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Childhood Sexual Abuse is Associated With Physical Illness Burden and Functioning in Psychiatric Pat

INTRODUCTION

The association between childhood sexual abuse (CSA) plus other childhood traumas and elevated levels of mental illness burden (1-6) and poorer physical function (7-10) has been documented in nonpsychiatric samples, largely comprised of younger adults and women.Studies conducted on mixed-gender samples of middle-aged or older adults are relatively rare,however. Krause, Shaw, and Cairney (11), reporting on a nationwide survey of 1518 adults aged ≥65 years, concluded that traumatic and adverse experiences in older adulthood were relatively more important to adult physical health status than experiences in childhood.

Nevertheless, significant associations were observed between self-reported health indices and traumatic or adverse events in childhood (specifically, those that occurred in the 6-11 year age range) among participants aged 65 to 74 years and those >85 years. Because childhood

traumatic or adverse events were examined in aggregate, the relative contributions to overall morbidity of specific traumatic events are unknown. Draper and colleagues (12), reporting on 21,000 adults aged ≥60 years in primary care practices, found that those with childhood sexual or physical abuse histories had poorer health-related function and a greater number of medical illnesses. Both studies depended entirely on patients’ self-reports on health indices.The current study is focused on the health effects of CSA among psychiatric patients aged ≥50years with primary diagnoses of mood disorder. Our assessment of physical health is based on a careful inspection of the medical chart, including a complete history and physical as well as laboratory values. This measure, along with the use of an interviewer-rated measure of physical function, enables us to minimize if not eliminate spurious associations. We hypothesized that a history of CSA would be associated with greater physical illness burden, more impaired physical functioning, and greater bodily pain (BP). Although the role of sexual abuse in adult medical illness and function (1-10), pain (13), and psychiatric illness (14,15) has been widely researched, investigations of the relationship of sexual abuse to medical illness burden have not extended to psychiatric patients. Documenting the effect of an early childhood trauma on the physical health of older adult psychiatric patients would attest to the robustness of the phenomenon, contribute to the development of theories concerning the effects of early life influences on disease in middle age and older adulthood, and provide a potential target for clinical intervention.

METHODS

Procedures

This report stems from a larger investigation examining the relationship between personality and suicidal behavior in middle-aged and older adults (16). The research protocol was approved by the Institutional Review Board at the University of Rochester Medical Center. Data collection was conducted from January 2001 to July 2004.

Patients were recruited from three inpatient units in different hospitals and one mental health outpatient clinic for older adults. In the inpatient units, research coordinators screened the records of all newly admitted patients aged ≥50 years to identify patients with a known or suspected mood disorder. After obtaining approval from an attending physician or primary clinician, a research assistant approached patients seeking their written informed consent for participation. In the outpatient clinic, patients responded to posted flyers that described the study by contacting research staff who proceeded to obtain the patients’ informed consent.The research assistant administered a structured interview and self-report questionnaires. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Axis I disorders (SCID) (17) was used to assess the presence, nature, and severity of mood disorders and other select mental disorders (16). After the acquisition of data

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and reviews of medical records, consensus diagnostic conferences were held, which were attended by at least one psychiatrist, one psychologist, other study investigators, and members of the research team. The research coordinator, who had interviewed the patient, delivered a case presentation incorporating information from the record review and diagnostic interview,and the research team reached diagnostic consensus. Patients were included in the analyses reported here if they met the criteria for a primary diagnosis of mood disorder and had

completed the measures of interest. The sexual abuse measure was included in the test battery 1 year into study recruitment.

Participants

Research coordinators approached 672 age-eligible patients with a suspected mood disorder.A total of 422 age-eligible patients were not enrolled for the following reasons: a) On approach,341 inpatients refused further assessment of eligibility for participation. b) Sixty patients declined further participation after providing consent. c) Ten potentially eligible inpatients could not be approached due to discharge or transfer. d) Eleven inpatients were not further assessed for eligibility due to severe psychosis, severe cognitive deficits, or a primary diagnosis of substance dependence. Demographic data on nonparticipants are not available.

