OET Reading Practice Test for Medicine – Part B & C

1. The seasonal influenza immunization
In an effort to protect our patients, visitors, and colleagues, we are announcing an important change regarding the requirement of seasonal influenza immunizations for all employees, physicians, active volunteers, vendors, contracted staff, and students. As health care providers, it is our responsibility and obligation to protect our
patients, visitors, and colleagues—as well as ourselves and our family members—by being immunized against the seasonal influenza virus. As we have done in the past, seasonal influenza immunizations will be provided free of charge to all employees, physicians, contracted staff and active volunteers. Participation in this year’s seasonal
influenza immunization program is required. All employees, physicians, contracted staff, active volunteers and students will be required to do one of the following:
• Receive a flu vaccination through RH Occupational Health Office.
• Provide proof of immunization if you received a vaccination outside of RH’s planned immunization program—
from another health care provider or local pharmacy, for example.

In this part of the test, there are six short extracts relating to the work of health professionals. For questions 1-6,
choose the answer (A, B or C) which you think fits best according to the text.

According to the extract, every physicians must

2. Risk Assessment of Medical Devices
The risk assessment should consider the proposed clinical use of the device, including the anatomical location, duration of exposure, and intended use population. For example, for pediatric patients with a limited life expectancy, the tolerance for risk associated with a permanently implanted medical device may be higher than the tolerance for risk from the same device in an otherwise healthy pediatric population. The potential exposure duration should also consider which material components of the device have direct or indirect contact with tissue, and whether exposure would be a one-time exposure, a constant exposure over time, or an intermittent  exposure over time that could have a cumulative effect. For example, pacemaker pulse generators commonly contain internal electronic components made from chemicals that could be toxic to the body, but appropriate bench testing can demonstrate that the pulse generator is hermetically sealed and will limit exposure of those
chemicals to the surrounding tissues.

The policy document tells us that tolerance for risk is greater for permanently implanted medical devices

3. Patient Admission
If the patient medically requires hospital inpatient services and the physician believes that the patient will need to stay in the hospital at least 2 midnights, the physician should order inpatient admission. If the patient does not medically require inpatient hospital services or the physician does not expect the patient to stay past 2 midnights,
the physician should order observation or outpatient services. The certification must be signed and documented in the medical record prior to patient discharge. Hospitals may choose to have physicians record these elements of the certification either on a specific form or throughout the medical record such as in the orders, history and physical, or physician progress notes.
Guidelines:
• Excellent patient care should continue to be the top priority.
• Document the diagnosis, medical rationale, plan of care and anticipated discharge.
• Sign the admission order and certification (if appropriate) prior to discharge.

What is being described in this section of the guidelines?

4. Respirators
Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator
itself can become a hazard to the worker. Workers who occasionally wear filtering face-piece respirators on a voluntarily basis must be aware of the following information. This information is intended for employees who are not required to wear respirators for protection from recognized airborne hazards. Employees who perceive
exposures to any airborne contaminants, particularly outside of a chemical fume hood, should request an exposure evaluation before selecting a respirator.

The purpose of these instructions is to explain

5. Hospital On-Call Coverage Program Review
We are requesting your assistance with the detailed review of the Hospital On-Call Coverage (HOCC) Program; your input will help evaluate the current HOCC program and assist to identify future directions. With your participation, we can ensure that the HOCC program meets the needs of patients, participating physicians and other health care stakeholders.
The HOCC Program review has three primary objectives:
1. To identify and examine the effectiveness of key elements of the program already in place at hospitals. These elements include eligibility criteria, compensation structures, process metrics, resource requirements, and others.
2. To develop recommendations for improving the organization and delivery of on-call services based on evidence and best practices identified through the data and information collection processes.
3. To explore specific issues: Participation of doctors, use of regional call networks, and coverage for long-term care, sexual assault centres, chronic care facilities and palliative care programs.

The extract informs us that your

6. Identification of Potential Risks
An assessment of potential biocompatibility risk should include not only chemical toxicity, but also physical characteristics that might contribute to an unwanted tissue response. These characteristics can include surface properties, forces on surrounding tissue, geometry, and presence of particulates, among others. In addition, changes in manufacturing and processing parameters can also have an impact on biocompatibility. For example, the original processing for an implanted device might include placing the device in an acid bath to facilitate passivation of the implant surface. If this passivation process is changed to eliminate the acid bath in favor of a different method of passivating the surface, removal of the acid bath might unintentionally lead to a smaller reduction in pyrogenic material, which could result in pyrogenic reactions (fever) following implantation of the device. Another common change that might impact biocompatibility is a change in resin supplier. For example, if the new resin supplier does not remove all processing solvents (some of which may be known toxic compounds, such as formaldehyde), the final manufactured device could cause unexpected toxicities that were not seen with devices manufactured from the original resin.

What point does the extract make about processing of medical devices?

7. Somewhere out in the future there's a final moment with our name on it: life's only certainty is death. It's coming, and the only mystery about mortality's last call is: when? But if your doctor could tell you, would you want to hear how long you are likely to live? American researchers now believe that they are able to determine a person's "natural" life span from a simple blood test. They have identified the ability of a common gene to influence the ageing process, and the form it takes in any given individual can they say, indicate medical vulnerability and predict when the person may die. The news has created much excitement but it also has raised concerns about the ethical dilemmas involved if science is able to read our lifelines and forecast our susceptibility to deadly diseases. It's a development that revives the eternal question: should a doctor tell?

Apo E, as it's known, is not a new discovery but, hitherto, scientists believed that its only function was to remove cholesterol from the bloodstream. Only lately as they have been able to study the ever increasing numbers of elderly, has the gene's relationship with longevity become apparent. It apparently operates as a kind of caretaker
gene, maintaining the system's cells and keeping them running smoothly, and its efficiency can determine the rate at which the body holds up or wears out. "Apo E is one of those genes that we suspect controls life span because it affects people’s susceptibility to diseases of ageing”, says Dr Jan Vigh; a molecular geneticist at Beth Israel Hospital, in Boston. The gene has three variants, known as E2, E3, E4, and we all inherit one of them from each of our parents. More than half of us are born with two E3s, but it is the distribution of the other two forms that has proved so compelling to scientists that they have been analyzing data on the elderly.

