2006年医学博士外语真题试卷

Culture shock might be called an occupational disease of people who have been suddenly transplanted abroad. Like most ailments, it has its own symptoms and cure.

Culture shock is precipitated by the【C1】___that result from losing all our familiar signs and symbols of social intercourse. Those signs or cues include the thousand and one ways in which we【C2】ourselves to the situation of daily life; when to shake hands and what to say, when we meet people, when and how to give tips, how to make purchases, when to accept and when to【C3】invitations, when to take statements seriously and【C4】. These cues, which may be words, gestures , facial expressions, customs, or norms, are acquired by all of us in the course of growing up and are【C5】a part of our culture as the language we speak or the beliefs we accept. All of us depend【C6】our peace of mind and our efficiency on hundreds of these cues, most of which we do not carry【C7】___conscious awareness.

Now when an individual enters a strange culture, all or most of these familiar cues are【C8】___. He or she is like a fish out water. No matter how broad-minded or full of goodwill you may be, a series of props have been knocked【C9】you, followed by feeling of frustrations and anxiety. People react to the frustration in much the same way. First they reject the environment which causes the discomfort. “ The ways of the host country are bad because they make us feel bad. ” When foreigners in a strange hand get together to grouse about the【C10】___country and its people. You can be sure they are suffering from culture shock.

It used to be that a corporation’ s capital consisted of tangible assets such as buildings, machines , and finished goods. But, in the information economy, value has shifted rapidly from tangible to intangible assets, such as management skills and customer loyalty. But how do you measure intangible assets?

Karl Erik Sveiby began trying to answer that question as a magazine publisher in Sweden and went to become Scandinavia’ s leading authority on knowledge-based businesses. In his latest book, The New Organizational Wealth, he offers insights into valuing and managing intangible assets.

Noting that Microsoft Corporation, the world’ s largest software firm, once traded at an average share price of $ 70 at a time when its book value was $ 7 , Sveiby asks: “ What is it about Microsoft that makes it worth 10 times the value of its recorded assets? What is the nature of that additional value that is perceived by the market but not recorded by the company?”

Sveiby’ s answer is intangible assets, which he defines as employee competence, internal structures(systems, patents, etc.), and external structures(customer and supplier relationships and the organization’ s image). Because of these factors, it follows that owners hold a kind of intangible equity in the company, in addition to tangible assets such as cash and accounts receivable.

Since knowledge is a key intangible asset, the ability to transfer knowledge from one employee to another, or from outside sources to employees, is a key business capacity, in Sveiby’ s view. The greater the transfer of knowledge, the more overall employee competence improves. The best method for transferring knowledge, says Sveiby, is through direct experience with a subject rather than simply listening to someone or reading about it.

Experience enables learning more than overt teaching because people acquire knowledge tacitly, by observation and listening in an unstructured environment. And, he adds, people will more readily learn from an activity if they enjoy it.

Once the flow of information within an organization is managed properly, the competence of the organization increases, and the relations with customers improve. But Sveiby also points out that knowledge and information are not the same thing. Information has no value until it becomes integrated knowledge and therefore useful.

High-speed living has become a fact of life, and the frantic pace is taking its toll, according to science writer James Gleick. It’ s as if the old “ type A” behavior of a few has expanded into the “hurry sickness” of the many.

” We do feel that we’ re more time-driven and time-obsessed and generally rushed than ever before,” writes Gleick in Faster; The Acceleration of Just About Everything, a survey of fast-moving culture and its consequences. We may also be acting more hastily, losing control, and thinking superficially because we lie faster.

Technology has conditioned us to expect instant results. Internet purchases arrive by next-day delivery and the microwave delivers a hot meal in minutes. Faxes, e-mails, and cell phones make it possible—and increasingly obligatory—for people to work faster. Gleick cites numerous examples of last-forward changes in our lives; Stock trading and news cycles are shorter; sound bites of presidential candidates on network newscasts dropped from 40 seconds in 1968 to 10 seconds in 1988; and some fast-food restaurants have added express lanes.

High expectations for instant service make even the brief wait for an elevator seem interminable(漫长的). “A good waiting time is in the neighborhood of 15 seconds. Sometime around 40 seconds , people start to get visibly upset” writes Gleick. We’ re dependent on systems that promise speed but often deliver frustration. Like rush-hour drivers fuming when a single accident halts the evening commute, people surfing the Internet squirm if a Web page is slow to load or when access itself is not instantaneous. And the concert of “customer service” can become an oxymoron for customers waiting on hold for a telephone representative.