Among the 250 consenting patients with a confirmed mood disorder, we report on three subsets:n = 163 with data on both sexual abuse and functional status; n = 140 with data on both sexual abuse and medical illness burden; and n = 144 with data on both sexual abuse and BP. The principal limitation on sample size stemmed from the fact that administration of the sexual abuse scale began after study recruitment had begun; 77 participants did not have Childhood Trauma Questionnaire (CTQ) data. Multivariate logistic regressions revealed no age, gender,race, or education differences between those included in the analyses reported here and the larger 250-person sample. Among the 163 participating patients, 132 (81%) had primary diagnoses of major depression, 24 (14.7%) had primary diagnoses of bipolar I or II disorder,and 7 (4.3%) had other primary mood disorders.

Measures

CSA was assessed with the sexual abuse scale of the CTQ-short form (18). The CTQ is a self-report instrument that instructs participants to rate the perceived frequency with which events occurred “when I was growing up,” using a 5-point scale with response sets of 1) “never true”;2) “rarely true”; 3) “sometimes true”; 4) “often true”; and 5) “very often true.” The items from the five-item sexual abuse subscale are: “Someone tried to touch me in a sexual way, or tried to make me touch them”; “Someone threatened to hurt me or tell lies about me unless I did something sexual with them”; “Someone tried to make me do sexual things or watch sexual things”; “Someone molested me”; and “I believe that I was sexually abused.” CSA was

categorized following the guidelines recommended by Bernstein et al. (18): none (score of 5),low (score of 6-7), moderate (score of 8-12), and severe (score >12). It should be noted that Bernstein et al. described these guidelines as “an approximation of the severity of maltreatment experiences” (19, p. 16), and that the categories reference the perceived frequency of abuse only. Other abuse parameters, such as whether the perpetrator was a parent figure or the abuse involved intercourse, could also be important. The CTQ has demonstrated excellent test-retest reliability and validity (19) as well as factor-structure invariance across diverse populations,and strong criterion-related validity for the sexual abuse scale (18). Given the small number of individuals in the low and moderate abuse groups, the two were combined (“low/moderate”)in statistical analyses.

Physical illness burden was assessed with the Cumulative Illness Rating Scale (CIRS) (20), a scale that quantifies the level of overall medical burden through ratings of disease severity across 13 organ-system subscales. For the purpose of this study, the psychiatric subscale was

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not included in the CIRS total score. The 12 included subscales were: cardiac, vascular,respiratory, eye-ear-nose-throat, upper gastrointestinal, lower gastrointestinal, hepatic, renal,other genito-urinary, musculoskeletal/integument, neurologic, and endocrine/metabolic. The CIRS was coded by a physician based on a review of the participants’ medical and psychiatric charts, including intake history and physical examination, laboratory tests, and other sources of health-relevant information. A score of 0 indicates no medical burden in an organ system;a score of 1 indicates mild burden; a score of 2 indicates moderate burden; a score of 3 indicates severe burden; and a score of 4 indicates a rare degree of extremely severe burden. The validity of the CIRS is well established, correlating with medical examiner ratings of illness burden at autopsy (21).

Physical function was assessed by the Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance scales (PSMS) (22), an interviewer-rated measure. The IADL scale assesses the extent of impairment in eight higher-order activities of daily living (ADLs), such as cooking, shopping, and housekeeping. The PSMS assesses six basic ADLs, such as feeding,dressing, and grooming. Each item refers to a separate activity in which there may be no, mild,moderate, or severe impairment. Because these items refer to elements of basic functioning in which older individuals are often unimpeded, scores of “0” are common. Given that scores in the present sample included a large number of 0s, they were dichotomized to distinguish between those with (score = >1) and without (score = 0) functional impairment. BP was evaluated with the BP subscale of the Medical Outcomes Study 36-Item Short Form (SF-36)(23), a self-report measure. Pain severity and interference with function are reported on a 6-point Likert scale ranging from none to very severe.

