When Mom and Dad Grow Old A)The prospect of talking to increasingly fragile parents about their future can be “one of the most difficult challenges adult children will ever face,“ says Clarissa Green, a Vancouver therapist. “People often tell me they don’t want to raise sensitive issues with their parents about bringing in caregivers or moving,“ she says. “They’ll say, ’I don’t want to see dad cry.’“ But Green usually responds, “What’ s wrong with that?“ Adult children, she says need to try to join their parents in grieving their decline, acknowledge their living arrangements may no longer work and, if necessary, help them say goodbye to their beloved home. “It’ s sad. And it’ s supposed to be. It’ s about death itself.“ B)There are almost four million men and women over age 65 in Canada. Nearly two thirds of them manage to patch together enough support—from family, friends, private and government services—to live independently until virtually the day they die, according to Statistics Canada. C)Of the Canadian seniors who live to 85 and over, almost one in three end up being moved —sometimes kicking—to group living for the last years of their lives. Even in the best-case scenarios(可能出现的情况), such dislocations can bring sorrow. “Often the family feels guilty, and the senior feels abandoned“, says Charmaine Spencer, a professor in the gerontology department of Simon Fraser University. Harassed with their own careers and children, adult children may push their parents too fast to make a major transition. D)Val MacDonald, executive director of the B.C. Seniors Services Society, cautions adult children against imposing their views on aging parents. “Many baby boomers can be quite patronizing(高人一等的),“ she says. Like many who work with seniors, Macdonald suggests adult children devote many conversations over a long period of time to collaborating on their parents’ future, raising feelings, questions and options—gently, but frankly. However, many middle-aged adults, according to the specialists, just muddle(应付)through with their aging parents. E)When the parents of Nancy Woods of Mulmur Hills, Ont., were in their mid-80s, they made the decision to downsize from their large family home to an apartment in Toronto. As Wood’s parents, George and Bernice, became frailer(更虚弱的), she believed they knew she had their best interests at heart. They agreed to her suggestion to have meals on Wheels start delivering lunches and dinners. However, years later, after a crisis, Woods discovered her parents had taken to throwing out the prepared meals. Her dad had appreciated them, but Bernice had come to believe they were poisoned. “My father was so loyal,“ says Woods, “he had hid that my mother was overwhelmed by paranoia(偏执狂).“To her horror, Woods discovered her dad and mom were “living.on crackers and oatmeal porridge“ and were weakening from the impoverished diet. Her dad was also falling apart with the stress of providing for Bernice—a common problem when one spouse tries to do everything for an ailing partner. “The spouse who’ s being cared for might be doing well at home,“ says Spencer, “but often the other spouse is burned out and ends up being hospitalized.“ F)Fortunately, outside help is often available to people struggling through the often-distressing process of helping their parents explore an important shift. Sons and daughters can bring in brochures or books on seniors’ issues, as well as introduce government health-care workers or staff at various agencies, to help raise issues and open up discussions, says Val Macdonald, whose nonprofit organization responds to thousands of calls a year from British Columbians desperate for information about how to weave through the dizzying array of seniors services and housing options. The long list of things to do, says MacDonald, includes assessing their ability to live independently; determining your comfort level with such things as bathing a parent; discussing with all household members whether it would be healthy for an elderly relative to move in; monitoring whether, out of pure duty, you’re overcommitting yourself to providing a level of care that could threaten your own well-being. G)The shock phone call that flung Nancy Woods and her parents into action came from her desperate dad. “I got this call from father that he couldn’t cope anymore. My mother was setting fires in the apartment,“ she says. “He didn ’t want to see it for what it was. Up to then he’d been in denial.“ Without knowing she was following the advice of experts who recommend using outside sources to stimulate frank discussion with parents, Woods grabbed a copy of The 36-Hour Day: A family guide to caring for persons with alzheimer disease, related dementing illness, and memory loss in later life. She read sections of the book to her dad and asked him, “Who does that sound like?“ Her father replied, “It’s mother. It’s dementia(痴呆).“ At that point, Woods said, her dad finally recognized their tragic plight(困境). She told her father she would help them move out of their apartment. “He nodded. He didn’t yell or roar. He took it on the chin(忍受痛苦).“ H)Woods regrets that she “had not noticed small details signaling mom’s dementia.“ But she’s satisfied her dad accepted his passage into a group residence, where he and his wife could stay together in a secure unit where staff were trained to deal with patients with dementia. “From the moment they moved into the Toronto nursing home, their physical health improved. On the other hand, it was the beginning of the end in term’s of their mental abilities. Perhaps they couldn’t get enough stimulation. Perhaps it was inevitable.“ I)After my father died in 2002, the grim reality of my mother’s sharply declining memory set in starkly. With her expanding dementia, mom insisted on staying in her large North Shore house, even though she was contused about how to cook, organize her day or take care of herself. For the next three years we effectively imposed decisions on her, most of them involving bringing in caregivers, including family members. In 2005 mom finally agreed, although she barely knew what was happening, to move to a nearby nursing home, where, despite great confusion, she is happier. As Spencer says, the sense of dislocation that comes with making an important passage can be “a very hard adjustment for a senior at the best of times. But it’ s worse if it’ s not planned out.“

