we like it or not, red meat is the richest dietary source of iron. But there are a few meat-free sources too. “Vegetarian sources of iron include pulses such as chickpeas and lentils, sprouted seeds and beans, breakfast cereals and bread. Spinach is famous for containing iron, but it is also found in other green leafy vegetables such as broccoli and kale,” explains Sambrook. She adds that your body can absorb iron from food more easily if it is eaten with vitamin C.
Questions 7-14 7) The first paragraph implies that a) Becoming a vegan is an ethical choice
b) Hippies and activists have always been vegan
c) Food-shopping for animal-free products is essential for vegans
d) Being a vegan has potential drawbacks
8) Paul McCartney’s 2009 campaign
a) Helped the number of people who understand that meat-free cooking is possible to increase
b) Was designed to help the environment for animals
c) Showed that vegetarian meals can be more attractive than meals prepared with meat
d) Was aimed at reducing saturated fats in processed food
9) What do we learn about protein in the third paragraph?
a) The human body only has a small reserve of protein
b) Without protein, bones and muscle tissues may build more slowly
c) Levels of protein in your body need to be replenished regularly d) It is not possible to find protein in meat-free diets
10) According to the fourth paragraph, how can vegans and vegetarians consume the right kinds of protein?
a) They should stick to basic food groups, such as grains or pulses
b) They should have a mixture of food types
c) They should eat vegetables that contain the same macronutrients as dairy products
d) They can enhance their diet by taking food supplements
11) What does the fifth paragraph tell us about vitamin deficiency?
a) Vegans can get enough vitamin D from sunlight on their skin
b) Coloured fruits and vegetables are good sources of vitamin D
c) Incidence of heart disease, dementia and multiple sclerosis among vegetarians is the same as among vegans
d) Vegans have a higher than normal risk of vitamin
D deficiency
12) What is the National Osteoporosis Society (NOS) concerned about?
a) Young people can cut themselves
b) More vegetarians and vegans will develop Osteoporosis
c) There may be a rise in a specific type of injury
d) Some people are not eating enough clean food
13) What does ‘it’ (the last word of the seventh paragraph) refer to?
a) Calcium
b) Vitamin D
c) Vitamin A
d) Protein
14) What does the last paragraph say about iron?
a) Vitamin C and iron consumed together is good for iron absorption
b) Vegans should consider eating red meat
c) You can become anaemic if you don’t eat enough vegetables
d) For oxygen-carrying blood cells, vitamin C is more important than iron
PART C TEXT 2
Jennifer Millar keeps rubbish bags and hand sanitizer near her tent, and she regularly pours water mixed with hydrogen peroxide on the pavement nearby. Keeping herself and the patch of concrete she calls home clean is her top priority. But this homeless encampment near a Hollywood freeway slip road is often littered with needles and rubbish. Rats occasionally run through, and Millar fears the consequences. “I worry about all those diseases,” said Millar, 43, who said she has been homeless most of her life.
Infectious diseases, including some that ravaged populations in the Middle Ages, are resurging in California and around the country and are hitting homeless populations especially hard. Los Angeles recently experienced an outbreak of typhus in city centre streets, a disease spread by infected fleas on rats and other animals. Officials briefly closed part of the City Hall after reporting that rodents had invaded the building. Hepatitis A, also spread primarily through faeces, has infected more than 1,000 people in Southern California in the past two years. The disease also has erupted in New Mexico, Ohio and Kentucky, primarily among people who are homeless or use drugs.
Public health officials and politicians are using terms like “disaster” and “public health crisis” to describe the outbreaks, and they warn that these diseases can easily jump beyond the homeless population. “Our homeless crisis is increasingly becoming a public health crisis,” California Governor Gavin Newsom said in his State of the State speech in February, citing outbreaks of hepatitis A, syphilis and typhus in Los Angeles.
Those infectious diseases are not limited to homeless populations, Newsom warned. “Even someone who believes they are protected from these infections may not be.” At least one Los Angeles city employee said she contracted typhus in the City Hall last fall. And San Diego County officials warned in 2017 that diners at a four-star restaurant were at risk of hepatitis A. Last month, the state announced an outbreak of typhus in Los Angeles city centre that infected nine people, six of whom were homeless. After city workers said they saw rodent droppings in City Hall, Los Angeles City Council President Herb Wesson briefly shut down his office and called for an investigation.
