2021 04 1
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This document discusses the use of novel oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF), particularly vulnerable populations. It notes that AF patients without anticoagulation have a 12.7% risk of ischemic stroke. Mortality after stroke is also higher for AF patients at 49.5% annually. While warfarin has been used, NOACs like dabigatran, rivaroxaban, apixaban and edoxaban were found to be as effective or more effective than warfarin in major clinical trials. The document recommends NOACs for AF patients who have had a stroke or other conditions that increase their risk of stroke according
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This document summarizes different types of antiplatelet, anticoagulant, vasodilator, and thrombolytic drugs. It discusses parenteral and oral anticoagulants including heparin, low molecular weight heparin, and direct oral anticoagulants. It also reviews antiplatelet drugs like aspirin, clopidogrel, ticagrelor, and prasugrel. Thrombolytic drugs for conditions like myocardial infarction and ischemic stroke are outlined. Finally, common vasodilators are presented including ACE inhibitors, calcium channel blockers, nitrates, and hydralazine. Perioperative management of these drug classes is also summarized.
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Heparin-Induced Thrombocytopenia (HIT) is a highly prothrombotic disorder mediated by strong platelet-activating antibodies against multi molecular complexes of platelet factor4 and heparin, leading to consumptive thrombocytopenia and potentially devastating thromboembolic complications. Three alternative anticoagulants have been approved for the treatment of HIT: lepirudin, argatroban, and danaparoidsodium. We present a case of multiple organ embolism secondary to heparin-induced thrombocytopenia after IABP insertion in a cardiac shock secondary to acute myocardial infarction and our fi rst experience with the use of a novel oral anticoagulant, rivaroxaban, to treat a case of HIT-associated thrombosis after IABP insertion.New anticoagulants (dabigatran, apixaban, rivaroxaban) for stroke prevention ...
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This document provides an outline on the topic of novel oral anticoagulants (NOACs) including:
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A review of the existing evidence that supports the current practice in perioperative medicine regarding Renin-angiotensin-aldosterone system antagonists, mainly ACE inhibitors and Angiotensin type 1 receptor blockers (ARB's).
Presented as the Cleveland Clinic Hospital Medicine Grand Rounds on April 1, 2009. CME AMA Category 1 - 1 hour.
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This document provides an outline on the topic of novel oral anticoagulants (NOACs) including:
1) An introduction to NOACs and their advantages over vitamin K antagonists.
2) Details on the properties, indications, dosing, and trial results of specific NOACs including Dabigatran, Rivaroxaban, Apixaban, and Edoxaban.
3) Guidance on switching between anticoagulant regimens, dealing with dosing errors, and follow-up of patients on NOACs.
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2. High-flow nasal cannula oxygen is an alternative to NIV and has been shown to reduce intubation compared to conventional oxygen in patients with acute hypoxemic respiratory failure.
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Millions of patients are hospitalized annually for heart failure, with the majority improving with diuretic therapy and being discharged. However, post-discharge mortality and rehospitalization rates remain high, demonstrating an unmet need. The document discusses characteristics of heart failure patients, common treatments, and outcomes following hospitalization. It concludes that most heart failure patients respond well to standard therapy and do not require intensive care, and that criteria are needed to determine appropriate ICU admissions and discharges.
Reversal of anticoagulation (joel 31.1.2017)
1) The document discusses various agents used to reverse the effects of anticoagulants, including vitamin K, fresh frozen plasma (FFP), prothrombin complex concentrate (PCC), recombinant factor VIIa, idarucizumab, and andexanet alfa.
2) PCC is shown to more rapidly correct elevated INR levels compared to FFP in patients taking vitamin K antagonists who have bleeding or require urgent surgery. However, FFP remains appropriate for massive hemorrhage.
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1) The document discusses trials evaluating the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, and apixaban for various indications.
2) The RE-NOVATE trials found dabigatran non-inferior to enoxaparin for VTE prevention after hip replacement with comparable bleeding risks.
3) The RE-COVER trials found dabigatran non-inferior to warfarin for VTE treatment and secondary prevention with lower bleeding risks.
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Ras-cuing the Heart (Cardiology 2011)
The document discusses the role of the neurofibromin 1 (NF1) gene in cardiovascular development and disease. Key points:
1) Mice lacking the NF1 gene (Nf1-/-) die during embryonic development due to cardiovascular failure and defects in the heart.
2) The NF1 gene's GAP-related domain (GRD) helps regulate Ras signaling and rescues the lethal heart defects seen in Nf1-/- embryos when expressed.
3) However, mice completely rescued from the Nf1 deletion still die shortly after birth, showing the gene is critical for postnatal cardiovascular function.
NOAC.pdf
1) The document discusses new oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF), comparing them to warfarin.
2) NOACs like apixaban, rivaroxaban, and dabigatran are preferable to warfarin due to their more predictable dosing, fewer drug and food interactions, and lack of required monitoring.
3) Clinical trials found NOACs to have similar or better efficacy in stroke prevention compared to warfarin, with lower risks of intracranial hemorrhage and death.
