IELTSwithJurabek

PASSAGE 2

Read the text and answer questions 14-26

THE YEAR OF EUROPEAN HEAT

It was that summer, scientists now realize, when global warming at last made itself unmistakably felt. People in the Northern Hemisphere knew that summer 2003 was remarkable. Britain had record high temperatures; Europe had out-of-control forest fires, great rivers drying to a trickle and thousands of heat-related deaths. But how remarkable that summer was is only now becoming clear.

June, July and August were the warmest three months recorded in western and central Europe. And they were the warmest by a very long way. Like Britain, Portugal, Germany and Switzerland had record national highs. Over a great rectangular block stretching from west of Paris to northern Italy, taking in Switzerland and southern Germany, the average temperature for the summer months was 3.78 degrees C higher than the long-term norm, says the University of East Anglia's Tyndall Centre for Climate Change Research, one of the world's leading institutions for monitoring and analyzing temperature records. That might not seem a lot until you are aware of the usual pattern. But then you realize it is enormous. There is nothing like this in previous data. It is considered so exceptional that Professor Phil Jones, the unit's director, says openly - in a way that few scientists have done - that 2003's extreme temperatures may be directly attributed to global warming caused by human actions, rather than natural climate variations.

Meteorologists have hitherto contented themselves with the formula that recent high temperatures are consistent with predictions of climate change. For the great block of the map in question, the unit has reliable temperature records dating back to 1781. Using as a baseline the average summer temperature between 1961 and 1990, departures from the temperature norm, anomalies, can easily be plotted.

Over the past 200 years, there have been at least half a dozen excess temperature anomalies approaching, or even exceeding, 2 degrees C. But there has been nothing remotely like that year, when the anomaly was nearly 4 degrees C. "That is quite remarkable," Professor Jones says. "It's very unusual in a statistical sense. If this series had a normal statistical distribution you would not get this number. The return period would be something like one in 1,000 years. If we look at an excess above the average of nearly 4 degrees C, then perhaps nearly 3 degrees C of that is natural variability, because we've seen that in past summers. But the final degree of it is likely to be due to global warming, caused by human action."

That year's summer had in a sense been one that climate scientists had long been anticipating. Until then, the warming had been manifesting itself mainly in winters that were less cold rather than in summers that were much hotter. Last week, the UN predicted that winters were warming so quickly that some of Europe's lower-level ski resorts will die out.

But sooner or later the unprecedented hot summer was bound to come - and that year it did. Over a large swathe of the western part of the European continent, records were broken in all three months. It was not only monthly averages, but daily extremes and the lengths of spells above thresholds. National records were set in at least four countries.

One of the most dramatic features of the summer was the hot nights, especially in the first half of August. The high night-time temperatures were related to the 15,000 extra deaths in France during August, compared with previous years. They gradually increased during the first 12 days of the month, peaking at about 2,000 a day on August 12 and 13 and severely overloading the medical services. Then they dropped dramatically after August 14 when minimum temperatures fell by about 5 degrees C. The elderly were most affected - their death rate rose 70 per cent.

For Britain, the year as a whole is likely to be the warmest recorded. But despite the temperature record on August 10, the summer itself - defined as the June, July and August period - comes behind 1976 and 1995, when there were longer periods of intense heat. At the moment, the year is likely to be the third-hottest in the global temperature record, which goes back to 1856, behind 1998 and 2002. But when the records for October, November and December are collated, it might move into second place. The ten hottest years in the record have occurred since 1990.

Professor Jones is in no doubt about the astonishing nature of that year's European summer. "The temperatures recorded that year were out of all proportion to the previous record," he says. "It was the warmest summer in the last 500 years and probably way beyond that. It was enormously exceptional."

His colleagues at the Tyndall Centre are planning a study of it. "It was a summer that had not been experienced before, either in terms of the temperature extremes that were reached, or the range and diversity of the effects of the extreme heat," says the centre's executive director, Professor Mike Hulme. "It will certainly have left its mark on a number of countries as to how they think and plan for climate change, much as the 2000 floods revolutionized the way the Government is thinking about flooding in the UK. The 2003 heatwave will have similar repercussions across Europe."

