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Unit11、Some factors that may lead to the complaint:·Neuron overload·Patients* high expectations·Mistrust and misunderstanding between the patient and the doctor2、Mrs. Osorio’s condition:·A 56-year-old woman·Somewhat overweight·Reasonably well-controlled diabetes and hypertension·Cholesterol on the high side without any medications for it·Not enough exercises she should take·Her bones a little thin on her last DEXA scan3、Good things:·Blood tests done·Glucose a little better·Her blood pressure a little better but not so great Bad things:·Cholesterol not so great·Her weight a little up·Her bones a little thin on her last DEXA scan 44、The situation:·The author was in a moderate state of panic: juggling so many thoughts aboutMrs. Osorio’s conditions and trying to resolve them all before the clock ran down.·Mrs. Osorio made a trivial request, not so important as compared to her conditions.and completely justified ·Mrs. Osorio seemed to care only about her “innocent —：the form signed by her doctor.—request”·The doctor tried to or at least pretended to pay attention to the patient whilecompleting documentation.5、Similarities:·In computer multitasking, a microprocessor actually performs only one task at a time. Like microprocessors, we human beings carft actually concentrate on two thoughts at the same exact time. Multitasking is just an illusion both in computersand human beings.Differences:·The concept of multitasking originated in computer science.·At best, human beings can juggle only a handful of thoughts in a multitasking manner, but computers can do much better.·The more thoughts human beings juggle, the less human beings are able to attune fully to any given thought, but computers can do much better.6、·7 medical issues to consider·5 separate thoughts, at least, for each issue·7 x 5 = 35 thoughts·10 patients that afternoon·35 x 10 = 350 thoughts·5 residents under the authors supervision·4 patients seen by each resident·10 thoughts, at least, generated from each patient·5 x 4 x 10 = anther 200 thoughts·350 + 200 = 550 thoughts to be handled in total·If the doctor does a good job juggling 98% of the time, that still leaves about 10 thoughts that might get lost in the process.7、Possible solutions:·Computer-generated reminders·Case managers·Ancillary services·The simplest solution: timeUnit21、The author implies:? Peoples inadequate consciousness about the consequence of neglecting the re-emerging infectious diseases·Unjustifiability of peoples complacency about the prevention and control of theinfectious diseases·Unfinished war against infectious diseases2、Victory declarations:·Surgeon General William Stewart's hyperbolic statement of closing “the book on infectious disease”.·A string of impressive victories incurred by antibiotics and vaccines·The thought that the war against infectious diseases was almost overWhat followed ever since:·Appearance of new diseases such as AIDS and Ebola·Comeback of the old afflictions:? Diphtheria in the former Soviet Union? TB in urban centers like New York City? Rising Group A streptococcal conditions like scarlet fever·The fear of a powerful new flu strain sweeping the world3、Elaborate on the joined battle:·WHO established a new division devoted to worldwide surveillance and controlof emerging disease in October 1995.·CDC launched a prevention strategy in 1994.·Congress raised fund from $6.7 million in 1995 to $26 million in 1997.4、The borders are meaningless to pathogenic microbes, which can travel fromone country to another remote country in a very short time.5、TB:·Prisons and homeless shelters as ideal places for TB spread·Emerging of drug-resistant strain or even multi-drug-resistant strain·A ride on the HIV w^on by attacking the immunocompromisedGroup A strep:·A change in virulence·Mutation in the exterior of the bacteriumFlu:Constant changes in its coat (surface antigens) and resultant changes in its levelof virulence6、Examples:·Experiment in England is seeing the waning immunity because of no vaccination. ·Du e to poor vaccination efforts, the diphtheria situation in the former Soviet Union is serious. '? The vaccination rates are dropping in some American cities, and it will lead to more diphtheria and whooping cough.7、The four areas of focus:·The need for surveillance·Updated science capable of dealing with discoveries in the field·Appropriate prevention and control·Strong public health infrastructure8、The infectious diseases such as TB, flu, diphtheria and scarlet fever will never really go away, and the war against them will never end.Unit31、Terry's life before·She loved practicing Tae Kwon Do·She loved the surge of adrenaline that came with the controlled combat of tournaments.·She competed nationally, even won bronze medal in the trials for the Pan American Games.·She attended medical school, practiced as an internal medicine resident, and became an academic general internist.·She got married and got a son and a daughter.2、The symptoms of MS and autoimmune disease:·Loss of stamina and strength·Problems with balance·Bouts of horrific facial pain·Dips in visual acuity3、Terry did the following before she self-experimented:·She started injections.·She adopted many pharmacotherapies.