GRACE2012ESC演讲PPT
电影《2012》英文简介ppt
Arriving in China in a crash-landing （紧急降落） that kills Sasha, Yuri and his sons are taken to the ships, stranding the Curtis family, Gordon, and Tamara, who do not possess tickets. The group is picked up by Nima, a Buddhist（佛教） monk(僧侣）. They sneak into an ark through its hydraulics chamber（水力学 舱） with the help of Nima‘s brother Tenzin, a welder （焊接工）for the ark project.
Scene2:Learning the ships are in China, the group lands in Las Vegas, where they meet Yuri, his sons, girlfriend Tamara, and pilot Sasha. They join the group and secure an Antonov 225, fleeing Las Vegas as it is destroyed（破坏）. The group flies to China, passing Honolulu（檀香山） as it is obliterated（湮没） by volcanic eruptions.
Today, I’d like to introduce a disaster film--2012 which will make you never feel disappointed.
2012年英语四级作文范文ppt
The Power of Perseverance: A Journey toSuccessIn the journey of life, perseverance is often the key to unlocking success. This statement resonates deeply with me, as I believe that success is not merely the result of talent or intelligence, but rather a product of our determination and resilience in the face of challenges.As I reflect on my own life experiences, I remember a particularly challenging moment when I was preparing for the CET-4 exam. The language barrier was a significant hurdle, and the pressure to perform well was immense. However, it was my perseverance that helped me overcome these obstacles. I committed myself to regular practice, dedicating hours each day to improving my language skills.I persevered despite the setbacks and failures, learning from each mistake and using it as a stepping stone to success.The power of perseverance is further exemplified by the stories of successful individuals from diverse fields. Whether it's a sports champion who trains relentlessly to achieve excellence, or a scientist who spends yearsconducting research to make a groundbreaking discovery, they all share a common trait: perseverance. They understand that success does not come easily, and that it requires hard work, dedication, and the ability to stay focused in the face of adversity.Moreover, perseverance instills in us a sense of purpose and direction. When we persevere, we are morelikely to set clear goals and work towards them with determination. This focus and clarity give us a sense of control over our own destiny, allowing us to shape our future according to our vision and aspirations.However, it's important to note that perseverance does not mean stubbornly sticking to one path regardless of obstacles. Instead, it involves a flexible and adaptive approach, where we are willing to learn from our mistakes, reevaluate our goals, and adjust our strategies as needed. This balance between perseverance and flexibility iscrucial for sustained success.In conclusion, perseverance is a critical component of success. It is the driving force that propels us forward in the face of challenges, helps us learn from our mistakes,and enables us to achieve our goals. As we embark on our respective journeys, let us remember that with perseverance, no dream is too big, and no goal is unattainable.**毅力的力量：通往成功的旅程**在人生的旅途中，毅力常常是通往成功的关键。
2012 英语PPT
1、The end of the mayans civilization (already been realized)
2、The appearance of cars, planes and emergence (already been realized)
3、The birth and death of devil (Hitler) (already been realized)
Do you still remember the scene in the movie 《2012》? The building collapsed, the violent earthquake and the terrible tsunami …… Now let’s see a part of this movie.
末日三行遗书体
调侃型 - “如果你没时间来看我，记得坟头装Wifi，蹭网的人多了我也就 不寂寞了”
- “就算世界末日不挂，四六级，也会挂的”
- “如果我死了，别为我报仇，你赢不了高数的” 恶搞型 - “土少盖点，压力很大，没了 ” - “我死了，这件事，麻烦火化前多确认几次” - “请务必，把我遗照，PS一下” - “我觉得，我，还能再被抢救一下”。
4、The outbreak of the war (the first and second world wars) (already been realized)
5、 Maya said, after the coming of the night on December 21st, 2012, the dawn of December 22nd will never come… (not yet…)
The flood of Noah(诺亚洪水)
关于2012预言的英语PPT
Is this prophecy true ?
•WHAT ARE YOU THINKING OF NOW?
专家：“2012为世界末日”说法毫无科学依据，无须恐慌。 电影《2012》在全球上映后，上海天文台已接到众多市民来电，纷纷咨询 “2012是否为世界末日？”在昨天上海天文台和上海市天文学会主办的科普讲坛上， 上海天文台天体物理研究室研究员陈力教授否定了这一论调，称“这是毫无科学依 据的说法”。据他介绍，最近一次小行星可能威胁地球的时间在2042年，但市民对 此也无须恐慌。 “‘世界末日’的说法并不罕见。”陈力介绍说，上世纪90年代，诺查丹玛斯 关于世界末日的预言甚嚣尘上，他预言1999年太阳系八大行星组成了“十字架”， 人类将会有大劫难。但是事实证明，这个说法只是流言。玛雅人的“2012世界末日 论”同样是个流言，玛雅人把2012年认为是一个历法轮回的结束，性质和2000年对 现代人的意义差不多，目前没有任何科学依据表明2012年是世界末日。 不过，小行星撞地球确实可能让地球遭到重大打击。据陈力介绍，最近天文学 家发现有一颗小行星对地球存在潜在威胁，2042年，这颗小行星距离地球仅3万多 公里，正好与地球“擦肩而过”。如果这颗小行星真的要撞上地球呢？陈力表示， 目前人类的科技水平已完全能做到发射空间飞船到达数亿公里外的遥远空间，因此 消除威胁的办法并不难找，比如发射氢弹在小天体附近爆炸，改变它的运行轨道； 利用太阳能使小天体表面物质气化，减少它的质量，从而改变轨道；还有一种设想 很“浪漫”，给小天体装“帆”，利用太阳风改变它的轨道。 天文学家可以肯定的是，地球的真正威胁来自50亿年之后，届时太阳将成为一 个红巨星吞没地球，但是到那时人类还是否存在，就不得而知了。
2012 DOOMSDAY
Wenchuan 8.0earthquake
冠状动脉粥样硬化性心脏病诊断标准
解读：在稳定型心绞痛的辅助检查方面，强调血糖、血脂等危 险因素的识别及控制。特别是目前我国空腹血糖及糖耐量试验 异常人群比例增加，增加对血糖的检测有助于早期干预，降低 冠心病发生的风险
临床需要更为合适、准确，且简单实用 的危险分层工具
1-Fox KA, et al. BMJ. 2006;333:1091. 2-AT Yan, et al. AM Heart J .2004;148:1020–1007.