Prevencion de complicaciones en fibrilacion atrial
This document discusses atrial fibrillation (AF), a common arrhythmia. It notes that the number of AF patients is currently around 5 million worldwide but is expected to increase significantly by 2050. AF contributes to over 80,000 deaths annually and increases the lifetime risk of developing it for those over age 40 to 1 in 4. The costs associated with AF are estimated to be $26 billion annually. The document discusses complications of AF and treatments to help prevent complications like stroke, including newer oral anticoagulants that have been shown to be as effective as or more effective than warfarin with a better safety profile in terms of bleeding risks.
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This document discusses respiratory support for patients with acute heart failure in the intensive care unit (ICU). It provides the following key points:
1. Noninvasive ventilation (NIV), including CPAP and bilevel PAP, should be the first-line treatment for acute pulmonary edema and can reduce intubation rates and mortality compared to conventional oxygen therapy.
2. High-flow nasal cannula oxygen is an alternative to NIV and has been shown to reduce intubation compared to conventional oxygen in patients with acute hypoxemic respiratory failure.
3. Invasive mechanical ventilation should be reserved for patients with significant hypercapnia, acidosis or respiratory distress that cannot be managed with NIV.
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- The PIONEER-HF trial showed that among patients hospitalized for acute heart failure, sacubitril/valsartan led to a greater reduction in NT-proBNP levels at 8 weeks compared to enalapril, with similar rates of adverse events.
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Millions of patients are hospitalized annually for heart failure, with the majority improving with diuretic therapy and being discharged. However, post-discharge mortality and rehospitalization rates remain high, demonstrating an unmet need. The document discusses characteristics of heart failure patients, common treatments, and outcomes following hospitalization. It concludes that most heart failure patients respond well to standard therapy and do not require intensive care, and that criteria are needed to determine appropriate ICU admissions and discharges.
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1) The document discusses various agents used to reverse the effects of anticoagulants, including vitamin K, fresh frozen plasma (FFP), prothrombin complex concentrate (PCC), recombinant factor VIIa, idarucizumab, and andexanet alfa.
2) PCC is shown to more rapidly correct elevated INR levels compared to FFP in patients taking vitamin K antagonists who have bleeding or require urgent surgery. However, FFP remains appropriate for massive hemorrhage.
3) Clinical trials demonstrate PCC allows surgery to begin sooner than FFP after reversing vitamin K antagonists, with a similar safety profile. Vitamin K is still needed for sustained
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This document summarizes the risk factors, pathophysiology, treatment, and role of new oral anticoagulants in preventing strokes related to atrial fibrillation. It describes how conditions like hypertension, heart failure, and diabetes increase stroke risk in atrial fibrillation patients. The pathophysiology leads to irregular heart rhythms that increase clotting. Treatment involves rate/rhythm control and anticoagulation using warfarin or new oral anticoagulants. Clinical trials found the new anticoagulants reduce stroke and intracranial bleeds compared to warfarin, with similar or lower risks of major bleeding. Patient characteristics and renal function help determine which new anticoagulant
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Noacs use in patients other than atrial fibrillation
1) The document discusses trials evaluating the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, and apixaban for various indications.
2) The RE-NOVATE trials found dabigatran non-inferior to enoxaparin for VTE prevention after hip replacement with comparable bleeding risks.
3) The RE-COVER trials found dabigatran non-inferior to warfarin for VTE treatment and secondary prevention with lower bleeding risks.
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Oral anticoagulants Sao Paulo
This document discusses oral anticoagulants (OACs) for preventing thromboembolic events in patients with atrial fibrillation (AF). It outlines the rationale for using OACs in AF patients, different types of OACs including vitamin K antagonists and novel oral anticoagulants (NOACs), and clinical trial results demonstrating the efficacy and safety of NOACs compared to warfarin. It also discusses calculating the net clinical benefit of OACs, guidelines for indications of anticoagulation treatment, factors to consider when selecting an OAC, and conclusions regarding the effectiveness and appropriate use of OACs in AF patients.
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This document discusses direct oral anticoagulants (DOACs), including their mechanism of action, pharmacological properties, and comparisons to standard anticoagulants. It addresses the use of DOACs in special situations, reversal of their effects, preoperative use, and combinations with antiplatelet drugs. Guidance is provided on switching between anticoagulants and managing DOACs in various clinical scenarios.
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This case report describes a 76-year-old female patient who presented with acute ischemic stroke while taking rivaroxaban for atrial fibrillation. Magnetic resonance imaging showed an infarction in the left middle cerebral artery territory. Despite an elevated INR of 1.51, the patient underwent intravenous thrombolysis with rt-PA 210 minutes after symptom onset due to a recent dose of rivaroxaban. She recovered completely without hemorrhage. This case highlights the need for further research on thrombolysis safety in patients taking rivaroxaban, as current tests may not accurately reflect anticoagulation levels from new oral anticoagulants like rivaroxaban. Sensitive bedside coagulation testing is urgently
study of Apixaban in netherlands
This document outlines a non-interventional study protocol to describe the utilization pattern of the anticoagulant drug apixaban in the Netherlands. The study will use data from the PHARMO medical record linkage system to identify patients who received apixaban prescriptions between 2011-2014. The objectives are to estimate the proportion of on-label and off-label apixaban use and describe patient characteristics. Off-label use will be defined as use in children under 18 or adults without recent knee/hip surgery. The data will be analyzed annually to describe trends in apixaban utilization over time.
