1、1考试时间 2014 年 3 月 22 日星期六 下午 2:00-5:00 原创作者 qq 347952582Since Would War II considerable advances have been made in the area of health-care services. These include better access to health care (particularly for the poor and minorities), improvements in physical plants, and increased numbers of physici
2、ans and other health personnel. All have played a part in the recent improvement in life expectancy. But there is mounting criticism of the large remaining gaps in access, unbridled cost inflation, the further fragmentation of service, excessive indulgence in wasteful high-technology “gadgeteering,”
3、 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 disappointments multiply at almost the same rate. This has led to an increased pessimism“everything has been tried and nothing works”which s
4、ometimes borders on cynicism or even nihilism.It is true that the automatic “pass through” of rapidly spiraling costs to government and insurance carriers, which was set in a publicized environment of “the richest nation in the world,” produced for a time a sense of unlimited resources and allowed t
5、o develop a mood whereby every practitioner and institution could “do his own thing” without undue concern for the “Medical Commons.” The practice of full-cost reimbursement encouraged capital investment and now the industry is overcapitalized. Many cities have hundreds of excess hospital beds; hosp
6、itals have proliferated a superabundance of high-technology equipment; and structural ostentation and luxury were the order of the day. In any given day, one-fourth of all community beds are vacant; expensive equipment is underused or, worse, used unnecessarily. Capital investment brings rapidly ris
7、ing operating costs.Yet, in part, this pessimism derives from expecting too much of health care. It must be realized that care is, for most people, a painful experience, often accompanied by fear and unwelcome results. Although there is vast room for improvement, health care will always retain some
8、unpleasantness and frustration. Moreover, the capacities of medical science are limited. Humpty Dumpty cannot always be put back together again. Too many physicians are reluctant to admit their limitations to patients; too many patients and families are unwilling to accept such realities. Nor is it
9、true that everything has been tried and nothing works, as shown by the prepaid group practice plans of the Kaiser Foundation and at Puget Sound. In the main, however, such undertakings have been drowned by a veritable flood of public and private moneys which have supported and encouraged the continu
10、ation of conventional practices and subsidized their shortcomings on a massive, almost unrestricted scale. Except for the most idealistic and dedicated, there were no incentives to seek change or to practice self-restraint or frugality. In this atmosphere, it is not fair to condemn as failures all a
11、ttempted experiments; it may be more accurate to say many never had a fair trial.1. The author implies that the Kaiser Foundation and Puget Sound plans (lines 47-48) differed from other plans by2(A) encouraging capital investment(B) requiring physicians to treat the poor(C) providing incentives for
12、cost control(D) employing only dedicated and idealistic doctors(E) relying primarily on public funding2. The author mentions all of the following as consequences of full-cost reimbursement EXCEPT(A) rising operating costs(B) underused hospital facilities(C) overcapitalization(D) overreliance on expe
13、nsive equipment(E) lack of services for minorities3. The tone of the passage can best be described as(A) light-hearted and amused(B) objective but concerned(C) detached and unconcerned(D) cautious but sincere(E) enthusiastic and enlightened4. According to the author, the “pessimism” mentioned at lin
14、e 35 is partly attributable to the fact that(A) there has been little real improvement in health-care services(B) expectations about health-care services are sometimes unrealistic(C) large segments of the population find it impossible to get access to health-care services(D) advances in technology h
15、ave made health care service unaffordable(E) doctors are now less concerned with patient care5. The author cites the prepaid plans in lines 46-48 as(A) counterexamples to the claim that nothing has worked(B) examples of health-care plans that were over-funded(C) evidence that health-care services ar
16、e fragmented(D) proof of the theory that no plan has been successful(E) experiments that yielded disappointing results6. It can be inferred that the sentence “Humpty Dumpty cannot always be put back together 3again” means that(A) the cost of health-care services will not decline(B) some people shoul
17、d not become doctors(C) medical care is not really essential to good health(D) illness is often unpleasant and even painful(E) medical science cannot cure every ill7. With which of the following descriptions of the system for the delivery of health-care services would the author most likely agree?(A