GARCE评分：评估住院期间和出院后缺血风险
GRACE危险评分是多指标、多级分值的评分系统
1+1诊断模式的出现：主要是敏感性和特异性很高的心肌坏死 生化标志物 检测方法的问世。
肌钙蛋白（I/T）：优选生化标志物 特异性：几乎100%
敏感性：很高，显微镜下小灶心梗
持续时间长：7－14天
ESC/ACC/AHA/WHF心肌梗死新定义
MI分为如下6型:
Ⅰ型:自发性MI,与原发的冠状动脉事件如斑块破裂相关。
标准制定的依据
Braunwald 心脏病学（第8版） Topol 心脏病学（第3版）
心脏病学 经典著作 最新版本
主要内容
强制性条款：疾病的病史、临床表现、必要的辅助检查、 风险评估
推荐性条款：目前未推广普及的检查手段，如冠状动脉造 影、核素心肌显像等
标准制定过程
2007.8～2007.11 院内讨论，制定了冠心病诊断治疗标准（草案） 2007.12～2008.1上海会议、北京会议专家讨论 2008.2～2008.6 两轮函审，标委会委员评审
《2023 ESC急性冠状动脉综合征管理指南》解读PPT课件
高血压、高血脂、糖尿病、吸烟、肥 胖、缺乏运动等不良生活习惯是ACS 的主要危险因素。
临床表现与诊断依据
临床表现
典型症状包括胸痛、胸闷、心悸、气促等，可伴随恶心、呕 吐、出汗等表现。严重者可出现休克、心力衰竭等症状。
诊断依据
心电图检查可见ST段抬高或压低，T波倒置等改变；心肌酶学 检查可见肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）等 指标升高；影像学检查如超声心动图、冠状动脉造影等有助 于明确诊断。
PCI围手术期管理优化
PCI术前评估
强调对患者进行全面评估，包括 缺血风险、出血风险、肾功能等
，以制定个体化治疗方案。
PCI术中策略
推荐使用径向动脉入路进行PCI 术，以降低出血和血管并发症风 险；对于复杂病变，可考虑使用 血管内超声（IVUS）或光学相干 断层成像（OCT）指导手术策略
。
PCI术后管理
定义与分类
定义
急性冠状动脉综合征（ACS）是 由于冠状动脉内斑块破裂、血栓 形成导致心肌缺血、损伤或坏死 的一组临床综合征。
分类
ACS包括急性心肌梗死（AMI） 、不稳定型心绞痛（UA）和非ST 段抬高型心肌梗死（NSTEMI） 。
发病原因及危险因素
发病原因
主要病因包括冠状动脉粥样硬化、斑 块破裂、血栓形成以及冠状动脉痉挛 等。
人工智能辅助诊断与治疗
运用人工智能技术辅助医生进行急性冠状动脉综 合征的诊断和治疗决策，具有广阔的发展前景。
THANKS
感谢观看
感染防控
加强无菌操作，合理使用 抗生素，降低感染风险。
长期随访管理建议
01
02
03
04
定期随访
对患者进行定期随访，了解病 情变化和治疗效果。
急性心肌梗死合并消化道出血的防治策略课件
监测ECG、心肌酶
及时补充血容量 必要时输血 保证心脏灌注
急性心肌梗死合并消化道出血的防治策略
心梗 & 消化道出血的治疗
血运重建 抗凝抗血小板治疗 PPI及H2RA的使用 输血 内镜检查及治疗 其他治疗措施
Thrombotic
Bleeding
急性心肌梗死合并消化道出血的防治策略
18
5.6(3.5-8.8)
24
2.4(1.7-3.3)
42
P值
<0.001 <0.001
0.001 0.12
<0.001 <0.001 <0.001 <0.001
输血 0-1天 2-7天 8-30天 >31天
6.7(3.1-14.7)
7
8.1(4.6-14.1)
15
6.4(3.7-10.9)
17
3.1(2.1-4.5)
31
<0.001 <0.001 <0.001
<0.001
0.5 1
2
4急性心8肌梗死16合并消32化道出血的防治策略
HR(95%CI)
Eur Heart J. 2009;30:1457-1466.
心梗合并消化道出血的发生率
UGI 上消化道出血 MAUGIEs（主要不良消化道事件）：包括上消化道出血、 经胃镜证实的胃溃疡及十二指肠溃疡
MI 0-1天 2-7天 8-30天 >31天
HR(95%CI)
17.6(10.8-28.7) 8.2(5.0-13.6) 2.9(1.6-5.3) 1.4(0.9-2.1)
死亡
21 19 12 25
2012年哈佛毕业典礼谢丽尔·桑德伯格的演讲
2012年哈佛毕业典礼谢丽尔·桑德伯格的演讲Please join me and welcome Sheryl Sandberg请和我一起欢迎谢丽尔·桑德伯格Thank you, thank you Catherine谢谢谢谢你凯瑟琳It's an honor to be here today今天很荣幸来到这里to address HBS's distinguished faculty为尊敬的哈佛商学院的教员proud parents, patient guests自豪的毕业生家长和耐心的来宾们and most importantly, the class of 2012尤其是为今年的毕业生们演讲Today was supposed to be a day of unbridled celebration今天原本应该是狂欢的日子and I know that's no longer true不过我知道现在并不合适了I join all of you in grieving for your classmate Nate让我们一起为Nate同学表示哀悼I know there are no words that makes something like this better当然任何言语在这样的悲剧前都苍白无力Although laden with sadness尽管有悲伤萦绕在大家心头today still marks a distinct and impressive achievement for this class今天仍然象征着你们取得的杰出成绩So please everyone join me所以让我们一起in giving our warmest congratulations to this class of 2012为12届的毕业生们献上最热烈的祝贺When the wonderful Dean Nohria invited me to speak here today当尊敬的院长Nohria邀请我今天来做演讲时I thought, come talk to a group of people我想来给一群way younger and cooler than I am?远比我年轻比我有活力的人们演讲I can do that我没问题I do that every day at Facebook这正是我每天在Facebook做的事情I like being surrounded by young people我喜欢和年轻人在一起except when they say to me除了当他们问我What was it like being in college without the internet?没有互联网的大学是怎样的？or worse或者更夸张Sheryl, can you come here?谢丽尔你能过来下么？We need to see我们想知道what old people think of this feature老人会对这个新功能怎么看这类问题It's not joking我不是在开玩笑It's a special privilege for me to be here this month能够在毕业季来到这里我觉得很荣幸When I was a student here 17 years ago17年前当我是哈佛的学生时I studied social marketing with Professor Kash Rangan我上了Kash Rangan教授的社交化营销One of the many examples Kash used to explain the concept其中Kash用来解释社交化营销概念的例子of social marketing was the lack of organ donors in this country就是美国在器官捐赠方面的不足which kills 18 people every single day每天因此有18人死亡Earlier this month本月早些时候Facebook launched a tool to support organ donations Facebook推出了一款支持器官捐赠的工具something that stems directly from Kash's work这是对Kash工作的直接应用Kash, wherever you are here Kash 无论你今天坐在哪里we are all grateful for your dedication我们都十分感激你的贡献So, it wasn't really that long ago所以也就在不久之前when I was sitting where you are我坐在你们现在的位置上but the world has changed an awful lot但是这个世界已经变化了很多My section, section B我所在的小组Section Btried to have HBS's first online class曾尝试进行HBS的第一次在线课程We had to use an AOL chat room我们用的是AOL的聊天室and dial up service和电话拨号上网服务Your parents can explain to you later what dial-up service is你们的父母可以向你们解释什么是拨号上网We had to pass out a list of screen names because我们得给每人发一张写有我们网名的列表it was unthinkable to put your real name on the internet因为那时在网上用真名是件让人难以想象的事And it never worked不过这完全不行It kept crashing and kicking all of us off一直断网我们会被踢出聊天室Because the world just wasn't set up因为当时的世界for 90 people to communicate at once online还无法让90人同时在线交流For a few brief moments不过有几个瞬间we glimpsed the future我们仿佛看到了未来a future where technology would power who we are一个由于科技进步让我们and connect us to our real colleagues和现实生活中的同事家人和朋友our real family, our real friends更好地联系在一起的未来It used to be that in order to reach more people在过去如果想在一天内联系到than you could talk to in a day比你能当面交谈更多的人you had to be rich and famous and powerful你要么有钱要么有名要么有权You had to be a celebrity, a politician, a CEO你得是名人政客或者CEOBut that's not true today但是今天不一样了Now ordinary people have voice现在普通人也可以获得话语权not just those of us lucky enough to go to HBS不仅是那些能到HBS读书的幸运儿but anyone with access to Facebook, to Twitter, to a mobile phone而是任何能上Facebook