READING TEST – 4

NOROVIRUS

Text A
Norovirus is a virus that is commonly known as the ‘Vomiting bug’ because vomiting is the main
symptom. It also causes diarrhoea and cannot be treated with antibiotics.

Most people do not have norovirus for very long but it can lead to complications in children,
sick people or elderly people.

Norovirus spreads very easily by eating food or drinking liquids that are contaminated with
norovirus; touching surfaces or objects contaminated with norovirus, and then placing their
hand in their mouth; having direct contact with another person who is infected and showing
symptoms (for example, when caring for someone with illness, or sharing foods or eating
utensils with someone who is ill).

Handwashing is the best way to stop the norovirus starting. It must be with handwashing with
soap and water not alcohol gels. Alcohol gels do not stop the spread of norovirus.

Text B
Signs and symptoms of norovirus are:

 Vomiting (being sick)

 Nausea (feeling sick)
 Diarrhoea (very, loose, frequent bowel movements)
 High temperature
 Headache
 Aching arms and legs

Managing norovirus

 People with signs and symptoms of norovirus must stay at home until 24 hours after
they had diarrhoea or vomiting.
 People can eat anything they want but it does not matter if they do not eat anything for
one or two days.
 Taking simple painkillers such as paracetamol can ease the fever and pain
 To stop spreading the virus everyone in the home :
must be very strict about washing their hand

 every time they go to the toilet

 every time they vomit
 before they prepare or handle food for others
 every time they help someone who has diarrhoea or vomiting

- thoroughly clean toilet areas and food preparation surfaces, using a bleach-based household
cleaner

- immediately remove and wash clothing or linens that may be contaminated with virus after an
episode of illness

 Rest is very important to help people get better

 Drinking fluids is the most important thing people need to do. If they do not drink, they
may become dehydrated. This can lead to them becoming very ill

If a person does become very dehydrated, they may need to be admitted to hospital and get
treated with intravenous fluids.

Text C
Looking after a baby or child with norovirus

 Most people suffer with the norovirus for one or two days and recover quickly. This
means they probably will not visit the doctor.
 Babies and young children can become very quickly dehydrated, due to diarrhoea and
vomiting so need close monitoring
 A baby should see a doctor if they have signs of dehydration, which includes :-

- sunken eyes

- a sunken soft spot (fontanelle) on a their head

- few or no tears when they cry

- a dry mouth

- fewer wet nappies

- dark yellow urine

- are less responsive than usual

- have a temperature

- have blood or mucus in their bowel motion

- A child should see a doctor for dehydration if they:

- are less responsive than usual

- have a temperature

- have blood or mucus in their bowel motion

- A child should see a doctor for dehydration if they:

- have dry, cracked lips and a dry mouth.

- do not pass as much urine as usual or none for eight to 12 hours,

- are drowsy or irritable.

- are very weak or limp.

- have no tears when crying.

 Other reasons why a child should see a doctor include if they have :

- 8 -10 watery bowel motions or 2-3 larger motions a day

- diarrhoea and vomiting at the same time - bowel motions have blood or mucus in them

- diarrhoea that lasts for longer than 10 days

TEXT D
Elderly person or people with a chronic illness and norovirus

 This group of people can become very ill if they have norovirus because they can
become dehydrated
 Signs and symptoms that an adult is dehydrated include:
- having a dry mouth and/or dry skin in the armpit
- a high heart rate (usually over 100 beats per minute)
- a low systolic blood pressure
 - weakness
- delirium (new or worse-than-usual confusion)
- sunken eyes
- passing urine less often
- dark - coloured urine
 Blood tests can be carried out to diagnose if the person is dehydrated and how badly

- the blood tests check to see if there is a:

- raised plasma serum osmolality

- raised creatinine and blood urea nitrogen

- electrolyte imbalances, such as abnormal levels of blood sodium

Questions 1-7
For each question, 1-7, decide which text (A, B, C or D) the information comes from. You may
use any letter more than once.

In which text can you find information about

1. signs of dehydration in babies?

2. how norovirus is transmitted between people?

3. what to use in the hand hygiene procedure?

4. what people can eat if they have norovirus?

5. cleaning surfaces?

6. the tests that might be done to see if a person is dehydrated?

