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1). Patient Access to Physician Notes Is Gaining Momentum■Family physician Richard Martin， MD， sees many patients with chronic conditions.Among them is a man in his 80s who arrives prepped by Martin′s notes from his last visit.Martin was one of the first physicians at Geisinger Health System， headquartered in Danville， Pennsylvania， to volunteer in 2010 for an OpenNotes pilot program making physician notes readily available through a secure online portal，( ).■Sharing medical notes with patients is a trend more health institutions are adopting they foster transparency in medical records.OpenNotes is an initiative to promote medical note sharing that was launched in 2010 by clinicians and researchers at Beth Israel Deaconess Medical Center in Boston.Funded by the Robert Wood Johnson Foundation and other charitable groups， OpenNotes has developed copyrighted materials that it shares for free with health systems to introduce simple patient access to medical notes.■“My patient contends that reading his medical notes motivated him to maintain his health，” said Martin.( ) According to a recent study， patients who frequently read their physician′s notes reported they better understood their health condition， took better care of their health， and had a better relationship with their physician.■For decades， patients could legally access their medical notes as part of the Health Insurance Portability and Accountability Act of 1996.( )What sets OpenNotes apart is the ease and speed with which patients can access notes.■The OpenNotes initiative was the brainchild of Tom Delbanco， MD， a professor of general medicine and primary care at Harvard Medical School， and Jan Walker， RN，an assistant professor of medicine， also at Harvard.Throughout his 40 years of practice，Delbanco freely shared his notes with patients.When patent portals were introduced，Delbanco realized that patients could email their physicians and schedule appointments，but physician notes were hidden.He and Walker decided to investigate the consequences of inviting patients to view physician notes via online patient portals by setting up a 1-year research and demonstration project， funded by the Robert Wood Johnson Foundation and 2 other organizations.■The project involved 105 primary care physicians and 13，564 patients at 3 sites：Beth Israel， Geisinger， and Harborview Medical Center in Seattle.Both participating patients and participating and nonparticipating physicians completed an online survey at the beginning of the study assessing their attitudes toward medical note sharing.( )At the study′s conclusion， after a year of access to physician notes，participating patients and physicians completed a follow-up online survey， which asked the same questions as the baseline survey， but with the verb tense changed to reflect that patient access to medical notes had been established.The results showed that 99% of responding patients supported continued access to medical notes online， and the majority of responding physicians at each of the 3 sites， ranging from 85% at Beth Israel to 91%at Geisinger， agreed that access was a good idea.■Some physicians were skeptical at first， expressing concerns that giving patients access to medical notes might add to their workload if patients called and emailed with questions based on what they read， Delbanco said.For the most part， those fears were unfounded， he noted.( )■Since the pilot study， other health systems have adopted the OpenNotes concept.Delbanco estimates that about 100 health care institutions are at some stage， from planning to implementation， of sharing medical notes with patients.Some have used the OpenNotes resources， and others have not， Delbanco said.■The medical notes that the patients read are the physician′s notes一the patient′s story - Delbanco emphasized， and not simply the after-visit laundry list of medications and instructions that patients customarily receive.■Despite OpenNotes′ benefits， some concerns remain.One is that patients might find the information they read upsetting.To cushion a potential blow， MD Anderson Cancer Center holds laboratory， radiology， and pathology results for 7 days and Mayo Clinic delays patient access to radiology and pathology results for 3 days so physicians can first speak with patients.■In addition， OpenNotes raises issues of access and fairness for patients who don′t have a computer or have a limited knowledge of English， noted Nancy Berlinger， PhD， a Hastings Center research scholar.■( ) The OpenNotes pilot study found that 28% of participating physicians at Beth Israel， 9% at Geisinger， and 11% at Harborview reported in the poststudy survey that they were less candid in their notes knowing patients could read them， suggesting the concern may be valid.■Steven Malkin， MD， an internist who practices in Arlington Heights， Illinois， is concerned that if his patients routinely read his notes， he would be less forthcoming.“My notes are for me，” Malkin said.“If I knew a patient was going to read them， I would write them differently.′”■Although Geisinger′s Martin said he has not changed the way he writes notes， he has learned that patients may， interpret a word differently than anticipated， citing a patient who took offense to being described as obese.( ).■Despite lingering apprehension， Milliner thinks sharing notes with patients is a good tool for improving communication between patients and physicians.“It is one more way they become part of decision making，” Milliner said.“I view that as a very positive thing.”( )
