TEXT A: Description: Glaucoma is the name given to as group of eye disease in which the optic nerve at the back of the eye is slowly destroyed. In most people this damage is due to an increased pressure inside the eye – a result of blockage of the circulation of adequous, or its drainage. In other patients, the damage may because by poor blood supply to the vital optic nerve fibbers weakness in the structure of the nerve, and or a problem in the health of the nerve fibers themselves. Over 146000 Australians have been diagnosed with glaucoma. While it is more common as people age, it can occur at any age. Glucoma is also far less common in the indigenous population.

Symptoms: Chronic glaucoma is the common type. It has no symptoms  until eyesight  is lost at  a later stage.

Prognosis: Damage progresses very slowly and destroys vision gradually, starting with the   side vision. One eye covers for the other, and the person remains unaware of any problem until a majority of nerve fibers  have been damages, and  a large part of vision has been  destroyed.  This damage is irreversible.

Treatment: Although there is no cure for glaucoma it can usually be controlled and further loss of sight either prevented or at least slowed down. Treatments include: Eyedrops – these are the most common form of treatment and must be used regularly. Laser (laser trabeculoplasty) – this is performed when eye drops do not stop deterioration in the field of vision. Surgery (trabeculectomy) – this is performed usually after eye drops and laser have failed to control the eye pressure. A new channel for the fluid to leave the eye is created. Treatment can save remaining vision but it does not improve eye sight.

Text B.      Table 1: Study of  eye pressure  and corneal thickness  as predictors of Glaucoma                         
lntraocular pressure (IOP) Central corneal thickness (CCT) and Glaucoma  correlations.

Central corneal thickness	Intraocular pressure	Intraocular pressure + Central corneal thickness	Predictor of development of glaucoma (r2)
thickness of 555 microns or less			.36*
thickness of more than 5BB microns			-.13*
	pressure of less than 21 mmHg		.38*
	pressure of more than 22 mmHg		.07*
*power >.05		Thickness less than 555and pressure less than 21 mmHg	-.49*

Text C. Other forms of Glaucoma.        •

• Low-tension or normal tension glaucoma. Occasionally optic nerve damage can occur in people  with so-called normal  eye  pressure.
• Acute  (angle-closure)  glaucoma. Acute  glaucoma  is when  the pressure inside the eye rapidly increases due to the iris blocking the drain. An attack of acute glaucoma is often severe. People suff er pain, nausea, blurred vision and redness of the eye.     /
• Congenital glaucoma. This is a rare form of glaucoma caused by an abnormal drainage system. It can exist at birth or develop later.
• Secondary glaucomas. These glaucomas can develop because of other disorders of the eye such as injuries, cataracts, eye inflammation. The use of steroids (cortisone) has a tendency to raise eye pressure; therefore, pressures  should be  checked  frequently when  steroids are used.

Text D: Overview  of  Glaucoma Facts: Glaucoma  is the leading  cause  of  irreversible blindness worldwide. One in 10 Australians over 80 will develop glaucoma.

• First degree relatives of glaucoma patients have an 8-fold increased risk of developing  the disease.

• At present,  50% of  people  with glaucoma in Australia  are undiagnosed.
• Australian  health  care cost of  glaucoma in 2017 was $342  million.
• The total annual cost of  glaucoma  in 2017 was  $1.9 billion.
• The total cost is expected to increase to $4.3 billion by 2025.
• The dynamic model of the economic impact of glaucoma enables cost­effectiveness comparison of various interventions to inform policy development.

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. which is the rare form of glaucoma?  

2. what is the leading cause of irreversible blindness in the world?

3. what has the highest value for the predictor of development of glaucoma?

4. which is the most common form of glaucoma?? __

5. what has the lowest value for the predictor of development of glaucoma?

6. what was the total annual cost of glaucoma in 2017? __

7. what is the most common form of treatment for glaucoma? __

Questions 8-13. Answer each of the questions, 8-13, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.

8. Which form of glaucoma can develop due to eye inflammation?

9. What is the predicted total cost of glaucoma in 2025?

10. What is the predictor of development of glaucoma for intraocular pressure more than 22 mmHg?

11. How many Australians have been diagnosed with glaucoma?

12. What was the Australian health care cost of glaucoma in 2017?

13. what is the current percentage of undiagnosed glaucoma patients in Australia?

Questions 14-20. Complete each of the sentences, 14-20, with a word or short phrase from one of the texts. Each answer may include words, numbers or both.

14. Glaucoma is a group of eye diseases in which the________ is slowly destroyed

15. First degree relatives of glaucoma patients have _________ increased risk of developing the disease.

16. ______can cause pain, nausea, blurred vision and redness of the eye.