Americans and Their Cars A)It has been one of the world’s most enduring and passionate love affairs: Americans and their cars. It’s no secret that America is a nation of cars. A recent survey of the number of cars on America’s roads counted some 204 million vehicles in the U. S. There is an average of 1.9 motor vehicles for every household in America, and just to illustrate how many cars this is, consider that the average American household has only 1.8 drivers; America has more vehicles than it has drivers to drive them. By the time a middle-class American reaches 35 years of age, he or she has likely owned 3 cars in his or her life. B)The United States’ lawmakers have done little to undermine the romance between their citizens and their automobiles. Taxes on gasoline have been kept low, while massive highway building projects allow more and more cars to take to the road. Public transportation, on the other hand, has traditionally suffered from neglect. From the 1970s, since Americans have more than doubled their reliance on cars for long-distance rides, train and bus usage has largely stopped developing. Inner city transit systems in most cities were either deteriorating or crime-ridden, as in New York, or dysfunctional(机能不良的),as in Los Angeles. C)There are, however, signs that U.S. drivers are quietly looking for alternatives to car usage—with growing backing from legislators. Throughout the country a record number of commuters are taking buses and transit to work. In Washington DC, city officials say this summer has been the busiest in the history of the Metro rail system, with trains often carrying more than 600,000 passengers a day. In Cincinnati, transit authorities say there have been up to 50 percent more users this summer on some commuter routes. The Atlanta and Portland transit systems are also recording heavy usage. Nationwide, public transportation systems have recorded a 4.8 percent increase for the first quarter of 2003 over the same period in 2002, according to the American Public Transportation Association(APTA). D)Transit officials say the main reason is the recent rise in gasoline prices. Feeling the impact of cuts in production by oil-exporting countries, gasoline prices in US shot up from a national average of $1.30 a gallon(nearly 3.8 litres)late last year to high of $1.68 a gallon in June this year. In parts of the country, prices even reached $2 a gallon for the first time. E)While the price rise angered car drivers, many transportation experts feel it has turned attention to America’s meager(不景气的)public transport. “The public transport system has been better now than in the past decades,“ says Delon Lowas, an urban planning analyst at the Sierra Club, the environmental group. According to APTA, a person commuting 10 miles to work every day by train instead of by car could save as much as 314 gallons(1,193 liters)of gasoline annually—thus reducing emissions of hydrocarbon gases and other pollutants. F)The oil price rise might just have been the induction to result in a new revolution in the travel habits of US commuters, say environmentalists. As evidence, they point to the popularity of new light-rail systems in cities such as Portland. Even Los Angeles, whose residents are famous for their infatuation(迷恋)with cars, recently installed 17 miles of subway tracks. Now, US politicians are also warming to public transport. Federal and state governments are toying(玩弄)with some initiatives, such as tax breaks for people who use trains or buses. G)But public transportation continues to have its ideological critics. “It shouldn ’t be encouraged at the expense of private ownership of vehicles,“ says Ben Lieberman of the Competitive Enterprise Institute(GEI). He asserts that the government’s priority should be to make owning and driving a car more affordable by reducing environmental restrictions that push up the price of gasoline. H)The expansion of public transportation systems also draws opposition from those who are worried about the immense costs involved. They cite Los Angeles’ subway expansion, which cost a record $4.7 billion, as an instance of how expensive public transport can be. I)Citing costs of construction, Tome DeLay, the powerful Republican Whip of the House of Representatives, have moved to block funds for a proposed light-rail system in Houston. Mr. DeLay argues that die city should conduct a referendum(公民投票)before investing taxpayer’s money. The result: the Houston authorities might well have to manage without federal funds—or scrap the light-rail project entirely. Given the strong political pressure against it, some observers think the flirtation(对......的一时兴趣) with public transport will pass, not least because there are signs already that gas prices have started to fall. Mr. Lovaas, however, thinks that there has been “genuine grass-roots change“ as people understand the environmental and social need for cutting down on automobile use. But he admitted that political opposition could take a long time to overcome. “The people at the top will be the last to get it.“

