Reading & Listening Materials

for Health Professionals

preparing for the OET Test

This collection of practice materials has been

produced by Marg Tolliday – OETWorkshop Pty Ltd
http://www.oetworkshop.com

Copyright permission has been granted to

Marg Tolliday – OETWorkshop Pty Ltd.
Sourced from Open Access websites
and other places

If you would like official material,

please go to the OET website
 (http://www.occupationalenglishtest.org)

No part of this publication may be reproduced or transmitted in any form or by any means electronic,
photocopying, recording or otherwise without the written permission of Marg Tolliday –
OETWorkshop Pty Ltd The author has been given permission to use copyright materials appearing
in this eBook,
ISBN 9781973266860
© 2017 Marg Tolliday – OETWorkshop Pty Ltd
Produced by Marg Tolliday – OETWorkshop Pty Ltd, Melbourne 3000 Australia.
info@oetworkshop.com Ver 4.0 October 2017
 Contents
Part A & Part B Reading.ppt
Part A Exercise 1 : Alcohol Related Brain Impairment
Part A Exercise 2 : Pharmacy Asthma Care Program
Part A Exercise 3 : Wood Dust Allergies
Part B Exercise 1 : Drug for diabetics goes on sale in
Ireland
Part B Exercise 2 : New AIDS vaccine hope
Part B Exercise 3: Myths about dental care
Part B Exercise 4 : Goslings of gay geese
Reading answers

Part A & Part B Listening.ppt

Part A Listening : Tammy Driscoll
Part A Listening : Mystery of M.S.
Part B Listening: Fish Oil
Part B Listening : A Good Death
Listening answers.
PART A reading & PART B reading

What is the difference?

PART A reading is a series of 4 separate pieces of information - on
the one topic. The information could be in the form of a dot-pointed
list / a table with numbers or percentages / perhaps a flow chart / a
map / a few short paragraphs / one page of writing - in short,
different ways of presenting information.
Your task in this part is to complete the “gap fill” exercise. There
will be somewhere between 25 and 30 gaps to be completed -
drawing on the information in the separate pieces of information.
You are given 15 minutes to complete Part A. (Not enough time).
The OETWorkshop strongly recommends you adopt a ‘time
management’ approach to Part A - and follow this strategy:

1. Read only the headings of each separate piece of information

2. Go to the gap-fill exercise and find out how many gaps are to be
filled in

3. Estimate how much time you have to find the answer to each
‘gap’.
Example: 15 minutes LESS 2 minutes to “read” / “skim read” the 4
pieces of text – that leaves you with 13 minutes. 13 minutes X 60
seconds = 780 seconds. Let’s say you have 30 gaps to be filled.
780 DIVIDED BY 30 = 26 seconds per gap.

4. Don’t forget: You only need 65% correct to get a “B” score.
[65% of 30 gaps = 19.5 rounded up to 20 gaps.
Get 20 out of 30 correct = “B” - a pass! ]

5. If you have any problems finding the answer to a particular gap –

move on – don’t waste time - remember, you only need 65% correct
to get a pass.
PART B reading is comprised of TWO x 600 to 650 word pieces
of text – each one with 10 multiple choice questions. You have to
circle a, b, c or d - to indicate which option you think best fits the
question. [Often there are two options which could be the right
answer - but one will be more correct than the other.]

You are given 45 minutes to complete Part B - about 22 minutes

for each reading.

The OETWorkshop strongly recommends you try to understand the

question that is being asked: The author asserts - is different
from According to the data .... . If the author is asserting something,
the author is putting forward his / her opinion on something -
whereas, ‘according to the data’ relies on factual evidence.

Again, if you have any problems trying to find a clear-cut

answer to one of the questions – leave it – move on – come
back to it later. Remember, you only need 65% correct to
get a pass. 65% of 20 questions (10 questions for each
passage) = 6.5 rounded up to 7 out of 10 for each passage.
You need 14 out of 20 questions to get a “B” score.

Click here for 18-slide powerpoint on OET Reading

OET Reading Test–Part A – Alcohol Related Brain
Impairment (ARBI)
Time allowed: 15 minutes
• Complete the following summary gap-fill exercise using
information from the
four texts provided.
• Gaps may require 1, 2 , 3 or even 4 words.
• You should write your answers next to the appropriate number in
the right-
hand column.

Please use correct spelling in your responses.

TEXT 1

Alcohol Related Brain Impairment (ARBI)

Alcohol is one of the many causes of acquired brain injury. The
injury inflicted by alcohol misuse is called alcohol related brain
impairment (ARBI). A person with ARBI might experience
problems with memory, cognitive (thinking-related) abilities and
physical coordination.

More than 2,500 Australians are treated for ARBI every year, with
approximately 200,000 Australians currently undiagnosed. Around
two million Australians are potentially at risk of developing ARBI
due to their drinking habits.

Just how much damage is done depends on a number of factors.

These include individual differences, as well as the person’s age,
gender, nutrition and their overall pattern of alcohol consumption.
A younger person has a better chance of recovery because of their
greater powers of recuperation. However, the effects of ARBI can
be permanent for many sufferers.

Alcohol and brain injury

Brain injury can be caused by alcohol because it:
Has a toxic effect on the central nervous system (CNS)
Results in changes to metabolism, heart functioning and blood
supply
Interferes with the absorption of vitamin B1 (thiamine), which
is an important brain nutrient
May be associated with poor nutrition
Can cause dehydration, which may lead to wastage of brain cells
Can lead to falls and accidents that injure the brain.

Treatment
A person with suspected ARBI needs to be assessed by a
neuropsychologist. Treatment depends on the individual and
the type of brain damage sustained.
TEXT 2
Health benefits of alcohol

Very moderate amounts of alcohol (around half a standard drink

a day) may provide health benefits for some middle-aged or older
people by reducing the risk of some types of cardiovascular
disease. However, people who do not already drink alcohol are
not encouraged to take up drinking just to get some health
benefits.

Recent scientific evidence suggests that the potential for health

benefits may have been overestimated in earlier studies. Possible
benefits need to be balanced against the risk of cirrhosis, some
cancers and other diseases (which becomes greater with increased
alcohol consumption).

The same benefits do not extend to younger people. Drinking

alcohol can affect how the brain develops in people under the age
of 25. Teenagers under 15 years of age are particularly at risk.
TEXT 3

Australian Guidelines to reduce health risks from

drinking alcohol

Summary

Alcohol has a complex role in Australian society. Most

Australians drink alcohol, generally for enjoyment, relaxation
and sociability, and do so at levels that cause adverse effects.
However, a substantial proportion of people drink at levels
that increase their risk of alcohol-related harm. For some,
alcohol is a cause of significant ill health and hardship. In
many countries, including Australia, alcohol is responsible for
a considerable burden of death, disease and injury. Alcohol-
related harm to health is not limited to drinkers but also
affects families, bystanders and the broader community.

These 2009 National Health and Medical Research Council

(NHMRC) guidelines aim to establish the evidence base for
future policies and community materials on reducing the
health risks that arise from drinking alcohol. The guidelines
communicate evidence concerning these risks to the
Australian community to allow individuals to make informed
decisions regarding the amount of alcohol that they choose to
drink.

Research since the previous edition of the guidelines in 2001 has

reinforced earlier evidence on the risks of alcohol-related harm,
including a range of chronic diseases and accidents and injury. The
new guidelines take a new approach to developing a population-
health guidance, which:

- goes beyond looking at the immediate risk of injury and the

cumulative risk of chronic disease, to estimating the overall risk of
alcohol-related harm over a lifetime

- provides advice on lowering the risk of alcohol-related harm, using

the level of one death for every 100 people as a guide to acceptable
risk in the context of present-day Australian society.

- provides universal guidance applicable to healthy adults aged 18

years and over (Guidelines 1 & 2) and guidance specific to children
and young people (Guideline 3) and to pregnant and breastfeeding
women (Guideline 4)
TEXT 4
Graph 1 : Risky / High Risk Alcohol Consumption by
Gender
Graph 2 : Risky / High Risk Alcohol Consumption by
Age
 Summary Task

Summary Answers

Most Australians drink alcohol in amounts that 1.

lead to few (1). , for enjoyment, relaxation, and

(2) ….. . 2.

Unfortunately though, a large number of

3.
Australians drink amounts of alcohol that
increase their risk of
4.
(3) …. , and this proportion is increasing.

In 2004-05, roughly (4) …. % of adult males 5.

and 12% of adult females reported drinking at

a risky/high risk levels. The increase in those 6.

drinking at a risky/high risk levels since 1995

7.
has been greater for (5) ….. than (6) …. .

The proportions of males and females 8.

drinking at risky and high risk levels were

9.
highest in the middle
 (7) …. and this proportion has increased over
time. 10.
Although drinking moderately may provide
some
11.
(8) …. for people of middle age or older, such
as a reduced

risk of some forms of (9) ….. , more recent

research

suggests that previous studies may have (10)

…. alcohol’s

potential for health benefits. Thus, it is

important to weigh

these benefits against the risks of alcohol-

related diseases,

- and starting drinking to receive these benefits

is not (11)

…. .

Summary Answers

Drinking alcohol under the age of (12) …. 12.

years old can affect mental development,

with a particularly high risk for adolescents 13.

under the age of (13) …. .

14.
Damage caused to the brain by alcohol is 15.
known as

16.
(14) …. Impairment. Some of the common

symptoms are problems with memory, (15)

17.
….. and motor skills. Over two and a half

thousand Australians receive treatment for 18.

ARBI annually, with around (16) …. more

estimated to be living with the condition 19.

undiagnosed, and a further (17) …. at risk of

developing ARBI as a result of risky 20.

drinking.

Among other factors, alcohol can cause 21.

ARBI as it has a (18) ….. on the central

nervous system, affects metabolism, (19) 22.

…. and blood supply, and can result in (20)

…. , which can contribute to brain cell

death.

ARBI requires assessment by a (21) …. .

Younger people have better prospects for

recovering from ARBI, but the effects are

often (22) …. .
Summary Answers

23.
The National Health and (23) …. developed

new guidelines in 2009 to reduce the health 24.

risks of alcohol consumption. The previous

edition of the guidelines was released in (24) 25.

… , and new research since that time has

26.
strengthened (25) ….. .

The features of the new guidelines include a

27.
focus on acute injury, chronic disease and

overall risk of

(26) …. over a lifetime, and advice specific to TOTAL:

three key groups: Healthy adults, children and

young people, and (27) …. women.

PART A READING EXERCISE

PHARMACY ASTHMA CARE PROGRAM (PACP)

IMPROVES OUTCOMES FOR PATIENTS IN THE COMMUNITY

Time limit – 15 mins

Read the following reading material about the PACP

You only have 15 minutes to scan and fill in the synthesizing
exercise so only skim and scan the reading material – do not
spend a lot of time reading it in depth
Do not spend more than 15 minutes on this exercise
TEXT 1

Title: Pharmacy Asthma Care Program

(PACP) improves outcomes for
patients in the community
Authors: Carol Armour, Sinthia Bosnic-
Anticevich, Martha Brillant, Debbie
Burton, Lynne Emmerton, Ines
Krass, Bandana Saini, Lorraine
Smith, Kay Stewart

Abstract

Method: Fifty Australian pharmacies were randomised into two

groups: intervention pharmacies implemented the PACP (an ongoing
cycle of assessment, goal setting, monitoring and review) to 191 patients
over 6 months; control pharmacies gave their usual care to 205 control
patients. Both groups administered questionnaires and conducted
spirometric testing at baseline and 6 months later. The main outcome
measure was asthma severity/control status.
 Results: 186 of 205 control patients (91%) and 165 of 191
intervention patients (86%) completed the study. The intervention
resulted in improved asthma control. Patients receiving the intervention
were 2.7 times more likely to improve from “severe” to “not severe”
than control patients. The intervention also resulted in improved
adherence to preventer medication, decreased mean daily dose of
reliever medication, a shift in medication profile from reliever only to a
combination of preventer, reliever with or without long-acting β agonist
and improved scores on the risk of non-adherence, quality of life,
asthma knowledge and perceived control of asthma questionnaires. No
significant change in spirometric measures occurred in either group.

