Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how healthcare dollars are spent.In practical terms, the new guidelines being developed could result in doctors choosing one drug over another for cost reasons or even deciding that a particular treatment—at the end of life, for example—is too expensive. In the extreme, some critics have said that making treatment decisions based on cost is a form of rationing.Traditionally, guidelines have heavily influenced the practice of medicine, and the latest ones are expected to make doctors more conscious of the economic consequences of their decisions, even though there's no obligation to follow them. Medical society guidelines are also used by insurance companies to help determine reimbursement（报销）policies.Some doctors see a potential conflict in trying to be both providers of patient care and financial overseers."There should be forces in society who should be concerned about the budget, but they shouldn't be functioning simultaneously as doctors." said Dr. Martin Samuels at a Boston hospital. He said doctors risked losing the trust of patients if they told patients, "I'm not going to do what I think is best for you because I think it's bad for the healthcare budget in Massachusetts."Doctors can face some grim trade-offs. Studies have shown, for example, that two drugs are about equally effective in treating macular degeneration, and eye disease. But one costs 50 dollars and the other close to 2, 000 dollars. Medicare could save hundreds of millions of dollars a year if everyone used the cheaper drug, Avastin, instead of the costlier one, Lucentis.But the Food and Drug Administration has not approved Avastin for use in the eye. And using it rather than the alternative, Lucentis, might carry an additional, although slight, safety risk. Should doctors consider Medicare's budget in deciding what to use?"I think ethically（在道德层面上）we are just worried about the patient in front of us and not trying to save money for the insurance industry or society as a whole," said Dr. Donald Jensen.Still, some analysts say that there's a role for doctors to play in cost analysis because not many others are doing so. "In some ways," said Dr. Daniel Sulmasy, "it represents a failure of wider society to take up the issue."(1)What do some most influential medical groups recommend doctors do? A.Reflect on the responsibilities they are supposed to take.B.Pay more attention to the effectiveness of their treatments.C.Take costs into account when making treatment decisions.D.Readjust their practice in view of the cuts in health care.(2)What were doctors mainly concerned about in the past? A.Specific medicines to be used.B.Effects of medical treatment.C.Professional advancement.D.Patients' trust.(3)What may the new guidelines being developed lead to? A.The redefining of doctors' roles.B.Overuse of less effective medicines.C.onflicts between doctors and patients.D.The prolonging of patients' suffering.(4)What risk do doctors see in their dual role as patient care providers and financial overseers? A.They may be involved in a conflict of interest.B.They may be forced to divide their attention.C.They may have to use less effective drugs.D.They may lose the respect of patients.(5)What do some experts say about doctors' involvement in medical cost analysis? A.It may add to doctors' already heavy workloads.B.It will help to save money for society as a whole.C.It results from society's failure to tackle the problem.D.It raises doctors' awareness of their social responsibilities..

