travel medicine and travel vaccination
2020版约翰霍普金斯ABX指南-特殊人群感染性疾病的筛查
Screening for and Prevention of Infectious Diseases inSpecial PopulationsCLINICALDefinition•Immune suppression (IS) has potential therapeutic implications for those with underlying conditions requiring the need to alter the immune response (examples include, but are not limited to, inflammatory bowel conditions, autoimmune disorders, connective tissue diseases, and other inflammatory conditions). [13]•Screening for and vaccinating against infectious diseases prior to initiation of IS when feasible, is critical to help lower potential infectious complications.•The opportunity to update vaccinations and screen for infectious diseases prior to initiation of IS may be missed. In most scenarios, there is time prior to initiation of IS to take the necessary steps to foster prevention of infectious complications down the road.•The definition of “immune suppression” for this module is:▫The use of corticosteroids such as prednisone > 20mg/day (or 2mg/kg/day if < 10kg) for 2 weeks or more and within 3 months of stopping.▫Effective doses of immunomodulators, methotrexate, or biologics within 3 months of stopping these agents▫Any combination of therapies above.•The purpose of this module is to help guide physicians to optimize patient outcomes when initiating IS. Many of these recommendations are evidence-based, and others based upon expert opinion.Screening for infectious diseases:A thorough history and physical exam are required with close attention paid to the following historical details:•Travel history, area of residence, occupational exposures and exposures through hobbies, water and food exposures, sick contacts, and animal exposures.•History of bacterial infections (e.g., recurrent UTIs)•History of fungal infections (e.g., oral and vaginal candidiasis)•Risk of active or latent tuberculosis•Prior history of chickenpox and/or shingles•History of recurrent herpes simplex virus infection•Vaccination history•Travel history and area of residence may be telling of endemic fungal infections and/or Strongyloides exposure, as well as tuberculosis exposure risks.▫Traveling after receiving IS would benefit from assistance of a Travel Medicine/Infectious Diseases specialist.▫If your patient is anticipating travel after the initiation of IS, it would be prudent to refer to a Travel Medicine/Infectious Diseases specialist prior to starting IS as many travel related vaccinations are live vaccines that can be given prior to ISinitiation, but are contraindicated after IS initiation.•Occupational exposure and exposure through hobbies may indicate exposure to various fungal infections, such as Cryptococcus and Aspergillus.•Water exposures▫Often, patients’ homes are supplied through untreated well water, which increases their risks for Giardia, Legionella, Cryptosporidium, Microsporidium, as well as non-tuberculous mycobacterial infections.▫If well water is supplying a patient’s home, they should be advised to either obtaina water treatment system, boil the water for at least one minute prior to use orconsumption, or use bottled water routinely for consumption purposes.•Food exposures▫Raw and undercooked eggs, poultry, and meat carries Salmonella and E.colirisks.‣Avoidance of unpasteurized products is necessary to avoid infections, such as Listeria.‣Similarly, soft cheeses and cold cuts of meat (i.e. delicatessen processed meats, hot dogs, and refrigerated pates) should be avoided for risk ofListeria.•Animal exposures▫All patients who are to receive IS should avoid sick animals and live vaccinations in their animals (such as the kennel cough vaccine, which protects against Bordetella bronchiseptica. This live vaccine has been reported as having the potential to infect immunocompromised individuals.). [12]▫If a cat is present, it is essential that your patient does not handle the cat litter for possible exposure to various bacterial and parasitic exposures, such as Toxoplasma.▫Turtles, snakes, and other reptiles have a risk of carrying Salmonella.▫New animals should not be acquired while on IS.•Bacteria▫Active bacterial infections, including UTI, cellulitis, and pneumonia should halt the initiation of IS until the infection has cleared and all necessary therapies for the infection are completed.▫Routine dental care should be performed prior to starting IS.•Mycobacteria▫M. tuberculosis‣Patients on steroids or other IS may not mount a response (anergy) to a tuberculin skin test (such as the Protein Purified Derivative [PPD]assay).[13][15]‣Patients who have received a bacilli de Calmette-Guerin (BCG) vaccine will test positive on a PPD assay in the early years after administration,but typically wanes after 15-20 years.‣Therefore, the PPD assay can both under- and over- estimate the incidence of latent TB in these circumstances. A more reliable assay to use wouldbe the interferon-gamma release cellular assay.[13][15]‣T-SPOT TB and QuantiFERON TB Gold are two availableinterferon-gamma release assays in the U.S.‣All patients should have an interferon-gamma release assay performed prior to initiating IS, especially immunomodulators and biologics.‣ A positive TB test is not a contraindication for IS as long as the patient is started on isoniazide or other appropriate latent TB therapy (such asrifampin, isoniazide plus rifapentine) for at least 4 weeks prior to startingIS.•Viruses▫Viruses of concern include the following:‣HIV, HA V, HBV, HCV, HSV, VZV, CMV, EBV, HPV, and Influenza ▫Human immunodeficiency virus (HIV), hepatitis A virus (HA V), hepatitis B virus (HBV), and hepatitis C virus (HCV)‣Prior to starting IS, the following should be considered:‣Serum HIV screening should be performed on all individuals ages 15-64 (as per the U.S. Preventative Services Task Force)[6]‣If positive, refer to Infectious Diseases to initiate onappropriate antiretroviral therapy prior to starting any IS‣If negative, counsel against engaging in risky behaviors thatmay increase one’s risk of acquiring HIV‣Serum HA V IgG should be sent, if negative would advise vaccination.‣HBV has been known to progress in the context of IS.[13]‣Screening for HBV should be performed even if one has beenvaccinated in the past. Some immunocompetent individuals donot mount biologically adequate antibody levels without abooster vaccination.⁎Serum serologies to send: Hepatitis B surface antigen,surface antibody, core total antibody (IgG + IgM)‣If negative and deemed HBV susceptible, should vaccinateagainst HBV. Would also educate against engaging in riskybehaviors that may increase one’s risk of acquiring HBV.‣If serologic testing reveals acute infection, chronic infection,or resolving infection, would refer to Infectious Diseases orGastroenterology for evaluation of treatment for HBV prior tostarting IS.⁎Treatment is necessary at minimum 3 weeks prior tostarting IS.‣HCV Antibody (serum IgG) should be screened prior to starting IS.‣If positive, would refer to Infectious Diseases orGastroenterology for evaluation of treatment for HCV prior tostarting any IS.‣If negative, would counsel against engaging in risky behaviorsthat may increase one’s risk of acquiring HCV ▫Herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV)‣Serum antibodies (IgG) to each of these should be evaluated for todetermine prior exposure.‣If HSV and/or VZV positive, then should monitor for reactivation.‣HSV: If a patient has frequent (>4 episodes) and/or severeHSV outbreaks, would provide prophylaxis againstreactivation while on IS.⁎Prophylaxis: Valacyclovir 500mg po twice-daily orAcyclovir 400mg po twice-daily‣VZV: If a patient develops shingles, would provideprophylaxis after treatment course while on IS.⁎Prophylaxis: Valacyclovir 500mg po twice-daily orAcyclovir 400mg po twice-daily⁎See VZV module for treatment of active infection.‣If reactivation of either virus is severe, it may be necessary tostop IS until infection resolves.‣If CMV IgG positive, closely monitor for signs/symptoms consistent with CMV reactivation.‣Fevers, chills, diarrhea, vision changes, hepatitis, etc.‣Outside of the solid organ transplant and hematopoietic stemcell transplant populations, there is no clear role for pre-emptive monitoring for CMV reactivation.‣If IgG negative, patient is at risk for primary CMV Infectionwhile on IS.▫Human papilloma virus (HPV)‣Women should have documentation of an updated Pap smear to rule out active HPV infection or abnormal cytology prior to starting IS.