Conclusions: A pharmacist-delivered asthma care program based on

national guidelines improves asthma control. The sustainability and
implementation of the program within the healthcare system remains to
be investigated.

TEXT 2
 Asthma Severity Status at Baseline and
Title:
Final Visit
Pharmacy Asthma Care Program, Final
Report, Jan.2006

University of Sydney, Faculty of

Authors:
Pharmacy

Control Intervention All

(n=202) (n=191) (n=393)
Number Number (%) Number
(%) (%)

Asthma Mild 3
Severity 5 (2.6)
(1.5) (2.0)
* Moderate 56 74
18 (9.4)
(27.7) (18.8)
Severe 143 311
168 (88.0)
(70.8) (79.1)
v χ 2 = 21.7; df=2; p<0.001

TABLE 8: Asthma severity status at baseline

Control
Intervention
Spirometry measures

The proportion of patients who reported using a short-acting

bronchodilator prior to the spirometry test, was the same at
baseline for both the Intervention and the Control groups.
Hence, the decision was made that there was no need to correct
the spirometry results for medication use
.

TEXT 3
Title: Pharmacy Program Improves Asthma
Care

Author: Amy Norton

Pharmacy
Program Improves Asthma Care [excerpt]

Some advice and help from a pharmacist may help asthma sufferers get
their condition under better control - according to an Australian study.

The findings, reported in the journal Thorax, add to evidence that

education and advice from a pharmacist can help people who take
medication for chronic illnesses.

Many people in fact, visit their pharmacy far more often than their
doctor’s office, yet pharmacists remain “underused” when it comes to
interaction with patients.

Their findings suggest that similar pharmacy programs for asthma

management should be developed and tested, lead author Dr Carol
Armour told Reuters Health.

The program worked, according to Armour, because of the time patients

spent one-on-one with their pharmacists, setting goals for improving
their asthma management.

“This is the kind of help that patients typically don’t get from many
healthcare practitioners, and they certainly appreciated it,” she said,
“plus, it got their asthma under control”.
 TEXT 4

Pharmacy Asthma
Asthma Pilot Program Fact Care Program
Title: (PACP) - what is
Sheet
the pharmacist’s
role?
The Pharmacy Guild of
Author:
Australia

Community pharmacists participating in the pilot program will schedule

in-pharmacy appointments with patients to assist them manage their
asthma.

These appointments will involve assisting patients to self-manage their

asthma in line with the patient’s written asthma action plan. This will
include:

Assessing a patient’s asthma severity and monitoring lung

function;
Reviewing and assisting with inhaler techniques and
management;
Assisting with self-monitoring and providing self-management
education;
Assessing adherence to asthma medications and assisting with
the quality use of medicines, and
Facilitating communication between the patients, their G.P.
[or other health service provider] and the community pharmacy to
improve continuity of care.

Community pharmacists will also be required to collect specified patient

data, and participate in other activities at various times during the pilot
program to assist in evaluating the effectiveness of the program.
Pharmacy Asthma Care Program – Summarising task
Summary Task [Fill in the gaps Answers
using 1, 2 or 3 words]
A 2007 article by Armour, Bosnic- 1.
________________________________
Anticevich and Brillant et.al,
2.
reported that a recent trial of a ________________________________
new …….. (1) asthma care 3.
________________________________
program had improved patients’ 4.
(2) (3) ________________________________
asthma …….. . The ……..
5.
(PACP) involved …….. (4)
________________________________
pharmacies split into two groups: 6.
one group trialled the new ________________________________
intervention program while those 7.
________________________________
in the other group continued with 8.
their …….. (5). ________________________________
9.
________________________________
Those pharmacists trialling the 10.
program scheduled a number of ________________________________
11.
…….. (6) with asthma patients ________________________________
with the aim of helping them to 12.
…….. (7) their condition. A core ________________________________
13.
component of this self- ________________________________
management process was the 14.
development of a written …….. ________________________________
15.
(8)
which included assessment of ________________________________
the …….. (9) of the patient’s
condition and their monitoring of 16.
it, assistance with using the ________________________________
…….. (10)
, education in self- 17.
management and …….. (11) , _________________________________
assessment of compliance with
correct medication use, and help
with the maintenance of ongoing
…….. (12) between the patient
and their health service provider.

The trial lasted …….. (13),

after which all asthma sufferers
who remained in the trial (91% of
control patients and …...% (14)
of intervention patients), were
tested and their results compared.

The outcomes strongly suggest

that the intervention ……..
(15)
asthma control. The severity
of the asthma of those patients on
the new trial program was ……..
(16)
times more likely than those in
the other group, to improve from
“severe” to …….. (17). This
seems likely to be a result of the
improved patient self-management
apparent in their improved scores
on risk of ............ (18)

and …….. (19) knowledge. In 18.

practice, there was an increase in _________________________________
the use of …….. (20) medicine 19.
_________________________________
that probably explains the 20.
decrease in the use of …….. (21) _________________________________
21.
medication.
__________________________________
22.
However, it should be noted _________________________________
that, at baseline, there was a 23.
_________________________________
considerably higher percentage 24.
of patients with “severe” asthma _________________________________
severity in the “intervention 25.
_________________________________
group” than in the “control 26.
group” (……..% (22) as opposed __________________________________
to …….. % (23) ) which makes
the results less reliable than if
the two groups were initially
more similar

Having said that, at the very

least, the findings are promising
for the more effective
management of asthma and
other …….. (24) illnesses. As
the report’s authors point out,
(25)
many people visit a ……..
more often than they do a
…….. (26) and so pharmacists
can potentially play a significant
role in day-to-day health care.
Reading Part A – WOOD DUST ALLERGIES
TIME LIMIT 15 MINUTES - YOUR TASK IS TO FILL IN THE MISSING
WORDS IN THE SUMMARY AT THE END. YOU CAN USE ONE, TWO OR THREE
WORDS TO COMPLETE A GAP.

READING TEXT # 1 -EXPOSURE TO TOXIC DUST

Workers may come into contact with many forms of toxic dust ranging from
crystalline silica to wood dust and nanoparticles. This chapter provides an
overview of the health impacts of exposure to respirable crystalline silica,
beryllium, wood dust, alumina and textile dusts. The emerging issue of
nanoparticle hazards is discussed in the following pages

Exposure to respirable crystalline silica (RCS) occurs through cutting,

chipping, drilling or grinding objects containing crystalline silica or through
the use of materials that contain crystalline silica for abrasive blasting, for
example sandblasting.

Workers in many occupations and industries use and come into contact with
materials containing crystalline silica, contact occurring through

• excavation, where dust is created by drilling, chipping, jackhammering, etc;

• cutting to size of bricks, blocks, lightweight concrete panels, tiles, etc;
• sandblasting;
• grinding of floor slabs, granite for decorative purposes;
• concrete cutting and drilling;
• road building;
• glass manufacturing;
• refractory bricklaying;
• demolition; and
• sweeping concrete floor slabs.
 WOOD DUST ALLERGIES

READING TEXT # 2 -NUMBERS OF WORKERS EXPOSED

The number of workers potentially exposed to silica in the course of their

work was reported by the National Occupational Health and Safety
Commission (NOHSC) as nearly 294 000 in 2002.

NOHSC noted that ’it should be kept in mind that workers in some of these
industries have a different likelihood of exposure compared to those in
others, that not all workers in the same industry will have the same likelihood
of exposure, and the different exposed workers are likely
to be exposed to different levels of silica’.

Exposure to crystalline silica is known to cause a number of diseases and is

linked to others.

Silicosis has long been known as a disease associated with mining and is
caused by the inhalation of dust containing crystalline silica. Silicosis is
characterised by a diffuse, nodular, interstitial pulmonary fibrosis. Silicosis
may cause breathing difficulties, chest pain, respiratory failure and lead to
death. There are three main types of silicosis:

• Chronic/classic silicosis, which is the most common type, occurs after 15-
20 years of moderate to low exposure. Worker may experience shortness of
breath upon exercising. In the later stages the worker may experience extreme
shortness of breath, chest pain or respiratory failure.

• Accelerated (subacute) silicosis, can occur after 5-10 years of exposure to

high levels of silica. Symptoms include severe shortness of breath, weakness
and weight loss. The onset of symptoms takes longer than in acute silicosis.

• Acute silicosis, occurs after a few months or as long as two years following
exposure to extremely high concentrations of respirable crystalline silica.
Symptoms include severe disabling shortness of breath, weakness and weight
loss, which often leads to death.
WOOD DUST ALLERGIES

READING TEXT # 3 -LATENCY OF CHRONIC SILICOSIS

The fatal course of the disease is not influenced by treatment. This disease is
primarily reported in occupations that can have very high exposures to fine
silica dusts and include sandblasters, stone crushers, ceramic workers and
workers in abrasive manufacturing.

There was extensive discussion in evidence on the latency of chronic

silicosis.
Cement Concrete and Aggregates Australia (CCAA) stated that chronic
silicosis has a latency that may be up to seven years after cessation of
exposure: ’that is, a worker may have no symptoms or signs of silicosis either
clinical or on chest X-ray at the time of cessation of exposure and then be
diagnosed with clinical silicosis up to about seven years later, with little or no
clinical evidence of disease in the intervening period (and no ongoing
exposure)’.

CCAA went on to state that this delayed appearance or latency is rare and
’’probably 95 per cent of all cases of silicosis are diagnosable within a year
of cessation of exposure, if not at the time of exposure’’. CCAA commented:

The evidence from the literature is that nearly all workers who will eventually
be diagnosed as having silicosis are diagnosable at the time their exposure
ceases. Some who cease work because they are unwell, or leave work
without having a recent X-ray, may not actually be diagnosed until they are
investigated, but this usually occurs in a short period after they report illness
to their doctor. If they have been under surveillance in compliance with the
Hazardous Substances Regulations governing crystalline silica (in all
Australian jurisdictions) they should have had an X-ray within 5 years of
ceasing exposure. It can be expected that almost all who will eventually be
diagnosed as having silicosis will have evidence on those X-rays.

