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MatthiasMullenbeck_2017S-_如果我们付钱给医生，让他们保持人民的健康，听起来如何？_
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| It's 4am in the morning. |
时间是凌晨四点。 |
| I'm waking up in a Boston hotel room and can only think of one thing: tooth pain. |
我在波士顿一间 酒店的客房中醒来, 脑中只能想着一件事: 牙痛。 |
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Boston:n.波士顿(美国城市);
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| One of my ceramic inlays fell off the evening before. |
前一晚,我的一个瓷镶体脱落了。 |
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ceramic:adj.陶瓷的;陶器的;制陶艺术的;n.陶瓷;陶瓷制品; inlays:v.镶嵌; n.[医]嵌体; (inlay的第三人称单数);
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| Five hours later, I'm sitting in a dentist's chair. |
五小时之后,我坐在牙科的椅子上。 |
| But instead of having a repair of my inlay so that I can get rid of my pain, the dentist pitches me on the advantages of a titanium implant surgery . |
但牙医并没有修复我的瓷镶体, 好让我脱离牙痛之苦, 反而在跟我推销 钛植牙手术的优点。 |
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repair:v.修理;修补;修缮;补救;n.修理;修补;修缮; pitches:pitch的变形; advantages:n.有利条件; v.有利于; titanium:n.[化学]钛(金属元素); implant:vt.种植;灌输;嵌入;n.[医]植入物;植入管;vi.被移植; surgery:n.外科;外科手术;手术室;诊疗室;
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| Ever heard of that? |
有听过吗？ |
| (Laughter) |
（笑声） |
| It essentially means to replace a damaged tooth by an artificial one, that is screwed into your jaw. |
基本上,就是要把一颗受损的牙齿 换成一颗人工牙齿, 用螺钉固定在你的下颌上。 |
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essentially:adv.本质上;本来; artificial:adj.人造的;仿造的;虚伪的;非原产地的;武断的; screwed:v.用螺丝固定;旋紧;拧紧;拧上去;(screw的过去分词和过去式)
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| Estimated costs for the implant surgery may add up to 10,000 US dollars. |
植牙手术的估计花费 可能会高达一万美金。 |
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Estimated:adj.估计的;预计的;估算的;
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| Replacing the ceramic inlay I had before would come in at 100 US dollars. |
但把我之前的瓷镶体换掉, 只要大约一百美元。 |
| Was it my health or the money that could be earned with me that was the biggest concern for my dentist? |
到底是我的健康, 还是能从我身上赚到的钱, 是我的牙医最先考虑的事？ |
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concern:v.涉及,关系到;使担心;n.关系;关心;关心的事;
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| As it turned out, my experience wasn't an isolated case. |
结果发现,我的经历并非个案。 |
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isolated:adj.偏远的; v.隔离,孤立,脱离;
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| A study by a US national newspaper estimated that in the United States, up to 30 percent of all surgical procedures -- including stent and pacemaker implantations , hip replacements and uterus removals -- were conducted |
美国一家全国性报纸的研究指出, 在美国所有的手术当中, 大约有三成—— 包括支架和心律调节器植入、 髋关节置换,及子宫移除—— 被实施, |
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United:adj.联合的; v.联合,团结; (unite的过去分词和过去式) surgical:adj.外科的;外科手术的; procedures:n.程序;规程(procedure的复数); stent:n.斯滕特氏印模膏;展伸;adj.扩张的; pacemaker:n.[基医]起搏器;领跑者;标兵; implantations:n.移植;灌输;鼓吹; hip:n.臀部;蔷薇果;忧郁;adj.熟悉内情的;非常时尚的; replacements:n.替代,替换件;补充; uterus:n.[解剖]子宫; removals:n.屏蔽选项设置;效果移除(removal的复数); conducted:v.组织;安排;实施;执行;指挥;带领;引导;(conduct的过去分词和过去式)
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| although other nonsurgical treatment options had not been fully exploited by the physician in charge. |
尽管其他非手术的 治疗方式尚未完全 被其主治医生采用过。 |
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treatment:n.治疗;疗法;对待;处理;讨论; options:n.选择; v.得到或获准进行选择; (option的三单形式) exploited:v.剥削;压榨;运用;利用;发挥(exploit的过去分词和过去式) physician:n.[医]医师;内科医师;
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| Isn't that figure shocking? |
那数字不是挺吓人的吗？ |