Twitter或者有手机的人This is disrupting traditional power structures这正在打破传统的权利结构and leveling traditional hierarchy让传统的阶层界限变得模糊Voice and power are shifting from institutions to individuals话语权正从机构转向个人from the historically powerful to the historically powerless从曾经有权有势的人转向普通人And all of this is happening so much faster而且这一切的变化速度远远超出了than I could have ever imagined当时坐在今天你们所坐的when I was sitting where you are today位置上的我的想像and Mark Zuckerberg was 11 years old那时候马克·扎克伯格才十一岁As the world becomes more connected and less hierarchical当世界变得更紧密界限更模糊时traditional career paths are shifting as well传统的职业生涯也在发生变化In 2001, after working in the government2001年在为政府工作了几年之后I moved out to Silicon Valley to try to find a job我搬到硅谷找到一份工作My timing wasn't really that good当时并不是个好时机The bubble had crashed泡沫破灭了Small companies were closing小公司都在倒闭Big companies were laying people off大公司都在裁员One women CEO looked at me and said一个女性CEO看着我说we would never even think about hiring someone like you我们根本不会考虑招你这样的人After a while I had a few offers and I had to make a decision过了一段时间我拿到几个offers 需要做决定了so what did I do? I am MBA trained那么我是怎么做的呢？由于我受过MBA的训练so I made a spreadsheet所以我做了一个Excel表I listed my jobs in the columns我把工作都列了出来and the things for my criteria in the rows并且一行行把我的评判标准也列了出来and compared the companies, the missions, and the roles比较公司的远景工作的职责等One of the jobs on that sheet was表格中有一个工作to become Google's first Business Unit general manager是去做Google的第一个业务部总经理which sounds good now这现在听起来很不错but at the time no one thought但是当时没人相信consumer internet companies could ever make money直接面对消费者的互联网公司可以赚钱I was not sure there was actually a job there at all我都不敢确定那儿是不是真有这样的职位Google had no business units Google就没有业务部so what was there to generally manage?那要我去总管什么呢？And the job was several levels lower何况那职位than jobs I was being offered at other companies比我在其他公司得到的offers都要低好几级So I sat down with Eric Schmidt后来我和当时刚刚上任的CEOwho had just become the CEO艾里克·施密特见了面and I showed him the spreadsheet and I said我给他看了我的列表我说this job meets none of my criteria这份工作完全不合我的选择标准He put his hand on my spreadsheet and he looked at me and said他用手按住我的表格看着我说Don't be an idiot不要犯傻Excellent career advice极佳的职业忠告And then he said, Get on a rocket ship然后他说重要的是坐上火箭When companies are growing quickly and having a lot of impact当公司在飞速发展而产生很大影响力时careers take care of themselves事业自然也会突飞猛进And when companies aren't growing quickly当公司发展较慢时or their missions don't matter as much或者公司前景一般时that's when stagnation and politics come in停滞和办公室政治就会出现If you're offered a seat on a rocket ship如果你得到了坐上火箭的机会don't ask what seat. Just get on别管是什么位置上去就行About six and one-half years later大概六年半之后when I was leaving Google当我要离开Google的时候I took that advice to heart我记住了这句忠告I was offered CEO jobs at a bunch of companies当时好几家公司请我去做CEObut I went to Facebook as COO但是我去了Facebook做COO(首席运营官)At the time people said那时有人问你why are you going to work for a 23-year-old?为什么要去给一个23岁的年轻人打工？The traditional metaphor for careers is a ladder职业发展通常会被比作爬阶梯but I no longer think that metaphor holds但我认为这个比喻不再恰当了It just doesn't make sense在越来越扁平的世界里in a less hierarchical world这种说法是没有意义的When I was first at Facebook我刚到Facebook的时候a woman named Lori Goler, a 1997 graduate of HBS97届HBS的校友Lori Golerwas working in marketing at eBay还在eBay做市场营销and I knew her kind of socially我和认识了她并且知道她善于交际She called me and she said她打电话给我说I want to think about you know talk with you我想和你谈谈about coming to work with you at Facebook到Facebook和你一起工作的事So I thought about calling you我想到给你打电话and telling you all the things I'm good at and all the things I like to do和你说我有哪些特长以及我想做的事情But I figured that everyone is doing that但我知道所有人都会这样说So instead I want to know what's your biggest problem所以我就想知道什么是你现在最棘手的问题and how can I solve it我又该如何帮你解决这个问题My jaw hit the floor我感动得五体投地I'd hired thousands of people up to that point in my career那时我一路过来雇了上千人but no one had ever said anything like that但是从来没有人对我这样说过I had never said anything like that我自己也从来没有这样说过Job searches are always about the job searcher找工作一直是关于找工作的人是怎样要什么but not in Lori's case但是Lori不是这样想的I said, You're hired我说你被录用了My biggest problem is recruiting and you can solve it我最大的问题就是招人你可以帮我So Lori changed fields之后Lori就换到了这个into something she never thought she'd do她自己都从未想过去做的领域went down a level to start in a new field还降了一级重新开始She has since been promoted之后她被升职and runs all of People Operations at Facebook负责整个Facebook的人事运行and is doing an extraordinary job, having an amazing impact现在做得非常好在公司有很大的影响力Lori has a great metaphor for careers Lori对职业有个很好的比喻She says they're not a ladder她说职业不是阶梯they're a jungle gym而是游乐场里儿童玩的立方格攀登架As you start your post-HBS career当你们开始HBS之后的职业生涯时look for opportunities, look for growth你们要去寻找机会追随成长look for impact, look for mission力求影响力发现远景Move sideways, move down, move on, move off可以平调降级升职甚至换新的领域Build your skills, not your resume培养你的技能而不是填充你的简历Evaluate what you can do根据你能做的事来评判工作not the title they're going to give you而不是你可以得到的职位Do real work做真正的工作Take a sales quota接受一个销售目标a line role, an ops job一个生产线上的工作一个涉及运营方面的工作Don't plan too much别作太多计划and don't expect a direct climb也别要求要青云直上If I had mapped out my career如果我在坐在你们的位置上时when I was sitting where you are就计划好我的职业I would have missed my career我会错过我现在的职业You are entering a different