CCAA stated that silicosis does not have a long latency period, comparable
with
mesothelioma (which may occur up to 40 years after exposure has ceased) or
some other occupational cancers. Those workers whose X-ray is classed as
’no opacities’ when they cease exposure, will rarely develop opacities (with
or without any signs of silicosis) in later years. CCAA concluded ’latency is
not a major issue in relation to silicosis, and there will not be a wave of
hidden cases occurring years ahead. The few who do will develop those
opacities within a short time of ceasing work.’
 WOOD DUST ALLERGIES

READING TEXT # 4 -AIRWAY DISEASE and LUNG

CANCER

AIRWAY DISEASE LUNG CANCER

- While silicosis has long been Since 1997 silica has been listed
identified as an occupational as a
disease arising from inhalation of Class One carcinogen by the
dust containing crystalline silica, International Agency for
there has been some dispute over Research on
the association of airway disease Cancer (IARC).
with
crystalline silica. In 2002 NIOSH commented that
’the carcinogenicity of
- There has been extensive crystalline silica in humans has
discussion in evidence as to the been strongly debated in the
incidence of airway disease scientific community’.
related to toxic dust
The NOHSC Regulation Impact
- Chronic obstructive pulmonary State-ment (2004) stated that ’the
disease (COPD) refers to a balance of evidence suggests that
combination of cough and RCS exposure causes lung
phlegm, breathlessness and cancer’ but that ’there is dispute
airflow obstruction. Professor E as to whether RSC exposure
Haydn Walters, University of causes lung cancer directly, or
Tasmania, stated that generally, whether RCS exposure causes
’it is likely that somebody will lung cancer indirectly, i.e.,
go from having some irritant whether the develop- ment of
cough and a silicosis increases the risk of
bit of sputum to gradually lung cancer’.
developing
some airflow obstruction to then The Regulation Impact
becoming symptomatic and Statement
breathless provided the following
on exercise perhaps over a 15- to comparison of
20-year period if they have carcinogen classifications of
moderate dust crystalline
exposure which is continuing’. silica.

- There was also a view that - Crystalline silica . human

exposure to silica and other toxic carcinogen
dust causes lung parenchymal
fibrosis or silicosis and not - Crystalline silica . potential
airway disease. occupational carcinogen

- RCS . known to be a human

carcinogen

- RCS . causes lung cancer, but

is
probably a weak carcinogen

- Crystalline silica . suspected

human carcinogen
WOOD DUST ALLERGIES

READING TEXT # 5 -GLOBAL EVIDENCE

-A literature review by the UK Institute for Environment and Health

concluded
that the literature suggested there are clearly elevated risks of developing
COPD associated with several occupations including welding, flour mill
work and cotton textile work.

-The US National Institute for Occupational Safety and Health (NIOSH)

published a hazard review on RCS in 2002. It concluded that silica is one of a
number of occupational dusts associated with COPD. The review also noted
that some studies suggest these diseases may be less frequent or absent in
non-smokers.

-In 1999 British miners were recognised as suffering a high incidence of

COPD in
relationship to mineral dust exposure, even in the absence of classic Coal
Workers’ Pneumoconiosis (CWP). Subsequently, the British Government
assessed miners and ex-miners and provided compensation.

-The Australian Institute of Occupational Hygienists (AIOH) also commented

on
airway disease and noted that it has been statistically associated with some
occupational groups such as miners who may have been exposed to long term
high dust exposures. It commented that: The findings are controversial as the
associated disease symptoms are confounded due to lifestyle factors,
particularly tobacco smoking. Similar to the findings with lung cancer
outcomes, for airways disease detailed examination of the various risk factors
indicates that tobacco smoking contributes a higher risk component and
hence the majority of the case numbers.

-The AIOH also noted that in its Regulation Impact Statement on the
Proposed
Amendment to the National Exposure Standards for Crystalline Silica in
October
2004, the Committee stated emphysema, the main cause of chronic
obstructive
lung disease, can be caused by inhalation of crystalline silica and that silica
dust can worsen theamage done by smoking.
PART A READING -WOOD DUST ALLERGIES - SUMMARISING
EXERCISE
Complete the gaps with 1, 2 or 3 words

Silicosis, a respiratory disease caused by exposure to crystalline silica, has a

history of being associated with ……… 1 . Toxic dust reaches workers in a
variety of ways: cutting, chipping, drilling or grinding objects or even
……… 2 . Toxic dusts occurs in the form of ………3 , wood dust and even
……… 4 . Common contact occupations include road building, ……….
5
manufacture and excavation work where dust results from jackhammering,
drilling and ………6

In Reading 2 we find that nearly ……… 7 workers in 2002 were possibly

exposed to silica during their working hours. According to the NOHSC,
not ……… 8 workers in one particular industry have the same exposure
risk. The NOHSC also reported that individuals are likely to be exposed
to………9 of silica.

There are three main types of Silicosis: ……… 10 or classic silicosis,

accelerated or ……… 11 silicosis and ……… 12 silicosis. The common
symptom is ……… 13.

The UK and US literature reports that development of COPD is associated

with ……… 14 dusts. The NIOSH noted that in some of its research,
respiratory illness may be less frequent or ……… 15 in ………16 . In 1999,
the British Government awarded ……… 17 to British miners who were found
to be suffering a high ……… 18 of COPD in ratio to their ………19 dust
exposure.

So is there any evidence that occupational dust causes lung cancer or disease
of the airways? One view is that exposure to toxic dusts causes ……… 20 but
not airway disease. However, since ……. 21, silica has been listed as a Class
1 carcinogen and in ……… 22 an impact statement ruled that RCS exposure.
………23

According to a Tasmanian researcher, COPD develops over a …..…. to

…...… 24 year period if the sufferer has ………25 exposure to moderate
dust levels. It seems the debate is set to run for a number of years yet:
the Committee in 2004 stated ………. 26 , recognised as the main cause
of COPD , may be caused by breathing in silica dust but that the
likelihood of developing the disease was exacerbated by ………27 .

PART B – #2 DRUG FOR DIABETICS GOES ON SALE

IN IRELAND
1. Hospital consultants in the Republic of Ireland can now
prescribe a new drug for patients suffering form a major complication
of diabetes mellitus. Wyeth Laboratories, which makes tolrestat,
claims that the drug hits the progressive degeneration of nervous
tissue which can make diabetic people seriously ill.
2. Until the discovery of insulin in 1922, two-thirds of diabetics
eventually entered a coma, because they had too much sugar in their
blood, and died. Now patients can control their blood sugar, and their
life expectancy has improved dramatically, but they have become
exposed to long-term complications of the disease. Many diabetics
find that the sensory nerves in their limbs degenerate - a condition
known as diabetic peripheral neuropathy.
3. Peripheral neuropathy causes painful tingling and
hypersensitivity in the lower limbs. Patients lose their reflexes,
making the limbs vulnerable to damage. In extreme cases, a limb
may have to be amputated. According to Michael Dvornik, a
researcher at Wyeth who has worked since 1967 on substances
related to tolrestat, diabetic neuropathy is responsible for half of the
amputations carried out in the U. S.
4. Since the 1950s, researchers have known that diabetics have
large amounts of sorbitol, an alcohol produced by the breakdown of
glucose, in their red blood cells. Physiologists have found that this
high level of sorbitol in the blood cells is associated with high levels
of the substance in the nerve cells and damage to the nervous tissue,
although researchers disagree about how the damage happens.
 5. Studies on rats show that, in vitro sorbitol passes more slowly
than glucose through the cell membrane, disrupting normal osmosis.
However, James Crabbe, a microbiologist at the University of
Reading, who has done extensive research on diabetic neuropathy,
says there is little evidence about how sorbitol affects nervous tissue
in humans.
6. Tolrestat reduces the level of sorbitol in the red blood cells. The
drug belongs to a class of chemicals known as aldose reductase
inhibitors, first synthesised by Dvornik, and his colleagues at Wyeth
in 1967. Some research has demonstrated that ARIs appear to stop
the degeneration of nervous tissue and allow new tissue to grow.
7. For example, a team in Canada studied an aldose reductase
inhibitor called Sorbinil. Anders Sima, a pathologist at the
University of Manitoba in Winnipeg, and his colleagues from other
centres in Canada found a 3.8 increase in the average number of
nerve fibres that regenerated in a group of patients who took Sorbinil
for a year. The researchers also found that patients' nerves functioned
better after treatment with the drug (The New England Journal of
Medicine, Vol 319pg.548). But several other clinical trials of Sorbinil
failed to find any significant improvement in nervous function in
patients, according to Crabbe.
8. Like all other aldose reductase inhibitors, sorbinil failed to reach
the market because it had serious side effects. Now, however, the
National Drug Advisory Board in Dublin has authorised tolrestat
following Wyeth's clinical trials. The NDAB is the first authority in
the world to license the drug.
9. Last month, tolrestat became available to patients in hospital in
Ireland in a two year surveillance programme, which is standard practice
for a drug that contains a "novel ingredient". If this limited programme is
successful, tolrestat could then become available to general practitioners.
Wyeth, a British subsidiary of the pharmaceuticals company Wyeth-Ayerst
in Philadelphia has applied for product licences in several other countries,
including Britain and Italy.
10. Patients in Britain, the U.S. and Europe have participated in clinical
trials of the drug for the manufacturers. Another study, led by Philip
Raskin at the Department of Internal Medicine in the University of Texas
Health Science Centre at Dallas, has assessed the drug in 23 patients with
diabetes.

11. Raskin and his colleagues found that the level of sorbitol in red
blood cells fell, on average, by 57 per cent in diabetic patients who
received 100 milligrams of tohestat twice daily for two weeks (Clinical
Pharmacology and Therapeutics, Vol 38, pg. 625).

12. So far, doctors have observed two occasional side effects of

treatment with tolrestat. Some patients developed mild dizziness, and the
levels of certain liver enzymes rose in 2 per cent of the patients. Such
patients stopped receiving the drug immediately, and their liver enzymes
returned to normal level

13. In Dublin, Allene Scott, the director of the NDAB, says that there is
no evidence yet that either side effect is serious, but stresses the need for
the two-year monitoring programme. "Time alone will tell just how
effective it (tolrestat) is", she says. "But certainly it is one of the few
things that will help diabetic patients suffering from these
complications".

14. However, Crabbe is guarded about the benefits of the drug. He says
"There is no evidence that the lowering of sorbitol in diabetic peripheral
neuropathy is relevant in humans.. . . I feel there are a lot of unanswered
questions".

QUESTIONS: Drug for Diabetics goes on sale in Ireland

1. After the discovery of insulin all of the following happened except

a) deaths among diabetic patients reduced slightly.
b) diabetic patients were able to control their blood sugar levels.
c) diabetes was found to have long-term effects on surviving patients.
d) diabetic peripheral neuropathy was revealed as a problem.

2. As a result of peripheral neuropathy

a) Wyeth was asked to research into a drug to cure it.

b) diabetics feel no pain in their limbs.
c) diabetics are particularly affected in lower limbs.
d) half the diabetics in the US need to have a limb amputated.

3. Researchers disagree

a) that high levels of sorbitol in the blood cells are connected with
damage to
nervous tissue.
b) that diabetics have high levels of sorbitol in their blood cells.
c) how high levels of sorbitol in the blood and nerve cells cause
damage.
d) how sorbitol is produced in the red blood cells.

4. Studies on rats show that

a) sorbitol levels should be lowered in humans too.

b) sorbitol behaves differently from glucose.
c) sorbitol causes damage to the nervous tissue in humans in the same
way.
d) tolrestat would be a suitable drug to use.

5. Clinical trials of sorbinil were

a) successful in 3.8% of patients.
b) carried out by Crabbe.
c) promising in some cases.
d) all of the above.

6. Tolrestat has been licensed in Ireland

a) as a result of clinical trials by Wyeth.

b) because it contains a ‘novel ingredient’.
c) because the NDAB wanted to be the first in the world with the
drug.
d) because other countries were unwilling to take the risk.

7. From last month tolrestat may be used by

a) general practitioners in Ireland.

b) hospitals in Ireland.
c) patients in Britain and Italy.
d) Wyeth-Ayerst in Philadelphia.

8. Raskin found that the level of sorbitol in red blood cells fell

a) in 57 per cent of diabetic patients.

b) in diabetic patients taking 100 milligrams of tolrestat daily.
c) in 23 per cent of diabetic patients taking tolrestat twice daily.
d) by an average of 57 per cent in 23 diabetic patients taking
tolrestat.

