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Since Would War II considerable advances have been made in the area of health-care services. These include better access to health care (particularly for the poor and minorities), improvements in physical plants, and increased numbers of physicians and other health personnel. All have played a part in the recent improvement in life expectancy. But there is mounting criticism of the large remaining gaps in access, unbridled cost inflation, the further fragmentation of service, excessive indulgence in wasteful high-technology “gadgeteering,” and a breakdown in doctor-patient relationships. In recent years proposed panaceas and new programs, small and large, have proliferated at a feverish pace and disappointments multiply at almost the same rate. This has led to an increased pessimism—“everything has been tried and nothing works”—which sometimes borders on cynicism or even nihilism.
It is true that the automatic “pass through” of rapidly spiraling costs to government and insurance carriers, which was set in a publicized environment of “the richest nation in the world,” produced for a time a sense of unlimited resources and allowed to develop a mood whereby every practitioner and institution could “do his own thing” without undue concern for the “Medical Commons.” The practice of full-cost reimbursement encouraged capital investment and now the industry is overcapitalized. Many cities have hundreds of excess hospital beds; hospitals have proliferated a superabundance of high-technology equipment; and structural ostentation and luxury were the order of the day. In any given day, one-fourth of all community beds are vacant; expensive equipment is underused or, worse, used unnecessarily. Capital investment brings rapidly rising operating costs.
Yet, in part, this pessimism derives from expecting too much of health care. It must be realized that care is, for most people, a painful experience, often accompanied by fear and unwelcome results. Although there is vast room for improvement, health care will always retain some unpleasantness and frustration. Moreover, the capacities of medical science are limited. Humpty Dumpty cannot always be put back together again. Too many physicians are reluctant to admit their limitations to patients; too many patients and families are unwilling to accept such realities. Nor is it true that everything has been tried and nothing works, as shown by the prepaid group practice plans of the Kaiser Foundation and at Puget Sound. In the main, however, such undertakings have been drowned by a veritable flood of public and private moneys which have supported and encouraged the continuation of conventional practices and subsidized their shortcomings on a massive, almost unrestricted scale. Except for the most idealistic and dedicated, there were no incentives to seek change or to practice self-restraint or frugality. In this atmosphere, it is not fair to condemn as failures all attempted experiments; it may be more accurate to say many never had a fair trial.
1. The author implies that the Kaiser Foundation and Puget Sound plans (lines 47-48) differed from other plans by
(A) encouraging capital investment
(B) requiring physicians to treat the poor
(C) providing incentives for cost control
(D) employing only dedicated and idealistic doctors
(E) relying primarily on public funding
2. The author mentions all of the following as consequences of full-cost reimbursement EXCEPT
(A) rising operating costs
(B) underused hospital facilities
(C) overcapitalization
(D) overreliance on expensive equipment
(E) lack of services for minorities
3. The tone of the passage can best be described as
(A) light-hearted and amused
(B) objective but concerned
(C) detached and unconcerned
(D) cautious but sincere
(E) enthusiastic and enlightened
4. According to the author, the “pessimism” mentioned at line 35 is partly attributable to the fact that
(A) there has been little real improvement in health-care services
(B) expectations about health-care services are sometimes unrealistic
(C) large segments of the population find it impossible to get access to health-care services
(D) advances in technology have made health care service unaffordable
(E) doctors are now less concerned with patient care
5. The author cites the prepaid plans in lines 46-48 as
(A) counterexamples to the claim that nothing has worked
(B) examples of health-care plans that were over-funded
(C) evidence that health-care services are fragmented
(D) proof of the theory that no plan has been successful
(E) experiments that yielded disappointing results
6. It can be inferred that the sentence “Humpty Dumpty cannot always be put back together again” means that
(A) the cost of health-care services will not decline
(B) some people should not become doctors
(C) medical care is not really essential to good health
(D) illness is often unpleasant and even painful
(E) medical science cannot cure every ill
7. With which of the following descriptions of the system for the delivery of health-care services would the author most likely agree?
(A) It is biased in favor of doctors and against patients.
(B) It is highly fragmented and completely ineffective
(C) It has not embraced new technology rapidly enough
(D) It is generally effective but can be improved
(E) It discourages people from seeking medical care
8. Which of the following best describes the logical structure of the selection?
(A) The third paragraph is intended as a refutation of the first and second paragraphs.
