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The field of 3-D printing comes with a new set of legal questions hospitals using the  technology will need to consider, said Bruce Kline, a technology licensing manager who oversees patents for new technology developed at Mayo Clinic. For starters, he said the STL file printers use are a lot like MP3 music files, in that they can be protected under copyright and require licensing to use. Copyright violations can occur if a purchased STL anatomical model file for rare disease is illegally shared with another institution that did not purchase the file from the vendor that created the file.  Under the law, if a device has a functional use it falls under patent law. If it is not functional, it falls under copyright law. Kline said most medical 3-D printing for educational models and complex anatomy evaluation currently falls under copyright. But, he said that will rapidly change in the coming years as customizable 3-D printable medical devices see wider use.  Additive manufacturing (AM) allows the creation of patient-specific devices at the point of care. Kline said an interesting fact is that these devices are FDA 510(k)-exempt if produced by a hospital instead of a medical device vendor. He said this blurs the lines between traditional vendor relationships, since the hospital can now become the manufacturer. However, if a hospital makes a device, it also becomes liable for it. He advised that it might be better for a commercial vendor to make the device for the hospital so the vendor assumes the liability of the device. Custom-made medical devices are also exempt under FDA regulations, Kline said. So, if a physician creates or modifies a device to meet the clinical needs of a specific patient’s anatomy, he said it is acceptable to use under current FDA rules. This may leave the door wide open for use of 3-D printed devices that are customized for each patient using their own 3-D imaging datasets.  It is possible printable device files may become available in the next few years to customize and print on demand. However, Kline said it will be much more difficult to enforce patents on these types of devices. He explained if someone makes one or two devices, there is no economical way for the creator of those device files to go after the user/maker of of unlicensed copies of the device to claim lost profits.
4. The word “it” in paragraph 2 refers to _____

Find synonym:
In order to stay healthy, make sure you have a balanced intake of vitamins and minerals.

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The climate crisis is poised to deliver a severe blow to America’s most threatened animals, with a new study finding that almost every species considered endangered is vulnerable in some way to global heating. Of the 459 animal species listed as endangered by the US government, researchers found that all but one, or 99.8%, have characteristics that will make it difficult for them to adapt to rising temperatures. The California condor, once close to being completely wiped out, faces increased risk of contamination in hotter conditions. Key deer, found only in the Florida Keys, face losing habitat to the rising seas. Whole classes of animals including amphibians, mollusks and arthropods are sensitive to the greatest number of climate-related threats, such as changes in water quality, shifting seasons and harmful invasive species that move in as temperatures climb. Mammals, such as the north Atlantic right whale and Florida panther, also face increased hardships, albeit on fewer fronts than amphibians, mollusks and arthropods.  Despite the overwhelming peril faced by America’s endangered species due to the climate crisis, the report, published in Nature Climate Change, found a patchy response from the US government. Federal agencies consider just 64% of endangered species to be threatened by the climate crisis, while just 18% of listed species have protection plans in place. Astrid Caldas, a study co-author and a climate scientist at the Union of Concerned Scientists said: “While agencies have increasingly listed climate change as a growing threat to species whose survival is already precarious, many have not translated this concern into tangible actions, meaning a significant protection gap still exists.” Nearly half of Australian species are threatened by the climate crisis, researchers have found. A spokesman for the US Fish and Wildlife Service, which oversees the endangered species list, said that while a species may be sensitive to changes in the climate, this sensitivity may not be so severe as to warrant being put on the list. “Our process for determining this looks at five factors: threats to a species’ habitat, overutilization, disease or predation, existing regulatory mechanisms, and other factors that may affect its continued existence,” he said. “Through this scientifically rigorous process we examine and account for the effects of climate change.  
4. According to paragraph 3, which word best describe the reaction of the government to the problem?