·She began her own study of literature:? She read articles on websites such as PubMed.? She searched for articles testing new MS drugs in animal models.? She turned to articles concerning neurodegeneration of all types — dementia，Parkinson's disease, Huntington's disease, and Lou Gehrig's disease.? She relearned basic sciences such as cellular physiology, biochemistry, andneurophysiology.4、Approaches Terry mainly used:·Self-experimentation with various nutrients to slow neurodegeneration based on literature reports on animal models·Self-experimentation with neuromuscular electrical stimulation which is not an approved treatment for MS·Online search to identify the sources of micronutrients and having a new diet ·Reduction of food allergies and toxic load5、Cases mentioned in the text:·Increased mercury stores in the brains of people with dental fillings·High levels of the herbicide atrazine in private wells in Iowa·The strong association between pesticide exposure and neurodegeneration·The association of single nucleotide polymorphisms involving metabolism of sulfur and/or B vitamins·Inefficient clearing of toxins6、With 70% to 90% of the risk for diabetes, heart disease, cancer, andautoimmunity being due to environmental factors other than the genes, we cantake many health problems and the health care crisis under our control, for example, optimizing our nutrition and reducing our toxic load.Unit41、Two concepts:·Complementary medicine refers to the use of conventional therapies together with alternative treatments such as using acupuncture in addition to usual care to help lessen pain. Complementary and alternative medicine is shortened as CAM.·Alternative medicine refers to healing treatments that are not part of conventional therapies —like acupuncture, massage therapy, or herbal medicine. They are called so because people used to consider practices like these outside the mainstream.2·TCM does not require advanced, complicated, and in most cases, expensivefacilities.·TCM employs needles, cups, coins, to mention but a few.·Most procedures and operations of TCM are noninvasive.·The substances used as medicine are raw herbs or abstracts from them, andthey are indeed all natural, from nature.·TCM has been practiced as long as the Chinese history, so the efficiency i s proven and ensured.·Ongoing research around the world on acupuncture, herbs, massage and Tai Chi have shed light on some of the theories and practices of TCM3、It may be used as an adjunct treatment, an alternative, or part of a comprehensive management program for a number of conditions: post-operativeand chemotherapy induced nausea and vomiting, post-operative dental pain, addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma.4、A well-justified NO:·More intense research to uncover additional areas for the use of acupuncture ·Higher adoption of acupuncture as a common therapeutic modality not only in treatment but also in prevention of disease and promotion of wellness·Exploration and perfection of innovative methods of acupuncture point stimulation with technological advancement·Improved understanding of neuroscience and other aspects of human physiology and function by basic research on acupuncture·Greater interest by stakeholders·An increasing number of physician acupuncturists5、·Appropriate uses of herbs depend on proper guidance:? Proper TCM diagnosis of the zheng of the patient?Correct selection of the corresponding therapeutic strategies and principles that guide the choice of herbs and herbal formulas·Digression from either of the above guidence will lead to misuses of herbs, andwill result in complications in patient6、·Randomized controlled trialsAdvantages:?Elimination of the potential bias in the allocation of participants to the intervention group or control group? Tendency to produce comparable groups? Guaranteed validity of statistical tests of significanceLimitations:? Difficulty in generalizing the results obtained from the selected sampling to the population as a whole? A poor choice for research where temporal factors are anissue?Extremely heavy resources, requiring very large samplegroups? Quasi-experimentsAdvantages:? Control group comparisons possible?Reduced threats to external validity as natural environments do notsuffer the same problems of artificiality as compared to a well-controlledlaboratory setting.?Generalizations of the findings to be made about population since quasiexperiments are natural experimentsLimitations：? Potential for non-equivalent groups as quasi-experimental designs donot use random sampling in constructing experimental and controlgroups.?Potential for low internal validity as a result of not using random sampling methods to construct the experimental and control groups? Cohort studiesAdvantages:?Clear indication of the temporal sequence between exposure and outcome? Particular use for evaluating the effects of rare or unusual exposure? Ability to examine multiple outcomes of a single risk factorLimitations:? Larger, longer, and more expensive? Prone to certain types of bias? Not practical for rare outcomes? Case-control studiesAdvantages:? The only feasible method in the case of rare diseases and those with longperiods between exposure and outcome? Time and cost effective with relatively fewer subjects as compared to other observational methodsLimitations：? Unable to provide the same level of evidence as randomized controlled trialsas it is observational in nature? Difficult to establish the timeline of exposure to disease outcometrials? “N=1”Advantages? Easy to manage? InexpensiveLimitations：? Findings difficult to be generalized to the whole population? Weakest evidence due to the number of the subject7、? Synthesis of evidence is completely dependent on:? The completeness of the literature search (unavailable for foreign studies)? The accuracy of evaluation·There are situations in which no answer can be found for the questions of interest in RCTs and database analyses.