Statistical Analyses

The predictor was CSA; indicator variables were used for low/moderate and severe CSA (with a reference category of none). The four dependent variables were the CIRS, BP, IADL, and ADL (the PSMS). Associations between CSA and the dependent variables were modeled, using multivariate regressions adjusting for the effects of age, gender, and education. Models

included a random effect to account for nesting of patients within site. The CIRS and BP data were modeled, using linear regressions. Logged CIRS scores reduced the influence of a few high-scoring outliers by stabilizing the residual variance. The IADL and ADL data were modeled, using logistic regressions, with the presence of IADL or ADL impairment as the dependent variable. In the event of significant associations with overall illness burden, we conducted follow-up analyses to determine if there were associations between CSA and individual subscales of the CIRS (e.g., vascular, respiratory). Subscale scores were

dichotomized for exploratory logistic-regression analyses (score of >1, functional impairment versus score = 0, no functional impairment).

RESULTS

Most patients were women (n = 94, 57.7%), Caucasian (n = 145, 89%), and non-Latino (n =157, 96.3%). Age ranged from 50 to 88 years (mean ± standard deviation (SD) age = 60.6 ±9.9 years). The mean ± SD level of education was 13.3 ± 2.6 years. Sixty-eight (41.7%) patients reported a history of a CSA. Of these, the CTQ scores for 35 (21.5%) were <12, with the remaining 33 (20.3%) scoring above the cutoff of 12 for severe abuse.

As seen in Table 1, results showed a significant association between severe CSA and medical illness burden, as indexed by the CIRS (B = 0.31; standard error (SE) = 0.14; z = 2.10; p = .036). Follow-up logistic regression analyses of any versus no medical burden on CIRS subscales yielded significant associations between severe CSA and the presence of medical burden in the musculoskeletal-integument system (odds ratio (OR) = 3.69; z = 2.10; p = .036)and the respiratory system (OR = 3.11; z = 2.25; p = .024). Finally, severe CSA was also

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associated with greater BP on the SF-36, for which higher scores indicate less pain (B = -12.76;SE = 6.46; z = -1.98, p = .05).

To gain a sense of the practical importance of the CSA effects on health outcomes, we used the model coefficients to compare the effects of CSA and those of one decade of age on health outcomes. For the CIRS, we report coefficients from a model with nonlogged CIRS scores to preserve the scale of the dependent variable for these interpretations. Severe CSA was

associated with CIRS scores 1.47 times higher than no CSA, whereas one decade of age was associated with a 1.85-increase in CIRS scores. This suggests that the difference in cumulative illness burden between patients reporting severe sexual abuse and those reporting no sexual abuse was approximately 79% (1.47/1.85 = 0.79) that of a decade of age, or equivalent to 7.9years of illness burden accumulation. With respect to the CIRS subscales, two of the 12

subscales were significantly associated with sexual abuse. Patients with severe CSA were 3.11times as likely to have some degree of illness burden in their respiratory system compared with those without CSA; and one decade of age was associated with a 1.48-fold increase in risk,suggesting that severe CSA was associated with enhanced vulnerability toward respiratory illness burden roughly twice (3.11/1.48 = 2.1) that of a decade of age. Severe CSA was also associated with a 3.69-fold increase in risk for musculoskeletal-integument system burden and one decade of age with a 1.92-fold increase in risk, suggesting the vulnerability associated with severe CSA was approximately 1.9 times (3.69/1.92 = 1.92) as much as 10 years of age. Finally,severe CSA was associated with greater bodily pain by approximately 12.76 points, and 10years of age with greater pain by about 5.46 points, suggested that severe CSA affected BP on an order of magnitude more than twice (12.76/5.46 = 2.34) that of a decade of age, or equivalent to the effect of 23 years of age on bodily pain.

Table 1 also shows the results of two logistic regressions examining the relationship of sexual abuse severity to functional status. Results indicated that severe CSA was associated with increased risk for impairment in ADLs on the PSMS (OR = 3.03; z = 2.36; p = .018), but not in IADLs. Severe CSA increased risk for having any ADL impairment roughly 1.82 times (3.03/1.66) that of a decade of age, or 18 years of aging. Finally, random effects in all models suggested no significant variation in any health outcomes across sites.