18、) It is biased in favor of doctors and against patients.(B) It is highly fragmented and completely ineffective(C) It has not embraced new technology rapidly enough(D) It is generally effective but can be improved(E) It discourages people from seeking medical care8. Which of the following best descri
19、bes the logical structure of the selection?(A) The third paragraph is intended as a refutation of the first and second paragraphs.(B) The second and third paragraphs explain and put into perspective the points made in the first paragraph.(C) The second and third paragraphs explain and put into persp
20、ective the points made in the first paragraph.(D) The first paragraph describes a problem, and the second and third paragraphs present two horns of a dilemma.(E) The first paragraph describes a problem, the second its causes, and the third a possible solution.9. The authors primary concern is to(A)
21、criticize physicians and health-care administrators for investing in technologically advanced equipment(B) examine some problems affecting delivery of health-care services and assess their severity(C) defend the medical community from charges that health-care has not improved since World War II(D) a
22、nalyze the reasons for the health-care industrys inability to provide quality care to all segments of the population(E) describe the peculiar economic features of the health-care industry that are the causes of spiraling medical costs41. C 2. E 3. B 4. B 5. A6. E 7. D 8. C 9. B 10.Behavior is one of
23、 two general responses available to endothermic (warm-blooded) species for the regulation of body temperature, the other being innate (reflexive) mechanisms of heat production and heat loss. Human beings rely primarily on the first to provide a hospitable thermal microclimate for themselves, in whic
24、h the transfer of heat between the body and the environment is accomplished with minimal involvement of innate mechanisms of heat production and loss. Thermoregulatory behavior anticipates hyperthermia, and the organism adjusts its behavior to avoid becoming hyperthermic: it removes layers of clothi
25、ng, it goes for a cool swim, etc. The organism can also respond to changes in the temperature of the body core, as is the case during exercise; but such responses result from the direct stimulation of thermoreceptors distributed widely within the central nervous system, and the ability of these mech
26、anisms to help the organism adjust to gross changes in its environment is limited.Until recently it was assumed that organisms respond to microwave radiation in the same way that they respond to temperature changes caused by other forms of radiation. After all, the argument runs, microwaves are radi
27、ation and heat body tissues. This theory ignores the fact that the stimulus to a behavioral response is normally a temperature change that occurs at the surface of the organism. The thermoreceptors that prompt behavioral changes are located within the first millimeter of the skins surface, but the e
28、nergy of a microwave field may be selectively deposited in deep tissues, effectively bypassing these thermoreceptors, particularly if the field is at near-resonant frequencies. The resulting temperature profile may well be a kind of reverse thermal gradient in which the deep tissues are warmed more
29、than those of the surface. Since the heat is not conducted outward to the surface to stimulate the appropriate receptors, the organism does not “appreciate” this stimulation in the same way that it “appreciates” heating and cooling of the skin. In theory, the internal organs of a human being or an a
30、nimal could be quite literally cooked well-done before the animal even realizes that the balance of its thermomicroclimate has been disturbed.Until a few years ago, microwave irradiations at equivalent plane-wave power densities of about 100 mW/cm2 were considered unequivocally to produce “thermal”
31、effects; irradiations within the range of 10 to 100 mW/cm2 might or might not produce “thermal” effects; while effects observed at power densities below 10 mW/cm2 were assumed to be “nonthermal” in nature. Experiments have shown this to be an oversimplification, and a recent report suggests that fie
32、lds 5as weak as 1 mW/cm2 can be thermogenic. When the heat generated in the tissues by an imposed radio frequency (plus the heat generated by metabolism) exceeds the heat-loss capabilities of the organism, the thermoregulatory system has been compromised. Yet surprisingly, not long ago, an increase
33、in the internal body temperature was regarded merely as “evidence” of a thermal effect.1. The author is primarily concerned with(A) showing that behavior is a more effective way of controlling bodily temperature than innate mechanisms(B) criticizing researchers who will not discard their theories ab
