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

Energy conservation is any behavior it results in the use of less energy

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Body postures and movements are frequently indicators of self-confidence, energy, fatigue, or status. Cognitively, gestures operate to clarify, contradict, or replace verbal messages. Gestures also serve an important function with regard to regulating the flow of conversation. For example, if a student is talking about something in front of the class, single nods of the head from the teacher will likely cause that student to continue and perhaps more elaborate. Postures as well as gestures are used to indicate attitudes, status, affective moods, approval, deception, warmth, arid other variables related to conversation interaction.
The saying “A picture is worth a thousand words” well describes the meaning of facial expressions. Facial appearance – including wrinkles, muscle tone, skin coloration, and eye color- offers enduring cues that reveal information about age, sex, race, ethnic origin, and status.
A less permanent second set of facial cues-including length of hair, hairstyle, cleanliness, and facial hair-relate to an individual’s idea of beauty. A third group of facial markers are momentary expressions that signal that cause changes in the forehead, eyebrows, eyelids, cheeks, nose, lips, and chin, such as raising the eyebrows, wrinkling the brow, curling the lip.
Some facial expressions are readily visible, while others are fleeting. Both types can positively or negatively reinforce the spoken words and convey cues concerning emotions and attitudes.

According to the writer, “A picture is worth a thousand words” means ................

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Like the revolutions that preceded it, the Fourth Industrial Revolution has the potential to raise global income levels and improve the quality of life for populations around the world. To date, those who have gained the most from it have been consumers able to afford and access the digital world; technology has made possible new products and services that increase the efficiency and pleasure of our personal lives. Ordering a cab, booking a flight, buying a product, making a payment, listening to music, watching a film or playing a game — any of these can now be done remotely. In the future, technological innovation will also lead to a supply-side miracle, with long-term gains in efficiency and productivity. Transportation and communication costs will drop, logistics and global supply chains will become more effective and the cost of trade will diminish, all of which will open new markets and drive economic growth. At the same time, as the economists Erik Brynjolfsson and Andrew McAfee have pointed out, the revolution could yield greater inequality, particularly in its potential to disrupt labor markets. As automation substitutes for labor across the entire economy, the net displacement of workers by machines might exacerbate the gap between returns to capital  and returns to labor. On the other hand, it is also possible that the displacement of workers by technology will, in aggregate, result in a net increase in safe and rewarding jobs. We cannot foresee at this point which scenario is likely to emerge, and history suggests that the outcome is likely to be some combination of the two. However, I am convinced of one thing — that in the future, talent, more than capital, will represent the critical factor of production. This will give rise to a job market increasingly segregated into “low-skill/low-pay” and “highskill/high-pay” segments, which in turn will lead to an increase in social tensions. In addition to being a key economic concern, inequality represents the greatest societal concern associated with the Fourth Industrial Revolution. The largest beneficiaries of innovation tend to be the providers of intellectual and physical capital — the innovators, shareholders and investors — which explains the rising gap in wealth between those dependent on capital versus labor. Technology is therefore one of the main reasons why incomes have stagnated, or even decreased, for a majority of the population in high-income countries: the demand for highly skilled workers has increased while the demand for workers with less education and lower skills has decreased. The result is a job market with a strong demand at the high and low ends, but a hollowing out of the middle. This helps explain why so many workers are disillusioned and fearful that their own real incomes and those of their children will continue to stagnate. It also helps explain why middle classes around the world are increasingly experiencing a pervasive sense of dissatisfaction and unfairness. A winnertakes-all economy that offers only limited access to the middle class is a recipe for democratic malaise and dereliction.  
5. What does the word “this” in the third paragraph refer to?