DISCUSSION

We studied psychiatric patients aged ≥50 years, a group with elevated levels of morbidity (24). The effects of severe sexual abuse on health indices had clear and compelling clinical significance: the effect on medical illness burden was roughly comparable to adding 8 years of age, and on functional impairment and BP was roughly comparable to adding 20 years. We believe these are the first such estimates to appear in the literature.

Exploratory analyses showed that CSA was strongly associated with increased burden in two of the 12 CIRS subscales, the musculoskeletal/integument and respiratory subscales. Prior epidemiological studies among women with lifetime trauma sexual or physical assault histories have reported increased rates of at least two chronic afflictions in these organ systems, arthritis (25) and asthma (6). However, the issue of whether CSA is associated with specific organ-systems or medical conditions is not settled (26). Finding increased risk for certain medical disorders among older women with lifetime sexual assault histories, Stein and Barrett-Connor (25) concluded that there was no obvious common pathogenesis for those disorders, but their study design combined childhood and adult sexual assault. Assuming that there are differences in the biological repercussions of severe sexual assault according to the developmental stage of its occurrence—from early to middle childhood into adolescence and adulthood—then illness and disease patterns may vary accordingly.

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Interrelated biopsychosocial mechanisms have been posited to explain the sustained,

deleterious effects of childhood sexual assault on adult physical health (27,28). Early sexual trauma may lead to chronic dysregulation of stress-responsive systems (28-31), which in turn increases abused individuals’ “allostatic load” (32,33). In a longitudinal prospective study,Danese et al. (27) found that childhood maltreatment (not confined to sexual abuse) predicted clinically significant biomarkers of inflammation in adulthood, even with adjustments for co-occurring risk factors and potential mediating variables. The investigators hypothesized that inflammation is a likely mediator in the established link between maltreatment and increased risk for many adult diseases.

Sexual abuse can also produce chronic negative emotions (4,34), such as shame, that have been linked to disease (4) and compromised immune function (35,36). Similarly, early abuse has implications for personality development (37), and personality traits have been shown to influence health in older adulthood (38). Childhood abuse seems to have effects on adult health status only partially mediated by adult psychiatric disorder (39).

Beyond the implications of abuse for neuroimmune regulation, neuroendocrine regulation,psychiatric disorder, emotion regulation, and personality, early abuse is associated with high-risk health behaviors (3,4,40), such as smoking and unsafe sex, which in turn influence

morbidity (41). Finally, severe sexual abuse can catalyze a developmental course characterized by significant social morbidity (37). The interpersonal consequences of early abuse—including low social support, marital instability, and additional interpersonal traumas—may themselves take a physiological toll and contribute to adult disease processes (42).

In this relatively small sample, a complex model of interrelated mechanisms could not be tested.Further, this study is limited by a cross-sectional design, which precludes conclusions about causal relations. These findings may not apply to other diagnostic groups, nonclinical samples,younger cohorts, or more racially/ethnically diverse samples. Data on nonparticipants are unavailable. Participants’ retrospective reports regarding CSA were not independently

verified; either overreporting or underreporting is possible. Due to sample size limitations, we could not examine gender or age differences. Chief among the study’s strengths is its focus on a vulnerable older psychiatric population. Our approach to the measurement of medical burden and functional impairment effectively rules out the interpretation that the reported associations are spuriously inflated products of shared method variance. The significance of study findings is underscored both by the high rate of reported CSA, 41.7%, that is comparable to other reports (43) and by the attempt to compare the health effects of abuse with that of age; the latter estimates warrant replication and could generate hypotheses about the potential contribution of early abuse to the aging process.