The infections around the country are not a surprise, given the lack of attention to housing and health care for the homeless and the dearth of bathrooms and places to wash hands, said Dr. Jeffrey Duchin, the health officer for Seattle, Washington State. “It’s a public health disaster,” he said. In his area, Duchin said, he has seen shigellosis, trench fever and skin infections among homeless populations.
In New York City, where more of the homeless population lives in shelters rather than on the streets, there have not been the same outbreaks of hepatitis A and typhus, said Dr. Kelly Doran, an emergency medicine physician and assistant professor at NYU School of Medicine. But Doran said different infections occur in shelters, including tuberculosis, a disease that spreads through the air and typically infects the lungs. These diseases sometimes get the “medieval” moniker because people in that era lived in squalid conditions without clean water or sewage treatment. People living on the streets or in homeless shelters are vulnerable to such outbreaks because their weakened immune systems are worsened by stress, malnutrition and sleep deprivation. Many also have mental illness and substance abuse disorders, which can make it harder for them to stay healthy or get health care.
One recent February afternoon, Community Clinic physician assistant Negeen Farmand walked through homeless encampments in Hollywood carrying a backpack with medical supplies. She stopped to talk to a man sweeping the sidewalks. He said he sees “everything and anything” in the gutters and hopes he doesn’t get sick. “To get these people to come into a clinic is a big thing,” she said. “A lot of them are distrustful of the health care system.” On another day, 53-year-old Karen Mitchell waited to get treated for a persistent cough by St. John’s mobile health clinic. She also needed a tuberculosis test, as required by the shelter where she was living. Mitchell, who said she developed alcoholism after a career in pharmaceutical sales, said she has contracted pneumonia from germs from other shelter residents. “Everyone is always sick, no matter what precautions they take.”
During the hepatitis A outbreak, public health officials administered widespread vaccinations, cleaned the streets with bleach and water and installed hand-washing stations and portable toilets near high concentrations of homeless people. But health officials and homeless advocates said more needs to be done, including helping people access medical and behavioural health care and affordable housing. “It really is unconscionable,” said Bobby Watts, CEO of the National Homeless Council, a policy and advocacy organization. “These are all preventable diseases.”
Questions 15-22
15) What is the most important thing for Jennifer Miller?
a) Avoiding diseases
b) Sanitizing her immediate environment
c) Finding a permanent home
d) Stopping rats and other rodents
16) What does the second paragraph tell us about Hepatitis A?
a) The recent outbreak was not confined to California
b) Hepatitis A is transmitted by fleas on rats and other animals
c) More than 1000 contracted the disease through sharing dirty needles
d) Some people in the City Hall now have Hepatitis A.
17) What problem did California Governor Gavin Newsom highlight?
a) Hepatitis A, syphilis and typhus have jumped into the homeless population
b) Politicians are not doing enough to stop the outbreak
c) The health situation in his state (California) is now a ‘disaster’
d) There is a link between public health and homelessness
18) What statistic is given in the fourth paragraph?
a) Four percent of restaurants were at risk of hepatitis A
b) Two thirds of typhus cases in Los Angeles city centre concerned people living on the streets
c) Nine out of ten people are concerned about the crisis
d) Ninety percent of people believe they are protected from these infections
19) What does Dr. Jeffrey Duchin think?
a) The infections are surprising b) There are insufficient washing facilities
c) Shigellosis and trench fever have disastrous consequences
d) More houses should be built for the homeless
20) What does the sixth paragraph help us to understand?
a) The conditions in New York shelters are worse than those in Los Angeles
b) Tuberculosis infections could be due to poor sewage treatment
c) Homeless people are more susceptible to these diseases for a number of reasons
d) The pathology of these diseases has not changed since medieval times
21) What problem does Karen Mitchell have?
a) She has a chronic cough
b) She lost her job in pharmaceutical sales
c) She has to go to a new shelter
d) She has tuberculosis
22) In the final paragraph, what else needs to be done?
a) A Install more portable toilets and hand-washing stations
b) B Prevent more diseases
c) C Give free health care to homeless people
d) D Give assistance to people who want medical help or an inexpensive place to live.
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We hope this information has been valuable to you. If so, please consider a monetary donation to Lifestyle Training Centre via UPI. Your support is greatly appreciated.
Would you like to undergo training for OET, PTE, IELTS, Duolingo, Phonetics, or Spoken English with us? Kindly contact us now!
We hope this information has been valuable to you. If so, please consider a monetary donation to Lifestyle Training Centre via UPI. Your support is greatly appreciated.
Would you like to undergo training for OET, PTE, IELTS, Duolingo, Phonetics, or Spoken English with us? Kindly contact us now!