business world than I entered你们现在正迈入一个和我当时不同的世界Mine was just starting to get connected我的世界刚刚开始被连接起来Yours is hyper-connected你的世界已经高速连接在一起Mine was competitive我当时竞争很激烈Yours is way more competitive你们现在的竞争更加激烈Mine moved quickly我的世界变化很快As traditional structures are breaking down你的世界变化更快leadership has to evolve as well在这个传统结构正被打破的时代from hierarchy to shared responsibility领导班子也需要演变from command and control to listening and guiding从设立阶层到责任共享You've been trained by this great institution从命令与控制到聆听和引导not just to be part of these trends你在HBS这个伟大的学院学习but to lead不仅是为了能够跟上浪潮As you lead in this new world更重要的是能去引领潮流you will not be able to rely on who you are or the degree you hold当你在这个新世界里乘风破浪时You'll have to rely on what you know你能依靠的不是你是谁也不是你的学位Your strength will not come from your place on some org chart你要依靠的是你的知识your strength will come from building trust and earning respect你的力量不会源自你在公司的位置You're going to need talent, skill, and imagination and vision而来自于建立信任获得尊敬But more than anything else你会需要天赋技能想象力和视野you're going to need the ability to communicate authentically不过最最重要的是to speak so that you inspire the people around you具有真诚沟通的能力and to listen既能鼓舞你身边的人so that you continue to learn each and every day on the job又能聆听他们的建议If you watch young children在每一天的工作中不断学习进步you'll immediately notice how honest they are如果你留意小孩My friend Betsy from my section你会立刻发现他们是多么的诚实a few years after business school was pregnant with her second child我的一个HBS小组里的朋友BetsyAnd her first child, Sam, was about five在毕业后几年怀上了第二个孩子and he looked around and said,她的第一个小孩Sam 那时大概五岁Mommy, where is the baby?Sam环视了下她问She said, The baby is in my tummy妈妈小宝宝在哪里啊？He said, Really?她说小宝宝在我肚子里Aren't the baby's arms in your arms?他说真的么？She said, No, the baby's in my tummy难道小宝宝的手不在你的手里？Really? Are the baby's legs in your legs?她说不小宝宝在我肚子里No, the whole baby is in my tummy真的？小宝宝的腿不在你腿里？And he said, Mommy不整个宝宝都在我肚子里啊what is growing in your butt?然后她说妈妈As adults, we are never this honest为什么你的屁股越来越大？And that's not a bad thing作为成年人我们从不如此直接I have borne two children这未必是件坏事and the last thing I needed were those comments我也是两个孩子的妈妈which obviously could be made我最不想听到的恐怕就是这些评论But it's not always a good thing either当然这些评论用在我身上也确实没错Because all of us, and especially leaders但是那也不总是件好事need to speak and hear the truth因为我们所有人尤其是领导者The workplace is an especially difficult place需要说真话听真话for anyone to tell the truth在工作环境中because no matter how flat we want our organizations to be说真话尤其得难all organizations have some form of hierarchy因为无论我们多希望将组织架构扁平化And what that means is that one person's performance所有的组织都会有某种层级is assessed by someone else's perception这就意味着一个员工的表现This is not a setup for honesty会由别人对其印象来评估Think about how people speak in a typical workforce这是不鼓励真诚的设计Rather than say想象一下人们在典型的工作环境中是如何沟通的I disagree with our expansion strategy人们不说or better yet,this seems truly stupid我不同意我们的扩张策略They say, I think there are many good reasons或者更好这看起来真傻why we're entering this new line of business人们会说我知道进入这个新领域and I'm certain the management team有众多好处has done a thorough ROI analysis而且我相信管理团队but I'm not sure we have fully considered一定做过细致的投资回报分析the downstream effects of taking this step forward at this time不过我不确定我们是否完整地考虑了As we would say at Facebook or on the Internet在这个时刻采取这个方案会产生的所有后果three letters: WTF对此就该用我们在Facebook或者互联网上Truth is better served by using simple language常说的三个字WTFLast year, Mark decided to learn Chinese事实最好用简短的语言来表达and as part of studying去年马克·扎克伯格决定开始学中文he would spend an hour or so each week作为学习的一部分with some of our employees who were native Chinese speakers他每周会花大约一个小时的时间One day和一些来自中国的员工交谈one of them was trying to tell him something about her manager有一天She said this long sentence有一个员工谈到了她的老板and he said simpler please她说了一通之后And then she said it again马克说请说简单点and he said no, I still don't understand她再说了一遍之后simpler please…and so on and so on他说不行我还是没明白Finally, in sheer exasperation, she burst out请再简单点就这样来回了几次my manager is bad终于她愤怒地说道Simple and clear and super important for him to know我老板坏People rarely speak this clearly简单明了而且非常重要需要让马克知道in the workforce or in life在工作或者生活中And as you get more senior人们很少会把话说那么明了not only will people speak less clearly to you尤其是当你的级别上升后but they will overreact to the small things you say人们不仅不会和你把话说清楚When I joined Facebook还会对你所说的小事反应过激one of the things I had to do当我加入Facebook的时候was build the business side of the company我的职责之一and put some systems into place就是把公司商业那块给建立起来But I wanted to do it without destroying the culture将其系统化that made Facebook great但是我不想破坏Facebook原有的文化So one of the things I tried to do was encourage people就是这些文化促成了Facebook的伟大not to do formal PowerPoint presentations for meetings with me我尝试的一件事就是I would say things like鼓励人们和我开会时不要做正式的PPTDon't do PowerPoint presentations for meetings with me我会说Why don't you come in with a list of what you want to discuss和我开会不用做PPTBut everyone ignored me and they kept doing their presentations把你想讨论的事列出来就行meeting after meeting但是所有人都无视我的要求仍然在做PPTmonth after month就这样一个又一个会议So about two years in, I said一个月又一个月没有改变OK, I hate rules but I have a rule大概两年后我说no more PowerPoint in my meetings OK 我不喜欢条条框框但我要定个规矩And I mean it, No more和我开会不用做PPTAbout a month later我是认真的别再做了I was about to speak to our global sales team on a big stage大约一个月之后and someone came up to me and said我在一个大型场合正要和全球销售团队讲话Before you get on that stage一个同事上来对我说you really should know everyone's pretty upset在你上台之前about the no PowerPoint with clients thing你应该知道大家对你制定的I said, What no PowerPoint with clients thing?