·There's the requirement of using less stringent information rather than “hard data”8、·Assessment of the intrinsic value of traditional medicine in society·Research and education·Political, economic, and social factorsUnit51、·Dis-ease refers to the imbalance arising from：? Continuous stress? Pain? Hardships·Disease is a health crisis ascribable to various dis-eases.·Prompting elimination of dis-eases can alleviate some diseases.2、·Wellness is a state involving every aspect of our being: body, mind and spirit.·Manifestations of a healthy person:? Energy and vitality? A certain zip in gait? A warm feeling of peace of heart seen through behavior3、·Constant messages, positive and negative，are sent to our mind about the health of our body.·Physical symptoms are suppressed by people who go through life on automatic pilot.·Being well equals to being disease- or illness-free in the minds of them.·They confused wellness with an absence of symptoms.4、·People's minds are infected by spin:? Half-truth? Fearful fictions? Blatant deceit: some as a form of self-deceit·Spin is a result of unconscious living.·The kind of falseness is pandemic.5·Our body intelligence is suppressed or dormant from a lack of use.·There are tremendous amount of stress on a daily basis.·Our bodies are easily ignored for years because of a lack of recreation time. ·Limiting, self-defeating and even self-destructive behaviors undermine our wellbeing and keep them from achieving our full potential.6·We grow more reluctant to take risks.·We lose the ability to feel and acknowledge our deepest feelings and the courage to speak our truth.·We continue to deny and repress our feelings to protect ourselves.·Fear, denial and disconnection from our bodies and feelings become an unconscious, self-protective habit, a kind of default response to life.7·A multi-faceted process:? Looking for roots of and resolutions for the issues in different dimensions? Building our wellness toolbox slowly? Picturing our whole state of being·Attention to the little stuff:? Examining our lives honestly and setting clear intentions to change? Striving to maintain a balance of our mind, body and spirit? Taking small steps in the way to perceive and resolve conflict8·Try to awaken and evolve in order to live more consciously.·Get in touch with our genuine feelings and emotions.·Come to terms with the toxic emotionsUnit61、In the past, most people died at home. But now, more and more people are caredin hospitals and nursing homes at their end of life, which of course brings a newset of questions to consider.2、·Sixty-four years old with a history of congestive heart failure·Deciding to do everything medically possible to extend his life·Availability of around-the-clock medical services and a full range of treatmentchoices, tests, and other medical care·Relaxed visiting hours, and personal items from home3、Availability of around-the-clock medical resources, including doctors, nurses, andfacility.4、·Taking on a job which is big physically, emotionally, and financially·Hiring a home nurse for additional help·Arranging for services (such as visiting nurses) and special equipment (like ahospital bed or bedside commode)5、·Health insurance·Planning by a professional, such as a hospital discharge plaimer or a social worker·Help from local governmental agencies·Doctor's supervision at home6、·Traditionally, it is only about symptom care.·Recently, it is a comprehensive approach to improving the quality of life for people who are living with potentially fatal diseases.7、·Stopping treatment specifically aimed at curing an illness equals discontinuing all treatment.·Choosing a hospice is a permanent decision.Unit71、·A dying patient·Decision whether to withdraw life-support machines and medication and startcomfort measures·The family's refusal to make any decision or withdraw any treatments2、·The doctor as exclusive decision-maker·The patient as participant with little say in the final choice3、·Respect for the patient, especially the patient s autonomy·Patient-centered care·The patient as decision-maker based on the information provided by the doctor4、·Patients are forced to make decisions they never want to.·Patients, at least a large majority of them, prefer their doctors to make final decisions.·Shifting responsibility of decision-making to patients will bring about more stress to patients and their families, especially when the best option for the patient is uncertain.5、Doctors are very much cautious about committing some kind of ethicaltransgression.6、·Shouldering responsibility together with the patient may be better than havingthe patient make decisions on their own.·Balancing between paternalism and respect for patients autonomy constitutes alarge part of medical practice.Unit81、·Research:An activity to test hypothesis, to permit conclusions to be drawn, and thereby to develop or contribute to generalizable knowledge·Practice:Interventions solely to enhance the well-being of an individual patient or client and that have a reasonable expectation of success·Blurred distinction:? Cooccurrence of research and practice like in research designed to evaluate a therapy? Notable departures from standard practice being called “experimental” withl”and “research” carelessly definedthe terms “experimenta2、·Autonomy：Individuals treated as autonomous agents .