9. Which statement is not true regarding the side effects of tolrestat

a) They have not yet been found to be serious.

b) All patients experienced side effects, even if minor.
 c) Levels of liver enzymes went up in a small number of patients.
d) Some patients experienced dizziness.

10. Crabbe feels that, as far as diabetic peripheral neuropathy is

concerned

a) patients must be discouraged from using tolrestat.

b) the monitoring programme will give useful information.
c) more proof is needed that sorbitol levels need reducing.
d) none of the above.

PART B – #3 NEW AIDS VACCINE HOPE

Paragraph 1
For decades, scientists have vigorously searched for a cure for the AIDS
virus. Recent research just may have uncovered a significant key to
developing that long-awaited vaccine. Scientists have discovered two key
antibodies that seem to prevent the AIDS virus from mutating and spreading
through out the body.

Paragraph 2
The AIDS virus has claimed millions of lives around the world. According
to the World Health Organization, 33 million people currently are infected
with HIV. While search efforts for an AIDS cure are abundant, several
previous stabs at developing a vaccine proved to be non-effective.

Paragraph 3
The International AIDS Vaccine Initiative, a non-profit organization, is
funding the efforts to develop a vaccine and kicked off their effort in 2006,
called Protocol G. Protocol G utilizes blood gathered from HIV patients in
developing countries, to help pinpoint antibodies that could neutralize
strains of the AIDS virus. Through this initiative, the Scripps Research
Institute discovered two critical antibodies which naturally fight against the
spread of the AIDS virus. During the study, released recently in the journal
Science, researchers not only discovered two vital antibodies, but also
discovered a new part of the virus the antibodies attack. This discovery may
lead to a new technique for the creation of a vaccine.

Paragraph 4
For the study, researchers gathered blood from 1,800 HIV patients who had
suffered from the virus, without exhibiting symptoms for at least three
years. The participants were mainly from Africa, but also involved HIV
patients from Thailand, Australia, the United States and the United
Kingdom.

Paragraph 5
The team pinpointed those who had not exhibited HIV signs, though
suffering from the virus for at least three years, because these patients
produce large amounts of natural antibodies in their blood, which fight
against almost all strains of HIV around the world. Dennis Button, a
scientist at the Scripps Research Institute, the key player in the new research
said, “We said if we want broadly neutralizing antibodies, we should look
for people, infected individuals, who are making them,” He added, “The key
thing about the antibodies we’ve found is that they’re more potent than
previous ones and that’s great for a vaccine.”

Paragraph 6
Once the blood was gathered from the HIV patients, the samples were
shipped back to a team with the Monogram Bioscience laboratories in San
Francisco, where researchers studied the samples to determine which
antibodies lead to more resistance to the virus. The team had developed a
process that caused the enzyme embedded in the virus to glow when it
entered a cell. If the researchers did not see a glow when performing the
process, it was a signal the patient’s natural antibodies had fought off the
virus

Paragraph 7
Once the samples containing antibodies that fought off the HIV virus were
identified, they were shipped to Theraclone Sciences, in order to isolate the
antibodies. Burton said “If you want to make a vaccine that works, it has to
protect against not just one, but most of the strains that are out there.” The
 team at Theraclone Sciences isolated two antibodies, which were able to
block against three-quarters of the different strains of HIV tested against the
antibodies. The two antibodies were recognized in the blood of an African
HIV patient.

Paragraph 8
While the new findings do not create an overnight cure for AIDS, they do
help scientists with new options for treatment and a potential vaccine. The
hope is for a vaccine that will encourage a person’s immune system to fight
the virus more vigorously by producing its own antibodies.

QUESTIONS - New AIDS Vaccine Hope

1. According to Paragraph 1, how do scientists hope their new discovery can help fight AIDS?

a) By stopping the virus from proliferating inside the patientʼs system

b) By preventing the virus from transmitting from patient to patient
c) By preventing the patient from suffering secondary illnesses
d) By keeping patients away for longer

2. How many people have HIV?

a) 30 million Africans
b) 3 million homosexual men
c) 33 million people globally
d) 3,000,000 people

3. Which of the following statements is true?

a) Previous viral strains, while abundant, have not been effective when stabbing patients
b) Although patients are abundant, most have been unaffected by the virus
c) Not many scientists have attempted to create an AIDS vaccine so far
d) Masses of research has been done into curing AIDS but none has been successful

4. Which is the most accurate description of Protocol G?

a) It is a viral antibody transmitted into the blood of AIDS patients in poor countries via a pin prick.
b) It is a procedure for searching for AIDS-combating antibodies in the blood of AIDS victims.
c) It is a new part of the virus attacked by antibodies discovered in the study.
d) It is a group made up of The International AIDS Vaccine Initiative and the Scripps Research
Institute.
5. According to Paragraph 3, what could be a possible result of the scientistsʼ findings?

a) A new technique to create vacillation

b) A new viral antibody discovery
c) A new method to build a vaccine
d) A new part of the virus the antibodies attack

6. Which is the most accurate description of the participants in the study?

a) Scientists from The International AIDS Vaccine Initiative and the Scripps Research Institute
b) Scientists involved in the Protocol D Project
c) Asymptomatic HIV patients, mostly from the third world
d) HIV positive people with no symptoms from all over the world

7. Why did the scientists decide to examine blood from these people?

a) Because the majority of AIDS cases are in these countries

b) Because these people are making AIDS neutralizing antibodies
c) Because they have large amounts of the virus after at least three years of infection
d) Because their bodies contain enzymes that glow when the virus enters a cell

8. Which statement best summarizes Denis Burtonʼs opinion about the results of the research?

a) He thought that the best place to find an HIV vaccine was inside the bodies of HIV patients who are
making antibodies.
b) The key thing is that the potential of previous ones is great for a vaccine.
c) The new antibodies fight HIV more successfully than prior attempts.
d) A working vaccine must protect against not one, but all types of HIV.

9. Which statement best describes the procedure used in the study?

a) After the blood was collected, Theraclone identified the antibodies responsible and Monogram
Bioscience identified signs of success in fighting the virus.
b) After the blood was collected, Theraclone identified signs of success in fighting the virus and
Monogram Bioscience identified the antibodies responsible.
c) After the blood was collected, Monogram Bioscience identified the antibodies responsible, and
Theraclone identified signs of success in fighting the virus
d) After the blood was collected, Monogram Bioscience identified signs of success in fighting the
virus, and Theraclone identified the antibodies responsible.

10. Which statement is the most appropriate summary of the article?

a) Scientists have found a vaccine they hope will encourage a person’s immune system to fight the
virus more vigorously by producing its own antibodies.
b) Scientists have found two antibodies which can fight most strains of HIV and may lead to a
vaccine.
c) Researchers have studied blood samples to determine which antibodies lead to more resistance to
the virus.
 d) Scientists have found a new strain of HIV they hope will lead to a new vaccine.

PART B – #4 MYTHS ABOUT DENTAL CARE

Brushing, flossing, and twice-yearly dental check-ups are standard for oral
health care, but there are more health benefits to taking care of your pearly
whites than most of us know. In a review article, a faculty member at
Tufts University School of Dental Medicine (TUSDM) debunks common
dental myths and outlines how diet and nutrition affects oral health in
children, teenagers, expectant mothers, adults and elders.
Myth 1: The consequences of poor oral health are restricted to the
mouth
Expectant mothers may not know that what they eat affects the tooth
development of the fetus. Poor nutrition during pregnancy may make the
unborn child more likely to have tooth decay later in life. "Between the
ages of 14 weeks to four months, deficiencies in calcium, vitamin D,
vitamin A, protein and calories could result in oral defects," says Carole
Palmer, EdD, RD, professor at TUSDM and head of the division of
nutrition and oral health promotion in the department of public health and
community service. Some data also suggest that lack of adequate vitamin
B6 or B12 could be a risk factor for cleft lip and cleft palate formation.
In children, tooth decay is the most prevalent disease, about five times
more common than childhood asthma. "If a child's mouth hurts due to
tooth decay, he/she is less likely to be able to concentrate at school and is
more likely to be eating foods that are easier to chew but that are less
nutritious. Foods such as donuts and pastries are often lower in nutritional
quality and higher in sugar content than more nutritious foods that require
chewing, like fruits and vegetables," says Palmer. "Oral complications
combined with poor diet can also contribute to cognitive and growth
problems and can contribute to obesity."
Myth 2: More sugar means more tooth decay
It isn't the amount of sugar you eat; it is the amount of time that the sugar
has contact with the teeth. "Foods such as slowly-dissolving candies and
soda are in the mouth for longer periods of time. This increases the
amount of time teeth are exposed to the acids formed by oral bacteria from
the sugars," says Palmer.
Some research shows that teens obtain about 40 percent of their
carbohydrate intake from soft drinks. This constant beverage use increases
the risk of tooth decay. Sugar-free carbonated drinks and acidic beverages,
such as lemonade, are often considered safer for teeth than sugared
beverages but can also contribute to demineralization of tooth enamel if
consumed regularly.
Myth 3: Losing baby teeth to tooth decay is okay
It is a common myth that losing baby teeth due to tooth decay is
insignificant because baby teeth fall out anyway. Palmer notes that tooth
decay in baby teeth can result in damage to the developing crowns of the
permanent teeth developing below them. If baby teeth are lost
prematurely, the permanent teeth may erupt mal-positioned and require
orthodontics later on.
Myth 4: Osteoporosis only affects the spine and hips
Osteoporosis may also lead to tooth loss. Teeth are held in the jaw by the
face bone, which can also be affected by osteoporosis. "So, the jaw can
also suffer the consequences of a diet lacking essential nutrients such as
calcium and vitamins D and K," says Palmer.
"The jawbone, gums, lips, and soft and hard palates are constantly
replenishing themselves throughout life. A good diet is required to keep
the mouth and supporting structures in optimal shape."
Myth 5: Dentures improve a person's diet
If dentures don't fit well, older adults are apt to eat foods that are easy to
chew and low in nutritional quality, such as cakes or pastries. "First,
denture wearers should make sure that dentures are fitted properly. In the
meantime, if they are having difficulty chewing or have mouth
discomfort, they can still eat nutritious foods by having cooked
vegetables instead of raw, canned fruits instead of raw, and ground beef
instead of steak. Also, they should drink plenty of fluids or chew sugar-
free gum to prevent dry mouth," says Palmer.
Myth 6: Dental decay is only a young person's problem
In adults and elders, receding gums can result in root decay (decay along
the roots of teeth). Commonly used drugs such as antidepressants,
diuretics, antihistamines and sedatives increase the risk of tooth decay by
reducing saliva production. "Lack of saliva means that the mouth is
cleansed more slowly. This increases the risk of oral problems," says
Palmer. "In this case, drinking water frequently can help cleanse the
mouth."
Adults and elders are more likely to have chronic health conditions,
like diabetes, which are risk factors for periodontal disease (which
begins with an inflammation of the gums and can lead to tooth loss).
"Type 2 diabetes patients have twice the risk of developing
periodontal disease of people without diabetes. Furthermore,
periodontal disease exacerbates diabetes mellitus, so meticulous oral
hygiene can help improve diabetes control," says Palmer.