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Spend just a minute watching the world population counter tick up on Worldometers and you’ll see just how quickly we’re swelling in numbers. The current figure stands at around 7.7 billion, and this is projected to become 9.8 billion by 2050, according to the UN. More people means more carbon footprints - more cars, waste and emissions, more houses and infrastructure to be constructed using the world’s limited resources, more mouths to be fed using more water and energy in food production. Governments recognise the severity of the situation and have mostly come together over global policies like the UN’s Paris Agreement, to limit carbon emissions and their impact on climate change. In addition, new technologies are being developed to make our use of resources more efficient. As for controlling population growth, the education of women is one key factor. Research shows the higher level to which a woman is educated, the fewer children she is likely to have. In Ghana, for example, women who have been to high school, have a fertility rate of between two and three children, compared with six for those who have no education. This could be for several reasons including learning about desired family size and understanding child health better. This means that the mother is more confident her children will survive. She is also likely to hold more sway within the family, arguing for fewer children if that is what she wants.  There is also plenty that individuals can do to reduce their personal footprint. Earth Overshoot Day is defined as the day when humanity has used up nature’s resource budget for the year. The Global Footprint Network calculates that moving Earth Overshoot day back by five days every year would mean that, by 2050, we’d be using the resources of less than one planet. Just eating 50% less meat and replacing it with vegetarian alternatives could save the planet five days. As David Attenborough says, if we want to save Earth, we can no longer afford to keep eating meat: “We are omnivores, so biologically, if you could have a biological morality, you can say, yes we evolved to eat pretty well everything. But now we’ve got to a stage in our own social evolution in which that is no longer practical.” Sir David says he himself now eats less meat and is bolstered by the knowledge that it’s helping the planet.  
6. The word “it” in paragraph 5 refers to _____

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

When oil or coal is burnt, a great number of smoke that contains some kinds of acid is produced

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Elephants need a large amount of habitat because they eat so much. Humans have become their direct competitors for living space. Human populations in Africa and Asia have quadrupled since the turn of the century, the fastest growth rate on the planet. Forest and savanna habitat has been converted to cropland, pastureland for livestock, and timber for housing and fuel. Humans do not regard elephants as good neighbors. When humans and elephants live close together, elephants raid crops, and rogue elephants rampage through villages. Local people shoot elephants because they fear them and regard them as pests. Some countries have established culling programs: park officials or hunters kill a predetermined number of elephants to keep herds manageable and minimize human-elephant conflicts. Hunting has been a major cause of the decline in elephant populations. Elephants became prized trophies for big-game hunters after Europeans arrived in Africa. More recently, and more devastatingly, hunters have slaughtered elephants for their ivory tusks. The ivory trade became a serious threat to elephants in the 1970s. A sudden oil shortage caused the world economy to collapse, and ivory became more valuable than gold. In fact, ivory has been called “white gold” because it is beautiful, easily carved, durable, and pleasing to the touch. Most of the world’s ivory is carved in Japan, Hong Kong, and other Asian countries, where skilled carvers depend on a supply of ivory for their livelihoods  Hunting elephants is no longer legal in many African countries, but poaching was widespread until very recently. For many the high price of ivory, about $100 a pound in the 1980s, was too tempting to resist. Local people often had few other ways to make a living, and subsistence farmers or herders could make more by selling the tusks of one elephant than they could make in a dozen years of farming or herding. As the price of ivory soared, poachers became more organized, using automatic weapons, motorized vehicles, and airplanes to chase and kill thousands of elephants. To governments and revolutionaries mired in civil wars and strapped for cash, poaching ivory became a way to pay for more firearms and supplies. Poaching has caused the collapse of elephants’ social structure as well as decimating their numbers. Poachers target the biggest elephants because their tusks are larger. They often kill all the adults in the group, leaving young elephants without any adults to teach them migration routes, dry-season water sources, and other learned behavior. Many of Africa’s remaining elephant groups are leaderless subadults and juveniles.
3. According to the second paragraph, culling programs have been established as a method to ______.

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Long life expectancy can be attributed to a person’s diet - a healthy, balanced diet has been proven to improve longevity. Experts recommend eating at least five portions of a variety of fruit and vegetables every day, basing meals on higher starchy foods like potatoes, bread and rice, having some dairy or dairy alternatives, eating some protein, choosing unsaturated oils and spreads, and drinking plenty of fluids. But new research, published this week, has found the times of day a person eats holds the most benefits. Dr Mark Mattson, a professor of neuroscience at John Hopkins University School of Medicine, in the US, has said “intermittent fasting could be part of a healthy lifestyle.” Intermittent fasting diets usually involve daily time-restricted feeding, which narrows eating times to six to eight hours per day and so-called 5:2 intermittent fasting, in which people limit themselves to one moderate-sized meal two days each week. A range of human and animal studies have shown that alternating between times of fasting and eating supports cellular health, probably by triggering an age-old adaptation to periods of food scarcity called metabolic switching. Such a switch occurs when cells use up their stores of rapidly accessible, sugar-based fuel, and begin converting fat into energy in a slower metabolic process. Dr Mattson says studies have shown that this switch improves blood sugar regulation, increases resistance to stress and suppresses inflammation. Because most Americans eat three meals plus snacks each day, they do not experience the switch, or the suggested benefits. In an article in the New England Journal of Medicine, Dr Mattson said four studies in both animals and people found intermittent fasting also decreased blood pressure, blood lipid levels and resting heart rates.  
1. Which best serves as the title for the passage? 