People with one or – more rarely – two E2s tend to survive the longest, while those with E4s die considerably earlier than the rest. Studies in Canada, France, Sweden and Finland found that E2 carriers were about four times more likely to reach their 100th birthday than those born with an E4. The E2 is, it seems, an excellent caretaker. By
comparison, E4 does sloppy work and its inadequacies at cell upkeep make those who have it vulnerable to illness and early death. Doctors now accept that the presence of the Apo E4 gene signals a risk of heart disease and Alzheimer's. American studies show that middle aged women with an E4 are twice as likely to develop coronary
heart disease as those who don't, while E4 men have a 50 per cent higher risk than other men. Among men under 40 who require surgery for clogged heart arteries, the incidence of two E4s is 16 times higher than among others in their age group And Dr Alan Roses, the Duke University neurologist who first made the link between Apo E and Alzheimer's, says those with two E4s have about six times the normal risk of developing the disease, while people born with two E2s may be protected from it.

More than 4 million Americans are afflicted by this devastating brain disorder and nearly two-thirds of them have at least one Apo E4 gene, compared with only 15 percent in the general population. So Apo E may be a critical marker for life span and vulnerability to grave diseases, and evidence of its presence is in the records of millions of blood tests conducted for other reasons. But is it ethical or wise for doctors to use that information to tell people something they may not want to know and which, in any case, alerts them to threats that may be unavoidable? “We consulted bioethicists and got a variety of opinions," says Dr Norman Relkin, the New York neurologist who gathered other concerned doctors to discuss the issue at a conference in Chicago. After two days, they called for more research to establish the nature and the risks of the Apo E family but many researchers seem opposed to confronting people with alarming news about conditions that cannot be fought, based on blood samples given for other purposes.

"Have you done them a service?" asks Dr Lindsay Farrer, an Alzheimer 's researcher at Boston University Medical Centre. "What good does it do to tell someone about being at risk from a dreaded disease that can neither be prevented nor effectively treated?" Dr Rudolph Tanzi, an Alzheimer's specialist at Massachusetts General Hospital,
agrees but, because his own family has a history of early heart problems, he was unable to resist having his own Apo E analyzed. He is an E3, in the same wide, neutral middle ground as most of humanity. The problems raised by Apo E are varied and complex. Some doctors worry about possible discrimination from employers and insurance companies if people are routinely told they may have a predisposition to serious illness and premature death. Because blows to the head seem to increase the risk of getting Alzheimer's among people with the E4 gene, should boxers and other athletes, and children wanting to play contact sports, be tested for their Apo classification? “Already!”, says Dr Relkin, pregnant women are asking for their fetuses to be screened so they can consider abortion if their babies show two E4s.

Duke University's Dr Roes is working with a major drug company to try to define what gives Apo E2 its ability to improve the body's defenses, so that its protection can be duplicated in the laboratory. "The hope is that we shall be able to make a drug that does what Apo E2 does," he says. Meanwhile, for millions of people around the world, their destiny -how they will live, when they will die is perhaps already foretold in a dusty medical file.

Researchers have identified ______

8. Somewhere out in the future there's a final moment with our name on it: life's only certainty is death. It's coming, and the only mystery about mortality's last call is: when? But if your doctor could tell you, would you want to hear how long you are likely to live? American researchers now believe that they are able to determine a person's "natural" life span from a simple blood test. They have identified the ability of a common gene to influence the ageing process, and the form it takes in any given individual can they say, indicate medical vulnerability and predict when the person may die. The news has created much excitement but it also has raised concerns about the ethical dilemmas involved if science is able to read our lifelines and forecast our susceptibility to deadly diseases. It's a development that revives the eternal question: should a doctor tell?

Apo E, as it's known, is not a new discovery but, hitherto, scientists believed that its only function was to remove cholesterol from the bloodstream. Only lately as they have been able to study the ever increasing numbers of elderly, has the gene's relationship with longevity become apparent. It apparently operates as a kind of caretaker
gene, maintaining the system's cells and keeping them running smoothly, and its efficiency can determine the rate at which the body holds up or wears out. "Apo E is one of those genes that we suspect controls life span because it affects people’s susceptibility to diseases of ageing”, says Dr Jan Vigh; a molecular geneticist at Beth Israel Hospital, in Boston. The gene has three variants, known as E2, E3, E4, and we all inherit one of them from each of our parents. More than half of us are born with two E3s, but it is the distribution of the other two forms that has proved so compelling to scientists that they have been analyzing data on the elderly.

People with one or – more rarely – two E2s tend to survive the longest, while those with E4s die considerably earlier than the rest. Studies in Canada, France, Sweden and Finland found that E2 carriers were about four times more likely to reach their 100th birthday than those born with an E4. The E2 is, it seems, an excellent caretaker. By
comparison, E4 does sloppy work and its inadequacies at cell upkeep make those who have it vulnerable to illness and early death. Doctors now accept that the presence of the Apo E4 gene signals a risk of heart disease and Alzheimer's. American studies show that middle aged women with an E4 are twice as likely to develop coronary
heart disease as those who don't, while E4 men have a 50 per cent higher risk than other men. Among men under 40 who require surgery for clogged heart arteries, the incidence of two E4s is 16 times higher than among others in their age group And Dr Alan Roses, the Duke University neurologist who first made the link between Apo E and Alzheimer's, says those with two E4s have about six times the normal risk of developing the disease, while people born with two E2s may be protected from it.

More than 4 million Americans are afflicted by this devastating brain disorder and nearly two-thirds of them have at least one Apo E4 gene, compared with only 15 percent in the general population. So Apo E may be a critical marker for life span and vulnerability to grave diseases, and evidence of its presence is in the records of millions of blood tests conducted for other reasons. But is it ethical or wise for doctors to use that information to tell people something they may not want to know and which, in any case, alerts them to threats that may be unavoidable? “We consulted bioethicists and got a variety of opinions," says Dr Norman Relkin, the New York neurologist who gathered other concerned doctors to discuss the issue at a conference in Chicago. After two days, they called for more research to establish the nature and the risks of the Apo E family but many researchers seem opposed to confronting people with alarming news about conditions that cannot be fought, based on blood samples given for other purposes.

"Have you done them a service?" asks Dr Lindsay Farrer, an Alzheimer 's researcher at Boston University Medical Centre. "What good does it do to tell someone about being at risk from a dreaded disease that can neither be prevented nor effectively treated?" Dr Rudolph Tanzi, an Alzheimer's specialist at Massachusetts General Hospital,
agrees but, because his own family has a history of early heart problems, he was unable to resist having his own Apo E analyzed. He is an E3, in the same wide, neutral middle ground as most of humanity. The problems raised by Apo E are varied and complex. Some doctors worry about possible discrimination from employers and insurance companies if people are routinely told they may have a predisposition to serious illness and premature death. Because blows to the head seem to increase the risk of getting Alzheimer's among people with the E4 gene, should boxers and other athletes, and children wanting to play contact sports, be tested for their Apo classification? “Already!”, says Dr Relkin, pregnant women are asking for their fetuses to be screened so they can consider abortion if their babies show two E4s.