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The document discusses the role of the neurofibromin 1 (NF1) gene in cardiovascular development and disease. Key points:
1) Mice lacking the NF1 gene (Nf1-/-) die during embryonic development due to cardiovascular failure and defects in the heart.
2) The NF1 gene's GAP-related domain (GRD) helps regulate Ras signaling and rescues the lethal heart defects seen in Nf1-/- embryos when expressed.
3) However, mice completely rescued from the Nf1 deletion still die shortly after birth, showing the gene is critical for postnatal cardiovascular function.
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3) Clinical trials found NOACs to have similar or better efficacy in stroke prevention compared to warfarin, with lower risks of intracranial hemorrhage and death.
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Pacientes con FA que sufren un SCA y son sometidos a intervención coronaria percutánea. Guías y preguntas abiertas
Dr. Antonio Fernández Ortiz, Hospital Universitario Clínico San Carlos (Madrid)landmarck trial in HF.pdf
Catheter ablation was associated with lower rates of death and hospitalization for heart failure compared to medical therapy alone in patients with reduced ejection fraction heart failure and atrial fibrillation according to the CASTLE-AF trial. The PARADIGM-HF trial found that the combination drug sacubitril-valsartan reduced rates of cardiovascular death and heart failure hospitalization compared to enalapril in heart failure patients. The MOMENTUM-3 trial showed that a new fully magnetically levitated left ventricular assist device, the HeartMate 3, had fewer device malfunctions compared to the axial-flow HeartMate II pump.
Recent trials in heart failure
- The PARADIGM-HF trial found that treatment with LCZ696 (a combination of sacubitril and valsartan) was more effective at reducing cardiovascular death and heart failure hospitalization compared to enalapril. LCZ696 also reduced overall mortality more than enalapril.
- The CASTLE-AF trial found that catheter ablation for atrial fibrillation was superior to pharmacological rate or rhythm control methods for reducing mortality and heart failure hospitalization in patients with left ventricular dysfunction and atrial fibrillation. Ablation resulted in more time in sinus rhythm and a greater increase in left ventricular ejection fraction.
- The document reviewed results from major clinical trials investigating treatments for heart failure
udaipur 19.11.2022 noac.pptx
Oral anticoagulation with vitamin K antagonists or non-vitamin K antagonist oral anticoagulants (NOACs) is the standard of care for reducing thromboembolic risk in patients with atrial fibrillation (AF). Warfarin is effective but has limitations including a narrow therapeutic window requiring frequent monitoring and dose adjustments. NOACs have advantages over warfarin such as rapid onset, fewer drug interactions and no requirement for routine monitoring. Apixaban and edoxaban have been shown to have the lowest risk of gastrointestinal bleeding compared to other NOACs based on data from pivotal clinical trials. Dosing of NOACs requires adjustment based on renal function and bleeding risk.
Rivaroxaban versus Warfarina en el tratamiento de la Fibrilación Auricular
This randomized controlled trial compared the anticoagulant rivaroxaban to warfarin for preventing stroke in patients with nonvalvular atrial fibrillation. Over 14,000 patients were assigned to either rivaroxaban or warfarin. In the primary analysis, rivaroxaban was found to be noninferior to warfarin in preventing strokes and systemic embolisms. Rivaroxaban was also associated with less intracranial hemorrhaging and fatal bleeding than warfarin. Major bleeding events occurred at a similar rate between the two groups. The study provides evidence that rivaroxaban is a noninferior alternative to warfarin for preventing strokes in patients with atrial fib
Anti thrombotic in patients with af undergoing pci
- The PIONEER AF-PCI trial found that rivaroxaban plus a P2Y12 inhibitor was non-inferior to VKA plus dual antiplatelet therapy (DAPT) for preventing cardiovascular events in patients with atrial fibrillation undergoing percutaneous coronary intervention. However, the trial did not use approved doses of rivaroxaban for stroke prevention.
- The RE-DUAL PCI trial showed that dual antiplatelet therapy (DAT) with dabigatran was non-inferior to triple antiplatelet therapy (TAT) with warfarin for preventing thrombotic events. DAT significantly reduced bleeding risks compared to TAT.
- The AUGUST
La gestion du traitement par NOAC chez le patient avec une cardiopathie isché...
La gestion du traitement par NOAC chez le patient avec une cardiopathie isché...Brussels Heart Center
La gestion du traitement par NOAC chez le patient avec une cardiopathie ischémique.
Par le Pr C. HermansClinical Effectiveness of Dabigatran Versus Apixaban in Non-Valvular Atrial F...
Many real-world studies conducted across the world revealed that the use of dabigatran and apixaban is similar or superior to warfarin in reducing the risk of stroke and bleeding. But its safety and efficacy in Indian scenario is not that much well established. The aim of this study was to evaluate the clinical outcomes such as ischemic stroke (efficacy end-point) and major bleeding (safety end-point) of dabigatran in clinical practice when compared to apixaban in non-valvular atrial fibrillation real world south Indian patients. Among non-valvular atrial fibrillation patients who initiated dabigatran or apixaban therapy during the period between 2016 and 2018, 82 patients were included in the study. The follow up period was 1 year. Compared to dabigatran group, the hazard ratios of ischemic stroke, major bleeding and minor bleeding in the apixaban group were 0.0031 [95% Confidence Interval (CI): 0.0000-3.2586, P = 0.3363], 1.1108 [CI: 0.0903-13.6604, P=0.9406] and 0.2465 [0.0839-0.7238, P=0.0046] respectively. The ability of dabigatran to prevent ischemic stroke was comparable to that of apixaban; efficacy rate was higher for apixaban and safety outcome was higher for dabigatran. Dabigatran was associated with lower risk of minor bleeding as compared to apixaban. Dabigatran 110 mg bid propound best benefit-risk balance for stroke prevention in non-valvular atrial fibrillation. Dabigatran 150 mg may be favoured for high risk embolism patients.