7. how long a person with norovirus must stay at home for?

Questions 8-14
Answer each of the questions, 8-14, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both

8. What is most vital activity for people to do if they do have norovirus?

9. Does a majority of people have norovirus?

10. At how many beats per minute in an adult would the heart rate be considered high?

11. What is the medical term for feeling sick?

12. What is the best indicator that a person has norovirus?

13. What hospital treatment is likely to be started if a person is admitted with norovirus?

______________________________________________________________________________

14. What should hands be washed with if norovirus is infected with?

Questions 15-20
Complete each of the sentences, 15-20, with a word or short phrase from one of the texts.
Each answer may include words, numbers or both.

15. A person may need a ______________________ to see if they have an electrolyte

imbalance due to dehydration

16. A person with norovirus might have aching _______________

17. A doctor should be seen if a child has __________________ watery bowel motions a day.

18. People with norovirus can eat ________________________

19. Norovirus can lead to more serious conditions in children, ______________ or

______________people.

20. An adult is probably dehydrated if they have a ________________ blood pressure

 PART B
Blood cells could hold the key to understanding schizophrenia

Australian scientists have made a remarkable discovery about what is lurking in the brains of
people with schizophrenia, giving them new clues about what might cause the illness.

Using new molecular techniques, Professor Cyndi Shannon Weickert showed a particular type
of immune cell was causing inflammation in the brain. Her research found the cells could
"squeeze through the cracks in the blood - brain barrier" to get into tissues, and start affecting
how the brain functions. That was confirmed when she did blood tests on people with
schizophrenia. Those who were suffering psychosis had double the level of inammation
compared to patients who were not psychotic at the time of testing. @medcity "We can study
the white blood cells in living patients and try to find how this relates to their symptoms, their
hallucinations, their delusions and their cognitive problems," she said.

1. What discovery have scientists made about possible causes of schizophrenia?

A. Certain cells cannot move across the blood-brain barrier affecting how the brain
functions in relation to hallucinations and delusions.
B. Certain cells cause inflammation in the blood affecting how the brain functions in
relation to hallucinations and cognition.
C. Certain cells move from the blood into the brain to alter how it functions in relation
to cognition and delusions.
What are the effects of alcohol?

As soon as we have a drink, our brains start producing dopamine which makes us feel euphoric.
@miak. They also produce a neurochemical called GABA, which makes us feel relaxed. Once we
have had a couple of drinks, the inhibitory parts of our brains are affected too, so it is much
harder to make the decision to stop drinking. For some people it is especially hard to stop once
their blood alcohol content is above a certain amount, and that is based on their genetics and
personality. Often what happens is that we are used to having a drink to bring on those feelings
of happiness, or to take away feelings of sadness/loss/boredom/anxiety, but then it is hard to
stop there. That is a really common issue and one that takes time to change.

We really like the buzz from the dopamine and those feelings of calm from the increase in
GABA, but that doesn’t last as we become more affected by the alcohol itself.

2. According to this article what makes it especially hard to stop drinking even if their
alcohol level is high?
A. A person’s reason for starting drinking and dopamine levels.
B. A person’s characteristics and hereditary traits.
C. A person’s inhibitions and GABA levels
MEMO re: Requirements for Inpatient Admission Facilitation

The Director of Emergency Medicine and ED Nurse Unit Manager (NUM) (or equivalent) shall
ensure that:
Patients presenting to the ED are to be discharged, transferred to another facility or admitted
to an inpatient unit within four hours of arrival where clinically appropriate;
Appropriate service delivery models, according to site specific demographics and local casemix,
are utilised;
A Senior ED Medical Officer (MO) (Registrar or Consultant) is involved early in the care and
treatment of all patients to facilitate definitive decision making; The relevant inpatient team
shall be notified as soon as it has been identified that a patient requires admission
The hospital Bed Manager shall be notified as soon as it has been identified that a patient
requires admission;
All potential admissions to an Inpatient Unit shall be reviewed and approved by the ED Medical
Shift Coordinator;
Any increase in ED activity which impacts on ED capacity is identified early and local escalation
procedures activated in a timely manner