ReadingA STUDENT OF AFRICAN WILDLIFEIt is 5:45 am and the sun is just rising over GombeNational Park in East Africa. Following Jane’s way of studying chimps, ourgroup are all going to visit them in the forest. Jane has studied thesefamilies of chimps for many years and helped people understand how much 5 theybehave like humans. Watching a family of chimps wake up is our first activityof the day. This means going back to the place where we left the familysleeping in a tree the night before. Everybody sits and waits in the shade ofthe trees while the family begins to wake up and move off. Then we follow asthey wander into the forest. Most of the time, chimps either feed or clean eachother as a way of showing love in their family. Jane warns us that our group isgoing to be very tired and dirty by the afternoon and she is right. However,the evening makes it all worthwhile. We watch the mother chimp and her babiesplay in the tree. Then we see them go to sleep together in their nest for thenight. We realize that the bond between members of a chimp family is as strongas in a human family. Nobody before Jane fully understood chimp behaviour. Shespent years observing and recording their daily activities. Since her childhoodshe had wanted to work with animals in their own environment. However, this wasnot easy. When she first arrived in Gombe in 1960, it was unusual for a womanto live in the forest. Only after her mother came to help her for the first fewmonths was she allowed to begin her project. Her work changed the way peoplethink about chimps. For example, one important thing she discovered was thatchimps hunt and eat meat. Until then everyone had thought chimps ate only fruitand nuts. She actually observed chimps as a group hunting a monkey and theneating it. She also discovered how chimps communicate with each other, and herstudy of their body language helped her work out their social system.For forty years Jane Goodall has beenoutspoken about making the rest of the world understand and respect thelife of these animals. She has argued that wild animals should be left in thewild and not used for entertainment or advertisements. She has helped to set upspecial places where they can live safely. She is leading a busy life but shesays:“Once I stop, it all comes crowding in and Iremember the chimps in laboratories. It's terrible. It affects me when I watchthe wild chimps. I say to myself, 'Aren’t they lucky? ’ Andthen I think about small chimps in cages though they have done nothing wrong.Once you have seen that you can never forget She has achieved everything shewanted to do: working with animals in their own environment, gaining a doctor’sdegree and showing that women can live in the forest as men can. She inspiresthose who want to cheer the achievements of women.Choose thecorrect answers after reading the passage.2.What did the group do first in the morning? They______.A went into the forest slowly B left the chimp family sleeping in a tree C observed the family of chimps wake up D helped people understand the behaviour of the chimps 3.Why did Jane go to Africa to study chimps in the wild?Because she wanted A to work with them in their own environment B to prove the way people think about chimps was wrong C to discover what chimps eat D to observe a chimp family4.Jane was permitted to begin her work after _____ A the chimp family woke up Bshe lived in the forestC her mother came to support her Dshe arrived at Gombe5.The purpose of her study was to _______ A watch the wild chimps in cagesB gain a doctor’s degree C understand and respect the lives of chimps D live in the forest as men can6.In pairsdiscuss the following questions. Make notes of your ideas and report to yourclass.1 Why do you think Jane is called a studentof African wildlife?2 What did Jane have to give up whenshe went to live in the forest?3 Do you think it is important to studychimps in the wild rather than in a zoo? Give reasons.4 Do you think you will go if you areasked to study animals in the wild? Why or why not? 7.Learning about Language1 Findthe word or phrase from the previous pages of this unit for each of thesemeanings.1 _______close connection that people havewith each other 2 _______home made in a tree usually for abird3 _______organization with a special purpose,especially for research or teaching4 _______ (of thoughts, questions, etc) tofill one’s mind5 _______the period of time when someone is achild6 _______giving opinions openly and honestly7 _______to move away from a place; to leave8 _______happiness and health of people;money paid by the government 9 _______task that requires a lot of time andeffort8.Fill inthis chart with the proper verb or noun form. Pay attention to the connectionbetween them. Verb Noun achieve behavior observation specialize advertisement Verb Noun connect organize inspiration argument permit Some nouns and verbs remain the same. Here isone example: to shade (someone from something)-, the shade (of a tree). Can youfind at least two more in this unit?9.Replace thewords underlined with a word of opposite meaning. Use the words from the textto help you.1 She saw my friend and ignored him ashe danced happily.She saw my friend and ______ him as he danced happily.2 He knew what he was doing andit was not worth it.He knew what he was doing but it was______.3 It is usual for people to agreeabout the price of a new car.It is usual for people to______about the price of a newcar.4 Many people look down upon poorpeople.Many people_______________ poor people.

Section B-|||-Directions: In this section,you will hear two passages.At the end of each passage,you will hear three or four questions.-|||-Both the passage and the questions will be spoken only once.After you hear a question,you must choose the best answer from-|||-the four choices marked A),B),C)and D).Then mark the corresponding letter on Answer Sheet 1 with a single line through-|||-the centre.-|||-Questions 9 to 11 are based on the passage you have just heard.-|||-9.A)The ability to predict fashion trends. C)Years of practical experience-|||-B)A refined taste for artistic works. D)Strict professional training.-|||-10.A)Promoting all kinds of American han made specialties.-|||-B)Strengthening cooperati with foreign governments.-|||-C)Conducting trade in art works with dealers overseas.-|||-D)Purchasing handicrafts from all over the world.-|||-11.A)She has access to fashionable things. C)She can enjoy life on a modest salary.-|||-B)She is doing what she enjoys doing. D)She is free to do whatever she wants.-|||-Questions 12 to 15 are based on the passage you have just heard.-|||-12.A)Join in neighborhood patrols. C)Voice his complaints to the city council.-|||-B)Get involved in his community. D)Make suggestions to the local authorities.-|||-13.A)Deterioration in the quality of life. C)Renovation of the vacant buildings.-|||-B)Increase of police patrols at night. D)Violation of community regulations.-|||-14.A)They may take a long time to solve. C)They have to be dealt with one by one.-|||-B)They need assistance from the city. D)They are too big for individual efforts.-|||-15.A)He had got some groceries at a big discount. C)He had done a small deed of kindness.-|||-B)He had read a funny poster near his seat. D)He had caught the bus just in time.Section B Directions: In this section, you will hear two passages. At the end of each passage, you will hear three or four questions. Both the passage and the questions will be spoken only once.After you hear a question, you must choose the best answer from the four choices marked A), B), C) and D). Then mark the corresponding letter on Answer Sheet 1 with a single line through the centre. Questions 9 to 11 are based on the passage you have just heard. 9. A) The ability to predict fashion trends. C) Years of practical experience. B)A refined taste for artistic works. D) Strict professional training. 10.A) Promoting all kinds of American hand-made specialties. B) Strengthening cooperation with foreign governments. C) Conducting trade in art works with dealers overseas. D) Purchasing handicrafts from all over the world. 11. A) She has access to fashionable things. C) She can enjoy life on a modest salary. B) She is doing what she enjoys doing. D) She is free to do whatever she wants. Questions 12 to 15 are based on the passage you have just heard. 12. A) Join in neighborhood patrols. C) Voice his complaints to the city council. B) Get involved in his community. D) Make suggestions to the local authorities. 13. A) Deterioration in the quality of life. C) Renovation of the vacant buildings. B) Increase of police patrols at night. D) Violation of community regulations. 14. A) They may take a long time to solve. C) They have to be dealt with one by one. B) They need assistance from the city. D) They are too big for individual efforts. 15. A) He had got some groceries at a big discount. C) He had done a small deed of kindness. B) He had read a funny poster near his seat. D) He had caught the bus just in time.