Patophysiology of ACS: Role of Thrombosis
DR.Dr. Antonia Anna Lukito, SpJP, FIHA. 3rd Pekanbaru Cardiology Update, August 24th 2013. Pangeran Hotel Pekanbaru. Learn more at PerkiPekanbaru.com
Role of ACE Inhibitors as Secondary Prevention in ACS
Dr. Nani Hersunarti, SpJP (K), FIHA. 3rd Pekanbaru Cardiology Update, August 25th 2013.
Pangeran Hotel Pekanbaru. Learn more at PerkiPekanbaru.com
Early recurrence and cerebral bleeding in patients with acute ischemic stroke...
(1) This study evaluated the risk of recurrent stroke and bleeding in patients with acute ischemic stroke and atrial fibrillation treated with different types and timings of anticoagulation.
(2) It found that initiating anticoagulation between 4-14 days had the lowest risks, with a 7.6% risk of recurrent stroke and 3.6% risk of symptomatic bleeding.
(3) Oral anticoagulants alone were associated with the lowest bleeding risk, while low molecular weight heparin followed by oral anticoagulants or low molecular weight heparin alone had higher bleeding risks.
Prevention of recurrent stroke in atrial fibrillation Jacek Staszewski
Prevention of recurrent stroke in atrial fibrillation. Comaprison of NOAC vs VKA. Riks of hemorrhagic stroke. When anticoagulation should be initiated following acute stroke.
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Prevencion de complicaciones en fibrilacion atrial
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Pacientes con FA que sufren un SCA y son sometidos a intervención coronaria p...
Pacientes con FA que sufren un SCA y son sometidos a intervención coronaria p...
Rivaroxaban versus Warfarina en el tratamiento de la Fibrilación Auricular
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Anti thrombotic in patients with af undergoing pci
Anti thrombotic in patients with af undergoing pci
La gestion du traitement par NOAC chez le patient avec une cardiopathie isché...
La gestion du traitement par NOAC chez le patient avec une cardiopathie isché...
Clinical Effectiveness of Dabigatran Versus Apixaban in Non-Valvular Atrial F...
Clinical Effectiveness of Dabigatran Versus Apixaban in Non-Valvular Atrial F...
Role of ACE Inhibitors as Secondary Prevention in ACS
Role of ACE Inhibitors as Secondary Prevention in ACS
Early recurrence and cerebral bleeding in patients with acute ischemic stroke...
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Prevention of recurrent stroke in atrial fibrillation Jacek Staszewski
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Parabolic antenna alignment system with Real-Time Angle Position Feedback
Introduction
Parabolic antennas are a crucial component in many communication systems, including satellite communications, radio telescopes, and television broadcasting. Ensuring these antennas are properly aligned is vital for optimal performance and signal strength. A parabolic antenna alignment system, equipped with real-time angle position feedback and fault tracking, is designed to address this need. This document delves into the components, design, and implementation of such a system, highlighting its significance and applications.
Importance of Parabolic Antenna Alignment
The alignment of a parabolic antenna directly affects its performance. Even minor misalignments can lead to significant signal loss, which can degrade the quality of the received signal or cause communication failures. Proper alignment ensures that the antenna's focal point is accurately directed toward the signal source, maximizing the antenna's gain and efficiency. This precision is especially crucial in applications like satellite communications, where the antenna must track geostationary satellites with high accuracy.
Components of a Parabolic Antenna Alignment System
A parabolic antenna alignment system typically includes the following components:
Parabolic Dish: The primary reflector that collects and focuses incoming signals.
Feedhorn and Low Noise Block (LNB): Positioned at the dish's focal point to receive signals.
Stepper or Servo Motors: Adjust the azimuth (horizontal) and elevation (vertical) angles of the antenna.
Microcontroller (e.g., Arduino, Raspberry Pi): Processes sensor data and controls the motors.
Potentiometers: Provide feedback on the antenna's current angle positions.
Fault Detection Sensors: Monitor for potential faults such as cable discontinuities or LNB failures.
Control Software: Runs on the microcontroller, handling real-time processing and decision-making.
Real-Time Angle Position Feedback
Real-time feedback on the antenna's angle position is essential for maintaining precise alignment. This feedback is typically provided by potentiometers or rotary encoders, which continuously monitor the azimuth and elevation angles. The microcontroller reads this data and adjusts the motors accordingly to keep the antenna aligned with the signal source.
Fault Tracking in Antenna Alignment Systems
Fault tracking is vital for the reliability and performance of the antenna system. Common faults include cable discontinuities, LNB malfunctions, and motor failures. Sensors integrated into the system can detect these faults and either notify the user or initiate corrective actions automatically.