3. In the memo below, what must the ED shift coordinator do?

A. Consider the decision to admit a patient to the hospital and agree it is appropriate
B. Look at the diagnosis made about all the patients and decide the planned care is
what is needed.
C. Make sure all patients arriving in ED are admitted to an inpatient facility within 4
hours.
New Horizons: The review of alcohol and other drug treatment services in
Australia

The review of alcohol and other drug treatment services in Australia (the Review) sought to
clarify current Australian drug and alcohol treatment funding processes; current and future
service needs; the gap between met and unmet demand; and planning and funding processes
for the future. The review included two reports: New Horizons: The review of alcohol and other
drug treatment services in Australia and the Review of the Aboriginal and Torres Strait Islander
Alcohol, Tobacco and Other Drugs Treatment Service Sector: Harnessing Good Intentions. New
Horizons identified a lack of clarity around the roles and responsibilities of the Commonwealth
and state and territory governments and a need for further analysis and feasibility work to be
conducted collaboratively.

The department has commenced consultations with the states and territories to progress this
collaborative approach

4. What was a key ending of the New Horizons review

A. States and territories worked in collaboration to decide their responsibilities
B. There is no clear understanding among states and territories about their roles.
C. States and territories were clear about their roles.
Monitoring fetal movements

A Cochrane review assessed the effect of formal fetal movement counting and recording (eg
using kick charts) on perinatal death, major morbidity, maternal anxiety and satisfaction,
pregnancy intervention and other adverse pregnancy outcomes (5 RCTS; n=71,458). The review
did not find sufficient evidence to inform practice. In particular, no trials compared fetal
movement counting with no fetal movement counting. Only two studies compared routine fetal
movements with standard antenatal care. Indirect evidence from a

large cluster-RCT (Grant et al 1989) suggested that more babies at risk of death were identified
in the routine fetal monitoring group but this did not translate to reduced perinatal mortality.
Therefore it is recommended that Maternal concern about decreased fetal movements
overrides any definition of decreased fetal movements based on numbers of fetal movements.
It is also recommended not to advise the use of kick charts as part of routine antenatal care

5. Whose definition of reduced baby movements is endorsed by this review?

A. Cochrane’s
B. Mangesi et al’s
C. The mother
Concern grows over hernia mesh Royal Australasian College of Surgeons (RACS) said General
Surgeons Australia was investigating the feasibility of establishing a mesh audit. According to
RACS, nearly 100,000 Australians are hospitalised for hernia each year. Last month Australian
surgeons told the ABC that complications were rare for hernia-mesh surgery, usually about five
per cent of patients. But in the United States where there are 54,000 hernia-mesh lawsuits
pending, a surgeon who has developed mesh-free hernia surgery has rejected claims made in
Australia that the mesh is safe. RACS has previously outlined concerns in a submission to a
Therapeutic Goods Administration's consultation on surgical mesh. More than a dozen people
from across Australia have now contacted the ABC to share post-surgery outcomes they say
have left them in agony and depressed. They are mainly men who have said they wanted to
share their stories to give comfort to others who have been affected.

6. In Australia
A. Less than 10% of hernia-mesh surgery operations cause unexpected problems.
B. More than a dozen people have had complications following surgery
C. There are 54,000 lawsuits underway as a result of hernia-mesh surgery.
 PART - C

Text 1
Now, researchers at the Salk Institute in La Jolla, California have discovered a way to turn back
the hands of time. Juan Carlos Izpisua Belmonte led this study, published in the journal Cell.
Here, elderly mice underwent a new sort of gene therapy for six weeks. @medcity Afterward,
their injuries healed, their heart health improved, and even their spines were straighter. The
mice also lived longer, 30% longer.

Today, we target individual age-related diseases when they spring up. But this study could help
us develop a therapy to attack aging itself, and perhaps even target it before it begins taking
shape. But such a therapy is at least ten years away, according to Izpisua Belmonte.

Many biologists now believe that the body, specifically the telomeres—the structures at the
end of chromosomes, after a certain time simply wear out. Once degradation overtakes us, it’s
the beginning of the end. This study strengthens another theory. Over the course of a cell’s life,
epigenetic changes occur. This is the activation or depression of certain genes in order to allow
the organism to respond better to its environment. Methylation tags are added to activate
genes. These changes build up over time, slowing us down, and making us vulnerable to
disease.