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Let’s knock on their door to see ……… home.

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Nature photographer Joel Sartore is passionate about endangered species. He uses his  camera to make people aware of environmental problems. They tell the stories of animals that may disappear unless we work fast to save them.  Sartore’s latest project is called Photo Ark. The goal of the project is to make a photographic record of the world’s biodiversity. As Sartore says, “For many of Earth’s creatures, time is running out.”  When asked how he became interested in saving endangered species, Joel said “When I was a child, I read about Martha, the very last passenger pigeon. Martha died in 1914. I was shocked. In the past, there were 5 billion passenger pigeons – probably more than any other bird. But here was the last one, and there was no way to save it. How did we let this happen? I couldn’t understand it. I still feel the same way. I want to prevent this from ever happening again.” Photography is the best way to show problems to the world. It gets people to care about the problem. It’s not enough to just show pretty animals in a beautiful landscape. Now, we must show the threats to these animals as well. The good news is that there are many ways to publish stories and photographs on environmental issues. Self-publishing on the Web is one way to do this. Even nonprofessional photographers can help to make us aware of these problems
1. The best title of the passage can be “_________”.

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:
It is said that George Washington was one of the first to realize how important tire building of canals would be to the nation’s development. In fact, before he became the President, he headed the first company in the United States to build a canal, which was to connect the Ohio and Potomac rivers. It was never completed, but it showed the nation the feasibility of canals. As the country expanded westward, settlers in western New York, Pennsylvania, and Ohio needed a means to ship goods. Canals linking natural waterways seemed to supply an effective method.
In 1791, engineers commissioned by the state of New York investigated the possibility of a canal between Albany on the Hudson River and Buffalo on Lake Eric to link the Great Lakes area with the Atlantic seacoast. It would avoid the mountains that served as a barrier to canals from the Delaware and Potomac rivers.
The first attempt to dig the canal, to be called the Eric Canal, was made by private companies but only a comparatively small portion was built before the project was halted for lack of funds. The cost of the prospect was estimated $5 million, an enormous amount for those days. There was some on-again-off-again federal funding, but this time the War of 1812 put an end to construction. In 1817, DeWitt Clinton was elected Governor of New York and persuaded the state to finance and build the canal. It was completed in 1825, costing S2 million more than expected.
The canal rapidly lived up to its sponsors’ faith, quickly paying for itself through tolls. It was far more economical than any other form of transportation at the time. It permitted trade between the Great Lake region and the East coast, robbing the Mississippi River of much of its traffic. It allowed New York to supplant Boston, Philadelphia, and other eastern cities as the chief center of both domestic and foreign commerce. Cities sprang up along the canal. It also contributed in a number of ways to the Norths victory over the South in the Civil War.
An expansion of the canal was planned in 1849. Increased traffic would undoubtedly have warranted its construction had it not been for the railroads.

The word “tolls” in paragraph 4 is closest in meaning to which of the following?