Design and Implementation
1. Parabolic Dish and Feedhorn
The parabolic dish is designed to reflect incoming signals to a focal point where the feedhorn and LNB are located. The dish's size and shape depend on the specific application and frequency range.
2. Motors and Position Control
Stepper motors or servo motors are used to control the azimuth and elevation of
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Switching Careers Slides - JoyceMSullivan SocMediaFin - 2024Jun11.pdf
Joyce M Sullivan, Founder & CEO of SocMediaFin, Inc. shares her "Five Questions - The Story of You", "Reflections - What Matters to You?" and "The Three Circle Exercise" to guide those evaluating what their next move may be in their careers.
LinkedIn for Your Job Search June 17, 2024
This webinar helps you understand and navigate your way through LinkedIn. Topics covered include learning the many elements of your profile, populating your work experience history, and understanding why a profile is more than just a resume. You will be able to identify the different features available on LinkedIn and where to focus your attention. We will teach how to create a job search agent on LinkedIn and explore job applications on LinkedIn.
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3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
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5 key differences between Hard skill and Soft skills
𝐓𝐡𝐞 𝐏𝐞𝐫𝐟𝐞𝐜𝐭 𝐁𝐥𝐞𝐧𝐝:
𝐖𝐡𝐲 𝐘𝐨𝐮 𝐍𝐞𝐞𝐝 𝐁𝐨𝐭𝐡 𝐇𝐚𝐫𝐝 & 𝐒𝐨𝐟𝐭 𝐒𝐤𝐢𝐥𝐥𝐬 𝐭𝐨 𝐓𝐡𝐫𝐢𝐯𝐞 💯
In today's dynamic and competitive market, a well-rounded skillset is no longer a luxury - it's a necessity.
While technical expertise (hard skills) is crucial for getting your foot in the door, it's the combination of hard and soft skills that propels you towards long-term success and career advancement. ✨
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The synergy between hard and soft skills is what creates true value in the workplace. Strong communication allows you to clearly articulate your technical expertise, while problem-solving skills help you navigate complex challenges alongside your team. 💫
By actively developing both sets of skills, you position yourself as a well-rounded professional who can not only perform tasks efficiently but also contribute meaningfully to a collaborative and dynamic work environment.
Go through the carousel and let me know your views 🤩
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【业务选择办理准则】
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二、回国进私企、外企、自己做生意的情况，这些单位是不查询毕业证真伪的，而且国内没有渠道去查询国外文凭的真假，也不需要提供真实教育部认证。鉴于此，办理一份毕业证【微信176555708】即可
三、进国企，银行，事业单位，考公务员等等，这些单位是必需要提供真实教育部认证的，办理教育部认证所需资料众多且烦琐，所有材料您都必须提供原件，我们凭借丰富的经验，快捷的绿色通道帮您快速整合材料，让您少走弯路。
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
留信网服务项目：
1、留学生专业人才库服务（留信分析）
2、国（境）学习人员提供就业推荐信服务
3、留学人员区块链存储服务
→ 【关于价格问题（保证一手价格）】
我们所定的价格是非常合理的，而且我们现在做得单子大多数都是代理和回头客户介绍的所以一般现在有新的单子 我给客户的都是第一手的代理价格，因为我想坦诚对待大家 不想跟大家在价格方面浪费时间
对于老客户或者被老客户介绍过来的朋友，我们都会适当给一些优惠。
选择实体注册公司办理，更放心，更安全！我们的承诺：客户在留信官方认证查询网站查询到认证通过结果后付款，不成功不收费！
