考试时间 2014年3月22日星期六 下午2:00-5:00 原创作者qq 347952582 h6(\ tRd!\
Passage 72(9/22) n([9U0!gu
SinceWould War II considerable advances have been made in the area of health-careservices. These include better access to health care (particularly for the poorand minorities), improvements in physical plants, and increased numbers ofphysicians and other health personnel. All have played a part in the recentimprovement in life expectancy. But there is mounting criticism of the largeremaining gaps in access, unbridled cost inflation, the further fragmentationof service, excessive indulgence in wasteful high-technology “gadgeteering,”and a breakdown in doctor-patient relationships. In recent years, proposed panaceas and new programs,small and large, have proliferated at a feverish pace and disappointmentsmultiply at almost the same rate. This has led to an increasedpessimism—“everything has been tried and nothing works”—which sometimes borderson cynicism or even nihilism. $[xS>iuD
Itis true that the automatic “pass through” of rapidly spiraling costs togovernment and insurance carriers, which was set in a publicized environment of“the richest nation in the world,” produced for a time a sense of unlimitedresources and allowed to develop a mood whereby every practitioner andinstitution could “do his own thing” without undue concern for the “MedicalCommons.” The practice of full-cost reimbursement encouraged capital investmentand now the industry is overcapitalized. Many cities have hundreds of excesshospital beds; hospitals have proliferated a superabundance of high-technologyequipment; and structural ostentation and luxury were the order of the day. Inany given day, one-fourth of all community beds are vacant; expensive equipmentis underused or, worse, used unnecessarily. Capital investment brings rapidlyrising operating costs. ng6".u9
Yet,in part, this pessimism derives from expecting too much of health care. It mustbe realized that care is, for most people, a painful experience, oftenaccompanied by fear and unwelcome results. Although there is vast room forimprovement, health care will always retain some unpleasantness andfrustration. Moreover, the capacities of medical science are limited. HumptyDumpty cannot always be put back together again. Too many physicians arereluctant to admit their limitations to patients; too many patients andfamilies are unwilling to accept such realities. Nor is it true that everythinghas been tried and nothing works, as shown by the prepaid group practice plansof the Kaiser Foundation and at Puget Sound. In the main, however, suchundertakings have been drowned by a veritable flood of public and privatemoneys which have supported and encouraged the continuation of conventionalpractices and subsidized their shortcomings on a massive, almost unrestricted scale.Except for the most idealistic and dedicated, there were no incentives to seekchange or to practice self-restraint or frugality. In this atmosphere, it isnot fair to condemn as failures all attempted experiments; it may be moreaccurate to say many never had a fair trial. xo.k:F
1. The author implies that the KaiserFoundation and Puget Sound plans (lines 47-48) differed from other plans by 2e<u/M21>
(A)encouraging capital investment N87)rhXSo,
(B)requiring physicians to treat the poor U(rY,4'
(C)providing incentives for cost control :AYhBhitC
(D)employing only dedicated and idealistic doctors &~K4I
(E)relying primarily on public funding crbph.0
2. The author mentions all of the following asconsequences of full-cost reimbursement EXCEPT /_D_W,#P
(A)rising operating costs ) -^(Su(!