·Protection:Persons with diminished autonomy entitled to protection·A case in point:Prisoners involved in research3·“Do no harm” as the primary principle·Maximization of possible benefits and minimization of possible harms .·Balance between benefits and potential risks involved in every step of seedingthe benefits4、·“Do no harm” as a fundamental principle of medical ethics·Extension of it to the realm of research by Claude Bernard·Benefits and risks as a set “duet” in both medical practice and research 5、·Unreasonable denial of entitled benefit and unduly imposed burden：Enrolment of patients in new drug trial: Who should be enrolled and who should not?·Equal treatment of equals:Determining factors of equality: age, sex, severity of the condition, financial status, social status6、·Definition:The opportunity to choose what shall or shall not happen to them·Application:? A process rather than signing a written form? Adequate information as the premise? A well-informed decision as the expected result7、·Requirements for consent as entailed by the principle of respect for persons ·Risk/benefit assessment as entailed by the principle of beneficence ·More requirements of fairness as entailed by the principle of justice: ? At the individual level: fairness? At the social level: distinction between classes。
Drug Discovery and Natural Products It may be argued that drug discovery is a recent concept that evolved from modern science during the 20th century, but this concept in reality dates back many centuries, and has its origins in nature. On many occasions, humans have turned to Mother Nature for cures, and discovered unique drug molecules. Thus, the term natural product has become almost synonymous with the concept of drug discovery. In modem drug discovery and development processes, natural products play an important role at the early stage of "lead" discovery, i.e. discovery of the active (determined by various bioassays) natural molecule, which itself or its structural analogues could be an ideal drug candidate.1.origin ['ɔridʒin] n.起点，端点; 来源；出身, 血统.2.Synonymous [sɪ'nɔnəməs]adj.同义的，类义的.3.i.e. [,aɪ'i:] <拉> abbr. (=id est) 即，换言之.4.candidate ['kændidit] n.申请求职者, 候选人；报考者；候选物.有人可能认为药物发现是一个20世纪才出现的、来源于现代科学的新概念，但是事实上这个概念是源于自然界的，可以追溯到许多个世纪以前。
Unit11、Some factors that may lead to the complaint:·Neuron overload·Patients* high expectations·Mistrust and misunderstanding between the patient and the doctorcondition:2、Mrs. Osorio’s·A 56-year-old woman·Somewhat overweight·Reasonably well-controlled diabetes and hypertension·Cholesterol on the high side without any medications for it·Not enough exercises she should take·Her bones a little thin on her last DEXA scan3、Good things:·Blood tests done·Glucose a little better·Her blood pressure a little better but not so great Bad things:·Cholesterol not so great·Her weight a little up·Her bones a little thin on her last DEXA scan 44、The situation:·The author was in a moderate state of panic: juggling so many thoughts aboutMrs. Osorio’s conditions and trying to resolve them all before the clock ran down.·Mrs. Osorio made a trivial request, not so important as compared to her conditions.and completely justified ·Mrs. Osorio seemed to care only about her “innocent ——request”：the form signed by her doctor.·The doctor tried to or at least pretended to pay attention to the patient whilecompleting documentation.5、Similarities:·In computer multitasking, a microprocessor actually performs only one task at a time. Like microprocessors, we human beings carft actually concentrate on two thoughts at the same exact time. Multitasking is just an illusion both in computersand human beings.Differences:·The concept of multitasking originated in computer science.·At best, human beings can juggle only a handful of thoughts in a multitasking manner, but computers can do much better.·The more thoughts human beings juggle, the less human beings are able to attune fully to any given thought, but computers can do much better.6、·7 medical issues to consider·5 separate thoughts, at least, for each issue·7 x 5 = 35 thoughts·10 patients that afternoon·35 x 10 = 350 thoughts·5 residents under the authors supervision·4 patients seen by each resident·10 thoughts, at least, generated from each patient·5 x 4 x 10 = anther 200 thoughts·350 + 200 = 550 thoughts to be handled in total·If the doctor does a good job juggling 98% of the time, that still leaves about 10 thoughts that might get lost in the process.7、Possible solutions:·Computer-generated reminders·Case managers·Ancillary services·The simplest solution: timeUnit21、The author implies:Peoples inadequate consciousness about the consequence of neglecting the re- emerging infectious diseases·Unjustifiability of peoples complacency about the prevention and control of theinfectious diseases·Unfinished war against infectious diseases2、Victory declarations:·Surgeon General William Stewart's hyperbolic statement of closing “the book on infectious disease”.·A string of impressive victories incurred by antibiotics and vaccines·The thought that the war against infectious diseases was almost overWhat followed ever since:·Appearance of new diseases such as AIDS and Ebola·Comeback of the old afflictions:Diphtheria in the former Soviet UnionTB in urban centers like New York CityRising Group A streptococcal conditions like scarlet fever·The fear of a powerful new flu strain sweeping the world3、Elaborate on the joined battle:·WHO established a new division devoted to worldwide surveillance and controlof emerging disease in October 1995.·CDC launched a prevention strategy in 1994.