17. Steroids such as _______has a tendency to raise eye pressure.

18. Glaucoma is far less common in the_______

19. ________has no symptoms until eyesight is lost at a later stage.

20. Laser trabeculoplasty is performed when _______ don’t stop deterioration in the field of vision.

Part B.

Parenteral  Infusion Devices: Intravenous (IV) and intraarterial access routes provide an effective pathway for the delivery  of  fluid, blood,  and medicants  to a patient’s vital  organs. Consequently, about 80% of hospitalized patients receive infusion therapy. A variety of devices can be used to provide  flow through  an intravenous catheter. An intravenous delivery system typically consists of three major components:  (1) fluid or drug reservoir,  (2) catheter  system for transferring the fluid or drug from the reservoir into the vasculature  through a   venipuncture,  and (3) device for regulation  and/or  generating  flow.

1. What  does this extract tell us about parenteral infusion devices?

1. used  to provide  flow through  an intravenous catheter
2. 80% of hospitalized  patients receive parenteral  infusion   devices
3. provide an effective pathway  for the delivery of fluid,   blood

Biomedical  Lasers: Three important factors have led to the expanding biomedical use of laser technology, particularly in surgery. These factors are: (1) the increasing understanding of the wave-length  selective interaction  and associated  effects of ultraviolet-  infrared  (UV-IR) radiation with biologic tissues,  including those of acute damage and long-term healing, (2) the rapidly increasing availability of lasers emitting (essentially monochromatically) at those wave­ lengths that  are strongly  absorbed by  molecular  species within  tissues, and (3) the availability of both optical fiber and lens technologies as well as of endoscopic technologies for delivery of the laser radiation to the often remote internal treatment site.

2. The purpose  of  these notes about Biomedical  Lasers is to

1. state the factors that led to the expanding biomedical use of laser technology
2. give valid reasons  for the increase in the biomedical use of lasers   in surgery
3. recommend an alternate for ultraviolet- infrared (UV-IR) radiation in biomedical use

Infant Monitor: Many infants are being monitored in the home using  apnea monitors because they have been identified with breathing problems. These include newborn premature babies who have apnea of prematurity, siblings of babies who have died of sudden infant death syndrome, or infants who have had an apparent life-threatening episode related to lack of adequate respiration. Rather than keeping infants in the hospital for a problem that they may soon outgrow, doctors often discharge them from the hospital with an infant apnea monitor that measures the duration of breathing pauses and heart rate and sounds an alarm if either parameter crosses limits prescribed by the doctor.

3. The notice is giving information about

1. the circumstances  for prescribing  the infant monitor  by  the doctor
2. why  infants shouldn’t be  discharged  from the hospital with infant  monitor
3. why infants unidentified with breathing problems need infant monitor

Postoperative complications: Surgery and  anesthesia  are stressful events for the patient. The patient   handles stress in accordance with their overall condition, the nature of the surgery and associated diseases. Post-traumatic stress disorder (stress  syndrome)  can be expected in all patients  following surgery. This is an  overall and local response of the organism to stress and its effort to cope with the strain. It is a physiological reaction of the organism to stress, which in the worst-case scenario can become a pathological  or a post-operative complication.

4. What  does this extract tell us about post-traumatic  stress   disorder?

1. It is a physiological reaction of the patient to stress. •
2. It is only a local response of the patient to stress.
3. It can definitely turn into a post-operative    complication.

Rinses: These are prescribed when redressing necrotic, infected wounds. The rinse, · especially with antiseptic solution for clean, granulating and epithelizing wounds is not substantiated. The wound rinse helps to dean the wound of early leaching residues, coatings, necrotic tissue, pus, blood dots, toxins or residues of bacterial biofilm. Rinsing a colonized chronic wound reduces the existing microbial population.

Solutions suitable for application to wounds: Prontosan solution, Ostenisept, Dermacin,  DebsriEcaSan

Less suitable solutions: Betadin,  Braunol,  saline,  Permanganate

Solutions not suitable for application to wounds: Chloramin, Persteril, Rivanol, Jodisol.

5. The email is reminding  staff that  the

1. benefits  of  rinses to patients  using suitable solutions.
2. solutions less suitable should not be  applied to   wounds.
3. epithelizing  wounds  should be rinsed  with  antiseptic solution.

Drains and drainage systems: Drains are used to drain physiological or pathological  fluids from the  body. The use of drains and drainage systems in surgery significantly affects the overall healing process. The accumulated fluid can endanger the whole body as it has a mechanical and toxic effect on the surrounding 4ssue and is a breeding ground for microorganisms.  Drains are used to drain fluids from body cavities, organs, wounds and surgical wounds (e.g. blood, wound secretion, bile, intestinal contents, pus etc.) and air (chest drainage).