| Numbers may be slightly different in other countries, but what it means is that if you go to a doctor in the US, you have a not-insignificant chance to be subjected to a surgical intervention without there being an immediate need for it. |
在其他国家,数字可能稍有不同, 但这意味着,如果你在美国看医生, 你有极大的可能性, 会在不立即需要手术的情况下 被要求进行手术治疗。 |
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slightly:adv.些微地,轻微地;纤细地; intervention:n.介入;调停;妨碍;
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| Why is this? |
为什么会这样？ |
| Why are some practitioners incentivized to run such unnecessary procedures? |
为什么有些从业医生 会被鼓励去做这类不必要的手术？ |
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practitioners:n.实践者;开业者;实习者(practitioner的复数); incentivized:v.对…实行物质刺激;(incentivize的过去式和过去分词)
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| Well, perhaps it is because health care systems themselves incentivize in a nonideal way towards applying or not applying certain procedures or treatments . |
也许是因为医疗体制本身, 用一种不尽理想的方式, 鼓励采用,或不采用 某些手术或治疗。 |
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health care:n.卫生保健; nonideal:adj.[物]非理想的; applying:v.申请,请求;使用;应用;(apply的现在分词) treatments:n.治疗;疗法;对待;处理;讨论;(treatment的复数)
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| As most health care systems reimburse practitioners in a fee-for-service-based fashion on the number and kind of treatments performed , it may be this economic incentive that tempts some practitioners to rather perform high-profit surgical treatments instead of exploring other treatment options. |
大部分的医疗系统 对从业医生的补助 是以按次付费的医疗费为基础的, 根据治疗的数量和类型来付款, 可能就是这种经济上的奖励 诱使一些从业医生 选择采用高利润的手术治疗, 而不去寻求其他治疗方案。 |
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reimburse:vt.偿还;赔偿; performed:v.表演;执行;履行;演出;工作,运转(好/不好)(perform的过去分词和过去式) economic:adj.经济的,经济上的;经济学的; incentive:n.动机;刺激;adj.激励的;刺激的; tempts:vt.诱惑;引起;冒…的风险;使感兴趣; exploring:v.探索:考察:探查;(explore的现在分词)
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| Although certain countries started to implement performance-based reimbursement , anchored on a quality and efficacy matrix , overall , there's very little in today's health care systems' architecture to incentivize practitioners broadly |
虽然有些国家开始导入 以绩效为基础的补助, 综合考虑治疗的质量和效率, 整体来说,现今的医疗 系统结构中,很少会有某种方式, 广泛鼓励开业医生 |
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implement:v.实施;执行;贯彻;使生效;n.工具; performance-based:adj.绩效为基础的; reimbursement:n.退还,偿还;赔偿; efficacy:n.功效,效力; matrix:n.[数]矩阵;模型;[生物][地质]基质;母体;子宫;[地质]脉石; overall:v.全部; n.外套; adj.全面的; architecture:n.建筑学;建筑风格;建筑式样;架构; broadly:adv.明显地;宽广地;概括地;露骨地;粗鄙地;
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| to actively prevent the appearance of a disease in the first place and to limit the procedures applied to a patient to the most effective options. |
在一开始就主动预防疾病出现, 并只对病人进行 效果最佳的手术。 |
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appearance:n.外貌;外观;外表; disease:n.病,[医]疾病;弊病;vt.传染;使…有病; in the first place:首先;起初; applied:adj.应用的;实用的;v.应用;使用;申请,请求;(apply的过去分词和过去式) patient:adj.有耐心的,能容忍的;n.病人;患者; effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象;
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| So how do we fix this? |
这问题要如何解决呢？ |
| What it may take is a fundamental redesign of our health care system's architecture -- a complete rethinking of the incentive structure . |
可能会需要从根本上重新设计 我们的医疗系统结构—— 完全重新思考激励性的结构。 |
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fundamental:n.基础; adj.十分重大的; redesign:vt.重新设计;n.重新设计;新设计; rethinking:n.反思;v.重新考虑(rethink的现在分词); structure:n.结构;构造;建筑物;vt.组织;构成;建造;
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| What we may need is a health care system that reimburses practitioners for keeping their customers healthy instead of almost only paying for services once people are already sick. |
我们需要把医疗系统的补助条件 改成是医生要保持其客户的健康, 而不是几乎只支付 已患病之后的治疗服务。 |