MYTHS ABOUT DENTAL CARE – QUESTIONS

Q1 This article is about

1. disproving some long held beliefs

2. how diet and nutritional needs of children, teenagers, mothers to be,
and adults affects one’s oral health
3. how the oral health is not affected by nutritional needs of children,
teenagers, expectant mothers and other groups
4. how the nutritional needs of children, teenagers and expectant
mothers
has an affect on oral health

Q2 Carole Palmer observes that

1. pies and pastries have low food value and require more chewing
2. lower nutritional quality food needs more chewing
3. nutritious foods like fruits and vegetables have less sugar and require
more chewing
4. too much Vitamin B6 or B12 coud lead to problems with cleft palate
formation

Q3 According to Palmer
1. asthma is five times less common in childhood than tooth decay
2. school kids with tooth decay pain may have concentration problems at
school
3. mouth and dental problems plus a poor diet can affect thinking
abilities
and be a factor later on in obesity
4. all of the above

Q4 According to the article

1. it is important to make sure you retain baby teeth
2. it is important that teeth are not exposed for a long time to acids
formed by oral bacteria as a result of eating sugary foods
3. it is important to look after your baby teeth
4. it is important that teeth are not exposed to acids formed by oral
bacteria from sugary foods

Q5 According to the article, baby teeth

1. are dispensable
2. develop to help eat food
3. if lost prematurely, may result in poor development of permanent
teeth
4. help with correct development of permanent teeth

Q6 Dental health in older people requires

1. properly fitting dentures
2. a calcium rich diet
3. nutritious food containing Vitamins D and K
4. all of the above

Q7 The article says that Osteoporosis

1. may prevent loss of teeth
2. may affect jaw bones
3. jaw bone health may be affected by chewing sugar-free gum
4. None of the above
Q8 Lack of saliva
1. results in the mouth being cleansed more slowly
2. can be addressed by chewing sugar free gum
3. may increase the risk of tooth decay
4. All of the following

Q9 Palmer says that Type 2 Diabetics

1. have the same amount of tooth decay as the rest of the population
2. develop periodontal disease twice as fast as the rest of the population
3. develop periodontal disease twice as fast as people without Type 2
diabetes
4. can help themselves by watching their sugar intake

Q10 Dental decay is up to us

1. Teenagers obtain almost half their daily carbohydrate requirements
from soft drinks increasing the risk of tooth decay – so they should
drink less sugary drinks
2. Older adults with ill fitting dentures, often eat easily-chewable food, low
in nutritional quality – which leads to tooth decay – so they should get
their dentures fixed
3. If baby teeth are not looked after, they may need to come out
prematurely, thus affecting correct development of erupting permanent
teeth – so parents should make sure their children’s baby teeth are kept
clean by regular brushing
4. All of the above

PART B READING - GOSLINGS OF GAY GEESE

by Jared M. Diamond, Professor of Physiology at the University of
California Medical School, Los Angeles, California.

Homosexual female pairs of wild birds - already reported for four

tern and one goose species - have aroused much interest. Does the
phenomenon reflect a hormonal or behavioural idiosyncracy of the
homosexual females that distinguishes them from heterosexual
females, one that produces no evolutionary benefit (no offspring)?
Or is it instead an adaptation compatible with reprodnction and
favoured by natural selection under conditions of male scarcity? A
recent study by Quinn demonstrates the feasibility of the latter
interpretation.
Recognition of the phenomenon stemmed from the observation that
up to 14 percent of western gull clutches on Santa Barbara Island,
California, contained twice as many eggs as do normal clutches.
Although this observation might in principle have arisen from other
causes (such as polygamous females sharing a nest, brood parasitism
or egg dumping), the prevalent cause turned out to be pairs
consisting of two females, both of whom laid eggs. Like male/female
pairs of gulls, paired females often make lasting bonds and nest with
each other in successive years in the same colony, even at the same
nest site. Homo- sexual female pairs of Western Gulls practise the
same courtship and territorial behaviour as do heterosexual pairs,
except that courtship feeding is rare and only three homosexual pairs
exhibited attempted copulation. ·

Homosexual pairing is often associated with a shortage of males in

the nesting colony. The ratio of males to females collected since
1950 among adult Western and Herring Gulls is only 0.42 - 0.43, for
example, because of selective post-fledging mortality of males. It is
interesting that above-average sized clutches have been regularly
observed in these two species only since 1950; before 1950, the sex
ratio was closer to 1 : 0. Experimental removal of many males
from California and ring-billed gull colonies resulted in a threefold
increase in frequency of 'supernormal' clutches compared with
control colonies.

Homosexual pairing in gulls. - to be explicable by natural selection

at the individual level - the female must somehow become fertilized
and succeed in rearing offspring. Western Gull female pairs provided
experimentally with fertile eggs from other nests do incubate, feed and
fledge young with virtually normal success rates . Among the eggs
found naturally in supernormal clutches, many are infertile but some are
fertile. So, how do paired females become fertilized?

Quinn et al reported results of a restriction-fragment-length polymorphism

analysis to determine parentage of goslings hatched by a female pair of
Lesser Snow Geese on Hudson Bay, Canada. When discovered - the nest
contained eight eggs, twice the normal clutch size for the species. Seven of
the eggs hatched. Both females defended the goslings and removal of one
female led the other to give loud 'mate calls' typical of male/female pairs.
The genetic analysis indicates that goslings

l, 2 and 3 stemmed from one of the females fertilized by one male; goslings
4, 6 and 7 stemmed from the other female fertilized by a different male; and
gosling 5 could have stemmed from either female but had to have been sired
by yet a third male. Thus, both females had become fertilized
independently and were not the co-widows of one deceased or absent
polygamous male.

This is the first observation of female pairing in Lesser Snow Geese: a

species for which the sex ratio is not known to be skewed. Although the
advantage of female pairing is thus uncertain for the geese, its adaptive
value now becomes clear for the gull colonies having a shortage of
males. One gull alone is incapable of rearing young because other gulls
destroy the clutch when the single parent leaves to feed.

Normal nests of male/female pairs are always attended by one parent. In

a nominally monogamous colony a male deficit means that some females
cannot obtain male mates. But any female can still become fertilized (at
least in gulls) by some nominally monogamous male, as mated males
seek to copulate with females other than their mate. Once fertilized, two
females can rear the young almost as well as one female plus one male

These observations raise the perennial question of why males exist at all
at a sex ratio near 1 : 0. After a male gull has contributed semen, he
appears to play almost no role that a female cannot play equally well. It
is true that female gulls do not provide each other with the courtship
feeding that male gulls provide their mates, with the result that eggs of
homosexual female pairs are smaller and may have poorer post-hatching
survival than do eggs of heterosexually paired females. However, if
long-term reproductive success per egg is at least 50 per cent of
normal, homosexual pairs would still have a higher reproductive output
per individual than do heterosexual pairs.
It is also true that, in species whose males are much bigger than females
(unlike male gulls), males are useful for protecting the young. Yet other
males themselves are one of the main threats in the first place. Further
study of homosexually paired female birds may help clarify what, if
anything, males are good for - in an evolutionary sense, of course

GOSLINGS OF GAY GEESE - QUESTIONS

1. Quinn's study on homosexual female pairs of wild birds suggest that

they

a. still reproduce
b. do not reproduce
c. have hormonal problems
d. do not really exist

2. Observation of the gulls on Santa Barbara Island showed that

a. twice as many birds as usual laid eggs

b. some nests contained 14% more eggs than normal
c. up to 14% of nests contained twice as many eggs as usual
d. up to 14% of western gulls lay twice as many eggs as other gulls

3. The large number of eggs in the nest was caused by

a. more than two females sharing a nest

b. two females sharing a nest
c. birds dumping their eggs in other birds nests
d. eggs left at the nest site from the previous year

4. Homosexual female pairs of western gulls rarely

a. try to mate with each other

b. stay together for a long time
c. nest at the same place
d. practise courtship behaviour

5. Larger clutches have been observed when

a. the ratio of males to females is l.0

b. the ratio of females to males is l.0
c. the ratio of males to females is 0.42 - 0.43
d. the ratio of females to males is 0.42 - 0.43

6. G.L. and M.W. Hunt reported on how

a. homosexual female pairs became fertilized

b. supernormal clutches of eggs occurred
c. the parentage of goslings was determined
d. researchers gave other birds' fertile eggs to female pairs

7. Which statement is not true regarding the female pair of lesser snow
geese studied on Hudson Bay?

a. Their nest contained twice as many eggs as normal

b. They behaved in some ways like a male/female pair
c. Three different males had fathered their goslings
d. It was impossible to tell which goslings had different fathers

8. Female pairing is valuable when there is a shortage of males because

a. males are not as good at protecting the nest

b. two birds are needed tc protect the nest
c. males will destroy the eggs
d. two females can rear the young better than a male/female pair

9. Compared with male/female pairs, female pairs of gulls

a. rear fewer young
b. lay larger eggs
c. lay smaller eggs
d. rear more male young

10. The author questions male gulls’ usefulness in an evolutionary sense

because

a. they are not large enough to protect their young

b. they are a threat to the young of other gulls
c. female birds can do nearly everything males can do
d. all of the above.

ANSWERS – Part A - Alcohol Related Brain injuries

Q1 Forced Q5 recently
Q2 Cancer Q3 study Q4 requests
sterilization program deceased
Q7 lawful Q8 fertilization
Q6 sperm removal Q9 consent Q10 freezing
consent procedure
Q11 reproductive Q12 unfertilized Q15 perinatal
Q13 viable Q14 over 20%
insurance oozytes outcomes
Q16 embryo transfers Q17 56.9% Q18 2006 Q19 lower Q20 Babies*
Q25 Perinatal
Q21 those Q22 research Q23 resulted in Q24 lower rate
outcomes
Q27 lifetime
Q26 infertility Q28 pregnancy Q29 women Q30 thirties
chance
Q34 41 year
Q31 forties Q32 double Q33 pregnancy Q35 guarantee
old
* Must be a capital “B” because it is the first word of a new sentence

ANSWERS - Part A - Pharmacy Asthma Care Program

Q1 health Q2 16.6% [one

Q3 health care Q4 33% Q5 heart failure
insurance in 6]
Q6 ischaemic
Q7 hypertension Q8 encouraging Q9 smoking Q10 moderation
heart disease
Q11 eating Q12
Q13 passed on Q14 new drugs Q15 living cells
development
 Q17
Q16 benefits Q18 quarter Q19 bioethicist * Q20 physicians
resuscitating
Q21 actively Q25 premature
Q22 doctors Q23 hospitals Q24 service fee
allow patients babies
* [in the footnote on the header
page!] This happened in a previous
Q26 reduction Q27 slashing
OET Test where the answer was on
the cover sheet.

ANSWERS – Part A - Wood Dust Allergies

Q3 crystalline
Q1 mining Q2 sandblasting Q4 nanoparticles Q5 glass
silica
Q9 different
Q6 chipping Q7 294,000 Q8 all Q10 chronic
levels
Q13 shortness of Q14
Q11 subacute Q12 acute Q15 absent
breath occupational
Q16 non Q17
Q18 incidence Q19 mineral Q20 silicosis
smokers compensation
Q23 causes lung
Q21 1997 Q22 2004 Q24 15 to 20 Q25 continuous
cancer
Q26 emphysema Q27 smoking

PART B ANSWERS

ANSWERS – Drug for diabetes on sale in Ireland

Q1 a Q2 c Q3 c Q4 b Q5 c
Q6 a Q7 b Q8 d Q9 b Q10 d

ANSWERS - New AIDS vaccine hope

Q1 a Q2 c Q3 d Q4 b Q5 c
Q6 c Q7 b Q8 d Q9 c Q10 b
ANSWERS - Myths about dental care

Q1 b Q2 c Q3 c Q4 a Q5 b
Q6 a Q7 c Q8 b Q9 a Q10 d

ANSWERS – Goslings of gay geese

Q1 a Q2 c Q3 d Q4 b Q5 c
Q6 c Q7 b Q8 d Q9 c Q10 b

Part A & Part B Listening

The following pages have

2 Part A listening questionnaires, and
2 Part B questionnaires.

In Part A you hear two voices: the patient and the health professional.