和客户会面不做PPT的规定很有意见They said, You made rule no: PowerPoint我说什么和客户会面不做PPT？So I got on the stage and said他们说你制定了一个规定:不做PPTone, I meant no PowerPoint with me之后我上了台就说But two, more importantly首先我说的是和我开会不用PPTnext time you hear something that's really stupid其次更重要的是don't adhere to it下次你们听到一些你们认为很傻的话Fight it or ignore it不要去遵循它even if it's coming from me or Mark而要去提意见或者无视它A good leader recognizes that哪怕你知道那话是我或者马克说的most people won't feel comfortable challenging authority一个好的领导者so it falls upon authority to encourage them to question知道大部分人不愿意去挑战权威It's easy to say that you're going to encourage feedback所以领导者有义务去鼓励大家来质疑but it's hard to do当然说鼓励反馈容易because unfortunately it doesn't always做起来难come in a format we want to hear it因为听到的反馈When I first started at Google往往不是我们想要的那种I had a team of four people当我刚开始在Google工作时and it was really important to me我的团队里面有四个人that I interview everyone who was on my team所以对我而言It felt like being part of my team meant I had to know you由我自己来面试团队的每个成员就尤其重要When the team had grown to about 100 people要成为我的团队的一份子我必须了解你I realized it was taking longer to schedule my interviews当团队增长到大约有100人的时候So one day at my meeting of just my direct reports我意识到在面试上花的时间越来越多I said maybe I should stop interviewing所以有一天在我的报告会上fully expecting them to jump in and say我说也许我应该停止面试no, your interviews are a critical part of the process那时我完全预计他们会打断我说They applauded不行你的面试是流程中很重要的一步Then they fell over themselves explaining that然而他们都对此非常赞赏I was the bottleneck of all time然后他们转过来解释说I was embarrassed我一直都是流程中的瓶颈Then I was angry and I spent a few hours just quietly fuming我先是觉得羞愧Why didn't they tell me I was a bottleneck?然后恼怒我花了几个小时的时间生闷气Why did they let me go on slowing them down?他们为什么不告诉我我是瓶颈？Then I realized that if they hadn't told me为什么他们不阻止我拖大家的后腿？it was my fault后来我明白了如果没人告诉我I hadn't been open enough那这就是我的错told them that I wanted that feedback我还不够开怀and I would have to change that going forward没有告诉他们我想要他们的反馈When you're the leader我决定从此改变这点it is really hard to get good feedback and honest feedback当你是领导no many how many times you ask for it得到有用的真实的反馈是很难的One trick I've discovered is that哪怕你反复要求I try to speak really openly about the things I'm bad at我发现的一个小技巧because that gives people permission to agree with me是尝试主动地谈论你的某些缺点which is a lot easier than pointing it out in the first place因为这样会让人愿意来认同我To take one of many possible examples这比直接指出我的缺点要容易许多when things are unresolved I can get a tad anxious从众多可能中举个例子来说Really, when anything's unresolved当事情没有搞定时我会有点焦躁I get a lot anxious真的只要有事情没有搞定I'm quite certain no one has accused me of being too calm我会变得非常焦躁So I speak about it openly and that gives people permission我敢肯定没人会说我过于冷静to tell me when it's happening后来我就主动地谈论这个缺点But if I never said anything让大家来认同我因而可以在我焦躁时告诫我would anyone who works at Facebook walk up to me and say但是如果我对此一句不提Hey Sheryl, calm down会有Facebook的员工走上来对我说You're driving us all nuts! I don't think so嘿谢丽尔冷静点As you graduate today你快把我们搞疯了我可不这样认为ask yourself, how will you lead?在你们毕业的今天Will you use simple and clear language?问自己你将如何去领导？Will you seek out honest feedback?你会用简单明了的语言吗？When you get honesty feedback你会追寻真实的反馈吗？will you react with anger or with gratitude?当你得到真实的反馈As we strive to be more authentic in our communication你会愤怒还是感激？we should also strive to be more authentic in a broader sense当我们努力更真诚地沟通时I talk a lot about bringing your whole self to work我们也应该在更多的意义上做到真实something I believe in very deeply我经常会说带着完整的自己去上班Motivation comes from working on things we care about这是我深深相信的一点But it also comes from working with people we care about工作的动力来自于做我们在乎的事情And in order to care about someone但也来自于和我们在乎的人一起工作you have to know them要做到在乎某人You have to know what they love and hate你必须了解他们what they feel你必须知道他们喜欢什么讨厌什么not just what they think他们会有什么样的感受If you want to win hearts and minds而不只是他们会想什么you have to lead with your heart as well as your mind如果你想得到人心I don't believe we have a professional self你必须用心去领导from Mondays through Fridays我不相信周一到周五and a real self for the rest of the time我们是职业的自己That kind of division probably never worked其它时间才是真正的自己but in today's world, a real voice and authentic voice类似这样的分离从来就不太可行it makes even less sense在越来越提倡真实的当今世界里I've cried at work这就更没有意义了I've told people I've cried at work我在工作时流过泪And it's been reported in the press that我告诉过别人我在工作时流过泪Sheryl Sandberg cried后来这被媒体报道成on Mark Zuckerberg's shoulder谢丽尔·桑德伯格which is not exactly what happened在马克·扎克伯格的肩膀上哭泣I talk about my hopes and fears事实当然不是如此and ask people about theirs我会谈论我的希望和恐惧I try to be myself honest about my strengths and weaknesses也会询问别人的希望和恐惧and I encourage others to do the same我努力做真实的自己直面我的优点和缺点It is all professional and it is all personal我会鼓励别人也这么做all at the very same time一切都与职业相关也都与个人相关As part of bringing my whole self to work两者无时无刻不交融在一起I recently started speaking up about作为带着完整的自己去上班的一部分努力the challenges women face in the workforce最近我开始公开谈论something I only had the courage to do in the last few years女性在工作环境中面临的挑战Before this这也是我最近几年才有勇气做的事情I did my career like everyone else does it在此之前I never told anyone I was a girl我和大家一样小心翼翼地在职场上打拼Don't tell我从没和别人强调我是女儿身I left the lights on不说原则when I went home to do something for my kids当我暂时回家照顾下孩子时I locked my office door and pumped milk for my babies我会把办公室的灯留着while I was on conference calls当我锁上门在办公室边参加电话会议People would ask,what's that sound?