Duke University's Dr Roes is working with a major drug company to try to define what gives Apo E2 its ability to improve the body's defenses, so that its protection can be duplicated in the laboratory. "The hope is that we shall be able to make a drug that does what Apo E2 does," he says. Meanwhile, for millions of people around the world, their destiny -how they will live, when they will die is perhaps already foretold in a dusty medical file.

The discovery of being able to estimate the life span of a person ______

9. Somewhere out in the future there's a final moment with our name on it: life's only certainty is death. It's coming, and the only mystery about mortality's last call is: when? But if your doctor could tell you, would you want to hear how long you are likely to live? American researchers now believe that they are able to determine a person's "natural" life span from a simple blood test. They have identified the ability of a common gene to influence the ageing process, and the form it takes in any given individual can they say, indicate medical vulnerability and predict when the person may die. The news has created much excitement but it also has raised concerns about the ethical dilemmas involved if science is able to read our lifelines and forecast our susceptibility to deadly diseases. It's a development that revives the eternal question: should a doctor tell?

Apo E, as it's known, is not a new discovery but, hitherto, scientists believed that its only function was to remove cholesterol from the bloodstream. Only lately as they have been able to study the ever increasing numbers of elderly, has the gene's relationship with longevity become apparent. It apparently operates as a kind of caretaker
gene, maintaining the system's cells and keeping them running smoothly, and its efficiency can determine the rate at which the body holds up or wears out. "Apo E is one of those genes that we suspect controls life span because it affects people’s susceptibility to diseases of ageing”, says Dr Jan Vigh; a molecular geneticist at Beth Israel Hospital, in Boston. The gene has three variants, known as E2, E3, E4, and we all inherit one of them from each of our parents. More than half of us are born with two E3s, but it is the distribution of the other two forms that has proved so compelling to scientists that they have been analyzing data on the elderly.

People with one or – more rarely – two E2s tend to survive the longest, while those with E4s die considerably earlier than the rest. Studies in Canada, France, Sweden and Finland found that E2 carriers were about four times more likely to reach their 100th birthday than those born with an E4. The E2 is, it seems, an excellent caretaker. By
comparison, E4 does sloppy work and its inadequacies at cell upkeep make those who have it vulnerable to illness and early death. Doctors now accept that the presence of the Apo E4 gene signals a risk of heart disease and Alzheimer's. American studies show that middle aged women with an E4 are twice as likely to develop coronary
heart disease as those who don't, while E4 men have a 50 per cent higher risk than other men. Among men under 40 who require surgery for clogged heart arteries, the incidence of two E4s is 16 times higher than among others in their age group And Dr Alan Roses, the Duke University neurologist who first made the link between Apo E and Alzheimer's, says those with two E4s have about six times the normal risk of developing the disease, while people born with two E2s may be protected from it.

More than 4 million Americans are afflicted by this devastating brain disorder and nearly two-thirds of them have at least one Apo E4 gene, compared with only 15 percent in the general population. So Apo E may be a critical marker for life span and vulnerability to grave diseases, and evidence of its presence is in the records of millions of blood tests conducted for other reasons. But is it ethical or wise for doctors to use that information to tell people something they may not want to know and which, in any case, alerts them to threats that may be unavoidable? “We consulted bioethicists and got a variety of opinions," says Dr Norman Relkin, the New York neurologist who gathered other concerned doctors to discuss the issue at a conference in Chicago. After two days, they called for more research to establish the nature and the risks of the Apo E family but many researchers seem opposed to confronting people with alarming news about conditions that cannot be fought, based on blood samples given for other purposes.

"Have you done them a service?" asks Dr Lindsay Farrer, an Alzheimer 's researcher at Boston University Medical Centre. "What good does it do to tell someone about being at risk from a dreaded disease that can neither be prevented nor effectively treated?" Dr Rudolph Tanzi, an Alzheimer's specialist at Massachusetts General Hospital,
agrees but, because his own family has a history of early heart problems, he was unable to resist having his own Apo E analyzed. He is an E3, in the same wide, neutral middle ground as most of humanity. The problems raised by Apo E are varied and complex. Some doctors worry about possible discrimination from employers and insurance companies if people are routinely told they may have a predisposition to serious illness and premature death. Because blows to the head seem to increase the risk of getting Alzheimer's among people with the E4 gene, should boxers and other athletes, and children wanting to play contact sports, be tested for their Apo classification? “Already!”, says Dr Relkin, pregnant women are asking for their fetuses to be screened so they can consider abortion if their babies show two E4s.

Duke University's Dr Roes is working with a major drug company to try to define what gives Apo E2 its ability to improve the body's defenses, so that its protection can be duplicated in the laboratory. "The hope is that we shall be able to make a drug that does what Apo E2 does," he says. Meanwhile, for millions of people around the world, their destiny -how they will live, when they will die is perhaps already foretold in a dusty medical file.

Apo E functions within a person's system as ______

10. Somewhere out in the future there's a final moment with our name on it: life's only certainty is death. It's coming, and the only mystery about mortality's last call is: when? But if your doctor could tell you, would you want to hear how long you are likely to live? American researchers now believe that they are able to determine a person's "natural" life span from a simple blood test. They have identified the ability of a common gene to influence the ageing process, and the form it takes in any given individual can they say, indicate medical vulnerability and predict when the person may die. The news has created much excitement but it also has raised concerns about the ethical dilemmas involved if science is able to read our lifelines and forecast our susceptibility to deadly diseases. It's a development that revives the eternal question: should a doctor tell?

Apo E, as it's known, is not a new discovery but, hitherto, scientists believed that its only function was to remove cholesterol from the bloodstream. Only lately as they have been able to study the ever increasing numbers of elderly, has the gene's relationship with longevity become apparent. It apparently operates as a kind of caretaker
gene, maintaining the system's cells and keeping them running smoothly, and its efficiency can determine the rate at which the body holds up or wears out. "Apo E is one of those genes that we suspect controls life span because it affects people’s susceptibility to diseases of ageing”, says Dr Jan Vigh; a molecular geneticist at Beth Israel Hospital, in Boston. The gene has three variants, known as E2, E3, E4, and we all inherit one of them from each of our parents. More than half of us are born with two E3s, but it is the distribution of the other two forms that has proved so compelling to scientists that they have been analyzing data on the elderly.