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reimburses:vt.偿还;赔偿;
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| What we may need is a transformation from today's system that largely cares for the sick, to a system that cares for the healthy. |
我们需要转变, 从现今主要的治疗疾病的体制, 转变为预防疾病的体制。 |
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transformation:n.转变;(用于南非)民主改革; largely:adv.主要地;大部分;大量地;
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| To change our current "sick care" approach into a true "health care" approach. |
把我们目前的“疾病诊治”方法, 改变为真正“健康维护”方法。 |
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approach:n.方法;路径;v.接近;建议;着手处理;
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| It is a paradigm shift from treating people once they have become sick to preserving the health of the healthy before they get sick. |
这是一种示范性的转移, 从在大家生病之后才进行治疗, 变成在他们生病之前 努力维持他们的健康。 |
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paradigm shift:n.范式转移(指行事或思维方式的重大变化); treating:v.以…态度对待;把…看作;处理;讨论;(treat的现在分词) preserving:n.保留,保存;
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| This shift may move the focus of all those involved -- from doctors, to hospitals, to pharmaceutical and medical companies -- on the product that this industry ultimately sells: health. |
这种转移,可能会让 所有相关群体的焦点发生改变—— 医生、医院、药厂, 及医疗器材公司—— 把重心转移到这个产业 最终要销售的产品上: 健康。 |
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involved:adj.有关的; v.涉及; (involve的过去式和过去分词) pharmaceutical:adj.制药(学)的;n.药物; ultimately:adv.最终;最后;归根结底;终究;
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| Imagine the following. |
想像以下情况。 |
| What if we redesign our health care system into one that does not reimburse practitioners for the actual procedures performed on a patient but rather reimburses doctors, hospitals, pharmaceutical and medical companies for every day a single individual is kept healthy and doesn't develop a disease? |
如果我们重新设计医疗系统, 这个系统不会对于病人 实际上执行的手术而补助从医者, 而是让医生、医院、 药厂,以及医疗器材公司, 确保每天每一个病人能健康无疾病, 就能得到补助？ |
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What if:如果…怎么办? individual:n.个人;有个性的人;adj.单独的;个别的;
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| In practical terms, we could, for example, use public money to pay a health fee to an insurance company for every day a single individual is kept healthy and doesn't develop a disease or doesn't require any other form of acute medical intervention. |
从实践的角度来说,比如,我们可以 用公款来支付健康费给保险公司, 只要每天每一个人能保持健康 无疾病, 或是不需要任何 其他形式的急性医疗干预就付款。 |
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practical:adj.实际的;真实的;客观存在的;n.实习课;实践课; insurance:n.保险;保险业;保险费;保费;adj.胜券在握的; acute:adj.严重的,[医]急性的;敏锐的;激烈的;尖声的;
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| If the individual becomes sick, the insurance company will not receive any further monetary compensation for the medical interventions required to treat the disease of that individual, |
如果一个人生了病, 保险公司不会从治疗 所需要进行的医疗干预中 收到任何进一步的金钱补助, |
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monetary:adj.货币的;财政的; compensation:n.补偿;报酬;赔偿金; interventions:n.[法]干预,干涉;处置(intervention的复数);
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| but they would be obliged to pay for every evidence-based treatment option to return the customer back to health. |
他们反而有义务要支付 让客户恢复健康的治疗选择, 只要能够证明治疗的必要性。 |
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obliged:adj.感激的;感谢的;v.强迫,迫使;帮忙,效劳;(oblige的过去分词和过去式) evidence-based:adj.基于证据的;
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| Once the customer's healthy again, the health fee for that individual will be paid again. |
一旦客户再次恢复健康, 他们就会再次收到那个人的健康费。 |
| In effect, all players in the system are now responsible for keeping their customers healthy, and they're incentivized to avoid any unnecessary medical interventions by simply reducing the number of people that eventually become sick. |