·Congress raised fund from $6.7 million in 1995 to $26 million in 1997.4、The borders are meaningless to pathogenic microbes, which can travel fromone country to another remote country in a very short time.5、TB:·Prisons and homeless shelters as ideal places for TB spread·Emerging of drug-resistant strain or even multi-drug-resistant strain·A ride on the HIV w^on by attacking the immunocompromisedGroup A strep:·A change in virulence·Mutation in the exterior of the bacteriumFlu:Constant changes in its coat (surface antigens) and resultant changes in its levelof virulence6、Examples:·Experiment in England is seeing the waning immunity because of no vaccination. ·Du e to poor vaccination efforts, the diphtheria situation in the former Soviet Union is serious. 'The vaccination rates are dropping in some American cities, and it will lead to more diphtheria and whooping cough.7、The four areas of focus:·The need for surveillance·Updated science capable of dealing with discoveries in the field·Appropriate prevention and control·Strong public health infrastructure8、The infectious diseases such as TB, flu, diphtheria and scarlet fever will never really go away, and the war against them will never end.Unit31、Terry's life before·She loved practicing Tae Kwon Do·She loved the surge of adrenaline that came with the controlled combat of tournaments.·She competed nationally, even won bronze medal in the trials for the Pan American Games.·She attended medical school, practiced as an internal medicine resident, and became an academic general internist.·She got married and got a son and a daughter.2、The symptoms of MS and autoimmune disease:·Loss of stamina and strength·Problems with balance·Bouts of horrific facial pain·Dips in visual acuity3、Terry did the following before she self-experimented:·She started injections.·She adopted many pharmacotherapies.·She began her own study of literature:She read articles on websites such as PubMed.She searched for articles testing new MS drugs in animal models.She turned to articles concerning neurodegeneration of all types — dementia，Parkinson's disease, Huntington's disease, and Lou Gehrig's disease.She relearned basic sciences such as cellular physiology, biochemistry, andneurophysiology.4、Approaches Terry mainly used:·Self-experimentation with various nutrients to slow neurodegeneration based on literature reports on animal models·Self-experimentation with neuromuscular electrical stimulation which is not an approved treatment for MS·Online search to identify the sources of micronutrients and having a new diet ·Reduction of food allergies and toxic load5、Cases mentioned in the text:·Increased mercury stores in the brains of people with dental fillings·High levels of the herbicide atrazine in private wells in Iowa·The strong association between pesticide exposure and neurodegeneration·The association of single nucleotide polymorphisms involving metabolism of sulfur and/or B vitamins·Inefficient clearing of toxins6、With 70% to 90% of the risk for diabetes, heart disease, cancer, andautoimmunity being due to environmental factors other than the genes, we cantake many health problems and the health care crisis under our control, for example, optimizing our nutrition and reducing our toxic load.Unit41、Two concepts:·Complementary medicine refers to the use of conventional therapies together with alternative treatments such as using acupuncture in addition to usual care to help lessen pain. Complementary and alternative medicine is shortened as CAM.·Alternative medicine refers to healing treatments that are not part of conventional therapies —like acupuncture, massage therapy, or herbal medicine. They are called so because people used to consider practices like these outside the mainstream.2·TCM does not require advanced, complicated, and in most cases, expensivefacilities.·TCM employs needles, cups, coins, to mention but a few.·Most procedures and operations of TCM are noninvasive.·The substances used as medicine are raw herbs or abstracts from them, andthey are indeed all natural, from nature.·TCM has been practiced as long as the Chinese history, so the efficiency i s proven and ensured.·Ongoing research around the world on acupuncture, herbs, massage and Tai Chi have shed light on some of the theories and practices of TCM3、It may be used as an adjunct treatment, an alternative, or part of a comprehensive management program for a number of conditions: post-operativeand chemotherapy induced nausea and vomiting, post-operative dental pain, addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma.4、A well-justified NO:·More intense research to uncover additional areas for the use of acupuncture ·Higher adoption of acupuncture as a common therapeutic modality not only in treatment but also in prevention of disease and promotion of wellness·Exploration and perfection of innovative methods of acupuncture point stimulation with technological advancement·Improved understanding of neuroscience and other aspects of human physiology and function by basic research on acupuncture·Greater interest by stakeholders·An increasing number of physician acupuncturists5、·Appropriate uses of herbs depend on proper guidance:Proper TCM diagnosis of the zheng of the patientCorrect selection of the corresponding therapeutic strategies and principles that guide the choice of herbs and herbal formulas·Digression from either of the above guidence will lead to misuses of herbs, andwill result in complications in patient6、·Randomized controlled trialsAdvantages:Elimination of the