‣If positive, evaluation by Gynecology should be performedprior to starting IS.‣There may be data to suggest that immunosuppressed women should undergo more frequent screening with Pap smears.‣Current guidelines recommend routine Pap smears every 3years.‣Literature suggests that for the immunocompromised woman,Pap smears every year would improve early detection ofabnormal cytology and/or HPV infection.‣If appropriate based on age, vaccination against HPV is warranted prior to starting IS.▫Influenza‣Each respiratory virus season, those receiving IS should receive the inactivated influenza vaccine.‣Avoid giving the live intranasal vaccine to theimmunosuppressed patient and their close contacts as this canlead to transmission of the attenuated influenza strain.‣If a live, intranasal vaccine is given to a household/closecontact, the immunosuppressed individual should avoid thevaccine recipient for 7 days at minimum after receiving thevaccine.•Fungi▫Endemic fungi have the potential to reactivate in the setting of IS.▫Fungi of concern: Coccidiomycosis, Histoplasma, Blastomycoses, Cryptococcus, Pneumocystis jirovecii (PJP), Aspergillus.▫Exposure to endemic fungi should be determined based upon history acquired from patient (see exposure history above).▫Based upon historical information, send serum for Coccidiomycosis antibodies and/or Histoplasmaantibodies to determine if evidence of prior infection.‣If a patient presents with fever and pulmonary symptoms, it may be necessary to rule out active/acute hisotplasmosis - send urine Histoplasmaantigen.▫If determined as necessary based upon history obtained regarding occupational and hobbies exposures, send cryptococcal antigen to determine if any evidence of active cryptococcal infection exists/is present prior to starting IS.‣If positive, would delay initiation of IS by at least 4-6 weeks, during which time, the patient should receive the appropriate work up and treatment foractive cryptococcus.▫PJP prophylaxis: Treatment with either steroids (20mg or greater (or the equivalent) for longer than 2 weeks), a biologic or an immunomodulatory agent requires PJP prophylaxis.‣First line: Bactrim 1 SS tab po daily or 1 DS tab po qMWF‣Second line: Dapsone 100mg po daily‣If using dapsone, would check G6PD levels prior to starting.If deficient should avoid dapsone for risk of developinghemolytic anemia‣In pediatric patients, IV pentamidine is often used as a secondline agent.‣Third line: Atovaquone 750mg po twice-daily or inhaled pentamidine •Parasitic infections▫Risks depend on historical data acquired from the patient‣It is important to obtain a travel history as well as a history of areas of residence over one’s lifetime▫Strongyloidesis ubiquitous on all continents, except Antarctica. It is most commonly found in the tropics, subtropics, and in warm temperate regions (such as Southeast Asia and rural Appalachia)▫If traveled or lived in a strongyloides endemic area, would send strongylides IgG.‣If positive, then patient is at risk for strongyloides hyperinfection syndrome while on IS.‣Thus if positive, treat with Ivermectin 200mcg/kg po x 2 doses (each dose given 2 weeks apart). Treatment should be completed prior to starting IS. Vaccinations•All patients should undergo a thorough vaccination history with documentation ofvaccinations, if possible.•Based upon small studies, patients with chronic immunologic diseases will respond to vaccinations and produce adequate antibodies.▫Vaccinations in these populations is not a risk factor for flare of clinical disease.•All vaccinations that require updating or boosters as per the CDC Adult Immunization Schedule should be administered prior to starting IS.[2]▫Any killed (inactivated) vaccine should be given at least 2 weeks prior to starting any IS.▫Any live vaccinations should be given at least 4-6 weeks prior to starting any IS.▫All live vaccines in the immunosuppressed individual should be avoided after IS has begun.▫Live vaccinations in household/close contacts:‣As noted above, influenza live vaccine (intranasal) can be given to household/close contacts if needed, but should be avoided when possible.‣If given, the immunosuppressed individual should avoid thevaccinated recipient for 7 days at minimum after receiving thevaccine.‣VZV and MMR vaccines can be given to household/close contacts of immunosuppressed individuals.[4]‣If a VZV vaccine (ZOSTA V AX, V ARIV AX or PROQUAD) isgiven and a herpetic lesion/rash develops at the site ofvaccination, the immunosuppressed individual should avoidcontact with the VZV vaccine recipient until the lesion hasfully healed.‣Rotavirus vaccine can be given, but immunosuppressed individuals should avoid changing diapers for at least 14 days after vaccination hasbeen given.‣Oral polio vaccine should not be given under any circumstances to household or close contacts.‣Live typhoid and yellow fever vaccines can be given to household/close contacts.▫Tetanus and diphtheria (Td) vaccine should be given once ever 10 years, with the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) given at least once during this period.▫Travel vaccinations should be given under the direction of a Travel Medicine or Infectious Diseases specialist.‣In some instances avoidance of travel may be necessary while on IS. OTHER INFORMATIONMonitoring while on immunosuppressive therapy[19]•Patient education is vital for the prevention and treatment of infections while on IS.•Patients should be counseled about monitoring for the development of infections while receiving immunosuppressive therapies.▫Fever is often the first and only sign of a serious infectious complication.•Vaccinations should remain up to date.•Routine CBC should be monitored while on IS.If neutropenia and/or lymphopenia develop, this will increase one’s risk for infectious complications.。
医院医疗卫生英语大全
公共场所双语标识英文译法（医疗卫生部分）1 范围DB11/T 334本部分规定了北京市医疗卫生双语标识英文译法的原则。
本部分适用于医疗卫生场所中的英文标识译法。
2 规范性引用文件下列文件中的条款通过本部分的引用而成为本部分的条款。
凡是注日期的引用文件，其随后所有的修改单（不包括勘误的内容）或修订版均不适用于本部分,然而，鼓励根据本部分达成协议的各方研究是否可使用这些文件的最新版本。
凡是不注日期的引用文件，其最新版本适用于本部分。
GB/T 16159 汉语拼音正词法基本规则3 术语和定义下列术语和定义适用于本部分。
3.1 医疗卫生health and medicine医疗卫生是指以医疗、预防、保健、医疗教育和科研工作为功能，由不同层次的医疗卫生机构组成。
4 分类4.1 医疗卫生的英语标识按内容可分为：警示提示信息、功能设施信息。
4.2 其中功能设施信息分为：通用信息、医院系统信息、疾病预防控制中心系统信息、急救中心系统信息、血液中心系统信息。
4.3 警示提示信息见附录A.1。
4.4 通用信息见附录A.2.1，医院系统信息见附录A.2.2，血液中心系统信息见附录A.2.3，疾病预防控制中心系统信息见附录A.2.4。
5 要求5.1 警示提示信息译法原则按照本标准第0部分的规定。
5.2 功能设施信息5.2.1 国际通用功能设施采用相应的英文词语，如医院Hospital、疾病预防控制中心Center for Disease Prevention and Control (CDC)、诊室Consulting Room、血液中心Blood Center、卫生监督所Health Inspection Institute。
5.2.2 医疗卫生标志上的地名通常采用汉语拼音标注，汉语拼音用法应符合GB/T 16159的要求，如宣武医院Xuanwu Hospital；已经被社会普遍接受的单位名称，如协和医院Peking Union Medical College Hospital，可延续此用法。
医学常用治疗方法英语翻译
医学常用治疗方法英语翻译In this article, we will explore commonly used medical treatment methods and provide their English translations. Please note that the following translations are provided for reference purposes and may vary depending on the context and usage.1. Hand washing: 手部洗净Hand washing is a fundamental practice in preventing the spread of infections. It involves using soap and water to clean the hands thoroughly.2. Vaccination: 接种疫苗Vaccination is the administration of vaccines to stimulate the immune system and provide protection against specific diseases. It helps prevent illness and reduce the spread of infectious agents.3. Antibiotics: 抗生素Antibiotics are medications used to treat bacterial infections. They work by inhibiting the growth or destroying bacteria, effectively treating the infection.4. Chemotherapy: 化疗Chemotherapy is a cancer treatment that uses drugs to destroy cancer cells. It can be administered orally or intravenously, and sometimes in combination with other treatments.5. Radiation therapy: 放射治疗Radiation therapy uses high-energy radiation to destroy cancer cells and shrink tumors. It can be delivered externally or internally, depending on the cancer type and location.6. Surgery: 手术Surgery is a medical procedure that involves an incision or manipulation of tissues to treat a condition or disease. It can be performed for various purposes, including removing tumors, repairing injuries, or correcting abnormalities.7. Physical therapy: 物理治疗Physical therapy is a rehabilitation treatment that focuses on improving mobility, function, and quality of life. It includes exercises, manual therapy, and other techniques to address musculoskeletal