Study findings may well have important implications for treating patients with sexual abuse histories. Early detection of patients’ abuse histories could inform targeted interventions to prevent or decelerate the progression of morbidity. Given the myriad biological, psychological,social, and economic processes that may engender, exacerbate or stem from childhood abuse,no one form of intervention or single site for intervention could suffice. Educational,

psychotherapeutic, pharmacological, and medical interventions across healthcare settings,schools, and workplaces could cast a broad net for detection and treatment. Public health advertisements would increase awareness about both the long-term effects of childhood abuse on health and about available remedies, likely motivating some individuals to divulge trauma histories to their healthcare providers. The physical health effects of trauma have arguably been underemphasized in the public sphere.

At minimum, our findings point to the need for integrated if not colocalized mental health care for these patients when they are seen in primary and specialty care (44), and for careful medical

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evaluations when they are seen in mental health settings. Taking the implications of these findings further requires reenvisioning healthcare systems with a prevention focus, including systematic screening for trauma exposure; among identified patients, further screening in physiological, psychological (e.g., depression, posttraumatic stress disorder (PTSD)),

behavioral (e.g., smoking, alcohol consumption), and social domains (e.g., domestic violence)that may be affected by exposure to trauma; and, based on screening results, developing

individualized treatment plans to address problematic areas through health education, increased medical surveillance and healthcare contacts, behavioral interventions, social service referrals,and mental health care.

Although interventions to identify and address abused adults’ health-risk behaviors (4,40)could prevent or decelerate associated morbidity and mortality, some research suggests that adolescent girls and women with sexual assault histories have relatively poor compliance with behavioral-health and medical interventions (45-48). Among the reasons for noncompliance is the possibility that invasive medical interventions and the accompanying psychological experience of helplessness stimulate reexperiencing of the traumatic event (49). Specialized psychological interventions could improve adherence to treatment regimens among medically ill patients with sexual abuse histories (40), address issues of comfort, trust, and communication with health professionals, and improve a wide range of health outcomes.

Conceivably, effective psychotherapy for PTSD and depression among trauma-exposed individuals could improve not just psychiatric illnesses but also improve health and health-related quality of life (50-52). Limitations in our current therapeutic methods suggest that more treatment innovations and research are needed to develop treatment algorithms for the complex health problems of those with sexual assault histories. Some forms of psychotherapy have been found to be useful for PTSD, yet treatment attrition is relatively high (53-55). Depression can respond to pharmacotherapy and/or psychotherapy (56,57), but remission rates for the chronic,complicated depression that is often associated with CSA leave much room for improvement (58). Biological outcomes among psychotherapy patients need to be examined.

The impact of CSA is profound even into later life, and future research on the mechanisms and remediation of its effects is warranted. Finally, a society committed to preventing child sexual assault would likely observe dramatic declines in morbidity and mortality.

Acknowledgments

This project was supported, in part, by Grants R01MH60285 (P.R.D.), R01 MH076928 (N.L.T.), K24MH072712(P.R.D.), P20MH071897 (Y.C.), T32MH073452 (B.C.), and R21AG023956 (B.C., S.C., P.R.D., N.F., N.L.T.) from the US Public Health Service.

Glossary

ADLs, activities of daily living; IADLs, instrumental activities of daily living; CSA, childhood sexual abuse; CTQ, Childhood Trauma Questionnaire; CIRS, Cumulative Illness Rating Scale;PSMS, Physical Self Maintenance Scale; BP, bodily pain; SF-36, Medical Outcome Study 36-Item Short Form; PTSD, posttraumatic stress disorder.