(B) The second and third paragraphs explain and put into perspective the points made in the first paragraph.
(C) The second and third paragraphs explain and put into perspective the points made in the first paragraph.
(D) The first paragraph describes a problem, and the second and third paragraphs present two horns of a dilemma.
(E) The first paragraph describes a problem, the second its causes, and the third a possible solution.
9. The author’s primary concern is to
(A) criticize physicians and health-care administrators for investing in techno?logically advanced equipment
(B) examine some problems affecting delivery of health-care services and assess their severity
(C) defend the medical community from charges that health-care has not improved since World War II
(D) analyze the reasons for the health-care industry’s inability to provide quality care to all segments of the population
(E) describe the peculiar economic features of the health-care industry that are the causes of spiraling medical costs
Behavior is one of two general responses available to endothermic (warm-blooded) species for the regulation of body temperature, the other being innate (reflexive) mechanisms of heat production and heat loss. Human beings rely primarily on the first to provide a hospitable thermal microclimate for themselves, in which the transfer of heat between the body and the environment is accomplished with minimal involvement of innate mechanisms of heat production and loss. Thermoregulatory behavior anticipates hyperthermia, and the organism adjusts its behavior to avoid becoming hyperthermic: it removes layers of clothing, it goes for a cool swim, etc. The organism can also respond to changes in the temperature of the body core, as is the case during exercise; but such responses result from the direct stimulation of thermoreceptors distributed widely within the central nervous system, and the ability of these mechanisms to help the organism adjust to gross changes in its environment is limited.
Until recently it was assumed that organisms respond to microwave radiation in the same way that they respond to temperature changes caused by other forms of radiation. After all, the argument runs, microwaves are radiation and heat body tissues. This theory ignores the fact that the stimulus to a behavioral response is normally a temperature change that occurs at the surface of the organism. The thermoreceptors that prompt behavioral changes are located within the first millimeter of the skin’s surface, but the energy of a microwave field may be selectively deposited in deep tissues, effectively bypassing these thermoreceptors, particularly if the field is at near-resonant frequencies. The resulting temperature profile may well be a kind of reverse thermal gradient in which the deep tissues are warmed more than those of the surface. Since the heat is not conducted outward to the surface to stimulate the appropriate receptors, the organism does not “appreciate” this stimulation in the same way that it “appreciates” heating and cooling of the skin. In theory, the internal organs of a human being or an animal could be quite literally cooked well-done before the animal even realizes that the balance of its thermomicroclimate has been disturbed.
Until a few years ago, microwave irradiations at equivalent plane-wave power densities of about 100 mW/cm2 were considered unequivocally to produce “thermal” effects; irradiations within the range of 10 to 100 mW/cm2 might or might not produce “thermal” effects; while effects observed at power densities below 10 mW/cm2 were assumed to be “nonthermal” in nature. Experiments have shown this to be an oversimplification, and a recent report suggests that fields as weak as 1 mW/cm2 can be thermogenic. When the heat generated in the tissues by an imposed radio frequency (plus the heat generated by metabolism) exceeds the heat-loss capabilities of the organism, the thermoregulatory system has been compromised. Yet surprisingly, not long ago, an increase in the internal body temperature was regarded merely as “evidence” of a thermal effect.
1. The author is primarily concerned with
(A) showing that behavior is a more effective way of controlling bodily temperature than innate mechanisms
(B) criticizing researchers who will not discard their theories about the effects of microwave radiation on organisms
(C) demonstrating that effects of microwave radiation are different from those of other forms of radiation
(D) analyzing the mechanism by which an organism maintains its bodily temperature in a changing thermal environment
(E) discussing the importance of thermoreceptors in the control of the internal temperature of an organism
2. The author makes which of the following points about innate mechanisms for heat production?
I. They are governed by thermoreceptors inside the body of the organism rather than at the surface.
II. They are a less effective means of compensating for gross changes in temperature than behavioral strategies.
III. They are not affected by microwave radiation.
(A) I only
(B) I and II only
(C) I and III only
(D) II and III only
(E) I, II, and III
3. Which of the following would be the most logical topic for the author to take up in the paragraph following the final paragraph of the selection?