A.Nonetheless， that description motivated the patient to lose weight， he said
B.Less than 10% of participating physicians reported increased length of visits or time responding to patient queries
C.Sharing medical notes， he said， appears to engage his patients and refreshes their memory of office conversations
D.But fees or long wait times to receive the records sometimes hampered the process
E.Furthermore， physicians may be inclined to censor themselves because patients can electronically peer over their shoulder
F.The feedback from Martin′s elderly patient illustrates why health systems across the country are making physician notes easily available to patients
G.Although individual physicians can′t opt out of note sharing， certain types of notes， such as confidential psychiatric notes， may be withheld
H.Initially， most patients (92%～97%) at the 3 sites thought patient access to notes was a good idea， although fewer participating physicians thought so (69%～81 % at the 3 sites)

正確答案：D
2). Patient Access to Physician Notes Is Gaining Momentum■Family physician Richard Martin， MD， sees many patients with chronic conditions.Among them is a man in his 80s who arrives prepped by Martin′s notes from his last visit.Martin was one of the first physicians at Geisinger Health System， headquartered in Danville， Pennsylvania， to volunteer in 2010 for an OpenNotes pilot program making physician notes readily available through a secure online portal，( ).■Sharing medical notes with patients is a trend more health institutions are adopting they foster transparency in medical records.OpenNotes is an initiative to promote medical note sharing that was launched in 2010 by clinicians and researchers at Beth Israel Deaconess Medical Center in Boston.Funded by the Robert Wood Johnson Foundation and other charitable groups， OpenNotes has developed copyrighted materials that it shares for free with health systems to introduce simple patient access to medical notes.■“My patient contends that reading his medical notes motivated him to maintain his health，” said Martin.( ) According to a recent study， patients who frequently read their physician′s notes reported they better understood their health condition， took better care of their health， and had a better relationship with their physician.■For decades， patients could legally access their medical notes as part of the Health Insurance Portability and Accountability Act of 1996.( )What sets OpenNotes apart is the ease and speed with which patients can access notes.■The OpenNotes initiative was the brainchild of Tom Delbanco， MD， a professor of general medicine and primary care at Harvard Medical School， and Jan Walker， RN，an assistant professor of medicine， also at Harvard.Throughout his 40 years of practice，Delbanco freely shared his notes with patients.When patent portals were introduced，Delbanco realized that patients could email their physicians and schedule appointments，but physician notes were hidden.He and Walker decided to investigate the consequences of inviting patients to view physician notes via online patient portals by setting up a 1-year research and demonstration project， funded by the Robert Wood Johnson Foundation and 2 other organizations.■The project involved 105 primary care physicians and 13，564 patients at 3 sites：Beth Israel， Geisinger， and Harborview Medical Center in Seattle.Both participating patients and participating and nonparticipating physicians completed an online survey at the beginning of the study assessing their attitudes toward medical note sharing.( )At the study′s conclusion， after a year of access to physician notes，participating patients and physicians completed a follow-up online survey， which asked the same questions as the baseline survey， but with the verb tense changed to reflect that patient access to medical notes had been established.The results showed that 99% of responding patients supported continued access to medical notes online， and the majority of responding physicians at each of the 3 sites， ranging from 85% at Beth Israel to 91%at Geisinger， agreed that access was a good idea.■Some physicians were skeptical at first， expressing concerns that giving patients access to medical notes might add to their workload if patients called and emailed with questions based on what they read， Delbanco said.For the most part， those fears were unfounded， he noted.