2023年医学博士外语真题试卷

The novel coronavirus pandemic has【C1】_____the education of about 300 million students across the world. Over 160 countries have shut down schools nationwide, which【C2】_____the pandemic poses an unprecedented challenge on the education system, and could change our idea of education from in-person teaching in brick-and-mortar classes on campuses to online classes.

The education-related problem was not deferred for very long. In China, in two to three weeks, solutions to those problems, from the local to the national levels, started【C3】_____. With more cities in the United States reporting an increase in confirmed coronavirus cases, the provost of Stanford University【C4】__the cancellation of all in-person class meetings, and said classes that required in-person instruction【C5】__to the online format. And the University of Washington took the same action. 【C6】__, it takes three basic elements to move an entire school or university online: determination, broadband and broadcast. So there is a high possibility that more educational institutions, including universities, will shift to online teaching to【C7】_____” normal” classes.

Could the【C8】_____shift to online education also【C9】__a paradigm shift? Is online education sustainable, at least parallel to normal school teaching? And can it fundamentally change the nature of school teaching? Or will online teaching【C10】_____with the end of the pandemic? Only an in-depth, long-term research can give us the correct answers.

The more medical science discovers about the complex interplay between nature and nurture, genetics and environment, the larger the role family history appears to play in disease. Last month’s announcement that most of the 30,000-plus genes in the human genome had been identified is likely to prompt a better understanding of family-related illness and new gene-based treatments. But until such treatments are available, people with a family history of certain diseases need to be watchful. They also need to remember that for most diseases,family history is not destiny.

If you have what’s known as a first-degree relative—a parent or sibling—who has been diagnosed with an illness, say, cancer, then your risk of developing the same illness rises. Having two affected first-degree relatives, or family members across generations—your mother and your grandmother—increases your risk further. If the illness is occurring in multiple, close relatives, at younger ages than is typical for that disease, and over more than one generation, you have a truly problematic family history, says Robin Bennett of the Medical Genetics Clinic at the University of Washington Medical Center.

In families afflicted with certain inherited disorders such as sickle cell anemia and cystic fibrosis, genes alone seem to determine who gets sick. But for most people, family history, lifestyle, and environment all influence which illnesses they develop, and at what age. Even if you have strong family history of, say, breast cancer, heart disease, or diabetes, taking advantage of the proven screening tests and treatments and changing your lifestyle may tip the odds back in your favor.

Nearly everyone faces some kind of genetic risk. By comparing the health histories of twins with same genetic makeup, scientists have estimated the contribution genes make to trait like weight, cholesterol level, and blood pressure. Kenneth Kendler, a professor of psychiatry and genetics at the medical College of Virginia, has found that genes contribute heavily to some mental disorders, too.

“We’re pretty sure that with schizophrenia and bipolar disorders, 70 or 80 percent is inherited. Alcohol and drug dependence, 50 to 60 percent. Depression, 35 to 40 percent. ” Even so, he adds, “The strongest predictor of major depression is still your life experience. There aren’t genes that make you depressed; there are genes that make you vulnerable to depression. “

Japan is one of the planet’s oldest societies, pipped only by tiny Monaco for the proportion of elderly in the population. Lengthening life expectancy is a boon for millions of Japanese retirees leading full lives. But it also means a sharp increase in the numbers suffering from dementia. Who, asks Florian Coulmas, an expert on Japanese ageing, should accept responsibility for people unable to articulate their own interests or care for themselves?

Over 5m elderly Japanese suffer from dementia. By 2025 some 7m will need care, the health ministry predicts. Most live at home, putting a strain on relatives. A new survey says three-quarters of people looking after elderly family members are at their wits’ end, and many have considered suicide or worse; last year police recorded 44 cases of murder or attempted murder in such homes.

Japan has made strides in coping with the problems of a population with ever fewer young people. The retirement age has been pushed back, and it is not unusual for 70-year-olds to be driving taxis, working as watchmen on building sites and serving in supermarkets. Many elderly say they are keen to keep on working for as long as they are fit. As for dealing with senility, some approaches have been innovative. Convenience stores, everywhere in Japan, offer themselves as safe havens for wandering pensioners. Phone and car companies have made products with simpler, more intuitive functions.

Policy lags, however. Public funding for long-term care for the elderly was the equivalent of just 1.2% of GDP in 2010 versus 3.7% in the Netherlands, according to the most recent OECD comparison. One reason is that relatives are still the main caregivers in Japan, says Miharu Nakanishi of the Tokyo Metropolitan Institute of Medical Science. Family members often quit work and burn through savings to look after senile parents.