Up-tempo living has turned people multitaskers—eating while driving, writing an e-mail while talking on the phone, or skimming dozens of television programs on split screen. Gleick suggests that human beings may be capable of adjusting to these new levels of stimuli as high-speed culture challenges our brains “ in a way they were not challenged in the past, except perhaps in times of war”. We may gain the flexibility to do several things at once but lose some of our capacity to focus in depth on a single task.

Imagine a disease spreading across the globe, killing mostly middle-aged people or leaving them chronically disabled. Then one day researchers come up with a drug that can prevent some of the disease’ s nastier effects. You would think the world’ s ageing public would be eternally grateful.

The disease does exist. It is called tobacco addiction. The drug too is real and in animal tests has prevented lung damage that leads to emphysema. But the inventors have received no bouquets. Prevailing medical opinion seems to be that the drug is a mere sideshow, distracting smokers from the task of quitting. Another experimental drug, which could protect smokers against cancer, is also viewed with suspicion because it could give smokers an excuse not to quit.

On the face of it these responses make sense. It is ingrained in society that smokers have only themselves to blame and their salvation lies in a simple act of will. If they will not quit smoking, they cannot expect help from anyone else.

But this logic is flawed. Check a survey of smokers and you find two-thirds want to give up and one-third will have tried in the previous year. Yet, even with nicotine gum, patches and drugs to ease the ordeal, the quit rate is still under 10 percent. In the UK, the proportion of people who smoke has not fallen in a decade. Tobacco has a powerful grip, and many smokers are caught in a trap they cannot escape; they have a disease like any other and deserve the chance to reduce the harm it does to them.

This reasoning is hard for many to swallow. It certainly leaves governments and anti-smoking groups in a bind. They are happy to pay lip service to methods for reducing harm—of which there are a growing number—but they are slow to create policies based upon them. European Union countries, for example, took years to even consider regulating the dangerous additives in cigarettes.

One fear is that methods for reducing harm will dilute the message that tobacco kills—especially when given to youngsters. But that message won’ t change. In the present case, even if both drugs turn out to work in human trials, they would not protect against all the deadly side effects of smoking. And the drugs do not have to be free to all. They could be available only on prescription for people who doctors believe genuinely cannot give up.

There are things that no drug aimed at harm reduction will ever be able to be. It will not cut passive smoking or stop tobacco companies persuading millions of teenagers to light up. For these reasons all other ways to counter smoking must continue, from banning tobacco advertising to raising tobacco taxes. But it would be a mistake to ignore the harm reduction measures. For those who are not convinced, forget smokers for a moment. Preventive drugs could also help non-smokers, especially those working long hours as, say, musicians and bar staff in smoky rooms. Should we deny them too?

Eating is related to emotional as well as physiologic needs. Sucking, which is the infant’ s means of gaining both food and emotional security conditions the association of eating with well-being or with deprivation. If the child is breast-fed and has supportive body contact as well as good mild intake, if the child is allowed to suck for as long as he or she desires, and if both the child and the mother enjoy the nursing experience and share their enjoyment, the child is more likely to shrive both physically and emotionally. On the other hand, if the mother is nervous and resents the child or cuts him or her off from the milk supply before either the child’ s hunger or sucking need is satisfied, or handle the child hostilely during the feeding, or props the baby with a bottle rather than holding the child, the child may develop physically but will begin to show signs of emotional disturbance at an early age. If, in addition, the infant is further abused by parental indifference or intolerance, he or she will carry scars of such emotional deprivation throughout life.

Eating habits are also conditioned by family and other psychosocial environments. If an individual ’ s family eats large quantities of food, then he or she is inclined to eat large amounts. If an individual’ s family eats mainly vegetable, then he or she will be inclined to like vegetables. If mealtime is a happy and significant event, then the person will tend to think of eating in those terms. And if a family eats quickly, without caring what is being eaten and while fighting at the dinner table, then the person will most likely adopt the same eating pattern and be adversely affected by it. This conditioning to food can remain unchanged through a lifetime unless the individual is a-wakened to the fact of conditioning and to the possible need for altering his or her eating patterns in order to improve nutritional intake. Conditioning spills over into and is often reinforced by religious beliefs and other customs so that, for example, a Jew, whose religion forbids the eating of pork, might have guilt feeling if he or she ate pork. An older Roman Catholic might be conditioned to feel guilty if he or she eats meat on Friday, traditionally a fish day.