issues.8. Psychotherapy: 心理治疗Psychotherapy, also known as talk therapy, is a treatment that aims to improve mental health and well-being. It involves speaking with a trained therapist to explore thoughts, emotions, and behaviors.9. Acupuncture: 针灸疗法Acupuncture is an alternative medical practice originating from traditional Chinese medicine. It involves inserting thin needles into specific points on the body to relieve pain or treat various conditions.10. Herbal medicine: 中草药Herbal medicine utilizes plants and plant extracts to treat illnesses and promote overall health. Different herbs are used to target specific symptoms or imbalances in the body.11. Homeopathy: 顺势疗法Homeopathy is a system of alternative medicine that uses highly diluted substances to stimulate the body's self-healing abilities. It operates on the principle that "like cures like."12. Massage therapy: 按摩疗法Massage therapy involves manipulating muscles, soft tissues, and joints to promote relaxation and relieve tension. It can be used for pain management, stress reduction, and improving circulation.13. Herbal tea: 草药茶Herbal tea is an infusion of herbs, flowers, or other plant materials in hot water. Different herbs offer various benefits, such as reducing inflammation, aiding digestion, or promoting relaxation.14. Meditation: 冥想Meditation is a practice that involves focusing the mind to achieve mental clarity and calmness. It can help reduce stress, enhance self-awareness, and promote overall well-being.15. Yoga: 瑜伽Yoga is a mind-body practice that combines physical postures, breathing exercises, and meditation. It promotes flexibility, strength, and relaxation while improving mental and emotional well-being.Conclusion:These are some commonly used medical treatment methods and their English translations. It's important to consult with medical professionals to determine the most appropriate treatment for specific conditions. Remember, this article provides translations for reference purposes and may not always capture the full meaning or nuances of the original terms.。
治疗疾病和疼痛英语作文
In the realm of medical science,the treatment of diseases and pain has always been a central focus.The goal is to alleviate the suffering of patients and improve their quality of life.Heres a detailed essay on the subject:Title:The Treatment of Diseases and PainIntroductionDiseases and pain are inevitable aspects of human life.They can range from minor discomforts to lifethreatening conditions.The medical field has made significant strides in understanding and treating various ailments,aiming to reduce the impact of these health issues on individuals and society.DiagnosisThe first step in treating any disease or pain is accurate diagnosis.Modern medicine utilizes a variety of diagnostic tools and techniques,such as blood tests,imaging studies like Xrays,MRI,and CT scans,and biopsies,to identify the root cause of a patients symptoms.Early and precise diagnosis is crucial for effective treatment. Pharmacological TreatmentsMedications are a primary method for treating diseases and managing pain. Pharmaceuticals can be classified into various categories,including analgesics for pain relief,antibiotics for bacterial infections,antivirals for viral infections,and chemotherapy drugs for cancer treatment.The development of new drugs is an ongoing process,with researchers constantly seeking more effective and less harmful treatments.Surgical InterventionsIn some cases,diseases or conditions that cause pain may require surgical intervention. Surgeons use various techniques to remove,repair,or replace damaged tissues and organs. Advances in surgical technology,such as minimally invasive procedures and robotic surgery,have improved patient outcomes and reduced recovery times.Physical Therapy and RehabilitationFor patients recovering from injuries or surgeries,or those living with chronic pain, physical therapy and rehabilitation play a vital role.These treatments help restore function,improve mobility,and manage pain through exercises,stretches,and othertherapeutic activities.Complementary and Alternative Medicine CAMIn addition to conventional treatments,many patients seek complementary and alternative medicine for pain management and disease treatment.This includes practices such as acupuncture,massage therapy,herbal medicine,and meditation.While the efficacy of these treatments can vary,they are often used in conjunction with traditional medical care to enhance overall wellbeing.Pain ManagementPain management is a specialized field focusing on the relief of pain and improvement of a patients functional capacity.It involves a multidisciplinary approach,combining pharmacological,interventional,and nonpharmacological methods tailored to the individuals needs.Preventive MeasuresPrevention is a key aspect of reducing the incidence of diseases and the associated pain. This includes vaccination programs,public health initiatives,and individual lifestyle choices such as a balanced diet,regular exercise,and avoiding harmful behaviors like smoking and excessive alcohol consumption.ConclusionThe treatment of diseases and pain is a complex and evolving field.It requires a combination of medical expertise,technological advancements,and patientcentered care. As our understanding of the human body and the causes of diseases continues to grow,so too does our ability to provide effective treatments that improve the lives of those affected by illness and pain.。
专八英语阅读
英语专业八级考试TEM-8阅读理解练习册（1）(英语专业2012级)UNIT 1Text AEvery minute of every day, what ecologist生态学家James Carlton calls a global ―conveyor belt‖, redistributes ocean organisms生物.It’s planetwide biological disruption生物的破坏that scientists have barely begun to understand.Dr. Carlton —an oceanographer at Williams College in Williamstown,Mass.—explains that, at any given moment, ―There are several thousand marine species traveling… in the ballast water of ships.‖ These creatures move from coastal waters where they fit into the local web of life to places where some of them could tear that web apart. This is the larger dimension of the infamous无耻的，邪恶的invasion of fish-destroying, pipe-clogging zebra mussels有斑马纹的贻贝.Such voracious贪婪的invaders at least make their presence known. What concerns Carlton and his fellow marine ecologists is the lack of knowledge about the hundreds of alien invaders that quietly enter coastal waters around the world every day. Many of them probably just die out. Some benignly亲切地，仁慈地—or even beneficially — join the local scene. But some will make trouble.In one sense, this is an old story. Organisms have ridden ships for centuries. They have clung to hulls and come along with cargo. What’s new is the scale and speed of the migrations made possible by the massive volume of ship-ballast water压载水— taken in to provide ship stability—continuously moving around the world…Ships load up with ballast water and its inhabitants in coastal waters of one port and dump the ballast in another port that may be thousands of kilometers away. A single load can run to hundreds of gallons. Some larger ships take on as much as 40 million gallons. The creatures that come along tend to be in their larva free-floating stage. When discharged排出in alien waters they can mature into crabs, jellyfish水母, slugs鼻涕虫，蛞蝓, and many other forms.Since the problem involves coastal species, simply banning ballast dumps in coastal waters would, in theory, solve it. Coastal organisms in ballast water that is flushed into midocean would not survive. Such a ban has worked for North American Inland Waterway. But it would be hard to enforce it worldwide. Heating ballast water or straining it should also halt the species spread. But before any such worldwide regulations were imposed, scientists would need a clearer view of what is going on.The continuous shuffling洗牌of marine organisms has changed the biology of the sea on a global scale. It can have devastating effects as in the case of the American comb jellyfish that recently invaded the Black Sea. It has destroyed that sea’s anchovy鳀鱼fishery by eating anchovy eggs. It may soon spread to western and northern European waters.The maritime nations that created the biological ―conveyor belt‖ should support a coordinated international effort to find out what is going on and what should be done about it. (456 words)1.According to Dr. Carlton, ocean organism‟s are_______.A.being moved to new environmentsB.destroying