People with one or – more rarely – two E2s tend to survive the longest, while those with E4s die considerably earlier than the rest. Studies in Canada, France, Sweden and Finland found that E2 carriers were about four times more likely to reach their 100th birthday than those born with an E4. The E2 is, it seems, an excellent caretaker. By
comparison, E4 does sloppy work and its inadequacies at cell upkeep make those who have it vulnerable to illness and early death. Doctors now accept that the presence of the Apo E4 gene signals a risk of heart disease and Alzheimer's. American studies show that middle aged women with an E4 are twice as likely to develop coronary
heart disease as those who don't, while E4 men have a 50 per cent higher risk than other men. Among men under 40 who require surgery for clogged heart arteries, the incidence of two E4s is 16 times higher than among others in their age group And Dr Alan Roses, the Duke University neurologist who first made the link between Apo E and Alzheimer's, says those with two E4s have about six times the normal risk of developing the disease, while people born with two E2s may be protected from it.

More than 4 million Americans are afflicted by this devastating brain disorder and nearly two-thirds of them have at least one Apo E4 gene, compared with only 15 percent in the general population. So Apo E may be a critical marker for life span and vulnerability to grave diseases, and evidence of its presence is in the records of millions of blood tests conducted for other reasons. But is it ethical or wise for doctors to use that information to tell people something they may not want to know and which, in any case, alerts them to threats that may be unavoidable? “We consulted bioethicists and got a variety of opinions," says Dr Norman Relkin, the New York neurologist who gathered other concerned doctors to discuss the issue at a conference in Chicago. After two days, they called for more research to establish the nature and the risks of the Apo E family but many researchers seem opposed to confronting people with alarming news about conditions that cannot be fought, based on blood samples given for other purposes.

"Have you done them a service?" asks Dr Lindsay Farrer, an Alzheimer 's researcher at Boston University Medical Centre. "What good does it do to tell someone about being at risk from a dreaded disease that can neither be prevented nor effectively treated?" Dr Rudolph Tanzi, an Alzheimer's specialist at Massachusetts General Hospital,
agrees but, because his own family has a history of early heart problems, he was unable to resist having his own Apo E analyzed. He is an E3, in the same wide, neutral middle ground as most of humanity. The problems raised by Apo E are varied and complex. Some doctors worry about possible discrimination from employers and insurance companies if people are routinely told they may have a predisposition to serious illness and premature death. Because blows to the head seem to increase the risk of getting Alzheimer's among people with the E4 gene, should boxers and other athletes, and children wanting to play contact sports, be tested for their Apo classification? “Already!”, says Dr Relkin, pregnant women are asking for their fetuses to be screened so they can consider abortion if their babies show two E4s.

Duke University's Dr Roes is working with a major drug company to try to define what gives Apo E2 its ability to improve the body's defenses, so that its protection can be duplicated in the laboratory. "The hope is that we shall be able to make a drug that does what Apo E2 does," he says. Meanwhile, for millions of people around the world, their destiny -how they will live, when they will die is perhaps already foretold in a dusty medical file.

Scientists have been in a position to study the Apo E phenomenon because _____

11. Somewhere out in the future there's a final moment with our name on it: life's only certainty is death. It's coming, and the only mystery about mortality's last call is: when? But if your doctor could tell you, would you want to hear how long you are likely to live? American researchers now believe that they are able to determine a person's "natural" life span from a simple blood test. They have identified the ability of a common gene to influence the ageing process, and the form it takes in any given individual can they say, indicate medical vulnerability and predict when the person may die. The news has created much excitement but it also has raised concerns about the ethical dilemmas involved if science is able to read our lifelines and forecast our susceptibility to deadly diseases. It's a development that revives the eternal question: should a doctor tell?

Apo E, as it's known, is not a new discovery but, hitherto, scientists believed that its only function was to remove cholesterol from the bloodstream. Only lately as they have been able to study the ever increasing numbers of elderly, has the gene's relationship with longevity become apparent. It apparently operates as a kind of caretaker
gene, maintaining the system's cells and keeping them running smoothly, and its efficiency can determine the rate at which the body holds up or wears out. "Apo E is one of those genes that we suspect controls life span because it affects people’s susceptibility to diseases of ageing”, says Dr Jan Vigh; a molecular geneticist at Beth Israel Hospital, in Boston. The gene has three variants, known as E2, E3, E4, and we all inherit one of them from each of our parents. More than half of us are born with two E3s, but it is the distribution of the other two forms that has proved so compelling to scientists that they have been analyzing data on the elderly.

People with one or – more rarely – two E2s tend to survive the longest, while those with E4s die considerably earlier than the rest. Studies in Canada, France, Sweden and Finland found that E2 carriers were about four times more likely to reach their 100th birthday than those born with an E4. The E2 is, it seems, an excellent caretaker. By
comparison, E4 does sloppy work and its inadequacies at cell upkeep make those who have it vulnerable to illness and early death. Doctors now accept that the presence of the Apo E4 gene signals a risk of heart disease and Alzheimer's. American studies show that middle aged women with an E4 are twice as likely to develop coronary
heart disease as those who don't, while E4 men have a 50 per cent higher risk than other men. Among men under 40 who require surgery for clogged heart arteries, the incidence of two E4s is 16 times higher than among others in their age group And Dr Alan Roses, the Duke University neurologist who first made the link between Apo E and Alzheimer's, says those with two E4s have about six times the normal risk of developing the disease, while people born with two E2s may be protected from it.

More than 4 million Americans are afflicted by this devastating brain disorder and nearly two-thirds of them have at least one Apo E4 gene, compared with only 15 percent in the general population. So Apo E may be a critical marker for life span and vulnerability to grave diseases, and evidence of its presence is in the records of millions of blood tests conducted for other reasons. But is it ethical or wise for doctors to use that information to tell people something they may not want to know and which, in any case, alerts them to threats that may be unavoidable? “We consulted bioethicists and got a variety of opinions," says Dr Norman Relkin, the New York neurologist who gathered other concerned doctors to discuss the issue at a conference in Chicago. After two days, they called for more research to establish the nature and the risks of the Apo E family but many researchers seem opposed to confronting people with alarming news about conditions that cannot be fought, based on blood samples given for other purposes.