Read the following passage and choose the best answer (A, B, C, D)
Gender inequality remains an everyday reality for the world’s women and girls. It can begin right at the moment of birth and continue throughout the course of a woman’s life. Despite critical advances over the course of recent history, women in all countries and across all socioeconomic levels in society can face various forms of unfair treatment, including discrimination, harassment, domestic violence and sexual abuse. Other forms of abuse that are particularly prevalent in certain countries or cultural contexts include forced marriage, honor killings, deprivation of education, denial of land and property rights, and lack of access to work and to health care. Women may experience human rights abuses at different points in their working lives, including during recruitment, hiring, promotion and termination processes, as well as in daily interactions with colleagues and supervisors. Outside of the workplace, women are often particularly vulnerable to the social and environmental impacts of business activities. For example, in many developing countries, women and girls are primarily responsible for fetching and hauling water. When company operations contaminate local sources, it is they  who carry the burden of walking, often for hours, to the nearest substitute, which can prevent them from working or going to school. According to the UN Entity for Gender Equality and the Empowerment of Women, gender “refers to the social attributes and opportunities associated with being male and female and the relationships between women and men and girls and boys, as well as the relations between women and those between men. These attributes, opportunities and relationships are socially constructed and are learned through socialization processes.” Furthermore, gender equality “refers to the equal rights, responsibilities and opportunities of women and men and girls and boys. Equality does not mean that women and men will become the same but that women’s and men’s rights, responsibilities and opportunities will not depend on whether they are born male or female.” Women and girls comprise half of the planet’s population; their empowerment is essential in expanding economic growth and promoting social development in a sustainable way. Evidence from around the world shows that gender equality advancements have a ripple effect on all areas of sustainable development, from reducing poverty, hunger and even carbon emissions to enhancing the health, well-being and education of entire families, communities and countries. In fact, “Equality between women and men is seen both as a human rights issue and as a precondition for, and indicator of, sustainable people-centered development.”  
8. The passage implies that ______

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As the world’s population continues to grow, so does the amount of garbage that people produce. On-the-go lifestyles require easily (1) ___________ products, such as soda cans or bottles of water, but the accumulation of these products has led to increasing amounts of plastic pollution around the world. As plastic is composed of major (2) ______________ pollutants, it has the potential to cause great harm to the environment in the form of air, water and land pollution. Put simply, plastic pollution is when plastic has gathered in an area and has begun to (3) _________ impact the natural environment and create problems for plants, wildlife and even human population. Often this includes killing plant life and posing dangers to local animals. Plastic is an incredibly useful material, but it is also made from toxic compounds known to cause illness, and because it is meant for (4) _______, it is not biodegradable. Next time you go for a shopping, don’t forget to carry a paper or cloth bag. Also, try to (5) ______ bringing plastic bags at home and purchasing items with too much of packing. This way you can help in contributing towards the environment in the form of reducing plastic pollution whose ill effects are irreversible

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It was practically the anthem for 2019 World Series, with tens of thousands of Washington Nationals fans clapping in unison and belting out “Baby Shark, doo-doo doo-doo doo-doo.” In Lebanon, it became a rallying cry after a video of protesters singing to soothe a frightened toddler went viral. And in many other places, the earworm has drawn ridicule, with late-night comedian Jimmy Kimmel suggesting its creator should be jailed for life. To the contrary, the catchy tune about a family of sharks has become so lucrative that the Korean family behind it is now sitting on a rapidly growing multimillion-dollar fortune. Kim Min-seok co-founded closely held SmartStudy Co. in 2010, and five years later its children’s educational brand, Pinkfong, released “Baby Shark”. His father runs Samsung Publishing Co., which also owns part of the startup. The family fortune, based on stakes held by Kim’s immediate relatives in those two companies, is now about $125 million – much of it thanks to the song. However, when asked, SmartStudy declined to comment on the family’s wealth. Shares of Samsung Publishing soared 89% the week the World Series began as local media reported on the song’s surging popularity among U.S. baseball fans. National outfielder Gerardo Parra began using it as his walk-up music, leading to crowd sing-alongs with shark-jaw gestures, scenes that echoed across TVs as the team broke out of an early season slump. They rode the wave all the way to the championship. Kim, 38, hardly set out to write a hit global song. After working at gaming companies including Nexon and developing content for kids at Samsung Publishing, he co-founded SmartStudy to focus on the growing market for educational content for smartphones.
2. The underlined word “lucrative” in the passage is closest in meaning to ________