In Part B you hear one voice: it is a lengthy (30 to 35 minutes) piece of

narration on a health-related topic.

In both “A” and “B” you are required to fill in the missing information.
Sometimes you are required to finish off a sentence.
Sometimes you are required to circle the most appropriate option.

Weblinks to the soundtracks, which are stored in the cloud, are given.

Part A Listening : Tammy Driscoll

https://www.dropbox.com/s/9k3o9rq3ucv5e1c/Tammy_Driscoll2.mp3?
dl=0

PART A – LISTENING
Consultation between Dr Heathcote and Tammy Driscoll

SECTION 1

Q1 Symptoms felt by the patient

...................................................................................................
..................................................................................................

Q2 Particular details about the patient

...................................................................................................
...................................................................................................
...................................................................................................

Q3 History of what’s happened

. ...................................................................................................
...................................................................................................
...................................................................................................
...................................................................................................

Q4 Since admission to the hospital:

(Circle the events mentioned on the soundtrack)

a. patient fainted b. had sublingual glyceryl trinitrate tablet

c. had a chest xray d. had an ECG
e. had a CT f. had an echocardiograph
g. had an angiogram h. had a meal

Q5 Check x-ray revealed:

. ...................................................................................................
...................................................................................................
 ...................................................................................................

Q6 Patient is to get some tests. Which ones?

. ...................................................................................................
...................................................................................................
...................................................................................................

Q7 The patient gives the following details about her lifestyle:

(Circle the correct options)

a. Smokes about 20 a day

b. Smokes about 30 a day
c. Non smoker
d. Drinks wine and beer
e. Drinks half a bottle of red wine
f. Mostly drinks up to 2 glasses of wine
g. Works 24/7 [all day long, 7 days a week]
h. She builds houses then sells them
i. She’s a property developer
j. currently takes medication

Q8 The doctor notices: (Circle correct options)

a. patient is in poor health b. patient is in reasonable health

c. patient is very obese d. patient needs to lose some weight
e. patient needs to work less
Q9 Possible treatment plans: Which ones?
a. open heart surgery b. abdominal aortic surgery
c. thoracic aortic surgery d. medication

SECTION 2
https://www.dropbox.com/home/Public?
preview=Tammy_Driscoll_Pt2v3.mp3
Q10 After tests are conducted, doctor sets out treatment for immediate
future:

. ...................................................................................................
 ...................................................................................................

Q11 Doctor suggests a holiday. The patient gives details about her family
overseas:

. ...................................................................................................
.....................................................................................................
.....................................................................................................
.....................................................................................................
.....................................................................................................

Q12 The patient queries how she can take a holiday while she’s running
a business. The Doctor warns her: “It will be on ……………. ………. If
you die.”

Q13 How does the Doctor know the patient has a raised cholesterol level?
. ...................................................................................................

Q14 The Doctor wants the patient to see:

. ...................................................................................................
...................................................................................................

Q15 Last advice for the patient to follow:

....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................

Q16 Patient is being taken home by her husband.

What does she (the patient) suggest to her husband?
 ...................................................................................................
...................................................................................................

Part A Listening : The mystery of Multiple Sclerosis

https://www.dropbox.com/s/mh6rn6ka06konm1/Mystery%20of%20Multiple%
dl=0

PART A – LISTENING
Interview with John Blades, an MS sufferer, talking to ABC radio
personalities.
The listening track lasts approximately 21 minutes. As you listen, fill in the
missing information on these answer sheets.

At the OET Test, you will hear the track only once.

With this practice test, you can replay again and again to go back over your
work.

OET LISTENING - Part A The Mystery of Multiple Sclerosis

[Sound track starts with John Blades using voice activation on his computer,
dictating an email.]

[Voice over – John Blades talking to his computer] ...

Wake up. Switch to normal mode. ‘Hi guys’. Cap that. Comma, New
line. ‘It is necessary to begin putting together our performance for the
opening night at the Performance Space on July 5.’ Full stop.

Q1 What is he arranging? [Circle the correct option]

a. an email
b. his next musical gig
Q2 Why is he using voice activation? [Circle the correct option]

a. it’s the only way he can utter words

b. he has lost movement from the neck down
c. he has Cancer of the Larynx

Q3 He directs an experimental music group called: _________________

Q4 How long has he had MS? . .. . . . . years

Q5 He is one of almost . . . . . . . people in Australia and . . . . . . . . .

worldwide who are affected by this inflammatory disease of the .. . . .
. and. . . . . . Scientists are still . . . . . . . . for . . . . . to prevent its . . .
..

Q6 According to Dr Anne Louise Ponsonby: [Circle correct options]

a. Sometimes the body self attacks its pancreas such as in Type II

diabetes
b. MS is a disease where there seems to be a problem with the immune
system
c. The immune system recognises self from non-self very well
d. MS does not affect the brain and spinal cord
e. MS goes through the nervous system
f. MS is when the myelin, surrounding the nerves and the CNS, is the
main target.

Q7 Lynne Macolm gives some general information about MS: [Fill in

the gaps]

MS begins between the ages of . . . . . and . . .. . .

People are at the . . . . . . . of their lives
 Q8 Professor George Ebers sums up Multiple Sclerosis : [Choose
one of the following headings - which one would best summarise
what he says]

a. MS is a cruel disabling disease

b. MS destroys peoples’ ability to manage their lives affecting their ability
to walk, lose the use of their bladders and ability to think
c. MS can be relatively mild
d. Sometimes people remain relatively well

Q9 John Blades describes early signs of the disease: [Fill in the gaps]
(i) The . . .. . . symptoms were .. . . . . . . neuritis, a disturbance in the optic
nerve – it’s like pins and needles without the . . . . . .
(ii) The next symptoms were .. . . . and .. . .. . in feet and fingers. The
numbness grew up both . .. . so that in 1992 John went into a . .. . .
wheelchair. He decided to put the MS on the “back burner” rather than let it
take centre stage.

Q10 John Blades continues: [Fill in the gaps]

a. In the wheelchair, the MS affected the . . . . . controlling . . . . . . . so
John’s . . .. . . became more difficult to use.
b. He stopped . .. . . in 1997 and gave up work in . .. . . . . because writing
had become difficult as well as . . . things like turning pages.
c. But he kept up all his . . . .. . .
d. In 1982 he graduated from .. . . . , started work as a structural
engineer, started work in . .. . . doing experimental music programs.
e. He was pursuing interests in .. . . and . .. . “ferociously”.

Q11 How did he feel in 1982?

(a) .. . .. . . . . . . . . . .. . . . . .
(b) His mother’s MS was fairly mild.
 Based on his mother’s experience, he felt :
. . . . . . .. . . . . . . .. . . . . .

Q12 Dr Anne Louise Ponsonby describes MS as a “multifactorial”

condition: several factors involved in the initiation (the start) of MS; these
factors may operate at various stages of one’s life from very early life until
the onset of the disease.

She describes her work surrounding the relationship between MS and

exposure to other children in early life:
(i) . .. . . . . hypothesis
(ii) children from large families appeared . . .. . . . . to have hay fever
(iii) more than 50 studies have found that children who have many . .. . . . . .
OR who are exposed to markers of early life . . .. . . . such as day care
attendance, have a reduced risk of . .. . . . . and hay fever.
(iv) In the context of MS, she found that family size did not seem important
- exposure to infants during . . .. . year of life was inversely related to MS
- so that children who were . . .. . . . to more . . . .. . . in the first .. . . . years
of life were less likely to develop MS.

Q13 Ponsonby is asked if this is related to the building up of one’s

immune system: She gives some characteristics of how one’s immune
system builds up because of exposure to infection. Ponsonby believes the
immune system: [select correct options]
1. Does not develop in isolation
2. It’s a static system
3. It does not need environmental exposure
4. It does need infectious exposure
 5. Immune system needs exposure to environmental and infectious
factors to train it to work in a targeted way.
Q14 Professor Ebers is particularly interested in : [Fill in the gaps]
Studying the interaction between ………….. and …………..
Studying ……… ………………
Also looked at ………….. and …………………
Q15 Why was it possible to look at this cohort?
........................................................
......
Q16 Professor Ebers was able to examine the risk for MS in individuals
who had MS and then had a half-brother or half-sister with the disease, and
we asked was there a difference in risk between the people who are raised
apart versus the people who are raised together? The answer was:
………………… (i)

The second thing he examined were individuals who are related through a
single parent rather than both parents. If the mother is the common
parent, is the risk any different than if it is the father who is in common?
In this case it turns out that it matters …………. (ii)

The . . . . . . . . . . . . . is much more likely to be in common with the MS

affected child, than the . . . . .. . . . . . . . .
(iii)

The third thing was that when one examines the risk for half-brothers and
half-sisters, the risk …… ………. – which was contrary to
expectations. (iv)

Q17a What is John Blades’ “link to the world” ? [Tick one]

a. his telephone
b. Vital Call service
c. a little tube he blows into
Q17b How does he turn pages of a book? He uses a ……………….
which is useful for not just turning pages, but also for:
1. ...
2. ...
3. ...

Q17c His days are filled by

.
.
.
.

Lynne Malcolm: Anne Louise Ponsonby is an Australian researcher who's

trying to determine what environmental factors may be associated with MS.
And it seems that something as simple as where you live and how much sun
you're exposed to may play an important role.

Anne Louise Ponsonby: (Select correct option)

Q18 One of the biggest signs we have that an environmental factor may be
important is :
a. The incidence of MS goes down as one moves further away from the
equator
b. The incidence of MS goes up as one moves further away from the
equator
c. More people in Australia have MS than the rest of the world.
d. More people in Scandinavia have MS compared to Italy or Spain.

Lynne Malcolm: Different rates of MS in Tasmania and Queensland ?

Q19. Study in Tasmania in 1981 revealed:
- 6 times higher than in Queensland
Lynne Malcolm: What are the reasons for those findings ?
Q20 Several possible reasons: (Select correct option)
a. lack of sunlight (Vitamin D)
b. too much sunlight
c. Vitamin D has special properties in relationship to the immune system
in humans
d. Ultraviolet rays are harmful to the immune system
e. infections picked up by infants differ, depending on climatic conditions

Lynne Malcolm: If it's the case that the vitamin D that we get from
sunlight has a role in protecting against MS, what about the message we're
constantly getting to cover up in the sun?
Q 21 : George Ebers: How much sun?
If you are getting too much sun
If you are not getting enough sun

If you avoid sunlight, you need to

Dermatologists say too much sun
ensure you
increases
are not .. . . . . . . (i) deficient -
one’s risk of getting
by
. . .. . . . . . . . . . . (iii)
taking it by . . . . (ii)

Saudi women have an increased rate

of
. . . . . . . . . . . . . . . (iv)

MS in Saudi Arabia appears to be

steadily
. . . . . . . . . . . . . . . (v)

Lynne Malcolm: John Blades can't afford to wait around for a medical
breakthrough. He's decided to take the bull by the horns, as he puts it, and be
proactive. He's speaking with Sherre Delys.

