单选题Disability among the elderly has declined markedly in the United States in the past two decades. In 1984, 25 percent of the elderly population reported difficulty with activities associated with independent living. By 1999, the share had fallen to 20 percent, a decline of one-fifth. Although these basic facts are well known, their interpretation is not clear. Is the reduction in disability a result of improved medical care, individual behavioral changes, environmental modifications that allow the elderly to better function by themselves, or other demographic changes? Will the trend continue, or is it time limited? What does the reduction in disability mean for years of healthy life and labor force participation? The researchers David Cutler, Mary Beth Landrum, and Kate Stewart focus on disability caused by cardiovascular disease to investigate the role of improved medical care on reductions in disability. By looking at just one condition, they can analyze health shocks and their outcomes in some detail. Cardiovascular disease is a natural condition to analyze, because it is the most common cause of death in the United States and most other developed countries. Also, more is spent on cardiovascular disease than on any other condition, clearly a case where medical care could really matter. The researchers measure disability as the presence of impairments in. Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Their data source, the National Long-Term Care Survey(NLTCS) , includes information on six ADL measures: eating, getting in or out of bed, walking around inside, dressing, bathing, and getting to or using the toilet. There are also questions about eight IADL measures: doing light housework or laundry, preparing meals, shopping for groceries, getting around outside, managing money, taking medications, and making telephone calls. The NLTCS is a nationally representative longitudinal survey of the health and disability profile of the population aged 65 and over. Cutler and his co-researchers find that reduced disability associated with cardiovascular disease accounts for a significant part of the total reduction in disability--between 14 and 22 percent. The evidence suggests that improvements in medical care, including both increased use of relevant procedures and pharmaceuticals, led to a significant part of this decline in disability. Regions with higher use experienced substantial reductions in mortality and disability. While precise data on the implications of reduced disability are lacking, the possible impact of disability reductions is staggering. The researchers estimate that preventing disability after an acute cardiovascular event can add as much as 3.7 years of quality-adjusted life expectancy, or perhaps $ 316,000 of value. The cost of this outcome is significantly smaller. The initial treatment costs range from $ 8,610 to $ 16,332, depending on the procedure used. Further, recent cost analyses reported that annual Medicare spending was lower for the non-disabled than the disabled, which suggests that higher treatment costs may be offset by lower future spending among a more healthy population. By virtually any measure, therefore, the researchers conclude that medical technology after acute cardiovascular episodes is worth the cost.

单选题As used in the last sentence, the word "drains" means ______.

单选题Michael Porter, who has made his name throughout the business community by advocating his theories of competitive advantages, is now swimming into even more shark-infested waters, arguing that competition can save even America's troubled health-care system, the largest in the world. Mr. Porter argues in " Redefining Health Care" that competition, if properly applied, can also fix what ails this sector. That is a bold claim, given the horrible state of America's health-care system. Just consider a few of its failings: America pays more per capita for health care than most countries, but it still has some 45m citizens with no health insurance at all. While a few receive outstanding treatment, he shows in heart-wrenching detail that most do not. The system, wastes huge resources on paperwork, ignores preventive care and, above all, has perverse incentives that encourage shifting costs rather than cutting them outright. He concludes that it is "on a dangerous path, with a toxic combination of high costs, uneven quality, frequent errors and limited access to care. " Many observers would agree with this diagnosis, but many would undoubtedly disagree with this advocacy of more market forces. Doctors have an intuitive distrust of competition, which they often equate with greed, while many public-policy thinkers argue that the only way to fix America's problem is to quash the private sector's role altogether and instead set up a government monopoly like Britain's National Health Service. Mr. Porter strongly disagrees. He starts by acknowledging that competition, as it has been introduced to America's health system, has in fact done more harm than good. But he argues that competition has been introduced piecemeal, in incoherent and counter-productive ways that lead to perverse incentives and worse outcomes:" health-care competition is not focused on delivering value for patients," he says. Mr. Porter offers a mix of solutions to fix this mess, and thereby to put the sector on a genuinely competitive footing. First comes the seemingly obvious (but as yet unrealized ) goal of data transparency. Second is a redirection of competition from the level of health plans, doctors, clinics and hospitals, to competition "at the level of medical conditions, which is all but absent". The authors argue that the right measure of "value" for the health of treatment, and what the cost is for that entire cycle. That rightly emphasizes the role of early detection and preventive care over techno-fixes, pricey pills and the other failings of today's system. If there is a failing in this argument, it is that he sometimes strays toward naive optimism. Mr. Porter argues, for example, that his solutions are so commonsensical that private actors in the health system could forge ahead with them profitably without waiting for the government to fix its policy mistakes. That is a tempting notion, but it falls into a trap that economists call the fallacy of the $ 20 bill on the street. If there really were easy money on the pavement, goes the argument, surely previous passers-by would have bent over and picked it up by now. In the same vein, if Mr. Porter's prescriptions are so sensible that companies can make money even now in the absence of government policy changes, why in the world have they not done so already? One reason may be that they can make more money in the current sub- optimal equilibrium than in a perfectly competitive market--which is why government action is probably needed to sweep aside the many obstacles in the way of Mr. Porter's powerful vision.