Dirty Britain

Before the grass has thickened on the roadside verges and leaves have started growing on the trees is a perfect time to look around and see just how dirty Britain has become. The pavements are stained with chewing gum that has been spat out and the gutters are full of discarded fast food cartons. Years ago I remember travelling abroad and being saddened by the plastic bags, discarded bottles and soiled nappies at the edge of every road. Nowadays, Britain seems to look at least as bad. What has gone wrong?

The problem is that the rubbish created by our increasingly mobile lives lasts a lot longer than before. If it is not cleared up and properly thrown away, it stays in the undergrowth for years; a semi-permanent reminder of what a tatty little country we have now.

Firstly, it is estimated that 10 billion plastic bags have been given to shoppers. These will take anything from 100 to 1,000 years to rot. However, it is not as if there is no solution to this. A few years ago, the Irish government introduced a tax on non-recyclable carrier bags and in three months reduced their use by 90%. When he was a minister, Michael Meacher attempted to introduce a similar arrangement in Britain. The plastics industry protested, of course. However, they need not have bothered; the idea was killed before it could draw breath, leaving supermarkets free to give away plastic bags.

What is clearly necessary right now is some sort of combined initiative, both individual and collective, before it is too late. The alternative is to continue sliding downhill until we have a country that looks like a vast municipal rubbish tip. We may well be at the tipping point. Yet we know that people respond to their environment. If things around them are clean and tidy, people behave cleanly and tidily. If they are surrounded by squalor, they behave squalidly. Now, much of Britain looks pretty squalid. What will it look like in five years?

2. According to the writer, things used to be ________.

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My mom is a pretty talented pianist. She reads music very well and loves to play  Chopin and various other classical artists. One of my earliest memories involves sitting under her piano bench while she played. It gave her a lot of joy and a lot of personal pride, I think. I trust that she naturally wanted those things for me when she enrolled me in piano lessons when I was about seven years old.  I hated them. I was scared of my teacher. I hated practicing. I hated the songs I was being forced to learn. I hated reading music. I was a young kid, and there were other things I wanted to do instead. It just didn’t interest me, and no amount of begging and pleading on my mother’s part could get me to enjoy practicing. One thing in particular that she used to say as she was begging me to practice was, “One day, when you’re older, you will cherish the ability to sit down and play.” Nevertheless, after a couple years of once-a-week torture, she finally allowed me to quit.  Years went by. I switched schools when I was 11 years old, got a new best friend, and got interested in music. This was a critical turning point. My best friend loved the band Bush and lots of other alternative bands of the ‘90s, and listening to them unlocked a whole new sonic world for me. I fell in love, fell completely and totally in love, with rock music.  My friend taught me the form for a power chord on her acoustic guitar. If you know how to play a power chord, you can play or at least convincingly fake pretty much every single rock song in the world. It was like someone had given me my first hit of a powerful opiate.  I spent hours practicing in my room. Hours sounding out my favourite songs. More hours playing along with those songs in front of my mirror, pretending I was Scott Weiland, Dolores O’Riordan, Chris Cornell, or my personal favourite Louise Post (of Veruca Salt). I unlocked a talent within myself that had gone obscenely undiscovered and undeveloped when I was a young child banging my head against a piano keyboard, trying and failing to read a piece of music - I could play the guitar by ear. I just hadn’t had the time to figure that out because my mom was trying so hard to get me to do something that did not come naturally to me and that I had no desire to do.
7. Who made the writer love music?

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People should eat ............... and do ............. to reduce the risk of heart disease.