potential bias in the allocation of participants to the intervention group or control groupTendency to produce comparable groupsGuaranteed validity of statistical tests of significanceLimitations:Difficulty in generalizing the results obtained from the selected sampling to the population as a wholeA poor choice for research where temporal factors are anissueExtremely heavy resources, requiring very large samplegroupsQuasi-experimentsAdvantages:Control group comparisons possibleReduced threats to external validity as natural environments do notsuffer the same problems of artificiality as compared to a well-controlledlaboratory setting.Generalizations of the findings to be made about population since quasiexperiments are natural experimentsLimitations：Potential for non-equivalent groups as quasi-experimental designs donot use random sampling in constructing experimental and controlgroups.Potential for low internal validity as a result of not using random sampling methods to construct the experimental and control groupsCohort studiesAdvantages:Clear indication of the temporal sequence between exposure and outcomeParticular use for evaluating the effects of rare or unusual exposureAbility to examine multiple outcomes of a single risk factorLimitations:Larger, longer, and more expensiveProne to certain types of biasNot practical for rare outcomesCase-control studiesAdvantages:The only feasible method in the case of rare diseases and those with longperiods between exposure and outcomeTime and cost effective with relatively fewer subjects as compared to other observational methodsLimitations：Unable to provide the same level of evidence as randomized controlled trialsas it is observational in natureDifficult to establish the timeline of exposure to disease outcomeN=1” trials“AdvantagesEasy to manageInexpensiveLimitations：Findings difficult to be generalized to the whole populationWeakest evidence due to the number of the subject7、Synthesis of evidence is completely dependent on:The completeness of the literature search (unavailable for foreign studies)The accuracy of evaluation·There are situations in which no answer can be found for the questions of interest in RCTs and database analyses.·There's the requirement of using less stringent information rather than “hard data”8、·Assessment of the intrinsic value of traditional medicine in society·Research and education·Political, economic, and social factorsUnit51、·Dis-ease refers to the imbalance arising from：Continuous stressPainHardships·Disease is a health crisis ascribable to various dis-eases.·Prompting elimination of dis-eases can alleviate some diseases.2、·Wellness is a state involving every aspect of our being: body, mind and spirit.·Manifestations of a healthy person:Energy and vitalityA certain zip in gaitA warm feeling of peace of heart seen through behavior3、·Constant messages, positive and negative，are sent to our mind about the health of our body.·Physical symptoms are suppressed by people who go through life on automatic pilot.·Being well equals to being disease- or illness-free in the minds of them.·They confused wellness with an absence of symptoms.4、·People's minds are infected by spin:Half-truthFearful fictionsBlatant deceit: some as a form of self-deceit·Spin is a result of unconscious living.·The kind of falseness is pandemic.5·Our body intelligence is suppressed or dormant from a lack of use.·There are tremendous amount of stress on a daily basis.·Our bodies are easily ignored for years because of a lack of recreation time. ·Limiting, self-defeating and even self-destructive behaviors undermine our wellbeing and keep them from achieving our full potential.6·We grow more reluctant to take risks.·We lose the ability to feel and acknowledge our deepest feelings and the courage to speak our truth.·We continue to deny and repress our feelings to protect ourselves.·Fear, denial and disconnection from our bodies and feelings become an unconscious, self-protective habit, a kind of default response to life.7·A multi-faceted process:Looking for roots of and resolutions for the issues in different dimensionsBuilding our wellness toolbox slowlyPicturing our whole state of being·Attention to the little stuff:Examining our lives honestly and setting clear intentions to changeStriving to maintain a balance of our mind, body and spiritTaking small steps in the way to perceive and resolve conflict8·Try to awaken and evolve in order to live more consciously.·Get in touch with our genuine feelings and emotions.·Come to terms with the toxic emotionsUnit61、In the past, most people died at home. But now, more and more people are caredin hospitals and nursing homes at their end of life, which of course brings a newset of questions to consider.2、·Sixty-four years old with a history of congestive heart failure·Deciding to do everything medically possible to extend his life·Availability of around-the-clock medical services and a full range of treatmentchoices, tests, and other medical care·Relaxed visiting hours, and personal items from home3、Availability of around-the-clock medical resources, including doctors, nurses, andfacility.4、·Taking on a job which is big physically, emotionally, and financially·Hiring a home nurse for additional help·Arranging for services (such as visiting nurses) and special equipment (like ahospital bed or bedside commode)5、·Health insurance·Planning by a professional, such as a hospital discharge plaimer or a social worker·Help from local governmental agencies·Doctor's supervision at home6、·Traditionally, it is only about symptom care.