(A) A suggestion for new research to be done on the effects of microwaves on animals and human beings
(B) An analysis of the differences between microwave radiation
(C) A proposal that the use of microwave radiation be prohibited because it is dangerous
(D) A survey of the literature on the effects of microwave radiation on human beings
(E) A discussion of the strategies used by various species to control hyperthermia
4. The author’s strategy in lines 39-42 is to
(A) introduce a hypothetical example to dramatize a point
(B) propose an experiment to test a scientific hypothesis
(C) cite a case study to illustrate a general contention
(D) produce a counterexample to disprove an opponent’s theory
(E) speculate about the probable consequences of a scientific phenomenon
5. The author implies that the proponents of the theory that microwave radiation acts on organisms in the same way as other forms of radiation based their conclusions primarily on
(A) laboratory research
(B) unfounded assumption
(C) control group surveys
(D) deductive reasoning
(E) causal investigation
6. The tone of the passage can best be described as
(A) genial and conversational
(B) alarmed and disparaging
(C) facetious and cynical
(D) scholarly and noncommittal
(E) scholarly and concerned
7. The author is primarily concerned with
(A) pointing out weaknesses in a popular scientific theory
(B) developing a hypothesis to explain a scientific phenomenon
(C) reporting on new research on the effects of microwave radiation
(D) criticizing the research methods of earlier investigators
(E) clarifying ambiguities in the terminology used to describe a phenomenon
Agricultural progress provided the stimulus necessary to set off economic expansion in medieval France. As long as those who worked the land were barely able to ensure their own subsistence and that of their landlords, all other activities had to be minimal, but when food surpluses increased, it became possible to release more people for governmental, commercial, religious and cultural pursuits.
However, not all the funds from the agricultural surplus were actually available for commercial investment. Much of the surplus, in the form of food increases, probably went to raise the subsistence level; an additional amount, in the form of currency gained from the sale of food, went into the royal treasury to be used in waging war. Although Louis VII of France levied a less crushing tax burden on his subjects than did England’s Henry II, Louis VII did spend great sums on an unsuccessful crusade, and his vassals—both lay and ecclesiastic—took over spending where their sovereign stopped. Surplus funds were claimed both by the Church and by feudal landholders, whereupon cathedrals and castles mushroomed throughout France.
The simultaneous progress of cathedral building and, for instance, vineyard expansion in Bordeaux illustrates the very real competition for available capital between the Church and commercial interests; the former produced inestimable moral and artistic riches, but the latter had a stronger immediate impact upon gross national product. Moreover, though all wars by definition are defensive, the frequent crossings of armies that lived off the land and impartially burned all the huts and barns on their path consumed considerable resources.
Since demands on the agricultural surplus would have varied from year to year, we cannot precisely calculate their impact on the commercial growth of medieval France. But we must bear that impact in mind when estimating the assets that were likely to have been available for investment. No doubt castle and cathedral building was not totally barren of profit (for the builders, that is), and it produced intangible dividends of material and moral satisfaction for the community. Even wars handed back a fragment of what they took, at least to a few. Still, we cannot place on the same plane a primarily destructive activity and a constructive one, nor expect the same results from a new bell tower as from a new water mill. Above all, medieval France had little room for investment over and above the preservation of life. Granted that war cost much less than it does today, that the Church rendered all sorts of educational and recreational services that were unobtainable elsewhere, and that government was far less demanding than is the modern state—nevertheless, for medieval men and women, supporting commercial development required considerable economic sacrifice.
1. According to the passage, agricultural revenues in excess of the amount needed for subsistence were used by medieval kings to
(A) patronize the arts
(B) sponsor public recreation
(C) wage war
(D) build cathedrals
(E) fund public education
2. According to the passage, which of the following was an important source of revenue in medieval France?
(A) Cheese
(B) Wine
(C) Wool
(D) Olive oil
(E) Veal
3. The passage suggests that which of the following would have reduced the assets immediately available for commercial investment in medieval France?