Q22 John Blades speaks about his MS experiences:

a. Not had any . . . . .. . .. . . . . . . . . . . . . .
b. Has pursued all his various . . . . . . .. . . . . . .
c. He put his MS on the . . .. . . . . . . . . . . . . .
d. He eventually lost the use of his. . . . , his . . . .. . , his . . . . . and
.. . . . functions and also the . . . .. . that controlled his chest muscles.
e. He got . . .. . . . . . . . . . and would spend days . . . . .. . . . . . . into space.
f. I discovered the . .. . . . . . . . . and . . .. . . . . . . .
g. He learned he could use a . . . . .. . . .. . . . . . . . . . computer
h. He hasn’t looked back and has had none of those .. . . . . . . . . feelings
again.

END OF THE LISTENING TEST

Part B Listening: Fish Oil – a handy little capsule

https://www.dropbox.com/s/pga36nqie3w4x33/PART%20B_Fish%20Oils.wma?
dl=0

Fill in the gaps as you listen

Q1 BBC News has reported that taking a daily fish oil capsule can stave off
. . . . (1) in those at highest risk,”

The news comes from a study that enrolled . . . . . (2) people at high risk
of . . . . . . . . . . . . . . ., (3) and randomly assigned them to take either . . . .. (4)
or a dummy pill for . . . . . . (5) months.

After a year, those in the fish oil groups were about a quarter less likely to
have developed a psychotic illness such as schizophrenia.

Q2.1 This small study Choose EITHER 2.1(a) OR 2.1(b)

2.1(a). could prevent young people at high risk from progressing to psychotic
illness
OR

2.1(b). could prevent young people at high risk from regressing to psychotic
illness
Q2.2 Does fish oil prevent or delay onset of psychotic illnesses?
Tick the correct option

2.2a. This research was too short to come to a definite conclusion

2.2b. This research was too long to come to a definite conclusion
2.2c. The research sample was not large enough
2.2d. The research sample was small

Q3 What is the research about?

[Tick the options which concur with the speaker]

a. double-blind
b. Looked at affects of polyunsaturated fatty acids
c. placebo-controlled
d. Do Omega3 fatty acids play a part in the development of psychotic illness
?
e. Randomised-controlled trial
f. Low levels of Omega 3 and Omega 6 polyunsaturated fatty acids with
Schizophrenia

Q4 So far, studies on the affects of omega-3 and Omega-6 fatty acids in

people with schizophrenia have been Select the correct options

(a) found in oily fish

(b) found in all vegetable oils
(c) found in fish oil capsules

Q5 This study was a placebo-controlled RCT, the best study design for
determining whether a treatment has an effect on an outcome of interest. The
participants of an RCT (randomised control trial) are:

Tick all the correct options

a. randomly allocated into groups
b. groups should be characteristically different
c. Using balanced groups in a trial means any differences between the
groups
 results should be minimised
d. Some participants received dummy pills instead of fish oil pills
e. Participants and assessors did not know who was receiving which
treatment
f. The participants’ beliefs about whether or not the supplements worked
affected the outcomes

Q6 What did the research involve? Fill in the gaps

The researchers recruited .... adolescents and young adults aged ....... to .......
years
old who had characteristics that put them at high risk of developing psychotic
disorders such as .............. They randomly assigned the participants to
take either daily fish oil capsules (containing about 1.2g omega-3 PUFAs) or
placebo capsules for ......... months. The researchers then followed them up
for a year to identify any participants who developed a ............. disorder and
to monitor the level of any psychotic symptoms seen.

Q7 The researchers enrolled participants who had at least one of the

following risk factors for psychosis: Fill in the gaps

Low levels of psychotic symptoms (delusions, ........., suspiciousness, or

..........disorganisation measured on a standard scale), ............ psychosis,
i.e. lasted less than a week and resolved without antipsychotic medication,
or
having either a schizotypal personality disorder or a .............. relative (such
as a mother, father, sister or brother) who had psychosis, plus the participant
experienced a significant reduction in ............. to function in the last year.

Q8 These people may have Select all the correct options

(a) a high risk of developing psychosis within the following year.

(b) a high risk of developing psychosis within three months.

Participants were considered as having developed a psychotic disorder if they

reached a pre-specified level of psychotic symptoms that lasted for at least a
week, with all diagnoses being confirmed by a psychiatrist.
Researchers monitored how much of their supplements the participants took
by
monitoring the number of pills they had left and by taking blood samples.
The placebo pill contained .......... (which does not contain PUFAs) and an
equivalent amount of vitamin E to the fish oil capsules, plus 1% fish oil to
make the taste of the capsules similar.

Q9 The researchers carried out statistical analyses to look for differences

between the groups in terms of: Fill in the gaps

(a) the proportion developing a first episode ...........

(b) how long it took before these ............................
(c) the participants’ levels of ..................... over time.
They also looked at whether the groups differed in their use of psychological
and psychosocial treatments or in their use of medication.
Q10 What were the basic results?

Fish Oil Group Placebo Group

3 out of . . . . . people 2 out of . . . . . . .
= ..... % people
= . ...%
. . . people in this . . . . . . people in this
group group (27.5%)
( 4.9%) developed developed psychotic
psychotic illness illness
.......% lower risk of
developing psychosis
in this fish oil group
 Q 11 (a) Fish Oil Group
...... people at high risk of
psychosis would have to take
fish oil for ...... months to
prevent them from developing
psychosis over the course of
..........
Q 11 (b) Placebo Group
Q12
The placebo group had How did
.......levels of psychotic the
symptoms and better overall
psychological, social and
occupational functioning than
the fish oil group at the end of
the study.

researchers interpret the results? Fill in the gaps

The researchers concluded that, “a 12-week intervention with omega-3

significantly reduced the ............................ rate to psychosis” and led to
“significant symptomatic and functional improvements during the
......................follow-up period (12 months)”.

Q13 They also say that their study Select all the correct options

a. strongly suggests that omega-3 PUFAs may offer a viable prevention

b. Also offers a treatment strategy with minimal associated risk in
 young people at ultra-high risk of psychosis.
c. The researchers suggest that the potential of the supplements as
a preventive intervention should be explored further.
d. This trial used a robust study design.
e. It suggests that fish oil supplementation may reduce the risk of
transition to psychotic illness in people at very high risk of these
disorders.

Q14 However, there are some points to consider, which the researchers
themselves raise:

The study was relatively small ( ....... people). In smaller studies,

.................
participants may be less effective at balancing groups. Although the
researchers did show that the groups were balanced for a number of factors,
there may have been others that were not balanced and could affect results.
The small size of this study may also limit its ability to .............. from each
group.

Q15 The people in this study : Select all the correct options

a. were frail
b. young adults at low risk of psychotic illness
c. they were referred to a specialised psychosis detection clinic
d. Were not high risk of psychotic illnesses
e. Were carefully selected to participate in the trial

Q16 Overall, this study provides promising results that suggest that
..............
warrant further investigation as a ...........treatment in ............ people at
............. risk of psychosis. Future studies should include a ............number of
participants and follow them up for a ...........period of time.
- END OF LISTENING -

Part B Listening : A Good Death – Challenging law

and medical ethics
https://www.dropbox.com/s/t8gp6v9e0b4cu99/A%20Good%20Death.mp3?
dl=0

This is an extract of a talk given by Dr Rodney Syme, former President and

currently the Vice President of Dying With Dignity Victoria. Dr Syme was
the keynote speaker at the Sydney Law School’s seminar on the moral, legal
and ethical issues relating to euthanasia. This talk was first given in
September 2008.

You will hear this recording once only. As you listen, write down answers
or select the correct option. In some questions, more than one option is
correct – in which case, circle all correct options for that particular
question. The test will take about 30 minutes.

You have about one minute to look through the paper.

Q1 What does Syme believes constitutes “a good death” ?

Acceptance of (1) __________ __________
Calm state of (2) __________ devoid of (3) __________
__________
A minimum of (4) __________
Being able to (5) __________ __________ and not (6)
__________ alone.
For many it requires (7) _______ ___ ___ _______ _______
An ability to choose (8) _______ _______ and (9) _______ one
dies.
It requires dying with (10) _______ _______ and (11) _______
Q2 The six “givens” - unarguable basic medical positions on death
and dying. The first given: Dying may be associated with
__________ There may be an increase / decrease [circle one] of suffering
as death approaches.

Q 3 The second given: Palliative care cannot relieve all pain and suffering
in dying patients. This is agreed by __________ __________ __________

Q 4 The third given: Some suffering will only be __________ by

__________

Q 5 The fourth given: When patients have terminal diseases, it is

__________ for them to __________ __________ __________ __________

Q 6 The fifth given: It is the doctor’s duty to __________ __________

Dr John Gregory, lecturing on the duties of a Physician, stated: It is as much
the business of a Physician to__________ pain and to smooth the
__________ to death when unavoidable, as it is to __________
__________ . Diane Meier, a palliative care specialist in New York agrees:
A peaceful death must be acknowledged as a __________ goal of medicine
and as an __________ part of a Physician’s responsibilities.

Q 7 The sixth given: The doctor’s duty to __________ __________

__________

Q 8 Is the patient requesting help to bring about death? Or help to

relieve pain and suffering? What does Syme believe?
 ____________________________________________________________
__________
__________________________________________________

9 Syme has found that if suffering can be relieved, then the patient
a. is happy to die
b. stops asking for help in dying
c. happy to go on living
d. just wants to die quickly

Q 10 Suffering and dependency

Q 10a For many who are dying, the biggest problem in being dependent on
someone else, is:
a. loss of independence
b. loss of function
c. loss of one’s role in society
d. all of the above

Q 10b According to Eric Cassel, physical suffering is when:

a. one’s whole person is affected
b. just the body is affected

Q 10c Increasing levels of dependency – existential and

psychological suffering Complete the following table as you hear
the talk:
Physical Psychological / existential
deterioration suffering
Q 10d Most dying patients have a combination of physical, psychological
and existential pain, referred to in palliative care as
____________________

Q 11. Six options:

Q 11 a The first option
__________________________
What affect does this have on the patient?
_____________________
_____________________
Q 11 b The second option
_______________________

Q 11 c The third option

__________ with a promise of intensive palliation.

Q 11 d The fourth option

______________________
What are some problems associated with this course of action?
______________________
______________________

Q 11 e The fifth option

______________________
 What does this “fifth option” involve?
______________________
This method is also called:
___________________

Q11f First described in

a. 1998
b. 1988
c. 1990

Q 11g Ventafridda described in 1990 how he used it in

a. 50% of patients receiving home palliative care
b. 45% of patients receiving home palliative care
c. 5% of patients receiving home palliative care.

Q 11h Various situations when terminal sedation in palliative care

might be chosen:
__________ __________
__________
__________
__________
__________ and __________

as well as psychological and existential suffering - these are all common

pretexts for terminal sedation in palliative care.
Q 11j A patient in a coma :
__________________
__________________
__________________
Q 11k More on terminal sedation:
[Select the correct options]
a. Provision of intensive care hastens death
b. Patient may die from the sedation
c. Some doctors use terminal sedation in a “miserly” way
d. Doctors never use anaesthetic or hydration when using terminal
sedation
e. Most palliative care workers agree with euthanasia
f. Some are concerned that sedation in the dying patient may be
underused because of fear of employing ‘terminal sedation’.

Q 11m Double effect

Developed by St Thomas Aquinas in the 13th Century, this doctrine posits
that where an action may have both good (relief of suffering) and bad
(hastening of death) effects, the action is justified if the bad effect is
_____ ______ . To protect the doctor’s morals, the creation of oblivion
must be _______ . Patients may argue that hastening death is not
always bad but they do not have a say in the _______ _________ debate.
Deaths from this type of sedation are not always reported to the
___________ .

Q 11n The ethical dilemma –

a. Some patients ask for sedation to render them unconscious at the end
of their life;
b. Some doctors inject patients with overdoses of a drug to bring about
death;
c. Some doctors inject patients with overdoses of a drug to induce
unconsciousness [with the intention of keeping them unconscious until
death comes.]