Want to Know Your Disease Risk? Check Your Exposome A)When it comes to health, which is more important, nature or nurture? You may well think your genes are a more important predictor of health and ill health. Not so fast. In fact, it transpires(得知)that our everyday environment outweighs our genetics, when it comes to measuring our risk of disease. The genome(染色体组，基因组)is out—welcome the exposome(环境暴露). B)“The exposome represents everything a person is exposed to in the environment, that’s not in the genes,“ says Stephen Rappaport, environmental health scientist at the University of California, Berkeley. That includes stress, diet, lifestyle choices, recreational and medicinal drug use and infections, to name a few. “The big difference is that the exposome changes throughout life as our bodies, diets and lifestyles change,“ he says. While our understanding of the human genome has been growing at an exponential(迅速发展的)rate over the last decade, it is not as helpful as we hoped in predicting diseases. “Genes only contribute 10 percent to the overall disease burden,“ says Rappaport. “Knowing genetic risk factors can prove absolutely futile(无用的),“ says Jeremy Nicholson at Imperial College London. He points to work by Nina Paynter at the Brigham and Women’s Hospital in Boston, who investigated the effects of 101 genetic markers implicated in heart disease. After following over 19,000 women for 12 years, she found these markers were not able to predict anything about the incidence of heart disease in this group. C)On the other hand, the impact of environmental influences is still largely a mystery. “There’ s an imbalance between our ability to investigate the genome and the environment,“ says Chris Wild, director of the International Agency for Research on Cancer, who came up with the idea of the exposome. In reality, most diseases are probably caused by a combination of the two, which is where the exposome comes in. “The idea is to have a comprehensive analysis of a person’s full exposure history,“ says Wild. He hopes a better understanding of exposures will shed a brighter light on disease risk factors. D)There are likely to be critical periods of exposure in development. For example, the time from birth to 3 years of age is thought to be particularly important. “We know that this is the time when brain connections are made, and that if you are obese(过度肥胖的)by this age, you’ll have problems as an adult,“ says Nicholson. In theory, a blood or urine sample taken from an individual could provide a snapshot of what that person has been exposed to. But how do you work out what fingerprints chemicals might leave in the body? The task is not as formidable(艰难的)as it sounds. For a start, researchers could make use of swatches(样本)of bio-bank information that has already been collected. “There has been a huge international funding effort in adult cohorts(一群)like the UK Bio-bank already,“ says Wild. “If we improved analysis, we could apply it to these groups.“ E)Several teams are also working towards developing wearable devices to measure personal exposure to chemicals in the environment. “We can put chemicals in categories,“ says Rappaport. “We could start by prioritizing toxic chemicals, and look for markers of these toxins in the blood, while hormones and metals can be measured directly.“ Rappaport is looking at albumin(白蛋白),a common protein in the blood that transports toxins to the liver where they are processed and broken down. He wants to know how it reacts with a range of chemicals, and is measuring the products. “You can get a fingerprint —a display of all the products an individual has been exposed to.