34、out the effects of microwave radiation on organisms(C) demonstrating that effects of microwave radiation are different from those of other forms of radiation(D) analyzing the mechanism by which an organism maintains its bodily temperature in a changing thermal environment(E) discussing the importanc
35、e of thermoreceptors in the control of the internal temperature of an organism2. The author makes which of the following points about innate mechanisms for heat production?I. They are governed by thermoreceptors inside the body of the organism rather than at the surface.II. They are a less effective
36、 means of compensating for gross changes in temperature than behavioral strategies.III. They are not affected by microwave radiation.(A) I only(B) I and II only(C) I and III only(D) II and III only(E) I, II, and III3. Which of the following would be the most logical topic for the author to take up i
37、n the paragraph following the final paragraph of the selection?(A) A suggestion for new research to be done on the effects of microwaves on animals and human beings(B) An analysis of the differences between microwave radiation(C) A proposal that the use of microwave radiation be prohibited because i
38、t is dangerous(D) A survey of the literature on the effects of microwave radiation on human beings(E) A discussion of the strategies used by various species to control hyperthermia64. The authors strategy in lines 39-42 is to(A) introduce a hypothetical example to dramatize a point(B) propose an exp
39、eriment to test a scientific hypothesis(C) cite a case study to illustrate a general contention(D) produce a counterexample to disprove an opponents theory(E) speculate about the probable consequences of a scientific phenomenon5. The author implies that the proponents of the theory that microwave ra
40、diation acts on organisms in the same way as other forms of radiation based their conclusions primarily on(A) laboratory research(B) unfounded assumption(C) control group surveys(D) deductive reasoning(E) causal investigation6. The tone of the passage can best be described as(A) genial and conversat
41、ional(B) alarmed and disparaging(C) facetious and cynical(D) scholarly and noncommittal(E) scholarly and concerned7. The author is primarily concerned with(A) pointing out weaknesses in a popular scientific theory(B) developing a hypothesis to explain a scientific phenomenon(C) reporting on new rese
42、arch on the effects of microwave radiation(D) criticizing the research methods of earlier investigators(E) clarifying ambiguities in the terminology used to describe a phenomenon1. C 2. B 3. A 4. A 5. B6. E 7. A 8. 9. 10.Agricultural progress provided the stimulus necessary to set off economic expan
43、sion in medieval France. As long as those who worked the land were barely able to ensure their own subsistence and that of their landlords, all other activities had to be minimal, but when food 7surpluses increased, it became possible to release more people for governmental, commercial, religious an
44、d cultural pursuits.However, not all the funds from the agricultural surplus were actually available for commercial investment. Much of the surplus, in the form of food increases, probably went to raise the subsistence level; an additional amount, in the form of currency gained from the sale of food
45、, went into the royal treasury to be used in waging war. Although Louis VII of France levied a less crushing tax burden on his subjects than did Englands Henry II, Louis VII did spend great sums on an unsuccessful crusade, and his vassalsboth lay and ecclesiastictook over spending where their sovere
46、ign stopped. Surplus funds were claimed both by the Church and by feudal landholders, whereupon cathedrals and castles mushroomed throughout France.The simultaneous progress of cathedral building and, for instance, vineyard expansion in Bordeaux illustrates the very real competition for available ca
47、pital between the Church and commercial interests; the former produced inestimable moral and artistic riches, but the latter had a stronger immediate impact upon gross national product. Moreover, though all wars by definition are defensive, the frequent crossings of armies that lived off the land an
48、d impartially burned all the huts and barns on their path consumed considerable resources.Since demands on the agricultural surplus would have varied from year to year, we cannot precisely calculate their impact on the commercial growth of medieval France. But we must bear that impact in mind when e
49、stimating the assets that were likely to have been available for investment. No doubt castle and cathedral building was not totally barren of profit (for the builders, that is), and it produced intangible dividends of material and moral satisfaction for the community. Even wars handed back a fragment of what they took, at least to a few. Still, we cannot place on the same plane a primarily destructive activity and a constructive one, nor expect the same results from a new bell tower as from a new water mill. Above all, medieval France had little room for investment over and above the