"Have you done them a service?" asks Dr Lindsay Farrer, an Alzheimer 's researcher at Boston University Medical Centre. "What good does it do to tell someone about being at risk from a dreaded disease that can neither be prevented nor effectively treated?" Dr Rudolph Tanzi, an Alzheimer's specialist at Massachusetts General Hospital,
agrees but, because his own family has a history of early heart problems, he was unable to resist having his own Apo E analyzed. He is an E3, in the same wide, neutral middle ground as most of humanity. The problems raised by Apo E are varied and complex. Some doctors worry about possible discrimination from employers and insurance companies if people are routinely told they may have a predisposition to serious illness and premature death. Because blows to the head seem to increase the risk of getting Alzheimer's among people with the E4 gene, should boxers and other athletes, and children wanting to play contact sports, be tested for their Apo classification? “Already!”, says Dr Relkin, pregnant women are asking for their fetuses to be screened so they can consider abortion if their babies show two E4s.

Duke University's Dr Roes is working with a major drug company to try to define what gives Apo E2 its ability to improve the body's defenses, so that its protection can be duplicated in the laboratory. "The hope is that we shall be able to make a drug that does what Apo E2 does," he says. Meanwhile, for millions of people around the world, their destiny -how they will live, when they will die is perhaps already foretold in a dusty medical file.

A molecular geneticist in Boston has found that ______

12. Somewhere out in the future there's a final moment with our name on it: life's only certainty is death. It's coming, and the only mystery about mortality's last call is: when? But if your doctor could tell you, would you want to hear how long you are likely to live? American researchers now believe that they are able to determine a person's "natural" life span from a simple blood test. They have identified the ability of a common gene to influence the ageing process, and the form it takes in any given individual can they say, indicate medical vulnerability and predict when the person may die. The news has created much excitement but it also has raised concerns about the ethical dilemmas involved if science is able to read our lifelines and forecast our susceptibility to deadly diseases. It's a development that revives the eternal question: should a doctor tell?

Apo E, as it's known, is not a new discovery but, hitherto, scientists believed that its only function was to remove cholesterol from the bloodstream. Only lately as they have been able to study the ever increasing numbers of elderly, has the gene's relationship with longevity become apparent. It apparently operates as a kind of caretaker
gene, maintaining the system's cells and keeping them running smoothly, and its efficiency can determine the rate at which the body holds up or wears out. "Apo E is one of those genes that we suspect controls life span because it affects people’s susceptibility to diseases of ageing”, says Dr Jan Vigh; a molecular geneticist at Beth Israel Hospital, in Boston. The gene has three variants, known as E2, E3, E4, and we all inherit one of them from each of our parents. More than half of us are born with two E3s, but it is the distribution of the other two forms that has proved so compelling to scientists that they have been analyzing data on the elderly.

People with one or – more rarely – two E2s tend to survive the longest, while those with E4s die considerably earlier than the rest. Studies in Canada, France, Sweden and Finland found that E2 carriers were about four times more likely to reach their 100th birthday than those born with an E4. The E2 is, it seems, an excellent caretaker. By
comparison, E4 does sloppy work and its inadequacies at cell upkeep make those who have it vulnerable to illness and early death. Doctors now accept that the presence of the Apo E4 gene signals a risk of heart disease and Alzheimer's. American studies show that middle aged women with an E4 are twice as likely to develop coronary
heart disease as those who don't, while E4 men have a 50 per cent higher risk than other men. Among men under 40 who require surgery for clogged heart arteries, the incidence of two E4s is 16 times higher than among others in their age group And Dr Alan Roses, the Duke University neurologist who first made the link between Apo E and Alzheimer's, says those with two E4s have about six times the normal risk of developing the disease, while people born with two E2s may be protected from it.

More than 4 million Americans are afflicted by this devastating brain disorder and nearly two-thirds of them have at least one Apo E4 gene, compared with only 15 percent in the general population. So Apo E may be a critical marker for life span and vulnerability to grave diseases, and evidence of its presence is in the records of millions of blood tests conducted for other reasons. But is it ethical or wise for doctors to use that information to tell people something they may not want to know and which, in any case, alerts them to threats that may be unavoidable? “We consulted bioethicists and got a variety of opinions," says Dr Norman Relkin, the New York neurologist who gathered other concerned doctors to discuss the issue at a conference in Chicago. After two days, they called for more research to establish the nature and the risks of the Apo E family but many researchers seem opposed to confronting people with alarming news about conditions that cannot be fought, based on blood samples given for other purposes.

"Have you done them a service?" asks Dr Lindsay Farrer, an Alzheimer 's researcher at Boston University Medical Centre. "What good does it do to tell someone about being at risk from a dreaded disease that can neither be prevented nor effectively treated?" Dr Rudolph Tanzi, an Alzheimer's specialist at Massachusetts General Hospital,
agrees but, because his own family has a history of early heart problems, he was unable to resist having his own Apo E analyzed. He is an E3, in the same wide, neutral middle ground as most of humanity. The problems raised by Apo E are varied and complex. Some doctors worry about possible discrimination from employers and insurance companies if people are routinely told they may have a predisposition to serious illness and premature death. Because blows to the head seem to increase the risk of getting Alzheimer's among people with the E4 gene, should boxers and other athletes, and children wanting to play contact sports, be tested for their Apo classification? “Already!”, says Dr Relkin, pregnant women are asking for their fetuses to be screened so they can consider abortion if their babies show two E4s.

Duke University's Dr Roes is working with a major drug company to try to define what gives Apo E2 its ability to improve the body's defenses, so that its protection can be duplicated in the laboratory. "The hope is that we shall be able to make a drug that does what Apo E2 does," he says. Meanwhile, for millions of people around the world, their destiny -how they will live, when they will die is perhaps already foretold in a dusty medical file.

Middle aged women with an Apo E4 gene _____

13. Somewhere out in the future there's a final moment with our name on it: life's only certainty is death. It's coming, and the only mystery about mortality's last call is: when? But if your doctor could tell you, would you want to hear how long you are likely to live? American researchers now believe that they are able to determine a person's "natural" life span from a simple blood test. They have identified the ability of a common gene to influence the ageing process, and the form it takes in any given individual can they say, indicate medical vulnerability and predict when the person may die. The news has created much excitement but it also has raised concerns about the ethical dilemmas involved if science is able to read our lifelines and forecast our susceptibility to deadly diseases. It's a development that revives the eternal question: should a doctor tell?