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How fit are your teeth? Are you lazy about brushing them? Never fear: An inventor is on the case. An electric toothbrush senses how long and how well you brush, and it lets you track your performance on your phone. The Kolibree toothbrush was exhibited at the International Consumer Electronics Show in Las Vegas this week. It senses how it is moved and can send the information to an Android phone or iPhone via a Bluetooth wireless connection The toothbrush will be able to teach you to brush right (don’t forget the insides of the teeth!) and make sure you’re brushing long enough. “It’s kind of … like having a dentist actually watch your brushing on a day-to-day basis,” says Thomas Serval, the French inventor. The toothbrush will also be able to talk to other applications on your phone, so developers could, for instance, create a game controlled by your toothbrush. You could score points for beating monsters among your teeth. “We try to make it smart but also fun.” Serval says he was inspired by his experience as a father. He would come home from work and ask his kids if they had brushed their teeth. They said “yes,” but Serval would find their toothbrush heads dry. He decided he needed a brush that really told him how well his children brushed. The company says the Kolibree will go on sale this summer, for $99 to $199, developing on features. The U.S. is the first target market. Serval says that one day, it’ll be possible to replace the brush on the handle with a brushing unit that also has a camera. The camera can even examine holes in your teeth while you brush.
1. Which is one of the features of the Kolibree toothbrush?

Mark the letter A, B, C, or D on your answer sheet to indicate the undelined part that needs correction in each of the following questions:
Four West Indian geckos, with human assistance, have recently entered the United States. The yellowheaded gecko, the ashy gecko, the reef gecko, and the ocellated gecko are presently inhabiting the tropical areas of the Keys and the tip of southern Florida. The Mediterranean gecko also arrived along the Gulf coast some time ago, via the West Indies. The only other geckos in the United States live in the Southwest. In extreme southern California, the leaf-gingered gecko lives

in dry, rocky country and scampers over boulders at night, hiding by day in crevices. It has a slender, tapered tail and stalks insects by raising itself high on its legs, cocking its head, and twitching its tail nervously before leaping on its prey. In courtship, the tail is also waved by the male as he approaches the female.
Although most lizards are excellent climbers, the geckos are able to walk on smooth surfaces with the help of unique clinging devices under the toes. Also, the undersides of most geckos have pads of large scales, each of which bear microscopic hairs with hundreds of branches having minute, blunt ends that press against the surface that the gecko is on, enabling the gecko to cling to almost any surface. Like other lizards, geckos have the ability to shed their tails if attacked by an enemy. They stump heels and a new tail is grown in approximately the same shape as the original. Unlike most lizards, most geckos have no moveable eyelids. The nocturnal geckos have vertical pupils, which contract in bright light. All geckos, except several New Zealand species, lay eggs. The eggs have a tough, white shell and are laid under stones, behind window shutters or under bark.

What is the most likely subject of the paragraph following this passage?

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All plants rely on nutrients taken from the soil in order to survive. However, in areas where the soil does not contain enough (35)_____ nutrients, some plants have adapted to (36) _____ their diets from another source: living organisms. Though they are few in number, carnivorous plants are (37)_____ fascinating beings that ―eat‖ anything from one-celled organisms to insects in order to survive. They are commonly found in marshlands. Carnivorous plants feature one of several types of ―traps‖ to ensnare prey, which they consume to make up for nutrients that may be missing from the soil. While there are over 400 species of carnivorous plants in the world today, some are more (38)_____ than others. The most well-known of these plants are the snap traps, which include the Venus flytrap. Snap traps are easily identified by their leaves, which are separated into two lobes that have the ability to fold together. Inside the lobes, the surface is covered with tiny hairs that are (39) _____ to movement. When the plant‘s prey brushes against the hairs, it triggers a closing mechanism that rapidly brings the two lobes together, trapping the prey (40)_____ inside. The response of the traps is phenomenal (41)_____ speed: the time between triggering the hairs and snapping shut is less than a second. As the prey struggles inside the trap, it only triggers more hairs, causing the leaves to tighten their (42) _____. The plant then secrets liquid chemicals from special glands into the trap to dissolve the prey and absorb all of its nutrients. Besides the Venus flytrap, only one other type of snap trap exists today, (43)_____ to as the waterwheel plant. The two share a common ancestor and differ only in a few ways. For instance, the waterwheel is an aquatic plant, while the flytrap is exclusively terrestrial. In addition, the flytrap feeds primarily on arthropods like spiders, while the waterwheel lives (44)_____ simple invertebrates, like certain types of plankton