【题目】Section CQuestions 16 to 18 are based on the passage you have just heard.16. A)Carry out a thorough checkup.C)Keep extra gas in reserve.B) Try to keep the gas tank full.D) Fill up the water tank.17. A)Attempting to leave your car to seek help.C) Running the engine every now and then.B)Opening a window a bitto letin fresh ar.D)Keeping the heater on for a long time.18. A) It exhausts you physically.C)It causes you to lose hody heat.B) It makes you fall asleep easily.D)It consumes too much oxygen.Questions 19 to 21 are based on the passage you have just heard.19. A)They are very generous in giving gifts.C)They regard gifts as a token of friendship.B)They refuse gifts when doing business.D)They give gifts only on special occasions.20.A)They enjoy giving gifts to other people.C)They have to follow many specific rules.B)They spend a lot of time choosing gifts.D)They pay attention to the quality of gits.21. A)Gift-giving plays an important role in human relationships.B) We must be aware of cultural differences in giving gifts.C)We must learm how to give gifts before going abroad.D) Reading extensively makes one a better gift-giver.Questions 22 to 25 are based on the passage you have just heard.22. A)Itreflects American people's view of French politics.B) It is first published in Washington and then in Paris.C) It explains American politics to the French public.D)Itis popular among French government officials.23. A) Work on her column.C)Entertain her guests.B)Do housework at home.D)Go shopping downtown.24.A)To reportto her newspaper.C)To visit her parents.B)To refresh her French.D)To meet her friends.25.A)She might be recalled to France.C) She might close her Monday column.B) She might change her profession.D) She might be assigned to a new post.

The____ravaged the city causing widespread illness and death .A. reconstructionB. garbageC. plagueD. slogan

7.No matter what crimes the suspects have committed, they should be treated with dignity and respect - they are human beings _.A. in allB. at allC. after allD. all right

When she finally saw the present that was beautifully_in gold paper, Betty burst into tears.A. storedB. wrappedC. piledD. folded

Emily s intense training sessions left her muscles filled with___making it challenging for her to continue exercising . A health B energy C strength D fatigue

wasn't easy. Suiole, she discovered, is a topic everyone prefers to avoid.But Cervasio persisted. Every 16 minutes, she told audiences, someone commits suicide in the United States. There are more suicides than murders. Cervasio and her board of directors organized an annual high school variety show and a five-kilometer walk. Before long, the donations and volunteers started to roll in.Within two years, Cervasio had raised 25,000 for her nonprofit organization. Today Cares operates a suicide-prevention resource center in Cape Coral staffed by volunteers, with two licensed therapists (治疗师) on call. The center offers counseling, referrals (转诊), and support groups for teens and adults. Cervasio has also talked to more than 2,500 students about warning signs and places to find help.In the end, Angelo's death has also had a positive impact on Cervasio, now 50. "I am going to college for the first time in my life, to become a victim advocate," she says. "My son changed my path."53. What is people's attitude toward suicide?A People don't think suicide is a serious problem.B People don't like to talk about suicide.C People don't care about suicide.