Though we may add life to years, don’t consider immortality an option, at least not in the near-
term. “There are probably still limits that we will face in terms of complete reversal of aging,”
Izpisua Belmonte said. “Our focus is not only extension of lifespan but most importantly health-
span.” That means adding more healthy years to life, a noble prospect indeed. medcity

The technique employs induced pluripotent stem cells (iPS). These are similar to those which
are present in developing embryos. They are important as they can turn into any type of cell in
the body. The technique was first used to turn back time on human skin cells, successfully.

By switching around four essential genes, all active inside the womb, scientists were able to
turn skin cells into iPS cells. @medcity These four genes are known as Yamanaka factors.
Scientists have been aware of their potential in anti-aging medicine for some time. In the next
leg, researchers used genetically engineered mice who could have their Yamanaka factors
manipulated easily, once they were exposed to a certain agent, present in their drinking water.

Since Yamanaka factors reset genes to where they were before regulators came and changed
them, researchers believe this strengthens the notion that aging is an accumulation of
epigenetic changes. What’s really exciting is that this procedure alters the epigenome itself,
rather than having the change the genes of each individual cell.
In another leg of the experiment, mice with progeria underwent this therapy. Progeria is a
disease that causes accelerated aging. Those who have seen children who look like seniors
know the condition. @medcity It leads to organ damage and early death. But after six months
of treatment, the mice looked younger. They had better muscle tone and younger looking skin,
and even lived around 30% longer than those who did not undergo the treatment.

Luckily for the mice, time was turned back the appropriate amount. If turned back too far, stem
cells can proliferate in an uncontrolled fashion, which could lead to tumor formation. @medcity
This is why researchers have been reticent to activate the Yamanaka factors directly. However,
these scientists figured out that by intermittently stimulating the factors, they could reverse the
aging process, without causing cancer. The next decade will concentrate on perfecting this
technique.

Since the threat of cancer is great, terminally ill patients would be the first to take part in a
human trial, most likely those with progeria. Unfortunately, the method used in this study could
not directly be applied to a fully functioning human. But researchers believe a drug could do the
job, and they are actively developing one

Questions 7-14
7. How does the author feel about the results of the study in first Paragraph?
A. Optimistic
B. Pessimistic
C. Neutral
D. Unbiased

8. Which of the following causes is considered to be a reason for aging?

A. Degradation of telomeres
B. Genetic changes
C. Depression
D. Vulnerability to diseases

9. Izpisua Belmonte’s ideas, as expressed in fourth Paragraph, are

A. Scientifically oriented
B. Selfish
C. Virtuous
D. Success oriented
10. Which of the following is not true about Yamanaka factors?
A. They are genes
B. They can turn into any type of cell in the post-natal period
C. They can reset genes
D. They can be used to reverse the aging process.

11. What does “leg” mean in sixth and eighth paragraphs?

A. Stage
B. Concept
C. Limb
D. Period

12. in eighth paragraph, the experiment that involved mice with progeria that underwent
the treatment showed that:
A. Progeria can be treated
B. Progeria inevitably leads to early death
C. The lifespan of mice could be extended
D. The quality of life of mice could be at stake

13. In the ninth paragraph, the writer claims that the best way to activate Yamanaka
factors is:
A. Directly
B. Occasionally
C. Appropriately
D. Reversibly

14. What will the positive outcomes of this method be as delineated in last paragraph?
A. It will be of great benefit to cancer patients.
B. It will be of great benefit to progeria patients.
C. It will be of great benefit to terminally ill patients.
D. It will lead to the development of a new drug.
TEXT 2
Brain tests at the age of three appear to predict a child's future chance of success in life, say
researchers. Low cognitive test scores for skills like language indicate less developed brains,
possibly caused by too little stimulation in early life, they say. These youngsters are more likely
to become criminals, dependent on welfare or chronically ill unless they are given support later
on, they add. @medcity Their study in New Zealand appears in the journal, Nature Human
Behaviour.

The US researchers from Duke University say the findings highlight the importance of early life
experiences and interventions to support vulnerable youngsters. Although the study followed
people in New Zealand, the investigators believe that the results could apply to other countries.
They followed the lives of more than 1,000 children. Those who had low test scores for
language, behavioural, movement and cognitive skills at three years old went on to account for
more than 80% of crimes, required 78% of prescriptions and received 66% of social welfare
payments in adulthood.