(B)underused hospital facilities [lz#+~rOS
(C)overcapitalization )jPIBzMys
(D)overreliance on expensive equipment VxAG=E
(E)lack of services for minorities gski:C
3. The tone of the passage can best bedescribed as %5ovW<E:
(A)light-hearted and amused d^+0=_[PmK
(B)objective but concerned %:!ILN
(C)detached and unconcerned QX+Xi<YE-
(D)cautious but sincere
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(E)enthusiastic and enlightened ,v#O{ma
4. According to the author, the “pessimism”mentioned at line 35 is partly attributable to the fact that TXS{=
(A)there has been little real improvement in health-care services _A~>?gJ;,
(B)expectations about health-care services are sometimes unrealistic Tvl"KVGm
(C)large segments of the population find it impossible to get access tohealth-care services !<vy!pXg
(D)advances in technology have made health care service unaffordable qs>&Xn
(E)doctors are now less concerned with patient care 8bdx$,$
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5. The author cites the prepaid plans in lines46-48 as q&2L@l3A
(A)counterexamples to the claim that nothing has worked `O]$FpO
(B)examples of health-care plans that were over-funded J-z<&9
(C)evidence that health-care services are fragmented Q%:Z&lgy
(D)proof of the theory that no plan has been successful UCo`l~K)qg
(E)experiments that yielded disappointing results S.; ahce
6. It can be inferred that the sentence“Humpty Dumpty cannot always be put back together again” means that [0!*<%BgK'
(A)the cost of health-care services will not decline ,B#*<_?E5
(B)some people should not become doctors '?Xf(6o1
(C)medical care is not really essential to good health ~t<uX "K
(D)illness is often unpleasant and even painful iXLH[uhO;
(E)medical science cannot cure every ill eExI3"|Q
7. With which of the following descriptions ofthe system for the delivery of health-care services would the author mostlikely agree? ?_d3|]N
(A)It is biased in favor of doctors and against patients. %6
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(B)It is highly fragmented and completely ineffective 1}~ZsrF
(C)It has not embraced new technology rapidly enough P2F8[o!<
(D)It is generally effective but can be improved (6i4N2
(E)It discourages people from seeking medical care %<|cWYM="z
8. Which of the following best describes thelogical structure of the selection? ?CldcxM#
(A)The third paragraph is intended as a refutation of the first and secondparagraphs. q ,+29
(B)The second and third paragraphs explain and put into perspective the pointsmade in the first paragraph. MaLH2?je^n
(C)The second and third paragraphs explain and put into perspective the pointsmade in the first paragraph. x *a_43`
(D)The first paragraph describes a problem, and the second and third paragraphs presenttwo horns of a dilemma. IP^1ca#<
(E)The first paragraph describes a problem, the second its causes, and the third apossible solution. <Y"HCa{
9. The author’s primary concern is to c`/kx
(A)criticize physicians and health-care administrators for investing in techno-logicallyadvanced equipment w~3z);
(B)examine some problems affecting delivery of health-care services and assesstheir severity H`,t "I
(C)defend the medical community from charges that health-care has not improvedsince World War II @ V_i%=go
(D)analyze the reasons for the health-care industry’s inability to provide qualitycare to all segments of the population =7EkN% V:{
(E)describe the peculiar economic features of the health-care industry that arethe causes of spiraling medical costs fNV-_^,R9
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Passage 71(8/22)
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Behavioris one of two general responses available to endothermic (warm-blooded) speciesfor the regulation of body temperature, the other being innate (reflexive)mechanisms of heat production and heat loss. Human beings rely primarily on thefirst to provide a hospitable thermal microclimate for themselves, in which thetransfer of heat between the body and the environment is accomplished withminimal involvement of innate mechanisms of heat production and loss.Thermoregulatory behavior anticipates hyperthermia, and the organism adjustsits behavior to avoid becoming hyperthermic: it removes layers of clothing, itgoes for a cool swim, etc. The organism can also respond to changes in thetemperature of the body core, as is the case during exercise; but suchresponses result from the direct stimulation of thermoreceptors distributedwidely within the central nervous system, and the ability of these mechanismsto help the organism adjust to gross changes in its environment is limited. R[rOzoNp0