( )■Since the pilot study， other health systems have adopted the OpenNotes concept.Delbanco estimates that about 100 health care institutions are at some stage， from planning to implementation， of sharing medical notes with patients.Some have used the OpenNotes resources， and others have not， Delbanco said.■The medical notes that the patients read are the physician′s notes一the patient′s story - Delbanco emphasized， and not simply the after-visit laundry list of medications and instructions that patients customarily receive.■Despite OpenNotes′ benefits， some concerns remain.One is that patients might find the information they read upsetting.To cushion a potential blow， MD Anderson Cancer Center holds laboratory， radiology， and pathology results for 7 days and Mayo Clinic delays patient access to radiology and pathology results for 3 days so physicians can first speak with patients.■In addition， OpenNotes raises issues of access and fairness for patients who don′t have a computer or have a limited knowledge of English， noted Nancy Berlinger， PhD， a Hastings Center research scholar.■( ) The OpenNotes pilot study found that 28% of participating physicians at Beth Israel， 9% at Geisinger， and 11% at Harborview reported in the poststudy survey that they were less candid in their notes knowing patients could read them， suggesting the concern may be valid.■Steven Malkin， MD， an internist who practices in Arlington Heights， Illinois， is concerned that if his patients routinely read his notes， he would be less forthcoming.“My notes are for me，” Malkin said.“If I knew a patient was going to read them， I would write them differently.′”■Although Geisinger′s Martin said he has not changed the way he writes notes， he has learned that patients may， interpret a word differently than anticipated， citing a patient who took offense to being described as obese.( ).■Despite lingering apprehension， Milliner thinks sharing notes with patients is a good tool for improving communication between patients and physicians.“It is one more way they become part of decision making，” Milliner said.“I view that as a very positive thing.”The feedback shows participating patients have some concerns about the easy access to physician notes.( )
A.True
B.False
C.Not mentioned

正確答案：C
3). (一)■Age-dependent Changes in Pancreatic Function Related to Diabetes Identified■1Age-related changes in the human pancreas govern how our bodies respond to rising and filling blood sugar levels throughout our lifetimes， and could affect whether we develop diabetes as adults.But it′s been nearly impossible to study this process in detail because human pancreatic tissue is not readily available.Instead， most researchers have relied on animal models to learn more about the development and function of the pancreas.■2 Now researchers at the Stanford University School of Medicine has made an advance in studying the human islet cells.“Studying human islet cells has been a major challenge in the field of diabetes research for decades because the pancreas essentially digests itself shortly after a person′s death，” said professor of developmental biology Seung Kim， MD， PhD.“We′ve developed a nationwide network capable of removing and studying pancreatic tissue from organ donors as young as 6 months and as old as 66 within about a day and half after death.This gave us an unprecedented opportunity to chart changes in gene expression spanning the course of a lifetime.” Kim is the senior author of the study.Postdoctoral scholar Efsun Arda， PhD， is the lead author.The study has been published in the April 28 issue of Cell Metabolism.■3In the study， Kim， Arda and their colleagues identified two proteins never before directly implicated in pancreatic function whose expression increases as a person ages.Increasing the expression of one of the proteins， SIX3， in the insulin-producing cells isolated from younger donors enhanced their ability to respond efficiently to rising glucose levels.“Pancreatic islets， which are the sites of insulin production， mature and change in their function after a baby is born，” said Kim.“We think our findings suggest that this maturation process goes on for nearly a decade.There′s been a growing realization among diabetes researchers that human islet development differs significantly from islet development in typical laboratory animals like mice.”■4Cells in the pancreatic islets called beta cells are responsible for modulating the body′s response to the rise and fall of blood glucose levels after a meal.When glucose levels rise， the beta cells release insulin to cue cells throughout the body to squirrel away the sugar for later use.Type 1 diabetes is caused by a failure to produce insulin； Type 2 diabetes is caused by combined deficits in the body to respond to and make insulin.Both types have been linked to reductions in the number of insulin-producing beta cells.Although beta cells proliferate robustly during the first decade or so of life， this proliferation slows dramatically with age.Understanding the age-related signals that cause this slowdown could one day lead to new diabetes treatments.But something more significant than the changes in cell number is also going on.Studies in rodents and in human fetal beta cells have showed that the responses of very young beta cells to increases in blood glucose are blunted when compared to their more-mature counterparts.