单选题Wherever people have been, they have left waste behind, which can cause all sorts of problems. Waste often stinks, attracts vermin and creates eyesores. More seriously, it can release harmful chemicals into the soil and water when dumped, or into the air when burned. And then there are some really nasty forms of industrial waste, such as spent nuclear fuel, for which no universally accepted disposal methods’ have thus far been developed. Yet many also see waste as an opportunity. Getting rid of it all has become a huge global business. Rich countries spend some $120 billion a year disposing of their municipal waste alone and another $150 billion on industrial waste. The amount of waste that countries produce tends to grow in tandem with their economies, and especially with the rate of urbanization. So waste firms see a rich future in places such as China, India and Brazil, which at present spend only about $5 billion a year collecting and treating their municipal waste. Waste also presents an opportunity in a grander sense: as a potential resource. Much of it is already burned to generate energy. Clever new technologies to turn it into fertiliser or chemicals or fuel are being developed all the time. Visionaries see a world without waste, with rubbish being routinely recycled. Until last summer such views were spreading quickly. But since then plummeting prices for virgin paper, plastic and fuels, and hence also for the waste that substitutes for them, have put an end to such visions. Many of the recycling firms that had argued rubbish was on the way out now say that unless they are given financial help, they themselves will disappear. Subsidies are a bad idea. Governments have a role to play in the business of waste management, but it is a regulatory and supervisory one. They should oblige people who create waste to clean up after themselves and ideally ensure that the price of any product reflects the cost of disposing of it safely. That would help to signal which items are hardest to get rid of, giving consumers an incentive to buy goods that create less waste in the first place. That may sound simple enough, but governments seldom get the rules right. In poorer countries they often have no rules at all, or if they have them they fail to enforce them. In rich countries they are often inconsistent: too strict about some sorts of waste and worryingly lax about others. They are also prone to imposing arbitrary targets and taxes. California, for example, wants to recycle all its trash not because it necessarily makes environmental or economic sense but because the goal of “zero waste” sounds politically attractive.