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In the 1930s, a lot of people in the USA were out of work. Among these people was a man named Alfred Butts. He always had an interest in word games and so, to fill his time, he planned a game which he called “Lexico”. However, he was not completely satisfied with the game, so he made a number of changes to it and, in time, changed its name from “Lexico” to “Alph” and then to “Criss Cross”. He wanted to make some money from his new game but he didn’t have any real commercial success. In 1939, Butts happened to meet a man called Jim Brunot who showed an interest in the new game. The two men worked together on developing the game and in 1948 it was offered for sale in the United States under its new name - “Scrabble”. At first, it didn’t sell very well. In the first year it sold just 2,250 sets and by 1951 it had only reached 8,500 sets a year. Then, in 1952 the manager of Macy’s department store in New York, Jack Strauss, happened to play “Scrabble” while he was on holiday. He thought it was a wonderful game and, when he went back to work after his holiday, he insisted that Macy’s should stock the game and make an effort to call the public’s attention to it. As a result, “Scrabble” became a big success in the United States and it soon spread to Australia and then to other English-speaking countries
3. According to the passage, it was ____ who made “Scrabble” popular

Mark the letter A, B, C, or D on your answer sheet to indicate the undelined part that needs correction in each of the following questions:
In the United States, it is important to be on time, or punctual, for an appointment, a class, a meeting, etc... This may not be true in some other countries, however. An American professor discovered this difference while teaching a class in a Brazilian university. The two-hour class was scheduled to begin at 10 a.m, and end at 12 a.m. On the first day, when the professor arrived on time, no one was in the classroom. Many students came after 11 a.m. Although all of the students greeted the professor as they arrived, few apologised for their lateness. Were these students being rude? He decided to study the students’ behavior.
In American university, students are expected to arrive at the appointed hour. On the other hand, in Brazil, neither the teacher nor the students always arrive at the appointed hour. Classes not only begin at the scheduled time in the United States, but they also end at the scheduled time. In the Brazilian class, only a few students left the class at noon, many remained past 12:30 to discuss the class and ask more questions. While arriving late may not be important in Brazil, neither is staying late.
The explanation for these differences is complicated. People from Brazilian and North American cultures have different feelings about lateness. In Brazil, the students believe that a person who usually arrives late is probably more successful than a person who is always on time. In fact, Brazilians expect a person with status or prestige to arrive late, while in the United States, lateness is usually considered to be disrespectful and unacceptable. Consequently, if a Brazilian is late for an appointment with a North America, the American may misinterpret the reason for the lateness and become angry.
As a result for his study, the professor learned that the Brazilian students were not being disrespectful to him. Instead, they were simply behaving the appropriate way for a Brazilian student in Brazil. Eventually, the professor was able to adapt his own behavior to feel comfortable in the new culture.

What is the main idea of this passage?

Each sentence has a mistake. Find it bychosing A B C or D

 The earhthquake is worst  nature disater that this country has experienced

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Sam’s uncle, _____________is very rich, came to visit our orphanage.

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NASA continues to plan a flight to Mars. The technological challenge is immense, first  of all, because it will be very difficult to carry tons of material for the construction of a habitat. This is why NASA is looking for alternative solutions, such as the possibility of growing structures out of fungi to become our future homes in the stars. The concept of these “houses” is based on three distinct layers. The first is made of ice. It must protect people from radiation, but also provide the resources necessary for the second layer. This is made of photosynthesizing microbes or cyanobacteria, which produce oxygen for astronauts and nutrients for the final layer of mycelia. That last layer of mycelia is what organically grows into a sturdy home, first activated to grow in a contained environment and then baked to kill the lifeforms.  Researchers have already experimented with creating objects using mycelia. A team from Stanford and Brown universities grew a stool as part of a myco-architecture project at NASA’s Ames research center in 2018. After two weeks of growth, the stool looked like something that would have been long forgotten in a refrigerator. It was then baked that leads to a clean and functional piece of furniture. From the point of view of space conquest, mushrooms could also be used to filter water for future explorers and extract minerals. Once these prototypes are designed for other worlds, we can bring them back to ours. Building this kind of housing could reduce the huge carbon footprint of the construction industry. This research project is still in its infancy, but it shows us how scientists are able to broaden horizons, and it’s exciting.
5. According to paragraph 2, what is correct about the developing materials project?