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日落即景五年级作文范文3篇

日落即景五年级作文范文3篇导语：渐渐的，夕阳收敛起他最后的光芒，还来不及说一声再见，便垂下头去，合上了双眼，静静地睡去了。下面是小编为大家整理的日落即景五年级作文范文，仅供参考，欢迎大家阅读。日落即景五年级作文范文一“夕阳无限好，只是近黄昏。”日出金光万丈的壮丽景色固然美，但那迟暮的落日，却也有着独特的韵味。傍晚，太阳收敛了刺眼的光芒，倚靠着西山，像一位老者一样缓缓下移，而在它的四周，那团团绚丽多彩的火烧云，毫不吝啬地向万物释放着自己的美丽。它们带着一抹微笑，挥舞着手中那若隐若现的纱巾，为这片天地增光添彩。淡黄、浅红、淡紫，各种淡雅的色彩在它身上渲染着，却又显得这么和谐。过了一会儿，太阳渐渐西斜，只剩下了半边脸，在山体的遮掩下，如同一位“犹抱琵琶半遮面”的女子，腼腆而又神秘。虽然“少”了半张脸，但太阳的热情依然无限，风采仍然不减。它慷慨地舞动衣袖，将那昏黄的阳光洒到每一处可以看见的地方。仿佛一位老画家在为大地填涂上落日前的最后一丝色彩。一行大雁排着“人”字从空中掠过，在日光的衬托

下，如同下凡的金色神鸟。不久后，略显昏暗的天幕已没有了落日的轮廓，可那最后一丝余晖却仿佛不甘就此落幕。它披着一件“霞光裙”，还在这个落日舞台上进行最后的谢幕表演。它将云朵的一边染得金黄，又沿着山体勾勒出一条曲折有致的金线。直到月亮散发着清冷的光芒升起，余晖还是意犹未尽，最后被一群调皮的星星撵下了台…… 或许，夕阳并不是最迷人的，但在我的眼里，它是最独特的。日落即景五年级作文范文二俗话说：十月的天碗里转，说黑就黑，还不到五点，太阳就要回家看它和月亮的孩子去了。此时的太阳想立刻回家，它渐渐接近西方的群山。它那圆圆的脸庞，像极了一位慈祥和蔼的父亲。它那耀眼的金色光芒，把西边半个天空照得金灿灿的，把地上的路面、汽车、高楼、树木照得金灿灿的，在刺骨的寒风中给路上的行人送去了一丝丝温暖。西方的天空飘着几小朵云彩，阳光让云彩变成了金色的灿烂的晚霞，西方的天空变成了燃烧着的炉膛。彩云在天空中不断变化着形状，一会儿变成了一匹骏马，奔腾着，身后扬起许多沙子；一会儿又变成了一条大狗，身后还跟着一群小狗，跑着跑着不见了；一会儿又变成了一尊石狮子，静静的蹲在那里。

新视野大学英语3课文翻译

新视野大学英语3课文翻译第一课无限的爱我哥哥吉米出生时遇上难产，因为缺氧导致大脑受损。两年后，我出生了。从此以后，我的生活便围绕我哥哥转。伴随我成长的，是“到外面去玩，把你哥哥也带上。” 不带上他，我是哪里也去不了的。因此，我怂恿邻居的孩子到我家来，尽情地玩孩子们玩的游戏。我母亲教吉米学习日常自理，比如刷牙或系皮带什么的。我父亲宅心仁厚，他的耐心和理解使一家人心贴着心。我则负责外面的事，找到那些欺负我哥哥的孩子们的父母，告他们的状，为我哥哥讨回公道。父亲和吉米形影不离。他们一道吃早饭，平时每天早上一道开车去海军航运中心，他们都在那里工作，吉米在那搬卸标有彩色代号的箱子。晚饭后，他们一道交谈，玩游戏，直到深夜。他们甚至用口哨吹相同的曲调。所以，父亲1991年因心脏病去世时，吉米几乎崩溃了，尽管他尽量不表现出来。他就是不能相信父亲去世这一事实。通常，他是一个令人愉快的人，现在却一言不发，无论说多少话都不能透过他木然的脸部表情了解他的心事。我雇了一个人和他住在一起，开车送他去上班。然而，不管我怎么努力地维持原状，吉米还是认为他熟悉的世界已经消失了。有一天，我问他：“你是不是想念爸爸？” 他的嘴唇颤抖了几下，然后问我：“你怎么看，玛格丽特？他是我最好的朋友。” 接着，我俩都流下了眼泪。六个月后，母亲因肺癌去世，剩下我一人来照顾吉米。吉米不能马上适应去上班时没有父亲陪着，因此搬来纽约和我一起住了一段时间。我走到哪里他就跟到哪里，他好像适应得很好。但吉米依然想住在我父母的房子里，继续干他原来的工作。我答应把他送回去。此事最后做成了。如今，他在那里生活了11年，在许多人的照料下，同时依靠自己生活得有声有色。他已成了邻里间不可或缺的人物。如果你有邮件要收，或有狗要遛，他就是你所要的人。当然，母亲的话没错：可以有一个家，既能容纳他的缺陷又能装下我的雄心。