I. Renovation of a large cathedral
II. A sharp increase in the birth rate
III. An invasion of France by Henry II
(A) III only
(B) I and II only
(C) I and III only
(D) II and III only
(E) I, II, and III
4. It can be inferred from the passage that more people could enter government and the Church in medieval France because
(A) the number of individual landholdings in heavily agricultural areas was beginning to increase
(B) an increase in the volume of international trade had brought an increase in the population of cities
(C) a decrease in warfare had allowed the king to decrease the size of the army
(D) food producers could grow more food than they and their families needed to survive
(E) landlords were prospering and thus were demanding a smaller percentage of tenants’ annual yields
5. The author implies that the reason we cannot expect the same results from a new bell tower as from a new water mill is that
(A) bell towers yield an intangible dividend
(B) bell towers provide material satisfaction
(C) water mills cost more to build than bell towers
(D) water mills divert funds from commerce
(E) water mills might well be destroyed by war
6. The author of the passage most probably bases his central argument on which of the following theoretical assumptions often made by economists?
(A) Different people should be taxed in proportion to the benefit they can expect to receive from public activity.
(B) Perfect competition exists only in the case where no farmer, merchant, or laborer controls a large enough share of the total market to influence market price.
(C) A population wealthy enough to cut back its rate of consumption can funnel the resulting savings into the creation of capital.
(D) A full-employment economy must always, to produce one good, give up producing another good.
(E) There is a universal tendency for population, unless checked by food supply, to increase in a geometric progression.
7. The author suggests that commercial expansion in medieval France “required considerable economic sacrifice” (lines 59-60) primarily for which of the following reasons?
(A) Cathedrals cost more to build and rebuild than did castles.
(B) The numerous wars fought during the period left the royal treasury bankrupt.
(C) Louis VII levied a more crushing tax burden on his subjects than did Henry II.
(D) Although much of the available surplus had been diverted into vineyard expansion, the vineyards had not yet begun to produce.
(E) Although more food was being produced, the subsistence level was not very far above the minimum required to sustain life.
8. The passage implies that which of the following yielded the lowest dividend to medieval men and women relative to its cost?
(A) Warfare
(B) Vineyard expansion
(C) Water mill construction
(D) Castle building
(E) Cathedral building
9. Which of the following statements best expresses the central idea of the passage?
(A) Commercial growth in medieval France may be accurately computed by calculating the number of castles and cathedrals built during the period.
(B) Competition between the Church and the feudal aristocracy for funds created by agricultural surplus demonstrably slowed the economic growth of medieval France.
(C) Despite such burdens as war and capital expansion by landholders, commerce in medieval France expanded steadily as the agricultural surplus increased.
(D) Funds actually available for commerce in medieval France varied with the demands placed on the agricultural surplus.
(E) The simultaneous progress of vineyard expansion and building in medieval France gives evidence of a rapidly expanding economy.
Astrophysicists wrestling with the study of a new kind of star, the flat, “two-dimensional” configurations known as accretion disks have recently gained new insights into the behavior of these stars. Accretion disks exist in a variety of situations where matters swirl around a compact star such as a white dwarf star or a neutron star. Accretion disks are also suspected of playing a part in more exotic situations, in which the central object is imagined to be a supermassive black hole, the ultimate form of collapsed matter, rather than a compact star. The modeling of accretion disks is still in its infancy, a situation analogous to the days when ordinary stars were modeled by using elementary scaling laws without benefit of knowledge of the nuclear processes that power the stars. Similarly, the basic physics of the power by which accretion disks radiate, thought to originate in a form of turbulent friction, is known only at the crudest level.
Accretion disks were first defined in the context of Cataclysmic variables. In these systems, matter from the outer layers of an ordinary star is attracted by the gravitational influence of a nearby orbiting white dwarf star, the matter lost from the ordinary star cannot strike the surface of the tiny white dwarf directly but settles into an orbit around the star. The viscosity in the disk thus formed causes heating, radiation, and a slow spiraling of disk matter onto the surface of the white dwarf.
The rapid advances made in x-ray astronomy in the past decade have identified a second type of system in which accretion disks occur. In such a system, an accretion disk whirls about a neutron star rather than a white dwarf. The inner reaches of the accretion disk extend deeply into the gravitational potential of the neutron star where very rapid motion is the rule. The energy released by friction and the actual raining of the material from the disk onto the surface of the neutron star is so great that radiation is given off in a powerful flood of x-rays. And in at least one case, x-ray astronomers believe that the object in the center of an accretion disk is a black hole, suggesting that a third system may exist.