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【我们承诺采用的是学校原版纸张（纸质、底色、纹路）我们拥有全套进口原装设备，特殊工艺都是采用不同机器制作，仿真度基本可以达到100%，所有工艺效果都可提前给客户展示，不满意可以根据客户要求进行调整，直到满意为止！】
【业务选择办理准则】
一、工作未确定，回国需先给父母、亲戚朋友看下文凭的情况，办理一份就读学校的毕业证【微信号:176555708】文凭即可
二、回国进私企、外企、自己做生意的情况，这些单位是不查询毕业证真伪的，而且国内没有渠道去查询国外文凭的真假，也不需要提供真实教育部认证。鉴于此，办理一份毕业证【微信号:176555708】即可
三、进国企，银行，事业单位，考公务员等等，这些单位是必需要提供真实教育部认证的，办理教育部认证所需资料众多且烦琐，所有材料您都必须提供原件，我们凭借丰富的经验，快捷的绿色通道帮您快速整合材料，让您少走弯路。
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
留信网服务项目：
1、留学生专业人才库服务（留信分析）
2、国（境）学习人员提供就业推荐信服务
3、留学人员区块链存储服务
【关于价格问题（保证一手价格）】
我们所定的价格是非常合理的，而且我们现在做得单子大多数都是代理和回头客户介绍的所以一般现在有新的单子 我给客户的都是第一手的代理价格，因为我想坦诚对待大家 不想跟大家在价格方面浪费时间
对于老客户或者被老客户介绍过来的朋友，我们都会适当给一些优惠。
选择实体注册公司办理，更放心，更安全！我们的承诺：客户在留信官方认证查询网站查询到认证通过结果后付款，不成功不收费！
一比一原版(surrey毕业证书)英国萨里大学毕业证成绩单修改如何办理
原版定制【微信:741003700】《(surrey毕业证书)英国萨里大学毕业证学位证成绩单》【微信:741003700】成绩单 、雅思、外壳、留信学历认证永久存档查询，采用学校原版纸张、特殊工艺完全按照原版一比一制作（包括：隐形水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠，文字图案浮雕，激光镭射，紫外荧光，温感，复印防伪）行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备，十五年致力于帮助留学生解决难题，业务范围有加拿大、英国、澳洲、韩国、美国、新加坡，新西兰等学历材料，包您满意。
【业务选择办理准则】
一、工作未确定，回国需先给父母、亲戚朋友看下文凭的情况，办理一份毕业证【Q微信741003700】文凭即可
二、回国进私企、外企、自己做生意的情况，这些单位是不查询毕业证真伪的，而且国内没有渠道去查询国外文凭的真假，也不需要提供真实教育部认证。鉴于此，办理一份毕业证【Q微信741003700】即可
三、进国企，银行，事业单位，考公务员等等，这些单位是必需要提供真实教育部认证的，办理教育部认证所需资料众多且烦琐，所有材料您都必须提供原件，我们凭借丰富的经验，快捷的绿色通道帮您快速整合材料，让您少走弯路。
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
【关于价格问题（保证一手价格）】
我们所定的价格是非常合理的，而且我们现在做得单子大多数都是代理和回头客户介绍的所以一般现在有新的单子 我给客户的都是第一手的代理价格，因为我想坦诚对待大家 不想跟大家在价格方面浪费时间
对于老客户或者被老客户介绍过来的朋友，我们都会适当给一些优惠。
欧洲杯足彩-欧洲杯足彩体育投注-欧洲杯足彩投注网站|【网址🎉ac99.net🎉】
【网址🎉ac99.net🎉】欧洲杯足彩是世界上历史最悠久的博彩公司之一。其历史可以追溯到十九世纪末，确切时间是1886年。这家英国公司拥有超过15000名员工，是博彩行业规模最大的公司。欧洲杯足彩是英国最受欢迎的实体博彩公司之一，其排名仅次于欧洲杯足彩，旗下2800家投注站遍布全英国。
Learnings from Successful Jobs Searchers
Are you interested to know what actions help in a job search? This webinar is the summary of several individuals who discussed their job search journey for others to follow. You will learn there are common actions that helped them succeed in their quest for gainful employment.
一比一原版美国西北大学毕业证(NWU毕业证书)学历如何办理
原版办理【微信号:BYZS866】【美国西北大学毕业证(NWU毕业证书)】【微信号:BYZS866】《成绩单、外壳、雅思、offer、真实留信官方学历认证（永久存档/真实可查）》采用学校原版纸张、特殊工艺完全按照原版一比一制作（包括：隐形水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠，文字图案浮雕，激光镭射，紫外荧光，温感，复印防伪）行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备，十五年致力于帮助留学生解决难题，业务范围有加拿大、英国、澳洲、韩国、美国、新加坡，新西兰等学历材料，包您满意。
【我们承诺采用的是学校原版纸张（纸质、底色、纹路）我们拥有全套进口原装设备，特殊工艺都是采用不同机器制作，仿真度基本可以达到100%，所有工艺效果都可提前给客户展示，不满意可以根据客户要求进行调整，直到满意为止！】
【业务选择办理准则】
一、工作未确定，回国需先给父母、亲戚朋友看下文凭的情况，办理一份就读学校的毕业证【微信号BYZS866】文凭即可
二、回国进私企、外企、自己做生意的情况，这些单位是不查询毕业证真伪的，而且国内没有渠道去查询国外文凭的真假，也不需要提供真实教育部认证。鉴于此，办理一份毕业证【微信号BYZS866】即可
三、进国企，银行，事业单位，考公务员等等，这些单位是必需要提供真实教育部认证的，办理教育部认证所需资料众多且烦琐，所有材料您都必须提供原件，我们凭借丰富的经验，快捷的绿色通道帮您快速整合材料，让您少走弯路。
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
留信网服务项目：
1、留学生专业人才库服务（留信分析）
2、国（境）学习人员提供就业推荐信服务
3、留学人员区块链存储服务
【关于价格问题（保证一手价格）】
我们所定的价格是非常合理的，而且我们现在做得单子大多数都是代理和回头客户介绍的所以一般现在有新的单子 我给客户的都是第一手的代理价格，因为我想坦诚对待大家 不想跟大家在价格方面浪费时间
对于老客户或者被老客户介绍过来的朋友，我们都会适当给一些优惠。
选择实体注册公司办理，更放心，更安全！我们的承诺：客户在留信官方认证查询网站查询到认证通过结果后付款，不成功不收费！
美洲杯买球-美洲杯买球下注平台-美洲杯买球投注平台|【网址🎉ac55.net🎉】