边为我的宝宝们挤奶时I would say,What sound? I hear a beep有人会问那是什么声音00:17:43,290 --> 00:17:46,790我会说什么声音？我听到哔的一声Oh, there's a fire truck really right outside my office噢我窗外正好有一辆消防车But the lack of progress we've made in the past decade然而由于我们在上个10年取得的进展很小has convinced me we need to start talking about this我决定要开始公开讨论这点I graduated from HBS in 1995我是1995年从HBS毕业的and I thought it was completely clear that by the time当时我想等到我们这届someone from my year was invited to speak at this podium有人被邀请到这个讲台演讲的时候we would have achieved equality in the workforce我们一定已经实现了工作上的男女平等But women at the top C-level jobs但是在C级别的工作上are stuck at 15-16 percent女性的比例始终停留在15%到16%and have not moved in a decade10年来一点都没有变化Not even close to 50%离50%还差很远and worse no longer growing而且更糟的是已经停止增长We need to acknowledge openly that我们需要公开承认在执行级别的领导层gender remains an issue at the highest levels of leadership性别仍然是个大问题The promise of equality is not equality对平等的承诺不等于真正的平等We need to start talking about this我们需要就此进行谈论We need to start talking about我们要讨论how women underestimate their abilities女性相比男性compared to men and for women为什么会低估自己的能力but not men而且和男性不同success and likeability are negatively correlated对于女性成功和受欢迎程度是反向相关的That means that as a woman is more successful in your workplaces这意味着一个女性在事业上越成功she will be less liked她就会越不受人喜爱This means that women这意味着女性need a different form of management and mentorship需要另一种形式的管理和辅导a different form of sponsorship and encouragement另一种形式的支持和鼓励and some protection甚至一些保护in some ways, more than men在某些方面要比男性有更多的保护And there aren't enough senior women out there to do it而且现在有资历做这些的女性还太少so it falls upon the men who are graduating today所以在座的男性毕业生们要和女性毕业生们just as much or more as the women一起肩负起这个责任甚至更多not just to talk about gender不仅仅讨论性别but to help these women succeed而且要帮助女性取得成功When they hear a woman is really great at her job but not liked当听到一个工作上很优秀的女性不为人爱戴take a deep breath and ask why深呼吸一下问问自己这是为什么We need to start talking openly about我们需要公开地探讨the flexibility all of us need to have both a job and a life我们都需要的灵活机制来平衡工作和生活A couple of weeks ago in an interview I said that几周前我接受了一个采访I leave the office at 5:30 p.m. to have dinner with my children我说我会5点半离开公司去和我的小孩吃晚饭And I was shocked at the press coverage而媒体报道让我震惊了One of my friends said我的一个朋友说she wasn't sure I couldn't get more headlines她不确定就算我用斧子砍人if I had murdered someone with an ax是否能上一样多的头条I told her I wasn't really interested in trying that我告诉她我对砍人没兴趣But this showed me不过这让我明白this is an unresolved issue for all of us对于我们所有人不管是男人还是女人for men and women这是个未解决的问题Otherwise要不是这样。
2012年SIFE全国赛PPT英文分享版
（2）Analysis
分析
Background
Analysis
Solution
FA
R TRADE 公平贸易
How do these NGO protect the profit of those peasants?
Background
Analysis
76,104yuan
（3）GO OUT 心理康复
Background
Sell Out
Go Out
+
华师大心理咨询中心 Psychological Consultation Center of SCNU
One-to-one Psychological files 一对一心理档案
hypnosis therapy 催眠疗法
（3）Solution
解决方法
Background
Analysis
Solution
提高利润
Solution A
Increase Profit
Background
Analysis
Solution
利润 Profit
=
收入 Income
售价不变 ① Price Unchanged
-
成本 Costs ② 租金不变
Sell Out
Go Out
One and a half years ago…
一年半以前……
工疗站
Gongliaozhan
手工制作 Making Handicrafts
Background
Sell Out
Go Out
提高收入 Improve income
自信的演讲PPT课件讲解学习
Jack E Rossin
Tell Us a Story
2 minutes long Take 10 to prepare
Jack E Rossin
Critique
Name a spokesperson
Jack E Rossin
Techniques that make you appear confident...
Speaking more slowly Storytelling Experience presenting Listening Skills Preparation/rehearsal
Jack E Rossin
Warning
Major “Opening” exercise coming up!
Jack E Rossin
Building the Presentation
Open
Middle
Close
Jack E Rossin
Focus on the Open
Audiences are most attentive in the beginning
Jack E Rossin
Techniques that make you Appear confident...
Speaking more slowly Storytelling Experience presenting Listening Skills Preparation/rehearsal
Jack E Rossin
Eye Contact
Eye contact wins people to your side One thought, one person Don’t talk without eye contact Straight shooters make eye contact
ted演讲稿PPT
利用空白区域突出关键信息，引导观众关注重点。
图片和视频素材选用
高质量图片
选用与演讲内容相关的高质量图片，增强信息的视觉冲击力。
短视频辅助
适当插入短视频，有助于观众更直观地理解演讲内容。
素材授权
确保使用的图片和视频素材已获得合法授权，避免侵权纠纷。
07 演讲实战应对策 略
面对紧张情绪的处理方法
力。
互动环节设计
提问环节
预留观众提问时间，鼓励观众 参与讨论，增强演讲互动性。
调查或小游戏
通过现场调查或小游戏，让观 众更直观地了解演讲主题。
故事或案例分享
分享与主题相关的故事或案例 ，激发观众兴趣，增强演讲说 服力。
邀请观众参与
邀请观众上台参与演示或分享 经验，让观众更深入地了解演
讲内容。
06 幻灯片制作要点
主题亮点
提炼演讲中的亮点和创新 点，激发听众对演讲的兴 趣。
演讲者背景
演讲者简介
简要介绍演讲者的基本信 息，包括姓名、职业、成 就等。
演讲者经历
分享与演讲主题相关的个 人经历或故事，增强演讲 者的可信度。
演讲者专长
强调演讲者在相关领域的 专业知识和技能，提高听 众对演讲的期待值。
演讲目的
传递信息
ted演讲稿
目录
• 引言 • 演讲核心内容 • 支撑材料 • 演讲结构安排 • 语言表达技巧 • 幻灯片制作要点 • 演讲实战应对策略 • 总结与展望
01 引言
主题介绍
01
02
03
演讲核心主题
明确阐述演讲的核心主题 ，使听众对演讲内容有初 步了解。
主题背景
介绍主题的历史背景、现 实意义以及社会关注度， 增强听众对主题的认知。
国王的演讲 英文 ppt
Superb Drama of Courage and Humanity
1
• Story Summary
Content
• How Can I Apply This to My Life? • Discussion Questions
2
Characters Introduction
13
Apply to My Life
14
Discussion
15
1.How is family portrayed in the film?