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Paul Watson is an environmental activist. He is a man who believes that he must do something, not just talk about doing something. Paul believes in protecting endangered animals, and he protects them in controversial ways. Some people think that Watson is a hero and admire him very much. Other people think that he is a criminal. On July 16th, 1979, Paul Watson and his crew were on his ship, which is called the Sea Shepherd. Watson and the people who work on the Sea Shepherd were hunting on the Atlantic Ocean near Portugal. However, they had a strange prey, instead of hunting for animals, their prey was a ship, the Sierra. The Sea Shepherd found the Sierra, ran into it and sank it. As a result, the Sierra never returned to the sea. The Sea Shepherd, on the other hand, returned to its home in Canada. Paul Watson and his worked thought that they had been successful. The Sierra had been a whaling ship, which had operated illegally. The captain and the crew of the Sierra did not obey any of the international laws that restrict whaling. Instead, they killed as many whales as they could, quickly cut off the meat, and froze it. Later, they sold the whale meat in countries where it is eaten. Paul Watson tried to persuade the international whaling commission to stop the Sierra. However, the commission did very little, and Paul became impatient. He decided to stop the Sierra and whaling ships in any way that he could. He offered to pay $25,000 to an one who sank any illegal whaling ship, and he sank the Sierra. He acted because he believed that the whales must be protected. Still, he acted without the approval of the government; therefore, his action controversial. Paul Watson is not the only environmental activist. Other men and women are also fighting to protect the Earth. Like Paul Watson, they do not always have the approval of their governments, and like Watson, they have become impatient. Yet, because of their concern for the environment, they will act to protect it.
7. The captain and the crew of the Sierra were acting illegally because: 

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There are many types of family systems around the world. In North America and  northern Europe, the nuclear family (with two generations - a father, a mother and one or more children) is often seen as the most typical. In contrast, in most other parts of the world, extended families, which include other family members such as grandparents, aunts, uncles and cousins, are seen as the norm.  The common view is that the nuclear family has become the norm in many Western societies as a result of industrialization and urbanization. This trend began in the late eighteenth and nineteenth centuries, when people were forced to move to cities to find work in the factories that sprang up during the Industrial Revolution. In the twentieth century, greater industrialization resulted in even more people leaving their large extended families. Urbanization also meant that people lived in much smaller houses, which were not big enough for an extended family.  The trend towards nuclear families meant that many of the duties and responsibilities of a family, such as providing food and shelter, cleaning the home, preparing the food, caring for children and their education, and caring for the sick and elderly are no longer shared among the members of the extended family. The parents (or parent) now have to do this, with some help from the state. However, this is the price that people pay for the higher standard of living that may come from living in a city.  We may think we know what we mean by a ‘nuclear’ family and an extended family, but reality is more complicated than most people believe. Most nuclear families are part of extended families: children have grandparents and, in many cases, aunts, uncles and cousins as well. Part of what makes them ‘nuclear’ is that they live in their own separate household, but it is not the whole story. In Greece or Italy, for example, a nuclear family may live in its own flat, but the extended family may live in the same apartment block or in the same street and family members see each other and even eat together every day. There is at least one more factor to consider. Family members may be separated from each other by geographical distance, but they may have close emotional ties. Even in North America and northern Europe, grandparents usually have close bonds with their grandchildren, and families often travel long distances so that they can see each other. Grandparents often help their adult children, for example, by cooking and looking after their children in emergencies. In the same way, when their parents become too old to live on their own, adult children may take them into their own homes. As a result, they turn their nuclear family into an extended family.  The structure of families changes over time. The effects of urbanization and industrialization are enormous, but they are not the only reasons for the changes. People marry, have children, become widowed, divorce and die. Children grow up and adults grow old. Nuclear families become extended families and extended families become nuclear families. Family ties stay strong or become weak. One thing is certain: in a changing world, the family will continue to change, but ultimately, it is likely to continue to be the basic unit of society
2. What made the nuclear family become the norm?

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His bad mark in the exam was the consequence of his laziness.

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He suggests _______ to France this summer time.