“ F)By combining this information with an enhanced understanding of how exposure affects health, the exposome could help better predict a person’ s true disease risk. And we shouldn’t have to wait long—Rappaport reckons we can reap the benefits within a generation. To this end, the US National Institutes of Health has set up an exposure biology program. “We’ re looking for interactions between genes and exposure to work out an individual’s risk of disease,“ says David Balshaw, who manages the program. “It would allow you to tailor(使合适)the therapeutic response to that person’ s risk.“ An understanding of this interaction, reflected in a person’ s metabolic(新陈代谢的)profiles(数据图表), might also help predict how they will respond to a drug. Nicholson has been looking for clues in metabolite profiles of urine samples. G)Last year, his research group used these profiles to predict how individuals would metabolise paracetamol(扑热息痛). “It turned out that gut(肠子)microbes(微生物)were very important,“ says Nicholson. “We’ve shown that the pre-dose urinary metabolite profile could predict the metabolism of painkilling drugs, and therefore predict drug toxicity.“ The findings suggest that metabolic profiles of exposure could help doctors tailor therapies and enable them to prescribe personalized medicines. Justin Stebbing at Imperial College London has already shown that metabolic profiles of women with breast cancer can predict who will respond to certain therapies. It is early days, but the initial findings look promising. “We’re reaching the point where we’re capable of assessing the exposome,“ says Balshaw. With the implications for understanding disease causes and risks, and a real prospect of developing personalized medicine, the exposome is showing more promise than the genome already, he adds. H)How does air pollution or stress leave a trace in the blood? The US National Institutes of Health in Bethesda, Maryland, is trying to find out. One group funded by the NIH and led by Nongjian Tao at Arizona State University’s Biodesign Institute in Tempre is developing wearable wireless sensors to monitor an individual’ s exposure to environmental pollutants. Tao’ s team started by creating software for Windows phones(视窗话筒), but they are working on apps(应用程序)that could be used on any smart phone. In theory, anyone could pop on(戴)a sensor and download an app to receive real-time information on exposure to environmental pollutants. At the same time, smart phones monitoring your location can combine the level of pollution with an exact time and place. Tao presented his sensor at the Circuits and Systems for Medical and Environmental Applications Workshop in Yucatan Mexico last week. I)“We’ re now moving prototypes(原型, 样品)into human studies, and progressing those prototypes into products,“ says David Balshaw of the NIH. Earlier this year, Tao’s group tried out the sensor on individuals taking a stroll around Los Angeles, California. They were able to measure how exposure to pollutants changed as each person wandered near busy roads and petrol stations.

Clarissa Green suggests that adult children should try to share their fragile parents’ grieving feelings.

When Nancy Woods’ father got to know their tragic situation, he finally moved out of their apartment.

When Nancy Woods’ parents reached their mid-80s, they moved into an apartment.

Despite knowing little about what was happening, his mother lived more happily in a nearby nursing home.

Val MacDonald’s organization is non-profit and helps adult children cope with their aging parent issues through phone calls.

Under stress from their own careers and children, adult children will always push their parents to group living.

Most Canadian seniors older than 65 live independently until they die, Statistics Canada, reported.

Val MacDonald hopes baby boomers not to force their parents to understand their ideas.

Since Nancy Woods’ parents moved into the Toronto nursing home, they became physically healthier, but had new problems with their mental abilities.

When her mother set fires in the apartment, Nancy Woods’ father couldn’t handle it.