It had been assumed that portions of accretion disks would be unstable and that, as a result, clumping of their matter into rings would occur. There is no evidence from observation, however, that accretion disks do, in fact, suffer from these instabilities. In recent work, Abramowicz has shown that added gravitational effects due to general relativity may alter the expected Newtonian gravitational relationships in such a way that the disk remains stable, indicating that it is possible that these predicted instabilities do not occur.
Further progress toward understanding accretion disks will involve defining and proposing solutions to restricted problems just as was done in this case and was done and continues to be done for ordinary stars. Abramowicz’ work is a valuable example of the care that must be taken before reaching conclusions regarding accretion disks.
1. The author of the passage is primarily concerned with
(A) comparing Abramowicz’ work to the work of earlier astrophysicists
(B) providing information about accretion disks and discussing significant new work
(C) defining the conditions under which accretion disks can be observed
(D) exploring the question of whether a black hole can ever be the central object of an accretion disk
(E) describing the phenomenon of accretion disks and reviewing several conflicting theories of their origins
2. It can be inferred from the passage that predictions of the instability of accretion disks were based on which of the following?
(A) A calculation of the probable effects of standard Newtonian gravitational relationships
(B) A calculation of the probable relationship between general relativity and standard Newtonian gravitational relationships
(C) A calculation of the energy released by friction within a compact star
(D) Observation of the x-rays radiated by compact stars
(E) Observation of the clumping of accretion disk matter into rings around compact stars
3. The author’s attitude toward Abramowicz’ work can best be described as one of
(A) uncertain approval
(B) unqualified respect
(C) mild interest
(D) careful dismissal
(E) hostile skepticism
4. The passage suggests which of the following about current scientific knowledge of the nuclear processes of ordinary stars?
(A) Its pattern of development has been analogous to that of developments in x-ray astronomy.
(B) Its role in the explanation of turbulent friction has been significant.
(C) It has contributed to a more accurate modeling of ordinary stars.
(D) It lags behind knowledge of scaling laws.
(E) It explains the behavior of accretion disks as well as that of ordinary stars.
5. The passage suggests that Abramowicz’ work was motivated by which of the following assumptions?
(A) The quantity of energy released by accretion disks can be as large as it is only if the disks are stable.
(B) Improved techniques in x-ray astronomy would reveal any instabilities occurring in accretion disks.
(C) The lack of observational evidence of instabilities in accretion disks suggests that predictions of their occurrence might be wrong.
(D) Known methods of observing accretion disk surrounding compact stars and black holes do not permit the observation of the matter in accretion disks.
(E) The gravitational potential of compact stars does not vary from star to star.
6. The passage implies which of the following about the progress of knowledge in astrophysics?
(A) Adherence to outdated theories has, in the past, limited the activities of astrophysicists and restricted progress.
(B) Progress has, in the past, occurred only as a result of significant breakthroughs in basic physics and chemistry.
(C) Progress has, in the past, occurred as a result of a process of defining and solving restricted problems.
(D) Given the recent acquisition of knowledge about the nuclear processes of stars, further progress is likely to be limited to the refinement of what is already known.
(E) Conclusions in astrophysics have, in the past, been seriously flawed, thus limiting progress, although there have recently been signs of change.
7. The passage suggests that, compared to the study of ordinary stars, the study of accretion disks is
(A) derivative
(B) more sophisticated
(C) less clearly focused
(D) at an earlier stage of development
(E) more dependent on technological advances
8. According to the passage, some accretion disks originated in
(A) an increase in heat and radiation around an ordinary star
(B) a powerful flood of x-rays emitted by a neutron star
(C) a collision between two stars
(D) the turbulent friction on the surface of a compact star
(E) the accumulation of matter removed from an ordinary star
9. It can be inferred from the passage that the significance of Abramowicz’ work is that it
(A) provides a means of measuring the gravitational potential of neutron stars
(B) opens a new area for exploration in the field of x-ray astronomy
(C) proves that scaling laws cannot be applied to accretion disks
(D) proposes a new system of classification of stars
(E) suggests a resolution of a discrepancy between a theoretical prediction and actual observation
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