6. The purpose  of  these notes  about drains and drainage  systems is to

1. help maximize  efficiency of healing  process.
2. give  guidance  on certain medical procedures.

• avoid accumulation  of  fluid in body cavities.

Part C Text 1. Choose the answer (A, B, C or D) AIDS deaths blamed on immune therapy

Paragraph 1: THE DEATHS of three patients during trials of an experimental immune therapy for people with AIDS have renewed controversy over experiments carried out by the French scientist Daniel Zagury. The affair has also   highlighted shortcomings in the system of checks and controls over clinical research. The French health minister, Bruno Durieux, recently announced that  an inquiry had cleared Zagury and his team at the Pierre and Marie Curie University  in Paris of  alleged irregularities in the way they conducted tests of   a potential vaccine and an experimental immune therapy in patients at the Saint-Antoine Hospital  (This Week,  13 April). But Durieux  made  no mention of  three deaths which the inquiry had  reported.

Paragraph 2: Following revelations about the circumstances in which the patients died, Durieux has now announced a new assessment of the tests to be undertaken by ANRS, the national agency for AIDS research. Last July, Zagury and his colleagues reported in a letter to The Lancer  (vol 336, p  179)  a trial on patients with AIDS or AIDS-related complex. The patients received a preparation based on proteins from HIV that was designed to boost their immune  systems.

Paragraph 3: The preparation  was made from samples of  the patients’  own white blood  cells, purified and cultured in the laboratory. The researchers had infected the white blood cells with a genetically engineered form of the vaccinia virus that had  genes from HIV inserted into its DNA. The vaccinia, or cowpox, virus, had  first been  inactivated with  formaldehyde,  said the researchers.  Last week, the Chicago Tribune and Le Monde alleged that at least two of the deaths were caused by vaccinia disease, a rare complication of infection with vaccinia virus. Vaccinia is harmless in healthy people and has been used in its live form as the vaccine against smallpox worldwide. But, in people whose immune systems are suppressed, the virus can ‘occasionally spread rapidly in the body and kill.

Paragraph 4: A Paris dermatologist, Jean-Claude Guillaume, said that when he warned Zagury’s team that he was convinced one of their patients had contracted vaccinia disease “the response was that this was not possible” because the vaccinia had been inactivated. Shortly before his death, the patient had consulted  Guillaume  about large, rubbery  lesions  across his abdomen. Guillaume  consulted  a colleague, Jean-Claude  Roujeau,  about the rare disease. Roujeau told the Chicago Tribune that his tests on the tissue samples taken from two patients before they died had detected vaccinia virus in their skin cells.

Paragraph 5: The Saint-Antoine team’s postmortem tests did not reveal vaccinia. Odile Picard, who is in charge of administering the treatment, says there were three possible causes of death – vaccinia disease, herpes or a toxic reaction to the procedure used to prepare white blood cells before injecting them into patients. Zagury, however, insisted that “nothing allows us to affirm it [was vaccinia]. It could have been herpes or Kaposi’s sarcoma”. The tests are continuing, he says.

Paragraph 6: Luc Montagnier, co-discoverer of HIV, called for an immediate halt to the experiments. He says that intravenous injections could lead to generalised vaccinia disease. His team at the Pasteur Institute has already shown in laboratory tests that vaccinia virus maybe dangerous if the immune system is unable to resist it. The findings at the Pasteur Institute were apparently unknown to Zagury’s team, which works with Montagnier’s rival, the researcher  Robert Gallo. Gallo’s collaboration with  Zagury has been  suspended by the National Institutes of Health in the US because of alleged irregularities.

Paragraph 7: Zagury and his team have also denied charges that they covered up the deaths, which are not mentioned in their report in The Lancet. “They were not covered up,” Picard said. “They were accepted [into the trial] on compassionate grounds.” The Lancet report concerns 28 patients. 14 who were treated  and  14  controls who  were not  able to receive  the treatment.

Picard says that five other patients were also treated with the preparation but were not compared with the  controls. Their T4 cell counts had fallen too low to be comparable with the control group, so they were  excluded  from the  study and not mentioned  in its  report.

Paragraph 8: AIDS patients are particularly  vulnerable to infection. Furthermore, the French ethics council had specified that volunteers should be chosen because “their state was so advanced it excluded  treatment with AZT”. At least some of the patients were being treated with AZT at the same time as immune therapy. The council had also asked to be informed of the results of the trials case by case, but had not been told of the deaths. The geneticist Andre Boue, a member of the council, said: “The ethics council does not have judicial powers;  we are not the fraud  squad.”