It is known that disadvantaged people use a greater share of services. While many of the
children in the study who were behind in brain development came from disadvantaged
backgrounds, poverty was not the only link with poor futures. @medcity When the researchers
took out children below the poverty line in a separate analysis they found that a similar
proportion of middle class children who scored low in tests when they were three also went on
to experience difficulties when they were older.

The researchers stress that children's outcomes are not set at the age of three. The course of
their lives could potentially be changed if they receive support later in life, for example through
rehabilitation programmes when they are adults. Prof Terrie Moffitt, from Duke University in
North Carolina in the US, who co-led the study, said: "The earlier children receive support the
better. That is because if a child is sent off on the wrong foot at three and not ready for school
they fall further and further behind in a snowball effect that makes them unprepared for adult
life".

Prof Moffitt said nearly all the children who had low scores in cognitive assessments early on in
life went on to fall through "society's cracks". "We are able to predict who these high cost
service users will be from very early in life. Our research suggests that these were people who,
as very young children, never got the chance that the rest of us got. @medcity They did not
have the help they needed to build the skills they need to keep up in this very complicated and
fast-paced economy". She said society should rethink their view of these people who are often
condemned as "losers" and "dropouts" and instead offer more support.
Prof Moffitt conducted the study with her husband, Prof Avshalom Caspi, from King's College
London. He said he hoped that the study would persuade governments to invest in those in
most need early on in life. "I hope what our study does is not feed into prejudice. I hope that
our research will create the public compassion and political will to intervene with children and
more importantly offer services to families of children so they can get a better start in life".

Successive governments have invested in expanding nursery education in the UK over the past
20 years. According to Josh Hillman, who is the director of education for the Nuffield
Foundation, policy makers already realise the value of early years’ education. @medcity "But
this new research suggests that they may have underestimated its importance," he said. "The
issue now in the UK is to provide more high quality nursery provision and to consider targeting
it to those disadvantaged groups that would benefit the most."

Participants were members of the Dunedin longitudinal study, an investigation of the health
and behaviour of a representative group of the population of 1,037 people born between April
1972 and March 1973 in Dunedin, New Zealand.

Questions 15-22
15. Researchers in first Paragraph suggest that cognitive tests at the age of three
A. Can show the development of language skills
B. Can influence children’s future life prospects.
C. Can give us an idea of how children will fare in the future
D. Can predict chronic illness.

16. Researchers in second Paragraph think that the results of the study
A. Can help problematic children
B. Point to the importance of early-life development
C. Highlight the vulnerability of some children
D. Point to the necessity of conducting studies in other countries

17. Another study in third Paragraph showed that

A. Disadvantaged children take advantage of social welfare services
B. Children from disadvantaged families had less developed brains
C. Scoring low in cognitive tests is not linked solely to poverty
D. Many of the children from disadvantaged families had less developed brains
18. Which of the following according to fourth Paragraph is not mentioned by Prof
Moffitt
A. underdeveloped children at the age of three are not ready for school
B. giving support to children increases the possibility of a better adult life
C. the consequences of a lack of early support can be long-term.
D. giving support to children early in life prepares them better for adulthood

19. The snowball effect

A. Indicates that underdeveloped children are unprepared for adult life
B. Means that children who do badly at school do badly later in life
C. Means that problems which are relatively small in early life gradually worsen as the
child grows up
D. Means that success in adult life is gradually built upon success in earlier stages of life

20. Prof. Caspi

A. Hopes that the study will eliminate prejudice
B. Hopes that the research will help build a better life for children who need support
most
C. Is Prof. Moffitt’s wife
D. Believes that the study will stir up public compassion

21. Nursery education

A. Has expanded in the UK over the course of over the last decade
B. Has been recently recognized as an invaluable factor for early years’ development
C. Should offer higher standards
D. Has been a constantly underestimated factor in early years’ education

22. Longitudinal mean:

A. The study was conducted between 1972 and 1973
B. The study investigated health and behavior
C. The study was conducted over the course of 40 years.
D. The study showed a great disproportion between the people who use public services
and the overall population