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One of the highest honors for formalists, writers, and musical composers is the PulitzerPrize. First awarded in 1927, the Pulitzer Prize has been won by Ernest Hemingway, Harper Lee,John F. Kennedy, and Rodgers and Hammerstein, among others. As with many famous awards,this prize was named after its founder, Joseph Pulitzer.
Joseph Pulitzer’s story, like that of many immigrants to the United States, is one ofhardship, hard work and triumph. Born in Hungary, Joseph Pulitzer moved to United States in1864. He wanted to be a reporter, but he started his American life by fighting in the AmericanCivil War. After the war, Pulitzer worked for the German - language newspaper, the WestlichePost. His skills as a reporter were wonderful, and he soon became a partial owner of the paper.
In 1978, Pulitzer was able to start a newspaper of his own. Right from the first edition,the newspaper took a controversial approach to new. Pulitzer wanted to appeal to the averagereader, so he  produced  exciting  stories  of  scandal  and  intrigue.  Such  an  approach   iscommonplace today, but in Pulitzer’s time it was new and different. The approach led to thediscovery of many instances of corruption by influential people. Pulitzer ‘paper became veryfamous and is still produced today.
The success of Joseph Pulitzer’s newspaper made him a very wealthy man, so he wantedto give something back to his profession. Throughout his later years, he worked to establishuniversity programs for the teaching of journalism, and he funded numerous scholarships toassist journalism students. Finally, he wanted to leave a legacy that would encourage writers toremember the importance of quality. On his death, he gave two million dollars to ColumbiaUniversity so they could award prizes to great writers
The Pulitzer Prize recipients are a very select group. For most, winning a Pulitzer Prize isthe highlight of their career. If an author, journalist, or composer you know has won a PulitzerPrize, you can be sure they are at the top of their profession.

According to the reading passage, why did Joseph Pulitzer invent the Pulitzer Prize?

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Graphic novels, as the name suggests, are books written and illustrated in the style of a comic book. Adults may feel that graphic novels do not help children become good readers. They believe that this  type of  reading material  somehow prevents  "real"   reading. (1)_____ , many quality graphic novels are now being seen as a method of storytelling on the same level as novels, films or audiobooks. Many librarians and teachers are now accepting graphic novels as proper literature for children as they (2)____ young people and motivate them to read. This has been especially true with children who are not (3)_________to read, especially boys.Language learners are also motivated by graphic novels because the pictures provide clues to the meaning of the words. Therefore, they will (4)______ new vocabulary more quickly. Many teachers have reported great success when they used graphic novels with their students, especially in the areas of English, social studies and art. The idea that graphic novels are too simple to be regarded as serious reading is no longer valid. Reading them can, undoubtedly, help students develop the skills (5) _____ are necessary to read more challenging works

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More than a decade ago the UK investigative journalist Nick Davies published Flat Earth News, an exposé of how the mass media had abdicated its responsibility to the truth. Newsroom pressure to publish more stories, faster than their competitors had, Davies argued, led to journalists becoming mere “churnalists”. Shocking as Davies’ revelations seemed in 2008, they seem pretty tame by today’s standards, writes Ben Lorica, Chief Data Scientist at O’Reilly. We now live in a post-truth world of Fake News and “alternative facts”; where activists don’t just seek to manipulate the news agenda with PR but now use advanced technology to fake images and footage. A particularly troubling aspect of these ‘”deepfake” videos is their use of artificial intelligence to fabricate people saying or doing things with almost undetectable accuracy. The result is that publishers risk running completely erroneous stories – as inaccurate as stating that the world is flat – with little or any ability to check their source material and confirm whether it is genuine. The rise of unchecked fakery has serious implications for our liberal democracy and our ability to understand what’s truly going on in the world. The technology to manipulate imagery has come a long way since Stalin had people airbrushed out of history. Creating convincing yet fake digital content no longer requires advanced skills or a well-resourced (mis)information bureau. Anyone with a degree of technical proficiency can create content that will fool even the experts. Take the faked footage of Nancy Pelosi earlier this year, which was doctored to make her look incoherent and was viewed two and a half million times before Facebook took it down. This story shows how social media is giving new life to the old aphorism that “a lie can go halfway around the world before the truth has a chance to put its boots on”. The propagation of lies and misinformation is immeasurably enhanced by platforms like Twitter and Facebook that enable virality. What’s more, the incentives for creating fake content now favour malicious actors, with clear economic and political advantages for disseminating false footage. Put simply, the more shocking or extreme the content, the more people will share it and the longer they will stay on the platform. Meanwhile, counterfeiters can manipulate the very tools being developed to detect and mitigate deepfak content, just as the security industry inadvertently supplies software that can be misused for cybercrime.
7. The word “inadvertently” in paragraph 4 is closest in meaning to _______.