Paragraph 9: The director  of the -AIDS research  agency ANRS, Jean-Paul  Levy, is concerned that all the controversy may lead to a crisis of public confidence  but laid the blame firmly at the door of the media where “excessive praise is followed by  excessive rejection”.  Levy, who had still heard nothing, “even   informally” from the health ministry the day after Durieux told parliament  that ANRS would assess immune therapy trials, said he wanted to study the problems  “in depth, but not in the atmosphere  of  a  tribunal”.

Paragraph 10: ANRS has a panel of experts in therapeutic trials, which, says Levy, “might seek international contacts to obtain a broad consensus” on the issues  involved. The research agency’s r-ole is to carry out a purely scientific evaluation, not to assess whether there was a breach of ethical guidelines, according to Levy. “If the government called on us to examine this case, we could act very quickly,” said Philippe Lucas of  the ethics   council.      

                           

Q1. “Which of the following is FALSE?

1. Zagury’s  experiments have been  controversial  before.
2. An inquiry found obvious irregularities in Zagury’ s work.
3. ANRS  is to re-evaluate  Zagury’s tests.
4. Zagury’s intention  had been to increase patients’  immune  systems   with proteins.

Q2. The preparation which the patients received

1. had been  accidentally  infected with  a form of the vaccinia  virus.
2. was made from white blood cells which had been manufactured in the laboratory.
3. had been stored in formaldehyde,
4. contained laboratory-treated white blood cells which had been taken from them.

Q3. According to the article, vaccinia   _

1. is potentially  lethal for all humans.
2. has been used to fight both  cowpox  and smallpox  all around the  world.
3. can be dangerous  in people  who have  abnormal  immune systems.
4. in none of the  above.

Q4. Jean-Claude Guillaume         _

1. was  also a member  of  Zagury’s team.
2. examined one of the patients who had been referred to him by Zagury’ s team.
3. informed the Chicago Tribune about the results of the tests on the tissue samples.
4. was/did none  of the above.

Q5. Which  of  the following people  does NOT work with  Zagury?

1. Odile Picard.
2. Luc Montalgnier.
3. Robert Gallo.
4. None  of  the above works with Zagury.

Q6. It is FALSE that findings at the Pasteur institute —

1. were ignored by Zagury’s team.
2. did not lead to intervention  by the National  institutes of   Health.
3. showed that intravenous injections were not good for patients with weaker immune systems.
4. led to Zagury’s team  keeping  quiet about the patients who had   died.

Q7. How many people  were injected with the preparation  in the   trial?

1. Fourteen 
2. Nineteen
3. Twenty eight
4. Thirty three ‘

Q8. Which of the following statements best describes the initial condition of the people who took part in the   trial?

1. Fewer than half  of them had  AIDS
2. Half  of them had AIDS
3. Most of them had  AIDS

• All of them had  AIDS

Part C. TEXT 2.

Going blind in Australia

Paragraph 1: Australians  are living longer and so face increasing levels of visual  impairment. When we look at the problem  of visual impairment and the  elderly, there are three main issues. First, most impaired people retire with relatively  “normal” eyesight, with no more than presbyopia,  which  is  common in most people over 45 years of age. Second, those with visual impairment do have eye disease and are not merely suffering from “old age”. Third, almost all the major ocular disorders affecting the older population,  such as cataract, glaucoma and age-related macular degeneration (AMD), are progressive and if untreated will cause visual impairment and eventual blindness.

Paragraph 2: Cataract accounts for nearly half  of  all blindness  and remains the  most prevalent cause of blindness worldwide. In Australia, we do not know how prevalent cataract is, but it was estimated in 1979 to affect the vision of 43 persons per thousand over the age of 64 years. Although some risk factors for cataract have been identified, such as ultraviolet radiation, cigarette  smoking and alcohol consumption, there is no proven means of preventing the development of most age-related or senile cataract. However cataract blindness can be delayed or cured if diagnosis is early and therapy, including_ surgery,  is accessible.

Paragraph 3: AMD is the leading cause of new cases of blindness in those over 65. In the United States, it affects 8-1 1%  of those aged 65-74, and 20% of those over  75 years. In Australia, the prevalence of AMD is presently unknown but could be similar to that in the USA…Unlike cataract, the treatment  possibilities  for AMD are Hmited. Glaucoma is the third major cause  of vision loss in the elderly. This insidious disease is often undetected until optic nerve damage is far advanced. While risk factors for glaucoma,  such as  ethnicity and family history, are known, these associations are poorly understood. With early detection, glaucoma can be controlled medically or surgically.