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The town of Chichen-Itza was established during the Classic period close to two natural cavities (cenotes or chenes), which gave the town its name “At the edge of the well of the Itzaes”. The cenotes facilitated tapping the underground waters of the area. The dates for this settlement vary according to subsequent local accounts: one manuscript gives 415-35 A.D., while others mention 455 A.D. The town that grew up around the sector known as Chichen Viejo already boasted important monuments of great interest: the Nunnery, the Church, Akab Dzib, Chichan Chob, the Temple of the Panels and the Temple of the Deer. They were constructed between the 6th and the 10th centuries in the characteristic Maya style then popular both in the northern and southern areas of the Puuc hills. The second settlement of Chichen-Itza, and the most important for historians, corresponded to the migration of Toltec warriors from the Mexican plateau towards the south during the 10th century. According to the most common version, the King of Tula, Ce Acatl Topiltzin Quetzalcoatl, or Kukulkan as the Maya translated the name, reportedly took the city between 967 A.D. and 987 A.D. Following the conquest of Yucatán a new style blending the Maya and Toltec traditions developed, symbolizing the phenomenon of acculturation. Chichen-Itza is a clear illustration of this fusion. Specific examples are, in the group of buildings to the south, the Caracol, a circular stellar observatory whose spiral staircase accounts for its name, and, to the north, El Castillo. Surrounding El Castillo are terraces where the major monumental complexes were built: on the north-west are the Great Ball Court, Tzompantli or the Skull Wall, the temple known as the Jaguar Temple, and the House of Eagles; on the north-east are the Temple of the Warriors, the Group of the Thousand Columns, the Market and the Great Ball Court; on the south-west is the Tomb of the High Priest. After the 13th century no major monuments seem to have been constructed at Chichen-Itza and the city rapidly declined after around 1440 A.D. From its abandonment during the 15th century, Chichen-Itza underwent a process of gradual deterioration until the first excavations at the site began more than a century ago. Nevertheless, the excellent materials and building techniques used by the Maya in the construction of the buildings secured that the architectonic, sculptural and pictorial essence of Chichen-Itza would be conserved through the centuries  
6. The following statements are true, EXCEPT_______

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There is no conflict between big business and the green movement towards the fight  against climate change and the two are “totally compatible”. That’s according to Mike Hughes, Zone President, Schneider Electric UK & Ireland, who believes while there may be differences on how organisations play their part in the move towards the net zero target and the speed at which it happens, the two are “totally aligned”.  Speaking to ELN at the Energy Live Expo event last week, which attracted more than 450 people from across the industry, he said: “Big business goes where there is opportunity. Big business is a force for good. It has to be involved in this transition, in this change, in this climate change. If you look at it, there are two things that have happened in the last five to seven years that have really accelerated this topic. One is the general public getting on board with the whole concept of climate change, the emergency. The second is actually the business community and particularly the financial community starting to look at the financial risks around climate change and moving its money and where it will invest.”  Mr Hughes added the UK’s target for net zero carbon emissions by 2050 is a “hugely ambitious step” and it shows leadership, direction and ambition, enabling businesses to focus on where they can invest. He is also “extremely optimistic” and from a technology point of view, he believes there are technologies available to support the transition. He said: “It’s now around awareness, incentives from government, the right regulations to get people to make the right step and boosting the use of these technologies. I’m extremely positive.”
5. The word “incentives” in paragraph 3 is closest in meaning to ______.