实际上,在这个体制中的所有参与者 现在都有责任要保持客户健康, 他们若能避免不必要的 医疗干预,就能得到奖励, 只要做到减少生病的人数。 |
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responsible:adj.负责的,可靠的;有责任的; eventually:adv.最后,终于;
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| The more healthy people there are, the less the cost to treat the sick will be, and the higher the economic benefit for all parties being involved in keeping these individuals healthy is. |
大家越健康, 治疗疾病的成本就会越低, 而保持每位客户健康的相关各方, 也会有更高的经济利益。 |
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individuals:n.[经]个人;[生物]个体(individual的复数);
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| This change of the incentive structure shifts , now, the attention of the complete health care system away from providing isolated and singular treatment options, towards a holistic view of what is useful for an individual to stay healthy and live long. |
将奖励结构做这种改变 会转移整个医疗体制的注意力, 从专注在提供独立 且单一的治疗选择, 转变成从整体的角度关注要做什么, 才能让人保持健康和长寿。 |
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shifts:n.转移; v.转移; (shift的第三人称单数) singular:adj.单数的;单一的;非凡的;异常的;n.单数; holistic:adj.整体的;全盘的;
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| Now, to effectively preserve health, people will need to be willing to share their health data on a constant basis, so that the health care system understands early enough if any assistance with regard to their health is needed. |
若要有效地保持健康, 大家需要愿意,并且经常分享 他们的健康数据, 这么一来,医疗系统就能及时 了解大家保持健康 需要什么样的协助。 |
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preserve:vt.保存;保护;维持;腌;禁猎;n.保护区;禁猎地;加工成的食品;
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| Physical examination, monitoring of lifetime health data as well as genetic sequencing , cardiometabolic profiling and imaging-based technologies will allow customers to make, |
体检、 监控终身健康数据, 还有DNA测序、心血管代谢分析, 以及成像相关的技术, 会让客户配合健康教练 |
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Physical:adj.[物]物理的;身体的;物质的;符合自然法则的;n.体格检查; as well as:也;和…一样;不但…而且; genetic:adj.基因的;遗传学的; sequencing:n.[计]排序; v.[计]定序(sequence的ing形式); profiling:n.资料搜集;v.扼要介绍;概述;写简介;(profile的现在分词) technologies:n.技术;科技(technology的复数);
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| together with health coaches and general practitioners, optimal and science-guided decisions -- for their diet, their medication and their physical activity -- to diminish their unique probability to fall sick of an identified , individual high-risk disease. |
和广大从业医生, 做出由科学引导的最佳决策—— 包括饮食、用药, 以及身体活动相关的决策—— 以降低每个人得到 每种可认定的高风险疾病的机率。 |
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optimal:adj.最佳的;最理想的; medication:n.药;药物; diminish:vt.使减少;使变小;vi.减少,缩小;变小; unique:adj.独特的,稀罕的;[数]唯一的;n.独一无二的人或物; probability:n.可能性;机率;[数]或然率; identified:v.确认;认出;找到;发现;说明身份;(identify的过去式和过去分词) high-risk:adj.高危险度的;
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| Artificial intelligence-based data analysis and the miniaturization of sensor technologies are already starting to make monitoring of the individual health status possible. |
以人工智能为基础的数据分析 以及传感器技术的微型化, 已经开始让监控 个人健康状况成为可能。 |
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analysis:n.分析;分解;验定; miniaturization:n.小型化,微型化; sensor:n.传感器; status:n.地位;状态;情形;重要身份;
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| Measuring cardiometabolic parameters by devices like this or the detection of circulating tumor DNA in your bloodstream early on after cancer disease onset are only two examples for such monitoring technologies. |
用像这样的装置来 测量心血管代谢参数, 或赶在癌症袭击之前 就先检测你的血液中 有无血液循环肿瘤DNA, 只是这类监控技术的 两个例子而已。 |