单选题These are hard times for Deutsehe Bank, despite its huge strides in investment banking. Next week its chief executive, Josef Ackerman, goes on trial in Dusseldorf. Careless words by Rolf Breuer, the head of its supervisory board, led to another court ruling last month that may cost Germany' s biggest bank several hundred million euros in damages. Then there is Parmalat. Although no evidence has emerged of complicity in the Italian dairy group' s fraud, Deutsche' s name has become entwined in the affair. In many other respects, however, Deutsche' s reputation has never been higher. In dubbing it " Bank of the Year 2003", International Financing Review, the capital markets' favorite newssheet, purred that Deutsche was a "lean, aggressive, focused universal bank" In the league tables that investment banks watch so keenly, Deutsche excelled last year as lead manager of bonds and convertible bonds and of some racier products, such as repackaged debt securities and high-yield "junk" bonds. In other disciplines it rarely fell below the top ten in the world. However, it is still nowhere near the top in equity offerings and advice on mergers and acquisitions, except in Germany. It still has a problem with costs,which were a fat 82% of income in the third quarter of 2003, thanks mainly to the thick pay packets of its investment bankers and its poor returns from corporate and retail banking. Mr. Ackermann must try to improve the weak spots while spending two clays a week, probably until June, in a courtroom. He and four others face charges of "breach of trust" over the way bonuses were awarded to board meinbers of Mannesmann, a telecoms company. Mr. Aekermann sat on Mannesmann' s supervisory board. There is no suggestion that he gained personally. Nor was there any harmful intent in Mr. Breuer' s remarks in a television interview about the financial health of the Kirch media group shortly before its bankruptcy. But he was careless, and a Munich court found Deutsche (but not Mr. Breuer) liable for damages, to be set in due course, without right of appeal. The bank said this week it has lodged a protest with the federal supreme court in Karlsruhe. Meanwhile, Kirch has filed a suit against Deutsche in America. Deutsche's involvement with Parmalat also looks sloppy. It led a 350m bond issue fur the group in September. It was also a leading borrower and lender of Parma[at shares, so that in November it technically held the voting rights to over 5% of Parmalat stock. That stake had fallen to 1.5% by December 19th, the day the dairy company's black hole became public. It reported this, perhaps over-zealously, to the Italian authorities. That may have given the wrong impression, say, sources close to the bank, because the transactions were for third parties. This is awkward for a bank that managed to avoid most serious attacks on conflicts of interest thai beset the investment-banking industry following the collapse of Enron in 2001 and the bursting of the tech-stock bubble. Mr. Ackermann will need a clear head to steer the bank through the coming storms.

单选题{{B}}Text 4{{/B}} Trying to get Americans to eat a healthy diet is a frustrating business. Even the best-designed public-health campaigns cannot seem to compete with the tempting flavors of the snack-food and fast-food industries and their fat-and sugar-laden products. The results are apparent on a walk down any American street—more than 60% of Americans are overweight, and a full quarter of them are overweight to the point of obesity. Now, health advocates say, an ill-conceived redesign has taken one of the more successful public-health campaigns—the Food Guide Pyramid—and rendered it confusing to the point of uselessness. Some of these critics worry that America's Department of Agriculture caved in to pressure from parts of the food industry anxious to protect their products. The Food Guide Pyramid was a graphic which emphasizes that a healthy diet is built on a base of grains, vegetables and fruits, followed by ever-decreasing amounts of dairy products. meat, sweets and oils. The agriculture department launched the pyramid in 1992 to replace its previous program, which was centered on the idea of four basic food groups. The "Basic Four" campaign showed a plate divided into quarters, and seemed to imply that meat and dairy products should make up half of a healthy diet, with grains, fruits and vegetables making up the other half. It was replaced only over the strenuous objections of the meat and dairy industries. The old pyramid was undoubtedly imperfect. It failed to distinguish between a doughnut and a whole-grain roll, or a hamburger and a skinless chicken breast, and it did not make clear exactly how much of each foodstuff to eat. It did, however, manage to convey the basic idea of proper proportions in an easily understanable way. The new pyramid, called" My Pyramid", abandons the effort to provide this information. Instead, it has been simplified to a mere logo. The food groups are replaced with unlabelled, multi-colored vertical stripes which, in some versions, rise out of a cartoon jumble of foods that look like the aftermath of a riot at a grocery store. Anyone who wants to see how this translates into a healthy diet is invited to go to a website, put in their age, Sex and activity level, and get a Custom. designed pyramid, complete with healthy food choices and suggested portion sizes. This is fine for those who are motivated, but might prove too much effort for those who most need such information. Admittedly, the designers of the new pyramid had a tough job to do. They were supposed to condense the advice in the 84-page United States' Dietary Guidelines into a simple, meaningful graphic suitable for printing on the back of a cereal box. And they had to do this in the face of pressure from dozens of special interest groups—from the country's Potato, Board, which thought potatoes would look nice in the picture, to the Almond Board of California, which felt the same way about almonds. Even the National Watermelon Promotion Board and the California Avocado Commission were eager to sect heir products recognized. Nevertheless, many health advocates believe the new graphic is a missed opportunity. Although officials insist industry pressure had nothing to do with: the eventual design, some critics suspect that political influence was at work: On the other hand, it is not clear how much good even the best graphic could do. Surveys found that 80% of Americans recognized the old Food Guide Pyramid—a big success in the world of public, health campaigns. Yet only 16% followed its advice.