Read the following passage and mark the letter A, B, C, or D on your answer sheet to indicate the correct answer to each of the following questions:
In the United States, presidential elections are held in years evenly divisible by four (1888, 1900, 1964, etc.). Since 1840, American presidents elected in years ending with zero have died in office, with one exception. William H. Harrison, the man who served the shortest term, died of pneumonia only several weeks after his inauguration.
Abraham Lincoln was one of four presidents who were assassinated. He was elected in 1860, and his untimely death came just five years later. James Garfield, a former Union army general from Ohio, was shot during his first year in office (1881) by a man to whom he wouldn’t give a job. While in his second term of office (1901), William McKinley, another Ohioan, attended the Pan-American Exposition in Buffalo, New York. During the reception, he was assassinated while shaking hands with some of the guests. John F. Kennedy was assassinated in 1963 in Dallas only three years after his election.
Three years after his election in 1920, Warren G, Harding died in office. Although it was never proved, many believe he was poisoned. Franklin Roosevelt was elected four times (1932, 1936, 1940 and 1944), the only man to serve so long a term. He had contracted polio in 1921 and eventually died of the illness in 1945.
Ronald Reagan, who was elected in 1980 and reelected four years later, suffered an assassination attempt but did not succumb to the assassin’s bullets. He was the first to break the long chain of unfortunate events. Will the candidate in the election of 2020 also be as lucky?

The word “assassinated” in the second paragraph is closest in meaning to     .

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It’s extremely important for kids of middle childhood to continue, or to start to lead a healthy lifestyle, including eating nutritious meals as well as getting plenty of exercise and adequate sleep every day. These positive health habits will help children grow strong, stay healthy, and decrease the likelihood that they will become obese. Childhood obesity rates have increasing dramatically in recent years. According to the Centers for Disease Control, in 2004, 18.8% of school-aged children were obese, versus 4% of children 30 years before in 1974. Children’s skyrocketing rate of obesity is worrisome because it greatly increases children’s risk for remaining obese in adulthood, which in turn raises their risk for heart disease, stroke, cancer, diabetes, and premature death as adults. Obese children may also develop associated health problems during the middle childhood stage, such as high blood pressure, high cholesterol levels, and respiratory problems. Obesity can also set the stage for problems with self esteem, depression, anxiety and social ostracism, and/or being victimized by bullies Healthy diet and adequate exercise are important in preventing Type II diabetes in childhood as well as obesity. Diabetes is a metabolic disease in which the body cannot properly metabolize the sugars from food. Because the body cannot metabolize sugars, the sugars accumulate in the bloodstream instead and ultimately stress children’s kidneys, heart, circulatory system, and eyes. Insulin, which is created in the pancreas, is the chemical that breaks down blood sugar. In Type II diabetes, the body does not produce enough insulin to deal with all the sugars coming into the body. This medical diagnosis used to be called “adult-onset diabetes” because the disorder primarily affected adults with poor eating and activity habits. Today, however, this illness is now diagnosed in America’s children far more than in adults. It is now referred to as “Type II diabetes”, to reflect this shift in prevalence. In contrast to the many youth in America who overeat and don’t get enough exercise, other children become obsessed with over-controlling their food intake and with exercising too much. With the constant barrage of perfect, photoshopped bodies in the media today, many children are feeling pressure at younger and younger ages to imitate those images. Children as young as 6 are reporting that they are trying to lose weight by dieting. Overemphasis on extreme thinness can put children at risk for poor self-esteem, unhealthy exercise patterns, and eating disorders such as anorexia and bulimia. Children who embrace healthy eating and exercise habits during middle childhood will have a much easier time maintaining a healthy lifestyle through adolescence and adulthood than individuals who try to make the shift later in life. Teaching children to habitually eat moderate portion sizes and to choose healthy foods in preference to junk foods becomes increasingly important as children begin to spend more time away from home and gain more independence over their food and activity choices. Even though parents have less control over their children’s eating habits during middle childhood than when children were younger, it remains vital that parents continue to reinforce children’s healthy habits whenever possible. 
1. Which of the following best serves as the title for the passage?