PASSAGE 3

Read the text and answer questions 27-40

IMPROVING PATIENT SAFETY

How improved drug packaging could provide some answers to patient safety issues

Packaging

One of the most prominent design issues in pharmacy is that of drug packages and the patient information leaflets included in them. Many pharmacists are concerned that current designs are accidents waiting to happen. The UK government shares this concern and, in 2003, the National Patient Safety Agency created a new role, appointing Colum Lowe, who has 14 years' experience as a designer in the private sector, as head of design and human factors.

Packaging design in the pharmaceutical industry is handled by either in-house teams or external design agencies. For packaging design of over-the-counter medicines, which do not have to be dispensed by a pharmacist but can be bought directly from a sales assistant, characteristics such as attractiveness and distinguishability are important and so these are usually commissioned from an external design team. The marketing team prepares the initial brief and the designers come up with six or seven designs. Two or three of these are then tested on a consumer group. In contrast, most designs for prescription-only products are created in-house. In some cases, this may simply involve the company's design team applying the house design and then handing it over to design engineers rather than testing the design on a consumer group. Clearly this process cannot adequately address the needs of the wide variety of patients using medication.

Design considerations

In her book Information Design for Patient Safety, Thea Swayne highlighted a multitude of design problems. For example, drugs that look or sound alike can lead to confusion, small type sizes and even the glare on silver foil packaging can lead to names or instructions being misread. One such example is a drug that was accidentally injected into a patient through the spine rather than through the veins. Investigations following this tragedy attributed some blame to the poor choice of typescript used on the drug container. Furthermore, according to Swayne, real situations in which medicines are used include a parent giving a cough medicine to a child in the middle of the night; packaging should be designed for moments such as these rather than for the ideal world of a hospital.

Safety and compliance

Child protection is another area that gives designers opportunities to improve safety. According to the Child Accident Prevention Trust, 70% of children admitted to hospital with suspected poisoning have swallowed medicines, and although child-resistant lids have helped, they are not yet fully effective. There is scope for improving what is currently available, according to Richard Mawle, a freelance product designer who feels it is not just children who are blocked by child-proof closures. "Many child-resistant packs are based on strength but older people may have the same level of strength as a child," he explained, and suggested that better designs could rely on cognitive skills.

Mawle also worked on a project which involved applying his skills to packaging and patient information leaflets. Commenting on the information presented, he said: "There can be an awful lot of junk at the beginning of leaflets. For example, why are company details towards the beginning of a leaflet when what might be more vital for the patient is that the medicine should not be taken with alcohol?"

Design principles and guidelines

Most designers work according to basic principles, for example, certain print styles are known to be more difficult to read than others. Look-alike boxes present the potential for errors and an obvious solution would be to use colours to highlight a larger dosage of a drug. However, according to Thea Swayne, designating a colour to a particular dosage is not recommended because this could lead to the user not reading the text on a box.

Design features can provide the basis for lengthy debates. One argument is that if all packaging was white with black lettering, people would have no choice but to read every box carefully. The problem is that trials of drug packaging are few - common signage studies concern road traffic signs and visual display units. Although some designers take results from such studies into account, proving that a particular feature is beneficial can be difficult. For example, current UK legislation requires packaging to include the name of the medicine in Braille, but, according to Karel van der Waarde, a design consultant to the pharmaceutical industry, "it is not known how much visually impaired patients will benefit nor how much the reading of visually able patients will be impaired." Van der Waarde is sceptical about current legislation and says that many regulatory authorities do not have the resources to handle packaging information properly. "They do not look at the use of packaging in a practical context - they only see one box at a time and not several together as pharmacists would do," he said.

Innovation

On a positive note, a recent innovation exhibition revealed several new designs. The popper aims to help arthritis sufferers remove tablets from blister packs, and Pluspoint is an adrenaline auto-injector, a device that allows diabetics to inject themselves, aimed at overcoming the fact that many patients do not carry their medication due to its prohibitive size. The aim of good design is to try to make things more user-friendly as well as safer. The guidelines in Information Design for Patient Safety are not intended to be legally binding. Rather, the book's purpose is to create a basic design standard and to stimulate innovation. The challenge for the pharmaceutical industry is to adopt such a standard.