Apo E, as it's known, is not a new discovery but, hitherto, scientists believed that its only function was to remove cholesterol from the bloodstream. Only lately as they have been able to study the ever increasing numbers of elderly, has the gene's relationship with longevity become apparent. It apparently operates as a kind of caretaker
gene, maintaining the system's cells and keeping them running smoothly, and its efficiency can determine the rate at which the body holds up or wears out. "Apo E is one of those genes that we suspect controls life span because it affects people’s susceptibility to diseases of ageing”, says Dr Jan Vigh; a molecular geneticist at Beth Israel Hospital, in Boston. The gene has three variants, known as E2, E3, E4, and we all inherit one of them from each of our parents. More than half of us are born with two E3s, but it is the distribution of the other two forms that has proved so compelling to scientists that they have been analyzing data on the elderly.

People with one or – more rarely – two E2s tend to survive the longest, while those with E4s die considerably earlier than the rest. Studies in Canada, France, Sweden and Finland found that E2 carriers were about four times more likely to reach their 100th birthday than those born with an E4. The E2 is, it seems, an excellent caretaker. By
comparison, E4 does sloppy work and its inadequacies at cell upkeep make those who have it vulnerable to illness and early death. Doctors now accept that the presence of the Apo E4 gene signals a risk of heart disease and Alzheimer's. American studies show that middle aged women with an E4 are twice as likely to develop coronary
heart disease as those who don't, while E4 men have a 50 per cent higher risk than other men. Among men under 40 who require surgery for clogged heart arteries, the incidence of two E4s is 16 times higher than among others in their age group And Dr Alan Roses, the Duke University neurologist who first made the link between Apo E and Alzheimer's, says those with two E4s have about six times the normal risk of developing the disease, while people born with two E2s may be protected from it.

More than 4 million Americans are afflicted by this devastating brain disorder and nearly two-thirds of them have at least one Apo E4 gene, compared with only 15 percent in the general population. So Apo E may be a critical marker for life span and vulnerability to grave diseases, and evidence of its presence is in the records of millions of blood tests conducted for other reasons. But is it ethical or wise for doctors to use that information to tell people something they may not want to know and which, in any case, alerts them to threats that may be unavoidable? “We consulted bioethicists and got a variety of opinions," says Dr Norman Relkin, the New York neurologist who gathered other concerned doctors to discuss the issue at a conference in Chicago. After two days, they called for more research to establish the nature and the risks of the Apo E family but many researchers seem opposed to confronting people with alarming news about conditions that cannot be fought, based on blood samples given for other purposes.

"Have you done them a service?" asks Dr Lindsay Farrer, an Alzheimer 's researcher at Boston University Medical Centre. "What good does it do to tell someone about being at risk from a dreaded disease that can neither be prevented nor effectively treated?" Dr Rudolph Tanzi, an Alzheimer's specialist at Massachusetts General Hospital,
agrees but, because his own family has a history of early heart problems, he was unable to resist having his own Apo E analyzed. He is an E3, in the same wide, neutral middle ground as most of humanity. The problems raised by Apo E are varied and complex. Some doctors worry about possible discrimination from employers and insurance companies if people are routinely told they may have a predisposition to serious illness and premature death. Because blows to the head seem to increase the risk of getting Alzheimer's among people with the E4 gene, should boxers and other athletes, and children wanting to play contact sports, be tested for their Apo classification? “Already!”, says Dr Relkin, pregnant women are asking for their fetuses to be screened so they can consider abortion if their babies show two E4s.

Duke University's Dr Roes is working with a major drug company to try to define what gives Apo E2 its ability to improve the body's defenses, so that its protection can be duplicated in the laboratory. "The hope is that we shall be able to make a drug that does what Apo E2 does," he says. Meanwhile, for millions of people around the world, their destiny -how they will live, when they will die is perhaps already foretold in a dusty medical file.

Which statement is not true?
The neurologist who made initial connection with Apo E and Alzheimer' s believes people with _____

14. Somewhere out in the future there's a final moment with our name on it: life's only certainty is death. It's coming, and the only mystery about mortality's last call is: when? But if your doctor could tell you, would you want to hear how long you are likely to live? American researchers now believe that they are able to determine a person's "natural" life span from a simple blood test. They have identified the ability of a common gene to influence the ageing process, and the form it takes in any given individual can they say, indicate medical vulnerability and predict when the person may die. The news has created much excitement but it also has raised concerns about the ethical dilemmas involved if science is able to read our lifelines and forecast our susceptibility to deadly diseases. It's a development that revives the eternal question: should a doctor tell?

Apo E, as it's known, is not a new discovery but, hitherto, scientists believed that its only function was to remove cholesterol from the bloodstream. Only lately as they have been able to study the ever increasing numbers of elderly, has the gene's relationship with longevity become apparent. It apparently operates as a kind of caretaker
gene, maintaining the system's cells and keeping them running smoothly, and its efficiency can determine the rate at which the body holds up or wears out. "Apo E is one of those genes that we suspect controls life span because it affects people’s susceptibility to diseases of ageing”, says Dr Jan Vigh; a molecular geneticist at Beth Israel Hospital, in Boston. The gene has three variants, known as E2, E3, E4, and we all inherit one of them from each of our parents. More than half of us are born with two E3s, but it is the distribution of the other two forms that has proved so compelling to scientists that they have been analyzing data on the elderly.

People with one or – more rarely – two E2s tend to survive the longest, while those with E4s die considerably earlier than the rest. Studies in Canada, France, Sweden and Finland found that E2 carriers were about four times more likely to reach their 100th birthday than those born with an E4. The E2 is, it seems, an excellent caretaker. By
comparison, E4 does sloppy work and its inadequacies at cell upkeep make those who have it vulnerable to illness and early death. Doctors now accept that the presence of the Apo E4 gene signals a risk of heart disease and Alzheimer's. American studies show that middle aged women with an E4 are twice as likely to develop coronary
heart disease as those who don't, while E4 men have a 50 per cent higher risk than other men. Among men under 40 who require surgery for clogged heart arteries, the incidence of two E4s is 16 times higher than among others in their age group And Dr Alan Roses, the Duke University neurologist who first made the link between Apo E and Alzheimer's, says those with two E4s have about six times the normal risk of developing the disease, while people born with two E2s may be protected from it.