the planetC.succumbing to the zebra musselD.developing alien characteristics2.Oceanographers海洋学家are concerned because_________.A.their knowledge of this phenomenon is limitedB.they believe the oceans are dyingC.they fear an invasion from outer-spaceD.they have identified thousands of alien webs3.According to marine ecologists, transplanted marinespecies____________.A.may upset the ecosystems of coastal watersB.are all compatible with one anotherC.can only survive in their home watersD.sometimes disrupt shipping lanes4.The identified cause of the problem is_______.A.the rapidity with which larvae matureB. a common practice of the shipping industryC. a centuries old speciesD.the world wide movement of ocean currents5.The article suggests that a solution to the problem__________.A.is unlikely to be identifiedB.must precede further researchC.is hypothetically假设地，假想地easyD.will limit global shippingText BNew …Endangered‟ List Targets Many US RiversIt is hard to think of a major natural resource or pollution issue in North America today that does not affect rivers.Farm chemical runoff残渣, industrial waste, urban storm sewers, sewage treatment, mining, logging, grazing放牧,military bases, residential and business development, hydropower水力发电,loss of wetlands. The list goes on.Legislation like the Clean Water Act and Wild and Scenic Rivers Act have provided some protection, but threats continue.The Environmental Protection Agency (EPA) reported yesterday that an assessment of 642,000 miles of rivers and streams showed 34 percent in less than good condition. In a major study of the Clean Water Act, the Natural Resources Defense Council last fall reported that poison runoff impairs损害more than 125,000 miles of rivers.More recently, the NRDC and Izaak Walton League warned that pollution and loss of wetlands—made worse by last year’s flooding—is degrading恶化the Mississippi River ecosystem.On Tuesday, the conservation group保护组织American Rivers issued its annual list of 10 ―endangered‖ and 20 ―threatened‖ rivers in 32 states, the District of Colombia, and Canada.At the top of the list is the Clarks Fork of the Yellowstone River, whereCanadian mining firms plan to build a 74-acre英亩reservoir水库，蓄水池as part of a gold mine less than three miles from Yellowstone National Park. The reservoir would hold the runoff from the sulfuric acid 硫酸used to extract gold from crushed rock.―In the event this tailings pond failed, the impact to th e greater Yellowstone ecosystem would be cataclysmic大变动的，灾难性的and the damage irreversible不可逆转的.‖ Sen. Max Baucus of Montana, chairman of the Environment and Public Works Committee, wrote to Noranda Minerals Inc., an owner of the ― New World Mine‖.Last fall, an EPA official expressed concern about the mine and its potential impact, especially the plastic-lined storage reservoir. ― I am unaware of any studies evaluating how a tailings pond尾矿池，残渣池could be maintained to ensure its structural integrity forev er,‖ said Stephen Hoffman, chief of the EPA’s Mining Waste Section. ―It is my opinion that underwater disposal of tailings at New World may present a potentially significant threat to human health and the environment.‖The results of an environmental-impact statement, now being drafted by the Forest Service and Montana Department of State Lands, could determine the mine’s future…In its recent proposal to reauthorize the Clean Water Act, the Clinton administration noted ―dramatically improved water quality since 1972,‖ when the act was passed. But it also reported that 30 percent of riverscontinue to be degraded, mainly by silt泥沙and nutrients from farm and urban runoff, combined sewer overflows, and municipal sewage城市污水. Bottom sediments沉积物are contaminated污染in more than 1,000 waterways, the administration reported in releasing its proposal in January. Between 60 and 80 percent of riparian corridors (riverbank lands) have been degraded.As with endangered species and their habitats in forests and deserts, the complexity of ecosystems is seen in rivers and the effects of development----beyond the obvious threats of industrial pollution, municipal waste, and in-stream diversions改道to slake消除the thirst of new communities in dry regions like the Southwes t…While there are many political hurdles障碍ahead, reauthorization of the Clean Water Act this year holds promise for US rivers. Rep. Norm Mineta of California, who chairs the House Committee overseeing the bill, calls it ―probably the most important env ironmental legislation this Congress will enact.‖ (553 words)6.According to the passage, the Clean Water Act______.A.has been ineffectiveB.will definitely be renewedC.has never been evaluatedD.was enacted some 30 years ago7.“Endangered” rivers are _________.A.catalogued annuallyB.less polluted than ―threatened rivers‖C.caused by floodingD.adjacent to large cities8.The “cataclysmic” event referred to in paragraph eight would be__________.A. fortuitous偶然的，意外的B. adventitious外加的，偶然的C. catastrophicD. precarious不稳定的，危险的9. The owners of the New World Mine appear to be______.A. ecologically aware of the impact of miningB. determined to construct a safe tailings pondC. indifferent to the concerns voiced by the EPAD. willing to relocate operations10. The passage conveys the impression that_______.A. Canadians are disinterested in natural resourcesB. private and public environmental groups aboundC. river banks are erodingD. the majority of US rivers are in poor conditionText CA classic series of experiments to determine the effects ofoverpopulation on communities of rats was reported in February of 1962 in an article in Scientific American. The experiments were conducted by a psychologist, John B. Calhoun and his associates. In each of these experiments, an equal number of male and female adult rats were placed in an enclosure and given an adequate supply of food, water, and other necessities. The rat populations were allowed to increase. Calhoun knew from experience approximately how many rats could live in the enclosures without experiencing stress due to overcrowding. He allowed the population to increase to approximately twice this number. Then he stabilized the population by removing offspring that were not dependent on their mothers. He and his associates then carefully observed and recorded behavior in these overpopulated communities. At the end of their experiments, Calhoun and his associates were able to conclude that overcrowding causes a breakdown in the normal social relationships among rats, a kind of social disease. The rats in the experiments did not follow the same patterns of behavior as rats would in a community without overcrowding.The females in the rat population were the most seriously affected by the high population density: They showed deviant异常的maternal behavior; they did not behave as mother rats normally do. In fact, many of the pups幼兽，幼崽, as rat babies are called, died as a result of poor maternal care. For example, mothers sometimes abandoned their pups,and, without their mothers' care, the pups died. Under normal conditions, a mother rat would not leave her pups alone to die. However, the experiments verified that in overpopulated communities, mother rats do not behave normally. Their behavior may be considered pathologically 病理上，病理学地diseased.The dominant males in the rat population were the least affected by overpopulation. Each of these strong males claimed an area of the enclosure as his own. Therefore, these individuals did not experience the overcrowding in the same way as the other rats did. The fact that the dominant males had adequate space in which to live may explain why they were not as seriously affected by overpopulation as the other rats. However, dominant males did behave pathologically at times. Their antisocial behavior consisted of attacks on weaker male,female, and immature rats. This deviant behavior showed that even though the dominant males had enough living space, they too were affected by the general overcrowding in the enclosure.Non-dominant males in the experimental rat communities also exhibited deviant social behavior. Some withdrew completely; they moved very little and ate and drank at times when the other rats were sleeping in order to avoid contact with them. Other non-dominant males were hyperactive; they were much more active than is normal, chasing other rats and fighting each other. This segment of the rat population, likeall the other parts, was affected by the overpopulation.The behavior of the non-dominant males and of the other components of the rat population has parallels in human behavior. People in densely populated areas exhibit deviant behavior similar to that of the rats in Calhoun's experiments. In large urban areas such as New York City, London, Mexican City, and Cairo, there are abandoned children. There are cruel, powerful individuals, both men and women. There are also people who withdraw and people who become hyperactive. The quantity of other forms of social pathology such as murder, rape, and robbery also frequently occur in densely populated human communities. Is the principal cause of these disorders overpopulation? Calhoun’s experiments suggest that it might be. In any case, social scientists and city planners have been influenced by the results of this series of experiments.11. Paragraph l is organized according to__________.A. reasonsB. descriptionC. examplesD. definition12．