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parameters:n.决定因素;规范;范围;(parameter的复数) devices:n.[机][计]设备;[机]装置;[电子]器件(device的复数); detection:n.侦查,探测;发觉,发现;察觉; circulating:adj.运行的; v.(液体或气体)环流,循环; (circulate的现在分词) tumor:n.肿瘤;肿块;赘生物; bloodstream:n.[生理]血流,血液的流动; cancer:n.癌症;恶性肿瘤; onset:n.开始,着手;发作;攻击,进攻;
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| Take cancer. |
比如癌症。 |
| One of the biggest problems in certain oncological diseases is that a large number of patients is diagnosed too late to allow them to be cured, although the drugs and treatments that could potentially have cured them are already existing today, if the disease had only been detected earlier. |
（治疗）某些肿瘤疾病遇到 最大的问题之一, 就是太多病人都太晚才确诊, 已经来不及治愈, 尽管现今已经有些 药品和治疗手段 有可能治愈他们, 只要疾病能更早被筛查出来。 |
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oncological:肿瘤学的(oncology的形容词形式); diseases:n.[医]病(disease的复数);[医]疾病;[植保]病害;疾病种类; patients:n.接受治疗者,病人;(patient的复数) diagnosed:v.诊断(疾病);判断(问题的原因);(diagnose的过去分词和过去式) potentially:adv.可能地,潜在地; detected:v.发现;查明;侦察出;(detect的过去分词和过去式)
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| New technologies allow now, based on a few milliliters of blood, to detect the presence of circulating tumor DNA and thus, the presence of cancer, early on in a really convenient manner. |
最新的技术已经能 根据几毫升的血液 检测出是否有 血液循环肿瘤DNA, 因此,在早期就能用 很方便的方式检测出癌症。 |
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milliliters:n.毫升; presence:n.存在;出席;参加;风度;仪态; convenient:adj.实用的;便利的;方便的;
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| The impact that this early-stage detection can have may be dramatic . |
这种早期检测会造成的影响 是非常巨大的。 |
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impact:n.影响;效果;碰撞;冲击力;v.挤入,压紧;撞击;对…产生影响; dramatic:adj.突然的;巨大的;令人吃惊的;激动人心的;
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| The five-year survival rate for non-small cell lung cancer when diagnosed at stage one, which is early, is 49 percent. |
非小细胞肺癌的五年存活率, 如果在第一期,也就是很早期 就诊断出来,五年存活率是49%。 |
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survival:n.幸存,残存;幸存者,残存物;
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| The same, when diagnosed at stage four, which is late, is below one percent. |
如果在第四期, 也就是晚期才诊断出来, 五年存活率就不到1%。 |
| Being potentially able to prevent a large number of deaths by something as simple as a blood test for circulating tumor DNA could make certain cancer types a manageable disease, as disease onset can be detected earlier and positive treatment outcomes can likely be increased. |
只要用很简单的东西, 比如血液循环肿瘤DNA的血液检测, 就有可能防止许多人因此丧命, 它能让某些类型的 癌症变成可以控制的疾病, 疾病的发生能及早被检测出来, 因此也更可能会有正面的治疗结果。 |
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blood test:n.验血;vi.作血液检查; make certain:弄清楚;弄确实; manageable:adj.易管理的;易控制的;易办的; positive:adj.积极的;[数]正的,[医][化学]阳性的;确定的;n.正数;[摄]正片; outcomes:n.结果;成果;后果;出路;(outcome的复数)
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| In 2012, 50 percent of all Americans had a single chronic disease, resulting in 86 percent of the $3 trillion US health care budget being spent for treating such chronic diseases. |
2012年, 有50%的美国人得了单一种慢性病, 导致美国三万亿美元的 医疗预算中有86% 花在治疗这类慢性病上。 |
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chronic:adj.慢性的;长期的;习惯性的; trillion:n.[数]万亿;adj.万亿的;num.[数]万亿; budget:n.预算,预算费;v.安排,预定;把…编入预算;adj.廉价的;
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| Eighty-six percent. |
86%。 |
| If new technologies allow now to reduce this 86 percent, why have health care systems not reacted and changed already? |
如果新技术能减低这86%, 为什么医疗体系 还没有做出应对和改变？ |
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reacted:v.起反应; (react的过去分词和过去式)
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| Well, a redesign of what today is a sick care system into a true health care system that focuses on prevention and behavioral changes requires every actor in the system to change. |
要把现今的疾病治疗体系 重新设计成真正的 聚焦在预防和行为改变上的 预防性医疗体系, 这需要体制中的 每个行为者都做出改变。 |