·Recently, it is a comprehensive approach to improving the quality of life for people who are living with potentially fatal diseases.7、·Stopping treatment specifically aimed at curing an illness equals discontinuing all treatment.·Choosing a hospice is a permanent decision.Unit71、·A dying patient·Decision whether to withdraw life-support machines and medication and startcomfort measures·The family's refusal to make any decision or withdraw any treatments2、·The doctor as exclusive decision-maker·The patient as participant with little say in the final choice3、·Respect for the patient, especially the patient s autonomy·Patient-centered care·The patient as decision-maker based on the information provided by the doctor4、·Patients are forced to make decisions they never want to.·Patients, at least a large majority of them, prefer their doctors to make final decisions.·Shifting responsibility of decision-making to patients will bring about more stress to patients and their families, especially when the best option for the patient is uncertain.5、Doctors are very much cautious about committing some kind of ethicaltransgression.6、·Shouldering responsibility together with the patient may be better than havingthe patient make decisions on their own.·Balancing between paternalism and respect for patients autonomy constitutes alarge part of medical practice.Unit81、·Research:An activity to test hypothesis, to permit conclusions to be drawn, and thereby to develop or contribute to generalizable knowledge·Practice:Interventions solely to enhance the well-being of an individual patient or client and that have a reasonable expectation of success·Blurred distinction:Cooccurrence of research and practice like in research designed to evaluate a therapyNotable departure s from standard practice being called “experimental” withl”and “research” carelessly definedthe terms “experimenta2、·Autonomy：Individuals treated as autonomous agents .·Protection:Persons with diminished autonomy entitled to protection·A case in point:Prisoners involved in research3·“Do no harm” as the primary principle·Maximization of possible benefits and minimization of possible harms .·Balance between benefits and potential risks involved in every step of seedingthe benefits4、·“Do no harm” as a fundamental principle of medical ethics·Extension of it to the realm of research by Claude Bernard·Benefits and risks as a set “duet” in both medical practice and research 5、·Unreasonable denial of entitled benefit and unduly imposed burden：Enrolment of patients in new drug trial: Who should be enrolled and who should not?·Equal treatment of equals:Determining factors of equality: age, sex, severity of the condition, financial status, social status6、·Definition:The opportunity to choose what shall or shall not happen to them·Application:A process rather than signing a written formAdequate information as the premiseA well-informed decision as the expected result7、·Requirements for consent as entailed by the principle of respect for persons ·Risk/benefit assessment as entailed by the principle of beneficence ·More requirements of fairness as entailed by the principle of justice: At the individual level: fairnessAt the social level: distinction between classes。
首先介绍，在生命尽头的关爱有几种形式？Asked where they would like to spend their last days, most people always say at home, surrounded by people they love. In real life, though, only one in five achieves that. More than 30% die in a nursing home, where almost no one wants to be, and over half end up in a hospital, often in an intensive-care unit, heavily sedated and attached to life-saving equipment until their doctors give up the battle.【参考资料：有at hospitals and nursing homes，有at home，有hospice（临终关怀服务）。
】然后开始重点阐述“临终关怀”：一、什么是“临终关怀”服务的对象&目的？Hospice care is a system of care that helps those with an incurable illness（对象）to focus on making the most of whatever time is left（目的）. They offer a range of support, often alongside active treatment for an illness. The focus of modern hospice care is on helping people to live well until they die. Dying in a hospice care can bring families（对象）peace and allow a closeness which isn't always possible at home.【参考资料：临终关怀（palliative care = hospice care = terminal care）并非是一种治愈疗法，而是一种专注于在患者在将要逝世前的几个星期甚至几个月的时间内，减轻其疾病的症状、延缓疾病发展的医疗护理。
Drug Discovery and Natural Products It may be argued that drug discovery is a recent concept that evolved from modern science during the 20th century, but this concept in reality dates back many centuries, and has its origins in nature. On many occasions, humans have turned to Mother Nature for cures, and discovered unique drug molecules. Thus, the term natural product has become almost synonymous with the concept of drug discovery. In modem drug discovery and development processes, natural products play an important role at the early stage of "lead" discovery, i.e. discovery of the active (determined by various bioassays) natural molecule, which itself or its structural analogues could be an ideal drug candidate.1.origin ['ɔridʒin] n.起点，端点; 来源；出身, 血统.2.Synonymous [sɪ'nɔnəməs]adj.同义的，类义的.3.i.e. [,aɪ'i:] <拉> abbr. (=id est) 即，换言之.4.candidate ['kændidit] n.申请求职者, 候选人；报考者；候选物.有人可能认为药物发现是一个20世纪才出现的、来源于现代科学的新概念，但是事实上这个概念是源于自然界的，可以追溯到许多个世纪以前。
大学英语精读第二册UnitSix课文讲解大学英语精读第二册Unit Six课文讲解导语：外科医生主要是诊断外科疾病，为患者提供手术治疗的医务工作者。
