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ReviewFor2015studentsJustforreference•Doyouagreethatitissheerneuronoverloadonthedoctorsidethatleadstothecomplaintthatdoctorsdon’tlisten?(Pre.1)•Neuronoverload•Patients’highexpectations•MistrustandmisunderstandingbetweenthepatientsandphysicianUnit1TextA•PleaselistMrs.Osorio’scondition(Pre.2)•A56-year-oldwoman•Somewhatoverweight•Reasonablywell-controlleddiabetesandhypertension•cholesterolonthehighsidewithoutanymedicationsforthis•Notasmuchexerciseassheshould•ThinningofherbonesonlastDEXAscan•Stressfulbutgoodaboutkeepingherappointmentsandgettingherbloodtests•GenerallyhealthyWhatthingsaboutMrs.Osorio’sconditionsrunthroughtheauthor’smind?(Pre.3)•GoodThings•Bloodtestsdone•Glucosealittlebetter•Herbloodpressuregoodbutnotgreat•BadThings•Herweightalittleup•HerbonesalittlethinontheDEXA•DoyouagreethatParagraph4justillustratesthatonestrayrequestfromMrs.Osoriosendsthedelicatelybalancedthree-ringcircustumblingdown?(Pre.4)Thekeyisinpara.4•Theauthorwasinmoderatestateofpanic:jugglingsomanythoughtsaboutMrs.Osorio’sconditionsandtryingtoresolvethemallbeforetheclockrandown•Mrs.Osoriomadeatrivialrequest,notsoimportantascomparedtoherconditions•Mrs.Osorioseemedtocareonlyabouther“innocent—andcompletelyjustified—request”:theformsignedbyherdoctor•Thedoctortriedtooratleastpretendtopayattentiontothepatientswhilecompletingdocumentation•Complaintsthatdoctorsdon’tlistenmighthaveotherreasonsthanjustdoctors’neuronoverload•See(Paras.7-8)Howcanyoucomparemultitaskinginhumanbeingsandcomputers?(pre.5)•Multitaskingoriginatedincomputerscience.•Microprocessorsinfactlinear,actuallyperformonlyonetaskatatime.•Multitaskingseemsjustasanillusionbothincomputerandhumans.•Atbest,Manjugglesonlyahandfulofthoughtsinthismanner•Themorethoughtswejuggle,thelessweareabletoattunefullytoanygiventhought.•Socanwesaymultitaskingisarecipefordisaster?How?•Whatistheuseofthenumbers?Usethesenumberstojustifythatitisthejugglingmindthatkeepsdoctorsawakeatnight.(pre.6)Whatarethereasonswhydoctorskeptawakeatnight?Aretheythereasonsoftheirneuronoverload?(Pre.6)•7medicalissuestoconsider•5separatethoughts,atleast,foreachissue•7X5=35thoughts•10patientsthatafternoon•35X10=350•5residentsundertheauthor’ssupervision•4patientsseenbyeachresidents•10thoughts,atleast,generatedbyeachpatients•5X4X10=200•350+200=550thoughtstobehandledintotal•Ifthedoctordoesagoodjobjuggling98%ofthetime,thatstillleavestenthoughtsthatmightgetlostintheprocess.•Explainthelastsentenceofthisparagraph.(page5)Arethoseproposedsolutions,likecomputer-generatedreminders,casemanagers,ancillaryservices,capableofsolvingtheauthor’sproblemofoverload?(Pre.7)Unit2TextA•Whatdoestheauthorimplybymentioningtwochoices?(para.1,Pre.1)•Whatfollowedeversincetheheadydaysofvictorydeclarations?(para.4,Pre.2)•Whatdoesthejoinedbattlereferto?Andelaborateonit.(paras.5-12,pre.3)Thefirstquestionhassomethingtodowith…ornot?•People’sinadequateconsciousnessabouttheconsequenceofneglectingtheemergingandreemerginginfectiousdiseases.•Unjustifiabilityofpeople’scomplacencyaboutthepreventionandcontroloftheinfectiousdiseases.•Unfinishedwaragainstinfectiousdisease.•Aboveall,somethingtodowithmoney(budget).Whatfollows•Out-of-expectationoutcome•AppearanceofnewdiseasessuchasAIDSandEbola.•Comebackoftheoldafflictions.•DiphtheriaintheformerSovietUnion.•TBinurbancenterslikeNewYorkCity.•RisingGroupAstreptococcalconditionslikescarletfever.•Thefearofapowerfulnewflustrainsweepingtheworld.•Elaborateonthejoinedbattle.(Pre.3)•WHO:establishmentofanewdivisiondevotedworldwidesurveillanceandcontrolofemergingdiseaseinOct.1995•CDC:launchingpreventionstrategyin1994•Congress:raisingfundfrom$6.7millionin1995to$26millionfor1997•Justify“therealizationthatworldhealthisindivisible”.(Pre.4)•AttentiontothehealthconditionsoftheglobebeforesatisfyingOURmostparochial(地方范围的)needs•Meaninglessnessofborderstopathogenic(致病的)microbes•With24hoursoftime,fromacrowdedmarketplaceinKikwit,ZairetoaNewYorkCitysubwayExemplifythestatementthat“Everyreturning…”(pre.5)•Examples(1)•TB•PrisonsandhomelesssheltersasidealvenuesforTBspread•Developmentofdrug-resistantstrainsorevenmulti-drug-resistantstrain•ArideontheHIVwagonbyattackingtheimmunocompromised(免疫功能不全的)Examples(2)•GroupAstrep•Achangeinvirulence（毒性）•Mutationintheexteriorofthebacterium•fleshing-eatingbacteriaof1994•rheumaticfever•scarletfever•flu•Constantchangesinitscoat(surfaceantigens表面抗原)andresultantchangesinitslevelofvirulence•Looming(逼近)nextflupandemicasbadasthatof1918•Whyarevaccinationpracticesattheheartofthemostinfectiousdiseases?Useexamplestoproveit.(Pre.6)•WhatarethefourareasoffocusaccordingtoBobHoward?(Pre.7)Examples•Waningimmunity•SeriousdiphtheriasituationintheformerSovietUnion•DeteriorationinsomeAmericancities•IncreasedreportsofmalariaThefourareasoffocus•Needforsurveillance•Updatedsciencecapableofdealingwithdiscoveriesinthefield•Appropriatepreventionandcontrol•Strongpublichealthinfrastructure•“Oldenemiesneverdie.”Justifyitmedically.•Discussing•Istherea100%solutionforeveryproblem?•Istherea100%cureforeveryailment?•Whatdoesthetile“TheSeventyPercentSolution