【网址🎉ac55.net🎉】美洲杯买球是爱尔兰的博彩公司，成立于1988年，位于爱尔兰的都柏林。美洲杯买球通过在爱尔兰和英国的一系列持牌博彩商店以及经营爱尔兰最大的电话博彩服务来开展业务。在互联网上，美洲杯买球提供体育博彩，在线扑克，在线宾果游戏，在线赌场和在线游戏。
一比一原版(kcl毕业证书)英国金斯顿大学毕业证如何办理
原版一模一样【微信：741003700 】【(kcl毕业证书)英国金斯顿大学毕业证成绩单】【微信：741003700 】学位证，留信认证（真实可查，永久存档）原件一模一样纸张工艺/offer、雅思、外壳等材料/诚信可靠,可直接看成品样本，帮您解决无法毕业带来的各种难题！外壳，原版制作，诚信可靠，可直接看成品样本。行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备。十五年致力于帮助留学生解决难题，包您满意。
本公司拥有海外各大学样板无数，能完美还原。
1:1完美还原海外各大学毕业材料上的工艺：水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠。文字图案浮雕、激光镭射、紫外荧光、温感、复印防伪等防伪工艺。材料咨询办理、认证咨询办理请加学历顾问Q/微741003700
【主营项目】
一.毕业证【q微741003700】成绩单、使馆认证、教育部认证、雅思托福成绩单、学生卡等！
二.真实使馆公证(即留学回国人员证明,不成功不收费)
三.真实教育部学历学位认证（教育部存档！教育部留服网站永久可查）
四.办理各国各大学文凭(一对一专业服务,可全程监控跟踪进度)
如果您处于以下几种情况：
◇在校期间，因各种原因未能顺利毕业……拿不到官方毕业证【q/微741003700】
◇面对父母的压力，希望尽快拿到；
◇不清楚认证流程以及材料该如何准备；
◇回国时间很长，忘记办理；
◇回国马上就要找工作，办给用人单位看；
◇企事业单位必须要求办理的
◇需要报考公务员、购买免税车、落转户口
◇申请留学生创业基金
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
办理(kcl毕业证书)英国金斯顿大学毕业证【微信：741003700 】外观非常简单，由纸质材料制成，上面印有校徽、校名、毕业生姓名、专业等信息。
办理(kcl毕业证书)英国金斯顿大学毕业证【微信：741003700 】格式相对统一，各专业都有相应的模板。通常包括以下部分：
校徽：象征着学校的荣誉和传承。
校名:学校英文全称
授予学位：本部分将注明获得的具体学位名称。
毕业生姓名：这是最重要的信息之一，标志着该证书是由特定人员获得的。
颁发日期：这是毕业正式生效的时间，也代表着毕业生学业的结束。
其他信息：根据不同的专业和学位，可能会有一些特定的信息或章节。
办理(kcl毕业证书)英国金斯顿大学毕业证【微信：741003700 】价值很高，需要妥善保管。一般来说，应放置在安全、干燥、防潮的地方，避免长时间暴露在阳光下。如需使用，最好使用复印件而不是原件，以免丢失。
综上所述，办理(kcl毕业证书)英国金斯顿大学毕业证【微信：741003700 】是证明身份和学历的高价值文件。外观简单庄重，格式统一，包括重要的个人信息和发布日期。对持有人来说，妥善保管是非常重要的。
一比一原版(uwm毕业证书)美国威斯康星大学密尔沃基分校毕业证如何办理
原版一模一样【微信：741003700 】【(uwm毕业证书)美国威斯康星大学密尔沃基分校毕业证成绩单】【微信：741003700 】学位证，留信认证（真实可查，永久存档）原件一模一样纸张工艺/offer、雅思、外壳等材料/诚信可靠,可直接看成品样本，帮您解决无法毕业带来的各种难题！外壳，原版制作，诚信可靠，可直接看成品样本。行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备。十五年致力于帮助留学生解决难题，包您满意。
本公司拥有海外各大学样板无数，能完美还原。
1:1完美还原海外各大学毕业材料上的工艺：水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠。文字图案浮雕、激光镭射、紫外荧光、温感、复印防伪等防伪工艺。材料咨询办理、认证咨询办理请加学历顾问Q/微741003700
【主营项目】
一.毕业证【q微741003700】成绩单、使馆认证、教育部认证、雅思托福成绩单、学生卡等！
二.真实使馆公证(即留学回国人员证明,不成功不收费)
三.真实教育部学历学位认证（教育部存档！教育部留服网站永久可查）
四.办理各国各大学文凭(一对一专业服务,可全程监控跟踪进度)
如果您处于以下几种情况：
◇在校期间，因各种原因未能顺利毕业……拿不到官方毕业证【q/微741003700】
◇面对父母的压力，希望尽快拿到；
◇不清楚认证流程以及材料该如何准备；
◇回国时间很长，忘记办理；
◇回国马上就要找工作，办给用人单位看；
◇企事业单位必须要求办理的
◇需要报考公务员、购买免税车、落转户口
◇申请留学生创业基金
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
办理(uwm毕业证书)美国威斯康星大学密尔沃基分校毕业证【微信：741003700 】外观非常简单，由纸质材料制成，上面印有校徽、校名、毕业生姓名、专业等信息。
办理(uwm毕业证书)美国威斯康星大学密尔沃基分校毕业证【微信：741003700 】格式相对统一，各专业都有相应的模板。通常包括以下部分：
校徽：象征着学校的荣誉和传承。
校名:学校英文全称
授予学位：本部分将注明获得的具体学位名称。
毕业生姓名：这是最重要的信息之一，标志着该证书是由特定人员获得的。
颁发日期：这是毕业正式生效的时间，也代表着毕业生学业的结束。
其他信息：根据不同的专业和学位，可能会有一些特定的信息或章节。
办理(uwm毕业证书)美国威斯康星大学密尔沃基分校毕业证【微信：741003700 】价值很高，需要妥善保管。一般来说，应放置在安全、干燥、防潮的地方，避免长时间暴露在阳光下。如需使用，最好使用复印件而不是原件，以免丢失。
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- 1. Optimal NOAC for Vulnerable Population with AF ChenHung Lee (李振宏)
- 2. History • Early 1920s- Northern United States and Canada • In 1921- Sweet clover • In 1929- a lack of functioning Prothrombin • In 1940- synthesize Dicoumarol • In 1948- Warfarin, rodenticide • In 1954- medical use; Dwight Eisenhower heart attack • In 1978- inhibits epoxide reductase- interferes with vitamin K metabolism