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prevention:n.预防;阻止;妨碍; behavioral:adj.行为的;
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| It requires the political willingness to shift budgets and policies towards prevention and health education to design a new set of financial and non-financial incentives . |
这也需要政治意愿将预算和政策 转向预防和健康教育, 来设计一组新的经济 和非经济上的奖励方式。 |
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willingness:n.乐意;心甘情愿;自动自发; budgets:n.[财政]预算(budget复数形式);v.为…做预算(budget的第三人称单数形式); policies:n.政策;方针;原则;为人之道;保险单(policy的复数) non-financial:非财务性的,非金融类的; incentives:n.激励;奖励;诱因(incentive的复数形式);奖励措施;
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| It requires creating a regulatory framework for the gathering, using and sharing of personal health data that's at the same time stringent and sensible . |
这就需要创造一个规范的构架, 来收集、使用和分享个人健康数据, 严格且合理的规范构架。 |
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regulatory:adj.管理的;控制的;调整的; personal:adj.个人的;身体的;亲自的;n.人事消息栏;人称代名词; at the same time:同时;另一方面;与此同时; stringent:adj.严格的;严厉的;紧缩的;短缺的; sensible:adj.明智的; n.可感觉到的东西;
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| It needs doctors, hospitals, insurers , pharmaceutical and medical companies to reframe their approach and, most important, it can't happen without the willingness and motivation |
这需要医生、医院、保险从业者、 药厂,以及医疗器材公司 重新调整他们的方法, 而且,最重要的是, 这件事若要成真, 需要依靠每个人都有 |
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insurers:n.[保险]保险公司;承保人(insurer的复数形式); reframe:v.再构造,再组织;重新制订;给…装上新框架; motivation:n.动机;积极性;推动;
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| of individuals to change their lifestyle in a sustained way, to prioritize staying healthy, in addition to opening up for sharing the health data on a constant basis. |
意愿和动机去改变他们的 生活方式,变得更可持续, 把保持健康列为优先事项, 此外还要能开放地 经常分享健康数据。 |
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sustained:adj.持续的; v.维持; (sustain的过去分词和过去式) prioritize:v.按重要性排列;划分优先顺序;优先处理; in addition to:除…之外; opening up:n.解禁;开放;供开发;启用;
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| This change may not come overnight . |
这种改变不会一夕成真。 |
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overnight:adj.夜间的; v.在夜间; n.(美)前一天的晚上;
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| But by refocusing the incentives within the health care industry today to actively keep people healthy, we may not only be able to prevent more diseases in the first place |
但现在就行动,在医疗产业中 将奖励的焦点转变为 主动保持民众健康, 我们不但能在一开始 就先预防更多的疾病, |
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refocusing:v.归核化;再聚焦;使重新集中(refocus的ing形式);
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| but we may also be able to detect the onset of certain preventable diseases earlier than we do today, which will lead to longer and healthier lives for more people. |
也能够检测出 某些可预防之疾病的发生, 且比现今能做到的更早, 这就会让更多人 能更长寿、更健康。 |
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preventable:adj.可预防的;可阻止的;可防止的;
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| Most of the technologies that we need to initiate that change are already existing today. |
要开始这项改变, 我们所需要的技术 大多已经存在了。 |
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initiate:vt.开始,创始; n.开始; adj.新加入的;
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| But this is not a technology question. |
但这不是个技术问题。 |
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technology:n.技术;工艺;术语;
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| It is primarily a question of vision and will. |
根本上讲,这是个远见, 以及意愿的问题。 |
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primarily:adv.首先;主要地,根本上; vision:n.视力;美景;幻象;想象力;v.想象;显现;梦见;
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| Thanks a lot. |
非常感谢。 |
| (Applause) |
（掌声） |