Calhoun stabilized the rat population_________.A. when it was double the number that could live in the enclosure without stressB. by removing young ratsC. at a constant number of adult rats in the enclosureD. all of the above are correct13.W hich of the following inferences CANNOT be made from theinformation inPara. 1?A. Calhoun's experiment is still considered important today.B. Overpopulation causes pathological behavior in rat populations.C. Stress does not occur in rat communities unless there is overcrowding.D. Calhoun had experimented with rats before.14. Which of the following behavior didn‟t happen in this experiment?A. All the male rats exhibited pathological behavior.B. Mother rats abandoned their pups.C. Female rats showed deviant maternal behavior.D. Mother rats left their rat babies alone.15. The main idea of the paragraph three is that __________.A. dominant males had adequate living spaceB. dominant males were not as seriously affected by overcrowding as the otherratsC. dominant males attacked weaker ratsD. the strongest males are always able to adapt to bad conditionsText DThe first mention of slavery in the statutes法令，法规of the English colonies of North America does not occur until after 1660—some forty years after the importation of the first Black people. Lest we think that existed in fact before it did in law, Oscar and Mary Handlin assure us, that the status of B lack people down to the 1660’s was that of servants. A critique批判of the Handlins’ interpretation of why legal slavery did not appear until the 1660’s suggests that assumptions about the relation between slavery and racial prejudice should be reexamined, and that explanation for the different treatment of Black slaves in North and South America should be expanded.The Handlins explain the appearance of legal slavery by arguing that, during the 1660’s, the position of white servants was improving relative to that of black servants. Thus, the Handlins contend, Black and White servants, heretofore treated alike, each attained a different status. There are, however, important objections to this argument. First, the Handlins cannot adequately demonstrate that t he White servant’s position was improving, during and after the 1660’s; several acts of the Maryland and Virginia legislatures indicate otherwise. Another flaw in the Handlins’ interpretation is their assumption that prior to the establishment of legal slavery there was no discrimination against Black people. It is true that before the 1660’s Black people were rarely called slaves. But this shouldnot overshadow evidence from the 1630’s on that points to racial discrimination without using the term slavery. Such discrimination sometimes stopped short of lifetime servitude or inherited status—the two attributes of true slavery—yet in other cases it included both. The Handlins’ argument excludes the real possibility that Black people in the English colonies were never treated as the equals of White people.The possibility has important ramifications后果，影响.If from the outset Black people were discriminated against, then legal slavery should be viewed as a reflection and an extension of racial prejudice rather than, as many historians including the Handlins have argued, the cause of prejudice. In addition, the existence of discrimination before the advent of legal slavery offers a further explanation for the harsher treatment of Black slaves in North than in South America. Freyre and Tannenbaum have rightly argued that the lack of certain traditions in North America—such as a Roman conception of slavery and a Roman Catholic emphasis on equality— explains why the treatment of Black slaves was more severe there than in the Spanish and Portuguese colonies of South America. But this cannot be the whole explanation since it is merely negative, based only on a lack of something. A more compelling令人信服的explanation is that the early and sometimes extreme racial discrimination in the English colonies helped determine the particular nature of the slavery that followed. (462 words)16. Which of the following is the most logical inference to be drawn from the passage about the effects of “several acts of the Maryland and Virginia legislatures” (Para.2) passed during and after the 1660‟s?A. The acts negatively affected the pre-1660’s position of Black as wellas of White servants.B. The acts had the effect of impairing rather than improving theposition of White servants relative to what it had been before the 1660’s.C. The acts had a different effect on the position of white servants thandid many of the acts passed during this time by the legislatures of other colonies.D. The acts, at the very least, caused the position of White servants toremain no better than it had been before the 1660’s.17. With which of the following statements regarding the status ofBlack people in the English colonies of North America before the 1660‟s would the author be LEAST likely to agree?A. Although black people were not legally considered to be slaves,they were often called slaves.B. Although subject to some discrimination, black people had a higherlegal status than they did after the 1660’s.C. Although sometimes subject to lifetime servitude, black peoplewere not legally considered to be slaves.D. Although often not treated the same as White people, black people,like many white people, possessed the legal status of servants.18. According to the passage, the Handlins have argued which of thefollowing about the relationship between racial prejudice and the institution of legal slavery in the English colonies of North America?A. Racial prejudice and the institution of slavery arose simultaneously.B. Racial prejudice most often the form of the imposition of inheritedstatus, one of the attributes of slavery.C. The source of racial prejudice was the institution of slavery.D. Because of the influence of the Roman Catholic Church, racialprejudice sometimes did not result in slavery.19. The passage suggests that the existence of a Roman conception ofslavery in Spanish and Portuguese colonies had the effect of _________.A. extending rather than causing racial prejudice in these coloniesB. hastening the legalization of slavery in these colonies.C. mitigating some of the conditions of slavery for black people in these coloniesD. delaying the introduction of slavery into the English colonies20. The author considers the explanation put forward by Freyre andTannenbaum for the treatment accorded B lack slaves in the English colonies of North America to be _____________.A. ambitious but misguidedB. valid有根据的but limitedC. popular but suspectD. anachronistic过时的，时代错误的and controversialUNIT 2Text AThe sea lay like an unbroken mirror all around the pine-girt, lonely shores of Orr’s Island. Tall, kingly spruce s wore their regal王室的crowns of cones high in air, sparkling with diamonds of clear exuded gum流出的树胶; vast old hemlocks铁杉of primeval原始的growth stood darkling in their forest shadows, their branches hung with long hoary moss久远的青苔;while feathery larches羽毛般的落叶松,turned to brilliant gold by autumn frosts, lighted up the darker shadows of the evergreens. It was one of those hazy朦胧的, calm, dissolving days of Indian summer, when everything is so quiet that the fainest kiss of the wave on the beach can be heard, and white clouds seem to faint into the blue of the sky, and soft swathing一长条bands of violet vapor make all earth look dreamy, and give to the sharp, clear-cut outlines