- 3. An Avoidable Stroke Burden in Patients with AF National Health Insurance research database in Taiwan (1996 – 2011). AF patients without use of any anti-platelet or anti-coagulant agent during the follow-up of 3.4 years. 12.7% Patients experienced Ischemic Stroke • AF patients: 186,570 • Ischemic stroke experienced patients: 23,723 Chao et al. J Am Coll Cardiol 2014;64:1658–65
- 4. High Mortality after Stroke in Patients with AF First-ever ischemic stroke included in a 5-year period (1994 –1998) in the prospective, population-based registry and identified 3,530 patient with ischemic stroke. Annual mortality rates were higher in patients with AF than in those without AF at 1 year (49.5% versus 27.1%). 49.5% Annual Mortality Rate after Stroke in Patients with AF Marini et al. Stroke. 2005;36:1115-1119
- 5. Worldwide Utilization of Oral Anticoagulation in AF: Results from a Global Registry Healey et al. ESC 2011 65.1 44.8 63.5 38.7 55.8 36.9 39.9 10.5 43.6 0 20 40 60 80 100 % OAC in CHADS2 ≥2 53.5 43.5 66.9 59.1 46.8 39.5 33.9 36.1 38.4 0 20 40 60 80 100 % TTR* *Based on 3 most recent INR values Based on 15,174 patients with AF between Jan 2008 and Apr 2011, appropriate use of OAC remains low, when used, INR control is suboptimal.
- 6. 6 Pivotal Warfarin-Controlled Trials Stroke Prevention in AF RE-LY (Dabigatran) Open label 2 doses Twice daily ROCKET AF (Rivaroxaban) Double blind 2 doses Once daily ARISTOTLE (Apixaban) Double blind 2 doses Twice daily ENGAGE AF-TIMI 48 (Edoxaban) Double blind 2 doses Once daily NOACs vs. Warfarin 71,683 Patients 2009 2010 2011 2012 2013 2014 Connolly SJ, et al. NEJM 2009; 361:1139-1151 Patel MR, et al. NEJM 2011; 365:883-891 Granger CB, et al. NEJM 2011;365:981-992 Giuliano RP, el al. NEJM. 2013;369:2093-2103
- 7. Prothrombin Thrombin Fibrinogen Fibrin Coagulation Cascade Intrinsic activation Extrinsic activation X Xa Dabigatran Rivaroxaban Apixaban Endoxaban Novel oral anticoagulants (NOACs)
- 8. Relative risk for stroke in vulnerable patients with AF HR = 1.46 HR = 1.85 HR = 2.86 HR = 2.86 HR = 2.61 HR = 2.27 HR = 1.62 HR = 1.49 Circ J. 2012;76(10):2289-304. Epub 2012 Sep 19. N Engl J Med. 2012 Aug 16;367(7):625-35. Vulnerable Population with AF Coronary Artery Disease Aging population Stroke Heart Failure HTN Chronic Renal Failure Diabetes mellitus Transient ischaemic attack
- 9. Novel oral anticoagulants (NOACs) • 限用於非瓣膜性心房纖維顫動病 患，且須符合 下列條件之一： (1)曾發生中風或全身性栓塞。 (2)左心室射出分率小於40%。 (3)有症狀之心臟 衰竭：收案前依紐 約心臟協會衰竭功能分級為 第二 級或以上。 (4)年齡75歲(含)以上。 (5)年齡 介於65歲至74歲且合併有糖 尿病、高血壓或冠 狀動脈疾病。
- 10. Age is a key risk factor in CHA2DS2- VASc and HAS-BLED score Risk Factor in CHA2DS2-VASc Score Congestive heart failure 1 Hypertension 1 Age ≧ 75 y 2 Diabetes mellitus 1 Previous Stroke / TIA 2 Vascular disease (prior MI, PAD, or aortic plaque) 1 Age 65–74 y 1 Sex category (i.e., female sex) 1 Maximum score 9 Risk Factor in HAS-BLED Score Hypertension 1 Abnormal renal and liver function (1scoreeach) 1 or 2 Stroke 1 Bleeding tendency or predisposition 1 Labile INRs 1 Elderly (>65 y) 1 Drugs or alcohol (1 score each) 1 or 2 Maximum score 9 C.-E. Chiang et al. / Journal of Arrhythmia 33 (2017) 345–367
- 14. Thank you.