Several classes of bitter citrus compound have looked promising as anticancer agents in laboratory tests. A new study indicates that long-term consumption of orange juice, a source of such chemicals cuts cancer risk in rats.

In test-tube studies, one class of the bitter compounds—flavonoids—has inhibited the growth of breast cancer cells. Related studies showed that bitter citrus limonoids similarly ward off cancer in animals. Mulling over such data, Maurice R Bennink of Michigan State University in East Lansing wondered whether drinking orange juice would have a beneficial effect.

His team injected 60 young rats with a chemical that causes colon cancer and then raised half of the animals on a normal diet. The others received orange juice instead of drinking water—and less sugar in their food to compensate for sugars in the juice.

At an American Institute for Cancer Research meeting last week in Washington D. C. , Bennink reported that after 7 months, 22 of the animals receiving a normal diet had developed colon cancers. Only 17 of the rats on the orange-juice diet showed tumors. That’ s 77 percent of the control group’ s incidence.

Concludes Bennink, whose work was supported by orange-juice producer Tropicana products of Brandenton, Fla. , “ These data show orange juice helps protect against cancer. ” He says that the study might also apply to breast, prostate, and lung cancers.

Bandaru S. Reddy of the American Health Foundation in Valhalla, N. Y. , was not surprised by Bennink’ s finding of an orange juice benefit. However, he calls the reported risk reduction unimpressive. His own data show that citrus limonoids protect against chemically induced colon cancer in lab animals.

Luke K. T. Lam of LKT Laboratories in St. Paul, Minn. , finds Bennink’ s data “ quite interesting ,” although he describes as “ borderline” the suppression of cancer incidence observed by Bennink. Lam has inhibited tumors in the lung, skin and forestomach of mice with limonoinds.

The scientists don’ t know what compounds in orange juice underlie its effect. The juice is rich in one limonoid—a sugar-containing version of limonin, which suppressed tumors in Lam’ s experiments. It’ s possible, Lam speculates, that rats convert the juice’ s limonoid into limonin.

Indeed, argues Gary D Manners of the Agricultural Research Service in Albany, Calif. , “ there is no doubt that these [ anticancer ] citrus compounds are bioavailable in animals to the site of a cancer. The question remains whether they are similarly available in people”. To find out, his team will soon begin measuring the human body’ s uptake of limonoids from orange juice.

Just before dawn we received a call that an unresponsive infant was being brought by emergency medical services to our hospital. As the medical team—the paecliatric resident, intern, respiratory therapist, nurse and me—prepared for the incoming patient, an eerie silence enveloped the trauma room, an event that frequently precedes a pediatric resuscitation.

The child arrived in our emergency department pulseless and cold, with compressions being performed on him in the arms of the paramedic. Further history obtained by the paramedics indicated that the mother had left the infant alone in the home with two young children to watch the child, and upon her return the infant was found in bed not breathing and cold. As a medical team we simultaneously performed multiple procedures,(intubation, insertion of intraosseous lines, administration of epinephrine, cardiac compression), all to no avail. Twenty minutes after he arrived, I declared this 2-month-old child dead with a high suspicion of abuse of neglect. Everyone vacated the room almost immediately, except for the nurse, who never left the child’ s beside. I asked her why she needed to stay, and she looked at me and smiled, “ why of course, to be with my patient a little bit longer.

I knew the difficult part was yet to come: telling the family the bad news. The mother was still at home being interviewed by the police. The father had arrived from his place of employment to the emergency department minutes after death was pronounced and not knowing the condition of his son.

The father and I sat with chaplain to explain what we had done for the baby. I could tell from the stunned look on his face that he knew before I finished my story that his child was dead. Despite this I said in muffled voice,” I am so sorry your child passed away.

We walked slowly back to the resuscitation room. The infant, who only moments ago lay covered with blood and secretions oozing from every orifice, had been transformed. The nurse had left her patient, tending to him, cleaning him, wrapping in soft blankets, and now presenting the body to the grieving father. He seemed relieved to see his baby, not alive, surely, but at peace and thus the man could begin in the mourning process. I again left the room tend to the busy emergency department; seeing patients somehow seemed to blunt my emotional response to what had just happened. As I listen to a resident present the next case, I saw the nurse carry the blanketed body of the child to the morgue.

As I reflect on this episode, I realized that our medical resuscitation of this child was futile, as has been shown in children who present to the emergency department in full cardiac arrest. But it was the compassionate work of the nurse that ultimately made the difference in how we performed our job.

Next time, I may stay a little bit longer to be with my patient.