单选题The role of governments in environmental management is deficit but inescapable. Sometimes, the state tries to manage the resources it owns, and does so badly. Often, (1) , governments act in an even more harmful way. They actually subsidize the exploitation and (2) of natural resources. A whole (3) of policies, from farm-price support to protection for coal-mining, do environmental damage and often (4) no economic sense. Making good policies offers a two-fold (5) : a cleaner environmentpolilicians and a more efficient economy. Crowth and environmentalism can actually go hand in hand, if politicians have the courage to (6) the vested interest that subsidies create. No activity affects more of the earth's surface than farming, h shapes a third of the planet's land area, not (7) Antarctica, and the proportion is rising. World food output per head has risen by 4 percent between the 1970s and 1980s mainly as a result of increases in (8) from land already in (9) , but also because more land has been brought under the plough. Higher yields have been achieved by increased irrigation, better crop breeding, and a (10) in the use of pesticides and chemical fertilizers in the 1970s and 1980s. All these activities may have (11) environmental impacts. For example, land clearing for agrieuhure is the largest single (12) of deforestation; chemical fertilizers and pesticides may (13) water supplies; more intensive farming and the abandonment of fallow periods (14) worsen soil erosion; and the spread of monochord and use of high-yielding varieties of euros have been accompanied by the (15) of old varieties of food plants which might have provided some (16) against pests or diseases in future. Soil erosion threatens the productivity of land in both rich and poor countries. The United States, (17) the most careful measurements have been done, discovered in 1982 that about one-fifth of its farmland was losing topsoil at a rate (18) to diminish the soil's productivity. The country subsequently (19) a program to convert 11 percent of its cropped land to meadow or forest. Topsoil in India and China is (20) much faster than in America.

单选题Remember the days when companies such as Microsoft and Mc-Kinsey took immense satisfaction from subjecting job candidates to mind-crunching strategy sessions? If you thought that was rough, imagine an interview in which no amount of research or questioning of insiders will help. Imagine instead that all you can do is have a healthy breakfast, pick out your nicest suit, and hope for the best. In the new interview, they"re not just testing what you know. They"re also testing who you are. It"s called the situational interview, and it"s quickly becoming a must in the job-seeking world. In the post-Enron culture of caution, corporations are focusing on an obvious insight: that a gold-plated resume and winning personality are about as accurate in determining job performance as Wall Street analysts are in picking stocks. Now, with shareholder scrutiny, hiring slowdowns, and expense-reducing, no manager can afford to hire the wrong person. Hundreds of companies are switching to the new methods. Whereas the conventional interview has been found to be only 7% accurate in predicting job performance, situational interviews deliver a rating of 54%— the most of any interviewing tool. The situational technique"s superiority stems from its ability to trip up even the wittiest of interviewees. Of course, every applicant must display a healthy dose of occupational know-how, but behavior and ethical backbone play a big role. For example, a prospective analyst at a Wall Street bank might have to face, say, a customer with an account argument. It"s not happening on paper, but in real time—with managers and experts watching nearby. The interviewer plays the role of a fierce customer on the phone, angry about money lost when a trade wasn"t executed on time. It"s set up as an obvious mistake on the banker"s part. Interviewers watch the candidates" reactions: how they process the complex account information, their ability to talk the client down, what their body language displays about their own shortcomings, and which words they choose. In this instance, not being honest about the mistake or showing anger or frustration—no matter how glowing your resume—means you"re out. Behavioral interviews are also being rounded out by other tools that, until recently, had been reserved for elite hires. Personality-testing outfit Caliper, for example, which probes candidates for emotional-intelligence skills and job ability, has seen its business jump 20% this year. Clearly, the new interview isn"t without its drawbacks. Companies run the risk of arousing hostility in candidates, who may feel as if some line has been crossed into personal territory. Moreover, some companies worry about the fairness of personality tests. They have to make sure there are no inherent gender or racial biases in the test.