Undaunted, the prime minister, promises that Japan will become an example to the world in dealing with senility. Among his promises is better funding for research into Alzheimer’s disease and more money to train 60,000 doctors in its early diagnosis. But much more should be done, including lowering the immigration barriers that keep out foreign care workers (which the president shows little sign of doing). Ms Nakanishi says the entire national strategy for dealing with dementia is fragmented. Above all, she says, the government has failed properly to consult with those who actually take care of the elderly.

For all the technological wonders of modern medicine, from gene-editing to fetal surgery, health care—with its fax machines and clipboards—is often stubbornly antiquated. This outdated era is slowly drawing to a close as, belatedly, the industry catches up with the artificial-intelligence (AI) revolution. And none too soon, argues Eric Topol, a cardiologist and enthusiast for digital medicine.

Dr. Topol’s vision of medicine’ s future is optimistic. He thinks AI will be particularly useful for repetitive, error-prone tasks, such as sifting images, scrutinizing heart traces for abnormalities or transcribing doctors’ words into patient records. It will be able to harness masses of data to work out optimal treatments (for both conditions and individuals), and improve workflows in hospitals. In short, AI is set to save time, lives and money.

Much of this is hypothetical—but AI is already outperforming people in a variety of narrow jobs for which it has been trained. Eventually it may be able to diagnose and treat a wider range of diseases. Even then, Dr. Topol thinks, humans would oversee the algorithms, rather than being replaced by them.

The fear, for some people, is that AI will be used to deepen the assembly-line culture of modern medicine. If it confers a “gift of time” on doctors, he argues thatthis bonusshould be used to prolong consultations, rather than simply speeding through them more efficiently.

That is a fine idea, but as health swallows an ever-bigger share of national wealth, greater efficiency is exactly what is needed, at least so far as governments and insurers are concerned. Otherwise, rich societies may fail to cope with the needs of ageing and growing populations. An extra five minutes spent chatting with a patient is costly as well as valuable. The AI revolution will also empower managerial bean-counters, who will increasingly be able to calibrate and appraise every aspect of treatment. The autonomy of the doctor will inevitably be undermined, especially, perhaps, in public-health systems which are duty-bound to trim inessential costs.

The Hippocratic Oath holds that there is an art to medicine as well as a science, and that “warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug”. That is not just a platitude: the patients of sympathetic physicians have been shown to fare better. As Dr. Topol says, it is hard to imagine that a robot could really replace a human doctor. Yet as demand for health care outstrips the supply of human carers, the future may involve consultations on smartphones and measurements monitored by chatbots. The considerately wanned stethoscope, placed gently on a patient’s back, may become a relic of the past.

In the end, technology may even be able to solve the empathy deficit. Japanese engineers are working on robots that simulate human presence, or sonzai-kan. A machine could never truly develop the shared humanity that helps patients heal. That doesn’t mean it cannot be faked.

Do you remember all those years when scientists argued that smoking would kill us but the doubters insisted that we didn’t know for sure? That the evidence was inconclusive, the science uncertain? That the antismoking lobby was out to destroy our way of life and the government should say out of the way? Lots of Americans bought that nonsense, and over three decade, some 10 million smokers went to early graves.

There are upsetting parallels today, as scientists in one wave after another try to awaken us to the growing threat of global warming. The latest was a panel from the National Academy of Sciences, enlisted by the White House, to tell us that the Earth’s atmosphere is definitely warming and that the problem is largely man-made. The clear message is that we should get moving to protect ourselves. The president of the National Academy, Bruce Alberts, added this key point in the preface to the panel’s report “Science never has all the answers. But science does provide us with the best available guide to the future, and it is critical that our nation and the world base important policies on the best judgments that science can provide concerning the future consequences of present actions. “

Just as on smoking, voices now come from many quarters insisting that the science about global warming is incomplete, that it’s OK to keep pouring fumes into the air until we know for sure. This is a dangerous game: by the 100 percent of the evidence is in, it may be too late. With the risks obvious and growing, a prudent people would take out an insurance policy now.

Fortunately, the White House is starting to pay attention. But it’s obvious that a majority of the president’s advisers still don’t take global warming seriously. Instead of a plan of action, they continue to press for more research—a classic case of “paralysis by analysis”.

To serve as responsible stewards of the planet, we must press forward on deeper atmospheric and oceanic research but research alone is inadequate. If the Administration won’t take the legislative initiative, Congress should help to begin fashioning conservation measures. A bill by Democratic Senator Robert Byrd of West Virginia, which would offer financial incentives for private industry, is a promising start. Many see that the country is getting ready to build lots of new power plants to meet our energy needs. If we are ever going to protect the atmosphere, it is crucial that those new plants be environmentally sound.