of the northern landscape all those mysteries of light and shade which impart such tenderness to Italian scenery.The funeral was over,--- the tread鞋底的花纹/ 踏of many feet, bearing the heavy burden of two broken lives, had been to the lonely graveyard, and had come back again,--- each footstep lighter and more unconstrained不受拘束的as each one went his way from the great old tragedy of Death to the common cheerful of Life.The solemn black clock stood swaying with its eternal ―tick-tock, tick-tock,‖ in the kitchen of the brown house on Orr’s Island. There was there that sense of a stillness that can be felt,---such as settles down on a dwelling住处when any of its inmates have passed through its doors for the last time, to go whence they shall not return. The best room was shut up and darkened, with only so much light as could fall through a little heart-shaped hole in the window-shutter,---for except on solemn visits, or prayer-meetings or weddings, or funerals, that room formed no part of the daily family scenery.The kitchen was clean and ample, hearth灶台, and oven on one side, and rows of old-fashioned splint-bottomed chairs against the wall. A table scoured to snowy whiteness, and a little work-stand whereon lay the Bible, the Missionary Herald, and the Weekly Christian Mirror, before named, formed the principal furniture. One feature, however, must not be forgotten, ---a great sea-chest水手用的储物箱,which had been the companion of Zephaniah through all the countries of the earth. Old, and battered破旧的，磨损的, and unsightly难看的it looked, yet report said that there was good store within which men for the most part respect more than anything else; and, indeed it proved often when a deed of grace was to be done--- when a woman was suddenly made a widow in a coast gale大风，狂风, or a fishing-smack小渔船was run down in the fogs off the banks, leaving in some neighboring cottage a family of orphans,---in all such cases, the opening of this sea-chest was an event of good omen 预兆to the bereaved丧亲者;for Zephaniah had a large heart and a large hand, and was apt有…的倾向to take it out full of silver dollars when once it went in. So the ark of the covenant约柜could not have been looked on with more reverence崇敬than the neighbours usually showed to Captain Pennel’s sea-chest.1. The author describes Orr‟s Island in a(n)______way.A.emotionally appealing, imaginativeB.rational, logically preciseC.factually detailed, objectiveD.vague, uncertain2.According to the passage, the “best room”_____.A.has its many windows boarded upB.has had the furniture removedC.is used only on formal and ceremonious occasionsD.is the busiest room in the house3.From the description of the kitchen we can infer that thehouse belongs to people who_____.A.never have guestsB.like modern appliancesC.are probably religiousD.dislike housework4.The passage implies that_______.A.few people attended the funeralB.fishing is a secure vocationC.the island is densely populatedD.the house belonged to the deceased5.From the description of Zephaniah we can see thathe_________.A.was physically a very big manB.preferred the lonely life of a sailorC.always stayed at homeD.was frugal and saved a lotText BBasic to any understanding of Canada in the 20 years after the Second World War is the country' s impressive population growth. For every three Canadians in 1945, there were over five in 1966. In September 1966 Canada's population passed the 20 million mark. Most of this surging growth came from natural increase. The depression of the 1930s and the war had held back marriages, and the catching-up process began after 1945. The baby boom continued through the decade of the 1950s, producing a population increase of nearly fifteen percent in the five years from 1951 to 1956. This rate of increase had been exceeded only once before in Canada's history, in the decade before 1911 when the prairies were being settled. Undoubtedly, the good economic conditions of the 1950s supported a growth in the population, but the expansion also derived from a trend toward earlier marriages and an increase in the average size of families; In 1957 the Canadian birth rate stood at 28 per thousand, one of the highest in the world. After the peak year of 1957, thebirth rate in Canada began to decline. It continued falling until in 1966 it stood at the lowest level in 25 years. Partly this decline reflected the low level of births during the depression and the war, but it was also caused by changes in Canadian society. Young people were staying at school longer, more women were working; young married couples were buying automobiles or houses before starting families; rising living standards were cutting down the size of families. It appeared that Canada was once more falling in step with the trend toward smaller families that had occurred all through theWestern world since the time of the Industrial Revolution. Although the growth in Canada’s population had slowed down by 1966 (the cent), another increase in the first half of the 1960s was only nine percent), another large population wave was coming over the horizon. It would be composed of the children of the children who were born during the period of the high birth rate prior to 1957.6. What does the passage mainly discuss?A. Educational changes in Canadian society.B. Canada during the Second World War.C. Population trends in postwar Canada.D. Standards of living in Canada.7. According to the passage, when did Canada's baby boom begin?A. In the decade after 1911.B. After 1945.C. During the depression of the 1930s.D. In 1966.8. The author suggests that in Canada during the 1950s____________.A. the urban population decreased rapidlyB. fewer people marriedC. economic conditions were poorD. the birth rate was very high9. When was the birth rate in Canada at its lowest postwar level?A. 1966.B. 1957.C. 1956.D. 1951.10. The author mentions all of the following as causes of declines inpopulation growth after 1957 EXCEPT_________________.A. people being better educatedB. people getting married earlierC. better standards of livingD. couples buying houses11.I t can be inferred from the passage that before the IndustrialRevolution_______________.A. families were largerB. population statistics were unreliableC. the population grew steadilyD. economic conditions were badText CI was just a boy when my father brought me to Harlem for the first time, almost 50 years ago. We stayed at the hotel Theresa, a grand brick structure at 125th Street and Seventh avenue. Once, in the hotel restaurant, my father pointed out Joe Louis. He even got Mr. Brown, the hotel manager, to introduce me to him, a bit punchy强力的but still champ焦急as fast as I was concerned.Much has changed since then. Business and real estate are booming. Some say a new renaissance is under way. Others decry责难what they see as outside forces running roughshod肆意践踏over the old Harlem. New York meant Harlem to me, and as a young man I visited it whenever I could. But many of my old haunts are gone. The Theresa shut down in 1966. National chains that once ignored Harlem now anticipate yuppie money and want pieces of this prime Manhattan real estate. So here I am on a hot August afternoon, sitting in a Starbucks that two years ago opened a block away from the Theresa, snatching抓取，攫取at memories between sips of high-priced coffee. I am about to open up a piece of the old Harlem---the New York Amsterdam News---when a tourist。
医学作文三个分论点
医学作文三个分论点【中英文版】英文文档：Medical Composition: Three SubtopicsThe field of medicine is vast and diverse, covering a wide range of topics that can be explored in a medical composition.When writing about medicine, it is important to choose a specific topic and develop three main subtopics that support the main theme.Here are three subtopics that can be used as a starting point for a medical composition:1.The importance of preventive healthcare: This subtopic can discuss the significance of preventive measures in reducing the burden of diseases.It can explore various preventive methods such as vaccination, regular health check-ups, and adopting a healthy lifestyle.2.The impact of technology on medical advancements: This subtopic can focus on how technology has revolutionized the field of medicine, leading to improved diagnostics, treatment, and patient care.It can discuss specific examples such as the use of artificial intelligence in diagnosing diseases or the role of telemedicine in providing healthcare services remotely.3.Ethical considerations in medical research: This subtopic can delve into the ethical dilemmas faced by medical researchers, including the balance between patient welfare and scientific progress.It can exploretopics such as informed consent, the use of animal testing, and the ethical implications of gene editing.中文文档：医学作文：三个分论点医学领域广泛而多样，涵盖了许多可以在医学作文中探讨的主题。