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写自然风景的作文400字沙漠落日如果你在沙漠里，当你在看沙漠落日时，那无疑是一次美丽的画面。太阳下去了，天色渐渐暗了下去，绚烂的云朵变成深红了，沙漠的雾也逐渐变浓了，沙丘也变得很不清楚。就在这时，太阳收敛了耀眼的光芒，像喝醉了似的，脸上通红。它像一个害羞的姑娘，携来了一块纱巾，遮住了自己红扑扑的脸蛋儿。残阳的余晖映红了天空中的云霞，渐渐地，粉红，紫红，桃红……弥漫着整个天空，像整个展开了一匹绚丽的锦缎，一片片云朵像一个个身披嫁衣的新娘正在跳舞。几分钟后，西方就剩下了一片柔美的嫣红，天地间也镀上了一层金辉。此时，每一景，每一物都沐浴在金色的光芒中，使人仿佛置身幻境，感觉心旷神怡。又过了一会儿，夕阳终于将最后的光芒洒向大地，然后恋恋不舍地跳到小丘之后。当太阳下去之后，一张蔚蓝的轻纱笼罩整个天际，维纳斯女神已悄然离去，不一会儿，月亮升上

来了。据说白天的沙漠非常干燥，炎热，只有到太阳下去之后，才是真正的沙漠。蚂蚁，松鼠，蝎子等小型昆虫，动物才会到这时寻找食物，仙人掌而也是在夜里开花，而在白天，它们有的会躲起来。这时，有时还会明亮，只不过雾气较大，容易产生海市蜃楼。在沙漠中，落日可能比较漫长，不过也是一道很美丽的风景线。沙漠落日是我最喜欢的一道美丽的风景线。如果你在沙漠里，当你在看沙漠落日时，那无疑是一次美丽的画面。太阳下去了，天色渐渐暗了下去，绚烂的云朵变成深红了，沙漠的雾也逐渐变浓了，沙丘也变得很不清楚。就在这时，太阳收敛了耀眼的光芒，像喝醉了似的，脸上通红。它像一个害羞的姑娘，携来了一块纱巾，遮住了自己红扑扑的脸蛋儿。残阳的余晖映红了天空中的云霞，渐渐地，粉红，紫红，桃红……弥漫着整个天空，像整个展开了一匹绚丽的锦缎，一片片云朵像一个个身披嫁衣的新娘正在

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One way of summarizing the American position is to state that we value originality and independence more than the Chinese do. The contrast between our two cultures can also be seen in terms of the fears we both harbor. Chinese teachers are fearful that if skills are not acquired early, they may never be acquired; there is, on the other hand, no comparable hurry to promote creativity. American educators fear that unless creativity has been acquired early, it may never emerge; on the other hand, skills can be picked up later. However, I do not want to overstate my case. There is enormous creativity to be found in Chinese scientific, technological and artistic innovations past and present. And there is a danger of exaggerating creative breakthroughs in the West. When any innovation is examined closely, its reliance on previous achievements is all too apparent (the "standing on the shoulders of giants" phenomenon). But assuming that the contrast I have developed is valid, and that the fostering of skills and creativity are both worthwhile goals, the important question becomes this: Can we gather, from the Chinese and American extremes, a superior way to approach education, perhaps striking a better balance between the poles of creativity and basic skills?