■5 Kim and his colleagues worked for over six years to develop a multi -institutional collaboration to quickly collect pancreatic tissue and isolate and analyze islet cells from newly deceased donors.They also developed a unique cell- sorting technique to isolate islet cells from other cells in the pancreas.Once they had pure populations of cells， they compared their patterns of gene expression， as well as changes in the structure of the DNA.■6“We identified hundreds of genes that are dynamically regulated in islet beta cells during the journey from childhood to adulthood，” said Kim.“One gene，SIX3， turns on sometime around age 9.We wondered whether its expression might change the function of the beta cell.” Forcing the expression of SIX3 in beta cells obtained from children under the age of 9 improved the ability of the cells to secrete insulin in the presence of glucose， the researchers found.SIX3and a related gene， SIX2， with a similar pattern of expression in human beta cells，encode proteins known as transcription factors that control the expression of many other genes in the cell.Although they have not been implicated directly in pancreatic function， genomewide association studies have linked the presence of a mutation near： the genes to an impaired ability to properly；manage fasting blood-glucose levels.“This is a tantalizing link，” said Kim.“It appears that genes whose expression changes from childhood to adulthood may be disproportionately associated with an increased risk for diabetes.”■7 Importantly， SIX3 and SIX2 are not expressed in mouse beta cells.“This is why it is so important to study human tissue，” said Kim.“Until now there has been no way of knowing the gradual changes that happen over a period of years.”Besides， “This study is a tour de force，” said Andrew Stewart， MD， the director of the Diabetes， Obesity and Metabolism Institute at the Mount Sinai School of Medicine who is unconnected with the study.“It is very important to the field of diabetes research.”■8Kim and his colleagues are planning to continue their studies of pancreatic and islet- cell development as part of a Stanford focus on diabetes and metabolism research.The researchers also anticipate that their gene expression data and newly described islet-cell isolation technique， coupled with the ongoing tissue procurement effort， will be helpful to others studying pancreatic development and diabetes.“This is a unique and valuable resource for researchers wishing to begin to understand how gene expression is dynamically regulated in human islet cell，”said Kim.“Our study charts a new road map for researchers working to use stem cells to replace human islet cells by highlighting changes that normally occur and should perhaps be taken into consideration when analyzing cells for transplant.”■(二)■It was unlikely to study the effect of age-dependent changes in pancreatic functions on the diabetes before.Now， Stanford-led collaboration to( )and analyze human pancreatic tissue from deceased donors on a ( )level illustrates how the organ′s function changes as we age， and could point the way toward new diabetes treatments.■The researchers at the Stanford University School of Medicine have for the first time compared the patterns of gene expression in the insulin- producing cells and other cells of the pancreas from dozens of deceased donors ( )in age from 6months to 66 years.They have found significant differences in gene expression patterns and DNA( ) between donors at different ages.The findings， published on April 28 in Cell Metabolism， ( ).the importance of two genes not previously implicated directly in pancreatic function， and show that the pancreas continues to develop and ( ) during the first decade of life.They may also have implications for current clinical trials testing stem- cell-based therapies for diabetes.choose the most suitable subheading from list A-J for Paragraph 3 ( )
A.How changes in gene expression patterns affect glucose levels
B.Sorting islet cells
C.SIX3 and SIX2 identified only in humans
D.Prospects of the study
E.A great step in the study of human islet cells
F.The relationship of beta cells with two types of diabetes
G.Limitations of previous research on the pancreas
H.The significance of the study only in humans
I.A brief introduction of results of the study
J.Changes in the function of islet cells with their maturation

正確答案：I

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