单选题 Imagine a world where your doctor could help you avoid sickness, using knowledge of your genes as well as how you live your life. Or where he would prescribe drugs he knew would work and not have debilitating side-effects. Such a future is arriving faster than most realise: genetic tests are already widely used to identify patients who will be helped or harmed by certain drugs. And three years ago, in the face of a torrent of new scientific data, a number of new companies set themselves up to interpret this information for customers. Through shop fronts on the internet, anyone could order a testing kit, spit into a tube and send off their DNA—with results downloaded privately at home. Already customers can find out their response to many common medications, such as antivirals and blood-thinning agents. They can also explore their genetic likelihood of developing deep-vein thrombosis, skin cancer or glaucoma. The industry has been subject to conflicting criticisms. {{U}}On the one hand, it stands accused of offering information too dangerous to trust to consumers; on the other it is charged with peddling irrelevant, misleading nonsense.{{/U}} For some rare disorders, such as Huntington's and Tay-Sachs, genetic information is a diagnosis. But most diseases are more complicated and involve several genes, or an environmental component, or both. Someone's chance of getting skin cancer, for example, will depend on whether he worships the sun as well as on his genes. {{U}}America's Government Accountability Office (GAO) report also revealed what the industry has openly admitted for years: that results of disease-prediction tests from different companies sometimes conflict with one another, because there is no industry-wide agreement on standard lifetime risks.{{/U}} Governments hate this sort of anarchy and America's, in particular, is considering regulation. But three things argue against wholesale regulation. First, the level of interference needs to be based on the level of risk a test represents. The government does not need to be involved if someone decides to trace his ancestry or discover what type of earwax he has. {{U}}Second, the laws on fraud should be sufficient to deal with the snake-oil salesmen who promise to predict, say, whether a child might be a sporting champion. And third, science is changing very fast.{{/U}} Fairly soon, a customer's whole genome will be sequenced, not merely the parts thought to be medically relevant that the testing companies now concentrate on, and he will then be able to crank the results through open-source interpretation software downloadable from anywhere on the planet. That will create problems, but the only way to stop that happening would be to make it illegal for someone to have his genome sequenced— and nobody is seriously suggesting that illiberal restriction. Instead, then, of reacting in a hostile fashion to the trend for people to take genetic tests, governments should be asking themselves how they can make best use of this new source of information. Restricting access to tests that inform people about bad reactions to drugs could do harm. The real question is not who controls access, but how to minimise the risks and maximise the rewards of a useful revolution.

单选题The views of Alan Milburn and David Culter on the reforms of heal-care systems are

单选题How is television said to distort life in reporting warfare and conflicts?

单选题{{B}}Text 3{{/B}} When they advise your kids to "get an education" if you want to raise your income, they tell you only half the truth. What they really mean is to get just enough education to provide manpower for your society, but not too much that prove an embarrassment to your society. Get high school diploma, at least. Without that, you are occupationally dead, unless your name happens to be George Bernard Shaw or Thomas Alva Edison and you can successfully drop out in grade school. Get a college degree, if possible. With a B.A., you are on the launching pad(发射台). But now you have to start to put on the brakes. If you go for a master's degree, make sure it is a M. B. A., and only from a first-rate university. Beyond this, the famous law of diminishing returns begins to take effect. Do you know, for instance, that long-haul truck drivers earn more a year than full professors? Yes, the average 1977 salary for those truckers was ＄24000, while the full professors managed to average just ＄23930. A Ph. D. is the highest degree you can get, but except in a few specialized fields such as physics or chemistry, where the degree can quickly be turned to industrial or commercial purposes, you are facing a dim future. There are more Ph. D.s unemployed or underemployed in this country than in any other part of the world by far. If you become a doctor of philosophy in English or history or anthropology or political science or language or—worst of all—in philosophy, you run the risk of becoming overeducated for our national demands. Not for our needs, mind you, but for our demands. Thousands of Ph. D. s are selling shoes, driving cabs, waiting on tables and filling out fruitless applications month after month. And then maybe taking a job in some high school or backwater college that pays much less than the janitor(看门人)earns. You can equate the level of income with the level of eduction only so far. Far enough, that is, to make you useful to the gross national product, but not so far that nobody can turn much of a profit on you.

单选题What should a driver do when ascending?