Q 11o The differences are [Select the correct options]

a. In the first scenario, the result is to avoid legal difficulties
b. In the second and third scenarios, the actions gives comfort to the
patient
c. Terminal sedation provides palliation by taking away
consciousness and, ultimately, eliminating life.
d. The terminal sedation method protects the moral and legal
interests of the doctor.
e. Terminal sedation is no different from physician-assisted dying.

Q 11p The sixth option: the physician assists a patient with his/her
death, by
__________ __________
__________ __________

Q 12 The sixth option presents a crucial difference

[Circle the correct option or options]
a. Prescribing a lethal medication for the patient to use – leaves the
final decision with the suffering patient
b. Prescribing a lethal medication for the patient to use – leaves the
final decision with the physician
c. Control remains in the hands of the sufferer
d. Control remains in the hands of the physician
e. Providing lethal oral medication is regarded as a serious crime:
aiding and abetting suicide

Doctors face a difficult ethical and moral dilemma:

f. Assist the dying person and risk prosecution

g. Do not assist the dying patient and increase the patients’ suffering

Q 13 The evidence shows:

[Select the correct options]
a) Sedation and lethal injection can be delivered only with the
consent of the patient
b) Sedation and lethal injection can be delivered without the
 consent of the patient
c) A self-administered oral drug does not require the complete
control of the patient
d) A self-administered oral drug will cause death
e) Research in Oregon shows that 30% of legal lethal
prescriptions are not used
f) The un-used legal lethal prescriptions do, however, provide
valuable psychological palliation.

Q 14 No accurate data on frequency of terminal sedation use in

Australia - Why?
__________
__________
__________
Q 15 The Chief Justice of West Australia, the Honorable Justice David
Malcolm, wrote: At present members of the medical profession are
placed in a __________ __________ __________ where they have
patients who are terminally ill and suffering great pain and mental anguish or
otherwise suffering, who know that matters need to be brought to a
__________ __________ . The dilemma facing doctors is the twin
obligations to __________ __________ and to __________
__________ The question is: should we leave doctors in this exposed
position without statutory protection?

Q16 Victorian Senior Counsel Richard McGarvie says:

'’As the law stands, only the good sense of prosecuting authorities and juries
stands between __________ and courageous medical practitioners and
__________ ______ __________ ‘‘.

Q 17 As far as Syme is concerned:

Only __________ doctors in Australia have been charged with either
murder or manslaughter, or aiding and abetting suicide, in the last _____
years. Both were acquitted. It is therefore often argued that the lack of
prosecutions of doctors should give the profession confidence that they are
__________ __________ So long as doctors assist patients with drugs of
therapeutic value, such as __________ and __________ they do remain
relatively safe.

Q 18 Difference in legal systems

The Dutch legal system
__________ __________ __________ __________ to justify the use
of drugs that end life/relieve suffering
The English and Australian law seem to be:
__________ with the idea of necessity
To a doctor, the concept of necessity has more _____________ than
double effect.
Professor Roger Magnusson prefers which argument: [Circle one]
a. necessity
b. double effect

Q 19 The medical profession Q 19 The medical profession itself has

“made the law” covering assisted dying

With the advent of new technologies to save and prolong life such as
__________ doctors faced prosecution if they withdrew treatment that
would directly cause the __________. Doctors deemed it was the
__________ thing to do. Prosecutors demurred from charges, and the practice
of the law was changed, even if arguments about causation had to be invented
which, according to Law Lord Mustill, 'seems to require not __________
of the law so much as its __________ in an entirely new and illogical way.'
The introduction of _______ _______ , with the clear potential to cause
death, did not have the sanction of statutory law. It relied on an extension of
the Devlin principle of legal double effect as applying to the deeply sedating
effect of drugs other than __________ . Doctors welcomed this
development for, as Australian palliative care Dr Alexandra Burke said, 'It
provided a readily available means of controlling symptoms and overcoming
patient distress where no feasible alternative existed before.' Potentially
death hastening treatment was introduced and no one was charged.
__________ doctors had again remade the law.

Developed by the OET Workshop © Copyright

Permission granted by the author July 2016

END OF THE LISTENING

Listening Answers

Tammy Driscoll

1. Bad pains in the chest / pain radiating to the neck

2. Tammy Driscoll, 55 Rubens Grove, Canterbury, 64 years old
3. Was taking a kip [short rest] listening to the radio. Woke up – pain in chest. Called husband. He
called the ambulance.
4. b, c
5. Widening of the mediastinum / pleural matter in left lung. Aortic artery has an aneurysm.
6. ECT, CT, echocardiograph, angiogram
7. b, f, g, i
8. b, d, e
9. c, d
10. More walking / occasional swim / change of diet / less stress /
take Metoprolol / get a check-up every 4 to 6 months / some tests
11. One son in Denver. One son in the ‘big Apple’ [New York]
12. Your life will be on permanent hold
13. Fatty deposits under the eyes
14. Nutritionist / Cardiologist
15. Cut down on smoking / use Nicobate / chew nicotine gum / halve alcohol intake / walk for 30
minutes daily / eat fish 2 times a week
16. See Ben in New York / See Anthony in Denver

Mystery of M.S.

1. b. ‘his next musical gig’

2. b. lost movement from the neck down
3. the Loop Orchestra
4. 24 years
5. 15,000 / 2.5 million / brain / spinal cord / searching / possible causes / onset
6. b, e, f
7. 20 & 40 / prime
8. b
9. first / optic sensation / numbness / tingling / legs / manual
10. nerves / arm muscles / arms / hands / driving / 1998 / simple / activites / University / radio /
art / music
11. a. more positive b. felt his MS would be tolerable
12. (i) hygiene (ii) less likely (iii) siblings / infections / asthma
(iv) first / exposed / infants / six
13. 1, 5
14. genes / environment / twins / half brothers /
half sisters
15. many divorced couples in Canada
16. (i) absolutely not – no difference (ii) matters a lot
(iii) the mother more likely to be in common than the father
(iv) risk did not drop very much
17. a, b 17b: head pointer / making phone calls / operating the television / DVD remote
controls
17c: days are spent 1. Listening to the radio 2. Using the computer 3. Going to movies 4.
Going to exhibitions 5. Watching DVD’s 6. Listening to music
18. b, d
19. Six times higher in Tasmania; seems to be increasing MS prevalence as one moves
southwards in Australia
20. a, c, e
 21. (i) Vitamin D (ii) mouth (iii) melanoma (iv) rickets (v) increasing
22. a. negative feelings b. activities c. back burner d. legs, arms, bladder, bowel, nerves e.
depressed, staring f. interest, emailing g. voice activated computer h. negative

Fish Oil
1.1. mental illness in those at highest risk
1.2. 81 people at high risk
1.3. Psychosis and randomly assigned them …
1.4. fish oil capsules or a dummy pill
1.5. three months

Q2.1. a
2.2. a , c

Q3 a (double blind);
c (placebo controlled);
d (do Omega 3 fatty acids play a part in the development of psychotic illness?
e (randomised-controlled trial);

Q4 Studies on affects of Omega 3 & Omega 6 fatty acids in people with schizophrenia have
been: (a) found in oily fish (c) found in fish oil capsules

Q5 a, (randomly allocated into groups)

c, (balanced groups in a trial meant any differencesbetween the groups’
results would be minimised)
d, (some participants received dummy pills instead of fish oil pills)
e, (participants and assessors didn’t know who was receiving which treatment) f.
(participants’ beliefs about whether or not the supplements worked, affected
the outcomes).
Q6 81 / 13 to 25 schizophreniathreepsychotic

Q7 hallucinations / conceptual / transient / first-degree / ability

Q8 (a) is correct - The placebo pill contained Coconut oil

Q9 -a The proportion developing a first episode of psychotic illness

-b How long it took before these illnesses developed
-c The participants’ levels of symptoms over time.

What were the basic results?

Q10

Fish Oil Group Placebo Group

3 out of . . . 41. . people
= . . 7.3. . . %
. 2. . . . people in this group
(4.9%) developed psychotic
illness
22% lower risk of developing
psychosis in this fish oil group
2 out of . . . 40. . . . people
= . 5.0. . . . %
. . . .11 . . people in this group
(27.5%) developed psychotic
illness

Q11
Q 11 (a) Fish Oil Group
...4... people at high risk of psychosis
would have to take fish oil for ...3....
months to prevent them from developing
psychosis over the course of .1/ one year.
Q 11 (b) Placebo Group
The placebo group had . higher. . . levels
of psychotic symptoms and better overall
psychological, social and occupational
functioning than the fish oil group at the
end of the study.

Q12 Researchers concluded

- …… reduced the transition rate to psychosis
- …... during the entire follow up period (12 months)

Q13 (a) (c) (d) (e)

Q14 81 people / Randomising / Detect differences

Q15 Option “c” is correct - no others, just “c”

Q16 Overall, the study

fish oils / preventive / young / high / larger / longer /

A Good Death

Q1 (1) approaching death

(2) Mind (3) toxic anxiety
(4) Suffering
(5) Say goodbye (6) dying
(7) Control of the dying process
(8) When, where (9) how
(10) Peace, dignity (11) security

Q2 intolerable suffering / increase

Q3 Palliative Care Australia
Q4 relieved by death
Q5 rational / request assistance to die (with dying)
Q6 relieve suffering / alleviate / avenues / cure diseases / legitimate / integral
Q7 respect patient autonomy
Q8 Patient accepts that death is preferable to continuing distress
Request for help is fundamentally a desire to be relieved of suffering

Q9 b.
Q10a d.
Q10b. a

Physical deterioration Psychological suffering Existential suffering

Decline in physical
Loss of role
health is stressful
Powerless
Feelings of being a burden
Loss of control
Loss of personality
Loss of cognition
Loss of dignity
Lose meaning for living
Feelings of hopelessness

No more enjoyment in life

Extreme anxiety, fear, terror

Clinical depression – alleviated
if pain is alleviated

Q10d total pain syndrome

Q11a - Doctor can reject the request for assistance to die /

- Forces the patient to continue suffering
- Patient may cease eating and drinking

Q11b Doctor may deflect the request, explore its origins, attempt to alter
them
Q11c Doctor may discuss refusal of treatment, which may hasten death

Q11d Doctor provides increasing doses of morphine /

It will not relieve all the pain/
It depresses respiration

Q11e Doctor can provide deep continuous sedation /

Use of sedative drugs to render the patient into a deep sleep /
Terminal sedation

Q11f a. 1998

Q11g (a) 50%

Q11h unrelievable pain / delirium / breathlessness / fatigue / nausea and

vomiting

There is no question 11i

Q11j Cannot ingest any food or fluids / will dehydrate / may develop
lethal pulmonary complications

Q11 k b, c, f,

There is no question 11l

Q11 m not intended

Slow
Double effect
Coroner

Q11 n a, c

Q11 o a, c, d, e,

Q11 p lethal injection / prescribing lethal medication for patient to end his/her own life

Q12 a, c, e, f, g
Q13 b, d, e f

Q14 unregulated / no official guidelines / goes unreported – unmeasured

Q15 very difficult situation / dignified end / preserve life / relieve suffering

Q16 compassionate / convictions for murder

Q17 two / 45 / not at risk / analgesics / sedatives

Q18 applies the argument of necessity / uncomfortable / validity / (a)

Q19 artifical ventilation / the death of the patient / proper / manipulation

/ application / deep continuous sedation / morphine /
compassionate

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