More than 4 million Americans are afflicted by this devastating brain disorder and nearly two-thirds of them have at least one Apo E4 gene, compared with only 15 percent in the general population. So Apo E may be a critical marker for life span and vulnerability to grave diseases, and evidence of its presence is in the records of millions of blood tests conducted for other reasons. But is it ethical or wise for doctors to use that information to tell people something they may not want to know and which, in any case, alerts them to threats that may be unavoidable? “We consulted bioethicists and got a variety of opinions," says Dr Norman Relkin, the New York neurologist who gathered other concerned doctors to discuss the issue at a conference in Chicago. After two days, they called for more research to establish the nature and the risks of the Apo E family but many researchers seem opposed to confronting people with alarming news about conditions that cannot be fought, based on blood samples given for other purposes.

"Have you done them a service?" asks Dr Lindsay Farrer, an Alzheimer 's researcher at Boston University Medical Centre. "What good does it do to tell someone about being at risk from a dreaded disease that can neither be prevented nor effectively treated?" Dr Rudolph Tanzi, an Alzheimer's specialist at Massachusetts General Hospital,
agrees but, because his own family has a history of early heart problems, he was unable to resist having his own Apo E analyzed. He is an E3, in the same wide, neutral middle ground as most of humanity. The problems raised by Apo E are varied and complex. Some doctors worry about possible discrimination from employers and insurance companies if people are routinely told they may have a predisposition to serious illness and premature death. Because blows to the head seem to increase the risk of getting Alzheimer's among people with the E4 gene, should boxers and other athletes, and children wanting to play contact sports, be tested for their Apo classification? “Already!”, says Dr Relkin, pregnant women are asking for their fetuses to be screened so they can consider abortion if their babies show two E4s.

Duke University's Dr Roes is working with a major drug company to try to define what gives Apo E2 its ability to improve the body's defenses, so that its protection can be duplicated in the laboratory. "The hope is that we shall be able to make a drug that does what Apo E2 does," he says. Meanwhile, for millions of people around the world, their destiny -how they will live, when they will die is perhaps already foretold in a dusty medical file.

Neurologists and bioethicists who met at a conference in Chicago _____

15. An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause. The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit. The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals. Infections have so far only been linked to Spanish
cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected. The European Union says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

The ECDCP says the bacteria's impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection. However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 people at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized. Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water or food -- especially raw vegetables and undercooked meat. It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a lifethreatening kidney failure. The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics. In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure. The ECDPC says the outbreak is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across Western Europe but so far the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to
Germany. The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.

Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. "Personal hygiene messages are important," it says. With exports of Spanish vegetables "paralyzed" according to officials, weekly
losses of about €200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain's fruit and vegetable market, last year worth €8.6 billion. Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain. Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain's prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: "In the absence of proof, we're not ruling out using all necessary measures to make sure there's compensation for the (economic) damage," she wrote. "From the first day, the government launched a diplomatic offensive to prevent the linking of this
health crisis with our products." While Germany accounts for much of Spain's vegetable export market, the country does export further afield to countries including Russia and the United States. There is also the risk of socalled "secondary clusters" of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

What is the meaning of the word ‘fallout’ in the first paragraph?

16. An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause. The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit. The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals. Infections have so far only been linked to Spanish
cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected. The European Union says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

The ECDCP says the bacteria's impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection. However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 people at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized. Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water or food -- especially raw vegetables and undercooked meat. It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a lifethreatening kidney failure. The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics. In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure. The ECDPC says the outbreak is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across Western Europe but so far the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to
Germany. The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.

Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. "Personal hygiene messages are important," it says. With exports of Spanish vegetables "paralyzed" according to officials, weekly
losses of about €200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain's fruit and vegetable market, last year worth €8.6 billion. Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain. Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain's prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: "In the absence of proof, we're not ruling out using all necessary measures to make sure there's compensation for the (economic) damage," she wrote. "From the first day, the government launched a diplomatic offensive to prevent the linking of this
health crisis with our products." While Germany accounts for much of Spain's vegetable export market, the country does export further afield to countries including Russia and the United States. There is also the risk of socalled "secondary clusters" of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

The source of the E. Coli outbreak is thought to be caused by_____

17. An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause. The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit. The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals. Infections have so far only been linked to Spanish
cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected. The European Union says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

The ECDCP says the bacteria's impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection. However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 people at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized. Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water or food -- especially raw vegetables and undercooked meat. It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a lifethreatening kidney failure. The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics. In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure. The ECDPC says the outbreak is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across Western Europe but so far the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to
Germany. The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.

Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. "Personal hygiene messages are important," it says. With exports of Spanish vegetables "paralyzed" according to officials, weekly
losses of about €200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain's fruit and vegetable market, last year worth €8.6 billion. Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain. Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain's prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: "In the absence of proof, we're not ruling out using all necessary measures to make sure there's compensation for the (economic) damage," she wrote. "From the first day, the government launched a diplomatic offensive to prevent the linking of this
health crisis with our products." While Germany accounts for much of Spain's vegetable export market, the country does export further afield to countries including Russia and the United States. There is also the risk of socalled "secondary clusters" of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

Which one of the following statements is not true?

18. An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause. The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit. The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals. Infections have so far only been linked to Spanish
cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected. The European Union says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

The ECDCP says the bacteria's impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection. However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 people at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized. Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water or food -- especially raw vegetables and undercooked meat. It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a lifethreatening kidney failure. The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics. In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure. The ECDPC says the outbreak is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across Western Europe but so far the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to
Germany. The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.

Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. "Personal hygiene messages are important," it says. With exports of Spanish vegetables "paralyzed" according to officials, weekly
losses of about €200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain's fruit and vegetable market, last year worth €8.6 billion. Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain. Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain's prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: "In the absence of proof, we're not ruling out using all necessary measures to make sure there's compensation for the (economic) damage," she wrote. "From the first day, the government launched a diplomatic offensive to prevent the linking of this
health crisis with our products." While Germany accounts for much of Spain's vegetable export market, the country does export further afield to countries including Russia and the United States. There is also the risk of socalled "secondary clusters" of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

What do the statistics published on May 27 show?

19. An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause. The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit. The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals. Infections have so far only been linked to Spanish
cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected. The European Union says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

The ECDCP says the bacteria's impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection. However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 people at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized. Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water or food -- especially raw vegetables and undercooked meat. It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a lifethreatening kidney failure. The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics. In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure. The ECDPC says the outbreak is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across Western Europe but so far the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to
Germany. The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.

Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. "Personal hygiene messages are important," it says. With exports of Spanish vegetables "paralyzed" according to officials, weekly
losses of about €200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain's fruit and vegetable market, last year worth €8.6 billion. Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain. Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain's prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: "In the absence of proof, we're not ruling out using all necessary measures to make sure there's compensation for the (economic) damage," she wrote. "From the first day, the government launched a diplomatic offensive to prevent the linking of this
health crisis with our products." While Germany accounts for much of Spain's vegetable export market, the country does export further afield to countries including Russia and the United States. There is also the risk of socalled "secondary clusters" of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

Which of the following statements is correct?

20. An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause. The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit. The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals. Infections have so far only been linked to Spanish
cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected. The European Union says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

The ECDCP says the bacteria's impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection. However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 people at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized. Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water or food -- especially raw vegetables and undercooked meat. It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a lifethreatening kidney failure. The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics. In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure. The ECDPC says the outbreak is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across Western Europe but so far the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to
Germany. The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.

Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. "Personal hygiene messages are important," it says. With exports of Spanish vegetables "paralyzed" according to officials, weekly
losses of about €200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain's fruit and vegetable market, last year worth €8.6 billion. Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain. Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain's prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: "In the absence of proof, we're not ruling out using all necessary measures to make sure there's compensation for the (economic) damage," she wrote. "From the first day, the government launched a diplomatic offensive to prevent the linking of this
health crisis with our products." While Germany accounts for much of Spain's vegetable export market, the country does export further afield to countries including Russia and the United States. There is also the risk of socalled "secondary clusters" of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

How is E. coli transmitted?

21. An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause. The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit. The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals. Infections have so far only been linked to Spanish
cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected. The European Union says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

The ECDCP says the bacteria's impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection. However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 people at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized. Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water or food -- especially raw vegetables and undercooked meat. It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a lifethreatening kidney failure. The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics. In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure. The ECDPC says the outbreak is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across Western Europe but so far the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to
Germany. The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.

Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. "Personal hygiene messages are important," it says. With exports of Spanish vegetables "paralyzed" according to officials, weekly
losses of about €200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain's fruit and vegetable market, last year worth €8.6 billion. Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain. Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain's prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: "In the absence of proof, we're not ruling out using all necessary measures to make sure there's compensation for the (economic) damage," she wrote. "From the first day, the government launched a diplomatic offensive to prevent the linking of this
health crisis with our products." While Germany accounts for much of Spain's vegetable export market, the country does export further afield to countries including Russia and the United States. There is also the risk of socalled "secondary clusters" of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

Why is this strain of E.Coli so deadly?

22. An outbreak of E. coli in Germany that has killed at least 16 people and left hundreds battling infection across Europe raises questions about what risks the infection continues to pose and what fallout it will cause. The source of the E. coli outbreak is still unknown but has been traced to cucumbers imported to Germany from Spain. It is not clear whether the vegetables were infected at source or in transit. The European Center for Disease Prevention and Control (ECDPC) says transmission of the strain of bacterium, commonly found in cattle, usually occurs through contaminated food or water and contact with animals. Infections have so far only been linked to Spanish
cucumbers originating from the cities of Almeria and Malaga, but there are fears other raw vegetables such as lettuce and tomatoes could be affected. The European Union says a suspect batch of cucumbers imported from either Denmark or the Netherlands and sold in Germany is under investigation.

The ECDCP says the bacteria's impact on individuals can be affected by their age with children under five usually at higher risk of developing disease and dying from infection. However, statistics published on May 27 showed that of 276 cases, 87% were adults and 68% were women. One hospital in Hamburg said it had up to 700 infected patients. Of 85 people at risk of renal failure, 20 were children and 65 were adults. Sweden, which appears to have the biggest cluster of cases outside of Germany, has reported several dozen people hospitalized. Escherichia coli (E. coli) is a bacteria found living in the intestines of people and animals. It can be transmitted through contaminated water or food -- especially raw vegetables and undercooked meat. It is usually harmless, but can cause brief bouts of diarrhea. Some nastier strains can cause severe diarrhea and followed by serious organ system damage such as kidney failure. Healthy adults usually recover within a week, but young children and older adults can develop a lifethreatening kidney failure. The European Food Safety Alert Network identifies the bacteria linked to the contaminated cucumbers as EHEC, or enterohemorrhagic Escherichia coli, a strain which is particularly virulent and resistant to antibiotics. In Hamburg, up to 30% of people admitted to hospital with the infection were said to have developed haemolytic-uremic syndrome, a life-threatening form of kidney failure. The ECDPC says the outbreak is the largest in the world of its kind. So far there have been more than a dozen E. coli-linked deaths in Germany and hundreds of infections, but more are expected. Infections have also been reported across Western Europe but so far the cases in Austria, Britain, Denmark, France Netherlands, Sweden and Switzerland have all involved people returning from travel to
Germany. The European Food Safety Alert Network said E. coli had been found in cucumbers from Spain, packaged in Germany, and distributed to countries including Austria, the Czech Republic, Denmark, Germany, Hungary and Luxembourg.

Germany is advising people to avoid all raw vegetables, particularly cucumber, lettuce and tomatoes. The ECDPC says there is a risk of person-to-person transmission from people carrying the infection. "Personal hygiene messages are important," it says. With exports of Spanish vegetables "paralyzed" according to officials, weekly
losses of about €200 million ($288 million) are predicted. There are also concerns about the long-term impact this will have on Spain's fruit and vegetable market, last year worth €8.6 billion. Producers have already reported that seeded fruit exports are being affected, despite being unrelated to the scare. In addition to Germany, a number of European countries including Russia and Belgium have banned vegetable imports from Spain. Germany has reportedly also drastically reduced imports from the Netherlands. The cucumber alert could also have diplomatic fallout, with producers urging Spain's prime minister to step in, complaining German authorities have condemned Spanish produce without proof.

Leire Pajin, the Spanish Health Minister, has discussed the outbreak on Twitter, saying: "In the absence of proof, we're not ruling out using all necessary measures to make sure there's compensation for the (economic) damage," she wrote. "From the first day, the government launched a diplomatic offensive to prevent the linking of this
health crisis with our products." While Germany accounts for much of Spain's vegetable export market, the country does export further afield to countries including Russia and the United States. There is also the risk of socalled "secondary clusters" of infection caused by person-to-person transmission by anyone who had become contaminated during a visit to Germany.

Which of the following is not true?
Infections have been reported in people who ______