下面YJBYS店铺分享一篇关于外科医生的大学英语课文，欢迎学习!A famous surgeon tells about the importance of self-confidence from his own experience.The Making of a SurgeonHow does a doctor recognize the point in time when he is finally a "surgeon"? As my year as chief resident drew to a close I asked myself this question on more than one occasion.The answer, I concluded, was self-confidence. When you can say to yourself, "There is no surgical patient I cannot treat competently, treat just as well as or better than any other surgeon" - then, and not until then, you are indeed a surgeon. I was nearing that point.Take, for example, the emergency situations that we encountered almost every night. The first few months of the year I had dreaded the ringing of the telephone. I knew it meant another critical decision to be made. Often, after I had told Walt or Larry what to do in a particular situation, I'd have trouble getting back to sleep. I'd review all the facts of the case and, not infrequently, wonder if I hadn't made a poor decision. More than once at two or three in the morning, after lying awake for an hour, I'd get out of bed, dress and drive to the hospital to see the patient myself. It was the only way I could find the peace of mind I needed to relax.Now, in the last month of my residency, sleeping was no longer a problem. There were still situations in which I couldn'tbe certain my decision had been the right one, but I had learned to accept this as a constant problem for a surgeon, one that could never be completely resolved - and I could live with it. So, once I had made a considered decision, I no longer dwelt on it. Reviewing it wasn't going to help and I knew that with my knowledge and experience, any decision I'd made was bound to be a sound one. It was a nice feeling.In the operating room I was equally confident. I knew I had the knowledge, the skill, the experience to handle any surgical situation I'd ever encounter in practice. There were no more butterflies in my stomach when I opened up an abdomen or a chest. I knew that even if the case was one in which it was impossible to anticipate the problem in advance, I could handle whatever l found. I'd sweated through my share of stab wounds of the belly, of punctured lungs, of compound fractures. I had sweated over them for five years. I didn't need to sweat any more.Nor was I afraid of making mistakes. I knew that when I was out in practice I would inevitably err at one time or another and operate on someone who didn't need surgery or sit on someone who did. Five years earlier - even one year earlier - I wouldn't have been able to live with myself if I had had to take sole responsibility for a mistake in judgment. Now I could. I still dreaded errors - would do my best to avoid them -- but I knew they were part of a surgeon's life. I could accept this fact with calmness because I knew that if I wasn't able to avoid a mistake, chances were that no other surgeon could have, either.This all sounds conceited and I guess it is - but a surgeon needs conceit. He needs it to encourage him in trying moments when he's bothered by the doubts and uncertainties that are part of the practice of medicine. He has to feel that he's as good asand probably better than any other surgeon in the world. Call it conceit - call it self-confidence; whatever it was, I had it.NEW WORDSsurgeonn. doctor who performs operations 外科医生self-confidencen. 自信心makingn. means of gaining success 成功之道residentn. 住院医生concludevt. arrive at a belief or opinion by reasoning 得出结论surgicala. of, by, or for surgery 外科的;手术的competentlyad. with the necessary skill 称职地;胜任地competenta.nearvt. approach; come closer toemergencyn. sudden and dangerous happening needing immediate action 紧急情况;急症encountervt. be faced with (difficulties, danger, etc.); meet unexpectedly 遭到;意外地遇见dreadvt. fear greatly 畏惧criticala. important at a time of danger and difficulty 紧要的;关键性的particulara. belonging to some one person, thing, or occasion 特定的casen. instance of disease or injury 病例infrequentlyad. seldom; not oftenrelaxvi. become less tense 放松relaxationn.residencyn. the last stage of a doctor's training at a hospital 高级专科住院实习(期)constanta. happening all the time; unchanging 不断的;始终如一的resolvevt. solve 解决resolutionn.considereda. carefully thought out 经过深思熟虑的dwellvi. live (in a place) 居住bounda. very likely; certain 一定的，必然的sounda. correct; based on good judgment 正确的，合理的'confidenta. sure of oneself and one's abilities 自然的confidencen.handlevt. manage, deal with 处理butterflyn. 蝴蝶abdomenn. belly 腹(部)anticipatevt. see beforehand 预期anticipationn.sweatn. 汗vi. 流汗stabn. thrust made with a pointed weapon 刺;戳bellyn. 肚，腹部puncturevt. make a small hole in (sth.) with sth. pointed 刺穿compounda. having more than one part 复合的fracturen. break in a bone 骨折compoundn. 复合性骨折inevitablyad. unavoidably 不可避免地inevitablea.errvi. make mistakes; do wrongoperatevi. perform a surgical operation 动手术surgeryn. 外科;外科手术solea. unshared; one and only 唯一的responsibilityn. 责任;责任心avoidvt. escape; keep or get away from 避免conceiteda. having too high an opinion of oneself 自负的conceitn. too high an opinion of oneselftryinga. hard to endure or bear; very difficult 难受的;恼人的bothervt. annoy, trouble 烦扰，麻烦uncertaintyn. uncertain condition; doubtPHRASES & EXPRESSIONSdraw to a closecome to an end 结束live withlearn to accept (sth. unpleasant); tolerate 学会;适应;容忍dwell onthink, write, or speak a lot about 老是想着;详述;强调(be) bound to (do)(be) certain to (do) 一定..., 必然...in practice(医师,律师等) 在开业中;在实践中butterflies in the stomachfeelings of nervousness 忐忑不安open upcut open 切开,给...开刀in advanceahead of time 预先,事前at one time or anothersometime or other 早晚sit ondelay taking action on; do nothing about 拖延;搁置PROPER NAMESNolen诺兰(姓氏)Walt沃尔特(男子名 Walter 的昵称)Larry拉里(男子 Lawrence 的昵称)。