全新版大学英语综合教程3课文原文及翻译6-8

unit 6 The Last Leaf When Johnsy fell seriously ill, she seemed to lose the will to hang on to life. The doctor held out little hope for her. Her friends seemed helpless. Was there nothing to be done? 约翰西病情严重，她似乎失去了活下去的意志。医生对她不抱什么希望。朋友们看来也爱莫能助。难道真的就无可奈何了吗？ 1 At the top of a three-story brick building, Sue and Johnsy had their studio. "Johnsy" was familiar for Joanna. One was from Maine; the other from California. They had met at a cafe on Eighth Street and found their tastes in art, chicory salad and bishop sleeves so much in tune that the joint studio resulted. 在一幢三层砖楼的顶层，苏和约翰西辟了个画室。“约翰西”是乔安娜的昵称。她们一位来自缅因州，一位来自加利福尼亚。两人相遇在第八大街的一个咖啡馆，发现各自在艺术品味、菊苣色拉，以及灯笼袖等方面趣味相投，于是就有了这个两人画室。 2 That was in May. In November a cold, unseen stranger, whom the doctors called Pneumonia, stalked about the district, touching one here and there with his icy fingers. Johnsy was among his victims. She lay, scarcely moving on her bed, looking through the small window at the blank side of the next brick house. 那是5月里的事。到了11月，一个医生称之为肺炎的阴森的隐形客闯入了这一地区，用它冰冷的手指东碰西触。约翰西也为其所害。她病倒了，躺在床上几乎一动不动，只能隔着小窗望着隔壁砖房那单调沉闷的侧墙。 3 One morning the busy doctor invited Sue into the hallway with a bushy, gray eyebrow. 一天上午，忙碌的医生扬了扬灰白的浓眉，示意苏来到过道。 4 "She has one chance in ten," he said. "And that chance is for her to want to live. Your little lady has made up her mind that she's not going to get well. Has she anything on her mind? “她只有一成希望，”他说。“那还得看她自己是不是想活下去。你这位女朋友已经下决心不想好了。她有什么心事吗？” 5 "She -- she wanted to paint the Bay of Naples some day," said Sue. “她――她想有一天能去画那不勒斯湾，”苏说。 6 "Paint? -- bosh! Has she anything on her mind worth thinking about twice -- a man, for instance?" “画画？――得了。她有没有别的事值得她留恋的――比如说，一个男人？” 7 "A man?" said Sue. "Is a man worth -- but, no, doctor; there is nothing of the kind." “男人？”苏说。“难道一个男人就值得――可是，她没有啊，大夫，没有这码子事。” 8 "Well," said the doctor. "I will do all that science can accomplish. But whenever my patient begins to count the carriages in her funeral procession I subtract 50 per cent from the curative power of medicines." After the doctor had gone Sue went into the workroom and cried. Then she marched into Johnsy's room with her drawing board, whistling a merry tune. “好吧，”大夫说。“我会尽一切努力，只要是科学能做到的。可是，但凡病人开始计算她出殡的行列里有几辆马车的时候，我就要把医药的疗效减去一半。”大夫走后，苏去工作室哭了一场。随后她携着画板大步走进约翰西的房间，口里吹着轻快的口哨。 9 Johnsy lay, scarcely making a movement under the bedclothes, with her face toward the window. She was looking out and counting -- counting backward. 约翰西躺在被子下几乎一动不动，脸朝着窗。她望着窗外，数着数――倒数着数！ 10 "Twelve," she said, and a little later "eleven"; and then "ten," and "nine"; and then "eight" and "seven," almost together. “12，”她数道，过了一会儿“11”，接着数“10”和“9”；再数“8”和“7”，几乎一口同时数下来。 11 Sue looked out of the window. What was there to count? There was only a bare, dreary yard to be seen, and the blank side of the brick house twenty feet away. An old, old ivy vine climbed half way up the brick wall. The cold breath of autumn had blown away its leaves, leaving it almost bare. 苏朝窗外望去。外面有什么好数的呢？外面只看到一个空荡荡的沉闷的院子，还有20英尺开外那砖房的侧墙，上面什么也没有。一棵古老的常青藤爬到半墙高。萧瑟秋风吹落了枝叶，藤上几乎光秃秃的。

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