Untilrecently it was assumed that organisms respond to microwave radiation in thesame way that they respond to temperature changes caused by other forms ofradiation. After all, the argument runs, microwaves are radiation and heat bodytissues. This theory ignores the fact that the stimulus to a behavioralresponse is normally a temperature change that occurs at the surface of theorganism. The thermoreceptors that prompt behavioral changes are located withinthe first millimeter of the skin’s surface, but the energy of a microwave fieldmay be selectively deposited in deep tissues, effectively bypassing thesethermoreceptors, particularly if the field is at near-resonant frequencies. Theresulting temperature profile may well be a kind of reverse thermal gradient inwhich the deep tissues are warmed more than those of the surface. Since theheat is not conducted outward to the surface to stimulate the appropriatereceptors, the organism does not “appreciate” this stimulation in the same waythat it “appreciates” heating and cooling of the skin. In theory, the internalorgans of a human being or an animal could be quite literally cooked well-donebefore the animal even realizes that the balance of its thermomicroclimate hasbeen disturbed. ^a$L9p(
Untila few years ago, microwave irradiations at equivalent plane-wave powerdensities of about 100 mW/cm2 were considered unequivocally toproduce “thermal” effects; irradiations within the range of 10 to 100 mW/cm2might or might not produce “thermal” effects; while effects observed at powerdensities below 10 mW/cm2 were assumed to be “nonthermal” in nature.Experiments have shown this to be an oversimplification, and a recent reportsuggests that fields as weak as 1 mW/cm2 can be thermogenic. Whenthe heat generated in the tissues by an imposed radio frequency (plus the heatgenerated by metabolism) exceeds the heat-loss capabilities of the organism,the thermoregulatory system has been compromised. Yet surprisingly, not longago, an increase in the internal body temperature was regarded merely as“evidence” of a thermal effect. {"*_++|
1. The author is primarily concerned with
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(A)showing that behavior is a more effective way of controlling bodily temperaturethan innate mechanisms C}ASVywc,1
(B)criticizing researchers who will not discard their theories about the effectsof microwave radiation on organisms ^V7)V)Z;0
(C)demonstrating that effects of microwave radiation are different from those ofother forms of radiation cYBjsN(!A|
(D)analyzing the mechanism by which an organism maintains its bodily temperaturein a changing thermal environment Lt
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(E)discussing the importance of thermoreceptors in the control of the internaltemperature of an organism J ~KygQ3%
2. The author makes which of the followingpoints about innate mechanisms for heat production? ZZ/k7(8
I. They are governed by thermoreceptorsinside the body of the organism rather than at the surface. 6R*eJICN
II. They are a less effective means ofcompensating for gross changes in temperature than behavioral strategies. ?O"zp65d(
III. They are not affected by microwaveradiation. 7I*rtc&Kb
(A)I only <sX_hIA^Fx
(B)I and II only Qwp2h"t`
(C)I and III only k5*Z@a
(D)II and III only ,c
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(E)I, II, and III ~#)9Kl7<X
3. Which of the following would be the mostlogical topic for the author to take up in the paragraph following the final paragraph of the selection? s@Loax6@B
(A)A suggestion for new research to be done on the effects of microwaves on animalsand human beings vl?fCO
(B)An analysis of the differences between microwave radiation 7[i&EPN
(C)A proposal that the use of microwave radiation be prohibited because it isdangerous c(Fo-4K
(D)A survey of the literature on the effects of microwave radiation on humanbeings %e_){28 n
(E)A discussion of the strategies used by various species to control hyperthermia
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4. The author’s strategy in lines 39-42 is to L`fT;2
(A)introduce a hypothetical example to dramatize a point 2vddx<&
(B)propose an experiment to test a scientific hypothesis k^K%."INn
(C)cite a case study to illustrate a general contention SRU#Y8Xv|
(D)produce a counterexample to disprove an opponent’s theory W .Al\!Gi
(E)speculate about the probable consequences of a scientific phenomenon gKgdu($NJ
5. The author implies that the proponents ofthe theory that microwave radiation acts on organisms in the same way as otherforms of radiation based their conclusions primarily on {UF|-VaG
(A)laboratory research Zm(}~C29
(B)unfounded assumption V#c=O}
(C)control group surveys ie7TO{W
(D)deductive reasoning \lyHQ-gWhc
(E)causal investigation 3wfJ!z-E8
6. The tone of the passage can best bedescribed as $N|Spp0
(A)genial and conversational 2d<`dQY{l3
(B)alarmed and disparaging |>-0
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(C)facetious and cynical `qZ@eGZ
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(D)scholarly and noncommittal h*sL' fJ]
(E)scholarly and concerned g%D.sc)69
7. The author is primarily concerned with U]ZI_[\'U
(A)pointing out weaknesses in a popular scientific theory 9'KOc5@l^
(B)developing a hypothesis to explain a scientific phenomenon fvG4K(
(C)reporting on new research on the effects of microwave radiation gV'=uz v
(D)criticizing the research methods of earlier investigators '%a:L^a?
(E)clarifying ambiguities in the terminology used to describe a phenomenon [&zSY