16
2. How is the radio referenced in the film?
17
3.How did the Prince of Wales see the job of king?
10
Gravely ill
The lessons come to a pause when George V becomes gravely ill.
11
Coronation
As David abdicates and Bertie ascends to the throne, Bertie realizes how much he needs Lionel to help him with his speeches.
7
Last Try
Despite her husband’s resistance, the duchess visits Lionel Logue, a speech
therapist, and is convinced by him to
try one last time to help her husband.
《2023 ESC急性冠状动脉综合征管理指南》解读PPT课件
定期随访
出院后定期进行电话或 门诊随访，了解患者病
情变化和用药情况。
风险评估
根据患者临床情况、危 险因素等进行风险评估 ，及时调整治疗方案。
药物调整
根据患者病情变化和药 物反应，适时调整抗血 小板药物、降脂药物等
治疗方案。
血糖控制
关注患者血糖水平，对 糖尿病患者进行降糖治 疗，并加强血糖监测。
关注患者心理健康及家庭支持
基于风险评估结果
根据患者的危险分层，制定相应的治疗策略，如药物治疗、血运 重建等。
考虑患者意愿和预期寿命
与患者充分沟通，了解其治疗期望，并结合预期寿命制定治疗方案 。
跨学科团队协作
心内科、心外科、影像科等多学科团队共同参与，确保治疗方案的 全面性和可行性。
优化药物治疗策略
抗血小板治疗
根据患者的血栓风险，选用阿 司匹林、P2Y12受体拮抗剂等 抗血小板药物，并注意出血风
他汀类药物可降低血脂，稳定斑块，减少心 血管事件。
抗凝血治疗
应用肝素、低分子肝素等，减少凝血酶形成 ，防止血栓形成。
硝酸甘油等扩血管药物
扩张冠状动脉，增加心肌供血，缓解疼痛。
介入治疗
经皮冠状动脉介入治疗（PCI）
通过导管在冠状动脉内放置支架，撑开狭窄的血管，恢复血流。
冠状动脉内溶栓治疗
在PCI无法实施时，通过导管向冠状动脉内注入溶栓药物，溶解血栓，恢复血流 。
准确率。
治疗方案调整
根据最新研究成果，对急性冠状 动脉综合征患者的药物治疗、介 入治疗和外科治疗等方案进行调
整和优化。
康复管理重视
强调急性冠状动脉综合征患者康 复管理的重要性，提供康复评估 、运动处方和二级预防等方面的
指导建议。
英语演讲PPT-(主题：sciene)
Experimental method
Types
Laboratory experiments, field experiments, and natural
experiments
Advantages
It allows for precision control over variables, enables
Types
Participant observation, non participant observation, structured observation, and unstructured observation
Disadvantages
It can be time consuming and expensive, and the results may be subject to observer bias and interpretation
develop strategies to protect our planet, such as reducing
pollution and preserving natural resources
The impact of science on individuals
Enhancing knowledge and understanding
Philosophy
The study of fundamental questions about existence, knowledge, values, reason, mind, and language
Literature
The study of written works, including novels, poetry, and drama
2012版中考复习课件英语人教版第二十讲
REPORTING
2012 edition of high-quality courseware for middle
2023
目录
• Course Introduction • Course content explanation • Course exercises • Course Summary and Review • Course resource recommendation
详细描述
本节课将通过分析中考英语阅读理解真题，教授学生阅读技巧和解题方法。通过模拟练习和解析，帮 助学生提高阅读速度和理解能力，提升应试水平。
Writing skills
总结词
提升写作技巧
详细描述
本节课将针对中考英语写作要求，教 授学生写作技巧和规范。通过范文解 析和练习，帮助学生提高写作水平， 培养逻辑思维能力。
Importance
This courseware provides a comprehensive review of English language skills, covering reading, writing, listening and speaking, essential for exam success.
Assessment of learning outcomes
Students were tested on their understanding of the present perfect tense through a series of multiple-choice and open-ended questions.