到澳大利亚旅游带药品申报流程
到澳大利亚旅游带药品申报流程1.抵达澳大利亚后，游客需要在海关填写入境申报表。
Upon arrival in Australia, tourists need to fill in an arrival declaration form at the customs.2.申报表上需要填写携带的药品信息。
The declaration form requires information about the medications being carried.3.游客需要提供药品的名称、数量和用途等信息。
Tourists need to provide information about the name, quantity, and purpose of the medications.4.对于处方药，游客需要提供医生处方和药品包装上的标签。
For prescription medications, tourists need to provide a doctor's prescription and the medication's packaging label.5.非处方药也需要进行申报，包括药品名称和数量。
Over-the-counter medications also need to be declared, including the name and quantity of the medications.6.如果游客携带大量药品或特殊药品，可能需要提供进一步的证明文件。
If tourists are carrying a large quantity of medications or special medications, they may need to provide further documentation.7.申报药品的目的是确保游客携带的药品符合澳大利亚的进口规定。
考研英语翻译模拟试卷76_真题-无答案
考研英语（翻译）模拟试卷76(总分60,考试时间90分钟)2. Reading ComprehensionSection II Reading ComprehensionPart CDirections: Read the following text carefully and then translate the underlined segments into Chinese.The technological revolutions of the last two decades have placed a severe burden on the concept of technology transfer. It is quite clear that the concept has serious limitations; with time, it is not at all clear that its methods have improved or its result progressed.【F1】The underlying assumption in "technology transfer" is that the application of new discoveries to the development of new technology through the developed countries produces results which are applicable to underdeveloped countries.Although this assumption has never really been put to a true global test, it is through now clear that this can not be the main means of technological progress in developing areas such as Africa South East Asian and Latin America, irrespective of its possible utility elsewhere.【F2】The question is whether such an outcome is inevitable and inherent in the process or whether it merely reflects the shortage of resources and improper management.It is my contention that "technology transfer" as a vehicle of progress for the developing countries is irreparably flawed and cannot succeed.【F3】The fundamental flaw is that "technology transfer" is cast in the die of a colonial process where through developed countries do things in ways that they find acceptable for their former colonies, the developing countries.Whether the development process is carried out through citizens of the recipient nation or not is irrelevant; the philosophy upon which "technology transfer" is based, beginning with training and ending with application, is composed of a set of socioculturally and economically determined values within the institutionalized fabric of science, which select the questions found to be meaningful, dictate the preferred research plans and evaluate the significance only of the results obtained.Clearly, technology based on the set of determinants is not likely to be very relevant to the vastly different economic and sociocultural conditions of developing countries. It will hardly get to the needs of the developing countries, perhaps even serving to slow progress.【F4】This situation must be replaced through a new process which might be called "basic knowledge transfer" as part of growth of a forefront science in the developing countries.This approach contains the following features:Given full access to new scientific discovery at the cutting edge of science, that is, at the region of high intensity transfer from basic to applied knowledge, the scientists of developing countries can create their own technology transfer from basic to applied. Scientists in the developing countries, in active dialogue with other elements such as government, community and industry, can identify and prioritize problems and develop a practical situation.【F5】The problem of internal "technology transfer" will require for each country or region a suitable number oftrained scientific specialists; means for maintaining **petency of these leaders will need to be developed through each nation or region.1. 【F1】2. 【F2】3. 【F3】4. 【F4】5. 【F5】【F1】When a disease of epidemic proportions rips into the populace, scientists immediately get to work, trying to locate the source of the affliction and find ways to combat it.Oftentimes, success is achieved, as medical science is able to isolate the parasite, germ or cell that causes the problem and finds ways to effectively kill or contain it. In the most serious of cases, in which the entire population of a region or country may be at grave risk, it is deemed necessary to protect the entire population through vaccination, so as to safeguard lives and ensure that the disease will not spread.【F2】The process of vaccination allows the patient's body to develop immunity to the virus or disease so that, if it is encountered, one can ward it off naturally.To accomplish this, a small weak or dead strain of the disease is actually injected into the patient in a controlled environment, so that his body's immune system can learn to fight the invader properly. Information on how to penetrate the disease' s defenses is transmitted to all elements of the patient's immune system in a process that occurs naturally, in which genetic information is passed from cell to cell.【F3】This makes sure that, should the patient **e into contact with the real problem, his body is well equipped and trained to deal with it, having already done so before.There are dangers inherent in the process, however.【F4】On occasion, even the weakened version of the disease contained in the vaccine proves too much for the body to handle, resulting in the immune system succumbing, and, therefore, the patient's death.【F5】Such is the case of the smallpox vaccine, designed to eradicate the smallpox epidemic that nearly wiped out the entire Native American population and killed massive numbers of settlers.Approximately 1 in 10, 000 people who receives the vaccine contract the smallpox disease from the vaccine itself and dies from it. Thus, if the entire population of the United States were to receive the Smallpox Vaccine today, 3, 000 Americans would be left dead.Fortunately, the smallpox virus was considered eradicated in the early 1970's, ending the mandatory vaccination of all babies in America. In the event of a re-introduction of the disease, however, mandatory vaccinations may resume, resulting in more unexpected deaths from vaccination. The process, which is truly a mixed blessing, may indeed hide some hidden curses.6. 【F1】7. 【F2】8. 【F3】9. 【F4】10. 【F5】【F1】The evolution of intelligence among early large mammals of the grasslands was due in great measure to the interaction between two ecologically synchronized groups of these animals, the hunting carnivores and the herbivores that they hunted.The interaction resulting from the differences between predator and prey led to a general improvement in brain functions; however, **ponents of intelligence were improved far more than others.【F2】The kind of intelligence favored by the interplay of increasingly smarter catchers and increasingly keener escapers is defined by attention—that aspect of mind carrying consciousness forward from one moment to thenext.It ranges from a passive free floating awareness to a highly focused, active fixation, the range through these states is mediated by the arousal system, a network of tracts converging from sensory systems to integrating centers in the brain stem. From the more relaxed to the more vigorous levels sensitivity to novelty is increased.【F3】The organism is more awake more vigilant, this increased vigilance results in the apprehension of ever more subtle signals as the organism becomes more sensitive to its surroundings.The processes of arousal and concentration give attention to its direction. Arousal is at first general with a flooding of impulses in the brain stem; then gradually the activation is channeled. Thus begins concentration, the holding of consistent images. One meaning of intelligence is the way in thigh these images and other alertly searched information are used in the context of previous experience. Consciousness links past attention to the present and permits the integration of details with perceived ends purposes.The elements of intelligence and **e together marvelously to produce different styles in predator and prey. Herbivores and carnivores develop different kinds of attention related to escaping or chasing.