Eating disorders are a range of psychiatric conditions characterized by these main patterns of behavior: restricting food intake, bingeing, or rapidly consuming large amounts of food, and purging or eliminating calories through vomiting, laxatives, excessive exercise, and other harmful means. An eating disorder can involve any one or any combination of these behaviors. For example, people living with anorexia usually restrict the amount of food they eat, while bulimia nervosa is an eating disorder characterized by recurrent binges and purges.

You can’t tell whether someone has an eating disorder from their weight alone. People who weigh what medical professionals might consider a healthy range can have eating disorders, including severe ones that damage their long-term health in invisible ways, including osteoporosis, anemia, heart damage, and kidney damage.

Just as we can’t tell whether someone has an eating disorder based on their weight alone, we can’t get rid of these disorders simply by eating differently. That’s because eating disorders are, at their core, psychiatric illnesses. From what we understand, they involve a disruption to someone’s self-perception. Most people who experience them are severely critical of themselves and report many self-perceived flaws. They may use eating to try to regain some control over an internal sense of chaos.

We still don’t know exactly what causes eating disorders. There likely isn’t a single cause, but a combination of genetic and environmental risk factors that contribute. Sometimes, other mental illnesses—like depression or anxiety—can cause symptoms of eating disorders. In addition, certain psychological factors, such as perfectionism and body image dissatisfaction, are risk factors for eating disorders. Several social factors contribute, too, including internalized weight stigma, exposure to bullying, racial and ethnic assimilation, and limited social networks. Although there is a common misconception that only women experience eating disorders, people of all genders can be affected. As these disorders intimately affect the development of one’s identity and self-esteem, people are particularly vulnerable to developing them during adolescence.

Although these are among the most challenging psychiatric disorders to treat, effective therapies and interventions exist, and many people who receive treatment make a full recovery. Treatment has a higher chance of success the earlier it starts after someone develops disordered eating behaviors. But unfortunately, less than half of people with an eating disorder will seek and receive treatment. Because of the complex effects of eating disorders on both the body and the mind, treatment usually includes a combination of nutritional counseling and monitoring, psychotherapy, and in some cases, medications.

The prevention of eating disorders usually involves active communication between the parents and the teens. Educate the teens on eating disorders. Discuss the influence of media and famous people. Encourage the teens to question messages delivered to them, especially the body image. Follow healthy eating habits and show positive body image behavior.

Understanding what distinguishes people who battle with Alzheimer’s as they age from those whose mental acuteness remains strong well into their 80s, 90s and even older, is a major focus of current psychiatric research. Previous studies have pointed to the potentially protective value of exercise, social support and even language skills. And other studies have also shown that having a strong sense of purpose in life is, unsurprisingly, associated with greater overall mental health, happiness, and even longevity. A study published recently in the Archives of General Psychiatry expands on that research, finding that people who reported feeling a greater sense of purpose in life were less likely to develop Alzheimer’s disease than those who reported feeling less fulfilled.

The study, conducted by researchers at Rush University Medical Center in Chicago, analyzed medial records and life outlook among 951 participants from the Rush Memory and Aging Project. At the beginning of the study, participants’ overall sense of purpose in life was measured by assessing their level of agreement with 10 statements—such as, “I have a sense of direction and purpose in life,” — derived from a psychological well-being scale.

After an average of four years of follow-up, 16.3% (155) participants had developed Alzheimer’s disease. When researchers analyzed the relationship between the psychological well-being scale and risk of Alzheimer’s, they found that participants who reported higher levels of fulfillment were significantly less likely to have developed the degenerative mental disease than those who expressed less sense of validation in life. In fact, participants with high scores on the life purpose test were 2.4 times less likely to develop Alzheimer’s compared with those who had the lowest scores.

Researchers say that what drives the correlation between reduced risk and heightened sense of purpose is not clear, and should be explored with future research. Still, they expressed optimism at the findings, which add to studies that have linked sense of fulfillment in life everything from better sleep to improved psychological health. What’s more, because a sense of purpose is something that can be cultivated, researchers say that these findings could point toward new treatments designed to improve sense of fulfillment in older adults. If these findings are replicated, they say, “the implications could be far-reaching, and efforts to increase purpose in life may help reduce the rapidly increasing burden of cognitive impairment in old age. “

Perhaps Marlow and Frances Cowan can offer some insight into how to make the most of life as you age. It’s hard to watch the elderly couple’s playful—and off-hand—piano performance in a lobby at the Mayo Clinic without admiring their sense of fulfillment, and breaking into a grin.