"Longman Dictionary of Contemporary English"
STEMI指南
全球心肌梗死工作组发布MI新定义 (ESC/ACC/AHA/WHF 2007→2012)
（三）存在下列任何一项时，均可诊断心肌梗死
项目
诊断标准
心脏生物标志物及心 肌缺血的证据
心脏生物标志物(最好是肌钙蛋白)增高或增高后降低，至少有1次数值超过参考 值上限的99百分位(即正常上限)
并有以下至少1项心肌缺血的证据:
应注意非典型疼痛部位、无痛性心肌梗死和其他不典型的 表现，特别是女性、老年、糖尿病及高血压患者。
血清生化标志物
• A：建议于入院即刻、2-4小时、6-9小时、12-24小时 测定。
• B：肌钙蛋白是诊断心肌坏死最特异和敏感的标志物， AMI症状发生后2-4小时开始升高，10-24小时达到 峰值，肌钙蛋白超过正常上限结合心肌缺血证据即 可诊断AMI。
心肌梗死
目录
1 心梗的定义、分类和诊断
3 入院后一般治疗
早期医疗和急诊流程 2
入院后再灌注治疗 4
目录
5 抗栓治疗
7 并发症及处理
抗凝治疗 6
其他治疗及治疗总结 8
一、定义、分类和诊断
（一）定义 AMI可从与临床、心电图、生物标志物和病理特 征相关的几个不同方面定义。 按ESC/ACC/AHA/WHF共同制定的“心肌梗死通用定义”： 2000年第一版强调了心肌缺血情况下任何心肌 坏死均应定义为心肌梗死。2007年第二版进一 步明确了心肌梗死可由不同临床情况所致。 2012年第三版则在细节上进行了更新。
在首次医疗接触（FMC）时→立即行12导联心电图→所有 12 小时内发病并且有症状的 ST 段抬高型急性心肌梗死都 应该实施再灌注治疗（首选PCI）→FMC到PCI理想状态不 超过90分钟！
不具备PCI能力的医院，从FMC→转院→PCI，不超过120 分钟！
急性冠脉综合征 GRACE评分及其临床医学意义.ppt
GRACE评分计算器操作步骤
➢ 第一步 打开计算器 ➢ 开/关 屏幕显示“MEDICAL CAL PLS
SELECT”，提示选择计算公式 ➢ 医院评分 U按着计算院内死亡风险评分，显示
“GRACE SCORE IN HOSAPITAL” ➢ 第二步 ➢ 跟随屏幕提示键入患者信息，如果输错，可按“清
ESC/ACC/AHA指南指出： ACS患者入院、出院至门诊随访均应进行危险分层评估
2007 ESC UA/NSTEMI指南1
2007 ACC/AHA UA/NSTEMI指南2
• 应当在入院起始阶段以及随后 临床诊治过程中，用危险评分 工具（如GRACE）给患者做危 险分层评估（IB）
• 危险分层工具，如TIMI积分、 GRACE评分或PURSUIT危险 评分，都可在临床中使用， 对可能符合ACS诊断的患者， 有助于决定其起始治疗策略
• 年龄 • 心力衰竭史 • 心肌梗死史 • 心率 • 血压 • ST段压低
• 初始血清肌酐 • 心肌酶升高 • 非院内PCI史
GRACE评分计算器操作步骤
➢ 例子： ➢ 患者男性70岁，因急性发作胸前区剧烈疼痛到医
院急诊，就诊时心率120次/分、SBP140mmHg， 无心衰表现，CPK高于正常范围，血清肌酐 Cr89umol/L，心电图检查ST端压低，初步诊断为 ACS，立即将患者收入心内科病房，患者既往无 心梗发作史，按照以下步骤根据患者病史和急诊 （或入院）时情况计算患者在院内死亡风险
➢ 目前最大规模的多国、前瞻性注 册研究；
➢ 在真实环境里，不干涉现有的治 疗模式，真实反映医生治疗决策 和病情转归
➢ 覆盖ACS整个疾病谱 ➢ 进行住院期间和6个月或者更长时
间的随访
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• Project coordination, data management and statistical analyses - independently provided by the Population Health Research Institute in Hamilton, Canada, which was also the site for the Core CUS and the Central Biochemistry Laboratories
ORIGIN-GRACE- Study Design
2 x2 Factorial Multicenter International Trial Insulin Glargine
10 day run-in
Standard Care N-3 FA Placebo
N-3FA* Placebo
Glargine + N-3 FA Glargine + Placebo
N=1091; 32 sites; 7 countries; 2 Comparisons
Insulin Glargine N-3FA* Glargine + N-3 FA
Standard Care N-3 FA
Placebo
Glargine + Placebo
Placebo
N-3 FA*: double-blind; 1 cap/day* Insulin Glargine: non-blinded design vs. standard care
Study Organization
• Investigator- initiated substudy of the ORIGIN trial • Conducted at 32 ORIGIN centers in 7 countries, selected based on interest and availability of adequate US equipment and expert sonographers • Funding and regulatory support were provided by Sanofi and capsules containing n–3 FA and placebo by Pronova BioPharma, Norway
• Additional Outcome
– The annualized change in Maximum Far Wall CIMT (6 segments)
Statistical Analyses
• Primary Efficacy Analyses
– Repeated linear mixed-effects models including all segment maximum measurements for each patient as the dependent variables, with random intercepts and slopes as a function of time and fixed effects for geographic region, age, gender, treatment assignment for the other arm of the factorial design, carotid segment, treatment, time, and interaction between time and treatment.
AND AND
• High CV Risk • Adequate baseline CIMT
AND
– ≥ 4 measurable segments
Key Exclusion Criteria
• Type 1 DM • Insulin requiring, or on > 2 OADs, or “high” HbA1c • Unable to give insulin or check home glucose levels (at least 4 X) • Serum Cr > 176M/L (2); ALT or AST > 2.5 X ULN
• On TZD and unwilling to stop the TZD
• On Omega-3 FA Supplements and unwilling to stop • Heart Failure • Recent CABG • Cancer
ORIGIN-GRACE Factorial Design
ቤተ መጻሕፍቲ ባይዱ
Study Rationale
• Essential long chain N-3 PUFA may have beneficial effects on atherosclerosis in experimental settings • Higher intake of fish or of N-3 FA supplements are associated with lower rates of CHD and death • Some, but not all, previous randomized trials reported reduced CV events in patients receiving N-3 FA supplements • Effects of these supplements on human atherosclerosis were evaluated in few small studies and remain inconclusive
Research Questions
• In high risk people with dysglycemia does treatment with: – Basal insulin glargine targeting fasting normoglycemia (< 5.3 mM or 95 mg%), reduce the progression of atherosclerosis? – Omega-3 Fatty Acid Supplements reduce the progression of atherosclerosis?
Randomization
0
Years CIMT FPG HbA1C Lipids
1
2
3
4
5
6
1184 Clinical Eligibility + adequate baseline CUS Overall study population included in the safety and clinical outcomes analysis
599 Assigned to Placebo
46 Excluded from the primary efficacy analysis 13 died before the first follow-up CUS - 33 had no adequate postrandomization CUS
Reproducibility: Baseline (250 pairs): ICC=0.98 for Mean maximum CIM T (12 segments) ICC=0.93-0.98 for additional CIMT measurements Study End: (26 pairs): ICC=0.95 for Mean maximum CIM T (12 segments) ICC=0.87-0.98 for additional CIMT measurements
533 Assigned to Insulin Glargine 558 Assigned to Standard Care 539 Assigned to N-3 Fatty Acids 552 Assigned to Placebo
Quantitative Carotid Ultrasonography
47 Excluded from the primary efficacy analysis - 5 died before the first follow-up CUS - 32 had no adequate postrandomization CUS
1091 Participants with and at least one post-randomizaton adequate CUS are included in the main CIMT efficacy analyses
Key Inclusion Criteria
• Age > 50 yrs • Dysglycemia
– EITHER IFG or IGT or new type 2 DM by OGTT [i.e. FPG > 6.1 (110); or 2 Hr PG > 7.8 (140)] – OR early type 2 • on no more than 1 Oral Antiglycemic Drug • HbA1c < 9.0%
Median Clinical (IQR) F/U: 6.2 yrs (5.8 – 6.5 yrs) Median (IQR) F/U from BS to last CIMT scan: 4.9 yrs (3.0-5.0)
Omacor contains EPA 465 mg & DHA 375 mg
Main Efficacy Outcomes
• Primary Outcome
– The annualized change in Maximum CIMT form 12 sites