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Culture has a strong influence on non–verbal communication. Even the simple act of  looking someone in the eye is not at all that simple. In the USA, Americans are (1) ______ to look directly at people when speaking to them. It shows interest in what they are saying and is thought to carry a (2) ______ of honesty. Meanwhile, in Japan and Korea, people avoid long periods of eye contact. It is considered more polite to look to the side during a conversation. The Lebanese, (3) ______, stand close together and look intensely into each other’s eyes. The action shows sincerity and gives people a better sense of what their counterparts want. Given such differences with even the most common expressions, people (4) ______ travel or work abroad have a real need to learn the other culture’s body language. People tend to be unaware of the messages they are sending to others. So, it is (5) ______ to consider your own body language before dealing with people from other cultures. Knowing about the body language of friends, clients, and colleagues can be very helpful in improving understanding and avoiding miscommunication

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The International Monetary Fund (IMF) is an organization of 189 member countries.  It stabilizes the global economy in three ways. First, it monitors global conditions and identifies risks. Second, it advises its members on how to improve their economies. Third, it provides technical assistance and short-term loans to prevent financial crises. The IMF’s goal is to prevent these disasters by guiding its members. These countries are willing to give up some of their sovereign authority to achieve that aim.  The IMF has the rare ability to look into and review the economies of all its member countries. As a result, it has its finger on the pulse of the global economy better than any other organization. The IMF produces a wealth of analytical reports. It provides the World Economic Outlook, the Global Financial Stability Report, and the Fiscal Monitor each year. It also delves into regional and country-specific assessments. It uses this information to determine which countries need to improve their policies. Hence, the IMF can identify which countries threaten global stability. The member countries have agreed to listen to the IMF’s recommendations because they want to improve their economies and remove these threats.  Since the Mexican peso crisis of 1994–95 and the Asian crisis of 1997–98, the IMF has taken a more active role to help countries prevent financial crises. It develops standards that its members should follow. For example, members agree to provide adequate foreign exchange reserves in good times. That helps them increase spending to boost their economies during recessions. The IMF reports on members countries’ observance of these standards. It also issues member country reports that investors use to make well-informed decisions. That improves the functioning of financial markets. The IMF also encourages sustained growth and high living standards, which is the best way to reduce members’ vulnerability to crises.  The IMF provides loans to help its members tackle balance of payments problems, stabilize their economies, and restore sustainable growth. Because the Fund lends money, it’s often confused with the World Bank. The World Bank lends money to developing countries for specific projects that will fight poverty. Unlike the World Bank and other development agencies, the IMF does not finance projects. Traditionally, most IMF borrowers were developing countries. They had limited access to international capital markets due to their economic difficulties. An IMF loan signals that a country’s economic policies are on the right track. That reassures investors and acts as a catalyst for attracting funds from other sources. All that shifted in 2010 when the Eurozone crisis prompted the IMF to provide short-term loans to bail out Greece. That was within the IMF’s charter because it prevented a global economic crisis.  The role of the IMF has increased since the onset of the 2008 global financial crisis. In fact, an IMF surveillance report warned about the economic crisis but was ignored. As a result, the IMF has been called upon more and more to provide global economic surveillance. It’s in the best position to do so because it requires members to subject their economic policies to IMF scrutiny. Member countries are also committed to pursuing policies that are conducive to reasonable price stability, and they agree to avoid manipulating exchange rates for unfair competitive advantage.
5. According to paragraph 3, which of the following is NOT a method of IMF to help countries prevent financial crises? 

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After inventing dynamite, Swedish-born Alfred Nobel became a very rich man. However, he foresaw its universally destructive powers too late. Nobel preferred not to be remembered as the inventor of dynamite, so in 1895, just two weeks before his death·, he created a fund to be used for awarding prizes to people who had made worthwhile contributions to humanity. Originally there were five awards: literature, physics, chemistry, medicine, and peace. Economics was added in 1968, just sixty-seven years after the first awards ceremony.
Nobel's original legacy of nine million dollars was invested, and the interest on this sum is used for the awards which vary from $30,000 to $125,000. Every year on December 10, the anniversary of Nobel's death, the awards (gold medal, illuminated diploma, and money) are presented to the winners. Sometimes politics plays an important role in the judges' decisions. Americans have won numerous science awards, but relatively few literature prizes.
No awards were presented from 1940 to 1942 at the beginning of World War 11. Some people have won two prizes, but this is rare; others have shared their prizes.

How much money did Nobel leave for the prizes?

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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.
2. The word “enforce” in paragraph 4 is closest in meaning to _______