【F4】Although in both kinds of animal arousal stimulates the production of adrenaline and norepinephrine by the adrenal glands the effect in herbivores is primarily fear, whereas in carnivores the effect is primarily aggression.For both, arousal attunes the animal to what is ahead. Perhaps it does not experience forethought as we know it but the animal does experience something like it.The predator is searchingly aggressive inner directed, used by the nervous system and the adrenal hormones, but aware in a sense closer to human consciousness than, say, a hungry lizard' s instinctive snap at a passing beetle. The large mammal predator is working out a relationship between movement and food, sensitive to possibilities in cold trails and distant sounds and yesterday's unforgotten lessons. The herbivore bray is of a different mind.【F5】Its mood of wariness rather than searching and its attitude of general expectancy instead of anticipating are silk thin veils of tranquility over an explosive endocrine system.11. 【F1】12. 【F2】13. 【F3】14. 【F4】15. 【F5】It was the biggest scientific grudge match since the space race. The Genome Wars had everything: two groups with appealing leaders ready to fight in a scientific dead heat, pushing the limits of technology and rhetoric as they battled to become the first to read every last one of the 3 billion DNA "letters" in the human body.【F1】The scientific importance of the work is unquestionable, **pleted DNA sequence is expected to give scientists unprecedented insights into the workings of the human body, revolutionizing medicine and biology.But the race itself, between the government's Human Genome Project and Rockville, Md., **pany Celera Genomics, was at least partly symbolic, the public/private conflict played out in a genetic lab.Now the race is over. After years of public attacks and several failed attempts at reconciliation, the two sides are taking a step toward a period of calm. HGP head Francis Collins(and Ari Patrinos of the Department of Energy, an important ally on the government side)and Craig Venter, the founder of Celera, agreed to hold a joint press conference in Washington this Monday to declare that the race was over(sort of), that both sides had won(kind of)and that the hostilities were resolved(for the time being).No one is exactly sure how things will be different now.【F2】Neither side will be turning off its sequencing machines any time soon—the "finish lines" each has crossed are largely arbitrary points, "firstdrafts" rather than the definitive version.【F3】And while the joint announcement brings the former Genome Warriors closer together than they've been in years, insiders say that future agreements are more likely to take the form of coordination, rather than outright collaboration.The conflict blew up this February when Britain's **e Trust, an HGP participant, released a confidential letter to Celera outlining the HGP's complaints. Venter called the move "a lowlife thing to do." But by spring, there were the first signs of a thaw. "The attacks and nastiness are bad for science and our investors," Venter told Newsweek in March, "and fighting back is probably not helpful."【F4】At a cancer meeting earlier this month, Venter and Collins praised each other's approaches, and expressed hope that all of the scientists involved in sequencing the human genome would be able to share the credit.By late last week, that hope was becoming a reality as details for Monday's joint announcement were hammered out. Scientists in both camps welcomed an end to the hostilities. "If this ends the horse race, science wins."【F5】With their difference behind them, or at least set aside, the scientists should now be able to get down to the interesting stuff: figuring how to make use of all that data.16. 【F1】17. 【F2】18. 【F3】19. 【F4】20. 【F5】。
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• Investigation of patients after returning from tropics
WHO IS VACCINATING?
• • • • • Centers of travel medicine Departments of hygiene and epidemiology Deprtments of infectious diseases Departments of working medicine GPs
New conjugated vaccines: against type C
– NeisVac-C – polysaccharide C conjugated with tetanic toxoid (Aventis) – Meningitec – conjugated with diphteric toxoid (Weith) – Menomune – Menjugate – conjugated with diphteric toxoid (Chiron) Not used in travellers to tropics, where epidemic type A dominate Effective at least for 8 years, application at childern under 1 year possible
REQUARED TRAVEL VACCINATION
• Yellow fever • Meningococcal meningitis • Cholera
YELLOW FEVER DISRIBUTION
ŽLUTÁ ZIMNICE - ROZŠÍŘENÍ
ŽLUTÁ ZIMNICE - ROZŠÍŘENÍ
• RECOMMANDED
– Hepatitis A, B, Typhoid fever, Meningococcal meningitis, Rabies, Japanese B Encephalitis
• SPECIAL
– Influenza, Pneumococcus, TBE
GENERAL CONTRAINDICATIONS OF VACCINATION
• •
CHOLERA DISRIBUTION
CHOLERA
• • • • Not requiered by WHO Some countries may requiere (Tanzania, Kenia, Egypt, Saudy Arabi – travelers to Mekka a Medina) Inactivated, parenteral vaccines no more recommended (low effectivity, severe side effects) New oral vaccines for persons over 2 years
INTERNATIONAL CERTIFICATE OF VACCINATION
YELLOW FEVER
STAM ARIL
18 MAY 2008
29 MAY 2008
18 MAY 2018
Yellow Fever - Complications
SEVERE VISCEROTROPIC COMPLICATIONS ASSOCIATED WITH VACCINATION OF ELDERLY PERSONS (over 60 years) • 36 cases recorded (5 cases per 1 million vaccinated) since 1996 • Isolated virus of YF genetically identical with vaccination 17D strain • 2 – 8 days after vaccination; risc factors:
10%
10 000
Malaria (W. Africa, w/o proph.)
Acute respiratory infections 1% 1000
Hepatitis A Dengue (S.E. Asia) Gonorrhea Animal bites w. rabies risc Hepatitis B Typhoid fever (Indian Subcont.) HIV infection
Typhoid fever (other regions) Legionella Cholera Poliomyelitis Meningococcal infection
0.1%
100
Air evacuation
0.01%
10
Died abrod (chronicly ill)
0.001%
1
Died abrod (healthy)
ADVERSE EFFECTS OF VACCINATION
• Local reaction (pain, erythema in the aplication site) • General signs: featigue, head pain, muscle, joints pain, fever – increased body temperature • Alergic reaction – exanthema, cought, dyspnoe • Anaphylactic reaction (cave i.v. aplication!)
YELLOW FEVER VACCINE
• • • • • • • • • • STAMARIL (Aventis-Pasteur) Live, attenuated strain 17D cultured on the chick embryo (contains agg proteins (albumine – cave alergy!), developed in the 30-ties of 20 centure Lyophilized vaccine – aplication during 1 hour after dissolution - 0,5 ml s.c. Effective 10 days after application and for 10 years Aplikovat min. 4 týdny po jiné živé atenuované vakcíně, odstup minimálně 2 týdny, jestliže YF předchází jiné živé vakcíně Application together with polysaccharide typhoid Vi vaccine increases antibody production against YF Contraindications: pregnancy, immunosupression (HIV < 400 CD4), allergy to the egg proteins, neomycine, polymyxine, children under 6 – 9 months Side effects: local (pain at the application site); general (muscle pain, headache, flu-like symptoms 5-12 days after application, mild hepatitis) Indication: Tropical Africa and America; travellers from endemic regions to Asia, America, Meditteranien Application is noticed to the International Certificate of Vaccination
HEALTH PROBLEMS AFTER 1 MONTH STAY IN TROPICS
100% Travel diarrhea ETEC diarrhea
30 - 80%
100 000
Any health problem Subjectively ill felt Physicion consulted Steyed in bed Incapacity of work after ret. Stayed in hospital
TRAVEL MEDICINE AND TRAVEL VACCINATION
27.5.2015
TRAVEL MEDICINE
• Recommandation before travel to tropical countries
– – – – – – Compulsary and recommended vaccination Antimalarial prophylaxis Mosquito nets, repelents, insecticides Prophylaxis of travel diarrhea Other medical and health riscs Travel pharmacy
MENINGOCOCCAL VACCINE A + C (Aventis); MENCEVAX A+C (SKB)
• • Inactivated bivalent polysacharide vaccine Childern over 2 years, 1 dose, 0.5 ml s.c.; effective 10–14 days after application for 3 years
0.0001%
TRAVEL VACCINATION
• REQUARED (COMPULSARY)
– Yellow fever – Meningococcal meningitis, (Cholera)