Paragraph 4: While older people use a large percentage  of  eye services, many more may   not have access to, or may underutilise, these services. In the United  States  33% of the elderly in Baltimore had ocular pathology requiring further investigation or intervention. In the UK, only half the visually impaired in London were known by their doctors to have visual problems, and 40% of  those visually impaired in the city of Canterbury had never visited an ophthalmologist. The reasons for people underutilising eye care services are, first, that many elderly people believe that poor vision is inevitable or untreatable.  Second, many  of  the visually  impaired  have  other  chronic disease and may neglect their eyesight. Third, hospital resources and rehabilitation centres in the community are limited and, finally, social factors play a role.

Paragraph 5: People in lower socioeconomic groups are more likely to delay seeking treatment; they also use fewer preventive, early intervention and screening services, and fewer rehabilitation and after-care services. The poor use more health services, but their use is episodic, and often involves hospital casualty departments or general medical services, where eyes are not routinely examined. In addition, the costs of services are great deterrent for those with lower incomes who are less likely to have private health insurance. For example, surgery is the most effective means of treatment for cataract, and timely medical care is required for glaucoma and AMD. However, in December 1991, the proportion of the Australian  population  covered by private health insurance was 42%. Less than 38% had supplementary  insurance cover. With 46% of category 1(urgent) patients waiting for more than 30 days for elective eye surgery in the public system, and 54% of category 2 (semi-urgent) patients waiting for more than three months, cost appears to be a barrier to appropriate and adequate  care.

Paragraph 6: With the proportion of Australians aged 65 years and older expected to double from the present 11% to 21% by 2031, the cost to individuals and to society of poor sight will increase significantly if people do not have access to, or do not use, eye services. To help contain these costs, general practitioners can actively investigate the vision of all their older patients, ref er them earlier, and teach them self-care practices. In addition, the government, which is responsible to the taxpayer, must provide everyone with equal access to eye health care services. This may not be achieved merely by increasing expenditure – funds need to be directed towards prevention and health promotion, as well as treatment. Such strategies will make good economic sense if they stop older people going blind.

Q1. In paragraph 1, the author suggests that         _

1. many people have poor eyesight at retirement  age.
2. sight problems of the aged are often  treatable.
3. cataract and glaucoma  are the inevitable results  of  growing  older.
4. few sight problems  of  the elderly are potentially  damaging.

Q2. According to paragraph 2, cataracts       _

1. may affect about half  the population  of  Australians  aged over 64.
2. may occur in about 4-5% of Australians aged over 64.
3. are directly related to smoking and alcohol consumption in old age.
4. are the cause of more than  50% of visual   impairments.

Q3. According to paragraph 3, age-related macular degeneration (AMD)

1. responds well to early treatment. ,’;
2. affects 1in 5 of people  aged 65-74.
3. is a new disease which  originated  in the USA.
4. causes  a significant  amount  of sight loss in the elderly.

Q4. According to paragraph 3, the detection of glaucoma      _

1. generally  occurs too late for treatment  to be  effective.
2. is strongly associated  with  ethnic  and genetic factors.
3. must  occur early to enable effective  treatment.
4. generally occurs before optic nerve damage is very advanced.

QS. Statistics in paragraph 4 indicate that    _

1. existing  eye care services are not fully utilised by the   elderly.
2. GPs are generally  aware of  their  patients’  sight difficulties.
3. most  of  the elderly in the USA receive  adequate  eye treatment.
4. only 40% of  the visually  impaired visit  an opthalmologist.

Q6. According to paragraph 4, which one of the following statements is   true?

1. Many elderly people believe that eyesight problems cannot be treated effectively.
2. Elderly people with chronic diseases are more likely to have  poor eyesight.
3. The facilities for eye treatments  are not always readily   available.
4. Many elderly people think that deterioration of eyesight is a product of ageing.

Q7. In discussing social factors affecting the use of health services in paragraph 5, the author points out that _

1. wealthier  people  use health  services more  often than poorer people.  
2. poorer  people use health  services more regularly  than wealthier  people.
3. poorer people deliberately avoid having their eye sight   examined.
4. poorer  people have less access to the range of  available  eye care  services.

Q8. According to paragraph 6, in Australia in the year 2031   _

1. about  one tenth  of  the country’s population  will be elderly.
2. about one third  of  the  country’s population  will be elderly.
3. the proportion  of people  over 65 will be twice the present proportion.
4. the number  of visually impaired will be twice the present number.

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